News

“The Truth About the Drug Companies” By Marcia Angell

New York Review of Books - Volume 51, July 15, 2004

1. Every day Americans are subjected to a barrage of advertising by the pharmaceutical industry. Mixed in with the pitches for a particular drug—usually featuring beautiful people enjoying themselves in the great outdoors—is a more general message. Boiled down to its essentials, it is this:

“Yes, prescription drugs are expensive, but that shows how valuable they are.
Besides, our research and development costs are enormous, and we need to cover them somehow. As ‘research-based’ companies, we turn out a steady stream of innovative medicines that lengthen life, enhance its quality, and avert more expensive medical care. You are the beneficiaries of this ongoing achievement of the American free enterprise system, so be grateful, quit whining, and pay up.” More prosaically, what the industry is saying is that you get what you pay for.

Please click here to read the review

Posted by pnhp at 01:16 PM | Permalink

51 Legislators Pledge their Support in Writing!!
ConCon next Wednesday ñ July 7th.

Dear Affordable Health Insurance Supporter,

Your hard work and determination has paid off! 51 Legislators have pledged in writing to vote YES on the Constitutional Amendment for Affordable Health Insurance.

50 is what we need to get through this ConCon and spark a vigorous debate for reform. 51 votes will prevent amendments completely replacing the language you support. But it isnít enough to guarantee a vote or to prevent every amendment.

Last week, because of your hard work, the Legislature received over 500 Vote Yes Letters and a substantial number of calls. The result? 5 legislators who had made oral commitments to vote YES put their promise in writing. The ConCon reconvenes July 7th at 1:00 pm. We can win a vote if it happens. Our goal is still 101 written pledges to guarantee a vote and to control amendments.

Many legislators have said they will vote YES. We want them to put it in writing. So please keep the calls and letters coming. Ask your family, friends, neighbors and co-workers to call their legislators.

We need you to:
Call the State House switchboard at (617) 722-2000 and ask for your Legislators.
1. Tell them who you are and where you live so they’ll know you’re a constituent;
2. Ask them to Vote YES on the Affordable Health Insurance Amendment in the next ConCon; and
3. Call the Campaign at (617) 868-1280, or email us back and tell us what happened. If you have already called - organize friends, neighbors and co- workers to call their legislators.

Or take a minute to download Vote YES Letters asking your Senator and Representative to vote YES on Affordable Health Insurance for everyone. Sign one. Have family, friends, neighbors and co-workers sign one. Bring them to your local 4th of July parade. Send or fax (617-868-1363) them back to us. We’ll make sure YOUR legislators get your message! Time’s short. So please do it today!

Send a Vote YES Letter
Click Here to Send your Legislators a Vote YES Letter http://healthcareformass.org/get-involved/index.shtml

Need to find your Legislators?
Click here to conveniently find your legislator’s contact information http://www.wheredoivotema.com/bal/myelectioninfo.php

New Bedford Resolution: Last week, the New Bedford City Council unanimously passed a resolution endorsing the Constitutional Amendment for Affordable Health Insurance. A similar resolution of support is now pending before the Boston City Council. Thanks to everyone who has encouraged their local officials to endorse this amendment. Itís not too late to ask your City Council. We have sample language.

Special Event: A Tribute To Steve Collins, Executive Director of Mass. Human Services Coalition tomorrow (Tuesday, June 29th) from 5:30 ñ 7:30 pm at the Women’s Industrial and Educational Union, 356 Boylston Street, Boston. Steve is gravely ill. He has an aggressive form of cancer that will take his life in a very short time. Steve has long been a tireless and effective advocate for those in need. Please join the many in celebrating Steve and sharing some comfort with those who love and admire him. For more information or to make an online tax-deductible contribution, visit>> http://www.ForSteve.org or call MHSC at 617-482-6119. Checks, made payable to MHSC, may be sent to: For Steve, PO Box 390773, Cambridge, MA 02139.

Thank you for being a critical part of this historic campaign.

Sincerely,

Barbara Roop, PhD, JD :: Campaign Co-Chair
John Goodson, MD :: Campaign Co-Chair
Michael B. Carr, JD :: Campaign Coordinator
Ann Eldridge Malone, RN, MSN :: Campaign Outreach Coordinator
Sandy Eaton, RN :: Campaign Outreach Committee
Robert Gaw, President, NASRO :: Campaign Outreach Committee

Please go to our contact page>> http://healthcareformass.org/contact/index.shtml for email addresses to any of our Campaign personnel.

Visit Our Web Site: http://www.HealthCareForMass.org

Posted by pnhp at 01:44 PM | Permalink

American Medical News
July 5, 2004
Physicians want HSA access for Medicare recipients
By Katherine Vogt

The AMA will work to ensure that Medicare-eligible individuals have access to health savings accounts and will also study alternative means of financing health care.

The policies, passed at the AMA’s Annual Meeting in June, seek to help fine-tune health savings accounts, which were created under last year’s Medicare reform act. While the AMA supports HSAs as an option for consumers, the law “could use some tweaking,” said Duane M. Cady, MD, chair-elect of the AMA Board of Trustees.

“Health savings accounts are clearly part of our overall program for health system reform,” Dr. Cady said. “[But] we need to get it right.”

Under current law, HSAs are available only to people younger than 65. But in 2005, the Centers for Medicare & Medicaid Services is expected to establish Medicare savings accounts, which are essentially HSAs for Medicare participants. The AMA resolution calls on the organization to monitor the pending regulations to ensure that Medicare participants can take advantage of these tax-saving tools.

In a separate action, AMA delegates voted to further study alternative means for financing health care. The resolution sprang from a call to improve HSAs. That original call included a push to seek legislation establishing a new kind of account called an “individual medical account” that could be created without requiring consumers to have high-deductible insurance.

While the final resolution did not specifically address the idea of individual medical accounts, it left the door open for further study.

http://www.ama-assn.org/amednews/2004/07/05/gvsc0705.htm

Comment:  Health savings accounts (HSAs) are funded through regressive tax policies that benefit the wealthy. Under these policies, lower income individuals pay more for their health care than do the wealthy. Eliminating the requirement for high deductible insurance coverage would only increase the inequities of these policies targeted to selectively benefit the wealthy.

AMA members who support health savings accounts (HSAs) and individual medical accounts (IMAs) do so because they perceive them to be income sources that have no restrictions on fees nor on which services would be covered.

Try this. Write a list of the issues that must be addressed in health care reform. As a starter, I’ll suggest a few: the uninsured, inadequate coverage, affordability, accessibility, inequitable funding, flawed distribution of capacity, deficient support for a primary care infrastructure, inadequate IT support for error reduction, elimination of administrative waste, and the list goes on. Go ahead and add to the list some of your other concerns about our health care system. Then when you are finished, look over your list. Do you find on there the need to make health care purchases a better bargain for the rich than for the rest of us? Do you find on there the need to replace risk pools with individual accounts which remove all constraints on physicians’ fees and services?

The difference is clear. The AMA advocates for doctors; PNHP advocates for patients.

Posted by pnhp at 01:39 PM | Permalink

June 28, 2004
OP-ED COLUMNIST
A Second Opinion
By BOB HERBERT

In an article a few years ago in The Journal of the American Medical Association, Dr. Barbara Starfield of the Johns Hopkins School of Medicine took a look at the overall health of the American people, and compared conditions here to those in other industrialized countries.

What she found was disturbing.

“The fact is that the U.S. population does not have anywhere near the best health in the world,” she wrote. “Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from the bottom) for 16 available health indicators.”

She said the U.S. came in 13th, dead last, in terms of low birth weight percentages; 13th for neonatal mortality and infant mortality over all; 13th for years of potential life lost (excluding external causes); 11th for life expectancy at the age of 1 for females and 12th for males; and 10th for life expectancy at the age of 15 for females and 12th for males. She noted in the article that more than 40 million Americans lacked health insurance (the figure is about 43 million now) and she described the state of Americans’ health as “relatively poor.”

“U.S. children are particularly disadvantaged,” she said, adding, “But even the relatively advantaged position of elderly persons in the United States is slipping. The U.S. relative position for life expectancy in the oldest age group was better in the 1980’s than in the 1990’s.”

The article was published in the summer of 2000. At the time Japan ranked highest among developed countries in terms of health, and the United States ranked among the lowest.

Last week I talked with Dr. Starfield, an internationally respected physician, professor and researcher, and asked whether the situation had improved over the last four years.

“It’s getting worse,” she said, noting, “We’ve done a lot more studies in terms of the international comparisons. We’ve done them a million different ways. The findings are so robust that I think they’re probably incontrovertible.”

The U.S. has the most expensive health care system on the planet, but millions of Americans without access to care die from illnesses that could have been successfully treated if diagnosed in time. Poor people line up at emergency rooms for care that should be provided in a doctor’s office or clinic. Each year tens of thousands of men, women and children die from medical errors and many more are maimed.

But when you look for leadership on these issues, you find yourself staring into the void. If you want to get physicians’ representatives excited, ask them about tort reform, not patient care. Elected officials give lip service to health care issues, but at the end of the campaign day their allegiance goes to the highest bidders, and they are never the people who put patients first.

To get a sense of just how backward we’re becoming on these matters, consider that in places like Texas, Florida and Mississippi the politicians are dreaming up new ways to remove the protective cloak of health coverage from children, the elderly and the poor. Texas and Florida have been pulling the plug on coverage for low-income kids. And Mississippi recently approved the deepest cut in Medicaid eligibility for senior citizens and the disabled that has ever been approved anywhere in the U.S.

Even the affluent are finding it more difficult to obtain access to care. For patients with insurance the route to treatment is often a confusing maze of gatekeepers and maddening regulations. The costs of insurance are shifting from employers to employees, and important health decisions are increasingly being made by bureaucrats and pitchmen interested solely in profits. In the maddening din that passes for a national conversation in this country, distinguished voices like Dr. Starfield’s are not easily heard.

Echoing so many other patient advocates, she continues to call for movement on two crucial needs: coverage for the many millions who currently do not have access to care, and the development of a first-rate primary care system, which would bring a sense of coherence to a health care environment that is both chaotic and wildly expensive. “We don’t have any national health policy at all in this country,” said Dr.Starfield.

And there is no sign of that changing anytime soon.

Posted by pnhp at 08:39 AM | Permalink

HarrisInteractive
Health Care News
Editor: Humphrey Taylor, Chairman of The Harris Poll
June 22, 2004
Reputations of Pharmaceutical and Health Insurance Companies Continue Their Downward Slide

In this year’s survey, 44% of all adults think the pharmaceutical companies are doing a good job for their consumers (and 48% think they are doing a bad job). In 1997, fully 79% thought the industry was doing a good job.

Health insurance companies were never as popular, during the last seven years, as pharmaceutical companies, but in 1997 a 55% majority believed they were doing a good job for their consumers. …only 36% now give them good marks - 19 points lower than seven years ago.

Some members of the public see a difference between managed care and health insurance companies, even though virtually all insurance companies now sell managed care, and it really is just one industry. Only 30% of the public give managed care companies good marks… For the past two years, managed care has been tied for last place with the tobacco companies.

http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2004Vol4_Iss11.pdf

Comment: In this survey of the public view of 15 industries, they were asked, “Do you think health insurance companies (or one of 14 other industries) generally do a good or bad job of serving their consumers?”

With pharmaceutical firms, other surveys have indicated that the public believes that drug prices in the U.S. are too high. We now need government intervention in drug pricing, through bulk purchasing and/or regulation, balancing value for purchasers with fair profits for the manufacturers.

The public clearly recognizes that the insurance plans are not serving us well. This is further reinforced by a plethora of studies confirming that private insurers provide essentially no value when judged by cost and quality. Administrative costs are outrageous. And, rather than pooling risk, they serve as wasteful middlemen for healthier individuals as they dump the more costly patients into taxpayer funded programs or, worse, out into the street. Destroying the fundamental functions of insurance certainly results in impaired quality of their insurance products. High costs with poor quality, by definition, destroys value. In contrast, administrative efficiency and a universal risk pool, features of a single payer system, would provide the value that we now need in health care coverage.

Since the public recognizes that private insurers are serving us poorly, why do they keep electing politicians that support policies that nurture this industry at a great cost to the rest of us?

The fact that we need change, isn’t that like a… well… Duh!

Posted by pnhp at 11:10 AM | Permalink

California’s single payer bill passes Assembly Health Committee
Wed, 23 Jun 2004
(These two releases were distributed by e-mail and are not currently available by a link, therefore they are presented here in their unedited versions. Please excuse the length of this important message.)

California State Senator Sheila Kuehl
FOR IMMEDIATE RELEASE
June 22, 2004

CONTACT: Sara Rogers 916 445 1353 or Robin Podolsky 310 441 9084

KUEHL‘S STATEWIDE HEALTH COVERAGE BILL TAKES HISTORIC STEP FORWARD IN ASSEMBLY HEALTH COMMITTEE

Senate Bill 921, authored by State Senator Sheila Kuehl (D-23) which would
provide comprehensive health benefits to every Californian at no new cost to
California’s general fund, has been passed by the State Assembly Health Committee by a vote of 12 to 5.

SB 921 would create a single, streamlined reimbursement system for medical
care in California that has been projected to save the state about $14 billion dollars in administrative healthcare costs alone. These and other substantial savings make it possible to insure every resident of California with a comprehensive health plan that would include medical, dental, vision, mental health and prescription drug coverage among benefits.

Because SB 921 would cover every Californian, it would offer each patient the freedom to choose among all healthcare providers. Healthcare provision would remain subject to competition and in private hands. The legislation would also require the State of California to use its purchasing power to negotiate directly with pharmaceutical companies to buy prescription drugs in bulk, thus drastically lowering their cost.

“I’m very grateful to my colleagues in the Assembly Health Committee for voting to extend healthcare coverage to every Californian,” said Senator Kuehl. “SB 921 will make it possible for every Californian to keep their health care coverage even if they change jobs; start a business; start a family; continue our education; or travel out of state. Our important relationships with the doctors we trust will not be interrupted. People with undetected chronic illnesses will get the care they need to avert the heartache and economic burden of medical catastrophes. This bill will save our state money and improve the quality of life for all of us.”

Today, approximately 1 out of 5 Californians is uninsured, and, nationally, catastrophic medical illness remains the leading cause of personal bankruptcy. Most uninsured Californians are employed but either cannot afford the medical insurance offered to them at work or are not offered healthcare benefits through their job. Analysts agree that the costs of healthcare are propelled upward by the overuse of emergency room care (the most expensive kind of healthcare delivery) by people who are not insured and do not receive regular medical attention. Doctors and hospitals also report that, as insurance premiums rise in cost, the reimbursements paid by private insurance companies to medical providers are shrinking.

Cost Controls in SB 921 would mean that businesses would not be burdened
with suddenly rising health care premiums; would no longer have the responsibility for negotiating complicated health care benefits packages for
their employees; and would also insure the self-employed.

SB 921 would also relieve doctors and hospitals of the administrative costs
associated with multiple insurance plans. Since all patients will be insured, healthcare providers will not have to worry about uninsured patients being unable to pay for the care they receive. Physicians will have a direct voice in the amount of reimbursement they receive. Those reimbursements will reflect the actual costs, on a regional basis, of providing care, and they will come on time. Doctors, not insurance companies, will be in charge of deciding what is medically appropriate for patients.

SB 921 will be funded with those federal and state dollars already earmarked
for healthcare, along with a means-based, equitable tax. Individuals and
employers will pay into the plan based on what they can afford, not what
insurance companies want to charge. This tax will replace all premiums, deductibles, co-pays and out-of-pocket expenses. For most taxpayers and businesses, this will lead to sizeable savings.

PAGEBREAK

HEALTH ACCESS UPDATE
Tuesday, June 22nd, 2004

UNIVERSAL COVERAGE BILL PASSES ASSEMBLY HEALTH COMMITTEE

In a boost to the goal of quality, affordable health care for all, SB 921 (Kuehl), a groundbreaking bill to establish a universal single-payer health system in California, was passed in Assembly Health Committee Tuesday. Having passed the full Senate last year, this new vote raises the profile of this comprehensive health reform solution. The vote was not a given: When Senator Sheila Kuehl decided to schedule the bill in this committee a few weeks ago, she did not know if she would get the votes.

SUPPORT TESTIMONY: Senator Kuehl opened her testimony by stating how “very proud” she was to author SB 921. After describing the “perfect storm” crisis in health care, she described that the bill “imagines a system that provides
high quality, affordable health care for all.” Her stated emphatically that “this bill is possible,” pointing to Medicare and the Veterans Administration.

Dr. L. Paul Smith, who practiced and taught at McGill University in Canada
and now is a member of AARP California, followed on that point, stating that “America is no stranger to single-payer health plans.” He mentioned key benefits of such a plan, including universality, comprehensiveness, and consolidated administration, leading to cost effectiveness. Dr. Bill Durston, a Sacramento emergency room doctor also with significant credentials, talked of his personal experiences, both with uninsured and underinsured patients. He also highlighted the significant administrative hassles of the current system.

