« June 2004 | Main | August 2004 »

July 30, 2004

Global budgets and sustainable growth rate

Global budgets and sustainable growth rate

United States General Accounting Office Testimony Before the Subcommittee on Health, Committee on Energy and Commerce, House of Representatives
May 5, 2004
Medicare Physician Payments
Information on Spending Trends and Targets
Statement of A. Bruce Steinwald, Director, Health Care-Economic and Payment
Issues

Concluding Observations

To a large extent, the physician fee cuts projected by Medicare’s Trustees are required under SGR’s system (Sustainable Growth Rate system) of cumulative spending targets to make up for excess spending in earlier years. MMA (Medicare Prescription Drug, Improvement, and Modernization Act of 2003) added to the excess spending by specifying minimum fee updates for 2004 and 2005 without resetting the spending targets for those years. As a result, physician fee cuts were postponed, not avoided.

In considering the projected fee cuts, however, it is important to recall that Congress originally established Medicare spending targets for physician services in response to runaway spending in the 1980s. The recent increase in volume and intensity growth suggests that Medicare faces a fundamental physician spending growth problem even if the SGR slate of missed spending targets were somehow wiped clean. Currently, projected Medicare spending for physician services exceeds what policymakers have specified-through the parameters of the SGR system-is the appropriate amount to spend. Because of expected increases in the volume and intensity of services provided by physicians, real spending per beneficiary is projected to grow by more than 3 percent per year. SGR, designed to promote fiscal discipline, allows such spending to grow by just over 2 percent per year. If the growth in real spending per beneficiary is not lowered through other means, SGR will mechanically reduce fee updates in an attempt to impose fiscal discipline and moderate total spending increases. Although this mechanical response may be desirable from a budgetary perspective, any consequences for physicians and their patients are uncertain.

http://www.gao.gov/new.items/d04751t.pdf

Comment: A common response to escalating prices is the institution of price (fee) controls. This response is not limited to governments, as in the case of Medicare, but it is also characteristic of the private sector, as in the dictated fees of the managed care plans. In health care, in order to increase income when fees are fixed, physicians respond by increasing the volume of services (number of services provided to each patient) and by increasing the intensity of services (increasing the complexity and costliness of those services). The experience with Medicare confirms that this phenomenon is very real.

Because of escalating spending in the Medicare program, the sustainable growth rate (SGR) system was established. Total program spending for physicians was allowed to increase at a “sustainable” rate of about 2% per year. It is important for single payer supporters to understand this concept because it is somewhat analogous to the “global budgets” which would be used to limit excessive growth in health care expenditures. A more rational rate than an arbitrary 2% would be adopted, but the system would still be funded within the confines of a defined budget.

Because the volume and intensity of Medicare services have been increasing significantly, the fees (prices) per unit of service will decrease over the next several years. This has been compounded by the requirement to recapture, through lower fees, payments made in previous years that were high due to forecast estimates that proved to be erroneous. But even without these errors, physicians will perceive the lower fee schedule to represent pay cuts, even though the global payments will increase by about 2%. It can be anticipated that there will be increased physician opposition to any “government-run” program like Medicare. We should be prepared to explain to them how lower fees will not reduce their gross incomes (although overutilizers could drain funds away from physicians who are trying to provide care at more appropriate levels of utilization).

Fee-for-service incentivizes excessive services. Capitation for individual physicians incentivizes the erection of barriers to care. Salary plus incentives seems to be the least perverse mechanism of compensation, but would we be willing to convert our health care system into a national health service?

July 29, 2004

Our Health Care Mocks Equality

Our Health Care Mocks Equality

I was reading the Berkshire Eagle on July 4th, and was moved by our Declaration of Independence, printed on the editorial page, and its proclamation  of equality for all people,  and of their rights to life, liberty and the pursuit of  happiness. It made me think of all the people who live in poverty in the Berkshires, and of our current health care crisis. Many Americans cannot afford the basics for life ( like food, shelter and health care), let alone pursue happiness. And while the health care crisis affects us all, it is even more of a disaster for those who are thrust into bankruptcy because of catastrophic illnesses for which they have no health insurance, for those who are unable to afford primary health care and suffer from pain and untreated illnesses, and for those who have to choose between food and necessary medications. The World Health Organization ranks the United States 72nd on the performance of our health care system, based on our level of health.  This is below all industrialized nations, and below many third world nations.
  
In Pittsfield, 5,075 residents (11.4%) live below the poverty line (defined as $18,400 per year for a family of four), as do 18.2% of North Adams residents. Over twelve thousand Berkshire County residents live in poverty, which represents almost 10% of the people in our county. The United States is number one in poverty among industrialized nations, with 35 million people living below the poverty line. Seventeen percent of children in the United States live in poverty.  Our poverty levels are 60% higher than in the United Kingdom and Canada, twice those of Sweden , and three times those of the Netherlands.  Yet our average income is similar to, or higher than, these nations.  Our poverty rate is due to income inequalities. Forty three million Americans were without health insurance in 2002; these uninsured exceeded the total population of 24 states.  Medicaid insured 14 million in 2002 (30% of those in poverty), but 10.5 million others in poverty had no health insurance.  Of those in poverty, workers are less
likely to be covered than non-workers.  For every medical problem that has been studied (cardiovascular disease, diabetes, high blood pressure, etc.), the poor, the uninsured, and minority group members in the United States receive inappropriately low rates of care.

Canada has a single payer national health care system that covers everyone. Even the poorest Canadians now have mortality rates below the U.S. average.
All other industrialized nations have a single payer national health care system, funded and administered by the government, that provides universal access to health care.  Yet in the United States, we make a mockery of the document from our founding fathers that supports such a right. There are organizations in Berkshire County which are working hard to address the health care needs of those in poverty, or those who fall dangerously close to that abyss. The Children’s Health Center in Great Barrington and the Neighborhood Health Center in Pittsfield have cared for those in poverty for years. Ecu-Health Care in North Adams helps people find medical care through public health programs, or from doctors who will reduce their fees.  Volunteers in Medicine, a clinic in which doctors will donate their time, is slated to open next month in Great Barrington. These are all efforts worthy of our support, to address the immediate needs of
those in poverty.  But they can only ameliorate the symptoms of a system that breeds these inequities.

The Declaration of Independence further states, “..To secure these rights, governments are instituted among men.”  Bills are in the legislatures in Massachusetts and other states, as well as in the federal legislature, to create single payer health care, that would provide universal coverage, and be funded and administered by the government.  It is time for the government to intervene in our health care crisis.  It is time to take health care funding and administration out of the hands of profit-making insurance corporations.  It is time for the United States to further the vision of our founding fathers, who wrote that stirring
document when our country was created. The Declaration of Independence started a revolution. Two hundred years later it can be the inspiration for another revolution, that will change the face of health care delivery in our country and make it accessible to every American citizen.

Susanne L. King, M.D., Lenox, MA
7/26/04    

Can the Democrats learn from the swallows?

Can the Democrats learn from the swallows?

In These Times
July 23, 2004
Cure a Sick Healthcare System
By Steffie Woolhandler and David Himmelstein

Like Capistrano’s swallows, the Democrats always return to health reform. Unfortunately, this year they’re showing little more brain power than the birds.

Don’t get us wrong, we’re no fans of President George Bush’s health agenda:
Ship tens of billions of federal dollars to a panoply of healthcare firms, privatize Medicare, and dangle skimpy tax credits in front of the 44 million uninsured. But Kerry seems intent on refilling a failed prescription for reform: by proposing to give hundreds of billions to private insurers in exchange for measly coverage for some of the uninsured.

Kerry promises more of the same. He proposes to spend about $65 billion annually to expand coverage through two mechanisms: One, offer government
subsidies for private insurance; two, expand Medicaid. As a nod to middle-class Americans, he’d try to hold down private premiums by having the feds pick up the tab for any patient whose care costs more than $50,000-a misguided effort that shifts some costs to the taxpayers but leaves control in the hands of private firms. Kerry’s massive new spending would leave at least 17 million uninsured (by his own estimate) and tens of millions more with inadequate coverage, and stimulate the malignant growth of healthcare costs.

Kerry’s plan would actually boost bureaucracy. He’d funnel hundreds of billions of additional public dollars through wasteful private plans. And he’d do nothing to cut the tens of billions that doctors and hospitals waste on insurance paperwork. Kerry claims administrative savings for his plan-through computerized billing and claims processing. But such claims are not credible; more than two-thirds of all healthcare bills already are filed electronically. It’s not sending the bill that’s expensive. It’s the insurance advertising and sales, utilization review, eligibility
determination, obtaining pre-approvals for referrals, cost-tracking, and co-payment collections. All would continue under Kerry.

For the 85 percent of Americans who currently have insurance, Kerry offers virtually nothing. No plausible plan to upgrade their coverage, slow premium
increases, bring down drug costs, improve quality, or expand the number of
nurses. He’d just ask tax-payers facing skyrocketing premiums to chip in for
the coverage of the uninsured.

http://www.inthesetimes.com/site/main/article/cure_a_sick_healthcare_system/

And…

infoplease
Accessed July 28,2004

The famous cliff swallows of San Juan Capistrano… land at the mission in San Juan, California, on or around St. Joseph’s Day, March 19, to the ringing bells of the old church…

Legend has it that the swallows took refuge in the Mission San Juan Capistrano from an irate innkeeper who destroyed their muddy nests. The swallows return to the old ruined church each spring knowing they will be protected within the mission’s walls.

The mission is located near two rivers and was an ideal spot for the swallows to nest for years because of the abundance of the insects on which they feed. The reduction in numbers of the insects, largely as a result of the development of the area, has caused some of the swallows to locate further from the center of town and explains why there are no longer huge clouds of swallows descending on the Mission.

http://www.infoplease.com/spot/swallows1.html

Comment: Thanks in a large part to the inspiration provided by the work of Steffie and David, I know something about health policies that would correct the profound deficiencies in our system. As a life-long liberal, I also know something about the Democrats and their positions on issues of social justice. And as a resident of San Juan Capistrano, as I look out of my home office window towards Dana Point Harbor and observe the darting and diving flight of the swallows catching their food, I do know a little bit about the swallows of Capistrano.

Steffie and David state that the Democrats are showing little more brain power than the swallows. But when the swallows return to Capistrano, they know how to adapt to the havoc that has been wreaked on their habitat. They know where to go to build their nests and collect their food. When the Democrats return to Washington, they too recognize the havoc that has been wreaked on our health care system. But they don’t seem to know where to go to find the policy wonks who would show them how to build a health care system that would care for everyone. They can’t seem to get past their political advisors who are reminding them that the Democrats are the party of inclusiveness, and they can’t afford to offend the libertarians.

No, Steffie and David, I’m afraid that the swallows are the ones with the superior brain power.

Don McCanne
San Juan Capistrano, CA

July 28, 2004

Cure a Sick Healthcare System

July 23, 2004
In These Times
Cure a Sick Healthcare System
Universal coverage under National Health Insurance would not increase health costs
By Steffie Woolhandler and David Himmelstein
 

Like Capistrano’s swallows, the Democrats always return to health reform. Unfortunately, this year they’re showing little more brain power than the birds.

Don’t get us wrong, we’re no fans of President George Bush’s health agenda: Ship tens of billions of federal dollars to a panoply- of healthcare firms privatize Medicare and dangle skimpy tax credits in front of the 44 million uninsured. But Kerry seems intent on refilling a failed prescription for reform: by proposing to give hundreds of billions to private insurers in exchange for measly coverage for some of the uninsured.

Our healthcare system is so sick that even people with good insurance are feeling the fever. Premiums for employers and their workers are rising 12 percent, even 18 percent per year. Employers have downsized coverage by super-sizing copayments and deductibles. Insurance often proves illusory when it’s most needed—payment denials, visit limits, loopholes and policy cancellations leave millions stuck with huge medical bills despite what they thought was good coverage. Most people’s choice of doctors and hospitals is restricted. Seniors can’t afford drugs, Medicaid recipients face draconian cuts and everyone’s rushed out of the hospital.

Investor-owned healthcare has flourished, despite definitive evidence that it raises both costs and death rates. And bandit CEOs regularly raid our health system, making off with seven- and even eight-figure incomes as their reward for cooking the books, defrauding Medicare and abusing patients to inflate profits.

Bush’s signal healthcare achievement, passage of the $534 billion Medicare drug bill, already is unravelling. Double-digit yearly price increases—even for older drugs—already have eaten up the paltry savings (about 15 percent) available from the recently introduced Medicare drug discount cards. Even the massive flow of federal funds that will commence in 2006, when the full drug benefit kicks in, will only get seniors back where they started last year in terms of drug spending.

Why will $534 billion in new federal spending (over 10 years) buy so little? First, the new drug coverage will be purchased through private insurance plans with overhead costs that average four times Medicare’s. Second, the bill prohibits Medicare from negotiating with drug companies to lower their prices (and effectively bans imports of Canadian drugs on the preposterous pretext that they’re unsafe). Both the Canadian government and our own Defense Department have used their purchasing clout to garner volume discounts. Prohibiting such bargaining assures drug firms of hundreds of billions in excess profits.

Finally, the bill hands Medicare HMOs—which have been ripping off Medicare for years—an extra $46 billion. Since 1985, Medicare has paid HMOs for seniors who choose to enroll. The payment formula has allowed HMOs to collect far more than it would have cost the taxpayers to care for these seniors in the traditional Medicare program. The Congressional Budget Office and the General Accounting Office have estimated these extra costs at about $2 billion per year. Yet HMOs—burdened by administrative overhead far higher than Medicare’s—complained they couldn’t make a profit from Medicare patients.

Bush’s solution? Send them more money. So in 2004, Medicare will pay HMOs an extra $552 above the cost of traditional Medicare for each senior they enroll, according to an estimate by the Commonwealth Fund.

Incredibly, the Republicans (and many Democrats) describe this corporate welfare program as a “pro-competition” health policy. Drug firms are granted patents that shield them from generic competitors, foreign drug imports are banned, government is precluded from negotiating over prices and HMOs are given huge subsidies to compete unfairly against Medicare—all in the name of competition.

Sadly, many Bush initiatives merely continued Clinton’s policies. Kerry promises more of the same. He proposes to spend about $65 billion annually to expand coverage through two mechanisms: One, offer government subsidies for private insurance; two, expand Medicaid. As a nod to middle-class Americans, he’d try to hold down private premiums by having the feds pick up the tab for any patient whose care costs more than $50,000—a misguided effort that shifts some costs to the taxpayers but leaves control in the hands of private firms. Kerry’s massive new spending would leave at least 17 million uninsured (by his own estimate) and tens of millions more with inadequate coverage, and stimulate the malignant growth of healthcare costs.

In contrast, a single payer national health insurance (NHI) program could simultaneously cover all of the uninsured, upgrade coverage for most other Americans and save money. Under NHI, everyone would be covered for care at any hospital, doctor’s office or clinic without copayments or deductibles. Patients would enjoy a free choice of provider, and doctors and nurses would be freed from the massive bureaucracy that encumbers care and wastes money. For-profit ownership of hospitals and other clinical facilities would be proscribed, and private health insurers and most HMOs would be eliminated—saving billions now squandered on profits and executives’ incomes, while upgrading quality.

Surprisingly, universal coverage under NHI would not increase health costs. At $6,200 per capita, Americans already spend nearly twice as much for care as do Canadians, Australians, Germans, Swedes and the Swiss—all of whom enjoy universal coverage and lower death rates than ours. Much of the cost difference is due to our mammoth health bureaucracy, which wastes upward of $300 billion annually. NHI could slash bureaucracy by replacing the current welter of private plans with a single public payer and simplifying payments. Even the Congressional Budget Office and the General Accounting Office concede that NHI could save enough on bureaucracy to cover all Americans for what we’re now spending.

