News

Illinois’ Program to Provide Health Care for All Kids
State of Illinois
All Kids

Governor Rod R. Blagojevich

…more than a quarter of a million children right here in Illinois do not have health insurance. That means they can’t see a doctor or get medicine when they need to. When they do get medical care, it’s often in the emergency room, after a small problem has grown into a big problem. That’s wrong. I believe every child should be able to get medical care when they need it, before it becomes an emergency.

That’s why I created the All Kids program: to make health care a reality for hundreds of thousands of families across the state. Illinois will be the first state in the nation to provide affordable, comprehensive health insurance for every child. Of the 250,000 children in Illinois without health insurance, more than half come from working and middle class families who earn too much to qualify for state programs like KidCare, but not enough to afford private health insurance. Through All Kids, comprehensive health insurance will be available to every uninsured child at rates their parents can afford.

The All Kids program will offer Illinois’ uninsured children comprehensive health care that includes doctor’s visits, hospital stays, prescription drugs, vision care, dental care and medical devices like eyeglasses and asthma inhalers. Parents will pay monthly premiums for the coverage, but rates for middle-income families will be significantly lower than they are on the private market. The program officially begins on July 1, 2006.

http://www.allkidscovered.com/

Comment:

By Don McCanne, M.D.

Gov. Blagojevich and the state of Illinois are to be commended for taking this initiative to become “the first state in the nation to provide affordable, comprehensive health insurance for every child.” Although our one goal is to enact a single payer national health insurance program covering everyone, as individuals most of us support interim incremental measures that do expand access and coverage.

Dedicated advocates of universal health insurance, such as Sen. Ted Kennedy and Sen. Hillary Clinton, insist that adopting a single program of national health insurance is not politically feasible, so we should abandon that effort and direct our attention to incremental steps that will eventually result in universal coverage. One of the most radical steps that currently has some political traction is to provide universal coverage for all children. Supporting health care for innocent little children is a political winner, not to mention that it is not much of a budget buster since most children are quite healthy and have only very modest health care needs. Although most incremental measures have been referred to as baby steps, covering all children would be a major giant step, even if incremental.

So Illinois is the first state to enact universal coverage for children.

Let’s look at some of the specifics.

• Current employer-sponsored and individually purchased insurance programs remain in place. Very low income families may qualify for a rebate if they follow a complex process. Adding administrative complexities to the current excessive administrative burden is flawed policy.
• In the future, individuals who wish to switch their children from private coverage to the All Kids program, primarily because of its premium structure, will have to wait one year without any coverage whatsoever before they can be enrolled (except for very low income families). Mandating a period of uninsurance is flawed policy.
• The program is means tested. Not only are premiums adjusted by income level, but also co-payments are tiered based on income, and even the total out-of-pocket maximum for cumulative co-payments is adjusted. This results in administrative complexities that are compounded by the fact that income levels change, creating instability in the benefit level for which the children qualify. Also, means tested programs are somewhat intrusive and demeaning and NEVER result in 100 percent participation. Means testing for a universal program is flawed policy.
• Failure to pay premiums results in cancellation of coverage. Reinstatement requires retroactive payment of all premiums plus a three month penalty of having no coverage. The majority of uninsured children are in families on tight budgets. Periodic problems paying bills are inevitable. Terminating coverage for personal financial difficulties is flawed policy.
• Under All Kids, physicians and pharmacies may refuse to provide services if co-payments are not paid. Including program requirements that obstruct access to care is flawed policy.
• The cost to the state is to be offset by the dubious savings theoretically attained by shifting state health insurance programs to a managed care system. Failure to establish a permanent, reliable source of funding is flawed policy.
• The application is eight pages and requires submission of various supporting documents. To improve enrollment rates, a large network of Application Agents has been established. Even with this costly administrative program, it is anticipated that only 50,000 of the 250,000 uninsured children will be enrolled this year. A true universal program should automatically enroll everyone. Even though all children uninsured for over a year are qualified for this program, administrative barriers will keep many out. Anything less than automatic enrollment is flawed policy.
• Physicians must contract with the state to provide services under this program. It is clear that many physicians are unwilling to do so, partly because of distrust due to a backlog of claims under the state’s Medicaid program (which will be folded into All Kids). Parents may lose the option of taking their children to their current primary care physicians merely because of provider contracting considerations. Establishing restricted primary care provider lists is flawed policy.
• Primary care physicians will serve as the gatekeeper for specialized services. Although the specifics are not yet clear, presumably primary care providers will have to use restricted, in-network provider lists when referring children for specialty care, if such services are even covered. Such restrictions may not allow the primary care physician to use established, coordinated referral patterns, possibly resulting in fragmented, disruptive, and less accessible care. Not including all providers of health care services is flawed policy.

This is that giant incremental step of covering all children that everyone is talking about. It is a truly beneficial program. But it fails to provide universal coverage. It fails to reduce costly administrative excesses but rather adds more to our fragmented system of funding care. It fails to remove financial barriers to access. It fails to provide free choice of health care providers.

Simply stated, it costs more than a single payer system and it fails to establish single payer policies that would ensure accessible, comprehensive health care for everyone.

The next legislator that tells you that single payer should be rejected because it’s not politically feasible, tell him or her that the election of obstructionists to health care justice is no longer politically feasible.
Then share the word with others and follow through on election day.

Posted by pnhp at 07:10 PM | Permalink

Redefining Health Care
Creating Value-Based Competition on Results By Michael E. Porter and Elizabeth Olmsted Teisberg

(2006 - Harvard Business School Publishing)

The fundamental flaw in the health care sector is not competition, but the wrong kind of competition. Health care competition is not focused on delivering value for patients. Instead, it has become zero sum: the system participants struggle to divide value when they could be increasing it. Although health care offers tremendous value, the unnecessary costs of zero sum competition undermine and erode that value.

* Competition is based on results

If, and only if, providers have to demonstrate excellent results in addressing specific medical conditions will errors decline, unnecessary tests not be performed, unnecessary treatments stop, the use of ineffective treatments cease, and the withholding of effective services come to an end. Supply-induced demand for unneeded care will decline when results are measured and compared. Physicians who cannot demonstrate patient value will go out of business.

* Competition is centered on medical conditions over the full cycle of care

Providers should organize themselves around medical conditions, not skills of discrete specialties or services necessary to address a medical condition. Integrated practice units, as we term them, should include all the services necessary to address a medical condition, usually in dedicated facilities.

* Value is driven by provider experience, scale, and learning in medical conditions

Value in health care delivery is created by doing a few things well, not by trying to do everything. Yet health care delivery currently is not organized this way - indeed, the current system encourages just the opposite.

As in every field, health care providers that concentrate their effort and learn from experience in addressing a medical condition usually deliver the most value and innovate the most rapidly.

What is needed in health care delivery is not narrow specialization, but critical mass and experience in a medical condition over the care cycle.

* Competition is regional or national

The relevant geographic scope for competition in health care delivery is regional, national, or even international, not just local.

In obtaining care, patients, referring physicians, and health plans should seek out excellent care that best meets patient needs wherever it is located.

While traveling to a preeminent regional facility may sound expensive and inconvenient, cost savings and better short- and long-term medical outcomes can make travel clearly worthwhile for both patients and health plans. The cost and inconvenience of travel are easily justified by avoiding other, higher costs that arise with inferior outcomes (longer recovery times, less complete recovery, chronic pain, complications, and mistakes).

* Results information is widely available

In measuring results, data on medical outcomes is essential, but price information is just as important. Together, outcome and price data enable judgments to be made about value.

Current piecemeal prices for discrete interventions and services are not the prices that patients really want, or that matter for patient value. Prices should cover service bundles involved in episodes or full cycles of care.
The relevant price is the overall price for care, not the price of a visit, treatment, or service by an individual physician.

* Innovations that increase value are strongly rewarded

It is nonsensical to argue that disease-curing innovations do not lower costs and increase value. That stance confuses value creation in the treatment of a medical condition with costs of treating other conditions in the future. It ignores the productive contributions of more healthy individuals, including the revenues they contribute through premiums to the health insurance system, and the value (including less need for care) of a better quality of life for patients. Also, a substantial portion of health care costs occur early in life, so a patient may have decades of good health before succumbing to a different disease.

* The opportunity of value-based competition

If competition on results drove the pursuit of health care value for patients, the gains would be enormous.

To reap these benefits, however, the nature of competition must change. Each constituent in the system must shift its roles, strategies, and policies.

http://www.isc.hbs.edu/firm-soci-healthcare.htm

Comment:

By Don McCanne, M.D.

This is an important book. Its authors are two of the most noted authorities on competition, strategy and innovation. If anyone could bring sense to the topic of competition in health care, certainly they should be able to.

Many policymakers in the United States have continued to cling to the theory that competition in the health care marketplace will provide better value by improving quality and reducing costs. Porter and Teisberg now join those who acknowledge that market failures in health care have resulted in mediocrity and very high costs, just the opposite of what market theorists would predict. In “Redefining Health Care,” Porter and Teisberg describe quite accurately many of the failures, though they contend that they are due to the fact that we have the wrong kind of competition in health care.

Being avid believers that only competition can improve value, they then describe changes that they believe should be made to the health care delivery system so that it would conform to the theory of market competition. Since competition is the be-all and end-all, they would abandon much of what does work well in the delivery system and substitute it with a contorted system that arguably would function even less well than our current, highly-flawed system.

Imagine a system in which care is delivered based on teams, without geographical limitations, organized around medical conditions, competing with other teams organized around the same conditions. Imagine your community hospital and its specialists providing care for a very limited list of medical conditions selected on the basis of providing better outcomes and lower prices. Your community hospital may very well lack a team that is dedicated to your particular problem, requiring you to travel to the next county, or maybe the next state, for care. Then allegedly to create transparency in pricing, you receive a single bill that totally obscures any understanding as to where your payment goes. You really have to read the book to understand the extent to which this line of reasoning is carried.
The flaws in their reasoning are due to the fact that they place market competition at the first order, and then would modify 15 percent of our economy, the $2 trillion health care industry, to comply with their academic exercise.

Since I was already aware of their theories, I decided to do a mental exercise when I read their book. Wherever they discussed “competition” as the solution to our health system flaws, I substituted “cooperation” and then imagined how that would play out. Think about that. Instead of a Lake Wobegon system where all providers are above average because “physicians who can’t demonstrate value would go out of business,” we would have a system in which everyone joins together to try to maximize health care value for the benefit of patients. This seems to represent a conflict of ideologies.

Competition is ideally suited for markets and the business community (a good thing - for commodities). Cooperation is ideally suited for democratic governments and its citizens (also a good thing - for health care services).
But then ideologies are abstractions. Health care isn’t.

This book would be of value to members of the policy community who may have struggled with the concept of competition in health care when it didn’t really seem to be relevant to their work. Reading it will provide reassurance that they can proceed without concerns that they might be ignoring a potent tool.

This book is also an important resource for avid supporters of market competition in health care. Since the best that these noted authors can come up with is the bizarre concept of competing medical-condition teams without geographical boundaries, then you know that you no longer have to look for the magic of the marketplace in health care. There’s no magic there.

Posted by pnhp at 09:52 PM | Permalink

Health of societies mostly relies on political and economic policies, not the individual treatment of disease

By STEPHEN BEZRUCHKA
GUEST COLUMNIST - Seattle PI
Sunday, June 25, 2006

http://seattlepi.nwsource.com/opinion/275142_focus25.html

The headlines read that rich Americans aren’t as healthy as poor Brits, despite our spending twice as much money on health care as they do. Our newborns die at the highest rates of any rich country, even with our ever-advancing medical technologies. The feds report our mortality rates have never been lower. The United Kingdom study director suggests it is the nature of an unequal society in the United States that affects everybody, while experts over here are puzzled. What is going on?

Thomas Pynchon wrote in “Gravity’s Rainbow” that “if they can get you asking the wrong question, they don’t have to worry about the answers.” Which medical care drug plan to choose is the wrong question. Instead let’s ask, “What makes a society healthy?”

An MDeity can’t answer that, nor can most people working in public health departments. One reason for their ignorance: It is very difficult to get people to understand something when their salary depends on their not understanding it. Medical doctors are paid to treat diseases, so everyone has a disease if we do enough tests. Public health workers ply a trade, make sure enough kids get their shots, tell people to say no or wear a condom and check the water for arsenic. They consider efforts to understand basic conditions that produce health in society to be outside their job description.

Who can tell us the answer to what makes a population healthy? Few in this country know, because we don’t ask that question. Anyone who does is marginalized for acting stupid. I was told “Medical care, of course, that’s why we are teaching you to be a good doctor.” Our federal government, in its Institute of Medicine 2003 report “The Future of the Public’s Health in the 21st Century,” states on page 59: “more egalitarian societies (i.e. those with a less steep differential between the richest and the poorest) have better average health.” This remarkable finding has emerged from research carried out over the last 25 years, and the science is as good as that linking smoking and poor health.

Why aren’t the media broadcasting this news? For the last quarter century it has become unpatriotic to believe in economic justice. Instead we give ever more to the rich through tax cuts and subsidies and demand that the poor accept having less, in the hopes of some trickling down. Egalitarianism is not a treatment taught in U.S. medical and public health schools, nor in any school except kindergarten.

What is it about a bigger differential between the richest and poorest that leads to worse average health? Intuitively, we can see that not everyone shares the same stress in a bigger-gap society and those lower down suffer more of the slings and arrows of misfortune rained down from above. There is less caring and sharing in society when the gap is in our face.

Other research findings demonstrate that individual behaviors are not as important for our health as political policies that impact the gap between the rich and the poor. These behaviors are those we have learned since about toddlerdom: diet, exercise and not smoking. They are good ideas but when compared with economic justice, these individual practices are relatively unimportant. For example, the healthiest country in the world, Japan, has the highest proportion of men smoking among all rich countries. Obviously smoking is not good for your health but compared with the less steep differential, it is not as important a factor. As a doctor who used to badger people about this habit, it was very difficult for me to reconcile this finding. Studies demonstrate the individual behaviors are not that important for our health. Health care, even universal health care, has been shown to have little or no overall impact on a nation’s health.

The spending on health care in the United States makes up nearly one half of all monies paid for health care worldwide. Despite that, we who live in the USA, the richest country in world history (with half of the globe’s billionaires), die younger than we should. To understand this conundrum, the first step we must take is to recognize that health and health care are two very different concepts — despite sounding so similar. Health of societies is mostly determined by political and economic policies while health care can only prevent and treat individual diseases.

The United States used to be one of the healthiest countries in the world when egalitarian principles were near the horizon. President Kennedy told us not to ask what our country can do for us but to ask what we can do for our country. His request came after a decade of policies in which the poor made relatively more economic gains than the rich, something Robin Hood might have admired. For example, in the United States the general population shared its income growth with returning World War II veterans and subsidized their re-entry into society. Back then we were one of the healthiest countries in the world — but not for long. The rich and powerful interpreted the president’s remarks to mean, “What can ordinary people do for us?” During the last 30 years the rich have gotten much richer, and we have strayed far from egalitarian ideals

The increasingly steep differential between the richest and poorest is the reason why we are as healthy as Cuba, the country we have been strangling for almost 47 years. While our health as a nation has been improving, other countries are seeing better and faster results. People in more than 25 countries, including nearly all the rich nations and a few poor ones as well, live longer and healthier lives than we do.

There is currently no federal agency, or any other body, whose goal it is to make us healthier compared with other nations. Our Centers for Disease Control and Prevention have put forth Healthy People 2000 and 2010 initiatives, with disease and behavior oriented national goals, but we did not achieve these goals in 2000, and have no chance of coming close to fulfilling them in the next four years. They do not address our standing compared with other nations. This is like giving the Olympic Gold Medal not to the winner, but to the contestant who said they tried the hardest!

The illiterate of the 21st century will not be those who can’t read or write but those who cannot learn, unlearn and relearn. Much of what I learned in medical school is not acceptable practice today. Some of what we think we know today will be folly tomorrow. What the Institute of Medicine reports will, I think, stand the test of time. If we want healthy grandchildren, we must seriously consider what the feds have said.

Economic justice is the medicine we need. In today’s situation, this requires overturning all the recent federal legislation that gives ever more to the rich. The work of the Hood Robins (who take from the poor and give to the rich) is bad for our health, as our own Institute of Medicine acknowledges. Perhaps we should demand a Health Impact Assessment like other countries, to track the toll in human lives sacrificed by political policies that favor the rich over the poor.

This state’s Washington Health Foundation is unique in the nation for trying to make Washington state the healthiest in the country. According to a composite indicator used to rank the health of states, we have fallen to 15th place while Minnesota is first and Louisiana is last. To effect real change and improve health through this country, I suggest we strive to make Louisiana first in the nation. That state has among the highest infant death rates, the shortest length of life, the highest homicide rates, the highest teen birth rates and the biggest gap between rich and poor. Katrina’s aftermath was no accident. By concentrating on improving health in this country’s worst off state, everyone will do better.

