News

Modern Physician
May 30, 2003
Most Americans would prefer more health coverage to a tax cut, poll shows
By Leigh Page

Almost two-thirds of Americans think the federal government should extend health coverage to the uninsured, while only one-quarter would want the recently passed tax cut, according to a new poll by researchers at Stony Brook University in New York.

Among those who want an extension of coverage, more of them prefer a major effort involving a tax increase to a more moderate effort that would not, says the study, released Tuesday.

Specifically, the study of 810 adults nationwide finds that 36% of all respondents support a tax increase to expand healthcare.

The poll also finds support for an expansion across the political spectrum. It says 72% of Democrats, 65% of independents and 53% of Republicans prefer action on health insurance to a tax cut. And even 27% of Republicans are willing to pay higher taxes for it.

The study also finds that 71% favor government requiring businesses to offer health insurance to all of their employees, a proposal that died in the healthcare debate in the Clinton administration. This “employer mandate” is favored by 69% of Republican, 77% of Democrat and 72% of independent respondents, it says.

http://www.modernphysician.com/news.cms?newsId=866

Comment: It appears that Americans have accepted the rhetoric that we don’t need a “tax cut for the rich” when we have unmet social needs such as inadequate health care coverage. When framed as a “tax increase,” support declines, although it does not vanish.

Rather than discussing the need for tax increases to fund health care, we should be discussing the impact of reform on total health care spending, public and private combined. Converting public and private spending into a ratio would emphasize that we don’t want to know only the public part of health care costs; we want to know the total health care costs and the respective components. Dismissing private spending from the debate while discussing the change in taxes makes no more sense than if we were to dismiss taxes from the debate and discuss exclusively the changes in private spending. If we want to know what health care is going to cost, we need to know both.

This concept has an important application to the finding that there is very strong support for an employer mandate. Even though many proposals include tax policy, the general misperception is that employer-sponsored insurance is funded predominantly by the employer and does not impact taxes. In fact, not only do tax benefits support employer-sponsored plans, but almost all economists agree that employees also fund health coverage through implicit salary concessions. The public needs to understand that they are not avoiding “tax increases” by receiving “free” health care coverage from their employers. Between taxes and salary concessions, they are paying the full tab collectively. Even worse, both the tax benefit and the salary “reductions” of employer-sponsored plans are regressive methods of funding health care. Lower-income individuals pay a disproportionately higher percentage of their income for health care than do higher-income individuals.

But a properly designed tax component (public) would tend to be more equitably funded since it would be progressive, whereas the salary component (private) would remain a regressive method of funding health care. In fact, all private health care spending is regressive since the percentage of income spent has an inverse relationship to total income. Thus a high ratio of public to private health care spending would represent a more equitable method of funding care, whereas a low ratio would represent a less equitable system.

We really do need to convert the debate into terms of total health care costs and a ratio that represents how equitable the funding really is. There will certainly still be some who believe that government and taxes must be minimized at all costs. Since it is now firmly established that the administrative excesses of our current fragmented system of private plans and public programs create more costs than a single payer system would, we can legitimately ask advocates of private funding (low ratio) whether they would prefer to pay less through an equitable system of funding health care, or pay more merely for the dubious benefit of saying that they are paying into a private system, even though to egregiously wasteful private health plan bureaucracies.

Let’s change the focus of the debate from merely concentrating on taxes to a more informative debate that identifies total costs with a ratio that represents how equitable funding would be. That debate would still include tax policy, but it would place it in a more meaningful perspective.

Posted by pnhp at 01:26 PM | Permalink

The Harris Poll
May 28, 2003

Supermarkets and packaged food companies top the list of industries which get the best marks for serving their customers.

At the bottom of the list, only 30% think tobacco companies and managed care companies do a good job, and only 40% think health insurance companies do so.

http://www.harrisinteractive.com/harris_poll/printerfriend/index.asp?PID=379

Comment: We are paying an outrageous amount for poor service from the health insurance companies. Why do so many politicians insist that tax policies be expanded to favor this superfluous and wasteful industry?

Posted by pnhp at 01:25 PM | Permalink

The New York Times
May 28, 2003
WHO Vows to Overhaul Health Regulations
By The Associated Press

Voicing its alarm at the spread of the SARS virus, the World Health Organization vowed to overhaul outdated international health regulations to deal more effectively with epidemics and the threat of bioterrorism.

“The current regulations are obviously insufficient in view of today’s rapid, high-volume migration, emerging infections and the threats of bio-terrorism,” said U.S. delegate David Hohman. But he stressed that the new rules should represent a “careful balance among disease containment efforts, respect for individual liberties, and a nation’s right to engage in international commerce.”

The debate on intellectual property was the most divisive of WHO’s 10-day assembly, which ends Wednesday. It pitted the United States, which insists that patent protection is paramount in encouraging innovation and new drugs, against developing countries led by Brazil, which argued that health should be given priority over trade.

http://www.nytimes.com/aponline/international/AP-UN-Health.html

Comment: Is the quest for mega-wealth the only motivating factor that drives innovation and new drug development? Maybe we should ask the tens of thousands of dedicated employees and grantees of the National Institutes of Health.

It is instructive to see what the mission statement of NIH says about health and about trade:

The NIH mission is to uncover new knowledge that will lead to better health for everyone. NIH works toward that mission by: * conducting research in its own laboratories; * supporting the research of non-Federal scientists in universities, medical schools, hospitals, and research institutions throughout the country and abroad; * helping in the training of research investigators; and * fostering communication of medical information.

http://www.nih.gov/about/NIHoverview.html

Should our national and international health care policies be guided predominantly by intellectual property and trade issues, or by priorities of health? The NIH and the Bush administration seem to have a disconnect on these priorities.

Posted by pnhp at 01:23 PM | Permalink

The Financial Times
May 24 2003
America takes its dose of socialist healthcare
By Christopher Caldwell

…a bus trip into nearby Canada. The seniors load up on American-made prescription drugs that are, because of price caps, half as expensive north of the border…

Last week, the US Supreme Court delivered a blow on their behalf. The Pharmaceutical Research and Drug Manufacturers of America (PhRMA), an industry lobby, has spent two years trying to block the state from implementing Maine Rx, a new programme that pressures drug companies to sell to the state’s 325,000 uninsured at a cut rate. The court lifted an injunction PhRMA had won, and now the programme will proceed. More than symbolism is at stake. Twenty-eight states filed amicus curiae briefs on Maine’s behalf.

…the market irony that the working poor pay much more for their medications than anybody else. The middle class get private coverage through their jobs; the indigent get public coverage from the state.

A 1990 law says drug companies that sell to Medicaid must give states the same “best price” that would result from market competition between “health maintenance organisations” and other group insurers - a reduction of about 25 per cent. Maine thinks all its citizens should get this discount. So it is demanding “rebates” from the pharmaceutical companies that it will pass on to the uninsured.

Health creates funny economics in the best of circumstances. If the commodity is life, then the demand is infinite and the supply is 1. Unsurprisingly, then, the Bush administration has approached the problem with an ad hoc mix of policies. The Supreme Court case, in fact, could have been avoided had the administration simply declared whether it thought Maine Rx legal. But Bush dawdled, because he was trapped between his free-market base and an electorate that is increasingly interventionist on health questions.

Maine has tried to act like a big HMO, winning bulk-purchase rates for the last corner of American society that lacks them. The plan is very much in the US style of regulatory welfare. Through the tax code and the Federal Register, private interests are given “incentives” or “directives” that amount to offers one cannot refuse. Maine has ascertained that there is spare profit in drug companies that it would rather use for consumer purposes than for product development. So it is essentially shifting private sector money out of research and into welfare. Americans still do not realise that the prescription-drug controversy, like discussions of national health policy everywhere, is at root an argument over terms of rationing. One enthusiast even calls Maine Rx a “no-cost reform”. That’s wrong. It is a hocus-pocus way of levying a tax on business to fund social services - minus the democratic accountability of a welfare programme. The vast sums that are moved this way never get recorded in the budget ledger, permitting Americans to delude themselves that they are less socialist and more “independent” than their European cousins.

http://news.ft.com/servlet/ContentServer?pagename=FT.com/StoryFT/FullStory&c=StoryFT&cid=1051390299862

Comment: This is yet more evidence that the free market in health care simply does not exist. Instead of beginning the reform debate with a discussion of free markets versus the government, we need to discuss the policies that will result in the best health care utilization of our resources. Once those are decided, then we can define the appropriate role of government in ensuring that those policies are carried out.

