News

Los Angeles Times
June 24, 2001
Opinion
Our national interest has become little more than making it easier for people to pursue their material dreams.
By Neal Gabler, a senior fellow at the Norman Lear Center at USC Annenberg

"... to be a nation a people must have a sense of something other than their own self-interest. It is a message the current president might well heed, for without it... we are not citizens, only consumers."

(The entire article can be accessed at www.latimes.com, click "Archives," and enter "Neal Gabler" into the search box. A one-time registration is required.)

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Medical Economics
June 18, 2001
Letters to the Editors

I read with interest the April 23 "Memo From the Editor" regarding the roundtable discussion on the state of our nation's health care. While I respect the members of that select panel, I don't think it should have dismissed a universal national health plan as passé.

I, along with nearly 10,000 other disgruntled physicians, belong to Physicians for a National Health Program (www.pnhp.org). We readily acknowledge that the US health care system is seriously flawed. Despite the fact that this country spends far more on health care than any other industrialized nation, over 42 million Americans have no health care coverage.

I agree that Hillary Clinton's plan was flawed, but we've got to do something other than apply more Band-Aids to remedy our current mess. While Congress has already passed a gigantic tax cut, and is considering a multitrillion-dollar defense shield, we still have not acted to ensure that every citizen has adequate access to health care.

Howie Wolf, MD
Lafayette, CO
Lobo985@home.com

Editor's Note: For the roundtable discussion itself, see "What it will take to fix the system."

Part I of the roundtable discussion is now available at: http://me.pdr.net/me/public.htm?path=content/journals/m/data/2001/0618/round1.html

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The New York Times
June 26, 2001

To the Editor:

Re "A Wrong Turn on Patients' Rights," by Marcia Angell (Op-Ed, June 23):

Dr. Angell is right when she says "a single-payer system that covers everyone" offers the only solution to this country's deepening health care crisis. As long as we permit corporate medicine to squander precious resources on marketing, excessive administrative costs and profits, patients will be left in the lurch.

We should do what every other industrialized country in the world does: guarantee health care to all. Although we support patients' rights legislation like the Kennedy-McCain bill, it won't provide insurance for the 43 million uninsured or prevent employers and H.M.O.'s from continuing to cut back benefits.

OLIVER FEIN, M.D. JOANNE LANDY New York, June 23, 2001

The writers are, respectively, chairman and executive director, Physicians for a National Health Program, New York chapter.

The concluding remarks from the original Op-Ed by Marcia Angell, M.D, former editor of the New England Journal of Medicine.:

"The answer is a single-payer system that covers everyone and more efficiently uses the resources we allocate to health care. That is tantamount to extending Medicare to all Americans. Medicare is not perfect, but it provides a uniform set of benefits to nearly everyone who qualifies, and it does so far more efficiently than the private employment-based system. Extending and improving Medicare would be simpler and more realistic than trying to shore up a fundamentally irrational system by measures like patients' rights bills."

The entire article is available at: http://www.nytimes.com/2001/06/23/opinion/23ANGE.html

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Mark Hannay, Director, Metro New York Health Care for All Campaign:

"The author of the latest Kaiser Family Foundation study re: the private individual health insurance market (Karen Pollitz) did a briefing for legislative staff here in NY (Albany) last week, and showed that while you are right, a universal public program is ultimately the only long-term solution, in the shorter-term, there are steps states can take to stabilize and make their individual markets work successfully to some degree. These include: community rating, guaranteed issue, standardized comprehensive products, re-insurance & risk-sharing/adjustment mechanisms, public subsidies to insurers who end up with a disproportionate share of high-cost people, and not allowing opt-outs for special categories of individuals (e.g., sole proprietors into the small group market) but rather keeping the market whole as much as possible.

"In fact, NY is one of the few (only?) states to have taken these various steps, and as a consequence, unlike in the states she looked at, ALL the persons profiled in her study would be able to get comprehensive coverage without having to pay more or suffer a loss in benefits in NY. However, they would still have to pay high premiums of $4,000+ annually for individuals (more than double that for families), which is a never-ending battle -- this year the average rate increases in NY so far are 20-30%+, with some rates going up as much as 75+%!

