News

Press Release: Doctors Describe Human Toll As System Fails
September 30, 2003

Physicians Group Decries 2.4 Million Rise in Number of Americans Lacking Health Insurance

Doctors Describe Human Toll, Especially for Children and Minorities As Employers Drop Coverage and Incremental Reforms Fail

SEPTEMBER 30, 2003, CHICAGO, IL

The number of Americans without health insurance jumped sharply for the third year in a row, up 2.4 million to 43.6 million, 15.2% of the population, according to a report released by the U.S. Census Bureau today. Members of Physicians for a National Health Program offered graphic descriptions of the human toll behind these numbers.

In cities across the country the rising number of uninsured is straining the nations safety net health care providers and taking a toll on state government budgets. The resulting gaps in access to care can be fatal. This month, in Dyersburg, Tennessee, a 26 year old patient was turned down for coverage by the states TennCare program after losing his job and workplace-based insurance. Denied access to mental health care, his psychiatric condition worsened and he took a room full of college students hostage, severely injuring two classmates before being killed by police.

In a small town, everyone is affected by a tragedy like this, said retired Tennessee pediatrician Dr. Jim Hudson. This is criminal, that in the wealthiest country in the world, we dont assure access to basic life-saving care.

Minorities have been particularly hard hit. One-in-three Latinos are uninsured (32.4%, including 25% of Latinos who were born in the US), as are one-in-five blacks (20.2%). Latinos suffer staggering health consequences from being uninsured, said Dr. Olveen Carrasquillo, a leading academic researcher on the uninsured at Columbia University in New York. Diabetes is 2-3 times more common in Latinos, which can cause blindness, kidney failure, and leg amputation if untreated. Asthma is 3-5 times more common in Latino kids.

The proportion of all children who are uninsured held steady at 11.6%. 8.5 million children remain uninsured, a graphic illustration of the failure of incremental reforms, such as the Childrens Health Insurance Program which is supposed to sharply reduce the number of uninsured children.

Texas residents are the worst insured in the nation, with one in four (24.1%) lacking any health coverage. Over 50% of my young patients are uninsured, said Houston pediatrician Dr. Ana Malinow, who easily recalls a half-dozen patients with terrible complications from being uninsured, including a two year old with a chronic ear infection and perforated eardrum whose family cant afford the $1,000 deposit required for surgery. In Texas, a simple ear infection in a child may not be properly treated for years, causing preventable hearing loss, speech deficits, and lifelong learning problems. The leave no child behind state is frighteningly callous when it comes to childrens health, and its no better for the adults I see in my volunteer work at a local shelter. The health care system in Texas is failing everybody.

Posted by pnhp at 11:48 AM | Permalink

Doctors Describe Human Toll, Especially for Children and Minorities As Employers Drop Coverage and Incremental Reforms Fail

SEPTEMBER 30, 2003, CHICAGO, IL—The number of Americans without health insurance jumped sharply for the second year in a row, up 2.4 million to 43.6
million,15.2% of the population, according to a report released by the U.S. Census Bureau today. Members of Physicians for a National Health Program offered graphic descriptions of the human toll behind these numbers.

This month in Dyersburg, Tennessee, a 26 year old patient was turned down for coverage by the state’s TennCare program after losing his job and workplace-based insurance. Denied access to mental health care, his psychiatric condition worsened and he took a room full of college students hostage, severely injuring two classmates before being killed by police.

“In a small town, everyone is affected by a tragedy like this,” said retired Tennessee pediatrician Dr. Jim Hudson. “This is criminal, that in the wealthiest country in the world, we don’t assure access to basic life-saving care.”

Minorities have been particularly hard hit. One-in-three Latinos are uninsured (32.4%, including 25% of Latinos who were born in the US), as are one-in-five blacks (20.2%). “Latinos suffer staggering health consequences from being uninsured,” said Dr. Olveen Carrasquillo, a leading academic researcher on the uninsured at Columbia University in New York. “Diabetes is 2-3 times more common in Latinos, which can cause blindness, kidney failure, and leg amputation if untreated. Asthma is 3-5 times more common in Latino kids.”

The proportion of all children who are uninsured held steady at 11.6%. 8.5 million children remain uninsured, a graphic illustration of the failure of incremental reforms, such as the Children’s Health Insurance Program which is supposed to sharply reduce the number of uninsured children.

Texas residents are the worst insured in the nation, with one in four (24.1%) lacking any health coverage. “Over 50% of my young patients are uninsured,” said Houston pediatrician Dr. Ana Malinow, who easily recalls a half-dozen patients with terrible complications from being uninsured, including a two year old with a chronic ear infection and perforated eardrum whose family can’t afford the $1,000 deposit required for surgery. “In Texas, a simple ear infection in a child may not be properly treated for years, causing preventable hearing loss, speech deficits, and lifelong learning problems. The ‘leave no child behind’ state is frighteningly callous when it comes to children’s health, and it’s no better for the adults I see in my volunteer work at a local shelter. The health care system in Texas is failing everybody.”

In Chicago, Dr. Claudia Fegan (who is also incoming president of Physicians for a National Health Program) runs the outpatient clinics for one of the city’s busiest safety-net hospitals. “People who thought they’d never be here find themselves begging for care. Yesterday a woman who had recently suffered a stroke sat crying outside my office in a wheelchair. Another hospital had discharged her and brought her here via ambulance. They told her she had to come here to receive her medications and follow-up care. We took care of her but we do not have any more available appointments for new patients until 2004. Where are people supposed to go?”

In Massachusetts, Dr. Steffie Woolhandler is in charge of quality reviews for the Department of Medicine at Cambridge Hospital. “I review the cases of people who should not have died to find out what went wrong. Too often the problem was that the patient didn’t have insurance and delayed care,” said Dr. Woolhandler. She cited the case of an uninsured health care professional who died of a treatable cancer before her biopsy results had even come back from the laboratory. “She correctly diagnosed herself with a liver problem based on her symptoms. She thought if she quit drinking she’d improve on her own. If she’d come in sooner, we could have treated the lymphoma we found in her liver.”

“The incremental reforms of the past two decades have failed,” said Dr. Carrasquillo. “The economic boom of the 1990’s barely dented the number of uninsured. The last three years of recession has exposed the cracks in our unsound health system. The number of people without insurance is skyrocketing, while benefits for people who still have coverage are shrinking rapidly. This should be a wake-up call to all political and health care leaders, including Latino leaders, that the time for bold solutions is now.”

Physicians for a National Health Program has more than 11,000 members across the country which advocates national health insurance for the U.S. PNHP members take care of the uninsured in every state and medical specialty. To interview a PNHP physician about the problems of lacking health insurance and options for reform, contact Ida Hellander at (312) 782-6006 or
pnhp@aol.com .

Posted by pnhp at 09:08 AM | Permalink

IN SOME AREAS, PEOPLE MUST WAIT MONTHS FOR APPOINTMENTS OR TRAVEL LONG DISTANCES. SOME MEDICAID FAMILIES CAN‘T GET TREATED AT ALL.

By David Crary
Associated Press Writer of LA Times
September 28, 2003

BERLIN, N.H. - Every few days, an agonized child or adult shows up at the emergency room of this mill town’s lone hospital, seeking relief from a pain that should have been treated elsewhere.

They have an abscess or a toothache, long-festering and suddenly unbearable. They turn to ER doctors, who can do little beyond supplying antibiotics, because Berlin - like hundreds of communities nationwide - has too few dentists.

Home to 10,600 people - just two of them dentists - in far-northern New Hampshire, Berlin is one of 1,480 areas in the United States designated by federal authorities as suffering from a dentist shortage. That number has nearly doubled since 1990.

