News

On the need a pragmatic solution for the uninsured: "irreducible minimum, probably about 15 million":

Don and other Folks---Corlin has been misunderstood here. I talked with him. He supports doing SOMETHING to get as many people covered as possible, rather than waiting forever for a universal solution---which he nonetheless fully supports also. Please make sure Barbara (author of response) gets this too---I don't have an e-mail address for her.----Jack Lewin

Comment: Dr. Lewin is absolutely correct. Dr. Corlin has repeatedly stated that he supports covering the uninsured, and he supports expanding coverage through pragmatic approaches. The "Quote of the Day" messages are intended to provoke constructive thought on health policy issues facing us today. Dr. Corlin's isolated comment accomplished this, but failed to communicate the sincere dedication of Dr. Corlin to creating a better health care system for all of us.

But our concepts of pragmatism in health care reform are in sharp contrast. The difference can be illustrated by comparing the recent actions of the House of Delegates of the California Medical Association (a leader in influencing AMA policies) with the recent results of the California Health Care Options Project.

In March, 2002, the CMA House adopted a resolution (Report B-1-02) that "CMA participate in health care reform efforts by creating, convening and/or joining coalitions... whose purpose will be to create necessary national and state legislative packages designed to achieve health insurance coverage for all Californians." But in the same resolution, they called for establishing policy "supporting defined contributions," "expanded choices of health care financing," continuing to "provide charitable care," and combining "economic incentives and reasonable regulations."

The intent of the CMA House is quite apparent in the concomitantly adopted Resolution 209a-02, "Consumer-Driven Financing of Health Care." The CMA House resolved "That CMA assert a leadership role in the support, expansion, and design of consumer-driven and consumer-controlled health care financing programs that bring patient choice to health care financing such as Medical Savings Accounts, Flexible Savings Accounts, Personal Care Accounts, Health Freedom Accounts, Health Savings Accounts, and other versions of consumer-driven health care purchasing, and forward same for national action; and be it further resolved: That CMA assert a leadership role in the support, expansion, and design of refundable tax credit programs for the purchase of health insurance, and forward same for national action; and be it further resolved: That CMA work with California's Congressional delegation to support the right of all patients to use pre-tax dollars for the purchase of their medical care; and be it further resolved: That CMA help physicians bring such recommendations directly to our patients for their education and political support; and be it further resolved: That CMA work with the AMA to support federal legislation to provide a refundable tax credit for the purchase of catastrophic health insurance, consistent with Report B-1-02."

Conservative and progressive economists agree that these policies can never result in universal health care coverage and will erect greater financial barriers to care for precisely those individuals that have a greater need for care. Pragmatism? Solutions that control costs by preventing access to necessary care may be pragmatic, but they are also inhumane.

(Physicians for a National Health Program provided information to the Technical Advisory Committee of the CMA that produced the report on financing health care. Although the proposals of the Heritage Foundation were enthusiastically endorsed, PNHP's proposals were cursorily dismissed with the false statement that a single payer system could not control health care costs. Obviously, the committee did not understand the fundamentals of single payer reform since a major advantage of single payer is to establish a structural mechanism of containing costs in an equitable system. The only other possible conclusion is that the committee did understand the proposal but denied the truth because of their own ideology. Regardless, the CMA and AMA have a pressing need to inject more objectivity into their process.)

In contrast, our concept, a model supported by the results of the California Health Care Options Project, would provide comprehensive care to everyone and reduce costs. Pragmatic? The CMA calls for taking recommendations to patients for education and political support. Our position is that ALL models should be taken to all patients and potential patients for their education. Once they understand which model serves physicians well at the cost of health care access, and which model serves the public well with the benefit of access and coverage for all, then the public will tell us which is the "pragmatic" approach.

CMA resolutions: http://www.cmanet.org/upload/FinalB02.pdf

California Health Care Options Project: http://www.healthcareoptions.ca.gov/

LANDMARK STUDY OF OPTIONS FOR HEALTH CARE REFORM

The final results of the California Health Care Options Project have been posted: http://www.healthcareoptions.ca.gov/

Two page summaries of the nine options: http://www.healthcareoptions.ca.gov/final/Summaries_ALL%20040502.pdf

Cost and coverage analysis by the Lewin Group: http://www.healthcareoptions.ca.gov/final/CA%20Report%20-%20Medi-Cal.pdf

Qualitative analysis by AZA Consulting: http://www.healthcareoptions.ca.gov/docs/Final%20presentation%20document%201-22.pdf

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

"Harry, did you see this article on the California study on single payer?"

"Is that like that terrible Clinton plan?"

"No, honey. This one's really different. This study was done by reputable health policy researchers, including many from the University of California. It shows that absolutely everyone could have truly comprehensive health care while saving Californians billions in health care costs."

"Now Louise, that's impossible."

"No. Really. By replacing the hodgepodge of health plans with a single insurance program, enough administrative waste would be eliminated to pay for comprehensive health care for everyone. And we wouldn't be limited to that list of doctors that our current plan requires. We'd have free choice again."

"Wow. It sounds like the voters should be checking this out."

"And our legislators too."

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

The NHS reforms under Tony Blair go much farther than to make up for years of underfunding, which previous Prime Ministers denied was the case. Mr. Blair and Mr. Milburn have open acknowledged central flaws in the NHS that resulted from compromises that Bevan had to make to the medical profession in 1948, and they are rectifying them all.

Severe shortages in nearly every subspecialty are coming to an end. The lack of quality standards is being addressed more systematically than here. The coordination of training of all clinical staff is starting up (like the vision out of PEW in the 1990s here but unlikely to be realized). The hospital-centric system is being systematically transformed into the obverse, with community-based primary care as the center of the system and with GPs and community nurse teams holding the budgets for nearly all health care. These will be population-based and risk-adjusted, roughly what David Kindig envisions in Population-Based Purchasing (Wisconsin 1996). The waiting lists are being transformed. They will be taken away from consultants and coordinated through referral centers. Patients will be given appointments as much as possible. The conflicts of interest in the consultants' contract are being replaced with productivity-based terms. This is a reform I have been working to bring about for several years, and the Blair Government has accepted most of the recommended changes.

There are serious problems in implementing all this, but the design and vision are worth serious attention by anyone interested in a population-based, community-centered model of health care like that envisioned in the Dawson Report of 1920. I have written several short pieces on aspects of all this as I have worked on the reforms every quarter since 1990.

Don Light

Prof. Donald W. Light
Fax: 1-609-924-1830
Tel: 1-609-924-9220

AMA President Richard Corlin's insensitive remark on the uninsured provoked more responses than any prior "Quote of the Day" message. Barbara Rylko-Bauer eloquently expresses the innate emotional response that most of us felt on reading his words. My comments follow hers.

