News from Columbus, OH

Posted by on Thursday, Mar 25, 2010

PUSH Private Insurance Over the Cliff!

From Alice Faryna M.D.

At a presentation to Concerned Ohio Retired Educators on March 17th, I used Paul Krugman’s recent article on the “death spiral” of for profit insurance industry to call on pension plans to divest from this industry. This is the latest financial bubble and is unsustainable. Private insurance is headed for the cliff. We should give it a push. We will take this proposal to State Teachers Retirement Board next.

Reconciliation Act includes wealth transfer

Posted by on Wednesday, Mar 24, 2010

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Health Care and Education Reconciliation Act of 2010

H.R.4872
The Library of Congress

SEC. 1402. UNEARNED INCOME MEDICARE CONTRIBUTION.

(a) Investment Income-
(1) IN GENERAL- Subtitle A of the Internal Revenue Code of 1986 is amended by inserting after chapter 2 the following new chapter:
CHAPTER 2A–UNEARNED INCOME MEDICARE CONTRIBUTION

Sec. 1411. Imposition of tax.

(a) In General- Except as provided in subsection (e)–
(1) APPLICATION TO INDIVIDUALS- In the case of an individual, there is hereby imposed (in addition to any other tax imposed by this subtitle) for each taxable year a tax equal to 3.8 percent of the lesser of–
(A) net investment income for such taxable year, or
(B) the excess (if any) of–
(i) the modified adjusted gross income for such taxable year, over
(ii) the threshold amount.
(2) APPLICATION TO ESTATES AND TRUSTS- In the case of an estate or trust, there is hereby imposed (in addition to any other tax imposed by this subtitle) for each taxable year a tax of 3.8 percent of the lesser of–
(A) the undistributed net investment income for such taxable year, or
(B) the excess (if any) of–
(i) the adjusted gross income (as defined in section 67(e)) for such taxable year, over
(ii) the dollar amount at which the highest tax bracket in section 1(e) begins for such taxable year.
(b) Threshold Amount- For purposes of this chapter, the term `threshold amount’ means–
(1) in the case of a taxpayer making a joint return under section 6013 or a surviving spouse (as defined in section 2(a)), $250,000,
(2) in the case of a married taxpayer (as defined in section 7703) filing a separate return, 1/2 of the dollar amount determined under paragraph (1), and
(3) in any other case, $200,000.

—-

SEC. 1409. CODIFICATION OF ECONOMIC SUBSTANCE DOCTRINE AND PENALTIES.

(a) In General- Section 7701 of the Internal Revenue Code of 1986 is amended by redesignating subsection (o) as subsection (p) and by inserting after subsection (n) the following new subsection:
(o) Clarification of Economic Substance Doctrine-
(1) APPLICATION OF DOCTRINE- In the case of any transaction to which the economic substance doctrine is relevant, such transaction shall be treated as having economic substance only if–
(A) the transaction changes in a meaningful way (apart from Federal income tax effects) the taxpayer’s economic position, and
(B) the taxpayer has a substantial purpose (apart from Federal income tax effects) for entering into such transaction.

http://thomas.gov

And…

Is Single-Payer Health Care The Best Option?

By Don McCanne
The New Republic
July 16, 2008

Because of our very high costs, we must accept the fact that the insurance function is no longer simply a transfer from the many who are healthy to the fewer with health care needs, but it now must also include a partial transfer from the wealthy to middle- and lower-income individuals with needs. There is no alternative to this wealth transfer.

http://www.pnhp.org/news/2008/july/response-to-tnrs-jonathan-cohn

The traditional role of health insurance has been to transfer funds from the many who are healthy to the few who are sick. But now health care costs in the United States are so high that if we expect everyone to have the health care that they need, a transfer of funds from the wealthy down would be absolutely mandatory if we are to be able to finance that care.

The easiest way to accomplish that transfer would be to establish a single national risk pool that covered everyone, and fund that pool through progressive taxes. Unfortunately, Congress and the President selected a much more complex financing scheme for their health reform program. Nevertheless, there was no way that they could escape the necessity of including a wealth transfer mechanism. So what did they do?

The most obvious transfers are contained in the bill signed yesterday that is now law. Individuals purchasing their health plans from the state exchanges will receive federal subsidies in an amount inversely related to their incomes. Individuals with very low incomes will be enrolled in Medicaid and will not have to contribute any premium. Since the taxes collected to support these programs are progressive, the wealth transfer is automatic.

