April 8, 2011
Dear PNHP colleagues,
Spring is here, and PNHP activities are bursting out all over. We can only recount a few of them here. But April could indeed shape up to be “the cruelest month” if the opponents of single payer are allowed to have their way.
In this e-issue:
– Current Vermont legislation falls far short of single payer, battle moves to Senate
– Opportunity to push single payer in response to Ryan plan to eliminate Medicare
– Teleconference on Ryan plan to eliminate Medicare: Monday, April 11, 7 p.m. eastern. RSVP online here.
– New PNHP slide show available now
– Corvallis City Council endorses single-payer system
In Vermont, single-payer advocates are in their toughest fight yet
Despite the election of a pro-single-payer governor and Legislature, the health reform legislation that emerged from Vermont House falls far short of single payer. See the statement on the current bill by the PNHP Board, below.
Characterized by some as a “road map to single payer,” the legislation largely stalls after the creation of an insurance exchange, as required by federal health law, by 2014. The very term “single payer” has been stripped from the bill.
“I could tell how bad it was when I saw how happy the lobbyists for the insurance companies and hospitals looked,” says former PNHP President Dr. Deborah Richter of Vermont. She says the fight is on to strengthen the bill in the Senate, where the governor presumably has more influence as former speaker.
Don McCanne, PNHP’s senior health policy fellow, comments on the Vermont developments here.
While the challenges facing single-payer advocates in Vermont are steep, PNHP members are united in the struggle for single payer for the long-term. (We reported on the health-professional student rally for a single-payer system in our last message to you; however, since then we’ve published a few of the speeches at the Vermont Statehouse here.) Stay tuned for more updates from the “battle of Vermont.”
Nationally, the Medicare privatization ‘zombie’ is back
Canadian health economist Robert Evans, Ph.D., defines a health policy “zombie” as an idea that has been thoroughly discredited but keeps coming back.
In the U.S., eliminating and privatizing Medicare by turning it into a voucher program is this season’s zombie. The House budget committee chair, Rep. Paul Ryan, R-Wis., is aggressively promoting the dismantlement of Medicare as a social insurance program and is pushing new, draconian Medicaid cuts as deficit-cutting “necessities.”
Dr. Don McCanne swiftly commented on Ryan’s proposals here. Dr. Margaret Flowers, PNHP’s congressional fellow, also quickly responded to Ryan’s proposals in an article titled “Ryan turns knife on Medicare, Medicaid” here.
PNHPers are encouraged to write letters to the editor and opinion pieces on these developments. Medicare’s benefits are already inadequate, and the program doesn’t doesn’t have all the tools it needs to control costs (e.g. the ability to negotiate drug prices with drug firms, to slash administrative bloat system-wide and globally budget hospitals). Private insurers have raised, not lowered, costs in Medicare (by 14 percent per beneficiary).
The only way to control costs in the Medicare program is, paradoxically, to adopt a universal single-payer program that covers everyone. If you’d like help polishing a letter or opinion piece on this or other topics, please contact Mark Almberg, PNHP’s communications director, at mark@pnhp.org.
(In Canada, the zombie that won’t stay dead is that Canada’s health system is unsustainable and that privatization would cut spending. Robert Evans’ recent paper on this topic is worth reading, below. We’re delighted to note that Evans will be speaking at PNHP’s 2011 Annual Meeting in Washington, D.C., on Saturday, October 29. Save the date!).
Teleconference Monday, April 11, on proposed changes to Medicare and Medicaid with Dr. Margaret Flowers, others at 7 p.m. eastern
PNHP and Healthcare-Now are co-hosting an emergency one-hour teleconference on Rep. Ryan’s proposal to eliminate and privatize Medicare. RSVP for the call here.
With Spring’s arrival, we have a new edition of the PNHP slide show!
The new PNHP slide show is available to paid-up members at www.pnhp.org/slideshows. (If you haven’t already renewed your membership, please do so today.)
PNHP co-founders Drs. Steffie Woolhandler and David Himmelstein have updated the PNHP slide set for 2011. While the presentation is geared towards grand rounds and other medical audiences, community groups are extremely receptive as well. The health care debate has been characterized by more rhetoric than substance, and people really appreciate how much they learn from PNHP speakers and materials. You may wish to use fewer slides and leave more time for Q and A with community groups, however.
If you use the new slides, please drop us a note. We’d love to hear who you have been speaking to!