The last 40 years have seen an unbridled giveaway to the minority of the wealthy and powerful, as politicians distorted Kennedy’s words and did what they could for the rich of America. It is now time for the majority, who make up the bottom 80 percent of this nation, to ask what our country can do for us. Everyone’s health, both rich and poor, will benefit from this old-fashioned idea: economic justice.

Stephen Bezruchka, M.D., MPH, is with the Department of Health Services, School of Public Health and Community Medicine, at the University of Washington.

© 1998-2006 Seattle Post-Intelligencer

Posted by pnhp at 08:00 PM | Permalink

by S.R.Collins, Commonwealth Fund

Executive Summary

Invited Testimony before the Committee on Ways and Means U.S. House of Representatives Hearing on “Health Savings Accounts,” June 28, 2006

Thank you, Mr. Chairman, for this invitation to testify on health savings accounts (HSAs). The Committee is to be commended for focusing attention on the manifold problems currently confronting the U.S. health care system: steady growth in the number of uninsured Americans, rising health care costs and premiums, wide variation in the quality and cost of care, and inefficiencies in the delivery and administration of care.

Some maintain that HSAs, coupled with high-deductible health plans (HDHPs), are an important part of the solution for the cost, quality, and insurance problems that plague the U.S. health care system. Asking families to pay more out-of-pocket, the reasoning goes, will create more prudent consumers of health care, driving down growth in health care costs and improving the quality of care as providers compete for patients. And the tax incentives of HSAs will lure previously uninsured people into the individual market, reducing the numbers of families without health insurance.

But while it is comforting to believe that such a simple idea could help solve our health care problems, nearly all evidence gathered to date about HSAs and HDHPs points to the contrary. Indeed, there is evidence that encouraging people to join such health plans might act as salt on a wound, exacerbating some of the very maladies that undermine our health care system’s ability to perform at its highest level.

Higher Patient Cost-Sharing Is the Wrong Prescription

• Americans already pay far more out-of-pocket for their health care than citizens in any other industrialized country.


• Real per capita out-of-pocket spending has been steadily rising since the late 1990s. Combined with sluggish growth in real incomes, families are spending increasingly more of their incomes on medical costs.


• There is considerable evidence that high out-of-pocket costs lead patients to decide against getting the health care they need.


• Rising out-of-pocket costs reduce people’s ability to save for the future.

Early Experience with HSA-Eligible HDHPs Reveals Low Enrollment, Low Satisfaction, High Out-of-Pocket Costs, and Cost-Related Access Problems

• Few people are currently enrolled in HSA-eligible HDHPs; those who are enrolled are much less satisfied with many aspects of their health care than adults in more comprehensive plans.


• People in these plans allocate substantial amounts of income to their health care, especially those who have poorer health or lower incomes.


• People in HDHPs are far more likely to delay, avoid, or skip health care because of cost. Problems are particularly pronounced among those with poorer health or lower incomes.


• People in these plans are more cost-conscious consumers of health care: they are more likely to ask for lower-priced drugs and more likely to discuss with their doctors different treatment options and the cost of care.


• Few Americans in any health plan have the information they need to make decisions. Just 12 to 16 percent of insured adults have information from their health plan on the quality or cost of care provided by their doctors and hospitals.

• It is unrealistic to expect that even with adequate information and patient financial incentives, the transformation of health care system will be driven by patients’ choice of provider. Patients are in the weakest position to demand greater quality and efficiency.


• Most health care costs are incurred by very sick patients, often under emergency conditions. Shopping for the best physician or hospital is impractical in such circumstances.


• Payers, federal and state governments, accrediting organizations, and professional societies are much better positioned to insist on high performance.

• Economists Sherry Glied and Dahlia Remler estimate that under current law, fewer than 1 million currently uninsured people are expected to gain coverage as a result of HSAs. This is primarily because 71 percent of uninsured Americans are in a 10-percent-or-lower income tax bracket and would thus benefit little from the tax savings associated with HSAs.

New Proposals to Expand HSAs May Fragment Group Insurance Markets, Increasing the Number of Uninsured

• Additional tax incentives proposed by the Administration’s 2007 fiscal year budget aim to equalize the tax treatment of HSAs in the individual market to those in the employer market, with premium tax deductibility and tax credits. Economist Jonathan Gruber estimates that the Adminstration’s proposals would actually increase the number of uninsured Americans by 600,000. While 3.8 million previously uninsured people would become newly insured through HSA-eligible HDHPs in the individual market, many employers, especially small employers, would drop coverage. Some 8.9 million people would lose their employer-based health insurance.

• Expanding group insurance coverage, with costs shared among individuals, employers, and government. This could be done by expanding employer-based coverage, eliminating Medicare’s two-year waiting period for coverage of the disabled, letting older adults “buy in” to Medicare, and building on Medicaid and the State Children’s Health Insurance Program (SCHIP) to cover low-income parents, young adults, and single adults.


• Ensuring affordable coverage for families by placing limits on family premium and out-of-pocket costs as a percentage of income (e.g., 5% of income for low-income families).


• Greater transparency with regard to provider quality and the total costs of care.


• Pay-for-performance incentives to reward health care providers that deliver high quality and high efficiency.


• Development of “value networks” of high performing providers under Medicare, Medicaid, and private insurance.


• High cost care management and disease management.


• Improved access to primary care and preventive services.


• Investment in health information technology.

Posted by pnhp at 07:43 PM | Permalink

Organization for Economic Cooperation and Development (OECD) OECD Health Data 2006
How Does the United States Compare

Total health spending accounted for 15.3% of GDP in the United States in 2004, the highest share in the OECD and more than six percentage points higher than the average of 8.9% in OECD countries.

The United States also ranks far ahead of other OECD countries in terms of total health spending per capita, with spending of 6,100 USD (adjusted for purchasing power parity), more than twice the OECD average of 2,550 USD in 2004.

Between 1999 and 2004, health spending per capita in the United States increased in real terms by 5.9% per year on average, a growth rate exceeding the OECD average of 5.2% per year.

The public sector is the main source of health funding in all OECD countries, except for the United States and Mexico. In the United States, only 45% of health spending is funded by government revenues, well below the average of 73% in OECD countries. The public share of total health spending remains the lowest among OECD countries. On the other hand, private insurance accounts for 37% of total health spending in the United States, by far the largest share among OECD countries.

Despite the relatively high level of health expenditure in the United States, there are fewer physicians per capita than in most other OECD countries.

The number of acute care hospital beds in the United States in 2004 was 2.8 per 1000 population, also lower than the OECD average of 4.1 beds per 1000 population.

http://www.oecd.org/dataoecd/29/52/36960035.pdf

Comment:

By Don McCanne, M.D.

These numbers confirm once again that the United States has the highest spending on health care per capita, and as a percentage of its GDP. The rate of growth in spending also continues to exceed that of OECD averages.

We should take a closer look at the reported health spending that is funded by the government (45 percent), and that funded by private insurance (37 percent). Steffie Woolhandler and David Himmelstein, in a 2002 Health Affairs article, have demonstrated that those numbers should be adjusted to improve our understanding of the spending.

The OECD calculations do not include two important sources of government funding of health care: (1) the funding of private insurance for government employees, an undisputed government expense, and (2) the tax subsidy received by employers providing insurance for their employees, since employer-sponsored coverage is deductible to the employer but is not taxable income to the employee. When these are included, the United States government funds 60 percent of health care.

Since the number of individuals covered by employer-sponsored plans is much larger than individual plans, employers have had a major influence on health policy. Although a great many individuals are covered through their employment (about 60 percent of those under age 65), these are working individuals and their families who are comparatively healthy and thus have lower health care costs. If we exclude government employees and look at those covered by private employers, then only 19 percent of health care costs are paid by employer-sponsored plans (or only 11 percent if you were to assume that the tax subsidy accrues to the employer rather than the employee).

What is the lesson? Since we already pay so much through the tax system, policies need to be directed to providing greater health care value for our public dollars. Perpetuating a highly dysfunctional system of funding health care merely to cater to the private insurance industry should be abandoned as irrational and irresponsible public policy.

Steffie Woolhandler and David Himmelstein, Paying for national health insurance—and not getting it:
http://www.healthaffairs.org (Use Quick Search for abstract)

Posted by pnhp at 07:16 PM | Permalink

Budget Writers Nix Children’s Coverage Expansion
Health Access Alert
June 26, 2006

Legislative leadership and Governor Arnold Schwarzenegger, announced earlier today that they had come to a deal on a state budget. Eager to pass a budget on time this year, they gave up on the fight to expand children’s coverage, one of the sticking points with Republican legislators. Since a budget requires a two-thirds vote, Republican legislators were able to hold up the budget on this issue.

Republicans from both houses had been fuming over $23 million, which had been added by Gov. Arnold Schwarzenegger in his May Revise, to cover about 24,000 children who were awaiting coverage through their local county “Healthy Kids” initiatives. This money is no longer in the budget.

Last week, Republicans had succeeded in getting Democrats to abandon a plan that would have expanded Healthy Families (SCHIP) to all children living in families with incomes below 300 percent FPL ($60,000 for a family of four) beginning in 2008. Also opposed by Governor Schwarzenegger, that plan was slated to cost $1.8 million this year and expand over the next few years.

Both efforts included covering all children, including undocumented children, which make up around 12% of the uninsured children in the state.

http://www.health-access.org/

Kids’ health hooks voters
By Soraya Sarhaddi Nelson
The Orange County Register
June 25, 2006

The two leading gubernatorial candidates say ensuring that basic health care is available to all of the state’s children will be a top priority for them if they’re in the Governor’s Office next year. The issue is important enough to Gov. Arnold Schwarzenegger that he parted company with fellow Republicans in his proposed budget this year, earmarking $23 million to provide coverage for youngsters in 18 counties who don’t qualify for programs like Medi-Cal or Healthy Families (SCHIP) because they aren’t poor enough or are here illegally.

“As you have heard me say many times, we should not politicize the children and drag them into this,” Schwarzenegger told reporters in mid-June. “Children need to get all the attention, if they are here legally or illegally.”

http://www.ocregister.com/ocregister/news/state/stateelections/article_1192707.php

Comment:

By Don McCanne, M.D.

There is almost universal support for providing all children with health care coverage. Although employer-sponsored coverage has continued to decline, efforts to cover children have offset much of this decline, slowing the rate at which the numbers of uninsured are increasing.

Instead of a universal program of health care coverage, we depend on a fragmented system of providing coverage. Special efforts have been made to cover low-income children though Medicaid, SCHIP (Healthy Families in California), and county programs such as California’s Healthy Kids. Theoretically, all low-income children should be covered through these programs. But what is the reality?

Because of greater state revenues than anticipated, in his May Revise of the budget Gov. Schwarzenegger was able to include funding for the county Healthy Kids program. These funds were not to expand eligibility, but rather they were to fund care for children that were already qualified for this program but were excluded merely for lack of budgeted funds. But in the legislative budget battles, these funds were once again cut, leaving 24,000 children on the waiting list (eligible but unfunded).

SCHIP (State Children’s Health Insurance Program) has been the most successful program of the past decade in expanding coverage for children. Many support its expansion to include all uninsured children. Yet partisanship has prevented a modest expansion of the program in California that would have been accomplished by setting the threshold for eligibility at 300 percent of the federal poverty level.

As long as we have a fragmented system of providing health care coverage, the political debates will center not simply over how much we can “afford” to budget for health care, but also about which citizens we will exclude from any coverage whatsoever.

(I used “citizens” deliberately to separate immigration issues from health insurance issues. Fragmented systems of funding health care result in profound inequities in coverage and access. The fact that 12 percent of uninsured children in California are also undocumented does not change that fundamental premise. We can agree on covering the other 88 percent of uninsured children, and then many of us can continue the battle to see that every person living in the United States receives affordable health care regardless of what documents they possess.)

Posted by pnhp at 08:35 PM | Permalink

Commonwealth Health Policy Report

June 22, 2006 — An annual event that typically gives Washingtonians blinkered by spin and ideology a bracing dose of business perspective on health care lived up to its reputation Wednesday.

Among the blunt assessments offered by Wall Street analysts at the event: the commercial insurance industry has given up trying to control health costs; much of the enrollment growth in the private plan side of Medicare is in plans that do little if anything to actually try to manage care; Medicare drug plans are going to set premiums for 2007 with basically no clue about whether they are running profits or losses in 2006; and starting in 2008, those plans are likely to cover a much more limited range of drugs.

Much of the focus of this year’s “Wall Street Comes to Washington Conference” was on the first year of the Medicare drug benefit, a reflection perhaps of the much greater impact that private sector behavior has on Medicare since the passage of the Medicare overhaul law (PL 108-173) in 2003.

Wall Street types noted the drug benefit has commanded center stage in the health care investment community, even though it has about as much impact on the overall earnings of the companies that offer those benefits as the price of paper clips, said Douglas Simpson, an analyst at Merrill Lynch.

But Wall Street’s growing focus on Washington seems less surprising due to the larger trend suggested by the Medicare drug benefit—the growing use by Republicans of private or public–private approaches to health care ills that policy makers more traditionally have targeted with government solutions.

Insurance industry analyst Robert Laszewski noted there are now three “important experiments” testing those approaches—the Medicare drug benefit, health savings accounts, and the new Massachusetts law requiring individuals without insurance to buy private coverage, in some cases with the help of government subsidies.

The result of those experiments tilting toward the private sector may be known within a few years, when the health care cost crisis may be reaching the boiling point nationally, Laszewski suggested, hinting at the possibility of dramatic government intervention in health care if those experiments don’t work out well.

‘Training Wheels’ on Rx Benefit

Laszewski said Medicare drug plans won’t have enough data on claims this year to make their premium bids for next year anything other than guesswork. He said one plan told him that premium bids for 2007 would be nothing more than “a crapshoot.”

But Christine Arnold, a managed care analyst with Morgan Stanley, noted that the drug benefit comes with “training wheels” for drug plans. She was referring to reinsurance provisions and “risk corridors” that cushion plans against losses, particularly in 2007.

But those wheels start to come off in 2008, with plans absorbing a larger share of any losses they occur that year, Arnold said. The result is that plans will have more restrictive formularies that year to rein in costs, she predicted. Plans also may be in a much tighter cost control mode because they tried to get a larger market share at the start of the benefit by charging low premiums, analysts suggested.

Because enrollment surpassed their projections, the analysts suggested that “adverse selection” would not be a big problem in the first year of the benefit. Adverse selection is when so many people with high health costs sign up for coverage that it forces the plan to charge sharply higher premiums the following year. This causes enrollees with relatively low costs to seek a better deal and creates a continuing spiral of rising premiums that makes the plan unaffordable.

Analysts suggested that enough healthy people are enrolling to keep that from happening, but they expressed some caution. “I think it’s way too early to know anything,” said Laszewski, referring to a lack of data on claim costs.

“It doesn’t look like adverse selection was an issue per se,” said Matthew Borsch, an insurance analyst with Goldman Sachs. But Borsch said he’ll be interested to see how high premiums are next year in drug plans with more comprehensive coverage that are more attractive to seniors who expect to fully utilize the drug benefit as compared with low premium plans offered by Humana that were expected to attract relatively healthy seniors.

‘Policy Mess’ in ‘08?

Laszewski suggested that the drug benefit’s future may not be serene. “What happens when the federal government makes up for all the underpricing” by drug plans in early premium-setting? he asked.

If risk corridors entail much added federal spending to bail out plans with losses, and if plans also have to boost premiums 25 to 30 percent [in 2008] “to make up for all of this, you’ve got a policy mess on your hands,” he said. “I think there’s a real issue in terms of long-term policy sustainability of the program.”

Arnold agreed with Laszewski that managed care plans in Medicare, called Medicare Advantage plans, will have to trim benefits because strong reimbursement by the federal government since passage of the Medicare overhaul law won’t continue.

Medicare Advantage enrollment is up by about a million since then, but Laszewski expressed surprise that growth hasn’t been greater because of the extra benefits and lower-cost sharing offered by those plans. The plans are a “fantastic deal” for seniors but “the leap was just too much” out of traditional Medicare for many seniors, he said.

Much of the enrollment growth in Medicare Advantage has been in “private fee-for-service” plans, which allow enrollees to see the providers of their choice without financial penalty while also getting good coverage of costs not covered by traditional Medicare, analysts said. But there is little management of care in the plans. It’s unclear how sustainable the plans will be, said Borsch, apparently referring to their cost to taxpayers.

‘Boring’ Consolidation

Simpson said consolidation in the insurance industry has been “huge” and will continue over the next several years. Other analysts agreed, saying the trend is troubling. “I don’t like it—I just get bored,” Arnold said, complaining that she has just five big companies to follow and they have stopped innovating.

“When has anything interesting ever come out of a huge company trying to integrate 30 others,” she said.