Barbara M. Rylko-Bauer:

Dear Don:

According to your "quote of the day," Dr. Richard Corlin, president of the AMA, during a trip to Cedar Rapids last week, was supposed to have said the following with regards to the uninsured:

"We need a pragmatic, not an ideological solution. Reduce the number from 39 million to its irreducible minimum, probably about 15 million, and consider that a victory and not a terrible tragedy."

If Dr. Corlin truly did say these very words, then I think that all responsible physicians should call for his resignation...for he has served medicine and the physicians he represents, as AMA president, very poorly, to say the least.

By responsible physicians I mean those :

* who consider that their role is not just to treat a disease that walks in the door, but also to be concerned about larger health care issues facing communities and populations,

* who are compassionate,

* who are concerned with what is happening in health care delivery in this country... NOT just in relation to how it affects medicine's autonomy, not just in relation to how it is affecting doctor-patient relations, not just in relation to how it affects their pocket book...(ALL valid things to be concerned about.)... but also in terms of how it is affecting the patients they are privileged to treat,

* and who are concerned about all the other people who ARE NOT patients because they have no real access to care.....in other words, those pesky uninsured folks that Dr. Corlin so readily dismisses.

Dr. Corlin should also do a little reading about the state of affairs of health care in the United States. He might discover that it's not just those 40 million that are the "problem." There are also another 40 million or so who are unstably insured (with gaps during the year) or underinsured. What, oh what, are we going to do with them?

Of course, the bigger question is why, in the wealthiest country in the world, which in the year 2000 spent $1.3 trillion on health care --- that averages to $4,637 per person....(but of course, not distributed evenly) --- we even have to be discussing problems like:

* the large and growing number of people who are uninsured,

* the fact that despite all our advanced biotechnology, we are plagued with serious safety and quality problems in health care delivery,

* the large racial and ethnic disparities in health care delivery,

* and the fact that our headlong race to embrace a market-oriented health care system (of which managed care is just one part) has undermined the "health care safety net" which so many of the poor and vulnerable populations rely on?

These are all topics that the prestigious Institute of Medicine of the National Academy of Science has been exploring. Within the last few years there have been in-depth reports published on all these topics. We are not talking here about some tangential problems, but rather things that are AT THE CORE of health care delivery in the United States. I would be happy to order copies of these for Dr. Corlin... to help him get "up to speed" about the state of affairs for health care in the United States.

I am not a physician. I have, however, studied U.S. health care for many years, as a social scientist. I am frankly astounded that in this day and age, a physician could so glibly erase 15 million people, could stand up and publicly say that if we got the numbers down to 15 million, we could pat ourselves on the back and say, "job well done." And then to have the insensitivity (and amorality) to consider that having ONLY 15 million uninsured would be a victory, not a tragedy...it boggles the mind. I am also, as a scholar-of-sorts, curious as to how he came to this magical number of 15 million as the "irreducible" denominator. Not from studying health care delivery in other industrialized countries; from where, then?

Dr. Corlin should do even more reading and find out WHO these uninsured folks are....

* he would find out that most of them are employed, hard-working citizens who are in lower paying jobs or with small firms that can't afford health insurance;

* he would find out that 5.9 million of them are mothers;

* he would find out that about 1/4 of them are children;

* he would find out that many of them are members of minority groups.

I would be willing to bet that herein lies one of Dr. Corlin's problems. I am looking at a picture of Dr. Corlin as I write...and I can tell you that he:

* is not one of the hard-working poor, not even one of the hard-working middle income Americans who simply can't afford health insurance,

* is not one of those 5.9 million mothers with small children,

* is not, obviously, a child,

* and is most likely not a member of a minority group.

Dr. Corlin can't relate to these folks. What I can't tell from the picture, but can tell from his remarks of last week, is that Dr. Corlin is not a true physician. And he has shamed his profession and his professional position with the irresponsible remarks he made in Cedar Rapids last week. He owes all the uninsured people of this country an apology....and he also owes one to the physicians he is supposed to be representing, as president of one of the major medical associations.

With Dr. Corlin at its head, organized medicine is beginning to look a bit like a ship adrift, these days. Doctors dropping Medicare, opting out of Medicaid, setting up boutique practices, complaining loudly about the abuses of managed care (and there certainly is plenty to complain about, that I agree with) but going along with the for-profit program for the most part, and largely remaining silent about the ways in which big business is shaping health care delivery for its own interests. Its time for more courageous, visionary leadership....and some better ideas for how to solve the problems of health care delivery in this country.

Sincerely,

Barbara Rylko-Bauer

Comment: Dr. Corlin's apparent insensitivity mandated responses such as Barbara's. But Dr. Corlin is not the evil person implied by his isolated comment. He is a very fine person, representing the best of the Hippocratic traditions in medicine. So how could he have made such an awful statement?

Health policies that the members of the AMA leadership support include tax credits, MSAs, shifting costs (risk) to individual patients, multiple health plan products (multi-tiered benefits), and eliminating the employment link for health insurance. Dr. Corlin is aware that these policies can never provide true universal coverage. His comment was based on his belief that the AMA policies are in the nation's interest, and that we have to accept the consequences of these "great" policies. We accept that employment rates will never be 100%, and, likewise, we should accept that health insurance coverage will never be 100%. From his perspective, his comment was a very benign remark on the realities of health care reform.

But what a remark! The AMA leaders are so sold on the righteousness of their approach that they cannot see the cruelty and inhumanity that would be inflicted on those for whom they should be leading the charge: the patients that are most in need of health care! The outrage expressed in response to Dr. Corlin's comment should bring the AMA Board of Trustees out from their board room to find out what the ruckus is about.

Actually, Dr. Corlin and other members of the AMA leadership, in their tours of the communities, are hearing more and more from many members of the medical profession that we should be taking a very serious look at single payer reform. It is time for the AMA and state and county medical associations to set aside their conservative political ideology and rhetoric, and place on the table all options for reform. It is essential that all policy implications be clearly understood and discussed objectively. The single payer model would provide equitable, comprehensive coverage for absolutely everyone while providing free choice of providers of care and controlling costs. The policies currently supported by the AMA would accomplish none of those goals. But they are goals truly worthy of pursuit.

Don McCanne

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

April 19, 2002
By David DeWitte

American Medical Association President Dr. Richard Corlin drop-kicked the notion that national health insurance will ever solve the health insurance crisis during a visit to Cedar Rapids on Thursday.

Finding a system that will cover all Americans is both costly and politically hamstrung, Corlin said.

