News

The Danger of Consumer-Driven Health Care Crash Course
by Jonathan Cohn
The New Republic
Nov. 7, 2005

Health care operates by what economists commonly call an “80/20” rule. In any given year, most of the money being spent on medical care in the United States (about 80 percent of the total) is for the relatively small portion of Americans (about 20 percent of the population) recovering from severe accidents, fighting off a life-threatening disease like cancer, or struggling with a serious chronic condition like diabetes.

… traditional health insurance spreads the financial burden, using premiums paid by people who don’t use many medical services to help pay the bills of those who do. The trouble with HSAs is that they change the equation, dramatically, allowing people in relatively good health to keep much more of their own money. “One hundred percent of the time it makes sense for a healthy person to take the savings account,” one benefits consultant explained in The Tampa Tribune. “That’s a no-brainer.” But, once that happens, there’s less money to subsidize care for the people with high medical bills—which means those people must either make up the difference themselves or simply go without care. “A wholesale switch to [HSAs] would redistribute the nation’s overall financial burden of health care from the budgets of chronically healthy families to those of chronically ill families,” Princeton economist Uwe Reinhardt has written. “One should simply not brush these ethical issues aside.”

…we need to go back to the guiding principle of group health care—that the way to both lower costs and serve as many Americans as possible is to broaden, rather than shrink, the patient pool. One way to do this is through the plan we’ve been flirting with since the Progressive era—universal health coverage. These days, the case for it seems stronger than ever.

Depending on how it’s structured, universal health care would either limit or eliminate altogether the employers’ responsibility for their workers’ health bills, by transferring greater financial responsibility to an even broader base: the entire population, through some combination of taxes and premiums.

(Jonathan Cohn is a senior editor at The New Republic. He is currently writing a book on the U.S. health-care system.)

http://www.tnr.com/user/nregi.mhtml?i=20051107&s=cohn110705&pt=5%2FcM70%2FKqHd9828cDSfJPW%3D%3D

Comment: The full article is well worth reading for those who want an excellent crash course on the danger of consumer-directed health care.

We are looking forward to the publication of Jonathan Cohn’s new book on the U.S. health-care system. Now, more than ever, there is a greater need for more light and less heat on the subject.

Posted by pnhp at 03:50 PM | Permalink

Kalamazoo Gazette
Friday, October 28, 2005

Remember back in the 1960s when many politicians were having apoplexy over the prospect of Medicare?

Pure socialism, they ranted. It’ll break the bank!

Well, it hasn’t yet, although it has become obvious that Medicare, the health-insurance program for senior citizens, and Medicaid, a companion federal-state program to aid the destitute of all ages, have become hugely expensive and require streamlining and reform.

Now comes Gov. Jennifer Granholm with a suggestion for a national health plan. Is that a risky strategy for Granholm’s campaign for re-election next year?

Maybe not. This is Michigan, after all, and our auto industry is hurting. The big news recently is that Toyota will open a second auto manufacturing plant in Woodstock, Ontario, in 2008.

Toyota executives decided to forgo hundreds of millions of dollars in subsidies from several American states in favor of erecting their new plant less than 25 miles from its second Ontario plant and skilled workforce in Cambridge. It is expected that the new plant will bring well-paying jobs to 1,300 workers who would make 100,000 vehicles annually.

Often, in this space, we have called attention to the importance of a community having skilled workers. That’s why Michigan thrived for so many decades. The Japanese place a great importance on the abilities of the Canadian workers, much more so apparently than they did on those in southern states vying for the new plant.

The Toyota people also are aware of health-care costs. It was reported that because Canada has a taxpayer-supported national health insurance program that covers all citizens regardless of age, Toyota could save $4 to $5 an hour in benefits. Fortunately, the U.S. auto manufacturers and the labor unions have reached agreement on a new contract, which includes health-care provisions.

In America, excellent health care is available for seniors when they reach 65, affluent people who are covered by some type of private policy, or public health insurance for the very poor. But it’s different for tens of millions of our working poor. Many of them, honest and hard-working people, have lost everything they have to an expensive illness. In this land of plenty, that’s disgraceful.

All of these facts have not been lost on Granholm. The governor said Monday that some form of a national health care program — perhaps beginning with the use of public funds to take care of catastrophic costs for citizens of all ages — could be a starter.

Years ago, heads of big corporations and a lot of conservatives would have been aghast over such a plan. But, today, employee health-care insurance premiums are eating many industries alive.

Some otherwise unlikely allies could decide to receive Granholm’s notion with at least a modicum of enthusiasm.

Posted by pnhp at 03:14 PM | Permalink

Medicare Drug Benefit May Expand ‘Catastrophic’ Protection
By Karen Pallarito
Forbes.com
Oct. 26, 2005

The number of seniors protected against formidably high drug costs will increase sharply under the new Medicare prescription drug program, a new analysis finds.

The study focused on the 1.5 million Medicare beneficiaries in the United States who spend more than $4,000 annually on prescription drugs and who lack coverage for so-called “catastrophic” drug costs. These people include individuals who do not have supplemental drug coverage or whose “medigap” insurance does not pay for prescription drugs

“There’s no question of the impact this benefit will have on the lives of those who are dealing with serious illness and their accompanying prescription drug costs,” said Mary R. Grealy, who chairs the Medicare Today partnership. “Our task is simply to get the word out.”

But Robert M. Hayes, president of the Medicare Rights Center, a New York City-based information and consumer advocacy group, said the numbers are somewhat misleading.

“The point of a real Medicare drug benefit would be to assist folks who go without that medication because they cannot afford the $4,000,” he said.

http://www.forbes.com/lifestyle/health/feeds/hscout/
2005/10/26/hscout528779.html

And…

Medicare Prescription Drug Benefit Calculator
The Lewin Group

(The following is an example entered by The Lewin Group to demonstrate the use of the calculator, but you must click “calculate” to get correct results for the example entered.)

Information entered:
$6,000 - Your individual annual drug costs $25,000 - Your annual household income Single - Marital status

Calculated results:
$1,200 - Estimated savings due to Rx plan’s buying discounts $1,500 - Medicare Rx plan’s share of drug costs $3,300 - Your out-of-pocket costs under the new benefit $3,720 - Your costs including estimated premium

The calculator assumes savings to beneficiaries of 20% resulting from bulk purchasing of prescription drugs, compared to the retail prices many seniors face today as individual cash purchasers.

http://webstudies.lewin.com/pdb/medicare2.htm

Comment: Wow! $2,280 savings for $6,000 worth of drugs. Who could ever complain about that?

Before looking closer at these numbers, it’s important to understand that the Medicare drug benefit was carefully designed to advance the conservative agenda of privatizing Medicare. They wanted to allow drug coverage only under the private Medicare Advantage plans to give them a competitive advantage over the traditional Medicare program. But political realities were such that they had to develop some sort of a Medicare D option to provide drug coverage for those remaining in the traditional Medicare program. Otherwise, the Medicare privatization legislation was doomed to certain defeat.

In order to embed the privatization agenda into the public Medicare D program, the conservatives required that the program be administered privately, through insurers and pharmacy benefit managers. They recognized that this private sector drug bureaucracy would consume much of the negotiated discounts because of their very high administrative costs. If Medicare were allowed to negotiate the same discounts, then the entire scheme would fall apart because Medicare would have been granted an “unfair” competitive advantage because of its greater efficiency. Consequently, the conservatives inserted into the legislation a prohibition against government-negotiated drug discounts. Now, let’s look at the numbers.

Suppose Medicare had been allowed to negotiate discounts. The amount of the discount should be greater since the much higher volume of drug utilization would increase drug costs by only the marginal costs of increasing manufacturing volume, a very small percentage of the overall costs for the pharmaceutical industry. But lets ignore this additional savings and assume that Medicare would receive the same discount as the private pharmacy benefit managers, estimated by The Lewin Group to be 20%.

In the example provided by The Lewin Group, the beneficiary pays the first $250, plus 25% of the next $2,000 ($500), plus the full amount between $2,250 and the discounted total of $4,800 ($2,550), and a premium of $35/month ($420), for a total of $3,720. Medicare pays 75% of the amount between $250 and $2,250, or $1500. Since the Medicare portion is paid from tax funds, it is really an allocated portion of pooled consumer funds and, thus, a portion of the costs paid indirectly on behalf of the Medicare beneficiary. So the full amount paid by the beneficiary, directly and indirectly, is $5,220 ($3,720 plus $1,500).

Wait a minute. If Medicare didn’t even set up a drug program but merely negotiated a 20% discount, the cost would have been $4,800. Thus an extra $420 ($5,220 minus $4,800) is the penalty assessed because we prohibited Medicare from negotiating the same discount that the pharmacy benefit managers receive.

This example assumes only a negotiated drug discount for Medicare and nothing else. But suppose that Congress were to authorize a bona fide Medicare drug benefit. We would receive not only the discounts, but also the tremendous power of spreading the risk through an equitable system of funding the program. By expanding the program into a Medicare for All, we would further dilute the costs per beneficiary by including younger, healthier individuals who have little need for drugs now, but who want to have affordable access when they are older and in poorer health.

Privatize Medicare? No way! We need a single payer, national health insurance program. How about Medicare for All?

Posted by pnhp at 02:56 PM | Permalink

By Gregory P. Marchildon
Healthcare Quarterly
Vol 8, No 4, 2005

Abstract:
There has been considerable speculation about the potential impact of the Supreme Court of Canada’s judgment in Chaoulli v. Quebec. Even if those who are most friendly - or most hostile - to Canadian medicare are exaggerating the impact of the decision, its impact will be large. While the decision does not strike down any existing single-payer medicare system in any province, including Quebec’s single-payer system, it is certainly capable of becoming the Magna Carta for two-tier medicare through future judicial interpretation and extension. In any event, it has already become the battering ram of choice for medicare’s most tenacious opponents.

In recent years, the critics of medicare have become more vocal about what they invariably describe as the monopoly of single-payer health care, often comparing Canadian healthcare to the command economy of the former Soviet Union. This perception is not only misleading - it is fundamentally wrong on a number of counts.

In the first place, Canadians are awash in choices when it comes to medicare. We have the freedom to choose our physician. Within our respective provinces and territories, we are free to choose our health institutions - one hospital over another, one clinic over another, depending on our personal preferences. And in contrast to the imagery of a single government bureaucracy perpetuated by the critics of medicare, almost all of our physicians are independent professionals working on fee schedules or contracts freely negotiated with provincial and territorial governments. Many of our clinics are private (not-for-profit as well as for-profit) and the majority of our hospitals are either private not-for-profit institutions or part of regional health authorities that have varying degrees of managerial autonomy from government. This contrasts sharply with the history of the National Health Service in Britain, in which hospitals and their employees all became part of a central government bureaucracy.

In the second place, medicare refers to a quite narrow range of health services - mainly hospital, diagnostic and physician services that are provided on a universal basis and without direct payment by the patient. These services constitute about 43 per cent of total healthcare expenditures in the country. Almost all other healthcare, including home care, nursing home care, prescription drugs, vision care and alternative medicines, are outside the medicare basket. In other words, the so-called monopoly covers less than one-half of Canadian healthcare and does not at all apply to mixed and private sectors of healthcare - sectors in which private insurance, user fees and direct payment are the rule rather than the exception. Moreover, the mixed and private sectors - comprising over 50 per cent of health expenditures - have contributed far more than the public sector to the high rate of growth in healthcare expenditures over the last decades.

Finally, we have always permitted two small exceptions to our single-payer medicare regimes - one private, the other public. On the private side, no one is prohibited from purchasing private health services as long as they pay out-of-pocket for those services from providers who have chosen to be non-participating members of a provincial medicare scheme. On the public side, workers’ compensation health benefits predate medicare and were legally excluded from the operation of the Canada Health Act and provincial medicare laws. Of the two, at least until the Chaoulli decision, the public tier of workers’ compensation has been more problematic in terms of its damage to the principle of universality by allowing a segment of the population preferential access to medicare services, occasionally through non-participating physicians and private facilities.

In contrast, the private exception based upon private payment never really developed in Canada for a number of complex reasons, particularly the refusal of provincial and territorial governments to subsidize private care or encourage physicians to work both sides of the public-private street at the same time. Although I know it is contentious to do so, I would add that the generally high quality of Canadian medicare has also prevented a large private market from developing. At any rate, the very few Canadians who have wanted such services have always been free to purchase them in the United States, where a ready market for privately purchased services has always existed because of the truncated nature of public health insurance in that country.

This brings us to the nub of the Supreme Court’s decision. Despite the lack of evidence, opponents of Canadian-style medicare, including Dr. Jacques Chaoulli, have long argued that the inability to purchase private insurance for medically necessary health services has been the key factor in preventing a viable second tier from emerging capable of competing with publicly administered medicare for customers (Coffey and Chaoulli 2001). They often point to examples such as Australia, where public and private hospital and physician services co-exist. Of course, they conveniently ignore the fact that the Australian government has had to provide a huge public subsidy in the form of a 30 per cent deduction for private insurance premiums to keep the private system in business, an experience that seems common in countries with such two-tier systems. In other words, public funds are often diverted to the wealthier members of society in order to prop up the private tier where it exists.

Proponents of medicare have long argued that to preserve the universality of a system, with access based solely on need, government needs to discourage the emergence of a separate “upper” tier of care based on ability to pay. Most governments in Canada have done so because they wanted to prevent major exceptions to the principle that access should be based on urgency of need. They have also done so to prevent a parallel private system from robbing the financial and human resources needed to run a top-notch public system. To protect their single-payer systems, different provinces have selected different and various means to discourage a second private tier. These means include: not allowing non-participating physicians to charge more than the medicare fee schedule; refunding patients only the medicare portion of fees paid to non-participating physicians; and in the case of six provinces (British Columbia, Alberta, Manitoba, Ontario, Quebec and Prince Edward Island) prohibiting private health insurance for medicare services.

In Chaoulli, the Supreme Court decided that Quebec’s prohibition on private health insurance is contrary to the Quebec Charter of Human Rights and Freedoms when an individual’s lengthy wait for medicare services seriously compromises the health of that individual. The court provided little guidance, however, in helping governments, health organizations and physicians know at what point a waiting time is too long. Moreover, little or no consideration was given to the fact that many provincial governments and health organizations, through initiatives such as the Western Canada Wait List Project and the Saskatchewan Surgical Care Network, have focused their efforts at understanding and shortening wait lists. Indeed, while the degree of success varies across and within provinces, there has been considerable progress in reducing waiting times in many parts of the country in the last couple of years.

Contrary to the majority view of the court, which seemed to swallow the monolithic, monopoly view of the world, medicare is actually a highly local system depending on the management and decisions of individual physicians, hospitals and regional health authorities. It is up to these organizations, under a publicly administered framework provided by the provincial government, to balance the many priorities, from urgent to elective care, and from sickness care to illness prevention and health promotion. We must ask ourselves whether the court’s concern with one waiting list problem in one city in one province is going to end up dictating the priorities of health organizations and governments throughout Canada, even further tipping the balance in favour of downstream illness care and away from prevention and promotion efforts that will keep us all healthier (and at less cost) in the long run.

So, what next?

In the face of this decision, those governments that support medicare should act now rather than waiting for the inevitable offensive driven by the powerful interests supporting the radical privatization of Canadian medicare. Individuals and groups within those provinces can strengthen the resolve of these governments by expressing their support for universal medicare, their opposition to allowing a private upper-tier of care, and initiating their own litigation to support the principles of medicare.

Those provinces that have prohibited private insurance should consider amendments that clarify the reasons for prohibition and the merits of a single-tier system of medicare. The legislative debates will force everyone to make their positions and assumptions clear and will provide an opportunity for medicare-friendly governments to set out the evidence supporting a single-tier system. Once enshrined in law, each government’s legislative intent will have to be taken into consideration in future court rulings.

The provinces that have not previously prohibited private insurance have at least two options open to them. They can re-examine the combination of measures they have used in place of an outright prohibition on private health insurance to protect the integrity of their single-payer systems, and the extent to which their circumstances may be similar to, or different from, the provinces with express prohibitions. They can then amend their own medicare laws to make clear their legislative intent to continue to preserve the integrity of their single-payer systems.

Although unlikely because of the inherent cautiousness of the advice given by health bureaucracies to their political masters, it would be interesting to see at least one provincial jurisdiction carefully draft a new law prohibiting private health insurance for the express purpose of having it tested in the courts, perhaps through a reference case. I am quite sure that it would be relatively easy in such a case to demonstrate the broader point that the policy measures relied upon by any government to protect medicare are better determined by governments accountable to the public through the democratic process than by the courts.

The federal government could also take some long overdue action to enforce the Canada Health Act. There is a reason that Montreal has the largest number of private MRI clinics in the country - a market has been created because of the extremely long waiting lists in the public sector and the willingness of participating physicians to encourage their more well-off patients to jump the medicare queue by getting a private MRI. If the federal government had forced this issue into the public domain years ago through a (temporary) reduction in its transfer payments, the Quebec government might have better ensured timeliness of care through the public system and not relied so surreptitiously on its private release valve. In more general terms, while it is up to individual provinces to decide on how best to administer (and protect) their respective single-payer systems, the federal government needs to continue to ensure that it is effectively discouraging major exceptions to the fundamental principles of public administration, universality, comprehensiveness, portability and accessibility.