Finally, PNHP was pleased to learn that the Corvallis (Ore.) City Council endorsed a resolution in support of a single-payer system on April 4. The council endorsed both their state single-payer bill and the national “Expanded and Improved Medicare for All Act,” H.R. 676. Thanks and congratulations to Oregon PNHPer Dr. Hank Elder!
Best regards,
Ida Hellander, M.D.
Executive Director
FOR IMMEDIATE RELEASE
April 7, 2011
Contact:
Garrett Adams, M.D., president PNHP
David Himmelstein, M.D., co-founder PNHP
Andrew Coates, M.D., board member PNHP
Mark Almberg, communications director, (312) 782-6006, mark@pnhp.org
Vermont health bill mislabeled ‘single payer’: doctors’ group
Physicians for a National Health Program says draft legislation gives wide berth to private insurers, falls far short of single-payer reform
The following statement was released today by the national board of Physicians for a National Health Program.
Health reform legislation initiated by Vermont Governor Peter Shumlin was recently passed by that state’s House of Representatives and awaits action in the Senate.
Many journalists and commentators have portrayed this bill as fully embracing the single-payer appr
oach to reform. We write to clarify the views of Physicians for a National Health Program on the Vermont legislation.
We appreciate the enthusiasm for progressive health reform shown by Gov. Shumlin and the many dedicated single-payer supporters in Vermont. However, it is important to note that the bill passed by the Vermont House falls well short of the single-payer reform needed to resolve the health care crisis in that state and the nation. Indeed, as the bill moved through the House the term “single payer” was entirely removed, and restrictions on the role of private insurers were loosened.
In its present form, the legislation lays out in considerable detail a structure to implement Vermont’s version of the federal reform passed in March of 2010, which would expand coverage by private insurers and Medicaid. However, it offers only a vague outline of the additional reform promised by the governor and Legislature at such time when states will be allowed to experiment with alternatives to the federal program in 2017 (or 2014, if the effort to move up the date succeeds).
The Vermont plan promises a public program open to all residents of the state in 2017, but even then it would allow a continuing role for private insurance. This would negate many of the administrative savings that could be attained by a true single-payer program, and opens the way for the continuation of multi-tiered care.
Within the public program, the plan would continue to lump together payments for operating and capital costs, allowing hospitals and the newly established Accountable Care Organizations (ACOs) to use funds not spent on care for institutional expansion. Meanwhile, those with operating losses would shrink or close even if they were meeting vital health needs. This would perpetuate incentives for hospitals and ACOs to cherry-pick profitable patients and services, and hobble the health planning needed to assure rational investments in new facilities and high-technology care.
Under the legislation, many patients would continue to face co-payments that obstruct access to care, and the bill makes no mention of expanding coverage of long-term care. The legislation fails to proscribe the participation of for-profit hospitals and other providers (e.g. ACOs and dialysis clinics), which research has shown deliver inferior care at inflated prices.
Finally, the bill offers no concrete funding plan or structure for the public program that it promises.
We applaud the sentiments expressed by the governor and legislative leaders and remain hopeful that the legislation’s rhetorical commitment to further reform will become a reality. We urge the Vermont Senate to address the shortcomings in the House bill.
Much work, including efforts to enact federal enabling legislation – and continued advocacy by single-payer supporters – will be needed in the years ahead to achieve Vermont’s goal of universal access to high quality, affordable care.
*******
Physicians for a National Health Program (www.pnhp.org) is an organization of 18,000 doctors who support single-payer national health insurance, an improved Medicare for all. A March 26 rally at the Vermont Statehouse organized by medical and other health-professional students from PNHP and the American Medical Student Association drew over 200 attendees in support of single-payer health reform.
Public health care as sustainable as we want it to be
By Robert G. Evans
Toronto Star, Tue Jun 01 2010
“There are stark and unpalatable choices that we face with respect to health care, but there is no magic solution. We absolutely must have an adult debate about how we deal with this.” That’s what David Dodge, former governor of the Bank of Canada and former deputy finance minister, told the Liberal policy conference last March.
Dodge joined a list of economists and other pundits who predict that public health care will be financially unsustainable in coming years as Canada faces an aging population and escalating costs for scientific advances in care and treatment. But an “adult debate” on the sustainability of public health care must start from who and what drives health-care spending.