Dozens of organizations came forward to declare their support, as Senator Kuehl joked, half in fun and full in earnest, “I apologize that there are over 500 organizations in support of this bill.” When closing on the bill, she again stated how she had “never seen anything” like the support SB921 has, and simply said that this the bill “is in the interest of California.”

OPPOSITION TESTIMONY: Opposition witnesses used several arguments. The Chamber of Commerce representative stated “we do not support the concept of universal health coverage.” The Chamber stated their belief that the bill would entail “significant costs” beyond what Californians currently spend, but did not produce research to back up that argument. She referred to the recent Oregon ballot initiatives for a single-payer plan, where 79% of the state voted no. She claimed that SB 921 does “nothing to address the underlying cost of health care.”

A representative of health plans challenged the belief that “in order to get to universal coverage, you must junk the concept of private competition.” He argued that we all rely on vital services, such as “food, clothing, and housing,” which are “delivered best by a private, competitive approach.” Finally, he cited that this was a “danger” in thinking there were “easy options” to the health care crisis, and that instead, there are “very difficult tradeoffs.”

Other business associations railed against “government-run health care,” and
instead argued for health savings accounts and association health plans. Representations of manufacturers pointed out that the bill removes employers
from the “control and cost of utilization of health care,” and the employer would be stuck with “whatever bill that the state sent them.” Health underwriters noted that the United States spends more than most countries with single-payer systems, and “what services will be rationed to reduce our costs?”

LEGISLATOR COMMENTS: Assemblyman Frommer raised concerns that there were “no limits on revenues collected,” “no controls on costs,” and “a Cadillac benefits package.” He also questioned the timing, with the upcoming referendum to repeal SB 2, the Health Insurance Act passed last year. Senator Kuehl responded that she was a co-author of SB 2 and strongly supported its passage and will work to defend it this fall, and that there is no contradiction to support both.

Assemblywoman Goldberg referred to her experiences in Los Angeles with a
health system that is unraveling: “If we don’t do something, nobody will
have health care.” Assemblyman Dymally supported the bill and urged the
people to challenge the monied interests.

Assemblyman Richman stated that he supports “universal coverage” but does
not support a single-payer system, and does not believe the terms are interchangeable. He raised concerns about “no limits what the income tax
would be, the payroll tax,” etc. He cited provider rate reimbursement concerns, citing the low reimbursement in Medi-Cal, another “government run” health insurer. Senator Kuehl responded that she was not surprised that a program directed at the poor is “nickel and dimed,” and the bill seeks to insulate the health plan from the political concerns of the Governor and legislature.

Assemblywoman Wolk stated she would support the bill to “move it forward,”
but had concerns about it being “not cooked,” especially with the lack of
clarity on the revenues to fund the system, and the potential legal challenges. Having lived in other countries, she also has expressed concerns about “the choices and limitations that others live with that would not be put up with here” in America. Finally, Assemblywoman Rebecca Cohn, Chair of the Assembly Health Committee, gave her support, “since everybody has a body,” and each body eventually breaks down.

NEXT STEPS: The bill will not move forward this year. Senator Kuehl will
continue to work to develop the revenue package to fund the health system,
based in part on economic studies are in the works. This will be a challenge: while the tax system to fund this universal health plan would replace the billions Californians currently spend in premiums, deductibles, and other costs, it still would be considered a tax increase and thus need a two-thirds vote. Yet Senator Kuehl has committed to reintroduce this bill next year, and the organizing and advocacy from this session has created a strong base of support to move forward.

For the text of SB 921 and related legislative documents:
http://www.leginfo.ca.gov/cgi-bin/postquery?bill_number=sb_921&sess=CUR&house=B&search_type=email

Comment: This historic action establishes, with no doubt whatsoever, the
credibility of the single payer model of reform. When legislators seriously examine all of the options, the superiority of the single payer model is evident.

Unfortunately, peculiarities of the California legislative process will prevent the passage of SB 921 in this session. California requires a two-thirds vote in both the Assembly and the Senate to pass any measure that involves a tax increase. California’s legislative districting process has established safe districts which allows the parties to nominate ideological extremists. The Republicans vote as a solid block on all tax measures, and they constitute more than one-third of each chamber.

But the significance of this landmark event cannot be overstated. Legislators can learn the complexities of our health care financing structure, and they can identify solutions that would rectify many of the inherent flaws in the system.

This victory should provide an incentive for you to pull out all stops in your efforts to educate your colleagues and the public on the model of reform that will finally bring health care justice to America: a single payer system for everyone.

Please share this message with others who care.

Posted by pnhp at 08:54 AM | Permalink

Source: NBC Nightly News (6:30 PM ET) - NBC
June 22, 2004 Tuesday

BROKAW: Robert, clearly not very many doctors are going to want to deal with 250 different health-care plans. What’s the American medical community doing about this growing mountain of red tape?

BAZELL: Well, some doctors are so disgusted, they’re beginning to support the idea of a single payer, whether it’s the government or some other entity.

Posted by pnhp at 01:34 PM | Permalink

Trying To Bridge the Gap Fighting For Health Care For All

Richard Gilluly
06/23/2004

Walkers Cross the Longfellow Bridge for Health Care

Many hundreds of people representing groups as diverse as the Massachusetts Nurses Association, the Harvard Medical School, labor unions, members of the Boston City Council and the Massachusetts Senior Action Council rallied in Boston Saturday to protest the fact 82 million Americans lacked health insurance at some point during the past two years — and that some 43 million permanently lack it.

“The figure includes about 600,000 uninsured people in Massachusetts, and millions more of us are struggling to keep the coverage we have,” said Jon Weissman of Springfield, who coordinated Western Massachusetts participation in the rally on behalf of a group called Jobs with Justice.

The Purpose of the rally was not just to protest the present system but also to advocate elimination of the vast and costly array of 1,100 health insurance companies, health maintenance organizations and other private groups involved in the health care payment system and replace them with a single-payer system operated by state or federal governments, speakers said.

Letter Carriers Walk for Health CareReputable economists quoted in such publications as the Journal of the American Medical Association and The New England Journal of Medicine believe savings from a single-payer system would more than generate enough revenue to provide health insurance for all Americans, speakers said.

Western Massachusetts, including Franklin County and West County, was well-represented on a blessedly cool, cloudy late Saturday morning as the colorful group of demonstrators, waving banners and placards, marched a mile and a half from Kendall Square in Cambridge across the Longfellow Bridge to the Boston Common — where many more already had gathered.

“Bridging the Gap” was the theme of the rally, which meant that for millions of Americans the lack of health-care insurance is a great gap that stands between them and the health care they, and especially their children, desperately need, said speakers. Similar marches were held all over the nation, including one across the Golden Gate Bridge in San Francisco in which Sen. John F. Kerry (D-Mass.), presumptive Democrat nominee for the presidency, was scheduled to march.

“Health Care is a right, we’re ready to fight” was one of many chants heard from the marchers, but while that may have had a ring reminiscent of earlier, more unkempt demonstrations, this was a very serious demonstration, indeed, with a very large middle-class component.

Among the speakers at the Boston Commons, for example, was self-employed physical therapist Nancy Bullett of North Adams, who told the crowd that not only are her patients increasingly hard-pressed, and often unable, to pay for the treatment they need but that she and her two children lack coverage themselves, because premiums of over $800 a month are too high for her to pay.

Her children, she said, are on a waiting list for a state program, the Children’s Medical Security Plan (CSMP), and there are 14,900 kids on that waiting list statewide. While the Legislature last week passed a bill which would immediately fully fund CSMP, Ms. Bullett said she is not placing any bets yet.. “It did pass,” she said, “but now it has to go to Governor Romney.” Whether he will sign it was unknown at press time.

A USA Today story handed out at the demonstration reported that one in three Americans younger than 65 were uninsured for a time during 2002 and 2003, according to a study commissioned by Families USA. Half were uninsured for at least nine months and two-thirds for at least six months, the story said.

And while most Americans over 65 have some health insurance through Medicare, that, too, is threatened, declared speakers, including Isaac BenEzra of Amherst, president of the Massachusetts Senior Action Council, who said many thousands of people in the US die annually because of the “collateral damage” inflicted by runaway prescription drug prices charged by “monopolistic” pharmaceutical companies, and because they lack health insurance.

And Ms. Bullett told West County News that the recently-passed Medicare “reform” bill, which has drawn strong opposition from health activists, would cut payments for rehabilitation of seniors, including physical therapy and speech therapy for stroke victims. The mechanism for the cuts would be a new Medicare rule limiting combined payments for both kinds of therapy to $1,500 a year. Currently, there is no limit. “It’s so bizarre,” she said, “None of us can afford to get sick.”

Stressed again and again were two other factors, first that America’s failure to provide needed health care to people on a timely basis ultimately costs far more, because treatment is offered only in overcrowded emergency rooms after an emergency medical crisis already is occurring.

Second, as Harold Cox, member of the Cambridge health Board and president of the Massachusetts Public Health Association, pointed out, preventive medicine is neglected under our current system, because uninsured people do not receive screening for a variety of diseases, including breast cancer and prostate cancer. Besides, he said, people with contagious diseases, such as AIDS, do not receive the treatment and education they need to prevent the contagion from spreading. “Our health care system is sick,” Mr. Cox said bluntly.

Union members, including John Hogan of Local 2222 of the International Brotherhood of Electrical Workers, told of the fact that employer-union contract disputes these days almost always occur over health insurance benefits that formerly were routinely paid by employers but often are no longer. Contract disputes over health insurance began to occur frequently in the late 1980s, he said, “but the situation is much worse now.”

Speakers also pointed out that a single-payer system is not, as detractors claim, “socialism,” because while government would operate the health-care payment system under single-payer, most doctors, hospitals and other providers would remain independent entities, as they are now. A bill currently wending its way through the Massachusetts Legislature contemplates such a system for Massachusetts.

Western Massachusetts marchers numbered 60 and included students, seniors, and in-between, with members of the following organizations struggling with the health care system:

Alliance for Injured Workers
Arise for Social Justice
Franklin/Hampshire Health Care Coalition
International Brotherhood of Teamsters Local 404
Mass. Senior Action Council
National Association of Letter Carriers Branch 46
Odyssey Bookshop
Service Employees International Union Local 2020
Social Workers for Peace and Justice
United Auto Workers Local 2322

article posted on www.pvaflcio.org
Pioneer Valley, Massachusetts, AFL-CIO

Posted by pnhp at 01:13 PM | Permalink

Georgia’s single payer study

The Atlanta Journal-Constitution
6/22/04
‘Single-payer’ Georgia health plan pushed
By Andy Miller

A proposal for a Medicare-like system that would give health insurance coverage to all Georgia residents would cut total health spending for the state by about $716 million annually, according to study released Monday by a consumer group.

The proposed, government-run “single-payer” plan would be financed by a combination of payroll taxes, increases in tobacco and alcohol taxes, a 1 percent sales tax and a tax on individuals, said Georgians for a Common Sense Health Plan, a group that promotes health coverage for all residents.

But all current payments by employers and individuals, including health insurance premiums and co-pays, would be eliminated under the consumer group’s SecureCare program. Most families earning $75,000 or less would pay less under the proposal, said Rita Valenti, a registered nurse and former state legislator who’s a founder of the Common Sense group.

The study, conducted by the Virginia-based Lewin Group, a health care consulting firm, was financed by a grant from the nonprofit Healthcare Georgia Foundation, a private organization whose mission, in part, is to expand access to affordable, quality health care.

“On paper, there’s a lot of merit to it,” said Ken Thorpe, an Emory University health policy expert and former health official in the Clinton administration. “The politics is always the thing that bottles it up. You’re moving money from the private sector to the public sector.”

http://www.ajc.com/news/content/business/0604/22insurance.html

Comment: How many more studies do we need before we act? Where is our effort to change the politics?

Posted by pnhp at 09:37 AM | Permalink

Important advances in our knowledge about women’s health have been made in the past decade. Health insurance cover-age helps make these improvements accessible to millions of women. However, the patchwork of different private sector and publicly-funded programs in the U.S. leaves nearly one in every five nonelderly women uninsured.

Please click here to read the report on Womens Health Insurance Coverage

Posted by pnhp at 11:25 AM | Permalink

Group Proposes Single-Payer Insurance Plan in Georgia

Georgians for a Common Sense Health Plan is proposing a single-payer plan to provide health insurance coverage to all state residents, the Atlanta Journal-Constitution reports. The SecureCare program would offer residents a comprehensive benefits package that includes long-term care and prescription drug coverage. It would be financed by a combination of payroll taxes, increased tobacco and alcohol taxes, a 1% sales tax and an individual tax, according to the Journal-Constitution. Emory University professor Kenneth Thorpe said the proposal would require more federal funding to lower the employer payroll tax, which has been suggested at 9.1%. According to a study released Monday by the Lewin Group, a Virginia-based health care consulting firm, the proposal would decrease the state’s total health care spending by about $716 million per year. Rita Valenti, founder of Georgians for a Common Sense Health Plan and a former state legislator, said, “Health care needs to be viewed as a necessary infrastructure, like roads or police services. I don’t think anyone is doing well under the current system, except for the private insurance industry and the pharmaceutical industry.” Thorpe said, “On paper there’s a lot of merit to [the proposal].” He added, “The politics is always the thing that bottles it up. You’re moving money from the private sector to the public sector.” Charlie Harman, a vice president of Blue Cross Blue Shield of Georgia, said, “We believe that Americans want their leaders and all health stakeholders to work together to improve what is already a very good system without the tax and fee increases suggested in this proposal.” Susan Pisano of America’s Health Insurance Plans added that single-payer systems in other countries have long waits for care and can be slow to adapt to change and medical innovations (Miller, Atlanta Journal-Constitution, 6/22).

Posted by pnhp at 10:24 AM | Permalink

FOR IMMEDIATE RELEASE
June 22, 2004

Kuehl’s Statewide Health Coverage Bill Takes Historic Step Forward In Assembly Health Committee

CONTACT: Sara Rogers (916) 445 1353 or Robin Podolsky (310) 441 9084

Senate Bill 921, authored by State Senator Sheila Kuehl (D-23) which would provide comprehensive health benefits to every Californian at no new cost to California’s general fund, has been passed by the State Assembly Health Committee by a vote of 12 to 5.

SB 921 would create a single, streamlined reimbursement system for medical care in California that has been projected to save the state about $14 billion dollars in administrative healthcare costs alone. These and other substantial savings make it possible to insure every resident of California with a comprehensive health plan that would include medical, dental, vision, mental health and prescription drug coverage among benefits.

Because SB 921 would cover every Californian, it would offer each patient the freedom to choose among all healthcare providers. Healthcare provision would remain subject to competition and in private hands. The legislation would also require the State of California to use its purchasing power negotiate directly with pharmaceutical companies to buy prescription drugs in bulk, thus drastically lowering their cost.

“I’m very grateful to my colleagues in the Assembly Health Committee for voting to extend healthcare coverage to every Californian,” said Senator Kuehl. “SB 921 will make it possible for every Californian to keep their health care coverage even if they change jobs; start a business; family; continue our education; or travel out of state. Our important relationships with the doctors we trust will not be interrupted. People with undetected chronic illnesses will get the care they need to avert the heartache and economic burden of medical catastrophes. This bill will save our state money and improve the quality of life for all of us.”

Today, approximately 1 out of 5 Californians is uninsured, and, nationally, catastrophic medical illness remains the leading cause of personal bankruptcy. Most uninsured Californians are employed but either cannot afford the medical insurance offered to them at work or are not offered healthcare benefits through their job. Analysts agree that the costs of healthcare are propelled upward by the overuse of emergency room care (the most expensive kind of healthcare delivery) by people who are not insured and do not receive regular medical attention. Doctors and hospitals also report that, as insurance premiums rise in cost, the reimbursements paid by private insurance companies to medical providers are shrinking.

Cost Controls in SB 921 would mean that businesses would not be burdened with suddenly rising health care premiums; would no longer have the responsibility for negotiating complicated health care benefits packages for their employees; and would also insure the self-employed.

SB 921 would also relieve doctors and hospitals of the administrative costs associated with multiple insurance plans. Since all patients will be insured, healthcare providers will not have to worry about uninsured patients being unable to pay for the care they receive. Physicians will have a direct voice in the amount of reimbursement they receive. Those reimbursements will reflect the actual costs, on a regional basis, of providing care, and they will come on time. Doctors, not insurance companies, will be in charge of deciding what is medically appropriate for patients.

SB 921 will be funded with those federal and state dollars already earmarked for healthcare, along with a means-based, equitable tax. Individuals and employers will pay into the plan based on what they can afford, not what insurance companies want to charge. This tax will replace all premiums, deductibles, co-pays and out-of-pocket expenses. For most taxpayers and businesses, this will lead to sizeable savings.

Posted by pnhp at 09:34 AM | Permalink

Congressional Budget Office
June 2004
The Effects of Tort Reform: Evidence from the States

This Congressional Budget Office (CBO) paper reviews the major recent studies that evaluate state-level tort reforms and assesses the relevance of that research for evaluating similar proposals at the federal level.

