News

By Nicholas D. Kristof
New York Times, op-ed
January 31, 2006

First, a quiz: What “vegetable” do American infants and toddlers eat most?

Weep, for it’s the French fry. A major study conducted by Gerber found that up to one-third of young children don’t eat any vegetable daily, but that the French fry is the single most common one they do consume. And among children age 19 months to 24 months, 20 percent eat French fries at least once a day.

President Bush is slated to discuss health care in his State of the Union address tonight. It’s about time: it’s scandalous that babies born in the United States are less likely to survive their first year than babies born in Slovenia. But the solutions to the health crisis lie less in reorganizing medical treatment than in improving public health — such as steering kids away from French fries.

Think of two of the biggest breakthroughs in improving Americans’ health over the last generation or two. They had nothing to do with doctors, but arose from higher cigarette taxes and other efforts to discourage smoking, and from compulsory seatbelts and improvements in auto safety.

So what can we do? In my last column, I praised Gov. Mike Huckabee of Arkansas for leading a series of initiatives to confront obesity and lack of exercise. Health experts suggest a variety of others (a book by Tom Farley and Deborah Cohen published last year, “Prescription for a Healthy Nation,” offers excellent ideas). Building on them, here are my suggestions:

Ban soda, potato chips and other unhealthy snacks from American schools, and discourage them in the workplace. It’s unforgivable that our schools help to send children on the road to diabetes. Obesity kills far more Americans than heroin does.

Sell cigarettes only in pharmacies and raise cigarette taxes. Smoking still kills 440,000 Americans a year, including 50,000 nonsmokers. One study found that raising the federal excise tax on cigarettes by 75 cents a pack would generate $13.1 billion in additional revenue per year and cut youth smoking by 13 percent and adult smoking by 3 percent, saving 1.2 million lives. Let’s do it.

Tax junk foods. Some 19 states already impose taxes on particular junk foods, like soda, and a nickel-a-can tax on soft drinks would generate $7 billion in revenues. In particular, we should tax high-fructose corn syrup, which is used as a sweetener in a vast array of products and is a major culprit in the fattening of America.

Promote jogging and biking. Since we pay for all the consequences of inactivity (like those heart bypasses), we should encourage exercise. We should build more bicycle paths and turn more streets over to bikers, skaters and pedestrians — starting with Sixth Avenue in Manhattan.

Encourage exercise breaks. Governor Huckabee gives state employees a 30-minute daily “exercise break” that is modeled on the smoking breaks that smokers take. It’s a good idea.

Distribute fruits and veggies to certain low-income people, as Maine does in FarmShare, a potent antipoverty program.

Expand P.E. It’s ridiculous that schools have been cutting back on P.E. when students need more of it. Likewise, kids should be encouraged to walk to school. When my eldest son attended a Japanese elementary school in Tokyo, the school required him to walk or bike to school beginning in the first grade.

Design better stairways. The default system for getting from one floor to the next in America (but not the rest of the world) is the elevator. Let’s encourage stair use instead, by having new buildings constructed with open and appealing stairs that are actually meant to be used — while perhaps making elevators dark, dingy and out of the way.

I’m sure there are other creative approaches. I’ve thought of subsidies for running shoes, which make more sense than subsidies for corn. And since the average American child spends 24 hours a week sitting in front of a television, how about developing televisions for kids that are powered by Exercycles?

Look, personally I’m convinced that we need universal health care based on a single-payer system. But that is not politically feasible now, while a systematic assault on the causes of American ill health could make a big difference.

Granted, a War on Sloth isn’t as dramatic for the Bush administration as a War on Terrorism. And for Democrats, attacking junk food isn’t as attention-grabbing as denouncing corruption in Congress. But there is perhaps no area of public policy where it would be easier to save the lives of countless Americans than in promoting public health.

Posted by pnhp at 04:22 PM | Permalink

FOR IMMEDIATE RELEASE
JANUARY 24, 2006

Cambridge Health Alliance: Alison Harris, aharris@cha.harvard.edu (617) 499-8323 UCLA: Elaine Schmidt, eschmidt@mednet.ucla.edu (310) 794-2272

Click Here For Study Text
RESEARCH ALERT

LESS THAN HALF OF U.S. HEALTHCARE WORKERS GET FLU SHOTS FINDS UCLA/HARVARD STUDY; HEALTHCARE WORKER’S LACK OF ACCESS TO HEALTHCARE PUTS PATIENTS AT RISK

FINDINGS: UCLA and Harvard researchers analyzed data from the 2000 National Health Interview Survey to measure flu vaccination rates among U.S. healthcare workers. From a nationally representative sample of 1,651 workers, the overall vaccination rate was only 38 percent. Rates were particularly low in workers who were health aides (e.g. nurses aides, medical assistants or orderlies), African American, or under 50.

IMPACT: The low flu vaccination rate among healthcare workers increases their likelihood of contracting the flu and passing it to patients. Healthcare workers, especially those who are minority, poor, or young, need both better education and improved access to primary care in order to reduce the spread of flu. Inequalities in healthcare currently undermine our ability to stop flu transmission. Should an epidemic of bird flu emerge, such inequalities will hamstring efforts to contain it.

BACKGROUND: More than 36,000 people died between 1990 and 1999 from influenza, the sixth leading cause of death in the nation. A severe pandemic of bird flu might kill many times that number. The Centers for Disease Control and Prevention recommend vaccinating healthcare workers with direct patient contact as a priority in preventing spread of the disease. Yet many healthcare workers lack access to healthcare for their own medical needs. Earlier studies have found that 12.2% of healthcare workers have no health insurance coverage. Workplace vaccination programs are also failing to reach such workers.

AUTHORS: Dr. William King, visiting assistant physician, Department of Infectious Diseases, David Geffen School of Medicine at UCLA; and Dr. Steffie Woolhandler, physician at Cambridge Health Alliance and associate professor of medicine at Harvard Medical School, are available for interviews. Two of the other authors work at Cambridge Health Alliance: David H. Bor (Infectious Disease Specialist and Chairman of the Department of Medicine) and David U. Himmelstein (Associate Professor of Medicine, Harvard Medical School).

JOURNAL: The research will appear in the February edition of the peer-reviewed Journal of General Internal Medicine, Vol. 21, No. 2.

FUNDING: Funding from the National Institutes of Health supported the research.

Posted by pnhp at 04:10 PM | Permalink

The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation’s Health Care
American College of Physicians
January 30, 2006

Conclusion

Unless immediate and comprehensive reforms are implemented by Congress and CMS, primary care-the backbone of the U.S. health care system-will collapse.

The consequences will be higher costs and lower quality as patients find themselves in a confusing, fragmented and over-specialized system in which no one physician accepts responsibility for their care, and no one physician is accountable to them for the quality of care provided. The state of the nation’s health care in 2006 already is deficient, as evidenced by increasing costs, more uninsured persons, persistent gaps in quality, and the decline in the numbers of physicians going into primary care. But the state of the nation’s health care in the near future will be far worse if the collapse of primary care is allowed to happen.

The recommendations being advanced today by the American College of Physicians offer a comprehensive strategy to redesign how primary care is financed and delivered to allow physicians to provide care that is centered on the needs of patients. ACP believes that our recommendations, coupled with reforms in medical education and relief from student debt, can reverse the decline in the number of physicians going into primary care. The federal government must accept its responsibility to redesign Medicare payment policies to recognize the value of physician-guided care coordination through an advanced medical home, to increase reimbursement for undervalued evaluation and management services, to expand coverage and provide reimbursement for health information technology, and to link payments to quality in a way that is non-punitive and provides substantial increases—commensurate with effort-to those physicians who participate in quality improvement, measurement and reporting focused on the top 20 conditions described in the IOM’s Crossing the Quality Chasm report.

Such reform will help strengthen the state of the nation’s health care, now and in the future, by acknowledging and supporting the value and role of primary care physicians in delivering better care at lower cost.

http://www.acponline.org/hpp/statehc06_1.pdf

ACP Policy Monograph on The Advanced Medical Home:
http://www.acponline.org/hpp/statehc06_5.pdf

Comment: By Don McCanne, M.D.

One of the greatest crises in health care today is the accelerating deterioration of our primary care infrastructure. Shifting to a fragmented primary system of multiple specialized services, the current trend in the United States, has been well documented to increase costs and result in lower quality outcomes.

The concept of the advanced medical home will not be addressed here other than to say that it is important that we improve the way that health care services are delivered, especially with current demographic shifts and evolving needs. The policy monograph accessible through the link above can provide more information on this important concept.

Although there are many reasons for the decline in primary care, two of the most important are comparatively low pay, and very long, labor-intensive hours. Concern about the latter can be reduced by improving the practice environment through application of innovative thinking of the type that led to the advanced medical home model. A gratifying practice environment would certainly make primary care a more attractive practice choice.

What about compensation? Most would agree that, by U.S. standards, primary physicians are under-compensated. Most would also agree that the amount of our GDP delegated to physicians is about right. The obvious conclusion is that some of the compensation directed to specialists should be shifted to generalists. Specialist compensation would still be adequate to provide for a very comfortable lifestyle, and would meet needs such as college expenses for the children and very comfortable pensions. If a physician really needs a fleet of luxury automobiles and a condo in every climate, then medicine might not be a good career choice.

Under a single payer system, physician compensation would be negotiated. The playing field would be leveled wherein primary care representatives would advocate for a more appropriate generalist/specialist compensation ratio. It would be beneficial to remove money as a major factor in the decision of a physician-in-training on whether to enter primary care or a specialty.

The process of negotiating compensation with the single payer administrators should be contrasted with our current system of paying physicians. The ACP report, as an example, is appropriately critical of the SGR (sustainable growth rate) method used by Medicare. With rigid fee schedules, physicians increase the frequency and intensity of services. The SGR is designed to keep the growth of spending in line with inflation and demographic changes.

As some physicians siphon off more funds by increases in frequency and intensity, downward adjustments must be made in the per unit payments. This penalizes physicians who make greater efforts to ensure that services are appropriate and efficient.

Although total Medicare spending for physicians is adjusted upwards, the per unit payments were reduced 4.4% this year. In the budget reconciliation process taking place now, these cuts will be restored. But look at what is happening.

S. 1932 - Deficit Reduction Act of 2005
Cost Estimate
Congressional Budget Office
January 27, 2006

“The act would increase payment rates for physicians’ services to the 2005 level (those payment rates were reduced by 4.4 percent on January 1, 2006).

That provision would increase outlays during the 2006-2009 period, and would reduce Medicare’s payments to physicians below current-law levels in subsequent years.”

http://www.cbo.gov/ftpdocs/70xx/doc7028/s1932conf.pdf

Further comment: You probably read that too fast, so let’s stop and see what it says. It was anticipated that the same dynamics would continue and that additional cuts beyond this year’s 4.4% would eventually add up to about a 25% reduction. Those reductions are being eliminated through 2009, but in 2010, the full level of reductions will be reinstituted with one dramatic drop in rates. But wait, there’s more! The funds that will be used to reestablish 2005 rates through 2009 are only a loan. As of 2010, the repayment of the loan will be added to the scheduled reductions resulting in a drop in Medicare compensation rates that virtually no physician will tolerate. By coincidence, that is the same year that Congress has called for the beginning of the process to entice physicians to exit the traditional Medicare program and provide their services through the private Medicare Advantage plans. What a nefarious plot! (In fairness, the reconciliation act does call for a report from the Medicare Payment Advisory Commission for suggestions on replacement of the SGR system, though primarily through methods of controlling volume growth - another problematic approach.)

The $2 trillion that we are spending is enough to provide high quality care for everyone, but it will never happen under our current flawed system. We won’t get it right until we establish a single national health insurance program. Once we have that in place then we will have the ability to allocate sufficient resources to our primary care infrastructure to ensure higher quality, more cost-effective care for everyone.

Posted by pnhp at 02:21 PM | Permalink

by Andy Coates
Published in MRZine

Physicians for a National Health Program held its annual meeting on December 10, 2005. Originally planned for New Orleans, it was relocated to Philadelphia after Hurricane Katrina. Founded in 1987, the organization has over 14,000 members nationally. PNHP advocates and educates for a single national health insurance plan: in the words of PNHP National Coordinator Quentin Young, MD, “everybody in, nobody out.” With about 250 in attendance, the meeting consisted of a series of panel discussions.

The PNHP “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance” has been published in the New England Journal of Medicine (in 1989) and the Journal of the American Medical Association (in 2003). Over 12,000 physicians endorsed the plan in 2003-2004. The proposed plan would cover all necessary medical care, including mental health and dental care, long-term care, hospitalization, and all prescription medications.

The Physicians’ Proposal articulates four principles:

1. Access to comprehensive health care is a human right. It is the responsibility of society, through its governement, to assure this right. Private insurance firms’ past record disqualifies them from a central role in managing health care.

2. 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.

3. 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.

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

PNHP President John Geyman, MD, welcomed participants to the meeting with brief remarks. Former editor of The Journal of Family Practice and author of many works including the Textbook of Rural Medicine, Dr. Geyman has written several books on the crisis in American health care.

Dr. Geyman’s soon-to-be-released book Shredding the Social Contract: The Privatization of Medicare (Common Courage Press, 2006) was available at the meeting. He writes in its first chapter that “the great debate of the 21st century will be about how the new rules for a global market can be rewritten in the public interest. The current model of ‘corporate managed trade’ serves corporate self-interest at the expense of entire populations.”

Steffie Woolhandler, MD, PNHP co-founder and associate professor of medicine at Harvard Medical School, started the day at 78 rpm with a brisk update of the PHNP slideshow, an activists’ speaking tool that digests evidence from the medical literature of the injustice, inequality, and inefficiency of health care in the United States.

Dr. Woolhandler explained, for example, that it is a myth that those who have trouble paying for care are uninsured but young and healthy. In a study Dr. Woolhandler published this year with PNHP co-founder David Himmelstein, MD, Elizabeth Warren, and Deborah Thorne, “Illness and Injury as Contributors to Bankruptcy,” over half of those declaring bankruptcy were driven into debt by medical costs. Of these, three quarters of debtors had insurance at the onset of illness and three fifths had private insurance at the onset of illness!

As part of a panel discussion on market-driven health care, Adewale Troutman, MD, spoke. An author, with former U.S. surgeon general David Satcher, MD, of “What If We Were Equal? A Comparison of the Black-White Mortality Gap in 1960 and 2000,” Dr. Troutman illustrated, with the case of a 56-year-old African American woman, how the failures of the American health care system lead to avoidable death and suffering. He advocated using the terms “injustice” and “inequality” instead of “disparities.” He suggested Episode III of Race: The Power of an Illusion, which looks at the question of housing, as a useful video analogy to portray the systemic racism in U.S. health care.

A panel devoted to Canada proved so popular that an extra session had to be organized for continued discussion. Steven Barrett, an attorney who was counsel for the Canadian Labor Congress before the Supreme Court of Canada in the Chaoulli v. Quebec case, gave an overview of medical malpractice in Canada, which is scarcely comparable to the United States. (Among many differences, with a single-payer system like the Canada’s Medicare, future health care costs need not be considered in lawsuits.) Joel Lexchin, MD, emergency physician at the University Health Network in Toronto and author of over 60 peer-reviewed articles, spoke on the questions of pharmaceutical regulation and drug costs, comparing the U.S. and Canada. Public health official and family physician Rosana Pellizzari, MD, discussed the Chaoulli decision and the struggle to resist privatization of health care in Canada. Along the way, Dr. Pellizzari addressed the problem of waitlists in Canada’s health system. She included a slide of the lawn sign of the Canadian Health Coalition: “Protect Medicare: Don’t privatize it!” Dr. Himmelstein suggested that it was a yard sign that might do just as well south of the Canadian border.

Rocky White, MD, an internist from Alamosa, Colorado, a self-described “hard-core, dyed-in-the-wool, capitalistic, fee-for-service Republican” gave an animated speech. Dr. White became convinced of the need for a single-payer solution after his Nebraska multi-specialty group was forced into a buy-out by the local hospital in 2004 due to the increasing number of uninsured and underinsured. He called upon health care reform activists to work to unite diverse communities around the demand for single-payer health reform, no matter how deep disagreements on other issues might be. He quoted from the Bible to show how he has called upon his own conservative Christian community to stand up for the uninsured. Dr. White also spoke about Martin Luther King, Jr., the 1965 Selma march across the Edmund Pettis Bridge, and passage of the Voting Rights Act as a hopeful example of the tempo that large movements for social change may develop.

Founder of Vermont Health Care for All, Deb Richter, MD, a Vermont family physician and past PNHP president, spoke on the panel together with Dr. White. She showed slides from a talk she has given hundreds of times to make the case that health care reform is in the interest of business. She reported that business people respond favorably to the argument that much of health care costs are fixed infrastructure costs (perhaps more than 70%) that should be borne by the whole society. To illustrate, she tells business people that, when someone goes to the emergency room, we are not paying for the sick person but for the nurse who will be there at the ready.

Ana Malinow, MD, pediatrician at the Harris County Hospital District Ben Taub General Hospital Pediatric Emergency Center and co-founder of Health Care for All Texas, spoke on lessons from Hurricane Katrina. An organizer of the Houston Astrodome medical clinic — where over 15,000 patient visits took place over a span of two weeks, including 2,000 visits in one day, and at one point, 100 visits per hour — Dr. Malinow said that practicing medicine had never been so rewarding for the physicians involved: the emergency conditions forced bureaucracy and billing paperwork to vanish, leaving the doctor-patient relationship unfettered. She underscored the strain that Hurricane Katrina placed upon the already stressed Texas health system — following Hurricane Katrina, some 373,000 people re-located to Texas. (Of these, 59,680 had been covered by Medicaid.) The annual increased cost to the state of Texas could be about $1.6 billion — provided the health system can absorb the increased demand for services.

From Louisville, Kentucky, Garrett Adams, MD reported on the vigorous work the PNHP chapter there, particularly with successful interventions at a broad range of meetings, “including those to which we were invited as well as those at which we were not invited to speak.” Also in attendance from Louisville was Kay Tillow, Director of the Nurses Professional Organization, who has spearheaded an effort to gain union support for HR 676, “The United States Health Insurance Act.” At dinner, the Executive Director of the California Nurses Association, Rose Ann DeMoro spoke to the PNHP members. The California Nurses Association recently merged with the AFL-CIO with the specific goal of leading a union campaign for a single-payer health care system.

Dr. Himmelstein, as a panel respondant, offered remarks on the importance of unconventional thought and a diversity of approaches to building a movement for a single-payer health system — just as the diversity of patients demands a diversity of doctors. He told a story of a patient, a smoker, who had suffered a heart attack. After the episode subsided, the patient went to see a cardiologist. The cardiologist asked if the patient had quit smoking. The patient replied that he had smoked for decades and had no intention of quitting just because he had had a heart attack. The cardiologist, an intense and excitable man, began jumping up and down, swearing at the patient and yelling words to the effect that he would “not take care of a goddamned smoker.” This so frightened the man that he quit smoking — “which is either brilliant medicine or utter malpractice,” Dr. Himmelstein concluded.

Don McCanne, MD was welcomed by warm applause as he participated in afternoon panel discussions from the stage. He is the author of the listserv Quote of the Day, which PNHP activists rely upon. He concluded his remarks on the strategy for health reform by saying: “We have a mission to educate. We will educate our colleagues, the policy community, the media, and our patients.”

http://mrzine.monthlyreview.org/coates050106.html

Posted by pnhp at 01:52 PM | Permalink

A healthcare prescription that’s hard to swallow Rationing may be the only way to ensure that access for all remains affordable
By Henry Aaron
Los Angeles Times
January 30, 2006

Something needs to be done, but no one seems quite ready to come forward with a solution. The only thing American politicians all agree on is this: The United States must at all costs avoid healthcare “rationing.” One after another, they step forward to deplore this much-hated approach, insisting they will fight off efforts to deny the insured any beneficial service that their insurance covers.

But it’s too late for that. The truth is that sensible rationing may be the only way to make sure that fair access to healthcare for all remains affordable. The U.S. can no longer afford to offer every available service no matter how high the cost or how small the benefit to the patient.

