News

Star Tribune
March 30, 2005
Bill mandates health coverage for Minnesotans
By Patricia Lopez

Every Minnesotan would be required to have at least minimal health insurance and every insurer would have to offer such a plan under a far-ranging health care overhaul bill offered by the Minnesota Medical Association on Tuesday… which was introduced with bipartisan support in the House and Senate…

Dr. Michael Gonzalez-Campoy, MMA president, said that the plan was the result of “months of work,” and that health providers briefed on it had been enthusiastic.

At its core, the plan would set out an as yet undefined set of “essential benefits” that would provide minimal coverage with an emphasis on prevention.

Dr. Judith Shank, a dermatologist and former MMA president who led the organization’s health reform committee, said that while no guarantee of a subsidy exists in the bill, there is a presumption that “there would have to be subsidies for people who cannot afford” even the essential benefits coverage on their own.

Some additional money would come from the thousands of young people who are uninsured either by chance or choice. Shank has argued that “it is unfair for people who assume they are young and healthy to opt out” of health insurance, as some do. By requiring them to have some type of coverage, risk would be spread as broadly as possible, she said.

(Sen. Sheila) Kiscaden said that under the bill Minnesotans might be required to offer proof of coverage when they filed their income taxes or applied for a driver’s license. By the same token, insurers would have to offer the essential benefits and could not reject anyone because of age, gender or health history. Preexisting health conditions, a common reason for rejection for traditional policies, could not be taken into account.

Gonzalez-Campoy said the mandatory requirement would bring another 374,000 uninsured Minnesotans into the system, resulting in earlier treatment, more prevention and more affordable care. Ultimately, he said, “health care costs will be lower.”

http://www.startribune.com/stories/587/5318643.html

Comment: The Minnesota Medical Association and the Minnesota state legislature are to be commended for placing comprehensive health care reform on the political agenda. My critique of their proposal should not be allowed to detract from their sincere support of much needed reform. But we should look at what their “months of work” on the policy issues has produced.

The plan begins with a core of “’essential benefits’ that would provide minimal coverage” for everyone. But this presumes that there are additional beneficial health care services to which lower-income individuals are not entitled. Rather than defining a core of basic benefits, it would be more appropriate to define those health care services that should not be universally accessible.

Once you list items such as vanity cosmetic surgery or hospital penthouse suites, it becomes more difficult to define the care that you would deny. Since the purpose of reducing access to care is to control spending, it would be much more rational to use mechanisms that shift spending from useless or detrimental services to spending on all beneficial services for everyone. The spending on useless administrative services, on high tech excesses, and on other inappropriate services have been estimated to be 50% of our health care budget. Single payer policies would recover more of that waste than would be required to pay for the current gap in universal access to beneficial services.

Perhaps the most difficult political hurdle is to broker an agreement on how you pay for universal coverage. Acknowledging that subsidies will be necessary for people who cannot afford even the essential benefits is important, but there already is near universal agreement on that point. Leaving funding out of the bill reveals the fear of advancing a proposal that involves the government and taxes. Again, there is agreement across the political spectrum that reform must involve both government and taxes since there is no other way to equitably fund access to reasonably comprehensive services. That bull is charging us, and we have no choice but to grab it by the horns… now!

It would be nice to believe that a significant source of funding would be the young and healthy who are uninsured by choice. But since most of them actually are uninsured because they cannot afford coverage, no juice will be forthcoming from that turnip. For the few free riders who can afford to pay, an equitable system would ensure their compliance.

Requiring individuals to offer proof of coverage is the equivalent of requiring uninsured individuals to pay for their own coverage (individual mandate), an impossibility for those who do not have the funds yet fall above the levels qualifying for subsidies. An effective policy would be to automatically cover everyone, then the need to provide proof of coverage would be eliminated.

With our current system of multiple private plans, community rating and guaranteed issue drive up premiums, making plans unaffordable for those with low or even modest incomes. Again, the problems of community rating and guaranteed issue would be eliminated by the adoption of a single payer system.