On the contrary, Kerry’s plan would actually boost bureaucracy. He’d funnel hundreds of billions of additional public dollars through wasteful private plans. And he’d do nothing to cut the tens of billions that doctors and hospitals waste on insurance paperwork. Kerry claims administrative savings for his plan—through computerized billing and claims processing. But such claims are not credible; more than two-thirds of all healthcare bills already are filed electronically. It’s not sending the bill that’s expensive. It’s the insurance advertising and sales, utilization review, eligibility determination, obtaining pre-approvals for referrals, cost-tracking, and co-payment collections. All would continue under Kerry.

For the 85 percent of Americans who currently have insurance, Kerry offers virtually nothing. No plausible plan to upgrade their coverage, slow premium increases, bring down drug costs, improve quality, or ex-pand the number of nurses. He’d just ask tax-payers facing skyrocketing premiums to chip in for the coverage of the uninsured.

Much of what Kerry is pro-pos-ing already was tried, and failed miserably. Medicaid expansion has been pushed by Democrats for decades. Since 1987, 11.4 million people have been added to the Medicaid rolls, and Medicaid spending has risen from $50 billion to $228 billion, eating a hole in state budgets. Yet the number of uninsured has grown by 10.2 million people during this period, and Medicaid has remained second-class coverage, segregating the poor. On many measures, Medicaid patients fare no better than the uninsured. Medicaid should be replaced by mainstream coverage, not expanded.

Subsidies for private coverage also have a dismal track record. A 2002 federal program offers to pay 65 percent of premium costs for workers who’ve lost jobs due to foreign imports. As of December 31, 2003, 8,874 of the 500,000 eligible workers were taking advantage of the subsidy. With private coverage costing about $10,000 per family, few low-income workers can afford insurance, even with a big boost from government.

NHI isn’t just good policy, its good politics. According to a recent Washington Post/ABC News poll, 62 percent of Americans favor “a universal health insurance program, in which everyone is covered under a program like Medicare that’s run by the government and financed by taxpayers.”

Of course, NHI would be a death blow to the health insurance industry and it would threaten the super-profits of powerful drug and hospital firms. Presumably, that is why only Ralph Nader and Dennis Kucinich have been willing to buck the special interests, and say what Americans long to hear about health care: NHI can succeed. Healthcare is a right, not a commodity.

Low Medicaid fees impair access

Low Medicaid fees impair access

Health Affairs
Web Exclusive
June 23, 2004
Changes In Medicaid Physician Fees, 1998-2003: Implications For Physician Participation Despite recent gains, the relative attractiveness of Medicaid patients
has not improved much over the longer term.
by Stephen Zuckerman, Joshua McFeeters, Peter Cunningham, and Len
Nichols

Despite some improvement among primary care physicians in states with the
lowest fee levels, physicians continue to be paid less for Medicaid beneficiaries than for other groups of insured patients, and they are much less likely to accept new Medicaid patients than other insured patients.

States are now dealing with the worst financial crisis since the Great Depression and will not be in position to raise provider fees greatly, so access for Medicaid recipients may be at increasing risk.

http://content.healthaffairs.org/cgi/reprint/hlthaff.w4.374v1

Comment: As long as Medicaid remains chronically underfunded, access to
essential services will remain impaired due to a lack of willing providers. Impaired access results in impaired outcomes. By continuing to support a
separate program for low income individuals, we tacitly accept the principle that they are not entitled to the same level of improved outcomes that the rest of us expect.

Most incremental proposals would leave Medicaid in place. But shifting Medicaid patients into a universal program would improve access and outcomes. Shouldn’t we be supporting health care policies that result in improved outcomes?

July 27, 2004

Medicare empowers patients to enjoy financial hardship

Medicare empowers patients to enjoy financial hardship

Department of Health and Human Services
Centers for Medicare and Medicaid Services (CMS)
Office of the Actuary
July 2, 2004
Letter (excerpts)
From: Sol Mussey, Director of the Medicare and Medicaid Cost Estimate Group of the Office of the Actuary

To: The Honorable Pete Stark of the Subcommittee on Health, Committee on Ways and Means

Table II.C14 was not included in the 2004 report… The attached table provides the information you requested in the same form as Table II.C14 from the 2003 report. The out-of-pocket payments for parts A, B and D of the Medicare program are shown as a percentage of an illustrative 65-year-old’s Social Security benefit. Also shown are the Medicare out-of-pocket payments for the same illustrative beneficiary 20 years later at age 85.

For the purposes of this table, an illustrative beneficiary is defined as (1) paying the standard Part B premium, (2) paying the average Part D premium, (3) incurring the average level of copayments for all aged beneficiaries each year, and (4) receiving a monthly Social Security benefit at age 65 equal to approximately the average benefit for all OASDI beneficiaries in the year shown, with the standard OASDI benefit increases applying in subsequent years.

http://www.familiesusa.org/site/DocServer/CMS_data_on_Medicare_oop_costs.pdf?docID=3963&JServSessionIdr012=lkg0yrebn2.app27a

Comment: The tables attached to the letter demonstrate that the average 65 year old Medicare and Social Security beneficiary this year, 2004, pays 18.6% of his or her Social Security benefits as out-of-pocket expenses under the Medicare program. The percentages continue to increase each year.

By 2065, the average 85 year old will pay 100.2% of his of her Social Security benefits as out-of-pocket expenses under the Medicare program. In fact, by 2078, even the average 65 year old will be paying 97.0% of Social Security benefits as out-of-pocket expenses under Medicare. At the start of retirement, the Social Security check is already wiped out.

Note that these are average values. For individuals with greater health care needs, the Part B and D out-of-pocket expenses and copayments will dramatically increase. In spite of Medicare, medical bills will wipe out Social Security income for these individuals at a much earlier date.

We are rapidly entering a phase in health care financing in which costs are being shifted to those with greater health care needs. This is being accomplished through polices such as defined contribution funding, higher deductibles, greater coinsurance and copayments, and manipulation of benefits covered. The conservative agenda is to shift medical costs from pooled resources with risk sharing to “empowered” individual health care consumers who can then take control of their own health care. The obvious flaw is that individuals with greater health care needs have no empowerment if they do not have adequate access to pooled insurance funds.

In the private sector, individual plans and many group programs are rapidly shifting to these policies that are designed to keep premiums affordable by shifting costs to patients. But the tragedy demonstrated by the tables, attached to the Office of the Actuary letter, is that the conservatives in Congress, with the support of the current administration, have been successful in converting our one program of social insurance, Medicare, into a “consumer-driven” product that will not provide financial security for those with significant health care needs.

But there is also an ethical issue here. The administration was blatantly dishonest in deleting these important tables from the 2004 Medicare Trustees’ Report. And yet the polls indicate that half of our nation wants more of this. My national pride has suffered a staggering blow. How could we… ?

July 26, 2004

Ford: Health costs could drive investment overseas Firm's vice chairman says rising fees hurt competitiveness

Tuesday, July 20, 2004
Ford: Health costs could drive investment overseas Firm’s vice chairman says rising fees hurt competitiveness
By Eric Mayne / The Detroit News

If U.S. health care costs continue to soar, Detroit automakers may be forced to invest overseas rather than the United States to remain competitive, Ford Motor Co. Vice Chairman Allan Gilmour said in a speech Monday.

Ford spent $3.2 billion on health care in 2003 for 560,000 employees, retirees and their dependents. The costs added $1,000 to the price of every Ford car and truck built in the United States — up from $700 three years ago.

The rising health care tab means Ford has less money to invest in new products.

“Our foreign competitors don’t share these problems,” Gilmour said Monday in a speech before the National Governors Association in Seattle. “These health care challenges have created a competitive gap, that if unchecked, will drive investment decisions away from the United States.”

Automakers and other manufacturers increasingly arelooking overseas to take advantage of lower wages and cheaper benefits, raising fears that U.S. auto jobs could be outsourced. But the vast majority of vehicles sold in the United States are still assembled in North America. Toyota Motor Co.p., Honda Motor Co. and other foreign automakers with U.S. operations enjoy lower health care costs because they employ younger workers and support fewer retirees. Nationwide, health care expenditures have grown 7 percent annually for five years — more than double the inflation rate — to $1.67 trillion in 2003.

Gilmour told The Detroit News in an interview Monday that he addressed the group because state governments must be involved in the process to fix the system. But meaningful progress can’t be made until after November’s presidential election, and Ford isn’t taking sides. Until then, Ford plans to adopt better management and consumer education to affect change. “We have to help Americans become better health care consumers,” said Gilmour, who has spent the last six months studying health care costs and their impact on Ford, the auto industry and the country.

He questioned why insurance companies cover the cost of visits to a doctor’s office. But insurance companies won’t pay for phone advice from that same doctor.

It is possible to cover the cost of such service, without compromising a patient’s needs, said Jim Morell, immediate past chairman of the American Association of Healthcare Consultants.

“If you look at somebody who sees a doctor on a regular basis, there probably aren’t many surprises,” Morell said. “But right now, everything is geared to a face-to-face encounter. We don’t have a handle on the record-keeping for (phone service).”

Ford is encouraging increased Internet use to streamline and lower the cost of delivering health care services — such as the transfer of medical records.

“We’re auditing everything we can find to audit,” Gilmour said.
 
Gilmour urged the governors to take decisive action.

“We, as employers, need your leadership — perhaps including the establishment of a broad-based coalition — to find a solution for the long term. Not a quick fix for the present.”

You can reach Eric Mayne at 313-222-2443 or emayne@detnews.com.

Health costs talk is crucial

Sun, Jul. 25, 2004 
Health costs talk is crucial

States need incentives to try policy changes
Mercury News Editorial

Crisis doesn’t begin to describe the extent of America’s health care problem.
The nation’s economic future is being threatened by a system that is drowning America’s employers and its workers in a sea of rising insurance premium costs.

California’s business and labor unions should join forces to find common ground and demand a national conversation about health care reforms. Now.

Health care alternatives exist, ranging from the relatively simple — revamping our employer-based system — to the more radical, such as instituting a single-payer or voucher system.

Congress should be pushed to provide incentives for states to experiment with policy changes to see whether they would be effective at a national level.

The problem isn’t a lack of funding — America spends $1.6 trillion a year on health care. That’s 50 percent more per capita than the second-highest spending country, Switzerland.

Yet the health of the average American is worse than that of citizens in any of the major industrialized nations. Americans’ life expectancy has slipped to 24th in the world after topping the rankings three decades ago. The World Health organization now ranks the United States 37th in the world in overall health system performance, sandwiched between Costa Rica and Slovenia. Those low rankings are in large part due to the fact that 44 million Americans — many of them workers — have no health care insurance. As a result, inability to pay medical expenses is expected to soon become the leading cause of bankruptcy in America.

President Bush’s solution is underwhelming, at best. He proposes to cut the number of uninsured by roughly 10 percent by providing tax credits and personal savings accounts to the uninsured.

Democratic challenger John Kerry’s proposal is more ambitious. He advocates eliminating Bush’s tax cuts for households with an income of $200,000 or more and use those savings to fund coverage for an additional 27 million people. But his plan will have a difficult time passing Congress, if Republicans retain control.

Neither candidate puts enough emphasis on bringing down costs.

One way to accomplish that goal is to adopt a universal health care system. Many Californians are unaware that Sen. Sheila Kuehl’s single-payer bill — SB 921 — has passed the state Assembly and is pending in the state Senate. The thrust of her argument is that the United States wastes nearly 20 percent of its health care dollars — $300 billion annually — on health care administrative costs. In contrast, administrative costs account for only 2.1 percent of Medicare’s budget.

But universal health care contains its own set of unknowns. Oregon voters in 2002 voted down a single-payer initiative over fears that taxes would go through the roof and that rationing of certain medical procedures (a recurring criticism of Canada’s single-payer system) would ultimately become a fact of life. California would need further assurances on both fronts before making that leap of faith.

Kuehl gets high marks for having the courage to move the health care conversation forward.

Those who remain on the sidelines have themselves to blame if health care premiums jump another 14 percent next year and if costs continue to rise four times faster than wages.

July 24, 2004

Health Care Crisis Incites Residents

THE SAG HARBOR EXPRESS
ISSUE DATE: 6/24/04 June 2004

Health Care Crisis Incites Residents
by Beth Young

Sag Harbor has become known of late for its social activist groups, from the Women in Black to East End Direct Action to every stripe of neighborhood and community organization.

Several members of the Sag Harbor community launched the new Coalition for Health Coverage in Suffolk (CHCS) organization this weekend at a press event in front of the emergency department at Southampton Hospital.

The group is part of a nationwide campaign to bring attention to what members believe is a growing health care crisis in America.

Their concerns are broad-reaching, from prescription drug plans for seniors to women’s health issues to the underinsurance of immigrants and small businesses, but they share a focus on the unique issues facing the South Fork.

Kathleen Madigan of Sag Harbor is planning a new TV documentary called “On the Edge: Living Without Health Insurance,” which will be hosted by another Sag Harborite, investigative journalist Jim Henry. Terry Winchell will provide the music for the program.

“We’ve discovered thousands of people are suffering silently,” said Madigan. “People are working so hard to stay alive out here.”

Madigan, who helped form the Women’s Health Partnership to provide free mammograms and pap smears on the South Fork, has seen her share of those most impacted by the health care crisis here.

The show will follow the plight of both the average hard-working citizen and recent immigrants to an area where the needs of wealthy citizens are placed at the forefront. The program will include an interview with the CEO of Southampton Hospital, which recently came under fire for its now-rescinded Southampton PLUS program. That program would have entitled those who paid an additional fee to superior care at the hospital.

Dr. Elaine Fox has practiced medicine in Southampton for 17 years, and she came to the rally on Saturday because of the crisis many patients are having in getting the care they need.

“It’s totally unjust,” she said of the American health care system. “Health care is a right, not a privilege. This country treats healthcare as a commodity - its just not right.”

Though the hospital’s PLUS program may be an easy target for those upset about health care, Dr. Fox believes the issue is more complex.

“The hospital is having this problem because a not-for-profit hospital is forced to compete with for-profits to stay alive,” she said.

James Henry, whose recently completed book “The Blood Bankers” exposes shady international banking practices, has just as much of a concern for health care practices.

“It’s of interest to small business owners, immigrants,” he said. “Our focus is on organizing and educating people. There are 44 million uninsured people in the United States, 2.5 million more in the past year. In the U.S. as a whole, more than 80 million people have been uninsured for six months.”

Specific policies that the group would like to explore include that the government bargain more efficiently with pharmacies, and bringing attention to the new bill HR676, which would reorganize health care through a single payer system. That plan would save $280 billion in administrative costs over the current system.

Members of the group call themselves “Health Care Voters,” and they are pledging to make health care a priority every time they go to the polls. They plan to pressure elected officials to make health care a priority, by voting only for candidates who have detailed, feasible plans to provide quality, affordable health care.

The group estimates that over 250,000 Americans have signed on for the pledge.

SCHIP is now failing us

Today’s Topics:

1. SCHIP is now failing us (Don McCanne)
2. B. Capell on the declining enrollment in SCHIP (Don McCanne)
3. D.W. Light on the declining enrollment in SCHIP (Don McCanne)

Sat, 24 Jul 2004
Subject: qotd: SCHIP is now failing us

The Kaiser Commission on Medicaid and the Uninsured
News Release
July 23, 2004
New Survey Reports Children’s Enrollment in SCHIP Coverage Dropped for the First Time in the Six-Year History of the Program Reflecting both the economic downturn and the significant drop in state revenues over the past two years, enrollment of children in the State Children’s Health Insurance Program (SCHIP) declined during the second half of 2003 for the first time since enactment of SCHIP in 1997. Enrollment declines in 11 states and the District of Columbia more than offset moderate increases in 37 other states, according to the new 50-state survey.

http://www.kff.org/medicaid/kcmu072304nr.cfm

Comment: As we have continued to watch the expansion of the rolls of the uninsured, we have taken some solace in the one success of the past decade: the expanding coverage of children through the SCHIP program. Now current public policies have resulted in this significant setback in children’s coverage.

