News

Washington Post
February 11, 2003
AARP Offers a Plan, but Experts Aren't Buying It

AARP, in partnership with UnitedHealth Group, has launched an insurance plan for people too young for Medicare. Called the Medical Advantage Plan, it's open to people between 50 and 64 who live in any of 10 states.

The two partners call the product "an affordable alternative to major medical insurance." Unlike major medical policies, the plan does not, for example, guarantee to cover all or a certain percentage of hospitalization costs. Instead, the plan pays a fixed amount for a variety of small and large health items: ...up to $7,856 for a coronary-artery bypass operation, and so on.

Marilyn Moon, a senior fellow at the Urban Institute, said she asked a colleague how much the tab was for his recent triple bypass heart surgery. About $80,000, he said -- far more than the AARP plan would pay for such an operation.

"Trying to provide people in this age range" with insurance options "is very important," Moon said, but buying this policy might "lure people into thinking they have a lot of protection." Those with little to spend, she said, "should spend it on major medical [coverage] and not on this." With traditional coverage, she said, at least you "protect yourself from major expenses."

Julie Alexis, AARP's manager of member health products, acknowledged that the plan is "not comprehensive in any way, shape or form," but "we had to make something available [to] people who are going without coverage" because they cannot afford to buy individual insurance or to fully pay for their employer-sponsored group coverage after leaving their jobs.

"They shouldn't call it health insurance," said Karen Pollitz, project director of Georgetown University's Institute for Health Care Research and Policy. "This is a supplement [that] could help you fill in the cost-sharing" demanded by many major medical policies, she said, but if it is your only coverage, "it will not protect you from financial ruin."

http://www.washingtonpost.com/ac2/wp-dyn?pagename=article&node=&contentId=A5 4433-2003Feb10¬Found=true

Comment: In the individual market for health insurance, premiums increase with age. For people between 50 and 65 who are not eligible for a group plan, finding affordable coverage can be difficult. This AARP/UnitedHealth Group plan demonstrates that products designed with affordable premiums for this age group fail to provide adequate coverage. Those with significant medical needs will face financial ruin in spite of this coverage.

The only way we will ever provide satisfactory coverage for this sector is to include them in a universal risk pool with the rest of us. Why do we keep fighting this inevitable conclusion?

Posted by pnhp at 10:20 AM | Permalink | Comments (0)

Kaiser Health Poll Report
January/February 2003 Edition
Health Care Priorities

When asked in an open-ended question to name the most important problem in health or health care for the government to address, people give a diverse list of responses.

Between December 2002 and February 2003...

When given a list and asked more specifically about the importance of health care issues that are actually before the President and Congress, large majorities (two-thirds or more) say each issue is "very important." When forced to choose the most important priority, four in ten (44%) chose making health care more affordable. Smaller shares chose helping people age 65 and over pay for prescription drugs (16%), increasing the number of Americans covered by health insurance (14%), making Medicare more financially sound for future generations (12%), and protecting patients' rights in HMOs and managed care plans (4%). In nearly all demographic groups, a plurality of people chose making health care more affordable as the most important issue.

http://www.kff.org/healthpollreport/hcp/media/hcp.pdf

Comment: In this February 2003 poll, 86% said that "making health care more affordable" is "very important," and this doesn't even include those that believe it is "somewhat important." Another recent poll indicated that the combined total of those that believe this issue is important is 98%. There are very few issues on which Americans demonstrate this level of agreement.

There is now a consensus that reform is needed. But other polls have shown that there is greater support for employment-linked insurance than for a universal public program. However, those polls have used pejorative phrasing ("tax," "government-run," etc.) which would provoke a negative response about a publicly funded and administered program.

Ironically, the public does not understand that what they are looking for in health care (affordability, cost containment, lower out-of-pocket expenses, adequate access to modern technology, equity in both funding and access, stability of coverage, choice of health care providers, etc.) would be achieved by adopting a universal public program that is funded at our current level of health care spending. The employment-linked model that they support is only going to compound their concerns since it continues to waste resources in administrative excesses, and it is shifting more and more of the financial risk to the individual, not to mention the other problems such as losing coverage with unemployment, etc.

When will the pollsters begin to ask honest questions about the policy implications of universal versus incremental models of reform? 98% of Americans want to know the answers now. Isn't it time to begin to ask the right questions?

Posted by pnhp at 10:30 AM | Permalink | Comments (0)

James G. Kahn, MD, MPH, a professor at the Institute for Health Policy Studies at the University of California, San Francisco, responds to the comments on the Kaiser poll on the desire for affordable health care:

Don - you are so right. I would add that the respondents' focus on affordability means that they are ripe for believing reforms that appear to control costs (premiums, anyway) by (quietly, surreptitiously) restricting benefits and/or excluding the sickest from coverage. - Jim

Comment: Jim's point is absolutely crucial. Much of the discussion about affordability in health care has centered around the affordability of premiums. That is a very different issue than the affordability of health care.

Employers, individuals and even the government (FEHBP, Medicare + Choice, etc.) have directed attention to keeping premiums affordable. This can be done only by reducing coverage, through a reduction in benefits, an increase in patient cost sharing, or through measures to exclude high risk patients from coverage.

As Jim mentions, the control of premium rates is frequently engineered through quiet, surreptitious manipulations. Defined contribution programs, tiering of services, providing options of streamlined (i.e., bare bones) coverage, and offering low premium, high deductible coverage with some form of health reimbursement arrangement (similar to MSAs) are only a few of the manipulations that are designed to make premiums more affordable. The problem, of course, is that they do nothing to make HEALTH CARE more affordable. They merely shift costs to those with the greatest health care needs.

In our debates over the model of health care reform that should be adopted, we must diligently challenge those that claim affordability when they are referring only to controlling premiums. Those supporting employer mandate or individual mandate models of "universal" coverage will claim that they are controlling costs when, in fact, their current models will only control premiums. These models make health care UNaffordable by shifting costs to individual patients.

A universal, publicly administered program can make global health care costs affordable through mechanisms such as global budgeting, reduction of administrative waste, rate negotiation, and bulk purchasing. And with equitable funding, whether you call it an income-related premium or a tax, health care can be truly affordable for everyone.

Posted by pnhp at 10:22 AM | Permalink | Comments (0)

Posted on Wed, Feb. 26, 2003

L.A.'s critical condition
The needs of L.A.'s uninsured are overwhelming emergency rooms. Could this be the future for all of California?
By Barbara Feder Ostrov
Mercury News

It's a routine day at Los Angeles County's Harbor-UCLA Medical Center's emergency room: By 3 p.m., every bed is filled. The waiting room is packed with an additional 60 patients. An elderly man on crutches says dejectedly that he's been waiting 17 hours to see a doctor.

More than 100,000 patients will appear at Harbor-UCLA's ER this year. Most won't have health insurance, or doctors of their own. They turn to Los Angeles emergency rooms like this one for basic care -- to such an extent that on any given day, 40 percent of the county's 81 emergency rooms must divert incoming patients and ambulances to less crowded hospitals.

``We are a pitcher of water that can't be filled any more,'' the ER director, Dr. Robert Hockberger, said. ``It's just overflowing.''

Look hard at emergency rooms like this one. As patients around the state see their health care options shrink, the struggle in Los Angeles hospitals could be the future for health care throughout California.

In Los Angeles, the traditional emergency-room patient -- the heart attack victim, the person with a broken arm -- increasingly collides with California's newer emergency: millions of people with no health insurance.

Both groups need help quickly, often from the same place. There aren't enough doctors or beds in the public health system to care for them all. Here, the gap between the Beverly Hills executive pulled from a fender-bender and the flu-stricken laborer from East L.A. is erased: Neither can be sure of how quickly they will see an emergency-room doctor.

The shock of that convergence, combined with a severe budget deficit in Los Angeles County, has pushed the health care system here to the edge. The financial collapse has already forced the closing of two of the county's six public hospitals and 16 of its 40 health clinics. A move to shut down two other hospitals -- including Harbor-UCLA -- galvanized Los Angeles voters in November to approve a rare property tax increase. For now, the two hospitals are saved.

But the breathing room gained by that tax does nothing to address the underlying problem: that about 20 percent of Los Angeles County's population has no health insurance, compared with just 8 percent in the Bay Area, and that the needs of the uninsured are overwhelming the entire health system.

``Everybody's all maxed out,'' said Kazue Shibata, executive director of the Asian Pacific Health Care Venture clinic in West Los Angeles, where the wait for appointments has doubled and new patients are being turned away. ``It's a very stressful time.''

Is the rest of California headed the way of Los Angeles? Some experts think so, if other parts of the state begin to mirror Los Angeles' large numbers of poor, uninsured patients.

Rising health care costs, an increasingly sick population, and more people without insurance certainly aren't unique to Los Angeles. As the numbers of uninsured grow throughout the state, Los Angeles' plight -- however extreme -- looks more and more like California's fate.

``We're all on the same highway,'' said Bob Sillen, who oversees Santa Clara County's public health system. ``It's merely a question of timing.''

The following dispatches explore the travails of a health care system shaken to the core, and its implications not only for Angelenos, but the rest of us.

`Lurking danger'

Crowded emergency rooms are the most visible symbol of Los Angeles County's health care crisis -- and the one that most concerns everyone, rich and poor alike.

``I think people know there's a lurking danger that when they clutch their chests, they're going to have a hard time getting into an ER and a hospital bed,'' said Dr. Michael Karpf, who directs UCLA Medical Center and Santa Monica Community Hospitals, both private hospitals.

``This is not just a problem for the poor,'' he said. ``The health care crisis in California transcends class. It covers everybody.''

The critical factor is ``diversion,'' when an emergency room gets so crowded it starts turning away patients. Ambulance drivers must often radio hospital after hospital looking for an ER willing to accept a patient, and then sometimes drive long distances to deliver patients to an open bed. The county's hospitals are on diversion status 40 percent of the time.

Just after 6 p.m. on a Friday night, the emergency room at UCLA-Harbor Medical Center is already chock-full, and so is its waiting room. In the entire hospital, only two beds are open.

By 8:15 p.m., as paramedics deliver a 20-something drunk driver with a four-inch gash on his scalp, only four of the county's 81 emergency rooms are accepting new ambulance patients. The others are on diversion.

With a click of a mouse, Harbor-UCLA joins them. ``It's time,'' said nurse Russ Wright. ``We're just too full.''

Jennifer Davis, who is 30 and lives in Paramount, was one of the ones who made it in. She had come to the ER to attend to a broken arm that fractured again after a fall. At Arby's restaurant, where Davis and her husband make sandwiches for $7 an hour, only managers are offered health insurance.

Davis waited only three hours this time. Two days earlier, trying to get her arm cared for, she waited seven hours.

``I was irritated,'' she said, ``but there are a lot of people that are sicker than I was.''