Richard Corlin, M.D., AMA president:

"We need a pragmatic, not an ideological solution. Reduce the number from 39 million to its irreducible minimum, probably about 15 million, and consider that a victory and not a terrible tragedy."

http://www.gazetteonline.com

Comment: Dr. Corlin leaves virtually no doubt as to why Physicians for a National Health Program should supersede the American Medical Association as the legitimate physician organization representing the cause of health care justice.

From Karen Palmer, who is currently on a sabbatical at the World Health Organization in Switzerland, commenting on the findings of The Lewin Group in the California Health Care Options Project:

I was skimming through a textbook written by two of my colleagues here at WHO, and I came across this quote, which so supports the findings of the Lewin group. Maybe folks are starting to get the picture, which is so well-known in the rest of the world that it is part of a standard college level text book on public health:

"The United States of America epitomises the problems wealthy countries experience when public health is neglected. The major dilemma facing public health in the United States continues to be its relationship with the organisation and delivery of medical care services. Until a national and equitable system of medical care is achieved, public health will be neglected and receive an inadequate share of the vast resources devoted to "health" in the United States. The tremendous amount spent on medical care limits the availability of funds for a whole range of public services, not just public health."

Citation: "Public Health at the Crossroads: achievements and prospects" by Robert Beaglehole and Ruth Bonita, Cambridge University Press 1997.

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BBC News
April 17, 2002

Spending on the NHS in England will top £100 billion in five years time, Chancellor Gordon Brown has announced.

Mr. Brown has accepted the recommendations of the Wanless Report into the future needs of the health service.

Earlier, a report by former NatWest chief executive Derek Wanless had called for NHS spending to more than double by 2022.

Mr. Wanless said spending on the NHS should rise to £184 billion a year from £68 billion a year now.

His report said the health service had been underfunded by £200 billion over the last 30 years. He called for an initial five year period of high growth to catch up, followed by a lower level of sustained investment.

In his Budget speech, the Chancellor said spending would increase by an average of 7.4% in real terms for each of the next five years - in part funded by a 1% increase in national insurance contributions.

The projections in the report show the UK spending between 10.6% and 12.5% of GDP on health care by 2022. This compares with 7.7% today.

Mr. Brown dismissed calls for alternative funding methods for the health service. General taxation was the equitable option, he said.

Chancellor Gordon Brown:

"We now have the best chance in a generation to secure our national health service, not just for a year or two, but for the long term. The NHS is a British ideal, free at the point of need for everyone in every part of Britain."

http://news.bbc.co.uk/hi/english/health/newsid_1935000/1935730.stm

Comment: It looks like the opponents of universal health care in the United States won't have the British NHS to kick around anymore.

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April 22, 2002

Steve Scully interviewing Dr. Henry Simmons, President, National Coalition on Health Care:

Steve Scully: An e-mail form Don McCanne, who is a medical doctor and president of an organization called Physicians for a National Health Program: "Isn't it time to include the single payer model in the debates on reform?"

Dr. Henry Simmons: Oh, I think it's time to discuss a fair number of propositions. In fact, in Roll Call today, Morton Kondracke, the editor, made exactly that point. There are not a whole lot of different options available to this country to deal with this problem. There are some, and we've got to examine them all and see which one makes sense for us given the circumstance we find ourselves in now.

http://www.c-span.org/journal/

Roll Call April 22, 2002 Partial Fixes Won't Solve Crisis In Health Care Costs By Morton M. Kondracke

Surging health costs and insurance premiums - and increases in the number of uninsured Americans sure to follow - cry out for Washington politicians to begin thinking comprehensively about America's impending health care crisis.

One of these days, they will - ideally, as part of the 2004 election campaign. But for now, they are taking only piecemeal whacks at the problem.

Sometimes incrementalism in Washington produces good results, such as creation of the State Children's Health Insurance Program that widened Medicaid benefits for lower-income families.

But often it simply results in efforts by one group in the health care industry - say, doctors or hospitals - to get the upper hand over another, such as pharmaceutical or insurance companies.

(Kondracke discusses competing interests and then the CalPERS premium increases.)

Even CalPERS, which theoretically has huge bargaining power with health insurers and providers, has been unable to hold down costs. Most employers lack that power.

So CalPERS has joined the National Coalition on Health Care in urging a new comprehensive look at the health crisis - the first since the ill-fated 1993 Clinton health care plan. The group comprises business, labor, consumer and religious groups, and large-state pension plans.

President Henry Simmons says the group has no plan of its own, but that debate should start over three basic models. One is "play or pay," in which employers continue to provide most insurance coverage and would receive government help if they can't do so.

A second, favored by liberals during the 1993 debate, is a single-payer system in which all citizens would get their health insurance from Medicare or another government program.

The third, proposed by some Republicans, would impose an individual requirement on all citizens to have health insurance and offer government subsidies to those who can't afford it.

Democratic presidential contenders need to be heard on this issue soon, and they should pressure President Bush to be heard, too.

http://www.rollcall.com/pages/columns/kondracke/

National Coalition on Health Care: http://www.nchc.org/ (If you have not yet read Joel Miller's "A Perfect Storm," you must. It is available on the NCHC website.)

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

The New York Times
April 21, 2002

By Reuters

Britain's Prime Minister Tony Blair said Sunday his government's mission to overhaul public health care was a huge challenge and he would take the blame if it failed.

Opinion polls published Sunday suggested most Britons were ready to pay more for better health treatment.

But they also revealed a widespread belief that Blair had broken an election pledge not to raise income tax...

...Chancellor Gordon Brown hiked taxes last week to pump billions of extra pounds into the ailing National Health Service (NHS).

Wednesday, Brown outlined plans to pour an extra 40 billion pounds ($58 billion) into public health care over the next five years. Most of the money will come from taxes, with a one percentage rise in National Insurance -- a payroll tax -- right up the salary scale being the biggest revenue earner.

Blair has refused to rule out further tax rises but said the changes to the health services were covered by Brown's steps on Wednesday. He dismissed as "nonsense" accusations that his Labor government was returning to a "tax and spend" policy.

http://www.nytimes.com/reuters/world/international-britain-blair.html

Comment: Innumerable models have demonstrated that public funding and public administration can deliver more health services to more people for less money. But public funding has been a major weakness of the existing programs.

In the United States, our system of combining both public and private funding has resulted in the most generous health care funding of all nations, estimated to be 14.7% of our GDP for 2002 (Office of the Actuary of CMS). But we have seen that other nations that have relied on public funding have failed to provide enough resources to assure capacity that would prevent excessive queues for services. The British system has been frozen at 7% of their GDP, primarily because of political resistance to taxes. Apparently the administration of Prime Minister Blair has finally decided to confront the real issue. The National Health Service simply needs more tax revenue.

