News

JAMA Vol. 286 No. 20, November 28, 2001
by Robert L. Ferrer, MD, MPH

"My waiting room is bigger than yours. It seats 228 and by mid-afternoon it is usually packed. On a good day patients will wait two to three hours to see me or one of the other clinicians who work here. On a bad day the wait can reach five or six hours. Not as many patients complain as you might think. Almost all are uninsured, and they have nowhere else to go. Our 'acute care' clinic is a large county-hospital walk-in clinic -- portal of entry to the public health care system in a county in which 360,000 of the 1.3 million inhabitants are uninsured. The numbers are alarming, but the stories underlying them are even worse."

(Dr. Ferrer then describes the shocking realities of ten patients seen at the clinic. A description of one follows in the next paragraph.)

"A man in his early 20s with a worsening dental infection who was unable to afford a dentist. He finally saw a physician who prescribed an antibiotic, but the patient was unable to pay for the prescription. He presented to our clinic with sepsis and spread of the infection to his mediastinum. He died soon after admission."

"I wish this was a top-ten list of lamentable stories, but it is not. The egregious is commonplace in our setting. My colleagues and I are part of what is widely known as the health care 'safety net' for the uninsured, but to work here is to realize that, for many, the safety net does not provide a soft landing, nor are its failures the random 'accidents' implied by the image of missing a net.

"In actuality, events such as these are the product of a system, an increasingly coherent system of exclusion that denies care to the uninsured: the system of no-system. The system of no-system's components are the fragmented resources locally available to the uninsured, embedded within the national nonsystem of health care. It is a netherworld of closed doors and shrinking services. The paradox of the system of no-system is that it is becoming increasingly systematized. Unintended consequences of changes in health care organization and financing, positive feedback loops enabled by the nonsystem, and maladaptations to the health care market are solidifying the barriers to care for the uninsured."

(Dr. Ferrer then explains the features of the system of no-system: inversion, concentration, fragmentation, evasion, degradation, resignation, amplification, and maladaptation. The descriptions of these features will alarm you. As one example, the process of evasion is described in the next paragraph.)

"Despite legislation to prohibit patient 'dumping,' it still occurs. To survive, it has mutated into a less visible form. Private hospitals are no longer shipping indigent patients off to public EDs in a taxicab. Instead, they now offer perfunctory treatment, forego any diagnostic procedures, and discharge patients with instructions to 'follow up tomorrow with your primary care physician.' They might as well be advised to see their personal banker."

(And, concluding... )

"It is time to rescue the 39 million Americans who are forced to seek care within the system of no-system. If there is to be universal health care, we cannot keep having the same dialogues about the government vs. the market, equality vs. liberty, efficiency vs. bureaucracy. Stripped of all the ideology, the need and the suffering are there, now, plain for all to see. Stop by my waiting room sometime and I'll show you."

Robert L. Ferrer, MD, MPH San Antonio, Tex

http://jama.ama-assn.org/issues/current/ffull/jpo10168-1.html#aainfo

Comment: Download and save this one. The next person that tells you that the uninsured still receive care, hand them a copy of this and insist that they read it.

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Health Affairs

Medicare+Choice: Doubling Or Disappearing? by Robert A. Berenson

Robert A. Berenson, senior advisor at the Academy for Health Services Research and Health Policy:

Abstract:

Although the changes in the program created by the Balanced Budget Act are often viewed as the reason for the current instability in the Medicare+Choice (M+C) program, in fact, health plans are having difficulties in all of their markets, not just in Medicare. It may be time to reconsider the purpose of the program and to fundamentally redesign how payments are made to managed care organizations contracting with Medicare. Two alternative approaches are suggested: treating M+C like another provider type by severing the payment linkage to spending under traditional Medicare, and overhauling the program by creating a value-based purchasing orientation rewarding plans that provide higher-quality care to beneficiaries with chronic diseases.

http://www.healthaffairs.org/

Comment: Although all objective evaluations to date have revealed that the Medicare + Choice program has failed miserably in its goal to reduce costs and improve quality, our policy leaders continue to flog this dead horse. Costs have been higher for comparable patients in the Medicare + Choice (M+C) plans than they have been in the traditional fee-for-service (FFS) Medicare program. The quest for quality has eluded the M+C plans with several studies suggesting that the level of quality may actually be lower.

Ignoring the rigor mortis of this horse, Robert Berenson has proposed two life saving measures. Suggesting that the plans be rewarded for advancing quality is an admirable recommendation. But rewarding quality should not be the exclusive domain of the M+C plans. Once we have adequate methods of evaluating quality, a reward system can and should be applied to all patient care, certainly including that in the FFS program. Thus quality rewards should not be considered to be a specific reason to extend the M+C options.

His other recommendation is much more problematic. It is clear that it is impossible to show that M+C will ever be able to save the taxpayers money as long as the fiscal mechanisms are linked to the traditional FFS program. By their very design, costs of administering private plans (e.g., M+C) will always be higher than publicly administered programs (e.g., FFS Medicare). Also, they have now proven that aggressive managing of care is not capable of achieving savings that will offset the higher administrative costs.

Yet, Berenson recommends that the link of M+C options to the FFS program be eliminated so that M+C options can be evaluated on a stand-alone basis. This might hide the inefficiencies of the M+C plans, but it will never create a new model which would, in fact, reduce costs below the FFS model. Hiding inefficiencies through creative accounting is hardly a solution to the fatal flaws in the M+C program.

This report, appearing in the web version of Health Affairs, brings up another painful issue. Health Affairs is considered by many to be the leading journal of health policy. As such, it has a responsibility to cover the spectrum of ideas in traditional and innovative health policy. In this instance, the editor invited five different responses to Berenson's proposals. This should fulfill the editor's responsibilities in providing a spectrum of opinions. But what happened here?

The five responses all, to some degree, discuss mechanisms for salvaging the M+C program. There was not even a hint that the program should be terminated based on its now-proven failure (though one suggested utilizing a "payment to organizations" authority, allowing private plans to survive in a FFS model). The decision of the editor to continue to publish articles heavily biased toward market solutions should be challenged. To assemble five pro-market solutions, while excluding consideration of the option of terminating the M+C program (while repairing the publicly administered FFS program), in my opinion constitutes editorial malpractice. To maintain its academic integrity, Health Affairs needs to open its coverage to all reasonable health care policy options. Managing editorial policy based on sightings on the political radar screen is not acceptable.

Don McCanne

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by Rudolph Mueller, M.D.
Olin Frederick, Inc., 2001

Rudolph Mueller, M.D., from the Introduction:

"This is the story of the American healthcare system at the turn of the millennium from my perspective as a primary care and geriatric physician."

"The premise of this book is that the American healthcare system is sick, As Sick As It Gets. It is a system with a confused purpose and mission, contaminated by its focus on money and its exploitation of the massive cash flow that modern medical technology has created. Its mission should be to maximize the well-being and health of every individual and our society as a whole, as well as to prevent illness and relieve pain."

"This book includes the true stories of real-life illnesses of people who cannot afford adequate healthcare or who are denied it and my everyday experiences with them. It also includes stories about the system, the pharmaceutical industry, the insurance industry and HMOs, and the providers. These accounts are from one practice of one primary care physician... "

http://www.olinfrederick.com/Our_Bookshelf/our_bookshelf.html

Comment: Dr. Mueller defines the problems of our sick health care system in terms of his real life patients and our current flawed policies that impair their care. He provides an economic picture of the great wealth in our system which has been distributed with a misdirected mission of enhancing the personal wealth of the few, rather than improving the health of the many. He then explains why a single payer, national health care program is the imperative solution.