Intelligent healthcare rationing - limiting the availability of care that costs society more to produce than it is worth to patients - is not a horror to be avoided. It’s a regretfully necessary limit to sustain fair access to healthcare that is worth what it costs.

Some people argue that simply boosting deductibles will encourage consumers to squeeze out low-benefit care because they won’t want to spend their own money without a high chance of a good outcome. Unfortunately, this approach is being greatly oversold. First, patients whose healthcare costs more than $4,000 a year consume roughly 80% of all health services. They are, of course, the sickest - and their doctors, acting in good faith, prescribe tests, procedures and drugs, most of which are demonstrably beneficial but some of which have only a small chance of helping the patients much, if at all. These very sick patients are in no position to decide which treatments are cost effective, which are likely to work and which are probably wasteful. So “consumer-directed healthcare” - a clever marketing label for high-deductible insurance that makes the patient pay the first $4,000 - won’t do much to curb high-cost, low-benefit treatments for those patients.

Other analysts believe that computerizing healthcare records and billing would reduce paperwork and costly medical errors. But careful estimates put the savings at no more than about 3%.

The kind of rationing that is necessary will require steps that may now seem unimaginable to most Americans and to elected officials, including restrictions on the purchase of costly equipment, caps on hospital budgets and well-enforced protocols for using treatments that have been proved effective for various conditions. Failure to ration, however, will mean that the cost of caring for the aged, disabled and poor will require astronomical tax increases - and that working Americans will have less money to spend on anything other than healthcare. Employers will find it increasingly unattractive to sponsor coverage for workers, and workers will refuse increasingly costly coverage. What Winston Churchill said of democracy may also apply to healthcare rationing: the worst system - except for all the others.

http://www.latimes.com/news/opinion/commentary/la-oe-aaron30jan30,0,885710,print.story?coll=la-news-comment-opinions

Comment: By Don McCanne, M.D.

“Ration refers to equitable division in limited portions of scarce, often necessary, items.” (The American Heritage Dictionary of the English Language, Fourth Edition)

Henry Aaron’s leading message of the past decade is an important one. Health care spending has reached a level that we must now consider “limiting the availability of care that costs society more to produce than it is worth to patients.” “Rationing” may not be quite the appropriate term since health care in the United States is not a scarce resource, though our distribution is limited based on our flawed system of funding care. Limiting access based on ability to pay does make it a somewhat scarce resource for those who cannot afford to pay for their care.

Although Aaron’s message on controlling spending on wasteful high-tech excesses is an important one, his message on how we do that seems muddled, if not obstructionist. Single payer activists are certainly offended with his pompous assertion that “no one seems quite ready to come forward with a solution.” Also, he does not move reform forward when he attacks a seminal article on administrative waste as “questionable answers to a questionable question.”

The single-payer model of national health insurance would accomplish much of Aaron’s goal, including measures that he explicitly endorses: budgeting of capital improvements, global budgeting for hospitals, and increased use of evidence-based medicine. In spite of his attack on the numbers, he does concede that much is wasted in excess administrative costs, another potential source for controlling spending. Policy experts are already aware of the other effective single-payer methods of controlling costs while improving quality and value, so they won’t be repeated here.

One caveat: We cannot allow Aaron’s use of the term “rationing” to be used by the opponents of single payer to attack our model. It has been demonstrated repeatedly that improving use of health care resources prevents excessive queues. Also, a single-payer purchaser is in a position to demand value for new innovations. That means only that worthless technology would be rejected. The pharmaceutical and high-tech industries will never walk away from the $2 trillion that we are spending on health care, but they are going to have to show us that their advances provide value.

Yes, all systems ration care, but some systems use their resources better than others. With our inhumane method of rationing by ability to pay, we do the worst. By switching to a single payer system of allocating our $2 trillion, we would change the dialogue on reform from that of “rationing” to that of “rational.”

Posted by pnhp at 04:46 PM | Permalink

By Laura Ungar
Monday, January 30, 2006
The (Louisville, KY) Courier-Journal

It is the paradox of America’s medical system: While hands can be transplanted and the tiniest babies kept alive, many people cannot afford to see a doctor and live with the threat of financial ruin if they get sick.

Francene Shepard of Louisville had a heart attack in 1999, needed stents to open blocked arteries and ran up about $50,000 in medical bills that went unpaid.

Ian Copeland, a 27-year-old self-employed carpet cleaner who lives in Louisville, goes to the emergency room when he’s sick because he cannot afford a private doctor.

“It’s a gamble,” said his mother, Michelle Copeland. “If something happens, it could be devastating.”

Such stories are increasingly common and are leading to growing support among some politicians and medical groups for implementing a national health system offering care for all, including the 45 million Americans and more than half a million Kentuckians without health insurance.

Earlier this month, the Kentucky House Health and Welfare Committee voted to urge Congress to pass a bill, introduced by Democratic Rep. John Conyers Jr. of Michigan, that would expand Medicare to cover all Americans.

The bill would create a “single-payer” health-care system, publicly financed and privately delivered. All Americans would have access regardless of employment, income or health. Each year, the program would set reimbursement rates for health-care providers and negotiate the cost of prescription drugs.

Critics say such a measure would be too costly and unwieldy, but the passion of supporters was evident when the Kentucky House committee vote was called, and Rep. Kathy Stein, D-Lexington, answered: “Hell, yes!”

Conyers’ office and the group Physicians for a National Health Program are watching Kentucky and hoping that the General Assembly will back the effort.

“It would be historical to have a Southern state endorse universal health care and medicine for all,” said Joel Segal, a legislative assistant for Conyers who handles health-care issues. “This is a life-and-death crisis for many people.”

A possible groundswell

A 2002 report by the Institute of Medicine, which advises the federal government on health issues, said 18,000 adults die each year because they lack health insurance. Overall, the United States has a lower life expectancy than several countries, including Canada and the United Kingdom, that have national systems.

“The health-care system is in a deepening crisis,” said Dr. Steffie Woolhandler, an associate professor of medicine at Harvard University and co-founder of Physicians for a National Health Program. “The public is quite fed up.”

There are signs that the idea of a national system has increasing support here:

A poll last year by the Pew Research Center found that 65 percent of Americans favor national health insurance, even if it means higher taxes.

An Indiana University poll, published in the Annals of Internal Medicine in 2003, said 49 percent of doctors support government legislation to establish national health insurance, while 40 percent oppose it.

Membership in Physicians for a National Health Program, meanwhile, has risen from about 10,000 to 14,000 in recent years.

City councils have passed resolutions in support of the Conyers’ bill in Morehead, Ky.; Baltimore; and Erie, Pa.

Locally, Conyers’ proposal has gained support from the Kentucky Psychiatric Medical Association, the Louisville-based Falls City Medical Society, and Dr. Adewale Troutman, director of the Louisville Metro Health Department.

A faction of the Kentucky Medical Association also supports the idea of a national health system, said its president, Dr. Daniel Varga.

And although Varga and others say they doubt that the United States will be ready, philosophically, to enact a national health plan anytime soon, experts say the debate points to a growing dissatisfaction with the status quo.

That sentiment has been reflected in polls such as one released last week by the Center for American Progress and the Service Employees International Union, which found that nearly nine out of 10 Americans think the current system is broken.

Opposition to proposal

Although opponents agree that the problem of the uninsured must be addressed, they say a national system would drive up taxes, stifle medical innovation and lead to waits for services.

“If you think you can get free health care and you don’t have to pay for it in some way, you’re being naïve,” said Robert Moffit, director of the center for health policy studies at the Heritage Foundation, a Washington-based conservative think tank.

Moffit pointed to a proposal for a state-level universal plan in Oregon that would have required a new personal income tax of as much as 8 percent and a payroll tax for businesses of 3 percent to 11.5 percent.

In addition to tax increases, Moffit said, “once the health-care dollar becomes a part of the federal budget, it competes with education and other priorities.”

State Rep. Bob DeWeese, R-Prospect, a retired physician who voted against the Conyers resolution in the Kentucky House committee, also expressed concern about rising taxes.

He said something must be done about the growing number of uninsured Americans, but “we don’t have to change the whole system to fix this problem.”

Proponents argue that a national health plan would save money. In recent years, increases in insurance premiums have far outpaced inflation. A summary of the Conyers bill says 95 percent of families would pay less for health care under the plan than they do today.

Moffit argued that ultimately, the quality of care would suffer with a national setup, partly because such systems generally don’t invest as much in medical technology.

He also pointed to waits for services. One recent survey by a Canadian economic think tank called the Fraser Institute — which seeks to bring attention to the issue of market competition — found that waiting times there between referrals and treatment averaged 17.7 weeks across specialties last year.

Proponents of national health care say that concern is overblown.

But Julia Costich, chairwoman of the department of health services management at the University of Kentucky, said the Conyers bill stands little if any chance of passing, partly because it calls for such sweeping change.

“I applaud their ambition,” Costich said of proponents, “but it seems very far-fetched.”

Idea spreading

Kentucky is not the first state to show support for a government-run health system. Some states have gone so far as to move toward their owns plans. In Oregon, where voters rejected a single-payer proposal in 2002, supporters are pushing for another measure in 2008.

In Ohio, a coalition claims it has collected tens of thousands of signatures in support of such a plan and hopes to put the issue on the ballot next year.

Maine already has a program offering affordable health-care coverage that aims to cover all uninsured residents eventually.

Dr. Garrett Adams, a retired physician who heads up the Kentucky chapter of Physicians for a National Health Program, said universal health care is a matter of fairness and humanity. His group prefers a national system to state efforts.

Adams said the problems faced by the uninsured are particularly acute in Kentucky, which was shown in a recent Courier-Journal investigation to be among the least healthy states in the nation.

“This is so wrong,” Adams said. “They’re real lives. They’re people.”

Shepard, a 51-year-old home health aide who spoke before the state House Health and Welfare Committee, said that since her heart attack, she has been diligent about getting care at the Family Health Centers’ Portland clinic.

But with a low income, specialized care can be a struggle.

A national program would help her “and others like me who fall through the cracks,” she said in an interview.

One patch of common ground for supporters and opponents is the belief that the current U.S. system has serious problems.

A 2003 ABC News/Washington Post poll showed that more than half of Americans are dissatisfied with the quality of health care, the first majority in three polls since 1993.

Sandie Limpert of Louisville, a 53-year-old graduate student who has gone half her adult life without health insurance, said she believes the system is in such disarray that a major overhaul would be better than small reforms.

“It’s like we’re trying to plug our fingers into the dam,” she said. “But it’s only a matter of time before the whole thing cracks and explodes.”

Reporter Deborah Yetter contributed to this story.

Posted by pnhp at 04:16 PM | Permalink

Collinsville, IL A third AFL-CIO Building and Construction Trades Council has endorsed legislation that would institute a single payer health care system in the U.S. by expanding Medicare to cover everyone.

The Southwestern Illinois Building & Construction Trades Council joined two other building Trades Councils in St Louis, MO and Cape Girardeau, MO endorsing the legislation introduced by Cong. John Conyers (D-MI).

HR 676 now has 62 congressional co-sponsors in addition to John Conyers Jr. (D-MI). It would institute a single payer health care system in the U.S. by expanding a greatly improved Medicare system to every resident.

HR 676 would cover every person in the U. S. for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health,
physical therapy, rehabilitation (including for substance abuse), vision care, chiropractic and long term care. HR 676 ends deductibles and co-payments. HR 676 would save billions annually by eliminating high overhead and profits of the private health insurance industry and HMOs.

Posted by pnhp at 01:43 PM | Permalink

By Alex Gerber
Washington Times
January 29, 2006

Medicaid, the government health-care plan for low-income people, has been targeted by congressional mediators as a prime source for savings in a bloated federal budget.

Medicaid’s costs have increased a staggering 54 percent in the past five years. This has been deemed “unsustainable.” Jointly financed by the federal and state governments, the program now accounts for an average 25 percent of state budgets, threatening many with insolvency.

A lowering of Medicaid costs by $6.9 billion is proposed over the next five years, which will decrease benefits and raise out-of-pocket expenses for the 47 million Americans covered by Medicaid. The nonpartisan Congressional Budget Office predicts an appreciable number of Medicaid recipients, finding the additional costs unaffordable, will join the ranks of the medically uninsured. The adverse morbidity and mortality statistics of the uninsured are well documented.

Medicaid’s problems were far from anticipated in 1965 when passed into law under the jurisdiction of the former federal Department of Health, Education and Welfare (HEW). At the time, I was a health care consultant to HEW Commissioner Dr. Ellen Winston and remember well the department’s euphoria over Medicaid’s prospects. All the public charity hospitals were to be phased out within 10 years, and “second-class care” was to be eliminated as Medicaid recipients were shunted into the private care “mainstream.”

But within three years, a federal commission was investigating gross fraud and an explosion of Medicaid costs. The program continued downhill as doctors’ fees were slashed, benefits cut and only about 50 percent of the poverty class and the working class near poverty remained in the program.

Few are happy with Medicaid today. Patients are unhappy with eligibility red tape and the declining number of doctors willing to treat them. Doctors are unhappy with the mountains of paper work and unrealistically low fees. Most hospitals are unhappy because Medicaid’s reimbursement doesn’t cover the cost of patient care so they only remain afloat by shifting costs to private patient insurance plans. But unhappiest of all are government agencies struggling to control costs that have escalated far beyond their original projections. Meanwhile, the public hospitals are alive but not well.

Medicaid is simply another example of medical socioeconomics not keeping pace with brilliant advances of medical science and technology. After 40 years, we must reluctantly conclude Medicaid has been a well-intentioned program that has fallen short of expectations and that further Band-Aid efforts to resuscitate the program should be abandoned.

The great majority of Americans, however, believe health care should be a fundamental right and a public rather than a private good. A single standard of health care, regardless of ability to pay, is in concert with the beliefs of most Europeans and Canadians. What, then, should replace Medicaid?

The easiest answer is to include health care for the medically indigent in the badly needed reform of our “broken health-care system,” which has become a crisis.

Our outmoded, employer-based, privately financed, multipayer health-care system — a holdover from World War II wage-and-price controls — is an anachronism in the 21st century. The world’s richest and mostt powerful nation is unique in not sponsoring government-controlled Universal Health Insurance (UHI) other industrialized nations have enjoyed for decades.

Unlike Medicaid, Medicare — UHI for the elderly — has been a resounding success. Medicare, though also targeted by Congress for budget cuts by increassing patient-out-of pocket payments, is indeed widely recognized as the most important advance of the last century in our health-care socioeconomics. Medicare for our entire population is probably the most likely answer to Medicaid’s “meltdown.”

I have previously advocated on these pages a change to the Canadian, single-payer health-care plan funded by national health insurance. The need to find a substitute for Medicaid provides an opportune time to hasten this change.

Briefly, Canada’s health-care system provides one standard of care for its entire population under a plan funded by tax dollars, and there are no additional expenses at the time of treatment. Canada’s medical results equal ours at a huge savings.

Perhaps the superiority of Canada’s health-care system was best expressed by a Harris Interactive Poll among the leading industrial societies that evaluated patient satisfaction with their system: Canada ranked first and the U.S. last. Moreover, 50 percent of Americans favor the Canadian health-care system and only 8 percent of Canadians prefer ours. Significantly, The new Conservative government in Canada did not advocate major changes in the UHI program.

Of interest is a comparison of prescription drug prices in the U.S. and Canada. Our new Medicare Prescription Drug legislation, with some 40 plans to choose from, is a mishmash of confusion and a rich source of material for cartoonists and late-night TV comedians.

The attempt to constrain skyrocketing drug prices was hamstrung from the beginning by President Bush’s insistence there be no price negotiations with pharmaceutical companies. Thus, our Medicare population, 41 million strong, has been denied the advantage of bulk-buying economies of scale. Imagine the uproar if Hertz and Avis were, by law, denied discounted prices on autos they purchased in huge lots.

Since 1987, Drug prices in Canada have been regulated by the Patented Medicine Price Review Board, a quasijudicial body that negotiates prices with the drug industry. Prices are held in check because they are geared to the Consumer Price Index. The drug houses know the rules; only four times in the last 18 years has legal action been taken to force drug prices lower.

The future for national health insurance looks bleak. The issue has never been on President Bush’s agenda. Indeed, during his governorship, 24½ percent of Texans were medically uninsured — the highest of the 50 states. During his presidency, the uninsured have increased by 4 million and continue rising 100,000 monthly.

A major reform of our wasteful health-care system will help put the brakes on an inexorably rising national debt that will eventually fall on our children and grandchildren.

It would be well to recall an admonition from George Washington’s 1796 Farewell address: “by vigorous exertion to discharge the debt” — not ungenerously throwing upon posterity the burden which we ourselves ought to bear.

Alex Gerber, M.D., clinical professor of surgery, emeritus at the University of Southern California, is a former health-care consultant to the White House and the U.S. Department of Health and Human Services.

Posted by pnhp at 10:56 AM | Permalink

Opinion
Atlanta Journal Constitution
January 27, 2006

The fiasco during the first few weeks of Medicare’s prescription drug program seems to provide critics of government-provided health insurance with a wealth of ammunition.

But before firing off the first round, those critics should look closely at what has happened. Yes, the program has been a disaster. But it has been a disaster mainly because government turned its citizens into captive customers for private firms looking to maximize their own profits, then provided those citizens little protection.

The biggest immediate problem was an example of the fundamental flaw with the plan. An estimated 6.2 million beneficiaries (including about 135,000 in Georgia) had drug coverage through state Medicaid programs and under law had to be moved into one of the new federally funded but privately operated Medicare plans.

Some of these poor and elderly patients never got assigned to a private drug plan; others did get switched, but information about their enrollment didn’t get transferred from government computer databases to those maintained by the private companies.

On Dec. 31, those people were doing fine with the government drug plan they had, but after Jan. 1 — the date the new Medicare plan went into effect — many were told their newly assigned plan did not cover the drugs they routinely take to stay alive.

Computer records were often missing and pharmacies had to extend their customers credit. In about half the states, government officials had to step in and guarantee coverage until the glitches were fixed.

While some of those technical difficulties are being ironed out, other problems won’t be solved so easily. For example, consumers are still being forced to choose from dozens of plans offered by private companies, each with its own schedule of co-payments, monthly premiums and lists of which drug it will cover. Trying to make financial sense of all those options would challenge even a professional accountant, yet senior citizens are being forced to make that decision with little or no assistance.

Contrast that with how traditional Medicare pays for hospital care: The hospital is paid a flat rate based on the patient’s diagnosis, severity of illness and length of stay. The patient is not forced to choose among competing plans for hospital care, and rarely sees a bill. Medicare tells the hospital what it will pay. (Physician services come under another relatively simple Medicare plan with fixed premiums and standard benefits).

So far, Medicare has enrolled about 24 million beneficiaries in the new plan, but many of those already had some form of drug coverage. Unfortunately, the worst sign-up rate is among the 12 million to 15 million beneficiaries who had little or no drug coverage to start with. Only about 3.6 million of these low-income Medicare beneficiaries have signed up for one of the drug plans.

At some point the nation’s senior citizens and others covered by Medicare will demand to know why the drug program is so complicated and works so poorly compared to the simplicity and cost-effectiveness of how Medicare handles hospital and physician coverage, and how it can be changed.

The answer will be a national health insurance program utilizing the government’s purchasing power to provide the highest quality of care at the most reasonable cost, for patients and taxpayers alike.

Posted by pnhp at 10:48 AM | Permalink

Savings Accounts for Health Costs Attract Wall Street
By Eric Dash
The New York Times
January 27, 2006

Even after the Bush administration began pushing for the creation of health savings accounts with the Medicare Modernization Act of 2003, the banking industry mainly stayed on the sidelines.

“Put it this way, the impact of this law did not really become clear to them until after it passed,” said Mr. Perrin, the H.S.A. Coalition director. Once they understood how the accounts worked, however, the big banks realized the next I.R.A. had landed at their feet.

Now, some financial institutions are urging the Bush administration and Congress to raise the tax-deductible contribution limit to encourage consumers to put more money in their accounts - a proposal that President Bush is expected to endorse in his State of the Union speech.