Actually, this homework has already been done. All studies confirm that a single, universal, publicly administered health insurance program, funded at our current level, would provide comprehensive health care services for everyone. Why do we continue to refuse to embrace this well documented fact?

Is it really better to limit the discussion to “lack of political traction” in our “free market” economy? People are dying while we dwell on this senseless debate.

Posted by pnhp at 01:22 PM | Permalink

The Santa Fe New Mexican
May 14, 2003
Mexican President Approves ‘Universal’ Health Plan

President Vicente Fox signed into law a new public-health plan Thursday which he hopes will eventually provide near-universal health coverage to millions of Mexicans not covered under two job-based hospitalization programs founded in the 1940s.

The new plan, based on a pilot program already in place known as the “Seguro Popular” or People’s Insurance, eliminates means-testing currently employed at government hospitals and seeks to give all Mexicans access to hospitals run for people with job-based insurance.

Starting in January, it will institute a sliding-scale insurance program based on federal and state funding, together with monthly payments by individuals, whose coverage cost will be based on their ability to pay.

“A health system that claims to be just must be universal,” Fox said at a signing ceremony in Mexico City. “For this reason, the new system no longer conditions services on a family’s health, employment or economic situation.”

http://www.santafenewmexican.com/main.asp?FromHome=1&TypeID=1&ArticleID=27273&SectionID=2&SubSectionID=7

SISTEMA INTERNET DE LA PRESIDENCIA DE LA REPÚBLICA Discurso - 13/05/2003 Vicente Fox durante la ceremonia en la que suscribió el Decreto por el que se expide la Reforma a la Ley General de Salud en Materia de Protección Social

Los fondos provendrán de un esquema tripartita, en el que el Gobierno Federal aportará la mayor parte, las entidades federativas una proporción menor y las familias una cuota acorde con su capacidad de pago.

De este modo, cuando requieran atención médica, hospitalización o cirugía, no tendrán que desembolsar un solo peso adicional. En otras palabras, la población recibirá los servicios de salud en forma oportuna y adecuada en función de sus necesidades y no de acuerdo a su condición laboral o a su capacidad de pago.

Este es un cambio que modificará radicalmente la inequidad en el financiamiento de la salud que prevalecía en nuestro país, es también un ejemplo extraordinario de responsabilidades compartidas, de solidaridad con los que menos tienen y de genuino federalismo.

El Sistema de Protección Social en Salud significará la diferencia entre la vida y la muerte, entre la salud y la enfermedad para quienes no tenían acceso a los hospitales, a los medicamentos y a los tratamientos.

Porque la salud no es una mercancía sujeta a las leyes del mercado, porque la salud es, ante todo, un derecho social que hoy tutela el Estado mexicano.

http://www.presidencia.gob.mx/?Art=5239&Orden=Leer

One year ago, Health Affairs published an important article on the inequities in health and health care in Mexico. The article is available at: http://www.healthaffairs.org/freecontent/v21n3/s8.pdf

Comment: If Mexico, with only very modest resources and with a conservative president, can move forward with efforts to improve equity in health care, why can’t we in the United States, with our abundant resources, accomplish the same goal of true health care equity?

May we see the day when we can rephrase President Fox’s words as follows:

Porque la salud no es una mercancía sujeta a las leyes del mercado, porque la salud es, ante todo, un derecho social que hoy tutela el Estado americano.

Posted by pnhp at 01:21 PM | Permalink

Center for Studying Health System Change
Issue Brief No. 63
May 2003
Health Care Cost and Access Problems Intensify
Initial Findings From HSC’s Recent Site Visits
By Cara S. Lesser and Paul B. Ginsburg

Continued high-cost trends are threatening the affordability of health insurance and many consumers’ access to care. Early findings from the Center for Studying Health System Change’s (HSC) 2002-03 site visits to 12 nationally representative communities show the retreat from tightly managed care continues to shape local health care markets. Employers are aggressively shifting higher health costs to workers, and absent tight managed care controls to limit the use of care and slow payment rate increases, hospitals and physicians in many markets are competing fiercely for profitable specialty services. These developments have sparked growing skepticism about the potential for market-led solutions to the cost, quality and access problems facing the health care system today.

Few Bright Spots Ahead

Safety net improvements have been a bright spot in an otherwise grim picture of the health system. Although the economic downturn and state budget shortfalls have focused attention on cost control again, there appear to be few strategies developing in local markets that promise significant relief. Premium increases have helped plans to restore profitability, but they continue to grapple with limited influence over utilization and provider payment rates. Largely unchecked by countervailing pressure from plans, purchasers or policy makers, competition among providers for key specialty services has intensified, driving investment in specialized facilities and equipment that threatens to increase costs and aggravate the broader system capacity constraints already posing access problems.

Employers are generally at a loss about how to respond, other than by passing on more costs to employees. As a result, consumers are paying more out of pocket for health care at a time when many workers face stagnant or declining wages. Although higher cost sharing may help to reduce the use of inappropriate care, it also may cause people to delay needed care. And there are limits to the levels of cost sharing employers can impose on workers. While increasing cost sharing will depress trends in spending for a few years, many observers are skeptical about its potential to lower trends substantially over the long term. But if trends in health care spending are not reduced, the cost of health insurance will rise out of more people’s reach, threatening to increase the ranks of the uninsured.

Reflecting on changes in local health care markets today, health care executives, employers and state and local policy makers interviewed for this study have become increasingly skeptical about the ability of market-led solutions to rein in rapidly rising health care costs. Although there is not a strong sense of the alternatives, many stakeholders in local health systems have concluded that there are serious limits to the effects of competition and market-led efforts to constrain health care spending, especially given the poor experience in the 1990s with managed care.

Some remain committed to realizing the vision of managed care and integrated delivery systems, building on the lessons learned in the 1990s. Many more, however, see health care organizations as responding to the immediate pressures in their environment-to generate return for investors or to generate revenue to support a mission to provide health care, for example-in ways that are often at odds with the goals of controlling overall health care spending and protecting access to high-quality care.

http://www.hschange.com/CONTENT/559/

Comment: “Bleak” is an inadequate descriptive of the future of health care, unless, of course, we enact comprehensive reform. Continued mere tweaking of our system can only magnify the bleakness we face.

Posted by pnhp at 01:19 PM | Permalink

Famed HMO Whistleblower and Patients’ Rights Ethicist Threatened with Jail For Protecting Humana Insurance Insider

MAY 23, 2003, LOUISVILLE, KENTUCKY— Dr. Linda Peeno, famed HMO whistleblower, and subject of the film Damaged Care (Showtime), was under court order this week to make known the source of her knowledge about the cost of a sculpture purchased by Humana, Inc., one of the nation’s largest publicly traded health insurers. By revealing her source under duress to meet the Thursday, May 22 deadline, she avoided contempt and imprisonment for up to six months. Although the cost of the sculpture is not relevant in the legal case in which Peeno is currently an expert, a lawyer who has worked for Humana used the power of the court to acquire information about Peeno’s knowledge of the accurate cost of a piece of sculpture. Humana is not even a party to the case.

As portrayed in Damaged Care, Peeno believed the sculpture cost about a half million dollars. After the movie aired, a Humana employee informed her that the actual cost was nearly four million dollars. Peeno’s source was Clarence Jones — the brother of Humana founder and Board Chair, David Jones. After Clarence Jones revealed the cost of the sculpture in a phone call, Peeno found a document in her mail box the next morning detailing costs of some Humana art, including the sculpture in question.

In 1987, Peeno was employed by Humana as a physician advisor, a doctor responsible for approving and denying care for Humana patients. Peeno denied coverage for a heart transplant, then suffered a crisis of conscience which was magnified by seeing the installation of sculptor Giacometti’s “Tall Figure Number Two” in the rotunda of Humana’s corporate headquarters. Humana justified the denial of the heart transplant with claims that the “savings” would be reallocated into the provision of more health care for others, a position belied by the existence of the sculpture costing what she believed to be the equivalent of the “savings” from the patient’s necessary transplant. In 2002, Peeno learned that the sculpture actually cost the equivalent of eight heart transplants, or more than $3.8 million dollars.