The Reconciliation Act that is still under consideration in the Senate provides additional measures that acknowledge the need for a wealth transfer, including the unearned income Medicare contribution, and the codification of the economic substance doctrine.

Our current tax policies extract both income taxes and payroll taxes from hard-earned wages, but passive unearned income such as interest, dividends and capital gains may receive favorable treatment for income taxes, and totally escape payroll taxes. It seems unfair to tax individuals who are contributing to society by their personal work effort at a higher level than wealthy individuals who contribute little more than conversation at the nineteenth hole of the golf course. The common argument that those funds shouldn’t be taxed so that they can be invested in the economy holds little water when you consider that increased productivity comes from the workforce and not from passive investors.

In recognition of this imperative of wealth transfer, the Reconciliation Act includes a Medicare tax of 3.8 percent on passive income over $200,000 for individuals or $250,000 for couples. Although that is a relatively modest tax for wealthy individuals, it is a giant step forward in solidifying the principle of wealth transfer.

The codification of the economic substance doctrine is simply locking into law the principle that wealthy individuals can no longer establish sham transactions that have the sole function of reducing income tax liability. Although this is not a wealth transfer in the same sense as the Medicare tax on passive income, it does ensure that the rightful transfer can no longer be avoided by these devious transactions, subject to an extra 40 percent penalty if attempted.

Although the decision of Congress and the President to continue to use private health insurers to finance health care was a terrible decision that we will continue to attempt to upend by pushing for a single payer system, nevertheless we can celebrate some of the beneficial features of the legislation such as the expansion of community health centers and the reinforcement of primary care.

One of the most important beneficial features of all is the firm establishment of the principle that the transfer will not come only from the healthy but must also come from the wealthy. That is a policy bridge that we will have already crossed on our march to an improved Medicare for all.

Campaign for SB 810 – Single Payer Universal Health Care

Posted by on Tuesday, Mar 23, 2010

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

California OneCare

Lily Tomlin as Ernestine

30 second video:

http://californiaonecare.org/365-ad-campaign/365-ad-archive/365-ad-35-2/

We have been saturated with commentary since the passage and signing of the trillion dollar Private Insurance Industry Stimulus legislation. Lily Tomlin provides us with a much needed break as she reminds us, in her own incomparable style, of the industry that Congress and the President have so richly rewarded.

Private insurer nightmare

Posted by on Monday, Mar 22, 2010

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Effects of health overhaul will take time to become clear

By Duke Helfand
Los Angeles Times
March 22, 2010

(The industry’s Washington lobbying arm, America’s Health Insurance Plans) ran ads in national newspapers last week criticizing the overhaul for failing to adequately contain costs. Without bolder action, it warned in its “Open Letter to the American People,” the country could face a healthcare cost “crisis similar to the financial crisis that has rocked our economy.”

“Virtually everyone believes that we have a huge number of issues that remain to be addressed,” said Jay Gellert, chief executive of Woodland Hills-based Health Net Inc. “If anyone thinks that just by passing this we’re going to solve the problems, they are seriously mistaken.”

http://www.latimes.com/business/la-fi-insure22-2010mar22,0,3396267.story

I had a nightmare last night. I dreamed that we reformed the financing of health care in America, but that we left the private insurance industry in charge. Oh, wait… Oh, no!

If this bill were a step forward, we would support it
by Margaret Flowers, MD

If this bill were a step forward, we would support it.

If we believed and evidence indicated that this bill could be “tweaked” into something better, we would support it.

But this bill is a step backwards, a step away from single payer. This bill further cements the privatization of health care, further enriches the industries that are the problem.

We are seeing the same scenario play out at the national level that has played out at the state level for decades. People see the suffering because it is very real. They are told that we must do something and that this all they can get. So the people accept this believing it is an incremental step towards reform. And guess what – it is not a step in the right direction. This type of reform has failed every time. This is why we continue to be in a health care crisis.

As this passes, the public will be told it is a solution. They will be told to wait and see how it works when it is implemented in 2014. In the meantime, people will continue to suffer, go bankrupt or die of preventable causes. This is unacceptable.

We want health CARE reform. Health insurance reform makes no sense. Health insurance is very regulated but they are rich enough and clever enough to evade regulation. We will not support health insurance reform: it is a waste of time, money and human life.