Finally, I would like to offer some unsolicited advice to Premier Klein of Alberta, given his comments following the Chaoulli decision. If he truly believes that the founding principles of medicare are fundamentally flawed, then this court decision should finally give him the courage of his convictions. If he truly believes that Albertans endorse his vision, then he should immediately introduce a two-tier system. He can bypass the Canada Health Act by simply refusing federal health transfers in the future. If Saskatchewan was able to go it alone for years when it first introduced medicare, then surely oil-rich Alberta can now afford to go it alone. Albertans could then pay directly out-of-pocket or indirectly through private health insurance for a portion of their medicare services. Access for the majority would be based mainly on “ability to pay,” while access for the very poor (often defined as those on welfare) would be determined by a safety net type medicare program. Where the working poor fit into this picture is a little harder to determine but all Canadians outside Alberta would have a home-grown point of comparison on how the systems stack up against each other.

In the 1960s, this option was called Manningcare because Premier Ernest Manning was convinced of its merits compared to the universal medicare model. Personally, I would be confident that single-tier medicare would prove itself more efficient, effective and equitable in the comparison, just as it has done so relative to the American system. Whether a majority of Albertans would willingly go along with Premier Klein on this trip back to the past is highly questionable. Indeed, I suspect the majority of Albertans remains as opposed to a two-tier system as all other Canadians, a stubborn fact that explains the gap separating Klein’s bravado from his government’s timid actions on the ground.

We all know that the demand for healthcare services is potentially limitless. After protracted debates almost a half century ago, we decided that, at least for medicare services, rationing should be based upon urgency of need rather than ability to pay. Though the majority of Canadians continue to support that democratic decision and the founding principles of medicare, the Supreme Court through its Chaoulli Magna Carta is doing its best to force us back to the drawing board again.

About the Author
Gregory P. Marchildon, is Canada Research Chair and Professor Graduate School of Public Policy, University of Regina and Fellow, School of Policy Studies, Queen’s University. Email: greg.marchildon@uregina.ca.

References
Coffey, J. Edwin and J. Chaoulli. 2001. Universal Private Choice: Medicare Plus. Montreal: Montreal Economic Institute.

Posted by pnhp at 02:53 PM | Permalink

Tarrant’s healthy idea
Brattleboro Reformer
October 26, 2005

IDX co-founder Richard Tarrant may be running for the Republican U.S. Senate nomination in 2006, but when it comes to health care, he has some ideas that are quite different from the same old things we hear from the Republican Party.

Tarrant’s company, which was recently purchased by General Electric for $1.2 billion, specializes in creating computer software for the health care industry. Through his work with IDX, Tarrant says he has a unique perspective on the health care issue.

“I’ve spent 35 years in it,” Tarrant told the Reformer during a meeting with the editorial staff on Monday. “I’ve seen a lot of different health care plans.”

Unlike many Republicans, Tarrant thinks single-payer health care isn’t a terrible thing. One reason why is that, at least for the elderly and the poor, the United States already has a form of it.

“Medicare is a bureaucracy, but it is one of the most efficient bureaucracies out there,” said Tarrant.

Because Medicare works in this regard, Tarrant would like to see it expanded so that the uninsured, small businesses and farmers could participate. It would be means-tested, with premiums based upon the ability to pay. Those who want to participate can do so, or stick with the current private insurance plan they might have.

Ultimately, Tarrant said, he would like Medicare, the elder health care plan, to merge with Medicaid, the health care plan for the very poor. This merger would make providing insurance more efficient.

“You have one plan for Medicare and a different plan in 50 different states for Medicaid,” said Tarrant. “And every state is having trouble paying for it. Medicaid can only be fixed on the federal level and I can see both programs eventually merging.”

Tarrant’s vision of a limited single-payer health insurance system functioning side-by-side with the current free market system is an intriguing idea. Although he didn’t discuss how it would be funded, his proposal certainly doesn’t reflect conservative orthodoxy.

His thoughts on health care may be a sign that Tarrant, who is better known for being one of the richest people in Vermont than for being a political thinker, may have some fresh ideas for next year’s Senate race.

http://www.reformer.com/Stories/0,1413,102~8854~3106021,00.html

Comment: Single payer advocates will be quick to point out that allowing a parallel private health insurance system defeats some of the efficiencies and equities of a single payer system. But what a shift in health policy views for a Republican!

It is anticipated that Independent Bernie Sanders, a very popular Vermont politician and outspoken single payer supporter, will be a candidate for the U.S. Senate. It may be that Tarrant’s statement on single payer is defensive posturing. But even if so, it is gratifying to see that a successful Republican businessman recognizes the validity and credibility of the single payer model.

Posted by pnhp at 02:22 PM | Permalink

WellPoint’s 3Q Profit More Than Doubles
By The Associated Press
The New York Times
October 26, 2005

WellPoint Inc. on Wednesday said earnings for the third quarter more than doubled as the company continued to reap the benefits of last year’s merger creating the largest health insurer in the U.S.

The company was formed last November when Indianapolis-based Anthem Inc. bought Thousand Oaks, Calif.-based WellPoint Health Networks Inc. and changed its name to WellPoint Inc.

(Third quarter) net income rose to $640.7 million, or $1.02 per share, from $242.1 million, or 85 cents per share.

Improvement at the company’s health-care segment was driven by strong membership growth, moderating medical costs in the current year, and synergies realized from the WellPoint-Anthem combination.

WellPoint is in the process of acquiring WellChoice, parent of Empire Blue Cross and Blue Shield. For 2006, WellPoint said it remains committed to its goal of achieving 15 percent growth in net income per share, not taking into account any effect from the WellChoice acquisition or from expensing stock options.

http://www.nytimes.com/aponline/business/AP-Earns-WellPoint.html

Comment: Why should we care about another ho-hum report on the profits of the nation’s largest health insurer? Well, theoretically, as health care consumers we are paying WellPoint and the other insurers for the services that they provide. So it’s fair to ask what benefits we are receiving from this very expensive, highly profitable enterprise. (Although I’ll use WellPoint in this discussion, the principles apply generally to the entire private insurance industry.)

Health care coverage in the United States is heavily dependent on employment-based plans. Our national and state policies are designed to protect and nurture this important sector of health care coverage. Policies have been established to be certain that this industry thrives, even if more and more burdens are being placed on employers and their employees. Without healthy insurers, our system of funding care would collapse (unless structural reform were enacted).

So who is covered under employer-sponsored plans? The nation’s workforce. These are comparatively young, healthy, gainfully employed individuals and their young, healthy families. Insurance is about pooling risk wherein the large numbers of healthy individuals pay into a pool to cover the high costs of the few with major health problems. But employment-based coverage segregates this very large sector of primarily healthy individuals and places them into a separate low-cost pool. So we have presented, on a silver platter, to the private insurance industry this highly lucrative sector, while relieving them of the need to cover most of us who do have significant health care needs.

What about private individual coverage? The story is much worse. The higher administrative costs of the individual market drive rates up to about 30% higher than comparable group coverage. Since these costs would make individual coverage unaffordable, the industry has responded by shifting costs from the insurer to the individual patient. Everyone is aware of the impact that this has had on individual bankruptcy, in spite of having insurance coverage. Even more alarming, the private insurers have been quite successful in excluding those with needs from individual coverage, either by exorbitant premiums or by underwriting exclusions. Once again, our policies have allowed the private insurance industry to skim off the healthy, leaving the sick behind.

Is the private insurance industry helping us to fund the care of those who do have significant needs? End of life care is shifted to the taxpayers through the Medicare program. Many of those with chronic disabilities are shifted to the Medicare and Medicaid programs. The uninsurable theoretically are shifted to high-risk pools, but they don’t exist in many states, and are non-accessible because of minuscule quotas and high premiums in most other states. Some low-income individuals with a high incidence of health care disparities are covered by the taxpayer-funded Medicaid program. And 46 million, mostly employed, low-income individuals, are not served by the private plans simply because they do not have the funds to support the insurance industry.

If the private insurers are avoiding risk pooling and are shifting costs to patients, then what are they selling us? Administrative services! Hundreds of billions of dollars in administrative services (though some of that is the wasteful administrative burden that they place on the health care delivery system).

WellPoint’s $641 million profit this quarter, annualized with the projected 15% increase means that WellPoint will have almost $3 billion in profits next year. But that number is dwarfed by the cost of the egregiously wasteful administrative services that they are foisting off on us.

19% of health care in the United States is funded through employer-sponsored plans. The other 81% is through public programs and private spending. Yet our legislators take far better care of the private insurers than they do us.

The insurers shun the sick, steal our money, and Congress and our state legislators want to keep them in charge!?

Posted by pnhp at 02:44 PM | Permalink

Effects Of Physician-Owned Limited-Service Hospitals: Evidence From Arizona
By Jean M. Mitchell
Health Affairs
October 25, 2005

In recent years physician ownership of so-called limited-service hospitals has become commonplace in many states lacking certificate-of-need regulations. Empirical evidence documenting the effects of these facilities is sparse. This study compares practice patterns of physician-owners of limited-service cardiac hospitals and physician-nonowners who treat cardiac patients at competing full-service community hospitals. Analyses of six years of Arizona inpatient discharge data show that physician-owners treat higher volumes of profitable cardiac surgical diagnosis-related groups (DRGs), higher percentages of low-severity cases, and higher percentages of cases with generous insurance compared with physician-nonowners who treat cardiac patients in community hospitals.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.481v1

And…

The Rise Of The Entrepreneurial Physician
By Allen Dobson and Randall Haught
Health Affairs
October 25, 2005

…after reviewing the evidence, we note that physicians’ demands for more clinical autonomy and control over their incomes will not go away if specialty hospitals are “banned.” The emergence of specialty hospitals is a manifestation of a larger issue: the rise of the entrepreneurial physician. In response, community hospitals are partnering with physicians in numerous creative ways. Thus, the future outlets for physician demand for clinical and economic control may go beyond specialty hospitals to include variants of partnering between community hospitals and physicians, and perhaps gain-sharing arrangements or pay-for-performance systems as advocated by the CMS and MedPAC.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.494v1

Comment: There is no dispute that physicians who own specialty hospitals admit higher volumes of more profitable patients with better insurance coverage while avoiding less-profitable, complex cases. Although advocates of physician-owned specialty hospitals argue that market competition with community hospitals results in a higher quality product, there is no evidence for that.

The true reason for skimming off more profitable patients is very clear. The physician is using the single patient to provide fees for professional services and to provide investment income for a parallel entrepreneurial venture. Professional fees and investment income are each legitimate, independent sources of income. But does it matter that they arise from the same patient source?

Advocating for the best care for the patient has traditionally been rewarded with professional fees. Although fee-for-service can result in excessive services, and salaries can result in sloth, in general, payment for professional services serves the patient fairly well.

What about receiving entrepreneurial income in caring for the same patient? In order to create a maximum return on investment, decisions are made on a business model basis. That may or may not benefit the patient, but that doesn’t matter as long as it has a positive impact, or at least no negative impact, on the specialty-hospital market. It does not take much imagination to think of measures that would increase revenues (e.g, high-tech services of questionable value) and other measures that would decrease expenses (e.g., a cheaper but less-tested, implantable cardio-defibrillator). Since the patient-care algorithm and the business-decision algorithm frequently depart at various junctures, a physician could never escape the fact that a conflict exists, no matter how altruistic that physician is.

A greater concern for many of us is the financial burden that is placed on community hospitals when the profitable patients are diverted away. Community hospitals already have the burden of providing uncompensated care which, hopefully, can be offset by insured patients. But when they lose the better-insured patients, their safety-net function is threatened. Do we really want to support a few specialty hospitals as a tradeoff for accepting under-funded mediocrity for the rest our community hospital needs?

Dobson and Haught suggest that, since we are in the age of the entrepreneurial physician, community hospitals can compete by making “gain-sharing arrangements” with physicians. When we accept the fact that market competition must be the driving force in health care, it leads to perverse concepts such as the need to supplement professional income with entrepreneurial gain-sharing income. Kickbacks and fee-splitting are historical terms that have no significance in today’s entrepreneurial environment, but maybe we should give more thought as to why they were made illegal.

We need comprehensive structural reform in the way that we fund health care. We should pay physicians, and pay them well, simply for caring for their patients. A national health insurance program would do that, but it would also establish safeguards against perverse non-professional income that might be deleterious to the patient or to the health care system as a whole. And, besides, physicians would have complete freedom to invest elsewhere.

Posted by pnhp at 02:34 PM | Permalink

By Jonathan Tasini
October 25, 2005
TomPaine.com

It is a measure of our lowered expectations, fueled by media spin, that people shrugged and seemed to think that it was inevitable that workers for General Motors were destined to have their health care coverage slashed. After all, some seemed to think, at a time when their company is teetering on the edge of oblivion, these “privileged” auto workers had “gold-plated” coverage that almost no other workers in America have.

But let’s be clear: The loss of benefits for GM workers was not inevitable. It happened as a result of many years of bipartisan political and economic decisions and the bipartisan lack of political courage to take on dumb ideology and corporate power.

In the minds of the elites, socking workers with a larger share of the costs of health care is just a natural part of the new economic order. As the Wall Street Journal editorial board said about the health care cost-cutting deal between GM and the United Auto Workers, “We hope it’s the beginning of wisdom about the global economy for the American labor movement.” Speaking about UAW president Ron Gettelfinger, Delphi CEO Steve Miller—who took his company into bankruptcy—said, “He’s going to have to help half a million of workers get used to the idea that globalization has taken away the ability to have someone who mows the lawn or sweeps the floor get $65 an hour.”

At least one thing is refreshing: It exposes as a fraud the liberal and conservative mantra about the wonders of the global economy. Democrats and Republicans alike—from Bill Clinton to George Bush, with a supporting cast of media and academic geniuses—have repeatedly told workers that the global economy will bring great benefits to America, after a period of “adjustment.” To their credit, Steve Miller and the Journal are more honest: The global economy is a tool to drive down living standards, starting with health care. Get with it, folks: Living large is so “old economy.”

So, the first obvious point to make is that employer-provided health care coverage has failed. Workers should never face the choice between sickness and financial ruin simply because the company they work for is going under, poorly managed or because they change jobs. More important, this has become, as I pointed out some months ago, a matter of economic competitiveness for corporations based in the United States: The health care system is dragging down profits.

The second point, then, is that health insurance can never be left to those whose sole motivation is profit. The last time health care was debated, the Clinton administration lost its nerve—or, perhaps, never had any other intention to pursue a system other than one that was destined to perpetuate the existing ideological flaws. “Hillarycare” was a disaster for the public not because the mismanaged process produced an overly complex system. Rather, the Clintons made a conscious decision to leave health care in the hands of the private insurers—which allowed the HMO industry to grow, if you’ll pardon the expression, like a malignant tumor.

If we had different philosophy, GM workers’ health care would never change. As Ida Hellander, executive director of Physicians for a National Health Program (PNHP), puts it, “Political will is infinitely harder to muster, especially when Congress is owned by the drug and insurance companies.” PNHP has a very straightforward set of four principles guiding its universal health care proposal, which I think, if properly understood by the public, would send millions of people to the streets demanding immediate change:

• Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to assure this right. Coverage should not be tied to employment. Private insurance firms’ past record disqualifies them from a central role in managing health care.

• The right to choose and change one’s physician is fundamental to patient autonomy. Patients should be free to seek care from any licensed health care professional.

• Pursuit of corporate profit and personal fortune have no place in caregiving and they create enormous waste. The U.S. already spends enough to provide comprehensive health care to all Americans with no increase in total costs. However, the vast health care resources now squandered on bureaucracy (mostly due to efforts to divert costs to other payers or onto patients themselves), profits, marketing and useless or even harmful medical interventions must be shifted to needed care.

• In a democracy, the public should set overall health policies. Personal medical decisions must be made by patients with their caregivers, not by corporate or government bureaucrats.

The economics of a single-payer, universal health care system are unassailable. It would save $300 billion in administration costs. It would be financed partly by the 60 percent of taxes that already go into the health care system via Medicaid, Medicare and payments for public employee coverage. The rest of the financing, over the long term, would be easily done with modest tax increases (by a 7 percent payroll tax and a 2 percent progressive income tax) —and result in better health care for people for less money than people shell out in ever-rising deductibles. With one bold stroke, a single-payer system would do more to help the bottom line of companies than any tax break or so-called “free trade” agreement.

The troubling reality to the arguments I’ve made is that they are not particularly original: The moral and economic need for a universal health care system has been well-known for a very long time. The only question now is: How many companies will have to go belly up and how many more millions of workers will face bankruptcy and illness because we allow ideology—the deification of the so-called free market—to triumph over common sense?

Jonathan Tasini is president of the Economic Future Group and writes his “Working In America” columns for TomPaine.com on an occasional basis. His blog Working Life chronicles the labor movement and other issues affecting American workers.

www.tompaine.com/articles/20051025/diagnosis_for_america.php

Posted by pnhp at 02:29 PM | Permalink

Wal-Mart to Expand Health Plan for Workers
By Michael Barbaro
The New York Times
October 24, 2005

Wal-Mart, which has long been criticized for the benefits it offers to its workers, is introducing a cheaper health insurance plan, with monthly premiums as low as $11 (available in a handful of areas), that the company hopes will greatly increase the number of its employees who can afford coverage.