Insurers are so big that they cope with Wall Street pressure for near-term earnings growth not through innovations in cost control but by acquiring other companies, Laszewski said. “It’s never been so boring—or profitable. The industry has given up on managing care and controlling costs,” he said. “We have a lot of people making themselves really rich and selling their industry down the river,” he said of insurance company executives. “I think my industry is on a long walk off a short pier.”

Posted by pnhp at 08:48 PM | Permalink

Health Care in Connecticut:
Sounding the Alarm
(A Policy Brief released June 22, 2006)

Economic and Social Research Institute (ERSI) (Jonathan Gruber, a health economist at the Massachusetts Institute of Technology developed the cost and coverage estimates used in the full report and this brief. The Urban Institute contributed to macroeconomic analysis to the report.)

This brief outlines three health care policies for Connecticut to consider as alternatives over its current helter-skelter system of health care and coverage. The implementation of each strategy would result in a range of benefits over the existing system. However, only one of the three strategies fully meets the criteria of universal health care established by the Institute of Medicine (IOM).

Policy I

One Health Plan Serving All State Residents

With all state residents under 65 in a single health plan sponsored by the state government, Connecticut would achieve 100 percent coverage while reducing total health care costs. By directly purchasing services from health care providers, the plan would provide benefits like those offered by typical private employers today. A standard benefits package would be available to all and would include the services covered by a typical benefits plan offered by the Connecticut employer now.

A new state commission would administer the plan either directly or through a private insurer. The commission would control costs by defining covered benefits and out-of-pocket sharing rules, setting a statewide budget for health spending, negotiating reimbursement levels with providers and setting standards for quality of care. Individuals and employers could purchase additional health care services or coverage.

…while all residents would be insured, total health care spending on the nonelderly would fall by 5 percent. Average health costs per insured would decline by 16 percent, from $4,121 to $3,447, in part because of reduced administrative costs incurred by insurers, health care providers and employers.

Total employer payments for health insurance would fall by $590 million or
11 percent.

Because of lower health insurance and health care costs, this approach would give Connecticut households $1 billion in new, net annual income available for purposes other than health care and health insurance.

This policy alternative could fully meet the criteria articulated by the Institute of Medicine:

• Universal coverage can be achieved - 100 percent of residents would be covered.


• Health care coverage would be more continuous, with all nonelderly residents enrolled in the state plan.


• Coverage would be affordable to state residents.


• The health insurance strategy would be affordable and sustainable for society, although some firms not offering coverage today would experience new costs.


• The one state plan would have the capacity to implement measures that dramatically improve quality and efficiency, and eliminate disparities in access to and the quality of care among ethnic and racial minorities.

(Endnote 6: Estimates are limited to the nonelderly. However, the reduction in health care prices… would probably affect costs for the elderly as well. If either such “ripple effects” or a federal waiver allowed Medicare beneficiaries to benefit fully from the cost savings achieved by the one state plan alternative, the average Medicare beneficiary could realize annual savings of up to $410 in out-of- pocket costs.)

Policy II

A State Pool with Competing Private Plans for Residents Lacking Employer-Sponsored Coverage

This second policy alternative would satisfy some, but not all, of the Institute of Medicine’s principles.

Policy III

Expanding the Health Coverage Safety Net for Low- and Moderate- Income Adults and Insuring All Children

While this approach would cover a significant number of the uninsured at modest cost, it would not satisfy the criteria of the Institute of Medicine.

http://www.universalhealthct.org/pdf/policybrief_web.pdf

Comment:

By Don McCanne, M.D.

Who’s surprised? We now have yet one more highly credible study from other independent sources demonstrating that single payer is the only model of the three which meets the reform criteria of the Institute of Medicine, while also being the most effective in reducing health care spending. An FEHBP-type program for the uninsured, or expanding the safety net for lower-income individuals and all children, both are more expensive and fall short of reform goals.

Although PNHP would tweak the single payer model studied, our changes would not alter the fundamental findings of this report. Single payer would provide continuous, comprehensive, high quality care for everyone, reduce disparities in access and quality, while being the most effective model in finally making health care affordable.

We really don’t need more studies. The policy science could not be more solid. What we need now is politics.

Posted by pnhp at 05:00 PM | Permalink

By Vincent P. Maconi
Delaware On-line, The News Journal, 6/25/06

Editorial for Single-Payer

When Gov. Minner nominated me to be Delaware’s secretary of Health and Social Services in January 2001, a few eyebrows were raised. I’m not a physician, nor had I spent any of my government career in health care. But if coming into the job without a lifetime of experience required me to climb a steep learning curve, it also allowed me to enter the field without preconceived notions.

It quickly became clear to me that this nation needs universal health care. America’s health care system, despite the efforts of millions of dedicated health care professionals, is broken. Frankly, nothing but national health insurance makes sense.

I might seem an odd official to be championing national health insurance, given that many of the times my name has appeared in this newspaper over the past few years, it has been to defend efforts to control costs of the state’s largest health care program, Medicaid. In fact, attempting to get my arms around state spending has given me an excellent vantage point from which to see the system’s problems — and the only logical solution.

Phil Soule, Delaware’s long-serving Medicaid director who recently retired, once told me that in years past, Medicaid was all about making people healthier. Now it’s all about who is paying the bills. He’s absolutely right, and sadly that focus extends to just about everyone else in the health care arena.

Everybody — doctors, hospitals, insurance companies, government officials, and patients themselves — spends too much time administering or coping with the system and figuring out who will pay for a service — and not enough time figuring how to deliver service better or to more people. No one spends enough time figuring out how to make people healthier.

Having spent my life in politics and government, I’m a realist. I know that the current president and leadership in Congress have no interest in a universal health care system. Those who don’t oppose it on philosophical grounds would likely argue that the country can’t afford it.

I could make the argument that the world’s wealthiest country should guarantee health care to all of its citizens. That’s the kind of society that I want to live in. But for those who aren’t moved by that aspiration, there’s every likelihood that a national health care system would not only pay for itself through a healthier populace, it would also cost less in dollars than what the nation pays for health care now.

Our money’s worth

The literature of health care is replete with studies comparing this country’s health care with other developed nations, all of which have national health care systems. Virtually every one shows the same thing: The United States spends more money per capita than any other country, yet is less healthy.

We’re paying the highest prices, but getting the lowest quality.

Look at a health spending analysis by the Organization for Economic Cooperation and Development, comprised of 30 of the world’s leading industrialized nations. Examining the 2002 data, the OECD reported that the United States per capita health care spending of $5,267 was not only 53 percent higher than that of the second-highest country, Switzerland, it was almost two and a half times the average per capita health care expenditure of all the other developed nations.

To put it another way, the United States is spending nearly 15 percent of its gross domestic product (the combined value of all goods and services produced by a nation) on health care. Only Switzerland and Germany also spend as much as 10 percent.

The United States pays much higher prices than other countries for hospital stays, drugs and physician services.

Administratively, we’re awash in red tape. Health administrative costs in America are triple what they are in Canada, which has universal health care.

What results are we getting for paying that huge bill? The system hasn’t produced health coverage for all. Even in Delaware, which has one of the lowest rates of people without health insurance in the country — thanks largely to the huge investments Gov. Minner and the General Assembly have made in the state’s major health care programs, Medicaid and the Children’s Health Insurance Program — 10 percent of our residents lack any form of coverage.

Nationwide, that figure is more than 15 percent. Many of the uninsured are the working poor, who earn too much to receive government aid, but not enough to afford insurance.

Let’s also examine two universally recognized measures of national health: life expectancy and infant mortality. A quick surf on the Internet reveals that, among those 30 OECD countries, the U.S. life expectancy of 76 years exceeds that of only seven: Mexico, South Korea, Turkey, and the former communist nations of Slovakia, Poland, Hungary and the Czech Republic.

People everywhere from Iceland to Australia live longer than we do in America.

Last November, ABC News reported that the United States ranks 28th in the world in infant mortality — not just far behind Sweden, France, Japan and Germany but behind Cuba too. The United States is on a par with Croatia and Lithuania.

If the lack of support for health care reform by the president and Congress isn’t puzzling, the lack of business support is. You can’t pick up a newspaper without reading about another company cutting back on health coverage for employees or pensioners.

Certainly, the business community has historically preferred less government. But given that private businesses are having the same difficulties paying for health care as the public sector, I predict that over time, more business executives will come to see that health care is better left to government.

In today’s global economy, American companies are at a competitive disadvantage when up against businesses in other nations whose out-of-pocket health costs are zero. It’s a mystery why General Motors and other automobile companies, with their well-publicized dilemmas regarding health care overhead, are not leading the call for national health care. Small businesses too are experiencing increased difficulty in locating affordable health insurance.

With all due respect to those passionate advocates for a single-payer system in Delaware, I doubt this state could do it alone. Were Delaware the only state to adopt universal health care, individuals from surrounding states (if not the entire country) would flock here, especially the sick and uninsured. Delaware would go broke quickly.

Universal health care likely wouldn’t work in Delaware alone unless it figures out a way to prevent individuals from moving to this state to take advantage of the health care system — something I’m sure the Supreme Court of the United States would find problematic.

Whether the president, Congress and business are uninterested or opposed to a nationwide health care system, the country nevertheless is going to get there sooner or later. The only question is whether it gets there accidentally or on purpose.

Right now it’s getting there accidentally. As fewer private businesses offer health insurance to employees, the percentage of the population that receives health care from government programs continues to rise. The New York Times recently projected that by 2014, more than half of Americans will receive their health care from the government. So let’s get there on purpose.

Taiwan did exactly that 11 years ago, switching from a system similar to that of the United States to universal health care. Within six years, its uninsured population declined from over 40 percent to less than 3 percent, without an increase in costs.

As Winston Churchill once said, “Count on Americans to do the right thing, after they’ve tried everything else.” It’s time to end the irrationality of this health care system and move to national health insurance.

Vincent P. Meconi is secretary of the Delaware Department of Health and Social Services.

Posted by pnhp at 03:42 PM | Permalink

It’s absurd how much we all pay for so little

By WILLIAM MARVEL
Concord Monitor (NH)
June 11, 2006

I lacked health insurance until my 40th year. Until then I had declined workplace packages because of relentlessly good health and because chronically low local wages left me unable to afford my share of the premiums.

It was understood among veterans that the Veterans Administration would take care of catastrophic ailments, and all male Marvels were veterans, so I paid the small bills for my own routine care and counted on a grateful nation to stand by me in the event of a major illness.

National gratitude usually lasts only about as long as the echoes of big-mouth patriotism, though, and so renowned a patriot as Ronald Reagan eviscerated VA services in the 1980s. Even my father, with his quarter-century of naval service, suddenly found himself ineligible for most VA care, and he shifted to Medicare. I could be treated for only a couple of service-connected disabilities if they ever troubled me, but I still felt too young to worry.

At last I fell in with a company big enough for a group rate. I had begun to find my contemporaries featured in obituaries, and some of them had led lives even healthier than mine, so the group rate seemed more attractive than it might have before.

I participated for a time, but reverting to self-employment disqualified me. I had to resort to a Cobra plan, and the premium proved so expensive that I considered dropping it altogether. A friend discouraged me from that by enumerating the devious restrictions insurance companies impose on any lapse in coverage. While I pondered her advice, my gall bladder disintegrated.

I fear debt worse than death, and that close call with hospital-induced bankruptcy demonstrated that entropy had turned the odds against me. The Cobra plan expired, and I arranged for an individual plan with an inattentive agent who allowed my coverage to lapse. As I was dialing the state insurance commission, he repaired that blunder, finally restoring my continuous coverage at a price equal to one quarter of my income.
The new carrier played the common game of threatening massive premium increases for the same policy, or promising smaller increases if I agreed to significant reductions in coverage. Either way, the price always went up, and over the years my premiums more than made up for the cost of that gall bladder operation.

Eventually I married someone young enough to warrant a relatively reasonable family rate, but once that policy was in place, the scam of higher premiums for less coverage resumed almost immediately.

The latest increase has sent us looking for another carrier, and we found a company called something like Chincoteague Marine, Mollusk, and Tidewater Trust. As I understand it, its introductory premium covers us fully for any illness or injury, but with one minor proviso: Our policy will be immediately discontinued if it can be demonstrated that any family member has approached within 75 feet of a hospital, health clinic or medical office building - voluntarily or otherwise - or if a family member can be proven to have made eye contact with a surgeon, physician, physician’s assistant, nurse or emergency medical technician, or otherwise indicated a desire or need for medical treatment.

The policy is also void if any family member makes a phone call to an establishment offering medical services or advice. To ensure compliance, the insured must agree to the monitoring of all land-line and cell phones. The phone prohibition covers wrong numbers, too, on the rationale that someone worried about a potential medical problem might dial the family doctor through stress-related subconscious error.

The restrictions of the company’s continuous-risk-assessment program may give pause to the nitpicker, but the low monthly rate of $557.63 is hard to beat, and the telephone monitoring devices are all included in the premium.

Like everyone, I’ve wondered why American medicine and medical insurance have become so abominably expensive. Castigate if you will the poor suburban doctor who makes a measly five or 10 times as much as the average American, or begrudge the overworked insurance executive his few million a year, but those people are innocent.

The real culprits are our neighbors to the north: If only those stubborn Canadians would abandon their nationalized health system and migrate to the United States, the size and better health of their population could reduce our group rates for months or years to come.

More to the point, dismantling their system of health care and coverage would eliminate the embarrassing comparison that makes ours look so damn bad.

(William Marvel is an author and historian who lives in South Conway.)

Posted by pnhp at 08:39 PM | Permalink

by Silver Donald Cameron
The Chronicle Herald, Halifax, Nova Scotia
June 23, 2006

I CAN‘T AFFORD to Get Sick! cried the cover of Reader’s Digest. And below that line was the somber title, Fixing Our Health Crisis.

Right, I thought. Here we go again. Economists viewing medicare with alarm. Politicians defending it by dismantling it. Soaring costs, a quicksand of bureaucracy, physicians departing for the States.

But no. This article was about the States. This was not the Canadian edition of Reader’s Digest, it was the U.S. version. And the Americans were evidently having a health crisis of their very own.

Like most discussions of medicine, the article was mostly about money. Americans who have medical insurance get it from private companies, often as a benefit of employment. The poor and the elderly are sometimes covered by government plans. About 15 per cent of the population — 45.8 million Americans — don’t have any coverage at all.

As in Canada, medical costs have been rising, driving insurance premiums up by 73 per cent since 2000. But employers resist, demanding that employees “co-pay” a larger share of the cost of treatment or accept a lower level of coverage. Many employees can’t afford the co-pay, especially if there’s serious illness in the family. They postpone treatment.

When they can’t postpone it any more, they go ahead with treatments they can’t pay for. They scramble desperately to cover the costs, spending their savings, borrowing heavily, running up their credit cards. Eventually they topple into bankruptcy. Health costs are by far the leading cause of personal bankruptcy in the U.S.

But if the patient doesn’t pay, the doctors and hospitals are stuck with the costs. They recover their losses by raising their prices, and the cycle begins again.

All of which led the Reader’s Digest to ask how costs could be better controlled in the first place. Malpractice suits are common and expensive, and the average jury award is now $600,000. Doctors may pay $200,000 a year just for malpractice insurance. And the wide array of insurance companies means that the system is choking on paper and stifled by bureaucracy. A doctor needs a whole staff just to process patients’ insurance claims.

The Digest dutifully surveyed the opportunities for reducing costs, including caps on malpractice awards, tax incentives for citizens, reform of the insurance regulations, the use of generic drugs, and digitization of records and prescriptions. Good, boring stuff, and some of it would be useful in Canada, too — like digital record-keeping.

But the issues the Digest did not consider provide a textbook lesson in the way the media can shape debate. The Digest notes, but doesn’t discuss, the cost of white collar crime in the form of health insurance fraud, which drains off $100 billion a year. And it doesn’t even mention the most obvious and effective way to get better coverage at a lower cost, which is to bring in national health insurance, like every other OECD nation except Mexico.

Canada’s health-care system is demonstrably more efficient (and infinitely more democratic) than the awful Rube Goldberg contraption which is failing the U.S. so badly. In 2001, for instance, health care cost Canadians $2,163 per capita — $1,533 through medicare, $630 out of pocket. The U.S. system cost more than twice as much — $2,168 from the government and $2,719 from the individual, for a total of $4,887.

Or, to put it another way, the U.S. spent 13.6 per cent of GDP on health care — and didn’t cover 15 per cent of its people at all. Canada covered everyone at 9.5 per cent of GDP. If we’re after effectiveness and efficiency, those numbers are pretty conclusive.

But Canada’s system, of course, is “socialized medicine,” a phrase too scary for the Reader’s Digest even to mention, a concept so terrifying that it freezes thought (and even arithmetic) in its tracks. What Americans mean by this phrase is “socialist medicine,” or “government-controlled medicine,” which is ideological poison. Of course that’s not what Canada has; we simply have a publicly-operated health insurance program which covers everyone. Doctors here are as free and independent as they are anywhere else — and in Canada they always get paid, no matter how poor their patients may be.