If we want real reform, it isn’t going to be pretty. It can’t be brought in through the back door or by tweaking. We will have to take on a very powerful industry that currently owns the White House, Congress and the media. But work for anything less is a waste of time. The smallest increment of change that will be effective is to change to publicly funded health care.

It is not going to be another 10 years or 50 years before we get real reform if this bill fails. The single payer movement is growing. We can organize and push for real reform. But we must stand strong and united on our principles. We must put single payer on the table. It won’t happen any other way.

Dr. Margaret Flowers, a Maryland pediatrician, is PNHP’s Congressional Fellow.

Arizona shuts down CHIP, slashes Medicaid

Posted by on Friday, Mar 19, 2010

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Governor signs Ariz. budget-balancing bills

By Casey Newton
The Arizona Republic
March 18, 2010

Gov. Jan Brewer signed the fiscal 2011 budget on Thursday, enacting $1.1 billion in spending cuts and program eliminations.

The budget, passed last week by the Republican-led Legislature on largely party-line votes, drew criticism from opponents for what they called a disproportionate impact on the poor.

“I’m not sure how cutting three-quarters of a billion dollars from public education and kicking 300,000 people off of health care puts our state on the back on the road to recovery,” said Rep. Kyrsten Sinema, D-Phoenix. “In fact, it dismantles what we have been working for years to build in Arizona — a vibrant, healthy state where people want to live and work.”

One aspect of the budget expected to be challenged is a cut of $385 million to the state’s Medicaid program, the Arizona Health Care Cost Containment System.

The budget bills also eliminate KidsCare, which provided health care to 38,599 children of low-income parents.

Hours after she signed the budget, Brewer appeared at a news conference to urge opposition to federal health-care reform. Asked by reporters what the hundreds of thousands of Arizonans set to lose coverage this year should do, Brewer said they should use community health clinics and emergency rooms.

http://www.azcentral.com/news/election/azelections/articles/2010/03/18/20100318brewer-signs-budget-bills-arizona.html

Programs benefiting low income individuals and families, such as Medicaid and CHIP, are politically vulnerable to the whims of conservatives wielding budget cleavers. Gov. Jan Brewer of Arizona has just provided us with a prime example of that.  Yet popular programs benefiting everyone, such as Medicare, are relatively impenetrable to the weapons of the conservatives.

The reform proposal likely to be enacted by Congress is heavily dependent on the expansion of Medicaid. Since it is a federal/state program, it requires the support of the government on both levels. In spite of the proposed increases in federal support, Gov. Brewer continues to urge opposition to the reform proposal. Low income families will remain vulnerable in her state as long as she and her Republican colleagues remain in charge.

Suppose Congress had included single payer in their deliberations and eventually decided that the benefits were too great to pass up ,and so enacted an improved Medicare program that covered everyone. Gov. Brewer and her ilk on the state level would be powerless to stop it. It would be so popular that conservatives who managed to take over the federal government would never be able to shut the program down.

Whether or not the current bill passes, we need to make every effort to replace our expensive, fragmented, often cruel, and relatively ineffectual system of health care financing with one that works for all of us – a single payer national health program – an improved Medicare for everyone.

Or failing that, as Gov. Brewer says, we could all just go to the emergency room when we can’t get into the clinic.

Keep your insurance? Ask locked-out employees in Boron

Posted by on Thursday, Mar 18, 2010

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Labor War in the Mojave

By Mike Davis
The Nation
March 29, 2010

The biggest hole in California, with the exception of the current state budget, is Rio Tinto’s huge open-pit mine at the town of Boron, near Edwards Air Force Base, eighty miles northeast of Los Angeles.

The Boron pit, which replaced an underground mine, produces almost half the world’s supply of refined borates.

Once upon a time, there were several thousand mining communities in North America; perhaps fewer than a hundred still exist. Boron (unincorporated, population 2,000) is one of the survivors.

In last year’s contract negotiations, Rio Tinto (the British-Australian multinational acquired its Boron facility, U.S. Borax, in 1968 and renamed it Rio Tinto Borax) stunned members of the International Longshore and Warehouse Union, ILWU, Local 30 (Boron), by demanding abolition of the contractually enshrined seniority system and the surrender of any worker voice in the labor process.