Jumping into a new area, Wal-Mart is also offering health savings accounts, which the federal government introduced last year. Few employers offer them.

The new benefits, which Wal-Mart calls the Value Plan, follow years of complaints that at Wal-Mart, the nation’s largest employer, health insurance is out of reach for many of its 1.2 million workers in the United States, forcing thousands of them to turn to state-sponsored programs or forgo health coverage altogether.

Health insurance specialists generally praised the new plan, saying its lower premiums were likely to attract more employees and thereby reduce the ranks of the uninsured. They also noted, however, that the plan’s $1,000 deductible would be high for Wal-Mart workers…

But the plan is unlikely to cover a complicated illness or expensive hospital stay during the first year, when there is a $25,000 insurance cap. (The cap is lifted for the second year.) Out-of-pocket payments range from $300 for prescriptions to $1,000 for hospital stays.

The company’s health savings accounts will combine low monthly premiums with a requirement that individuals cover a substantial part of their own health care costs.

Several health insurance specialists questioned whether the company, which is working to burnish its public image, was trying to quickly increase the number of workers who use its health insurance at the expense of the coverage’s quality.

http://www.nytimes.com/2005/10/24/business/24mart.html

Comment: Although we do not yet have the details of Wal-Mart’s Value Plan, enough information has been released to raise very serious questions about whether this coverage provides financial security for those with medical needs.

Although the premiums will be very low, they likely would not be affordable for an individual that has no discretionary income, which is the case for most Wal-Mart employees.

Health savings accounts are advantageous for higher-income individuals since they are subsidized by the taxpayer. But most Wal-Mart employees would not receive any tax subsidy for these accounts because their incomes are too low to pay income taxes. Why would they place personal funds in an account that provides no advantage but that would be penalized if they used their funds for other essential needs, such as food or rent? Besides, they simply do not have the extra income to fund a savings account even if they wanted to.

Although three visits are covered before the deductible kicks in (to encourage preventive services), a $1000 doughnut hole so early in accessing the benefits creates a chasm which most would not be able to ford.

And a major catastrophic event would leave many individuals exposed since the costs typically would exceed the $25,000 cap.

We already know that under-insurance perpetuates many of the problems experienced by the uninsured, such as impaired access due to lack of affordability, with resultant impaired health outcomes. But this degree of under-insurance in an employee population with very low incomes creates yet a new category of insurance: pseudo-insurance. It looks like insurance, but it isn’t.

Posted by pnhp at 03:39 PM | Permalink

GM DEAL: Cries of pain mix with sighs of relief
By Michael Ellis
Detroit Free Press
October 21, 2005

The UAW unveiled details of the much-anticipated health plan Thursday. Under it, retirees would have to pay monthly premiums and annual deductibles.

Active hourly workers at GM would defer $1 an hour from pay increases they were due in 2006, or about $2,000, into a fund to pay for their health care. By the end of 2006, that deferral would increase by 2 cents an hour every quarter.

With the concessions, GM hourly retirees would pay a maximum of $752 per family each year for health care, or $370 annually for an individual, plus co-payments for prescription drugs.

The package would create a defined contribution plan to help pay for health care costs. GM plans to contribute $3 billion — with $1-billion payments in 2006, 2007 and 2011. Wage deferrals by hourly workers would help fund the plan, which the UAW would administer.

“It’s a concrete demonstration of the health care crisis in our country,” said Richard Block, a labor professor at Michigan State University. “Everybody’s getting poorer because of health care.”

http://www.freep.com/money/autonews/gm21e_20051021.htm

Comment: This is the end of an era. The auto industry is the largest and the last of private employers to have provided complete health care coverage as a benefit of employment. They have now introduced cost sharing and defined contribution funding which transfers to the employee some of the responsibility for funding care.

The changes are quite modest compared to what has already happened to employer-sponsored coverage in other industries and services. Larger deductibles, the shift to coinsurance from co-payments, defined contributions in segregated accounts, innovative reductions in benefits, and other measures have all served to shift more and more of the costs from the employer to the individual.

All of this is in the name of making health coverage more affordable to the employer. The obvious trade-off is that it makes health care less affordable to the individual. This shift addresses the employers’ concerns over escalating health care costs, but in shifting those costs to the employees, it does absolutely nothing to address the fundamental underlying problem. Health care costs continue to skyrocket. Shifting those costs to the hapless employee can have only one outcome: the employee and his or her family members will be empowered to not receive the health care that they can no longer afford.

Although it seems that this is simply the end of the era of 100% coverage, we are really witnessing a process that will end the role of the employer as the guarantor of health care services. As the cost of coverage continues to rise, employers will further reduce or even eliminate benefits. The financial burden shifted to individual employees will be truly excessive and the entire employment-based system will collapse.

Anticipating this, many policymakers are encouraging a shift to the individual insurance market, a market that is characterized by underwriting requirements, greater administrative costs, Spartan coverage, higher cost sharing, and a relaxed regulatory environment. Individual coverage, as a universal or near-universal system, will never fly because it will be so heavily weighted down with financial burdens that it cannot possibly get off the ground. The reason that our fragmented system of individual and group plans is doomed is that they are unable to address the overriding issue: escalating health care costs.

To control costs, a system must be in place that is targeted to cost excesses. The tremendous administrative waste can be dramatically reduced by using a single, efficient administrative payer. Wasteful high-tech excesses can be reduced by ensuring appropriate capacity through planning of capital improvements, budgeted by a single payer. Greater efficiency can be established by strengthening our primary care infrastructure through incentives established by a single payer. Excessive pricing can be reduced through negotiation with a single payer.

Although the employment-based system is self-destructing, and the individual market will never get off the ground, the good news is that we can achieve affordable access to comprehensive care for everyone. As the current system continues to implode, the logic of a single payer becomes ever more apparent.

Posted by pnhp at 03:12 PM | Permalink

For Immediate Release: June 2, 2004

Contact:
NCHS/CDC Public Affairs, (301) 458-4800
E-mail: nchsquery@cdc.gov

The Joint Canada-United States Survey of Health (JCUSH)
View/download PDF 496 KB

The overwhelming majority of Americans and Canadians rate their health as good, very good or excellent, but there are differences in key risk factors and patterns of health care in the two countries, according to the first joint U.S.-Canadian health survey released today by the Centers for Disease Control and Prevention (CDC) within the U.S. Department of Health and Human Services. Overall, Americans were more likely than Canadians to report that they were very satisfied with health care (53 percent compared to 44 percent), but findings for uninsured Americans accounted for significant differences between the countries in a number of categories.

The Joint Canada/U.S. Survey of Health, conducted by Statistics Canada and CDC’s National Center for Health Statistics, covered measures of health status, risk factors, health disparities, access to health care, and quality of and satisfaction with health care services. Because the survey contacted a representative sample of adults in each country and asked for exactly the same information in the same manner in a one-time telephone interview, this survey achieves a degree of comparability never before attained.

In the survey, people were asked to rate their health from poor to excellent, and 85 percent of Americans and 88 percent of Canadians reported that they were in good, very good or excellent health. Americans were slightly more likely than Canadians to rate their health as excellent (26 percent compared to 24 percent). This was particularly true for senior citizens; almost twice as many Americans 65 and over (15 percent compared to 8 percent) reported they were in excellent health. Americans were also slightly more likely to indicate that their health was only poor or fair (15 percent compared to 12 percent). Among low-income respondents, 31 percent of Americans said they were in fair or poor health, compared with 23 percent of low income Canadians.

The survey looked at measures of physical and mental health. Overall, 25 percent of Americans and 24 percent of Canadians reported some level of mobility limitation (problems with walking, standing or climbing). More Americans, particularly American women (7 percent compared to 4 percent), report highly severe mobility limitations. Approximately 8 percent of adults and 10 percent of women in both countries had experienced a major depressive episode in the past year.

Two key risk factors - smoking and obesity - were examined. Canadians were more likely than Americans to be current daily smokers (19 percent compared to 17 percent) and this difference was more pronounced among older women. However, a significantly higher proportion of Americans than Canadians are obese, primarily because among U.S. women the rate of obesity is nearly twice that of Canadian women. In both countries, those with the lowest incomes report poorer health and higher rates of severe mobility limitations as well as higher levels of smoking and obesity.

Since the health systems and the role of public and private insurance differ in each country, another important aspect of the report compares access to health care and people’s satisfaction with the health care they receive. Americans were more likely to report that the quality of their health care services in general was excellent compared with Canadians (42 percent compared to 39 percent.) Among uninsured American respondents, 28 percent said the quality of the health care services they received was “excellent,” 44 percent “good,” and 28 percent “fair” or “poor.” When asked about their satisfaction with health care services in general, 53 percent of Americans and 44 percent of Canadians said they were “very satisfied,” while 37 percent of Americans and 43 percent of Canadians said they were “somewhat satisfied.” Among uninsured Americans, 39 percent were “very satisfied” with the services they received, and 40 percent were “somewhat satisfied.”

Unmet medical needs during the past 12 months were reported by 13 percent of Americans and 11 percent of Canadians. Among those with an unmet need, Americans were more likely to identify cost as the primary barrier to health care (53 percent of unmet needs cases), while Canadians cited waiting for care as the primary barrier (32 percent of cases). Among the 11 percent of American respondents who were uninsured, four out of every ten reported an unmet medical need. Likewise, only 43 percent of the uninsured respondents said they had a regular medical doctor, compared with 80 percent of total American respondents and 85 percent of Canadian respondents.

The overall pattern of the use of prescription medicine was similar in the two countries, with use higher among those 65 years of age and older and among women. However, there was higher prescription drug use among Americans aged 45-64 than Canadians in this same age group.

The Joint Canada/US Survey of Health was conducted from November 2002 through March 2003 with a representative sample of civilian, non-institutionalized population of adults 18 and over; the sample size was approximately 3500 Canadians and 5200 Americans. For more information about the survey and a copy of the report check the Joint Canada/US Survey of Health website.

Posted by pnhp at 02:46 PM | Permalink

by Lloyd Grove
New York Daily News
October 17, 2005

Who knew that the multibillion-dollar U.S. pharmaceutical industry was so keen on publishing pulp fiction?

In a tale worthy of a zany Washington satire - except for the lamentable fact that it’s true - the rich and powerful pharmaceutical lobby secretly commissioned a thriller novel whose aim was to scare the living daylights out of folks who might want to buy cheap drugs from Canada.

When the project fell through in July, I’m told the drug lobby offered $100,000 to the co-authors and publisher in a vain effort to sweep it under the rug.

Talk about thinking outside the box!

“This is the most outrageous example of deception and duplicity on the part of a Washington lobby in the history of the country,” said Capitol Hill denizen Jeff Weaver, chief of staff to Rep. Bernie Sanders (I-Vt.), a diehard foe of the pharmaceutical industry.

Drug-lobby mouthpiece Ken Johnson, executive vice president of the Pharmaceutical Research and Manufacturers of America, acknowledged the hare-brained scheme but shifted blame.

“We did not commission a book,” Johnson argued. “The idea was brought to us by an outside consultant. We explored it, provided some background information … but in the final analysis, decided it wasn’t the right thing for us to do.”

I’m told that Mark Barondess, a well-known divorce lawyer in Washington, D.C., was the so-called outside consultant and approached L.A.-based Phoenix Books with the novel idea.

Phoenix honcho Michael Viner, who happens to be Barondess’ publisher, struck a six-figure deal. I’m told PhRMA made at least one payment to Phoenix.

Viner declined comment, and Barondess didn’t respond to my detailed message.

Work began in April, after Viner hired veteran ghostwriter Julie Chrystyn. Her story concerned a Croatian terrorist cell that uses Canadian Web sites to murder millions of unwitting Americans looking for cut-rate pharmaceuticals.

PhRMA has vigorously fought all efforts to legalize the purchase of cheap drugs from Canada. Even though the lobby has found some success, the underground business still takes an estimated $1 billion in annual profits from American drug behemoths.

Chrystyn titled her thriller-in-progress “The Spivak Conspiracy,” an homage to her friend Kenin Spivak, an L.A. telecomm entrepreneur and onetime Hollywood exec.

Spivak said he became Chrystyn’s co-writer after she delivered the first 50 pages, and PhRMA made several editorial suggestions.

“They said they wanted it somewhat dumbed down for women, with a lot more fluff in it, and more about the wife of the head Croatian terrorist, who is a former Miss Mexico,” Spivak told me.

Apparently, women are among the most loyal buyers of Canadian drugs.

“They also wanted to change the motivating factor of the terrorists to greed, because they didn’t want it to be politics,” Spivak said. “They wanted lots of people to die.”

Spivak told me that since PhRMA pulled out - and he and his colleagues rejected the lobby’s offer of $100,000 to kill the project - he and Chrystyn have finished a revised version, “The Karasik Conspiracy,” due early next year.

Posted by pnhp at 02:36 PM | Permalink

Payroll, income taxes would cover costs
By David Wenner
The Patriot-News (Harrisburg, PA)
Tuesday, October 18, 2005

A grassroots organization yesterday proposed tearing down the health insurance system in Pennsylvania and building a new one that would cover everyone.

The proposal calls for universal coverage through a single-payer system that would pay 100 percent of medical and prescription drug costs while involving no direct charges to patients.

It would cost an estimated $43 billion annually and be funded through a 10 percent tax on business payrolls and a three percent tax on personal income.

Supporters says the winners would be state residents and businesses who can’t afford the high cost of health care, and the losers would be drug companies and health insurers.

Drug companies would lose because the system would obtain bulk discounts on drugs, and insurers would lose because they would no longer be needed, said Steve Larchuk, a Pittsburgh-area lawyer and a leader of Pennsylvania Healthcare Solutions Coalition, which has proposed the system.

The insurance industry, including Pennsylvania’s four Blue Cross-Blue Shield plans, will fight to preserve the existing system, Larchuk said.

“I expect the Blues will fight to the death to stop any kind of health care reform. But that’s a battle we have to fight sooner or later; and if we’re unwilling to fight that battle, we might as well hand the keys to the Capitol to the Blues right now,” he said.

Charlie Crystle, a Lancaster business owner and member of the coalition board, predicted businesses will support the single-payer system because the proposed payroll tax would be less than they now pay to provide health insurance for workers.

Larchuk said organizers have been working at the grassroots level for about a year, and avoiding involvement of politicians because the issue is so political.

The idea of universal, single-payer health insurance isn’t new.

Proposals exist in several states, Larchuk said.

Yesterday, supporters began visiting state legislators and passing out a draft of a bill to create the single-payer system.

Amy Kelchner, a spokeswoman for Gov. Ed Rendell’s Office of Health Care Reform, said Rendell is interested in any proposal to provide universal health insurance.

The administration recently received a federal grant it will use to explore universal coverage, she said.

The Pennsylvania Medical Society, the lobbying group for doctors, received the proposal yesterday and wasn’t ready to comment, spokesman Chuck Moran said.

State Sen. Pat Vance, R-Cumberland, a leader on health care issues in Pennsylvania, also said she had just heard of the proposal and hadn’t formed an opinion.

Cliff Shannon, president of SMC Business Councils and a leading advocate for health insurance reform in Pennsylvania, said no reform will succeed unless it includes a way to limit the cost of health care.

An uncapped, mandatory tax on businesses would have “no chance” of acceptance from businesses, he said.

Mike Fiachetti, a senior vice president for Highmark Blue Shield, said that with the high cost of health care, it’s no surprise that people are proposing a single-payer system.

But he said there’s no “silver bullet” solution for out-of-control health care costs.

“This all sounds good on paper, but there are so many things missing, it’s hard to even comment,” he said.

DAVID WENNER: 255-8172 or dwenner@patriot-news.com

Posted by pnhp at 02:29 PM | Permalink

UAW statement on tentative agreement with GM
UAW
October 20, 2005

UAW President Ron Gettelfinger and Vice President Richard Shoemaker:

“The tentative agreement asks every UAW-GM member, active and retired, to make sacrifices so that everyone can continue to receive excellent health care coverage today and in the future.

“We believe the tentative agreement is an innovative and equitable way to address the health care cost issue at GM.

“However, as we have said many times before, no one union and no one company can solve America’s health care crisis. America is the only advanced nation in the world without some form of national health care - and U.S. businesses and America’s working families are paying a high price for this nation’s uncompetitive public policies. Indeed, GM, Ford and DaimlerChrysler are benefiting from Canada’s national health care system.

“The UAW has long advocated single-payer national health insurance as the most cost-effective and fairest way to fix America’s health care crisis.
Today, we are more determined than ever to make single-payer national health insurance a reality.”

http://www.uaw.org/news/newsarticle.cfm?ArtId=359

Comment: So are we.

Posted by pnhp at 11:16 AM | Permalink

The Wall Street Journal
October 20, 2005
The Harris Poll

“Please indicate whether you support or oppose the policy.”