The link above will provide the publisher's information about this very readable and informative account. It should provide lay audiences and advocates with an excellent understanding of what really has gone wrong with our health care system and what we can do about it.

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The Detroit News
November 27, 2001
by Sarah A. Webster

"DaimlerChrysler AG's Chrysler Group has invited about 4,000 of its direct suppliers into a new program aimed at helping them reduce prescription drug costs. The new initiative may help the suppliers realize annual cost savings up to 10 percent through group purchasing."

"Chrysler will get an undisclosed brokerage fee for referring business to Merck-Medco, the pharmacy benefit manager that will administer the program."

http://detnews.com/2001/autos/0111/27/c01-352809.htm

Comment: In health care, discounts for favored groups result in increased costs for vulnerable groups. In this instance, DaimlerChrysler is shifting its pharmaceutical costs to the cash-paying senior subsisting on a modest retirement income. Even worse, DaimlerChrysler is becoming yet another middleman in the health care system by taking a cut of the action as it includes its suppliers in on the deal.

To prove that they have not entirely abandoned ethical principles, I'm sure that they will pass the financial benefit on as lower prices for their Mercedes line of automobiles. Or maybe not. They have a new ethical dilemma. Does this cost shift funded by pensioners accrue to the wealthy Mercedes purchasers, or to the wealthy shareholders?

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Los Angeles Times
November 26, 2001

The cuts in funding to California's "safety net" hospitals will certainly affect the poor (Nov. 21). But even if one is cynical enough to ignore the plight of the uninsured and underinsured, the impact upon services that we all take for granted will be devastating. If well-insured individuals are involved in an automobile crash and there is no trauma center, where will they go? If a wealthy couple's newborn needs emergency surgery and there is no children's hospital, what will they do? We can no longer deny the crisis situation in our health care infrastructure. Support of the "safety net" is not in the business interests of the insurance industry. Until a publicly administered system of universal coverage is enacted we will continue to drift closer to a health care meltdown.

Gerald Gollin MD Asst. Prof. of Pediatric Surgery Loma Linda University

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by John P. Geyman, M.D. Butterworth-Heinemann, 2002

John P. Geyman, M.D., Professor Emeritus of Family Medicine, University of Washington School of Medicine, Seattle:

"It is easy to become discouraged by the lack of real progress toward structural reform in our ailing health care system after at least 20 years' failure of the competitive marketplace approach. How much more time should be given to the experiment, and what real signs are there that it could yet work? The answers, in my view, are none and none. The stakeholders in the present system persist in their optimistic claims that the private sector marketplace will sort out the system's problems, but all the evidence is to the contrary. We have a multitiered health care system that is not sustainable. It is filled with inequities and waste and falls far short of what is possible and needed for the nation. Corporatization of health care now dominates the health care landscape and has become the problem rather than a solution."

Comment: In "Health Care in America," Dr. Geyman has masterfully assembled the current literature on the status of our health care system, especially its failures in access, quality, and cost containment. It is a sad story.

But then he discusses the options available. Quoting Dr. Geyman, "Both near-term and long-term scenarios are unhealthy unless incrementalism is abandoned as ineffective and a national effort launched toward systemic reform. Some oxen in the commons oppose that level of reform and need to be gored (even if a sacred cow) if they stand in the way of the reform required to assure universal access to cost-effective care of the best quality achievable within available resources."

"Health Care in America" is an excellent resource for organizing thoughts and updating our perceptions of the health care system in the United States. It is also an invaluable academic reference for facts about our ailing system. Information on this text is available at the website of the publisher, Butterworth-Heinemann:

http://www.bhusa.com and under "Medical and Health Professions" click "Primary Care," and then click on the title, "Health Care in America - Can Our Ailing System Be Healed?"

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This requires a political strategy. The insurance industry will fight it every step of the way. So many reputable organizations like League of Women Voters, AAUW, AARP, Neighbor to Neighbor, and organized Labor would be willing to work on reaching a consensus on a national health plan. You have your 10 million right there. Once consensus is reached you storm the doors of Congress and the White House. It took the League 2 years to reach consensus on universal health care which states:

(Please go to this link for the position of the League of Women Voters: http://www.lwv.org/where/creating/healthcare_read.html)

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I agree with Dr. LeBow. I was waiting for the other shoe to drop. One of my professors once said, "Don't let analysis lead to paralysis." What would it take for the National Coalition on Health Care to address the issue of achieving universal health care in the United States?

Aaron Beckerman

Professor Emeritus Yeshiva University

Adjunct Associate Professor of Medicine New York University Medical Center

Philip Pollner, M.D. and Nancy Wooten, Ph.D. of Unity for NHI (national health insurance) respond to Joel Miller ("A Perfect Storm") and to Robert LeBow's comments:

While we are trying, as we have for decades, to make single payer "marketable" to the kinds of organizations and individuals that Joel Miller represents, it would be far better (and probably easier) without "an appearance of some private sector involvement" to market it to those who have the most to gain - the uninsured, underinsured and even the insured who have witnessed the dark side of the present health care system. It would, as a colleague has stated, take only ten minutes to empower such individuals to agree. If only ten million of them were mobilized nationally, our movement would have three times the membership of the powerful NRA (3.5 million members); at those numbers and political clout we would finally achieve our goal. Unity for NHI is struggling to reach out to educate and empower large numbers of the grassroots into a formidable voting bloc. We need the support of all of those activists who wish to make the vision of universal health care a reality.

Philip Pollner, MD
Nancy Wooten, PhD

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Robert LeBow, M.D., a former president of Physicians for a National Health Program:

Joel Miller's essay is great. It gives much useful data and well thought-out projections. Its conclusions supporting universal coverage are succinct and right on. But its shortcoming, like that of the organization he works for, the National Coalition on Health Care, is that he states the obvious ("We need universal coverage for all the right reasons") but stops there. It's as if they all know what has to be done, but they're afraid to come out and say it.

When he says, "We must move towards a health system in which every American has health insurance coverage," is he endorsing "incremental" change? He must know, and we know, that unless we have universal coverage -- and not just tweaking this group or that group to increase the number of insured Americans -- none of what he's advocating for will happen. Risk avoidance will not go away. Profit-seeking and high administrative costs will continue. The most vulnerable will continue to be the most vulnerable. Costs will not be controlled.

So why doesn't he...and the organization he represents...finally come out and say it? We need one risk pool with everybody in and nobody out. The euphemistic way of saying single payer or its equivalent. Maybe we need to find some way of getting people to accept single payer for what it is by giving it an appearance of some private sector involvement so it's more marketable to people and groups that make up the kinds of organizations that Joel Miller represents. They're good people, but I get the feeling their hands are tied. It would be wonderful if the National Coalition on Health Care could come out and say what they know has to happen to solve the dilemma of health care in America.

Bob LeBow

Professor Theodore Marmor responds to Professor James Robinson (Nov. 20 quote - the end of managed care and the introduction of consumerism, which "consumers will hate"):

I agree with your reaction, Don. This commentary is in most ways a comment of nihilism.