The company wants a contract that would allow it to capriciously promote or demote; to outsource union jobs; to convert full-time to part-time positions with little or no benefits; to reorganize shift schedules without warning; to eliminate existing work rules; to cut holidays, sick leave and pension payments; to impose involuntary overtime; and to heavily penalize the union if workers file grievances against the company with the National Labor Relations Board.

“The company’s proposal,” union negotiators emphasize, “would destroy our union, lower our living standards, and give Borax total control over our jobs.” On January 30, Local 30 members unanimously rejected the concessions demanded by Rio Tinto.

The company deadline expired the next morning, when Terri Judd set off for work as usual with her lunchbox and thermos. At the locked front gate she and other day-shift workers encountered a phalanx of nervous Kern County sheriff’s deputies in full riot gear. Inside the plant, an elite “strike security team” hired by Rio Tinto had taken control of operations.

“Being locked out,” says Terri, “is different from going on strike. Initially there’s disbelief that the company is actually serious about booting you out the door. Hey, my granddad worked in this mine. But then you see that caravan of scabs coming to take your jobs, and the betrayal cuts like a knife in your heart.”

http://www.thenation.com/doc/20100329/davis/single

Empathetic souls will find the full version of this article to be very tough reading. When the 560 wage earners unanimously rejected the demands of Rio Tinto to give up much of their job security, the company terminated all of them in a job lockout. The impact on their small community of Boron is devastating.

Even though this story is not about health care, there is a very important health policy lesson here.

These people lost company support of their health benefits program at termination. With loss of their paychecks, many of these individuals are struggling to pay their rent and to buy food. Extension of health coverage through COBRA, even with subsidies, is of no benefit if they don’t have the funds to pay for it.

And President Obama’s promise of being able to keep the insurance you have if you want to? He left off the part that says you can keep it until your COBRA runs out, and at that only if you can pay your share (and all of the other reasons why hardly anyone still has the insurance they had twenty years ago, even if they wanted to keep it).

The policy lesson is that a health care financing system should be designed to cover absolutely everyone automatically throughout life. Individuals unfortunate enough to lose their jobs shouldn’t be further penalized by losing their health care as well.

Sen. Snowe’s policy advisor: Single payer in a decade

Posted by on Wednesday, Mar 17, 2010

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

The Health Care Letdown

By William F. Pewen
The New York Times
March 15, 2010

Should they succeed in blocking reform, Republicans should take no consolation. When Congress next attempts reform, in a decade or more, health costs and the number of uninsured and underinsured will have escalated — and the likely outcome will be the single-payer system that Republicans most abhor.

(William F. Pewen is a former senior health policy adviser for Senator Olympia Snowe, Republican of Maine.)

http://www.nytimes.com/2010/03/16/opinion/16pewen.html

William Pewen expresses the view of the majority of well informed moderates and conservatives: The likely eventual outcome of further deterioration in health care financing will be a single payer system, like it or not.

Although they may be opposed to single payer based on ideology, they understand simple math. A decade from now a family with an income of $100,000 will not be able to pay an insurance premium of $25,000 plus a $25,000 deductible plus a coinsurance of 30% of the balance of the medical expenses.

The private insurance industry never has been and never will be capable of reining in health care costs. Health care costs are now so high that the reliance on pure market forces can never be effective in ensuring that everyone receives the health care that they should have. Only the government has the capability of slowing spending and improving the allocation of our health care resources so that everyone is taken care of.

A decade from now costs will be so high that almost every informed individual will recognize that we can no longer afford the additional waste inherent in our fragmented, dysfunctional financing system. In all reality, only a single payer system will work. Opposition will be limited to the “I got mine” folk who do not accept the enlightened, civilized view that we are all in this together.

We likely are now about to begin an experiment to see if a combination of greater government regulation of private insurers along with a system of government subsidies can provide everyone with the health care that they need without busting the budgets of families, businesses and the government. It is an unfortunate delay since the results are in before the experiment has even begun. Tens of millions will be left out of the system, and by selecting the most expensive model of reform, budget busting will only compound.

So as William Pewen states, if the bill before Congress is blocked, the likely outcome a decade from now will be a single payer system. But health policy science tells us that, if this bill passes, the likely outcome a decade from now will be a single payer system.