The primary reason for providing comprehensive coverage for the uninsured is that it does improve health care outcomes. But does it really save money? Earlier intervention does prevent spending on some more expensive interventions that would otherwise result from deferred access to essential care, but there is an offset through the costs of improved access to care.

Although the net financial impact is difficult to quantify, any savings would not be enough to rely on to fund the gaps in coverage. Either we will have to spend much more money, or we will have to adopt a system that spends what we already have much more effectively, providing us with greater health care value. Of course, that’s what a single payer system is all about.

Another quote from this article is appropriate:

“Rep. Jim Abeler, R-Anoka, the bill’s House sponsor, said that even if the MMA proposal does not pass this year, it ‘puts a whole lot of ideas on the table for us to look at.’”

We just hope that their aversion to politically charged policies do not prevent them from looking at all policy options, including those that would provide affordable, comprehensive health care coverage for everyone.

Posted by pnhp at 01:58 PM | Permalink

Health Biz: Advancing national healthcare
By Ellen Beck
United Press International

Washington, DC, Mar. 29 (UPI) — National or universal health-coverage proposals go nowhere on Capitol Hill if they mandate business participation. Two plans proffered recently, however, either eliminate the need for employers to provide health benefits — which would cause many to breath a sigh of relief — or work through existing employer-based coverage.

What kills these plans, however, is another show-stopper: They rely on a value-added tax all Americans would pay.

The “Prescription for a Healthy America” is published in the journal Health Affairs and the “Prosperity Project” is found in the New England Journal of Medicine. Both come from highly respected experts in the health-policy field and both are destined for oblivion — at least while Congress and the White House are in Republican hands and possibly much longer.

What the proposals do, however, is to continue the national discussion of what kind of healthcare system Americans want in the future, allowing it to bubble up between the bigger controversies over Medicaid, Medicare and Social Security. They all weave together financially, but politically speaking, reforming any of the three big entitlement programs is easier for lawmakers and the public to grasp than is dumping the entire U.S. healthcare-financing system in favor of something that would look at lot like the British or Canadian alternative.

Congress is not going to move on the uninsured until the costs of doing nothing hit the middle class or upper-middle class squarely in the pocketbook and there is a resulting public outcry or mandate for change. That is just beginning to happen as Americans feel the side effects of 45 million uninsured citizens in the form of higher premiums and co-payments for their own insurance plans — the healthcare industry passing on the cost of unreimbursed care.

John Podesta, former White House chief of staff under President Bill Clinton and now president of the Center for American Progress, told a news briefing that the center’s “Prescription for a Healthy America” would build on the employer-based coverage and expand Medicaid.

The proposal would create new purchasing pools for individuals and employers to draw from. People who did not join a plan would be assessed an income-related fee for the cost of their future care under Medicaid. The plan would cost from $100 billion to $160 billion per year, not including any savings such a system might reap. It also would require a dedicated value-added tax of 3 percent to 4 percent, with small business, food, education, religion and medical care exempted.

“We believe Americans are ready for a bold solution to the real problems they and their neighbors struggle with every day,” Podesta said. “Such a solution, if designed to be practical, to be fair and responsible, can overcome the political obstacles.”

Dr. Ezekiel Emanuel of the National Institutes of Health, where he chairs the Department of Clinical Ethics, along with Dr. Vic Fuchs at Stanford University, proposed in NEJM the “Prosperity Project,” based the idea the healthcare system is broken and cannot be fixed — so dump it.

They also espouse a VAT as a funding mechanism, but their plan retains the private insurance industry, while getting rid of the employer-based system with its tax breaks for companies, as well as Medicare and Medicaid. Instead, it uses a voucher system, giving each American a government-paid voucher, with which to purchase a basic health plan. If a person wants more than the voucher affords, he or she can pay out-of-pocket for better coverage.

“We rely on the private sector to deliver care just as it does now,” Emanuel said. “We believe there will be some shake-out in the private sector. It can’t continue with 1,300 insurance and health plans in this country. It doesn’t make any sense, but we don’t mandate that.”

Dr. Jim Morgan, president of the Partners Health System in Boston, said the biggest obstacle to overcome is the anti-tax sentiment in Congress.