As Davis leaves at 12:45 a.m., Conan O'Brien, on TV, is failing to entertain dozens of sleepy, frustrated patients. An announcement comes over the ER loudspeaker.

``Will patient number 97 please go to Window 5.''

Preventive care

Los Angeles' public health system cares for 800,000 people a year, equivalent to nearly the entire population of San Jose.

Most are uninsured. Many are poor, sick and unable or unwilling to change their lives in ways that might make them healthier.

In the 1990s, county health officials tried to save money by paying community clinics to provide preventive care to thousands of uninsured or underinsured patients who previously went to county emergency rooms and clinics.

Doctors tried to do the right thing. At free clinics like the one in South Central operated by the University Muslim Medical Association, primary-care physicians identify problems they are not equipped to treat. They send those patients to specialists at the county's King-Drew Medical Center.

``The treatment we get at the UMMA clinic is fantastic,'' said Kathy Windley, a longtime patient there.

But that ``fantastic'' care is a key part of the reason the public health system is facing a crippling $710 million deficit over the next four years. The patients' needs are so great that many are referred to hospitals for expensive specialists -- treatment the county can't afford.

That high level of care has kept Windley, 52, alive. She has survived three heart attacks and five cases of congestive heart failure, the last occurring when her best friend was shot on Windley's porch.

Unable to exercise because of her weakened heart, she suffers from obesity as well as arthritis, pre-diabetes, hypertension, sinus infections and a persistent depression she doesn't like to talk about.

Her husband, Sam, also battles pre-diabetes, as well as high cholesterol, sleep apnea and a mysterious infection in his large intestine. Neither can work because of their health. They take 14 medications between them.

``As we emphasized more outpatient care, we picked up more disease that required specialty care or hospitalization,'' said Dr. Gail Anderson, medical director of the county-run Harbor UCLA Medical Center, which gets many clinic referrals. ``That's the irony here.''

Rush of patients

The strain on the county's public health clinics shows in the long lines at the Hubert H. Humphrey Comprehensive Health Center in South Central, a forbidding high-rise that is the most advanced and specialized of the county-run health centers.

When mounting costs forced county supervisors to close 11 public clinics last year, the nearby Imperial Heights clinic was among them. Twenty-thousand patients needed a new medical home, and all were sent to Humphrey.

Clinic officials insist that the quality of care has not changed, that it is merely more inconvenient. But the clinic is bursting at the seams, and experts say quality can't help but suffer when harried doctors can spend only a few minutes with each patient.

In handling such a huge pool of patients, the clinic is one of the county's guards against making problems worse at emergency rooms -- but crowding is forcing cracks in that wall.

Some patients, who can't or won't brave the long waits and leave the clinic before being seen, later wind up in emergency rooms when their illnesses worsen. Some people whose regular clinic closed now have no idea where else to go, and also head for the hospital.

Inside the clinic, interim director Joe Keys sifts through a mountain of 5,000 letters telling such patients where they could now find help. All these letters came back -- stamped ``Return to sender'' because of moves or the false addresses many undocumented patients give their doctors.

Clinic staffers have no time to track these patients down. Last year, doctors treated upward of 130 patients a day in the urgent care center, which stays open until midnight. ``Now,'' Keys said, ``we're hitting that number before noon.''

Outside, slumped in a plastic chair in a bleak concrete courtyard, Tyrone Jose Ayon had the resigned air of a man whose fate it is to wait.

When he arrived at the clinic's urgent care center on a weekday morning, Ayon was told it would take 10 hours to see a doctor about the silver-dollar-size abscess on his arm.

Four hours later, he had yet to embark on the first stage of his visit: having a nurse take his vital signs.

``I'm not paying for it,'' said Ayon, 43, who is studying to become a medical assistant before his welfare payments run out. ``So I guess I can't really complain. I just sit here. I bring my lunch -- and my dinner.''

On the day Ayon visited, the urgent care center had 60 patients waiting when it opened at 7:30 a.m. It had processed 98 patients by 11 a.m.

``We'll be up to 200 by 5 p.m.,'' said Dr. Casper Glenn, who directs urgent care. ``There's just such a big rush of patients now. I just don't know what's going to happen.''

Temporary fix

Capri Maddox has health insurance and a good job as a paralegal. She has never set foot in any of Los Angeles County's public clinics; she's never needed to.

But she did need emergency-room care for a severe asthma attack in 1999. That experience, she says, gave her new respect for the region's hospitals and hammered home the need to support them, even if it meant something close to unthinkable in Los Angeles -- new taxes.

``We all watch the news and you see every day that someone ordinary all of a sudden has something tragic happen to them,'' said Maddox, 31. ``You know that everyone is pretty vulnerable.''

For Los Angeles residents who are middle class or richer, the county's public health crisis isn't generally a major concern despite intense media coverage. County-run clinics and hospitals typically are in neighborhoods they avoid.

But in November an overwhelming proportion of county voters -- 73 percent -- approved Measure B, a property tax increase to shore up the county's public hospitals and trauma centers. They were spurred, many believe, by a last-minute barrage of television ads portraying paramedics desperate to find an open emergency room.

The passage of Measure B, showing public support for the health care system, also proved pivotal in the county's negotiations with state and federal authorities for a recent $250 million bailout that will help ease some of Los Angeles' problems. The tax -- three cents on each square foot of a building (the annual tax on a 2,000-square-foot house would be $60) is expected to raise $168 million a year.

But even with the passage of Measure B and a temporary bailout, Dr. Jane Spiegel, a West Los Angeles internist, worries that her patients won't be able to get the care they need, when they need it.

At St. John's Hospital in Santa Monica, where Spiegel is affiliated, ``a lot of the time our ER is completely filled and my patients can't get a bed in the hospital itself.'' Recently, one of her patients had to wait 36 hours for emergency abdominal surgery.

``No one cares if you have insurance if the doors are closed,'' said Maddox, the paralegal. ``It's not about insurance; it's about accessibility.''

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

BlueCross BlueShield Association News Release February 21, 2003 New BCBSA Report Shows Health Insurer Administrative Costs Rising Slower Than Premiums

Health plan administrative costs contribute to rising premium costs, but not as much as you might think. A new report from Milliman USA (Milliman), commissioned by the Blue Cross and Blue Shield Association (BCBSA), shows that administrative costs for America's health insurers are growing, but at a rate slower than the growth of premiums overall.

Milliman studied national health insurance administrative cost trends from 1998 to 2002 and found that while premiums for commercial business increased by an average of 7.4 percent annually, administrative costs grew at a much slower average rate of 4.6 percent annually. The report shows that in 2001, an average of 85.7 percent of commercial premiums went to pay medical claims with 11.6 percent going to administrative costs and 2.7 percent going to profits. In comparison, an average of 86.5 percent of commercial premiums among Blue Cross and Blue Shield Plans went to medical claims in 2001, with 11 percent going to administrative costs and 2.5 percent going to profits.

"This report clearly demonstrates that the majority of premium dollars are being spent on healthcare services - as they should be," said Scott P. Serota, BCBSA president and CEO.

"To keep healthcare affordable, we must know more than just how much we are spending. We need to know how well we are investing our healthcare dollars," Serota said. "This research, like BCBSA's previous research on healthcare cost-drivers, helps all of us - insurers, hospitals, physicians, employers, drug companies, consumers and government - find ways to eliminate unnecessary costs and improve quality. That's the only way we as a nation are going to be able to keep healthcare affordable."

For the press release: http://bcbshealthissues.com/relatives/20445.pdf?PROACTIVE_ID=cecfcbcec8c9c7c

Comment: BCBSA attempts to put a positive spin on these numbers by showing that medical claims grew more than administrative costs, but by the deceptive method of expressing them as a lower percentage increase compared to the higher percentage increase in actual health care costs. At a time when the health plans are under scrutiny for perpetuating excessive administrative waste, they wish to show that they are controlling administrative costs. But they aren't. Administrative costs grew at a rate of 4.6% annually, in excess of the rate of inflation. In fact, the very nature of the middleman business model of health plans makes it impossible for them to ever control these administrative costs.

The 14.3% of commercial premium dollars that is being burned up in administrative costs and profits is only a small part of the problem. The administrative burden of our fragmented system of multiple private plans, public programs and no programs at all further increases the diversion of funds from patient care to wasted public and especially private administrative excesses. And this does not include the impact of the flawed system of allocating our resources, a system in which some entities and regions receive 30% more funds without any improvement in health care outcomes.

A single, integrated system of funding health care would dramatically reduce these administrative excesses, and would provide a basis for more rational allocation of our resources. Bruce Bodaken, Chairman, President and CEO of Blue Shield of California, recently called for universal coverage, but his model only expands on the current flawed system, perpetuating inequities and waste.

Instead of turning to Milliman for advice on how the egregious administrative waste can be hidden, we should move ahead with change that will minimize the waste, and utilize those resources more effectively, assuring affordable access to comprehensive care for everyone. Unfortunately but understandably, the BlueCross BlueShield Association apparently does not want to lead that charge.

Posted by pnhp at 10:39 AM | Permalink | Comments (0)

Employee Benefit Research Institute
Issue Brief
February 2003
Retiree Health Benefits: Savings Needed to Fund Health Care in Retirement
by Paul Fronstin and Dallas Salisbury

An individual with access to employment-based health benefits in retirement to supplement Medicare will have needed to save a present value of between $37,000-$750,000 to retire at age 65 in 2003. The range is determined by various assumptions regarding age at time of death, premium levels, annual changes to premiums, and out-of-pocket expenses. An individual without access to employment-based health benefits who instead purchases Medigap coverage will have needed to save between $47,000-$1,458,000, to retire at age 65 in 2003. Estimates also are provided for early retirees. The illustrations presented from the model used in this report may underestimate health care expenses in retirement. Expenses for long-term care are not included in this discussion.

This Issue Brief has illustrated the amounts of money a person may need to save by his or her date of retirement in order to pay for insurance premiums and out-of-pocket costs in retirement. The estimates vary with assumptions on insurance premium levels, growth of insurance premiums over time, estimated age at time of death, rates of return on investments, out-of-pocket expenses, and retirement age. These are important factors in determining savings needs, and, just as important, they are uncertain factors.

http://www.ebri.org/pdfs/0203ib.pdf

Comment: Because there are so many variables, this study shows that the amount of supplemental savings needed to fund health care in retirement can be as high as $5,343,000. Although that amount is improbable for most of us, our potential exposure is nonetheless significant. Medicare pays only about one-half of health care costs. Medigap coverage is overpriced and provides only meager benefits. And now employment-based health benefit programs are diminishing in numbers and in the amount of coverage provided. All of this means that the exposure to financial risk of health care costs in retirement is increasing dramatically and is highly unpredictable for most of us.

Exposure to unpredictable major financial risk is reduced by pooling that risk. That is what insurance is all about. At our level of current spending, $1.66 trillion, we have enough to fund a universal pool that would cover comprehensive services for everyone. Distributing that risk to individuals makes no sense since it exposes those with the greatest health care needs to financial ruin.