We really don’t have to wait another decade. People already understand that health care costs are too high. What they need to understand is that they cannot rely on being able to keep the insurance they have if it becomes unaffordable for themselves or their employers, and they cannot rely on being able to purchase it though an exchange if the premiums are too high and the subsidies are too low. They also need to understand that, even if they have insurance, the relatively low actuarial value of basic coverage will leave them exposed to financial hardship should they develop significant health care needs, so the insurance they have won’t work as it should.

Regardless of the results of the vote on the reform bill, we need to intensify our efforts to inform the public. Health care justice in America is ultimately their decision.

Stealth group, backed by drug and insurance companies, selects Arizona as testing ground for ballot initiative campaign against Medicare for All, government mandates

By Chris Gray

An Arizona ballot measure to forbid government-mandated health care was voted down two years ago, but it’s back as part of a much larger national campaign this time around. The proponents’ main target? Single-payer, universal health care.

A statement by the American Legislative Exchange Council denounces the insurance mandates proposed by Congress and the Obama administration, but the bulk of the group’s news release in pushing for “freedom of choice” makes it clear that the real target is publicly financed universal health care, commonly referred to as a single-payer system or an improved Medicare for all.

“ALEC’s Freedom of Choice in Health Care Act ensures a person’s right to pay directly for medical care,” states a release from the American Legislative Exchange Council or ALEC, a national right-wing, pro-industry group. “[The] Act will prevent patients from being enrolled in a single-payer health system that will simultaneously pay for everyone’s health care and limit access to it.”

The council’s “Freedom of Choice in Health Care” proposal was drawn up with the support of corporate supporters PhRMA (the trade association of the large drug companies), Johnson & Johnson, and the Blue Cross Blue Shield Association.

The Arizona ballot measure, which is also a concurrent resolution in the state’s House, has strong similarities to ALEC’s draft resolution, which was written with the guidance of Joan Gardner of Blue Cross Blue Shield, an insurance lobby group that publicly pressured Obama to mandate private insurance for all Americans. Even as it continues to support the federal mandates publicly (while arguing the penalties for noncompliance be higher), Blue Cross Blue Shield has been working to undermine the administration’s bill, along with the prospects for single-payer legislation, through the stealth campaign of the American Legislative Exchange Council.

The original “Freedom to Choose Act” in 2008 was boosted primarily by a group called Medical Choice for Arizona, headed by Eric Novack, an orthopedic surgeon in Glendale, Ariz., who had teamed up with conservative groups like the Phoenix-based Goldwater Institute. Its unsuccessful campaign received over $400,000 in donations, much of it from out of state.

The current measure is once again being backed by Novack’s group, which has been renamed Arizonans for Health Care Freedom, in alliance with ALEC and others. The statewide ballot initiative, which would amend Arizona’s constitution, will appear on the Nov. 2 ballot.

ALEC stepped in to support the second go-round not long after Americans elected Barack Obama president on a platform of health care reform. ALEC hopes to use Arizona as a model to block universal health programs across the nation.

The attack on single payer in ALEC’s campaign could be seen as a sign that ALEC views state-based single-payer campaigns as a credible threat to the private insurance companies that help fund the organization. Several states where the ALEC legislation is being introduced have strong single-payer movements that could greatly cut into private insurance company profits if a publicly financed health plan gets passed in those states.

Supporters of ALEC’s Freedom of Choice in Health Care Act argue that the bill is all about the “right to choose” one’s health care coverage. However, if such a bill were enacted in Arizona, its residents would still be unable to freely choose their doctor or hospital. Their choices would be restricted by the private health plan they belong to, plans which themselves are becoming increasingly unaffordable.

In contrast, one of the hallmarks of the single-payer proposal is the guarantee that patients will have full freedom to choose their doctor, hospital or other provider.

The Orwellian title of the bill — “Freedom of Choice in Health Care Act” — is another ALEC hallmark. Much of ALEC’s previous work has involved opposing environmental protection legislation. The deceptively named Environmental Good Samaritan Act, Groundwater Protection Act and the Environmental Literacy Improvement Act were all designed to weaken environmental laws in favor of industry and curtail the regulatory powers of the Environmental Protection Agency.

The council has managed to stay well under the radar of the mainstream media, passing as advocates of “limited government and free markets” in a recent New York Times article. But, in fact, the council is much less concerned with limited government than with bolstering the business interests that fund the tax-exempt organization and vote on its proposals, according to the Nieman Foundation at Harvard University.