But in a different sense, this is certainly “socialized medicine.” The word “socialize” also means “to make fit for companionship with others; make sociable,” and “to convert or adapt to the needs of society.” That’s exactly the way that medical services should be oriented. They should be integrated with the social order, and have social well-being as their objective.

The U.S. system could justly be called “unsocialized medicine,” and you would think that a major piece by a major magazine would at least have to consider the idea that the U.S. system may be fundamentally flawed. But no. And Americans will be stuck with it at least until publications like the Reader’s Digest can describe their dysfunctional medical industry as the disgrace it truly is.

Silver Donald Cameron lives in D’Escousse.

Posted by pnhp at 07:29 PM | Permalink

Steven Sharfstein, M.D., ends his year as president of APA in the same way that he began it: by urging APA members to become or stay involved in advocating for psychiatric patients.

By Catherine F. Brown

Psychiatrists need to “tirelessly advocate” for a single-payer, universal health care system so every American has access to care as a right, not a privilege.

That was the message that outgoing APA President Steven Sharfstein, M.D., delivered to those attending the Opening Session of APA’s 2006 annual meeting last month in Toronto.

“To advocate and to lead, we must say five simple words about the state of our health care system in the U.S. today: the emperor has no clothes,” said Sharfstein, president and CEO of the Sheppard Pratt Health System in Maryland.

Sharfstein reminded his audience that in the speech he had delivered at last year’s Opening Session, he challenged fellow APA members to become involved in advocating for patients and the profession of psychiatry at the local, state, and national levels.

His challenge did not end with his presidency, however. “We cannot slow down,” he said. “Advocacy is not just calling on others to do what we want; it is a shining light for others to follow.”

Sharfstein’s year as president was punctuated by more crises and high-profile news events than usual. His term got off to a running start when he found himself being interviewed by Katie Couric on the “Today” show in response to antipsychiatry remarks that Tom Cruise had made to Matt Lauer a few days earlier. The incident had a silver lining: “At the end of it all, I can only thank Mr. Cruise for giving psychiatrists across North America the opportunity to get our message out—that we are physicians who prescribe treatments that work.”

But the incident also raised an issue that Sharfstein had addressed in his speech last year as well. He noted that one weapon the antipsychiatry movement uses against American psychiatry is its relationship with the pharmaceutical industry. While the industry has developed drugs that have transformed the lives of countless psychiatric patients, he said, it abides by ethics and values that are different from psychiatry’s, and psychiatrists need to be mindful of that difference.

“Our advocacy in favor of access to effective pharmacopeia should never have been seen as mere marketing on behalf of industry; it must come from a dispassionate reading of the science, access to all clinical trial data, and our clinical experience,” he said.

To ensure the credibility of continuing medical education (CME), Sharfstein called for independent review of CME programs and the phase-out of educational events sponsored by a single drug company. Also, he reminded his audience that accepting gifts from drug company reps generates distrust in patients.

Psychiatrists must be vigilant over other core values of the profession as well, he said. After reading in the New England Journal of Medicine that psychiatrists were participating in the interrogation of detainees at the U.S. Naval Station at Guantanamo Bay, Sharfstein expressed his concern in a letter to the assistant secretary for health in the Department of Defense. That letter led to an invitation to tour Guantanamo with the top health leaders in the military and other leaders of medical and psychological organizations. They were briefed on the involvement of “behavioral science consultation teams” and were told that while stress techniques had been used in the past, current techniques focused on building rapport with detainees because the development of positive relationships was found to be more effective. That wasn’t an acceptable alternative for Sharfstein, however.

“It is the thinnest of thin lines that separate such consultation from involvement in facilitating deception and cruel and degrading treatment,” he said. The detainees, being held as enemy combatants with no legal rights, live in despair, and multiple suicide attempts and hunger strikes are common. “Our profession is lost if we play any role in inflicting these wounds.”

Psychologists have taken a position allowing them to provide consultations in interrogations, Sharfstein noted, “and if you ever wondered what makes us different from psychologists, here it is.” Earlier that day, he announced, the Assembly, and then the Board of Trustees, voted in favor of a position statement reconfirming that psychiatrists should not participate in prisoner interrogations (see page 1).

Two other major events during Sharfstein’s presidential year demonstrated the Bush administration’s failure to take care of the poor and disadvantaged in this country, he said. The first was Hurricane Katrina late last summer, and the second was the launching of the Medicare Part D prescription drug benefit on January 1.

“To advocate and to lead, we must say five simple words about the state of our health care system in the U.S. today: the emperor has no clothes.”

Regarding Katrina, he praised the many APA members who helped traumatized survivors—some of whom were survivors themselves—but expressed outrage over the government’s failure to follow through on promises to provide health care and other assistance to them. Many survivors were poor and had lost everything to the violence of the storm and flooding.

Four months later, APA had a front-row seat for the train wreck that occurred when Medicare Part D went into effect. APA and other advocacy groups had warned the government about the serious flaws and limitations of Part D, Sharfstein said, but these warnings went largely unheeded. In particular, APA and its partners were concerned about the 6.5 million patients dually eligible for both Medicaid and Medicare; beginning January 1, their drug coverage was moved from Medicaid to Medicare. Within days of the new year, reports proliferated about patients who could not get the medications they needed for a variety of reasons, from confusion over which plan they had been enrolled in to high copays they could not afford, he noted.

The program’s unreasonably complex design and rocky start, said Sharfstein, represented “another abandonment of the most poor and vulnerable of our patients, another shocking insight into the failure to care for the less fortunate.”

The federal government needs to address Part D’s many inadequacies, but more than modest tinkering is required, said Sharfstein. “The solution is for the federal government to establish a basic drug plan that works for those who fail in the private Part D plans,” he advised. “This is a concept so obvious that it is easy to be pessimistic that it will ever be adopted.”

The events that Sharfstein weathered this past year underscored the importance of the advocacy mission in which he had challenged his fellow APA members to join him. He left them with this simple but weighty message:

“We must tirelessly advocate for [single-payer universal health reform]. As the health care crisis extends and mushrooms, with more and more Americans without adequate coverage, the opportunity for such change will come at national, state, and local levels. And we must be there as advocates for our patients.”

Posted by pnhp at 07:20 PM | Permalink

This may pinch a bit - Credit cards for health care can cost big bucks
By Jennifer Heldt Powell
BostonHerald.com
June 19, 2006

The cards and credit programs have been around for many years but they’re becoming more prevalent as credit card companies look to create new products. New consumer-driven health plans could also drive up demand. Under those plans, patients face higher co-pays and deductibles. They may look to put those payments on credit cards.

Overall, consumer advocates say they’re concerned about the use of credit cards to pay for health care costs, especially among those with lower incomes.

But those who offer the cards say they allow consumers to get treatments they might otherwise have to delay.

Some plans, like Capital One’s, work like a car loan with a fixed interest rate and a fixed monthly payment for a certain amount of time.

Others are credit cards with no interest for a number of months. If the card is not paid off by the end of the promotional period, interest rates of 22 percent or more will be charged retroactively to the beginning of the loan.

http://business.bostonherald.com/businessNews/view.bg?articleid=144360

Comment:

By Don McCanne, M.D.

How often have we heard that national health insurance should be rejected because it would suppress innovations that could only take place in the private sector? Well, they’re right.

Only in the private sector would insurers offer innovative products that are designed to shift risk from the insurer to the individual insured (by reducing benefits and increasing cost sharing). Only in the private sector would insurers establish health savings accounts and high-deductible health plans (with their lucrative fees and decreased risk for insurers). Only in the private sector would insurers expand their market to include credit cards and debit cards (with an additional twenty-two percent added to the patients’ out-of-pocket costs). Only in the private sector would insurers push for a mandate to require individuals to purchase their own affordable plans (affordable only because they shift unaffordable costs from the insurers to the patients). Only in the private sector would insurers push for regulatory relief allowing them to offer more profitable, lower-premium plans (threatening to eliminate financial security for patients). Only in the private sector would insurers support policies allowing them to cherry-pick the healthy (while shifting high-cost patients to public programs, proposed government reinsurance schemes, and to involuntary private charity when all else fails).

Wouldn’t it be terrible if we had to give up all of this innovation merely because we decided to establish a national health insurance program?

Twenty-two percent is hard to beat. Why look for health care value when private innovation can generate profits like that?

Posted by pnhp at 07:17 PM | Permalink

By ANGELA BURNS-PIPER
Virgin Islands Daily News
June 9, 2006

Tortola - Within one year, the government of the British Virgin Islands should receive a design for a national health insurance program to provide adequate health-care coverage for every man, woman and child in the territory.

Chief Minister Orlando Smith signed a contract Thursday with the University of the West Indies’ Health Economics Unit for the design and implementation of a national health insurance program for the BVI.

“While there are many intricate details to be worked out, the fundamental vision behind national health insurance is simple: We want a system of health-care coverage that will enable every man, woman and child of the BVI to get the health care that they need,” Smith said.

As in many other countries, the government of the BVI provides health care for certain categories of people, such as children younger than 15 years old and the elderly. Everyone else usually has to pay for their health care, although it is heavily subsidized.

“Though some people have health insurance, too many people do not and therefore cannot get access to the health care that they need, especially when they have to travel overseas to be referred,” Smith said. “So these are some of the things that had to be taken into consideration.”

Smith said that for the program to succeed, it will take the input and participation of the entire community, and he challenged every citizen and resident of the BVI to get involved.

“Over the coming year, there will be many opportunities for you to make your voices heard and to contribute to the formulations of a health-care system that works best for you,” he said. “Take up this challenge, speak your mind, ask hard questions, seek out information.”

The Social Security Board will be working closely with the UWI team during the coming months and will be responsible for administering this program after it is implemented.

Director Antoinette Skelton, who chaired Thursday’s signing ceremony, said the board is committed to making the program a success. “The Social Security Board is committed to this project because we see the access to adequate health care as the extension of the social protection presently offered by our organization,” she said.

“The failure to provide adequate social health protection leads to great inequality and poverty, since health expenditure puts pressure on family income and has an enormous effect on the most vulnerable,” she said.

She said it is a well-known fact that the high cost of treatment of illnesses such as HIV-AIDS, cancer, and heart disease is one of the main factors in generating poverty because it forces families who are not protected by health insurance to go to extreme lengths - sacrificing their savings or avoiding spending on basic necessities - to meet the high cost.

Professor Karl Theodore of UWI, who signed the contract with the chief minister, said it is important for the BVI and the university. “For in coming here to cooperate with the establishment of the national health insurance program, UWI is demonstrating its commitment to improving the quality of life of the people of the region,” he said.

Theodore said the program basically is about social insurance, in which there is prepayment and when an event occurs, contributors can access health services without having to put money in. He said it is different from private insurance, in which there is a pooling of risk and payment is based on individual risk.

“With social insurance, payment is based on risk assigned to the community as a whole,” Theodore said said. “The objective is to really maximize the access to health care of all the citizens and residents of the country.”

He said that when the system becomes functional, each person will be issued a card, which will be a guarantee to good service and an instrument to keep track of what is happening with the system in terms of quality and cost of service.

The professor said the program will take about three years to put in place.

The contract, worth $585,100, calls for UWI to perform a number of tasks, including developing the legislative framework, registering the population, developing information systems and generating actuarial projects.

- Contact Angela Burns-Piper at 284-494-1291 or send e-mail to angelaburnspiper@yahoo.com.

Posted by pnhp at 06:42 PM | Permalink

Our Unhealthy Tax Code
By Jason Furman
Democracy: A Journal of Ideas
Issue #1, Summer 2006

American health care is beset by a well-known litany of problems.

If this were a government-run health care system, the voting public and policymakers would be up in arms. Yet, perhaps because health care is largely perceived as a private-sector concern, there is relative quiet:
while voters tell pollsters that it is a top priority, there appears not to be comparable political pressure for serious reform or any fundamental change in the government’s involvement, either in the provision or funding of health care. This is in part because much of the federal government’s involvement with the health care system is through the hidden backdoor of the tax code. An important principle for modern progressives is that when the government has to intervene in the marketplace, it should not prop up failure. Yet the federal government is, in fact, deeply involved in perpetuating the current “private” health care system and all its flaws, spending approximately $200 billion annually in subsidizing employer-provided insurance. It is the single biggest subsidy in our tax system, more than twice as costly as the mortgage interest deduction. The only government programs that cost more are Social Security, national defense, and Medicare.

The fact that the tax subsidy, which supports the employer-sponsored system, is better than nothing is a feeble excuse for resisting any changes to the status quo. This massive program of tax breaks is ineffective and regressive, wasting money on those who have health insurance while doing little for those who can barely afford it and nothing at all for those without it.

A single-payer national health care system would, by definition, remedy the problem, but it is unlikely to happen any time soon, if ever at all. Beyond the political limitations, it is also an open question whether a single-payer system would be the most efficient way to provide quality health care for all Americans. In the meantime, reforming health care will come down to a set of incremental changes that build on the current system.
But that does not mean that change cannot be ambitious. As Massachusetts has shown, achieving a plan for universal health insurance coverage need not wait for the establishment of single-payer government insurance like Medicare or a national health care system like the United Kingdom’s.

http://www.democracyjournal.org/

And…

Employment-Based Health Insurance: A Prominent Past, But Does It Have A Future?
Hosts: Brookings Institution and the New America Foundation
kaisernetwork.org
HealthCast
6/16/2006

Andrew Stern, president, Service Employees International Union:

…this is not a matter of policy. If we could solve this health care system by policy it would have been solved every single year. There’s more good policy about health care in America than I can imagine. It is the most studied, researched, you know, we have commissions and committees publicly and privately all throughout Washington and the United States. It’s really about politics and leadership.

Our choice is we could keep making incremental changes in the health care system. And I certainly appreciate that everyone would like to build a better funding stream for the health care system but the truth is we’re way past incremental change. It’s not going to work.

…so the fundamental change for me means one, you have to recognize that employer based health care is ending, it’s dying in front our very eyes. The charts say it there. It will not rebound, I believe, in the next economic upturn in America. It was a good friend. It served America well in the 20th Century. We love it dearly. Employers, to their credit, lived with it for a long time despite all of the distortions that it created. But it’s collapsing in front of our eyes. It may still be breathing but anybody who can look into the future says, “This employer based health care system is over in America.”

I’m here to also say I don’t think we need to import Canada or any other system. We’re going to build an American system because we’re Americans and we don’t like anybody else’s system.

I think the single payer issue is kind of a stocking horse for I’m not sure what, because we’re going to have a multi-payer system or some kind of system, you know, that it’s built into the cost of goods in America.

Video and Transcript:
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1768

Comment:

By Don McCanne, M.D.

The conservative policy community has long advocated for an end to employer-sponsored coverage. They believe that insurance should be an individual choice while recognizing that government has to play some role in funding care for low-income individuals.

What are we hearing from these voices in the progressive community? They agree that the regressive tax policies are highly inequitable and must be changed. Andrew Stern goes even further and states that the deterioration in employer-sponsored coverage, declining enrollment, and the financial burden placed on employers leaves no real option other than to replace it with a better system.

The progressives acknowledge that the policy issues are well understood. In fact, single payer would certainly accomplish our goals (though Furman conjectures on the well-documented and irrefutable efficiency of single payer). So what do they say? Let’s adopt any better system, except single payer.

The policy issues are well understood. Simply changing tax policy (Furman) or adopting a universal, multi-payer system (Stern) perpetuate and expand some of the crucial policy flaws that we face today.

Single payer won’t fix all of the problems in our health care system, but it will fix all of the problems with the financing of health care. And isn’t that what the debate is all about?

Posted by pnhp at 07:43 PM | Permalink

June 19, 2006
Asheville Citizen Times, North Carolina

Economics is sort of like water; when it comes to cost, things tend to flow toward the lowest point.

Regarding health care, the water is beginning to flow to the other side of the world.

Rising costs for health care have been a major concern for families and businesses for years. Solutions to address the problem from the business side have included higher premiums, higher deductibles and in some cases elimination of insurance programs.

Even given this backdrop, it was still somewhat of a shock to see a solution being considered by Blue Ridge Paper Products in Canton: An option that would allow their employees to travel to India for medical care.

A look at the raw numbers shows there is the potential for huge savings. For example, a hip operation that costs $50,000 stateside checks in at $18,000 when performed in India – and that cost includes travel expenses for two people.

We can’t fault Blue Ridge for looking at the plan. And we can’t fault entrepreneurs like Tom Keesling, President of IndUShealth, for commenting that his company, which coordinates health care in India for American patients, that “We’re not exporting health care to India as much as importing competition in the United States.”