Peeno, a physician and ethicist, had been retained for a legal case, EMP Medical Services, Inc v. Vista Healthplan, Inc. to provide expert testimony regarding the reasonableness of the termination of a contract for claims of patient harm. The law firm of Waldman, Feluren & Trigoboff, representing Vista Healthplan (whose CEO is a former Humana executive) had represented Humana in two previous cases in which Peeno provided expertise. In one case, Chipps v. Humana, featured in part in Damaged Care, Humana suffered a $78 million dollar punitive damage award. Now, Glenn Waldman and Humana have high-jacked an unrelated case as a means to force Peeno to reveal the source of her knowledge about the cost, as well produce a document which they know to confirm the cost of the sculpture.

Just a sculpture? The excessive cost of the Humana sculpture represents the extravagant, unnecessary expenditures, and fraud, consistently demonstrated throughout managed care. Some of the nation’s largest health insurance companies and hospital chains are charged, fined and penalized, repeatedly for ongoing criminal activity.

Criminality in Corporate Health Care

HealthSouth, the giant for-profit operator of rehabilitation hospitals and clinics, overstated its earnings by at least $1.4 billion from 1999 to mid-2002, and inflated the value of its assets by $800 million. Between 1999 and 2001, HealthSouth reported profits of $1.22 billion – 100 times what the SEC says was the correct amount ($12 million). Another $180 million in fraudulent profits were reported in the beginning of 2002. The firm is accused of heavily inflating profits almost back to the chain’s public launch in 1986. HealthSouth operates 209 surgery centers, 1,427 outpatient and 118 inpatient rehabilitation centers, 136 diagnostic centers, and four medical centers. The FBI raided the company’s headquarters in Birmingham on March 19. The company is also being investigated for Medicare fraud

HCA, the nation’s largest for-profit hospital chain, and Senator Bill Frist’s family-owned business, settled its Medicare fraud charges with the government for a total of $1.7 billion in criminal and civil penalties, by far the largest amount ever secured by federal prosecutors. HCA has also agreed to plead guilty to 14 felonies. These settlements end a seven-year investigation by the U.S. Justice Department of Columbia-HCA for intentionally overcharging Medicare by inflating the seriousness of diagnoses; keeping a second set of (inflated) Medicare cost reports; conspiring with the wound-care firm Curative Health Services (which operates out of HCA hospitals) to bill Medicare for management fees and marketing expenses not eligible for reimbursement; submitting claims for home care not eligible for reimbursement; “bundling” unnecessary laboratory tests not eligible for reimbursement; and kickbacks for physician referrals

Cigna will pay up to $200 million in back claims to over 600,000 physicians to settle a class-action lawsuit brought against the firm in Illinois federal court. Cigna used a software program called “Claimcheck” that reduced or eliminated payments for legitimate services. A separate class-action lawsuit is underway in Miami federal court against Cigna and seven other HMO’s for allegedly rejecting claims for necessary treatments as part of a racketeering conspiracy. Cigna will also pay $24.5 million to settle allegations of Medicare fraud at a hospital it owns (Lovelace Hospital) in New Mexico. The settlement is the largest that the Justice Department has ever reached against a single hospital.

For-profit hospital chain Tenet, formerly National Medical Enterprises (NME), is the subject of four separate federal investigations. The Justice Department is suing the Santa Barbara-based firm for up to $500 million in damages for filing false Medicare claims between 1992 and 1998, and investigating inflated “outlier” payments the firm collected from Medicare. The FBI is investigating charges of unnecessary heart surgery at one or more Tenet hospitals. The SEC is looking into the sudden drop in the company’s stock price and charges of insider trading. The Justice Department has demanded information on 19 of Tenet’s 114 hospitals, including 15 in California. Last year, Tenet agreed to pay $17 million for incorrect laboratory billing in a similar Justice Department probe. In February of this year, Tenet paid $4.15 million to settle allegations that five Florida hospitals overbilled Medicare in the mid-1990’s. These fines are on top a $9.75 million settlement for Medicare fraud at a hospital in Culver City California, and another $29 million for improper billing for home health services associated with Florida’s Palmetto General Hospital.

Wellpoint has agreed to pay $9.25 million to settle charges that its Blue Cross subsidiary in California defrauded Medicare. The company falsified audit information so that the government would believe that it audited more Medicare claims and cost reports in than it actually did.

Aetna, one of the nation’s largest health insurers, has agreed to settle a class action brought by physicians and to overhaul business practices that doctors say have shortchanged patient care. Aetna will pay $170 million, which includes a $100 million payment to the doctors in the class action suit.

Posted by pnhp at 01:56 PM | Permalink

National Coalition on Health Care
May 19, 2003
Charting the Cost of Inaction
By Henry Simmons, MD, MPH, FACP and Mark A. Goldberg

What will happen if we do nothing to reform the health care system - nothing to secure health coverage for all Americans, nothing to contain or constrain surging costs, nothing to improve the quality of care?

First, in the absence of reform, health insurance premiums will rise rapidly. When we consider premium trends in real terms - that is, net of increases in the Consumer Price Index - the rate of rise is steeper.

Second, looking ahead, we expect premiums to continue to increase by leaps and bounds. The Coalition projects that the average annual premium for employer-sponsored family health coverage will surge to $14,545 in 2006.

Third, in the absence of reform, the number of uninsured Americans will climb rapidly over the next several years. …we now project that the number of uninsured Americans will reach 51.2 to 53.7 million in 2006.

Fourth, most Americans are apprehensive - and, as we have shown, realistically so - about the future affordability of health care.

Fifth, any reckoning of the potential budgetary impact of reform would be one-sided and incomplete without taking into account the potential effects of effective cost containment. The National Coalition on Health Care has long believed that the savings from cost containment, in a comprehensive package of health care reform, could more than offset the cost if securing universal coverage.

Lastly, and not just for that reason, time makes a difference. …the longer our nation waits to reform its health care system - to achieve universal coverage, contain costs, and improve the quality of care - the more reform will ultimately cost. Reform makes economic sense; delaying reform does not.

http://www.nchc.org/materials/studies/Cost_of_Inaction_Full_Report.pdf

Comment: At the press briefing on the release of this report, virtually all panel members, representing a broad spectrum of interests, agreed that a government solution is required. The video and the transcript of the briefing are available at:

http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=875

Posted by pnhp at 01:18 PM | Permalink

The Boston Globe
5/21/2003
Democrats must offer bolder health plans
By Robert Kuttner

With one exception, the health plans released by the Democratic presidential contenders are a set of little plans. They leave the current system largely intact and use subsidies and tax credits to reduce the number of uninsured — as if the whole system were not broken.

What is the nature of the health care crisis? For starters, coverage is eroding, even for the insured. There’s a squeeze on corporate profits in a climate of rising health costs. So health costs are being shifted from plan to individual, with the result that many people go without needed treatments that the plan won’t cover and that they can’t afford out of pocket.

The number of people without insurance is also increasing. Smaller businesses won’t provide insurance. More people are self-employed. And as bigger businesses increase the employee share costs, many lower-paid workers decline the insurance because they can’t afford it.

If we leave intact the present system, with its wasteful fragmentation, billing, underwriting, and insurance company profits, there is only one big place to reap savings — by withholding more care as nonessential and by avoiding the sick.

The best solution here is national health insurance. We already have it for one segment of the population, through Medicare. The program is easy to understand, and even fits on a bumper sticker: ”Medicare for all.”

Face it: Even incremental proposals by Democrats will be attacked as too costly and entailing too much government. They might as well do it right.

http://www.boston.com/dailyglobe2/141/oped/Democrats_must_offer_bolder_health_plans+.shtml

Comment: Why is this a partisan issue? Democrats are interested in ensuring access to affordable, comprehensive health care for everyone, or at least they should be. Republicans are interested in sound business principles which reduce administrative waste and contain costs, or at least they should be.

The one exception alluded to in Kuttner’s article that is not a “little plan” is the single payer proposal of Rep. Dennis Kucinich. It is the only proposal that offers the solutions that both Democrats and Republicans are seeking, even though the specific objectives may not be the same. But should a proposal that would successfully address the concerns or one political persuasion be rejected merely because it also addresses the concerns of the opposing party?

It is true that rhetorical disputes over abstract ideology continue to defeat rational proposals. But when we have an opportunity to adopt reform that provides a meeting ground for those advocating for a sound business approach to reform and for those advocating for health care justice, isn’t it time to set aside the superficiality of rhetorical debate, especially when so many lives are at stake?