ALEC was founded by Paul Weyrich of the Heritage Foundation in 1973 to offer sample legislation to conservative state legislators who would support ALEC’s industry backers. Legislators pay nominal dues to receive trips to conferences as well as model legislation, written courtesy of the big corporations that finance the council. Officially a legislators’ association, membership dues account for only 1 percent of the group’s funding, while donations come from corporations like ExxonMobil and Philip Morris make up much of the balance of the group’s $5 million budget.

Alan Rosenthal, a public policy professor at Rutgers University, told the Washington Post that ALEC is unique in state-legislature lobbying groups in that it allows corporations a direct vote on platform decisions.

In the Clinton era, ALEC championed the interests of tobacco companies R.J. Reynolds and Philip Morris. In the early Bush years, the organization pushed back against environmental regulation and climate change legislation that might hinder the business of key donor ExxonMobil. A recent expose in the Washington Post outlined how ALEC won state legislation in Virginia shielding a single asbestos company from liability in cancer-related deaths.

If the measure passes in Arizona, ALEC has stated that it has model legislation lined up in at least five other states (Indiana, Minnesota, New Mexico, North Dakota, and Wyoming). Bills have been introduced in 24 states to prevent single-payer health care and/or nullify Obama’s insurance mandate. A more limited version of the Arizona ballot measure already passed in Virginia on March 10.

Any state bill written to nullify a federal law such as the insurance mandate would be “constitutionally impossible” and serve as “political theater,” according to Timothy Jost, a Washington and Lee University law professor who wrote on the subject for the New England Journal of Medicine. But that’s not to say it would be shot down without a legal fight. Clint Bolick of the Goldwater Institute told the Boston Globe that he would like to test federal insurance mandates in the U.S. Supreme Court.

In order for a publicly financed, single-payer health system to work effectively and save on administration costs, it must cover everyone. By preventing such a system and enshrining into law the status quo, the “Freedom of Choice in Health Care” leaves Arizonans’ freedom of choice determined more by their income level or their luck than anything else.

Chris Gray is an intern at Physicians for a National Health Program (www.pnhp.org).

Massachusetts hospital spending out of control

Posted by on Tuesday, Mar 16, 2010

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Massachusetts Hospital Spending Reached 55.4% Per Person Above the U.S. Average in 2007

Most of Excess is Unjustified, and State’s Health Reform Law Is Negligible Factor

Report by Alan Sager and Deborah Socolar
Boston University School of Public Health
March 16, 2010

This report documents and investigates the excess in Massachusetts hospital costs per person above the average for the United States. It examines the recent rise in this excess after a prolonged earlier decline, analyzes the many causes of the excess, assesses their reasonableness, and offers recommendations for addressing the state’s resurgent hospital cost crisis.

http://sph.bu.edu/images/stories/scfiles/healthservices/health_reform/Mass_hospital_cost_55.4_Excess_15Mar10_FINAL.pdf

It is difficult to reduce this complex 211 page report on the very high level of spending by Massachusetts’ hospitals into a few paragraphs, but the title and subtitle alone deliver the dominant messages. For those who would like more insight without reading the full report, there is an excellent 30 page summary at the beginning the report.

For those following the health care reform process, one observation stands out. The Massachusetts health reform – a hybrid model of reform not unlike the proposal before Congress – was not a significant cause of the excesses in hospital costs. More importantly from the perspective of those of us concerned about reform, it played no role in slowing cost increases.

All nations struggle with rising health care costs, but all except the United States have been able to maintain a lower trajectory in those increases. Financing systems do make a difference, and they must enable strong government oversight to be effective. Fragmented hybrid systems such as that in Massachusetts, and, more importantly, that in the proposed federal legislation, are not particularly effective. The authors do not discuss this other than to state that in the United States, “Nationally, neither competitive forces of a market nor regulatory actions by government have succeeded in reining in health care costs generally or hospital costs specifically.”

Sager and Socolar do reemphasize an important point that they have made many times about controlling costs: “it is fundamentally about liberating, enabling, and persuading physicians to spend money more carefully on behalf of their patients.” That sure seems like it would be much easier in a single, publicly administered system devoid of the third party money manipulators.

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Physicians for a National Health Program's blog serves to facilitate communication among physicians and the public. The views presented on this blog are those of the individual authors and do not necessarily represent the views of PNHP.

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