In some areas, even patients with private dental insurance have to wait months for an appointment or travel long distances to a dentist with an open slot. Many low-income families have it worse: Their Medicaid coverage often isn’t enough to gain access to already busy dentists.

Loretta Morrissette, who runs an oral health program in Berlin’s public schools, sees the damage close-up in children whose parents can’t afford dental visits or can’t find a dentist who accepts new patients. She cited one mother who called 22 dental offices in one morning, many of them in distant towns, without getting an appointment for her child.

“If the children had early intervention, they could be helped before they get to the point of pain,” said Morrissette, a dental hygienist with Coos County Family Health Services. “They end up with an abscess two years down the road and a four-surface filling instead of one little one. It’s traumatic.”

Morrissette’s program tries to help children in kindergarten through third grade get dental treatment, although more than 70 students with cavities had to be placed on a slow-moving waiting list this year.

“I get an unbelievable amount of calls from parents wanting services, hoping for something that I can’t offer,” she said. “If they have a child in second grade and one in sixth, it’s very hard to tell them there’s no access for that older one.”

Dr. William Kassler, New Hampshire’s state medical director, said nearly 20% of the state’s 1.2 million residents live in communities with too few dentists. Many of those towns, Berlin among them, have unfluoridated water, causing higher cavity rates among children who then lack ready access to treatment.

As one of 16 states with no dental school, New Hampshire struggles to recruit newcomers to serve needy towns or replace the many dentists nearing retirement. The dentists who do come - like their peers elsewhere- generally prefer relatively well-to-do communities, not rural areas and poor urban neighborhoods with the most need.

Like many other states, New Hampshire is trying to ease the shortages by offering to repay the student loans of young dentists willing to work in underserved areas. Under another new program, the state will pay the malpractice insurance and license fees of retired dentists willing to donate at least 100 hours a year to treat needy patients.

“All states are struggling with these issues,” said Kassler, whose own family had to wait nine months for dental appointments after moving to New Hampshire five years ago. “It’s something that cries out for national policy intervention.”

Nationwide, there are about 152,000 active dentists, more than one-third of them over age 55, according to the American Dental Assn. Experts estimate that dentists’ ranks will begin to decline in about 10 years as the number of dental school graduates - now about 4,000 annually - falls below the number of dentists leaving the work force due to retirement or other reasons.

To reverse the trend, dental schools would need to graduate more students. But many of the nation’s 56 dental schools are struggling to maintain current operations; there are more than 350 vacant faculty positions because of an exodus of teachers into better-paying private practice.

Even now, there are severe shortages of dentists in certain regions - a huge swath of the Great Plains, southern Texas, much of Nevada, northern Maine and poor, rural counties in many other states. The U.S. Department of Health and Human Services says more than 31 million people live in shortage areas; officials estimate that 4,650 dentists would be needed to provide the proper level of service.

Senate Minority Leader Tom Daschle (D-S.D.) drew attention to the dentist shortage while touring his home state last month. “I’ve heard horror stories from South Dakotans who were forced to travel more than 100 miles for a simple dental procedure,” he said.

A recent South Dakota Dental Assn. survey projected that the number of practicing dentists in the state under age 65 could drop from 308 now to 217 by 2020.

Many of the nation’s problem areas have large minority populations, yet only 3.4% of the nation’s dentists are black and 3.3% are Latino.

Dr. Eugene Kruysman, one of the two practicing dentists in Berlin, has hired a headhunter agency to recruit an associate to help him with his overbooked practice. He is unable to take on new patients and even his regulars sometimes have to wait several months for a routine visit.

Kruysman, 49, has been practicing profitably in Berlin for 22 years; he raves about the appreciative attitude of his patients and the outdoor attractions of the surrounding White Mountains. But he knows that it won’t be easy to lure an associate to an economically struggling town several hours’ drive from the nearest big cities.

“It’s tough to draw someone up here,” he said. “The problem only worsens the more remote the location.”

He serves on a local dental-care task force and pitches in by treating some low-income emergency patients. His regulars include some Medicaid-covered families. But he knows that many children and adults in the area are suffering from lack of dental care.

“I don’t have an answer,” he said. “I see no solution to this shortage anywhere on the horizon.”

Posted by pnhp at 10:16 AM | Permalink

Toronto Star
Sep. 26, 2003
Ottawa, provinces agree to national health council

The federal government and provinces have reached agreement on the creation
of a 27-member national health council, a key source said today.

The council, which would monitor health policy and accountability, would be comprised of a chairperson, 13 government representatives and 13 people
from outside government.

Roy Romanow recommended the council last year in his royal commission
report on the future of health care.

click here to view the article

Comment: Imagine a national health council in the United States monitoring
health policy and accountability. Just to begin with, what would such a commission have to say about our very high costs in the face of the profound
deficiencies and inequities in our system?

Such a council would be invaluable to help fine tune a comprehensive health
care system such as Canada’s. But, in the United States, we don’t need to
fine tune a system. We need to establish a system. The sooner the better.

Sat, 27 Sep 2003 11:06:15 -0700
Subject: qotd: Federal regulations produce a return on our investment

The White House
Office of Management and Budget
Informing Regulatory Decisions: 2003 Report to Congress on the Costs and Benefits of Federal Regulations and Unfunded Mandates on State, Local, and
Tribal Entities.

OMB reviewed 107 major Federal rulemakings finalized over the previous ten
years (October 1, 1992 to September 30, 2002). The estimated total annual
quantified benefits of these rules range from $146 billion to $230 billion, while the estimated total annual quantified costs range from $36 billion to $42 billion.

Table 2: Estimates of the Total Annual Benefits and Costs of Major Federal Rules, October 1, 1992 to September 30, 2002 (millions of 2001 dollars):

Health & Human Services
Benefits: 9,129 to 11,710
Costs: 3,165 to 3,334

Environmental Protection Agency
Benefits: 120,753 to 193,163
Costs: 23,359 to 26,604

(six other agencies are listed, and each shows a significantly greater benefit than cost.) http://www.whitehouse.gov/omb/inforeg/2003_cost-ben_final_rpt.pdf

Comment: One of the most common objections to the role of government is the cost of regulatory requirements. Although the social benefits of many regulations may be priceless, it is very reassuring to know that President Bush’s OMB has provided a report that demonstrates that the regulations of each agency also produce a significantly greater dollar value in benefits than are the costs of fulfilling the regulations.

Although the greatest return has been through EPA regulations, agencies such as HHS have also produced a positive dollar return on the regulatory requirements.

The benefits of regulatory oversight are further evidence that our government is not our enemy. And we could benefit even more if we would begin to use a Universal, “government-run,” social insurance program to improve the value of our health care investment.

Posted by pnhp at 09:06 AM | Permalink

Canada Newswire
Sept. 24, 2003
Release from Canadian Institute for Health Information (CIHI)
CIHI report shows dramatic increase in MRI, CT scans and scanners

A new national report on medical imaging by the Canadian Institute for Health Information (CIHI) shows the supply of MRI (Magnetic Resonance Imaging) and CT (Computed Tomography) scanners and the number of scans performed have risen dramatically in the past decade, and that the distribution of major imaging equipment varies across the country.

A recent Statistics Canada survey found that 6.7% of Canadians age 15 and
over - a total of 1.7 million people - had a non-emergency MRI, CT, or angiography in 2001. Provincial data show volumes have risen sharply in
recent years.

Canada had a total of 147 MRI scanners in January 2003 compared to 30 in
1993, an increase of nearly 400%. The number of CT scanners rose by about
50% over the same period, from 216 in 1993 to 326 in January 2003. The country also had 594 nuclear medicine cameras, 165 angiography suites,
94 Catheterization labs, and 14 PET scanners in January 2003. Canada’s MRI and CT machines are, on average, newer than those in Europe.