“Make no mistake about it, increasing taxes to pay for health insurance will run into the teeth of the strongest political force of the last 40 years — the anti-tax movement,” Morgan said. “This obstacle will only be overcome when we as a nation answer the question, ‘What happened to social justice as a moral value?’”

That moral or social responsibility theme has existed in the background of national healthcare discussions, but not as a banner anyone in Washington would carry when delivering a proposal to Congress. Far easier to arm one’s self with statistics and forecasts and just imply the moral implications.

“In my judgment, morality will not be a compelling selling tool unless the United States is on the heels of a virtual economic collapse and true fear pervades the majority of American families,” said Wally Maher, a former vice president for public policy at DaimlerChrysler.

Maher said national coverage, with a VAT that spreads the financial burden, actually would be good for U.S. businesses — as the cost of providing healthcare benefits weighs heavily on the corporate bottom line.

“I would be far less than candid if I did not point out that our board (back in the 1980s) was also keenly aware of the fact that were the United States to develop universal coverage — particularly with cost containment as part of the solution — it would help moderate (DaimlerChrysler’s) healthcare cost and improve its global competitiveness,” he said.

National healthcare proposals that mandate business participation — for example one supported by at least one health plan and former Sen. John Breaux, D-La. — requiring them to provide the benefit to all employers or pay a percentage of their payroll into a national insurance fund, get a cold shoulder from the business sector.

“We keep in place the policies that are there to date that sustain employer coverage,” said Jeanne Lambert, a senior fellow at the Center for American Progress and the lead author of its proposal. “We create this new pool — that is small employers, large employers — any employer can come into to purchase coverage through. And in fact, if they do so, they qualify for some reinsurance or federal subsidy for their high-cost cases. So we kind of give a new option with some choices. We actually hope that there may be some employers who are not offering today that will do so.”

“If you’re interested in political feasibility, it seems me an employer mandate kills your plan,” Emanuel added. “Business wants out of healthcare. They don’t want to be locked into it and if you put an employer mandate, you can be sure they’re going to oppose you.”

The Physicians’ Proposal for Single-Payer National Health Insurance — offered up in 2003 by physicians and published in the Journal of the American Medical Association — went to another extreme. It all but eliminated the health insurance industry — a major nemesis of physicians — for a single-payer, government run system based on Medicare. The plan, its authors envisioned, would not cost more than what the United States now spends on healthcare because it would implement a system that would ensure best practices and reduce overhead, administration, inefficiency and waste.

An extreme shift, Lambrew said, was something the “Prescription for a Healthy America” plan tried to avoid.

“We learned in 1994 that people can easily be scared by people like Harry and Louise to think that they’re going to lose what they have today,” she said, “and even though you can argue that a more ideal system would be more seamless with one source of coverage, talking to seniors about losing their Medicare (as in the Prosperity Project plan), I think, might even scare them more.”

Some of what’s been proposed for national healthcare actually was included in Sen. John Kerry’s Democratic Party health platform when he ran for president last year. The public had a tough time grasping it, compared to the relatively simple idea of tax credits or health savings accounts supported by President George W. Bush.

Like any policy, however, the more the public hears about an issue — and Bush is banking on this in his Social Security proposals — the more likely people will latch on to an idea and push it forward — forcing Congress to act.

That moment is not here yet for national health insurance, but proponents will keep the discussion alive until that political time arrives.

Posted by pnhp at 11:41 AM | Permalink

By Bruce Pringle
Coast Press Reporter
UNHEALTHY PRICES?

The cost of health care leads to efforts to provide adequate, affordable insurance to more Delaware residents. Lloyd Mills, who has spent years studying the high cost of medical care, says there is at least one benefit of rising health-insurance prices: They keep people focused on trying to make those prices lower.

So far, the effort has paid few dividends. Insurance premiums continue to rise yearly by double-digit percentages.

“What’s encouraging is we have a lot of initiatives on the table,” said Mills, of Lewes, president of Delaware Small Business Health Care Coalition.

* Last week, state Rep. Joe Booth, R-Georgetown, formally reintroduced his proposal to allow businesses with fewer than 1,000 employees to obtain insurance coverage through the health-care plan for Delaware state workers. House Bill 66 is essentially the same as a proposal that stalled last year amid complaints that it would be too costly for the state to administer.