"In NY, most of our 'reforms' were fought against the initial opposition of the insurance industry, who were neutralized once we assured them that they'd not be put at an undue disadvantage and the state would help them shoulder the burden. After all, this market is disproportionately comprised of high-volume health care users (i.e., the chronically ill and disabled) who buy in this market because they MUST have this coverage to literally survive and often have no other alternatives, and so they scrape the pennies together somehow because it is THE most expensive way to buy insurance.

"All this is by way of saying that there are things which can be done to somewhat alleviate the crisis for people in the individual market, but clearly a long-term systemic solution is called for (i.e., universal health care.) If you want to see what's coming down the road for the rest of us as the American health care system continues to collapse, take a look at the individual market in most states. The modus operandi? Once you get sick and need coverage which you will actually use, you either can't get it at all, or can't get it for what you need it for, and you'll pay through the nose regardless.

"Makes sense huh? Kick 'em while they're down!"

For the full KFF report: http://www.kff.org/content/2001/20010620a/indivifull2.PDF

Comment: Mark has pointed out the fact that a tightly regulated insurance market, as in Albany, has the distinct advantage of assuring the theoretical availability of coverage for everyone. The crucial tradeoff is that the very high premiums that result create significant financial barriers to coverage for young and healthy consumers, along with everyone else. Once again this demonstrates the pressing need to eliminate the waste of our private health plan bureaucracies, to pay for health care in a fair and just manner through progressive funding, and to contain costs through mechanisms that improve the allocation of our health care dollars. Mark has shown us that application of rational health policies in our current health care market still fails to address the issue of affordability, and that there is no way to escape the reality that we really do need publicly administered, universal health insurance. We are getting closer to a rational system, and some day we'll get it right.

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Institue for Public Accuracy
June 19, 2001

Quentin Young, M.D., National coordinator of Physicians for a National Health Program:

"The heart of our problem is the takeover of health care by corporate interests. Having the right to sue an HMO is an attempt to seek justice after the HMO has inflicted the harm. But we have to stop the harm. We have an urgent need to establish universal coverage, like Medicare for all."

http://www.accuracy.org/new.htm

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Edmonde Haddad, former Deputy Assistant Secretary of State for Public Diplomacy:

"Both Drs - Beth Capell and the equally hardworking Don McCanne - are properly enraged by how America treats those who are either sick or poor. There seems to be no real way to combat the massive and crushing power wielded by such entities as the insurance companies, pharmaceutical industry, and the American Medical Association. Don suggests taking to the streets. It is really depressing that the United States ranks so low throughout the world in making available health care to all citizens regardless of ability to pay. There are doctors and other health care professionals who cannot abide the present healthcare delivery system. Perhaps, if they joined together in a common effort, well-financed and organized, they could force the issue. The present system is a disgrace and demeans us as a people. It is equally important that the United States look to the many more advanced democracies around the world where good health long has been considered a basic human right... "

Milton Braun, retired CPA and health care reform activist from Dallas, responding to the comments about abandonment of women with positive breast cancer screening tests:

"If these women were politicians or wives of politicians they would get treatment."

"YES, it is time to MARCH, to RALLY!!!!!"

Naomi Shaiken, Chair of Connecticut Call to Action:

"I've suggested this, but have been met by raised eyebrows! I believe we SHOULD get a march [a la 1972 against the 'Nam War] in DC - can't we get buses, set a date and do this? Why not? 'If not now, when??'"

Comment: Our nation's leaders are not listening. They are quibbling over patients' rights bills that will have virtually no impact on the real problems of our health care system. In fact, passage of any of these bills will be used as an excuse to shift more costs to patients, further impairing coverage and access for tens of millions in the United States. Worse, this legislation will be passed off as adequate health care reform, and Congress will move on to other issues. We urgently need genuine, comprehensive reform, but the current political climate remains an impenetrable barrier. To break through this barrier, our leaders need to hear the resounding voice of the people echoing throughout the land, demanding health care justice.