Waiting for Care: The 2001 Statistics Canada Health Services Access Survey
found that about half of Canadians aged 15 and older who reported receiving
a non-emergency CT, MRI, or angiography waited three weeks or less. Most
(55%) waited less than a month; about 5% waited six months or more. One-quarter of those who were tested felt their wait was unacceptable; about
one in six (16%) said the wait affected their lives. Most (68%) of those who
said the wait affected them said it caused worry, anxiety, or stress.

http://www.newswire.ca/releases/September2003/25/c4564.html

Comment: One of the most common arguments presented against the adoption of a single payer system in the United States is that there are unacceptable
queues or delays for services in any universal, government funded program.
Perhaps the most frequent example given is the unacceptable delays in diagnostic imaging in Canada due to the fact that they do not have enough CT or MRI scanners to meet their needs. This report reveals that, in the past decade, great progress has been made by Canada in addressing this problem.

Emergency imaging is always available without delay. And, by 2001, three-fourths of Canadians who had elective scans do not believe that they were subjected to unacceptable delays. Since the release of the Romanow report, an even greater effort has been made to ensure adequate capacity.

Canada’s access to imaging is not bad and is improving dramatically. Contrast that to imaging in the United States. We have the capacity, but the uninsured and many of the under-insured cannot afford CT or MRI scans. Tens of millions of Americans are not even allowed a place in the queue.

Which system is better: a lower cost system that recognizes a capacity problem and takes measures to resolve that, or a higher cost system that has adequate capacity but nevertheless engages in wholesale rationing based on ability to pay?

Posted by pnhp at 09:22 AM | Permalink

Editorial in Science calls for Debate on Single Payer National Health Insurance
September 25, 2003

“Physicians have a responsibility to help solve the problem of inequities in our health care system.” (excerpt)

September 25, 2003— An editorial in this week’s issue of Science Magazine authored by former US Surgeon General Dr. Julius B. Richmond and Harvard economist Rashi Fein calls on American physicians to become active in the debate over health reform.

Dr. Richmond is a professor of Health Policy at Harvard Medical School. He served as Surgeon General in the Carter Administration. Dr. Fein is a Professor of the Economics of Medicine at Harvard Medical School. The Science Magazine editorial comes as rising health costs and premiums, and the increasing number of uninsured have stimulated a new round of health reform initiatives.

The editorial comments on the “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance” (NHI), a proposal endorsed by more than 10,000 physicians which was published last month in the Journal of the American Medical Association (JAMA, 8/13/03). The Physicians’ Proposal critiqued the health reform plans that have been offered by the Bush administration and the presidential candidates and concluded that the times call for a single-payer, government-administered, but privately-delivered system of health care.

“Our health system is deteriorating rapidly,” said Dr. Quentin Young, an author of the Physicians’ Proposal and National Coordinator of Physicians for a National Health Program. “By admonishing all professionals to become engaged, Richmond and Fein render a great service to the nation.”

1. # #

Physicians for a National Health Program is an organization of 11,000 physicians that support universal access to health care. The group is headquartered in Chicago and has chapters across the United States (www.pnhp.org). A copy of the Physicians’ Proposal is available at www.physiciansproposal.org along with a list of endorsers.

To interview the authors contact Ida Hellander at tel: 312.782.6006 or pnhp@aol.com

To obtain an advance copy of the Science Magazine Health Insurance in the USA editorial, contact Kristina Smith at (202) 326-6440.

Posted by pnhp at 11:24 AM | Permalink

Beth Capell, Ph.D. responds on the AAHP/HIAA merger and the importance
of lobbying:

The budgets listed (in yesterday’s message on the AAHP/HIAA merger) probably do NOT include campaign contributions as your comment implies.Instead, these budgets are devoted to lobbying, providing information and “research” that supports lobbying, and activating grassroots presence (though perhaps not that either: it would depend on how these associations structure what they do: the overhead on grassroots could be modest and most of the cost of that effort could be buried within the budgets of individual companies).

Woody Allen says that 90% of life is just showing up. The same is true for moving an idea through the political process. Showing up counts. A lot. The insurers are ubiquitous on health issues—not just universal coverage, but Medicare prescription drugs and probably a dozen other key issues. And they are omnipresent: that’s what $30-$40 million in lobbying presence means: it means that every member of Congress who thinks a thought about health care knows who the insurance lobbyists are and probably what they will think about an issue.

PNHP has a plan for affordable health care for all—-but members of Congress won’t know about it or take it seriously without an effective lobbying presence and without grassroots capacity to back that up. An occasional appearance on public television or an article in a medical journal (not widely read on Capitol Hill) are good but not sufficient. It is not a matter of matching the insurance industry dollar for dollar: after all, we beat them on HMO reform in California with far less capacity than that—but we (you, me, lots of other people and a number of key organizations) were there day after day for five years to win that fight. A fight at the national level requires commensurately greater capacity.

Good ideas are important but not sufficient. Just showing up counts for a lot in advocacy. Creating that presence, that showing up is what organizing is about.

Beth Capell, Ph.D., political science, lobbyist for California Physicians Alliance, Health Access California and others.

Posted by pnhp at 09:15 AM | Permalink

“Physicians have a responsibility to help solve the problem
of inequities in our health care system.” (excerpt)

September 25, 2003— An editorial in this week’s issue of Science Magazine authored by former US Surgeon General Dr. Julius B. Richmond and Harvard economist Rashi Fein calls on American physicians to become active in the debate over health reform.

Dr. Richmond is a professor of Health Policy at Harvard Medical School. He served as Surgeon General in the Carter Administration. Dr. Fein is a Professor of the Economics of Medicine at Harvard Medical School. The Science Magazine editorial comes as rising health costs and premiums, and the increasing number of uninsured have stimulated a new round of health reform initiatives.

The editorial comments on the “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance” (NHI), a proposal endorsed by more than 10,000 physicians which was published last month in the Journal of the American Medical Association (JAMA, 8/13/03). The Physicians’ Proposal critiqued the health reform plans that have been offered by the Bush administration and the presidential candidates and concluded that the times call for a single-payer, government-administered, but privately-delivered system of health care.

“Our health system is deteriorating rapidly,” said Dr. Quentin Young, an author of the Physicians’ Proposal and National Coordinator of Physicians for a National Health Program. “By admonishing all professionals to become engaged, Richmond and Fein render a great service to the nation.”

Physicians for a National Health Program is an organization of 11,000 physicians that support universal access to health care. The group is headquartered in Chicago and has chapters across the United States (www.pnhp.org). A copy of the Physicians’ Proposal is available at www.physiciansproposal.org along with a list of endorsers.

To interview the authors contact Ida Hellander at tel: 312.782.6006 or
email: pnhp@aol.com
To obtain an advance copy of the Science Magazine Health Insurance in the USA editorial, contact Kristina Smith at (202) 326-6440.

Posted by pnhp at 08:49 AM | Permalink

The Hill
September 23, 2003
Insurance trade groups OK merger
AAHP and HIAA consolidates Hill lobbying efforts
By Michael S. Gerber

Washington, D.C.’s two largest health insurance trade groups (The American
Association of Health Plans (AAHP) and Health Insurance Association of America (HIAA)) announced Monday that their boards of directors had approved a merger…

Leading the new association in its efforts on Capitol Hill to promote
private insurers will be Karen Ignagni, who currently serves as president
and CEO of AAHP.

The two associations’ similar agendas in Washington make it easy to merge
the policy shops. Both have been pressing for a larger role for private insurers in the Medicare prescription drug package as well as increased
payments to HMOs.