TED

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National Coalition on Health Care
November 15, 2001
by Joel E. Miller, Director of Policy

"What we are about to witness is a fundamental sea change with the storm's aftermath leaving a significant number of middle-class people uninsured in the foreseeable future. In 2000, health insurance coverage rates decreased for those with household incomes between $50,000 and $75,000. This drop occurred during good economic times. With the economy in a recession, this drop for middle-income people will become even more pronounced."

"A sustained recession over the next few years would very likely exacerbate the decline in employer-based coverage. In the absence of government or private sector intervention, the erosion of employer-based health insurance coverage will be significant. The situation will not self-correct. We need to protect all Americans who are in the storm's path. Steps must be taken to ensure that the number of uninsured Americans does not increase, and instead is reduced over time. We must move towards a health system in which EVERY American has health insurance coverage, health care costs are contained, and quality of care is assured."

"The three major problems plaguing our health system today - mounting costs, the growing number of uninsured, uneven quality of care - are interrelated. Without universal coverage, you cannot assure equity or quality, and in the absence of quality, you cannot contain costs. In addition, without universal coverage you can neither make the system less complex administratively, control costs, stop risk selection and cost-shifting, achieve a level playing field of equitable financing, or create a truly competitive market-based system. It is thus a vicious cycle."

http://www.nchc.org/APerfectStorm.pdf

Comment: We have seen the numerous analyses of health care coverage and costs, and we have seen the gloomy predictions. Joel Miller has assembled these current studies and forecasts and has weaved them into a rousing treatise using the appropriate analogy of "A Perfect Storm," with the antecedent calm, the storm, the tidal wave, the sea change, and finally the need for a safe harbor of health insurance. It is a tragic story up to this point, but it has not ended. He shows us that we still can find the safe harbor of universal coverage.

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California Medical Association Fifth Annual Leadership Academy
La Quinta, CA
November 16-18, 2001

James C. Robinson, PhD, MPH, Professor of Health Economics, UC Berkeley:

"I think that we are heading into a more consumer driven system... Why? Because the other four candidates - government, employer, insurer, and physician organization - have all bailed... In the end, it is going to be the consumer who is going to have to make the decisions of who gets what and how much am I going to pay? Insurance is going to have a role in that, but clearly we're going to be placing a lot of this on the consumer, and that's going to be problematic. Some consumers are great decision makers. Some consumers have disposable income. Others are lousy decision makers. Others are in a coma. You know, they don't fit the profile of a shopper that well. This is no one's idea of a perfect system. There is no happy ending to this story."

Question from audience: "... I'm interested to find out what your theory is on medical savings accounts where the individual takes responsibility for their own health care."

Prof. Robinson: "What about MSAs? More broadly, the notion of the consumer paying more out of pocket. I do believe that it is going to be a major part of our system going forward. Deductibles are rising like crazy. The big new Aetna product - the high deductible MSA-type product... This is happening very, very fast. This is considered part of consumerism. I think that consumers are going to hate consumerism... I think that deductibles can be really good. All of us should be more cost conscious. But the problem is that they discriminate against the poor, against the sick. Aside from that, they're great."

Comment: Our next great experiment in health care funding is consumerism, and consumers are going to hate it. And yet we will continue to discriminate against the poor and sick. Do we really have to complete this experiment which we already know is doomed to fail? Instead, can't we just go ahead now and introduce equity into health care by adopting a publicly administered program of universal health insurance? If, in advance, we agree to maintain our current generous level of funding, patients would emphatically support our system. And, after all, isn't health care really about patients?

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California Medical Association Fifth Annual Leadership Academy
Creating the Future of Health Care
La Quinta, CA
November 16-18, 2001

Dee Hock, Founder and CEO Emeritus, VISA International, and Founder, The Chaordic Commons:

"Only with the evolution of a self-organizing, Chaordic, transcendent organization in which all parties have an appropriate voice in governance --in which the whole does not control the parts and the parts do not control the whole -- in which competition and cooperation are harmoniously blended -- in which public and private entities are seamlessly related --can order emerge and a universal, effective, low-cost system of health evolve. Such a governance structure could be put in place within two years, could extend nationwide within five and expand globally within a few more."

"It is far too late and things are far too bad for pessimism."

http://www.chaordic.org/

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USA Today
November 16, 2001

USA TODAY commentary writers Ted Halstead and Michael Lind make the claim that the war on terrorism calls for shifting the responsibility for health insurance to the individual and that a single universal plan should be avoided (''Lack of health care for all creates U.S. security risk,'' The Forum, Monday).

Their organization, the New America Foundation, supports the crafting of new public-policy solutions for our social ills. Shifting health-insurance purchasing from the employer to the employee might be new, but relying on the fragmented, inefficient and ineffective health-plan marketplace is a stale solution that should be discarded.

Private market approaches have failed to control costs and have fallen short of improving coverage. Even worse, current trends are to shift more of the costs on to patients, exposing them to even greater financial risk.

We already have excess capacity in our health-care system. But access to health care is impaired due to financial barriers and will only grow worse.

If we were to eliminate the egregious waste of the private plans, the financial resources currently directed to health care would be enough to pay for comprehensive care for everyone.

Publicly funded universal health insurance would solve the problems that have been compounded by perverse incentives in the market. Everyone would have health-care coverage, and costs would be contained by a public system that would require value for our health care investment.

Don R. McCanne, M.D. President-elect, Physicians for a National Health Program

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AMNews
November 19, 2001
by Markian Hawryluk

The Centers for Medicare & Medicaid Services announced Nov. 1 that the conversion factor used to calculate payments to physicians would decline by 5.4%.

Unlike payments for hospitals or other providers for which Medicare's annual updates allow some government discretion, physician payment is updated based on a set formula. In essence, CMS must simply input the numbers and arrive at an answer.

Unlike payments for hospitals or other providers for which Medicare's annual updates allow some government discretion, physician payment is updated based on a set formula. In essence, CMS must simply input the numbers and arrive at an answer.

The self-correcting nature of the formula is primarily responsible for the impending reduction. The formula updates payments on the basis of estimated changes in physician costs. But the update only equals the estimated change if actual spending is equal to a target -- the sustainable growth rate.

The target is based on four things: gross domestic product, enrollment in the traditional Medicare program, input prices, and spending due to new laws or regulations. If actual spending misses the target, the next year's update must be raised or lowered to bring spending in line. This year, revisions to previous year estimates of GDP, increases in physician spending and the economic slowdown have all added up to a large negative update.

http://www.ama-assn.org/sci-pubs/amnews/pick_01/gvl11119.htm

Comment: Medicare has led the way in slowing the rate of inflation in health care, using fee controls designed to reflect the real costs of delivering care. Private managed care health plans followed with measures that excessively squeezed profits and drove many physician groups into bankruptcy. Medicare's formula was designed to assure adequate compensation for physicians while still providing value for the taxpayer. Private health plans were strictly bottom line oriented, ignoring the threat to the fiscal stability of the medical profession.

Although Medicare's efforts were more noble, they didn't quite get it right. Although a 5.4 % decrease doesn't look like much, it can be disastrous. Keep in mind that overhead expenses are relatively fixed for solo and small group medical practices. The percentage change affects primarily the net income of the physicians. Thus a 5.4 % decrease in fees may translate into a 10 % or 15 % decrease in take-home pay. If similar adjustments were to occur in consecutive years (unlikely but not impossible), the implications are obvious. Using physicians' net income as the ultimate adjustment for the "sustainable growth rate" places on physicians too much of the burden of health care inflation control.