Edmonde Haddad suggests that doctors and other health care professionals could join together in a well financed and organized common effort, and force the issue. Physicians for a National Health Program (www.pnhp.org) is such an organization that is dedicated exclusively to this issue. We have 9000 physician members, but we need to recruit tens of thousands more. Each of you can help by contacting your personal physicians and physician colleagues and friends and directing them to PNHP. We could carry our message to the public much more effectively if we had significant additional funding, especially for a media campaign. If any of you know progressive minded individuals that have benefited from the upward shift in income redistribution, you may suggest that donating to PNHP may assuage their penurious guilt. We also need more active involvement on the part of physicians. They need to be heard distinctly as a rebel call standing out within the resounding voice of the people.

And what about taking to the streets with rallies and marches? Emphatically, YES! We need to bring together all of our people in a clear, loud, unified voice that will penetrate the sound barriers surrounding our political leaders. This should probably be done as part of a coordinated, universal effort, including a media campaign.

Now is the time for ideas. Start thinking about how we can create an effective, national movement. We have to do it. If not us, who?

Don McCanne

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Beth Capell, PhD, legislative representative for health care reform:

"We live in a society in which a man who loses a leg to diabetes can get the amputation but not the insulin to manage the disease; in which a woman who has cataracts loses her job because she is blind; in which a child goes deaf simply because she had the misfortune to lack clear immigration status; in which a person screaming with pain from metastasized cancer gets pain medications from the ER and nothing more. Every case is obscene.

"Every person who should be able to lead a productive life should be given that chance. This is not charity. This is not obligation. It is a society making the most of its most precious resource: its people."

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Oakland Tribune
June 15, 2001
by Lisa Friedman

"1000 California women each year enter state or federally funded detection programs only to find out they have cancer but cannot afford treatment."

"Now health advocates fear some or all of the $20 million Gov. Gray Davis pledged last year toward the federal matching funds program may fall victim to far-reaching budget cuts."

Barbara Brenner, executive director of Breast Cancer Action:

"It's not a matter of charity. It should be a matter of obligation."

http://www.oaklandtribune.com/S-ASP-BIN/REF/Index.ASP?PUID=490&Indx=927402

Comment: How can decent Americans tolerate a system in which the government will pay for mammograms to detect breast cancer, but then abandon the women that have positive tests? We already have enough funds to provide comprehensive care for everyone. Decent Americans should be out marching in the streets, demanding health care justice!

And in USA Today:

"The pity is that today's policymakers lack the courage and foresight to address the problem... "

http://www.usatoday.com/news/comment/2001-06-14-edtwof2.htm

Let's start marching! Really!

Don

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The Bush administration is currently considering new names for the Health Care Financing Administration (HCFA). American Medical News, a publication of the American Medical Association, is conducting a poll on proposals for a better name. If you check the polling page at the link that follows, you will find that most suggestions are not serious. However, one stands out as representing the goal to which many of us are dedicated: National Health Insurance Administration (NHIA). Voting for this choice would send a message to the AMA that we are serious in our support of national health insurance. If enough of us register our votes, the message may even reach our political leaders.

Cast your vote now, and then forward this message to your friends and colleagues.

Vote for: National Health Insurance Administration (NHIA)

http://www.ama-assn.org/public/journals/amnews/amnqp8.htm

On behalf of the dream of health care justice for all in the United States, thank you.

Don McCanne

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The Seattle Times
June 11, 2001
by Carol M. Ostrum

" ...'defined contribution' health plans are being offered in Washington by (Regence BlueShield)."

"Under the plans' most pure form, employers would hand employees a voucher, give them a push toward a list of insurance plans and wish them luck. Touted as giving employees more choice, the plans trouble some health-care economists who worry that the trend may unleash forces that will widen the gap between health-insurance haves and have-nots."

"Play it out a couple of years, critics say, and employees could get caught in the middle, as employers' contributions lose ground to rapidly escalating benefit costs. An early version of this movement found that when health-insurance premiums rose faster than company contributions, employees simply dropped coverage... "

Regence President Mary McWilliams:

"Health-care inflation is not abating. Employers need ways to fix what their costs are, and a lot of the tools we had in the past to try to manage health-care costs aren't workable today."

http://seattletimes.nwsource.com/html/localnews/134305355_contributions11m0.html

Comment: Isn't our health care system about patients? If we would redirect our reform efforts to creating a system that is designed specifically to provide the best possible care for everyone, within the limits of our resources, then employers, employees, providers, and everyone else would do just fine. Only the middleman profiteers would suffer under patient oriented reform, but then we can no longer afford the luxury of enriching our friends on Wall Street at the cost of losing patient care dollars.