“Universal health insurance”

75% - Strongly/Somewhat Favor
17% - Strongly/Somewhat Oppose

http://online.wsj.com/article/SB112973460667273222.html

Posted by pnhp at 02:48 PM | Permalink

Center for Studying Health System Change October 2005 Perception, Reality and Health Insurance: Uninsured as Likely as Insured to Perceive Need for Care but Half as Likely to Get Care By Jack Hadley and Peter J. Cunningham

While considerable research shows that uninsured people are less likely to seek and receive medical care, some contend that the uninsured are uninsured by choice and can obtain care when needed. A new study by the Center for Studying Health System Change (HSC), however, undercuts the validity of this contention, finding that there is no difference between insured and uninsured people’s perception of the need to see a medical provider when they experience a serious new symptom. However, among people who believed that they needed medical care, the uninsured were less than half as likely to see or talk to a doctor, indicating that lack of insurance is a major barrier to uninsured people getting needed medical care.

http://www.hschange.org/CONTENT/790/

Comment: One again, lack of health insurance is a major barrier to care for individuals with serious symptoms. How can the opponents of reform continue to dismiss this as merely a matter of personal choice?

Posted by pnhp at 02:46 PM | Permalink

Waiting Your Turn: Hospital Waiting Lists in Canada, 15th Edition
By Nadeem Esmail and Michael Walker
The Fraser Institute
October 2005

Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, fell from 17.9 weeks in 2004 back to the 17.7 weeks last seen in 2003.

The 2005 Waiting Your Turn survey indicates that waiting times for medical treatment in Canada have fallen slightly from 2004, but remain at a very high level historically. Even if one debates the reliability of waiting list data, this survey reveals that specialists feel their patients are waiting too long to receive treatment.

The survey was conducted in all 10 Canadian provinces. Cornerstone List Fulfillment provided mailing lists, drawn from the Canadian Medical Association’s membership rolls, for the specialists polled. Specialists were offered a chance to win a $2,000 prize (to be randomly awarded) as an inducement to respond. Survey questionnaires were sent to practitioners of 12 different medical specialties: plastic surgery, gynaecology, ophthalmology, otolaryngology, general surgery, neurosurgery, orthopaedic surgery, cardiac and vascular surgery, urology, internal medicine, radiation oncology, and medical oncology.

http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=801

A question from the survey (Appendix 2):

4. From today, how long (in weeks) would a new patient have to wait for the following types of elective surgery or diagnostic procedures? What would you consider to be a clinically reasonable waiting time for these types of surgery and procedures?

Chart 14: Median Actual Wait Versus Median Clinically Reasonable Wait by Specialty for Canada: Weeks Waited from Appointment with Specialist to Treatment in 2005

(median actual wait/median clinically reasonable wait)

Plastic Surgery (20.9/10.0)
Gynaecology (7.1/5.4)
Ophthalmology (13.1/7.7)
Otolaryngology (9.0/5.9)
General Surgery (6.2/4.0)
Neurosurgery (7.8/4.3)
Orthopedic Surgery (25.3/10.0)
Cardiovascular Surgery - urgent (1.1/0.7)
Cardiovascular Surgery - elective (5.2/4.2)
Urology (5.3/3.5)
Internal Medicine (6.3/3.1)
Radiation Oncology (4.1/3.7)
Medical Oncology (2.6/2.6)

http://www.fraserinstitute.ca/admin/books/chapterfiles/wyt2005.pdf#

Comment: It is important that reform advocates understand this report. It is the primary source used by the opposition to condemn the Canadian health care system for its outrageous delays in providing access to life-saving care. It is the product of The Fraser Institute, an organization which, according to their mission statement, “has as its objective the redirection of public attention to the role of competitive markets in providing for the well-being of Canadians.”

The study was limited to Canadian specialists, heavily weighted toward procedural rather than cognitive fields. This sector of physicians represents those who have a bias toward privatization since the market allows more freedom to enhance personal income. These individuals have an interest in demonstrating that the public system is a disaster and that patients must be granted the option to buy their way to the front of the queue. Fraser understands this sector well since they knew that they could entice a greater response by offering a cash reward.

When the specialists were asked to estimate the actual wait versus the reasonable wait, they listed them in two columns, side by side. So not only were they motivated to estimate greater delays, they were also motivated to provide estimates that would confirm that these were unreasonable delays.

What did the results show? For most specialties, the differences were not that unreasonable. When correcting for bias, the only real differences were in orthopedic surgery, plastic surgery and ophthalmology. (Internal medicine is a special case, not addressed here.) There is a need to increase capacity for orthopedics and ophthalmology, and efforts to do so are already underway.

One of the most disconcerting claims that we see in the conservative literature is that people are dying because they can’t gain timely access to urgent cardiovascular surgery or to treatment of their newly diagnosed malignancies. Even this biased study confirms that such claims are pure fiction.

Posted by pnhp at 03:36 PM | Permalink

Wednesday, October 19, 2005
San Francisco Chronicle
Page C1

By David Lazarus

And so the demolition derby that is the U.S. health care system shifts into high gear.

Mighty General Motors, the world’s largest automaker and biggest private-sector purchaser of health insurance, said this week that it’ll slash its $5.6 billion annual health care spending for workers, retirees and their families by about $1 billion a year.

For its part, the United Auto Workers, one of the nation’s most powerful unions, is apparently prepared to swallow this hit to organized labor’s most sacrosanct benefit to forestall additional job cuts.

We have reached a critical turning point in the decline of health care in the United States, one almost certain to expand the already appalling figure of 45 million people lacking health coverage nationwide.

“It’s not just a breaching of the social contract that’s existed between companies and workers,” said David Autor, an associate professor of economics at the Massachusetts Institute of Technology. “It’s a reflection of how health care costs are out of control.

“Hopefully this will be an opportunity for government and companies to rethink how health care is provided,” he added. “The old system is clearly breaking down.”

Since World War II, the old system has been predicated on the notion that employers will bear the primary cost of insuring U.S. workers and their families.

That system, as the GM announcement plainly illustrates, is no longer viable in the face of double-digit annual increases in health care costs. Businesses have responded by insisting that workers — and especially retirees — shoulder more of the burden of their health coverage.

To be sure, GM has been rewarding its more than 750,000 union members, retirees and their dependents with an uncommonly generous benefits package. The company also faces numerous other issues that affect its profitability (or lack thereof; GM reported a staggering $1.6 billion loss for the latest quarter).

But health care is undeniably one of the automaker’s biggest headaches. GM estimates that health care adds about $1,500 to the cost of every vehicle it sells in North America.

The company’s chief exec, Rick Wagoner, told employees on Monday that health care is an issue “of great importance for the future of overall U.S. competitiveness.”

He also all but pleaded with political leaders to do something about the situation.

“We would welcome a more proactive role from elected officials at the national and state levels in broad-based strategies to address the U.S. health care crisis,” Wagoner said.

Helen Darling, president of the National Business Group on Health, a nonprofit organization composed of some of the country’s largest employers, told me that more and more companies will follow GM’s example and significantly scale back health coverage for workers.

For example, Ford and DaimlerChrysler are already negotiating similar concessions from the UAW.

“There’s no one in the business world who doesn’t share the position that the U.S. health care system has a crisis,” Darling said. “The issue here isn’t General Motors. The issue is the unaffordability of health care.”

So what do we do about it?

I’ve written repeatedly about how a single-payer health care system could provide universal coverage for all Americans at a long-term cost to taxpayers well below what’s now paid annually by employers and workers.

Single-payer systems are the norm in virtually all other developed democracies. While far from perfect — long waits for treatment are a frequent complaint — such systems ensure that any citizen can receive care from any doctor at any hospital.

There are no co-pays or deductibles, no private-sector premiums soaring year after year.

“The basic system is quite good,” said Steffie Woolhandler, an associate professor of medicine at Harvard University. “We just need to fund it adequately.”

As it stands, she said about a third of all health care spending in this country is now squandered on bureaucratic overhead. Under a single-payer system, savings from streamlined paperwork alone would be sufficient to provide coverage for all Americans.

“The meaning of GM’s announcement is that even people working for a powerful company can have their health care cut,” Woolhandler said. “Anyone who gets health insurance from an employer or former employer should be worried.”

The right message: Speaking of the auto industry, senior execs at Delphi, the largest automobile supplier, have said they’ll take voluntary pay cuts until the company emerges from bankruptcy.

The company’s CEO, Robert Miller, will reduce his base salary from $1.5 million to just $1 annually and won’t receive any bonuses. Delphi’s president, Rodney O’Neal, will take a 20 percent pay cut, and other execs will forgo 10 percent of their salaries.

Declared Miller: “Delphi’s transformation message must be unambiguous and marked indelibly by the commitment of Delphi’s leadership.”

Compare that with the top brass at PG&E, who last year handed themselves $83 million in bonuses while the San Francisco utility was still mired in Chapter 11 proceedings.

“It’s become standard to reward executives for sticking around during bankruptcy,” said Kirk Hanson, executive director of the Markkula Center for Applied Ethics at Santa Clara University.

“Cutting your pay sends a strong message to employees that management understands they’re suffering,” he said.

David Lazarus’ column appears Wednesdays, Fridays and Sundays. Send tips or feedback to dlazarus@sfchronicle.com.

Copyright 2005 SF Chronicle

Posted by pnhp at 03:21 PM | Permalink

At least 18 states have introduced universal health care bills, most based on a single-payer model
By Amy Snow Landa
AMNews correspondent
Oct. 24/31, 2005

From Vermont to California, proponents of single-payer health care have been busy introducing legislation, circulating ballot petitions and broadening their coalitions — all with the hope that at least one state will enact legislation that can be used as a model for national health care reform.

But opponents of single-payer health care, including state medical societies, say they are not worried that all of the activity means that government-run health care will be enacted any time soon.

“We’re not ringing the alarm bell yet,” said Tim Maglione, senior director of legislative affairs at the Ohio State Medical Assn.

Although Ohio has one of the most active single-payer movements in the country, there is little chance that a single-payer bill will pass the state’s Republican-controlled Legislature or be signed into law by Republican Gov. Bob Taft.

“We feel pretty confident the Legislature doesn’t have any interest in pursuing this,” Maglione said.

Single-payer advocates, having drawn the same conclusion, have turned their efforts to a petition drive, said Johnathon Ross, MD, a Toledo internist and a leader of the Single-Payer Action Network of Ohio.

The group is attempting to collect about 100,000 signatures on its petition, which directs the Legislature to vote on the Health Care for All Ohioans Act. So far, they have collected “tens of thousands” of signatures, Dr. Ross said.

If the Legislature then refuses to take action on the bill, supporters will collect a second round of signatures to put single-payer legislation directly on the ballot.

“Our target [for putting it on the ballot] is November 2006 at the earliest,” Dr. Ross said. But the group may put it off if they need more time to prepare for what is likely to be a formidable challenge waged by the insurance industry and other opponents, he said. Single-payer ballot initiatives have been tried in Oregon and California but were unsuccessful when they faced the opposition’s overwhelming resources.

Single-payer advocates don’t want to see that happen in Ohio. “We have to make sure we have a movement” established before taking single-payer health care to the ballot box, Dr. Ross said. “We’re using the petition to drive this movement.”

In addition to Ohio, at least 17 other states have introduced universal health care measures, most of them based on a single-payer model, according to the National Conference of State Legislatures. But so far, none of the bills has been enacted.

The American Medical Association has opposed the establishment of single-payer health care both at the state and federal levels. It has long advocated for using tax credits and other market-based reforms to make health care coverage more affordable.

Vermont’s close call

The state that came closest this year was Vermont, where the Legislature passed a bill in June that would put the state on the road to establishing a single-payer system called Green Mountain Health.

The measure, called an Act Relating to Universal Access to Health Care in Vermont, would have phased in a single-payer system funded through taxes levied on individuals and employers. But Republican Gov. James Douglas vetoed the legislation.

Despite the veto, the Legislature was able to appropriate funds for the Commission on Health Care, a legislative panel that is studying a number of issues related to health care reform, such as governance and financing.

Both the commission and Douglas are holding hearings to solicit recommendations on health care reform. The Vermont Medical Society has been developing its own proposal, which it plans to submit in mid-October, Executive Director Paul Harrington said.

Rather than promote a single-payer system, the VMS proposal would keep in place existing insurance coverage paid for by employers, Medicare and Medicaid. It would offer residents in the individual market a basic benefit plan at an affordable cost through the Office of Vermont Health Access, the agency responsible for the state’s Medicaid and other health programs. The proposal also would subsidize premiums for low-income Vermonters and provide new incentives to encourage employers to offer health insurance to their employees.

Eyes on the prize

Of all the states where single-payer supporters are most active, California is considered the biggest prize because of its sheer size, both in terms of population and health care spending. Nearly $200 billion is spent in California each year — about 13% of the entire nation’s spending on health care, according to the UCLA Center for Health Policy Research.

Activists there have been working for years to enact single-payer legislation, but supporters and opponents have differing views on whether the movement has crested or continues to grow.

“As far as we know, their efforts are not any more prevalent today than they were a year ago or 10 years ago,” said Larry Akey, a spokesman for America’s Health Insurance Plans.

But that’s not the view of Ida Hellander, MD, executive director of the Chicago-based Physicians for a National Health Program. The single-payer movement in California “just continues to grow,” she said. “They have a pretty broad-based movement; they’ve educated a lot of people, and very large, well-organized groups like the California Nurses Assn. are on board.”

In the California Legislature, a single-payer bill passed the Senate in May but faces an uncertain future in the General Assembly. Even if the full Legislature approves the bill, Republican Gov. Arnold Schwarzenegger is likely to veto it.

“The bill is dead for the moment,” said Michael Sexton, MD, president of the California Medical Assn., which opposes the legislation. “We don’t think there should be an ability to ration care based on a global budget,” he said.

Instead, the CMA is working to advance its own proposal, which would cover the uninsured but preserve a public-private system of health care coverage, he said. The plan includes refundable tax credits for the purchase of health care.

ADDITIONAL INFORMATION:

The Vermont Legislature, for information on H 524, an Act Relating to Universal Access to Health Care (www.leg.state.vt.us)

California legislative information page, for information on SB 840, the California Healthcare Insurance Reliability Act (www.leginfo.ca.gov)

The Ohio General Assembly, for information on, HB 263 and SB 263, the Health Care for All Ohioans Act (www.legislature.state.oh.us)

Posted by pnhp at 03:56 PM | Permalink

2005 Health Confidence Survey: Cost and Quality Not Linked
By Ruth Helman, Mathew Greenwald & Associates, and Paul Fronstin, EBRI
Employment Benefit Research Institute
EBRI Notes
November 2005

Increasing health care costs continue to be strongly related to dissatisfaction with the health care system, and those who have experienced increased costs within the past year are more likely than those who have not to be dissatisfied their current health plan and other aspects of the health care.

A majority of Americans with health coverage have experienced health care cost increases in the past year. Those with employment-based coverage and those who report their health status has gotten worse over the past five years are more likely to report these cost increases.

Those who have experienced cost increases have compensated by making changes in the way they use health care. (54 percent) say they now go to the doctor only for more serious conditions or symptoms. (40 percent) have delayed going to the doctor. (21 percent) report cost increases have caused them to not take their prescribed medication. Lower-income Americans and those in poorer health are more likely to report making each of these changes.

Increased health care costs have also affected household finances, and many of those who have experienced cost increases have coped by reducing the amount they save or by depleting their savings. One-quarter report they have decreased their contributions to a retirement plan as a result of the increased cost of health care (26 percent), and almost half report they have decreased their contributions to other savings as a result of the increases (45 percent). One-quarter say they have had difficulty paying for basic necessities, like food, heat, and housing (24 percent), while one-third report difficulty paying other bills (34 percent). Three in 10 indicate they have used up all or most of their savings (29 percent), and 18 percent have borrowed money.

Despite the increasing amount of cost sharing that employers are asking of their workers, most Americans appear to value employment-based health coverage above the actual dollar amount that employers pay toward the care. When employed Americans with health coverage are asked whether they would prefer $6,700 in employment-based health insurance coverage or an additional $6,700 in taxable income, 8 in 10 choose the employment-based health coverage (80 percent). Two-thirds would prefer employment-based coverage to an increase in income even if an employer paid $10,000 toward the coverage(66 percent). Furthermore, this preference for employment-based coverage emerges regardless of demographic characteristics.

http://www.ebri.org/pdf/EBRI_Notes_11-2005.pdf

Comment: (Not addressed in the excerpts nor in these comments is the finding that Americans still have relative confidence in the quality of our health care system.)

The selected excerpts above confirm what we already knew. Americans are very concerned about increasing health care costs, and affordability is having a very significant negative impact on access and on their personal finances.

An important conclusion of this report is that Americans strongly support employment-based health coverage, and would relinquish comparable income increases in order to maintain employer-sponsored coverage. Advocates of reform based on employer-sponsored plans will surely jump on this study as an affirmation of the validity of their model of reform. But is that conclusion really warranted?

Individuals are very concerned about the risk of unanticipated health care costs. Right now, they have up to three options: coverage through their employment, individual coverage, or no coverage at all. Responsible individuals would never accept doing without coverage as being an acceptable option. The greater value and comprehensiveness of employer-sponsored coverage makes it a preferred option to individual coverage. So it is quite logical that most individuals would support plans offered through their employment.