Banks are already champing at the bit. “We happen to be in the camp that the H.S.A. is a second retirement account to be used for medical expenses,” said Nancy Todor, an executive who will oversee health savings accounts when Citigroup introduces them this year.

http://www.nytimes.com/2006/01/27/business/27health.html?hp&ex=1138424400&en=433af284a9e52683&ei=5094
&partner=homepage

Comment: By Don McCanne, M.D.

Health savings accounts (HSAs) represent a hybrid of tax policy, health policy and pension policy. To understand them better, they should be viewed as individual retirement accounts (IRAs) with a special penalty-free exemption for early withdrawals that are used for authorized health care expenses.

They represent regressive tax policy. As with an IRA, contributions are made with before-tax income, effectively providing higher-income individuals with a taxpayer subsidy that lower-income individuals do not receive. The poor pay the full amount of the contribution while the rich receive a significant discount at taxpayer expense. Demonstrating how this really is an IRA, higher-income individuals who have maxed-out their 401k contributions are turning to HSAs to expand their pension contributions.

In his attempts to reform Social Security, President Bush stressed the importance of personal retirement accounts as an important component of the “ownership society.” HSAs, as specialized IRAs, provide individuals with another similar opportunity to save for their retirements. By increasing personal accounts, the dependency on Social Security would diminish. But who benefits? Cumulative pensions will be reinforced for healthy individuals who accumulate significant funds in these accounts. Individuals who have the misfortune of having significant health problems will have to deplete their specialized IRAs (HSAs). Their health care miseries will be compounded further by the fact that they also will lose these pension funds. They are then left with only a high-deductible health plan that leaves them even more vulnerable to health care costs.

Thus HSAs represent highly flawed health policy, flawed tax policy and flawed pension policy. What is of even greater concern is the Bush administration’s intent to accelerate this shift towards consumer-directed health care. We should heed the following comments excerpted from a new report in The Economist.

America’s health-care crisis
Desperate measures
The Economist
January 26, 2006

The world’s biggest and most expensive health-care system is beginning to fall apart. Can George Bush mend it?

Mr Bush wants to accelerate the trend towards consumer-driven health care.

The truth is that the shift to consumer-directed health care and greater cost-sharing involves a culture change that may take decades. It will also come at the price of greater inequality. The burden of health spending will be shifted on to those who are sick, and not just because people will pay a greater share of their health costs themselves. High-deductible insurance policies are attractive to the young and healthy. But as these workers leave traditional insurance, the risk pool in other insurance plans will worsen and premiums will rise even faster. The real losers will be poorer workers with chronic illnesses.

American health care has already become more unequal as employers have cut back, and this will continue. The Bush team argue that “fairer” tax treatment will slow cost rises and enable more people to get basic insurance. The opposite is more likely. Bigger tax subsidies for health care are, if anything, likely to raise overall spending. Worse, since most tax breaks benefit richer people most, more tax incentives are likely to bring more inequality. They will also reduce tax revenue and worsen the budget mess.

Mr Bush’s health-care philosophy has a certain political appeal. It suggests incremental change rather than a comprehensive solution. It reinforces existing industry trends. And it promises to be pain-free. Unfortunately, it will not work. The Bush agenda may speed the reform of American health care, but only by hastening the day the current system falls apart.

http://www.economist.com/world/displaystory.cfm?story_id=5436968

Posted by pnhp at 02:01 PM | Permalink

Los Angeles Times
January 26, 2006

Re “Health Plan to Revive Debate,” Jan. 23

The problem with healthcare in the United States isn’t that Americans are over-insured — as claimed by many conservatives — but that private health insurers take up to 30% as administrative costs. Compare this with administrative costs of 2% for Medicare. America spends more on healthcare than any other country and doesn’t have results to show for it, as measured by leading health indicators as diverse as infant mortality and the number of uninsured people.

Healthcare is not a product that most people can compare and purchase, as one would a television or cellphone-service provider. Allowing people to save money from their personal health savings accounts by forgoing a clinic appointment, for example, will result in larger problems down the line, driving up costs and resulting in worse health outcomes.

Clearly, as people more knowledgeable than myself have proposed, the answer to the growing U.S. healthcare problem is universal single-payer coverage. The private insurance route is clearly not working. President Bush proposes more of the same.

Arman Afagh, MD
Riverside

Posted by pnhp at 11:22 AM | Permalink

HSAs Triple in 10 Months
America’s Health Insurance Plans
January 26, 2006

At least three million consumers currently receive health coverage through high-deductible health insurance plans offered in conjunction with health saving accounts (HSAs), according to preliminary results of a new study by America’s Health Insurance Plans (AHIP).

“HSAs are a remarkable success story and they are proving to be especially attractive to many who might not otherwise be able to afford coverage,” said AHIP president and CEO Karen Ignagni.

http://www.ahip.org/content/pressrelease.aspx?docid=14641

And…

Prognosis Is Mixed for Health Savings
By Milt Freudenheim
The New York Times
January 26, 2006

President Bush has made “consumer-directed” health savings plans a cornerstone of his policy for addressing runaway medical costs, and he plans to push them again in the State of the Union address next week. But so far there is little evidence that the approach is helping many consumers come to grips with the high price of health care.

… in many cases, people have evidently signed up not because they are eager to direct their own medical spending but because the plan looked cheap or they had no other insurance option. And at least half of those enrolled have not put money in their health savings accounts.

Pat Schoeni, executive director of the National Coalition on Health Care, a group seeking better, more affordable medical care, said, “The savings accounts are not designed to help people pay for health care; they are designed to help employers unload their health care costs.”

http://www.nytimes.com/2006/01/26/business/26accounts.html

Comment: By Don McCanne, M.D.

One percent of Americans now have health savings accounts, and half of them are not funded. Maybe an empty savings account is affordable, but the care that it will purchase is not.

In his State of the Union address, President Bush will propose the expansion of health savings accounts. Hopefully he’ll explain to us how unfunded accounts will make health care more affordable.

Posted by pnhp at 03:22 PM | Permalink

By Mat Herron
January 24, 2006

The last time Sandie Limpert had a job that paid for her health insurance, Ronald Reagan was in the Oval Office and a bunch of college hockey players whipped the Soviet Union at the Lake Placid Winter Olympics.

It was 1980.

Since then, aside from a brief stint on Medicaid, Limpert, 53, has gone without. Now she is an activist working to draw attention to the concept of universal health care in the United States.

“For me, this is a serious issue,” Limpert told representatives on the state’s Health and Welfare Committee last week.

She was one of more than two dozen members of the interest group Kentuckians for Single Payer Healthcare who drove to Frankfort to encourage the passage of HCR 40, a resolution urging the U.S. Congress to pass the National Health Insurance Act sponsored by Rep. John Conyers, D-Mich.

KSPH got what it came for — the committee passed HCR 40 by a vote of 9-3 — but the victory was merely ceremonial.

There are numerous figures that proponents of universal health care can cite: 46 million Americans without health care — 582,000 of them in Kentucky alone. Roughly 18,000 people die each year without health insurance, according to the Institute of Medicine.

Still, the concept of nationalized health care is a lightning rod issue. Republican committee members countered that HR 676, the health insurance act proposed by Conyers, is nothing more than socialized medicine, and that the government would administer health care inefficiently. But it’s not.

Under Conyers’ bill, HR 676, a single-payer system would allow a patient to choose his or her health care provider, who would then be reimbursed with government funds. According to data included with the bill, single-payer plans would save the federal government $150 billion on paperwork and $50 billion by allowing bulk-purchasing of prescription drugs, which is prohibited under federal law. Employers who pay 8.5 percent of their payroll toward employees’ health coverage would pay 3.3 percent, and private insurers would be prohibited from providing health insurance that duplicates the proposed benefits.

Garrett Adams, a retired doctor who specializes in infectious diseases in children and a member of Physicians for a National Health Plan, described single-payer health care as publicly financed health care delivered by private doctors. The plan would save money, he said, by eliminating the 20 percent to 30 percent of each health care dollar that goes toward the marketing and administrative costs of for-profit health insurance companies.

“Health care is not a marketable commodity,” Adams said. “It’s a social good.”

He compared what the United States spends on health care with the amount spent by the United Kingdom, Sweden, France, Japan and Germany.

Conclusion: Americans spend more than all of them combined.

“Even now, there’s enough public money to fund a national health insurance plan in this country,” Adams said.

Legislators agreed that the health care system needs improvement, but they disagreed on how it should be fixed. Committee Chairman Tom Burch, who voted for the resolution, sees the single-payer option as inevitable. “Our biggest investment is our people,” he said. “It’s gonna happen.”

Rep. Scott Brinkman, R-Louisville, pressed Adams, who also testified, for hard numbers on the cost to taxpayers to join such a plan. Adams said that 95 percent of Americans would pay less for health care under Conyers’ bill because it would eliminate co-pays for doctors’ visits, deductibles and premiums.

Compared with other countries, state Republican legislators said government-financed health care has had mixed results in countries like Canada.

Rep. Addia Wuchner, R-Burlington, said she’s traveled with physicians there and met a woman who had to wait two years to see an orthopedic surgeon.

“I’m not sure that government can do a better job,” she said.
But Ewell Scott, a doctor from Morehead, Ky., cautioned people not to mischaracterize a nationalized health care system as “socialized medicine.”

Patients can still have private doctors under single-payer, which he described as a fee-for-service program, paid for by the government. Without this, insurance companies will continue to discriminate, leaving more and more people without health insurance.

“We want teachers to have health care benefits,” he said. “But what about other classes of people?”

For her part, Limpert believes it’s only a matter of time before the United States joins the rest of the industrialized world and adopts some form of universal health care. She sees state and federal legislators’ opposition to it as proof of their allegiances to health insurance and pharmaceutical companies with strong lobbying arms in Washington.

And she won’t feel bad if, in the course of America adopting single-payer plans, health insurance companies lose business.

“Some of these companies are big enough to reinvent themselves,” she said.

Contact the writer at leo@leoweekly.com

Single-payer: what it is

Despite what insurance companies and other naysayers might have you believe, single-payer health care is not socialized medicine. Nor should it call to mind long white beards, waiting room delays or Karl Marx. The difference is simple: Socialized medicine is when the government employs doctors and hospitals. It’s like that in England, Spain and here, with Veterans’ Affairs, for instance.

With single-payer, on the other hand, the government simply pays the same private sector health care providers that your insurance company currently does. Instead of 1,500 different plans and myriad for-profit providers, the government holds all the cards. And everyone is covered. That’ll help about 46 million U.S. citizens get in to see a doctor, with no co-pay. No deductible. A slight tax increase anchored by the richest 5 percent of Americans. It’s something like a level playing field, which means it’s probably way too good to be true.

—Stephen George

Posted by pnhp at 03:19 PM | Permalink

Do Specialty Hospitals Promote Price Competition?
By Robert A. Berenson, Gloria J. Bazzoli, Melanie Au
Center for Studying Health System Change
January 2006

In three Center for Studying Health System Change (HSC) sites with significant specialty hospital development-Indianapolis, Little Rock and Phoenix-recent site visits found that purchasers generally believe specialty hospitals are contributing to a medical arms race that is driving up costs without demonstrating clear quality advantages.

Price Competition

Although previous research indicates that purchasers believe specialty hospitals have lower unit costs, some believe that referring physicians, especially those with a financial interest in the specialty hospital, increase volume by inducing patient demand for elective procedures. The higher volume more than offsets the savings achieved from lower prices from competition, leading to increased aggregate costs. Health plans indicated they had few tools to restrain the induced utilization that physician ownership of specialty hospitals can engender.

Focused Factories or Risk Skimmers?

Some health plans and employers believe that physicians referred relatively easy cases to specialty hospitals and more complex patients to general hospitals, whether out of quality concerns or financial considerations.

Competitive Juices Flow

Although there was some evidence of increased price competition, respondents observed that the more important outcome was the perceived need for general hospitals to compete aggressively with the new physician-owned specialty hospitals by developing similar dedicated centers, as distinct hospitals-within-hospitals or freestanding facilities.

Thus, in the views of purchasers and other market observers, physician-owned specialty hospitals caused general hospital competitive juices to flow, but most of those juices flowed toward capacity expansion for lucrative services and enhanced specialty service branding and not necessarily toward improved quality and efficiency.

Policy Implications

Some assert that specialty hospitals represent desirable competition for general hospitals and, therefore, public policy should consistently foster competition provided by new market entrants, including specialty hospitals.

These commentators call for reliance on antitrust enforcement, resist expansion of CON (Certificate of Need) laws that would limit specialty hospitals and oppose general hospital efforts to restrict the hospital privileges of physicians with ownership interests in competing specialty hospitals.

Others believe that specialty hospitals add unneeded, expensive capacity to the health care system, make it more difficult for general community hospitals to cross subsidize the care provided to the uninsured and underinsured, and intensify the problems associated with physician self-referral for economic gain. These advocates would design public policy to discourage the development of new specialty hospitals.

It is striking that purchasers and their health plan agents, some of which themselves are for-profit, entrepreneurial ventures, who might be expected to favor increased hospital competition, generally do not view the development of specialty hospitals positively. They believe that specialty hospitals add to health care costs and have not demonstrated clear quality advantages. Further, purchasers are concerned about the opportunity for physician owners to induce demand through self-referral, to cherry pick among the patient population and to threaten community hospitals’ reliance on profitable services to make up for shortfalls in other areas. To some extent, purchasers seemed implicitly to accept general hospitals’ need for insured patients to subsidize care for the uninsured and underinsured, and profits from well-compensated services to support unprofitable services.

In most sectors of the economy, specialized producers foster market competition. In the airlines industry, for example, leaner point-to-point air carriers have forced aggressive price competition and dramatic changes in the traditional cost structure of the major airlines, for better or worse. In contrast, in the case of specialty hospitals, the ability of providers with market power to tie particular specialty service prices to other contracted services; the seeming acceptance by at least some purchasers that general hospitals have a legitimate need to cross subsidize services because of uncompensated care burdens; and the lack of useful measures by which purchasers can differentiate the quality and efficiency of cardiac, orthopedic and other specialty hospital services contribute to a very different result. The findings again confirm that even a competitive health care system does not function like most other sectors of the economy.

It is important to note that purchasers also have described a medical arms race focused on the promotion and marketing of specialty services involving general hospitals in areas where there is no specialty hospital competition.

Indeed, increased competition among local hospitals and between hospitals and physicians for profitable services, including cardiac, orthopedic and cancer care, has been observed across the 12 HSC sites. This service-line competition has involved new facilities and dedication of existing hospital space to profitable specialty services and is taking place whether or not there are specialty hospitals, suggesting that the policy focus on specialty hospitals per se might be somewhat misplaced.

Marked disparities in the relative profitability of certain services under both Medicare and private plan payment policies appear to be a major force driving competition for these profitable services. These pricing distortions are contributing to the current emphasis on specialty service differentiation and to escalating health care costs generally, with specialty hospitals being one prominent manifestation of such distortions.

Indeed, proponents of greater provider competition and proponents of greater regulation to restrict new specialty facilities agree that distorted pricing policies create an unlevel playing field and influence providers’ resource-allocation decisions for the worse. CMS has indicated that it will revise its payment systems for both inpatient and ambulatory services to reduce the artificial financial advantage that specialty hospitals currently enjoy because of the limited range of services they provide.

http://www.hschange.org/CONTENT/816/

Comment: By Don McCanne, M.D.

Most policy analysts concede that free, unfettered markets do not exist in health care, and, consequently, market competition cannot be relied on to bring us higher quality care at a lower cost. Specialty hospitals are an exception, the physician-investors would have us believe. By developing technologically-advanced, streamlined hospitals, these investors contend that they force the general hospitals in the community to compete by both improving the quality of the specialized services and by providing greater value through lower prices.

The proponents do have a reach to try to convince us. Duplicating services that already exist in the community is very expensive. We are not talking about the marginal costs of improving existing services, with a full support structure already in place. We are talking about beginning anew with incorporation costs, venture capitalist costs, architect and building contractor costs, the costs of construction, the costs of the most advanced and most expensive high-tech equipment, the costs of support services required, the costs of a new set of operating expenses, and, not the least, the costs of the return on investment.

The magic of the marketplace is supposed to reduce costs, but it is inconceivable that the investors could ever conjure up enough magic to meet these expenses while providing a nifty profit. While competitively-contracted prices may provide the appearance of lower costs, this report confirms that there is no magic. The per-unit cost might be slightly lower, but John Wennberg and his colleagues have demonstrated repeatedly that increased capacity for high-tech services drives up untilization and total costs, without a commensurate return in quality or outcomes. Specialty hospitals increase total health care costs and do so while placing a greater economic burden on our community hospitals.

If our teenage driver is in a major collision, we want a trauma center to be there, backed up by a full service hospital. If our granddaughter develops meningitis, we want facilities available with a pediatric intensivist and appropriate infectious disease support. If a respected and endeared community activist blows a berry aneurysm, we want the neurosurgical team available and accessible to save her brain and her life. We will always want a fully equipped and well staffed general hospital to be there for us whenever we need it.

A boutique specialty hospital surely would provide us with elegant surroundings, gourmet meals, high-tech equipment in the latest designer styles, and all of the other amenities that we should expect from an organization dedicated to Profits through Patient-Pleasing.

Is that really worth the trade-off? Do we want to cater to the wealthy who value such niceties for their elective surgeries? Or do we want to use those funds to support a strong health care infrastructure that would be there for all of us whenever we need it?

Private solutions inject into the process the type of thinking that brings us boutique hospitals. This is a public problem, and it requires a public solution. Single-payer national health insurance would provide a public funding structure that would ensure that our health care funds are spent on our health care.

Posted by pnhp at 04:19 PM | Permalink

Letters

Outside America, most health care systems provide medications from one comprehensive formulary to all citizens. There are no restrictions or economic credentialing, and all citizens are included.

In addition, the rest of the world’s health care systems negotiate the prices of their drugs.

We seem to relish going from crisis to crisis. Many now face the economic decision of purchasing food or medications. There is, however, a solution.

The next time you hear the words “national health insurance” or “single-payer health care,” take note that this kind of system will cost less than our current system and cover all Americans with much less red tape.

Speaking of red, we are not talking about socialized medicine. It is American medicine for all Americans, by all Americans. For more information, visit www.pnhp.org/

Charles Katzenberg, M.D.
Physicians for a National Health Program, Tucson

http://www.azstarnet.com/allheadlines/112633

Posted by pnhp at 04:10 PM | Permalink

Closed-Door Deal Makes $22 Billion Difference
By Jonathan Weisman
The Washington Post
January 24, 2006

House and Senate GOP negotiators, meeting behind closed doors last month to complete a major budget-cutting bill, agreed on a change to Senate-passed Medicare legislation that would save the health insurance industry $22 billion over the next decade, according to the nonpartisan Congressional Budget Office.

Since managed-care companies first began working through Medicare in the 1990s, the government has recognized an issue in the way the companies are paid for their participation. Private insurers attract healthier seniors than the traditional government-run Medicare system, so their payment rates — based on the elderly population as a whole — exceed the actual cost of treatment.

In 2003, the government began lowering payments to Medicare HMOs to account for their healthier population of beneficiaries. But to keep those HMOs from fleeing the system, the Bush administration added a “hold harmless” payment that negated that cut.

http://www.washingtonpost.com/wp-dyn/content/article/2006/01/23/AR2006012301700_2.html

Comment: By Don McCanne, M.D.

Although the details of the CBO analysis are somewhat technical, the fundamental perversity is not. The Medicare Advantage private insurance programs are paid at a rate which assumes that patients enrolled in their programs have the same health care needs as the average patient remaining in the traditional Medicare program. That is not the case. The Medicare Advantage programs are successful in selectively marketing to a healthy subset of Medicare patients. Thus the private plans are overpaid when compared to payments for comparable patients within the traditional program.

This overpayment is vital to the Medicare Advantage plans. Without it, they could not meet their higher administrative costs. New private plans would not enter the market, and once rates are adjusted to match risk, existing plans would exit the market.