The lesson for the United States is that we must counter political efforts to isolate the concepts of "taxes" and "government" as if they were topics unrelated to our social needs and desires. Leaving half of our health care system under private funding in the private sector has resulted in the worst inequities in health care of all industrialized nations.

Most Americans do believe that we need greater equities in both access and coverage. The private sector has proven that these goals cannot be achieved without including taxes and the government in the comprehensive design of the system. Whereas other nations are facing the issue of needing more funding, we have already made the decision to devote the resources needed that would fund comprehensive care for everyone.

Let's now define the proper role of government and taxes in a system that actually would provide the universal access and coverage for which we are already paying. Even the political opponents admit that a single payer system would do this. Why do you think they are excluding us from the forums on reform? Simply because the logic of our message is so clear that our voice must be stifled. Thus, the deceptive "tax and spend" rhetoric is being used to dismiss us in our absence.

Let's end these deceptions by adopting more accurate rhetoric such as, "Comprehensive health care for everyone: We're paying for it! Let's have it!"

And then let's carry that message to the nation.

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

California State Capitol
Sacramento, CA April 12, 2002

John Sheils, Vice President of The Lewin Group, in his concluding remarks on the micro-simulation of the nine health care reform proposals:

"This next table (Change in Total Health Spending under Coverage Expansion Plans) is kind of interesting. It summarizes the impact of these plans on total health spending in the state. Now this is total health spending for everybody, regardless of who's writing the check, regardless of who's paying. This is the total amount spent for health care, including administration. We expect it to be $151.8 billion (for California) in the year 2002, this year.

"Under all of the plans here, there is an increase in costs, reflecting the fact that you'd have more insured people using more health services, and that represents some increase in costs. But, interestingly, under the single payer program, we show that there is a net reduction in spending. We actually spend less, in the aggregate, on health care. The reason for this is that there are very large administrative savings that are realized through using a simple, single program to pay for health care. There are also some bulk purchasing savings which we believe could be quite substantial.

"Now, one of the major claims of the single payer advocates for a long time has been that we could cover more people, for more services, for less money. Our study is showing that, for these very carefully designed plans, that's true. To the best of our ability to estimate it, that's true. So I think that's an important finding.

"I don't want to sound like I'm favoring one program over another at all, of course, because 'all of our children are above average.'"

http://www.healthcareoptions.ca.gov/

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San Francisco Chronicle
April 18, 2002

By Victoria Colliver

Marking an unprecedented increase in health care costs, the board of the California Public Employees' Retirement System said that its HMO premiums for 2003 will have to increase by an average 25.1 percent and that it will dump its PacifiCare and Health Net plans.

CalPERS officials mentioned several strategies to save money in 2003. They included what's known as "single-risk pool," a self-funded model that would put all employees in one pool and require everyone to pay the same amount for similar services.

Peter Lee, President and CEO of the Pacific Business Group on Health, a statewide purchasing coalition for major employers, saying that change needs to come from the state and federal government:

"This is a signal health care has to be at the top of legislative policy agenda."

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2002/04/18/BU16464.DTL

And from David Broder's column in the April 17 edition of The Washington Post:

Dr. Henry Simmons, President of the National Coalition on Health Care (of which CalPERS is a member):

"The message is that the problem is far more serious than anybody in the political process is acknowledging. The incremental strategy is bankrupt. We need a big debate on how to get a grip on this system."

http://www.washingtonpost.com/wp-dyn/articles/A63337-2002Apr17.html

Comment: The largest (next to the federal government) and most effective purchaser of health plans is on its knees, paying a 25% percent premium increase!

And now the president of the Pacific Group on Health, representing major employers, states that change needs to come from the state and federal government. And the president of a bipartisan coalition on health care states that the incremental strategy is bankrupt.

And the Los Angeles Times, in an editorial on April 16, states that the California Health Care Options Project "tells us there is a way to expand health coverage," including three (of nine proposals) "that would provide universal coverage under a single payer system."

Is there a message here?

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

Consumer Reports
May 2002

"Card programs often work like this: The company negotiates discounts and buys provider lists from preferred provider organizations (PPOs); the company generally does not contract with service providers. Some cardholders have reported that doctors, hospitals and pharmacies said they didn't know about the discount programs and wouldn't honor the cards."

Comment: The advertising for these programs is designed to make them appear to be very low cost insurance plans, but of course they are not. The ads are deceptive enough such that many will purchase these cards in the belief that they are a low cost substitute for insurance.

Examples: http://www.aquent.com/financial/medical_savings_card.html
http://www.careentree.com/
http://www.insurancequotes4u.com/discount-medical.html
http://www.addhealth.com/index.html
http://www.firstchoiceinvestors.com/health.html
http://www.ameriplanusa.com/about.asp

And the response of the AOL legal department: http://legal.web.aol.com/decisions/dljunk/national.html

And even Tommy Thompson and Tom Scully are being sued as potential perpetrators of this type of deception: http://www.heartland.org/health/aug01/pharmacy.htm

The Kentucky Department of Insurance has issued an informative consumer alert on health discount plans: http://www.doi.state.ky.us/Kentucky/Documents/consumer/consalertv3.pdf

This worthless industry will be discarded on the same trash heap as the private health plans once we establish a single payer system. What are we waiting for?

Beth Capell, Ph.D., on behalf of Health Access California, responds on health discount cards:

Major legislation is pending in this area in California. Both Consumers Union and Health Access California are involved.

The point you make is the one Health Access California has always made in opposing the creation of such plans: that some employers and workers will be confused and regard these dubious discounts as a substitute for health insurance.

And the discounts are dubious: since no one knows what the price of anything is in health care, how can a "real" discount be determined? No one has found an answer to this conundrum.

However, since seniors rely so heavily on these discount programs as a substitute for Medicare prescription drug coverage, they are unlikely to be banned outright.

Comment: One more reason to enact Medicare prescription drug coverage, or, better yet, a comprehensive, universal single payer system.

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

Rudolph Mueller, M.D., author of "As Sick As It Gets":

"... and, then, the other thing we do in this nation is we blame it on the individual. If someone dies prematurely, it's their fault. If they have a bad outcome, it's their fault. If they have a job that doesn't provide insurance, it's their fault that they didn't get a well paying job that had insurance. If they come in and their diabetes is uncontrolled, they didn't take their medicines, it's their fault they didn't take their medicines. No, it's more... They don't have insurance. They don't have prescription coverage. They can't afford their medicines. Their employer doesn't provide health insurance because they need to be profitable."