We need a system which would automatically enroll everyone in a program with comprehensive coverage. With our existing fragmented system, we have demonstrated that we have not met the threshold of adequate political support for these patchwork government programs. But the experience of other industrialized nations has demonstrated that a universal program would meet that threshold.

If we want a universal, comprehensive system, we are going to have to elect politicians who will enact it. Until then, we can weep, especially for the children.

————————————————————————————————————————————-
Date: Sat, 24 Jul 2004 09:41:45 -0700
Subject: qotd: B. Capell on the declining enrollment in SCHIP

Beth Capell, Ph.D., lobbyist for California’s Health Access:

I derive a sadder lesson from this experience: an initial spurt of political will is not sufficient to sustain commitment to adequate funding of health care. Sustaining adequate funding, even in tough times, takes sustained and ongoing effort by health advocates.

That will be as true in a system of universal coverage as it is for SCHIP. Having all of us in the same system will strengthen the will, but as the experiences in Canada, Britain, and elsewhere demonstrate, those who value profits over patients are always with us.
—————————————————————————————————————————————
Message: 3
Sat, 24 Jul 2004
D.W. Light on the declining enrollment in SCHIP

Donald W. Light, Ph.D., Professor of Comparative Health Care Systems, University of Medicine and Dentistry of New Jersey:

You are right that automatic enrollment is the key. So is a universal system rather than patches in a quilt. We are now seeing the same process that characterized CHIP occur with the new Medicare coverage. Millions of extra dollars and a sub-industry is being created just to overcome the bureaucratic complexities and many stipulations that are part of any one patch, so that those who “should” enroll do.

July 23, 2004

Beyond the rhetoric of consumer-driven health care

HSR (Health Services Research)
A Special Supplement to HSR
August 2004

Guest Editors’ Introduction
Consumer-Driven Health Care: Beyond Rhetoric with Research and Experience
By Anne K. Gauthier and Carolyn M. Clancy

The evidence and commentaries in this special issue, while needing to be interpreted with caution, are rich with lessons to help purchasers, policymakers, plans, consumers and researchers as consumer-driven health care continues to evolve. At the moment, the reality of consumer-driven health care appears to be neither the panacea promoters would wish nor the poison opponents fear, and there are still concerns for how the poorer and sicker will fare.

Commentary
Current MSA Theory: Well-Meaning but Futile
By George C. Halvorson

The MSA theory makes sense only until you add the actual cost data to the equation. Then the MSA approach runs into a real problem if you assume that the goal is to actually reduce health care costs. The typical MSA benefit package is irrelevant to expensive patients; irrelevant to cheap patients; and a potentially painful disincentive for chronic care patients.Despite its undoubted good intentions, that is not really a good care-based approach.

Commentary
Defined Contribution Health Plans: Attracting the Healthy and Well-Off
By Gail Shearer

The findings from these two studies (two studies in this special edition on consumer-driven health care plans or CDHCs) are troubling for another reason: because of the nature of adverse selection, over time, DCHPs (defined contribution health plan, a more apt label according to Shearer) may drive lower-deductible health insurance options out of the marketplace.

Bolstered in the health care market with the enactment of the health savings account provision in the Medicare bill, in a few short years, it is very possible that unpopular high-deductible health insurance coverage will be the only choice that many employees may face for their coverage in the employer-based market. Those with high health care expenses will face higher out-of-pocket costs than they would in the absence of DCHPs. It is troubling that this type of change in the health care marketplace will take place in the absence of a public debate. Advocates of medical savings accounts, for example, maintain that there should be a choice of plans. The reality is that over time, as adverse selection pushes the next “relatively healthy” group toward high-deductible plans, an insurance marketplace death spiral will result and ultimately will remove the very choice (a low-deductible plan) that employees want.

Concluding Commentary
Consumer-Directed Health Care: Will It Improve Health System Performance? By
Karen Davis

These studies are too preliminary and the consumer- directed health plan products too new to reach firm conclusions about their long-term value. However, concerns are raised by the initial experience. It seems clear that they are relatively more attractive to higher-income individuals. When health status is measured by prior utilization rather than demographic characteristics such as age or presence of chronic conditions CDHP plans appear to experience favorable risk selection. The downside of the growth of CDHP is likely to be increasing market segmentation, with lower-income and sicker individuals served by managed care plans and higher- income, healthier individuals enrolled in CDHP products. Without risk adjustment, sicker and lower-income individuals will pay higher premiums, and HMOs may eventually face a “death spiral” as unfavorable risk selection worsens.

http://www.blackwell-synergy.com/servlet/useragent?func=synergy&synergyAction=showTOC&journalCode=hesr&volume=39&issue=4p2&year=2004&part=null

And…

Kaisernetwork.org
Alliance for Health Reform
7/9/2004
Briefing: Consumer-Directed Health Care: The Next Big Thing?

Excerpts from the transcript of the Q & A portion:

Ed Howard: Time for one more question

Bridget: I’ll be very brief. I’m Bridget [inaudible] with the Energy and Commerce Committee. I spend a lot of my time working on the Medicaid program, and I have to tell you that every time I see that one of the states has made an application to put in their waiver to include HSAs I fall on the floor laughing, simply because I can’t imagine, since Medicaid was originally designed for people who have very low incomes to pay their deductibles and [inaudible] to have access to health care because they don’t have it. I would really just like to know how you would define a compassionate, competitive deductible for somebody who makes say $6,000 a year.

Michael Parkinson (chief medical officer, Lumenos, a provider of consumer-driven health care): …What we’re saying is, that if you look at the public resources, state and federal going into to pay for the Medicaid recipient and then even if you were broadly thinking about what went into everything around them that was meant to be health inducing behaviors, monetize that in a revenue neutral demonstration project to say, that is discretionary money that person can have. I’m not saying dealing with an HSA with $600 and make them come out of their own pocket. What I’m saying, think of the vehicle that has an insurance product and discretionary account that gives them disability control and support, somewhat like cash and counseling, and let’s basically do it…

Bridget: …the question I have is if you got somebody at that income level, they got a lot of things going on in their lives and you try to tell them that they can go out and shop for where they’re going to find a doctor who they’re going to pay, are they even going to know enough to ask the doctor what the right treatment or whatever, I think you’re just setting yourself up for a situation…

Michael Parkinson: That’s why we want to do a demo on the health care side. In reality here’s what we do. We assign you a personal health coach who helps you understand your case-

Bridget: That’s like a clinical trial for treating children. You’re going to take away health care services from people because you want to find out if it works or not.

Ed Howard: Gary, you have a comment?

Gary Claxton (vice president, Kaiser Family Foundation): What’s the risk that people, what happens when they do a bad job as consumers and they have absolutely no money, what happens? I think that’s Bridget’s question.

Michael Parkinson: That’s what happens today. We all pay for health care anyway in the end.

Gary Claxton: Some people have [inaudible].

Michael Parkinson: I guess I’m not expressing myself clearly folks. The community, the state of Tennessee, the state of Georgia, the state of Florida are paying 100% of all expenses in one way or another jointly with the feds.

Gary Claxton: You put them at risk [inaudible].

Michael Parkinson: I didn’t say anything about monetizing or giving them the average of the risk. I don’t want to do on the back of an envelope how this would work tactically. The reason that I came to the Hill today among others, is that you have the opportunity to think more broadly about designs in the employer sector, innovate and also I can tell you that there is some merits to this model as it relates . . . one of the things to me about this model, it’s very cost empowering and it’s very ennobling on the individual level. I personally, call me an idealist, but that’s another outcome of cash and counseling, people felt better about some of the things they can do, the choices that they had. I think that you might want to consider how this might work, that’s all. I’ll leave it at that…

http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1224

Comment: The comments here will be limited to consumer-driven health care (CDHC) as a means to reduce health care costs by increasing patient sensitivity to the costs of care. Improving an informed patient-consumer choice through greater transparency in the quality of care delivered by physicians, hospitals and other providers is also frequently labeled as consumer-driven health care. Though an important but essentially unrelated topic, it will not be addressed here.

Many respected, objective health policy analysts have cautioned that it is too early to draw clear conclusions on the impact of these proposals which shift the burden of paying for health care to those who have greater needs. Implicit in their comments is the fact that we will need another decade or so of experience to discover just what will happen, just as we had followed the impact of a decade and more of managed care. But it is crucial to realize that these proposals were not created in an informational void.

An extensive body of health policy literature provides us with enough information to use informal simulations to project quite precisely the impact. We already know that erecting financial barriers to care, which is fundamental to CDHC, impairs access and results in impaired health care outcomes. Period!

Using Bridget’s words, “taking away health care services from people because you want to find out if it works or not,” is nothing short of health policy malpractice! This experiment will kill people. Let’s abandon it immediately!

Op-ed by Drs. David Himmelstein and Steffie Woolhandler on the Kerry Health Plan

July 23, 2004
In These Times
Cure a Sick Healthcare System
Universal coverage under National Health Insurance would not increase health costs
By Steffie Woolhandler and David Himmelstein
 

Like Capistrano’s swallows, the Democrats always return to health reform. Unfortunately, this year they’re showing little more brain power than the birds.

Don’t get us wrong, we’re no fans of President George Bush’s health agenda: Ship tens of billions of federal dollars to a panoply- of healthcare firms privatize Medicare and dangle skimpy tax credits in front of the 44 million uninsured. But Kerry seems intent on refilling a failed prescription for reform: by proposing to give hundreds of billions to private insurers in exchange for measly coverage for some of the uninsured.

Our healthcare system is so sick that even people with good insurance are feeling the fever. Premiums for employers and their workers are rising 12 percent, even 18 percent per year. Employers have downsized coverage by super-sizing copayments and deductibles. Insurance often proves illusory when it’s most needed—payment denials, visit limits, loopholes and policy cancellations leave millions stuck with huge medical bills despite what they thought was good coverage. Most people’s choice of doctors and hospitals is restricted. Seniors can’t afford drugs, Medicaid recipients face draconian cuts and everyone’s rushed out of the hospital.

Investor-owned healthcare has flourished, despite definitive evidence that it raises both costs and death rates. And bandit CEOs regularly raid our health system, making off with seven- and even eight-figure incomes as their reward for cooking the books, defrauding Medicare and abusing patients to inflate profits.

Bush’s signal healthcare achievement, passage of the $534 billion Medicare drug bill, already is unravelling. Double-digit yearly price increases—even for older drugs—already have eaten up the paltry savings (about 15 percent) available from the recently introduced Medicare drug discount cards. Even the massive flow of federal funds that will commence in 2006, when the full drug benefit kicks in, will only get seniors back where they started last year in terms of drug spending.

Why will $534 billion in new federal spending (over 10 years) buy so little? First, the new drug coverage will be purchased through private insurance plans with overhead costs that average four times Medicare’s. Second, the bill prohibits Medicare from negotiating with drug companies to lower their prices (and effectively bans imports of Canadian drugs on the preposterous pretext that they’re unsafe). Both the Canadian government and our own Defense Department have used their purchasing clout to garner volume discounts. Prohibiting such bargaining assures drug firms of hundreds of billions in excess profits.

Finally, the bill hands Medicare HMOs—which have been ripping off Medicare for years—an extra $46 billion. Since 1985, Medicare has paid HMOs for seniors who choose to enroll. The payment formula has allowed HMOs to collect far more than it would have cost the taxpayers to care for these seniors in the traditional Medicare program. The Congressional Budget Office and the General Accounting Office have estimated these extra costs at about $2 billion per year. Yet HMOs—burdened by administrative overhead far higher than Medicare’s—complained they couldn’t make a profit from Medicare patients.

Bush’s solution? Send them more money. So in 2004, Medicare will pay HMOs an extra $552 above the cost of traditional Medicare for each senior they enroll, according to an estimate by the Commonwealth Fund.

Incredibly, the Republicans (and many Democrats) describe this corporate welfare program as a “pro-competition” health policy. Drug firms are granted patents that shield them from generic competitors, foreign drug imports are banned, government is precluded from negotiating over prices and HMOs are given huge subsidies to compete unfairly against Medicare—all in the name of competition.

Sadly, many Bush initiatives merely continued Clinton’s policies. Kerry promises more of the same. He proposes to spend about $65 billion annually to expand coverage through two mechanisms: One, offer government subsidies for private insurance; two, expand Medicaid. As a nod to middle-class Americans, he’d try to hold down private premiums by having the feds pick up the tab for any patient whose care costs more than $50,000—a misguided effort that shifts some costs to the taxpayers but leaves control in the hands of private firms. Kerry’s massive new spending would leave at least 17 million uninsured (by his own estimate) and tens of millions more with inadequate coverage, and stimulate the malignant growth of healthcare costs.

In contrast, a single payer national health insurance (NHI) program could simultaneously cover all of the uninsured, upgrade coverage for most other Americans and save money. Under NHI, everyone would be covered for care at any hospital, doctor’s office or clinic without copayments or deductibles. Patients would enjoy a free choice of provider, and doctors and nurses would be freed from the massive bureaucracy that encumbers care and wastes money. For-profit ownership of hospitals and other clinical facilities would be proscribed, and private health insurers and most HMOs would be eliminated—saving billions now squandered on profits and executives’ incomes, while upgrading quality.

Surprisingly, universal coverage under NHI would not increase health costs. At $6,200 per capita, Americans already spend nearly twice as much for care as do Canadians, Australians, Germans, Swedes and the Swiss—all of whom enjoy universal coverage and lower death rates than ours. Much of the cost difference is due to our mammoth health bureaucracy, which wastes upward of $300 billion annually. NHI could slash bureaucracy by replacing the current welter of private plans with a single public payer and simplifying payments. Even the Congressional Budget Office and the General Accounting Office concede that NHI could save enough on bureaucracy to cover all Americans for what we’re now spending.

On the contrary, Kerry’s plan would actually boost bureaucracy. He’d funnel hundreds of billions of additional public dollars through wasteful private plans. And he’d do nothing to cut the tens of billions that doctors and hospitals waste on insurance paperwork. Kerry claims administrative savings for his plan—through computerized billing and claims processing. But such claims are not credible; more than two-thirds of all healthcare bills already are filed electronically. It’s not sending the bill that’s expensive. It’s the insurance advertising and sales, utilization review, eligibility determination, obtaining pre-approvals for referrals, cost-tracking, and co-payment collections. All would continue under Kerry.

For the 85 percent of Americans who currently have insurance, Kerry offers virtually nothing. No plausible plan to upgrade their coverage, slow premium increases, bring down drug costs, improve quality, or ex-pand the number of nurses. He’d just ask tax-payers facing skyrocketing premiums to chip in for the coverage of the uninsured.

Much of what Kerry is pro-pos-ing already was tried, and failed miserably. Medicaid expansion has been pushed by Democrats for decades. Since 1987, 11.4 million people have been added to the Medicaid rolls, and Medicaid spending has risen from $50 billion to $228 billion, eating a hole in state budgets. Yet the number of uninsured has grown by 10.2 million people during this period, and Medicaid has remained second-class coverage, segregating the poor. On many measures, Medicaid patients fare no better than the uninsured. Medicaid should be replaced by mainstream coverage, not expanded.

Subsidies for private coverage also have a dismal track record. A 2002 federal program offers to pay 65 percent of premium costs for workers who’ve lost jobs due to foreign imports. As of December 31, 2003, 8,874 of the 500,000 eligible workers were taking advantage of the subsidy. With private coverage costing about $10,000 per family, few low-income workers can afford insurance, even with a big boost from government.