Private health plans have wreaked financial havoc without containing costs. They have to go. Universal insurance holds the promise of containing costs through global budgets and negotiation of provider rates. Although the formulas used by Medicare are rational, they create excessive instability of physician income. Negotiation must be added to the process. But allowing physician negotiation in our fragmented system could threaten further disruption of delivery of health care services (beyond that of contract terminations and bankruptcies). On the other hand, a universal program of public insurance should strive for equity in rate setting by adding negotiation to the process. Physicians would be protected from excessive decreases during unfavorable years, and the taxpayers would be protected from excessive physician compensation in more favorable years.

Does anyone in America oppose equity, or fairness, in the funding and delivery of health care? Then why aren't we moving ahead with reform that would establish equity?

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eHealth Institute
November 14-16, 2001 Aptos, CA

Convened by the nonprofit eHealth Institute, the Developers' Summit is the only national meeting that is solely focused on issues of importance to eHealth application developers.

Objectives: The eHealth Developers' Summit seeks to catalyze the sustainable development, adoption, and dissemination of effective eHealth tools by leveraging the collective expertise and vision of the most respected eHealth developers in the world. The Summit will:

1. Identify solutions for sustainable development and implementation of effective eHealth applications; 2. Enhance communication and collaboration among developers and other stakeholders; and 3. Provide a unique networking opportunity that fosters business relationships and collaborations among developers from commercial entities, academia, government and the nonprofit sector.

Invitation Only Attendance is by invitation only and limited to about 100 people. Invitees are chosen on the basis of their direct involvement in eHealth development and their potential impact on the field. Institutions that will be represented at the Summit include technology and health-related corporations, small businesses, academic institutions, health care organizations, investors, foundations, non-profit organizations, government agencies, and health care purchasers and payers.

Access a Detailed agenda for the meeting: Log in to the eHealth Summit 2001 Participants Only Site Provide your Email Address & Password

Participant directory: Log in to the eHealth Summit 2001 Participants Only Site Provide your Email Address & Password

http://www.ehealthinstitute.org/summit/index.cfm

Comment: eHealth Institute is a private, charitable organization with a mission of seeking to "explore ways to use emerging information and communication technologies to improve the health and well being of all people, including the underserved."

Inevitably, information technology will play a very major role in the future of our health care system. The industry is rapidly developing innovations that will bring us significant improvements in efficiency, error reduction, communication, quality enhancement, and other benefits of health care applications. The problem is that the private sector is designing systems that will maximize their access to the $1.4 trillion dedicated to health care today. If you believe that private health plans have been draining funds that should go to patient care, just wait until you see what this industry has in mind.

A very important summit on this topic is now being held, as the excerpts from the announcement above indicate. The secrecy of both the agenda and the list of invited-only attendees brings back unpleasant memories of the secret sessions during the planning of the failed Clinton health care reform proposal.

It is essential that such summits be held. But it is also essential that eHealth be developed in an environment that encourages value while enhancing our health care system, rather than an environment that is designed to develop methods of diverting funds away from patient care. It is essential that public policies in health care information technology be developed immediately, and that the NIH be enlisted to supervise the development of the technology in the public domain. Only with that approach can we be assured that we will be receiving value for our investment.

Those who believe that a public process will stifle technological development must also accept the belief that this industry will walk away from their rightful share of a $1.4 trillion health care budget. They will see to it that they get their share, and the public will see to it that we receive value.

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HEALTH AFFAIRS
Web Exclusive
November 13, 2001
by Robert J. Blendon, et al

"In contrast to health problems, health care issues have become less salient to the public. This is likely to lead to decreased support for government action on health care issues that were being debated by the Congress before September 11. These include Medicare reform, a Medicare prescription drug benefit, patients' rights legislation, and coverage for the uninsured.

"How long these opinion changes last and what direction they take in the future depend upon three critical yet unknown factors: the occurrence and severity of new domestic terrorist attacks; the duration and success of the war in Afghanistan; and the duration and depth of the economic recession."

http://www.healthaffairs.org/

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Dear Health Care Activists,

Most Members of Congress do not have a clear picture of how being uninsured and underinsured impacts the family or individual. This is a major problem. They think that an uninsured individual can receive their health care in an emergency room or a community clinic. Until members of Congress start receiving phone calls and letters from constituents who are angry and sick and tired of the American health care system, this is going to be a long and protracted struggle. We have to bring the pain and misery of this health care system into the Congress now! We need more stories like the one from Carol Gross; Cong. Conyers will put them on his web-site.

I know what it is like to be uninsured---- I used to raise money from friends, relatives, co-workers,and strangers whenever my medical equipment for sleep apnea broke down during the night. Blue Cross Blue Shield would not cover my equipment costs and various medical procedures for sleep apnea because it was a pre-existing condition, or it was experimental surgery. I have been kicked out of hospitals, once one day after major knee surgery because I did not have health insurance. I was often denied treatment for sleep apnea and prostate problems because I had unpaid medical bills. I owe over $80,000 in medical bills. My credit is shot--I cannot buy a car, a cell phone, or an apartment without somebody giving me a loan. My mother who is 72, has no money, because it went to all of my medical bills since I was 18 years old. She is totally stressed out because of her financial situation. This is the reality of our health care system!!

There are millions of Americans, especially senior citizens, who have chronic illnesses or are handicapped, and cannot afford quality treatment. There are millions that cannot afford private health insurance, and want decent coverage. We must organize these individuals and families. This can be done only if there is a grassroots organization with affiliates across the country, who can organize these folks into a strong and vocal movement for universal health care.

Sincerely,

Joel Segal Legislative Assistant Rep. John Conyers, Chair, Congressional Universal Health Care Task Force

Posted by pnhp at 12:00 PM | Permalink | Comments (1)

"Please keep on advocating for a national health plan. My husband and I both worked and paid for health insurance for many years and never really accessed those benefits until he became very ill with early-onset Parkinson's disease. Now, in order for him to be able to move, eat and speak, it takes up to $1500 a month in medications. We now live on one instead of two paychecks. It has become increasingly difficult for us to cover his medical costs even with having two private policies and Medicare. We are far more fortunate than some because I also am a working professional. Our out-of-pocket costs for medical services take nearly one-half of our annual income. If things keep on getting worse we will have to just become poor enough that we quit even trying to pay our own way. It seems that only the poor and the rich have any secure health benefits, and almost everyone can be touched by a health care crisis without out any real safety net of protection, no matter how long they've contributed. When they actually need the services they may no longer be available to them. The truth about health care is shocking."

Comment: Medicare and two private policies. And yet out-of-pocket medical expenses are nearly half of Mr. & Mrs. Gross' annual income. What has happened to the security of health care coverage?

The fact that we are tolerating the exclusion of 40 million from health care coverage is a national disgrace. But the explosion in under-insurance now threatens access to care for most of the rest of us. Private health plans are rapidly shifting more and more of the burden to the beneficiaries. The deficiencies in coverage under Medicare have long been recognized, creating a market for private Medigap and Medicare + Choice options. But these too are becoming less effective in covering out-of-pocket expenses.