AAHP and HIAA spent a combined $9.3 million on lobbying last year,according
to records filed with the Senate.Each group’s budget is around $20 million, according to the Government Affairs Yellow Book published by Leadership Directories.

AAHP currently employs a staff of 120 and HIAA 80, Ignagni said.(AAHP Chairman William) McCallum said the new organization’s budget would be about 40 percent greater than AAHP’s.

http://www.hillnews.com/business/092303_merger.aspx

Comment: So what? Well, AAHP/HIAA and its membership owns a controlling
interest in Congress. That’s what.

When our goal is to try to provide everyone with health insurance, why should we be concerned that this industry has a favored position with Congress? It’s because our current fragmented system of funding care through private and public programs has resulted in unacceptable waste, deficiencies and inequities in our system. Congress continues to perpetuate policies that protect and enhance private health plans at the cost of health care equity for all of us.

AAHP/HIAA’s $40 million budget can secure its position quite solidly in the
hallways and lobby rooms of Congress. In contrast, we have no significant
sources of funds. All we can offer is a plan to provide affordable, comprehensive health care for everyone. Unfortunately, policy position papers don’t have the color and smell of fresh U.S. Treasury ink that serves as an effective attractant to too many of the creatures of Congress.

Posted by pnhp at 01:26 PM | Permalink

The Committee for Health Care for Massachusetts is a statewide effort being led by the people of Massachusetts, including health professionals, community leaders, organizations, patients and their families to ensure that no state resident go without affordable, comprehensive and equitably financed health insurance.

click hereto view

Posted by pnhp at 12:45 PM | Permalink

Kaiser Commission on Medicaid and the Uninsured (KCMU)
News release on Medicaid reductions
September 22, 2003

In the Past Three Years, Two-thirds of States Have Reduced Eligibility and
Restricted Health Care Benefits for Families and Low-Income Seniors-Not Just
Curbing Payments

With most states coping with their fourth year of fiscal stress, all 50 states and the District of Columbia (DC) have planned or implemented Medicaid cost containment actions for fiscal year (FY) 2004.

Diane Rowland, executive director of KCMU:"The duration of the state fiscal crisis is impacting Medicaid coverage broadly and deeply-and it's not just actions curbing provider payments or controlling prescription drug costs that we have heard about consistently.

When 34 states have reduced eligibility and even more have restricted needed
health care benefits in at least one of the last three years and there is little short-term hope of states recovering their revenue losses, we have to be concerned about low-income seniors and families getting less health care or losing it altogether."

http://www.kff.org/content/2003/20030922/prls922.pdf

Comment: As long as Medicaid remains a welfare program for very low income individuals, it will always be used as tool to balance budgets in difficult economic times, even though it is a chronically underfunded program.

Having a Medicaid card alone does not ensure access to adequate health care.

Medicaid is becoming less and less a form of insurance, and more and
more a certification process declaring the individual has been subjected to
means testing and is incapable of paying for medical care. Providers are now
in a position of either accepting losses because of their belief that everyone
should have medical care, or refusing to provide care because the insurer
(state and federal government) has failed to adequately fund the actual costs of care.

If we had an egalitarian system of social insurance, the political will
would be there to ensure that the system would be adequately funded for all
of us. Wouldn't that be better?

Posted by pnhp at 12:50 PM | Permalink

The Providence Journal
September 21, 2003
There’s no shelter from this storm
By John Kostrzewa

Employees used to contribute about 15 percent of the cost of health care. Now, the contribution has risen to 25 percent to 35 percent. And health-care consultants forecast it will grow to 50 percent at some companies.

Some workers are cutting back on health care and elective Surgeries, deciding to live with the bad knee rather than get a replacement. Or they are deciding to postpone the eye exam to avoid the copay. Or they are going without health insurance.
No relief is on the horizon.

http://www.projo.com/business/content/projo_20030921_jk21x.777bd.html

Comment: Current health care reform efforts continue down this path of shifting costs to patients. But is this really reform? Reform is defined as a change for the better. Reducing affordable access to beneficial health care services is a change for the worse.

Let’s dump this movement to shift costs to patients and get on with the process of real reform!

Posted by pnhp at 01:21 PM | Permalink

please click here to read the article

Posted by pnhp at 11:20 AM | Permalink

The Washington Post
September 17, 2003
Health Plan Costs Up 10.6%
By Christopher Lee

Health insurance premiums for federal employees and retirees (under the Federal Employees Health Benefits Program) will rise an average of 10.6 percent next year, the fourth consecutive year of double-digit increases, the Bush administration said yesterday.

Kay Cole James, director of the Office of Personnel Management:”This is great news for the federal employees, and we’re excited today on their behalf.”

Alwyn Cassil, spokeswoman for the Center for Studying Health System Change:Although federal workers’ premium increases have been comparatively
smaller,10.6 percent “is still a very high rate of growth. It’s growing much faster than increases in wages, increases in growth of the economy and increases in inflation. That means that more and more money will be coming out of people’s pockets to pay for health care.”

The administration also announced that, for the first time in five years,the government will expand the number of health plan choices under the Federal Employees Health Benefits Program. The program will offer 205 plans nationwide next year, up from 188 in this year.

http://www.washingtonpost.com/wp-dyn/articles/A21909-2003Sep16.html Comment: The largest purchaser of health care coverage, the Federal Employees Health Benefits Program, has not been able to slow the rise in health care costs to anywhere near the rate of inflation. That is not good news.

The fact that more plans wish to participate in the program indicates that our national policies are designed to enhance the business model of private health plans at the cost of higher health care expenses for the employees and their families.

Should we continue with national policies that are designed to protect the health plans of the members of Congress, or should we change to policies that are designed to ensure access to affordable care for everyone?

Posted by pnhp at 01:40 PM | Permalink

The Washington Post
September 16, 2003
Proposals for Expanding Health Care Coverage
By Julie Ishida

While the uninsured are left to deal with the consequences of being uninsured, policymakers have designed a variety of proposals to expand access to health insurance. The majority of Americans polled in a 2003 survey by the Kaiser Family Foundation and the Harvard School of Public Health support increasing the number of people in the United States covered by health insurance, but there is no consensus on how to accomplish this.

Karen Davis, president of the Commonwealth Fund:

“The proposals that are now being talked about are more pragmatic and less ideological and more focused on building [on] what works currently. How can we find out what’s working now and add more people?”

Paul Ginsburg, president of the Center for Studying Health System Change:”The reason why individuals are uninsured differs so much that it is unlikely that a single provision is going to cover them all. We need different approaches for different segments of the population.”

Here’s a summary of the major approaches under discussion.

Universal Coverage Proposals:

• Single payer

• Employer mandate

• Individual mandate

Incremental Proposal:

• Expansion of Medicaid and Children’s Health Insurance Program (CHIP)
  eligibility

• Subsidization of private insurance

• Creation of a system similar to the Federal Employees Health Benefits
  (FEHB) Program

http://www.washingtonpost.com/wp-dyn/articles/A15812-2003Sep15_2.html

Comment: The messages of individuals such as Karen Davis and Paul Ginsburg have dominated the national dialogue on health care reform. They imply that only piecemeal measures are feasible.

But the failure to control increasing costs, combined with a failure to reduce the numbers of uninsured have created an awareness that we need a more aggressive approach toward reform.

The recent publicity surrounding the physicians’ proposal for national health insurance published in JAMA, and the administrative efficiency achievable by a single payer system published in NEJM, have regenerated an interest in looking again at truly universal models of health care coverage.