Shall we adopt a rational approach and establish a comprehensive, universal health care risk pool, or shall we each set aside an extra $5 million in retirement savings to cover our worst case scenario?

Posted by pnhp at 10:41 AM | Permalink | Comments (0)

California HealthCare Foundation
Health Currents
February 22, 2003

In Time of Need, Many to Lose Medicaid Coverage
by Robert Rosenblatt

If misery loves company, then Governor Gray Davis has a front-row seat in a packed house. Each of the nation's 50 governors is singing the blues about fiscal woes. And all of them are trying to balance their books by taking a bite out of Medicaid, the massive health program for the poor.

At least a million people in just 11 states, including California, are going to lose their benefits, according to a recent study by the Center for Budget and Policy Priorities, a liberal Washington research group. That figure could grow by several million more when all of the states have completed cuts needed to balance their budgets.

The conventional view is that recessions come and go and people go on and off the Medicaid rolls. But there is something much more ominous at work here: a combination of factors that could menace the future of Medicaid, which has become the workhorse of the national health care system, delivering services to 47 million low-income people.

It is even bigger than Medicare, which serves 40 million people (35 million over age 65 and 5 million disabled Americans). Rich or poor, they qualify for benefits because of their age or because they have been certified by the Social Security Administration as being disabled. But Medicaid eligibility is strictly determined by income and assets-it is only for those deemed poor enough to meet the rules.

Medicaid is the largest single insurer for children under 18, pays for a third of all births in the United States, and pays for more than 40 percent of the cost of nursing home care. It offers a comprehensive package of benefits: hospital care, doctor services, laboratory tests, and x-rays. States have the option of offering additional services and California provides dental care and eyeglasses under the Medi-Cal program.

Medicaid is a joint effort, with the federal government paying from 50 percent to 77 percent of the total tab, depending on how poor the state is. Last year's bill was $130 billion from Washington and $94 billion from the states. With prescription drugs leading the way, Medicaid has become the fastest growing social program, with spending up 10.8 percent in 2001, the fastest rate of growth since 1993. At the same time, enrollment rose 8.5 percent, reflecting the fact that more people were drawn into poverty during the recession.

There is no relief in sight because of the worsening fiscal situation for state governments. The federal government can simply print money and run unlimited deficits, but states are mandated by law to balance their budgets.

Last year, total revenues of the 50 states declined for the first time since anyone began keeping accurate records. But this did not just happen because of the plunge in revenue from capital gains taxes on the sale of stock in the aftermath of the dot-com bubble.

On a more basic level, the states' tax systems, with their heavy dependence on sales tax revenues, are outmoded. They were designed for the manufacturing economy of the 1950s. But the volume of goods on which sales taxes can be levied is growing at a comparatively slow pace. Instead, "Services are growing and we don't tax them," Raymond Sheppach, executive director of the National Governors Association, said at a recent briefing on the Medicaid crisis. And then there is the Internet, where growing volumes of commerce escape taxes entirely. Nobody knows for sure about the revenue loss, but Sheppach offers a guess that $10 billion to $20 billion a year in potential revenue is escaping untouched through the Internet.

State pension obligations, meanwhile, are taking up a bigger share of the budget, further squeezing Medicaid, which, even in the best of times, has little support among middle class voters. During the fat years of the stock market boom, state governments didn't have to send much money to the pension funds because the market was taking care of things. Between 1993 and 2000, pension payments by the 50 states rose from $52 billion to $100 billion. However, state earnings on stock and bond investments, which soared from $74 billion to $232 billion, dwarfed these obligations.

The stream of cash has dried up and may never return. In 2001, investment earnings plunged to $53.6 billion. State receipts, including contributions by workers and governments, along with earnings from stocks and bonds, totaled $118 billion, barely enough to cover the pension payments of $111 billion. The states will be hard pressed to meet their pension obligation to retired public workers and Medicaid will certainly be a prime target.

In the first two years of recent budget cuts, the states began trimming payments to providers, the doctors and hospitals and nursing homes that deal with Medicaid patients. But they can't do that anymore. If they cut too deeply, there will be no doctors left who accept Medicaid patients.

So California and other states now plan to trim the Medicaid rolls by tightening income eligibility standards and making it harder for people to qualify for benefits. Lots of health care that is now routine will become exceptional.

But there are limits to what the states can do. Women without health insurance will still give birth. The nursing homes will still be filled with hundreds of thousands of Alzheimer's patients who have exhausted all their savings and now rely on Medicaid to pay the bills. And millions of poor children will still need their immunization shots and their bones mended when they get hurt in schoolyard accidents.

Without help from Washington, and with a budget crunch that will persist for years, the states are likely to keep looking for additional ways to trim Medicaid benefits. It will be painful.

The process is called "going back to the trash can," according to Velvet Miller, a former deputy commissioner of the New Jersey Department of Human Services. Miller added, "These are ideas that you absolutely threw out [because] they were too harmful-now you have to revisit [them] again and again."

http://www.chcf.org/healthcurrents/

Comment: The clear message is that underfunding of Medicaid is here to stay. Health care for low-income individuals will be doled out from the "trash can."

The solution is obvious. Fund health care for low-income individuals at the same level as care is funded for the rest of us. Eliminate the profound inequities inherent in a "poverty program," inequities that are now also pervading our system of benefit-rich health plans for the wealthy, and deficient, Spartan plans for those with moderate income. Even the generous plans negotiated by unions are being paid for by dramatic reductions in the disposable income component of the paychecks of union members, or even by failure to provide inflationary increases required to fund the most basic needs. A disproportionate share of global health care funding is now being shifted to union members.

Health care spending for 2003 is $5775 per capita (CMS). Pooled together, we are spending $1.66 trillion. By eliminating the roughly $200 billion in excess administrative waste, we would have more than enough funds to pay for truly comprehensive health care services for absolutely everyone. And we could free up another $250 billion by reducing in half the current inappropriate utilization of our resources, a not unrealistic prospect if we had a single, integrated method of funding care. That would provide a nice buffer for new technological advances (worth funding as long as they provide value in health care).

Or shall we, instead, follow our current course and send the poor to the "trash can," and start sending moderate-income individuals to the "thrift store" of health care?

Posted by pnhp at 11:24 AM | Permalink | Comments (0)

California State Senate
Bill Number: SB 921
February 21, 2003

SB 921, as introduced, Kuehl (Sen. Sheila Kuehl). Single payer health care coverage.

This bill would establish the California Health Care System to be administered by the newly created Health Care Agency under the control of an elected Health Care Commissioner. The bill would make all California residents eligible for specified health care benefits under the California Health Care System, which would, on a single-payer basis, negotiate for or set fees for health care services provided through the system and pay claims for those services.

http://info.sen.ca.gov/pub/bill/sen/sb_0901-0950/sb_921_bill_20030221_introduced.html

Comment: Sen. Kuehl's bill is based on the findings of the California Health Care Options Project which demonstrated that all residents of Californian could have affordable, comprehensive health care coverage merely by eliminating the administrative excesses of the current system and establishing a single, publicly administered payer for health care services.

Sen. John Burton is also introducing a pay-or-play employer mandate which apparently is receiving the support of AFL-CIO and the California Medical Association.

Another measure (AB 30, Richman) would "reduce state funding for county hospitals and safety net providers" and transfer those funds to the Medicaid and SCHIP programs. Another proposal (AB 293, Daucher) would allow small businesses to provide insurance to employees working a minimum of 40 hours per week, using an hour of overtime to help pay for health care coverage.

Obviously, the debate in California will be between single payer and an employer mandate. Although the leadership of AFL-CIO and CMA may be attracted to the "politically feasible" employer mandate model, union members and physicians need to take a careful look at both proposals. They will see that the single payer program will not only provide greater benefit for all patients in California, but it will also provide greater benefit for union members and physicians. Union members will have greater health and financial security, and physicians will have freedom and the resources to provide the care that their patients need.

Posted by pnhp at 11:15 AM | Permalink | Comments (0)

sun-herald.com
02/20/03
Dr. Klein invited to speak in Washington

Dr. David Klein, who volunteers to help destitute AIDS patients and migrant workers in his spare time, will also be volunteering to tell the nation's leaders how to improve the medical system next week.

Klein was invited to speak to congressional leaders Tuesday and Wednesday in Washington, D.C., at the annual meeting of the Physicians Advisory Board.

To be held at the J.W. Marriott Hotel, the meeting features a series of "round table" discussions with such leaders as U.S. Sen. Majority Leader Bill Frist, R-Tenn., a medical doctor, and other Republican members of Congress.

"Somehow, I got invited," Klein said Wednesday. "I've been a pretty good member of the (Republican) party."

... Klein said he will also emphasize the need to address the plight of America's uninsured during his remarks.

"There're 45 million uninsured Americans," he pointed out, adding that all Americans should have access to at least a minimum level of basic health care.

He said he will advocate that the nation move toward a "single-payer" medical system, in which a government insurance program would replace the current system.

Under the current system, Medicaid, Medicare, private insurance and patients themselves pay for their health care.

"We're moving toward a single-payer system -- and that's my wish," he said.

http://www.sun-herald.com/NewsArchive2/022003/tp10ew9.htm?date=022003&story=tp10ew9.htm

Comment: In this day and age, when the term "bipartisan" has come to mean that a token Democrat has joined with the Republican majority, some may say that Dr. Klein is supporting a "bipartisan," single payer solution to our health care crisis (but with the parties reversed). Maybe it is time to set aside political polarization, and look at our reform options from a unified, nonpartisan perspective.

Posted by pnhp at 01:59 PM | Permalink | Comments (0)

by Charlotte Denny in Geneva
Published on Wednesday, February 19, 2003 by the Guardian/UK
 
George Bush's close links with the drugs industry were last night blamed for the failure of talks in Geneva aimed at securing access to cheap medicines for developing countries.

Delegates at the World Trade Organization expressed frustration after the US again rejected a deal that would have loosened global patent rules to enable poor countries to import cheap copies of desperately needed drugs.

"We believe that governments should maintain their distance and should not be directed by pressure groups," one EU trade official said.

Negotiators said a solution to the deadlock lay in America's hands. "The pharmaceuticals lobby is running the show in Washington," one development activist said.

The WTO's 144 members agreed more than a year ago that countries could override patent rules in the interests of public health and license local producers to copy essential drugs. But they failed to spell out how countries with no manufacturing capacity would gain access to life-saving medicines.

A draft accord on imports was rejected by the US last December after lobbying from drugs firms, which fear that relaxing the rules to allow poor countries to import copycat drugs will help generics manufacturers in India and Brazil to steal their markets.

America's counter proposal, limiting imports to drugs for a shortlist of diseases including HIV/Aids, malaria and tuberculosis, was rejected by developing countries as too restrictive.