The effort to gain coverage for the uninsured is only part of the battle. There is urgency in reversing the trend to "empower" patients by making care unaffordable, a market "solution" that can negatively impact all of us. Mrs. Gross is right. Only the wealthy, who are able to fund all of their needs, and the poor, who have access to under-funded public programs, can be assured that there will be no financial barriers to care. Those of the rest of us that are healthy may be complacent, but, in spite of our coverage, we may be one major illness or injury away from a serious financial hardship

For a nation that prides itself on its ingenuity, it is astounding that we accept this shameful state of our health care system that is deteriorating further before us. It does not require a genius economist to recognize that the $1.4 trillion we spend on health care is enough to provide comprehensive care for everyone. Why do we stubbornly continue to support our ineffective, wasteful, fragmented system of private health plans when a public program of universal health insurance would solve our problems? Mr. & Mrs. Gross and all of the rest of us deserve much more value for our health care investment than we currently are receiving.

And I especially want to thank Carol Gross for agreeing to share their story with us. I pray that she will inspire us to act.

Don

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American Medical News
November 12, 2001
by Cheryl Jackson, AMNews staff

Would you like to know, right when they walk in the door, if patients can pay you?

TransUnion LLC, a consumer credit information service headquartered in Chicago, and Englewood, Colo.-based Quovadx Inc., a software company, last month began offering ExpressCheck.

The system provides credit scores, which hospitals and doctors can use to determine payment arrangements. It follows the lead of Atlanta-based Equifax Inc., which last year began offering a similar product.

TransUnion's pitch: Hospitals and physicians will need to use such systems more often as patients become responsible for bigger shares of their medical bills.

Physicians and hospitals feeling the pressure from lower reimbursement rates have started honing in on billing inefficiencies. Managed care has reduced revenues, and in response to rising premiums, employers have pushed more of the costs on to workers, who are facing bigger deductibles and co-payments.

Having the credit history upfront can help a physician practice or a hospital in developing adequate payment plans, Smith said (Neal Smith, national sales manager for TransUnion). If a patient's credit history is poor, for example, the facility might insist on payment upfront for an elective procedure.

Brenda St. Pe-Bruno, vice president of sales for Equifax:

"Physicians every day are starting to come to us for access. The large physician groups are very interested. Even your onesies and twosies doctors' offices are interested in using it."

http://www.ama-assn.org/sci-pubs/amnews/pick_01/bisc1112.htm

Comment: As the numbers of uninsured continue to increase, the leadership of the American Medical Association is supporting defined contribution approaches that include medical savings accounts, tax credits, and greater cost sharing to empower the patient as a health care shopper. These policies are impairing access for the insured by making out-of-pocket expenses unaffordable. Underinsurance is growing at an even greater rate than the growth of the uninsured. It is heartbreaking for physicians with traditional values to see the profession responding today by adopting rapid credit checks that will protect the physician from the uninsured and underinsured. Isn't it time for the AMA leadership to begin supporting policies that will protect patients from health care debts that impair access to care? A comprehensive program of universal health insurance would serve us all just fine, physicians and patients alike.

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Amicore Press Release
October 10, 2001

"New York, October 10, 2001 - Pfizer, IBM and Microsoft today announced the launch of Amicore, a newly formed independent software and services company providing workflow and connectivity solutions to office-based physicians. Amicore's focus will be to reduce the administrative workload and paperwork for physicians, allowing them to dedicate more time toward their mission of providing quality patient care."

David Lubinski, Public Sector and Healthcare general manager, Enterprise Sales and Industry Group at Microsoft:

"Microsoft is committed to helping the healthcare industry and its providers reduce paperwork and streamline the practice of medicine. The Microsoft® .Net technology platform will enable physicians to practice medicine any time, any place, on any device."

http://www.amicore.com/press.html

Comment: Heads up! This may be the most important development in health care of this decade. But there has been virtual silence from the health policy community since this press release of a month ago. Why should we be concerned?

The current model of using private health plans to allocate our abundant health care resources has been a miserable failure. The health plans have been riddled with administrative waste, have failed to assure equitable access to care, and have failed to contain runaway health care costs. Because they have created instability in the health care delivery system, major changes are absolutely inevitable. Health plans as we know them are history.

Current functions of health plans include risk pooling, administration and management (managed care), and information management. What will happen to these roles?

Health plans already are abandoning risk pooling as they pass risk on to their beneficiaries, thereby compounding issues of access due to lack of affordability. Risk pooling works well in the public sector, as has been proven by the Medicare program, and it is inevitable that most, if not all, risk pooling will end up in the public sector. Health plans will be relieved of their risk pooling function.

The private health plans have been egregiously wasteful in the administration of their programs, diverting tremendous resources away from patient care and into their own industry. Managed care's greatest success has been in controlling fees through contracting. But that is a function that has been very effectively applied by the public sector, as witness the Medicare program. Other effective managed care tools also can be utilized by public programs with appropriate enabling legislation. In the future, health plans will be relieved of their role in managing care.

But information management holds the promise of improving efficiency, improving quality, reducing error, identifying and improving best practices resulting in better outcomes, improving both controlled access and confidentiality of patient information, and endless other applications that will make our great health care delivery system even better and more efficient. This was the new promise of health plans. But when they were flush with funds, they failed to deliver on this promise, preferring instead to concentrate on a simpler business model of improving profits. They now have one option left. They can metamorphose into information management vendors, or they can step aside while others fulfill this role.

That leads us to today's quote. Microsoft, IBM and Pfizer did not become the companies they are by simply concentrating on the bottom line. They have been astute at recognizing products and services that not only have broad appeal, their products and services have become essential in today's world. Just imagine the role of health care information technology once it has matured. To say that it will be essential to our health care delivery system is a world class understatement! If you think Bill Gates is wealthy now....

Why hasn't the health care system moved into the IT (information technology) age? There are plenty of application service providers with their networks of providers and vendors. But their IT packages have been too expensive. There has been a reluctance to move beyond simple business office management and claims management, partly because of the high cost, and partly because of the fear of rapid obsolescence and concern about the failure to adequately integrate with other IT applications that will be necessary to realize the full potential of IT in health care.

Does IT in health care have to be expensive? When you look at the low cost of today's very powerful home computers, and the low cost of the software and the negligible costs of accessing the Internet, you realize that much can be done at very little expense. The market should be able to provide the computer power needed for an integrated technology system with only a negligible drain on our health care resources. The anticipated value should be much greater than the costs.

The actual costs of developing software than can process medical records is very low. The high charges result from the proprietary interests that continue to profit from ownership and licensing of the software. The public sector could contract for development of the required software, not only for medical records but for all health care IT applications, and then move that software into the public domain. The costs would be a minute fraction of what the industry has in mind. And the public would be receiving great value for its extremely modest investment.

Information management services probably should be provided by vendors in the private sector at contracted rates that provide value for the public dollar. This would be analogous to the entities that currently provide claims processing for the Medicare program. There is plenty of opportunity for the IT industry to establish successful business models that also will create value for all of us, but without repeating the model of the health plans that were designed to suck the resources out of the health care system.

In the future we will most likely continue with our existing private and public health care delivery system, but we will move our risk pools into the public sector, and we will serve the system with a modern, integrated, information technology system.

The policy issue? The health care information technology system probably should be developed and serviced by the private sector, but the funding and policies should be established by the public sector, assuring value for our public dollars, and assuring that the information technology resources will have a mission of improving health care for everyone, instead of a mission of enhancing personal megawealth.