Washington Post reporter Julie Ishida exemplifies the changing dialogue as she now includes universal models in her list of proposals. Members of the media understand the need to broaden the debate. But we need to convince the leaders of those organizations which support comprehensive health care coverage that it is once again okay to discuss universal systems of reform.Davis and Ginsburg need to hear that message.

One more message that we need to deliver is that there are very fundamental differences between the single payer model of social insurance and other so-called universal proposals. As an example, SB 2, California’s employer mandate which passed last week (but not yet signed by Gov. Davis) will still fail to provide coverage for over four-fifths of those currently uninsured.

It will significantly increase costs because it fails to eliminate the administrative excesses and fails to provide any significant cost-containment features. It also represents flawed tax policy since it is regressively funded, providing tax advantages for the wealthy and a lower net cost of their coverage, a benefit not available to low income individuals. It falls so far short of single payer goals that it is inappropriate to consider it in the same general category of reform.

Let’s convince our policymakers that it is time to put everything on the table. But let’s also convince them that single payer needs to be in a special place on the table wherein the policies of all other models are challenged to meet the golden standard of a universal, single payer system of social insurance.

Posted by pnhp at 09:12 AM | Permalink

U.S. health care in ‘critical condition’
September 16, 2003

BY JERRY DAVICH, Times Staff Writer

If America’s ailing health care system was a hospital patient, it would be in the intensive care unit. And a chaplain would be waiting outside the door. “The system isn’t dead yet, but it needs to be saved,” said Dr. Quentin Young, a Chicago internist who’s been practicing medicine for half a century.With no miracle cure in the works, a transplant is needed, Young and thousands of doctors agree.

The country’s current system — infected with swelled administrative costs, inflamed malpractice suits and cancerous private-pay greed — needs to be extracted and replaced with a single-payer national health insurance program, Young said. As national coordinator of Physicians for National Health Care, he is encouraged that nearly 9,000 U.S. doctors endorsed his proposal, published Aug. 13 in the Journal of the American Medical Association.

Saturday, Young hopes to encourage other doctors and lawmakers during a health care reform conference at Indiana University Northwest. The public forum is sponsored by The Northwest Indiana Coalition for Health Care for All, made up of unions and environmental, religious and community groups.”This forum is the first step in building a regionwide coalition to see a health care system that takes care of all of us,” said organizer Ruth Needleman, an IUN professor.

Sponsors like Needleman admit they don’t share a single vision for what the system should look like, but “we do understand that our current system has failed completely,” she said.The forum, open to the public, will include sessions on local, state and federal action, information on health care bargaining, facts about the successful Canadian health care system and an update by U.S. Rep. Pete Visclosky, D-Ind., about congressional action on this issue.During his 1 p.m. talk, Visclosky also will receive a widely circulated petition for health care reform from the United Steelworkers of America District 7 office.

Dr. Linda Murray, chief medical officer of the county-run clinics in Cook County, Ill., will explain why the country’s health care system has failed and what feasible alternatives there are for the future.The proposal Young coauthored states that the United States treats health care as a commodity — distributed according to the ability to pay — rather than as a social service to be distributed according to medical need.It’s a market-driven system where insurers and providers compete by avoiding patients who can’t pay and shifting costs back to patients who can. This, Young said, creates the paradox of a health care system based on avoiding the sick.

“This issue is rising to the top of the national agenda with 44 million uninsured Americans leading the way,” he said.

What’s needed, Young said, is a critical mass of legislators to lend a hand with the operation of saving one state at a time, which could lead to national reforms. About a half-dozen states are in the process of enacting health care reform legislation, Young said.

“It’s not the best solution,” Young said. “It’s the only solution.”

Jerry Davich can be reached at jdavich@nwitimes.com or (219) 933-3376.

Posted by pnhp at 11:35 AM | Permalink

The New England Journal of Medicine
September 11, 2003
Health, Life Expectancy, and Health Care Spending among the Elderly
By James Lubitz, M.P.H., Liming Cai, Ph.D., Ellen Kramarow, Ph.D., and
Harold Lentzner, Ph.D.

Conclusions
The expected cumulative health expenditures for healthier elderly persons, despite their greater longevity, were similar to those for less healthy persons. Health-promotion efforts aimed at persons under 65 years of age may improve the health and longevity of the elderly without increasing health expenditures.

http://content.nejm.org/cgi/content/full/349/11/1048

Comment: Since living longer doesn’t increase health care costs, those who predict “bankruptcy” of Medicare are now limited to the premises that the numbers of Medicare beneficiaries will be too great, and that the increasing
technological costs will be excessive.

The ratio of retirees to workers will shift upward with the retirement of the baby boomers, but that increase is a relatively modest, finite number that is not “unaffordable” according to any reasonable actuarial forecast.And it will stabilize as the baby boomers transition through the other end of the life cycle.

The increase in health care costs is a major issue. But that is not a problem that is limited to the Medicare program. It applies to our entire health care system. There are many factors. Just a few of these are increased use of expensive technology, higher drug costs, higher pricing in the United States, and Overutilization of our higher capacity healthcare system. These are systemic problems that cannot be addressed simply by destroying Medicare as a program of social insurance.

We need structural reform of our health care system. A good start would be to revise the way that we pay for health care, keeping in mind the importance of access, equity and affordability.

Posted by pnhp at 12:55 PM | Permalink

The Proposed Conference Report No.1 for SB 2, an employer mandate, is now available. AB 1528, which originally was a combined employer and individual mandate has been converted into a quality and cost containment bill that must be enacted for SB 2 to become operative. The links to both proposed conference reports are provided.

SB 2, Health Insurance Act of 2003:
http://info.sen.ca.gov/pub/bill/asm/ab_1501-1550/ab_1528_bill_20030909_proposed.html
PDF version:
http://info.sen.ca.gov/pub/bill/sen/sb_0001-0050/sb_2_bill_20030909_proposed.pdf
AB 1528, California Health Care Quality Cost Containment Commission:
http://info.sen.ca.gov/pub/bill/asm/ab_1501-1550/ab_1528_bill_20030909_proposed.html
PDF version:
http://info.sen.ca.gov/pub/bill/asm/ab_1501-1550/ab_1528_bill_20030909_proposed.pdf

Comment: These bills could pass before adjournment this week and be on Gov.Davis’ desk before the recall election to be held next month. We are beyond conceptual abstractions and into the real world of health care reform.

Message: 2
From: “Don McCanne”
To:
Date: Wed, 10 Sep 2003 19:48:13 -0700
Subject: qotd: M. Wacker responds on ER call coverage rules

Margaret Wacker, M.D. responds to the change in ER call coverage rules under EMTALA:
As a neurosurgeon who covers emergencies at county hospitals, I would like to make a few comments. The rule that has been in place has caused many private-practice neurosurgeons to restrict their hospital privileges especially at hospitals that require a service to provide 24/7 coverage regardless of the number of a given specialty. Though this has usually been interpreted to mean that if 3 or more neurosurgeons are on staff the hospital must provide 24/7 coverage, neurosurgeons have tended to reduce the number of hospitals at which they work, so that the call burden does not become onerous. That has tended to make it even worse for those of us who work in the public sector.

Many neurosurgeons have told me that they would be willing to take some call, but don’t want to take every other to every third, so limited where they would practice to avoid that situation. If some of these neurosurgeons were indeed willing to take 1 in 5 or 6 call at a hospital, they might actually help relieve the shortage. Unfortunately, the problem of specialist shortage with the rule change without central/regional planning might be no better than the current situation, or may even get worse. Or each outcome might happen in a different area depending on how the involved individuals choose to act.