But what if they were offered another option? What if they were told that they could always have coverage regardless of what might happen to their employment? What if they were told that they would need to relinquish only an equitable portion of their income, through a payroll tax, rather than relinquishing an arbitrary amount such as the $10,000 in this survey? What if they were told that comprehensive benefits would always be provided since other more efficient mechanisms, rather than benefit reductions, would be used to maintain affordability?

Today, even General Motors employees might be interested in hearing about such an option. Even the New York Times, in an editorial yesterday, broke new ground by stating “…shame should also be aimed at Washington lawmakers who have done nothing to solve the larger problem, the crying need for national health insurance.”

New York Times editorial:
http://www.nytimes.com/2005/10/17/opinion/17mon3.html

Posted by pnhp at 09:05 AM | Permalink

Wrong Solution for the Uninsured
Editorial
The New York Times
October 17, 2005

As well-meaning legislation goes, it would be hard to beat the law recently approved by the New York City Council over the veto of Mayor Michael Bloomberg. It requires certain large grocers to provide health care benefits for their employees. The law - like a handful of similar efforts from Long Island to San Francisco - is a response to the growing strain on Medicaid and other government assistance programs from uninsured workers.

A major inspiration for the legislation is clearly Wal-Mart. One report showed that nearly 9,000 Wal-Mart workers needed public insurance in Wisconsin, and that more than 10,000 children of the store’s workers in Georgia were treated at taxpayer expense. The list goes on. Fed up, Maryland, New Jersey and Pennsylvania are in various stages of trying to force the big employer to take care of its own.

While it’s easy to sympathize with the frustration of local governments left holding the bag, this kind of piecemeal legislation is no answer. For one thing, it’s very possibly illegal - federal law generally protects employers from this kind of local mandate. And while it’s emotionally satisfying to take a whack at the big-box stores, it hardly addresses the real problem. In New York, caring for the city’s working uninsured costs more than $600 million annually, according to a Columbia University report. Wal-Mart can’t be blamed for any of that, as it has been unsuccessful in pursuing a site in the city.

The nation’s health care problems are too complicated to be addressed by a chock-a-block system of overzealous, homespun laws that fail to address the overarching problem of the uninsured and may not hold up in court, anyway. The problem cries out for a federal solution. Without some kind of aid, many small businesses would crumble under the cost of health care benefits - which the New York City law estimates at $5,000 per employee per year.

For right now, there is a commendable effort in Congress to post on the Internet the names of employers with large numbers of workers on public aid, the idea being that shame can be an effective weapon. The same kind of shame, however, should also be aimed at Washington lawmakers who have done nothing to solve the larger problem, the crying need for national health insurance.

Posted by pnhp at 03:58 PM | Permalink

Monday, October 03, 2005

LOS ANGELES As the cost of healthcare (search) continues to skyrocket, one businessman in Calexico, Calif., has found a solution to the problem.

Mark Holloway owns the Sam Ellis department store near the U.S. border with Mexico. He has about 50 employees and couldn’t afford health insurance (search) for them until he discovered a cross-border health plan that allows his workers to see doctors in Mexico.

“We were paying an excess of $100,000 a year to provide health insurance and that wasn’t even for all of the staff,” Holloway said. “When Blue Shield came to us and offered us an affordable way to bring down healthcare, we jumped on it.”

In Mexico (search), healthcare costs are about 40 to 50 percent lower than in California. That means patients only have to pay $10 to visit a Mexican doctor. Hospital stays, tests and medications also are more affordable south of the border.

One of Holloway’s longtime employees said the service is better in Mexico.

“I know that doctors across the border will see you that day if not in the morning, the afternoon, the evening. You will call them, they will give you their cells [phone numbers], whatever,” said Josie Llausas.

But some in the medical field in the United States are skeptical about the cross-border plans because of questions over the quality of care, specifically pointing to outdated technology like X-ray machines, ultrasound and MRI equipment.

Mexican doctors say while their equipment might not be state-of-the-art, their training is equivalent to that of American doctors.

Posted by pnhp at 03:54 PM | Permalink

Big Changes for Health Plans
By Kathy M. Kristof
Los Angeles Times
October 9, 2005

Every year, workers are advised to look closely at their benefits package during open enrollment season. This year, they have even more reasons to read the fine print.

Companies are increasingly requiring “active enrollment” - meaning that if employees don’t check the right boxes, they could end up without health insurance, or find themselves enrolled in a “default” plan.

“More and more companies won’t allow passive enrollment, which is when they don’t hear from you, they give you what you had last year,” said Tom Billet, senior consultant with benefits firm Watson Wyatt Worldwide. “Companies are increasingly demanding active enrollment.”

One reason is that benefit choices are changing significantly this year. That’s partly because laws have changed to allow new options such as health savings accounts. It’s also because employers are experimenting with ways to cut costs, which have more than doubled in the last eight years, according to benefit consulting firm Hewitt Associates.

“We are seeing increased deductibles, but also more of a consumer-oriented focus to healthcare,” said Sarah Taylor, annual enrollment leader at Hewitt. “There are a lot of plans that weren’t offered in the past - like health savings accounts and build-your-own plans.”

“You mix and match, and your premium would be based on the things that you choose,” (Taylor) said. “It’s really up to the employee to figure the benefits that have the most value to them.”

“It’s the rare plan today that has no change from year to year,” Billet said. “So making the same election that you made last year may not be the best decision. It’s a really good idea to evaluate the situation with a fresh eye.”

http://www.latimes.com/business/la-fi-perfin9oct09,1,6806534.column?coll=la-headlines-business

Comment: The lesson? The mainstay of private health care coverage, employer-sponsored plans, no longer provides the security of affordable, comprehensive benefits. Rather than deciding for their employees how much insecurity is acceptable, employers are shifting this difficult decision onto their employees.

The conflict is obvious. The employers’ concern is the affordability of health insurance; the employees’ concern is the affordability of health care. As long as health plans are sponsored by employers, there will be a continual effort to drive down insurance costs in the face of escalating health care costs. The burden of the increased health care costs are then shifted to the employees. This dynamic creates instability for our prevalent mechanism of funding health care: employer-sponsored plans.

Although a universal public insurance system would be under continual attack by libertarians, it would be vastly more stable than our current fragmented system of funding health care. Even libertarians don’t want their Medicare messed with.

Posted by pnhp at 03:51 PM | Permalink

Doctor prescribing national health plan
By Steve Blow
Dallas Morning News
Sunday, October 9, 2005

In the newspaper business, someone is always upset with how we play stories.

Put one on the front page, and it’s called “sensationalism.” Put it inside, and it’s “buried.”

Well, let me join the chorus. When I read a story the other day at the bottom of the business section, I wondered why in the world it wasn’t on Page 1.

The headline: “Fewer firms are providing health care, survey finds.”

OK, not very sexy, I know.

In fact, I have just divided readers into two groups. First, those of you who felt your interest sag. You have good health insurance at work – or through a spouse, a parent or Medicare.

And second, those who felt your stomachs knot. You are uninsured or on the verge of it – and you’re worried sick about getting sick.

That headline made me think about a local fellow in a small third group – those who are well insured and worried about those who aren’t.

Actually, Gerald Frankel of McKinney belongs to an even smaller group than that. He’s a doctor who favors a national health-care plan.

Dr. Frankel – “Jerry” to his friends – is a urologist on a mission. He says we’ve got to face that our country’s system of providing health coverage through employers is broken.

That recent news story documented the continuing decline in companies offering health insurance – down to 60 percent now, a 9 percent drop in just five years.

I asked Dr. Frankel about his reaction to that story. “I had a whole mess of reactions,” he said. “First, my heart goes out to the people affected by this.

“You don’t see the devastation because you can’t put it in a photograph like you can with Hurricane Katrina. But physicians and nurses see families whose lives have been wrecked on a daily basis. The number of families who have their own Katrina every day is just phenomenal.”

Dr. Frankel’s second reaction: “It’s just another nail in the coffin of the current system,” he said. “But at what point do we say enough is enough? What’s the breaking point?”

The surgeon is frustrated that he can’t make others see what is so obvious to him: People are dying because of the broken system of delivering health care.

“How can this country, which is based on the highest principles, allow this to go on?” he asked. By one study, 18,000 people die each year solely for lack of health care. Thousands more suffer needlessly.

Dr. Frankel understands the natural reluctance to get the government involved. “Government drives everyone crazy. They say, ‘The same people who run FEMA? You’re going to let them take over health care?’ “

But the government can do some things well, he said, and one of those is deliver decent, affordable health care to all its citizens.

It’s done that way in every other developed nation. And it’s not as foreign as it sounds. We already have it here, and I have already mentioned it – Medicare.

Good old Medicare. It may not be perfect, but older Americans look forward to the day they qualify for it. And Dr. Frankel sees no reason why such a national health plan can’t be expanded to all citizens, not just seniors.

If nothing else, the employer-based, private-insurance system offends Dr. Frankel for its inefficiency. He said about 25 percent of all premiums go to pay administrative costs. With Medicare, it’s 3 percent.

But worst of all, our system is bad medicine. We spend more on health care than any other country, but we’re the worst of developed nations in life expectancy and infant mortality, he said.

Dr. Frankel is active in Physicians for a National Health Program (www.pnhp.org). He tries to spread the message that way.

But he believes change will come only when the middle class is shaken from its comfort zone – only when enough people can’t find a job with health benefits, only when enough families are financially ruined by an illness, only when enough of “us” die unnecessarily.

Dr. Frankel wonders why we have to wait.

E-mail sblow@dallasnews.com

Posted by pnhp at 01:53 PM | Permalink

Treated for Illness, Then Lost in Labyrinth of Bills
By Katie Hafner
The New York Times
October 13, 2005

Medical paperwork is a world of co-payments and co-insurers, deductibles, exclusions and contracted fees. Nothing is as it seems: patients receive statements that often do not reflect what is actually owed; telephone calls to customer service agents are at best time-consuming and at worst fruitless. The explanations of benefits that insurers send out - known as E.O.B.’s - are filled with unintelligible codes.

The system is so impenetrable that it mystifies even the most knowledgeable.

“I’m the president’s senior adviser on health information technology, and when I get an E.O.B. for my 4-year-old’s care, I can’t figure out what happened, or what I’m supposed to do,” said Dr. David Brailer, National Coordinator for Health Information Technology, whose office is in the Department of Health and Human Services. “I can’t figure out what care it was related to or who did what.”

Ellen Mayer, 54, an artist who lives in Chester, N.Y… has a rare type of gastrointestinal cancer that requires constant monitoring through blood work, CT scans and PET scans.

The paperwork nightmare started for Ms. Mayer when her oncologist switched hospitals. Everything suddenly seemed to need a justification, or a new piece of paper with an authorization.

The stacks of papers, folders and Post-It notes related to Ms. Mayer’s treatment have started to take over her house. They fill manila envelopes, boxes and files, which fill closets. They spill from the dining room table onto chairs.

“You can’t just be sick,” she said. “You have to be sick and be drowning in paperwork.”

Insurance companies are, by and large, unapologetic.

“Even though the amount of paperwork a patient has to deal with might seem to be a lot, it would be much worse if there wasn’t a unifying organization like a health plan easing that burden,” said Dr. Alan Sokolow, chief medical officer at Empire Blue Cross Blue Shield in New York.

http://www.nytimes.com/2005/10/13/health/13paper.html

Comment: We can thank Alan Sokolow for providing us with one of the most compelling reasons for dismissing the private insurance industry and replacing it with our own universal program of public insurance. Talk about being oblivious to the problems! At least former FEMA Director Michael Brown recognized that there was a storm. Although the health care crisis has been repeatedly labeled as “The Perfect Storm,” Sokolow’s industry continues to plow through the levees that are failing to hold our fragile health care system together.

Ironically, they’re in the process of drowning their own industry, along with the rest of us. It’s too bad that we can’t prevent more health care tragedies by shrinking the private insurance industry down to size and drowning it in a bathtub!

Posted by pnhp at 12:37 PM | Permalink

Michael Hiltzik
LA Times
October 6, 2005

Business leaders, acting in what they regard as their economic self-interest, have torpedoed every attempt to improve the nation’s ridiculously ineffective healthcare system for decades. There hasn’t been a significant reform since Lyndon B. Johnson expanded Medicare and Medicaid in the 1960s.

The chickens are finally coming home to roost.Private industry assumed financial responsibility for employee healthcare after World War II. It no longer wants the burden. The crippling cost has been cited as a factor in the bankruptcies of United, Northwest and Delta airlines. Unscrupulous employers leave their workers medically stranded, thus undercutting competitors who try to do the right thing. (Think of the Wal-Mart effect in retail.)

The number of uninsured citizens is growing — more than a fifth of all non-elderly Californians, or 6.6 million persons, lack coverage — and the number of those insured whose benefits are being cut back by their employers is growing even faster.

So it shouldn’t be surprising that solutions once dismissed out of hand are suddenly getting a closer look. The most appealing is a single-payer system, which would replace today’s jigsaw puzzle of private insurance, public programs and nothing with a government-run healthcare program. In California, that option is being pushed by state Sen. Sheila Kuehl (D-Santa Monica), who says she senses growing, albeit still insufficient, support around the state after three years of proselytizing.

Kuehl’s plan is a work in progress. (She hopes to draft a full-fledged version next year.) Her basic proposal is for the state to finance comprehensive health coverage for all residents through a tax surcharge. Private insurers would be barred from selling equivalent coverage, but could market supplemental policies for services not on the state menu. An elected commissioner would establish benefits, set payments for providers, negotiate prescription drug deals, and so on.

Kuehl says her program would achieve universal coverage while cutting more than $8 billion from the medical costs of state government, employers and families, which are projected to reach $184 billion next year. (Her figures come from an analysis by the Lewin Group, a Virginia consulting firm, paid for by single-payer advocates.)

Hers is a radical solution. But many of the proposed alternatives in Sacramento merely involve letting insurance companies sell “affordable” strippeddown medical plans to workers. These remind me of my home earthquake policy, which won’t pay for most of the damage I might incur, but at least it’s cheap.

Critics of single-payer plans say they’re inefficient — the wait time for CAT scans in Canada averages a few months, to repeat a common rap on that country’s program. But such criticism assumes that the alternative is a system in which all patients have instant access to all the treatment they need. That system doesn’t exist in the United States, where even the insured can suffer long delays for diagnostic procedures and treatments, and the uninsured are lucky to get emergency room care.

Among single-payer’s virtues is that it cuts private insurers out of the loop. These companies exist largely to convert premium dollars into profits, sometimes at a rate of 10% or more. They win praise from Wall Street when they reduce the share of the premium dollar spent on medical treatment.

It’s true that the very notion of a government system gives some people the willies. “Considering our experience with having Congress run Medicare and Medicaid, I don’t think any physician or knowledgeable patient would say, let’s have them run it all,” says Jack Lewin, chief executive of the California Medical Assn. (He’s not connected to the Lewin Group.)

But the main objection doctors and hospitals have to those programs is that their reimbursements are too low. On the plus side, Medicare’s administrative costs are less than 2% of its benefit payments; for some private insurance plans, the ratio is 25%.

Still, even if one were to accept that a single-payer program would improve on the crumbling system we have today, there’s reason to doubt that it can work in a single state, even one with California’s immense bargaining power. As long as the rest of the country is operating by different rules, California will struggle with federal bureaucrats doing business the old way. (The state will need government waivers to absorb federally funded programs into its system.)
By replacing healthcare premiums with an employer-employee tax, Kuehl’s plan might reduce overall costs for employers who already offer comprehensive coverage, but it will raise costs for those that offer skimpy plans or none at all. This will anger small businesses and lobbyists for big skinflint companies. (Surprise: The California Chamber of Commerce has already labeled Kuehl’s proposal a “job killer.”) Such competitiveness issues can’t be solved except by nationwide healthcare reform.

Another concern is how the system will handle political pressure. Think it’s tough to close an urban firehouse? Wait until the state healthcare czar tries to close a neighborhood hospital. Of course, such decisions tend to be made now by insurance executives thousands of miles away; empowering a publicly accountable state official to weigh the pros and cons might be a step forward.

Kuehl’s plan isn’t perfect, but perfection is elusive in medicine, inside the hospital and out. It is an attempt to fix a failing system in one fell swoop, rather than with stopgap measures that will merely delay the reckoning. At the very least, it should focus the debate. As Kuehl told me this week, “We need to do more than nibble around the edges.”

Posted by pnhp at 02:30 PM | Permalink

Physicians: It’s in Your Court Now
By Steven Lewis

Canadian Journal of Nursing Leadership (CJNL), Vol 18, No. 3, 2005
http://www.longwoods.com/product.php?productid=17616

Abstract:
The Supreme Court decision of June 9, 2005 clarifies the political choice facing organized medicine in Canada.(1) Many of Canada’s doctors are strong and eloquent supporters of single-tier health care. Many are not, and never have been. A mere decade ago, at the CMA’s annual General Council meeting, a motion declaring that citizens “must have the right to choose regulated private insurance for all medical services” fell on a vote of 88 to 68.(2) Focus groups conducted by the CMA in 1996 revealed a wide chasm between the strong public support for public health care and the then 78% of physicians who believed stronger private-sector participation in health care was either very or somewhat acceptable.(3) And, of course, organized medicine was heatedly opposed to the introduction of medicare in Saskatchewan in 1962. More often than not, doctors’ organizations have strongly opposed measures that they have subsequently embraced. In this they are no different from any other privileged group - whatever their virtues, attunement to the will of the demos is not among them.