The most consistent finding in the studies that CBO reviewed was that caps on damage awards reduced the number of lawsuits filed, the value of awards, and insurance costs.

http://www.cbo.gov/showdoc.cfm?index=5549&sequence=0&from=7

Comment: Because of major controversies and the intensely emotional nature of the malpractice issue, at PNHP we attempt to avoid diverting much of our effort to this issue, even though it does consume 1% of health care spending. Although we certainly acknowledge that it is a very significant issue, we do concentrate our efforts on supporting changes that will redirect our resources toward ensuring affordable, comprehensive care for everyone. But as much as we try to stay on our message, inevitably during the Q & A segment of our sessions and forums, the malpractice issue is brought up.

Though I don’t want to dwell on this issue, I would like to make an important point. Much of the heated debate is over disputed issues. But we do have some solid data, and an objective assessment of that data can be provided by credible organizations such as the Congressional Budget
Office.

It is imperative that we begin the debate by agreeing to accept the credible, objective information that we do have.

As only one example, caps on damages clearly do decrease malpractice insurance costs, and they do it without placing caps on specific damages such as actual expenses and loss of income. They cap only punitive damages and general damages, the pain and suffering award for which no amount of dollar value can be objectively determined.

General damages are important because they provide the buffer for allowing the attorney to profit without dipping excessively into the specific damages which rightfully belong to the injured patient. As much as we want to support our colleagues in the legal profession who represent patients with genuine entitlement to legal redress, we must plea with them to accept caps that are high enough to fairly compensate injured patients, but at a level that would prevent excessive enrichment of the plaintiffs’ attorneys. Using health care dollars to create mega-wealth for attorneys is just as immoral as using them to create mega-wealth for insurance executives.

And for egregious acts that warrant punishment, the criminal courts would provide a more appropriate venue for retribution. Punitive awards are a misuse of health care dollars. If the attorneys want to participate in a lottery, they should buy a ticket.

Malpractice reform is a very important issue and must be addressed. But we at PNHP are too busy trying to save the lives that are literally lost by our very sick system of funding health care. The AMA has made malpractice reform their number one priority this year. They are certainly an appropriate organization to lobby for this much needed reform. Some of us, including me, wish them success in this endeavor.

Posted by pnhp at 09:29 AM | Permalink

Sick, and Tired of the Endless Paperwork

We’ve been charged for seeing doctors we never met, and even for the armrests on my wife’s wheelchair.
By Doug GarrNewsweek, June 21, 2004

When my wife, Meg, suffered a severe stroke that immobilized her left side, I knew we would be facing a grueling odyssey involving several hospitals, dozens of doctors and countless therapy sessions. What I wasn’t prepared for was the American Way of Managed Health Care, a system that is bureaucratic and often dysfunctional. Yes, medical practitioners in the United States are generally considered among the best in the world, and my wife primarily had first-rate care, but their back-office practice—a business dominated by third-party payers—is badly run at worst and woefully confusing at best.

Meg’s stroke occurred while we were vacationing in the south of France last summer. After being stabilized in the emergency room of a small hospital, she was transferred immediately to a large teaching hospital, where she received excellent treatment in a world-renowned stroke pavilion. When I received the bill for her 2-1/2-week stay at the Pasteur Hospital in Nice, I asked the deputy administrator for an itemized statement. I knew I’d need to show it to our health-insurance company—the one-page invoice for more than 20,000 euro wouldn’t do. The administrator was puzzled. There were only two daily rates, he explained, one for soins intensifs—or intensive care—and another for non-acute care. There were no extra charges; the numerous ambulance transfers, MRI brain scans, X-rays and assorted tests associated with any serious injury or illness were all-inclusive. In fact, the only supplement was 10.67 euros—about $13—a day for food which, although not three-star bistro quality, was certainly a bargain, and better than anything you can eat in a U.S. hospital.

I’m not arguing that the French health-care system should be a world benchmark, but compared with what we faced when we returned home, it was a model of simplicity and efficiency. Of course, everything in American medical care is a la carte, and the invoices are so dense with codes and abbreviations, it’s a wonder anyone can decipher them. I often wonder, how much does this cost the American public annually?

At one New York hospital, we received bills from doctors we’d never heard of, including one who charged for an office visit when Meg couldn’t even get out of bed. The managed care provider’s computer sent him a check without question. Had he not billed us for the co-payment I never would have noticed the error. Over the past few months, I spent hours clearing up these kinds of mistakes. A doctor friend who heads a department in a large hospital admitted that these kinds of complaints are all too common.

Meg’s medical tab has reached nearly $300,000, which seems monumental, even given the nature of her catastrophic injury. Thankfully, we were covered for most of it. Yet $90,000 of that figure had little or nothing to do with patient care. Roughly 30 cents of each health-care dollar goes to administration, or the processing of paperwork. If that figure could be reduced by a third, even $30,000 would go a long way toward extending her rehab treatments. (Meg’s 2004 benefits have run out.)

When Meg was finally discharged after spending 56 days in hospitals, we received co-payment bills for her medical equipment, including an itemized statement for every extra on her wheelchair (no, the brake extensions, foot pedals, armrest, anti-tip bars, seat and seat belt are not included). But the provider billed us two ways, one for leasing the chair and another for purchase. Even now, after numerous phone calls, I still don’t know whether we own or are renting the wheelchair.

The outpatient rehab therapy sessions presented their own set of challenges. The hospital sent a number of bills—printed in alphanumeric codes—for additional thousands of dollars even though we made the proper co-payments at the time of treatment. Billing administrators barely raised an eyebrow when I told them I had spent too much time on hold and would no longer bother calling to dispute the charges. (We have since received automated early-morning phone calls asking us to contact the hospital.)

I’ve checked with others who have had protracted negotiations with health-care providers and insurers over complex medical treatment. They echo my frustration. Why is it incumbent on the recipient to spend countless hours rectifying the medical administration’s mistakes? How much extra does this process add to the nation’s annual health-care bill?

Medicare—our government-subsidized system that cares for the elderly—has a much better record in administrative costs. It spends between three and four cents of every dollar on paperwork and processing. A single-payer system is easier and cheaper to run. We’ve had a two-tier health-care system in the United States for a while, and only one tier works. Isn’t it time for managed care to slim down and help its patients get better instead of burdening them with needlessly expensive paperwork?

Garr is a writer living in New York City.—

Posted by pnhp at 03:47 PM | Permalink

New York Times
Rules to Expose Long-Term Cost of Health Plans
By ROBERT PEAR

Published: June 21, 2004

WASHINGTON, June 20 — New accounting standards will require state and local governments to acknowledge the full cost of health benefits promised to retirees, putting immense pressure on public employers to reduce their liabilities by scaling back benefits or shifting more of the cost to retirees, government officials and accountants say.

Supporters say the rules will help state and local officials, investors and taxpayers understand the magnitude of these commitments to current and future retirees.

But public employees — civil servants, police officers, firefighters, judges, teachers and state university professors — predict that the rules, combined with the soaring cost of health care, will speed the erosion of health insurance in the public sector, as happened at many private companies in the early 1990’s.

The rules, developed by the Governmental Accounting Standards Board, an independent nonprofit organization, apply to all state and local governments. They require employers to measure and report the long-term costs of retiree health benefits while employees are still working. Under current practice, most public employers do not report such costs until they pay for the promised benefits, often many years after employees have retired.

“State and local governments have generally been looking at the tip of the iceberg,” said Karl D. Johnson, project manager for development of the new rules. “Our standards require them to measure the iceberg. Many public employers have never looked under the water. They just looked at what they could see on the surface — what they have to pay this year for current retirees — without measuring the cost of their commitment to provide retiree benefits to large numbers of active workers.”

In large states, Mr. Johnson said, such unfunded liabilities for retiree health benefits total billions of dollars.

The standards are set forth in two documents. In April, the seven-member board issued financial reporting standards for health plans that cover state and local government employees. It is scheduled to give final approval this week to a companion document, which sets accounting standards for public employers that sponsor such plans.

The board, formed in 1984, is a private entity, but accountants and auditors accept its pronouncements as authoritative. State and local governments have a strong incentive to follow its standards because compliance helps them borrow money in the bond market at favorable rates.

Most public employers finance retiree health benefits on a pay-as-you-go basis, as bills come due. Experts on employee benefits said the new standards would encourage state and local officials to set aside money in trust funds for the purpose of providing health benefits to retirees.

The cost of such contributions would be a new, immediate expense for state and local governments, many of which are already struggling with severe financial problems.

Labor unions and health plan administrators said the standards could jeopardize health benefits for millions of retired public employees. Moreover, they said, the standards will cause a fiscal shock to state and local government agencies and could harm their bond ratings.

“We are concerned that a lot of our retirees will end up losing their health benefits,” said Frederick H. Nesbitt, executive director of the National Conference on Public Employee Retirement Systems.

The Financial Accounting Standards Board, a sister organization, issued similar standards for private employers in 1990. Many companies have cited those standards as a reason for cutting retiree health benefits.

“What’s going to happen in the public sector is exactly what happened in the private sector,” Mr. Nesbitt said.

Daniel C. Givens, a Florida firefighter who is chairman of the Miami Firefighters Relief and Pension Fund, said: “The new standards will suddenly put a strain on the city for a long-term liability that has been developing for years and years. Retirees will feel the brunt of the impact. They can expect to see reductions in benefits and increases in costs.”

Public employers are more likely than most industries to offer health benefits, but the prevalence of retiree coverage in general has been declining. In a survey of large private and public employers, the Kaiser Family Foundation found that 38 percent offered retiree benefits last year, down from 66 percent in 1988. When coverage is still available, premiums, co-payments and deductibles are increasing.

Melvyn Aaronson, treasurer of the United Federation of Teachers in New York, said, “The new accounting standards will accelerate those trends.”

The board sets accounting standards for 80,000 state and local governments, affecting more than 15 million employees. About three-fourths of state governments and more than half of local governments provide health benefits to retirees.

Many of the arrangements were adopted years ago, when costs were relatively low, but “times have changed, and many employers now spend 5 percent to 10 percent of payroll, or more, on retiree health benefits,” said Paul Zorn, a consultant at Gabriel, Roeder, Smith & Company, which advises more than 400 state and local government entities.

Under the standards, public employers will have to disclose the assets and long-term liabilities of their health plans. They will also have to calculate the amount of annual contributions that would be needed, over many years, to provide the promised benefits.

Cynthia B. Green, a member of the governmental standards board, said: “Historically, government employees have sacrificed salary increases for promises of enhanced benefits. These governments rarely calculate the price tag. They almost never consider whether the promises are affordable. A retiree may have been promised generous benefits, but if the employer can’t honor the promise, what good is it?”

Ms. Green, a former vice president of the Citizens Budget Commission, a watchdog group in New York, said she did not know if the critics’ “dire predictions” would come true. “If governments find out they have big liabilities,” she said, “some may cut spending, some may raise taxes and others may change the benefit package. Or they could combine these options.”

Unions contend that the standards will force public employers to overstate their liabilities for retiree health benefits, because the standards ignore the fact that employers can reduce or eliminate health benefits in the face of fiscal pressures.

But the board refused to let employers take credit for savings that might result from benefit cuts in the future. Such bookkeeping techniques “lack objectivity and would give recognition to changes that have not occurred and may not occur,” the board said.

Cathie G. Eitelberg, senior vice president of the Segal Company, a benefits consulting firm, said the new disclosures would draw attention from taxpayers and elected officials.

“When taxpayers see the magnitude of the unfunded liability,” Ms. Eitelberg said, “there will be changes in the way benefits are financed and delivered, because ultimately the taxpayer pays the bill.”

Posted by pnhp at 09:46 AM | Permalink

Editorial page, Atlanta Journal-Constitution
June 20, 2004

Profit motive is health’s loss

In a country where capitalism is the state religion, it’s hard to get people to admit that the profit motive doesn’t improve every enterprise. Americans seem to think there is no problem that cannot be solved by some resourceful entrepreneur.

But we’re experiencing a crisis of faith in at least one area — health care. The soaring cost of hospitals and medicines suggests that capitalism is sometimes at odds with the common good.

Not many of us have the nerve to say that aloud yet. It’s heresy.

Besides, the last time any public figure made a serious effort to reform health care, the result was near excommunication. Hillary Clinton’s complex system of rules and regulations was easily caricatured by opponents, and the blowback was enough to keep any self-respecting politician away from health care for years. But in the coming decade, the soaring cost will force Congress and state legislatures to confront the problem.

We now have a health care system whose primary mission is not delivering
health care. Instead, insurance companies, pharmaceutical companies, medical device manufacturers and, in fact, many hospitals exist to make money. That’s their first priority, and also their second and third priority. The product they sell happens to be improved health. But they jack up the prices on the product and restrict it to those who can afford it.

In this enterprise, a little profit motive goes a long way. And in health care, it has gone too far.

Just take a look at what has happened recently to prices of some pharmaceuticals used by elderly patients. The prices shot up just as the new drug discount cards were released, ensuring that drug companies will earn just as much on products for ailments such as hypertension and arthritis as they did before. So those retirees who have struggled to pay for their medications will be no better off — even with discount cards. The prices of the 30 drugs used most often by retirees rose more than four times the rate of inflation from January 2003 to January 2004, according to consumer advocacy group Families USA.

In the United States, capitalism works as well as it does because businesses compete for customers. And there is usually a business willing to make any product available for a cheaper price. If a motorist can’t afford a Mercedes, he can buy a Mazda. If you can’t afford the $15,000 plasma TV, you can settle for the $500 cathode-ray tube model. But who wants to see the discount cancer doc?

Insurance companies have tried to hold down costs by reimbursing physicians at a standard rate for common procedures. But that has not kept health care costs from rising faster than the rate of inflation. Perhaps that’s because medicine is one of those mysterious enterprises where the average consumer can never be sophisticated enough to know what he’s actually buying. Most of us find a physician we like and do what he or she dictates. It’s simply not the same as buying a toaster or a dining room table. You don’t wait for a good sale to get your angioplasty.

There is also this difference with the average consumer product: Most Americans believe that access to doctors and hospitals is a right, not a privilege that comes with money. We don’t say that out loud either. Not yet. But federal regulations already guarantee treatment in case of an emergency. If you have pneumonia and need to see a doctor, a public hospital may not turn you away, even if you don’t have insurance.

But guaranteeing access to emergency room treatment has helped to push the cost of medicine even higher. It would be far cheaper to guarantee every American preventive care — regular check-ups for hypertension and diabetes, immunizations for school-age children, medications for routine illnesses such as ear infections.

As more and more working Americans find themselves without health insurance, our faith in the ability of capitalism to provide a fundamental asset of American life is being sorely tested. Sometime in the next decade, we’ll be forced to admit that government will have to step in and shore up the safety net by guaranteeing basic health care to all Americans.

The old-time religion will have some new hymns.
—————————————————————————————————————————

Cynthia Tucker is the editorial page editor. Her column appears Sundays
and Wednesdays.

Posted by pnhp at 03:26 PM | Permalink

Sunday, June 20, 2004
By GREGORY A. HALL
ghall@courier-journal.com

The Courier-Journal
Protesters march for universal health care Local rally allies with national movement for single system

[sidebar photos:  Psychiatrist Sue Bentley held a sign yesterday during a Bridge the Gap for Healthcare rally in Waterfront Park.   Melanie Phillips, right, and her husband, Aaron Phillips, held a banner reading “$32 million Athem CEO bonus”  as they marched from Waterfront Park]

About 42 million Americans do not have health insurance and 30 million to 40 million are underinsured, said Dr. Adewale Troutman, Louisville With purple signs saying, “I’m a health care voter,” a collection of activists, union members and health care professionals rallied yesterday in support of a national health care system.

Universal access to a single system of health care is “a long struggle,” said Dr. Adewale Troutman, director of the Louisville Metro Health Department. “It’s not a new struggle.”

Troutman, who said he was only representing his personal views, recalled am similar rally on the steps of the U.S. Supreme Court in 1978 when he was president of the Student National Medical Association.

About 42 million Americans are without health insurance and an additional 30 million to 40 million are underinsured, Troutman said.

Both Troutman and Dr. Garrett Adams, the keynote speaker and retired University of Louisville Medical School professor, said that a national system could provide health care without any more money than is currently being spent.

Such a national system would include allowing patients to choose their hospitals and doctors, “taking these decisions back from insurance companies,” Adams said.

Adams said the current system has failed and is experiencing spiraling costs.

“We’re not getting what we’re paying for,” Adams said.

About 80 people, including about a dozen children, and a couple of dogs took part in the march, which started at Waterfront Park, went across the Clark Memorial Bridge and returned to Louisville’s riverfront.

The Louisville event was part of a number of similar rallies and walks planned across the country. The national effort was sponsored by Americans for Health Care, Jobs With Justice, Rock the Vote and the Service Employees International Union.

The Louisville version had a decidedly Democratic Party flavor, with signs and supporters of the party’s presumptive nominee for president, Sen. John Kerry, and a speech by state Rep. Mary Lou Marzian, who is a registered nurse.

Republicans “are letting the health insurance industry run health care,” Marzian said.