In our opinion the jury is still out regarding whether this will import competition, but this tale out of Canton starkly illustrates the reality of the state of health care in this country and around the industrialized world.

The reality is there is now only one significant difference in health care in America and health care abroad:

We pay more for it.

A lot more.

Recent data from the Organization for Economic Cooperation and Development that compared health care spending in 30 industrialized nations put the annual average health bill for an American is $5,267. That’s more than double the world median of $2,193.

Now, the U.S. has the best doctors, nurses and health care professionals on the planet. But we are nowhere near having the best health care system. Despite the aforementioned lavish spending, millions of our citizens are underinsured and a growing number – 46 million – have no insurance at all.

Further, we’re toward the bottom on infant mortality, life expectancy and a host of other measures among industrialized nations.

What’s more, a relatively new phenomenon, medical debt, is reaching alarming levels. A study by the Commonwealth Fund showed nearly 20 percent of Americans are paying off medical debts. Among middle class Americans who are underinsured, according to a survey conducted by Reader’s Digest, almost half have refused or delayed medical treatments for serious conditions, or put off or didn’t renew prescriptions for drugs. Half had used credit cards to pay health costs.

This is despite health spending in this nation that represents 14.6 percent of the Gross National Product (compared to 7.7 percent in the United Kingdom).

We’re spending plenty. We’re not spending wisely.

There are really only two roads we can see in our future. Down one road there is rising spending, more uninsured, more debt and the occasional innovative approach such as Blue Ridge Paper is looking at.

The other is a serious discussion of single-payer national health insurance.

Actually, that brings our attention to a statement we made earlier that we need to correct. There are actually two major differences between the state of U.S. healthcare and the state of healthcare in other industrialized nations.

One, we pay a lot more, and two, they all have national health insurance.

Note, that’s “national health insurance,’’ not “socialized medicine.’’ Every time the subject of single-payer health insurance comes up, there will be those who want to paint it as some sort of communist plot, a system that will be incredibly expensive, that will force patients to go through bureaucratic labyrinths to receive care and will be cumbersome and time-consuming.

Actually, that sounds a lot like our current system, which doesn’t even cover everyone.

A nationwide plan could work – Medicare, despite some faults, has been an effective single-payer program for 40 years. The other solutions being put forth, like the wildly expensive and complex prescription drug plan, do not appear to be long-term solutions at all.

It’s worth discussing.

Otherwise, we’re going to be seeing a lot more things like people from Bethel headed to Bangalore.

Can’t we do better?

Posted by pnhp at 07:04 PM | Permalink

Feed the beast, starve the patient:
Too much money in the health-care system isn’t going to health care
Pittsburgh Post-Gazette
Sunday, June 04, 2006

I write this as a cancer survivor who has benefited from excellent medical care in Pittsburgh, all of it covered by employer-provided health insurance. Without these, I would likely be very sick, dying or dead, and my family might be bankrupt or close to it.

My continued existence makes me a tiny contributor to Allegheny County’s lowest mortality rate in 15 years. The drop, mirroring national trends, is attributed by experts to healthier living habits and improved therapies.

Of course I am grateful to be part of this good-news statistic, and for the coverage that paid for it. And yet, I still blow a gasket when I see what hospital and health insurance executives are being paid, even as premium hikes are bleeding the nation. And I do mean bleeding.

Since 2000, employer-based health premiums have increased a staggering 73 percent, far outstripping increases in wages (15 percent) and inflation (14 percent). In 2004, this country spent $1.9 trillion on health costs, or 16 percent of the gross national product.

If the rise in health costs correlated to the nation’s actual health, our death rate wouldn’t just be the lowest in 15 years, it would be zero. And I wouldn’t just be a survivor, I’d be immortal.

Administrative costs, accounting for about 20 percent of each health-care dollar, aren’t the cause of this cost spiral, they’re a symptom. But they cannot be ignored. Let’s connect the dots of some recent reports in this newspaper.

Item: The 10 highest-paid executives of Highmark, the region’s biggest health insurer, received 41 percent pay increases last year. That includes Kenneth Melani, the CEO, whose compensation went from $1.7 million to $2.5 million. Combined, the executives’ pay went from $8 million to $11.3 million — a $3.3 million hike in a single year.

Item: Meanwhile, Highmark was moving to raise its average premium by 6.6 to 7.6 percent for small businesses that can least afford it. This was less than its double-digit hike the previous year, but added on top of previous increases, it looks and quacks like price gouging — especially considering that the company is sitting atop a surplus of $2.8 billion.

Item: Hospital CEOs in this region are doing even better than their counterparts elsewhere. The University of Pittsburgh Medical Center’s Jeffrey Romoff was paid $2.88 million last year — $480,000 more than the year before. Elizabeth Concordia at UPMC Presbyterian Shadyside went from $649,500 to $927,800; Jerry Fedele at West Penn Allegheny Health System from $534,400 to $834,400; and James Collins at West Penn Hospital from $360,400 to $542,300.

These figures demonstrate the system’s central dysfunction: It is awash in money that is not going to health care. That might be just great for the executives, but it translates into unconscionable inequities for consumers and health-care workers, even as costs are killing American business, driving outsourcing and layoffs, gutting retiree benefits.

Here’s one example of how too much money in the wrong places affects the system. Hospitals don’t hire enough nurses even when they can afford to because they’d rather put the money elsewhere. So overtaxed nurses who are holding down the fort wind up laboring under terrible stress, which drives more members of the profession into non-hospital jobs and makes nursing unattractive to young people in search of a career, which contributes to the nursing shortage.

Clearly, we are treating health care as a commodity in a system geared as much or more to a profit (or, in the case of “nonprofits” like Highmark and UPMC, a “margin”) as it is to providing service. And as with any product that prices itself out of the market, its customer base is falling away — or, more accurately, being squeezed out. Some 50 million Americans are currently uninsured; many of them are working, and increasingly they are members of the middle class.

The problem with this commodity approach is self-evident. Health care is not the automobile market, where you can buy a cheaper model or take a bus. It’s life and death.

“All this talk about medical consumerism is a red herring,” said Pat Schoeni, executive director of the National Coalition on Health Care, a nonpartisan organization in Washington, whose 80 members represent a broad spectrum of interests.

“When you call 911 in a medical emergency, you aren’t researching which hospital is the cheapest. And God help you if you go to the hospital without health insurance and have any type of resources, because they’re going to eat you alive.”

The great paradox of this picture is that the health care “system” is acting like a cancer on health care. Excessive administrative expense, combined with inefficiencies, inflated prices, poor management, inappropriate care, waste and fraud are eating up the resources that the body needs elsewhere in order to survive.

“That’s a fair analogy,” said Ms. Schoeni. “There’s certainly enough money, but how is it being spent?”

An excellent question for American businesses and consumers to put front and center this election season. We have allowed our elected officials to recoil from reform for far too long. It has to happen, and I, for one, would like to be employed, insured and alive to see it.

(Sally Kalson is a Post-Gazette columnist (skalson@post-gazette.com, 412-263-1610). )

Posted by pnhp at 06:56 PM | Permalink

New York Times, editorial
June 14, 2006

The road back to prosperity will be a long and hard one for American automakers. Companies like Ford and General Motors groan under the weight of their history, manifested in the legacy costs that are a result of decades of promises to support workers and provide them with health care in their old age.

Foreign companies like Honda and Toyota have a double advantage. In the United States, their much newer manufacturing plants have hardly any retirees. Overseas, their workers can rely on national health care systems. Meanwhile, for American automakers, the costs are going only in one direction. In 1999, General Motors spent $3.6 billion to provide health benefits to 1.2 million workers, retirees and dependents. By 2005 the cost had ballooned to $5.3 billion for 1.1 million.

At the same time, vehicle production has been falling. G.M., Ford and the parts maker Delphi have all offered thousands of buyouts as part of efforts to restructure their inefficient manufacturing businesses, trimming payrolls to become more competitive. But that means fewer workers supporting armies of retirees, a demographic challenge not unlike the one facing the Social Security system.

The United Automobile Workers union has already made concessions on the superior health insurance its members receive. But slashing benefits is a short-term approach, and an insufficient answer when G.M. lost $10.6 billion in 2005.

In an ideal world, America would join the overwhelming majority of developed countries and hammer out some kind of national health care system. Failing such a sudden and unlikely onset of sanity, creative solutions are needed.

Sen. Barack Obama has proposed striking a bargain with American automakers to help them with retiree health care costs in exchange for higher fuel efficiency standards. While we have some questions about how to make such a system work, it is at least a worthy new idea — one of a very few in a field desperately in need of them.

Posted by pnhp at 06:34 PM | Permalink

The Daily Gazette
June 4, 2006

Editorial for Single-Payer

Ever wonder who gets stuck with the bill when the government undercompensates hospitals and doctors for services provided to Medicare and Medicaid patients? The hospitals and docs may eat part of the loss, but according to a new study, they pass a fair amount of it on to private payers, too. That’s insurers, employers, workers who buy their own insurance and people who pay for their health care out of pocket - anyone left with money in their pockets when the music stops.

The study, commissioned by a Washington state insurance company, provides yet another argument for scrapping the existing, unfair system and switching to a single-payer government-funded plan.

It’s hard to blame hospitals for shifting the burden for care they’re obligated to provide but don’t get adequately reimbursed for. Many are losing money. While the situation is somewhat different for doctors - they haven’t exactly been losing money, they’ve simply not been making as much - their sentiment is understandable: Why should they be required to work harder for less?

According to the study, reported in Thursday’s New York Times, hospitals in Washington state in 2004 charged $738 million - or 14.3 percent - more to private payers to help offset underpayments from Medicare and Medicaid. A similar study of Washington doctors found they charged private payers an additional $620 million, or 12 percent, to compensate for being undercompensated by the government.

So private payers, who already pay for Medicaid and Medicare through their tax dollars, have to pay again. Why not abandon the charade, put all the programs under one roof - the U.S. government’s - and presumably save a lot with a single bureaucracy and economies of scale?

Posted by pnhp at 03:46 PM | Permalink

CalPERS Rejects Co-Pay Increase
By Marc Lifsher
Los Angeles Times
June 21, 2006

A California Public Employees’ Retirement System committee on Tuesday rejected a proposal to increase healthcare co-payments for more than one million members.

Facing solid opposition from powerful public employee unions, the CalPERS health benefits committee turned down all staff proposals to hike co-payments for visits to doctors, emergency rooms, outpatient surgical centers and hospital stays.

As a result, the CalPERS committee was forced to approve rate increases of 11.6% for health maintenance organization participants and 12.9% for members who opt for preferred provider networks.

Most of the increase — 80% in the case of state workers — will be picked up by state and local government employers and ultimately taxpayers, based on collective bargaining agreements between state and public employee unions. The rest is paid by employees through higher payroll deductions.

The decision against increasing co-payments shows how CalPERS, the nation’s largest public pension fund, is subject to far greater political and union pressures than many private sector employers that have been more aggressive in forcing workers to pay a higher proportion of rising health benefit costs.

http://www.latimes.com/business/la-fi-calpers21jun21,1,2411053.story

Comments: The CalPERS health benefits committee is to be commended for accepting the union position that shifting more costs to patients in the form of copays is unacceptable because of its negative impact on access and outcomes. Erecting financial barriers to care is a potentially injurious method of controlling costs.

The unfortunate dilemma faced by CalPERS is that it must pay higher, much higher, premiums for health insurance because it is no longer able to control health care spending by methods other than making care unaffordable for precisely those individuals with needs.

The actual excessive cost drivers include non-beneficial high-tech excesses, profound administrative inefficiencies, high prices, and the lack of an adequate primary care infrastructure. The ineffectual, fragmented system of private insurers sit between CalPERS and the health care delivery system, effectively blocking reform efforts. Limited price moderation is about the only impact they can claim, but even that results in higher prices for others through cost shifting, especially for the uninsured.

The useless and wasteful middlemen, the private insurers, need to be eliminated. Also there are reasons that we should not fragment the representation of patients through organizations such as CalPERS for public employees and Pacific Business Group on Health for a portion of private industry employees. We need only one agency, our own, with a publicly-administered and publicly-funded universal risk pool. We need a single payer system.

Posted by pnhp at 08:58 PM | Permalink

Filed June 19, 2006)

United States District Court for the Southern District of Florida Miami Division

Master File No. 00-1334-MD-Moreno
(U.S. District Judge Federico Moreno)

IN RE: MANAGED CARE LITIGATION

Order Granting Summary Judgment in Favor of Remaining Defendants United and Coventry on All Claims

Presently before the Court is the Omnibus Motion for Summary Judgment (D.E.No. 3922) filed by Defendants United Healthcare, Inc., United Health Group, Inc. (collectively, “United”) and Coventry Health Care, Inc. Since the Defendants filed their motion for summary judgment, the Court has provided the Plaintiffs with multiple opportunities to demonstrate a triable issue of fact regarding whether the Defendants conspired to defraud doctors by manipulating their claims processing systems. The Plaintiffs and Defendants have filed numerous briefs regarding conspiracy, and the Court has heard oral argument several times, most recently on March 14, 2006. As explained below, because no reasonable juror could return a verdict in the Plaintiffs’ favor, the Defendants’ motion for summary judgment is GRANTED as to all remaining claims.

In granting judgment in favor of the remaining defendants, this court is reminded of the Eleventh Circuit’s opinion affirming class certification in this very case. See Klay v. Humana, Inc., 382 F.3d 1242 (11th Cir. 2004).
The appellate court indicated that “(i)t would be unjust to allow corporations to engage in rampant and systemic wrongdoing, and then allow them to avoid a class action because the consequences of being held accountable for their misdeeds would be financially ruinous.” Klay, 382 F.3d at 1274. As such, based on the allegations of conspiracy with each other to program their computer systems to systematically underpay physicians for their services, the class was certified. After reviewing thousands of documents, there simply is insufficient evidence of the wrongdoing claimed - i.e. agreeing with their competitors to defraud doctors. The evidence submitted here falls short of that needed to trigger the Racketeer Influenced and Corrupt Organizations Act’s remedial scheme described as “the litigation equivalent of a thermonuclear device.” See Miranda v. Ponce Federal Bank, 948 F.2d 41, 44 (1st Cir. 1991). In so holding, the Court is not giving its imprimatur to the Defendants’ actions or to the tremendous amounts of compensation received by their executives, described by some as exorbitant. But any reform related to executive compensation or individual practices by health maintenance organizations is beyond the power of this court. Those desiring changes in the way health care is provided in America must either look for remedies before Congress or allow the free market to dictate the results.

http://www.flsd.uscourts.gov/default.asp?file=cases/index.html (Under “00-MD-1334-MORENO-In Re Managed Care Litigation” click “”Order granting summary judgment in favor of remaining defendants United and Coventry on all claims”)

Comment:

By Don McCanne, M.D.

Although this insurance company racketeering lawsuit was dismissed because of the failure of the plaintiffs to demonstrate a joint conspiracy between the insurers, Judge Moreno did not rule that the insurers were blameless. In fact, he specifically stated that “the Court is not giving its imprimatur to the Defendants’ actions.” If the insurers had done no wrong, it is unlikely that the other defendant companies would have previously settled. These included, alphabetically, Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Net, Humana, Prudential Financial Services, and WellPoint Health Networks (though PacifiCare Health Systems also escaped by holding out for a summary judgment).

The primary allegation was that the insurers used claims processing software that was designed to reduce or deny payment to physicians for legitimate services provided and billed, using agreed-upon, standard CPT coding.
Physicians understandably felt that they were being cheated, and were particularly incensed by the outrageous executive compensation being granted with what seemed to be funds that rightfully belonged to the physicians.
(The reality of stock options is another story that won’t be covered here.)

In my opinion, the actions of the insurers were blatantly dishonest and should disqualify them from their role as managers of our health care funds.
Leaving crooks in charge merely because they manage to barely fall short of being criminals is not sound policy.

Judge Moreno states that, if we desire change, we should look to Congress or the free market. By continuing to leave control in the hands of private insurers, we have already selected the market approach. In the face of overwhelming evidence that this distorted market is not working to the benefit of patients or providers, we continue to do nothing. Well, we do something. Some of us whine. Some of us pay more. Some of us die!

Congress must provide us with the remedy. We desperately need a publicly-funded and publicly-administered program of national health insurance.

Posted by pnhp at 07:47 PM | Permalink

Retail clinics: The competition heats up
By Ken Terry
Medical Economics
June 16, 2006

“Retail” walk-in clinics, located in supermarkets and stores like CVS and Target, are already competing with physicians in many communities. Now Blue Cross and Blue Shield of Minnesota has added a new twist: It’s waiving copayments for patients who go to these in-store clinics.

Copayments for office visits are on the rise everywhere. So if there were no copays in retail clinics, an increasing number of patients would have an incentive to go there. Blue Cross sees this as a matter of saving money for its customers and for itself.