* In February, state Insurance Commissioner Matt Denn announced that a group of legislators, business and medical leaders and others were meeting to propose legislation to enable businesses to form an insurance purchasing pool. The pool would buy insurance for its members much as governments and huge corporations do for their employees.

* On Tuesday, a statewide committee was to resume discussion of how to make affordable health care available to every Delaware resident, possibly through a government-run “single-payer” system like those in Canada and much of Europe.
* And around April 1 a new, nonprofit, Sussex County-based player in the health-insurance field, First Healthy Choices, is to begin offering local chamber-of-commerce members coverage in which rates would be lower for people who follow their doctors’ orders. The cost of that coverage has yet to be announced.

Meanwhile, Mills said, many businesses and individuals are trying to cut costs by opting for policies that can require a patient stricken by a major illness or injury to pay up to $10,000 annually toward his own medical care.

“Moderate-income people don’t have the wherewithal to come up with $5,000 or $10,000,” he said.

A recent Harvard University study found that medical bills are the most common reason people file for bankruptcy. More than half the people surveyed cited a major family illness or injury as the reason they went into debt. Of those who blamed medical bills for their bankruptcies, more than 70 percent said they had health insurance.

“They think they’re safe,” Mills said of workers whose coverage proves insufficient when catastrophe strikes. “That’s the crime of it.”

BOOTH VS. DENN?

Booth said 270,000 people in private industry potentially could benefit from his bill. But he admits he’s in for a hard fight.

“My proposal was derailed (in 2004) by the threat that it would cost the state some money,” he said.

Critics of his plan say it could drive up the state’s health-insurance cost if private workers need more medical care than state employees. In addition, the state would bear the cost of serving as the go-between for insurers and private employers.

“The bottom line, I think, is (H.B. 66) will be amended to chop away at cost,” Booth said, predicting that other legislators will eliminate larger companies from potential eligibility to participate. Even with that change, he conceded, he will have to combat charges that the state would be overburdened by administrative costs.

Booth’s bill may be in competition with one crafted by the group backed by Denn, the insurance commissioner. The group is to present a formal proposal during the General Assembly’s current session, which runs through June 2006.

Attempts to reach Denn for comment were unavailing.

A third proposal for health-insurance reform in Delaware could promote a single-payer proposal to ensure health care for virtually every resident. It would place the state in the role now played by insurance companies. While the system might raise state expenses, its advocates say, it would reduce overall health-care costs by reducing paperwork and inefficiency.

Such a proposal was sponsored last year by state Rep. Dennis Williams, D-Wilmington. He wasn’t available to discuss whether he will introduce a similar bill.

While the General Assembly considers possible long-term, statewide health-insurance reform, a local initiative could result in a new line of coverage within the next several weeks. First Healthy Choices, a fledgling nonprofit that has attracted the attention of the Rehoboth Beach-Dewey Beach Chamber of Commerce, is to unveil its complete program soon, according to the chamber’s executive director, Carol Everhart.

Among the program’s unusual features will be a rate structure in which an individual would pay more if he failed to heed a doctor’s advice to, for instance, avoid gaining weight.

This article contains material from Gannett News Service.

* E-mail Bruce Pringle at bxpringle@gannett.com.

Originally published Wednesday, March 9, 2005

Posted by pnhp at 03:15 PM | Permalink

The Albuquerque Tribune
March 28, 2005
Sign of change
By Mike Tumolillo

The big news on the health front is the signing of the governor’s Insure New Mexico initiative. The legislation is four-fold and is aimed at reducing the number of uninsured people in the state.

The four bills are:

. Small Employer Health Care Coverage Access, which provides options for employers with 50 or fewer workers to buy into the state’s health insurance
program.

. Health Insurance Rates and Alliance Membership, which the governor’s office says will make health insurance more affordable for individuals and small businesses. The measure lowers premium rates offered by carriers through the Health Insurance Alliance.

. Health Coverage for Unmarried Dependents, which allows single people to remain on their parents’ health plan until they turn 25.