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Los Angeles Times
June 8, 2001
by Ellen Braunstein

In "Talking to Americans," Rick Mercer, a Canadian comedian and satirist, travels in the United States "asking people ridiculous questions to exploit their ignorance about their northern neighbor."

Julie Longo, a Canadian citizen that teaches Canadian history at Wayne State University in Detroit:

"I think the show illustrates well our perceptions of Americans -- that Americans know nothing beyond their own borders and have no problem with their ignorance."

http://www.latimes.com/archives/ (and enter name "Rick Mercer" and click "Begin Search)

Comment: It is not surprising that Canadians are quite well informed about the United States considering that the comparatively small population of Canada is concentrated along our border and significantly influenced by our dominance. On the other hand, for most of us in the United States, our understanding of Canada is limited to the exposure that we have had to deliberate information campaigns within our country. An example is the perceptions that we have as a direct result of marketing efforts on behalf of Canadian tourism, a beautiful but shallow impression of Canada.

Unfortunately, there has been a very concerted effort to spread disinformation about the Canadian health care system, a process that has been dominated by libertarian elements that wish to keep the government out of health care in the United States. Because knowledge about Canada by most of us is very limited, and because the supporters of universal health care coverage have not been adequately effective in carrying the message of the benefits of the Canadian Medicare program, the average individual in our country believes that the Canadian health care system is inferior. This misperception is not altogether the fault of health care reform activists. The message of a just, comprehensive health care system is a very complex message to deliver and exceeds the patience and desires of most Americans to study and absorb a subject that for most of them is very boring. On the other hand, the opposition can keep their message very simple by limiting the facts presented to very isolated problems within the Canadian system, while concentrating on simple rhetoric that lumps health care in with features of government that the public believes to be undesirable.

The media readily report the isolated stories of problems within health care. The horror stories of managed care in this country abound, just as the stories of the deficiencies of the government program in Canada make good copy, or at least news filler. The conclusions that our citizens draw from these reports are that (1) a patient bill of rights will correct the defects of managed care, and (2) we do not want a government system like Canada's. The members of the media reflect the same simplistic viewpoints, and most seem to lack the depth of understanding of the Canadian system that might otherwise influence their reporting stance. This is not laziness on their part but rather reflects the fact that they must make decisions on how to allocate their time effectively. The "government" health care system of Canada is simply not a priority for them.

Our efforts should be directed to informing the media of the realities of the Canadian health care system. We can never tell them what stories to cover, but we can encourage them to base their coverage on a background of comprehensive knowledge of the Canadian system. An excellent beginning source for them is a 251 page report by the Canadian government on the status of their health care system, released February 2, 2001. It can be downloaded at: http://www.hc-sc.gc.ca/medicare/home.htm

For those in the United States that wish further information about our Canadian neighbors, a wealth of such information is available at the website of the Canadian government: http://www.canada.gc.ca/

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The Washington Post
June 9, 2001
Editorial

"Health care costs appear to be rising rapidly again after a period in which they were relatively well behaved. Most analysts think that higher rates of increase will persist -- that they represent the norm and the respite was the anomaly."

"Higher health care costs are like a tax increase or an increase in energy costs... They squeeze people out of the health care system; the higher the cost of care, the greater the likelihood that more Americans will be uninsured."

"The resurgent cost of health care is arguable one of the most serious problems the country faces. But in our view neither political party is facing it."

http://www.washingtonpost.com/wp-dyn/articles/A43137-2001Jun8.html

Comment: Ignoring the issue of containing costs in health care is no longer an option; we simply cannot afford to continue to parasitize other sectors of our economy for the benefit of the health care industry. Denying access and coverage to tens of millions of Americans remains morally repugnant and can no longer be tolerated by a just society. It is now imperative that our political leaders take a fresh look at all options for reform, including the only proposal that will contain costs, reduce administrative waste, and improve allocation of our abundant health care resources: a publicly administered, universal health insurance program.

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The Providence Journal
by Edward Fitzpatrick

"The state's new health insurance subsidy program is off to a slow start with just 33 people enrolling since Rite Share was launched Feb.1... "

"Under Rite Share (a health insurance subsidy program), the state pays a portion of health-insurance premiums for workers if they stick with their employer-provided insurance rather than relying solely on the state. The subsidies are expected to cost the state less than having those people on Rite Care (a state health-insurance program for low- and moderate-income families)."