Eduardo Perez Motta, the Mexican ambassador to the WTO, who chairs the drugs talks, admitted the Organization's reputation had been damaged by the deadlock.

A Brazilian proposal, to let the World Health Organization decide which countries were allowed to import copycat drugs, was not even discussed yesterday.

Last week a South African plan that would have required countries to declare a national emergency also failed to win over the US drug industry.

© Guardian Newspapers Limited 2003

###

Posted by pnhp at 03:48 PM | Permalink | Comments (1)

The American Prospect
2/12/03
One Dimensional
The notion of individual mandates for health insurance is untenable and shortsighted.
By Jonathan Oberlander

Mandatory self-insurance -- which would compel all Americans to purchase health insurance (much like all drivers are required to purchase auto insurance) with public subsidies going to those who cannot afford the cost -- has emerged as the flavor of the month in health reform. Ted Halstead, president of the New America Foundation, argued in a Jan. 31 New York Times op-ed piece that mandatory insurance is "the most promising solution to America's health care crisis." Sen. John Breaux (D-La.), a congressional leader on health policy, has offered a similar plan, praising mandatory self-insurance as a "bold and new idea."

Halstead's case for individual mandates is based on a misleading portrait of the uninsured. To Halstead, the uninsured are mostly "middle class" -- young, healthy Americans who can afford to purchase health insurance. If only they were compelled to buy insurance, Halstead argues, not only would we get universal coverage but these healthy newcomers to insurance pools would also drive down the cost of premiums.

In fact, the uninsured are not mostly middle class: Nearly two-thirds (64 percent) of the uninsured earn less than 200 percent of the federal poverty level. As a result, if universal coverage is truly the goal, an individual mandate program would have to offer much higher subsidies to a much broader segment of the population than Halstead implies. And because the average premium for health insurance is $8,000 for families and $3,000 for individuals, Halstead seriously underestimates the federal price-tag for subsidizing individual mandates. That price would decline if the "basic" insurance that Halstead would require all to buy really means only catastrophic or bare-bones policies. But such plans would not provide adequate health security.

Moreover, individual mandate plans have no cost-control mechanisms. They instead rely on the vague hope that competition between private insurers will lower health-care costs. Yet the American experience with competition in medical care provides no basis for relying on a private insurance system -- the most expensive in the world, incidentally -- to slow health spending. Without government regulation and freed from the negotiating leverage that big companies now exert for premium discounts, there would be no constraints on private insurers who wanted to raise prices. Under an individual mandate program, health-care spending and insurance premiums would continue to escalate, necessitating sizable increases in public subsidies -- and likely generating political pressure to retreat from universal coverage.

The aspiration to universal coverage embodied by the new wave of individual mandate plans is a welcome improvement over the incrementalism that has dominated the health-care-reform debate for the last decade. Yet without generous subsidies, clear mechanisms to pool risk and effective cost control, an individual mandate that makes being uninsured illegal will no more solve the health-care crisis than a mandate that makes unemployment illegal would solve joblessness. If what we want is affordable and secure health insurance for all Americans, individual mandates simply won't get the job done.

http://www.prospect.org/webfeatures/2003/02/oberlander-j-02-12.html

Posted by pnhp at 09:59 AM | Permalink | Comments (0)

FOR IMMEDIATE RELEASE

February 3, 2003, 11:00 a.m.
CONTACTS:
Joel Segal, Office of Rep. John Conyers
202-225-5126
joel.segal@mail.house.gov

Physicians Propose Solution to Rising Health Care Costs and Uninsured

Introduce National Health Insurance Bill in Washington, D.C.

WASHINGTON, D.C. --- A group of the nation's most prominent physicians and progressive leaders of Congress will hold a press conference briefing Tuesday, February 4, 11am, 2226 Rayburn House Office Building, to unveil a new bill, The United States National Health Insurance Act, a single-payer national health program. The legislation proposes an effective mechanism for controlling skyrocketing health costs while covering all 42 million uninsured Americans. The bill also restores free choice of physician to patients and provides comprehensive prescription drug coverage to seniors, as well as younger people.

"Good news," says Dr. Quentin Young, convener of the physician panel. "There is now a way to exit the nightmare of a collapsing health system. We no longer have to put up with the outrageous costs that keep millions of Americans from receiving medical care and needed medications. Nor will tens of thousands of families have to declare bankruptcy over medical bills. Universal national health insurance (single payer) takes the resources we have in place and deals with them in an intelligent manner, excluding the tragic hemorrhage of resources into non-health entities."

Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine*, is the spokesperson for the Physicians Working Group on Single-Payer National Health Insurance, an ad-hoc collaboration of the nation's top physicians. Dr. Angell will present the proposal at the briefing.

Other members of the group include Dr. Gerald Thomson and Dr. Christine Cassel, former Presidents of the American College of Physicians, the second largest medical association in the country; Dr. Rodney Hood and Dr. Gary Dennis, former Presidents of the National Medical Association; Dr. Elinor Christiansen, immediate Past-President of the American Medical Women's Association; and Dr. Ron Anderson, CEO of Parkland Hospital in Dallas, Texas. (*Affiliations for identification only. A full list of Working Group members is at the end of this release).

Representative John Conyers, Dean of the Congressional Black Caucus and ranking minority Member of the House Judiciary Committee will introduce The United States National Health Insurance Act on February 4. A long time advocate of national health insurance, Rep. Conyers closely collaborated with the Physicians Working Group on the bill.

Additionally, nearly 4,000 individual physicians have endorsed the physicians' proposal including two former Surgeons General (Dr. David Satcher and Dr. Julius Richmond); a Nobel Laureate (Dr. Bernard Lown); the highly respected authors of major textbooks of surgery and family practice (Dr. William Silen and Dr. Robert Rakel, respectively); and a leading organizer of emergency services in NYC on 9/11(Dr. Lewis Goldfrank, Chairman of Emergency Medicine at New York University).

Also joining the physicians and Congressmen to endorse the National Health Insurance Act will be Dr. Maya Rockeymoore, Urban League Director of Health Policy; Dean Baker, Co-Director, Center for Economic and Policy Research; and Hillary Shelton, a spokesperson for Julian Bond, Chairman of the NAACP.

Original Congressional co-sponsors of the NHI bill at press time are: Dennis Kucinich (OH), Luis Guitierrez (IL), Jim McDermott (WA); Bobby Scott (VA); Donna Christensen (Virgin Islands); Barbara Lee (CA); Danny Davis (IL); Major Owens (NY); Jesse Jackson Jr.(IL); Maurice Hinchey (NY); Donald Payne (NJ); Elijah Cummings (MD); Carolyn Kilpatrick (MI); Alcee Hastings (FL); Chaka Fattah (PA); Ed Towns (NY); John Lewis (GA); BennieThompson (MS); Eleanor Holmes-Norton (delegate for DC), and Raul Grijalva (AZ) (listing in formation).

National Health Insurance Act Press Conference
February 4, 2003 11am
2226 Rayburn House Office Building, Judiciary Committee Room

*Physician Working Group Members

Marcia Angell, MD
Spokesperson
Past Editor
New England Journal of Medicine

Quentin Young, MD
Convener
National Coordinator PNHP
Former President American Public Health Association

Joel Alpert, MD
Former President
American Academy of Pediatrics

Ron Anderson, MD
President and CEO
Parkland Health &Hospital System

Peter Beilenson, MD, MPH
Commissioner
Department of Health, Baltimore

Christine Cassell, MD
Former President
American College of Physicians
Dean, Oregon University School of Medicine

Elinor Christiansen, MD
Past President
American Medical Women's
Association

Olveen Carrasquillo, MD, MPH
Assistant Professor of Medicine
Columbia School of Medicine
Advisory Committee Member
National Hispanic Medical Assn.
Gary Dennis, MD
Former President
National Medical Association

David Himmelstein, MD
Associate Professor of Medicine
Harvard Medical School
Co-Founder, Physicians for a National Health Program

Rodney Hood, MD
Past President of the National Medical Association which represents
African-American physicians

Edith Rasell, MD, PhD
Minister for Labor Relations in Community and Economic Development for
the United Church of Christ

Helen Rodriguez-Trias, MD
Past President
American Public Health Association
(recently deceased)

Sindhu Srinivas, MD
Past President
American Medical Student Assn.

Gerald Thomson, MD
Former President
American College of Physicians

Walter Tsou, MD, MPH
Former Commissioner of Health,
Philadelphia

Steffie Woolhandler, MD, MPH
Associate Professor of Medicine
Harvard Medical School

# # #

Physicians for a National Health Program (PNHP) is a research and education organization with more than 10,000 members representing every state and specialty. PNHP was founded in 1987 and has physician spokespeople across the country. For contact information, call the national headquarters in Chicago at
(312) 782-6006. Visit us online at pnhp.org.

*The Working Group members hold a number of distinguished positions, which are not limited to those listed above. The members' positions and affiliations listed here are provided for identification purposes only.

Editor's note: An interview room will be available immediately following the press conference.

Contact:

Kimberly Soenen
PNHP Media Relations
tel:312-782-6006
fax:312-782-6007
mobile:312-946-0938
kimberlysoenen@pnhp.org
www.pnhp.org

Physicians for a National Health Program (PNHP) is a physician advocacy organization with 12,000 members who support single-payer health care reform.

PNHP has been working since 1987 for universal health care. The national office is in Chicago.

Posted by pnhp at 03:06 PM | Permalink | Comments (2)

The Hartford Courant
February 12, 2003
Who's Shaping The Debate On Health Care Reform?
By Theodore Marmor and Kip Sullivan

The 2003 debate about health care reform, unfortunately, is likely to be as muddled as it was a decade ago, when President Clinton promoted universal health insurance under the banner of managed care and the inflation rate in health insurance premiums was also in double digits.

Now, as then, those with interests in rising health expenditures will try to make sure the American public does not understand the real causes of the recent surge in medical inflation. Their loudest argument is that Americans overuse medical care and that such overuse would only worsen if all Americans were insured.

Overuse does exist, the evidence indicates. But so does worrisome underuse. And overuse cannot explain the latest burst in health insurance prices or the sharp rises in what drugstores and doctors charge. There is no credible evidence that Americans received a lot more medical care in the past few years. But the price of health care has skyrocketed nonetheless. That inflation is because of the market power of insurers, drug manufacturers, hospitals and other suppliers of medical services.

Advocates of medical savings accounts and other high-deductible plans talk of overuse because they think they have an answer to it. With a few exceptions, these advocates avoid discussion of underuse. They know they have no solution for underuse and that their practices will almost surely aggravate it. But that does not dissuade them from disseminating the overuse thesis at the meetings of health insurers and the gatherings of groups like the National Association of Manufacturers.