NHI isn’t just good policy, its good politics. According to a recent Washington Post/ABC News poll, 62 percent of Americans favor “a universal health insurance program, in which everyone is covered under a program like Medicare that’s run by the government and financed by taxpayers.”

Of course, NHI would be a death blow to the health insurance industry and it would threaten the super-profits of powerful drug and hospital firms. Presumably, that is why only Ralph Nader and Dennis Kucinich have been willing to buck the special interests, and say what Americans long to hear about health care: NHI can succeed. Healthcare is a right, not a commodity.

July 22, 2004

The political process in repairing a single payer system versus a fragmented system

The political process in repairing a single payer system versus a fragmented system

Toronto Star
Jul. 22, 2004
Televising health summit `very risky, very bold’ move
Martin to meet provincial leaders Sept. 13 to 15
By Les Whittington

(Prime Minister Paul) Martin, who fought the recent election campaign largely on a promise to protect medicare from being eroded by private, for-profit services, revealed the date of his health-care showdown with the premiers after meeting for the first time with his newly appointed cabinet.

The written announcement of the first ministers’ meeting left no doubt about
Martin’s aims. “The major agenda item will be how to strengthen for the long
term Canada’s publicly funded, single-payer health-care system,” it said.

In a horse-trading session to be broadcast across the country from Ottawa,
Martin will seek support from restive premiers for the Liberals’ main electoral promise - a 10-year blueprint to refurbish the hard-pressed health-care program.

Much of the talk will focus on Martin’s offer of $4 billion in extra federal cash to the provinces in exchange for their help implementing a National Waiting Times Reduction Strategy.

This is envisioned by the Liberals as an “all-out drive” over the next five years to achieve significant reductions in waiting times for medical procedures in five areas: cancer, heart, diagnostic imaging (MRIs), joint replacements and sight restoration.

The federal Liberals also want provincial help with major reforms to reduce runaway medicare costs while improving access to health providers, expanding
home care and developing a national pharmacare program.

http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&c=Article&cid=1090447813703&call_pageid=968332188774&col=968350116467

Comment: Opponents of health care reform in the United States frequently claim that we don’t want to have a “mess” like they have in Canada. Canada does have a problem with queues (though often exaggerated), and they are now addressing, in an open political process, how they can best rectify this problem. Although single payer systems require continual political maintenance, they certainly do work in ensuring that everyone continues to have affordable access to health care.

Contrast that with health care in the United States, a non-system for which “mess” is a grossly inadequate descriptive term. Our fragmented system is suited to incremental measures which have failed to achieve universal coverage and access and have perpetuated mediocrity in our health care outcomes in spite of the massive infusion of funds. Until we adopt a comprehensive, universal system, we will not be able to resolve our current problems and then maintain higher standards by fine tuning our system through an open public process as is currently taking place in Canada.

Imagine the system that we would have if we exchanged our fragmented mess
for Canada’s single payer, and then infused the resources that we have already designated for health care. With the tweaking of incrementalism, our health care parameters have only worsened. But wouldn’t it be nice if we had a high quality, comprehensive system that really would require simply modest tweaking to enable it to continue to function well? That’s a mess that we could live with.

Article by PNHP member in New Haven

New Haven Register
July 22, 2004

With health care crisis, the trees are obscuring the forest
Steve N. Wolfson, M.D.  

Our health care system is in massive disarray, but we are focusing on the trees and missing the forest. This is most obvious in the “insurance state.”

This came home to me as I sat with a patient and she told me that she shortly will not be able to afford her medication. Her husband has been laid off from his job, and their insurance will lapse in three months. They will then join the uninsured, Americans whose prognosis for illness and death shames us all.

The trees: Faced with rising costs, declining reimbursement, and patients who are uninsured and unable to pay for services, formerly charitable hospitals are foreclosing on homes and garnisheeing wages. Faced with increasing barriers to reimbursement while malpractice insurance rates soar, physicians are leaving their practices and their patients.

Patients are foregoing needed medications and losing the opportunity to avoid illness. When illness comes, they are accumulating a crippling burden of debt. More and more of the burden of payment is being shifted to patients. The result is that expenditures that appear discretionary are being dropped.

Too often, this means preventive medicine is out. For those who cannot drop services, meaning those who are already ill, the burden is excruciating.

Meanwhile, businesses complain that the cost of health care for employees and retirees handicaps them in international commerce.

Faced with razor thin or negative bottom lines, the health care system as a whole copes with a rising tide of medical errors with an obsolete, incomplete information system and communications network. And those errors that are detected are snapped up by our legal colleagues, pursuing them within a tort system that with comparable inefficiency neither deters malpractice nor reliably compensates victims of negligence.

These are the trees. Newspapers are filled with examples of the injury done by the fragmented, incomplete approach we have taken toward health care, leaving only the insurers and the drug manufacturers as healthy, wealthy components of the industry.

We need to look at the forest. We have enormous resources in this great country, but they are being misdirected, confused, and diffused. Sophisticated information systems, thousands of nurses, countless thousands of administrative workers monitor insurance claims processing, sending bills with relentless efficiency, denying claims with speed and dispatch, while doctors’ offices, emergency rooms, laboratories and pharmacies barely communicate.

We have an accelerating nursing shortage, forcing hospitals to recruit talented nurses from all over the world to care for the sick, while here their colleagues are recruited away from the bedside to work for lawyers and insurance companies.

This is the forest. Our health care system is broken, the pieces lay all around, and directing our attention just to the pieces is doomed to failure.

This is the forest. We need a single health care system, a single payer for all services, a single focus for setting policies and priorities. It can incorporate all of the components.

We can use the enormous bureaucracy that has grown here. But it must be unified, prioritized, redirected toward delivering care, not paying for it. Clearly, this is an effort that would best be pursued by Congress and the national administration. But if not, then let it start in Connecticut.

Just by unifying the countless forms and applications, drug formularies and benefit plans, we can reduce the burden of administration that lies over health care, thereby freeing energies to address real problems, such as coverage for those now uninsured, and a systematic approach to medical errors. We need to do this now, for delay will only mean more pain.
————————————————————————————————————————————-
Dr. Steven Wolfson is a New Haven cardiologist. Readers may write to him in care of the Register, 40 Sargent Drive, New Haven 06511.

Single Payer Healthcare Study Approved

Commonwealth Of Massachusetts
MASSACHUSETTS SENATE
7/22/04

Contact: Kate Regnier, 617-722-1280
617-251-9567 (cell)

Senator Steven Tolman Announces Approval Of Bill to mandate Single Payer health care study

(BOSTON) - Senator Tolman today announced that the House and Senate have
approved a bill that mandates an analysis by the state of the effects of a single
payer health care system. A single payer system would replace the current
fragmented mixture of public and private health care plans with a single uniform
plan.

The bill requires that a study be made of, among other things, both the cost and the potential savings associated with the implementation of a single payer health care system. The bill further requires that a study be made of the impact on Massachusetts residents, the Commonwealth’s budget, health care professionals and institutions, the Medicare and Medicaid systems, and state and federal laws and regulations. An interim study must be filed with the general court by December 1, 2004, with the final report due by April 1, 2005, along with relevant draft legislation if necessary.

Massachusetts currently faces a crisis in its health care system, with studies indicating that approximately 1.5 million individuals under the age of 65 were uninsured at some point during 2002/2003. One of the primary arguments advanced by opponents of a universal health care system is the potential cost to
the state. However, a comprehensive study of the costs as well as the myriad
benefits (both financial and otherwise) has not previously been performed by the
Commonwealth.

“With literally millions of people un-or underinsured, despite the exorbitant amount of money that we spend on health care, it seems clear that our current health care system is broken,” said Senator Tolman. “We took powerful strides toward remedying that situation with the passage of the health care constitutional amendment last week. This study is vitally important and should highlight the waste and inefficiency that is endemic in our current health care system. We must continue to be vigilant, however, in exploring solutions that would offer affordable, quality health coverage to everyone.”

The bill will now go to Governor Romney for his signature.

July 21, 2004

A private health care information technology system

A private health care information technology system

Health and Human Services
July 21, 2004
The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care
By David J. Brailer, MD, PhD, National Coordinator for Health Information Technology

Conclusion

Health information technology provides a mechanism for refocusing care delivery around consumers without substantial regulation and industry upheaval. Information technology can result in better care (care that is higher in quality, safer, and more consumer responsive) and at the same time, more efficient (care that is appropriate, available, and less wasteful). There are very few other alternatives that can achieve both of these goals in a balanced and timely manner.

A national strategy for HIT is needed to achieve this change. This strategy should inform clinical care by introducing EHRs on a widespread basis everywhere clinicians provide treatment. It should interconnect clinicians to allow them to share data in a seamless and secure manner that protects patient privacy. It should customize health information and care so that consumers can have more control, more treatment options, and more choice of providers, including clinicians who may be at a distance. It also should improve population health by monitoring health care delivery in a simple and timely fashion so that quality, public health risks, and clinical research can be enhanced.

The changes that will accompany the application of information technology to health care will be difficult and will challenge fundamental assumptions that have been long held. However, this change is inevitable, needed, and beneficial. Actions can and should be taken to ensure that this change happens sooner rather than later, is more widespread rather than less, and also improves health care quality while addressing health care costs. The actions that are taken over the next decade will ensure that the best health care can be delivered to Americans, and that lasting and positive change in the health care industry will result.

And from the report:

Public-Private Leadership

Low adoption and use of HIT are attributable to many factors, including a
challenging marketplace and a previous lack of cohesive federal policies supporting it. Leaders across the public and private sector recognize that the adoption and effective use of HIT require a joint effort between federal, state, and local government and the private sector.

The private sector role

While the federal government plays an important role in HIT adoption, the effective use of, and value creation from, this technology lies predominantly with the private sector. The federal government will provide a vision and a strategic direction for a national interoperable health care system, but will rely on a competitive technology industry, privately operated support services, and shared investments in HIT adoption. The private sector must develop the market institutions to deliver the products and services that can transform the paper-based health care system into an electronic, consumer-centered, and quality-based system. The private sector can best ensure that HIT products are successfully implemented in ways that meet the varying needs of American health care across settings, cultures, and geographies. The private sector can also continue constant innovation in HIT and ensure that products are delivered on an affordable basis.

Federal and state governments have delegated most components of quality assurance to voluntary private organizations, including but not limited, to the JCAHO, NCQA, the National Quality Forum, residency review committees, and others. This will be true of quality and performance accountability in the future world of HIT. New market institutions need to be developed that can support clinician adoption of HIT, provide interoperability, and enhance the value realized by these investments. Close collaboration between public and private sectors can develop new methods for improving care without creating unnecessary regulation and minimizing reporting burdens on private industry.

The federal role

The federal government has substantial cause for addressing HIT adoption. Although the public is only now becoming aware of errors and mistreatments
in care delivery, the incidence and severity of errors has been known by researchers for some time. The health status of Americans is lower than it
would be if care were seamless, timely, and evidence driven. Health care
inefficiency and quality problems create economic burdens on other industries. When working Americans spend large shares of their time moving between physicians, dealing with the morbidity of improperly treated chronic illness, handling care burdens for their elderly parents, and recovering from errors and unnecessary therapies, the productivity of the American labor force, and America’s position as a global output leader, is harmed.

The federal government has numerous means of stimulating change in the health care industry, even if most of that change occurs in the private sector. While the federal government should not seek to reform health care without industry collaboration through the use of information technology, neither should it let the status quo exist simply because change will be difficult, complicated, and challenging to the industry. The DoD and VA are major federal health care delivery organizations and, increasingly, contractors for care in communities across the United States. The lessons these organizations have learned about HIT are an invaluable national asset and should be diffused through relationships with private delivery networks. Also, the Federal Employees Health Benefits Program (FEHB) contracts for care in most urban markets across the United States, and can drive positive economic change in general care delivery. Beyond finance and
contracting, the current operation of the health care industry results from a vast
patchwork of federal regulations that create many unintended inhibitory consequences for quality and efficiency.

The full report (178 pages):
http://www.hhs.gov/onchit/framework/hitframework.pdf

Press release:
http://www.hhs.gov/news/press/2004pres/20040721a.html

Comment: The private, competitive market has produced for us computers that are powerful yet inexpensive. Software that is used widely is quite inexpensive, and that in the public domain is essentially free after the initial development costs. With inexpensive computers and software developed in the public domain, the cost of an integrated health care IT (information technology) system should be quite modest. And the return in error reduction and administrative efficiency would far more than offset any real costs.

The Veterans Administration is far ahead of the rest of the nation in developing and utilizing an integrated IT system. And this has been developed in the public (government!) sector. Many other nations with universal health care systems have also introduced integrated IT systems primarily through the public sector.

What has the magic of the competitive marketplace produced in the way of an
integrated IT system to this date? High costs, very poor penetration, and system failures! Competitive market theory dictates that we should be leading the world with a high quality health care IT system at a low cost. What went wrong?

First of all, a fragmented system of multiple private plans, public programs and uninsurance does not provide an infrastructure that is very conducive to an integrated IT system. A single payer system, or, at minimum, a highly regulated system of universal coverage through multiple plans, would provide a framework that would ensure adaptability of an integrated IT system. Of course, a single, publicly administered system would be much preferred for an integrated IT system.

But the greatest difficulty with private IT solutions lies in the very nature of these marketplace models. Their goals are, above all, to maximize profits and to maximize the market price of their shares. To achieve those goals, corporate behavior varies from that of a public entity that has a simpler goal of establishing an effective and efficient high quality system that serves the heath care system and its patients well. The public system does not have to be concerned about being a successful business enterprise, but the private model does.

What might the private sector do that doesn’t serve our interests well? They will produce products that command the highest prices that the market will bear. They will design the products to provide a continuing revenue stream. Once gaining a significant share of the market, they will design incompatibility with other systems in an attempt to garner the entire market. They will design obsolescence into their systems to ensure future markets for their new innovative products. They will partner with and perhaps acquire other related entities that can expand profit potentials through greater control of components of the health care system which their products can influence. Although these are good business practices, they are terrible policies for our health care system.

But without market incentives, wouldn’t innovation be suppressed? We have market innovations now, and they have not resulted in the IT developments
that we desperately need. Public innovations have been effective in developing systems in other nations and in the VA that are already working. If private entrepreneurs can develop innovations that could benefit a public system, there is no reason that they couldn’t be sold to the government to place in the public domain. But they should be priced to reflect costs plus a fair one-time profit. We really don’t need more superfluous profit centers in our health care system.

The health information technology report released today should alarm us all.
Although we all agree on the importance of an integrated IT system, the Bush
administration is limiting the role of the government to being an enabler that encourages the private sector to develop a successful business model. Rather than higher quality at a lower cost, we’ll end up with mediocrity at a much higher cost, wasting even more of our health care dollars.

We desperately need strong leadership from our government in developing a
health care IT system that will serve us all well. But based on the current leadership that has failed to address even the fundamental issue of adequate
health care coverage for all, it is unlikely that we’ll see any enlightened leadership on this in the near future. But that said, “Watch this swing!”

NCHC's call for comprehensive reform

NCHC’s call for comprehensive reform

National Coalition on Health Care
July 20, 2004

Building a Better Health Care System

Principle 1 - Health Care Coverage for All

Principle 2 - Cost Management

Principle 3 - Improvement of Health Care Quality and Safety

Principle 4 - Equitable Financing

Principle 5 - Simplified Administration

Conclusion

The members of the National Coalition on Health Care are determined to work
for comprehensive reform of the American health care system. We offer these
specifications for reform as an agenda - an urgent agenda - for action. We close with two observations.

First, we would emphasize again our conviction that reform must be systemic
and system-wide. The problems of our health care system - and the principles
that guided our development of specifications for reform - are so closely
interrelated that they must all be addressed at the same time. One-dimensional reform will not work.