Posted by pnhp at 01:15 PM | Permalink

World Socialist Web Site
10 May 2003
Britain: Parliament backs plans to privatise health care
By Julie Hyland

The Labour government’s proposals to further open up National Health Service (NHS) hospitals to the private sector were passed by parliament on May 7.

Through the establishment of Foundation Hospitals the government aims to end the system of centralised control and accountability, enabling individual hospitals to raise finance from the private sector and determine their own wage rates and clinical priorities.

The proposals, contained in a new Health and Social Bill, are a clear break with the system of universal health provision established by the post-Second World War Labour government and are widely recognised as such.

Government ministers often complain of the affection in which the NHS is held by many in Britain-citing it as an example of the kind of backward-looking nostalgia that must be overcome if the country is to step into the twenty-first century. Their own ire is directed not at the very real failings of the NHS-the long waiting lists, overworked staff and poor facilities that have resulted from decades of underfunding-but the progressive principle on which health care has been organised in Britain since the Second World War.

As the “crown jewels” of the social reforms enacted by the postwar Labour government, the NHS was deemed to be an example of egalitarianism in practice, guaranteeing health care to all regardless of their financial status and free at the point of use.

In capitalist Britain, the ideal could never match the reality. Not even the most egalitarian structure could compensate for, much less overcome, the health problems generated by a system built on social inequality. The private drug companies continued to milk the system and add enormous costs in terms of taxation, while the rich could still utilise private treatment that occupied a parasitic relationship to the NHS-using staff it had trained and usually renting access to facilities bought from the public purse.

But under conditions where prior to 1948 more than 50 percent of Britain’s population had no access to health care, the NHS was correctly regarded as a significant advance and eminently preferable to the system of health care in the US, for example, which was seen as outdated and barbaric.

In line with the right-wing monetarist policies that have come to dominate official politics in Britain over the last 20 years, successive Conservative and Labour governments have carried out a policy of deliberate sabotage against public health care-starving it of the necessary funds and introducing numerous “reforms” aimed at resurrecting the profit principle and forcing people into privately funded insurance-based schemes, creating a financial bonanza for the corporate sector.

Utilising the poor state of public provision that their policies have caused, the official parties have sought to ridicule any notion of equality as simply meaning the right of all to suffer equally.

http://www.wsws.org/articles/2003/may2003/nhs-m10.shtml

Comment: Rather than face the delicate problem of ensuring adequate public funding for health care, British politicians are turning to the private sector to provide innovative methods of limiting public spending. No amount of rhetoric about market forces can ever change the reality that private business models in health care shift funds from patient care to the business entity. This then requires an even greater amount of private funding just to maintain the same deficient level of care as would exist under public funding. And worse, greater private control of funds automatically equates with greater inequities in care.

The British and American issues are different. At 7% of their GDP, the British are not spending enough on health care. At 15.2%, we’re spending enough, but we’ve placed the control of funds in the private sector. As a result, we have the most inequitable system of all industrialized nations.

Wouldn’t it be better for politicians to be honest and face the realities that public administration benefits health care, but that funding needs to be adequate? The British don’t need privatization; they need more public funds. Americans don’t need more funds; we need public administration with equitable public pooling of our existing funds.

Posted by pnhp at 10:47 AM | Permalink

Beth Capell, Ph.D. responds on safety net funding and the uninsured:

Don:

Your comment may unintentionally encourage those who wish to defund the safety net in order to fund coverage expansions for other Californians.

As the CAPH report demonstrates, the current safety net is badly underfunded. If the safety net for the uninsured were funded at the same level as care for the insured, California would spend $12-$14 billion on community clinics and public hospitals—-instead of the $4-$6 billion now spent.

It is important to acknowledge, as you have in other Quotes of the Day, that the uninsured get half as much care as the insured—and that they pay more for less care.

Every reputable estimate of the cost of covering the uninsured includes the cost of doubling the amount of care they receive. This is incorporated in the Lewin analysis of the various single payer options reviewed in the Health Care Options Project.

The reason that a single payer system can absorb the increased cost of providing a decent level of care for all Californians is the dramatic cost savings achieved by eliminating the administrative overhead of an insurance model of financing.

Those who say the costs are already in the system are right—but only if they are talking about money spent on unnecessary overhead and administrative costs.

It is not true that the uninsured get the care they need. Not at the emergency room, not at doctor’s offices, not at underfunded community clinics and public hospitals, not anywhere.

The cost of care for the uninsured is absorbed by the uninsured—-in premature deaths, in avoidable illnesses, in misery from untreated illnesses and chronic conditions. They don’t get the care they need and we should say it.

Beth Capell, MD

Posted by pnhp at 10:45 AM | Permalink

California Association of Public Hospitals and Health Systems

On the Brink: How the Crisis in California’s Public Hospitals Threatens Access to Care for Millions

California’s public hospitals and health systems today confront a severe crisis. Driving this crisis is a steadily growing demand by uninsured and vulnerable patients for health care services matched against a shrinking pool of funds available to pay for that care. If the imbalance between rising costs and declining revenues is allowed to continue, draconian cuts will have to be made. Emergency rooms and trauma centers will close. Thousands of health care workers will be laid off. Entire public hospitals will close. At stake is access to health care for millions of Californians.

Based on analysis by CAPH, over the next five years California’s public hospitals and health systems will face a cumulative budget shortfall of at least $3 billion. This drastic divergence between revenues and expenses cannot be sustained without extensive reductions in services and loss of access to care for millions of Californians.

Why the Crisis in Public Hospitals Matters to EVERYONE

Although they make up only six percent of hospitals statewide, California’s public hospitals and health systems:

• Provide 55 percent of the cost of hospital care to the uninsured * Serve a patient population that is 76 percent people of color, including more than 50 percent Latino * Represent 62 percent of the state’s level I trauma centers * Train almost half of all medical residents in the state * Provide 54 percent of all hospital-based outpatient visits to the uninsured * Employ more than 70,000 health care workers

Without public hospitals, the state’s emergency and trauma care network would collapse, thousands of jobs would be lost and millions of Californians would be forced to go without needed health care.

Unstable Patchwork of Funding

Public hospitals and health systems are uniquely reliant on a tenuous patchwork of funding made up primarily of Medicaid revenues and state and local funds. This unstable patchwork is the result of the lack of a comprehensive public policy to ensure universal access to health care for everyone, particularly those least able to afford care.

For the full report: http://www.caph.org/publications/WhitePaperFINAL.pdf (Although the report is on California’s safety net system, the principles apply throughout the nation.)

Comment: Although there may be political support for improved funding of trauma centers, there is only a feeble squeak of a political voice for those least able to afford care. We are already spending enough to fully fund the public health care safety net. But we lack a rational system for allocating our resources.

We desperately need a single, publicly-administered program of social insurance that includes everyone.

Posted by pnhp at 09:44 AM | Permalink

Health Affairs
May/June 2003
High Out-Of-Pocket Health Care Spending By The Elderly
High spending coupled with the erosion of insurance coverage expose the
elderly to great financial risk.
by Dana P. Goldman and Julie M. Zissimopoulos

Disturbing Trends:
* Erosion of managed care - For the near-poor, who rely most on Medicare HMOs, benefits have probably eroded…
* Declines in drug coverage - The share of M+C enrollees in plans with drug coverage declined… Copayments have increased… (and 98% face caps on coverage)
* Cuts in retiree benefits - …provision of retiree benefits declined steadily… (with) a decrease in the generosity of benefits.

With the erosion of market areas and the generosity of Medicare HMO benefits, the risks of large catastrophic expenses have likely increased among a group least able to afford it. In addition to imposing additional private costs on less affluent seniors, these changes may also impose public costs. They will make Medicaid a more attractive option to the near-poor elderly, and some may spend down assets to qualify. This will increase Medicaid’s costs, while exposing other elderly people to more financial risk.

http://www.healthaffairs.org/1130_abstract_c.php?ID=/usr/local/apache/sites/healthaffairs.org/htdocs/Library/v22n3/s26.pdf

Comment: Are these our American values? We establish a health benefits program for our retired seniors. But then we gradually shift more of the costs to the beneficiaries, making health care unaffordable for many. We then drive them into poverty in order to allow them to regain affordable access to health care.

What kind of a nation are we? We already know how to provide affordable, comprehensive benefits for everyone. Why do we continue with inhumane policies that require financial ruin for so many with significant health care needs?