Shelton Talbott, a Louisville Metro Housing Authority employee and service employees union member, said his wife recently lost her job and had to be put on his health care.

“The costs of it are just continually going up,” Talbott said.

And his son, Shelton Talbott Jr., 18, is in danger of losing coverage under his father’s health insurance because he recently graduated from Atherton High School and will be looking for a job.

One of the organizers, Sandra Limpert, said in an interview that the march and rally were important to her because she is uninsured.

“This is a very personal issue for me,” said Limpert, who lives near Churchill Downs.

Limpert said she is a University of Louisville student and single parent who can’t get Medicaid because the support payments she gets for her child count as income.

Neither the proposals of President Bush nor Kerry go far enough, she said.

“The people have to stand up and demand of their legislators that they listen and (that) something be done,” she said.

Kay Tillow, a member of the Nurses Professional Organization, said that American health insurance is “a disaster.” Deductibles are so high for a number of people that they make health insurance unaffordable, particularly when it comes to regular checkups and preventative treatment.

“We have to fix it,” she said

Posted by pnhp at 10:51 AM | Permalink

Rally hopes to bridge gap in health insurance

By Rob Daniel
Iowa City Press-Citizen

Health care was the focus Saturday at Hubbard Park as about 300 people rallied for improved access to health care insurance for all.

Bridge the Gap, highlighted by a march across the Iowa Avenue bridge, was one of several events across the country that highlighted the lack of medical coverage for about 82 million Americans, as a Family USA survey found. That includes 637,000 Iowans, most coming from working families, the survey said.

Iowa Lt. Gov. Sally Pederson highlighted the lack of health care coverage for some Iowans, saying people cannot be satisfied with numbers of those who do have coverage.

“If you don’t have health care insurance you can die,” Pederson said. “I believe it’s a right. You believe it’s a right.”

A speaking highlight was by Pat Swancutt of Spencer, who spoke of her 18-year-old granddaughter Janelle Polson dying in 2001 after not being able to get tests for an unknown medical condition. Her daughter and Janelle’s mother, Lisa Scott, was speaking at a similar rally at San Francisco’s Golden Gate bridge, she said.

“If we get this health care affordable, then we’ll feel we’ve done Janelle justice,” Swancutt said, flanked by Janelle’s sisters, Carly and Stevie.

The rally began with a march across the bridge, with marchers shouting phrases such as “Affordable health care - bridge the gap.” They also vowed to “remember in November” in a song sung to the tune of the “Battle Hymn of the Republic,” a shot at Republicans and the Bush administration, who they said did not back more universal health care coverage.

Bret McFarlin, a doctor and member of Physicians for a National Health Policy, a group that backs a government-backed universal health care system, said the Medicaid Reform Act approved by Congress last fall was a $500 billion giveaway to pharmaceutical companies.

“We’re already paying for universal health care,” McFarlin said. “We’re just not getting it. We see this as the surest route to affordable health care for all.”

The march and rally was designed to be non-partisan, said Sarah Swisher, state director of Iowa for Health Care, with no political candidates speaking.

“We’re anxious to get people excited about equal health care,” said Swisher, who also serves as the chairwoman of the Johnson County Democratic Party.

An outside group, Billionaires for Bush, also criticized the Bush administration before the march. Ten people dressed in tuxedos and evening gowns, carried glasses of champagne and signs that read “Less health care, more wealth care.”

“The thing we want people to know is Bush always has ulterior motives,” said Tom Garner, a Des Moines resident backing the group though not dressed up.

Iowans without health insurance

• More than one of every four people (25.2 percent) in Iowa under age 65 went without health insurance for all or part of the past two years.

• Of the 637,000 uninsured Iowans, nearly 60 percent were without insurance for six months or longer.

• Whites were the largest group - about 504,000 people- of uninsured.

• About 55 percent of Hispanics were uninsured, compared to 22.3 percent of white, non-Hispanic people.

• Most uninsured Iowans (82.4 percent) were members of working families.

• Families living at or below 200 percent of the federal poverty level were more likely to be uninsured.

Source: Families USA

The Associated Press contributed to this report.

Reach Rob Daniel at 339-7360 or rdaniel@press-citizen.com.

Posted by pnhp at 09:30 AM | Permalink

Los Angeles Times
June 17, 2004
Berkeley’s Living Wage Ordinance Is Upheld in Federal Appeals Court
By Henry Weinstein

A federal appeals court in San Francisco on Wednesday upheld Berkeley’s authority to require higher minimum wages for some workers, the first appellate ruling in the country on whether local governments have that power.

Berkeley’s law, enacted in June 2000, is fairly typical of living wage ordinances adopted nationally. The law mandated minimum hourly wages and employee benefits for certain companies that received financial benefits from the city such as city contracts, leases on city property or certain tax exemptions.

The Berkeley law set a minimum wage of $9.75 plus health benefits for those companies. Firms covered by the law but that did not provide health benefits were required to pay $11.37 an hour. The figures have risen with inflation.

http://www.latimes.com/news/nationworld/politics/scotus/la-me-wage17jun17,1,1268555.story?coll=la-news-politics-supreme_court

Comment: This U.S. 9th Circuit Court of Appeals ruling was split along ideological lines with two Clinton appointees supporting it and a Bush appointee opposing it. This is a minute and tenuous increment on the path toward universal health care coverage and access.

The political process remains dominated by forces that have only increased the numbers of uninsured, and have increased the risk of medical debt for those who are insured.

It is inappropriate to stop and celebrate a tiny victory when the health financing infrastructure is crumbling around us. We know how to build a financing infrastructure that would ensure affordable, comprehensive coverage and access for everyone. Let’s get on with it!

Posted by pnhp at 10:09 AM | Permalink

Scrooge & Marley, Inc. — The True Conservative Agenda
by Thom Hartmann
 
“That liberty [is pure] which is to go to all, and not to the few or the rich alone.”
—Thomas Jefferson to Horatio Gates, 1798.

There is nothing “normal” about a nation having a middle class, even though it is vital to the survival of democracy.

As twenty-three years of conservative economic policies have now shown millions of un- and underemployed Americans, what’s “normal” in a “free and unfettered” economy is the rapid evolution of a small but fabulously wealthy ownership class, and a large but poor working class. In the entire history of civilization, outside of a small mercantilist class and the very few skilled tradesmen who’d managed to organize in guilds (the earliest unions) like the ancient Masons, the middle class was an aberration.

If a nation wants a middle class, it must define it, desire it, and work to both create and keep it.

This is because a middle class is the creation of government participation (conservatives call it “interference”) in the marketplace, by determining the rules of the game of business and of taxation, and by providing free public education to all. And it wasn’t until 1776, when Thomas Jefferson replaced John Locke’s right to “life, liberty and property” with “life liberty, and the pursuit of happiness” that the idea of a large class of working people having the ability to “pursue happiness” - the middle class - was even seriously considered as a cornerstone obligation of government.

(That was also the first time in history that “happiness” had ever appeared in any nation’s formative documents. As Jefferson wrote in 1817 to Dr. John Manners, “The evidence of this natural right, like that of our right to life, liberty, the use of our faculties, the pursuit of happiness is not left to the feeble and sophistical investigations of reason, but is impressed on the sense of every man.”)

Thomas Jefferson laid out in an 1816 letter to Samuel Kerchival what today would be a blistering attack on the conservative/corporate war on labor and Bush’s union-busting planned privatization of over 700,000 government positions.

“Those seeking profits,” Jefferson wrote, “were they given total freedom, would not be the ones to trust to keep government pure and our rights secure. Indeed, it has always been those seeking wealth who were the source of corruption in government. No other depositories of power have ever yet been found, which did not end in converting to their own profit the earnings of those committed to their charge.”

He added: “I am not among those who fear the people. They, and not the rich, are our dependence for continued freedom. … We must make our election between economy and liberty, or profusion and servitude. … [Otherwise], as the people of England are, our people, like them, must come to labor sixteen hours in the twenty-four, … and the sixteenth being insufficient to afford us bread, we must live, as they now do, on oatmeal and potatoes; have no time to think, no means of calling the mismanagers to account; but be glad to obtain subsistence by hiring ourselves to rivet their chains on the necks of our fellow sufferers.”

A totally “free” market where corporations reign supreme, just like the oppressive governments of old, Jefferson said could transform America “…until the bulk of the society is reduced to be mere automatons of misery, to have no sensibilities left but for sinning and suffering. Then begins, indeed, the bellum omnium in omnia, which some philosophers observing to be so general in this world, have mistaken it for the natural, instead of the abusive state of man.”

As Jefferson realized, with no government “interference” by setting the rules of the game of business and fair taxation, there will be no middle class.

Although this may come as a sudden realization to many, we’ve really known it all our lives.

For example, every year, millions of Americans revisit Charles Dickens “A Christmas Carol” about Ebenezer Scrooge and Bob (and Tiny Tim) Cratchit. Yet somehow Americans fail to realize the subtext of the story (and so many of Dickens’ other works). That subtext is that the middle class is not a normal thing: exploited workers are the norm. In fact, in the six-thousand-year history of the “civilized” world, a middle class emerging in any nation has been such a rarity as to be historically invisible.

As Dickens pointed out, Cratchit lived the typical life of that day’s English working poor. He couldn’t afford medical care for Tim, dooming his son to death or a lifetime of deformity. He had no idea where his Christmas dinner may come from, let along how to get gifts for his children, and always lived on the edge of the terror of unemployment and homelessness. Although he had a full-time job at Scrooge & Marley, Inc., he was so desperately anxious to keep his job that he worked weekends and evenings and put up with years of daily abuse from his employer.

This demonstrates the true liberal/conservative divide. Conservatives believe what business does is business’s business, and government should keep its nose out of it, even when it leads to centuries of Tiny Tims and terrified-of-job-loss employees. As the Wall Street Journal noted in 1997, Alan Greenspan sees one of his main jobs as being to maintain a high enough level of “worker insecurity” that employees won’t demand pay raises and benefits increases, thus provoking “wage inflation.” (“CEO inflation” is fine with the cons.)

Liberals, on the other hand, subscribe to the notions of the founder of today’s Democratic Party — Thomas Jefferson — that if the government doesn’t actively participate in regulating how the game of business is played, the middle class (what in Jefferson’s day were the “yeomanry”) would vanish.

The United States has had two great periods of what we today call a middle class. The first was from the 1700s to the mid-1800s, and was fueled by virtually free land for settlers. People owned the means of their production (their farms), could sell their surplus, and had time to be among (as deTocqueville pointed out) the most well-educated, politically active “non-aristocrats” in the world.

As big business grew in the 1800s after the Civil War, the farm-based middle class collapsed, in large part because the early progenitors of companies like today’s Cargill or ADM came to control the sale and distribution of farm produce. Middle class farmers rose up, created the Grange movement as part of their own way of competing with the big ag companies, and — seeing that their “representative government” was being taken over by the largest corporate interests — launched the Populist and Progressive movements.

Step one was to limit the size of corporations to limit their power — thus the Sherman Anti-Trust Act of 1881 (still law, but unenforced for all practical purposes since Reagan.)

Step two was to take Teddy Roosevelt’s advice that, “We must drive the special interests out of politics. The citizens of the United States must effectively control the mighty commercial forces which they have themselves called into being. There can be no effective control of corporations while their political activity remains.” Progressives pushed hard, and in 1907 a law was passed (still on the books) making it illegal for corporations to give money to politicians. It needs to be expanded.

The last parts of the progressive agenda included a direct election of the U.S. Senate (Senators had been pointed by political machines in the states) so the progressives may get more democracy and representation, and the hope that when women voted (besides it being the morally right thing) they may help break up the old boy’s club of big business. (These goals were achieved in 1913 and 1920.) And, even in the face of corporate violence that often escalated to murder, Americans struggled to bring together the budding union movement.

But the middle class of the farmers never really again recovered their middle class status in America (although there are dying pockets of it still about, supported by Willie Nelson, Farm Aid, and other groups), and the Gilded age saw a very Dickens-like America — a small group of very wealthy business and land owners and a very large class of desperately poor workers.

It took the leadership of FDR for government to again take a hand in creating a middle class, this time via industrialized labor instead of land (times change, and we’d taken about all the land we could from the Native Americans).

The Wagner Act of 1935 guaranteed Americans the right to form a union and bargain collectively with their corporate employers. Combined with the later G.I. Bill that sent millions of young men and women to college and technical schools in the late 1940s and early 1950s, not only did America recover its prosperity, but a second great middle class began forming. A middle class that wouldn’t have existed without “government interference” in the game of big business.

(Some say WWII was the stimulus out of the depression, and it was an economic stimulus from which many, like the Bush family benefited [even to the extent of helping out Hitler], but the real events of the 1930s and 1940s that set the stage for a second American Middle Class were primarily the Wagner Act, the G.I. Bill, and tax changes ranging from raising the top rate on the most rich to 90 percent to offering an emerging middle class home interest tax deductions. Spending money on weapons that serve no useful purpose after they’re used doesn’t stimulate an economy the way building roads, bridges, houses, or domestic consumer industries, which “keep on giving,” does.)

And to stimulate that domestic economy, we instituted progressive taxation, which gave workers more to spend, thus stimulating demand for more goods and services.

Progressive taxation has a long history: As Jefferson said in a 1785 letter to James Madison, “Another means of silently lessening the inequality of property is to exempt all from taxation below a certain point, and to tax the higher portions of property in geometrical progression as they rise.”

But the conservatives — who since the days when John Adams called working people “the rabble” and Alexander Hamilton suggested they should play no (or only a token) role in government — fought back. A true middle class represented a threat to the aristocrats and pseudo-aristocrats of America’s conservatives. They may have to give up some of their power, and some of the higher end of their wealth may even be “redistributed” - horror of horrors - for schools, parks, libraries, and other things that support a healthy middle-class society but are not needed by the rich who live in a parallel, but separate, world among us.

At the height of early participation in the newly empowered union movement (at one point 35 percent of American workers were union members), in 1947, over Truman’s veto, congress passed the Taft-Hartley Law that significantly weakened union protections defined (and working well) under the 1935 Wagner Act. Taft-Hartley was (and still is) a powerful weapon for employers over employees (banning sympathy strikes, etc.), and was used, although most aggressively in the southern states (who declared themselves “right to work” states under another provision of Taft-Hartley) until Reagan declared a national war on unionization with his attack on PATCO in 1981.

The cons had first launched their attack on labor in 1947, and Reagan brought it to full fruition: education was next.

Today, although there are still some educational benefits to GI’s (Jessica Lynch joined the army to get financial aid to go to college to become an elementary school teacher, for example), they’re minimal and hard to both accumulate, track, and take advantage of (and must be paid for in most cases). Although Jefferson started the University of Virginia with the notion that part of building a middle class (necessary to a democracy, he said) would require people with some education, and advocated a national program of free education up to and including university levels, the last state to fall from that ideal was when Governor Ronald Reagan ended free enrollment in the University of California system.

Jefferson said, in an 1824 letter: “This degree of [free] education would … give us a body of yeomanry, too, of substantial information, well prepared to become a firm and steady support to the government.”

The attack on higher education was being won (and continues with cuts in college grant programs), and the cons moved to attack the third requirement for a society to produce a middle class: progressive taxation. This, of course, infuriates the elite cons who seem to truly believe that a CEO actually works 500 times harder than his employees (or is 500 times smarter).

But history shows that the third pillar of creating a middle class requires a modest control of how wealth is distributed. The richest, who benefit the most from our society, pay proportionately more, so the middle class can have home interest deductions, child tax credits, free public education, and health care. Progressive taxation has helped create every middle class in the First World, and without it the middle class will vanish (to Steve Forbes delight, apparently).

As Thomas Jefferson wrote to James Madison in 1784, “Taxes should be proportioned to what may be annually spared by the individual.” And, as earlier noted, as wealth rises, so should taxes — “geometrically.”

But as president, Reagan cut the top tax rate for billionaires from 70 percent to 28 percent, while effectively raising taxes on working people via the payroll tax and using inflation against a non-indexed tax system. It was another hit to the already-beginning-to-shrink middle class, to be followed by more “tax cut” bludgeons during the first three years of the W. Bush administration.

Nonetheless, a never-ending parade of conservative economists and commentators march through our living rooms daily via radio and TV, assuring us that it is good for American workers to go along with the Wal-Martization of America, accept lower pay and few benefits, and fear for their health, so multinational corporations can “level the playing field” for labor.

They say it will create winners in the system, and they are right. The winners are the multinational corporations, and the losers are the rest of us. No matter, say the TV commentators — nearly all millionaires themselves. “Free trade” sounds sexy; “protectionism” sounds downright selfish. And it’s all too complicated to explain in 20 seconds, even quoting Jefferson.

But, unless we repeal Taft-Hartley; start enforcing the Sherman act, provide free education for Americans (and not just Iraqis); abandon WTO/GATT and NAFTA; restore progressive taxation (including on dividend income); force corporations to pay their fair share; and go back to selective tariffs to protect domestic industries and stop offshoring to explicitly bring home the ability for us to make our own clothes, furniture, autos, and electronics, the conservatives will have won and the middle class — and, thus, democracy — will lose.