Dr. Mueller critiques the U.S. health care system in this 11 minute video that can be downloaded at: http://www.snowshoefilms.com/

Olin Frederick, Inc., the publisher of "As Sick As It Gets": http://www.olinfrederick.com/

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Callifornia State University, Sacramento, on the California Health Care Options Project (HCOP):

I attended the final HCOP meeting yesterday.

It is clear from the Lewin analyses that the single payer proposals meet the goals of universality and cost-savings. In fact - the conclusions are that everyone in California can be covered for less than the projected $151b in 2002.

The major challenges are to:

- Consolidate the three single payer proposals into one

- Organize the broadest coalition of organizations and individuals to inform and educate the population to support single payer

- Build the community-based, political structure, to legislate and implement the program

The recent reports of the collapsing "sick illness" system, and the HCOP assessment, provides the opportunity to confront the need for dramatic change.

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

San Francisco Chronicle
April 11, 2002
By Spyros Andreopoulos, Director Emeritus of the Office of Public Affairs at Stanford University Medical Center

(On April 12), California will unveil options calling for a major overhaul on health-care financing. The proposed alternatives include expanding health insurance coverage through modifications in existing programs and three proposals calling for a transition to a single-payer system.

Single payer, which is receiving considerable attention, would replace private insurance and HMOs with a publicly financed, privately delivered system covering 31 million Californians with comprehensive benefits, and would be administered by the state.

Although the three proposals differ in details, generally a single-payer system would offer a health-insurance package modeled on benefits now provided by employers. And it would be financed with new employer payroll taxes and health-care funding from the federal insurance programs of Medicare and MediCal, which would be combined with the new financing system.

Proponents believe single-payer can adequately cover all of the state's residents, including the 6.8 million uninsured, and provide more care for the money through reductions in administrative costs and other efficiencies.

The proposals culminate a two-year study by the Health Care Options Project (HCOP), created by the passage of SB480, signed into law by Gov. Gray Davis in 1999.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2002/04/11/ED24365.DTL

Comment: The final versions of the nine proposals for the California Health Care Options Project have been posted: http://www.healthcareoptions.ca.gov/

The final report of the analysis by The Lewin Group had not been posted by this morning (April 12), but the results will be presented this afternoon in Sacramento, and posted soon.

The forum will be broadcast on The California Channel from 1:00 to 3:30 PM, Pacific Daylight Time, April 12. Also it can be viewed live on the Internet at: http://www.calchannel.com In a few days it will be available in the archives for viewing at: http://www.calchannel.com/april2002.htm In addition, a videotape can be purchased from the Assembly TV office for $10.00 by calling 916-319-2813.

The Lewin Group analysis will show that the two single payer proposals and the health service model would each fulfill the goals of providing full comprehensive services to absolutely everyone while saving Californians billions of dollars in health care costs. The other six proposals that build on our current system would fall short on equity, universality and comprehensiveness, and would increase health care costs for Californians. One of those six models does come close to universality and comprehensiveness, though it leaves in place many flawed policies of our current system that impair equity. Also, this latter model is the most expensive of the proposals, increasing health care costs for Californians by billions of dollars.

Although this study was done for California, it should have national impact. It establishes forevermore the credibility of the single payer and health service models. Efforts to exclude single payer models from any and all discussions or forums on reform should be exposed as the nefarious, immoral, unethical acts that they are. The credibility and superiority of the single payer model is firmly established. It is now our responsibility to see that we are included in all future activities on reform, even if uninvited. It is time for ubiquitous, aggressive (but genteel) activism.

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

Two letters, published in The Toronto Star, responding to Tony Fell's call to open the Canadian health care system to private-sector funds:

Apr 10, 2002

Re Medicare rule changes urged, April 9.

For the chairman of the largest publicly funded hospital in Canada, Tony Fell of the University Health Network, to be championing private health care shows how profoundly out of touch he is with most Ontarians and how ignorant he is about the basics of health-care economics.

In poll after poll, Canadians have told whoever asks that they do not want two-tier health care.

Instead of worrying about his golfing friends waiting for hip or knee surgery, maybe Fell should talk to the nurses who work in the network's hospitals. They will tell him that two-tier health care and a more privatized system will only worsen the problems he acknowledged, such as the nursing shortage.

Increased and stable funding from our governments and a reorganization of health-care services with a focus on community health services is the place to start to address the system's problems.

If the nurses don't convince Fell, who is also chairman of RBC Capital Markets, perhaps he should lunch on the links with another banking leader, Charles Baillie, chair and CEO of TD Bank. Baillie warned in 1999 that: "To set aside our single-payer, publicly funded universal health-care system would not simply be a moral error. It would be a grave economic error as well."

Doris Grinspun

Executive Director Registered Nurses Association of Ontario Toronto

April 11, 2002

Believe U.S., Canadians, you don't want private care

Re Medicare rule changes urged, April 9.

It is astonishing that the University Health Network's chairman, Tony Fell, is calling for opening the Canadian health-care system to private-sector funds. He must be blind to what is happening in the United States.

Private plans are increasing cost-sharing with beneficiaries. This is a nice way of saying that the plans are passing risk on to the very beneficiaries that need health care the most. Not only are 40 million uninsured Americans having problems accessing care, but now average-income individuals who have serious acute and chronic disorders are facing financial barriers to care. This behaviour of the private health plans is only to be expected, since corporate regulators insist that the interests of shareholders must be placed first.

And this week a new report from the American College of Emergency Physicians reveals that 90 per cent of large U.S. hospitals operate at or over capacity, with overloading of our emergency rooms and frequent diversion of ambulances.

This year the U.S. is spending $1.55 trillion (U.S.) on health care, 14.7 per cent of our GDP, far more than any other nation, and yet we are receiving the worst value for our health-care dollars. The reason is that our fragmented system of private plans, government plans and no plans at all creates unbelievable administrative excesses that waste resources that should be going to care.

This week, the California Health and Human Services Agency completed a study of nine different models of reform. The single-payer models, similar to Canada's system, would provide full, comprehensive services for absolutely everyone and reduce health-care costs for California by $7 billion. Those models that build on our current private and public system failed to deliver on the goals of universality and comprehensiveness and would increase costs for Californians.

Canadians can be very proud of their publicly funded system. We hope that the California study will enlighten our political leaders in the United States as to the wisdom of your approach.

Dr. Don McCanne

President Physicians for a National Health Program Chicago, Ill.

Copyright 2002. Toronto Star Newspapers Limited. www.thestar.com

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

The Toronto Star
April 9, 2002
By Theresa Boyle

Canadians should be allowed to pay out-of-pocket for some medical procedures now covered by provincial health insurance plans, says (Tony Fell) the head of the University Health Network. (The University Health Network is the largest academic health sciences centre in Canada. It encompasses Toronto General Hospital, Toronto Western Hospital and Princess Margaret Hospital.)