Consider: Unless we improve the quality of care, we will not be able to manage costs or afford universal coverage. Unless we manage costs effectively, we will not be able to achieve equitable financing or cover all Americans. And unless we assure coverage for everybody, we will be unable to make the system less complex, establish a level playing field without cost-shifting, or create a truly competitive health care marketplace.

Second, the status quo - clearly, undeniably - is not working. It leaves tens of millions of Americans with no health insurance at all. It allows costs to skyrocket year after year, putting coverage out of reach for millions of Americans and compromising the vitality of our economy and its capacity to create and sustain jobs. And it jeopardizes the safety of patients because of widespread sub- standard care.

The status quo is not acceptable. It is time - it is past time - to change it. The readers of this report can have a tremendous impact on the prospects for reform and the shape of reform. We hope that you will work with us in this important effort.

Full report:
http://www.nchc.org/materials/studies/reform.pdf

Press release:
http://www.nchc.org/news/press_releases/2004_07_20.pdf

Webcast of the briefing:

http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1239.

Comment: On reading the full report it is difficult to come to any other conclusion than that a single payer, publicly funded and publicly administered insurance program offers the best option, and possibly the only realistic option, for achieving all of the Coalition’s goals. However, in order not to lose support of several coalition members, the other familiar options were included for consideration in this proposal.

Although this report is quite weak on specifying the one precise model of reform that should be adopted, it is very strong in supporting no less than truly comprehensive reform now. The message is that it is time to abandon the failed policies of incremental tweaking. That is a real step forward. We should move on it.

July 20, 2004

Nation’s Largest Health Coalition Calls For Sweeping Changes in Health Care System

For More Information, Contact:
Janet Firshein or Kari Root at (301) 652-1558, or
Pat Schoeni at NCHC, (202) 638-7151

Nation’s Largest Health Coalition Calls For Sweeping Changes in Health Care System

Washington, D.C., July 20, 2004: Alarmed at what it terms a deepening health care crisis and dissatisfied with the status quo, the nation’s largest, most broadly representative alliance of organizations working for health care reform today called on our nations policymakers to dramatically overhaul the health care system.

The National Coalition on Health Care, which includes nearly 100 of Americas largest businesses, unions, provider groups, insurers, pension funds, and consumer and religious organizations, urged comprehensive reforms that would insure all Americans, control rapidly rising health costs, and dramatically improve quality and patient safety.

Henry E. Simmons, M.D., president of the non-partisan Coalition said, The health care reforms we are recommending go far beyond any proposal now being considered. After a year of study and debate, the Coalition has concluded that incremental strategies will not be sufficient. What we need is action on comprehensive reform, and soon. And it is clear that over the long term, the cost of action is far less than the cost of inaction, he added.

The Coalition, which collectively represents 150 million Americans, today released specifications for system-wide reforms to help frame a renewed national debate about the health care system and to embolden political leaders to act rapidly regardless of who is elected President or wins control of Congress in November. The Coalitionís report, Building a Better Health Care System: Specifications for Reform, calls for:

1.Requiring health coverage for all Americans within two to three years after the enactment of legislation.
2.Bringing cost increases for health care in line with increases in other parts of the economy within five years.
3.Launching a nationwide effort to dramatically improve the quality, safety, and value of care.
4.Making the financing of health care more equitable.
5.Simplifying and modernizing the administration of health care.

At a press conference on Capitol Hill today, the Coalition warned that, if policymakers fail to act:

ï Premiums for family health coverage will exceed $14,500 in 2006 — more than double their level in 2001.
ï The number of Americans without health insurance will surge to more than 51 million in 2006 — an increase of more than 10 million since 2001.
ï Millions will be unnecessarily injured, and hundreds of thousands of Americans will die each year because of poor quality care.
ï Surging health care costs will add trillions of dollars to federal deficits in the coming decades.

According to the Coalition, The escalation of health care costs is not only a health care issue. It is also a major national economic problem.î Soaring health care costs, the new report says, are reducing economic growth and job creation, corporate profits, the global competitiveness of American firms, and the viability of pensions. Health care costs also have become the single most contentious issue in collective bargaining.

These and other pressures have pushed this unusual alliance of organizations to reach consensus and compromise to make progress, said former Governor Robert D. Ray (R-IA), Co-chairman of the Coalition. “If each of us — each political leader, each organization, each voter — holds out only for our ideal, we’ll remain deadlocked, he warned.

The status quo is unacceptable, added Coalition Co-Chairman Paul G. Rogers (D-FL), former U.S. Representative and Chair of the House Energy and Commerce Health Subcommittee. Todays report is politically significant because it shows that there is broad support across most sectors of the economy and society, and across party lines for tough, system-wide reform. The Coalition’s Honorary Co-Chairmen are former Presidents George H.W. Bush, Jimmy Carter, and Gerald R. Ford.

Speakers at today’s press event included:

Henry E. Simmons, M.D., President, National Coalition on Health Care
Former Gov. Robert D. Ray, Co-Chairman, NCHC
Former U.S. Rep. Paul G. Rogers, Co-Chairman, NCHC
John Aschenbrenner, President, Insurance and Financial Services, Principal Financial Group
John J. Sweeney, President, AFL-CIO
William Novelli, CEO, AARP
James Winkler, General Secretary of the General Board of Church and Society of the United Methodist Church, for the National Council of Churches of Christ in the U.S.A.
Barbara Ross-Lee, D.O., Chair of the Board of Directors, Association of Academic Health Centers
William J. Grize, President and CEO, Ahold USA
Sean Harrigan, President of the Board, California Public Employees Retirement System

A list of the Coalition members issuing today’s report is attached to this press release. Additional information about the Coalition and a copy of the report Building a Better Health Care System: Specifications for Reform, can be obtained by visiting the Coalition’s Website (www.nchc.org) or by calling (202) 638-7151.

WebMD calls for a government solution for electronic communications

WebMD
July 19, 2004
HIPAA Implementation: The Case for a Rational Roll-Out Plan

HIPAA Administrative Simplification, as it is currently being implemented,is increasing complexity and cost for health care providers and payers.

Introducing WebMD

WebMD Envoy conducts more HIPAA transactions than any other private entity. In total, WebMD processes more than 3.0 billion transactions on an annualized basis for 300,000 physicians, hospitals, dentists, labs and pharmacies, submitting to more than 1,500 payer connections.

The HIPAA Promise: Administrative Simplification

As envisioned by Congress, codified by law and embraced by the industry, HIPAA Administrative Simplification would reduce administrative costs by increasing efficiency through the exchange of electronic communications between providers and payers. As HHS noted in the preamble to the final Transaction Rule, “The lack of standardization makes it difficult and expensive to develop and maintain software. Moreover, the lack of standardization minimizes the ability of health care providers and health plans to achieve efficiency and savings.” At the core of the HIPAA promise is the commitment to reduce administrative costs by defining standards for electronic transactions so that all participants in the electronic health care marketplace would speak the same language and use the same practices.

Instead of negotiating the details of more than 400 claim forms,providers would fill out just one form that would be accepted by all payers. The information payers sent back to providers would be equally uniform. The simplicity brought about by standardization was expected to encourage more providers to switch from paper to electronic transactions.

The HIPAA statute specifies that the standards adopted “shall be consistent with the objective of reducing the administrative costs of providing and paying for health care.” Congress reiterated this objective in the statute three times, and the Department clearly stated that “[t]he purpose of [the Transaction Rule] is to improve the . efficiency and effectiveness of the health care system.” Consistent with Congress’s clear intent that Administrative Simplification reduce administrative costs, standard electronic health care communication must be implemented in a manner that is consistent with and satisfies this objective.

Missing the HIPAA Mark

The simplification envisioned by HIPAA has not materialized and the statutory HIPAA goals of reducing administrative costs and increasing efficiency are in jeopardy.

Transaction Format - Lack of Uniformity

The standards and implementation specifications are extremely complicated and thousands of pages long. Multiple versions of a HIPAA standard claim have emerged as each payer defines for itself what constitutes a “HIPAA-compliant” claim. Payers have published more than 600 different “companion documents” setting forth their individual interpretations and implementation of the government guidelines. That number is expected to grow to one thousand. The standards, as currently being implemented, are increasing the complexity, and therefore the costs of electronic transactions.

Getting HIPAA back on Track: HHS Leadership

HHS must take action to facilitate the successful implementation of Administrative Simplification. Industry efforts to implement Administrative Simplification have resulted in complex standards, expensive and inefficient implementation and uncertainty in the market place. A few strategic actions by the Department can leverage the remarkable forces and resources of the health care industry to achieve the objectives of Administrative Simplification.

Implement full complement of HIPAA transactions

It is widely recognized in the industry that only through implementation of all the covered transactions will administrative efficiencies, and therefore savings, be realized. CMS has an important leadership role to play in making this HIPAA objective a reality. We recommend that, as a payer, CMS focus its implementation efforts on the complete set of HIPAA transactions. To these ends, the Medicare contingency plan should address the full set of transactions, not simply HIPAA formatted claims. Other payers will follow Medicare’s example and diversify efforts to ensure a balanced implementation initiative that recognizes HIPAA is more than just submitting claims.

Conclusion

CMS action is vital to ensuring that the HIPAA objectives of cost savings and increased efficiency are achieved. The success or failure of HIPAA implementation will have significant implications for the success or failure of the National Health Information Infrastructure.

http://www.corporate-ir.net/media_files/IROL/11/116708/HIPAApaper1.pdf

Comment: Imagine if we had a single, publicly administered payer instead. The conclusion that we need a government agency to take action to implement the National Health Information Infrastructure would be the same. But the administrative nightmare of attempting to bring into efficient compliance our fragmented system of funding care would be nothing more than a bad dream.

July 19, 2004

The Georgia SecureCare Program

The SecureCare Program would cover all Georgians under a single uniform health plan that is administered and funded by the state. The SecureCare program would replace all current public-sector insurance systems including:
Medicare, Medicaid, PeachCare, CHAMPUS and the Federal Employees Health Benefits Plan (FEHBP). It would also replace private health insurance plans in the state. The program would be financed with current government health care funding for discontinued programs, a payroll tax to replace employer benefits plans and other dedicated revenues (i.e., taxes) on households.

Please click here to read the Lewin Group Analysis

July 16, 2004

Medical Class Warfare

Medical Class Warfare

By PAUL KRUGMAN.
E-mail: krugman@nytimes.com

If past patterns are any guide, about one in three Americans will go without health insurance for some part of the next two years. They won’t, for the most part, be the persistently poor, who are usually covered by Medicaid. They will be members of working families with breadwinners who have jobs without medical benefits or who have been laid off.

Many Americans fear the loss of health insurance. Last week I described John Kerry’s health plan. What’s the Bush administration’s plan?

First, it offers a tax credit for low- and middle-income families who don’t have health coverage through employers. That credit helps them purchase health insurance. The credit would be $3,000 for a family of four with an income of $25,000; for an income of $40,000, it would fall to $1,714. Last year the average premium for families of four covered by employers was more than $9,000.

A study by the Kaiser Family Foundation estimates that the tax credit would reduce the number of uninsured, 44 million people in 2002, by 1.8 million. So it wouldn’t help a great majority of families unable to afford insurance. For comparison, an independent assessment of the Kerry plan by Kenneth Thorpe of Emory University says that it would reduce the number of uninsured by 26.7 million.

The other main component of the Bush plan involves ”health savings accounts.” The prescription drug bill the Bush administration pushed through Congress last year had a number of provisions unrelated to Medicare. One of them allowed people who purchase insurance policies with high deductibles, generally at least $2,000 per family, to shelter income from taxes by setting up special accounts for medical expenses. This year, the administration proposed making the premiums linked to these accounts fully tax-deductible.

Although the 2005 budget presents that new deduction under the heading ”Helping the uninsured,” health savings accounts don’t seem to have much to do with the needs of the families likely to find themselves without health insurance. For one thing, such families need more protection than a plan with a $2,000 deductible provides. Furthermore, the tax advantages of health savings accounts would be small for those families most at risk of losing health insurance, who are overwhelmingly in low tax brackets.

But for people whose income puts them in high tax brackets, these accounts are a very good deal; making the premiums deductible turns them into a great deal. In other words, health savings accounts will offer the already affluent, who don’t have problems getting health insurance, yet another tax shelter. Meanwhile, health savings accounts, in the view of many experts, will actually increase the number of uninsured.

This perverse effect shouldn’t be too surprising: unless they are carefully designed, medical policies often have side consequences that worsen the problems they supposedly address. For example, the Congressional Budget Office estimates that one-third of the retirees who now have drug coverage through their former employers will lose that coverage as a result of the Bush prescription drug bill and will be forced to accept inferior coverage from Medicare.

In the case of health savings accounts, the key side consequence is a reduced incentive for companies to insure their workers. When companies provide group health insurance, healthier employees implicitly subsidize their sicker colleagues. They’re willing to do this largely because the employer’s contributions to health insurance are a tax-free form of compensation, but only if the same plan is offered to all employees.

Tax-free health savings accounts and premiums would provide healthier and wealthier employees an incentive to opt out, accepting higher paychecks instead, and would lead to higher insurance premiums for those who remain in traditional plans. This would cause some companies to stop providing health insurance, or raise employee contributions to a level some workers can’t afford.

The difference couldn’t be starker. Mr. Kerry offers a health care plan that would extend coverage to most of those now uninsured, paid for by rolling back tax cuts for those with incomes over $200,000. President Bush offers a tax credit that would extend coverage to fewer than 5 percent of the uninsured, plus a new tax break for the affluent that would actually increase the number of uninsured. As I said last week, I don’t see how Mr. Bush can win this debate.

July 15, 2004

Medicare cards little help

Medicare cards little help
Dawn MacKeen
STAFF WRITER
July 15, 2004
Seniors in Nassau County can save more money purchasing top-selling medications through Canada and the Veterans Administration than with a new Medicare-approved drug card, according to a Congressional committee report issued Wednesday.

Democrats in the House Committee on Government Reform analyzed discounts offered by the 34 different cards in Nassau County. They found, for example, that seniors can get their prescriptions filled for almost the same price online at the Web site drugstore.com. “I think seniors should care because the federal government will be spending more than $500 billion to give them a prescription drug card that is not working,” said U.S. Rep. Carolyn McCarthy, who represents Nassau County and requested the study.

Seniors were able to start using the cards, which offer discounts of up to 18 percent on brand-name drugs, on June 1. Although there are no local numbers, the federal agency overseeing the program, the Centers for Medicare & Medicaid Services boasts 3.8 million enrollees nationwide, most of whom were signed up automatically.

Peter Ashkenaz, the agency’s spokesman, defended the program. “The cards are showing real savings,” he said, pointing out that the new report primarily compared the program to mail-order pharmacies, such as drugstore.com or ones in Canada. “And remember that most seniors prefer to buy their drugs at their neighborhood drug store.”

To many senior advocates, the results of the congressional study were hardly surprising. The recent findings mirror other studies examining the savings offered by the cards nationwide. The congressional study found that in Canada, a 30-day supply of Celebrex, an arthritis drug, costs $38.69 compared with the Medicare drug card’s $74.14. And through the Veterans Administration, for example, the acid reflux medication Protonix costs $44.31, in contrast to the card’s $68.71.
The new report says the only people who can benefit from the cards are low-income seniors, who don’t have to pay the annual fee of up to $30 for the card. Once a person enrolls, he or she can obtain a $600 credit to apply toward the purchase of prescription drugs. But to qualify for the subsidy, a person must earn less than $12,569 and a couple less than $16,862.

“The low-income are getting the benefit of the $600, but that’s really a small percentage,” said Roberta Monat, director of Long Island’s Jewish Association for Services for the Aged. “Most of our people have not even gotten them [the cards]… It’s much too confusing, convoluted, seniors can’t figure it out.”