Even though Democrats were excluded from the behind-closed-doors sessions, the intent of these overpayments is no secret. In 2010, a process will begin which is designed to reduce payments in the traditional Medicare program. It will be important to have in place a market of private Medicare Advantage plans as patients begin to flee from an underfunded public program. That market of private plans cannot develop unless Congress and the administration pays this $22 billion bribe of taxpayer funds.

The Washington Post article also states, “Republican aides involved in the change dismiss its significance, saying the CBO is reading too much into it.” A $22 billion bribe may be insignificant to Republican aides, but the rest of us certainly should be concerned. That’s our tax money and our Medicare program that they’re messing with!

Posted by pnhp at 03:43 PM | Permalink

FOR IMMEDIATE RELASE:

Contact:
John Wasik at 847-223-9814, johnwasik@ameritech.net.
Stan Rosenberg at 847-543-1202, bcbarn@prairiecrossing.com.

A Prairie Crossing Public Forum

Saturday, February 4, 2006, 1:00 p.m.
Byron Colby Barn, Route 45 and Jones Point Road, Grayslake, IL

Affordable and accessible health care is a serious national problem that impacts everyone, yet it rarely tops the agenda for most politicians (Note: President Bush will mention health care in his upcoming State of the Union speech). Nevertheless, the topic needs to be aired, focusing on the following questions:

• Why is the U.S. losing the economic battle (jobs, factories) to compete worldwide because of its crippled health care system?

• Why is the single-payer Canadian health-care system being attacked so vigorously by American special-interest groups? What makes the Canadian system work?

• Why does the U.S. provide some of the most extensive healthcare and still lag behind industrialized countries despite having the highest gross domestic product on earth?

• Why are 45 million Americans without health insurance and 20 million underinsured?

• Why is it extremely difficult to find affordable coverage if you’re a part-timer, contract worker, small business employee or have serious pre-existing health conditions or are between jobs?

• Why are most employers cutting back on healthcare benefits, forcing you to pay more out of pocket?

At the Byron Colby Barn, we will have a number of expert speakers who will examine the current situation and propose solutions. There will be a question-and-answer session in which you can ask questions and enter into intelligent discussions concerning the alternatives to our present system. Here are some of the exciting and informed speakers you can expect to hear:

- One of our lead speakers will be Dr. Quentin Young with Physicians for a National Health Care Program. Dr. Young is the former chairman of Medicine at Cook County Hospital and a well-known authority on health care. He is a regular commentator on WBEZ-FM.

- Joining us from Canada will be Dr. Robert McMurtry, an expert on the Canadian health program and orthopedic surgeon (see bio below). Dr. McMurtry is a leader in efforts to reduce waiting times in the Canadian system. This is a great opportunity to learn the facts about health care in Canada, get your questions answered, and discuss evidence-based health care reform with a brilliant, committed, practicing physician from north of the border.

- We’ll also feature a speaker from the Illinois Health Care Referendum 2006, a statewide effort to ask the voters if they want lawmakers to improve our health care system. Citizen Action Illinois will also be presenting the “Healthy Illinois” proposal, a plan to provide health care to everyone in the state through partnerships with private insurers. As President Bush and other leaders embark upon a national dialogue to discuss health care, be a part of the discussion and debate.

Bio of Dr. Robert McMurtry

Dr. Robert McMurtry is a graduate of the University of Toronto in Medicine in 1965 and a Fellow of the Royal College of Physicians and Surgeons of Canada.

During his residency in Orthopedic Surgery, he spent 2 years in Africa, first in a mission hospital in Sekhukhuniland (South Africa) and then with the Canadian International Development Agency in Uganda. Following his residency, Dr. McMurtry did a fellowship in Hand Surgery at the University of Iowa. He started his practice at the former Sunnybrook Hospital (now Sunnybrook and Womens Health Centre) in 1975. It was there that Dr. McMurtry founded and directed Canada’s First Trauma Unit and the multi-disciplinary Hand Unit.

In 1987, he was appointed Professor and Chair of Surgery at the University of Calgary and Chief of Surgery at Foothills Hospital. In 1992, he became Dean of Medicine at the University of Western Ontario and subsequently Dean of Medicine and Dentistry, a post he held until 1999. In 1999, he became the first Cameron Visiting Chair at Health Canada - a post carrying the responsibility for providing policy advice to the Deputy Minister and Minister of Health for Canada.

Dr. McMurtry is the founding Assistant Deputy Minister of the Population and Public Health Branch of Health Canada. He was appointed to the Romanow Commission in 2002 as a Special Advisor to Commissioner Romanow.

Presently, Dr. McMurtry is Professor of Surgery at the University of Western Ontario and Orthopedic Consultant at St. Josephs Health Care in London, Ontario. His work involves an active clinical practice as well as teaching and research In December 2003, he was appointed to the Health Council of Canada and is Chair of the Wait Times and Accessibility Work Group. In June of 2003, he received the Presidential Award of Excellence from the Canadian Orthopedic Association.

Posted by pnhp at 03:38 PM | Permalink

An email that I received this morning from my daughter-in-law, Tami, who lives in Berkeley:

i thought of you this weekend as i was taking a training workshop for a clinic i will be volunteering at. the clinic serves low income women with cancer. it was extremely heart wrenching to see and hear their stories.

women who had to take public transportation to their chemo appts, living in cars while going through cancer and treatments, etc. and the #1 reason for the current poverty situation was lack of health care or not enough of it.

many or most had good or decent jobs prior to their diagnoses but because of deteriorating health they lost their jobs and then lost their insurance, or some just didn’t have it before and the diagnosis and bills, etc. put them into utter poverty. your mission for the need for universal health care slapped me in the face!

Comment: Tami understands.

Posted by pnhp at 04:40 PM | Permalink

Don’t mandate coverage by only large companies.
By Register Editorial Board
Des Moines Register
January 17, 2006

While millions of people flock to shop at Wal-Mart every day, the company has also gained a flock of critics for running small stores out of business, paying low wages and forcing many of its employees to turn to taxpayer-financed programs like Medicaid for health care.

It’s easy to throw stones at such a big target. But the Maryland General Assembly went too far last week when it overrode the governor’s veto and required employers with more than 10,000 workers ? i.e., Wal-Mart ? to spend at least 8 percent of their payroll on employee health care or pay into a fund for the uninsured.

Maryland is the first state in the country to pass a “Wal-Mart bill,” but labor unions are pushing legislatures in at least 30 other states - including Iowa - to enact similar requirements. It should end there: The law is unfair because it targets only companies of a certain size. Of the state’s large employers, only Wal-Mart spends less than 8 percent on health care. Other government mandates, such as those requiring companies to pay minimum wage or honor medical leave, apply to all companies.

So why did Maryland do it?

“The taxpayers are giving a health-care subsidy to the largest retailer on Earth,” said Maryland lawmaker Kumar Barve.

But that rationale is misguided because it assumes providing health care is the responsibility of employers. It shouldn’t be. Employers don’t pay workers’ car insurance, homeowners’ insurance or grocery bills. They shouldn’t be responsible for picking up their health care tab, either.

Unfortunately, the twists and turns of this country’s history have led to employer-based health insurance. Following World War II, a labor shortage and wage-freeze led to some companies offering insurance as a “perk.” Now it’s become an expectation that burdens companies financially. Worse, it keeps workers in dead-end jobs they hate. It thwarts entrepreneurial spirit when people are forced to stay with a company solely because it provides health insurance.

The United States is alone in the world in tying jobs to health care.

The country should be moving away from employer-based health care and toward a tax-financed system that provides health care to all Americans, regardless of where or if they’re employed.

What has happened in Maryland should be a wake-up call to businesses all over America to get on board with reforming health care. The best action for employers to take: support the expansion of the existing, tax-financed Medicare program for seniors to cover all Americans.

Companies and workers could contribute to the Medicare fund through payroll taxes the same way they pay into Social Security. Because Medicare has lower administrative costs and covers a larger pool of people, that may be cheaper for companies than the premiums they’re currently paying to private insurance companies to cover workers.

Maryland lawmakers had good intentions. They want more residents to have access to health care. They’re tired of Wal-Mart employees ending up on the public dime. But the move is unfair to large business and, in the long run, detrimental to moving this country toward a single system of health care that covers all Americans.

Posted by pnhp at 04:38 PM | Permalink

VA Care Is Rated Superior to That in Private Hospitals
By Rob Stein
The Washington Post
January 20, 2006

The Department of Veterans Affairs medical system once epitomized poor-quality care. But after a series of changes, the system has been hailed in recent years as a model for health care reform.

Now, survey results released this week indicate that those improvements have translated into a high level of satisfaction among veterans getting treated by the rehabilitated VA.

The telephone survey, conducted in October, found inpatient care received a rating of 83 on a 100-point scale; outpatient care got a rating of 80. In comparison, a similar survey of patients receiving private care found they rated their satisfaction at 73 for inpatient care and 75 for outpatient care.

(Veterans Affairs Secretary Jim) Nicholson acknowledged that some veterans do have to wait for care, but he said the waiting time has been improving and continues to improve.

http://www.washingtonpost.com/wp-dyn/content/article/2006/01/19/AR2006011902936.html

Comment: During discussions of national health insurance, how many times have you heard someone say that we don’t want government health care because then we would all have health care like they have at the VA?

Previous studies have shown that the quality of care in the VA system is actually higher than in the private sector, and now this study shows that patient satisfaction is also greater. It is ironic that the VA can still be used as an argument against national health insurance, but in an entirely different way. Imagine this comment: “We don’t want national health insurance that covers lower quality care in the private sector when we can have higher quality and greater patient satisfaction through a government-owned socialized medicine system as exemplified by the VA.“

Of course, you won’t hear such comments because the nation is not supportive of a public buy-out of our entire health care delivery system. They are having enough trouble accepting the concept of public insurance, as persuasive as are the arguments for a social insurance system.

One reason for the VA’s effectiveness is that it is an integrated health care delivery system, but many would prefer care in the private sector rather than in what they perceive to be a less personal, clinic-type environment. However, Kaiser Permanente, as an integrated health delivery system, has many features in common with the VA system, and yet many patients select Kaiser as their provider of choice.

If we had a national health insurance program, individuals would have the freedom to choose integrated health systems. For veterans, that should certainly include the VA. They should not be deprived of the option of higher quality and greater satisfaction with their care.

The VA does have a unique problem. Wars abruptly create new veterans, and a fixed system has limited flexible surge capacity to meet the increased demand. Queues for elective services can be a problem, though they can be moderated through modest capacity adjustments and queue management. Regardless, for those veterans who cannot afford care in the private sector, and who are stuck in a queue, a universal national health insurance program could provide them the option of obtaining their care in the private sector.

The least we could do for our veterans is to give them the additional choice of accessing the poorer quality and less satisfying care that the rest of us have.

Posted by pnhp at 02:14 PM | Permalink

By David Lazarus
San Francisco Chronicle
Sunday, January 8, 2006

David Ogden, a doctor in Marin County’s affluent Greenbrae, says he wants more time to spend with his nearly 3,000 patients, and he knows his patients want more face time with him.

Ogden’s solution: a $2,400 annual retainer to be paid by “several hundred” patients who want round-the-clock access to his expertise, no waiting for appointments, plus more leisurely visits with him in the examining room.

Everyone else — in other words, at least 2,000 current patients — will no longer see Ogden during routine checkups or for most ailments. Instead, they’ll have to make do with a nurse practitioner.

This is the latest trend in health care — variously called “concierge medicine” or “boutique medicine.” For an additional fee, patients receive more access to, and attention from, their physician, on top of the normal cost of treatment.

For those who can’t (or won’t) pay the extra charge, health care can be less convenient, less comprehensive and possibly less skillful. And that’s if the concierge doctor will still accommodate patients who aren’t paying retainers.

Most of the estimated 200 concierge doctors nationwide are making such people look elsewhere for primary care. Ogden is one of a relative few attempting to maintain a full practice through expanded use of nurse practitioners.

“This is about spending more time with patients,” he told me. “It’s what I want, and it’s what my patients want.”

Perhaps, but most apparently don’t want to pay thousands more each year for the privilege.

Ogden said he notified most of his patients shortly after Thanksgiving about the switch to what he prefers to call a “retainer practice.” As of last week, only about 1 percent had signed up for the new service.

“I’m very encouraged by the response so far,” Ogden said.

Gordon Schiff, a founder of Physicians for a National Health Program and a doctor at Chicago’s Cook County Hospital, responded that there’s little encouraging about concierge medicine. At least from a patient’s point of view.

“They should resent this,” he said. “Many of the things that doctors are saying they’ll do under concierge medicine should already be expected by patients. It shouldn’t be a privilege that you have to pay extra for.”

In-depth meetings with physicians, personal calls with test results, ready access to treatment — these should be staples of all medical practices, Schiff said.

“Concierge medicine is inherently discriminatory,” he observed. “Poor people will be treated differently from rich people, probably worse.”

But Schiff acknowledged that the U.S. health care system is so dysfunctional that most doctors are prevented from providing concierge-level service to all patients. It’s impossible when a physician is churning through 20 patients a day so he or she can reap sufficient returns from insurers.

This was Ogden’s situation. He said most visits with patients had to be limited to just 15 minutes so he could squeeze in as many as possible during an eight-hour shift.

“It’s not how I want to practice medicine,” Ogden said.

On the other hand, being restricted for the most part to seeing a nurse practitioner, and not their primary-care physician, is probably not what most of his non-retainer patients want either.

Worse, it might violate guidelines laid out by the American Medical Association, which determined in 2003 that concierge medicine raises “ethical concerns that warrant careful attention, particularly if retainer practices become so widespread as to threaten access to care.

“Physicians who engage in mixed practices, in which some patients have contracted for special services and amenities and others have not, must be particularly diligent to offer the same standard of diagnostic and therapeutic services to both categories of patients,” the association concluded.

“All patients are entitled to courtesy, respect, dignity, responsiveness and timely attention to their needs.”

This is why a Florida company called MDVIP, the leading force in concierge medicine, requires participating doctors to shift all non-retainer patients to other physicians.

“The hybrid approach with nurse practitioners is questionable,” said Darin Engelhardt, MDVIP’s chief financial officer. “If you’re providing priority to some patients, that could be detrimental to others.”

MDVIP accounts for about half of all doctors now practicing concierge medicine nationwide. The company essentially helps a physician get a concierge practice up and running. In return, it gets $500 of the doctor’s annual retainer, which typically runs $1,500.

Tommy Thompson, who until January 2005 served as President Bush’s secretary of health and human services, is on MDVIP’s payroll. He’s chairing a committee on preventive medicine.

Engelhardt confirmed that Thompson is being compensated for his role with MDVIP but declined to specify how much he’s being paid.

In 2002, Thompson was asked by members of Congress to clarify the government’s position on concierge medicine in general, especially as it relates to Medicare patients, and on MDVIP’s operations in particular.

Thompson responded that “it is not clear that such annual retainer agreements necessarily violate the law” and that “physicians may proceed with agreements of this type,” thus providing concierge doctors with the administration’s legal blessing.

Thompson didn’t address the lawmakers’ specific questions about MDVIP.

Engelhardt disputed critics’ charges that concierge medicine is responsible for a tiered health care system. He said managed care has already created different levels of service for patients.

“In a perfect world, the services provided by MDVIP physicians would be available to everyone,” he said. “The market reality precludes that.”

At Chicago’s Cook County Hospital, Schiff said, he can sympathize with doctors wanting to spend more time with patients. But he questions the ethics of any physician who demands more money for preferential treatment.

“If medicine is a public service and we’re here to take care of everyone, you don’t limit yourself to people who have money,” Schiff said. “Most people expect to be treated based on need, not on how much money they have.”

In Greenbrae, Ogden said, he feels comfortable that all his patients — retainer-paying and otherwise — will receive appropriate care.

“If someone needs me, I’m here,” he said. “I’m still a doctor.”

And, increasingly, a businessman.

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

Posted by pnhp at 02:11 PM | Permalink

John J. Sweeney, President of the AFL-CIO
National Press Club
January 18, 2006

… if I were President of the United States, I’d use this State of the Union speech to… challenge Congress to quit stalling and pass universal health coverage this year …

(Later in the speech…)

We need a simple national health care plan that covers everybody…

http://www.aflcio.org/mediacenter/prsptm/sp01182006.cfm

Comment: Everyone across the political spectrum supports “universal health coverage,” even though for some that means only providing everyone with the option of being able to purchase a low-cost, stripped-down plan of “basic” benefits, while excluding those who fail underwriting requirements. Individuals claiming to support universal coverage can be ignored unless they present specifics on a plan for comprehensive coverage that would automatically include absolutely everyone. The problem is that most people who speak about universal coverage really mean covering the most people we can with our fragmented system of public and private programs, recognizing that “we’ll never be able cover absolutely everyone,” often said with a wink and a nod.

What about “a simple national health care plan that covers everybody”? If this is a truly sincere statement, it says much more.

“Everybody” is much more specific than that abused term: “universal.” Presumably “everybody” really does mean everybody.

“National” means federal, as opposed to state and local programs that tend to be patchwork attempts to cover more (or sometimes less) under a shredded system. A national program presumably would be a standardized, equitable program that would cover everyone in the nation.

“Simple” is a term that you don’t hear from most individuals speaking about universal coverage. That is likely because their proposals are complex modifications of our fragmented system, such as the touted consumer-directed health plans that actually reduce coverage. On the other hand, “simple” is a term used by advocates of reform who would replace our complex, highly inefficient and wasteful system of administering health care funds with a simple, publicly-administered single payer system. Could that be what John Sweeney meant?

There is no doubt that John Sweeney’s words were chosen very carefully for this important speech before the National Press Club. As to the meaning behind his words, we anxiously await signals to see if AFL-CIO’s actions will quickly evolve beyond their current efforts to merely target a few large employers.

Posted by pnhp at 02:28 PM | Permalink

New York Times of Sunday, January 15.

To the Editor:

“States Intervene After Drug Plan Hits Early Snags” (front page, Jan. 8) reports that Medicare recipients are being denied promised prescription help. I would add that this has already increased hospitalizations.

I was outraged last week when one of my patients required hospital admission after stopping her medications because she couldn’t afford the new $45.57 co-payment demanded by her assigned private pharmaceutical benefit management company. Medicaid had previously covered her prescriptions.

The administration has designed a drug benefit to protect the pharmaceutical industry and discredit Medicare, our one single-payer health insurance program. Today’s mess could have been avoided if Congress had included the pharmacy benefit in Medicare and allowed Medicare to negotiate prices.

Congress should make changes in the drug benefit, instead of letting it serve as an opening wedge to privatizing and thus undermining original Medicare. Then it should extend Medicare coverage to everyone.

Oliver Fein, M.D.
New York, Jan. 9, 2006

The writer is chairman of the Metro New York chapter of Physicians for a National Health Program.

Posted by pnhp at 10:11 AM | Permalink

Citizens’ Health Care Working Group
“Health Care that Works for All Americans”

Note: This message is a call for action on your part. If you are already well informed on the Citizens’ Health Care Working Group, then skip to the three asterisks in the latter half of this message to take action. It is important that as many citizen voices as possible be heard during this process.

Background:

Senators Ron Wyden (D-Ore.) and Orrin Hatch (R-Utah) authored the “Health Care that Works for All Americans Act,” legislation designed to launch a national dialogue on health policy and bring quality care within the reach of every American. “Through open, public community meetings, the bill seeks to make citizen input the cornerstone of the reform process, giving citizens an opportunity to make hard decisions and voice their priorities for how to reshape the health care system. It would also guarantee a vote by Congress on the recommendations that result from the discussions.”