Posted by pnhp at 12:13 PM | Permalink

By  PAUL CARRIER, Portland Press Herald Writer

AUGUSTA  —  Gov. John Baldacci’s proposed health-care plan, which would retain a strong role for private insurers, has not silenced talk of creating a fully state-run insurance system in the years ahead that would leave no room for commercial insurance companies. 

  While many reformers are uniting behind the governor’s proposal, which is designed to expand access to health care and cut costs without eliminating private insurance, the state Senate gave near-final approval Wednesday to a separate bill that would continue an ongoing, long-term study of a single-payer system.  

  That ongoing study, which also has won preliminary approval in the state House of Representatives, now needs only final votes of enactment in both the House and the Senate. And even though Baldacci’s plan does not call for a single-payer system, his spokesman said Wednesday the governor will sign the study bill into law if the Legislature sends it to him. 

  The governor’s legislation, which he wants the Legislature to pass this session, and the continuing study of a single-payer system “work hand in hand,” said Lee Umphrey, Baldacci’s spokesman. “The introduction of (the governor’s) plan is the start of a process,” Umphrey said. He said supporters of that proposal and backers of a single-payer system should work together to develop the best plan for Maine people. 

  Even supporters of a single-payer system, which Baldacci opposes, are endorsing the governor’s package. They see the governor’s plan as a step in the right direction because, they say, it will insure more Mainers and help control the cost of health care.  

  The governor’s plan “can act as a transitional system to get us to single-payer,” said Paul Volenik, a former state representative who co-chairs the Health Care System and Health Security Board, which the Legislature created in 2001 to investigate creating a single-payer system. That’s the same board that the Legislature and the governor are now prepared to extend, so it can continue its work until November 2004. 

  The board released a preliminary report in January that said a single-payer system could provide coverage for all Mainers and save money. Such a system would insure Mainers through a standard benefits plan administered and financed by the state, or by a group under contract with the state. Insurers quickly attacked the report, saying it seriously underestimated the cost of a single-payer system. 

  “I’d like to see the conversation on single-payer continue” even though the main focus now is on Baldacci’s bill, said state Rep. John Eder of Portland, the lone Green Independent in the Legislature. Eder has filed a bill in the Legislature to implement a single-payer system, but the Legislature’s Insurance and Financial Services Committee quickly voted 9-0 against the bill Wednesday after holding a hearing on it. 

  Like other supporters of a single-payer system, Eder said he does not believe Baldacci’s plan has killed the idea of a state-run insurance program. Backers of such a system say the fact that the Legislature and the governor will allow the Health Care System and Health Security Board to continue its work will keep the issue alive, at least until the board issues its final report late next year. 

  Baldacci’s bill is “a major step forward” but it may not be the last step, Rep. Arthur Lerman, D-Augusta, a supporter of a single-payer system, said Wednesday during the committee hearing on Eder’s bill. “I still think that, in the long run, we may end up moving in this direction” of a government-run system, Lerman said. 

  Many disagree, including some supporters of Baldacci’s plan who believe it will meet a key goal of a single-payer system by assuring that all Mainers have health insurance. Baldacci says his package would provide universal health care in four years, by relying on a combination of public and private insurance programs, but some skeptics who support a single-payer system say Baldacci’s plan would not guarantee that everyone has adequate coverage. 

  “The governor’s bill really is front and center” and that places the single-payer system on the back burner, said Joseph Ditre of Consumers for Affordable Health Care, an activist group that backs Baldacci’s approach. Still, Ditre said, “it’s a little too early to tell how it’s all going to play out,” because key components of the governor’s plan would not even kick in until July 2004. 

  Sen. John Martin, D-Eagle Lake, who co-chairs the Health Care System and Health Security Board, said many people continue to support a single-payer system and it remains an option. “It’s not dead,” Martin said. 

Staff Writer Paul Carrier can be contacted at 622-7511 or at: 

pcarrier@pressherald.com

Copyright  2003 Blethen Maine Newspapers Inc.                       
http://business.mainetoday.com/news/030508healthcare.shtml

Posted by pnhp at 11:11 AM | Permalink

Health Affairs
May/June 2003
Does Universal Health Insurance Make Health Care Unaffordable? Lessons From
Taiwan
by Jui-Fen Rachel Lu and William C. Hsiao

…Taiwan’s single-payer NHI system enabled Taiwan to manage health spending inflation and that the resulting savings largely offset the incremental cost of covering the previously uninsured. Under the NHI, the Taiwanese have more equal access to health care, greater financial risk protection, and equity in health care financing.

Major Lessons

Taiwan offers an opportunity to study how an advanced economy can structure its health care system to advance societal goals. Taiwan learned from worldwide experience that while the free market can often produce products and goods efficiently, it is incapable of distributing the goods equitably because the income and wealth of households are not distributed equitably. Moreover, the health insurance market suffers major market failures from adverse selection and risk selection. When a society is seriously concerned about its people having equitable access to care and about pooling health risks efficiently, the free market is not a good choice. Evidence from the United States amply supports this conclusion also.

Taiwan established a compulsory national health insurance program that provided universal coverage and a comprehensive benefit package to all of its residents. Besides providing more equal access to health care and financial risk protection, the single-payer NHI also provides tools to manage health spending increases. Our data show that Taiwan was able to adopt the NHI without using measurably more resources than what it would have spent without the program. It seems that the additional resources that had to be spent to cover the uninsured were largely offset by the savings resulting from reduced overcharges, duplication and overuse of health services and tests, transaction costs, and other costs. The total increase in national health spending between 1995 and 2000 was not more than the amount that Taiwan would have spent, based on historical trends.

Additionally, Taiwan did not experience any reported increase in queues or waiting time under the NHI. Meanwhile, the government has taken regular public opinion polls every three months to gauge the public’s satisfaction with the NHI. It continuously enjoys a public satisfaction rate of around 70 percent, one of the highest for Taiwanese public programs.

One notable result that should interest Americans is that Taiwan’s universal insurance single-payer system greatly reduced transaction costs and also offered the information and tools to manage health care costs. Alex Preker, a leading health economist at the World Bank, came to a similar conclusion from his research of OECD countries. He concluded that universal health care led to cost containment, not cost explosion. Equally important, a single-payer system can gather comprehensive information on patients and providers, which can be used to monitor and improve clinical quality and health outcomes.

http://www.healthaffairs.org/1130_abstract_c.php?ID=http://www.healthaffairs.org/Library/v22n3/s15.pdf

Comment: Amazing! Single payer reform really does accomplish its intended goals. Taiwan now has equitable, affordable, comprehensive care for everyone. Taiwan has provided us with a real life laboratory for precisely the reform that we need in the United States.

So let’s fix our system… now!

Posted by pnhp at 10:16 AM | Permalink

An editorial
May 3, 2003

Madison’s Social Justice Center last week honored an incredibly dedicated Dane County couple - Eugene and Linda Farley - for their tireless devotion to improving health care, especially for those who can least afford it in our nonsensical and brutally unfair health insurance system.

The two doctors have spent their retirement years not only advocating for a national universal health care system, but endlessly volunteering to help the hundreds of families right here in Dane County who have no insurance to pay medical bills, a reality that’s nothing short of tragic in this, the richest and most powerful nation in the world.

If the country’s collective eyes are ever going to be opened to the need for true health care reform, it will be because of people like the Farleys, who refuse to give up a fight for what they know is right.

Eugene and Linda Farley know firsthand what the lack of health care coverage does to families. Because they voluntarily treat folks at the community health center and at the Salvation Army, they know how children from uninsured families go without care for their eyes, for their teeth and for those nagging infections that in the end make it more difficult for them to cope not only in later life, but today in school.

The Farleys know that most of these families are not the stereotypical laggards of society, but working people whose employers cannot afford to provide them with health benefits.

They know that those employers are increasing each year as insurance premiums take another double-digit jump because the cost of everything from a visit to the doctor to the bill at the pharmacy is beyond control.

And they know that we’re wasting so much money - on convoluted insurance plans, costly administrative procedures at practically every step in our current system, and inane pricing policies for medicines - that we could easily afford a national single-payer system that would cover every American with what we’re spending on health care now.

More than 40 million Americans go without health care coverage every single day of the year. The Institute of Medicine estimates that 18,000 of those people die prematurely every year because they put off seeing a doctor and getting care simply because they don’t want to burden their families with bills they can’t afford to pay.

Why do we refuse to change the system?