In fact, more than 100,000 low-income seniors already in Elderly Pharmaceutical Insurance Coverage (EPIC) were automatically enrolled in First Health Services Corp.’s Medicare card program. That card saves the user less than any other, according to the report. “Our EPIC program receives drug manufacturer discounts on prescriptions, and the federal drug discount program is bringing additional cost savings,” said Rob Kenny, a state health department spokesman. But consumer advocates point out that the cards that offer the least savings can deplete a senior’s $600 subsidy faster.

“The Pataki administration should ask some very hard questions as to why the card it selected offers the worst deal,” said Robert Hayes, president of the Medicare Rights Center, a Manhattan-based consumer group.

Coalition for Health Coverage forms in Southhampton

The Southhampton Press
June 24, 2004

By Kathleen Fitzpatrick

Members of the newly formed Coalition for Health Coverage in Suffolk held a vigil outside Southampton Hospital’s emergency room on Saturday in solidarity with thousands of protesters across the country who called attention to the millions of Americans who don’t have health insurance.

“This is a story that is playing out all over the U.S.,” said Kathleen Madigan, the eastern Long Island outreach coordinator for the Women’s Health Partnership, referring to the national day of action calling for government action. “There are people out here on the East End who are working three jobs and can’t afford health insurance.”

East End activist Michael O’Neill of the Unitarian Universalist Church said he’s 68 years old and can’t afford health insurance or dental care. “I have to hope I don’t get sick,” he said. “Medicine should not be a privilege.”

According to Families USA, a non-profit organization dedicated to achieving health care for all Americans, more than 75 percent of uninsured New Yorkers are members of working families. The remaining New Yorkers are either seeking employment or are not in the labor force because they are chronically ill, disabled or caregivers.

The coalition of South Fork organizations, which formed two months ago, is “pulling together to ring the bell” on the health insurance emergency in this community, said Ms. Madigan.

James S. Henry, author and investigative journalist, served as spokesperson for the coalition. “This group is coming together to start organizing on issues of concern to people who are not insured, but also to hospitals facing financial crisis in treating those who are uninsured, and the rest of us living in a population where doctors are not doing preventative care,” he said. “Seventy-two million Americans experienced a lack of coverage within the last two years. We’re making an effort to educate people to build support for specific policy changes at all levels.”

A bill championed by many at the vigil, the National Health Care Act, also referred to as Expanded Medicare for All Americans, has 30 sponsors in Congress. Dr. Elaine Fox of Physicians for National Healthcare who had a practice for 17 years in Southampton, has taken time off to be an activist, and supports the bill. She explained that the act would cover everyone under the “old-fashioned” Medicare.

“Medical administration costs would be 3 percent; right now, it’s at 10.25 percent with all other insurance plans,” she said. “The country would save $280 billion a year. That money is enough to cover all of the uninsured, to cover prescription drugs, and also cover those who are underinsured.”

Dr. Fox said that this bill would not cause an increase in health care spending. “Bush’s bill increases spending by $550 billion,” she said. “The reason that [this bill] has not passed yet is because of profits. Profit motive has no place in health care. Patients come before profits.”

The current system is profit-driven, not patient-driven, according to Mr. Henry. He said that such a system doesn’t work.

“Employer-based health care system is not doing the job,” he said. “Costs have risen 10 percent a year for the last decade. As a country, a larger share of our national income is going to pay health insurance, more than in any other country. Fifteen percent of our [Gross Domestic Product] goes toward health insurance. In European countries and in Canada they pay less than half of that.”

Mr. Henry explained that one of the problems with the medical market is that it’s not competitive. “It’s not the kind of market you expect to work well without regulation,” he said. “Consumers don’t know enough to evaluate their own care. Suppliers don’t have to compete. The people paying the bills—insurance companies—are not the ones receiving the care.”

“Those of us in this coalition believe health care should be viewed as a human right,” said Mr. Henry. “A lot of Americans wake up every day with this on their mind. People are losing their businesses. Small businesses are having a hard time competing. Hospitals like this one are in trouble.”

According to Donna Sutton, Southampton Hospital’s director of public affairs, in 2003 the hospital reported $1.3 million in “charity care,” free care provided to patients who are not expected to pay medical bills. In Suffolk and Nassau counties, there is a law that requires hospital to have a “charity care” program.

At Southampton Hospital, the amount of aid provided is based on need, which is determined by income and family size. The highest eligible income is twice the federal poverty level. The hospital actively screens those who could benefit from charity care, she said.

The hospital also reported $6 million in uncompensated care—expenditures not collected due to insurance companies not covering the bills and/or patients who the hospital expected would pay but who didn’t. The hospital’s total revenue for 2003 was about $80.7 million.

Dr. Allen Fein, who has a practice in Southampton, emphasized that the coalition was not attacking the hospital. “Hospitals are caught in a system where they aren’t being paid for the care they provide,” he said. “There’s very little good will between hospitals and insurance companies.”

Dr. Fox said that a disproportionate number of people of color are without health insurance. According to the coalition’s press release, 32 percent of Hispanics living in the United States are uninsured; 10 of the 13 million uninsured Hispanics are in working families. Twenty percent of black Americans and 18 percent of Asians are uninsured, compared with 11 percent of whites.

Most immigrants on the East End do not have health insurance—an issue the coalition will work on.

“If our goal is to provide care for everyone, and we want to include the immigrant community as well,” said Mr. O’Neill. “It is an injustice that they pay social security taxes and they’re not eligible to receive that money if they return to their home country.”

Ms. Madigan said the group would begin to meet regularly. “The next steps are for us to have an organizing meeting to formulate positions on this,” she said.

Currently the group is working on filming a documentary, “On the Edge: Living Without Health Insurance,” which highlights health insurance issues on the East End. The group hopes to have it finished by the fall, she said.

July 13, 2004

The New Economics of Being Young

The New Economics of Being Young
by Solana Pyne
One Sick Fall
With health insurance out of reach, a generation braces itself for the worst
July 13th, 2004

If they’re not outright poor as a class, young adults in this country are at least very, very broke. The average collegian graduates with more than $20,000 in debt, headed for a job market where real hourly wages have kept pace with neither inflation nor the cost of living. Young adults are broke in part because of their unprecedented schooling”in the latest census figures, 28 percent of those between 25 and 29 reported holding a bachelor’s degree”which promised to pluck them away from the constellation of problems plaguing America’s underclass, whether it was trouble with housing or inadequate medical care.
Yet there they are, these latest inheritors of the American dream, lined up in emergency rooms for toothaches and the flu, not because they’re having emergencies, but because they don’t have health insurance, and emergency rooms, unlike private doctors, are obliged to give them care. Since 1987, the number of uninsured young adults has grown at twice the rate of older adults, even though the demographic itself is shrinking. One-quarter to one-third of adults under 35 went without insurance for all of 2002, the most recent year for which statistics are available”an increase of 1.2 million from the year before. Half were uninsured for some part of 2002. Of the 43.6 million uninsured adults in the U.S., 41 percent are young.

Of all the rationales John Kerry and George Bush will give this year as they stump for their individual visions of helping the nation’s uninsured, one of the most pragmatic is that those little plastic cards can make the difference, for a crucial group of consumers, between having a financial parachute and cratering into debt.

Maria Davidson, of Meriden, Connecticut, was 26 and working for low pay with no benefits when her seven-year-old son tried to kill himself. The ambulance took him to Yale-New Haven Hospital. She had no private coverage for herself and her family. Her children were not eligible for public plans, and she wasn’t aware of programs that could have covered the hospital expenses. Her son amassed $3,900 in bills that Davidson just couldn’t pay. That was nine years ago. By the time the bill was resolved as the result of a lawsuit, she owed, with interest, over $6,000. Collection agencies were garnishing her wages and had put a lien on her condo.

Much of her story is sadly typical. A survey published in May by the Commonwealth Fund, a nonprofit based in New York City, found that of the uninsured between 19 and 29, half had trouble making payments, had been contacted by a collection agency, or had modified their lifestyles to pay off medical bills.

And the cost hardly stops with lost purchasing power. The Commonwealth Fund’s survey found that more than half of those young and not covered had gone without needed medical care in the last year, which included not seeing a doctor, failing to fill a prescription, or skipping a recommended medical test, treatment, or follow-up visit.

Long Islander Fred Gumm, 26, now has health insurance through his job at Starbucks, which, he said, is “pretty much the only reason I work there.” He went without coverage for two and a half years, during and after school at SUNY-New Paltz. While uninsured, he broke a few fingers and injured his shoulder and his back. He didn’t go to the doctor because he couldn’t afford the bill, and as a result, the injuries healed badly and still trouble him.
________________________________________
The story for middle-class kids these days is that you’re covered by your family’s insurance until you graduate college, and then you’re on your own. For those not in school, the cutoff comes even sooner. “You turn 19 and lose your parents’ coverage,” said Sara Collins, an economist for the Commonwealth Fund.

In theory, you quickly get a job that comes with insurance. That’s the way our system is designed to work, with employers rather than the government providing coverage. But as premiums have risen, companies have begun to consider forgoing health plans. In September, the trade journal BenefitsNews.com reported that among companies with 10 to 49 workers, the percentage of those offering insurance dropped from 66 percent to 62 percent. That four-point dip may not sound like much, but the journal estimated it could represent some 200,000 businesses. What’s more, young people tend to work for smaller firms” think entrepreneurial start-ups”and only 55 percent of companies with fewer than 10 workers carry health plans. A May 2003 report by the Commonwealth Fund found that 65 percent of working young adults are eligible for an employer-sponsored plan, compared to 77 percent of older adults.

What looked like a relatively seamless transition for your parents looks for you like a rickety bridge. You’re not making much money, you’ve got student debt, the job market stinks, and what jobs exist aren’t promising much. “The kinds of jobs you’re eligible for are the kinds that often don’t come with health insurance,” Collins said.

America’s approach to paying for medical care stretches back to World War II, when regulations made accident and health insurance for employees tax-exempt. Meanwhile, a simultaneous wage freeze and worker shortage encouraged employers to offer insurance as a perk to attract labor, explained Ken McDonnell, a research analyst with the Employee Benefit Research Institute.

During the same period, England instituted universal coverage. The reasons we didn’t are a complex knot of social and political influences now nearly impossible to untangle. “I think part of it is who’s being served here. In more homogeneous societies, like in Scandinavian countries, [universal health care] came as a no-brainer,” said David Jones, the president of the Community Services Society, a New York nonprofit. “But we’re not homogeneous. There’s a sense that ‘We’ve got ours, I’m not sure I want to give it to those guys.’ ” As employer-sponsored insurance took hold, the number of uninsured dropped steadily, reaching an all-time low of 23 million in 1976. But the very availability of good care quickly drove premiums up. In the 1980s, health care costs exploded, with annual increases peaking at 18 percent in 1989, before slowing briefly in the 1990s. Increases hit the double digits again in 2001, and reached 13.9 percent last year.

Perhaps not surprising, companies began to balk at providing benefits, leading individuals”the self-employed, the unemployed, the employed but not covered”to go it alone. Reforms designed to help the older and sicker buy private insurance served to further squeeze the able-bodied but vulnerable. Prices today are all over the map. A young, healthy adult in California can find basic catastrophic coverage for under $100 a month, but the same person could have to pay $280 for a similar plan in New York, largely due to differing state regulations.

For Lars Russell, in his early twenties, the cost of health insurance came as a shock. He graduated last year from the University of Michigan and moved to New York. “It’s not really anything I can afford,” he said in November. “I don’t even have car insurance right now.”
________________________________________
Russell would get little sympathy from McDonnell, the benefits research analyst. “That’s life,” he said, when asked about the huge number of uninsured young adults. “If you’re young and healthy, you’re going to take risks. It’s life everywhere.”

McDonnell cited an unwillingness to pay for insurance as a big reason young adults go without coverage. It’s a fine line, however, between being unwilling to pay even $100 a month and being unable to. And it’s significant that when offered health insurance by an employer in exchange for a deduction from each paycheck, 74 percent of young adults take it, just a hair less than the 79 percent of older adults who do the same. “The argument is that if it’s that important to you, then get a job that offers health insurance,” said McDonnell, who, like so many experts on health care issues, is over 35 and has long had jobs with good benefits.

Janet Murray “who asked that her name be changed because of pending litigation” followed McDonnell’s advice. Now in her late twenties, she was born with hypothyroidism and takes daily medication. During her first year of college in upstate New York, she contracted Lyme disease. Because she caught it early, she doesn’t need constant treatment, though she is prone to exhaustion and respiratory infections like pneumonia. Her health problems don’t prevent her from working, but they make it impossible for her to do without good insurance. Murray studied film in college but gave up on her dream of working in movie production. Instead, she took an office job with a media company because it came with benefits.

“I think the biggest thing for me was, if I had the stamina and I didn’t have the general expenses of being on a bunch of medication, I would have taken more risks,” Murray said. “I feel like I don’t really have that luxury.”

Maybe her dreams wouldn’t have panned out, but the American health care system has made it nearly impossible for her even to try. Or maybe Murray is lucky. At 21, Pedro Jimenez of South Williamsburg said he has never had health insurance at all. “I don’t really know anything about it, to be honest,” he said. When necessary, he has gone to the emergency room and tried to pay off the bills in installments. Otherwise, he has avoided going to the doctor. But basically, he has avoided thinking about the dangers, focusing instead on looking for work, getting his GED, and going to college.

It’s important to note that degrees of coverage vary greatly by race: African Americans were nearly twice as likely as non-Hispanic white people to be uninsured in 2002, and Latinos three times as likely.
________________________________________
Not having a job with benefits can mean being forced to choose between health insurance and other expenses, some of them critical to building a so-called life. Young adults “are in a stage where people have debts from school, they are trying to buy a house, and that seems more important than paying for health insurance, which might cost multiple thousands each year,” said Robert Blendon, a professor of health policy and political analysis at Harvard University.

The types and prices of plans for sale vary dramatically by state, largely according to regulations. Premiums nationwide for those under 35 average about $136 per month, according to eHealthInsurance, a website that sells individual and family insurance. Many states have plans with premiums below $100 for young, healthy adults without any pre-existing conditions. Cheaper plans are usually for emergencies only, don’t cover routine doctor visits, and carry four-digit deductibles.

At age 22, Kristen Gass had minor outpatient surgery to remove pre-cancerous cells from her cervix. At the time, she was working as an actress and had health insurance through the Actors’ Equity Association, a union that represents actors and stage managers working in theater. Soon after, she moved back home to Los Angeles, took a break from acting, and lost her coverage. When she looked into buying a policy, insurers quoted monthly premiums hundreds of dollars higher than she was able to afford, citing her recent surgery and a family history of cancer. They told her she would have to be without symptoms or treatment for at least two years before premiums would drop. So she went without.

“I just didn’t go to the doctor,” Gass said. “I went once for a checkup and that was it. I realized how much it would cost.” Had she been in New York, the cost of individual insurance would have been the same regardless of her history. But she still couldn’t have afforded it.

Only one New York insurer has posted a plan on eHealthInsurance, at am monthly premium of $280. The plan covers hospitalization but not doctor visits. According to the New York State Insurance Department, basic HMO plans start at $320 a month. The self-employed may be able to get insurance at group rates through organizations in their field. One of the more popular comes from the Freelancers Union “part of Working Today” which offers HMO coverage, including vision and dental, for $286 through Health Insurance Plan of Greater New York.