Article:

The profession’s support for single-tier health care has always been provisional, and it has been largely silent - one must infer approvingly so - on the growth of for-profit clinics. Some physicians have contracted out to the public system, others have plied their trade on both sides of the street and a few have abandoned medicare altogether. Until June 9, the debates among doctors were not central to the future of the system. Proponents of a private and parallel option had to chip away at medicare’s edges, abetted by a federal government that has been castigated by the Auditor General for refusing to enforce the Canada Health Act. Now “private and parallel” has the high court’s blessing, with a new twist: the legal buying and selling of insurance for medically necessary services. The court has tasered medicare; the question is now whether the system is temporarily stunned, or mortally wounded. CMA President Albert Schumacher declared the Supreme Court judgment “a stinging indictment of the failure of governments to respond to the mountains of studies that show we need real action on our health care system.” That we need real action on our health care system is incontestable. That government should be the exclusive or even principal target of indictment is the question on the table. The evidence suggests we should look elsewhere.

Governments fund health care and establish its general legislative and regulatory framework. Beyond that, the system is largely in the hands of physicians, who make the day-to-day decisions, prioritize patients, prescribe drugs, admit patients to and discharge them from hospital, order tests and carry out innumerable interventions with a remarkable degree of autonomy. They are not held accountable in any meaningful way for performance. They are indifferent, apparently, to the clinical practice guidelines produced by their own colleagues. There are huge variations in their practices that go unchecked, despite the obvious implications for quality and access.(4-7)

The “real action” needed on our health care system includes primary health care reform, a more rational division of labour, quality improvement and a remedy for inequities in pay scales that overvalue day-surgery assembly lines and undervalue geriatricians and rheumatologists. The call for these reforms has come largely from governments, and it has been thwarted or delayed not by governments but by doctors.(8) Both Romanow and Kirby noted the glacial advance of primary care reform. It is medical associations, not governments, that allocate incomes among specialties. Nurse practitioners, pharmacists and therapists are anxious to expand their scope of practice and to use their expertise fully. Try to find a government that disagrees. Try to find a medical association fully on board.

According to organized medicine, system failings are always someone else’s fault. Somehow Mr. Zeliotis’ hip surgery delay was caused by the nature and stinginess of the single-payer system. Nothing, apparently, is attributable to physicians retaining control over their individual wait lists and refusing to standardize criteria for assessing and prioritizing patients.(9) The failure to look for doctors with shorter wait times, to share responsibility for fairness and to participate in the kinds of process improvements that by 2003 got 88% of UK citizens into primary care within 48 hours of picking up the phone(10) is - government’s. If it’s government’s fault, it’s because government didn’t follow Whitehall’s lead and just say no to chaos.

Given its anarchic characteristics, it is bordering on miraculous that the system by and large serves most people well most of the time. The median wait time for cardiac surgery in Manitoba is 23 days.(11) Median wait times in British Columbia are well under three months for every surgical category except for corneal transplants (17 weeks), hip replacements (22 weeks) and knee replacements (28 weeks).(12) In Saskatchewan in 2004, 82% of surgeries were completed within six months, but 5% had wait times longer than 18 months.(13) And here is where the problem comes home to roost: if even as few as half of the 5% were waiting involuntarily, great harm was done.

Who is responsible? Governments don’t manage the wait lists. Governments are not responsible for following up, or not, with patients waiting for procedures. Governments do not decide that patient A will get served in two months while patient B, with identical needs, will wait 20 months. Doctors do. The Canadian long waits are not a capacity problem: simple arithmetic demonstrates that no one has to wait 18 months in a system where 4 out of 5 (or more) patients wait well under six months. But until recently the only response of organized medicine to these long waits was to cry poverty and enlist the public in government bashing. One would have thought the Hippocratic oath would have diverted some of this energy toward looking after the long-suffering. It does not take a cynic to observe that the long queues admirably served the purpose of extracting more money for health care - both public and private. And they also provided the pretext for Chaoulli, and here we are.

The history of medicare is a clash between the state’s goals of equity, order and efficiency with medicine’s goals of autonomy, growth and control. Society has made enormous concessions to organized medicine, such as the right of doctors to set up practice anywhere, the right to remain independent contractors rather than full partners in a complex system, freedom from the measurement, scrutiny and accountability of US-style managed care, and pay scales that vastly exceed those extant in the European systems the court and medicare’s critics selectively admire from afar. It has also encouraged governments to increase public spending by an astonishing 60% in the past eight years, an ongoing mea culpa for the four-year period in the last 35 when spending modestly declined. All the public expects in return is a shared commitment to single-tier equity, a willingness to participate in reforms and decent performance. Apparently this has been too much to ask.

Now, thanks to the Supreme Court, the legal underpinnings of the system have been dealt a blow, and the choices are starker for doctors. They can now openly abandon the public system and get in on the ground level of an emerging private insurance system catering to people with money. They can market the virtues of commodified medicine and concentrate on the sexy diagnostics and high-volume procedures under the guise of enhancing Canadians’ Charter rights. No more unlucrative sessions with the complex geriatric case. No more dealing with intractable chronic diseases. No more unrewarding encounters with the underclass. It’s an easy and pleasant $275,000 a year for family doctors at a clinic that bundles core services with the extras, charging $1,700 up front and $2,300 annually.(14) No doubt surgeons in the orthopedic and cataract centres can easily double and triple that income.

The Supreme Court has raised the stakes, and the public needs to know where official medicine stands. Will it accelerate public-system reforms, improve its performance and effectively preempt the market for private insurance? Or will it decant more care to the private sector, which, according to recent evidence from Australia’s hybrid system, increases public sector wait times?(15) Will it promote a fair income distribution so that graduating doctors no longer leave family medicine and geriatrics residencies unfilled while they flock to dermatology and orthopedics? Will it propose and participate in comprehensive wait-list management systems, like Saskatchewan’s, to ensure that no patient’s health is endangered by unmonitored waits and that those with greater needs get served first? Will it leap to the fore of the quality revolution, or continue to provide an endless source of material for the small-area-variation research industry?(16)

Perhaps, in its testily divided decision, the court has done the country a favour. We have not had a national, focused debate on where to draw the line on two-tier health care for decades, resorting to fictions about medically unnecessary services and ignoring the evidence under our very noses - most recently that for-profit long-term care facilities provide significantly less direct and support care to residents than their nonprofit counterparts.(17) Nor have we carefully and conclusively debated Tommy Douglas’s unrealized vision of a genuinely balanced continuum of care. Physicians have fought long and successfully to remain at arm’s length from the system. You wouldn’t get on a plane built by engineers who decided independently what parts to make and whether and how to fit them together. Why would anyone expect excellence from a health care system that is largely ungoverned and where mistakes and overuse trigger an avalanche of funding and income while prudent, efficient practice has the bracing effect of lowering one’s income?

This is not a time for hysteria or fear-mongering, but for self-examination, reflection and choice. How governments respond to the challenge is of course vitally important, and the political exchanges promise to be lively. But citizens and governments delude themselves if they imagine that a public system can succeed without a medical profession that is widely and officially committed to its values and more often than not promotes rather than resists constructive change.

For too long the rule of the game has been to spend more or lose physician support. We’ve spent more - a lot more - and the return on investment has been low. Canada is a country governed by elites. Will the medical profession rise to the challenge of creating a new and improved medicare, or will it, like so many elites, talk about the public interest but act in the interests of the few?

Steven Lewis is with Access Consulting Ltd., in Saskatoon, SK., and the Centre for Health and Policy Studies, University of Calgary, Calgary, AB.
————————————————————————————————————————
Footnotes
1. Chaoulli v. Quebec (Attorney General). 2005 SCC 35.

2. Sullivan P. Private health care dominates meeting as General Council calls for national debate. CMAJ 1995;153(6):801-3.

3. Sullivan P. Focus groups confirm that MDs, public differ on role of private health care. CMAJ 1996;154(8):1247-9.

4. Kennedy J, Quan H, Ghali WA, Feasby TE. Variations in rates of appropriate and inappropriate carotid endarterectomy for stroke prevention in 4 Canadian provinces. CMAJ 2004;171(5):455-9.

5. Jaglal SB, Carroll J, Hawker G, McIsaac WJ, Jaakkimainen L, Cadarette SM, et al. How are family physicians managing osteoporosis? Qualitative study of their experiences and educational needs. Can Fam Physician 2003;49:462-8.

6. Brownell M. Tonsillectomy rates for Manitoba children: temporal and spatial variations. Healthc Manage Forum 2002;Suppl:21-6.

7. Katz A, DeCoster C, Bogdanovic B, Soodeen RA, Chateau D. Using administrative data to develop indicators of quality in family practice. Winnipeg: Manitoba Centre for Health Policy; 2004. Available: www.umanitoba.ca/centres/mchp/reports/pdfs/quality_wo.pdf (accessed 2005 Jun 20).

8. Medical Reform Group. Nearsighted physicians reject deal with government [media release]. Toronto: The Group; 2004 Nov 21. Available: www.hwcn.org/link/mrg/press.release.html#Nearsighted_Physicians_Reject_Deal_With (accessed 2005 Jun 20).

9. Sanmartin C, Shortt SED, Barer ML, Sheps S, Lewis S, McDonald PW. Waiting for medical services in Canada: lots of heat, but little light. CMAJ 2000;162(9):1305-10.

10. Department of Health. Achieving shorter waits: the PPF promises shorter waiting times across the service. London (UK): The Department; 2005. Available: www.dh.gov.uk/PolicyAndGuidance/PatientChoice/WaitingBookingChoice/WaitingBookingChoiceArticle/fs/en?CONTENT_ID=4066038&chk=ZurIX5 (accessed 2005 Jun 20).

11. Winnipeg Regional Health Authority. Health services wait time information: cardiac surgery. Winnipeg: Manitoba Health. Available: www.gov.mb.ca/health/waitlist/cardiac.html (accessed 2005 Jun 20).

12. Median wait times and wait lists. Victoria: Government of British Columbia; 2005 Mar 31. Available: www.healthservices.gov.bc.ca/cpa/mediasite/waittime/median.html (revised 2005 May 17, accessed 2005 Jun 20).

13. Wait time information. Regina: Saskatchewan Surgical Care Network. Available: www.sasksurgery.ca/wait-list-info.html (accessed 2005 Jun 20).

14. Copeman D. Interview with Don Copeman, Copeman Health Centre, Vancouver. Interviewed by Barbara Budd and Mary Lou Finlay, As It Happens [radio program]; 2005 Jun 1. Produced by the Canadian Broadcasting Corporation, Toronto. Available: www.cbc.ca/insite/AS_IT_HAPPENS_TORONTO/2005/6/1.html (accessed 2005 Jun 20).

15. Duckett SJ. Private care and public waiting. Aust Health Rev 2005;29:87-93.

16. Tu JV, Pinfold SP, McColgan P, Laupacis A. April 2005. Access to health services in Ontario: ICES Atlas. Toronto: Institute for Clinical Evaluative Sciences; 2005. Available: www.ices.on.ca/webpage.cfm?site_id=1&org_id=67&morg_id=0&gsec_id=0&item_id=2862&type=atlas (accessed 2005 Jun 20).

17. McGregor MJ, Cohen M, McGrail K, Broemeling AM, Adler RN, Schulzer M, et al. Staffing levels in not-for-profit and for-profit long-term care facilities: Does type of ownership matter? CMAJ 2005;172(5):645-9.

————————————————————————————————————————
Acknowledgements
Reprinted from the Canadian Medical Association Journal 173(3): 275-77 by permission of the publisher. © 2005 CMA Media Inc.
Correspondence to: Steven Lewis, Access Consulting Ltd., 211-4th Ave. S., Saskatoon SK S7K 1N1; fax 306- 343-1071; steven.lewis@shaw.ca.

Posted by pnhp at 02:28 PM | Permalink

By Nicholas D. Kristof
The New York Times
October 2, 2005

In the aftermath of Hurricane Katrina, we have an opportunity to construct something far more important than higher levees - a national health care system that looks less like a tightrope and more like a safety net.

A dozen years after Bill Clinton’s health reform efforts were destroyed by the insurance industry’s duplicity, it’s worth trying again. The health care system is steadily becoming more gummed up in ways that are impossible to hide.

One of the bumper stickers attacking the Clinton plan read: “If You Like the Post Office, You’ll Love National Health Insurance.” That wouldn’t work today: the Postal Service runs a system that is manifestly more rational and efficient than our health care system. For starters, imagine a postal system that refused to deliver letters to or from 45 million Americans - except on rare occasions, by ambulance.

“This is one of those fleeting opportunities where a catastrophe creates an opportunity to rebuild something better than before,” says Dr. Irwin Redlener, president of the Children’s Health Fund and associate dean of the Mailman School of Public Health at Columbia University.

In a sign of the growing disenchantment with our health system, 13,000 doctors have joined Physicians for a National Health Program, which lobbies for a single-payer government-financed health program.

There are four main problems with the existing system. First, it leaves out 45 million uninsured Americans, and their number is rising. Second, it is by far the most expensive in the world, costing 15 percent of our national income, yet our outcomes are awful - U.S. life expectancy is worse than Costa Rica’s. Third, our business competitiveness is undermined when, for example, medical expenses add $1,500 to the sticker of each General Motors car. Fourth, our system is catastrophically inefficient: according to a study in The New England Journal of Medicine, health administrative costs are $1,059 per capita in the U.S., and just $307 in Canada.

A single-payer system would be most efficient but probably is not politically feasible at the moment. The smart new book “The Health Care Mess” suggests a variety of more gradual approaches that would face less opposition.

Whatever the mechanism, all children should be covered. It’s a disgrace that we use public funds to save the lives of nonagenarians but not those of 9-year-olds. And kids are a bargain: per capita medical spending is $1,525 for children less than 5, and $9,000 per person aged 65 to 74.

A second principle is that we should put less emphasis on curative medicine and more on public health and prevention - everything from preparing for avian flu to encouraging exercise. Sure, we can buy more “left ventricular assist devices,” which cost $210,000 per patient installed, or buy Erbitux for colon cancer, at $17,000 per month of treatment. But as a wise new book, “Prescription for a Healthy Nation,” argues, you get more bang for the buck when you promote healthier lifestyles - fighting obesity, cigarette smoking and the like.

Raising cigarette taxes saved far more American lives, for example, than an army of neurologists ever could. In the same spirit, I’d like to see a French-fry tax. And imagine the health gains if we banned potato chips and soda from schools.

Reforming the health system won’t be easy. In the real world, poor kids don’t see doctors not only because they’re uninsured, but also because Mom doesn’t have a car, can’t easily get time off from work, or doesn’t speak English. Those are hard nuts to crack - but one reason to think that we can do better is that much of the world does better.

I’ve been thinking of health care partly because of something that happened when I was on vacation in August. My kids and I were stacking firewood for my parents on the Yamhill, Ore., farm where I grew up, when suddenly the seven-foot stack collapsed - on top of my youngest. She was knocked down and pinned, her face bleeding, under a pile of logs.

I had insurance, and a car to get to the emergency room - and in the end the logs (stained with blood) turned out to be in worse shape than my daughter. She’s just fine. But that instant was heart-stopping in its terror - and the system routinely does fail such children in need. Isn’t it worth fighting one more time for reforms, so that we Americans can get health care every bit as good as Canada’s?

Posted by pnhp at 02:20 PM | Permalink

By REGISTER EDITORIAL BOARD
September 27, 2005

Your employer does not buy your groceries for you.

Your employer does not make your house payments for you.

Your employer does not pay your utility bills.

So why in the world is your employer expected to provide your health insurance?

Alone among the industrialized countries, the United States drifted into a cockamamie arrangement in which health insurance is job-based. The glaring flaws with such a system include complexity, confusion and gaps that leave 40 million Americans without insurance.

To those drawbacks add another: The soaring cost of job-based health insurance puts American companies at a disadvantage in global competition.

When U.S. companies move jobs to China or India or Mexico, they don’t get just cheaper labor. They escape the steep and rising cost of employee health care. It’s not the only reason U.S. manufacturing is threatened, but it’s a big factor. If America is going to retain a strong manufacturing base, it must level the playing field.

Manufacturers’ tab especially high

A study done for the National Association of Manufacturers looked at the built-in cost disadvantages U.S. companies face in the global marketplace. Employee benefits came in a close second to high corporate tax rates.

The disadvantage is especially felt by manufacturers, which traditionally have offered generous benefits. Health-care costs are one-third higher in manufacturing than in the service sector.

One reason is that venerable U.S. manufacturers pay health-insurance benefits to large numbers of retirees. As they have downsized their work forces, their retiree numbers have increased. Newer, service-sector companies aren’t burdened as much by these so-called legacy costs of retired workers.