As Jefferson warned in an 1826 letter to Will B. Giles, even then some conservatives “now look to a single and splendid government of an aristocracy, founded on banking institutions, and moneyed incorporations under the guise and cloak of their favored branches of manufactures, commerce and navigation, riding and ruling over the plundered ploughman and beggared yeomanry. This will be to them a next best blessing to the monarchy of their first aim, and perhaps the surest steppingstone to it.”

Jefferson’s vision rose to fruition in the Gilded age, was fought back by FDR, and again rose its antidemocratic head under Reagan, the first Bush, GATT/NAFTA Clinton, and Dubya.

If conservative economics are allowed to continue, and we fully revert to the way life was lived by the average person in America in 1890 or Dickens’ England (over 40 million in America already have, by the way, many in the past 3 years), there will be no more middle class, just a few more rich CEOs and Bushies, and a lot more terrified workers living in slavery to debt and terrified of unemployment or a serious health crisis.

It’ll be a marvelous thing for the profits of the multinationals (including those who supply our “news”), but the end of a way of life in America, and possibly around the world, since so many nations imitate our lead. And only you and I - the ploughman and yeomanry - can stop them and restore an America where it’s possible to raise a family on one income and still have enough for housing, transportation, food, education, vacations, health care, and a decent retirement.

The middle class is not a “normal” thing: it’s just the core that holds together democracy and an informed, healthy, and active citizenry.

To bring it back from its steady decline since the Reagan era is going to take a lot of active work spreading the word (call talk radio, blog, forward this article and similar ones, write a letter to the editor to your local paper), and participation in or contact with elected officials at all levels (writing elected officials, joining and volunteering to help your favorite local political party or activist organization, showing up for rallies, etc.). We must get out the vote and remove the whole con bunch from the White House and Congress, repeal Taft-Hartley, get corporate money and lobbyists out of our governmental processes, restore progressive taxation, rebuild our schools, return to the tariff system that protected American industries (and jobs and communities) from 1786 until 1996, strengthen Social Security, and turn Medicare into a universal single-payer health system (among other things).

Are you willing to join? Or would you prefer to re-read “A Christmas Carol” to your children, so they can understand the future America that conservatives have in mind for them?

Thom Hartmann (thom at thomhartmann.com) is a Project Censored Award-winning best-selling author and host of a nationally syndicated daily progressive talk show that runs in 57 markets from coast-to-coast. www.thomhartmann.com. His most recent books are “Unequal Protection: The Rise of Corporate Dominance and the Theft of Human Rights,” “The Last Hours of Ancient Sunlight,” “We The People: A Call To Take Back America,” and “What Would Jefferson Do?: A Return To Democracy.”

Posted by pnhp at 09:11 AM | Permalink

82 million uninsured at some point in time

Families USA
June 2004
One in Three: Non-Elderly Americans Without Health Insurance, 2002-2003

CONCLUSION

Approximately 81.8 million Americans-one out of every three non-elderly people-were uninsured at some point in time during 2002-2003, and two-thirds of these uninsured people were uninsured for six or more months. And, although the majority of insured Americans receive their health insurance through their jobs, four out of five of these uninsured individuals were workers or members of working families. Minorities and people with low incomes are at significantly higher risk of being uninsured.

People who go without health insurance-even for brief periods of time-can face devastating consequences to their health and their economic security.

Concrete action to tackle the mounting problem of uninsured Americans should be a national priority.

WHY INSURANCE MATTERS

The uninsured are less likely to have a usual source of care outside the emergency room.

The uninsured often go without screenings and preventive care.

The uninsured often delay or forgo needed medical care.

The uninsured are often subject to avoidable hospital stays.

Uninsured Americans are sicker and die earlier than those who have insurance.

http://www.familiesusa.org/site/DocServer/82million_uninsured_report.pdf?docID=3641

Comment: “Concrete action to tackle the mounting problem of uninsured Americans should be a national priority.”

Why isn’t it?

Posted by pnhp at 01:38 PM | Permalink

The Charleston Gazette Story:Dan Kurland

Saturday, in 100 cities across the country, thousands of people will march to “bridge the gap” in health care. From the Golden Gate Bridge to Brooklyn Bridge, people are banding together in a call for quality, affordable health care for all.  

Mention a gap in health care, and people immediately think of insurance. Without doubt, too many West Virginians lack insurance, and increasing numbers are underinsured.  

Focus on insurance, however, may not be the best approach toward assuring comprehensive, affordable health care.  

Health insurance today is a mix of disconnected programs. It currently includes individual plans, a variety of employer-based plans, need-based public plans (Medicaid) and contribution-based public plans (Medicare), and even charity and uncompensated care as de facto “insurance” for the uninsured.  

Health insurance is funded by a haphazard mix of payroll and income taxes, employer and individual contributions, as well as premiums and co-pays.

Current proposals for extending private insurance (e.g., medical savings accounts, drug discount cards) generally offer limited protection against the inherent greed of the marketplace. Proposals for the expansion of public insurance programs (e.g., CHIP, Medicaid) must compete in a tight market with other federal and state funding needs.  

Universal, affordable, quality care requires a more focused and comprehensive revenue stream than such a panoply of insurance programs can provide. Even more to the point, a health-care model based on insuring against the cost of infrequent services simply no longer meets the need for ongoing health promotion, disease management, and illness prevention activities that ultimately affect the overall cost of the system. Health insurance directly addresses the cost of health care, but does not necessarily guarantee access to physicians or hospital care.

If insurance is not the best model, what is? Education and public safety suggest an alternative. Universal education meets both individual and societal needs. Public education fosters both civic responsibility and economic development. Similarly, police protection and public safety assure order for both the individual and society as a whole.

Health care shares these dual perspectives. It is both essential for individual well-being and critical to the stability and development of the community. Adequate, affordable health care is not simply a health issue.  It is, above all, an investment in the human infrastructure of the society.  

Yet, unlike public safety and education, health care is left to market forces. All too many must struggle to devise a personal safety net. And while health care is regulated by the government, government’s interests often lie with the health of the health industry (pharmaceutical manufacturers, hospitals, insurance companies), not the health of its citizens.

The ideas expressed above are not new. This past session, the Legislature passed a resolution declaring “that health care … be considered a primary social benefit, similar to education and police protection, essential for community stability and economic development.” The resolution goes on to assert “the goal of the state to provide all West Virginians with comprehensive, quality, affordable health care.” A subcommittee in the interim session is charged with determining the most appropriate mechanisms for reaching that goal.

Admittedly, some gaps in health-care coverage can be addressed through incremental changes in existing insurance programs. Such efforts might stay the tide of rising expenses and diminished care for a while. But they would do little to assure a stable system into the future.

A lasting solution must simultaneously address gaps in health funding, access and delivery, and lifestyle decisions that affect individual health status. It must address the ever-expanding use of expensive technology, administrative waste, and the high cost of end-of-life care.  

We must re-examine the underlying nature of how we, as a society, choose to provide, or deny, health care to our community.  

Kurland is a Charleston artist and health action coordinator of Covenant House.

Posted by pnhp at 01:48 PM | Permalink

The People’s Media Reaches More People Than FOX Does
by Jim Hightower
 
While Big Media is “simply in the business of selling products, the people’s media reaches more people than FOX does.

Democratic reformer Henry Adams, who decried the decline in democracy as the robber barons rose to power in the nineteenth century, did not mince words about the failure of the news media of his day: “The press is the hired agent of a monied system,” he wrote, “and set up for no other purpose than to tell lies where the interests are involved.”

Imagine the verbal scorching Henry would give to today’s media barons, who are not merely hired agents of monied interests‹they have become the interests, fully corporatized, conglomerated and well-practiced in the art of journalistic lying to perpetuate the power and profits of the elites.

A handful of self-serving corporate fiefdoms now controls practically all of America’s mass-market sources of news and information. GE now owns NBC, Disney owns ABC, Viacom owns CBS, News Corp. owns Fox, and Time Warner owns CNN; these five have a lock on TV news. Of the 1,500 daily newspapers, only 281 are independently owned - three companies control 25 percent of the daily news circulated in the entire world.

These aloof giants openly assert that meeting their own profit needs is the media’s reason for existence - as opposed to meeting the larger public’s need for a vigorous, democratic discourse. Lowry Mays, honcho of Clear Channel Inc. (which owns more than 1,200 radio stations - a third of all the stations in America), opines that: “We’re not in the business of providing news and information We’re simply in the business of selling our customers’ products.”

The web gives us the means to bypass the corporate media, creating our own low-cost, decentralized network of news that, say, The New York Times does not consider “fit to print.”

In addition to hundreds of specialized news sites, there are “aggregators” that amount to news services for progressive content - credible outfits like Alternet.org, TomPaine.com, Buzzflash.com, and CommonDreams.org.

This single-minded mercenary focus combines with general corporate arrogance to bloat the egos of media chieftains, leading them to think that they really are the infallible gods of our daily newsfeed, with no need to be accountable to the public: “We paid $3 billion for these television stations,” said an executive with a Fox affiliate in Tampa; “We decide what the news is. The news is what we tell you it is.”

Crude, corporate censorship of our news by these boardroom types is less common than the subtle, internal self-censorship done by general managers, top editors, and some reporters who avoid topics and dilute stories that the corporate hierarchy might find offensive or simply not comprehend. A 2000 survey by the Pew Research Center for the People and the Press found that a third of local reporters admit softening a news story on behalf of the interests of their media organizations. A fourth say they have been told by superiors to ignore a story because it was dull, but the reporters suspected that the real motivation was that the story could harm the media company’s financial interests. And that’s only the reporters who confess!

If you detect a corporate bias in your news, don’t feel lonely. Two-thirds of Americans told pollsters last September that they believe special interests or a self-serving corporate-political agenda infect news coverage. We can all wring our hands and wail about this corporate, monopolistic grasp on our news sources, but here’s a better idea: Let’s do something about it. A grassroots flowering

A grassroots flowering

The Austin Motel is a refurbished, New Deal-era business on South Congress Avenue near my home. It has an old brightly-lit marquee out front that proudly boasts the credo of the current owners: “No additives, No preservatives, Corporate-free since 1938.”

Wouldn’t that make a fine slogan for a new democratic media for America?

Oh, you say, Hightower, don’t toy with us. It would take billions and billions of dollars to build a broad-based media network outside the established TV, radio, and newspaper conglomerates, so that’s just a pipe dream. Well, yes, it would take those impossible billions if we set out merely to duplicate the media Goliaths. But what if we wanted to develop a David ú a sprightly, nimble network of media outlets that are not capital-intensive and not burdened with either multimillion-dollar salaries or voracious conglomerate bureaucracies?

I have good news for you: This is already happening! Thousands of hardy, grassroots people have been working steadily and creatively over the years in every area of media, and the result of their combined efforts is that a new media force is now flowering coast to coast ú a force of hundreds of media outlets that is unabashedly progressive, fiercely independent, diverse, dispersed, and democratic. Some of these outlets are nationally known, others only locally known; some are brand new, others have been plugging away for decades. But the significant thing is that, collectively, they are a force to be reckoned with, celebrated, strategically deployed and deliberately expanded.

I’ve known and worked closely with many of these varied outlets my entire political life, but it was only last year that I realized what can happen if we learn to connect the various components and tap into the full power that they offer.

The occasion was a most modest one: The launch of my book, Thieves in High Places. In addition to being about the monied kleptocracy that has seized our people’s democratic power, the heart of this book is about the deeply-encouraging rise of you grassroots Americans out there who’re battling the thieves - and often beating them. These are inspiring stories of democratic activism that the media establishment largely ignores, and I wanted as many people as possible to know about the stories, so that others might take heart and battle on.

Call me cynical, but I knew from experience that the barons of media power were not likely to rush forward to embrace and disseminate my antiestablishment message. I was right ú none of the morning TV shows (“Today,” “Good Morning America,” etc.) allowed me to talk about it; no evening newsmagazine show (“20/20,” “Dateline,” etc.) would touch it; there were no reviews in the mass-market newspapers and magazines (New York Times, Newsweek, etc.) and even NPR and public television gave it the cold shoulder. It was a case of libra non grata. Yet, a funny (and fun) thing happened: Thieves rose into the top 10 of nearly every best-seller list across the country, including the New York Times list. You could almost hear the incredulous compilers of sales data asking: “How the hell did this thing get on our list?”

It got there, quickly reaching a mass-market audience, by way of your and my very own rag-tag, patchwork media network, which most of us don’t even know we have. I stumbled on the breadth and depth of this network because Sean Doles and Laura Ehrlich in my office had organized a guerrilla campaign to get the word out about the book. Working with community-radio stations, alternative newsweeklies, independent bookstores, web-active organizations, progressive (and aggressive) magazines, websites and publications of grassroots organizations, local organizing groups, some upstart television rebels - and, of course, you scrappy Lowdowners - we found that progressives are not voiceless in a corporate-media wasteland after all if only we recognize that we have powerful media assets of our own.

My book doesn’t matter, but the concept of connecting this patchwork of assets does matter greatly. Any particular piece of this progressive media patchwork is small (and too often scoffed at by progressives themselves as “insignificant”). But add the pieces together and we have a far-flung network of outlets that - each and every day - is reaching tens of millions of people.

Also, the people who are tuning in to our progressive outlets are not just cumulative numbers to be sold to advertisers; mostly they’re readers, listeners, online clickers, and viewers who give a damn and are looking for action. We saw an example last year of what can happen when even some of these components connect. The FCC, led by laissez-faire nutball Michael Powell, was ramming through a rules change that effectively would allow one or two media conglomerates to control the TV, radio, and newspaper outlets in every U.S. city.

Essentially, this unregulation of media ownership would lead to the full-scale monopolization of our news sources. Corporate lobbyists and government lawyers had holed up in a dark back room to whisper sweet legalese to each other, and we Joe and Joline Schmoes would have known nothing about it until after the fact, when we would’ve heard that wet, smoooooooching sound coming from Washington that tells us - uh-oh - another dirty deed has been done to us.

This time, though, was different. Several public-interest organizations picked up on the FCC’s back-room move and alerted such grassroots groups as Common Cause, which sent up red flares to engage its 200,000 members. Then, like the pamphleteers of old, dozens of community- radio stations plastered on-air broadsheets all across the country, translating the FCC’s regulatory gobbledygook into straightforward rallying cries. They pounded the issue day after day. Next came the Web-active group MoveOn.org, which gave this growing grassroots opposition the mechanism it needed for a targeted response - and some 170,000 emails poured into Washington.

The result was that, last July, the U.S. House of Representatives voted 400 to 21 in favor of an amendment by Rep. David Obey to stop the FCC’s media-monopolization rule. The decisive 400 House votes were from Congress critters (Democrats as well as Republicans) who had taken buckets full of campaign cash from the very media barons they suddenly decided they had to vote against.

The battle is not over, but the fact that this arcane issue of media-ownership regulations could, in such a short time, ignite a prairie fire of popular rebellion is a testament to the power at our disposal.
PAGEBREAK
Radio

As I’ve learned from the past dozen years of on-air experience, radio can be a very democratic little box‹in part because it’s ubiquitous (in our bedrooms, cars, showers, etc.), and also because people tend to hear what’s said on radio, as opposed to TV, where they get an image but don’t much follow the story being told. The bad news is that the radio dial is fast being bought up by Clear Channel and a couple of other conglomerates. The good news, however, is that we still have hundreds of extremely important stations in our hands, beaming out a steady progressive message to millions every day.

Since 1993, my own two-minute radio commentaries (“little pops of populism,” we call them) have aired every weekday, now being heard on a mix of 130 commercial and community stations coast to coast, plus Alaska, Hawaii, and - get this - Armed Forces Radio, as well as on the web (www.jimhightower.com). But I’m the least of it. From Amy Goodman’s sassy Democracy Now to Working Assets Radio with Laura Flanders, from New Dimensions to Latino USA, from Counterspin to RadioNation, from ACORN Radio to Alternative Radio with David Barsamian, from Media Matters with Bob McChesney to The World - there’s a wealth of national and local broadcasters putting forth progressive issues and insights every day.

Because of the corporate bias of its owners, commercial radio is the hardest nut to crack, but we have such voices as Enid Goldstein at KNRC in Denver, Sly Sylvester on WTDY in Madison, and Mitch Albom on WJR in Detroit. And now, Air America is making a bold play to bring 17 hours a day of progressive talk radio through its burgeoning network, broadcasting such live-wire hosts as Al Franken, Janeane Garofalo, Randi Rhodes, Chuck D, and Rachel Maddow. This brand-new upstart is already in 15 cities, and is drawing millions more listeners each day on the web (www.airamericaradio.com).

Then there are our community owned stations. Many people assume that these are little one-watt nothings, but that’s nonsense. Indeed, some are powerhouse blasters in big cities, such as the Pacifica Network’s five flagship stations in Berkeley, New York City, Los Angeles, Washington, DC, and Houston. Pacifica’s KPFK in LA, for example, is 110,000 watts, reaching from San Diego to Santa Barbara and stretching inland to San Bernardino. Likewise, the independent community station WMNF in Tampa is a 70,000- watt treasure that reaches from Sarasota on the Gulf Coast almost to Orlando in the middle of the state.