The only real resolution to the specialist shortage problem is to have regional planning, and not try to provide all services at all hospitals.Of course, then the specialists would be concentrated, so both goals—of 24/7 coverage and reasonable call schedules—could be achieved. It might even be possible to have some limited outreach from these centers, but not to have the 24/7 call coverage everywhere. The planned concentration would also have the benefit of not having ambulances go to uncovered hospitals as might happen with the simple change being proposed, which might lead to a somewhat haphazard schedule of which ERs are covered at a given time. Of course, the public would also need to understand that many “ERs” would only function for “urgent care”, but with a planned system could learn this.

This sort of regional planning has been happening with respect to trauma centers for some time, so certainly is possible. This is yet another way in which a national health plan would benefit the country.

Margaret Wacker, M.D. is a neurosurgeon with Arrowhead Neurosurgical Medical Group which covers Arrowhead (San Bernardino County) Regional Medical Center and Riverside County Regional Medical Center.

Posted by pnhp at 11:40 AM | Permalink

Health Affairs
Web Exclusive
August 11, 2003

Excerpt from a letter from Stephen M. Davidson, Professor, Health Care Management, Boston University school of Management, responding to Alain Enthoven’s previous article on multiple-employer exchanges:

Alain Enthoven believes that the employment-based system has failed to control health care costs because so many employers offer their employees coverage from only a single source instead of from multiple sources that would compete for the employees’ business. His solution is to create multiple-employer exchanges,” which would offer members’ employees choices among plans.

I am not commenting on his diagnosis. However, the success of his prescription depends on the probability that it will actually reduce the cost of care. Since I believe the chances of that are slim for several reasons, in my view, Enthoven’s solutions will not work…

Managed care plans can contain costs for a time by paying lower salaries or fees, buying supplies in bulk, or reducing administrative staff. But the key to keeping them down is improving the system’s efficiency by changing the processes of care. As noted above, that is a complicated, costly undertaking that health insurance plans are unlikely to attempt unless the incentives are a lot stronger and more reliable than those that would result from Enthoven’s exchanges.

Excerpt from Alain Enthoven’s response to Davidson’s letter:

Davidson leaves me wondering what alternative he would suggest to motivate process improvement. Would he suggest a single payer? A single payer could offer important advantages, such as universal coverage and government monopsony power to counterbalance provider monopolies, but it seems unlikely that it could motivate process improvement. Yet if U.S. employers don’t make a radical change toward managed competition pretty soon, a single payer will become inevitable, if it isn’t already.

http://www.healthaffairs.org/WebExclusives/Web_Exclusive_Letters_Davidson_081103.htm#Davidson

Posted by pnhp at 10:45 AM | Permalink

Read this article in The Gazette at http://www.gazettenet.com/09062003/health/8825.htm

Posted by pnhp at 10:04 AM | Permalink

For Immediate Release, August 4, 2003, Issue #1

Welcome back to the American Health Security News.  From 1993 to 1995, when
the national health reform debate was among our top national priorities, I published this same newsletter.   My intent is to give readers an update on universal coverage news, to discuss national health care and other health reform proposals, and to identify information resources for news media and Congressional offices following the health care reform debate.   I sincerely believe health care reform is becoming an unavoidable issue once again -
there is recognition that our system is broken and we are quickly running
out of options.

In this first issue, you will see a summary of the health reform proposals
of Democratic Presidential candidates, including Governor Howard Dean,
Senator John Edwards, Representative Richard Gephardt, Senator John Kerry,
and Representative Dennis Kucinich (other candidates have not issued
detailed plans).  The intent of these analyses is to provide an overview of
the approach each candidate has taken, with sufficient detail to provide an
understanding of each approach.  These analyses are based on press reports,
articles and documents provided by their campaign offices.  As such, these
analyses are not comprehensive and reflect my interpretation.

**********************
To view the full newsletter click on this link
www.adaction.org/ADAHealthSecurityNews.pdf or reply to this email to receive
the full newsletter as an attachment.

Posted by pnhp at 12:25 PM | Permalink

Proponents of a Canadian-style, single-payer health care system for the U.S. argue that excessive administrative costs represent a serious problem in multi-payer systems. In this analysis, Harvard researchers compared administrative costs in the U.S. and Canadian health care systems. In August 2003, these same authors co-authored a proposal for single-payer national health care insurance in the U.S. (JAMA 2003; 290:798).

Using a variety of sources, the researchers calculated the fiscal-year 1999 administrative costs of health care insurers, employers’ health care benefit programs, hospitals, office practices, nursing homes, and home health care agencies in both countries. The estimated per capita cost of health care administration was US$1059 in the U.S. and US$307 in Canada. These costs accounted for 31% and 17% of health care spending in the U.S. and Canada, respectively. The average overhead cost for U.S. private insurers was 11.7%; in contrast, this figure was 3.6% for U.S. Medicare and 1.3% for Canadian provincial insurance plans.

Comment: Although these researchers acknowledge limitations in their data,
their analysis suggests strongly that a single-payer system would yield Substantial savings in administrative costs. Elsewhere, the authors and others have argued that such savings essentially could fund health care for the uninsured segment of the U.S. population. In an accompanying editorial, an economist from the Brookings Institution contends that the authors have exaggerated the difference in administrative costs in the U.S. and Canada;
he also questions whether these comparisons provide useful guidance to policy makers, given the differing political histories and institutions in the 2 countries.

— Allan S. Brett, MD
Published in Journal Watch September 2, 2003

Source

Woolhandler S et al. Costs of health care administration in the United
States and Canada. N Engl J Med 2003 Aug 21; 349:768-75.

Aaron HJ. The costs of health care administration in the United States and
Canada — Questionable answers to a questionable question. N Engl J Med
2003 Aug 21; 349:801-3.

Posted by pnhp at 12:18 PM | Permalink

The Plain Dealer
09/07/03
Free health care disappearing for retired public employees
By Stephen Ohlemacher

Free health care, once an expectation for many of Ohio’s retired public employees, will soon be a memory for most.Even affordable health care is in jeopardy for a lot of retirees on fixed incomes.

All five of Ohio’s public employee pension funds are following national trends by increasing health care costs for retirees next year, some significantly.

The Ohio retirement systems have special funds to subsidize health insurance
for retirees. Officials at all the funds are adamant that pension benefits are secure. But without the price increases, officials at most of the systems said they would run out of money to help pay for health insurance in just a few years.

“The bottom line is, public employees still have great benefits,” said Laurel Johnson, spokes woman for the School Employees Retirement System.
“They just have to pay for it.”

http://www.cleveland.com/news/plaindealer/index.ssf?/base/news/1062946537109460.xml

Comment: When our most reliable programs of health care coverage no longer
guarantee permanent health security, isn’t it time to consider reform that
will?

Lifetime, affordable, comprehensive coverage for everyone is achievable now.
What are we waiting for?

Posted by pnhp at 09:37 AM | Permalink

Center on Budget and Policy Priorities
September 2, 2003
Reducing Waste, Fraud, and Abuse One Percent Of What? Double-Counting and Other Budget Committee Mistakes Will Require Some Committees to Cut Entitlement Programs More than One Percent
By Richard Kogan

Today (September 2, 2003), House and Senate Committees are scheduled to
submit recommendations on how to reduce “waste, fraud, and abuse” in federal
“mandatory,” or entitlement, programs. In May, the House and Senate Budget
Committees directed 12 Senate committees and 15 House committees to find
ways to reduce entitlement programs; the Budget Committees issued dollar
targets for each of these committees, supposedly equal to one percent of the
total entitlement spending in each committee’s jurisdiction. The Budget
Committees’ calculations were flawed, however, in major and minor ways.
As a result, most committees are required to find savings that represent
substantially more than one percent of the entitlement spending under their
jurisdiction, and a few are required to find savings of less than one percent.