The bill was enacted as an amendment to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). Sec. 1014 of the MMA describes “Health Care that Works for All Americans: Citizens’ Health Care Working Group,” and is available at the following link:
http://www.citizenshealthcare.gov/about/law.php

The process described in Sec. 1014 has begun. The Citizens’ Health Care Working Group has been established, and the initial steps have been completed. An informative website is accessible online:
http://www.citizenshealthcare.gov/

Hearings have been held to gather information to prepare “The Health Report to the American People.” That report has been completed (though subject to
revision) and can be downloaded at the following link:
http://www.citizenshealthcare.gov/healthreport/hrtap_full.php

Beginning in mid-January, “community meetings” will be held throughout the nation to receive citizen input on reforming our health care system. The Working Group is also accepting other input, including public responses to a web-based questionnaire. Further information on what you can do to participate follows the three asterisks below.

After the community meetings are completed, the Working Group shall prepare and make available to the public through the Internet and other appropriate public channels, an interim set of recommendations on health care coverage and ways to improve and strengthen the health care system based on the information and preferences expressed at the community meetings. There shall be a 90-day public comment period on such recommendations.

After the expiration of the public comment period, the Working Group shall submit to Congress and the President a final set of recommendations.

Not later than 45 days after receiving the final recommendations of the Working Group, the President shall submit a report to Congress which shall contain— (1) additional views and comments on such recommendations; and (2) recommendations for such legislation and administrative actions as the President considers appropriate.

Not later than 45 days after receiving the report submitted by the President, each committee of jurisdiction of Congress, the Committee on Finance of the Senate, the Committee on Health, Education, Labor, and Pensions of the Senate, the Committee on Ways and Means of the House of Representatives, the Committee on Energy and Commerce of the House of Representatives, Committee on Education and the Workforce of the House of Representatives, shall hold at least one hearing on such report and on the final recommendations of the Working Group.

***

What you can do to contribute to the national dialogue on reform:

(1) Provide your answer to each of the following four questions (framed by the Working Group):

What concerns you most about health care in America today?

Our current way of paying for health care includes payments by individuals, employers, and government. Are there any changes you think should be made to this system?

What trade-offs do you think the American public is willing to make in either benefits or financing to ensure access to affordable, high quality health care?

What is your single most important recommendation to make to improve health care for all Americans?

Submit your answers online at the following link:
http://www.citizenshealthcare.gov/speak_out/public_comment.php?pguid=e73766d8-f911-4ad1-af6c-45b2b461cf8f

(2) Attend a community meeting. For an overview, with links to meeting dates and locations, registration materials, etc.:
http://www.citizenshealthcare.gov/community/overview.php

(3) Tell your friends and members of organizations to which you belong to add their input to this process. For those without computers, please assist them in this process. Public libraries can provide computer access.

(4) For those willing to expand their efforts to advance this important national dialogue, further suggestions are listed at this link:
http://www.citizenshealthcare.gov/community/invitation.pdf

N.B.: The President, in his report to Congress, will make the final recommendations for any legislation and administrative actions. If we disagree with his recommendations, we will have no right to complain unless we have provided our input. If we do participate, then we have the right to expect from the President recommendations for “Health Care that Works for All Americans.”

Posted by pnhp at 03:38 PM | Permalink

Is the President Ready to Expand the Public Role?
By Sebastian Mallaby
Washington Post
Monday, January 16, 2006; A17

This time last year, President Bush was preaching Social Security reform; that got nowhere. This time six months ago, his team was thinking tax reform; it soon got cold feet. Now the new theme is health reform. “This is a big priority for the president,” Al Hubbard, the White House national economic adviser, told me Friday. “The system has got to be reformed.”

He’s right, of course. The U.S. economy as a whole is extraordinarily efficient: Since 1995 productivity has grown twice as fast as in the 1980s and 50 percent faster than in euro land. But U.S. health care is the opposite. It’s notoriously inequitable, it generates tens of thousands of fatal errors annually, and it’s unbelievably wasteful. It achieves shorter life expectancy than the British, French, German, Canadian or Japanese systems, but it eats up 16 percent of the resources in the economy, compared with between 8 and 11 percent in those other countries. The difference — 6 percent or so of economic output — suggests that the waste in the American system comes to $700 billion a year.

Back before Bush was elected, Hubbard convened a private-sector group to wrestle with this challenge. He recruited three academics — R. Glenn Hubbard of Columbia University and John F. Cogan and Daniel P. Kessler of the Hoover Institution — who continue to influence Hubbard as he ponders what Bush should say about health care in the forthcoming State of the Union address. Conveniently, the trio’s thoughts are not a secret. Their five fixes for health care have just been published as a short book.

Some look at the U.S. health mess and see a failure of the market, but the authors insist that government clumsiness prevents the market from working. Modest tort reform would free doctors from practicing expensive defensive medicine. Tougher antitrust policies would prevent price-raising alliances among hospitals. Pruning mandates on health insurers — which often reflect lobbying by doctors’ groups — might free insurers to cover only the most cost-effective procedures.

So far, so plausible: Nonpartisan health experts agree that these ideas push in the right direction. But they don’t push to the goal line, nor anywhere near it. By the authors’ own estimates, the proposals eliminate only a fraction of the waste in the American system.

Enter the authors’ really big idea — the one on which the White House is likely to build a story about its grand health-reform vision. To make the health market work, the trick is to create and then empower consumers. You create them by making individuals pay more out of pocket. And you empower them by forcing hospitals and doctors to publish information on quality and price.

The idea appeals to Al Hubbard, a bluff, no-nonsense business type with a genial, uncomplicated style. Hubbard invited me to imagine a world in which companies paid for their staffs’ groceries: Employees would load up with more food than they needed; supermarkets would seize the chance to mark up groceries; pretty soon, they wouldn’t even bother posting their prices. So it is today with medicine. You don’t know the cost of your hospital visit until a few days later, when the bill arrives.

There’s a weakness in this thinking. The country has moved far enough already toward out-of-pocket payments, which promise hardship for low-income people without much reduction in waste. Health is simply too complex for people to make smart, waste-reducing decisions; when you go to the hospital with screaming stomach pains, you have no idea how many tests you need — and you’re not in a fit state to embark on comparative shopping. A celebrated study by the Rand Corp. showed that out-of-pocket payments deter needed health consumption as much as wasteful consumption, confirming the point that ordinary people aren’t going to become savvy health shoppers.

But the White House is right to press hospitals and doctors for better information on price and quality. Limited state-level experiments suggest that public ratings shame the poorest performers into rethinking their procedures; doctors want to help their patients, and if they are confronted with evidence that they are failing to do so they are willing to shake themselves up. A few health plans have begun paying bonuses to hospitals and doctors that score well on quality and price measures. A recent study led by Harvard’s Meredith B. Rosenthal found that these incentives work.

So the White House is half right. If it sticks to the good bits of its program, it could help bring down health care inflation — which in turn would create more space for wage gains and would also stem the growth in the ranks of the uninsured. But this still raises a nagging question.

Beyond the imperative of restraining prices, the biggest challenges in health care are to get insurance to everyone and to create incentives for preventive treatment — even though prevention may pay off 30 years later, by which time the patient will have gone through multiple switches in health plans. The most plausible subsidizer of universal insurance is government, and the only entity with a stake in lifelong wellness is the government. Is the administration ready to see that?

mallabys@washpost.com

Posted by pnhp at 04:54 PM | Permalink

Friday, January 13, 2006
The Oregonian

Former Gov. John Kitzhaber has offered a proposal to extensively reform America’s health-care system. The plan would have the state collect Medicaid money (it does this already), Medicare money (federal insurance through Social Security) and tax savings that employers get when they pay for health insurance for their employees. He would do this by having the federal government “waive” existing restrictions on states (this could apply only to Medicaid; Medicare benefits belong to workers). The resulting pool of money ($6 billion) would support preventive care and care for “other common but often costly ailments.”

Presumably, existing services would remain (although this was not specified).

The flaws in this proposal are huge. Federal limitations in many instances serve valuable purposes. Medicare and Medicaid have very different purposes (insurance vs. welfare), structures (federal payment vs. federal/state payment) and beneficiaries (retired workers vs. the poor). Constitutionally, the federal government could not assign retirees’ Medicare benefits (earned through decades of work) to a state, nor could they constitutionally deny federal tax deductions to the employers in one state (Oregon) while extending them to the other 49 (or consider the deterrence of out-of-state or interstate employers).

Most importantly, the proposal does not increase the funding for services or expand covered people or services at a time when 43 million Americans lack health insurance.

The analogy Kitzhaber draws is to his Oregon Health Plan efforts, which were admirable and innovative. But this is different. OHP was limited to Medicaid, a federal/state program, specifically contemplating waivers. And even then, we have watched the failure of the Oregon Health Plan during the past five years. There are no state dollars in Medicare or federal taxes. The Kitzhaber proposal would require national legislation; there is no chance for a single state to lead in this way. And, as national legislation, it is far too little to address major needs.

But the critics, too, have it wrong. The proposal would not create a “single-payer” program. But it should. Our health-care failure is not that we have covered too many health services, but too few. The flaw is not that we pay too much — $1.3 trillion — but that we get too little for what we pay.

And Kitzhaber himself has it wrong in saying that health care is not as important as education or the economy. It is central to both.

In the end, Kitzhaber’s proposal is not, contrary to many commentators, nearly bold enough. We need adequate funding; national planning for health facilities and services (we had this for a decade in the 1970s and ‘80s); effective cost control (especially through bulk buying of drugs, as the Veterans Administration does); a broad definition of health to address smoking, obesity and alcoholism and to offer preventive health care; and a single-payer system retaining employers and insurers as delivery mechanisms, along with state agencies to reach the uninsured and the unemployed.

Paradoxically, we are getting there a bit at a time, and have been since 1970. Contrary to Kitzhaber’s proposal, incremental steps work. In the past 35 years, we have added health care for the poor, the aged, children, veterans and workers. We have improved hospitals, doctors, insurance and drugs. We now need to pull them together, fund them adequately and make them work. If we fail, the fault will be ours.

Arthur B. LaFrance is a law professor at Lewis & Clark Law School who teaches Bioethics, Health-Care Delivery and Health, Poverty and the Law.

Posted by pnhp at 04:51 PM | Permalink

Inequalities in access to medical care by income in developed countries
By Eddy van Doorslaer, Cristina Masseria, Xander Koolman for the OECD Health Equity Research Group
CMAJ
January 17, 2006

The member states of the Organization for Economic Cooperation and Development (OECD) represent the wealthiest and healthiest countries in the world. Most of them achieved nearly universal coverage of their populations for a fairly comprehensive package of medical services decades ago. Their governments are committed not only to pursuing the efficient delivery of high-quality medical care but also to ensuring equitable access to that care. In most OECD countries, access to good-quality physician services is ensured at relatively low and sometimes zero financial cost at the point of delivery. This is mainly the result of a variety of public insurance arrangements aimed at ensuring equitable access. The increasing tension between affordability and equity has spurred a number of countries to reconsider their public-private mix and to study reforms that may enhance efficiency while maintaining equity.

Like the World Health Organization, the OECD is committed to a watchful monitoring and comparison of the performance of its members’ health care systems, and equity in access is regarded as a key objective. In 2002, the OECD Health Project commissioned a cross-country comparative study to assess how the very diverse health care delivery systems of its members fare in terms of equitable access. This article summarizes some of the main results of this study.

Results: We found inequity in physician utilization favouring patients who are better off in about half of the OECD countries studied. The degree of pro-rich inequity in doctor use is highest in the United States and Mexico, followed by Finland, Portugal and Sweden. In most countries, we found no evidence of inequity in the distribution of general practitioner visits across income groups, and where it does occur, it often indicates a pro-poor distribution. However, in all countries for which data are available, after controlling for need differences, people with higher incomes are significantly more likely to see a specialist than people with lower incomes and, in most countries, also more frequently. Pro-rich inequity is especially large in Portugal, Finland and Ireland.

Interpretation: Although in most OECD countries general practitioner care is distributed fairly equally and is often even pro-poor, the very pro-rich distribution of specialist care tends to make total doctor utilization somewhat pro-rich. This phenomenon appears to be universal, but it is reinforced when private insurance or private care options are offered.

http://www.cmaj.ca/cgi/content/full/174/2/177

And…

Commentary (on the article above)
By Jeremiah Hurley and Michel Grignon

The international comparison carries some potentially important lessons for health care policy debates in Canada. The most important is perhaps the link between equity of utilization and a country’s system of financing. It should not be surprising that the 2 countries in the study that lack universal health care insurance coverage (Mexico and the United States) have both some of the lowest overall visit rates and the greatest income-related inequity of utilization. More subtle appears to be the effect of parallel private insurance (private insurance that covers publicly insured services) among those countries with universal public insurance coverage. Such private insurance is disproportionately purchased by the wealthy and is particularly targeted at specialist services. Countries in which parallel insurance plays an important role in financing (e.g., Ireland, Spain and Portugal) achieve equitable utilization of general practitioner services across income groups - indeed, there is a tendency toward a pro-poor bias - but utilization for specialist services displays some of the highest degrees of inequity. The results of this study do not allow any definitive conclusions in this regard, but they caution against any illusion that parallel private insurance will increase access for anyone except the higher-income people who purchase it.

http://www.cmaj.ca/cgi/content/full/174/2/187

Comment: This OECD study has some very good news, some bad news, and some terrible news.

The very good news is that nations with universal systems (all industrialized nations except the United States) have relatively equitable access to primary care services - the foundation of a well-functioning health care system.

The bad news is that access to specialized services is not equitable in most countries, but it is certainly no surprise that wealth opens doors to specialized services. This differential is exaggerated in nations with parallel private insurance systems. This is not to begrudge the wealthy their improved access to specialized services (which are not always beneficial), but rather it is to express alarm over the fact that the remaining population has even greater impairment in access to specialized services merely because of stratification of the masses into the universal public insurance program, while granting the wealthy the option of using the red-velvet-roped First Class entrance to health care.

The terrible news is that the United States, lacking universal health insurance, has amongst the lowest overall visit rates and the greatest income-related inequity of utilization. There is not much consolation in the fact that Mexico shares that honor. Mexico, a relatively poor country, spends 6 percent of its GDP on health care whereas the United States, a very wealthy nation, spends 16 percent. Where is that greater quality at lower cost that the market enthusiasts keep talking about?

A brief OECD statement on the health system of Mexico:
http://www.oecd.org/dataoecd/35/19/34685343.doc

Posted by pnhp at 04:48 PM | Permalink

The Wrong Prescription
Letter to the Editor
The Washington Post
January 16, 2006

I hope that The Post’s Jan. 10 editorial “Certificate of Need? Yes!” helps stop the plan to build another hospital in a city that does not need more hospital beds.

Almost all of the serious health care problems in the Washington area require more effective disease prevention and primary health care; better access to doctors and nurses for routine and early-stage problems; better nutritional counseling; access to affordable healthy food; and an array of health services that are either unavailable or available only on a fragmented and dysfunctional basis to low-income families.

Employers and employees pay on average more than $12,000 a year for family health coverage in the District. Unnecessary, costly additions to an expensive health care system will drive up costs more. Some employers will drop coverage as a result or move jobs out of the high-cost city. Either way, the poor and others with low incomes will suffer most.

The District has too much high-tech health care and too little good primary care. The worst step that the city could take is to waste $400 million on an unneeded hospital, which undoubtedly will cost even more than that before it is done.

Helen Darling
President
National Business Group on Health

http://www.washingtonpost.com/wp-dyn/content/article/2006/01/15/AR2006011500691.html

Comment: Health care reform is often presented as a divisive issue. In articles on the topic, the single payer model of Physicians for a National Health Program (PNHP) is often presented as a government solution which has been contrasted with private sector solutions such as those supported by the National Business Group on Health. But are private business interests and public insurance interests really incompatible when it comes to health care reform?

Without commenting on the advisability of a new district hospital for Washington (which should be based on an assessment of need), this letter by Helen Darling could have been written by a member of PNHP. Look at the points on which we agree:

• Capital improvements, such as new hospitals and bed capacity, such be based on regional planning responding to identified needs.

• Excessive, ineffective high-tech health care should not be funded.

• Our deteriorating primary care infrastructure should be dramatically reinforced, which can be done by improving resource allocation.

• Prevention should be a primary goal using public health measures such as disease prevention, better nutrition with access to affordable healthier food, earlier access to the health care delivery system, and removal of impairments in access to other health services - impairments that are partially due to the fragmentation of our public and private systems of funding care.

• Current trends are resulting in a further decline in employer-sponsored coverage and “the poor and others with low incomes will suffer most.”

What is divisive about this? We agree on these points. Now is the time for all individuals and organizations to come together on reform. This does not mean that we have to enter a process of compromise in which each side gives up maybe half of the fundamental issues they support.

The National Business Group on Health can continue to advocate for higher quality services, for error reduction, for reduction of wasteful high-tech excesses, for provider assessments designed to improve system performance and for other measures that achieve the market goals of higher quality at lower costs. PNHP can continue to advocate for universal coverage, for administrative efficiency in funding care, for improved allocation of health care resources, for an equitable system of funding the universal risk pool in which each individual or entity contributes a fair share, and for budgeting mechanisms that slow the rate of growth in health care spending. These and other important goals can be achieved without having to compromise, but rather by cooperating. Together we can achieve an equitable, affordable, high quality, comprehensive health care system that would meet the needs of every individual while fulfilling the commitment of business and government for better health care for all.

Although the following quote is on war and killing, the affirmation should help us reflect on why we should not let up in our fight for health care justice:

“Now let me say that the next thing we must be concerned about if we are to have peace on earth and good will toward men is the nonviolent affirmation of the sacredness of all human life.”

Rev. Dr. Martin Luther King, Jr.

Posted by pnhp at 04:45 PM | Permalink

Public Solutions to Health Care Wait Lists
By Michael M. Rachlis
Canadian Centre for Policy Alternatives
December 2005

Executive Summary

Waits for care are the biggest political issue facing Canadian health care. Both citizens and providers are concerned that too many waits are too long and put some patients at risk.

Canadians would do well to consider public sector solutions to the wait-times problem. The good news is that many such public solutions are at hand. Here are two of the most innovative ones:

• The health care system should establish more specialized short-stay surgical clinics within the public sector. These clinics provide the efficiencies that private clinics have capitalized on, without siphoning public dollars to shareholders.

• Lessons learned from queue-management theory should be adopted. Examples from both the public and private sectors - such as line-ups at banks and airports - show us how better coordination and flow of queues can dramatically reduce wait times.

Canadians tend to assume that, if there is a wait for health care, there isn’t enough of it. For example, many breast patients have to wait for a mammogram, then wait for an ultrasound, and then wait again for a biopsy. The Sault Ste. Marie breast health centre reduced the wait-time from mammogram to breast-cancer diagnosis by 75% by consolidating the previously separate investigations. If a woman has a positive mammogram, she often has the ultrasound, and sometimes the biopsy as well, on the same day.

The Rexdale Community Health Centre serves 6,000 patients in a disadvantaged community in northwest Toronto. In 2003, patients faced a four-to six-week wait for appointments. The centre temporarily increased resources to clear its backlog, and now provides same-day service.

This same plan can be followed for surgical wait lists. First, map the process. At each step, assess whether capacity is sufficient to meet demand. If it is, temporarily increase resources to clear the backlog and go to just-in-time servicing. If capacity is insufficient for demand, then re-design services. If there is still unmet demand, then a bottleneck has been identified. It requires more resources.

These public solutions - specialty clinics in the public sector and application of queueing theory to surgical wait lists - are but two of many alternatives to private finance and for-profit delivery. Others include increasing surgical capacity in public hospitals and putting greater emphasis on prevention. There is no shortage of such solutions if the political will is present.

Let’s not add private problems to our health care system. We already have the public solutions at hand. Let’s put them into practice.

http://www.policyalternatives.ca/documents/
National_Office_Pubs/2005/Health_Care_Waitlists.pdf

And…

Explaining Waiting-Time Variations for Elective Surgery Across OECD Countries
By Luigi Siciliani and Jeremy Hurst
OECD Economic Studies No. 38, 2004/1

This study has added to the limited evidence on variations in waiting times across OECD countries for publicly-funded elective surgical procedures and on their possible determinants.