Even the small-town community broadcasters pack a punch. WERU in Blue Hill, Maine (pop. 700), for example, reaches clear to the state capital in Augusta and is a beloved rallying point for the whole Penobscot Bay area (“We-are-you” is how the station pronounces its call letters). The same with KAOS in Olympia, KBOO in Portland, KGNU in Boulder, and so many more‹people don’t just tune in, they count on these stations, trust them in a way no one would trust Clear Channel, and are willing to act on the information they receive.

The web

A democratic tool that Jefferson, Madison, and the other Bill of Righters could not have imagined, but would gleefully embrace today, is the world wide web. This computerized architecture of interconnected hubs and spokes allows us to link our thoughts and actions instantly in virtual space and produce tangible political results that would have taken months before.

Every progressive group (even Luddites like me) now has lively, interactive web sites through which we can share a gold mine of information, forge coalitions, hold “meetings,” and mobilize mass actions (from local to global).

The growth of the net is explosive - 68 billion emails per day, for example, and 10 million daily blogs by everyone from the kid next-door to famous pundits to me! MoveOn.org, TrueMajority.org, and the Howard Dean campaign have shown the phenomenal potential of the web, not only for fund-raising and blitzing Congress with citizen opinion, but especially for organizing people for action (a breakthrough that you’ll hear more about as the Lowdown itself develops a web-active program to link all of us Lowdowners into more grassroots civil action).

The web gives us the means to bypass the corporate media, creating our own low-cost, decentralized network of news that, say, The New York Times does not consider “fit to print.”

In addition to hundreds of specialized news sites, there are “aggregators” that amount to news services for progressive content - credible outfits like Alternet.org, TomPaine.com, Buzzflash.com, and CommonDreams.org

Some are creating their own virtual newspapers. Check out iBrattleboro.com. For more than a year now, this Vermont website lets the readers be the reporters on what’s really going on in town. Anyone can contribute, and anyone can comment on the contributions. In a town of 12,000, the virtual pages of iBrattleboro are getting 260,000 viewers a year.

Alternatives galore

If reading the daily press depresses you, get a lift by going beyond your “Daily Blather” newspaper to such spunky journals as The Nation, Mother Jones, The Progressive, In These Times, American Prospect, Ms., Harper’s, and The Progressive Populist. Also, Utne rounds up articles every month from more than 2,000 alternative media sources. And two groups, the Independent Press Association (indypress.org) and the Alternative Press Center (altpress.org), give you access to magazines, newsletters, and ‘zines that cover every political and cultural issue imaginable.

Chances are your own town has one or more independent weekly newspapers offering detailed coverage of progressive issues and events that the monopoly dailies miss or avoid. The Association of Alternative Weeklies (aan.org) plugs you into 120 of these local voices that, collectively, reach 17 million readers a week. Even television, the feeblest member of our democracy’s media mob, is perking up a bit. PBS’s Now with Bill Moyers has been a blast of fresh air (though its direction is uncertain now that he has announced his retirement), and C-SPAN continues to do a great public service by simply clicking on its cameras and letting us see events without edits or editorializing. And you can forget the network news and go directly to The Daily Show for Jon Stewart’s irreverent, on-target satires, broadcast on Comedy Central.

Especially encouraging in TV-land are the insurgents of the air, including Free Speech TV and WorldLink TV, reaching a combined 20 million homes. Grassroots rebels are also making their own TV, thanks to Cable Access Television, available on some 600 public-access channels, as well as a feisty group of Independent Media Centers (indymedia.org) that are particularly good at streaming raw footage of protests and other actions, with their media activists taking their web-driven videocams right into the center of things, bringing you news as it happens.

Finally, don’t discount the power of face-to-face networks. On any given day, thousands of people are gathered in various-sized groupings to listen, learn, discuss, interact, strategize, and organize. These forums include the nation’s 2,200 independent bookstores, which are not merely book peddlers, but also community meeting places and informal bulletin boards (go to booksense.com to find ones near you). Public libraries, progressive speakers’ series, pot-luck suppers, conversation cafes and progressive festivals (Greenfest, Bioneers, Rolling Thunder, etc.) are also part of this vibrant, high-touch outreach that goes on daily in practically every city and neighborhood.

Years ago, my momma taught me that two wrongs don’t make a right - but I soon figured out that three left turns do. We must apply that same kind of street savvy if we’re ever to find our way around the media blockages that the corporate interests have put in place to shut out our voices.

Posted by pnhp at 01:27 PM | Permalink

The Ledger
June 15, 2004
Gov. Bush Signs Health Insurance Bill
By Brendan Farrington

Gov. Jeb Bush signed a wide-ranging bill Monday designed to lower the cost of health insurance and reverse the growing number of Floridians without health care coverage.

The heart of the bill (Rep. Frank) Farkas sponsored attempts to create less expensive options for health care coverage.

One provision seeks to lower premiums by requiring insurers to make high deductible plans available to small employers.

Those plans would be linked to health savings accounts, which work similarly to Individual Retirement Accounts.

Another provision expands the experimental Health Flex program that permits insurers, health maintenance organizations, local governments and other entities to offer stripped-down insurance coverage to low-income people.

Health insurance companies often cite a list of more than 50 benefits they’re required to cover — from maternity care to tests for certain types of cancer — as a big reason insurance costs so much.

Low-income Floridians can now be offered a plan that doesn’t have much of the required coverage.

http://www.theledger.com/apps/pbcs.dll/article?AID=/20040615/NEWS/406150343/1004

Comment: These policies are designed to increase the numbers of individuals who are insured. But the crucial tradeoff is that they threaten the financial security of many of those who already have insurance. The reductions in benefits and increases in patient cost sharing will
exceed the ability for many moderate and low income individuals to pay for essential medical services. The net impact is clearly a negative since a much greater number of individuals will face both significant medical debt and
impaired access due to lack of affordability.

These efforts to increase coverage by decreasing the value of plans have failed anyway. The numbers of uninsured continue to increase.

We need new policies that begin with the principle that everyone will have coverage automatically. Then we can work on policies that will enable the most effective allocation of our generous health care resources.

Posted by pnhp at 10:35 AM | Permalink

Let’s not get tangled up in America’s red tape
By ANDRÉ PICARD
PUBLIC HEALTH REPORTER
Thursday, June 10, 2004 - Page A21

It is fashionable these days to badmouth public services, and medicare in particular. From pothole repair through to open-heart surgery, it is virtually accepted as gospel that taxpayer-funded services are second-rate, delivered grudgingly by underworked fat cats comfortably ensconced in a bloated bureaucracy.

Bring in some market discipline, the rallying cry goes, and medicare’s woes will disappear: There will be no more wait lists, costs will plummet and services will be delivered with a smile to a society of satiated Methuselahs. Contrast the dream with the findings of two studies published during the past week. The first, a head-to-head comparison of U.S. and Canadian health indicators, found that, despite markedly different delivery systems, health outcomes and satisfaction rates are virtually the same in the two countries.

The second, conducted by researchers at McMaster University, found that the costs of services delivered by for-profit hospitals were 19-per-cent higher than those in not-for-profit facilities. At the same time, the death rate in private, for-profit institutions was about 8-per-cent higher. Sandwiched between these two research papers was the annual compilation of health spending from the Organization for Economic Co-operation and Development that showed the U.S. spends $5,297 (U.S.) per capita on health care, compared to $2,931 per capita in Canada — $2,366 more per person.

So why does Canada’s supposedly stodgily bureaucratic system get so much more bang for the buck than the lean, mean entrepreneurs who control the U.S. free-market health system?

The answer—at least one answer—can be found in a paper published last year in the New England Journal of Medicine, research that got virtually no attention because it was released during the SARS crisis.

The study, by Harvard University professors Steffie Woolhandler and David Himmelstein, concluded that the much-vaunted U.S. health system is choking in red tape.

The authors found that, in 1999, Americans spent $1,059 per capita on health-care administration, compared to $307 per capita for Canadians. Put another way, bureaucracy gobbles up 31 per cent of U.S. health dollars, compared to 17 per cent in Canada.

The authors of the Harvard study said this was due to a number of factors. For example, with Canada’s single-payer system, doctors bill a single provincial insurance plan using a single simple form, and hospitals receive lump-sum payments. In the United States, a hospital can deal with up to 800 insurance plans.

Private insurers, which dominate the U.S. system, have overhead costs averaging 11.7 per cent. That compares to 3.6 per cent for U.S. Medicare, and 1.3 per cent for provincial health plans in Canada. And for-profit institutions must provide a healthy return to investors, so they charge more. They also pay large bonuses to administrators.

Dr. Himmelstein said the stark differences between the U.S. and Canada were driven home during a visit to Toronto General Hospital. He searched long and hard for the billing office—a prominent feature of all U.S. hospitals—before locating two people whose job it is to bill U.S. patients who need treatment while visiting Toronto.

According to the authors, if the U.S. were to adopt Canada’s single-payer system, it would save approximately $286-billion a year in administrative costs ($982 per capita). The thorny problem of 43 million Americans without health insurance—whom it would cost about $69-billion a year to insure—could be eliminated, with money to spare.

Posted by pnhp at 09:37 AM | Permalink

SmartMoney.com
Buying Private Health Insurance
By Stacey L. Bradford

One of the hardest things about leaving a job is walking away from the benefits package. Once you’re out on your own… you must cough up a lot of dough for what will feel like inferior health coverage.

Before you start your search, brace yourself. The private health-insurance market isn’t pretty. “It’s a difficult, difficult road to go down,” says Kathleen Stoll, Director of Health Policy for consumer-advocacy group Families USA.

Here’s what you have to look forward to: steep monthly premiums, higher co payments, outrageous deductibles and fewer benefits.

While there are some benefits you can live without, others are important. A maternity rider is one of them, advises Ellen Corwin, an individual health-insurance broker from West Des Moines, Iowa. “I advise all of my female clients to get one,” she says. Unlike employer-sponsored plans, which usually cover birthing expenses, private plans don’t unless you pay for it upfront. Even if you decide to start a family in a few years, it may be too late to add the coverage. Blue Cross Blue Shield of Tennessee, for example, won’t let a woman add the benefit after she initially purchases a policy unless she submits an official “notification of change in status” and gets married.

http://www.smartmoney.com/consumer/index.cfm?story=20030929

Comment: According to advocates of consumer-driven health care, one of the benefits is that consumers save on health care costs by choosing to purchase only the coverage that they really need. But that requires either the ability to predict future health care needs, an impossibility, or the necessity of purchasing truly comprehensive coverage.

In the example given, the coverage decision is based on the acquisition of a marriage certificate. Everyone should have comprehensive coverage. Why do we leave health care decisions in the control of an industry that profits by making coverage decisions based on such ridiculous requirements as to how fresh the date is on a marriage certificate?

It really is time for us to establish our own universal, public program of health insurance.

Posted by pnhp at 09:21 AM | Permalink

Beebe chief: Health-care industry is sick
By Bruce Pringle
Delaware Coast Press Reporter

Like a doctor warning a patient to change his lifestyle today to avoid pain and suffering in years to come, the president of Beebe Medical Center says the nation’s health-care industry should act now to ensure it will be strong in future decades.

Jeffrey Fried, Beebe’s top executive since 1995, admits he doesn’t have easy solutions to existing problems caused by steadily rising health-care prices — or to challenges posed by an increasingly elderly population. But he does offer one prescription: a serious search for an alternative to a health-care system that, he says, cannot survive as it is.

“I don’t know all the answers, and I don’t know what the eventual solution is,” Fried said in a recent interview at his office on Beebe’s campus in Lewes. “But what I feel most strongly about is, the current system simply is not sustainable. So we ought to be looking at all the different possibilities and all the options right now.”

Current conditions — from millions of workers without health insurance to millions who have insurance that fails to provide comprehensive preventive medicine — may seem severe, but Fried said worse could be on the way as the number of retirement-age Americans rises. He noted federal statistics showing that in the year 2000 there were 3.9 tax-paying workers for every person on Medicare, but in the year 2030 the ratio will be just 2.4-to-1 — nearly 40 percent lower.

Already, he said, the federal government fails to fully reimburse any Delaware hospital for its Medicare expenses. Other patients’ payments make up the difference, a situation that could be exacerbated unless the health-care system is overhauled.

“So you’ve got an aging population, and we know an aging population uses more health-care services than younger people. And you’re going to have fewer people working to provide those services,” Fried said. “To me, that’s a train wreck waiting to happen.”

But little, he said, is being done to head off the collision. “The thing that frustrates me is that these statistics aren’t somebody’s private information,” he said. “They’re available to anybody. I don’t understand why people don’t see what’s looming on the horizon.”

Government’s role

He calls for government to lead the way. But one prominent government attempt at such leadership, during Bill Clinton’s first term as president, failed to spark dramatic change.

“You’ve got all kinds of people (in health care) who want to make the system better for (themselves), and nobody wants to give up anything,” Fried said. “Hillary Clinton tried to put everybody around the table. The problem is, everybody comes to the table trying to make the system better for themselves.”

But another effort should be made, he said, because the free-enterprise system isn’t geared to meeting the challenge on its own.

“I used to believe that the competitive model that works for the rest of the world would work for health care. The more time I spent in health care, the more I realized it doesn’t work,” said Fried, who was an executive at Lancaster (Pa.) General Hospital for 12 years before moving to Beebe. “The reason it doesn’t work is that, first of all, you don’t have a level playing field.

“You have hospitals providing all the services needed in a community, regardless of (patients’) ability to pay,” he said. But there also are “niche players who go after certain kinds of patients with certain kinds of services and aren’t really interested in serving the uninsured and the underinsured. You’ll see imaging centers going up, you’ll see surgery centers going up and you’ll see endoscopy centers going up. But these facilities aren’t interested in taking care of the uninsured.

“And pharmaceutical companies are developing new medications all the time. Medical-equipment companies are developing new technologies. But nobody’s really interested in providing services for people who can’t pay for them.”

Meanwhile, he said, insurance companies continually strive to enhance their profits by paying health providers less for services received by those who do have coverage. And that coverage isn’t always comprehensive; not everyone who is covered is assured of undergoing medical testing that would save money in the long run.

“So much of our system — I’m not saying it’s bad — is driven by the stock market, the capital markets and what’s happening on Wall Street and similar places around the world,” Fried said. “The market goes up and down based upon quarterly performance reports. The problem is, preventive medicine isn’t based on quarterly reports. You’ve got to make some investment over time to really see any benefit.”

Covering everyone

While the American Medical Association and many other forces within the health-care industry insist radical change isn’t necessary, Fried is among those calling for serious consideration of instituting the “single-payer universal” system common to many other industrialized nations.

Under single-payer, a government-run organization would collect all health-care fees and pay all medical bills. Advocates such as Physicians for a National Health Care Program say that replacing today’s complex billing system would save money that could be used to provide care for those who currently don’t get it. Under single-payer, all Americans would be covered and current health services would continue. Private insurance no longer would be necessary.

Some opponents of single-payer say the government would spend too much. Others predict the opposite, saying government wouldn’t spend enough to ensure patients received all the care they needed.

“I’m not sure single-payer is the right answer,” Fried said. “Maybe we’ll come up with a solution nobody has thought of. One of the great things about this system is that the entrepreneurial spirit has always allowed us to come up with new discoveries and look at things differently. Just to say ‘This won’t work’ or ‘That won’t work’ is not acceptable to me.

“My position more than anything else is, the current system doesn’t work. It isn’t going to last forever, so we’ve got to start thinking about something else. And the longer we wait to think about something else, the less time we have to do something before it becomes a crisis. It seems to me people would do best to deal with these problems now rather than waiting 10-20 years down the road.”

E-mail Bruce Pringle at bpringle@smgpo.gannett.com.
Originally published Wednesday, June 9, 2004

Posted by pnhp at 03:05 PM | Permalink

The Bob LeBow Bike Tour - “Health Care for All” is a local event aimed at encouraging a healthy lifestyle for riders of all ages, while enjoying the beauty of rural Canyon and Owyhee Counties. The Bob LeBow Bike Tour is held on the second Saturday of June and includes 5 different routes ranging from 3 to 100 miles. All rides start and finish at Nampa High School. Proceeds of the Bob LeBow Bike Tour - “Health Care for All” benefit the Terry Reilly Health Services Zero Pay Fund. Lunch, water stops, first aid, and sag wagons will be provided. Registration fees include a 2004 tour tee-shirt, water bottle, and entry to door prizes.

Please click on the link to view the full details

Posted by pnhp at 04:19 PM | Permalink

Porter & Teisberg: Redefining competition in health care

The Boston Globe
June 8, 2004
A prescription for healthcare
Professor: Get industry to compete over quality instead of shifting
costs
By Robert Weisman

Michael E. Porter has a new problem to fix.

The Harvard Business School professor, often described as America’s foremost
business strategist, has never shied away from tackling intractableproblems.

…his latest challenge is one that has stumped the best and brightest business theorists, politicians, and policy makers: America’s dysfunctional healthcare system. And Porter is staking his reputation on a prescription that calls for a healthy dose of competition.