Jane A. Hayward, Rhode Island Human Services Deputy Director:

"We think we are better off having people stay on employer-sponsored health care rather than coming onto a fully state-subsidized program --both for continuity of health care and for the state's fiscal interests."

http://www.projo.com/cgi-bin/story.pl/news/05599401.htm

Comment: Rhode Island's experience portends the future of health care in America, if the current political agenda is enacted. The Bush administration and moderates and conservatives in Congress support programs for low income individuals, including Medicaid and S-CHIP, and they support tax credits for assisting low to moderate income individuals with the purchase of private health plans. The experience in each state already has proven that it is impossible to enroll all low income individuals into the "welfare" health insurance programs (Medicaid and S-CHIP), as we still have 42 million without coverage. Rhode Island has now provided us with an example of the next phase of health care reform: insurance subsidies (analogous to vouchers, or tax credits, or other comparable proposals).

Rhode Island's early experience is proving the wisdom of the words of Sen. John Rockefeller, spoken at a Senate Finance Committee hearing on March 15. His words are worth repeating here:

"So that if you're going to do health insurance for people, then you have to do it properly. And the tax credit is the wrong approach. It is the wrong approach, period. That's all there is to it. It will not work. It will not work at the figures that are being offered by you... the figures that'll come in part from the other side, maybe some from our side. It won't work. And I think we have to decide on this committee do we want people to get health insurance or do we not?"

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Please click here to download file(pdf)

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The New York Times
June 5, 2001
by Robert Pear

"A top federal official said today that the Bush administration would try to double the enrollment of Medicare beneficiaries in health maintenance organizations within four years."

Thomas A. Scully, newly appointed administrator of the Health Care Financing Administration:

"The government is better in the long run when it's a buyer of insurance, rather than an insurer."

Comment: Unfortunately, this is not a mere rhetorical statement. It is a blatant lie, and Mr. Scully knows that. Although not without its problems, the HCFA has been much more efficient than the HMOs in the administration of health care coverage. GAO studies have confirmed this. What the HCFA needs now is leadership that will work with Congress to obtain legislative relief and adequate funding to further improve the efficiencies of the HCFA. The task of making the HCFA more user friendly for patients and health care providers alike would not be that great under a dedicated administrative-legislative partnership. Instead, Mr. Scully is intending to use our Medicare dollars to support his friends in the managed care industry, patients and providers be damned.

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amednews.com
(A publication of the American Medical Association)
June 11, 2001
Opinion

By Eric Anderson, M.D., AMNews contributor

Eric Anderson, M.D.:

"Originally a British-trained physician bitterly opposed to socialized medicine, I have actually come to the opinion that America now needs a single-payer system for health care."

http://www.ama-assn.org/sci-pubs/amnews/amn_01/edca0611.htm

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The Washington Post
June 1, 2001

By Ceci Connolly

Steven A. Schroeder, M.D., President and CEO of The Robert Wood Johnson Foundation:

"What we discovered was that six out of ten parents whose children qualified for CHIP or Medicaid didn't think they were eligible."

"He then hired ad makers at GMMB for a $48 million promotional campaign that used the power of television and the creativity of grass-roots groups to reel in new participants."

Comment: It is ironic that a large advertising budget is deemed to be required to sell a program of public insurance. Yet, it will be impossible to enroll every eligible child because of other obstacles, including access to the enrollment process for the eligible, the stigma of a program that smacks of welfare (income eligibility standards), difficulties in re-accessing the process for continued enrollment, premiums that are perceived to be unaffordable for those with no disposable income, changing eligibility because of changing family income levels, and isolated incidences of bureaucratic sloth, amongst other problems. At best, all efforts to increase enrollment can only raise the threshold of the steady state of enrollment, that is, raising the level at which those exiting the program equate to new enrollees. The only way to be sure that all children are enrolled, not to mention their parents, is to make insurance truly universal and truly permanent for life. We lack only the political will to adopt the moral imperative: publicly-administered, universal health insurance with everybody in, nobody out. Let's work on creating that will.

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