. Part-time Employee Insurance Coverage, which requires insurers to offer a plan to part-timers working more than 20 hours a week should their employers choose to extend coverage to them.

Pahl Shipley, a spokesman for the governor, said the bills will help expand access to health insurance to more than 35,000 New Mexicans. The state estimates the number of uninsured to top 414,000.

http://www.abqtrib.com/albq/bu_local/article/0,2565,ALBQ_19838_3656256,00.html

Comment: New Mexico’s Democratic governor, Bill Richardson, has steadfastly
opposed single payer reform, supporting instead incremental approaches to
covering the uninsured. It is likely that his Insure New Mexico initiative, that he just signed into law, will not provide enough coverage to offset the increases in the numbers of uninsured due to failing private coverage.

But let’s assume that his optimistic prediction of 35,000 newly insured will be met without any other decline in coverage. What does he plan to do about the other 91% of the uninsured in his state?

After two decades of incremental policies for reform, the results are in. The numbers of uninsured continue to increase, and the financial security of those who have insurance is under ever greater threat. Let’s get out of the reverse gear of incrementalism and put our reform movement in Drive, or we’ll never get to where we want to go.

Posted by pnhp at 10:20 AM | Permalink

American Medical News
April 4, 2005
Underinsured and overlooked: The growing problem of inadequate insurance
By Joel B. Finkelstein

Tens of millions of Americans have coverage that still leaves medical bills they cannot afford to pay, according to estimates by Consumers Union.

Now some physicians fear the problem is growing. They are seeing it regularly in their practices, often in the form of unpaid bills.

The culprit is increasing deductibles and other forms of cost sharing that employers are turning to in the face of steeply rising health care costs.

“Underinsurance is going to become a dramatic issue in the next two or three years,” predicted Thomas Bodenheimer, MD, MPH, an adjunct professor in the Family and Community Medicine Dept. at the University of California, San
Francisco, School of Medicine.

“More and more people are going to have plans that have huge deductibles and very large co-pays. Even HMOs now are beginning to have co-pays for hospital care that are quite significant, in addition to the deductible,” Dr.Bodenheimer said.

Just because someone has health insurance doesn’t necessarily mean they are covered, said Karen Pollitz, project director at the Institute for Health Care Research and Policy at Georgetown University, Washington, D.C. In an anecdotal study conducted in conjunction with the American Diabetes Foundation, Georgetown researchers found that some people with diabetes keep paying their health insurance premiums even if that means they will not be able to afford their routine medical costs, Pollitz said.

They couldn’t simultaneously pay for test strips and their insurance, but were too afraid of going without any coverage to stop paying premiums. In those cases, having insurance actually led to their diabetes worsening, she said.

“Something is not always better than nothing,” Pollitz said. In the future, politics has to play a bigger role in ensuring that people not only have health insurance, but that it offers appropriate coverage, Dr.(Alan) Sager said.

http://www.ama-assn.org/amednews/2005/04/04/gvsa0404.htm

Comment: Although we continue to fret about the tragic consequences of allowing 45 million Americans to remain uninsured, we have not really made the commitment to effect change. But there is a prevailing issue that has provoked major policy changes. Those who are paying for health insurance coverage are very concerned about the dramatic increases in insurance premium prices. Ignoring the problem of the uninsured, and ignoring the problem of the explosion in actual health care costs, almost all policy activity has now been narrowly limited to efforts to control the price of premiums.

The obvious consequence of controlling premium prices in the face of the escalating costs of health care delivery is that out-of-pocket expenses must increase for the individuals utilizing health care services. Thus we are facing a massive epidemic of underinsurance due to this large coverage gap. The irony is that this will largely spare those of us who are healthy but threaten the financial security of those with greater health care needs.

Our policymakers have managed to change the crisis in health care from the single problem of covering the uninsured to the dual problem of both covering everyone and providing financial security for those with health care needs. We can and should have both. But we need to fire our current policymakers and replace them with those who really care.

Posted by pnhp at 11:11 AM | Permalink

The New England Journal of Medicine
March 24, 2005
Health Care Vouchers - A Proposal for Universal Coverage
By Ezekiel J. Emanuel, M.D., Ph.D., and Victor R. Fuchs, Ph.D.