In a long essay in the June edition of Harvard Business Review, the 57-year-old Porter argues for redefining healthcare competition on the level of specific diseases and treatments, rather than on the level of health plans, networks, or hospital groups. ”The wrong kinds of competition have made a mess of the American healthcare system,” contend Porter and his coauthor, Elizabeth Olmsted Teisberg of the University of Virginia.

”The right kind of competition can straighten it out.”

The article is significant not only for its critique, but also because it bears the Michael Porter stamp. One of only 15 ”university professors” (the highest designation for faculty members) at Harvard University, his 16 books on strategy, competitive advantage, and business clusters have made him among the most sought-after business thinkers in the world. Porter consults for corporations, regions, and even nations.

Porter and Teisberg have a deceptively simple diagnosis: Healthcare competition today works on the wrong level. The players — health plans, payers, providers, and doctors — engage in what the authors call ‘zero-sum competition,” dividing value rather than creating it. They seek to transfer costs onto one another, limit access to care, hoard information, and stifle innovation, all to the detriment of patients.

The right kind of competition should occur at the level of preventing, identifying, and treating patients’ conditions and diseases, Porter and Teisberg assert. They call for collecting and disseminating information about the outcome of medical procedures, so patients can make intelligent choices about physicians and hospitals. They also recommend transparency in billing and pricing to reduce cost shifting, discrimination, and other inefficiencies. And they propose increased specialization by healthcare providers, resulting in more centers of excellence in conditions and treatments that compete for patients.

Most of the tried-and-failed healthcare reform efforts of the past decade have emphasized government playing a larger role, as it does in Canada, the United Kingdom, and other countries. By contrast, the Porter-Teisberg approach would be a largely private sector solution, with employers helping to instigate change by negotiating with health insurers and providers for quality, choice, and transparency.

Government would have a role, not as a ”single payer” or an insurer of last resort, but by blocking network restrictions, hospital consolidation, and multiple hospitalization bills, and helping to set a framework for reform through its Medicare program. The role of health plans, meanwhile, would be more akin to that of coaches and advisers, helping their members navigate the system and find the best care.

Teisberg… speaking of herself and Porter, said, ”Neither one of us has come at this as a healthcare expert. We’re out there talking to people because we care about this. It matters.”

http://www.boston.com/business/articles/2004/06/08/a_prescription_for_healthcare/?

Harvard Business Review
June 2004
Redefining Competition in Health Care
The wrong kinds of competition have made a mess of the American health
care system. The right kinds of competition can straighten it out.
by Michael E. Porter and Elizabeth Olmsted Teisberg

We believe that competition is the root of the problem with U.S. health care performance. But this does not mean we advocate a state-controlled system or
a single-payer system; those approaches would only make matters worse. On
the contrary, competition is also the solution, but the nature of competition in health care must change. Our research shows that competition in the health care system occurs at the wrong level, over the wrong things, in the wrong geographic markets, and at the wrong time. Competition has actually been all but eliminated just where and when it is most important.

The most fundamental and unrecognized problem in U.S. health care today is that competition operates at the wrong level. It takes places at the level of health plans, networks, and hospital groups. It should occur in the prevention, diagnosis, and treatment of individual health conditions or co-occurring conditions. It is at this level that true value is created-or destroyed-disease by disease and patient by patient. It is here where huge differences in cost and quality persist. And it is here where competition would drive improvements in efficiency and effectiveness, reduce errors, and spark innovation. Yet competition at the level of individual health conditions is all but absent.

To access the report (fee $16.95):
http://harvardbusinessonline.hbsp.harvard.edu/b02/en/home/index.jhtml;jsessionid=FVZ2U4LSFGSSECTEQENSELQ?_requestid=5752
and click on “Curing U.S. Health Care (HBR OnPoint Collection)”

Comment: The debate rages on as to whether the financing of health care should be guided by a government program or by competitive forces in the private marketplace. Innumerable studies have refuted the claim that, in health care, private marketplace competition improves quality and lowers costs. Professors Michael Porter and Elizabeth Teisberg concede that the existing “zero-sum competition” has “made a mess of the American health care system.” They now describe “positive-sum competition” as the solution. They contend that preserving market forces through a new model of competition would be the best means of providing value by improving quality while controlling costs.

Their article is to be followed by a book on the subject, with the intention that it be the guide to revolutionary reform of the health care marketplace. Because of the prestige and credibility of the authors, we should become well informed on their vision of reform, and be prepared to respond appropriately.

As academic leaders in the business world, it is no surprise that they are determined to make competition work in health care, with almost a religious
fervor. They concede that they are relative novices in the health care arena, but they believe that they can introduce innovative approaches to competition that would have a positive impact on the health care system. In spite of being health care novices, they have identified much in the health policy literature that confirms that competition has not provided enough value to offset the impaired quality that permeates our system, thus their “zero-sum” thesis.

As pro-competitive, free market advocates, they cannot accept a model, such
as single payer, that uses government mechanisms to achieve quality and control costs. But in their fervor to depend on private competition as the driving force for value, problems begin to appear as they develop their positive-sum” thesis. Only a small sampling of the issues will be listed here. If, in fact, their proposals gain political traction, a more detailed analysis can be prepared later, describing what is good and what is bad about their concepts.

(Quotations are from their paper.)

• They appropriately emphasize that we need greater value in health care. But most of their concepts are directed at improving quality, the more important component of value, whereas very little are directed toward controlling costs. It is true that eliminating ineffective or detrimental care does reduce costs, but an explosion in technological advances, some of dubious value, has been a major driver of cost escalation. They do not adequately address this important concern.

• Most of their recommendations for improving quality have already been covered extensively in the health policy literature. Efforts are already being made to address them, and even greater efforts will inevitably be made in the future.

• “The most fundamental and unrecognized problem in U.S. health care today is that competition operates at the wrong level. It takes place at the level of health plans, networks, and hospital groups. It should occur in the prevention, diagnosis and treatment of individual health conditions or co-occurring conditions.” What does competition have to do with this? We do recognize that many of the problems are in our approaches to prevention, diagnosis and treatment. We definitely need to continue to identify these problems and then correct them. But is that best approached by establishing an elaborate and necessarily imperfect system of measuring and reporting quality parameters for the purpose of enabling providers to be rewarded by relatively unsophisticated purchasers in the marketplace? Or would it be better to establish a single, integrated system of funding care that directs the financial resources to beneficial preventive, diagnostic and therapeutic services with incentives for higher quality? It seems that the direct approach would be more efficient and effective.

• “Under positive-sum competition, providers would have to issue a single bill for each service bundle, rather than a myriad of bills for each discrete service.” Billing abuses occur both with bundling and unbundling of charges. Suggesting that billing problems for chronic disorders would be solved by mandated bundling is simplistic reasoning at best.

• They suggest that hospitals should develop “unique expertise” and not try to “be all things to everyone.” Hospitals then could compete (nationally?) with other hospitals providing similar unique expertise. This ignores the fact that hospitals provide mostly very routine services and need to be geographically accessible in a timely manner. Also the emphasis on increased specialization has been demonstrated to decrease health care value, driving up spending without a commensurate improvement in outcomes.

• “Network restrictions” would be eliminated, and “co-pays would be the same inside and outside of the network.” Does this mean that price would no longer be a dominant factor in a competitive marketplace? Though it should be stated here that their emphasis on the goal of improving quality is to be commended.

• Although a major goal would be to keep the government out of the competitive marketplace, “antitrust authorities would scrutinize system participants” to prevent market domination. If higher quality is the goal, shouldn’t higher quality providers be allowed to dominate the market? And would we be able to stabilize the capacity of the system if the remaining providers were not able to survive financially? Wouldn’t it be more rational to adopt programs aimed at improving the quality of all providers, rather than a competitive model that automatically sacrifices those who fall on the lower part of the curve?

• To “eliminate price differentials for favored groups… the federal government could limit the spread between the most discounted price and the highest price charged by a provider for any service and then reduce this spread each year over a five year period.” How do price controls fit in with free market competition? And what happens when destabilization returns after the five years have passed?

• “For high-risk people unable to buy health plans, assigned risk pools, like those used in automobile insurance, will need to be developed.” Why didn’t we think of that?

• “Large deductibles combined with medical savings accounts would let some patients take financial responsibility for their choices.” But also under their model, the legal responsibility for bills would shift from the patients to the payers who would “bear full legal responsibility for the medical bills of paid-up subscribers.” Well, make up your mind. Is the financial responsibility that of the patient or of the payer?

• Although they give competition much credit as a potential driver of quality, they ignore the fact that a single payer system would address many of the quality issues that they describe. In fact, by design, the singlepayer system would attack the quality problems aggressively and effectively, whereas their competition model would approach them with primary attention given to the bottom line. But profits in health care have almost no correlation with quality, and their model, in spite of their rhetoric, provides negligible financial incentives to improve quality on a global basis, though it may be effective in a few isolated instances.

Professors Porter and Teisberg still have much to learn about the health care system. Let’s hope that they do not limit their exposure to their colleagues who believe that we must rely strictly on competition in free markets no matter how compelling the evidence that they simply do not work in health care. Maybe they’d like to take a closer look at the single payer model. A single payer system would provide value by enabling higher quality within the limits of the resources we have, and isn’t that what good business is all about?

Posted by pnhp at 11:03 AM | Permalink

Date: Wed, 9 Jun 2004 11:31:34 -0700
Downward trend in costs still double the growth of the economy

Health Affairs
June 9, 2004
Tracking Health Care Costs: Trends Turn Downward In 2003
By Bradley C. Strunk and Paul B. Ginsburg

Total health care spending per privately insured person rose 7.4 percent in 2003. This increase was 2.1 percentage points lower than the 2002 increase of 9.5 percent, which was itself slightly lower than the 2001 increase of 10 percent. Therefore, it is now clear that we have entered a period of decelerating cost trends following a steep acceleration during 1996-2001.

Nevertheless, the cost trend remained high by historical standards and continued to outpace U.S. economic growth by a sizable margin. With per capita gross domestic product (GDP) increasing 3.8 percent in 2003, the gap between it and the trend in health care spending remained larger than the average 2.5-percentage-point gap over the past thirty years.

http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.354/DC1

Center for Studying Health System Change
June 9, 2004
Health Care Spending Growth in 2003 Posts First Major Slowdown in a Decade
Despite Downtick, Health Care Spending Growth Continues to Outpace Economic
Growth

Gail Shearer, director of health policy analysis, Consumers Union:

“Despite a modest slowdown, health care costs continue to rise rapidly, threatening the affordability of health insurance for more and more people. Marketplace changes-combined with recent legislation that provides tax incentives that encourage high-deductible coverage-are steering our health care system further from the goal of spreading costs broadly across the entire population. Tragically, the long-term impact is likely to be increased financial barriers to getting needed health care, placing a growing burden on the sick and those with low-incomes.”

http://www.hschange.org/CONTENT/681/

Comment: “Downward trend” and “slowdown” have little meaning to patients to
whom costs are being shifted in order to relieve the purchasers of the burden of paying for health care costs that are increasing at twice the rate of growth of the U.S. economy.

We clearly need new policies, and single payer sounds more and more like just the right solution.

Posted by pnhp at 09:08 AM | Permalink

The high costs of for-profit care

CMAJ (Canadian Medical Association Journal)
June 8, 2004
Commentary
The high costs of for-profit care
By Steffie Woolhandler and David U. Himmelstein

Why do for-profit firms that offer inferior products at inflated prices survive in the market? Several prerequisites for the competitive free market described in textbooks are absent in health care.

First, it is absurd to think that frail elderly and seriously ill patients, who consume most care, can act as informed consumers (i.e., comparison-shop, reduce demand when suppliers raise prices or accurately appraise quality). Even less vulnerable patients can have difficulty gauging whether a hospital’s luxurious appurtenances bespeak good care.

Second, the “product” of health care is notoriously difficult to evaluate, even for sophisticated buyers like government. Physicians and hospitals create the data used to monitor them; self-interest puts the accuracy of such data into question. By labelling minor chest discomfort “angina” rather than “chest pain,” a US hospital can garner both higher Medicare payments and a factitiously improved track record for angina treatment. It is easier and more profitable to exploit such loopholes than to improve efficiency or quality.

Even for honest firms, the careful selection of lucrative patients and services is the key to success, whereas meeting community needs often threatens profitability. For example, for-profit specialty hospitals offering only cardiac or orthopedic care (money-makers under current payment schemes) have blossomed across the United States. Most of these new hospitals duplicate services available at nearby not-for-profit general hospitals, but the newcomers avoid money-losing programs such as geriatric care and emergency departments (a common entry point for uninsured patients). The profits accrue to the investors, the losses to the not-for-profit hospitals, and the total costs to society rise through the unnecessary duplication of expensive facilities.

Finally, a real market would require multiple independent buyers and sellers, with free entry into the marketplace. Yet, many hospitals exercise virtual monopolies. A town’s only hospital cannot compete with itself, but can use its market power to inflate its earnings. Not surprisingly, for-profit hospital firms in the United States have concentrated their purchases in areas where they can gain a large share of the local market. Moreover, many health care providers and suppliers enjoy
state-conferred monopolies in the form of licensure laws for physicians and hospitals and patent protection for drugs. Additionally, government pays most health costs - even in the United States. Indeed, public funding for health care in
the United States exceeds total health spending in Canada on a per capita
basis. It’s an odd market that relies largely on public funds.

Privatization results in a large net loss to society in terms of higher costs and lower quality, but some stand to gain. Privatization creates vast opportunities for powerful firms, and also redistributes income among health workers. Pay scales are relatively flat in government and not-for-profit health institutions; pay differences between the CEO and a housekeeper are perhaps 20:1. In US corporations, a ratio of 180:1 is average. In effect, privatization takes money from the pockets of low-wage, mostly female health workers and gives it to investors and highly paid managers.

Behind false claims of efficiency lies a much uglier truth. Investor-owned care embodies a new value system that severs the community roots and Samaritan traditions of hospitals, makes physicians and nurses into instruments of investors, and views patients as commodities. Investor ownership marks the triumph of greed.

For the full commentary:
http://www.cmaj.ca/cgi/content/full/170/12/1814

For the CMAJ article, “Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis,” by P.J. Devereaux, et al: http://www.cmaj.ca/cgi/content/full/170/12/1817

Comment: Physicians for a National Health Program is a single issue organization, advocating for the single payer model of universal health insurance. But most of us are strongly opposed to the intrusion into the health care delivery system of for-profit corporate boards and their passive investors. Both the article and commentary should be read in their entirety for a better understanding of why we are so deeply offended by the ethical compromises of investor-controlled health care.

Posted by pnhp at 01:38 PM | Permalink

Democracy dwindles with rise in inequality

American Political Science Association
June 7, 2004
American Democracy in an Age of Rising Inequality
By the Association’s Task Force on Inequality and American Democracy

Among the Task Force’s findings based on analysis of the U.S. economy, voting and other forms of political participation, and government policy making:

• The United States has, in effect, 2 classes of citizenship: Wealthier Americans are far more active across the board - from voting to contacting government officials and joining pressure groups in Washington-than are those with lower incomes.

• Both major political parties target many of their resources on recruiting those who are already the most privileged and involved.

• The Internet, which offers opportunities for virtual political participation and communication among citizens, may actually be reinforcing existing inequalities because it is more accessible to affluent, non-Hispanic whites, and the highly educated.

• The decline in union membership has reduced the traditional role of blue-collar trade unions in bringing working Americans into the political process.

• The rise of “public interest” citizen associations has not significantly corrected the bias of the system toward the more privileged.

• The economic disparities of U.S. citizens are growing more sharply in the United States than in other democratic nations like Britain, Canada, France,
  Germany and Italy.

Economic gaps have widened not just between the poor and the rest of society
but also between privileged professionals, managers and business owners on
the one hand, and the middle strata of regular white-collar and blue-collar employees on the other. Indeed, the report noted, “the very richest one percent of Americans has pulled away from not only the poor but also the middle class.” Individuals with privilege were less likely to press for policies aimed at problems with medical costs, education, housing, jobs and child care that affect the less well-off.

Theda Skocpol, Director of the Center for American Political Studies at Harvard University:

”…disparities in participation ensure that ordinary Americans speak in a whisper while the most advantaged roar. The concerns of lower or moderate income Americans, racial and ethnic minorities, and legal immigrants are systematically less likely to be heard by government officials. In contrast, the interests and preferences of the better-off are conveyed with clarity, consistency, and forcefulness.”

http://www.apsanet.org/news/index.cfm#inequality

Press release:
http://www.apsanet.org/Inequality/MediaPressRelease.pdf

To download a 22 page short version of the report:
http://www.apsanet.org/Inequality/generalreport.cfm

Comment: As if democracy alone were not enough, it seems that we need new
policies that will incentivize ordinary Americans to become a roaring voice in the democratic process. Without such policies, health care equity will remain only our pipe dream. But then could the roar of the masses with their disparate needs ever drown out the clear, consistent and forceful roar of the better-off?