The Budget Committees’ largest error was to double-count the cost of certain
“trust fund” programs. Double-counting makes these programs look costlier
than they really are, and so makes the savings targets for committees with
jurisdiction over these programs higher than one percent. The Budget Committees double-counted the cost of all programs that have trust funds
into which the U.S. Treasury transfers money, with the trust fund then using
the transferred funds to make payments to (or on behalf of) program beneficiaries. Programs with such a funding structure include the military
retirement program, the civil service retirement program, and Part B of
Medicare (the Supplemental Medical Insurance program, which pays for
visits to physicians, rather than hospital bills).

This is double-counting, and is scrupulously avoided by CBO and OMB.In total, double-counting of this nature by the Budget Committees produces ten-year savings targets that are $24 billion too high.

The Budget Committees also erred with regard to programs where the federal
government acts as an agent in “passing through” to other entities certain
funds that it collects for specified purposes… When a budget account is not really a government “spending program” but essentially is a pass-through for other transactions, there is no possibility of reducing the costs by one percent.

http://www.cbpp.org/9-2-03bud.htm

Comment: A major problem with programs of social insurance is that conservatives, when in control, continue to reduce funding (though usually simply by failing to provide adequate inflationary increases). They then plead that the programs are ineffective and should be replaced with private
alternatives.

Using dishonest calculations cloaked as reductions in “waste, fraud,and abuse” is in itself fraudulent and abusive. We need to demand that our legislators protect our public programs such as Part B of Medicare.
Failing that, we should replace them with legislators who will.

Date: Thu, 4 Sep 2003 10:26:29 -0700
Subject: qotd: Relaxing EMTALA rules will result in lethal outcomes

Department of Health and Human Services
Centers for Medicare & Medicaid Services
42 CFR Parts 413, 482, and 489
[CMS-1063-F] RIN 0938-AM34

Medicare Program; Clarifying Policies Related to the Responsibilities of Medicare-Participating Hospitals in Treating Individuals with Emergency Medical Conditions

ACTION: Final rule.
SUMMARY: This final rule clarifies policies relating to the responsibilities of Medicare-participating hospitals in treating individuals with emergency medical conditions who present to a hospital under the provisions of the
Emergency Medical Treatment and Labor Act (EMTALA).

Excerpt:
(2) Exception: Application to inpatients.

(i) If a hospital has screened an individual under paragraph (a) of this section and found the individual to have an emergency medical condition, and admits that individual as an inpatient in good faith in order to stabilize the emergency medical condition, the hospital has satisfied its special responsibilities under this section with respect to that individual.

http://cms.hhs.gov/providers/emtala/cms-1063-f.pdf

And…

Institute of Medicine
Care Without Coverage: Too Little, Too Late

Hospital-based Care

The poorer health status of uninsured adults at the time of hospitalization is compounded by experiences as inpatients. They receive fewer needed services, worse quality care, and have a greater risk of dying in the hospital or shortly after discharge.

Traumatic injuries: Surprisingly, provider response to traumatic injury can be influenced by insurance status. Uninsured trauma victims are less likely to be admitted to a hospital, receive fewer services when admitted, and are more likely to die than are insured trauma victims.

http://www.iom.edu/includes/DBFile.asp?id=4160

Comment: The way in which a problem is framed greatly influences the approaches to solving the problem.

The administration has elected to define the continued application of EMTALA
standards to an emergency patient, once that patient is admitted, as a burdensome and unnecessary regulatory requirement. Their solution is to waive EMTALA rules for emergency inpatients once admitted. Relaxing this requirement can only compound the negative outcomes described in the Institute of Medicine report.

Others would define the problem as impaired outcomes and even death resulting from lack of insurance coverage for many emergency patients. Most of us would agree that the solution for the problem framed in this manner should be to ensure that everyone has adequate health insurance coverage.

Should our administration begin supporting policies that improve health care
outcomes, or should it continue to place a higher priority on policies that reduce government oversight of serious deficiencies that adversely affect the health of our citizens?

(Although this message addresses the waiving of EMTALA rules for emergency
patients who are admitted, an even more consequential change is in the relaxation of the rules for specialist on-call backup of emergency services.

More preventable deaths are inevitable. Although adequate specialist coverage will always remain a problem, the immediate solution is not to merely diminish the obligation of specialists to provide coverage, but rather to ensure that they will be compensated when their services are required. Again, ensuring that everyone has adequate health care insurance is the first step toward solving these problems. Removing the issue of compensation allows for a less heated dialogue on the other important on-call disputes.)

Posted by pnhp at 09:49 AM | Permalink

The goal of a National Health Care program is to provide the best care for all at an affordable cost. Unfortunately, to institute such a system, the pressure of the corporate health groups has been for many years and continues to be, formidable.
Eleven years ago, prior to the 1992 elections, opinion polls indicated that 90 percent of Americans believed that the health care system needed “fundamental change’ or “a complete rebuilding”.

This called forth a full court press by the corporations which had a vested interest in their profit-making endeavors. Among them were the American Medical Association , the Blue Cross/Blue Shield and other health insurance companies, as well as the drug and medical equipment companies. With their millions and millions of dollars they were able to prevent any meaningful reforms. In the years since the 1992 election the amounts of money and propaganda have increased exponentially. The only force which can prevail against this kind of pressure is the common sense of the voters, and it can do so only if the people get out and vote against legislators who are in bed with the corporations ,and vote for people who have the interest of the public at heart.

Over the past two decades discussion about health care reform has intensified. In this process a number of statements and claims by those who oppose a single payer system have assumed a prominent place; enough so in fact, that they have acquired the status of myths and we must be prepared to refute them.

Most often heard is the claim that National Health Insurance is socialized medicine. In a real socialized system the government owns and operates it – it hires and pays the doctors and other personnel, it owns and operates the hospitals and clinics.

All other arguments can be answered by referencing the health statistics which show that the health of the American people is not rated as high as that of the other industrialized countries Life expectancy, infant mortality, maternal mortality, hospital admissions, physicians’ visits, surgical procedures etc. are all better in Canada, for example, than are those in the U.S.
Conversion of our present non-system to a national health insurance, despite what pessimists say, is possible if a knowledgeable electorate get out and vote for those who will support one.

©#651, Goodrich , June 1, 2003

Posted by pnhp at 10:59 AM | Permalink

San Francisco Chronicle
September 1, 2003
Health Insurance for All
SB2 an important step in solving the problems of the uninsured By John whitelaw, M.D., the immediate past president of the California Medical Association, and Art Pulaski, the executive treasurer of the California Labor Federation, AFL-CIO.

Nearly 7 million people in California lack health-care insurance. Most uninsured Californians work and pay taxes, but do not receive health-care coverage from their employers. In fact, 8 out of 10 uninsured Californians work or are the dependents of working, uninsured Californians.

A special committee in the California Legislature is reviewing historic legislation called “Health Care for Working Families.”

This legislation — SB2 — would significantly expand access to health care
by building on the national system of employer-based health coverage.
Employers would pay a user fee into a state health insurance purchasing pool. Employers who provide a basic level of coverage would get a credit against the fee. Beginning in 2005, companies with more than 200 employees would be required to provide health insurance for their employees and dependents. In 2006, companies with more than 20 employees would be required to provide coverage for their employees, but not their dependents.

Smaller companies will be exempt from this measure.By providing coverage to millions of uninsured Californians, SB2 would save lives, safeguard medical services and stabilize skyrocketing premiums.This historic legislation (authored by Senate President Pro Tem John Burton,D-San Francisco) is sponsored by the California Medical Association,the California Labor Federation, AFL-CIO and thousands of other community and health advocate groups.

click here to read the article

Comment: California’s SB2 is a prime example of why the dialogue on reform
should not be “either incremental or universal,” but rather should be “incremental and universal.”