In that context, a sensible discussion of medical inflation, let alone universal health insurance, is very difficult. It is almost impossible when the news media act like an echo chamber, amplifying the voices of the already heard. Well-financed interest groups have lobbyists who are paid and prodded to comment and who show up regularly in debates that journalists try to "balance." The trouble is that there are 50 industry spokespeople for every underfinanced representative of ordinary citizens. The news all too often then turns out to be what prominent figures in the medical-commercial complex claim.

No wonder that Americans support the reform principles of universal coverage but express fear at most efforts to act on them.

http://www.ctnow.com/news/opinion/op_ed/hc-marmor0212.artfeb12,0,2104280.sto ry?coll=hc%2Dheadlines%2Doped

Comment: Forums on reform today are amazing. As Marmor and Sullivan note, much of the discussion is on shifting to "consumer-directed" health care, based on the theory that the primary problem that needs to be addressed is the waste resulting from patients' incessant demand for unnecessary health care services.

The irony is that the problem of overutilization is not due to patients' quests to get more. It is due to practice patterns that fail to acknowledge that sometimes no medical intervention is a preferred course to an intervention that, in reality, is not beneficial or may even potentially be detrimental. Unnecessary hysterectomies, arthroscopies, antibiotic usage, body imaging and similar excesses are selected and controlled by the physician to whom the patient has turned for the best advice on health care decisions. These are problems that call for systemic reform that would improve physician behavior (another topic). Placing financial penalties between the patient and health care (consumer-directed care) results in decreased use of all services, including, especially, beneficial services. The most serious impact of this is in the care of patients with major medical needs. Erecting financial barriers will often prevent those with the greatest need to have precisely the services they require. This is perhaps the worst health care "reform" ever devised, the epitome of non-solutions.

The forums on health care still acknowledge that the numbers of uninsured continue to increase, that health care inflation continues to exceed the general rate of inflation, that the level of disparities are unacceptable, and, ironically, that the rate of under-insurance (consumer-directed!) is dramatically increasing to the point of causing a surge of personal bankruptcies for medical costs of both insured and uninsured patients. But then the forums go on to address the shift from the age of managed care to the age of consumerism. Where is the discussion of real solutions to these real problems?

Well, there is some discussion. But much of it is directed to finding compromises with this "consumerist" element that has gained control of the debate. Thus the discussion has shifted to tax credits, health reimbursement arrangements or MSAs, association health plans, and other reforms which may tweak the number of uninsured, but will leave those with the greatest health care needs highly vulnerable to financial risk. It is mind-boggling that those supporting universal access to comprehensive services are considering compromise as if there were something of substance with which to compromise. There isn't. Consumer-directed proposals have nothing to offer in the way of solutions to the real problems in health care.

Those covering the health care debate must insist on receiving answers to the questions they should be asking about these real problems in health care. I emphatically recommend reading the article, "Soaring health premiums creating more uninsured," by Nancy McVicar of the Sun-Sentinel in Florida. She addresses the real problems and discusses realistic solutions. Admittedly, she does discuss our approach, but then, is there any other that is better?

http://www.sun-sentinel.com/features/health/sfl-rxinsure09feb09,0,4782118.st ory?coll=sfla%2Dnews%2Dhealth

Posted by pnhp at 10:36 AM | Permalink | Comments (1)

When Sheila Wessenberg's breast cancer was diagnosed and she needed a lumpectomy and then a mastectomy, her husband Bob's insurance covered her care. Then Bob lost his job in December 2001, and they and their two children went from living comfortably on his $102,000-a-year salary to facing bankruptcy. They managed to pay for health insurance out of pocket for six months, until the premiums jumped to $832 a month. After being rejected for Medicaid because they had too many assets, the Wessenbergs joined the ranks of the 41 million uninsured Americans. Sheila, who was forced to quit chemotherapy midtreatment, is tempting the odds.

''We used to have a little left over for nicer things and enough to start saving for a rainy day,'' says Bob, a 51-year-old former Lotus programmer who recently found an $11-an-hour job. ''Then we got a rainy month and now we got a rainy year.'' Things remain dire, so his wife has turned to panhandling. Read the full story.

Posted by pnhp at 09:30 AM | Permalink | Comments (0)

Journal of the American Geriatrics Society
February, 2003
Differences in Mortality of Black and White Patients Enrolled in the Program of All-Inclusive Care for the Elderly
By Erwin J. Tan, Li-Yung Lui, Catherine Eng, Ashish K. Jha & Kenneth E. Covinsky

Abstract

OBJECTIVES: To examine the relationship between race and mortality in frail community-dwelling older people with access to a program providing comprehensive access and coordination of services.

DESIGN: A longitudinal cohort study.

SETTING: Twelve nationwide demonstration sites of the Program of All-Inclusive Care for the Elderly (PACE) from 1990 to 1996. PACE provides comprehensive medical and long-term care services for nursing home-eligible older people who live in the community.

PARTICIPANTS: Two thousand two white patients and 859 black patients.

MEASUREMENTS: Patients were followed after enrollment until death or the end of the follow-up period. Time from enrollment to death was measured with adjustment of the Cox proportional hazards model for comorbid conditions, functional status, site, and other demographic characteristics.

RESULTS: Black patients were younger than white patients (mean age 77 vs 80, P < .001) but had worse functional status (mean activity of daily living (ADL) score 6.5 vs 7.2, P < .001) on enrollment. Survival for black and white patients was 88% and 86% at 1 year, 67% and 61% at 3 years, and 51% and 42% at 5 years, respectively (unadjusted hazard ratio (HR) for black patients = 0.77; 95% confidence interval (CI) = 0.67-0.89). After adjustment for baseline comorbid conditions, functional status, site, and demographic characteristics, black patients still had a lower mortality rate (HR = 0.77; 95% CI = .65-0.93). The survival advantage for black patients did not emerge until about 1 year after PACE enrollment (HR for first year after enrollment = 0.97; 95% CI = 0.72-1.31; HR after first year = 0.67; 95% CI = 0.54-0.85, P-value for time interaction < .001). During the first year of enrollment, black patients were more likely to improve and less likely to decline in ADL function than white patients (P < .001).

CONCLUSION: In PACE, a system providing access to and coordination of comprehensive medical and long-term care services for frail older people, black patients have a lower mortality rate than white patients. This survival advantage, which emerges approximately 1 year after PACE enrollment, may be related to the comprehensive access and coordination of services provided by the PACE program. J Am Geriatr Soc 51:246-251, 2003.

http://www.blackwellpublishing.com/abstract.asp?ref=0002-8614&vid=51&iid=2&aid=16&s=

Comment: Impaired access is clearly a major contributor to heath care disparities. The significance of this study is that it demonstrates that providing access to comprehensive services was followed by an elimination of these disparities.

The first step in assuring access is to eliminate financial barriers to care by establishing a universal, comprehensive health insurance program. The PACE program is unique, and undoubtedly many other measures will be required to reduce disparities in other situations. But eliminating disparities is virtually impossible without an equitable system of funding health care.

Posted by pnhp at 12:47 PM | Permalink | Comments (0)

Transcript and video featuring PNHP's Quentin Young on Canada's health system.

Posted by pnhp at 11:04 AM | Permalink | Comments (0)

Budgeteer News
Last Updated: Friday, February 07th, 2003 11:57:45 AM

State Rep. Mike Jaros, DFL-Duluth, has authored a bill that would create a single-payer universal health care system in Minnesota.

“We cannot wait for the federal government to reform our medical system,” Jaros said. “If we want change, Minnesota is going to have to lead as it has on so many other issues. The Canadian health care system was not reformed from Ottawa, but from Saskatchewan. Washington has not made an attempt to seriously reform our health care system since the Clinton administration’s attempt 10 years ago.”

Jaros based his legislation on the findings of the Minnesota Healthcare Cost Study
Commission on which he served in the early 1990s. “Our commission found three major reasons for the huge health care cost increases over the last two decades,” Jaros said. “The first was top-heavy administration costs caused by so many complicated plans and the high commissions paid to sales agents during the first year. The second was technological advances that forced hospitals to invest in ever more expensive equipment as a way to compete. The third was a lack of coherent public policy on both the federal and state levels.”

Jaros said that administrative costs average between 20 and 40 percent for most health plans, far out of line when compared with the administrative costs of other consumer products. He also said that competition between plans and hospitals has more often than not led to higher health care costs.

“The big driver here is technology,” he said. “Competition between various clinics and hospitals actually increases costs because they are forced to buy more expensive equipment to keep up, even when demand for that equipment isn’t enough to justify the cost for the machines.”

Jaros said the system needs a fundamental restructuring to address these problems.

“We must change and simplify the system to reduce the administrative costs and regulate technological costs, otherwise these rising costs are going to bankrupt both businesses and government,” he said. “That’s going to take a coherent policy administered by the state.”

http://www.duluth.com/placed/index.php?story_id=132101

Posted by pnhp at 09:15 AM | Permalink | Comments (0)

Our concern is health, and everyone agrees that war is unhealthy.

The concepts in the following article make it clear that there are options other than war.

Washington Post
February 9, 2003
Is There a Better Way to Go?
By Jessica Tuchman Mathews

http://www.washingtonpost.com/wp-dyn/articles/A42716-2003Feb7.html

Jessica Tuchman Mathews is president of the Carnegie Endowment for
International Peace:
http://www.ceip.org

All of America must understand that war is not our only option, only our worst one.

Please make this message yours, and share it with others.

Posted by pnhp at 09:27 AM | Permalink | Comments (0)

Uwe Reinhardt, Ph.D. sends us a message in response to news reports on the elimination of retiree health benefits by Bethlehem Steel and by Aetna. Our response follows his.

Click on this link to learn about another American chicken coming home to roost. (Not ever having raised chickens, I don't actually understand this metaphor, but I hope its use here is appropriate). Bethlehem's workers should have expected this, as should all other workers with retiree benefits promised them by a corporation. After all, they were presumably adults when these deals with their company were done.

For some reason, millions of American workers in their prime were convinced that their particular company was stronger, smarter and had longer longevity than does the United States government. Where people learn such civics and economics has always been a mystery to me. But that is the "truth" they knew, perhaps because they had been taught it in high school or on TV or by their local Chamber of Commerce.

Did it ever occur to anyone that when the executive of the ABC Corporation in, say, 1975, promised a worker then that "the company" would purchase him or her $10,000 or more worth of health care 30 years hence (when that promising executive might be dead already), that such a promise was highly dubious on its face? How could that executive possibly have known that the ABC Corporation would even exist in 2005? After all, it might have been wiped out in 1995 by a competitor in Shanghai or Singapore or Japan. If not that, it might have been wiped out by a future American genius, such as Jerry Levin of Time Warner, who virtually gave away that company to the shareholders of AOL, a fluffy virtual company whose stock would be called "funny money" if it were not so tragically worthless (not even to speak of the geniuses who ran WorldCom, Enron and so on). If not that, the ABC Corporation might in the future be headed by a ruthless, greedy executive who might look to breaking such earlier promises as a nifty way to shore up the company's bottom line and, thereby, the value of his gazillion stock options--all to the loud cheers of an adulating financial press?

