Health Care Dilemma What Do We Do About It? Rx for "John Q" --universal health care
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>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