Because special interests - from pharmaceutical companies to insurance conglomerates - have bought and paid for legislators and members of Congress to keep the system the way it is. Meanwhile, prices have spiraled so far out of control that working Americans, when they do have insurance, forgo pay raises just to keep health coverage. And the ranks of the uninsured keep on growing.

It’s time that we start listening to the likes of the Farleys. They have no financial interest in the outcome, only an interest in helping working people and their children get the health care that as Americans they not only deserve, but should be their right.

The system can be changed if, like Drs. Eugene and Linda Farley, we refuse to give up the fight.

The views in this space are provided by The Capital Times, Wisconsin’s progressive daily newspaper.

http://www.madison.com/archives/read.php?ref=wsj:2003:05:04:266331:OPINION

Posted by pnhp at 11:09 AM | Permalink

BY ROBIN BIESEN
Times Staff Writer

An increasing need for health care and an inability by government and employers to keep pace with spiraling medical costs has state Sen. Vi Simpson calling for change.

In place of the current system, Simpson, an announced candidate for Indiana governor next year, is calling on state leaders to come together to explore the notion of universal health care for Indiana.

While not a new idea — Sen. Evan Bayh floated the idea while he was governor and the Clinton administration backed it in a failed proposal to reform the nation’s health care system — Simpson said it is time to explore the issue anew.
“We are at a point when fewer small businesses can afford to offer health insurance,” Simpson, D-Bloomington, said. “What we need to do is look for an approach to pay for health care that is the most effective and cost efficient.”
She won’t get an argument from Rep. Charlie Brown, D-Gary.

Brown, who has been delving into the costs and benefits of a single-payer system, said the state has to get its arms around health care costs — for the sake of the people it insures and that of employers who find themselves strapped by annual increases that eclipse profits.

“Eventually we all pay for health care for those who seek it, whether they have insurance or not,” Brown said. “Deciding that everyone should have health insurance could help control costs. It’s a pay me now or pay me later situation.
Small-business owners, who have become accustomed to skyrocketing employee health insurance premiums, say it would be nice to think there could be less costly options.

“I would say that over the last three or four years, we have seen annual increases of 30 percent — minimum,” said Howard Weiss, owner of Trim-A-Seal of Indiana Inc., a window manufacturing and installation firm that employs 11. “Small-business owners are at a complete disadvantage. But, it’s not only the business owner who suffers. The individual employee suffers as much, if not more, than the company because they, too, are being asked to pay more for health care.”

Like Weiss, Larry Gough, of Gough & Gough Inc. of Valparaiso, was intrigued at the idea of a single-payer system for Indiana.

“I think it sounds good, in theory, because ultimately their buying power would be so much greater than any individual corporation on its own,” Gough said. “Spreading the risk should mean you would be able to insure a larger group at less cost. I would love to see it work.”

Daniel Lowery, executive director of Northwest Indiana Quality of Life Council, said health care was just put back on the nation’s public policy initiative list for the first time since the early 1990s.

“The reason is, the current situation is not sustainable,” he said. “It can’t work.”
Northwest Indiana’s steel industry has been hampered not only by capacity issues and dumping, but also by legacy costs it bears for retirees, Lowery said.
“We don’t spread health care costs across the entire population, like other countries do, so it’s affected our competitiveness in steel,” he said.

The current system is a drag on overall economic performance, he said.

“People stay in jobs because they don’t want to lose their insurance when they might be productive somewhere else,” Lowery said. “Others can’t be hired over a fear of what their hiring might do to insurance costs.”

Thomas McDermott, president and chief executive of Northwest Indiana Forum Inc., said businesses — especially those in Lake County — are saying they can’t afford their property taxes and health care.

“If the situation isn’t corrected, I think we’ll begin to see health care looked at as the option they drop before they go out of business,” McDermott said.

One national solution to the “health care fiasco” involves a proposal to mandate companies provide health coverage for their employees and give them a tax credit for doing so, McDermott said. The idea has merit, he said.

“If one company provides insurance, and the other does not, they’re put at a competitive disadvantage. You need to create a balanced playing field.”

Times staff writer Debra Gruszecki contributed to this story.

Robin Biesen can be reached at biesen@nwitimes.com or (219) 933-4168.

http://www.thetimesonline.com/articles/2003/05/05/news/top_news/2e5f720b8707982c86256d1d000c343a.txt

Posted by pnhp at 11:05 AM | Permalink

Washington Post
May 5, 2003
No HMO Fits All Anymore
By Bill Brubaker

Kaiser (Mid Atlantic) is seeking regulatory approval to offer a plan, as soon as this fall, that would allow patients to visit the doctors and hospitals of their choice.

Kaiser did not have much choice… The nonprofit insurer, part of California-based Kaiser Foundation Health Plan Inc., has been losing members and money.

Patients could participate in an HMO and receive treatment in Kaiser’s 29 medical centers or at 12 hospitals in the Washington-Baltimore region. That is the least expensive option.

Members could choose from a PPO network of more than 10,000 non-Kaiser physicians. A primary-care visit typically would cost about $20, and patients would have a larger choice of hospitals…

Or they could receive treatment from any doctor or hospital in the United States. That option, known as an indemnity plan, is the most expensive: Patients would pay 30 percent of any charges.

“You can move among the three tiers,” (vice president of sales and marketing Bill) Little said.

http://www.washingtonpost.com/wp-dyn/articles/A10965-2003May3.html

Comment: Free choice… But with financial penalties for exercising that choice.

If we had a single payer system, financial penalties would be removed and the patient would truly have free choice of providers. Competition between providers would then be based on the patients’ perceptions of quality and service. Wouldn’t it be better if all providers were playing on the same financial field? Then Kaiser could concentrate on efforts to improve service, as would all other providers.

Fix the funding system, and then compete on quality and service.

Posted by pnhp at 11:03 AM | Permalink

`P3’ disasters elsewhere should be a warning

May. 4, 2003
MICHELE LANDSBERG

The SARS outbreak in Toronto was sad and scary enough. But imagine this: A new outbreak occurs, spreading across Ontario. Patients in Brampton and in Ottawa find, to their horror, that their lives depend on their spanking new “public-private partnership” hospitals. And the private owners don’t want to deal with the crisis, thank you very much.

Contracted-out maintenance crews balk at entering the hospital. Privatized cleaning staff demand danger pay, which the hospital owners can’t or won’t pay.

The public board of directors, responsible only for clinical care, finds itself at loggerheads with the private owners, who don’t want to pay for beefed-up security, screening, cleaning, dietary and maintenance crews. The board doesn’t even have access to the hospital’s books, let alone any power over the management of the physical plant.

Fighting back in defence of its threatened profits, the hospital sues the Ontario government for billions of dollars in unanticipated costs.

Bogged down in legal battles and unable to pass even minimal preventive hygiene standards, both hospitals dramatically shut down.

Yes, this scenario is a fantasy, but not so far-fetched. This year, the Ontario government is pushing ahead stubbornly with its Brampton and Ottawa “P3” arrangements — the friendly little nickname for “public-private partnerships.”

If they get away with it, they plan on creating lots more, in reckless disregard of the consequences.

The idea, and the only idea, behind P3 public facilities is that it gets the capital costs of building hospitals, schools and even police stations and city halls off the government’s books.

Private companies build and own the facilities and lease them back to the public for 30, 40 or 60 years — at the end of which, the private owners, not the public, usually own the building.

P3s are different from the usual mode of construction, because the people who put up the capital also own and manage the building. And they certainly don’t intend to open their books to the public or be responsive to public demands.

In fact, in a blood-chilling example of capitalist thinking, P3 lawyers in Vancouver, in a city hall presentation, deplored what they called “the Inherent Diseases” of the public sector. The diseases? An emphasis on process, transparency and public justification. In other words, the P3s think that democratic accountability is a “disease” akin to typhoid.

Everywhere these P3s have been tried, they’ve crashed in disaster. In England, shoddy construction in P3 hospitals has led to grotesque accidents, ceiling cave-ins and frightening mechanical failures, along with emergency sale of public land and assets to ensure private profit.

Britain’s auditor-general, looking at the P3 accounting schemes, called them “pseudo-scientific mumbo-jumbo.” The British Royal College of Nurses says that privatization of hospital cleaning services is closely related to a rise in infections. The British Medical Journal reports that P3 hospitals have cut medical and service staff by 30 per cent.