Where did Americans ever gain the impression that, over the long haul, a string of unknown future ABC Corporation executives of a corporation constantly being buffeted by global competition would be a more reliable source of retirement security than the government of these United States? Who teaches them these fairy tales? Can anyone enlighten me on this one?

In 2001, General Motors acknowledged in its annual report to have completely unfunded liabilities for retiree benefits other than pensions (mainly health care) of $34.5 billion. The company's net worth (shareholders' equity) that year was $19.7 billion. It gives you some idea of the financial pressures besetting the company for having taken on this social security system on behalf of GM workers, current and former. Although Rock Wagoner, the current CEO, is widely acclaimed for his operating skill, GM's stock tanked when earnings were up recently, reportedly over the huge unfunded retiree benefit overhang (health care plus unfunded pension obligations that should, ideally, have been funded). Can't you see some future GM manager simply throwing in the towel, union be damned? Sitting out a strike over that issue might be worth it to the GM shareholders and the executive's stock options.

I guess I am supposed to feel sorry for the Bethlehem Steel workers who might lose the promised health benefits, or for other workers who surely will in the years ahead. I don't. "Should have respected your government more," is what I would tell them. "Shouldn't call everyone who proposes to have government do what a private corporation cannot possibly do a 'socialist.' Now sit back and enjoy your American dream, my friends. And a dream it was, if only you had thought about it." That's where I am on this one.

Best

Uwe R.

Here's another story on retiree health benefits. Like the previous one, it comes to me courtesy of Naomi Shaiken.

http://www.ctnow.com/business/hc-aetna0208.artfeb08,0,5399206.story?coll=hc%2Dheadlines%2Dbusiness

Similar story--same response by me.

Uwe

Don's comment: What is your response to Professor Reinhardt's message? Are you angry with him for slamming the hapless working stiff who is the victim of corporate abuse? Are you angry with the corporate leaders who are depriving their hard-working employees of their promised benefits? Are you angry with the union leaders who failed to assure that trusts that they fought for were fully and permanently funded? Are you angry with the superfluous vested interests that are thriving as they continue to dispense the "government can't do it" rhetoric? Or are you angry with yourself for your continued inertia when the need is so great?

Regardless, do NOT walk away from this message simply fuming. Do NOT simply leave it to others to take up the task of reforming health care. The average American really does not understand the policy implications of various reform proposals. It will take a massive grassroots effort to educate the public. Each one of us MUST be a part of that effort.

The Coalition for a National Health Program (CNHP) is being launched to conduct education and advocacy on the only truly workable, cost-efficient solution: a publicly funded, publicly-administered national health insurance program for the United States. Participation in the coalition will require "only" that you agree to support health care reform by mobilizing friends, associates, organizations and the community in activities that advance the understanding of this option that is clearly the imperative. The strength of this movement will not be in funds, but in people: you, me, and everyone else that cares about the future of health care in America.

The CNHP website:
http://www.cnhp.us

Bookmark it now, and be prepared to visit it soon to sign on, and to use its resources in your grassroots efforts.

Posted by pnhp at 09:22 AM | Permalink | Comments (0)

GhanaHomePage
Ghana
05 February 2003
Health Insurance scheme to be fully operational

The National Health Insurance Bill would soon be placed before Parliament and become fully operational by the end of the year, Vice President Aliu Mahama, said on Tuesday.

The Vice President, who said this when he launched the Ghana Health Service (GHS), the service delivery arm of the Health Ministry, urged Ghanaians to support the scheme when it is implemented.

He said: "It is better to have an arrangement that enables you to prepare and plan for inevitable but unpredictable day of ill-health by paying for a health insurance policy, rather than the "Cash and Carry" system, which makes you pay when you are ill and at your most vulnerable.

"I am convinced that in the long run, health insurance is a more humane way of paying for health services and I urge you all to support the system when it comes into being later in the year."

The insurance scheme is being tested in 42 districts by mutual health organisations, owned by the communities. Vice President Mahama stressed the government's commitment to ensure that Ghanaians stay healthy and work for the growth of the economy...

http://www.ghanaweb.com/GhanaHomePage/NewsArchive/artikel.php?ID=32446

Comment: As the United States moves further toward a consumer-directed health care system "which makes you pay when you are ill and at your most vulnerable," Ghana is creating National Health Insurance which "enables you to prepare and plan for inevitable but unpredictable day of ill-health."

American Heritage Dictionary: "civilized" - adjective: ... 2. Showing evidence of moral and intellectual advancement; humane, ethical, and reasonable...

Hmmm...

Posted by pnhp at 09:12 AM | Permalink | Comments (0)

Health Affairs
Web Exclusive
February 7, 2003
Health Spending Projections For 2002-2012
By Stephen Heffler, Sheila Smith, Sean Keehan, M. Kent Clemens, Greg Won, and Mark Zezza (from the Office of the Actuary, Centers for Medicare and Medicaid Services)

Projection for 2003:

National Health Expenditures (NHE) (billions):
$1660.5

NHE, per capita:
$5775

NHE, as percent of GDP:
15.2%

Both the recently released historical health spending estimates and this set of projections have highlighted the enormous pressures mounting on our health care system. Private health insurance premiums are rising at rapid rates, federal and state budget shortfalls exist, a softer labor market has reduced the number of people with private insurance and has increased Medicaid enrollment, and provider costs are continuing to rise. These trends have the unique, although not unparalleled, impact of affecting all of the relevant parties-from payers to providers to employers to consumers-at the same time.

Experience indicates that changes in the mechanisms of payment and delivery of care, as well as consumers' preferences and public sentiment, will result in a slowdown in growth, temporarily alleviating some of these pressures. However, experience also indicates that society is likely to be willing to allocate more of each dollar of income to health care. We project both of these outcomes over the next decade: national health spending growth slowing from 8.7 percent in 2001 to 6.7 percent in 2012, and the share of GDP accounted for by health care increasing from 14.1 percent in 2001 to 17.7 percent in 2012. The intriguing part of the next decade may be where it leaves us, since the baby-boom generation will begin to become eligible for Medicare at the end of the projection period, and an unparalleled set of pressures on the system is likely to develop.

http://www.healthaffairs.org/WebExclusives/Heffler_Web_Excl_020703.htm

Posted by pnhp at 04:03 PM | Permalink | Comments (0)

By Randall Palmer

OTTAWA (Reuters) - Canada's political leaders reached an 11th-hour funding deal on Wednesday aimed at preventing further erosion of the country's ailing universal health care system but greatly expanding its coverage.

The federal government agreed to transfer an additional $8 billion to the provinces, while the provinces agreed to expand medicare over time to cover expensive drugs and home care.

The provinces, which were hit by federal spending cuts in the 1990s, quickly denounced the federal grant as insufficient and said they would be coming back for more.

"We will continue the battle, democratically of course," said Bernard Landry, the separatist premier of French-speaking Quebec.

Landry denounced Canadian Prime Minister Chretien as a "predator" for not being willing to part with more of the federal government's expected budget surpluses.

But in the end, the provincial premiers, most of whom face elections this year, could not walk away from the cash.

"At the end of the day, when you're told 'take it or leave it,' the patients come first," New Brunswick Premier Bernard Lord said.

Both sides recognized that the public wants repairs to a system that suffers from long waiting lines and a shortage of doctors and nurses.

Despite the system's problems, Canadians often cite it as an important cultural difference between their country and the neighboring United States.

The expansion to cover costly drugs and home care, together with a commitment to expand group medical practices where nurses would see patients in some cases, were part of a reform package aimed at making the health system more efficient.

As part of the C$12 billion total new money, the provinces will get C$2.5 billion before the end of the fiscal year on March 31. They will receive a further C$7.5 billion over the following three years.

If Ottawa is still running a surplus above the normal contingency reserves next January--as it has regularly for the last several years--the provinces will get another C$2 billion.

The federal government helps fund the health system and the provinces administer it.

Health spending has eaten up an increasing share of provincial budgets, now around 40%. The provinces say that with the federal government running regular budget surpluses, it should turn over a lot more to the provinces.

Total health spending--including private spending for things not covered by medicare--amounted to an estimated C$112 billion last year.

The federal government is giving C$19.1 billion in the current fiscal year to the provinces as a general transfer for health and social spending.

In November, a federal health commission recommended an increase of C$15 billion in federal health spending over the next three fiscal years, and the provinces also demanded this amount.

In addition to the C$12 billion through 2005-06, the government committed a further C$11.8 billion in new money for the following two fiscal years.

While the premiers of all 10 provinces agreed to the federal arrangement, the premiers of the three sparsely populated northern territories refused to sign on. They will negotiate their grants from Ottawa separately.

Posted by pnhp at 10:16 AM | Permalink | Comments (0)

The Washington Post
February 5, 2003
Director Seeks 'Just the Facts' To Improve Medical Care
By David Brown

It is an embarrassing but no longer well-kept secret that despite health care spending of about $1.3 trillion a year -- including about $25 billion in federally funded research -- many Americans receive medical care that is not terribly good.

Agency for Healthcare Research and Quality (AHRQ) enters a new phase of its occasionally rocky journey with the appointment expected today of Carolyn M. Clancy, 49, as the fourth director since its founding in 1989.

As Clancy sees it, AHRQ has two big challenges. One is to help develop the "evidence base" of medicine -- the raw material of better care. The second is to identify the best ways to get doctors and nurses to use optimal, up-to-date treatments.

The first effort acknowledges that the body of medical research on just about any important subject is vast -- too big for the average practitioner to grasp. Over the past 15 years, however, there has emerged a set of rules and methods by which a team of experts examines all the studies on a given question, evaluates their validity (combining numerous ones, on occasion, to increase the statistical power of the results) and ultimately extracts conclusions -- the "best evidence" -- from the mass of information.

This work is expensive and laborious. Health care organizations and professional societies cannot easily do it. Consequently, AHRQ has helped establish "evidence-based practice centers" at 13 universities, and is paying researchers there to create "systematic reviews" of many topics.

She describes the second challenge as the effort to figure out "what systems or strategies make the right thing to do the easy thing to do."

AHRQ is paying for dozens of studies of how clinics and hospital systems improve care, vaccination rates and patient satisfaction, and reduce waiting time, overlooked lab results and medication errors.

Carolyn Clancy, M.D.:

"The key is information. Making information available at the point of care when you need it."

http://www.washingtonpost.com/wp-dyn/articles/A26125-2003Feb4.html

U.S. Department of Health and Human Services press release: http://www.ahcpr.gov/news/press/pr2003/clancypr.htm

Agency for Healthcare Research and Quality: http://www.ahcpr.gov/

Comment: The appointment of Carolyn Clancy as director of AHRQ is an important step forward for improving the quality of our health care system. She understands the issues that will make our system a better system for those who matter the most: the patients. Her strong, patient-oriented values are exemplified by the fact that she is a former president of Physicians for a National Health Program.