He said the ban on extra billing of patients by physicians for "more exotic medical services and treatments over and above basic health care" should be lifted. The Canada Health Act should be opened up to allow private coverage of a hip or knee replacement "to facilitate a better golf game," he said, offering an example. He had no other examples available.

http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&c=Article&cid=1018303302131&call_page=TS_Canada&call_pageid=968332188774&call_pagepath=News/Canada&col=968350116467

Comment: If a joint replacement is not medically indicated, then it really wouldn't facilitate a game of golf and shouldn't be done, regardless of the funding source. Of course, the example chosen is ridiculous and would never be a basis for privatizing Canada's Medicare system.

But efforts continue in Canada to open the private markets in health care which can only result in two-tiered health care. Initially, the affluent will use the private approaches primarily to bypass the queue. But then the public Medicare program will be treated like a safety-net or welfare program and will be chronically under-funded. The irony is that health care for the wealthy will not improve significantly in spite of a greater infusion of personal funds, but health care for those with modest or low incomes will deteriorate because of inadequate public funding. Canada must reject privatization schemes that would defeat the public good.

Jeff Kirsch, Deputy Executive Director, Families USA, responds to Donald Light on employer coverage (March 30):

In the recent discussion of employer coverage via your email, Don Light wrote:

"In a detailed study of private employers, Marquis and Long found that 51.5% of small employers offer health insurance (many with high co-premiums that workers feel they cannot afford), but they also found that only 58.1% of all other employers offered health insurance. This is a strikingly low number for a system based on employers in a large, affluent nation."

Please pass along to Don the following information from a Kaiser Family Foundation/Health Research and Education Trust survey report on employer coverage (http://www.kff.org/content/2001/20010906a/EHB2001_sof.pdf , see page 3 ). Their data are very different than those cited by Don.

In the summary of this 2001 report from, the authors state that employer-sponsored coverage reaches 2 out of 3 Americans. Don may be using different criteria for "small" employers, but the report says that 65% of small business (3-199 employees) offered health coverage, and that virtually all firms with over 50 employees offer coverage. The breakdown of firms offering coverage looks like this: 58% of the smallest (3-9 employees); 76% of firms with 10-24 employees; 90% of firms with 25-49 employees; and 96% of firms with more than 50 employees.

Of course, this doesn't mean that all employees are eligible for coverage (overall about 20% are ineligible because of issues like waiting periods or minimum work hour requirements); nor does it mean that all those eligible elect to take it (about 17% of those offered coverage don't take it for cost reasons or because they have other coverage, such as through a spouse).

I'm not responding because I think that employer coverage is the answer to our many problems. Clearly, there are many concerns about the quality of coverage employees receive and how much they must pay. And there are more reasons to be worried about the movement of some employers to defined contribution policies (teaming catastrophic coverage with MSA-type schemes).

But the fact remains that approximately 9 out of 10 Americans with private coverage get their coverage from their employer, so we need to monitor that closely and work for improvements. Moreover, as much as we might want to move to a national health insurance system, we face a mighty challenge from those who want to move to an individually-based market system using individual tax credits. This threat is growing and it is not advocated just by the right-wing: many moderate Republicans and Democrats also support individual tax credits. In the face of that serious challenge, our sense is that supporting existing employer coverage becomes an important piece of the strategy to hold the line against an individual tax credit approach to health care "reform."

Hope this adds to the debate. Jeff

Ida Hellander, M.D., Executive Director of Physicians for a National Health Program, responds to Jeff Kirsch on employer-sponsored coverage:

Jeff's figures exclude Medicare beneficiaries -- if you add Medicare then Light is right. Also, much of that "employer-sponsored" coverage is actually publicly-funded coverage for government workers. If you exclude them, private employers only COVER 43% of Americans (not 90%!!) and only PAY for 21.2% of health costs.

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

Contacts:
Don McCanne, MD (949) 493-3714
Carla Woodworth (510) 832-7134
Quentin Young, MD (312) 782-6006

Providing Health Insurance to All Could Save Billions on Health Costs

Lewin Study Finds Single Payer Saves Money, Protects Doctor-Patient Relationship

A study of nine options for covering California’s seven million uninsured by the conservative D.C.-based consulting firm of Lewin, Inc. finds that a single payer system of government financing of health care in California would actually reduce health spending while protecting the doctor-patient relationship. The study will be officially released by the California Health and Human Services Agency this Friday, April 12.

“This study shows single payer is the only system that guarantees that every one of the 34 million Californians would get the health care they need when they really need it—and does so at a savings to us all,” said Don McCanne, MD, President of Physicians for a National Health Program (PNHP). “The findings apply equally to other states as to California.”

“As physicians, we know that protecting the doctor-patient relationship is at the core of providing good care. The Lewin study demonstrates again that a system with government financing like Medicare stabilizes care for patients. The current system that treats health care as a commodity to be bought and sold disrupts care incessantly while driving up costs,” said McCanne.

Single payer financing saves billions by reducing waste on paperwork and overhead. A 1991 study by the U.S. General Accounting Office predicted administrative savings of 10% of health spending with a national single payer system (over $140 billion in 2002).

Three of the nine options studied proposed a government-financed system.

}? A proposal by James Kahn, UCSF; Kevin Grumbach, UCSF; Krista Farey, MD; Don McCanne, MD, PNHP; and Thomas Bodenheimer, UCSF; would cover nearly all health care services including prescription drugs, vision and dental for every Californian through a government-financed system while saving $7.6 billion annually from the estimated $151.8 billion now spent on health care.

A second proposal by Ellen Shaffer, UCSF, would reform both financing of health care and the delivery system so that every Californian has a “medical home”, that is, a primary care physician with an ongoing relationship with that patient. Like the Kahn et al proposal, it saves about $7.5 billion through various efficiencies.

The third by Judy Spelman, RN, and Health Care for All, covers care for every Californian in a manner similar to the Kahn et al proposal but eliminates all out-of-pocket costs. Its cost savings are estimated at $3.7 billion.

All three proposals stabilize the health care system, reduce paperwork, and protect the doctor-patient relationship by eliminating the role of for-profit HMOs and insurers. The Kahn et al. proposal envisions that the non-profit Kaiser Permanente, the state’s largest integrated health system, would continue.

“Only those proposals with single payer financing guarantee that every Californian will get the health care they need when they really need it---and do so at reduced costs,” said Dr. Quentin Young. “California is pointing the way to a national solution.”

The Lewin study will be posted on Friday after its official release.

####

Dr. Don McCanne is President of PNHP and co-author of the Kahn et al. proposal for reform.