From "Networking Health," by the Committee on Enhancing the Internet for Health Applications: Technical Requirements and Implementation Strategies, National Research Council (National Academy Press):

"A Final Word"

"The recommendations offered above are intended to set the nation on a course that will ensure that technology, organizational practices, and public policies converge in ways that will lead to broader deployment of Internet-based systems in health applications."

Final comment: There is extreme urgency in establishing the public policies that need to be in place as the technology and health care organizational practices converge.

For those that are asleep, THERE IS EXTREME URGENCY IN ESTABLISHING THE PUBLIC POLICIES THAT NEED TO BE IN PLACE AS THE TECHNOLOGY AND HEALTH CARE ORGANIZATIONAL PRACTICES CONVERGE.

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Modern Healthcare
November 5, 2001
Washington Report
by Jonathan Gardner

"To help lure investors to healthcare, the Bush administration wants to make providing Medicare services a stable and moderately profitable business. The trouble is, it's Congress, not the administration, that turns Medicare's financial spigot on and off.

"Thomas Scully, administrator of the Centers for Medicare and Medicaid Services, says the boom-bust cycle in Medicare payments scares Wall Street away from the healthcare sector.

"So now he's proposing a different approach to give investors in the stock and bond markets more confidence in investing in healthcare providers and companies."

Bill Reiland, a principal with Morgan Stanley Dean Witter who runs high-yield healthcare research:

"`He (Scully) probably has a good intention and has a good objective, and I'm sure healthcare providers around the country rise up and cheer when he says that. The important question is, in five years will the administration have the same objectives? You don't know. You might not have the same administration."

http://www.modernhealthcare.com/currentissue/topten.php3?refid=7998&db=mh99up&published=20011105

Comment: Let us pray.

Sorry. I had intended to avoid political comments, believing that we all need to work together. But when Thomas Scully is more worried about the health of the health plans than he is about the health of the people of this nation, it is political.

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The Washington Post
November 6, 2001
by Melody Simmons

"Get ready. Those large packets beetling with details about health insurance re-enrollment will arrive soon, if they are not already on your nightstand nagging you for attention. And the bad news is, experts say that this year you really need to read them. Costs are going up and benefits are going down in nearly every plan, making this a lousy year to (go ahead, admit it) just put a check mark next to your current insurance plan and be done with it."

http://www.washingtonpost.com/wp-dyn/articles/A32938-2001Nov2.html

Comment: The remainder of the article discusses innumerable permutations and combinations of choices that must be made during the "open season" of the health plans. The "empowered consumer" is clearly the prey during this open season since the options available are specifically designed to shift more costs to the beneficiary. Increased cost shifting reduces affordability and consequently reduces access to care, the exact opposite of what our health policy should be.

Our current national health policies are specifically designed to perpetuate and enhance the health of health plans while neglecting the health of the patients. Let's place patients first by establishing one universal health plan that is specifically designed to assure access and affordability for everyone. The only loser would be the parasitic private health plans.

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Few would disagree that equity, or fairness, should be a goal of our health care system. Most of us want to see fairness in the way that we allocate our health care resources and fairness in the way that we fund our system.

For the uninsured and underinsured, the benefits of an equitable system of universal health insurance are obvious. Access to affordable health care would be assured. For the purchasers of health care, including employers, the government, and more affluent individuals, the adoption of publicly administered, universal insurance would provide mechanisms for containing health care costs, a goal that has been elusive for market based health plans. And, very importantly, it would assure the return of free choice of providers of health care. But, because of our progressive tax system, those taxpayers that fund a larger portion of our national budget understandably are concerned about the impact on their contribution to an equitable system that shifts more costs to higher income individuals. So is equity in health care good or bad for the affluent, especially business owners?

Equity is to be clearly distinguished from the unrealistic and inequitable goal of equality in health care. Equal access to cosmetic surgery, to penthouse suites in ivory tower medical centers, or to detrimental high technology interventions would waste resources and introduce inequity by forcing some to pay for such excessive services that are utilized by others. That would be unfair.

Of the two aspects of equity in health care, funding of care and allocation of resources, let's first look at equity in allocation. With our abundant health care resources, and with the excess capacity in our system, access to care should be available to everyone. But what care? Acute appendicitis, meningitis, a fractured hip, a heart attack, all require and would receive appropriate emergency services, regardless of how it is funded. Some preventive services, especially those with public health implications such as immunization programs, are, in general, readily accessible. On the other hand, management of chronic medical conditions, periodic screening for disorders with effective interventions, pharmaceuticals, and other beneficial services frequently are not accessible to those with limited funds or inadequate health care coverage, simply because of lack of affordability. In fact, this deficiency in our system is so great that, in spite of excess resources, of all industrialized nations we have the most inequitable mechanisms of allocating these resources.

What should be the basis of our decisions on allocation of our health care resources? Quite simply, services that prevent premature death and services that maintain or improve quality of life should be accessible to everyone in an equitable system. We currently have enough funds allocated to health care to assure equitable access to virtually all beneficial services for everyone. The inequities in allocation arise primarily from the financial barriers characteristic of our system, and usually not from barriers due to limited capacity.

The other issue of equity, funding of health care, is more complex than is commonly realized. What would be an equitable method of funding care? Fairness would dictate that each individual contributes his or her fair share, but that no person should suffer a financial hardship as a result of accessing the health care system. Since an equitable system would assure that the contribution of low-income individuals would be below the threshold of financial hardship, they would not be able to afford to contribute an equal amount as would higher income individuals. The result is that higher income individuals would be absorbing more costs than their sector would generate.

This concept of inequality in contributions to an equitable system has been a major stumbling block to enactment of health care reform. Inevitably, there is fear that a public funding system, whether through a tax or a premium, would "unfairly" burden higher income individuals, an irony since, in this instance, equity is falsely perceived as being unfair. The affluent sector has been successful in assuring that equitable systems are not adopted because of the distributive tax policies involved.

We currently have enough funds dedicated to our health care system, but is that funding equitable? Half of health care dollars already pass through the hands of the federal government, primarily collected as payroll taxes and general tax revenues. Payroll taxes are at a fixed percentage, creating a greater tax burden for low-income individuals who have little, if any, disposable income, and often do not have enough income to meet their most basic needs. Thus payroll taxes can be inequitable. Although general tax rates theoretically are set at levels that establish equity through their progressive bracketing, the perception of equity varies with the prevailing political element in control.

Health plan premiums tend to be inequitable. Those paying the premiums are paying costs that have been shifted to them from those that are not paying the full costs of the services they have received, even though they may be capable of doing so. Those paying premiums also are paying for expensive health plan bureaucracies that are not providing value for the health care dollars they consume. In addition, premiums "assigned" to lower income employees, whether nominally paid by the employer or the employee, constitute a significantly larger percentage of their net income than do the premiums paid on behalf of higher income employees, a gross inequity. Further, for employment-linked insurance plans, the tax system provides greater implicit discounts for higher income individuals than for those with lower incomes. This regressive tax policy is highly inequitable.