General Motors says health-care costs for active and retired employees add $1,500 to the price of every car the company makes. That’s an expense the foreign competition doesn’t have.

Maytag Corp. in Newton is in a similar situation — a mature company that not only provides health benefits to its active work force but also helps retirees with prescription-drug benefits and Medicare supplements. In a message to employees earlier this year, Maytag noted that its worldwide work force decreased about 25 percent (from 24,000 to 18,000) between 2000 and 2004. During the same time, the number of retirees eligible for health benefits increased by 25 percent, to 7,000. Retiree medical benefits cost Maytag $60 million a year and are expected to reach $80 million by 2010. Nationally, it’s estimated that more than 9 million retirees get health benefits from their former employers.

Health insurance was a major issue in a 2004 strike at the Newton plant, as it has been in almost every labor dispute in America in recent years.

Universal system offers pluses

The needed action is obvious, if not easy. The cost of health care should be lifted from the shoulders of employers. It should be the responsibility of individuals and taxpayers.

Studies show that a universal, government-sponsored system — similar to those in every other industrialized nation — could cover everyone in America for about the same amount Americans now pay for a disjointed, job-based system. The bonus: It would improve the competitive position of American manufacturers.

The U.S. Department of Commerce last year published a white paper on competitiveness in manufacturing. It recommended attempting to lower health-care costs through measures such as joint purchasing and malpractice tort reform.

Unfortunately, manufacturers’ groups and the Commerce Department stop short of advocating comprehensive reform. It is not sufficient to tinker with a dysfunctional health-care system. Joint purchasing isn’t enough to get the job done.

The health-care-cost disadvantage borne by American manufacturers will be removed only by abandoning the whole idea of job-based insurance.

And only business has the lobbying clout to make it happen.

Manufacturers and other employers could break the gridlock over health-care reform by weighing in on the side of universal coverage that is not job-based. They need to do so for their own sake, the sake of competitiveness and the sake of the country.

Posted by pnhp at 02:08 PM | Permalink

Provided by: Canadian Press
Written by: JOHN COTTER
Sep. 27, 2005

EDMONTON (CP) - World-renowned cancer specialist Eduardo Bruera is homesick for Canada’s health-care system.

Dr. Bruera left Edmonton’s Cross Cancer Institute after 15 years in 1999 to become chairman of the department of palliative care at the University of Texas M.D. Anderson Cancer Center in Houston. After working in both countries, Bruera, an oncologist, has a message for people who complain about medicare or who want to expand the use of private health insurance in Canada.

“The portability and the universality of health care in Canada are unbelievably good. I think Canadians are not aware of that,” said Bruera, who was to compare care in the two countries in a speech Wednesday at the annual conference of the Canadian Hospice Palliative Care Association.

“Don’t look at the United States. The public health-care system makes it possible for patients to access palliative care in Canada earlier and more effectively.”

Since moving to Texas, Bruera said he can’t get over the spectre of crushing debt that even upper-middle-class Americans face when a family member is dying from an advanced illness.

Even premium private health insurance in the United States rarely covers all the costs, which can lead to bereaved survivors facing an almost never ending list of medical bills, he said.

Of every $100 spent by families on medical care at the M.D Anderson Centre, only $32 is paid for by private insurance, he said.

More than 41 million Americans don’t have health insurance, he said. Of those who are insured, one in three will lose all their financial assets during illness.

“To me it is an enormous impact on quality of life. The burden of dying in the U.S. of cancer is much heavier than the burden . . . in Canada.”

Bruera’s remarks come as the federal and provincial governments work to come to grips with a Supreme Court of Canada decision in a Quebec case earlier this year which approved some uses of private health insurance.

Since the ruling, provinces such as Alberta have been actively considering expanding the use of private health insurance.

The province is expected to announce by the end of October which private insurance firm will be chosen to conduct an actuarial study of the pros and cons of such a scheme.

Premier Ralph Klein has said allowing private insurance firms to sell policies would benefit Albertans who want to shorten their waiting times for non-emergency medical procedures.

However, the province has yet to define exactly what it means by “non-emergency.”

Bruera said he is “100 per cent sure” that private insurance would not improve palliative care.

“In general, services such as palliative care, that is not highly profitable or high tech, are generally not insured very well in the U.S.,” he said.

“If you privatize parts of the system, the juicy parts, the ones that are more profitable, will be taken by the private insurers. The most costly and less rewarding will be left for the government services.”

Posted by pnhp at 02:07 PM | Permalink

A Health Care Disaster
By Nicholas D. Kristof

Kiln, Miss.

In the richest country in the world, a man named Eugene Johnson is going blind in a homeless shelter, because his eye medicine washed away in Hurricane Katrina and he can’t afford to buy more.

At one level, that’s an indictment of the official rescue effort: the authorities were sufficiently concerned about hurricanes that last year they pre-positioned 10,000 body bags in New Orleans, but they dozed as Katrina approached.

Yet at a deeper level, Mr. Johnson’s plight is a window into our broken health care system. Sure, we need to think about how to rebuild New Orleans, but we also need to reconstruct a sensible health care system.

And that task is urgent, for one study suggests that more than 18,000 Americans will die this year as a consequence of not having health insurance.

Barbara Bush thought that Hurricane Katrina worked out pretty well for the poor. (“Many of the people in the arena here, you know, were underprivileged anyway,” she said after touring the Astrodome, “so this is working very well for them.”) I’d like her to come here to the rural Mississippi town of Kiln, near the Louisiana line, and meet Mr. Johnson. A barrel-chested retired plumber, a white man of 57, Mr. Johnson suffers from diabetes that has already cost him two toes. Complications also threaten his eyesight, and so he must take nine prescription medicines, including two to preserve his vision.

But the hurricane destroyed Mr. Johnson’s house. Since then, he has been bouncing from one shelter to the next and is now sleeping on a cot in a school gymnasium, along with his wife and four of his five children (one is grown and has left home).

Once Mr. Johnson found a pharmacy that was open and had one of the medicines he needs. But it charged $119 for it, and he couldn’t afford that. So Mr. Johnson is slowly going blind.

“My eyes are starting to mess up,” Mr. Johnson explained. “I see little spots. And then sometimes they all move around, like a TV picture that’s gone bad.”

Finally, a first-rate aid group, Children’s Health Fund, brought doctors and a mobile clinic to Mr. Johnson’s shelter. One of the doctors, David Krol, examined Mr. Johnson, was horrified, and is working on obtaining the medications he needs. But as Dr. Krol described the mobile clinic: “We’re a stopgap. Nothing more.”

If Mr. Johnson were more mobile, more adept at working the system, and more of a complainer, he might have gotten help earlier. But the poor tend to be stuck in shelters, without vehicles, and many are busy looking after small children. And many, like Mr. Johnson, are disastrously polite, patient, deferential and even cheerful. Around here, if you have the patience of Job, you suffer like Job.

Nearly every medical worker I spoke to warned that there would be a surge in deaths from heart disease, strokes and other ailments, concentrated among the poor, because of the interruption in medicines. Dr. Jay Lemery told of treating a single mother in a shelter whose three children were bouncing off the walls because they had attention-deficit disorder and hadn’t had their medication. The mother herself was prone to depression and had run out of her own medicine as well - in an environment that would make Pangloss suicidal.

The shelter was hot and tempers were so frayed that two women were having a fistfight. Dr. Lemery added: “Even the Red Cross people, who have the patience of Mother Teresa, were in tears.”

Yet the reality is that our medical system failed this region long before Katrina arrived. One of the Children’s Health Fund doctors discovered a previously undetected hole in a 4-year-old boy’s heart. The mother said nobody had ever listened to the boy’s chest before.

In both Mississippi and Louisiana, infant mortality is worse (for every 1,000 babies born, 10 die in their first year of life) than in Costa Rica (8 die per 1,000). For black babies in either state, the picture is still more horrifying: 15 die per 1,000. In poor, war-torn Sri Lanka, where per capita medical spending is only $131, babies have better odds, with 13 dying per 1,000.

So let’s rebuild the levees, but let’s also construct a health care system that works. A dozen years after the last, failed attempt to reform health care, the system is more broken than ever. For the sake of Mr. Johnson, and for our children, it’s time to try again.

Posted by pnhp at 02:04 PM | Permalink

New Report Finds Medicare Drug Prices are 58.2 Percent Higher than VA Prices

49 of 50 Top-Prescribed Drugs Are More Expensive in Medicare than Through the Department of Veterans Affairs (VA)

Washington, D.C. – A new report released today found that seniors using Medicare drug discount cards are paying considerably more for 49 of the top-50 most frequently prescribed drugs than they would through the Department of Veterans Affairs (VA). The median price difference for the 50 drugs was $220.44.

The report, released by the consumer health organization Families USA, found that, for half of the top-50 drugs, the lowest Medicare discount card price is at least 58.2 percent higher than the best available VA price.

The Families USA report was issued at a time when many conservatives and liberals are concerned about the expense of the new Medicare drug program. A key controversial feature of the legislation that created the new program prohibits Medicare from bargaining for cheaper drug prices like the VA already does.

“The best way to make medicines affordable for seniors is to allow Medicare to negotiate for better prices directly with drug companies, the way the VA successfully does,” said Ron Pollack, Executive Director of Families USA. “The continued prohibition against such bargaining will not only hurt seniors, but it will also fleece the American taxpayer.”

This study about the temporary Medicare drug discount card program provides the best current forecast of the drug prices we will see in the new drug benefit program. It shows that, despite the cost-savings promises made by the Bush Administration and congressional leaders when the new Medicare law was enacted, the Medicare discount cards routinely failed to result in drug prices as low as the VA.

For the five drugs most frequently prescribed for seniors, the report found that the best price under the Medicare drug discount card is considerably higher than the best VA price:

- For Plavix (75 mg.), a blood-clot reducing agent that is the most heavily prescribed medication for seniors, the best VA price is $887.16 per year, compared to the best Medicare drug discount price of $1,230.36—a difference of $343.20, or 38.7 percent.

- For Lipitor (10 mg.), a cholesterol-lowering agent that is the second most heavily prescribed medication, the annual VA price is $498.84, compared to $730.56 under the Medicare discount cards—a difference of $231.72, or 46.5 percent.

- For Fosamax (70 mg.), an osteoporosis drug that is the third most heavily prescribed medication for seniors, the annual VA price is $493.32, compared to $650.52 under the Medicare discount cards—a difference of $157.20, or 31.9 percent.

- For Norvasc (5 mg.), a high-blood pressure treatment that is the fourth most heavily prescribed medication for seniors, the annual VA price is $301.68, compared to $467.042 under the Medicare discount cards—a difference of $165.36, or 54.8 percent.

- For Protonix (40 mg.), a stomach acid blocking agent that is the fifth most heavily prescribed medication for seniors, the annual VA price is $253.32, compared to $827.40 under the Medicare discount cards—a difference of $574.08, or 226.6 percent.

For the two most expensive drugs prescribed to seniors under the discount card program in the top-50 list, the report found that the best price under the Medicare drug discount card is considerably higher than the best VA price:

- For Aricept (10 mg.), an Alzheimer’s treatment that is the most expensive of the top-50 drugs prescribed for seniors, the annual VA price is $1,056.84, compared to $1,453.92 under the Medicare discount cards—a difference of $397.08, or 37.6 percent.

- For Pravachol (40 mg.), a cholesterol-lowering agent that is the second most expensive of the top-50 drugs, the annual VA price is $470.40, compared to $1,240.44 under the Medicare discount cards—a difference of $770.04, or 163.7 percent.

“A big reason why the new Medicare program is so costly is because Congress and the President chose to support the pharmaceutical lobby over the interests of America’s seniors and taxpayers,” said Pollack. “At a time when drug costs continue to skyrocket and the federal budget is in deep deficit, this needs to change.”

The Families USA report was based on a comparison of the Medicare discount card prices for the 50 drugs most frequently used by seniors with the prices the VA negotiates for those same drugs. The list of the 50 drugs most frequently prescribed to seniors is based on the drugs most frequently prescribed in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program. This program is the oldest and largest drug assistance program for seniors in the U.S., with nearly 200,000 enrollees.

Families USA collected all Medicare discount prices for each drug using a zip code for the Cincinnati area, 45206, and the findings are based on the lowest price recorded for each drug. These prices were then compared to the lowest publicly reported prices by the VA. The Medicare drug discount prices are very similar from one locale to another.

###

Families USA is the national organization for health care consumers. It is nonprofit and nonpartisan and advocates for high-quality, affordable health care for all Americans.

Posted by pnhp at 02:02 PM | Permalink

Keep our NHS public

You may be aware of a major campaign which is being launched, Keep our NHS public.

I would like to encourage you to visit its website
http://www.keepournhspublic.com/
where you can sign to support the campaign. You may wish to read the letter in The Guardian on 24 September 2005 calling for the campaign, signed by health practitioners, writers, and other leading figures:
http://www.guardian.co.uk/letters/story/0,,1577222,00.html

I would also encourage you to contact the campaign if you wish to help or if you are organising a relevant meeting or other activity. Please contact info@nhscampaign.org

You may be interested to know that there will be a meeting organised by the NHS Consultants’ Association on Saturday 08 October at 3.00pm in the Wilkins Old Refectory in UCL, Gower St, London. Please contact nhsca@pop3.poptel.org.uk if you are interested in attending.

Dr James Lancaster
Centre for International Public Health Policy
University of Edinburgh

Posted by pnhp at 01:58 PM | Permalink

Hospitals may close, says letter to Guardian
Timing seems designed to foment conference revolt

John Carvel, social affairs editor
Guardian
Saturday September 24, 2005

A campaign to halt the government’s drive to commercialise the NHS is being launched today by the former Labour health secretary Frank Dobson with the support of leading figures from the British medical establishment.

In a letter to the Guardian that is likely to form the focus of dissent at the Labour conference in Brighton next week, they say that reforms being introduced by the health secretary, Patricia Hewitt, threaten to destroy the character of the NHS by forcing hospitals and health professionals to compete with each other. The timing of the letter is clearly designed to foment a revolt in Brighton, where Dave Prentis, general secretary of the public service union Unison, intends to move a resolution on Wednesday calling on the government to “suspend any further expansion of the role of the private sector into the NHS”. The union was busy mobilising support yesterday among unions, MPs and constituency parties, predicting that victory for its motion could become the main flashpoint of the conference.

But the campaign’s reach extended beyond the Labour movement, with supporters of the letter including 19 professors of medicine and related disciplines, senior figures from the British Medical Association, and the poet laureate, Andrew Motion. It was also signed by Mr Prentis, the former cabinet minister Clare Short, and authors Philip Pullman, Claire Tomalin and Nick Hornby.

The letter came as the BMA published a survey of NHS medical directors across England suggesting that a third of NHS trusts are preparing to reduce services to avoid a debt crisis. The letter said: “Forced market competition will break up the NHS as a collaborating network … There will be winners and losers, with some units and even entire hospitals having to close … The NHS must be kept in public hands … We call on organisations, healthcare workers, patients and public to campaign to protect the NHS from further privatisation and fragmentation.”

Mr Dobson said: “The government’s policy of promoting competition within the NHS and franchising services out to the private sector is gathering momentum day by day. Before long we will have a health insurance system and the NHS’s role as a provider of care will be limited to picking up the difficult cases and looking after the worst off. There is great concern in the Labour party throughout the country about what is happening - and it is shared by more than 1m NHS employees. It is time we worked together to put some chocks under the wheels of this fashionable bandwagon.”

The BMA’s analysis of NHS cuts was based on a survey of 530 medical directors in England. On the basis of 120 replies, it said 73% of trusts face a funding shortfall in the current year. The required savings averaged £6.2m per trust. Almost half were proposing a recruitment freeze and 27% were considering redundancies. Some trusts are also intending to close beds.

The BMA said medical staff would be included in recruitment freezes in almost half (47.9%) of cases where this was being considered, with 14% saying redundancies would also include medical staff.

Paul Miller, chairman of the BMA’s consultants’ committee, said: “It is hard to understand why, at a time when the government has invested unprecedented funding in the health service, trusts may have to lay off staff and close wards. Something is going terribly wrong when patients pay the price for these financial problems and the government’s lack of joined-up thinking … It is madness to guarantee private providers huge volumes of work, often at a higher cost than the NHS, while NHS hospitals are deprived of essential funding.”

The NHS Confederation, representing managers and trusts, said the BMA’s findings should be treated with caution, since less than a quarter of medical directors replied to the survey.

The campaign’s website is www.KeepOurNHSPublic.com

The letter:

The future of the NHS is at stake

Saturday September 24, 2005

Guardian
The NHS stands at a crossroads. For nearly 60 years, Britain has enjoyed a National Health Service that strives to be comprehensive, accessible and high value for money. Now, government reforms threaten both the ethos of the NHS, and the planned and equitable way in which it delivers care to patients.

At the heart of the changes is the creation of a market that welcomes profit-driven international corpor-ations and will compel hospitals and health professionals to compete with each other. If these reforms continue the nature of the health system will change radically:

- Income and profit will come before clinical considerations.
- Profitable services and patients will attract money at the expense of unprofitable ones.
- Forced market competition will break up the NHS as a collaborating network of shared resources and information.
- Even more of the new money allocated to health will be diverted to shareholders and wasted on the huge administrative costs associated with a market.