Just as race plays a factor, so does gender. By the time he reaches age 34, the average Joe earns $30,677, and could expect to pay 11 percent of that gross for the cheapest plan in New York. The average Jane, earning $21,649, would fork over 4 percent more.
________________________________________
If the cost of insurance is unbearable, so is the cost of not having it. Even common injuries can be financially debilitating for people still trying to get on their feet. Manhattan resident Drew Brown, uninsured and unemployed, went to the emergency room at Beth Israel for a toothache and left with a prescription and a $500 bill. Brooklynite Andrea Craig had to pay $2,000 for surgery to treat a mouth infection before she got insurance through her current job. Some people have almost gotten used to it. “If I get sick, I go to the emergency room. I usually give them my real name. I get bills. If they are reasonable I pay them. If not “if they’re, like, four or five grand”I ignore them,” said a 35-year-old Manhattan photographer who refused to give his name.” The emergency room is the only place I go. It’s the only place that’s free.” High numbers of uninsured strain hospital budgets because emergency rooms can’t deny care to those who can’t pay, Harvard professor Blendon said. Disease outbreaks are worsened when a significant fraction of the population doesn’t have insurance. “We’ve lucked out because we haven’t had any big epidemics, but with SARS and anthrax it really struck experts that you are going to have people getting sick and not going to the doctor,” Blendon said. “Canada didn’t have that problem.”

The only real fix is universal health care, said Ken McDonnell, and with the current political climate, he says, such a policy has “a snowball’s chance in hell.” Estimates of the cost range from a net savings to a new burden of trillions. A study published by the journal Health Affairs estimated that extending coverage to the uninsured would lead to extra spending on the order of $33.9 billion to $68.7 billion each year as the newly insured sought additional medical care.

Short of universal health care, most reforms still leave young adults at risk. For now, many go it alone, scrounging up care where possible and resigning themselves to the hope that lighting won’t strike. After all, millions of people do it.

Jim Sykes Announces Health Plan

Jim Sykes Announces Health Plan
By bshepard@ktva.com!
Brett Shepard
Tuesday, July 13, 2004 - US Senate candidate Jim Sykes has ambitious plans for Alaska’s health care system if he gets elected.

According to Sykes contributions from medical and insurance companies have dictated the health care platforms for his fellow competitors Tony Knowles and Lisa Murkowski.

He says we need to get the health care money out of the campaign system in order to make progress towards lower cost in the system.

Sykes solution for lower health care cost would be to create a single-payer national health care system.

“We need a single-payer system. Imagine a country, our country I hope, where you can take your health care card, like they do in Canada, and you see the physician y! ou want to see and you get the help you need and it’s payed for by a universal insurance pool. That is what we need.”

Sykes said this system would help control the continually rising cost of health care in this country.

We contacted representatives with the Murkowski campaign and they said this type of system wouldn’t work in the US.

The Knowles campaign representative said one the key components of Knowles campaign to help lower health care cost would be to import drugs from Canada.

———————————————————————————————————————————-

July 12, 2004

Willingness of the insured to cover the uninsured

Willingness of the insured to cover the uninsured

Journal of General Internal Medicine
August 2004
Will Insured Citizens Give Up Benefit Coverage to Include the Uninsured?
By Susan Dorr Goold, MD, MHSA, MA, Stephen A. Green, MD, MA, Andrea K.
Biddle, PhD, MPH, Ellen Benavides, MHA, Marion Danis, MD

OBJECTIVE: To describe the willingness of insured citizens to trade off their own health benefits to cover the uninsured.

DESIGN: Descriptive study of individual and group decisions and decision making using quantitative and qualitative methods.

SETTING AND PARTICIPANTS:Twenty-nine groups of citizens (N= 282) residing throughout Minnesota.

INTERVENTIONS: Groups participated in Choosing Healthplans All Together (CHAT), a simulation exercise in which participants choose whether and how
extensively to cover health services in a hypothetical health plan constrained by limited resources. We describe individual and group decisions, and group dialogue concerning whether to allocate 2% of their premium to cover uninsured children in Minnesota, or 4% of their premium to cover uninsured children and adults.

MEASUREMENTS AND MAIN RESULTS: While discussing coverage for the uninsured, groups presented arguments about personal responsibility, community
benefit, caring for the vulnerable, social impact, and perceptions of personal
risk. All groups chose to insure children; 22 of 29 groups also insured adults.
More individuals chose to cover the uninsured at the end of the exercise, after group deliberation, than before (66% vs 54%; P < .001). Individual selections differed from group selections more often for the uninsured category than any other. Nevertheless, 89% of participants were willing to abide by the health plan developed by their group.

CONCLUSION: In the context of tradeoffs with their own health insurance benefits, groups of Minnesotans presented value-based arguments about covering the uninsured. All 29 groups and two thirds of individuals chose to
contribute a portion of their premium to insure all children and most groups chose also to insure uninsured adults.

http://www.blackwell-synergy.com/links/doi/10.1111/j.1525-1497.2004.32102.x

Comment: Two thirds of us believe in including everyone in the insurance risk pool, and nine tenths of us would be willing to abide by the health plan supported by the two thirds majority. Isn’t that strong enough support to move forward with a program of universal health care coverage?

July 09, 2004

Health Versus Wealth

Health Versus Wealth
July 9, 2004

Will actual policy issues play any role in this election? Not if the White House can help it. But if some policy substance does manage to be heard over the clanging of conveniently timed terror alerts, voters will realize that they face some stark choices. Here’s one of them: tax cuts for the very well-off versus health insurance.

John Kerry has proposed an ambitious health care plan that would extend coverage to tens of millions of uninsured Americans, while reducing premiums for the insured. To pay for that plan, Mr. Kerry wants to rescind recent tax cuts for the roughly 3 percent of the population with incomes above $200,000.

George Bush regards those tax cuts as sacrosanct. I’ll talk about his health care policies, such as they are, in another column.

Considering its scope, Mr. Kerry’s health plan has received remarkably little attention. So let me talk about two of its key elements.

First, the Kerry plan raises the maximum incomes under which both children and parents are eligible to receive benefits from Medicaid and the State Children’s Health Insurance Program. This would extend coverage to many working-class families, who often fall into a painful gap: they earn too much money to qualify for government help, but not enough to pay for health insurance. As a result, the Kerry plan would probably end a national scandal, the large number of uninsured American children.

Second, the Kerry plan would provide ”reinsurance” for private health plans, picking up 75 percent of the medical bills exceeding $50,000 a year. Although catastrophic medical expenses strike only a tiny fraction of Americans each year, they account for a sizeable fraction of health care costs.

By relieving insurance companies and H.M.O.’s of this risk, the government would drive down premiums by 10 percent or more.

This is a truly good idea. Our society tries to protect its members from the consequences of random misfortune; that’s why we aid the victims of hurricanes, earthquakes and terrorist attacks. Catastrophic health expenses, which can easily drive a family into bankruptcy, fall into the same category. Yet private insurers try hard, and often successfully, to avoid covering such expenses. (That’s not a moral condemnation; they are, after all, in business.)

All this does is pass the buck: in the end, the Americans who can’t afford to pay huge medical bills usually get treatment anyway, through a mixture of private and public charity. But this happens only after treatments are delayed, families are driven into bankruptcy and insurers spend billions trying not to provide care.

By directly assuming much of the risk of catastrophic illness, the government can avoid all of this waste, and it can eliminate a lot of suffering while actually reducing the amount that the nation spends on health care.

Still, the Kerry plan will require increased federal spending. Kenneth Thorpe of Emory University, an independent health care expert who has analyzed both the Kerry and Bush plans, puts the net cost of the plan to the federal government at $653 billion over the next decade. Is that a lot of money?

Not compared with the Bush tax cuts: the Center on Budget and Policy Priorities estimates that if these cuts are made permanent, as the administration wants, they will cost $2.8 trillion over the next decade.

The Kerry campaign contends that it can pay for its health care plan by rolling back only the cuts for taxpayers with incomes above $200,000. The nonpartisan Tax Policy Center, which has become the best source for tax analysis now that the Treasury Department’s Office of Tax Policy has become a propaganda agency, more or less agrees: it estimates the revenue gain from the Kerry tax plan at $631 billion over the next decade.

What are the objections to the Kerry plan? One is that it falls far short of the comprehensive overhaul our health care system really needs. Another is that by devoting the proceeds of a tax-cut rollback to health care, Mr. Kerry fails to offer a plan to reduce the budget deficit. But on both counts Mr. Bush is equally, if not more, vulnerable. And Mr. Kerry’s plan would help far more people than it would hurt.

If we ever get a clear national debate about health care and taxes, I don’t see how President Bush will win it.

URL: http://www.nytimes.com

ABC News' Medical Editor Dr. Tim Johnson says the U.S. health-care system is in Critical Condition

ABC News’ Medical Editor Dr. Tim Johnson says the U.S. health-care system is in Critical Condition.(ABCNEWS)

Peter Jennings Interviews ABCNEWS’Medical Editor on the Health-Care Crisis

Oct. 21 — Did you know that the United States spends more on health care, per capita, than any other country in the world?

Even so, 43 million Americans have no health-care coverage — including one in 10 children. Americans spend $1.6 trillion on health care and much of the system is clearly troubled.

Insurance premiums are going up for the third year in a row. Americans already pay twice as much for prescription drugs as anyone else. The ramifications of all this are huge in the world’s richest nation.

Every other country with a single-payer system, and all of the rich ones do, manage to cover everyone, have universal care, get very good results and do it at a far lower overhead than in the United States have.

This week, every news program on ABCNEWS is taking a closer look at the American health-care system. Peter Jennings interviewed ABCNEWS’ medical editor, Dr. Timothy Johnson for Critical Condition.

Peter Jennings: Tim, you helped us decide on the name of the series, Critical Condition. What is it essentially that is so critical?

Dr. Timothy Johnson: Costs are rising, we’re getting less for our money, we spend twice as much per person on health care in this country than any other industrialized country but we have 43 million uninsured. So we spend a lot of money but we don’t take care of a large section of our population. I think we’re at a critical juncture as to how we should proceed.

Jennings: So you think it’s a critical juncture as well as a critical condition.

Johnson: Yes, I think that’s a fair statement. Certainly for some people it’s a critical condition. The uninsured in our country, we know that they have a 15 to 18 percent mortality rate increase compared to those that are insured. We know that 18,000 of the uninsured die each year in this country for lack of insurance. For them, it’s critical condition. But for the rest of us it’s a critical juncture: What’s going to happen to our health insurance?
PAGEBREAK

Jennings: Why are so many people in the ABCNEWS poll apparently happy with their health care? [The poll found 64 percent of people with health insurance said they are satisfied with their health care, but 59 percent are worried about being able to afford it in the future.]

Johnson: That’s always been an interesting question. They feel good about their own doctor, their own hospital. But when they start to think about it as a system, and what may happen to their health insurance and their employment, they get worried.

Jennings: Do you see a change in this for a year ago or two years ago?

Johnson: Absolutely. They numbers of concerned are going up. Three years ago, 44 percent were concerned about the overall care in this country, now 54 percent … that’s a 10 percent increase in just three years.

Jennings: The conventional wisdom is Americans like to think that we have the best health-care system in the world.

Johnson: And we do, certainly for people that are very rich or who have very good health insurance and who have very good connections into the health-care system. But for too large a number, 43 million, and many who are underinsured, it is not the very best system in the world.

Jennings: So what was notable in that regard in this poll this time?

Johnson: What was notable is that 62 percent of our population said that they would favor a system of universal health insurance financed by the government, paid for by the tax payers, as opposed to the system we now have, the employer based system where many people are uninsured. I was stunned by that figure.

Jennings: I think conventional wisdom has it that in America, land of the free, that the marketplace is where the price is best established.
PAGEBREAK 

Johnson: That’s true for commodities like a car, where you can go in and make choices and you can even walk out of the showroom if you want. You can’t do that when you’re sick. You can’t do that with health care. So, for health care, you’re talking about a service and here I think the private sector has some real shortcomings. They have to spend a lot of overhead on sales and marketing and choosing the patients they’re going to serve. They shuffle a lot of paperwork. Their administrative paperwork is 15 percent versus the accepted figure of 3 percent for Medicare which is a single payer system where the government handles the money. The delivery system is free. You can pick whatever doctor or hospital you want.

Jennings: Why couldn’t you regard health care as a commodity the way you regard cars?

Johnson: Because in order for it to be a commodity you have to have a consumer who’s informed and can make choices. The consumer can go in and say I want this color, they have the information to make choices; they can walk away from the offered product. Think about getting a colonoscopy, a very common procedure today. Where can you find the Web site that tells you who is the best at it, where it might be the cheapest, who has the most training? The consumer doesn’t have the information to make the choices necessary for a commodity in the free marketplace.

Jennings: Some will say that Americans need to take more personal responsibility for their health care and be better informed.

Johnson: I would not disagree with that. And I think that if we could get better information that will certainly be part of our responsibilities as consumers but right now, that information is very hard to come by. The marketplace doesn’t really exist in terms of consumer information for health care.
PAGEBREAK
Jennings: Now, I think that the conventional wisdom is still the single-payer system, as you and others have described it, is socialized medicine and that isn’t for the U.S.

Johnson: Socialized medicine means that the government both finances health care and owns and operates the doctors and the hospitals.

Jennings: Like Britain?

Johnson: Like Britain. In Canada, it’s a split system. The government indeed does collect the money and disperse it. They run the financial part of health care. But the delivery system is free. People can choose whatever doctor or hospital they want to go to. So, we have a system like that in this country. It’s called Medicare. That’s exactly what happens with Medicare. So, to call the Canadian system socialized is to call Medicare socialized. I think it’s a pejorative word and inaccurate.

Jennings: When I walk past people who know that we’re doing this series this week and I mention the single-payer system, they just say, “Never in America.”

Johnson: I’ve talked to elderly people who say they love Medicare but they don’t want the government involved. They forget that the government has a role to play in setting standards, maybe in handling the money with lower administrative costs. It would be a tragedy for the government to try to run the health-care system in terms of delivery.

Jennings: On top of which, many Americans hold it to be conventional wisdom that private is better than public. Period.

Johnson: In fact the government does a few things well. And I’ll hold up one example in the health-care system: The NIH, the National Institutes of Health, is the shining gem of medical research in this entire world. It’s owned and run by the government. They can do some things well, especially when it comes to health care. Not everything, but some things.

PAGEBREAK 

Johnson: And the Republicans in general are very much opposed to that. But at the same time, they realize that Medicare is an example of something that works in part. It needs to be reformed, we need to have a drug benefit, we need to improve the services. They’re behind the times. We need to probably spend more money, believe it or not. At least on some of the administration. But, the same Republicans who don’t want a single-payer system would be loathe to say to our senior citizens, “We’re going to take away from you the one single-payer system we do have” — it’s called Medicare.

Jennings: We’re coming into an election year. It’s clearly a hot political subject. Do you think there is the political will in the country to compromise and provide a system with which all people of all political ideologies would agree?

Johnson: I would like to think so. I’m probably pessimistic about it, but with the latest poll results from our own poll, I’m more optimistic because all of a sudden we have a majority of people who are thinking in that direction. And that is what it’s going to take —a political majority to put pressure on congress. I think the heart of the American people want to do something right, in terms of the uninsured, and I think that the politicians will be dragged along.

Jennings: Conventional wisdom holds that, I think, that with the uninsured, they still have access to American medical care, they have it in the emergency room.
PAGEBREAK

Johnson: I would call that a real misunderstanding. It is true. We do not let people die in the streets if they get sick enough, they will get to the emergency room, but all too often by that time, they’re so much sicker that their outcomes are less assured. It’s going to cost a lot more money to take care of them. We have access through the emergency room, but if we could have it earlier through insurance coverage we could provide it at less cost, with better outcomes and with more dignity.

Jennings: If the uninsured are crowding the emergency rooms for basic care, is that adding to the cost of health care for the rest of us?