Costs have been astronomical. Hundreds of millions of dollars have been spent on consultant fees alone; legal costs are a bottomless pit as the private owners try to wiggle out of contractual obligations in patient care. And because all these deals are done in secrecy, in the interests of “corporate privacy,” corruption is rampant. Just what we need for the next globalized epidemic: dirtier hospitals, management secrecy, shoddy building practices and profit-taking at the expense of patient well-being.

Apparently, Health Minister Tony Clement hasn’t read all those alarming reports — especially last year’s McMaster University study showing that private for-profit hospitals have a higher death rate because they skimp on care.

Listen, Mr. Minister, stop long enough to consider the Canadian evidence that P3 really means Profligate, Perilous and Profiteering.

Nova Scotia cancelled its P3 schools project but is stuck with costly 35-year leases, plus $32 million in extra costs.

Construction was shoddy, siting arbitrary and public access limited. Students had to drink bottled water for a year after arsenic was found in one school’s water supply, and the school’s private owner refused to take responsibility.

In P.E.I., the government cancelled a P3 hospital when it realized how expensive it would be.

In B.C., a P3 information system in Vancouver General Hospital racked up an extra $82 million in costs instead of the $72 million it was supposed to save.

In Alberta, the public board of a P3 school is grimly shouldering the extra expense caused by cheap and hazardous building techniques.

In every case, from England to Australia, government auditors have found that the sole reason for building P3 facilities is to get capital costs off the government’s books in order to fool the public into believing the budget was “balanced.”

When Tories argue that we can’t afford health care or hospitals without private money, they are playing three-card monte. Believe their sleight-of-hand accounting at your peril. Huge sums of public money are poured into those P3 long-term leases, going straight into private pockets instead of public service. But those costs show up on the books of some future government — and that’s their sole point.

Most of Ontario’s citizens believe firmly in public medical care and public hospitals. They’d be horrified to see our public institutions slip away into private hands, where we can’t demand answers, insist on access or hold the owners to account.

We do, however, have one last way to fight back.

On Saturday, May 10, the Ontario Health Coalition will launch its Caravan of Protest at the corner of Front and Bay Sts. at 2:30 p.m.

The march will wind through the financial district, stopping at the Bank of Montreal and Borealis Building, two of the bidders on P3 medical facilities.

Join in, even if you’ve never marched before. The weather forecast looks fine, there will be a double-decker bus to symbolize two-tier medicine (but also to make it easy for tired walkers), and there will be entertainment by Samba Allegra, Sizzlestick Theatre, Tintower Puppets, Judith Thompson, clowns and street theatre.

Make a noise to save our public system. If we can’t do that much, we’ll deserve what we get when the next epidemic strikes.

Michele Landsberg’s column usually appears in the Star Saturday and Sunday. Her e-mail address is mlandsb@thestar.ca.

http://www.thestar.com/NASApp/cs/ContentServer?pagename=thestar/Layout/Article_Type1&c=Article&cid=1051643375965&call_page=TS_Columnists&call_pageid=970599109774&call_pagepath=Columnists

Posted by pnhp at 11:08 AM | Permalink

Sixty-fourth General Assembly
State of Colorado
House Bill 03-1164
A Bill for an Act Concerning the Expansion of Access to Health Insurance…

The commissioner shall promulgate rules to implement a basic health benefit plan and a standard health benefit plan to be offered by each small employer carrier as a condition of transacting business in this state.

The commissioner shall implement a basic plan that approximates the lowest level of coverage offered in small group health benefit plans and shall implement a standard plan that approximates the average level of coverage offered in small group health benefit plans.

(a) The standard health benefit plan shall reflect the benefit design of common plan offerings in the small group market…

(b) The basic health benefit plan shall NOT INCLUDE COVERAGE PURSUANT TO THE MANDATORY COVERAGE PROVISIONS OF SECTION 10-16-104 (4), (5), AND (8) TO (12).

http://www.leg.state.co.us/2003a/inetcbill.nsf/fsbillcont/360CC2703C66247E87256C5A00673004?Open&file=1164busn_01.pdf

Comment: This bill was passed by the Colorado State House, and then was amended (capital letters, above) and approved by the Colorado Senate. It now returns to the House for approval of the Senate amendments.

With this benign-sounding amendment, the bill creates state-sanctioned, bare-bones insurance plans which are stripped of “mandated” benefits. In the name of “affordability,” Colorado would be authorizing plans that will provide neither health security nor financial security.

This is a national issue. Legislation has been proposed to create association health plans (AHPs), which would be designed to allow small businesses to offer similar bare-bones coverage that would be exempt from state-mandated benefits. Affordability of health care coverage for small businesses and for the uninsured is a crucial issue. But creating affordability by destroying the security that should be offered by private plans is not the answer. And other current reform proposals to fund private plans through tax credits will only increase pressures to strip plans of their benefits.

We need affordable, comprehensive coverage for everyone. The only model of reform that promises that is a single, publicly-administered program of social insurance.

Posted by pnhp at 11:02 AM | Permalink

San Francisco Chronicle poll, 5/1/03

Results:
77% - Create single-payer system
3% - Make employers “play or pay”
2% - Restore clinics’ budgets
14% - Make cuts, we can’t afford the system we’ve got
3% - Take two aspirin and call Congress in the morning

About 1100 people voted in this poll, which totally lacks any scientific validity. But the poll does make one very important point. The California State Legislature is currently evaluating both an employer mandate model and a single payer model of reform. This poll demonstrates that legislators should not automatically dismiss the single payer model because it is not “politically feasible.”

Posted by pnhp at 11:01 AM | Permalink

House of Representatives
Committee on Ways and Means Subcommittee on Health
May 1, 2003
Hearing on Medicare Cost-Sharing and Medigap

Statement of Patricia Neuman, Sc.D., Vice President and Director, Medicare Policy Project, Kaiser Medicare Policy Project, Henry J. Kaiser Family Foundation:

I am testifying today on behalf of myself and Thomas Rice, Ph.D., Professor and Vice Chair of the Department of Health Services at the UCLA School of Public Health. This testimony reviews the evidence on the effects of cost-sharing on health-care utilization, and the implications for proposals that would modify Medicare’s cost-sharing structure.

Medicare plays a critical role in the lives of 41 million elderly and disabled Americans, offering a reliable source of health insurance at a time in their lives when they are most likely to need medical care. Medicare pays for much-needed basic medical services, such as physician and hospital care. However, with high cost-sharing requirements and no outpatient prescription drug coverage, Medicare is substantially less generous than plans typically offered by large employers.

Gaps in Medicare’s benefit package are increasingly problematic for beneficiaries given that many have relatively modest incomes and limited assets, and face declining access to affordable supplemental coverage. Four in ten Medicare beneficiaries live on incomes below twice the federal poverty level - about $18,000 per person and $24,000 per couple in 2003, and the same number have less than $12,000 in countable assets, leaving them with little capacity to pay for unexpected medical expenses. On average, Medicare beneficiaries spend more than a fifth of their income on health expenses, including Part B premiums; Medicare cost-sharing; non-covered services, such as prescription drugs; and premiums for supplemental insurance.

The evidence now suggests that access to supplemental coverage is on the decline… Between 1996 and 1999, while the share of beneficiaries with supplemental coverage remained stable due to the increase in Medicare+Choice enrollment, the number of beneficiaries with Medigap policies declined by 1.5 million, bringing the share of all Medicare beneficiaries with Medigap coverage from 29% to 24%. Since then, enrollment in Medicare+Choice plans has also dropped by roughly the same number.

In addition, results from several surveys point to an erosion of employer-sponsored retiree health benefits.

One key consideration in redesigning Medicare’s benefit package is an understanding of the effects of cost-sharing on beneficiaries’ access to care. Some have suggested, for example, that beneficiaries should bear a greater share of their health-care costs to deter use of non-essential services. A review of the literature, however, identifies several concerns associated with proposals that would raise cost-sharing under Medicare: (1) higher cost-sharing requirements are likely to lower use of medically necessary services and may have a negative impact on beneficiaries’ health status; (2) higher cost-sharing is inequitable, hitting the most financially vulnerable beneficiaries the hardest; and (3) many if not most seniors do not appear to have sufficient information and knowledge to navigate the health-care system and assess their options when faced with high cost-sharing requirements.