Back to work. And back to whispering…

Posted by pnhp at 09:20 AM | Permalink

EMBARGOED UNTIL:Monday, June 7, 5:00 p.m. 2004
Contacts: Dr. PJ Devereaux (cell) (289) 237-3748
Dr. Steffie Woolhandler (617) 665-1032
Dr. Quentin Young (312) 782-6006

For-Profit Hospitals are Costlier Than Non-Profits, Study Finds
Evidence Against For-Profit Health Care Now Conclusive

* Please Click on the below links to access the article and editorial

Payments for care at private for-profit and private not-for-profit hospitals

The high costs of for-profit care

Charging the patient to save the system ?

Investor-owned hospitals have 19% higher charges than non-profit hospitals, according to a study appearing today in the Canadian Medical Association Journal. The study, the most comprehensive analysis comparing for-profit and non-profit facilities, was carried out by a highly respected team of physicians and statisticians at McMaster University led by Dr. PJ Devereaux. That team had previously reported that investor-owned hospitals have 2% higher death rates. The researchers, though based in Canada, used data from U.S. hospitals, since for-profits are rare in Canada. The possible introduction of for-profit hospitals is expected to be a campaign issue in upcoming Canadian elections.

In an accompanying editorial, Drs. Steffie Woolhandler and David Himmelstein of Harvard Medical School calculate that converting all investor-owned hospitals (13 percent of U.S. hospitals) to non-profit ownership could have saved $6 billion of the $37 billion spent on care at investor-owned hospitals in 2001.

“Investor-owned hospitals charge outrageous prices for inferior care.” said Dr. Steffie Woolhandler. “That’s not just an opinion, it’s now a proven fact. The for-profits skimp on nurses, but spend lavishly on their executives and paper-pushers.” Previous research by Drs. Woolhandler and Himmelstetin, based on financial filings by virtually all U.S. hospitals, found that administration accounted for 24.5% of total costs at non-profit hospitals vs. 34% at for-profits, while payroll costs for clinical personnel were 7 percentage points higher at non-profits.

Dr. Woolhandler also noted that: “Previous studies have shown a consistent pattern - investor-ownership compromises care and raises costs. For-profit dialysis clinics have higher death rates. For-profit nursing homes deliver lower quality care. For profit hospices give dying patients less care. For-profit rehab facilities cost Medicare more. And for profit HMOs deliver poor quality care and have extraordinarily high overhead costs. In fact, the Congressional Budget Office has concluded that HMOs actually increases Medicare costs by at least $2 billion each year – and President Bush and the Republicans in Congress just handed them an extra $46 billion in the Medicare drug billDr. Himmelstein, Associate Professor of Medicine at Harvard commented: “For-profit hospitals milk the system for legal, but outrageous payments for executives and shareholders. And they also routinely bilk the system through fraud. Columbia/HCA – the largest hospital firm - paid a $1.7 billion settlement for overbilling Medicare last year. Tenet – the second largest - paid a half a billion dollars to settle fraud and abuse charges in the 1980’s (when the firm was known as NME) and is under investigation again for massive billing fraud, and performing hundreds of unnecessary heart operations. And HealthSouth – which dominates the rehab hospital market – just admitted to $3.4 billion in fraudulent accounting. In each case, the CEO who presided over the fraud was forced out. But only after Columbia/HCA’s got $324 million, Tenet’s received $111 million, and HealthSouth’s pocketed $112 million. In health care, crime pays handsomely.”

The researchers at McMaster are considered leading experts on research methodology. The team of 20 researchers reviewed 788 medical articles on hospital care, eventually honing in on the 8 highest quality and most relevant studies – which included a total of 350,000 patients and a median of 324 hospitals in each study. They contacted the original authors to verify the findings, then used advanced statistical techniques to combine the 8 studies. Of the 8 studies, only one showed that for-profits had lower costs. However, all of the non-profit hospitals included in this study were managed by a for-profit firm – in other words, both groups of hospitals in the study were under for-profit management.

“We can no longer afford to leave health care to the marketplace” said Dr. Quentin Young, National Coordinator of Physicians for a National Health Program. “This study demonstrates the marvelous opportunities for improved health services when the U.S. adopts a national health insurance system (single-payer) based on traditional not-for-profit care.”
________________

“The High Costs of For-Profit Care” Steffie Woolhandler and David U. Himmelstein. Canadian Medical Association Journal, 1814-1815, June 8, 2004.

“Payments for Care at Private For-Profit and Private Not-for-Profit Hospitals: A Systemic Review and Meta-Analysis” P.J. Devereaux et al, Canadian Medical Association Journal, 1817-1824, June 8, 2004.

A bibliography of references on the negative impact of investor-ownership on health care is also available.

####

Physicians for a National Health Program (www.pnhp.org) is an organization of 12,000 physicians advocating for non-profit national health insurance. PNHP has chapters and spokespeople across the country. For contacts, call (312) 782-6006.

Posted by pnhp at 03:17 PM | Permalink

Canadian and American health status the same, except for the poor and uninsured in the U.S.

Statistics Canada
and
Centers for Disease Control and Prevention
June 2004

Joint Canada/United States Survey of Health, 2002-03
By Claudia Sanmartin and Edward Ng, Health Analysis and Measurement Group,Statistics Canada
and
Debra Blackwell, Jane Gentleman, Michael Martinez and Catherine Simile,
National Center for Health Statistics, Centers for Disease Control and Prevention, United States

Conclusions

The JCUSH (Joint Canada/United States Survey of Health) represents a unique
population health survey conducted jointly by two national statistical agencies, Statistics Canada and the United States National Center for Health Statistics. The use of a common questionnaire and identical data collection and processing methods provides highly comparable data. As a result, the findings from JCUSH provide valuable insights regarding similarities and differences between Canada and the United States in a manner not previously possible.

Overall, the health status of Canadians and Americans is generally similar with most individuals in both countries reporting that they are in good, very good or excellent health. More Americans, however, reported being at either end of the health status spectrum - in excellent health and in fair and poor health - compared with Canadians. This was particularly true among women. This may be associated with the higher rate of highly severe mobility limitation and obesity among American women. There were relatively few differences between men.

Canadians and Americans were similar regarding access to health care services provided under similar funding models. In the case of dental services, for example, where most depend on private insurance, access was similar in the two countries.

Canadians and Americans differed overall, however, regarding access to health care services provided under different insurance models such as those covering physician services. While Canadians are similar to insured Americans regarding access to a regular medical doctor and regarding unmet health care needs, they face significantly less barriers to care when compared with uninsured Americans.

The greatest differences between the two countries are related to differentials by income in health. While there has been solid evidence for some time of the social gradient in health status in both Canada and the United States, this is the first time that we have been able to examine the question of whether there are systematic differences in health status by social position in the two countries. One of the important findings of this survey is that Americans in the poorest income quintile report fair or poor health, obesity and severe mobility impairment more frequently than their Canadian counterparts. At the other end of the income spectrum, there are no systematic differences in the reporting of fair or poor health or mobility impairment among the most affluent households on either side of the border.

http://www.statcan.ca/english/freepub/82M0022XIE/2003001/pdf/82M0022XIE2003001.pdf
or
http://www.cdc.gov/nchs/data/nhis/jcush_analyticalreport.pdf

Comment: In the first population health survey to provide both a comprehensive and precise comparison of the United States and Canada, two dramatic conclusions are evident. First, Canadians and insured Americans have similar access, whereas uninsured Americans clearly have impaired access and greater unmet health care needs. Second, affluent Canadians and Americans have comparable levels of health whereas low income Americans have poorer health than low income Canadians.

The conclusion seems inescapable that the unmet health care needs and poorer
health are due to lack of affordability because of lack of insurance. But many opponents of comprehensive health care reform have tried to explain these differences by claiming that there are fundamental cultural differences in low income Americans and low income Canadians, differences that do not extend into the average income and affluent sectors.

Maybe the United States does fail on other parameters of social solidarity that result in less favorable health outcomes for the poor. But a great first step to address these differences would be to eliminate financial barriers to health care by providing comprehensive coverage for everyone.

Posted by pnhp at 09:18 AM | Permalink

A single-payer response to the health care crisis

By Ross C. Anderson (mayor of Salt Lake City)
   

A health care crisis in this country is having a profound impact on the lives of millions of people. We live in one of the wealthiest nations in the world, yet more than 44 million of our citizens are without access to health care coverage, including 8.5 million children.

 Those who are covered, and employers who provide health care benefits to employees, are experiencing skyrocketing increases in the costs of medical insurance. Those higher costs are due largely to the huge profits of the middle-man insurance companies and the exorbitant compensation paid to insurance company executives.

 The reasons for lack of health care coverage are varied. Many people are self-employed and unable to afford the cost of health insurance. Millions of people work for employers who don’t provide health insurance. Others are unemployed but not poor enough to qualify for Medicaid.

The consequences of living without health insurance are often devastating. The cost of basic preventive health services such as prenatal care, well-child check-ups and cancer screenings can be prohibitive. Many of the uninsured go without preventive care, waiting until a health disaster strikes before seeking assistance, and then often facing bills that bankrupt them. Or, worse yet, they may be unable to obtain medical services because of their inability to pay.

The Institute of Medicine has estimated that 18,000 adults in America die every year because they are uninsured. Women with breast cancer who don’t have health insurance are twice as likely to die as those who are covered. Uninsured men are nearly twice as likely to be diagnosed at a late stage of colon cancer as those who are covered. A lack of health insurance and the high cost of medical care can have a disastrous effect on individual lives and on our entire community.

The rising cost of health care is negatively impacting all sectors of our economy. City government has been hit hard. The cost to Salt Lake City Corporation of providing employee benefits has risen 59.5 percent since 1998, primarily due to the increase in health care costs. The increase in health insurance costs has caused significant budget challenges, leading to a loss of jobs and a decrease in city services. Likewise, in 2003, employers across the nation faced average one-year premium increases of 13.9 percent for private health insurance.

There is a solution to this crisis. As a nation we can do more to provide all of our citizens access to basic, quality health care services. But to accomplish this will require the political courage to stand up to those in the health care industry resistant to change.

Creation of a system that provides access to health care for all Americans could best be accomplished by developing a single-payer system under which a government-sponsored entity serves as the insurer for all Americans. Under this system, physicians, hospitals and drug companies would remain privately owned. Only insurance coverage would be centralized.

A single-payer system is better for patients and better for doctors. Canada, which has a single-payer system, spends $1,000 less per capita on health care than does the United States, but delivers more care and greater choice for patients. Combining the single-payer efficiency of Canada’s system with the much higher funding of ours would yield better care than Canada’s or ours at present.

Under a single-payer system, the General Accounting Office projects an administrative savings on health care costs of 10 percent — which in 2002 amounted to $150 billion dollars. This savings alone would cover the cost of providing medical care to those currently without health care coverage.

The Congressional Budget Office projects that a single-payer system would reduce health care costs overall by $225 billion, while providing comprehensive care to all Americans. No other plan provides this kind of savings.

We can no longer afford our current health care delivery system. A single-payer system would provide health care coverage for all Americans, create greater efficiency in our health care system and result in a healthier population. It would benefit the vast majority of patients, employers, governmental entities and taxpayers.

We can stand up to those who continue to gain from the inefficiency of our current system — the insurance companies, enormous hospital chains and pharmaceutical companies that comprise the health care oligarchy — and create a fair, efficient, single-payer health care system for all Americans.
   
   

Posted by pnhp at 12:34 PM | Permalink

Feachem’s Kaiser study not credible

British Journal of General Practice
June 2004
Questioning the claims from Kaiser
By Alison Talbot-Smith, Shamini Gnani, Allyson M Pollock and Denis Pereira Gray

Summary

Background: The article by Feachem et al, published in the BMJ in 2002, claimed to show that, compared with the United Kingdom (UK) National Health Service (NHS), the Kaiser Permanente healthcare system in the United States (US) has similar healthcare costs per capita, and performance that is considerably better in certain respects.

Aim: To assess the accuracy of Feachem et al’s comparison and conclusions.

Method: Detailed re-examination of the data and methods used and consideration of the 82 letters responding to the article.

Results: Analyses revealed four main areas in which Feachem et al’s methodology was flawed. Firstly, the populations of patients served by Kaiser Permanente and by the NHS are fundamentally different. Kaiser’s patients are mainly employed, significantly younger, and significantly less socially deprived and so are healthier. Feachem et al fail to adjust adequately for these factors. Secondly, Feachem et al have wrongly inflated NHS costs by omitting substantial user charges payable by Kaiser members for care, excluding the costs of marketing and administration, and deducting the surplus from Kaiser’s costs while underestimating the capital charge element of the NHS budget and other costs. They also used two methods of converting currency, the currency rate and a health purchasing power parity conversion. This is double counting. Feachem et al reported that NHS costs were 10% less per head than Kaiser. Correcting for the double currency conversion gives the NHS a 40% cost advantage such that per capita costs are $1161 and $1951 for the NHS and Kaiser, respectively. Thirdly, Feachem et al use non-standardised data for NHS bed days from the Organisation for Economic Cooperation and Development, rather than official Department of Health bed availability and activity statistics for England. Leaving aside the non-comparability of the population and lack of standardisation of the data, the result is to inflate NHS acute bed use and underestimate the efficiency of performance by at least 10%. Similar criticisms apply to their selective use of performance measures. Finally, Feachem et al claim that Kaiser is a more integrated system than the NHS. The NHS provides health care to around 60 million people free at the point of delivery, long-term and psychiatric care, and continuing care after 100 days whereas Kaiser provides care to 6 million people, mainly employed and privately insured. Important functions, such as health protection, education and training of healthcare professionals, and research and development are not included or properly costed in Feachem et al’s integrated model.

Conclusion: We have re-examined the statements made by Feachem et al and show that the claims are unsupported by the evidence. The NHS is not similar to Kaiser in coverage, costs or performance.

http://www.rcgp.org.uk/webmaster/ebjgp/journallogin.asp?OrigURL=/journal/index.asp

BBC
JAN. 17, 2002
NHS ‘worse value than US provider’

Professor Richard Feachem:

“If an NHS patient moved to Kaiser they would be delighted with the experience, and if a Kaiser patient moved to the NHS they would be horrified.”

http://news.bbc.co.uk/1/hi/health/1764713.stm

Comment: The 2002 BMJ article by Richard Feachem et al has been cited frequently as proof that an American HMO is superior to the British National Health Service. 82 letters were published in response to the BMJ article, all challenging the validity of Feachem’s conclusions.

This article by Alison Talbot-Smith et al provides a definitive compilation and analysis of the criticisms of Feachem’s article. There is now absolutely no doubt that Feachem’s claims are not supported by the evidence.

The opponents of public models of reform likely will continue to cite Feachem’s work as proof that private HMOs are superior to publicly administered or publicly owned models of health care funding and delivery (even though this is an unwarranted extrapolation of his invalid conclusions). But with the publication of Talbot-Smith’s definitive critique, anyone who continues to use Feachem’s study to advance his or her arguments can be summarily dismissed as not being a credible voice in the debate.

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

Message: 2
Date: Sat, 29 May 2004 11:42:19 -0700
Subject: qotd: Judy Feder on single payer

Kaisernetwork.org HealthCast
5/11/2004
Policy Options To Expand Health Insurance Coverage Lauren Leroy: …a recent report that was published by the Institute of Medicine called “Insuring America’s Health” … set out a set of principals that any proposal or any policy that would be adopted to provide insurance coverage should meet. And those include coverage that is universal, continuous, affordable to individuals and society, sustainable, and offers access to high quality care. …which of the options of the proposals do you think best meet these criteria?

Judy Feder, dean of policy studies at Georgetown University: I think that the criteria that the Institute of Medicine has laid out are certainly the right ones for evaluating our health care system, but they are one mean feat for any kind of political proposal. And because Lauren asked me to keep the answers short, and because I am an honest woman, whatever one’s politics, the only thing that comes close to meeting all these criteria I would say would be a single payer system. It could be Medicare for all, but it would be substantially improved benefits than Medicare now offers evenwith the new drug benefit. So if you really are going to hold yourselves to those criteria, you don’t have a lot of choices…

And later…

Lauren Leroy:
…what have you learned about what are the critical messages that might convince the us, the 85% who are insured about the value of covering them, the 15%, to shift political will a bit?…

Judy Feder:
…What I believe is to start where the questioner asked about what is in it for me who has insurance. And we do need more stability. We do want lower costs. We do want to know that our coverage will be secure for us. And there are policy proposals that do make coverage more affordable and more secure for those of us who have it at the same time that we bring in other people. And I think being explicit about that is fine. I think that it is - and I am persuaded by others who have been making this argument longer than I - I think that we have to be willing to mobilize people around what’s the right thing to do. And what kind of a society do we want to live in? And I think that if we avoid that question and try to con people into “it’ll be okay,”

we’re not going to get from here to there. And so I would urge everybody, if you believe that, to start saying it and to say it loud and often and to tell elected officials you are willing to pool your resources to make that possible.

http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1139

Comment: …start saying it and say it loud and often…

Posted by pnhp at 09:47 AM | Permalink