Johnson: It is. Somebody has to pay those bills, obviously. And it falls on local and state and to some degree, federal governments. But we pay a much higher price, I think, in the moral issue involved and the medical outcomes involved.

Uninsured's ills worsen come bills

Uninsured’s ills worsen come bills
By jspencer@denverpost.com
Jim Spencer
Denver Post Columnist
Friday, July 09, 2004 -

To read Scott Ferguson’s hospital bill is to know the insanity of modern medical economics and the nightmare of 44 million Americans without health insurance.

Here is an albuterol inhaler available at drugstore.com for $13.99. Centura Health’s St. Anthony Central Hospital in Denver charged Ferguson $323.05.

Here is a 30-cent dose of the diuretic Lasix. Centura wanted Ferguson to pay $72.30.

Ferguson, a 51-year-old musician with a heart condition, also got 28-cent tablets of Motrin for $12.70 apiece, $1.73 doses of Ativan for $75.60 a pop and Valium for $79.15 a dose instead of the drugstore.com price of $2.24.

Six hundred milligrams of an antibiotic called Cleocin is readily available at $9.54. Centura’s charge to the uninsured? How does $136.30 grab you?

The bills from a six-day hospitalization for a heart attack last December threatened to grab Ferguson by the bank account and choke the financial life out of him.

That’s why he refused to pay his $67,000 hospital bill. Ferguson discovered that the government health-insurance programs Medicare and Medicaid would only reimburse Centura roughly $6,700 for the services he received.

“I offered them that, plus 30 percent profit,” Ferguson said. “I had the cash to pay them what the insurance companies would have.”

Centura wouldn’t settle, Ferguson said. So Ferguson joined a national lawsuit that challenges discriminatory pricing that victimizes folks already down on their luck.

“I see people destroyed by this,” Ferguson said. “I see no reason for that.”

Centura officials said they couldn’t talk about Ferguson’s case because of the lawsuit. But the people in charge of the Colorado Hospital Association claim this is how it has to be for the uninsured.

“By federal regulation, in order to participate in Medicare, Medicaid and private (health insurance) plans, everybody must be charged the same price,” said Peter Freytag, CHA’s vice president.

But while everyone gets charged the same price, nobody actually pays that price except, perhaps, the uninsured. Government and private insurance companies cut far better deals with hospitals across the country.

In an example that doesn’t involve Centura or Ferguson, records for someone with a private health-insurance plan showed a $16,108 charge for testing blood flow in the patient’s heart. The insurance company paid only $10,470 - $5,638 less than the bill.

To stay in business with so many discounts, Freytag said, hospitals must set prices high. The result is that a portion of all hospital costs are reflected in the charges. That’s why guys like Ferguson get bills of $323 for $14 inhalers.

The inflated charges can get written off as charity or bad debt, Freytag said.

Since joining the lawsuit, Ferguson says he’s heard from plenty of people who paid wacky amounts because of threats from hospital bill collectors.

The whole health-care pricing scheme reminds medical economist J.D. Kleinke of “a psychedelic version of what car dealers do with sticker prices. Everything’s on sale.”

Unless you happen to be uninsured. Then, said Kleinke, you prop up hospitals that remain “incredibly profitable.”

“The Daughters of Charity are known on Wall Street as the Daughters of Currency,” he said.

The answers aren’t easy. A single-payer health-care system would do it, Kleinke said, but Americans don’t seem ready. Meanwhile, regulatory changes that force hospitals to charge the uninsured the Medicaid reimbursement rate will have to do.

One thing is certain: Americans need a change of heart.

“There is,” contended Kleinke, “almost a disdain for the poor.”

Nothing says it better than trying to collect $136.30 for a $9.54 dose of antibiotics.

Jim Spencer’s column appears Mondays, Wednesdays and Fridays. He can be reached at 303-820-177

Pfizer's free drugs and the $800 million pill

Pfizer’s free drugs and the $800 million pill

Pfizer
News Release
July 7, 2004
Pfizer to Launch Comprehensive Initiative Expanding Access to Prescription Medicines for Millions of Americans

Pfizer Inc said today it will launch the pharmaceutical industry’s most comprehensive initiative to significantly expand access to prescription medicines across the United States, with a specific focus on enabling America’s 43 million uninsured to obtain Pfizer medicines at significant savings.

With enrollment beginning in August, Pfizer will provide millions of working families without drug coverage access to Pfizer medicines at an average savings of 37 percent.

“I applaud the steps Pfizer is taking today, which will provide America’s uninsured with access to medicine at significant savings. Pfizer is helping those in dire need get the medicine they often require. This effort holds the promise of helping people in real need, and that is vitally important,” said U.S. Senator Hillary Rodham Clinton (D-NY).

http://www.pfizer.com/are/news_releases/2004pr/mn_2004_0707.html

Frequently Asked Questions about Pfizer Pfriends
Does this new program provide health insurance or coverage for the uninsured?

The actions that Pfizer is taking are a first step, not a total solution for the uninsured. We believe that every American should have access to quality, affordable health insurance. In order to get to a place where every American
has access to quality, affordable health care, we will need to develop a solution that involves government, medical professionals, nonprofits and the private sector. Pfizer is committed to playing an active role in getting to that solution.

http://www.pfizer.com/are/news_releases/2004pr/mn_2004_0707_qa.html

The New York Times
July 8, 2004
Drug Companies Seek to Mend Their Image
By Gardiner Harris

Acknowledging its dismal public standing, Pfizer, the nation’s largest drug company, held a news conference on Wednesday to announce an effort to provide discounted drugs to the working poor and anyone without health insurance.

In a series of presentations, executives at Pfizer, which is based in New York, said yesterday that they were starting the discount program - whose cost will not significantly affect the company’s profits, they said - because it was the right thing to do.

http://www.nytimes.com/2004/07/08/business/08drug.html

New America Foundation
July 8, 2004
The $800 Million Pill: What Drives the Cost of Prescription Drugs?

Why do life-saving prescription drugs cost so much? Drug companies insist that prices reflect the millions they invest in research and development. In his book The $800 Million Pill, Merrill Goozner contends that American taxpayers are in fact footing the bill twice: once by supporting government-funded research and again by paying astronomically high prices for prescription drugs. Goozner demonstrates that almost all the important new drugs of the past quarter-century actually originated from research at taxpayer-funded universities and at the National Institutes of Health.

He reports that once the innovative work is over, the pharmaceutical industry often steps in to reap the profit. Goozner shows how drug innovation is driven by dedicated scientists intent on finding cures for diseases, not by pharmaceutical firms whose bottom line often takes precedence over the advance of medicine. The $800 Million Pill suggests ways that the government’s role in testing new medicines could be expanded to eliminate the private sector waste driving up the cost of existing drugs.

http://www.newamerica.net/index.cfm?pg=event&EveID=392

Comment: Pfizer’s program creates an administrative nightmare with multiple means-tested programs which will place a significant burden on the health care delivery system. The program will be limited to Pfizer’s products, thereby excluding most prescriptions. Most of the uninsured will still not be able to afford their share of the payment for the drugs in these programs. Since Pfizer has indicated that their generosity will not have a detrimental impact on profits, they obviously realize that this program will have a negligible impact when compared to existing needs.

The conclusions in Merrill Goozner’s report lead to a persuasive argument that Pfizer and the other pharmaceutical firms have an ethical obligation to cooperate with our public agencies in ensuring that everyone has affordable access to essential medications.

Pfizer states that they are “committed to playing an active role” in getting to a solution, which involves the government, wherein every American would, have access to “quality, affordable health insurance.” Pfizer would have more credibility if we saw the least inkling of “playing an active role in getting to that solution.”

July 08, 2004

CaliforniaChoice holds down premium increases, but at a cost

PR Newswire
Jun. 29, 2004
CaliforniaChoice Announces Zero to Single-Digit Increases in Health
Insurance Premiums

At a time when employers throughout California continue to experience significant increases in their health insurance premiums, CaliforniaChoice today announced a zero percent increase for one HMO carrier and single-digit increases for almost everyone else participating in their small-group health purchasing alliance. CaliforniaChoice is the state’s leading authority on small-group (employers with 2-50 employees) healthcare benefits.

Employers find purchasing health coverage an easy business decision to make thanks to CaliforniaChoice’s unique budgeting process. Instead of the health plan telling the employer how much they have to pay under the old “defined-benefit” model, it is the employer who determines precisely what they are capable and willing to spend on their employee’s health insurance. Employers establish this fixed budget — which is known as their “defined contribution” — and in doing so achieve cost controls and budget predictability.

Using their employer’s contribution as a sort of “voucher,” employees are then empowered to choose from multiple HMO and PPO carriers within the CaliforniaChoice spectrum of health plans. All of these health plans compete for business based on provider network, drug formulary, geographic convenience, reputation and, of course, price. Employees who want “richer” benefits than the employer is willing to fund simply contribute the difference out of their own pocket.

In 2002, the Health Insurance Association of America honored CaliforniaChoice with its prestigious “Innovators Award,” an annual recognition for a select company whose contributions have led to “true industry advancement.”

http://fsnews.findlaw.com/articles/prnewswire/20040629/29jun2004050042.html

Comment: Since CaliforniaChoice uses existing HMO and PPO plans, including Blue Shield and Kaiser Permanente, it functions as an additional middleman in the health care funding arena. Although they claim to reduce administrative costs, their model, as an additional administrative intermediary, is unlikely to do so.

Most small businesses that do not currently offer their employees health benefit programs are not expected to do so merely because products are available that slow the rate of premium increases. These products are still unaffordable for many, and they will not motivate employers who simply do not care about their employees’ welfare. Instead, the defined contribution products offered by CalifoniaChoice will result in a shift from coverage through traditional defined benefit programs which provide more comprehensive coverage. The current epidemic of under-insurance will explode with these newer products.

Personal bankruptcy due to medical bills accumulated by individuals who have health insurance have already become commonplace. With the increase in defined contribution products, we can anticipate a further expansion in the need for bankruptcy services. Perhaps CaliforniaChoice will now also qualify for the “Innovators Award” from the National Association of Consumer Bankruptcy Attorneys.

July 07, 2004

News Observer

July 4, 2004

News Observer, North Carolina

By VICKI CHENG, Staff Writer

Dr. Wes Wallace thinks we need cleaner air. He’s in favor of nuclear disarmament. And he thinks all people, even the impoverished, deserve decent health care.

But the UNC-Chapel Hill emergency room doctor does more than just talk about these ideals.

“He’s the physician, I think, that we all want to be, and aspire to be,” says Dr. Judith Tintinalli, who heads the department of emergency medicine at UNC-Chapel Hill.

Wallace is preparing to leave late this week for a two-week trip to the rural community of Bongo, Panama, near the Costa Rican border. There he will lead a team of volunteer health-care providers who will treat children for malnutrition and intestinal parasites. They will provide blood-pressure medicine to adults who make $4 or $5 a day and can’t afford the drugs. They will examine people who bring their children in on horseback or come in on foot.

Wallace will also take small gifts to John Wesley Gonzales, who is named for him. He delivered the baby on a folding table one evening six years ago as the clinic was closing for the day.

This will be Wallace’s sixth trip to Panama to provide free health care, through a group organized by the University United Methodist Church in Chapel Hill. The volunteers pay about $1,500 each. They sleep in a church dormitory or a basic hotel in a nearby town, where they count themselves lucky to have hot water.

“I guess at this point, I either have to go or I have to find someone else to go,” Wallace says. “They’re expecting us.”

Wallace, 56, grew up in Gainesville, Texas. His father was a doctor. “Growing up, I saw that he had a pretty tough life,” Wallace says. “I didn’t think I wanted to be a physician.”

So when it was time for Wallace to go to college at Texas Tech University, he studied speech and theater. He worked as a disc jockey. He thought about broadcast journalism. But he wound up at the Pacific School of Religion in Berkeley, Calif. There he volunteered as a chaplain intern in the emergency department of an Oakland hospital that treated many indigent patients. And he was hooked.

“I find it enormously interesting and exciting,” Wallace says of emergency medicine. “It is frequently a very direct way to make people’s lives better, or to save people’s lives. … I am frequently tired, but I am never bored. Something interesting or exciting is always happening.”

In the 1980s, it seemed to Wallace that one of the most pressing issues on the planet was the possibility of nuclear war. In 1989, he became president of Physicians for Social Responsibility, a national organization that promotes policies to protect people from weapons of mass destruction. It is an affiliate of the International Physicians for the Prevention of Nuclear War, which won the Nobel Peace Prize in 1985.

“One of the main reasons that I became a physician was to make life better for people, to help people enjoy the full measures of their lives, and to do that while minimizing their suffering,” Wallace says. “It seemed like everything … I was doing could be rendered meaningless in 15 minutes if we didn’t manage to pull back from the nuclear abyss.”

Dr. Adam Goldstein, an associate professor of family medicine at UNC-CH, says Wallace is well known among Triangle doctors active in social causes.

“I think it’s rare to combine compassion with comprehensive knowledge of a topic, and then advocacy on that topic,” Goldstein says. “He certainly does that. For medical students in training, they need to understand you can do all three. As a physician, you’re going to have leadership opportunities. If you want to step up, you can do whatever it is you want to do.”

About 12 years ago, Wallace left his native Texas and settled in Chapel Hill, where his wife grew up. In the late 1990s, he was one of the doctors actively involved in the N.C. Ad Hoc Committee to Defend Health, which spoke out against insurance companies’ growing control over medical decisions.

He testified about the health dangers of polluted air before a state House committee working on clean-air legislation. And he was appointed by Gov. Jim Hunt to the Smart Growth Commission, charged with finding ways to manage growth and its impact on people and the environment.

Last year, Wallace gave a lecture at UNC-CH on health-care reform in the United States. He believes that the nation should move toward a national health insurance plan similar to Canada’s. Forty-five million people in the United States have no health insurance, he says.

“Spending the amount of money that we now spend on health care, we could cover everyone in this country,” he says. “But the way our health-care situation is arranged now, there’s such an enormous amount of waste that we don’t do that.”

Still, Wallace doesn’t come off as preachy, his colleagues say.

“There are people that you meet and you say, ‘They are radical. They are obsessed,’ ” Tintinalli says. “He doesn’t try to strong-arm you, or convince you about his ideals. He basically lives them.”

To accommodate his social activism, Wallace works part-time at UNC-CH.

“I try to be modest in my use of financial resources,” he says. “I’d rather have the time than the money.”

He has also been studying Spanish intensively over the past four years, sitting in on undergraduate classes at UNC and traveling to Mexico for Spanish immersion courses. He speaks it well enough now to communicate with his patients in Panama, and with Hispanic immigrants who end up in the emergency room at UNC. And he’s finding other uses for his new skill: His newest project is to travel to Mexico to help train doctors there in emergency medicine.

Jan Sassaman, who organizes the annual trips to Panama for the Chapel Hill church, said he’s not surprised that Wallace volunteers year after year.

“Wes is a pretty down-to-earth guy,” the Chapel Hill resident says. “His priorities are not materialistic.”

Biographical Data:

WESLEY M. WALLACE

BORN: Sept. 26, 1947

EDUCATION: Texas Tech University, 1969; certificate in theological studies, Pacific School of Religion, 1970; Baylor College of Medicine, 1975; internship through the Central Texas Medical Foundation, 1976

JOB: Associate professor of emergency medicine, UNC-CH

FAMILY: Married to Raine Lee, trained as a lawyer. They live in Chapel Hill.

HOBBIES: Outdoor activities, including hiking, canoeing and birding

SPECIAL SKILLS: Expert in treating snake bites and other wilderness mishaps

MIGHT HAVE BECOME: An actor. Before enrolling in medical school, he lived in Canada for a year, where he acted in several radio dramas and had a small part in “Jerry Potts and the ‘74s,” a film about the Northwest Mounted Police, now known as the Mounties.