Our goal is comprehensive and affordable care for absolutely everyone which
can be achieved only by enacting a universal system of social insurance. But
because many barriers exist to achieving that goal in the immediate future,
we need to support interim measures that improve access and coverage without introducing detrimental policies that might negatively impact our goals.

It is estimated that SB2 will provide coverage to about 1.1 million of the
4.5 million Californians who are uninsured at any given point in time.
(At least 6.2 million Californians are uninsured at some point within a year.)
Expanding coverage to over a million residents is a very worthy goal,and
should be supported by all of us.

But SB2 still leaves several million without coverage. SB2 is the most expensive model of reform, and will increase California’s global healthcare costs significantly. It leaves in place the highly flawed and fragmented system of funding health care with its egregious administrative waste,catering to the private health insurance industry. It perpetuates many of the inequities in both the funding of health care and in the allocation of our health care resources. It clearly is not a measure that we can pass and then walk away from, as if the job were done.

SB921, the single payer bill of Sen. Sheila Kuehl, has not been included in
the conference committee deliberations, but it is still very much an active
bill. As a two year bill, it is scheduled for further consideration in January, 2004. It does have an almost insurmountable hurdle. Any tax increase in California must have a two-thirds vote in both the Senate and Assembly. The single payer model shifts private spending into the public sector. A variation of the model has not been created that would avoid a tax increase (even though offset by a reduction in private spending). The conservatives, though a minority, have been able to block any legislation involving a tax increase.

Although SB921 cannot pass in its present form, SB2 was crafted to avoid any
tax increase. Though SB2 falls far short of our goals, it can pass.Because
it is an improvement, it should be vigorously supported.

That said, we must not allow dissemination of the misperception that SB2
will have solved our health care problems. We must continue the fight for
coverage of the millions left uninsured, for eliminating the inequities in
our system, and for ensuring that comprehensive health care will be affordable for everyone.

We need to pass SB2. But then, instead of relaxing our efforts, we need to
become even more diligent in educating the public on the benefits of a single payer system of social insurance. California advocates need to send a loud and clear message on Sen. Kuehl’s SB921, the single payer bill.

Message: 2
From: “Don McCanne”
To:
Date: Tue, 2 Sep 2003 13:36:33 -0700
Subject: qotd: Understanding consumer-directed health care

California HealthCare Foundation
8/26/03
Understanding Consumer-directed Health Care in California
By Jon Gabel and Thomas Rice

Despite a shared interest among insurers and employers in exploring the potential of consumer-directed health plans, such coverage remains a rarity
in California-a state that typically leads the nation in innovative health
care models.

The report,Understanding Consumer-directed Health Care in California,examines consumer-directed health plans, which link consumers’ health coverage choices to the financial consequences of those choices. If,for example, consumers choose a health plan that results in greater overall expenditures, they will have to pay more in premiums. This report explains how the products work, identifies the industry players behind them, and discusses the factors likely to influence their growth.

The report focuses on three types of consumer-directed plans including:
* Health reimbursement arrangements (HRAs), whereby an employer establishes an individual health reimbursement arrangement for a specified dollar amount for each enrolled employee, generally in conjunction with a high deductible insurance product.

• Customized plans, whereby employers make a fixed contribution toward the
  employee’s premium, and the employee then chooses among an array of products
  with different prices that reflect a wide-range of benefit designs and provider networks.

• “Design your own” products, so far non-existent in California, let employees choose their own set of providers and benefit features-essentially designing their own provider network and specifying the services covered-with the employee’s premium contribution dependent on the choices made.

http://www.chcf.org/topics/view.cfm?itemid=21485

For the full report:
http://www.chcf.org/documents/insurance/ConsumerDirectedHealthCare.pdf

Comment: Since consumer-directed health care is being touted by some as the
next major trend in innovative reform efforts, activists should become informed on these proposals and their potential impact. The report by Gabel and Rice provides an excellent, straightforward explanation, along with a description of their initial impact in California.

Although purists in the health policy academic community might suggest that
we wait to observe the full impact of these innovations before we pass judgment on them, a few comments can be made in advance.

“Health reimbursement arrangements” (HRAs) are the insurance industry’s answer to medical savings accounts (MSAs). The accounts are funded by the employer. The accounts require administrative services since they can be used only for medical expenses, and they are not portable from employer to employer. They are combined with high deductible plans, usually PPOs.

Adverse selection is a problem if the employer offers any other options,resulting in excessive costs for plans that concentrate individuals with greater health care needs. Of concern is that the individual is exposed to 100% of the costs between the amount in the account and the deductible of the catastrophic coverage. Negative outcomes inevitably will result from failure to obtain timely care because of financial disincentives once the HRA account is depleted.

“Customized packages” are defined contribution programs in which the individual must pay more to obtain more comprehensive coverage of benefits and/or a greater selection of providers. Many healthy individuals will select lower cost coverage which may well prove to be inadequate if significant health care needs later develop. This defeats the purpose of insurance.

“Design-your-own” products do not exist in California. It is unlikely that they will ever be a significant player because of the difficulty of selecting and pricing almost unlimited variations in coverage.

Consumer-directed programs are designed to reduce health care costs for employers by shifting costs to employees. The health policy literature confirms that this can only result in reduced access to health care because of lack of affordability. Reduced access in turn results in impaired health outcomes. Consumer-directed programs are bad health policy. Why do we keep avoiding the inevitable conclusion that we need a comprehensive,universal program of social insurance?

(Thomas Rice discusses the issue of consumer choice in his chapter,”Should
Consumer Choice Be Encouraged in Health Care,” from the book, “The Social
Economics of Health Care,” edited by John B. Davis. It is well worth reading. http://www.semcoop.com/detail/0415251621)

Posted by pnhp at 10:24 AM | Permalink

The Pew Research Center
Survey
July 24, 2003

Scrap Tax Cuts for Health Insurance

Fully 72% of Americans agree that the government should provide universal
health care, even if it means repealing most tax cuts passed since Bush took
office. Democrats overwhelmingly favor this proposal (86%-11%) and independents largely agree (78%-19%). Even a narrow majority of Republicans
(51%) favor providing health insurance for all even if it means canceling the tax cuts, while 44% disagree.

A big majority of those who support this proposal,ú 61%,ú think of it as a moral as well as a political issue, while most opponents tend to see this in strictly political terms (58%).

http://people-press.org/reports/display.php3?PageID=725
And…

Al-Jazeerah
8/31/03
Opinion
Majority of Americans Call for Universal Health Care
By Sam Adams

The United States of America is the only 1st-tier country that does not provide a comprehensive national health care system for all of its citizens. It is an appalling scandal that the richest country in the world ignores the needs of nearly 45 million people who lack health care insurance. The majority of Americans call for Universal Health Care, according to a PEW
Research Center Survey…

http://www.aljazeerah.info/Opinion%20editorials/2003%20Opinion%20Editorials/August/31%20o/Majority%20of%20Americans%20Call%20for%20Universal%20Health%20Care%20Sam%20Adams.htm

Comment: Our administration is attempting to bring American values to Iraq.
Shouldn’t we be uncomfortable with this report distributed by Al-Jazeerah?
More importantly, should we continue to neglect our problems here at home?

72% of us believe that our government should provide universal health care,
even if that means repealing most of the tax cuts. Does our example show other nations that democracy works? We have much more work to do to prove that it can.

Posted by pnhp at 10:03 AM | Permalink