And then there is the hidden burden of funding health care through mechanisms that are often not considered when calculating the nation's health care costs. As examples, we should consider the added costs of the medical component of homeowners' policies, auto insurance, workers' compensation insurance, and malpractice and other liability coverage. Contributions to medical charities are part of the funding, but the deductibility also shifts the tax burden to others. A much greater shift of the tax burden occurs with established tax policies such as the tax deductibility of employer provided insurance. Funding of community clinics also may increase local taxes. The products that we purchase include added health care related costs of the businesses involved. Several of these more obscure funding sources overlap, shifting costs to a degree that it is sometimes difficult to know who is paying what in health care. But they all perpetuate significant inequities in the overall funding of our health care system.

Thus, besides the inequity of our allocation of resources, the funding of health care in the United States is the least equitable of all other industrialized nations. Those relatively affluent individuals that are concerned about the inequality of an equitable system of funding care should look more closely at the much greater inequalities of the inequitable system that we now have. Unequal equity certainly is better than unequal inequity.

Without changing our health care delivery system, and without increasing the financial resources dedicated to health care, we can bring equity to the funding of health care, and we can bring equity to the allocation of those health care resources that provide value. Equity would be realized by the simple measure of adopting a publicly administered program of universal health insurance.

Don McCanne

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November 2, 2001
By Robert F. Smith, Herald Correspondent

BELLOWS FALLS — Single-payer universal health coverage could save Vermonters more than $118 million a year over current medical insurance costs and cover every Vermonter in the process, according to a new report.

The study, paid for by a federal grant and prepared for the Office of Vermont Health Access by John Sheils and Randall Haught of the Lewin Group, was the center of discussion Thursday night during a Health Care for All forum. The forum was organized by Windham County Democratic Reps. Michael Obuchowski and Carolyn Partridge, and was held at the New Falls Cinema in Bellows Falls.

About 75 people attended, many of them local doctors, health-care practitioners, mental health counselors and politicians. Several spoke out in favor of the single-payer universal health coverage concept, and no one disputed its value.

The guest speaker was Dr. Deborah Richter, a family physician with the Cambridge, Vt., health center, who said the main problem with the U.S. health system is not that millions of citizens are uninsured or that it costs too much. The problem with the country’s health system is that it doesn’t really have a system, she said.

The U.S. has what she termed a “loose arrangement” that wastes billions of dollars in administrative costs created by the vast number of different health insurance companies offering various health plans and all requiring different types and amounts of paperwork.

“It’s cheaper to pay directly for the medical costs than to pay insurance premiums,” said Richter, who is a member of Physicians for a National Health Program. “Every other industrialized country realized this long ago.”

Several health professionals agreed that administrative costs had gotten out of hand. A woman who manages a clinic said that nearly every patient the clinic serves has a different kind of insurance coverage requiring its own special paperwork, and one mental health professional said she spends half of her working time filling out forms instead of treating patients.

Richter explained that 70 percent of health care costs are spent on just 10 percent of the population, while the majority of people, 80 percent, account for only 15 percent of health care costs. Healthcare administration, which involves mainly paperwork, overhead and bureaucracy expenses, is responsible for 24 percent of all healthcare costs she said. In the past 30 years there has been a 2500 percent increase in the number of healthcare administrators, while the number of healthcare practitioners - doctors and nurses - only increased by 159 percent during the same period.

The Lewin Report showed that under the current system, Vermont residents will spend $2.2 billion on health care in 2001. The report estimated that a single-payer program would provide coverage for everyone in the state — including the 51,000 estimated to be presently uninsured — and still save $118 million, mostly by reducing the administrative costs of health insurance programs.

Under a single-payer program health coverage would be paid for by a payroll or income tax. This arrangement would mean that taxpayers making less than $75,000 a year would see an average yearly decrease of more than $1,000 per family over current health insurance costs, while those earning $75,000 to $100,000 a year would see a nominal increase of about $58 over what they currently spend for insurance. Hardest hit would be families earning over $150,000 a year. Universal health coverage could cost them as much as $4,500 more per year.

Rockingham physician Dr. Matthew Peake asked Richter who in Vermont would oppose universal health care and such dramatic cuts in healthcare costs.

“Did you miss the parts about getting rid of insurance companies?” Richter replied. She said that universal health care administered by the state would eliminate the need for insurance companies, and these companies are very wealthy and influential.

“Every poll taken shows that two-thirds of the American people are in favor of this,” Richter said. “The problem is that insurance and pharmaceutical companies have more money than we do.” But Richter said that it is inevitable that universal insurance coverage will be adopted, and she said that she is confident Vermont will lead the way within the next five years.

And while there have been problems with the program in some countries, she said that Vermont and the nation could examine all the universal coverage programs now in use around the world and find out what has worked and what hasn’t.

The bottom line for Richter was that she felt single-payer universal coverage would allow her to concentrate on medicine and not on paperwork. “The good side of this is that I’d be able to focus on practicing medicine without having to worry if my patient could afford it,” she said.

Richter and several others at the forum agreed that the key to creating a national universal health care system was to educate the public on its benefits. “In general, this is a better deal for businesses,” she said, “and they know it. It’s common sense, and it makes business sense.”

For more information about universal healthcare, and especially how it affects Vermont, go to http://www.vthca.org.

Comment: Dr. Richter, a former president of Physicians for a National Health Program, is right on target when she is delivering her message to the business community. As with yesterday's Quote of the Day message, if business owners recognized the significant benefits of universal health insurance for both them and for their employees, then we would have a crucial ally in our efforts to bring equity to health care in America.

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The San Diego Union-Tribune
Oct. 30, 2001
"Threats expose health care problems"

By Jamie Court, Executive Director of the Foundation for Taxpayer and Consumer Rights, Kay McVay, President of the California Nurses Association, and Steve Thompson, Vice-President of the California Medical Association

"Employers believed that HMO control over medicine would reduce costs. Instead, employers have been bedeviled by the twin vices of double digit premium increases and increasing gripes from employees about obstacles to medical care. Employers concerned about the welfare of their employees face a market that allows them diminishing options for coverage, all gravitating to the lowest common denominator, and ever-increasing costs with no end in sight.

"In a deepening recession, businesses have been forced either to shift more or all of the payment burdens to their employees, making their companies less competitive and their employees more vulnerable, or have health care costs eat up their profits. Those businesses that cannot afford coverage will have far more concern for their workers' health in the post-Sept. 11 world than ever before."

"The time has come for employers to join physicians, nurses, hospitals and patient advocates in creating a model for health care that does not pit the private health care system against the public health system, but brings them together in a more rational way.

"The needs of the nation today demand better public controls over private health care delivery and dollars, both of which have run amok in recent years. Such public oversight over private health care could better direct resources to those in need, be they uninsured, underinsured or innocent victims of a terrorist attack. The irony is that such genuine public management of care and cost would save money. Preventing illness is the most cost effective way to treat it, and today's mismanaged system has failed miserably on this account as well.

"Our groups have reached out to corporations with an employer survey (http://www.businesshealthsurvey.org) that seeks businesses' views on health care. If any good in health care is to come from the rubble of Sept. 11, it will only happen when employers, doctors, nurses, patients and hospitals come together to make it happen."

For the full article: http://pqasb.pqarchiver.com/sandiego/index.html (enter title, Threats expose health care problems, into the search box)

Comment: To understand the significance of this breakthrough in the health care reform movement, you must visit the website listed above: http://www.businesshealthsurvey.org. This is a cooperative effort of the American Small Business Alliance, the California Nurses Association, the California Medical Association, and the Foundation for Taxpayer and Consumer Rights. These are mainstream organizations representing business, consumers, nurses and physicians.