Contact information for the study’s other authors may be obtained from Carla Woodworth, Executive Director of PNHP’s California Chapter, the California Physicians Alliance (CaPA).

Dr. Quentin Young is a Past President of the American Public Health Association and National Coordinator of PNHP. He is in private practice, internal medicine (773) 493-8212.

Physicians for a National Health Program (PNHP) is an organization of over 9,000 physicians that supports a single payer national health insurance program. PNHP is based in Chicago with chapters across the U.S. For local contact information, call (312) 782-6006, www.pnhp.org.

Posted by pnhp at 11:26 AM | Permalink | Comments (0)

Alliance for Health Reform

April 5, 2002
Washington, DC

James Robinson, Ph.D., Professor of Health Economics at the University of California at Berkeley:

The new increased cost sharing virtually is designed to shift more cost onto the ill. As one person said to me once, "New product designs are designed to protect non-users from users." And where did that come from? Where'd that come from?

Well, I think that, in the past decade, that the public sector has abdicated its basic responsibility to define what is a decent minimum health insurance and healthcare system or entitlement. And, to fight everything else, as optional and buy-out. It's abdicated that, and it has pandered to the special interest and defined everything as the basic minimum, which drove to the current affordability crisis simultaneously in our laws, step by step, every cost control mechanism in managed care.

And so the last response available to the payers, and I'm talking about the employers here, is cost sharing. That's the last thing. I mean, what are ya gonna do, capitation? Gate-keeping? I mean, you know. And so that's where we are. That's where we are. And cost sharing hurts the sick and it hurts the poor. That's the essence of cost sharing, all right?

Now, ideally, we would all have MSA accounts which were adjusted for income, and those of us that are high income would have small accounts and we'd pay most of the rest of it off our Visa card, and those that are low income people would have real fat accounts, okay?

Also, these would be health adjusted and people that had chronic diseases would have big MSAs and people who are the worried well, oh, yeah, I'm worried well, would have small accounts, right? That's the way, you know, the system ought to work, all right? But, as long as we're into this-this fantasy land, where healthcare is an entitlement, it's a right, and somebody else is gonna pay for it, and no choices have to be made, no priorities have to be set, no tradeoffs are necessary, we will never get there. And the system by itself, driven by the wishes of the individual employer and the individual employee, the healthy employee, wants the high deductible product. They want the MSA because they can spend an MSA on dental, vision, all kinds of other cool stuff. Of course, a diabetic is gonna spend the whole MSA just on diabetes care.

And that is the system that we have created. We, America, have created this system.

http://www.kaisernetwork.org/health_cast/uploaded_files/4.05.02_Transcript_HealthInsurance.pdf

Comment: Professor Robinson seems to support the concept that the public sector must define a basic tier of "decent minimum health insurance." Clearly he recognizes the terrible consequences of shifting the costs of essential services to the individual, cost sharing that hurts the sick and poor. He recognizes that MSAs destroy access to the risk pool for the sick and poor, by protecting non-users from users.

So the public sector needs to define the basic tier. Can Dr. Robinson create a template for that tier? For the middle-aged patient, disabled with advanced degenerative hip disease, is the first tier being provided with a walker or wheelchair, with hip replacement being limited to those capable of sharing the cost? Are mammograms or a PSA tests for prostate cancer, tests which may not lead to improved outcomes for most of those screened, basic tier tests, or should they also be limited to those that are capable of sharing the cost? Or should the basic tier be defined in general terms such that all beneficial health care services should be covered? And since "beneficial" is a fluid term that changes with the state of the art, how would Dr. Robinson's template accommodate this ephemeral concept? The reality is that placing "basic" care completely within the risk pool, and then requiring cost sharing for elective or more expensive services will inevitably prevent access to important, beneficial services for the sick and poor.

So what is the answer? The $1.55 trillion that we are spending on health care is more than enough to fund all providers and facilities that we need to provide the capacity for comprehensive services for everyone, providing that excessive administrative waste is reduced. Since the escalating costs of health care seem to be a primary concern that needs to be addressed, we can do this simply by establishing a global budget for our entire health care system. If capacity is pushed to the limit, decisions can be made on limiting services that are of negligible value, or, alternatively, we may actually want to shift more of the GDP to health care. But with a budget that is currently 14.7% of our GDP, under a single payer model there would never be a need to tell a person that your tier qualifies you only for a walker for the rest of your life.

Uwe Reinhardt, Ph.D. responds to James Robinson, Ph.D. on patient cost sharing:

I believe both Jamie Robinson and Don McCanne are right.

In a way, Jamie repeats the dire message that I wrote last August and that triggered such a heavy e-mail traffic, notably from Ted Marmor. Jamie says, "We, America, chose this." To which Ted might add the footnote, "'We America' is the small elite that makes health policy." Whatever the case may be, we are stuck with this system and shall now go through a lengthy (possibly permanent) phase in which the financial burden of health care is rolled over from the shoulders of the healthy to the shoulders of the sick. I see no way around it now, and I did not last summer.

Don is also right. If Canada spent 14% of its smaller GDP on health care, within the current structure of that system, one cannot imagine what they could not have. Gold-plated bed frames, perhaps; but everything we have and more they could have.

Alas, for some reason God won't allow us Americans to have a single payer system, so the point is moot. Nor, of course, will the elite making health policy in Canada ever allow 14% of the GDP to be spent on health care. So that scenario is moot for Canadians.

Jamie's (and my) prediction for America rules: Rationing by health status and income.

Mazel tov!

Best

Uwe

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

Boston Business Journal
April 4, 2002
By Linda Goodspeed

Yet even now that there's a commission looking at funding streams and options for achieving universal coverage, few think single-payer is the right course. Many believe the incremental expansions the state (Massachusetts) has enacted over the past decade, which have brought the state's uninsured rate to one of the lowest in the nation (about 7 percent of the entire population and less than 2 percent of children) is working.

State Sen. Richard Moore, D-Uxbridge, co-chairman on the joint legislative Committee on Health Care:

"Right now we have about 7 percent of the population uninsured. We're looking at a significant tax increase to get at those 7 percent by going to a single-payer system."

"Nothing will happen around single-payer health care in the current legislative session. We can't afford it."

http://www.bizjournals.com/industries/health_care/health_insurance/2002/04/08/boston_focus5.html

Comment: Sen. Moore has failed to acknowledge the cost savings of replacing the health plans with a single payer system. It is simply not true that Massachusetts "can't afford" to shift the wasted resources in the current system to filling in the voids in funding the delivery of health care services. Shifting funding to the tax system might be a "tax increase," but for most individuals, it would be a net reduction in their health care costs. Using tax rhetoric to hide the beneficial impact of single payer reform is deceptive, if not outright dishonest.