There will be winners and losers, with some units and even entire hospitals having to close. We are already seeing bed closures in NHS hospitals. The end result will undermine the choice that is most important to patients - access to comprehensive, trustworthy and l ocal health services.

The situation is grave. The NHS must be kept in public hands, serving the interests of all patients and the broader public. We therefore call on organisations, healthcare workers, patients and public to campaign to protect the NHS from further privatisation and fragmentation.

Prof David Hunter
University of Durham

Dr Mac Armstrong
Ex-Chief Medical Officer, Scotland

Sir Sandy Macara
ex-BMA council chair

Dr John Marks
ex BMA council chair

Professor Brian Jarman
Ex BMA president and head of the Dr Foster unit at Imperial College

Sir Iain Chalmers
Director, UK Cochrane Centre NHS Research and Development Programme

Professor Julian Tudor Hart
Medic, academic and writer

Frank Dobson MP
Ex Secretary of state for Health

Professor John Yudkin
Professor of Medicine Director, International Health and Medical Education Centre University College London

Professor Martin White
Chair of Public Health and Director Public Health Research Group School of Population & Health Sciences Faculty of Medical Sciences University of Newcastle upon Tyne

Professor George Davey Smith
(Professor of Epidemiology) Dept Social Medicine, Bristol

Professor Martin McKee
European Centre on Health of Societies in Transition London School of Hygiene and Tropical Medicine

Professor Allyson Pollock
Academic and writer

Peter Kilfoyle MP

Professor Colin Crouch
Chair of the Institute of Governance and Public Management Warwick University Business School

Professor Martin White
Chair of Public Health and Director, University of Newcastle upon Tyne

Professor Sara Arber
Department of Sociology, University of Surrey, Guildford

Dave Prentis
Unison, General Secretary

Prof Vincent Marks
Professor of clinical biochemistry at the University of Surrey

Professor Dame June Clark
Professor Emeritus at the University of Wales member of the Royal Commission into long term care of the elderly

Claire Rayner
writer, broadcaster

Phillip Pullman
author

Neal Lawson
Chair, Compass

George Monbiot
Writer, journalist

Clare Short MP

Professor Sir Andy Haines
Professor of Public Health and Primary Care

Mr Nick Astbury (personal capicity)
President of the Royal College of Ophthalmologists

Nick Hornby
author

John Bird
comedian

Andrew Motion
Poet Laureate

Prof Charles Webster
NHS historian academic, writer

Francis Wheen
Journalist

Claire Tomalin
winner of Whitbread book award

Prof Harry Keen CBE
President NHS Support Federation National Pensioners Convention

Frank Cooper

Professor Rodney Reznek
Professor of Diagnostic Imaging

Prof Emeritus Ron Taylor

Prof Emeritus David Metcalfe

Posted by pnhp at 01:54 PM | Permalink

By Jonathan M. Katz
Washington Post
September 21, 2005

Senate Majority Leader Bill Frist, a potential presidential candidate in 2008, sold all his stock in his family’s hospital corporation about two weeks before it issued a disappointing earnings report and the price fell nearly 15 percent.

Frist held an undisclosed amount of stock in Hospital Corporation of America, based in Nashville, the nation’s largest for-profit hospital chain. On June 13, he instructed the trustee managing the assets to sell his HCA shares and those of his wife and children, said Amy Call, a spokeswoman for Frist.

Frist’s shares were sold by July 1 and those of his wife and children by July 8, Call said. The trustee decided when to sell the shares, and the Tennessee Republican had no control over the exact time they were sold, she said.

HCA shares peaked at midyear, climbing to $58.22 a share on June 22. After slipping slightly for two weeks, the price fell to $49.90 on July 13 after the company announced its quarterly earnings would not meet analysts’ expectations. On Tuesday, the shares closed at $48.76.

The value of Frist’s stock at the time of the sale was not disclosed. Earlier this year, he reported holding blind trusts valued at $7 million to $35 million.

Blind trusts are used to avoid conflicts of interest. Assets are turned over to a trustee who manages them without divulging any purchases or sales and reports only the total value and income earned to the owner.

To keep the trust blind, Frist was not allowed to know how much HCA stock he owned, Call said, but he was allowed to ask for all of it to be sold.

Frist, a surgeon first elected to the Senate in 1994, had been criticized for maintaining the holdings while dealing with legislation affecting the medical industry and managed care. Call said the Senate Select Committee on Ethics has found nothing wrong with Frist’s holdings in the company in a blind trust.

“To avoid any appearance of a conflict of interest, Senator Frist went beyond what ethics requires and sold the stock,” Call said. Asked why he had not done so before, she said, “I don’t know that he’s been worried about it in the past.”

An HCA spokesman said the company had no part in Frist’s decision.

Frist’s father, Thomas, founded the company, and his brother, Thomas Jr., is a director and leading stockholder. The family is worth $1.1 billion, according to Forbes magazine.

HCA — formerly known as Columbia HCA Healthcare Corp. — has been a top contributor to the senator’s campaigns, donating $83,450 since 1989, according to the Center for Responsive Politics.

The sale of the shares was first reported by Congressional Quarterly.

Posted by pnhp at 01:48 PM | Permalink

Big-box retail stores add health insurance to wares
By Barbara Marquand
Sacramento Business Journal
September 30, 2005

Shoppers look for deals on everything from paper towels to computers at big-box warehouse stores. Now they can get health insurance too.

Costco Wholesale Corp. and the Sam’s Club unit of Wal-Mart have been offering small-business health insurance policies to customers for the last two years. Two months ago Costco expanded its line with a pilot program in Southern California to sell individual health insurance policies.

Costco decided to offer individual health insurance policies as one more way to offer value to customers… The coverage is available only to executive members, who pay $100 a year to shop at the warehouse, versus the $45-per-year standard membership fee.

PacifiCare has about 6,000 people enrolled in its Costco small-business plan and about 800 enrolled in its individual Costco PPOs. The Costco plans have higher deductibles and slightly different benefits from other PacifiCare products, which help achieve the premium savings.

Rita Gibson doesn’t think the big-box phenomenon will have a big impact for most traditional brokers. The big-box stores are selling insurance as a commodity, she said, and the benefits for those policies are not as strong as they are for other policies sold through brokers.

“In the short run it brings more competition to the market, and as an economist I think that’s good,” said Glenn Melnick, director of the University of Southern California Center for Health Policy and Management. “It makes it easier to have access to a lower-cost market.”

But he doesn’t expect a big impact in the long term unless insurers get more innovative…

http://sacramento.bizjournals.com/sacramento/
stories/2005/10/03/focus3.html

Comment: So now the big-box discount stores are entering the competitive market for health insurance. And how do they compete? By reducing benefits and require greater cost sharing than the competing products that have already reduced benefits and required greater cost sharing. It’s a race to the bottom!

How long has it been since you’ve seen a new insurance product that offers greater benefits and lower out-of-pocket costs? Well, you won’t see any because the competition is with premiums charged rather than with the quality of the insurance product. By far the largest sector of the market is composed of healthy individuals who have only relatively negligible current needs for health care. That sector finds it very difficult to devote a large portion of income to a “commodity” that they aren’t using.

Deterioration in the value of insurance products has already created financial hardships for those who do develop significant acute and chronic problems. As these innovative trends expand, more and more middle income individuals will be impacted. But for the affluent, who have a political voice, health care will never become unaffordable, so there will be little pressure for change.

Besides, look at the potential for new revenue opportunities. Right next to the insurance desk, the big-box stores can set up Chapter 13 agents. And that is destined to be a very high volume business!

Posted by pnhp at 01:42 PM | Permalink

Injured kids: no insurance, no chance?
Florida children who are hospitalized without insurance are more that twice as likely to die there, a study shows.
By Lisa Greene
St. Petersburg Times
October 4, 2005

Children stream into Florida hospitals every day after falling off bicycles or into swimming pools, being hurt in car wrecks or at the hands of a violent adult.

Whether they have insurance could in part foreshadow how well they will fare.

Children in Florida who enter the hospital without health insurance are more than twice as likely to die there as children with private health insurance or public insurance such as Medicaid, according to a new study by local researchers.

Of the nearly 11,000 children hospitalized in Florida with injuries in 2002, 131 died. About 18 percent of those deaths were uninsured patients, even though those patients made up only 8.5 percent of hospitalizations. Researchers released the findings Monday in a report produced by All Children’s Hospital, the Florida Suncoast SAFE KIDS Coalition and USF Health.

Researchers weren’t sure why but were concerned about the disparity and were applying for grant money to do another study.

These children are most likely in families of the working poor - those whose parents make too little to afford private insurance but too much for the children to be covered by Medicaid. For now, researchers can only guess at disturbing possibilities:

—There might be something different about the way these children are hurt. Maybe they’re in older cars that don’t protect them as well in accidents. Maybe their places to play aren’t as safe. Maybe they’re more likely to be abused.

—Parents of children with insurance may be more willing to rush their child to the emergency room after an injury just in case, while parents without might wait longer to see if the child is seriously hurt or not have a car to drive to the hospital.

—The children might be treated differently after they arrive at the hospital. Emergency rooms are required to treat patients regardless of whether they can pay, but studies have shown differences in outcomes for some medical conditions based on who has insurance.

http://www.sptimes.com/2005/10/04/State/Injured_kids__no_insu.shtml

And…

Care without Coverage: Too Little, Too Late
Institute of Medicine

The uninsured more often… receive fewer diagnostic and treatment services after a traumatic injury or a heart attack, resulting in an increased risk of death even when in the hospital.

http://www.iom.edu/Object.File/Master/4/160/0.pdf

Comment: The authors of this report are careful to point out that, although the lack of insurance is correlated with twice the risk of death in children with trauma, the cause of this higher mortality was not established.

Opponents of insurance reform will undoubtedly dismiss this study with their usual rhetoric. “Everyone gets the care they need whether they’re insured or not, and that is certainly always true for emergencies.” They will also resort to blaming the victim. “These people don’t take care of their kids. They don’t fasten their seatbelts. They don’t watch their kids around pools or on the playground.”

Everyone would agree that injury prevention efforts must be expanded, both in design and education. No matter how effective these measures are, some injuries are inevitable since people and systems are never perfect. The “blame the victim” mentality needs to be shifted to a “let’s do all we can to prevent injuries” mentality.

As far as everyone getting the care they need, innumerable studies have confirmed that the uninsured do not. The Institute of Medicine report confirms that uninsured trauma victims taken to hospitals do not receive as much care as the insured, and death rates are higher.

Lack of insurance kills children. How much longer are we going to tolerate this entirely preventable cause of death? They may be the victims, but we have only ourselves to blame.

Posted by pnhp at 01:38 PM | Permalink

Medicare Extra: A Comprehensive Benefit Option For Medicare Beneficiaries
By Karen Davis, Marilyn Moon, Barbara Cooper, Cathy Schoen
Health Affairs
October 4, 2005

Abstract

The proposed Part E, Medicare Extra, outlined in this paper adds a comprehensive benefit option to Medicare, eliminating the need for beneficiaries to purchase a private drug plan and Medigap supplemental coverage. Financed by a budget-neutral beneficiary premium, it has the advantages of greater simplicity, efficiency, and value without adding to federal costs. Beneficiaries now enrolled in Medigap plans would save money, as could employers by choosing a lower-cost alternative to current retiree health plans. Eliminating some of the excess payments to Medicare Advantage plans would yield savings that could be used to help finance premium subsidies for low-income beneficiaries.

Concluding Comments

Medicare beneficiaries have consistently expressed higher satisfaction with their coverage than nonelderly enrollees in employer health plans have. They are much more confident that they will be able to obtain care when needed, and they report fewer problems obtaining access to care. They are less likely than people with employer coverage to report negative insurance experiences and problems paying medical bills. Improving Medicare’s benefits should build on this record and permit those beneficiaries who are genuinely pleased with the traditional FFS program to consolidate their benefits there.

A comprehensive Part E benefit offered by traditional Medicare would have strong advantages for beneficiaries. Beneficiaries would get the benefits they want at lower cost and with much less confusion and complexity. It would create choices for beneficiaries and a genuine choice between Medicare Extra and MA plans. A strong role would remain for private insurers, both offering MA plans and serving as fiscal intermediaries in paying claims for basic Medicare and Medicare Extra. But savings also would be achieved, by having the government assume fiscal risk and negotiating rates with providers. In addition, employers could save money on retiree health benefits. Such an alternative should be a part of the debate over the future of Medicare and any midcourse corrections to the new drug benefit.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.442v1

For a brief description of this proposal from The Commonwealth Fund:
http://www.cmwf.org/publications/publications_show.htm?doc_id=302930&#doc302930

Comment: Although Medicare is the most popular insurance program in the United States, it does have some deficiencies.

Part A covers hospitalization and Part B covers physicians and other services, but with cost sharing. In order to reduce the financial vulnerability caused by Medicare cost sharing, Medigap plans were introduced into the private market. Unfortunately, these plans represent one of the worst values in health insurance. Not only are they overpriced considering the minimal benefits offered, they also compound the administrative burden of our fragmented system of funding health care. The Medicare Part E proposal would expand Medicare Parts A and B by rolling in the function of the Medigap plans, thereby eliminating the tremendous waste inherent in this supplemental coverage.

Medicare Part D establishes the principle that drugs are an essential part of health care and must be included as a Medicare benefit, but it is one the worst designed public insurance programs ever devised. Without listing the major flaws, we’ll simply state that, for Medicare Part E, many of the Part D defects are corrected and then this drug benefit is folded in as well.

The Medicare Advantage plans are private plans that can be selected by opting out of the traditional Medicare program. At present, the private plans are able to offer more generous coverage for two reasons. Plans have successfully marketed healthier sectors of the population, but Congress has continued to ignore adverse selection and has continued to compensate the plans as if they were covering their share of high-cost patients. Even worse, to encourage a greater shift to the private insurance market, Congress has authorized huge bonuses for the private plans to provide them with a perverse competitive advantage over the traditional providers. What an abusive use of our tax dollars! If Congress were a private corporate board, the SEC would have all of them in prison. If required to compete on an equal dollar basis, with full Medicare benefits and appropriate risk adjustment, the Medicare Advantage plans would walk away. And they should, once we allow the traditional Medicare program to include a bona fide prescription benefit.

Medicare Part E then is a combination of Medicare Parts A, B and an improved D, and the expansion would be funded mostly by eliminating the waste of Medigap and Medicare Advantage plans.

For incrementalists, Medicare Part E would be a dramatic step forward. For single payer supporters, Part E would fall far short. We must not let up on our message of affordable, high quality, comprehensive health care coverage for everyone. Until we are there, and we will be, we can support the efforts of those who would improve our system through beneficial, incremental steps. Under incrementalism, all parameters of our health care system are worse, but the fact that we are pushed two steps back doesn’t mean that we shouldn’t take one step forward when we can.

Single payer supporters may want to become actively involved in the Part E process. We could advocate for additional improvements that characterize the single payer model. Once an ideal Part E Medicare were established, we could advocate for expanding it to cover everyone. That would provide smug complacency to those in our movement who believe that we should be using the label, “Medicare for All.” I’m quite willing to give them that, as long as we end up with a single payer system.

Posted by pnhp at 01:29 PM | Permalink

Medical Debt and Access to Health Care
Prepared by Catherine Hoffman, Diane Rowland and Elizabeth C. Hamel
The Kaiser Commission on Medicaid and the Uninsured
September 2005

Health insurance alone is no longer a guarantee of financial protection from the costs of health care for many. Today’s higher premiums, deductibles, and copayments can create a substantial financial burden for families and many learn only through an unexpected serious injury or illness that they are not well protected financially.

In this study… we found that one in six adults who are privately insured - 17.6 million adults - report having substantial problems paying their medical bills.

Privately insured adults with medical debt are largely from middle-class families, not as poor as the uninsured, but not as well-off as the privately insured who have no medical debt. The large majority hold full-time jobs. An important difference between the privately insured with vs. without medical debt is their health status. Those with medical debt are more than twice as likely to report being in only fair or poor health and they are almost twice as likely to have an ongoing or serious health problem compared to others with private coverage.

Perhaps not surprising, the majority of those with medical debt reported underestimating what their health plan would pay towards their medical bills (vs. a third of those without sizable medical debt) and nearly half said their plan had not paid anything for care they thought had been covered.

If current trends in greater cost-sharing continue, more low- and middle-income families with private insurance, particularly those who are in less than good health, will not have the same access to care as others with private coverage who have higher incomes. In fact, as this study shows, they will limit their care in many of the same ways and as often as those who have no health insurance at all.

http://www.kff.org/uninsured/upload/Medicaid-Debt-and-Access-to-Health-Care-Report.pdf

Comment: Monotonous, isn’t it - study after study demonstrating that private health insurance is no longer serving its purpose - to ensure financial security for those who have health care needs.

Current insurance innovations are designed to make premiums affordable, and they do this by making access to care unaffordable. The insurers are not going to fix this broken system for us. Isn’t it time that we gave up on them?

Posted by pnhp at 01:11 PM | Permalink