Increased cost-sharing can therefore be viewed, colloquially speaking, as a “triple jeopardy” for elderly and disabled beneficiaries with modest incomes:

• Those with low incomes are more likely to be without any form of supplemental insurance that covers Medicare’s cost-sharing requirements; * Since those with low incomes also tend to be in poorer health and need more medical services, Medicare’s cost-sharing requirements will account for a greater portion of their limited incomes if they use the necessary additional services; and * If they do not use the additional services they need, their health is likely to suffer as a result.

In summary, there is substantial evidence showing that cost-sharing leads to lower utilization of health-care services - both necessary and potentially non-essential services. A number of studies show that cost-sharing (or lack of supplemental coverage) deters people from seeking diagnostic and preventive services, as well as services that are often used to treat chronic illness. Lower utilization may reduce health-care spending in the short term, but could ultimately result in poorer health outcomes for seniors and younger beneficiaries with disabilities.

http://waysandmeans.house.gov/hearings.asp?formmode=view&id=338

Comment: This important report should be downloaded. It contains an excellent discussion of the impact of cost-sharing on the use of services, and it explains why proposals to shift more of the burden of funding Medicare to the beneficiaries would result in impaired medical outcomes for many Medicare beneficiaries. The discussion is supported by solid data and informative charts and graphs.

It is much more important to understand the actual impact of policy decisions than it is to listen to advocates of “consumer sensitive” cost sharing state how they “wish” it would work, as if health policy science had confirmed that simply decreasing utilization improves the functioning of our health care system. It doesn’t. Let’s end “wishing” and instead deal with reality. Let’s move forward with reform that really benefits patients.

Posted by pnhp at 11:00 AM | Permalink

Modern Physician Apr 1, 2003 Editorial An irresistible force By Joseph Conn

…on March 10, an officer (Stuart Butler, vice president of domestic and economic policy studies) of the conservative and politically influential Heritage Foundation testified before a Senate committee that a “social contract” exists in the United States to “ensure all residents have affordable access to at least basic health care . . . “

So now, even the Heritage Foundation accepts the idea of universal coverage.

Butler concedes it would take a public/private partnership to cover everyone, but his plan, presented to the Senate subcommittee on aging, calls for phasing out what he calls the “regressive” tax breaks given on employer contributions to healthcare benefit plans. The excluded federal and state income and payroll taxes—estimated at $125 billion in 1988—would be better spent, he argues, providing “more progressive” tax credits or subsidies to individuals for obtaining health insurance themselves.

Butler did not urge employers to stop paying for their employees’ healthcare coverage, but that is inevitably what would happen without the tax breaks.

http://www.modernphysician.com/article.cms?articleId=1817

Comment: As we approach the inevitability of major reform of our highly flawed system of funding care, it is instructive to note policy issues on which groups as diverse as Physicians for a National Health Program and the conservative Heritage Foundation can agree.

Heritage believes in a “social contract” and PNHP believes in a “human right” to affordable, universal access to health care, though Heritage would limit that to “basic” care and PNHP would include all “beneficial” care.

Heritage recognizes a fundamental flaw in the regressive tax benefits of employer-funded health plans. The regressive nature is due to the fact that health plans provided by the employer are actually part of the employee compensation package. Since they are deductible to the employer, but not taxable to the employee, higher-income individuals receive a much greater tax benefit than do lower-income individuals. This is tax policy that benefits the wealthy but not the poor.

Remarkably, both Heritage and PNHP believe that our health care system should be funded through tax policies that are more progressive. This is a dramatic meeting of diverse minds. Both PNHP and Heritage believe that we should use the tax system in health care funding, and that the taxes should be more equitable.

Unfortunately, we are still in different worlds on the next step. Heritage would turn the hapless recipient of a tax credit loose in the overpriced and inadequate private individual insurance market where the masters of “market medicine” will relieve the patient of their funds without the necessity of providing adequate, affordable access to beneficial services. PNHP stands firm on the principle that only a publicly administered, single payer system of social insurance can ensure that everyone would have truly affordable access to all important beneficial services.

There is one important caveat. Although we agree that employment-linked insurance should be eliminated, we cannot do that until we have established a program of social insurance. In spite of the injustices of our current system, it is crucial that we maintain the employer’s role in providing coverage. Without it, tens of millions more would join the ranks of the uninsured.

We need to proceed, as expeditiously as possible, with our efforts to establish a single payer system. But, until we are there, let’s not dismantle the employer base of coverage.

Posted by pnhp at 10:59 AM | Permalink

The New York Times
April 30, 2003
Health Care Limps Up Political Ladder
By Robin Toner

The health care crisis is returning to American politics - gradually, but inexorably, with a force that will most likely grow as rising costs and deepening cuts squeeze more and more voters.

Pollsters say the issue ranks high with Democratic primary voters, which means that every presidential candidate must address it.

Meanwhile, rising health costs, coupled with declining revenues, are forcing states to consider major cutbacks in Medicaid - the program that already covers millions of people who would otherwise be uninsured. State officials have not, so far, received the help they are pleading for from Washington.

There is an incongruity here, as Bob Blendon, a Harvard University expert on public opinion and health, put it: Candidates are proposing bold visions to expand coverage in the future, "and we don't have enough money to pay for the present."

http://www.nytimes.com/2003/05/01/politics/01TALK.html

Comment: Dr. Blendon's comment is unfortunate. His polls (with KFF, NPR, WP and others) have been used to inform our political leaders that Americans do not want a government-run, taxpayer-funded system. His insistence on continuing with the pejorative phrasing of his question on social insurance has contributed to the belief that reform must be incremental and not comprehensive.

Now Dr. Blendon has adopted the rhetoric of those who are opposed to reform in stating that "we don't have enough money to pay for the present." Numerous studies have demonstrated that we are already spending more than enough to fund comprehensive health care for everyone, but we need to reform the system to make that a reality. 98% of Americans believe that the issue of affordability of health care must be addressed.

Dr. Blendon could improve his credibility by conducting polls that ask about views on universality, comprehensiveness and affordability of social insurance. Rather than asking exclusively about government and taxes, the poll should begin with a statement such as "Medicare and Social Security are programs of social insurance that are designed to include everyone and to be funded equitably." Then asking questions about support for adopting social insurance for health care for everyone should provide more objective responses.

It is helpful to understand the impact of the prevailing political rhetoric, but it would be even more helpful if we understood precisely what Americans really do want in the way of affordable access to health care.

Posted by pnhp at 02:45 PM | Permalink

The San Francisco Chronicle is conducting a poll on health care reform. Two of the choices include single payer and “play or pay” employer mandate. Although the poll is not scientifically valid, a large response could demonstrate the level of passion that we have for reform.

To cast your vote: http://www.sfgate.com/ (The question is half way down the right column.)

Posted by pnhp at 10:59 AM | Permalink

Response of Kip Sullivan to Robert Blendon’s polls:

From Don’s comment:

Dr. Blendon could improve his credibility by conducting polls that ask about views on universality, comprehensiveness and affordability of social insurance. Rather than asking exclusively about government and taxes, the poll should begin with a statement such as “Medicare and Social Security are programs of social insurance that are designed to include everyone and to be funded equitably.”

Kip Sullivan’s response:

Don,

I have what I think is an even more important suggestion for Dr. Blendon. He should stop asking respondents whether they would pay $50 or $200 or $500 more “to insure the uninsured,” and instead start asking, “If a universal insurance program would reduce your premium and out-of-pocket costs by $500, and increase your taxes by $500, would you support such a program?” Blendon’s question and my proposed question make different assumptions about costs. Blendon’s question assumes there is no way costs can be lowered while coverage is expanded; my question does not.

The other problem with Blendon’s question is that it assumes financing of universal coverage must be regressive. (A per head tax of $50 or $200 is regressive; it takes a rising portion of income as income declines.) My suggested question also suffers from that defect. Blendon should explore how support for universal coverage is affected by progressivity of financing by asking some follow-up questions, such as, “If a universal insurance program would reduce your premium and out-of-pocket costs by $500, and increase your taxes by $200, would you support such a program?”

Blendon keeps asking Americans his loaded question, and, not surprisingly, their responses show they are reluctant to pour even more money into our dreadfully expensive system. From this Blendon concludes, “Americans say they want universal coverage but they don’t want to pay for it.” If Blendon wants to continue posing his loaded question, fine, but the least he can do is draw the appropriately narrow conclusion, which is, “Americans want universal coverage, but they don’t want to buy it at the current price at which coverage sells these days, and they don’t want to pay for it with a regressive tax.”

Kip

Posted by pnhp at 10:57 AM | Permalink