We have compared key statistics for the group of countries where waiting times are a major health policy concern (Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and United Kingdom), with another group where waiting times are not a concern (Austria, Belgium, France, Germany, Japan, Luxembourg, Switzerland, and the United States). It is found that countries which do not report waiting times, on average spend more in health care, have higher capacity (measured in terms of acute care beds and doctors), and implement more frequently forms of activity-based funding for hospitals and fee-for-service systems for doctors (as opposed to salary). On the demand side, the two groups of countries do not differ markedly in need, as measured through the proportion of elderly in the total population or mortality rates, and in the degree of cost sharing (co-payments for surgery).

http://www.oecd.org/dataoecd/15/52/35028282.pdf

Comment: This and previous OECD papers have demonstrated that maintaining adequate capacity in the health care delivery system is important in avoiding excessive wait times or queues. Monitoring and adjusting capacity as appropriate prevents unnecessary queues.

The report by Michael Rachlis is important because he demonstrates that queue management need not be expensive. Sometimes modest resources must be added to expand capacity, but the amounts are negligible when considered as a percentage of the entire health care budget. His most important point is that the application of queue-management theory can correct the problems with virtually no increase in spending. A private system of funding care is not a prerequisite. The only requirement is a responsible steward with political will.

If the United States decided to include everyone in its health care system, we would have to ensure adequate capacity and apply queue-management theory. Fortunately, affordability would not be an issue since the $2 trillion that we will be spending this year is more than enough to meet those costs.

Our other option is to continue with our current, very effective method of controlling queues. We can continue to make access to health care unaffordable for a major sector of our society so those individuals don’t clog up the queue. That’s easy, and it works!

Posted by pnhp at 03:14 PM | Permalink

Medicare’s Hidden Administrative Costs: A Comparison of Medicare and the Private Sector
By Merrill Matthews, Ph.D.
The Council for Affordable Health Insurance
January 10, 2006

Executive Summary

One of the most common, and least challenged, assertions in the debate over U.S. health care policy is that Medicare administrative costs are about 2 percent of claims costs, while private insurance companies’ administrative costs are in the 20 to 25 percent range.

It is very difficult to do a real apples-to-apples comparison of Medicare’s true costs with those of the insurance industry. The primary problem is that private sector insurers must track and divulge their administrative costs, while most of Medicare’s administrative costs are hidden or completely ignored by the complex and bureaucratic reporting and tracking systems used by the government.

This study, based in part on a technical paper by Mark Litow of Milliman, Inc., finds that Medicare’s actual administrative costs are 5.2 percent, when the hidden costs are included.

In addition, the technical paper shows that average private sector administrative costs, about 8.9 percent - and 16.7 percent when commission, premium tax, and profit are included - are significantly lower than the numbers frequently cited. But even though the private sector’s administrative costs are higher than Medicare’s, that isn’t “wasted money” that could go to insuring the uninsured. In fact, consumers receive significant value for those additional dollars.

We also raise an important, although heretofore unrecognized, issue that gives Medicare an inherent advantage on administrative costs. Because of the higher cost per beneficiary, Medicare administrative costs appear lower than they really are. If the numbers were adequately “handicapped” for comparison with the private sector, they would be in the 6 to 8 percent range.

Finally, like the private sector, Medicare also has to obtain funds to pay claims. But the cost of raising that money, or borrowing it if the government doesn’t collect it from taxpayers, is excluded from Medicare administrative cost calculations. While we don’t in this paper draw any conclusions about what we shall call the “cost of capital” and its impact on Medicare’s administrative costs, we do want to highlight that those costs exist and that taxpayers, both today and in the future, must bear those costs.

http://www.cahi.org/cahi_contents/resources/pdf/
CAHI_Medicare_Admin_Final_Publication.pdf

Comment: The Council for Affordable Health Insurance (CAHI) is an association of insurance carriers advocating for market-oriented solutions to the problems of our health care system. Their bias for affordable private health insurance is at odds with our bias for affordable publicly-funded health care for everyone. They have now released a report “exposing” Medicare’s hidden administrative costs.

It is important to be aware of this report and the paper of Mark Litow of Milliman, Inc. on which this report is based. Opponents of single payer reform will use the concepts presented to dismiss the charge that private insurers are responsible for much more administrative waste than is our Medicare program.

When we are challenged, our best quick response would be to use their own numbers. After they have adjusted the numbers by applying their biased assumptions, the percent of private sector administrative costs is still over three times the administrative costs of Medicare (16.7 percent and 5.2 percent, respectively). The actuality of the administrative excesses is not in dispute - only the degree of the egregiousness of the excesses.

The opponents will also point out that the percent of administrative costs for Medicare beneficiaries is lower because the per person health care costs are higher than in the relatively healthy private insurance sector. But shouldn’t the administrative spending be directed primarily toward claims processing, especially since Medicare enrollment is a low-cost, once-in-a-lifetime event? Why should a greater percentage of health care dollars be used to administer private insurance programs with a much lower rate of claims processing? The administrative costs of claims processing is related much more to the volume of claims and much less to the number of beneficiaries. Thus their “handicapped” numbers are specious.

In another section of their report they claim that administrative costs “add value.” Most of us have difficulty recognizing the value of marketing costs, medical underwriting, brokers’ fees, excessive executive compensation packages, insurer profits, and other such administrative excesses. This claim alone, that these excesses add value, should destroy the credibility of this report.

The most important component of administrative waste was totally left out of this report - the administrative burden placed on the providers of health care. The recent Health Affairs report by J. Kahn and his colleagues demonstrated that just the billing and insurance related costs of private insurance consume about 21 percent of premium dollars, in a large part due to the administrative burden of physicians and hospitals. A single, administratively-streamlined system of claims management would dramatically reduce the waste of our current fragmented system.

And what is their conclusion?

“However, the issue is not and should not be which segment, private sector insurers or government-run plans, has the lowest administrative costs. The issue should be which does the best job of providing quality health insurance coverage for the best price. When one looks at all of the money pouring into Medicare, even with the price controls imposed by the government, the answer has to be the private sector.”

And we’re leaving these guys in charge? It almost makes you want to cry.

Posted by pnhp at 01:45 PM | Permalink

National Health Spending In 2004: Recent Slowdown Led By Prescription Drug Spending
By Cynthia Smith, Cathy Cowan, Stephen Heffler, Aaron Catlin the National Health Accounts Team (Office of the Actuary, Centers for Medicare and Medicaid Services)
Health Affairs
January/February 2006

U.S. health care spending rose 7.9 percent to $1.9 trillion in 2004, or $6,280 per person. Health spending accounted for 16 percent of gross domestic product (GDP).

Medicare spending rose 8.9 percent to $309 billion in 2004.

Total Medicaid spending (federal plus state and local) reached $290.9 billion in 2004.

Private health insurance premiums amounted to $658.5 billion in 2004, compared with $563.5 billion in benefits paid.

The employee share of employer-sponsored and individually purchased coverage rose to $206.4 billion in 2004, while out-of-pocket spending for copayments and deductibles and for noncovered goods and services reached $235.7 billion. When payroll taxes and premiums associated with government-subsidized care such as Medicare and Medicaid are added in, aggregate household spending totaled $557.2 billion-more than one-third of PHC (personal health care) spending in 2004. Aggregate private business spending was $448.3 billion.

The trajectory of health care spending continues to be driven by new medical treatments, rising prices, and growing utilization. Medical progress has improved health care for many families, but rising costs are also a growing burden for households, businesses, and governments. Medical spending continues to rise faster than wages and faster than economic growth, and workers are paying much more in health care premiums than just a few years ago. As costs rise, the efficiency of health care spending is increasingly scrutinized, which has led to greater interest in paying for improved quality or outcomes, disease management, and consumer-directed health care. Although much of health spending may be highly valued, continued spending growth will require difficult trade-offs for businesses, households, and governments as other spending also rises. These trade-offs are more stringent for those with fewer resources.

http://content.healthaffairs.org/cgi/content/abstract/25/1/186

Comment: Although presented as a “slowdown” in spending, the 7.9 percent increase is significantly greater than the increase in cost of living, and now constitutes 16 percent of the GDP.

In looking at the source of funds, it is important to recognize a principle accepted by virtually all economists. The employer component of the Medicare payroll tax is part of the total employee compensation package; employees fund that tax through a non-itemized reduction in take-home pay. Thus the $67.4 billion Medicare tax listed as a private business source of funds should really be listed as part of the aggregate household spending. (Actually, the entire employee benefit package is a business expense, but this principle acknowledges the fact that the source of payroll taxes for social insurance programs - Medicare and Social Security - is the employee-beneficiary of the program.)

Adjusting for the employer component of Medicare payroll taxes, private business is a source of $380.9 billion of the funds for health services and supplies, and the aggregate household spending is $624.6 billion. Although employer-sponsored coverage remains a very important source of health care funding, the out-of-pocket spending by households represents a significantly greater burden imposed by health cost escalation. In addition, taxpayers fund the public portion of health spending which is $682.7 billion.

So what are we doing about the increasing burden of rising health care costs? We are shifting more of the costs to the households. Although we all feel the pain, those with health care needs who can’t afford care will feel it the most.

The tragedy is that we know how to fix our system. But… we’re not doing it. What a shame.

Posted by pnhp at 01:38 PM | Permalink

By Robert Pear
New York Times
January 8, 2006

WASHINGTON, Jan. 7 - Low-income Medicare beneficiaries around the country were often overcharged, and some were turned away from pharmacies without getting their medications, in the first week of Medicare’s new drug benefit. The problems have prompted emergency action by some states to protect their citizens.

Although there are no hard numbers, concerns expressed by state officials and complaints from pharmacists suggest a widespread pattern of problems.

At least four states - Maine, New Hampshire, North Dakota and Vermont - acted this week to make sure poor people received the drugs they were promised but could not obtain through the federal Medicare program.

Gov. Jim Douglas of Vermont, a Republican, said the state would pay drug claims for low-income people until the federal government fixed problems in the new program, known as Part D of Medicare. Michael K. Smith, the state’s secretary of human services, said, “The federal system simply is not working.”

On Thursday, the Vermont Legislature passed a bill declaring, “There is a public health emergency due to the federal implementation of Medicare Part D, which has resulted in serious operational problems, causing Vermonters to be turned away at the pharmacy without the drugs they need.”

Many factors contributed to the initial chaos. Some people who enrolled in Medicare drug plans did not have any proof of coverage. Pharmacists could not get the information needed to verify eligibility for drug benefits and low-income subsidies. Insurance companies and their pharmacy benefit managers were swamped with calls, so pharmacists often had to wait an hour or more on telephone help lines.

Federal officials promised improvements, but state officials were growing impatient.

In Maine, Gov. John Baldacci, a Democrat, agreed to pay drug claims to provide medications for those in need. Since Tuesday, the state has incurred $2 million of expenses for Medicare beneficiaries.

On Friday, Gov. John Hoeven of North Dakota, a Republican, said he had to act because “some low-income elderly and disabled individuals can’t get their prescriptions filled through their Medicare drug plans.”

In New Hampshire, Gov. John Lynch, a Democrat, signed an executive order authorizing the state to pay drug claims that he said should have been covered by Medicare. Republican leaders of the state legislature called a special session to provide the money. The start of the Medicare drug program “has been a nightmare for many of our citizens,” Governor Lynch said.

“Many are being charged unaffordable co-payments for prescription drugs - co-pays much higher than they are supposed to be. Too many of them are leaving pharmacies without their prescriptions.”

Thomas T. Noland Jr., a spokesman for Humana Inc., a major national insurer, said that some problems were “to be expected in a new program with lots of new enrollment taking effect all at once.”

Cynthia G. Tudor, a senior Medicare official, told insurers on Wednesday that they must “immediately make improvements” to “ensure that all beneficiaries get their prescriptions filled at the point of sale.”

In a memorandum to insurers, Ms. Tudor said she had received “numerous reports” that they were “inappropriately denying some scripts,” or claims. In many cases, she said, insurers are not providing the data that pharmacies need to file claims and get paid.

Dr. Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid Services, said on Saturday that he was working closely with states to address their concerns and to help individual patients. “We are filling close to a million prescriptions a day, including hundreds of thousands for low-income beneficiaries,” Dr. McClellan said. “Many, many people are getting the prescriptions they need.”

But in an interview on Friday, Stan Rosenstein, the Medicaid director in California, said: “We are hearing more and more complaints. A significant number of people are not getting their prescriptions. That has us very troubled.”

Drug benefits are delivered by private insurers under contract to Medicare. The federal government is supposed to compute the subsidy available to each low-income beneficiary. But Michael Polzin, a spokesman for Walgreens drug stores, said that, in many cases, that information had not been shared with insurers or pharmacists.

Under Medicare rules, each drug plan is supposed to have a transition policy, providing a temporary supply - typically 30 days - of any prescription that a person was previously taking. But customer service representatives at Medicare’s toll-free telephone number said they knew nothing of this requirement, and beneficiaries said it had been virtually impossible to take advantage of it.

Nationwide, 6.2 million low-income people receive both Medicare and Medicaid. About 1.1 million of them live in California. They tend to have many chronic illnesses and high drug costs. Cheryl Meronk, manager of the health insurance counseling program in Orange County, Calif., said she was referring people to hospital emergency rooms because they had been unable to get urgently needed medications through Medicare.

Under the standard Medicare drug benefit, which took effect on Jan. 1, the patient pays a $250 deductible and 25 percent of the next $2,000 in annual drug costs.

Over the last year, Medicare officials repeatedly assured poor people that they would receive extra help, so they would not have to pay any deductible and their co-payments would not exceed $5 a prescription.

But Carol A. Herrmann-Steckel, commissioner of the Alabama Medicaid Agency, said that Medicare beneficiaries with very low incomes had often been required to pay the full $250 deductible and co-payments far exceeding $5. “One beneficiary borrowed the money,” she said. “Another charged the $250 on a credit card because she was in such dire need of the medicine.”

Beverly R. Churchwell, an aide to the Alabama commissioner, said: “Some Medicare beneficiaries have not been able to get their medications. They are being turned away at the pharmacy.”

John J. Morris, 42, of Ware, Mass., who has diabetes and multiple sclerosis, signed up for a Medicare drug plan on Nov. 16. The insurer told him his co-payments would not exceed $5, he said, but at the pharmacy this week, he was told he had to pay $23 for each of three drugs.

“I could not afford it,” Mr. Morris said, “so I was not able to get my insulin or my M.S. drug.”

In Oregon, Sandy K. Hata, a field manager for the State Department of Human Services, said: “We’ve had calls from people in tears who could not get their medications. These people were being asked to pay a $250 deductible and hundreds of dollars in co-payments.”

Jane-ellen A. Weidanz, the Medicare project manager at the Oregon Department of Human Services, said, the $250 deductible “is hitting people very hard,” adding: “People are very angry and very upset. They are yelling at us. They feel that we lied to them. They feel Medicare lied to them. They feel they cannot trust anything we say about this program.”

Texas reported a similar problem. Low-income beneficiaries are “being charged incorrect (high) co-payments,” the state’s Health and Human Services Commission said in an e-mail message to the Dallas office of the federal Medicare agency.

In Oklahoma, low-income Medicare beneficiaries were often charged the $250 deductible. “They are being treated as if they were in a higher income bracket,” said Mike Fogarty, chief executive of the Oklahoma Health Care Authority. “It’s a common problem.”

Steven E. Hahn, a spokesman for AARP, which offers a drug plan insured by UnitedHealth Group, said he knew that some low-income people had had difficulty getting medications. “We are taking this very seriously,” he said. “This is a global problem, a systemwide problem, for all plan sponsors.”

Elizabeth L. Stone, 86, who lives alone in an apartment in Manchester, N.H., is enrolled in both Medicare and Medicaid, has arthritis and a thyroid ailment and is in a wheelchair. She tried to use the new Medicare benefit to fill a prescription this week, but failed.

“I did not get any medication,” Ms. Stone said. “People at the pharmacy would not give it to me because they do not know how they will be reimbursed.”

Another low-income beneficiary, Terence J. Stevens, 65, of Lakeland, Fla., said he signed up for the drug plan on Nov. 15, the first day on which enrollment was allowed. His plan tried to charge him a $47 co-payment for a drug to treat irregular heartbeats and high blood pressure. Mr. Stevens said he was unable to pay and did not get the drug.

In Alabama, William M. Beasley, a pharmacist and a Democratic member of the State House of Representatives, said, “I have had more difficulty trying to process claims for Medicare recipients than I’ve had with any other insurer in 43 years as a pharmacist.”

Posted by pnhp at 12:10 PM | Permalink

Christian Science Monitor
January 6, 2006

(CBS) It was a very tough week for low income seniors who were supposed to be covered by the new Medicare drug benefit.

“It’s not covered!”

Time after time seniors were told they indeed have insurance under the system, just not for the specific drugs they use, CBS News correspondent Wyatt Andrews reports.

“And this particular plan does not cover this drug,” pharmacist Michael Kim said.

“But I am disabled,” said Joyce Thomas.

Thomas has her new Medicare drug card. But payment was still refused.

Did they automatically enroll Thomas in the plan?

“Yes they did, yes they did,” Thomas said.

And does your new plan cover her drug?

“No it don’t,” she said.

This also happened to Doris Strong. And to Robert Elum.

“This plan doesn’t cover my prescription,” Elum said.

When we visited Grubbs pharmacy, two blocks from the U.S. Capitol, not one senior citizen we tracked had a prescription filled smoothly. The problem is that many low-income seniors who used to be on Medicaid got randomly switched to the new Medicare system — a system of private insurance companies that may or may not cover their drugs.

Pharmacist Michael Kim also blames was insurance company meltdowns that brought denial after denial.

“There are several companies that we tried calling and the message on their machine just says: we’re so overloaded, please call back at another time,” Kim said.

So if you’re a senior citizen having trouble with your prescriptions, the best thing you can do right now is come to the pharmacy prepared.

Here’s what to do. If you have your new Medicare card, be sure to bring it. If not, bring the letter that confirmed your coverage. If, like Joyce, your drugs aren’t covered, call 1-800-MEDICARE and ask the counselor to switch you to a better plan.

Medicare officials tell CBS News these are all first-week shakedown problems that should be solved soon.

Posted by pnhp at 12:02 PM | Permalink

Physician Acceptance of New Medicare Patients Stabilizes in 2004-05
By Peter J. Cunningham, Andrea Staiti, Paul B. Ginsburg
Center for Studying Health System Change
January 2006

Despite an earlier Medicare payment rate reduction, the proportion of U.S. physicians accepting Medicare patients stabilized in 2004-05, with nearly three-quarters saying their practices were open to all new Medicare patients, according to a new study by the Center for Studying Health System Change (HSC).

Only 3.4 percent of physicians reported that their practices were completely closed to new Medicare patients in 2004-05, also statistically unchanged from 2000-01.

In fact, Medicare beneficiaries’ access to primary care physicians increased between 2000-01 and 2004-05, reversing an earlier decline. Among privately insured patients, trends in physician access are similar to those for Medicare patients, suggesting that overall health system dynamics have played a larger role in physician decisions about accepting Medicare patients than have Medicare payment policies.

Implications

… physicians likely consider Medicare payment rates in the context of what they receive from other payers, especially private insurers. In this context, Medicare payment as a percentage of private insurer payments has increased substantially in the past 10 years, from about 71 percent on average in 1996 to 81 percent in 2003. And Medicare fees are still much more generous than Medicaid fees, despite the fact that Medicaid fees increased relative to Medicare between 1998 and 2003-from 64 percent of Medicare in
1998 to 69 percent in 2003.

Given rapidly rising private insurance premiums, private payers’ pressure to keep physician payment rate increases to a minimum is likely to continue. In addition, continued decreases in the number of privately insured Americans, along with increases in the number of people with Medicaid or who are uninsured, may make it increasingly difficult for physicians to substitute higher paying privately insured patients for Medicare patients.