It’s true that total health-care spending in Canada has risen in recent years, taking larger shares of both government revenues and budget allocations. This has led to accusations of “crowding out” other public programs by those favouring further privatization of health care.
The data tell a much more nuanced story. The central fact is that, recession years apart, medicare spending — hospitals and physicians’ services — has fluctuated between 4 per cent and 5 per cent of gross domestic product since 1975. After the introduction of medicare in the late 1960s these costs stabilized because universal, comprehensive coverage consolidated expenditures in the hands of a single payer. The cost of health services not covered by medicare has risen from 3 per cent of GDP in 1975 to 7 per cent in 2009.
Today, Canada’s expenditures on health care match those by other OECD countries. The public share of overall health costs in Canada is relatively low for high-income OECD countries, around 70 per cent. Private insurance, primarily for prescription drugs and dentistry, now accounts for 12.7 per cent of Canadian health spending, 14th highest in the world. The OECD outlier is the United States, where extensive private finance supports uncontrollable cost escalation (now over 16 per cent of GDP). Getting these costs under control will be the major task facing Obama’s health-care reform.
Provincial governments’ spending on health care over the past 15 years has taken increasingly larger bites out of their expenditure budgets. But this is a simple consequence of large cuts in non-health programs, not of out-of-control medicare spending. These cuts in non-health spending are traceable to substantial cuts in personal and corporate income taxes by the federal and most provincial governments, particularly since 1997. Between 1997 and 2004, these tax cuts removed an estimated $170.8 billion from public sector revenues. Total provincial revenues are by now roughly $35 billion per year less, or about half provincial spending on medicare. Cumulative federal cuts are at least as large.
The provinces’ revenue shortfalls were not all self-inflicted. The federal government’s large cuts in financial transfers since the mid-1990s also left big holes in provincial budgets. Subsequent increases have not fully made up the loss.
What are the real motives behind the claims of financial unsustainability? Two, I think. First, under Canada’s universal tax-financed medicare, higher-income people contribute proportionately more to supporting the health-care system, without receiving preferred access or a higher standard of care. Any shift to more private financing would reduce the relative burden on those with higher incomes and offer (real or perceived) better or more timely care for those willing and able to pay.
Second, every dollar of health-care expenditures is also a dollar of someone’s income. The Ontario government’s recent change in reimbursement for generic drugs made this clear: the shares of Shoppers’ Drug Mart fell 10 per cent overnight. Privatization is a way to avoid cost containment, reopening greater income opportunities for providers of care (and private insurers) outside public control. Expenditures
would accordingly rise, as in the United States, but public budgets might (in the short term) be contained. “Unsustainable” public spending magically becomes sustainable when shifted from taxpayers to patients.
It is time, long past time, for an “adult conversation” about these motivations, and for a clear identification of the winners and losers from eroding or dismantling medicare. (Economists who evade this issue should be shamed.)
But it is also time for an adult conversation about the real drivers of cost escalation. Researchers have known for decades that population aging is a real but a minor factor. Its impact will certainly increase, but it will remain secondary to increases in intensity and costliness of care. This is the real issue. Where is the money going, both public and private, and are we getting value? Again the Ontario generic drug initiative makes the point. Rising expenditures are not a law of nature; several hundred millions will be cut at a stroke. The real issue is political; those millions are also cut from pharmacy’ incomes.
Are there other opportunities? Yes. Medical imaging and laboratory testing are currently the major sources of cost escalation. What are the benefits? No one knows. Ultrasound for low-risk pregnancies is up 50 per cent in 10 years. Why? Patterns of medical practice and hospital use vary widely across the country, for no apparent reason. Toronto’s Institute for Clinical Evaluative Science, among others, has tracked some of these large unexplained variations, but they are largely ignored. These are what we need to discuss, not “stark choices” about relieving the burdens on and improving the benefits for high-income taxpayers — and, incidentally, opening new markets for private insurers. Panic-mongering about a “grey tsunami” is simply a distraction.
Canadians consistently show that they support public health care. In May, a national poll by Nanos Research confirmed that 90 per cent of Canadians feel that health care is the most important national issue, and almost 90 per cent support public solutions to problems in the health-care system. They are right. Canada’s health-care system is as sustainable as we want it to be.
Robert G. Evans is a member of UBC’s university’s Centre for Health Services and Policy Research. He is an officer of the Order of Canada, and a fellow of the Royal Society of Canada and the Canadian Academy of Health Sciences.