FP Michael J. Morris of Willmar, MN, thinks the insurer’s approach to this issue works against its efforts (and those of other plans) to encourage primary care doctors to manage patients’ overall health.

FP David D. Luehr, president of the Minnesota Medical Association, agrees.

“It’s important for physicians to see patients in their offices, where they have their medical records,” he says. “This type of approach starts to disrupt that continuity.”

Rick Kellerman, president-elect of the AAFP, says the Blue Cross initiative is “a bit shortsighted. If they’re going to waive copays on visits to retail clinics, why don’t they waive them for a similar service in a physician’s office? They should try to encourage people to have a personal medical home, where cost can be better controlled and quality better assured.”

So why not give patients the same incentive to visit primary care physicians for minor problems that the plan gives them to go to retail clinics? It’s mainly a matter of price, replies (internist David W. Plocher, senior vice president and medical director of Blue Cross and Blue Shield of Michigan).

If a nurse practitioner can provide the same service at half the cost, Blue Cross wants patients to use the NP.

http://www.memag.com/memag/article/articleDetail.jsp?id=333253

And…

CalPERS to Weigh Cutting Health Benefits The proposed changes, including some higher co-pays, are designed to give patients incentives to choose cheaper medical care.
By Daniel Yi
Los Angeles Times
June 19, 2006

The California Public Employees’ Retirement System, once a benchmark of generous employer-sponsored health plans, is proposing to trim benefits for hundreds of thousands of its members in a bid to rein in runaway healthcare costs.

CalPERS’ plans include raising co-pays for more expensive treatments and lowering premiums for those willing to use a smaller network of doctors.

Health plans and large employers have been dropping more-expensive doctors and hospitals from their provider networks to save money, but such measures are reaching their limits. Increasing patients’ financial stakes may be unpopular but does drive down costs.

CalPERS currently offers two Blue Cross of California PPO plans. Among the measures being considered Tuesday is the creation of a third PPO that would have about half the number of doctors in the network compared with the other two plans, but premiums would be 7.5% cheaper.

“My problem with these proposals is that they don’t address the underlying problem of lack of affordable healthcare,” said Yvonne Walker, a bargaining official with Service Employees International Union Local 1000, which represents 90,000 state employees. “You have gas going up, the overall cost of living going up, and you want to put people in a position where they have to make financial decisions about their healthcare. I don’t think that is the direction we want to go.”

But that is the direction most are already headed, said Peter Lee, chief executive of the Pacific Business Group on Health, a coalition of employers.

If the system is not made more efficient, rising healthcare costs will drive more employers to drop benefits, leaving workers unprotected, Lee said.

“Costs will be shared one way or the other,” he said, either through co-pays or “taxes going up to treat more uninsured people.”

http://www.latimes.com/business/la-fi-calpers19jun19,1,5491259.story?coll=la-headlines-business

Comment:

By Don McCanne, M.D.

Copayments have continued to grow in popularity because they have been proven to reduce health care utilization, and, therefore, health care spending. The problem with copays is that they are a very blunt instrument.

They reduce utilization of beneficial health care services and result in impaired health outcomes. Clearly we should be looking for policies that contain costs while improving health care quality.

It has been well established that improving the primary care infrastructure, establishing a medical home for everyone, improves quality while reducing spending. It seems that the private insurers would want to establish policies that would promote primary care. But what are they doing?

BC/BS of Minnesota is now adopting a policy of discouraging use of primary care by requiring copays, but waiving them when the patient fragments their own care by using discount, walk-in, retail clinics. When insurers adopt policies to discourage efficient, higher-quality care in exchange for a cheaper, instant fix, it’s clearly not about encouraging better health consumer shopping; it’s purely “a matter of price.”

CalPERS’ new Blue Cross PPO raises similar flags. In order to reduce premiums, they are slashing the list of contracted providers. Insurers should be adopting policies that improve access to primary care providers, rather than disrupting the medical home of those whose primary care providers are deleted from the approved lists.

Blue Cross already uses coinsurance to limit patients’ choices of a medical home. Coinsurance is a percentage of the fee that the patient must pay. Like copays, coinsurance is a disincentive to obtaining care, but even more so since the out-of-pocket payments are often much higher than with copays.

Coinsurance can also be very disruptive when it heavily penalizes the patient for staying with his or her non-contracted primary care provider.

Affordability of health care concerns everyone today, but policies designed to reduce use of beneficial services are the wrong way to go.

Peter Lee says that we will share costs either through copays or taxes.

Clearly our current copay policies are detrimental to health care. What about taxes? Not only are they much more equitable, but the public stewards of a single payer system would ensure that each and every one of us has affordable access to a medical home.

Posted by pnhp at 05:30 PM | Permalink

APA President Urges Support For Single-Payer Insurance System
American Psychiatric Association
Psychiatric News
June 16, 2006

The events that (APA President Steven) Sharfstein weathered this past year underscored the importance of the advocacy mission in which he had challenged his fellow APA members to join him. He left them with this simple but weighty message:

“We must tirelessly advocate for [single-payer universal health reform]. As the health care crisis extends and mushrooms, with more and more Americans without adequate coverage, the opportunity for such change will come at national, state, and local levels. And we must be there as advocates for our patients.”

http://pn.psychiatryonline.org/cgi/content/short/41/12/1-a

Posted by pnhp at 03:17 PM | Permalink

State health law could be template
By Bob Kievra
Worcester Telegram & Gazette
June 16, 2006

The state’s 65-day-old health care law could have national significance - legislation that might alter presidential politics in 2008 and shift the vexing topic out of the “hopeless” category for the first time in a generation, a Harvard University professor said last night.

Robert J. Blendon, professor of health policy and political analysis at the Harvard University of Public Health and the John F. Kennedy School of Government, said the new Massachusetts law - if it can be made to work - offers hope that the problems of the uninsured can be tackled in a thoughtful, bipartisan manner.

The 145-page law, intended to provide health care coverage to the state’s 550,000 uninsured adults, imposes an individual mandate for everyone in Massachusetts to obtain health insurance by July 1, 2007.

http://www.telegram.com/apps/pbcs.dll/article?AID=/20060616/NEWS/606160517/1002/BUSINESS

And…

AMA: Penalize some uninsured Americans
By Bruce Japsen
Chicago Tribune
June 13, 2006

The AMA’s policy-making House of Delegates vote in favor of what it called “individual responsibility” comes as state and federal lawmakers are weighing similar ideas in the form of legislation in Congress and state houses across the country.

In the past, the Republican-leaning AMA has shied away from government mandates as a way to provide health insurance coverage for more Americans.
In this instance, the group acknowledged Tuesday at a press briefing that its support of tax penalties to incentivize people to buy coverage would be a “significant shift” in the organization’s thinking on matters of covering the uninsured.

http://www.chicagotribune.com/business/chi-060613ama,1,3515691.story?coll=chi-news-hed

And…

Can Massachusetts Lead the Way in Health Care Reform?
By Stuart H. Altman, Ph.D., and Michael Doonan, Ph.D.
The New England Journal of Medicine
May 18, 2006

Massachusetts will require everyone who can afford health insurance to buy it - an individual mandate.

We don’t know exactly what the new insurance plans will look like, how much they will cost, and whether government subsidies will prove adequate. The cost of the reform will be contingent on the actual price of available plans and subsidy levels, which will not be known until regulations are drafted and insurers and health plans offer new products for this market.

http://content.nejm.org/cgi/content/full/354/20/2093

And…

Editorial
Los Angeles Times
June 14, 2006

…the real solution to the nation’s healthcare problems will have to come from a Washington ZIP Code. If it’s smart, Congress will study some of the states’ innovative ideas to determine whether they could work on a national level.

Requiring all citizens to have health insurance, for instance, is an interesting idea that could gain bipartisan traction.

http://www.latimes.com/news/opinion/editorials/la-ed-vermont14jun14,0,4682219.story?coll=la-news-comment-editorials

And…

Cheers and jeers for Mass. insurance mandate By Leah Carlson Shepherd
Employee Benefit News
June 1, 2006

In a groundbreaking move with far-reaching implications, Massachusetts adopted a law in April to require state residents to obtain medical insurance by July 1, 2007. Previously, no state had required people to carry medical insurance.

U.S. Sen. Edward Kennedy (D-Mass.): “Massachusetts once again leads the nation with an innovative plan that will achieve our longstanding goal of expanding health care for all.”

http://www.benefitnews.com/detail.cfm?id=9026

Comment:

By Don McCanne, M.D.

There has been a dramatic surge in media reports that there is a developing consensus that the individual mandate, requiring each individual to purchase his or her own insurance, is the common ground which will bridge the partisan divide on health care reform. It is rumored that even the leading candidate for the 2008 Democratic Party presidential nomination is currently working with consultants to develop an individual mandate model.

The individual mandate does not displace consumer-directed health care as the leading right-wing proposal for reform. On the contrary, it would greatly expand the market for consumer-directed products such as HSAs and high-deductible health plans. It merely reframes the rhetoric, making the individual mandate appear to be the politically feasible compromise. But do the politicians really understand what they are supporting?

The fundamental flaw with the individual mandate model is that insurance plans will have a new responsibility. They will have to cover not only the relatively healthy: healthy employees, their healthy families, and those who pass underwriting standards in the individual market. Since the individual mandate means that everyone must be covered, the plans will have to cover those with higher health care costs as well. Pooling everyone together is expensive. This year we are already spending $7110 per person for health care. Can a middle-income family of four really afford to pay nearly $30,000 for their share of the health care spending pool? Of course not.

A universal individual mandate can work only if the insurance product is affordable. By mandating that everyone be included, there are only two ways of keeping premiums affordable.

The current consumer-directed trend is to strip benefits out of the plans, and to increase out-of-pocket spending through high-deductibles, co-payments and coinsurance. That way, the health insurance premium is affordable, but access to care is not affordable for those who have needs. This totally defeats the purpose of insurance: providing financial protection against the losses of adverse medical events.

The other way to keep premiums affordable would be to shift the bulk of health care costs to the government. Very large tax credits would help, but that would add even more to the current, relatively-opaque taxpayer burden that is already funding 60 percent of our health care. Another government role would be to provide re-insurance, protecting the insurance companies from major losses (i.e., that 20 percent of individuals who use 80 percent of our health care). But then what good are insurers if they are not going to insure us against loss?

Even if we did adopt a government-funded individual mandate, we would perpetuate the tremendous losses that we are already experiencing due to profound administrative excesses, and due to a highly wasteful and even harmful maldistribution of our health care resources. Now that’s what’s not affordable!

So the NBT (Next Big Thing) is the individual mandate? Single payer advocates - get on your horses!

Posted by pnhp at 07:32 PM | Permalink

HMO Rate Increases Continue to Decline for Fourth Consecutive Year, According to Hewitt Associates U.S. Employers Remain Focused on Managing Costs
Hewitt Associates LLC
Press Release
June 13, 2006

Preliminary information from Hewitt Associates, a global human resources services company, shows that 2007 HMO rates will increase approximately 11.7 percent — representing the fourth consecutive year of declining rate increases.

“Although there has been a steady decline in the level of HMO rate increases over the past several years, double-digit increases are still very difficult for employers to absorb,” said Paul Harris, senior health care strategist, Hewitt Associates. “The good news is that there do not appear to be market pressures that might cause rates to begin increasing again.”

Although increases are moderating, companies are still facing double-digit increases and, as a result, continue to make plan design changes and share more of the cost with employees.

http://was4.hewitt.com/hewitt/resource/newsroom/pressrel/2006/06-13-06.htm

Comment:

By Don McCanne, M.D.

This is good news? Rates are stabilizing at low double digit increases? Employers are managing costs by sharing more of the costs with employees?

These rate increases are well in excess of inflation, and costs are being shifted to employees at a time when their wages are failing to keep up with the rest of the economy. Patients are bearing much of the brunt of our failed health care funding policies.

It’s not that we don’t understand how to control health care costs. We do. The single payer model does precisely that (with the not insignificant additional advantage that it also provides truly comprehensive coverage for absolutely everyone).

The problem is that we continue to depend on private sector plans to manage costs, which now means that they manage to shift more of the costs to patients. Their model doesn’t work and it needs to be dumped. It’s time for single payer.

Posted by pnhp at 03:51 PM | Permalink

2006 Annual Meeting of the House of Delegates Reference Committee highlights
AMA

The AMA voted to support a requirement that individuals and families earning greater than 500 percent of the federal poverty level obtain, at a minimum, coverage for catastrophic health care and evidence-based preventive health care, using the tax structure to achieve compliance. Upon implementation of a system of refundable tax credits or other subsidies to obtain health care coverage, this requirement would apply to individuals and families earning less than 500 percent of the federal poverty level.

http://www.ama-assn.org/ama1/pub/upload/mm/471/refcom_highlights.pdf

Comment:

By Don McCanne, M.D.

For 2006, an income of 500 percent of the federal poverty level is about $50,000 for an individual and about $100,000 for a family of four. Only about one-tenth of the uninsured have incomes at that level or higher. This is obviously only a tiny step towards universal coverage.

What is important is that the AMA is now officially on record as supporting an individual mandate to purchase health coverage in the private insurance market. They would eventually expand that to cover all of the uninsured through a system of refundable tax credits. The good news is that the AMA is explicitly supporting universal health care coverage.

The bad news is that individual mandates for private plans is the most expensive method of achieving universal coverage, and it leaves patients vulnerable to medical debt because of the deterioration in the quality of plans available in the private market.

Let’s not simply settle for universal coverage. Let’s also make it efficient, affordable and comprehensive through a single payer program of national health insurance.

Posted by pnhp at 07:59 PM | Permalink

The Huffington Post
The Blog
(Accessed June 13, 2006)

In today’s NY Times (June 10), Hillary Clinton states, “I think you should cover all children who don’t have other access to coverage. We shouldn’t have any uninsured children. But we have to take that step by step.”

For decades, we have been reforming health care “step by step.” These steps have resulted only in more uninsured and in an explosion in medical debt due to deteriorating coverage. These financial barriers to care have resulted in impaired health outcomes.

John Conyers’ HR 676 would replace our inefficient, inequitable, fragmented system with an affordable national health insurance program providing comprehensive benefits for everyone. For those concerned about skyrocketing costs, this is the only effective proposal (which expands coverage) that actually brings costs under control. It should appeal to progressives who want access and coverage for everyone, and to the business community which wants relief from unrelenting cost escalation while ensuring adequate coverage for employees.

This should no longer be a partisan issue. If the Republicans would begin to discuss the business rationale of single payer, then Sen. Clinton should be willing to concede that comprehensive reform really is feasible. But we do need to sit down with our Republican friends to be sure that they understand the single payer business model.

By: dmccanne on June 10, 2006 at 01:05pm

http://www.huffingtonpost.com/deborah-burger/a-walking-tour-of-america_b_22478.html

Wounds Salved, Clinton Returns to Health Care (NY Times, June 10):
http://www.nytimes.com/2006/06/10/washington/10hillary.html?pagewanted=all

Comment:

By Don McCanne, M.D.

Seriously. Let’s make every effort to be certain that the Republicans and the business community clearly understand the single payer business model. The efficiencies and cost containment mechanisms should appeal to anyone who is struggling with budgets.

Posted by pnhp at 08:09 PM | Permalink

Washington Monthly
Political Animal

By Kevin Drum
June 11, 2006

THE S-WORD.…Ezra Klein, practicing for his career as a TV talking head, responds to a question about whether national healthcare is socialist

“We should stop running from that moniker. If we’re going to call what Canada, France, Germany, England, Japan, and essentially every - actually, not essentially, just every - other industrialized nation offers socialized health care, but they cover all of their citizens with better outcomes and lower costs than we do, then I’m happy to associate myself with that.”

OK, it was only a training session. But still. Can I suggest something a wee bit different?

“Socialist” is a scare word conservatives use when they’ve run out of serious arguments. But national healthcare isn’t socialism any more than Medicare is. It’s just a practical and efficient way of providing medical treatment for everyone in the country, the same way that interstate highways are a practical and efficient way of providing roads for everyone in the country.

The facts are simple: A well-designed national healthcare plan gives you greater choice of doctors, it’s less expensive than private insurance, it helps rein in spiraling costs, it keeps you covered even if you temporarily lose your job or have a preexisting condition, it helps out small companies that can’t afford to provide health coverage for their employees, it helps out big companies like GM and Ford that are nearly bankrupt because they do provide health coverage, and it covers everyone all the time.

And best of all, it gets rid of the bureaucratic hodgepodge we have now:
Medicare for the old, employer coverage for people who work for big companies, 50 different versions of Medicaid for the poor, emergency rooms for the destitute, and no coverage at all for people who are unlucky enough to work for Wal-Mart. It’s an expensive mess that drives doctors nuts and provides most of us with mediocre care.

Or something like that. In any case, the basic answer to “Is national healthcare socialist?” should always be no, not yes. We are not in favor of command economies, ownership of the means of production, or state control of doctors, and that’s what most people think of when you say “socialist.”