Posted by pnhp at 12:16 PM | Permalink | Comments (0)

The Kansas City Star
Jan. 26, 2003
As I See It: Single-payer system would fix health system
By Joshua Freeman

Those who observe that there are waits for some elective services in Canada are confusing how health-care resources are distributed (inequitably in the United States, equitably in Canada) and how much we spend on health care. Per capita, the United States spends twice what Canada spends and four times what Britain spends; if either country could afford to spend anything close to these levels, there would be no waits for any services in either country. What we lack is a structure that is rational and equitable, as is single payer.

The American people can demand a rational cost-effective system that provides equitable, necessary access to health care for all. Eliminating insurance industry profit and implementing a single-payer system can be a central part of this solution.

http://www.kansascity.com/mld/kansascity/5025963.htm

Joshua Freeman, MD is chairman of the department of family medicine at the University of Kansas Medical Center.

Posted by pnhp at 04:26 PM | Permalink | Comments (0)

National Journal,
February 5, 2003

Rep. John Conyers (D-Mich.), ranking member of the House Judiciary Committee, and Rep. Jim McDermott (D-Wash.), a member of the House Ways and Means Health Subcommittee, have introduced a bill that would create a national single-payer health system, CongressDaily reports.  According to McDermott, the bill would have the federal government finance but not administer the system and would keep the current system of private physicians and hospitals.  McDermott said it is "nonsense to suggest the nation cannot afford such a system," noting that the federal government "already spends $2,600 per person" on health care through Medicare, Medicaid, other public health plans and tax exclusions for employers who provide workers' coverage.  Conyers said, "Even the people who don't like [a single-payer system] are moving to it.  There's nothing else left" (Rovner, CongressDaily, 2/4).  According to a bill summary, the system would expand the current Medicare system to all U.S. residents. The system would be funded through the existing Medicare payroll tax and a new payroll tax and would provide coverage for a variety of services, including primary care, prescription drugs and dental and vision services (Bill summary).

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=15882

Posted by pnhp at 11:11 AM | Permalink | Comments (1)

The United States National Health Insurance Act
Executive Summary

The United States National Health Insurance Act establishes a new American national health insurance program by creating a single payer health care system. The bill would create a publicly financed, privately delivered health care program that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans, guaranteed by law, will have access to the highest quality and cost effective health care services regardless of one's employment, income, or health care status.

And from the PNHP press release:

Quentin Young, M.D., convener of the physician panel:

"Good news. There is now a way to exit the nightmare of a collapsing health system. We no longer have to put up with the outrageous costs that keep millions of Americans from receiving medical care and needed medications. Nor will tens of thousands of families have to declare bankruptcy over medical bills. Universal national health insurance (single payer) takes the resources we have in place and deals with them in an intelligent manner, excluding the tragic hemorrhage of resources into non-health entities."

Executive Summary of The United States National Health Insurance Act: http://www.pnhp.org/nhibill/nhi_execsumm.html

The full text of The United States National Health Insurance Act: http://www.pnhp.org/docs/nhi_bill_final.pdf

Recorded telecast of the press conference on kaisernetwork.org HealthCast: http://www.kaisernetwork.org/calendar/calendar.cfm?show=4 and click on the calendar under Feb. 4, "Physicians for a National Health Program - National Health Insurance Bill (DC)"

PNHP press release: http://www.pnhp.org/nhibill/nhi_press_release.html

The Coalition for a National Health Program is being launched to bring together all those who support the kind of national health plan embodied in the US National Health Insurance Act. Bookmark this site and return to it soon: http://www.cnhp.us/

Posted by pnhp at 01:53 PM | Permalink | Comments (1)

February 4, 2003
Washington D.C.

We are here today to introduce a national health insurance program. Such a program is no longer optional; it’s necessary.

Americans have the most expensive health care system in the world. We spend about twice as much per person as other developed nations, and that gap is growing. That’s not because we are sicker or more demanding (Canadians, for example, see their doctors more often and spend more time in the hospital). And it’s not because we get better results. By the usual measures of health (life expectancy, infant mortality, immunization rates), we do worse than most other developed countries. Furthermore, we are the only developed nation that does not provide comprehensive health care to all its citizens. Some 42 million Americans are uninsured – disproportionately the sick, the poor, and minorities -- and most of the rest of us are underinsured. In sum, our health care system is outrageously expensive, yet inadequate. Why? The only plausible explanation is that there’s something about our system – about the way we finance and deliver health care – that’s enormously inefficient. The failures of the system were partly masked during the economic boom of the 90’s, but now they stand starkly exposed. There is no question that with the deepening recession and rising unemployment, in the words of John Breaux, “The system is collapsing around us.”

The underlying problem is that we treat health care like a market commodity instead of a social service. Health care is targeted not to medical need, but to the ability to pay. Markets are good for many things, but they are not a good way to distribute health care. To understand what’s happening, let’s look at how the health care market works.

Most Americans receive tax-free health benefits from their employers, who pay insurers a portion of the premiums for health coverage. But not all employers offer benefits, and when they do, the benefits may not be comprehensive. It’s entirely voluntary. When employers are competing for workers, they offer good benefits; when unemployment rises, they drop them.

The insurers with whom employers do business are mostly investor-owned, for-profit managed care businesses. They try to keep premiums down and profits up by stinting on medical services. In fact, the best way for insurers to compete is by not insuring high-risk patients at all; limiting the coverage of those they do insure (for example, by excluding expensive services, such as heart transplantation); and by passing costs back to patients by denying claims or as deductibles and co-payments. We are the only nation in the world with a health care system based on dodging sick people. These practices add greatly to overhead costs because they require a mountain of paperwork. They also require creative marketing to attract the affluent and healthy and avoid the poor and sick. Not surprisingly, the U. S. has by far the highest overhead costs in the world.

It’s instructive to follow the health care dollar as it wends its way from employers toward the doctors and nurses and hospitals that actually provide medical services. First, private insurers regularly skim off the top a substantial fraction of the premiums – anywhere from 10 to 25 percent – for their administrative costs, marketing, and profits. The remainder is then passed along a veritable gauntlet of satellite businesses that feed on the health care industry, including brokers to cut deals, disease-management and utilization review companies, drug-management companies, legal services, marketing consultants, billing agencies, information management firms, and so on and so on. Their function is often to limit services in one way or another. They, too, take a cut, including enough for their own administrative costs, marketing, and profits. I would estimate that no more than 50 cents of the health care dollar actually reaches the providers – who themselves face high overhead costs in dealing with multiple insurers.

What are the signs of the imminent collapse of this system? Private health insurance premiums are now rising at an unsustainable rate of about 13 percent per year – and as much as 25 percent in some areas of the country. Coverage is shrinking, as more employers decide to cap their contributions to health insurance and workers find they cannot pay their rapidly growing share. And finally, with the rise in unemployment, more people are losing what limited coverage they had. This is not a system that can be tinkered with. It needs to change.

The program we are introducing today is the very soul of simplicity and efficiency, compared with our private health care system. It is a single-payer system – that is, health care funds would be distributed by a single, public entity, so that health care could be coordinated to eliminate both gaps and overlap. In many ways, our program would be tantamount to extending Medicare to the entire population. Medicare is, after all, a government-financed single-payer system embedded within our private, market-based system. It’s by far the most efficient part of our health-care system, with overhead costs of less than 3 percent, and it covers virtually everyone over the age of 65, not just some of them. Medicare is not perfect, but it is by far the most popular part of the U. S. health care system, and in my opinion its problems would be relatively easy to remedy – but that is another subject.

What are the usual objections to the sort of national program we are calling for today? They are mostly based on a number of myths.

Myth #1 is that we can’t afford a national health care system, and if we try it, we will have to ration care. My answer is that we can’t afford not to have a national health care system. A single-payer system would be far more efficient, since it would eliminate excess administrative costs, profits, cost-shifting and unnecessary duplication. Furthermore, it would permit the establishment of an overall budget and the fair and rational distribution of resources. We should remember that we now pay for health care in multiple ways – through our paychecks, the prices of goods and services, taxes at all levels of government, and out-of-pocket. It makes more sense to pay just once.

According to Myth #2, innovative technologies would be scarce under a single-payer system, we would have long waiting lists for operations and procedures, and in general, medical care would be threadbare and less available. This misconception is based on the fact that there are indeed waits for elective procedures in some countries with national health systems, such as the U. K. and Canada. But that’s because they spend far less on health care than we do. (The U. K. spends about a third of what we do per person.) If they were to put the same amount of money as we do into their systems, there would be no waits and all their citizens would have immediate access to all the care they need. For them, the problem is not the system; it’s the money. For us, it’s not the money; it’s the system.

Myth #3 is that a single-payer system amounts to socialized medicine, which would subject doctors and other providers to onerous, bureaucratic regulations. But in fact, although a national program would be publicly funded, providers would not work for the government. That’s currently the case with Medicare, which is publicly funded, but privately delivered.

As for onerous regulations, nothing could be more onerous both to patients and providers than the multiple, intrusive regulations imposed on them by the private insurance industry. Indeed, many doctors who once opposed a single-payer system are now coming to see it as a far preferable option.

Myth #4 says that the government can’t do anything right. Some Americans like to say that, without thinking of all the ways in which government functions very well indeed, and without considering the alternatives. I would not want to see, for example, the NIH, the National Park Service, or the IRS privatized. We should remember that the government is elected by the public and we are responsible for it. An investor-owned insurance company reports to its owners, not to the public.

Some people say that a single-payer system is a good idea, but politically unrealistic. That is a self-fulfilling prophecy. In my opinion, the medical profession and the public would be enthusiastic about a single-payer system if the facts were known and the myths dispelled. Yes, there would be powerful special interests opposing it and I don’t underestimate them, but with courageous leadership, such as Representative Conyers is providing, and the support of the medical profession and public, I believe there is nothing unrealistic about a National Health Insurance Program.

I want to mention one final and very important reason for enacting a national health program. We live in a country that tolerates enormous disparities in income, material possessions, and social privilege. That may be an inevitable consequence of a free market economy. But those disparities should not extend to denying some of our citizens certain essential services because of their income or social status. One of those services is health care. Others are education, clean water and air, equal justice, and protection from crime, all of which we already acknowledge are public responsibilities. We need to acknowledge the same thing for health care. Providing these essential services to all Americans, regardless of who they are, helps ensure that we remain a cohesive and optimistic country. It says that when it comes to vital needs, we are one community, not 280 million individuals competing with one another. In seeking to ensure adequate health care for all our citizens, we have an opportunity today to reassert that we are indeed a single nation.