Incremental reforms have been tried, but despite some successes, such as the
State Children’s Health Insurance Program, the system as a whole is getting
worse, not better. Major reform is needed but will not happen immediately. As problems mount, however, the demand for change will intensify. In anticipation of that demand, we propose a voucher system with 10 fundamental features.

• Universality
• Free Choice of Health Plan (Individuals and families would choose which basic insurance program or health plan they wanted among several alternatives.)
• Freedom to Purchase Additional Services
• Funding by an Earmarked Value-Added Tax
• Reliance on a Private Delivery System
• End of Employer-Based Insurance
• Elimination of Medicaid and Other Means-Tested Programs
• Phasing Out of Medicare
• Administration (a Federal Health Board modeled on the structure of the Federal Reserve System)
• Assessment of Technology and Outcomes

Universal Benefits Package

The universal benefits package covered by the voucher should be sufficiently
comprehensive to provide most Americans with most of their care most of the
time. It should not be designed as a safety net to serve only the poor. The
benefits provided should be those typically offered by large employers, including inpatient and outpatient hospital services, visits to physicians’ offices, well-child care and other preventive measures, mental health care, and tiered pharmaceutical benefits, typically with dollar limits. We suggest only modest deductibles and copayments to minimize access barriers for the poor. In 2004, the average annual premium for such coverage in an employer-based program was $9,950 for families and $3,695 for individuals.

Ultimately, the Federal Health Board would structure the benefits package after wide consultation with experts and involvement of the public through various mechanisms. The process would be iterative, with modifications reflecting a balance between the public’s desire for more health care services and its willingness to pay the valued-added tax.

http://content.nejm.org/cgi/content/short/352/12/1255

And an editorial from the same issue of NEJM:

Financing Health Care - Finding the Money Is Hard and Spending It Well Is Even Harder
By Richard Kronick, Ph.D.

…it is not clear whether payments should be made directly from the government to providers or whether risk-bearing intermediaries should be used. Direct payments have the great advantages of simplicity and low transaction costs. Approximately 20 percent of the resources used in health care are devoted to making payments and collecting money, and a single-payer system would allow many of those resources to be used in other ways. Direct-payment systems also promote equity and uniformity in coverage policies.

However, it is hard for the government to determine whether services that physicians provide do much to improve patients’ health. A fee-for-service structure is antithetical to the development of systems capable of providing the kind of well-coordinated, patient-centered care that is needed by the growing number of people with chronic illnesses. And direct payments make it difficult to reallocate resources, because the incumbents - providers who have received funds in the past - are able to hold on to those resources even if they would be better used elsewhere.

Paying health plans as intermediaries can potentially solve some of these problems. In theory, health plans can be more flexible in their internal allocation of resources than can governmental direct-payment systems. If changes in technology allow resources to be shifted out of the hospital into the community, it will be difficult for the government to claw funds out of hospital budgets, but it may be more feasible for private plans to do so.

Health plans may be better able than the government to determine which services are most valued by patients and shift resources to those services. In the best plans, doctors have a strong voice in the allocation of resources. A system that is based on competing private health plans could create a dynamic in which physicians and hospitals are rewarded, with more revenue and members, if they do a good job. Health policy analysts and politicians have engaged in intense disputes about whether the government should be a single payer of providers or a single payer of health plans; these debates will doubtless continue.

As messy and difficult as a publicly financed system is likely to be, the alternatives are worse. Under the status quo, expenditures are increasing at a rate that is unaffordable, many resources are used in clinical and administrative activities that do little to improve health, and accountability mechanisms are weak. Voluntary, employer-sponsored insurance will continue to recede as health care expenditures increase more quickly than workers’ wages or productivity. The resulting increase in the number of uninsured people will lead to additional health and financial catastrophes, increase the strain on the safety net, and increase political pressure for change.