And that’s Kevin’s media training for the day.

-Kevin Drum

http://www.washingtonmonthly.com/archives/monthly/2006_06.php

Uwe E. Reinhardt, Ph.D., James Madison Professor of Political Economy, Princeton University, responds:

“Socialism” is an arrangement under which the means of production are owned by the state. Government-run health insurance is not “socialism,”and only an ignoramus would call it that. Rather, government-run health insurance is a form of “social insurance,” that can be coupled with privately owned for-profit or not-for-profit health care delivery systems.

Conservative critics of “social insurance” often forget that they benefit from many other forms of “social insurance” — e.g., the principle of limited liability of shareholders, which is the rockbed of capitalism. In a real sense, the national defense system also is a form of “social insurance” against threats from abroad. People in the farmbelt may never rail against “socialized medicine,” because so much of their income is protected by another form of social insurance, agricultural price supports and import restrictions (like the sugar quota.)

In fact, none other than Hank Greenberg, former CEO of the huge AIG insurance company, asked for government help to protect insurance companies from catastrophic losses such as those following 9/11. That, too, is “social insurance.”

I have gotten tired of ignoramuses who call social insurance “socialism,”
all the while being beneficiaries of it. One has the right to argue with them quite aggressively and ad hominem (or ad feminam), if the case fits.

Republican Governors think nothing of going to Washington, hat in hand, demanding federal emergency funds after a natural disaster has struck their state. Well, breast cancer or severe neonatal illness is a natural disaster too, and there is nothing socialist about an individual in Texas or Mississippi asking her fellow Americans for helping financially with coping with that natural disaster as well.

Perhaps I am wrong, of course, in my assumption that this is a nation, and not just a bunch of people sharing a geography, and that the “national” flag we may not burn actually means something. I grew up in nations — Germany and Canada — where the idea of nationhood and the national flag do mean something (even though there one may burn the flags, I believe). I haven’t a clue what Americans actually think of that big blob of land south of Canada and north of Mexico.

-Uwe Reinhardt

Posted by pnhp at 07:55 PM | Permalink

Jonathan Tasini
June 30, 2005
Tom Paine.com

Jonathan Tasini is president of the Economic Future Group and writes his “Working In America” columns for TomPaine.com on an occasional basis.

The imploding health care system is finally making one thing crystal clear: Corporate America is shredding its own global competitiveness because it can’t shake the death grip of an anti-government ideology. This short-sighted ideology leads big business to shun single-payer national health insurance, which could save businesses hundreds of billions of dollars.

The simple fact is that private-sector insurance has failed. According to the 30-member-country Organization for Economic Cooperation and Development, in 2003, “the United States spent $5,635 per person on health, more than twice the OECD average and around ten times more than the lowest-spending countries, Mexico and Turkey.” According to the National Coalition on Health Care, “Health insurance premiums will rise to an average of more than $14,500 for family coverage in 2006.” The United States devotes 15 percent of its gross domestic product to health spending.

Because health care expenditures come either out of business profits or get passed on to consumers as higher prices, U.S. companies put themselves at a competitive disadvantage compared, at least, to every other country in the industrialized world. And that doesn’t even touch the issue of China. Though the China competitive issue is bigger than health care, The New York Times reported this week that a Chinese auto worker earns $1.50 an hour in wages and benefits, compared to $55 an hour at General Motors.

There are two responses that the business community has to this crisis: eliminate health coverage altogether or shift the costs of health care to workers. You want a headache, check this out: according to the Henry J. Kaiser Foundation, the annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $9,950, or $829 a month in 2004; workers contributed $2,661, or 10 percent more than they spent in 2003; and, for single coverage, workers contributed an average of $558 toward the $3,695 annual premium.

I’m not here to argue the moral imperative for single-payer national health care. Instead, progressives need to turn their rhetoric to hard-core, good ‘ole patriotic, rally ‘round the flag” American business interests. In a “Working in America” column six months ago , I wrote that “companies that don’t advocate for a single-payer system are endangering shareholder value, throwing money into a system that is dragging down profits and competitiveness.” That has become clearer as time passes.

What better example can one give than GM, the once-proud gold standard of American industry whose bonds’ credit rating has plummeted to junk status? GM will spend $5.6 billion this year on health care for its employees and retirees—more money than it shells out for steel for its cars—which means every GM car we buy costs $1,500 more because of health care. Speaking to GM shareholders recently, GM’s CEO Rick Waggoner said, “Our $1,500-per-unit health care expense represents a significant disadvantage versus our foreign-based competitors. Left unaddressed, this will make a big difference in our ability to compete in investment, technology and other key contributors to our future success.”

Now don’t get me wrong: GM has an obligation to its workers. And its saber-rattling threats that the United Auto Workers must agree by today to health care benefit cuts for auto workers is outrageous, and perhaps illegal (full disclosure: I am a UAW member). But the problem is unavoidable.

Even that poster child for corporate malfeasance, Wal-Mart, would have good reason to get behind a single-payer plan, if only to get some good press. Wal-Mart workers, who make an average of $14,000 a year, are forced to pay a $1,000 deductible—when they qualify at all for the company’s stingy plan. Since most workers can’t foot that bill, taxpayers already subsidize Wal-Mart: 13 percent of its 91,000 workers in Florida are enrolled in the state Medicaid program, 10,000 children of Wal-Mart workers in Georgia rely on state-funded health care and the company leads the pack in this dubious category in other states such as Iowa, Tennessee, Wisconsin, Arkansas and New Hampshire.

Some executives are starting to see the light. I recently had an exchange with a senior executive from a national employer lobbying group who said, “You’re right that some are thinking, ‘How much worse can it be?’ Thus far, though, national health care is a bridge too far.” Instead, companies are fiddling around the edges, engaging in discussions with various health care advocacy groups—but always falling short of the single-payer option. So we have to build that bridge and lead—or kick—corporate America across it.

Only a single-payer national plan will work. All the other gimmicks relying on market-based, employer-centered insurance have failed. The premiums for employer-based health insurance rose by 11.2 percent in 2004, the fourth consecutive year of double-digit increases—and every single type of plan (health maintenance organizations, preferred provider organizations, and point-of-service plans) registered double-digit increases. And, ultimately, state-based single-payer plans, while admirable, can’t survive in the long term because they will lack the economies of scale only a sweeping national plan can make possible.

We need to put the real onus on corporate executives with a carrot-and-stick approach that is based on a clear principle: your ability to compete depends on single-payer health care. For those who refuse, it’s time to mount an aggressive corporate and public relations campaign. One shareholder approach might be to cut back executive pay and benefits each year by the same percentage total health care costs amount to in the corporate bottom-line. If that doesn’t work, a more serious step would call for divesting from companies that oppose single-payer.

Organized labor and their allies in the huge public employee pension funds should lead the fight. If unions represented the same proportion of the workforce they did in the 1950s—35 percent—40 million people would not be without health insurance because more people would be under unionized, employer-based health plans. And we’d end up with a different system because unions—whose main fight at the bargaining table today is over health care costs—would have a stronger hand to play in lobbying for single-payer. But even in its smaller state, unions need to take the fight on for the public good. Pension funds, representing hundreds of thousands of current and retired workers who face health care cost pressure, have a significant financial interest in seeing the system changed; the California Public Employees Retirement System alone has $177 billion that it could use as leverage.

When I first broached this notion with colleagues, they snorted, “Yeah, but how do you pass this kind of thing with Republicans controlling the government?” That’s a fair point—if your thought process is driven solely through a “red state, blue state” prism.

But I’d wager that the wind could shift dramatically, driven by a population of all colors that can coax or bludgeon the business community into doing what’s in its best economic self-interest. And here’s a prediction: A serious campaign based on single-payer national health insurance could propel someone to the White House in 2008.

Posted by pnhp at 07:48 PM | Permalink

by Deborah Burger
June 7, 2006
on-line at The Huffington Post

June 7th 2006 is a national day of action for HR 676, Rep. John Conyers’ landmark bill to create Medicare for All. To mark this day, California’s nurses are taking a walking tour of the country’s broken healthcare system. Won’t you join us?

Everything you need to know about can be found in just one block of America, a quiet business-park block in a San Fernando Valley town named Woodland Hills. Here we find such the headquarters of such titans of the healthcare world as Blue Cross/Blue Shield, Wellpoint, Health Net, and Meridian Healthcare Management.

In just this handful of companies, we find the three values that mark today’s system of big-business healthcare: denial of care, cash register politics, and huge profits amidst a growing crisis.

Our tour guide Sue Cannon, RN, starts at Blue Cross, to talk about the corporate need to save money by denying care—hardly the way a health CARE system is supposed to work. We’re at Blue Cross because they’ve just been sued by numerous patients who’ve for”retroactive denial of coverage.” Here’s how that works: you get sick and Blue Cross approves a certain medical procedure. Then they go over your original application to see if they can find any inconsistencies; if so, they boot you out of the system, and leave you with the bills they just approved.

Nurse Cannon moves on to Health Net to talk about cash register politics and how it hurts patients. Between 1998 and 2004, healthcare corporations spent $1.2 billion on federal lobbying, winning favors such as George Bush’s Medicare Part D Prescription Drug benefit that forces seniors to enroll in a private health plan to qualify for the benefit and blocks the federal government from negotiating drug price discounts. Health Net symbolizes this excess. In California alone, for example, Health Net spent $580,615 lobbying in the 2005-2006 legislative session (to date).

Our final stop is WellPoint, to discuss the disparity between huge healthcare industry profits and the growing crisis of the uninsured. WellPoint used to be a for-profit division of non-profit Blue Cross. Subsequently, it bought Blue Cross of California, turning the whole organization for-profit. Why? In the words of one stock analyst, to “liberate them from their social responsibilities.” This liberation led to $2.5 billion in profits in 2005, and $157 million in direct compensation to their top five executives over the past three years. Yet HMOs have led the fight against a universal healthcare system based on a single standard of care for all, despite the fact that some 50 million Americans and over 6 million Californians have no health insurance,.

Denial of care, cash register politics, and record profits from a health care crisis. That’s the health care system we enjoy in America today. Thousands of people die unnecessarily each year because of this, and every year we fall further behind countries like Canada and England that haven’t handed their health care off to big corporations like these in Woodland Hills.

John Conyers’ has a plan to fix this, with Medicare for All, building on the most popular and effective federal program (George Bush’s efforts notwithstanding).

California nurses are taking up the fight to help Conyers revive our broken healthcare system. Here’s one way you can help: click here and send a message to your members of Congress, telling them it’s to extend Medicare to every single American.

_____________________________

Comment by PNHP Senior Health Policy Fellow, Dr. Don McCanne June 10, 2006

In today’s NY Times, Hillary Clinton states, “I think you should cover all children who don’t have other access to coverage. We shouldn’t have any uninsured children. But we have to take that step by step.”

For decades, we have been reforming health care “step by step.” These steps have resulted only in more uninsured and in an explosion in medical debt due to deteriorating coverage. These financial barriers to care have resulted in impaired health outcomes.

John Conyers’ HR 676 would replace our inefficient, inequitable, fragmented system with an affordable national health insurance program providing comprehensive benefits for everyone. For those concerned about skyrocketing costs, this is the only effective proposal that actually brings costs under control. It should appeal to progressives who want access and coverage for everyone, and to the business community which wants relief from unrelenting cost escalation while ensuring adequate coverage for employees.

This should no longer be a partisan issue. If the Republicans would begin to discuss the business rationale of single payer, then Sen. Clinton should be willing to concede that comprehensive reform really is feasible. But we do need to sit down with our Republican friends to be sure that they understand the single payer business model.

Posted by pnhp at 06:57 PM | Permalink

Conyers’ Single Payer Legislation

Newark, DE-On the eve of the UAW’s international union convention this week in Las Vegas, UAW Local 1183, representing 2,000 workers at the Daimler/Chrysler assembly plant here, has endorsed HR 676, a bill introduced by Congressman John Conyers (D-MI) to institute a single payer health care system in the U.S.

UAW local unions and CAP Councils in Birmingham, AL, West Mifflin, PA, Detroit, MI, Chicago, IL, and Holyoke, MA, have sent resolutions to the convention urging support for HR 676.

HR 676 now has 70 congressional co-sponsors in addition to John Conyers. 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 the high overhead and profits of the private health insurance industry and HMOs.

#30#

HR 676 has been endorsed by 144 union organizations including 26 central labor councils, two state AFL-CIO’s (KY and PA), and two area labor federations.

For further information and a complete list of union endorsers contact:
Kay Tillow
All Unions Committee For Single Payer Health Care-HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551, (502) 459-3393
email: nursenpo@aol.com

Posted by pnhp at 06:45 PM | Permalink

Medicare Advantage benchmarks and payments compared with average Medicare FFS spending
MedPAC
Medicare Briefs

The purpose of this report is to present data on the level of Medicare Advantage (MA) payments for Parts A and B services relative to the spending on similar beneficiaries in Medicare’s traditional fee-for-service (FFS) program. This responds to requests from Congressional committees to update our past analyses.

CMS no longer determines MA plan payments based solely on administratively set payment rates. Plans now submit formal bids, and then CMS compares the bids with benchmarks to determine payment. Medicare’s payment declines if bids are lower than the benchmarks.

Plan service areas have expanded to more rural and other areas with benchmarks that are high relative to Medicare FFS spending. The benchmarks were relatively high because these areas were given increases in payment rates under earlier law.

Finally, the risk adjustment system has changed payment rates. In 2004, the Centers for Medicare & Medicaid Services (CMS) adjusted plan payments with a blend of 70 percent demographic factors and 30 percent health risk factors.

For 2006, 25 percent of each payment is based on the demographic factors and 75 percent is based on the health risk factors. By 2007, payments will be based 100 percent on risk-adjusted rates.

With the introduction of risk adjustment, the payment system now explicitly takes into account the relative disease burden of the MA population. Risk adjustment (applied to 75 percent of payments in 2006) generally would lower payments to plans if they enrolled beneficiaries who were healthier. But CMS has taken steps to prevent overall payments to plans from going down. A hold-harmless adjustment increases the benchmark rates in 2006 by the amount that CMS expects payments would fall because of risk adjustment.

We find that the combined benchmarks are set at an average of 115 percent of FFS Medicare in 2006. After taking into account the amount that plans return to the trust fund through the bidding process, the 115 percent figure falls to 111 percent. In sum, this 111 percent includes all three factors we have discussed: the relationship of the MA benchmarks to FFS rates, the effect of bidding and returning funds to the trust funds, and the hold-harmless provisions.

http://www.house.gov/stark/news/109th/pressreleases/20060606_MedPAC.pdf

Comment:

By Don McCanne, M.D.

Hold-harmless!?

The private Medicare plans have always benefited by their ability to selectively market their products to healthier Medicare beneficiaries, even though they have received payments at a higher level that assumes that they enroll their fair share of those in poor health. Congress and the administration have promised us, and have now required by law, that the payments to the plans would be adjusted to reflect the risk based on the level of health of the enrollees.

The required risk adjustments are now in place. But what has CMS done? By giving back to the plans the required adjustments, CMS is ensuring that the plans will not be harmed by their success in excluding, by selective marketing, the higher-cost Medicare patients with greater health care needs.

“Hold-harmless” is yet another abuse of rhetoric that characterizes this administration. Granting a gift of taxpayer funds to the private Medicare Advantage plans certainly harms the taxpayer.

Worse, they promised to us and enacted measures that would establish fairness by adjusting for risk. They lied to us!

Posted by pnhp at 06:27 PM | Permalink

Interim Recommendations of the Citizens’ Health Care Working Group June 1, 2006

The Citizens’ Health Care Working Group was created by the Medicare Prescription Drug, Improvement and Modernization Act of 2003, Sec. 1014 to provide for the American public to “engage in an informed national public debate to make choices about the services they want covered, what health care coverage they want, and how they are willing to pay for coverage.”

Following this nationwide citizen engagement, the Working Group is required to prepare and make available to the public this 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.” Following a 90-day public comment period on these recommendations, the Working Group will submit to Congress and the President a final set of recommendations.

Across every venue we explored, we heard a common message: Americans should have a health care system where everyone participates, regardless of their financial resources or health status, with benefits that are sufficiently comprehensive to provide access to appropriate, high-quality care without endangering individual or family financial security.

Interim report:
http://www.citizenshealthcare.gov/recommendations/interim_recommendations.pdf

Comment:

By Don McCanne, M.D.

Those who have followed and participated in this process should agree that the “common message” above represents the prevailing views of the participants. We want a universal, comprehensive, high-quality system that does not endanger financial security for anyone.

Unfortunately, some of the actual details of the report do not seem to reflect this view but rather reflect the opinions of the current administration. Following, in quotations, are a few excerpts from the report, each followed by my comment.

• “No specific health care financing mechanism is optimal.”