— Marcia Angell, M. D.
Senior Lecturer, Department of Social Medicine, Harvard Medical School
Former Editor-in-Chief, New England Journal of Medicine
February 4, 2003
Washington, D.C.

Posted by pnhp at 11:46 AM | Permalink | Comments (0)

News from the Metro Washington Council,
AFL-CIO February 3, 2003

SHOW YOUR LOVE FOR JANITORS: DC janitors will march to the American Medical Association on Valentine's Day to highlight their need for health care. Contracts covering more than 4,000 DC janitors (members of SEIU 82) expire April 30th and health care is a top issue on the table. AMA headquarters are cleaned by janitors who receive no health care benefits, despite AMA claims to be working on addressing the disparity between the world's most advanced health care system and the lack of health care among many minority groups in the United States. SEIU Local 82 members will join janitors and other supporters in spotlighting their fight for health care for all janitors in the nation's capitol.

Disconcerting facts about DC janitors from SEIU Local 82:
http://www.seiu82.org/linked_pages/master_contract_2003.cfm

Posted by pnhp at 02:57 PM | Permalink | Comments (0)

Critics say private drug plans leave seniors paying more for less

By Deborah Barfield Berry
WASHINGTON BUREAU

February 3, 2003

Washington - Over the years, Diane Paulson has watched managed care plans promise seniors in Massachusetts cheaper health insurance complete with prescription drug coverage, only to pack up and leave.

"It was a shame that so many people were misled. Misled by the plans and in some ways misled by the government - that this was the best thing since sliced bread," said Paulson, managing attorney at the Medicare Advocacy Project, a Boston- based program representing Medicare beneficiaries. "It's been a mixed bag. But mostly negative."

Paulson, like many other advocates for seniors, doctors and some health experts, is now questioning why President George W. Bush would propose a plan that relies on private health plans to deliver a Medicare prescription drug benefit to seniors when the track record in an existing federal program, Medicare+Choice, has been shaky.

Citing Medicare+Choice as an example, advocates argue that private plans have abandoned seniors, leaving them scrambling to find new health care plans or paying higher premiums and co-payments for fewer benefits. In some cases, seniors have had to return to the more costly traditional Medicare, the federal insurance program for the elderly and disabled, which doesn't offer drug coverage.

"The whole privatization scheme is the wrong direction," said Don McCanne, president of the Phy- sicians for a National Health Program. "It will shift patients into an industry that has a much higher administrative cost ... and will do it at the cost of decreasing the benefit for Medicare beneficiaries."

Bush and Republican lawmakers support Medicare drug plans that rely on the private sector to deliver benefits. They contend that competition would drive down drug costs and offer seniors more coverage and choice.

"I believe seniors, if they're happy, should stay on the current Medicare system," Bush said last week in Grand Rapids, Mich., where he touted his plan. "Medicare must be more flexible ... They ought to be able to choose their own health care plan."

In 1997, Congress approved cost-cutting provisions that allowed HMOs to provide health care benefits to Medicare beneficiaries. Two years later, the program had enrolled 6.3 million people.

But from 1998 to 2002, the number of managed care plans contracting with Medicare dropped from 340 to 147, according to the General Accounting Office, the government's investigative arm. By last summer, the number of enrollees had fallen to about 5 million, or 12 percent of the 40 million Medicare beneficiaries. As a result, 1.6 million beneficiaries had to switch plans or go back to traditional Medicare.

Managed care plans complained that the federal government hadn't reimbursed them enough, leaving them with few options but to abandon unprofitable markets, reduce benefits or increase premiums.

This year, 33 managed care plans withdrew from the program or reduced their service area, affecting about 217,000 people, according to federal figures.

"We've been saying since 1997 there was a problem with the [funding] formula ... that led to unintended consequences," said Karen Ignagni, president of the American Association of Health Plans, a trade group.

Federal officials acknowledge the challenge is to attract more managed care plans and entice others to remain in some areas, particularly rural communities. Federal health officials are proposing that Congress increase reimbursements by 6.2 percent.

In 1999, Congress increased reimbursements from 3 percent to 5 percent in some rural areas. HMOs complained that the reimbursements didn't keep pace with rising health costs.

"These guys have been capped at 2 percent growth rate for a number of years," said Michael O'Grady, former senior research director at the Center for Health Affairs at Project HOPE, a health care think tank in Bethesda, Md. "Do they have something there? Sure. Both sides have their points."

Still, O'Grady said, "We have to see how much money is on the table. There is only so much money."

With adequate federal reimbursements, Ignagni said, managed care plans would remain in the program, which she called effective. The American Association of Health Plans is calling for an additional $1 billion a year.

"There isn't a problem in the delivery. There isn't a problem in the model. There isn't a problem in satisfaction," Ignagni said. "There is only a problem in the funding formula. And we know we can fix that."

The administration recently contracted with 35 private plans, called PPOs, to offer seniors health insurance that allows them to go to other doctors within a network. Several are in New York, including Queens, but none are in Suffolk and Nassau counties.

But consumer advocates and physicians say those private plans aren't very effective and emphasize there are more pressing issues, particularly restoring funding to doctors who treat Medicare patients. Some have stopped taking Medicare patients. "What we need to do is take care of the traditional program where we get the most value," McCanne said.

The Bush administration, which has yet to outline specifics on its Medicare prescription drug plan, has tried to downplay concerns about his proposal in recent days. Already the plan has drawn fire from Democrats and key Republicans who worry that seniors who don't enroll in private health plans will not have drug coverage.

Sen. Olympia Snowe (R-Maine), a moderate, said predicating prescription drugs on whether a beneficiary enrolled in a private health plan would exclude too many people, especially those in rural states like Maine where there are no managed care plans serving Medicare patients.

"It makes me very nervous," Paulson, of the Medicare Advocacy Project, said of Bush's plan. "Folks have become skittish about relying on the [private] plans ... It hasn't worked so far."

Staff writer Anne Q. Hoy contributed to this story.

Copyright (c) 2003, Newsday, Inc.

http://www.newsday.com/news/health/ny-usdrug023114656feb03.story

Posted by pnhp at 09:46 AM | Permalink | Comments (0)

Department of Health and Human Services
News Release
Jan. 31, 2003
Bush Administration Will Propose Innovative Improvements in States' Health
Coverage for Low-Income Americans

HHS Secretary Tommy G. Thompson announced today that the President will
propose a sweeping new plan to enable states to improve health insurance
coverage for low-income Americans.

Secretary Thompson is consulting with governors in developing the new plan,
which would be optional for states. The plan would:
* Provide an estimated $3.25 billion in extra federal funding for Medicaid
in fiscal year 2004, with $12.7 billion in extra funding over seven years.
* Preserve comprehensive benefits for "mandatory" groups, while giving
states expanded flexibility to tailor coverage for "non-mandatory"
recipients and services.
* Encourage coverage for whole families, not just the children in a
low-income family.
* Support increased use of home and community based services for Americans
with disabilities.

Based on the successful SCHIP model that Congress adopted in 1997, as well
as successful innovations developed by states in their Medicaid programs
through federally-approved waivers, the proposal would give states
flexibility to simplify eligibility rules and tailor benefits to better meet
current beneficiary needs. For example, as in SCHIP, states could work with
private insurers and provide premium support for beneficiaries enrolled in
private plans.

http://www.hhs.gov/news/press/2003pres/20030131d.html

Comment: In tough economic times, the Bush administration is offering a 2%
"bonus" as a carrot to entice states to increase "flexibility" in their
programs for low income individuals. (The "bonus" is a loan that will have
to be paid back in years 8 through 10.) The rhetoric of the press release
fails to reveal the deviousness of this nefarious proposal. This is a
proposal to advance the administration's efforts to shift the costs of
health care directly to patients, not only in the Medicare program but now
also in the Medicaid and SCHIP programs.

"Flexibility" allows the states to cover individuals and benefits that are
not mandated by the Medicaid program, without significantly increasing the
overall costs (a goal necessitated by current state budget deficits). These
non-mandated individuals desperately need the coverage, but how can a larger
number of individuals be covered without significantly increasing funding?
It's simple; reduce benefits, and increase premiums, co-payments and
deductibles. In fact, for the two-thirds that are not mandated, provide a
"premium support" and turn them over to the private health plans with their
Spartan benefit packages and high patient cost-sharing.

So the Bush administration is adopting, as our national policy, a program to
ration health care for our highly vulnerable, low-income population by
erecting new financial barriers to that care! The current trend to shift
financial risk to patients will hardly be tolerated by average-income
individuals. But for these low-income patients, this scheme will effectively
block care for even the most modest of medical problems.

We suffer the disgrace of being the only nation that rations care based on
the ability to pay. And those with the least ability to pay now are to have
the greatest amount of rationing!

But there is a solution. Medicaid, being a publicly funded program for the
poor, will never have the political support it needs and will always be
underfunded. It must be eliminated. Including everyone in a single,
universal, public insurance program would assure continuous political
support with adequate funding to provide affordable, comprehensive care for
all of us.

On February 4, Congressman John Conyers will hold a press conference to
introduce the United States National Health Insurance Act. This bill
provides the solution we need.

United States National Health Insurance Act:
http://www.pnhp.org/docs/nhi_bill.pdf

Executive Summary of the Act:
http://www.pnhp.org/nhibill/nhi_execsumm.html

Posted by pnhp at 10:21 AM | Permalink | Comments (0)

A special update from Bob and Gail LeBow

(For those new to the list, Bob LeBow is a very special person. He is former president of Physicians for a National Health Program and author of "Health Care Meltdown," published at the time of his bicycle accident six months ago. Although he is now a respirator-dependent quadriplegic, he vows to continue to use what energy he still has on behalf of the cause of health care justice.)

Dear Friends,

Each day brings its own surprises.and a lot of the surprises have been good ones. Yesterday marked six months since the day of Bob's accident. His progress continues to be a blessing. Thanks to a wonderful friend, Bob now has 3 sets of glasses in various combinations for reading, distance and computer.

Bob's first "reading assignment" was an email attachment from friends who sent an "executive summary" of Health Care Meltdown and an announcement about the Single-Payer legislation (the National Health Insurance Act bill) that will be introduced in Congress on February 4 (by Representative John Conyers, D, MI). Bob read one page aloud to me and followed along as I read the other pages aloud to him. He continues to be energized by the subject of health care reform. After we finished reading the email we had a wonderful conversation. Here are a few of Bob's comments:

"I think the time has come to do what is right for us as a nation and for the American people. We have the means to do it and we can develop the will to make it happen. (I'm barely able to breathe and I'm still fighting.) We will win and we will do what's right. (I'm running out of energy.) I think it has great potential. I'd like to see people create a movement that will inspire Americans to really do something about it. An inspiration to bring change - making people healthy - reaching the goal of improved health care for all. My energy quotient is miniscule but inspired by the goal of fair health care for all."

Posted by pnhp at 10:19 AM | Permalink | Comments (0)