Perhaps the greater risk is not that stagnant Medicare payment levels will reduce Medicare beneficiaries’ access to physicians, but that continued financial pressure from all payers and declining incomes will compel physicians to limit patients that generate the least revenue, especially Medicaid and uninsured patients.

http://www.hschange.org/CONTENT/811/#ib5

Comment: We frequently hear that we will see a mass exodus of physicians from the Medicare program because of the failure of Medicare rates to keep up with the increase in overhead expenses (and expected profits) for physician practices. We haven’t seen that exodus, and that may be due to the fact that private insurers have slowed their rate increases even more than Medicare, reducing the price differential that might motivate physicians to replace Medicare patients with privately insured patients. Also, with the decline in employer-sponsored coverage, there are fewer privately insured patients to fill the void that would be created by eliminating Medicare patients.

Ironically, the market response of the private insurance industry has protected access for patients in the public Medicare program, obviously benefiting Medicare patients. So how could this be bad news? With both Medicare and the private insurers placing greater restraints on the profit potential of patients, physicians must maximize the utilization of their time and resources. That would normally be desirable except for one major factor. They are forced to reduce their time allotment for charitable services provided to uninsured patients and for the uncompensated portion of costs of providing care to Medicaid patients. Access for these individuals is already significantly impaired and can only grow worse with current trends.

Under a single payer system, physicians would be granted the right to negotiate adequate rates that would cover their costs and provide fair profits. As a transparent process, it would be fair for physicians and fair for taxpayers who fund the system.

Why would taxpayers agree to fair compensation for physicians? When they are sick, they don’t want to try to obtain care from an overworked, underpaid malcontent who doesn’t have the time to see them. They want the field of medicine to continue to attract some of the most qualified candidates that society has to offer. Our fragmented system of funding care has placed that goal at risk.

Posted by pnhp at 11:54 AM | Permalink

By Amanda J. Crawford
The Arizona Republic
Jan. 4, 2006

Jessa Johnson was sick for a couple of weeks. She figured it was probably some kind of virus. But without health insurance, the 23-year-old Gilbert resident could not afford to see a doctor and find out.

“I need to be healthy,” Johnson said as she recovered by spending a pleasant afternoon at the Phoenix Zoo with her boyfriend. “But I need money to live.”

Johnson is not alone in her concerns about the cost of health care and the American health care system. The Arizona Republic poll completed in mid-December indicated that 39 percent of registered voters surveyed statewide worry about their ability to afford the health care or prescription drugs they need this year. Many more, 81 percent, believe it is time that the state or federal government step in and create a universal health care system that ensures everyone has access to medical care.

Chris Philbin, 26, of southeast Phoenix, like many of the voters surveyed, is not concerned about his ability to afford health care in the next year because he has health insurance through his job at Lowe’s Home Improvement. But Philbin strongly believes the nation needs to find a way to insure everyone even if it means he would personally have to chip in for it.

“I would gladly give up 10 percent of my paycheck to have free health care like they do in Canada - free prescriptions, everything,” Philbin said as he strolled through the zoo with his fiancée and their 2-year-old son. Philbin, a registered Republican, said it’s not right that Americans without insurance sometimes have to skip care and could die due to not having access to medical care. “We should take care of them,” he said.

In Arizona, nearly 1 million residents were without health insurance in 2004, according to the Census Bureau. And more than 1 million residents now get their health insurance through the Arizona Health Care Cost Containment System, or AHCCCS, the state Medicaid program that provides free or low-cost health insurance to low-income families at a cost to state and federal taxpayers of more than $5 billion per year.

With health care costs soaring and many employers scaling back job-based benefits, health insurance has, by many accounts, become one of the most significant issues facing Arizona and the nation as a whole. When the Arizona Legislature reconvenes next week, health care is anticipated to be the subject of several bills.

Rep. Phil Lopes, a Tucson Democrat, for example, plans to introduce a bill to create a universal health care system in Arizona. The legislation would lay out a plan to provide public insurance coverage for all residents who have been here longer than a year, funded by employers, Medicaid, Medicare and other payers in the current system. Modeled after a plan that has been pursued in New Mexico for more than a decade, the legislation would lay out the basic structure of the program, which would keep doctors, hospitals and other providers private, Lopes said. And it would establish a commission to iron out the details and implement the program.

“I think it is government’s role to step in when the private market fails to provide basic necessities that our residents need,” Lopes said. He said that many health insurance innovations that relied on the private market over the past few decades, including the move toward managed care, have failed to keep costs in check in the long run or expand coverage. Lopes, House minority leader, acknowledges that such an unusual and ambitious plan could be hard sell to Arizona’s conservative Legislature.

Still, he said: “I am committed to doing what I can. And I am convinced this is the best way to go.” Noting the support for universal coverage in The Republic’s poll, he added, “How often is it that 81 percent of people say that we need to do something?”

On the other side of the aisle, Rep. Russell Pearce, a Mesa Republican who is chairman of the House Appropriations Committee, said he wants to curb the amount of money that the state spends on health care. He wants to eliminate some public programs that provide low-cost insurance for the working poor, such as KidsCare Parents, and make all AHCCCS recipients pay significant co-pays to get care, which he said would put accountability in the system. He also wants to lower the income limits so that fewer people qualify for AHCCCS. That would require a ballot referendum to overturn Proposition 204, the measure passed by voters in 2000 to open AHCCCS to all residents below the poverty line.

”(Medicaid) is a runaway train and absolutely cannot be sustained the way it is going. It is a drain on taxpayers,” Pearce said, noting that the program eats away at the state’s General Fund. “I was raised poor, and we never took a penny from government. . . . This is not about being coldhearted but recognizing that moms and dads that work hard are paying for someone else’s health care. These bleeding-heart socialists have no respect for taxpayers.”

But Pearce may have trouble finding voter support for his plans. Only 8 percent of poll respondents agreed that the state should save money by lowering the income limits of AHCCCS and excluding more families from coverage.

On the contrary, nearly half (46 percent) of respondents said they thought that the state should spend more money on AHCCCS, raise the income limits and open up the program to more families without insurance. One-third of respondents thought it should be left as it is.

Carnelina Vaccaro, 62, of Tucson, has good benefits herself because she is a federal government retiree. But she says that she knows many people aren’t so lucky, and she worries about people who are uninsured or have trouble affording health care.

“There are so many people who need assistance,” Vaccaro said while having lunch at La Cocina restaurant in downtown Tucson. She said she thinks the United States needs to “take a look at the kind of coverage they have in Europe.”

In the meantime, she thinks expanding existing programs like AHCCCS to more low-income workers could help, especially because the state is anticipating a budget surplus this year.

“I think it should be expanded,” she said. “There are too many people who don’t have health care. Help out Arizona families.”

Posted by pnhp at 12:47 PM | Permalink

AFL-CIO President John Sweeney Remarks on Fair Share Health Care Campaign
AFL-CIO
January 5, 2006

…AFL-CIO unions are taking bold steps and paving the way — state-by-state and piece-by-piece — towards health care reform through our landmark Fair Share Health Care campaign in some 30 states.

AFL-CIO unions have been working hard on this landmark legislation since early last summer. And we are proud to announce our final product.

Our Fair Share Health Care legislation would set a minimum standard for health care; it requires large employers to pay their fair share for health care (defined as a percentage of total wages) or pay into a state fair share health care fund that can be used to provide or subsidize health care for uninsured workers in the state.

The bottom line is that our health care system is broken — but it didn’t just split open. Big companies like Wal-Mart are pulling it apart and profiting at taxpayers’ expense.

Health care is a basic need of every family. It’s nothing short of immoral that big, rich companies are shirking their responsibilities to their employees — we’re talking about mothers and fathers who are pushed to tears because they can’t take their children to the doctor. And it’s happening every day.

To make matters worse, those companies that DO provide insurance are increasingly shifting the cost onto workers and cutting back on the benefits they provide…

http://www.aflcio.org/mediacenter/prsptm/sp01052006.cfm

And…

Governor Schwarzenegger’s 2006 State of the State Address
Office of the Governor of the State of California
January 5, 2006

His complete, unedited comments on health care reform in California:

Health care. I ask myself, what’s the quickest way that we can help the greatest number of people with the spiraling health care costs? I believe in the free market. I believe in free trade. I mean we buy food from overseas. We buy cars from overseas. Why not prescription drugs? So I call upon the federal government to permit the safe importation of prescription drugs. I say, let the free market work.

http://www.governor.ca.gov/state/govsite/gov_htmldisplay.jsp?sCatTitle=Speeches&sFilePath=/govsite/selected_speeches/
20060105_StateoftheState.html&sTitle=2006&iOID=73545

Comment: This year we will surpass $2 trillion in health care expenditures - more than enough to provide high quality, comprehensive health care services for absolutely everyone. We already know that we can easily accomplish this by dumping our fragmented, highly flawed system of funding health care and adopting a single-payer national health insurance program. Yet we listen to others when they tell us that this might be the ideal, but we can’t do it because it’s not feasible. So we turn to incremental measures.

What will the Fair Share Health Care approach do to improve health care coverage and access? Targeting large employers in thirty states sounds like a massive expansion, but the large target actually is comparatively small: Wal-Mart. Wal-Mart employs about 1.2 million individuals, and many of them are already insured. Even if Fair Share legislation passed in every state, the net impact on covering the 46 million uninsured would be almost negligible.

There is another very serious flaw in this proposal. Our fragmented system of funding care has left us incapable of controlling the seemingly-eternal explosion in health care costs. Legislators and the policy community have thrown in the towel and instead have turned to efforts to make health care premiums affordable. Without a lid on actual costs, premiums can be controlled only by reducing coverage, increasing cost sharing through patient access fees, and using devious methods to exclude from coverage those with greater health care needs.

It can be anticipated that the compromise with Wal-Mart will be to allow consumer-directed products, with affordable premiums, that fail to provide financial security for those who will need to access the health care system. Other employers are looking for a way out, and they’ll gladly jump on that train. The only losers will be the patients who need care and the health care providers whom they can no longer afford.

While waiting for comprehensive reform to become politically feasible, we generally have supported incremental measures that do expand affordable access and coverage. We are now staring at a runaway locomotive heading toward us. Although a few more may be covered, the increasing momentum of cost shifting to those with needs will further diminish affordable access for average-income Americans. The Fair Share campaign will merely stoke the fires, driving us to the cliff. Once we’re over the cliff, the feasibility of comprehensive reform will be obvious, but do so many really have to suffer for us to finally act?

If the AFL-CIO continues to support inadequate incremental measures, the day of reckoning will be delayed further. Will the AFL-CIO help take control of that runaway locomotive by supporting national health insurance, or would they prefer to sit down with Gov. Schwarzenegger and other state governors and discuss measures that would allow the free market to work?

Posted by pnhp at 11:44 AM | Permalink

U.K. Conservative Party Reverses Health-Care Policy
Bloomberg.com
January 4, 2006

U.K. Conservative leader David Cameron reversed his party’s policy on health care, abandoning a pledge to help fund private treatment and promising to support the state-funded National Health Service.

Cameron’s pledge to keep the National Health Service free at the point of need challenges Prime Minister Tony Blair for the center ground on a core area of public services.

http://www.bloomberg.com/apps/news?pid=10000102&sid=ag.F7kpdlHls&refer=uk

And..

David Cameron’s speech on the NHS
Speech delivered today by the Conservative party leader to the King’s Fund January 4, 2006

Conservative commitment to the NHS

Some people think that we Conservatives want to change the NHS into something that it isn’t. Well, they’re right. We do.

We want to change the NHS into a more efficient, more effective and more patient-centred service. We want to change it into something of which we can be even more proud.

Other people - some of them in my own party - urge me to go much further. They want me to promise that under the Conservatives, the NHS will be transformed beyond recognition into a system based on medical insurance.

I will never go down that route.

Under a Conservative government, the NHS will remain free at the point of need and available to everyone, regardless of how much money they have in the bank.

From the Conclusion

Instead of helping a few to leave the NHS and go private, we want the private sector to come and help improve the NHS for everyone.

We will investigate the crucial questions; how would the NHS use greater freedoms? How can we harness the vitality and innovation of the social enterprise sector to improve the NHS? Is competition essential to deliver more efficient care? How can choice be made real and responsive to patient needs?

Full text of David Cameron’s speech:
http://politics.guardian.co.uk/conservatives/
story/0,9061,1677802,00.html

Comment: The American Heritage Dictionary defines rhetoric as “the art or study of using language effectively and persuasively.” It would be refreshing if politicians would become masters of this art, effectively communicating the policies for which they stand. Unfortunately, it is the politicians who have abused this art, necessitating an alternative definition of rhetoric: “Language that is elaborate, pretentious, insincere, or intellectually vacuous” (American Heritage Dictionary)

What does it mean to say “harness the social enterprise sector”? It is difficult to deduce any other meaning than “privatize.” If that’s what he means then why doesn’t he say it?

Posted by pnhp at 02:24 PM | Permalink

By Glenn Hameroff
Community Voices
Daytona Beach News-Journal
January 04, 2006

I was dismayed to read in The News-Journal on Saturday that as many as 65,000 local residents may be denied access to Flagler Hospital. This recent episode, coupled with the estimated 45 million Americans without health insurance, causes me to wonder why our government permits health care to be rationed based upon wealth. When health-care emergencies occur, a few extra minutes can mean the difference between life and death. It is particularly disturbing that this accident waiting to happen is the result of squabbling over money between two health insurance entities.

The significant issue, in this threat to reduce access to Flagler Hospital, is the rate of reimbursement that the Florida Health Care managed care plan pays to the Flagler hospital. On the surface this conflict seems to be waged by accountants employed by the hospital and the health-care insurer. The reality is that our health insurance edifice is hampered by the waste created by having more than 1,200 private health insurance companies in the United States. The conventional wisdom that competition ensures efficient use of scarce resources does not hold sway in the health-care delivery system.

A logical analysis of the realities of our health-care delivery system results in the conclusion that we would be better served by a single payer health-care insurer. Health care is a human right, not a battle between an insurance company and a hospital. The efficiencies achieved by employing economies of scale could go a long way to reducing the number of uninsured Americans.

According to popular belief, the existence of hundreds of companies ensures greater competition and lower costs. A fundamental tenet of the conventional wisdom alleges that if you really want to screw things up, let the government run the industry. References are made to the post office as an example of the chaos and inefficiencies that would result. Yet when you examine the facts regarding the costs of handling a medical claim, Medicare is the most efficient health-care insurer. Private insurance providers cost anywhere from five to 20 times Medicare’s per unit expenses. This fact should be widely revealed to the American people.

Hameroff, a retired history teacher, lives in Palm Coast.

Posted by pnhp at 02:22 PM | Permalink

By Tom O’Brien
San Francisco Chronicle
Thursday, December 29, 2005

After a long time away, you see with new eyes.

I moved back to the United States with my Canadian wife and two small boys after living 15 years in Toronto and Ottawa. U.S. health care now looks both expensive and scary, leading me to conclude that we’d do better with an entirely different system.

Nowhere has this been put in sharper relief than in the story of two colleagues. Struck in March with cancer, an American colleague worried about death, insurance loss and bankruptcy. In contrast, a Canadian colleague and cancer victim had only her disease to fight.

Susan was on sick leave when I came to work at my new job in August. She was middle-aged and single with a grown family and well liked in my office. She was undergoing chemotherapy to treat breast cancer and not able to work. Our employer supported her beyond the normal period of sick days and vacation.

But the scary question for anyone but the rich hit with a catastrophic illness in the U.S. health-care system is: How long will an employer’s support go on if the battle goes far beyond the time allotted for sickness and vacation? Susan worried about the loss of health-care coverage and what ensues — second-rate care, bankruptcy, choosing between timely drug therapies and even modest necessities. She died this month before those fears were realized. But had she lived, she and her family would have confronted the excruciating battle survivors have to fight with insurance companies, employers and health-care providers over cost, length and quality of treatment.

In contrast, my former colleague Kathleen back in Canada was gripped by uterine cancer, which had spread to her intestines. While she was locked in a life-and-death battle for 18 months, she didn’t have to worry about losing her health care and choosing which bills to pay. Canadian Medicare covers everyone for everything in hospitals and doctors’ offices, including some elective procedures. This means no health care-caused bankruptcies. No fights with insurers. No insurance-driven financial worries. Kathleen could save her energy for battling her cancer instead. She did recover, and while her recovery was not necessarily the direct result of differences in care systems, there is no question that she would have suffered more with the burden of financial worries related to her health-care needs.

I hear stories here about Canadians lining up for basic medical care. But despite plenty of doctor appointments, occasionally bringing my children to the ER, and having had a heart procedure myself, I didn’t witness any delays for necessary (let alone emergency) care. In survey after survey, Canadians support public, nonprofit health care by a wide margin.

And why not? Compared to the United States, Canada has much lower infant-mortality rates and a longer life expectancy, according to data from the World Health Organization. Canadian women get just as many mammograms, for example, as do American women. This is achieved despite spending far less per person on health care — 10 percent of per capita GDP in Canada goes to health care versus 15-plus percent in the United States, according to WHO research.

After 40 years of private health care in America and 15 years of Canada’s Medicare, I’ll take the latter. But of course, I can’t; it’s not available here. I love my country but not the private health-care system that abandons many people and worries even more.

Few Americans know that every other industrial country in the world has a health-care system more or less like Canada’s. I think even fewer realize that we do, too — it’s called (U.S.) Medicare. The system that boosted the health of Americans 65 and older is similar to Canada’s system for everyone. They’re both “public, not-for-profit, single-payer” systems with low overhead costs. So why not extend Medicare to every American?

Our seniors like it. Sure, it will raise the cost of this government program by billions of dollars, according to even the most conservative estimates. But it will save money for both individuals and employers who now purchase private health insurance. After all, it’s not how much of your income you pay, it’s how much you keep. You’ll keep more under Medicare-for-all, and every child, woman and man would get the timely health care they need.

Give people the opportunity to face and fight their illnesses, not their insurance companies.

Posted by pnhp at 11:16 AM | Permalink

It’s time to start a conversation about national health care. We should talk health to death, plan it out and then find a way to go for it
By Charles Madigan
Chicago Tribune
December 28, 2005

(A note: Your response to the request last week to write your own “Contract with America” was impressive. We will be publishing many of your suggestions in Perspective and at chicagotribune.com early in the new year. Thanks for your thoughts and your help.)

I had an unusual vacation this fall that I’m not going to say much about. I went to a cabin in the woods of Pennsylvania. I got the flu, with all the consequences. A tornado came. (It did, indeed, sound like a freight train.) It took out the electricity. There was no heat. No light. Worse, no water pressure. It was the first week of deer hunting season, so the woods sounded like a war zone.

I slipped into a fever-induced delirium.

That’s when I concluded it’s time for the nation to start having a serious conversation about national health care. I don’t know why that hit me, because I never thought of going to a doctor. Jeez luweez, it was just the flu. So it must have been the lingering effects of the high fever, or dealing with the trots in a waterless cabin in the woods.

Or was it just the news?

Word mysteriously reached the Micheau State Forest that General Motors was looking to slash something like 30,000 jobs. Among other things, it cited the high cost of health benefits as a great burden on its profits.

Unspoken in the announcement was this: Who wants a sport-utility vehicle the size of a house trailer?

We have this stalwart of American industry trapped between high costs and products that aren’t selling well, even as wily foreigners eat up market share by obsessively emphasizing quality, efficiency and giving people what they want.

It’s not that we don’t want cars, we just don’t want those GM cars.

I haven’t been able to get this health care thought out of my mind for weeks. I’m not going to hop up and say it’s clearly the time for national health care, because that would be easy and would diminish the complexity of the subject.

Instead I mean, quite literally, it’s time to start a conversation about national health care. It should be part of the 2006 congressional race. It should be at the heart of the 2008 presidential contest.

We should talk health to death, plan it out and then find a way to go for it.

What surprises me at this point is that this isn’t at the top of the legislative agenda of every manufacturer, every significant employer from coffee shop chains to assembly plants all over America. Can ideological opposition to something like national health care be so strong that employers are even willing to overlook the impact on their bottom line?

Somehow, one would think they would see the logic of a conversation to address this growing problem.

And what is the problem?

The way the system operates now, a lot of people are not covered, a lot of people are not covered very well and those who are covered very well are covered at costs that are becoming prohibitive for employers.

Why?

There are a couple of answers.