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

In MS Word format.

Posted by pnhp at 03:31 PM | Permalink | Comments (0)

Health Affairs
Web Exclusive
April 3, 2002
By John Holahan and Mary Beth Pohl

Abstract:

The number of uninsured Americans fell in 2000 for the second consecutive year. The reduction has been attributed to the continued expansion of employer-sponsored insurance. However, the increase in employer coverage among adults was offset by declines of other types of coverage. For children, increases in public coverage plus the growth in employer-sponsored insurance led to the reduction in the number of uninsured children. Over the longer period (1994-2000), one of great economic growth, the uninsurance rate was essentially the same at the end as at the beginning. The rate of employer-sponsored insurance increased sharply, so that more people had employer coverage. However, these increases were offset by reductions in other forms of coverage, particularly Medicaid and state-sponsored insurance and private nongroup coverage, so the overall rate of uninsurance did not change.

And from the article:

This analysis examines a period of great prosperity. As of this writing, the nation was in a recession, and there is concern that the number of uninsured persons will rise sharply.

http://www.healthaffairs.org/WebExclusives/Holahan_Web_Excl_040302.htm

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San Francisco Chronicle
April 2, 2002

By Oliver Fein, Joanne Landy

This country's employer-based health-care system is broken. It depends on private insurance companies to manage our health care needs, with disastrous results: Some 15 percent of Americans don't have health insurance at all.

And those who do have health insurance face spiraling premium costs and shrinking benefits.

Despite its limitations, our publicly funded ("single payer") Medicare system points the way to a workable alternative.

Under traditional Medicare, patients have their choice of physicians and hospitals, while administrative costs are 2.1 percent -- compared to private health plan administrative costs of 13 to 33 percent.

Medicare saves money because it places everyone under a single, universal insurance pool. It doesn't waste resources on marketing, on profits or on the sky-high administrative costs built in to a system that forces providers to comply with hundreds of different insurance plans.

We could have an improved Medicare-like program covering everybody without paying any more than we do now, but only if we have the political courage to do it.

(Oliver Fein and Joanne Landy are, respectively, chair and executive director of the New York chapter of Physicians for a National Health Program.)

http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2002/04/02 /ED91665.DTL

Steven A. Schroeder, M.D., President and CEO, The Robert Wood Johnson Foundation, responds to comments by Sumner Rosen, Ph.D. and Donald Light, Ph.D. on the role of foundations, especially RWJ, in health care reform:

Thank you for inviting me to reply to the PNHP listserv discussion about the role Foundations are playing in current efforts to expand health coverage. We are supporting several strategies to expand health insurance coverage.

The first strategy is to take advantage of existing opportunities such as SCHIP and Medicaid expansion programs. These programs provide health coverage for millions of children and working adults who would have been uninsured just a few years ago. That should be celebrated, even as we regret that more has not been done. These programs don't solve the entire problem, but we think they play a crucial role, and we want to enroll every eligible person we can reach. Moreover, we believe the fledgling SCHIP and Medicaid expansion programs represent an historical advance which we cannot ignore. The success or failure of SCHIP and Medicaid expansion programs will in part inform the next phase of public sector coverage expansion.

The second strategy is to look for new coverage expansion opportunities. We work with state governments to mount coverage expansion demonstration programs. We also work with private sector partners in efforts to make private insurance more accessible.

Third, we are mounting a paid ad campaign "Covering The Uninsured" to make plain the health and financial consequences of being uninsured. Our aim is to make certain that multiple proposals ranging from tax credits to single payer options are debated in an environment in which the consequences of the status quo are clear to all.

Last but not least, we support significant research into the consequences of being uninsured as well as policy development by a range of experts, including some of your members. As always, we would welcome suggestions from Dr. Rosen and his colleagues about new endeavors to expand coverage.

SAS

Comment: Dr. Schroeder has clearly stated that single payer reform should be an option included in the debate, and that we should be included as participants in the process of policy development. It will be our responsibility to make every effort to be certain that we are represented. Some of those attempting to control the process doubtlessly will need our reminder that all options need to be discussed. We need to be there, whether it's on the dais, or through our conspicuous placards and brochures at the entrance. Our voice must be heard.

Don McCanne

Joanne Landy responds to Steven Schroeder and to Don McCanne's comment:

Good for you, Don, for your persistence in insisting that the single payer view be part of the discussion of the health care crisis in this country.

I would go one step further: the single payer point of view should always be represented on the dais of any discussion that purports to be representative; we shouldn't ever be limited to flyers, signs and brochures--important as those are. The results of the California State Health Care Options Project have shown the single payer options to be far superior in terms of expense and in actually covering everyone. The ongoing debate, if it is to be credible, requires that single-payer voices be heard and that people hear how advocates of other proposals reply to our ideas and critiques.

--Joanne Landy, Executive Director, Physicians for a National Health Program, New York Chapter

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

The Dallas Morning News
By Connie Mabin
3/26/2002

Despite earlier promises of coverage, state lawmakers have failed to ensure funding for a program that provides breast and cervical cancer treatment for hundreds of uninsured women.

Last year, Texas lawmakers approved the state program authorized by the federal Breast and Cervical Cancer Prevention and Treatment Act of 2000.

The law allows Texas to use state and federal Medicaid money to provide free medical care to uninsured women who are found to have breast or cervical cancer but who earn too much to qualify for Medicaid. About 200 women per year were estimated to be eligible.

But in the final, hectic days of the last Legislature, budget writers quietly placed the $1.2 million program on a list of items to be funded in the $114 billion budget only if extra money could be found during the 2002-03 budget cycle.

Six months into that cycle, Comptroller Carole Keeton Rylander can't find the money.

http://www.dallasnews.com/health/stories/032602dntexcancerfunds.a2f16.html

Comment: This may be April Fools' Day, a day for humorous pranks, but this is perhaps the cruelest prank ever perpetrated by legislators. Funds have been provided to screen for breast and cervical cancer for low-income, uninsured women who are not eligible for other programs. But now, after their cancers are diagnosed, they are told that they are on their own. Only in America do we accept a method of funding health care that is capable of inflicting profoundly cruel and inhumane anguish.

Fortunately, in this instance the numbers of individuals involved are small enough, and there is enough altruism within the health care delivery system that most of these individuals will gain access to care. But, instead of putting these unfortunate individuals through a transitional period of terror that they may not have access to care, shouldn't it be a matter of routine policy that access is automatic? And what about the tens of millions of other unmet medical needs that altruism alone cannot fund? Shouldn't it be a matter of routine policy that these needs be automatically addressed by our health care delivery system?

We really do need a publicly administered and equitably funded program of comprehensive health benefits for everyone. What are we waiting for?

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