Perhaps the most important item on the website is the fact sheet, "Why Businesses Should Care About Universal Health Care." Business owners do care. The fact sheet provides them with a rational basis for reform that will assure the health security of their employees, while providing significant benefits for the employers themselves. This page should be downloaded and distributed widely to business interests. It is available at: http://www.businesshealthsurvey.org/factsheet1.html

Posted by pnhp at 12:00 PM | Permalink | Comments (0)

November 2, 2001
By ROBERT F. SMITH
Herald Correspondent

BELLOWS FALLS Single-payer universal health coverage could save Vermonters more than $118 million a year over current medical insurance costs and cover every Vermonter in the process, according to a new report. The study, paid for by a federal grant and prepared for the Office of Vermont Health Access by John Shells and Random Haughty of the Lewis Group, was the center of discussion Thursday night during a Health Care for All forum. The forum was organized by Windham County Democratic Reps. Michael Obuchowski and Carolyn Partridge, and was held at the New Falls Cinema in Bellows Falls.

About 75 people attended, many of them local doctors, health-care practitioners, mental health counselors and politicians. Several spoke out in favor of the single-payer universal health coverage concept, and no one disputed its value. The guest speaker was Dr. Deborah Richter, a family physician with the Cambridge, Vt., health center., who said the main problem with the U.S. health system is not that millions of citizens are uninsured or that it costs too much. The problem with the country's health system is that it doesn't really have a system, she said.

The U.S. has what she termed a 'loose arrangement' that wastes billions of dollars in administrative costs created by the vast number of different health insurance companies offering various health plans and all requiring different types and amounts of paperwork.

"It's cheaper to pay directly for the medical costs than to pay insurance premiums," said Richter, who is a member of Physicians for a National Health Program. "Every other industrialized country realized this long ago."

Several health professionals agreed that administrative costs had gotten out of hand. A woman who manages a clinic said that nearly every patient the clinic serves has a different kind of insurance coverage requiring its own special paperwork, and one mental health professional said she spends half of her working time filling out forms instead of treating patients.

Richter explained that 70 percent of health care costs are spent on just 10 percent of the population, while the majority of people, 80 percent, account for only 15 percent of health care costs. Healthcare administration, which involves mainly paperwork, overhead and bureaucracy expenses, is responsible for 24 percent of all healthcare costs she said. In the past 30 years there has been a 2500 percent increase in the number of healthcare administrators, while the number of healthcare practitioners - doctors and nurses - only increased by 159 percent during the same period. The Lewin Report showed that under the current system, Vermont residents will spend $2.2 billion on health care in 2001. The report estimated that a single-payer program would provide coverage for everyone in the state Ñ including the 51,000 estimated to be presently uninsured Ñ and still save $118 million, mostly by reducing the administrative costs of health insurance programs.

Under a single-payer program health coverage would be paid for by a payroll or income tax. This arrangement would mean that taxpayers making less than $75,000 a year would see an average yearly decrease of more than $1,000 per family over current health insurance costs, while those earning $75,000 to $100,000 a year would see a nominal increase of about $58 over what they currently spend for insurance. Hardest hit would be families earning over $150,000 a year. Universal health coverage could cost them as much as $4,500 more per year.

Rockingham physician Dr. Matthew Peake asked Richter who in Vermont would oppose universal health care and such dramatic cuts in healthcare costs.

"Did you miss the parts about getting rid of insurance companies?" Richter replied.

She said that universal health care administered by the state would eliminate the need for insurance companies, and these companies are very wealthy and influential.

"Every poll taken shows that two-thirds of the American people are in favor of this," Richter said. "The problem is that insurance and pharmaceutical companies have more money than we do."

But Richter said that it is inevitable that universal insurance coverage will be adopted, and she said that she is confident Vermont will lead the way within the next five years. And while there have been problems with the program in some countries, she said that Vermont and the nation could examine all the universal coverage programs now in use around the world and find out what has worked and what hasn't.

The bottom line for Richter was that she felt single-payer universal coverage would allow her to concentrate on medicine and not on paperwork.

"The good side of this is that I'd be able to focus on practicing medicine without having to worry if my patient could afford it," she said.

Richter and several others at the forum agreed that the key to creating a national universal health care system was to educate the public on its benefits.

"In general, this is a better deal for businesses," she said, "and they know it. It's common sense, and it makes business sense."

For more information about universal healthcare, and especially how it affects Vermont, go to http://www.vthca.org.

Posted by pnhp at 03:31 PM | Permalink | Comments (2)

The Washington Post
October 30, 2001

"Some Doctors Are Spurning Managed Care, Giving More Time -- and a Bigger Bill -- to Their Patients" by Marc Borbely

"Dorothy Faul, a librarian retired from the National Gallery of Art, received a 'Dear Patient' letter from her doctor in August that troubled her. Internist Jane Chretien announced that as of Sept. 1, she and Audrey Corson, her partner in Bethesda Physicians, would no longer participate in any health insurance plans."

"But for most of her patients, the change means having to pay in full, by cash, check or credit card, at the time of service. Then it's up to them to seek whatever reimbursement they can from their insurance company, should they choose, by submitting the itemized bill they get from their physician. Because Faul is a Medicare patient, she'll get a bit of a break: Her visit fees will be lower and her doctors are required to continue to file claims to Medicare for her; non-Medicare patients will be given the forms to file themselves."

"Bryan Arling and David Patterson on M Street, and Beth Unger and her 10 partners on New Mexico Avenue also accept no managed care outside of Medicare."

"Michael Newman, another internist at 2021 K St. NW, has also never had contracts with private managed care companies, though he emphasizes that he sees Medicare patients and will continue to do so."

http://www.washingtonpost.com/wp-dyn/articles/A8111-2001Oct29.html

Comment: So physician outrage with managed care has prompted many of them to refuse to accept contracts with private managed care companies. They are even willing to penalize their own patients with higher out-of-pocket expenses since they reject fee limits imposed by insurers, and insurers, in turn, penalize patients for receiving care from out-of-plan physicians. But isn't it ironic that these physicians, who reject fee controls and the other restrictions imposed by health plans, still accept Medicare?

What is there about Medicare that causes these renegade physicians to still accept the program? Many reasons can be given, but the fact remains that these physicians who are ardently opposed to private health plans still want to participate in our equitable, more efficient, publicly administered program of health care coverage that is universal for a given segment of our society. Obviously, they find some redeeming value in Medicare. If public insurance is good enough for the severest critics of our health care system, shouldn't it be good enough for all of us?

Posted by pnhp at 12:00 PM | Permalink | Comments (0)

Reuters

LOS ANGELES, Oct. 31 -- "Veteran Hollywood Reporter columnist George Christy quit the showbiz trade paper today after probes into health benefits he received from the Screen Actors Guild brought his integrity into question and ignited a management upheaval at his paper."

"Speculation centered on whether Christy, a sometime actor, was giving movie producers and others favorable mentions in his widely read column in return for being listed in film credits, thus qualifying for SAG benefits. Christy denied any wrongdoing."

http://www.washingtonpost.com/wp-dyn/articles/A21268-2001Oct31.html

Comment: Surely this nation can devise less devious methods of accessing health care coverage. George Christy would still be sitting at his desk if we had a publicly administered program of universal health insurance.

Posted by pnhp at 12:00 PM | Permalink | Comments (0)