My own would be the unpopular conclusion that we go to the doctor way too often, from birth until we shuffle off. I would hope that as my inevitable decline continues, I will view it as inevitable decline and not something that can be fixed by medical science at great expense.

Something big comes along, then I would need health care, preferably covered by insurance.

But it would have to be big. Either big or bleeding a lot. That would be my rule.

On top of that, the system’s appetite for money expands to eat up what is available, and then some, just like a teenager. That has to be addressed.

On the business side, something else is at work. The simple explanation is globalization.

America’s manufacturing muscle, and a wonderful muscle it has been, is now pitted against a whole world full of low-cost operators who don’t have to sweat the cost of health insurance in union negotiations, either because they don’t deal with unions, have national health care, or simply don’t have an iota of concern about the health of their employees because there are always so many more waiting for jobs.

Here in America, we don’t think that way.

Many manufacturers have stepped up over time and provided excellent health benefits for most of their workers. But now they are getting pinched.

The rest of the world makes an abundance of stuff for a fraction of the price it would cost to make here. Then low-cost sellers buy it up and sell it back to Americans.

It would be so easy to point the finger and blame manufacturing for being cheap, for trying to squeeze dollars out of their employees by cutting jobs and benefits.

But I think we should cut manufacturers a break. They are competing in a changing, demanding global game. They don’t need chiding or criticism. They need some help.

Should national health care be part of that package?

Posted by pnhp at 11:08 AM | Permalink

By Robert Fitch
The New York Times
December 28, 2005

AS most Americans are aware, our auto industry is in a crisis.

Workers’ wages are falling, and hundreds of thousands of jobs are being sent offshore. America’s largest parts supplier, Delphi, filed for bankruptcy protection, and General Motors, Delphi’s main customer, may too, if a threatened United Auto Workers strike occurs next month. Meanwhile, Ford and its main parts supplier, Visteon, seem to be skidding down the same road.

How did we get here? There are many causes: poor car designs, high pension costs, increased foreign competition. But much of it comes down to the overwhelming health insurance costs borne by the auto makers. This is why the union’s president, Ron Gettelfinger, has urged Congress to enact sweeping health insurance reforms.

If the government paid everyone’s health insurance bills, as those in Canada and most of Europe do, Detroit’s Big Three could save at least $1,300 per vehicle. Profitability would return. With deeper pockets, the auto makers could afford to pay their suppliers. Communities would be spared layoffs.

Of course, there are a lot of other compelling reasons to support a single-payer plan besides helping the auto industry. Although it is by far the most costly in the world, our health care system still leaves 43 million people uncovered. The latest World Health Organization rankings listed America’s system 33rd, below Costa Rica and only two notches above Cuba.

Most advocates of universal health care focus on the opposition of Republicans and insurance companies. But perhaps the most important factor keeping an overhaul off the national agenda is one that few Democrats acknowledge: most of Mr. Gettelfinger’s fellow labor leaders don’t support a single-payer system either.

The reason comes down to simple self-interest. The United Auto Workers is one of the few private-sector unions that doesn’t run its own health plan. Rather, most have created huge companies to administer their workers’ plans, giving them a large and often corrupt stake in the current system.

Opposition to a national health care plan is as much a part of the American trade union tradition as the picket line. It goes back to Samuel Gompers, the founder of the American Federation of Labor, who railed at early Congressional efforts to pass a law mandating employer coverage as Britain had done, which he said had “taken much of the virility out of the British unions.”

This line of thinking led to the notorious decision in 1991 by the A.F.L.-C.I.O.’s health care committee to reject a proposal that the federation support a single-payer plan. The majority said a national system simply had no chance in Congress, but others saw a conflict of interest: government-supplied health care would put union-run plans out of business.

The deciding vote was cast by Robert Georgine, chief executive of Ullico, a huge insurance provider created by the unions. A decade later, Mr. Georgine, who was paid $3 million a year by Ullico, and several other company directors - all heads of major A.F.L.-C.I.O. unions - were investigated by a federal panel for insider trading involving Ullico stock. Mr. Georgine and several directors resigned, and this year he agreed to pay back $13 million to the company.

Let’s face it: union-administered health insurance funds provide irresistible opportunities for labor leaders. First there’s patronage: hiring friends and relatives. Then there are the conventions, junkets and retreats provided by the plans and the providers. And for those willing to cross the line of legality, there’s the chance to take kickbacks from health care vendors.

Many officials are charged, but few go to prison, even when money allegedly winds up in Mafia hands. Last month federal prosecutors lost a criminal case in Brooklyn in which they charged that the Genovese crime family leaned on two International Longshoremen’s Association local presidents to, among other things, choose a favored health vendor.

Evidently, the jury was convinced by the defense’s argument that the union leaders were under duress. Even Lawrence Ricci, the principal accused Genovese figure, was acquitted, although he disappeared during the trial and never testified. (His body was found last month in the trunk of a car in Union, N.J.)

Despite shrinking membership, organized labor still has enough money and muscle to get behind a campaign for national health insurance. Last month, public-sector unions in California came up with tens of millions of dollars in a successful campaign to defeat a ballot measure that challenged their right to use union dues for political purposes.

The problem is getting American unions to fight for common concerns as opposed to narrow institutional interests. It may just be that a broad-scale union overhaul will have to precede one in American health care.

Robert Fitch is the author of the forthcoming “Solidarity for Sale: How Corruption Destroyed the Labor Movement and Undermined America’s Promise.”

Posted by pnhp at 11:06 AM | Permalink

Cuts to Medi-Cal threaten program’s future
By Sandy Kleffman
Contra Costa Times
January 3, 2006

Beginning this week, the state will cut by 5 percent its reimbursement rate for doctors who treat California’s poorest residents.

Some people fear this will cause even more doctors to abandon the Medi-Cal program, making it tougher for 6.8 million poor and disabled residents to find someone willing to treat them.

“Already, half of the providers in California do not take Medi-Cal,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group.

“It’s a real concern in terms of access to care. For certain people, Medi-Cal coverage is in danger of becoming a false promise.”

The cut comes as an improving economy has caused the state’s budget coffers to brim again after several years of multibillion-dollar shortfalls.

http://www.contracostatimes.com/mld/cctimes/13538192.htm

Comment: Medi-Cal already has the lowest physician reimbursement rates of all fifty state Medicaid programs. Physicians accepting Medi-Cal patients must make up the losses by shifting some of the net income from their other patients to cover overhead expenses. An additional 5 percent reduction will come out the physicians’ own pockets.

In order to be able to serve their patients, physicians must also be good businesspersons. In what other business does the state ask private contractors not only to relinquish any profit, but also to personally contribute to the funding of the services and/or goods provided? Why would any contractor agree to contribute an even greater amount of his/her own funds when the state budget crisis has been eliminated?

What is unique about the business of medicine is that these are real physicians, taking care of real patients, with real health care needs. For dedicated physicians, patients really do come before profits, but, sadly, insolvency trumps all.

Low-income populations are rapidly expanding. Physician charity can no longer serve as an effective policy to meet their health care needs. As long as Medicaid remains a welfare program, it will always be underfunded. We will not resolve this problem until we agree to switch to a universal program of social insurance.

When we have a single insurance program that covers everyone, then just try to tell physicians that they must personally fund the care that they are giving. Although they may be not be astute businesspersons, they’re not stupid!

Posted by pnhp at 02:14 PM | Permalink

By Paul Krugman
The New York Times
December 26, 2005

Health care seems to be heading back to the top of the political agenda, and not a moment too soon. Employer-based health insurance is unraveling, Medicaid is under severe pressure, and vast Medicare costs loom on the horizon. Something must be done.

But to get health reform right, we’ll have to overcome wrongheaded ideas as well as powerful special interests. For decades we’ve been lectured on the evils of big government and the glories of the private sector. Yet health reform is a job for the public sector, which already pays most of the bills directly or indirectly and sooner or later will have to make key decisions about medical treatment.

That’s the conclusion of an important new study from the Brookings Institution, “Can We Say No?” I’ll write more about that study another time, but for now let me give my own take on the issue.

Consider what happens when a new drug or other therapy becomes available. Let’s assume that the new therapy is more effective in some cases than existing therapies - that is, it isn’t just a me-too drug that duplicates what we already have - but that the advantage isn’t overwhelming. On the other hand, it’s a lot more expensive than current treatments. Who decides whether patients receive the new therapy?

We’ve traditionally relied on doctors to make such decisions. But the rise of medical technology means that there are far more ways to spend money on health care than there were in the past. This makes so-called “flat of the curve” medicine, in which doctors call for every procedure that might be of medical benefit, increasingly expensive.

Moreover, the high-technology nature of modern medical spending has given rise to a powerful medical-industrial complex that seeks to influence doctors’ decisions. Let’s hope that extreme cases like the one reported in The Times a few months ago, in which surgeons systematically used the devices of companies that paid them consulting fees, are exceptions. Still, the drug companies in particular spend more marketing their products to doctors than they do developing those products in the first place. They wouldn’t do that if doctors were immune to persuasion.

So if costs are to be controlled, someone has to act as a referee on doctors’ medical decisions. During the 1990’s it seemed, briefly, as if private H.M.O.’s could play that role. But then there was a public backlash. It turns out that even in America, with its faith in the free market, people don’t trust for-profit corporations to make decisions about their health.

Despite the failure of the attempt to control costs with H.M.O.’s, conservatives continue to believe that the magic of the private sector will provide the answer. (There must be a pony in there somewhere.) Their latest big idea is health savings accounts, which are supposed to induce “cost sharing” - that is, individuals will rely less on insurance, pay a larger share of their medical costs out of pocket and make their own decisions about care.

In practice, the health savings accounts created by the 2003 Medicare law will serve primarily as tax shelters for the wealthy. But let’s put justified cynicism about Bush administration policies aside: is giving individuals responsibility for their own health spending really the answer to rising costs? No.

For one thing, insurance will always cover the really big expenses. We’re not going to have a system in which people pay for heart surgery out of their health savings accounts and save money by choosing cheaper procedures. And that’s not an unfair example. The Brookings study puts it this way: “Most health costs are incurred by a small proportion of the population whose expenses greatly exceed plausible limits on out-of-pocket spending.”

Moreover, it’s neither fair nor realistic to expect ordinary citizens to have enough medical expertise to make life-or-death decisions about their own treatment. A well-known experiment with alternative health insurance schemes, carried out by the RAND Corporation, found that when individuals pay a higher share of medical costs out of pocket, they cut back on necessary as well as unnecessary health spending.

So cost-sharing, like H.M.O.’s, is a detour from real health care reform. Eventually, we’ll have to accept the fact that there’s no magic in the private sector, and that health care - including the decision about what treatment is provided - is a public responsibility.

Posted by pnhp at 11:14 AM | Permalink

By David Lazarus
San Francisco Chronicle
Friday, December 23, 2005

The devastating transit strike that left New Yorkers trudging through the cold this week probably made more than a few Bay Area residents think, “Glad that’s not happening here.”

Think again. It will happen here.

Perhaps not involving BART or the Muni. Perhaps not involving transportation at all. But experts say a major strike in any of a number of vital industries is all but inevitable, and the reasons are the same as those that drove New York transit employees off the job.

Pensions and health care.

“Employee benefits are a very big deal in labor issues,” said David Cutler, a professor of economics at Harvard University. “Pensions and health are the main costs companies face, and they don’t know what to do about them.”

In fact, many companies are addressing the pension side of the equation by abandoning traditional defined-benefit plans and moving instead toward defined-contribution plans like 401(k) programs.

This may not relieve employers of their obligations to current and soon-to-be retirees, but will help limit future liabilities.

Cutler said health care is much trickier because spiraling costs are beyond the control of employers and employees.

“This is an issue that’s only going to get worse,” agreed Michael Chernew, an economist and professor of health management and policy at the University of Michigan.

“Health care costs are going to keep going up and somebody will have to pay for them,” he said. “This will be a fundamental challenge for the country for decades to come.”

While pensions emerged in recent days as the main point of contention, health care was one of several key issues at the heart of the New York transit strike.

The strike ended Thursday as workers and the Metropolitan Transportation Authority agreed to resume negotiations.

Prior to the settlement, the transit authority said it wants all employees to cover higher co-payments for prescription drugs and visits to doctors’ offices.

It also wants workers to pay a portion of their health insurance premiums. Workers now make no such contribution to their plans.

The transit agency said it wants to raise the retirement age to 62 from 55 and wants new employees to contribute more to their pensions.

It’s also offering a significantly lower wage increase than sought by workers, despite running a reported $1 billion budget surplus.

At this point, it’s unclear where the two sides stand on these matters, although reports Thursday indicated that workers are now prepared to discuss paying part of their insurance premiums.

“The big problem is that health care is getting expensive faster than wages and other compensation are going up,” said Pamela Farley Short, a professor of health policy and administration at Penn State University.

“We’re going to be using more health care, not less, in the future,” she said. “A particular difficulty is all the people who will be retiring soon who have high expectations for getting all the health care they desire.”

With medical costs rising by double digits annually, this will be increasingly hard for coverage providers to deliver. And major employers nationwide are already cutting back their health care obligations to workers and retirees.

In October, General Motors, the country’s biggest private-sector purchaser of health insurance, said it will slash its $5.6 billion annual health care spending by about $1 billion a year.

In July, a strike by BART employees was averted after workers agreed to increase their health care contributions from $25 to $75 a month starting in January. Their contributions will continue to increase by 3 percent annually.

Health care also figured prominently in the bitter strike by Southern California supermarket workers two years ago.

This is indeed a problem that’s going to get worse — much worse — before it gets better, with repercussions that will be felt throughout the economy, and by virtually all workers and consumers.

As it stands, each labor action, and each subsequent remedy, will only prolong our suffering by perpetuating a health care system that squanders billions of dollars every year in bureaucratic overhead.

About a third of the nearly $2 trillion in annual health care spending in the United States goes to clerical matters, not treatment, according to researchers at Harvard University. This is due primarily to the wide array of private insurers involved.

At the same time, U.S. census figures show that a record 45 million Americans lack health coverage of any kind — an extraordinary statistic for a nation that leads the world in medical research and technology.

I’ve written repeatedly about how a single-payer health care system, similar to Medicare, 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. They’re far from perfect, with long waits for treatment a frequent complaint.

But the state-run programs, in which tax money is allocated to medical facilities nationwide, ensure that any citizen can receive care from any doctor at any hospital.

“The devil’s in the details,” said Chernew at the University of Michigan. “It could be substantially worse than the system we have now or substantially better.”

Similarly, Penn State’s Short said the trick to making a single-payer system work in a nation as diverse as the United States is being able to accurately and fairly determine health care costs and the best allocation of medical resources.

“I don’t know if there’s anyone smart enough to do that,” she said.

My thinking is that we need an independent body similar to the Federal Reserve, which oversees U.S. monetary policy.

The health care system would be monitored and guided by an Alan Greenspan-like figure who is beholden to no special interests or political parties and who could innovate as required to keep the standard of treatment in the United States second to none.

These are tough issues, to be sure, requiring heretofore unimagined depths of political courage to make a reality.

On the other hand, if such a system currently existed in this country, it’s a fair bet that a whole lot of New Yorkers wouldn’t now be soaking their tired tootsies in hot baths.

Posted by pnhp at 11:05 AM | Permalink

Note to Health Care Reform Activists: Public Employee Health Benefits to Evaporate
by Andy Coates
Monthly Review Zine
12/25/05

According to two recent articles, one in the New York Times and one in the Wall Street Journal, the federal Governmental Accounting Standards Board has begun to require municipalities — states, counties, cities — to account for how much it will cost them to provide all the health care promised to present and retired public employees. This process, to be completed over the next 3 years, has already started in states like Alaska, Delaware, and Maryland and cities like Duluth, Minnesota and Arlington, Texas.

In response, public employers have begun slashing the benefits offered to new hires. Retirees’ and current employees’ health benefits will be next. A union struggle will be enjoined, as public employee unions face an ever more defensive struggle to hold on to health benefits.

As of 2006, new hires in Arlington, Texas will have no retirement health benefits. Alaska, facing a health care cost deficit of $5.7 billion, pushed new employees into high deductible/ HSA (Health Savings Account) schemes (after some heavy lobbying from the White House). Thankfully, the state constitution protected the benefits of current state workers. In Michigan, legislation on is being prepared that will shift health care costs onto the retirees, period.

It might be tempting to imagine that this phantom emerged because of neo-conservative sorcery, as in Grover Norquist’s desire to shrink the government to a size where he might “drag it into the bathroom and drown it in the bathtub,” or George Bush’s call for an each-against-all “ownership society.” But the fact is that health care costs for all employers, public as well as private, have grown increasingly impossible as health insurance premiums and drug costs continue to escalate.

Unintentionally echoing Uwe Reinhardt’s quip that the big three auto makers are “basically social insurance systems” that sell cars, Mayor Herb Bergson says of Duluth: “The city isn’t going to function because it’s just going to be in the health care business.”

The wholesale effort on the part of employers — public as well as private — to shift costs onto individuals is under full steam because the existing non-system leaves employers no other choice. Whether employed by a large corporation or a large state, a small city or a small shopkeeper, no employee or retiree will be spared. Behind this wave will be an eddy in which the ranks of the uninsured — and the bankrupt! — drown, for individually we will simply not be able to meet the costs of our insurance, let alone our sick care.

Health care reform activists should heed these articles. They say something important about the tempo of change: the health care meltdown is accelerating rapidly. This disintegration will play out not in the coming years but in the coming months.

Amid this crisis our powerful idea will begin to flourish into social movement: health care should be equally available to all. National health insurance — covering prescription drugs and all necessary medical and dental care, including mental health, hospital stays, and long-term care — is the only workable solution.

Amid this crisis our powerful idea will begin to flourish into social movement: health care should be equally available to all. National health insurance — covering prescription drugs and all necessary medical and dental care, including mental health, hospital stays, and long-term care — is the only workable solution.

References

Freudenheim, Milt, and Mary Williams Walsh. “The Next Retirement Time Bomb.” New York Times 11 December 2005.

Hakim, Danny. “Carmakers Face Huge Retiree Health Care Costs.” New York Times 15 September 2005.

Solomon, Deborah. “State, Local Officials Face Looming Health-Care Tab.” Wall Street Journal 23 November 2005.

Andrew D. Coates, MD, is a member of Physicians for a National Health Progream

Posted by pnhp at 09:48 AM | Permalink

Public system achieved health-care success
Letter by Doris Grinspun, RN, Executive Director, Registered Nurses’
Association of Ontario, Toronto
Toronto Star
Dec. 30, 2005

… in Alberta, health-care success has come through much-needed reforms within the public system, not through privatization. Indeed, profit plays no role and is actually detrimental. The recipe for success in Alberta was based on establishing specialized teams of surgeons, nurses and physical therapists working together to move patients quickly through the system, performing surgeries according to well-managed waiting lists based on medical priorities.

In this pilot project in Alberta - which has seen wait times for hip and knee replacements reduced from an average of 47 weeks to 4.7 weeks - surgeons work consistently with the same team of nurses, focusing only on hip and knee replacements. The result: They are performing almost double the number of surgeries they used to perform.

http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&call_pageid=
971358637177&c=Article&cid=1135896621824

Comment: We continue to hear the charge that single-payer public insurance programs inevitably result in rationing, primarily in the form of excessive delays (queues) for elective surgeries. What is not said is that responsible stewards of a well monitored public system can easily make adjustments in capacity that would eliminate excessive queues.

The problem is that vested interests from the more lucrative private sector will use the political process to sabotage the public system by blocking capacity adjustments, thereby creating excessive queues. The unhappy patients then become both a source of political support and a market for their private medical enterprises. Under such a scenario, the vested interests are motivated to expand further the queues within the public system. Privatization makes public queues worse, not better.

The orthopedic experiment in Alberta demonstrates that responsible public stewards can eliminate unnecessary queues for everyone, rather than merely for the more affluent who can jump the queue by moving into the private sector for care. The supporters of privatization are being dishonest when they contend that they have the solution for excessive queues when, in fact, they are deliberately attempting to prolong queues within the public sector.

Posted by pnhp at 02:11 PM | Permalink