There was a clear preference for an equitable, progressively-funded system of insurance for everyone. The administration’s tax credit proposal was rejected by most of those who were offered that option in the sessions. This statement seems to reflect the opinion of the individuals preparing the report rather than the view of the majority of citizens participating.

• “We understand that the transition from the current system to a system that includes all Americans will take time and that multiple financing sources will need to coexist during the move to universal coverage.”

Incrementalism was not a concept discussed in the sessions. This statement, calling for an incremental process, also seems to represent the view of those preparing the report.

• “Define a ‘core’ benefit package for all Americans”

“Core” is a term selected by those preparing this report which suggests that only basic services should be covered by a universal program, and that, by inference, second-tier benefits should be provided only for those who can afford them. The “common message” in this report states that benefits should be “sufficiently comprehensive to provide access to appropriate, high-quality care.” However “core” is defined, it implies that access to other appropriate care will be impaired due to financial barriers. This does not seem to be the intent of the citizen-participants.

• “Guarantee financial protection against very high health care costs”

The report does call for financial protection for low-income individuals, but out-of-pocket health care expenses now threaten average-income Americans. Protection against “very high health care costs” is a call for high-deductible, catastrophic coverage, a policy supported by the administration. In contrast, the majority consensus of the citizen-participants is that the system should not endanger “individual or family financial security,” though many participants seemed to be uninformed about the adverse consequences of high-deductible health plans.

• “Expanding and modifying the Federally Qualified Health Center concept to accommodate other community-based health centers and practices serving vulnerable populations”

Rather than ensuring that every individual has comprehensive health care coverage, the administration supports the expansion of community health centers to serve low-income individuals, especially those who are uninsured.
Although community health centers serve a very important role, they should not be viewed as a substitute for adequate health care coverage.

• “Consumer-usable information about health care services that includes information on prices, cost-sharing, quality and efficiency, and benefits”

This statement supports the consumer-directed health care movement, the current market diversion from the need to focus on a comprehensive system of health care coverage.

It is likely that members of Congress will select those portions of this report that support their own individual agendas while ignoring the overriding message supporting an equitable, comprehensive, high-quality system for everyone. The Working Group has requested comments on this interim report before it is formally submitted to the President and Congress. You should provide those comments to help ensure that this process is not hijacked by the opponents of comprehensive reform.

Use the following link to submit your comments on the interim recommendations: http://www.citizenshealthcare.gov/speak_out/ircomment1.php

Posted by pnhp at 08:29 PM | Permalink

By John A. Ameriks, MD Health policy analyst
Las Cruces Sun-News

The U.S. population will rise above 300 million this year, and health care expenditures are projected to exceed $2.1 trillion. Simple arithmetic leads to the alarming realization that the price of health care in 2006 will be $7,000 for each American. Yet the Senate has failed to take up health reform and our governor vetoed funding for a similar effort in New Mexico.

Few will see the entire $7,000 taken from personal savings or paychecks. The more fortunate and healthy half of the population have small medical expenses in any given year, a circumstance that helps to insulate them from the “up close and personal” experience of health-care sticker shock. And historically only 20 percent of the population is sick enough to use 80 percent of the money, while the sickest 1 percent account for 22 percent of all expenses in the average year. The odds are that you and I are not likely to fall into the 20 percent or 1 percent this year; but the lifetime odds are that eventually we will.

So how do we respond to a problem that absorbs 16 percent of the dollars spent in our country and will demand 20 percent of the gross domestic product by 2015? The suggestions to be heard on the campaign trail will include personal choice, individual responsibility, health savings accounts and consumer-directed plans. Yet none of these provide sufficiently for the costs incurred by us when illness expenses overwhelm our personal economic resources. Simply put, the politically opportune solutions aren’t applicable.

Reforming health care is a troubling prospect. The only group unquestionably in favor is the 16 percent uninsured segment of the population. The remaining 84 percent with current access to insurance view reform with anxiety. They fear losing their existing level of protection or increasing the cost of what they presently have. And they remain unaware that a stealth version of insurance reform is already occurring by the introduction of higher deductibles, increased co-pays, limits on employer contributions and restrictions on provider choice. Yes, even those insured are gradually, and in many cases unknowingly, becoming underinsured. The discomforting truth is that most of us have already lost this game; but few have yet experienced the pain.

This is an election year, and voters have increasing reason to demand meaningful health care reform. We should not be diverted from that demand by the delaying tactic of promises to reform health care once the candidate discovers a uniquely American way to do it. Profound change of our health-care system is not only inevitable but desirable. We do not suffer from distinctly American diseases that require strictly American treatments. While there is no perfect health-care system on this planet, the systems in France, Japan, Germany and the Scandinavian countries are cheaper, provide universal coverage and result in easier access and better outcomes. These are the same countries whose automobiles and electronics appear to be cheaper, better built and more fuel efficient than the domestic choices. We can learn from them. The United States stands alone in not providing health care to all its citizens; and because of that policy, America is finally encountering economic disadvantage in world markets. Without change, this will remain our fate. Our market-based approach has failed to deliver on its promises to provide higher quality at lower cost.

Health-care reform makes greater economic and common sense than ever. It need not cost more than we are already spending; and reform of the entire system offers the only realistic path to future cost containment. In a world with open borders and global economic competition the involvement of elected officials in this issue is unavoidable and even desirable. Under these circumstances the public has every right to know the candidates’ position on health care. We should not give them a pass in 2006. The lives and dollars we save will be our own.

John Ameriks, a retired physician who lives in Las Cruces, is a health policy analyst for the New Mexico chapter of Physicians for a National Health Program, a national advocacy group.

Posted by pnhp at 07:55 PM | Permalink

By Dr. Susanne King
Thursday, June 08
LENOX

THE CANADIAN health care system hit the news again last week. A new study by Harvard Medical School researchers reported that Canadians are healthier than U.S. citizens, even though the United States spends twice as much per person for health care.

The study analyzed data from a joint survey carried out by U.S. and Canadian governmental agencies. The authors found that U.S. residents had higher rates of nearly all serious chronic illnesses, including chronic lung disease, arthritis, diabetes and high blood pressure. In addition, race and income disparities in health care were larger in the United States. Despite the fact that we currently spend $2.1 trillion annually on health care in the U.S., cost is the biggest barrier to care: 30.4 percent of U.S. residents reported having an unmet health care need because they could not afford it.

“Most of what we hear about the Canadian health care system is negative; in particular the long waiting time for medical procedures. But we found that waiting times affect few patients, only 3.5 percent of Canadians, vs. 0.7 percent of people in the U.S. No one ever talks about the fact that low-income and minority patients fare better in Canada,” said Dr. Karen Lasser, the study’s lead author.

#

AA co-author, Dr. Steffie Woolhandler, commented, “Our study, together with a recent study showing that people in England are healthier than Americans, is a terrible indictment of the U.S health care system. A single payer national health insurance system would avoid thousands of needless deaths, and hundreds of thousands of medical bankruptcies each year. In 1971, Congress almost passed national health insurance. Since then, at least 630,000 Americans have died because they failed to act. (18,000 people die each year because of lack of access to health care). “How much longer must we wait?”

We spend twice as much per person for health care in the United States as they do in Canada (in Massachusetts we spend almost three times as much), yet as the recent comparative study shows, we get much less for our health care dollar than our neighbor to the north. The percentage of the U.S. gross domestic product used for health care is almost double what is spent in Canada, taking away funds from other vital services in the U.S, like education. Yet our life expectancy is 2.5 years less in the United States, and the incidence of chronic illness is higher.

Last month, former president Bill Clinton was in Canada speaking at the World Leaders Forum. Responding to a question about the interest of some in Canada for privatization of their health care system, Clinton said the last thing they should do is “let the health care finance tail wag the health care dog.” He said our system is a mess because the U.S. spends 34 percent of its health care dollar ($280 billion) on administration “to pay two million people to go to work every day for all the providers and insurers, and play tug of war. It is insane. It is a colossal waste of money. Don’t go down that road.”

By contrast, our Medicare system spends 3 percent for administrative costs.

#

I was at the Democratic Convention last weekend, staffing a table for Physicians for a National Health Plan (PNHP), a group of 14,000 physicians who advocate for a single-payer health care system. Single-payer health care is just like the Canadian system, in which the government is the “single payer” for health care, eliminating the multiple insurance companies with their exorbitant profits and high administrative costs.

In Massachusetts, 62 percent of physicians have said they support single-payer. The movement for significant health care reform is growing. The extraordinarily flawed health care “reform” bill recently passed in Massachusetts will maintain our current system, which is much more expensive than Canada’s and leaves us sicker.

A change to a single-payer system is the only reform that will provide universal, affordable and comprehensive care, as well as contain rising health care costs. This is not an experiment. We have only to look to Canada to see that they not only do it cheaper, they do it better; with a healthier population that lives longer than we do.

Posted by pnhp at 07:05 PM | Permalink

testing testing testing

Posted by pnhp at 04:08 PM | Permalink

The list of reasons why the current system and its attempted fixes are failing grows longer

MAINE VOICES: Richard Dillihunt, M.D.
Wednesday, May 17, 2006

Six years ago I wrote here favoring a national single-payer health care system.

Since then, little has changed - and given the content of President Bush’s State of the Union address and subsequent campaigning, it seems that nothing positive can be expected from this administration.

Shame on us for allowing 47 million people to go without health insurance and countless others to be underinsured. Meanwhile, health care costs inflate in a category by themselves - well above the general inflation rate.

Some facts that might clarify this problem:

We are the only major nation without government insurance.

According to the World Health Organization, we do not have the best health care in the world - we are far down the list.

An authoritative article in the New England Journal of Medicine on March 6 discloses that, on average, Americans get mediocre care.

The cost of medical care per capita here is much higher than in other nations.

The people of Canada for example are happy with their relatively inexpensive system - despite propaganda to the contrary.

The new federal drug benefit program is poorly understood, unwieldy and fashioned to enrich drug companies.

The public relations efforts of the insurance and drug companies have succeeded in scaring average Americans away from single payer through an enormous expenditure on advertising and lobbying.

Family bankruptcy is most commonly related to healthcare debt, and now big corporations such as the automotive industry may suffer this fate.

Polls show that the majority of our population and their physicians support national health insurance.

Programs such as Dirigo are stop-gap initiatives serving few in need and engulfed in controversy. The insurance and drug companies must relish this diversion while lining up at the trough.

Activists usually favoring universal health care and single-payer coverage have compromised their goals by supporting Dirigo - perhaps feeling a few slices are better than a loaf that is still out of reach.

The new “solution’ offered by the governor in Massachusetts has a fatal flaw - no money.

Our government already demonstrates its administrative ability by paying over 50 percent of our entire health care costs.

Virtually everyone opposing single-payer already has insurance and is not faced with inadequate coverage.

Remember we are talking about nonprofit government-administered insurance here - not socialized medicine where all caregivers are employed by the government.

What of the new “solutions” being offered? Health Savings Accounts are another in a long line of inadequate fixes.

They would spawn a new layer of bureaucracy leading to more personal debt, with high interest rates suggesting predatory lending to the sick. Shifting costs to workers results in higher deductibles - discouraging needed care.

Tax credits to help buy coverage are meager and would not cover even the skimpiest plans. Only the wealthy would benefit significantly.

We cannot expect states to handle this national problem individually for the same reasons that we do not have 50 armies. Imagine the confusion in moving from state to state.

Let’s try a single-payer system and call it ” Universal Medicare.” How does it work? You pay premiums according to wealth and income - like a graduated tax.

You seek care as usual - giving your Social Security number to enter the system. Marketplace factors decide how care is dispersed. A warm relationship develops with your caregivers. You smile at your pharmacist.

Winston Churchill said “Americans will always do the right thing - after they’ve exhausted all alternatives.” We can hope we are nearly there.

About the Author: Richard Dillihunt, M.D. (e-mail: dillihunt8@aol.com) is a resident of Portland.

- Special to the Press Herald

Copyright © 2006 Blethen Maine Newspapers Inc.

Posted by pnhp at 08:32 PM | Permalink

Listen here: http://archive.wbai.org/pls.php?mp3fil=6207

Paul Krugman

“Building Bridges” a weekly radio program of WBAI-FM broadcast the talk on June 5. The radio show starts with a short Jazz interlude.

It can be found at: http://archive.wbai.org/pls.php?mp3fil=6207

The music that follows Krugman’s speech is Anne Feeney singing “We Need National Health Care Now” (www.annefeeney.com) from her “Union Maid” CD.

HR 676 now has 70 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 the high overhead and profits of the private health insurance industry and HMOs.

#30#

HR 676 has been endorsed by 143 union organizations including 25 central labor councils, two state AFL-CIO’s (KY and PA), and two area labor federations.

For further information and a complete list of union endorsers contact:
Kay Tillow
All Unions Committee For Single Payer Health Care-HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551, (502) 459-3393
email: nursenpo@aol.com

Posted by pnhp at 06:00 PM | Permalink

Click here to read PNHP Executive Director Ida Hellander’s Spring 2003 Ms. Magazine article. (pdf file)

Posted by pnhp at 08:26 PM | Permalink

Healthcare-NOW, a national coalition of community, faith based, and labor groups has called for local actions on June 7th in support of HR 676 the “United States National Health Insurance Act” introduced by Congressman John Conyers (D-Mich). The date was chosen to correspond with the bill’s number, HR 676.

Coast to coast actions include picketing Blue Cross offices (Pittsburgh), press conferences outside the offices of the two remaining Massachusetts congressmen who are not yet co-sponsors of the bill (Boston), a news conference to announce a campaign to get eight city councils to endorse HR 676 (St. Louis), noon rally in Rodney Square in Wilmington, DE, plus leafleting, the showing of a specially made video “Don’t Be A Chicken” and much more in communities across the country.

To find the action near you, obtain the video, or a complete list of nationwide activities, go to www.healthcare-now.org or call 1-800-453-1305.

HR 676 now has 70 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 the high overhead and profits of the private health insurance industry and HMOs.

#30#

HR 676 has been endorsed by 143 union organizations including 25 central labor councils, two state AFL-CIO’s (KY and PA), and two area labor federations.

For further information and a complete list of union endorsers contact:
Kay Tillow
All Unions Committee For Single Payer Health Care-HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551, (502) 459-3393
email: nursenpo@aol.com.

Posted by pnhp at 06:26 PM | Permalink

By Maggie Fox, Health and Science Correspondent
May 30, 2006

WASHINGTON, May 30 (Reuters) - Despite complaints about long waits for services, Canadians are healthier than their U.S. neighbors and receive more consistent medical care, according to a report released on Tuesday.

A telephone survey of more than 8,000 people showed that even though Americans spend nearly twice as much per capita for health care, they have more trouble getting care and have more unmet health needs than Canadians do.

The survey was done by Harvard Medical School researchers who include members of Physicians for a National Health Program, which advocates for a national health program in the United States.

“These findings raise serious questions about what we’re getting for the $2.1 trillion we’re spending on health care this year,” said Dr. David Himmelstein, an associate professor of medicine at Harvard.

“We pay almost twice what Canada does for care, more than $6,000 for every American, yet Canadians are healthier, and live two to three years longer,” Himmelstein added in a statement.

“Canadians had better access to most types of medical care (with the single exception of pap smears),” Himmelstein and colleagues wrote in the study, published in the American Journal of Public Health.

“Canadians were 7 percent more likely to have a regular doctor and 19 percent less likely to have an unmet health need. U.S. respondents were almost twice as likely to go without a needed medicine due to cost (9.9 percent of U.S. respondents couldn’t afford medicine versus 5.1 percent in Canada),” they added.

UNMET NEEDS

“After taking into account income, age, sex, race and immigrant status, Canadians were 33 percent more likely to have a regular doctor and 27 percent less likely to have an unmet health need.”

The researchers analyzed data from a telephone survey of 3,505 Canadian and 5,103 U.S. adults.

They wanted to see if there were any differences in health between Canadians, who have a tax-supported national health care system, and Americans, whose health care largely depends on private insurers, employers or the free market, with older Americans and the very poor cared for by Medicare, Medicaid and other joint federal-state health insurance plans.

The researchers found that U.S. residents had higher rates of diabetes, arthritis, chronic lung disease, high blood pressure and obesity.

“Most of what we hear about the Canadian health care system is negative; in particular, the long waiting times for medical procedures,” Dr. Karen Lasser an instructor of medicine at Harvard who worked on the study, said in a statement.

“But we found that waiting times affect few patients, only 3.5 percent of Canadians versus 0.7 percent of people in the U.S. No one ever talks about the fact that low-income and minority patients fare better in Canada,” she added.

“Based on our findings, if I had to choose between the two systems for my patients, I would choose the Canadian system hands down.”

The researchers said the study population was representative of 206 million U.S. adults and 24 million Canadian adults but noted that only half the Americans contacted took part in the survey, and 60 percent of the Canadians.

Posted by pnhp at 05:43 PM | Permalink