We do know how to ensure universal coverage, but we do not know how to ensure that our money will be spent well. We should not let uncertainty about how best to spend money prevent us from supporting proposals for universal coverage in the context of a system that would be less chaotic and more affordable. Emanuel and Fuchs offer a thought-provoking suggestion for moving in that direction.

http://content.nejm.org/cgi/content/short/352/12/1252

Comment: Single payer advocates, merely by reviewing the list of features of the Emanuel/Fuchs proposal, will immediately recognize many disputed policy concepts. No attempt will be made to address most of them here, but rather my comments will be limited to two important issues: (1) basic benefits, and (2) the use of health plans as risk bearing intermediaries.

Last year, in a debate at Stanford School of Medicine, Dr. Fuchs presented his proposal, and I discussed the single payer approach. During Q & A, I asked him how he would define basic care; would total joint replacement in an individual with advanced degenerative hip disease be basic care? He emphatically stated that it would be.

Then what is basic care? What beneficial health care services would we exclude from basic coverage? Single payer advocates would contend that all beneficial services should be included, excluding only those for which costs clearly exceed the benefit (e.g., $10,000 per dose for an antihistamine, an exaggeration to make the point).

The PNHP model of single payer, by design, includes all beneficial services. With a voucher system, the voucher is used to shop for plans with varying benefits, but with a floor of basic coverage. Would the menu of plans include versions that would exclude coverage of joint replacement? That demonstrates the fundamental fallacy of the concept that there is a nebulous cluster of basic benefits that exclude enough beneficial health care services to bring down health care spending without resulting in impaired outcomes due to impaired access because of financial barriers. We need to reject the concept that there is a floor of basic services beyond which lower-income individuals have no entitlement. We need to proceed with reform that provides access to comprehensive services for everyone.

Dr. Kronick seems to concede that we need a publicly financed program, but
he suggests that paying health plans may improve resource allocation compared to paying providers directly. Is that a valid concept?

Integrated health systems such as Kaiser Permanente are effective in improving resource allocation when facing limited budgets. But most health plans are not integrated systems. Coverage restrictions are designed to make premiums competitive, based on market principles, and have virtually nothing to do with resource allocation.

The PNHP single payer model recognizes that a federally administered system
does not function well. That is why we recommend that the federal funds be
distributed to state or regional administrations. The funds can be more precisely directed to ensure appropriate capacity that would enable universal access to comprehensive services. Private health plans would never direct resources toward the health care infrastructure, but would remained involved in their own turf issues such as adverse selection and ratcheting down benefits. We disagree that private plans could be more effective in resource allocation. A public administrator would always have a mission of improving resource allocation for the benefit of all patients, whereas the private plans would always have a mission of enhancing their own business as a vendor of administrative services. The mission really does make a difference.

Spending health care dollars well is hard. But our own public administrators would make far better decisions on health care justice than would the boards
and administrators of private plans.

Posted by pnhp at 10:32 AM | Permalink

The Center for Studying Health System Change
March 2005
More Americans Willing to Limit Physician-Hospital Choice for Lower Medical Costs
By Ha T. Tu

More Americans are willing to limit their choice of physicians and hospitals to save on out-of-pocket medical costs, according to a new national study by the Center for Studying Health System Change (HSC). Between 2001 and 2003, the proportion of working-age Americans with employer coverage willing to trade broad choice of providers for lower costs increased from 55 percent to 59 percent-after the rate had been stable since 1997. While low-income consumers were most willing to give up provider choice in return for lower costs, even higher-income Americans reported a significant increase in willingness to limit choice. Compared with other adults, people with chronic conditions were only slightly less willing to limit their choice of physicians and hospitals to save on costs. Perhaps as a result of growing out-of-pocket medical expenses in recent years, the proportion of people with chronic conditions willing to trade provider choice for lower costs rose substantially from 51 percent in 2001 to 56 percent in 2003.

http://www.hschange.org/CONTENT/735/

Comment: Respondents to this survey were asked if they agreed with this statement: “I would be willing to accept a limited choice of physicians and hospitals if I could save money on my out-of-pocket costs for health care.”

It is crucial to understand that they were not asked if they agreed with this statement: “I would prefer that my insurance plan restrict my choice of physicians and hospitals.” Yet the conclusion being drawn is that employers should offer more limited-choice insurance options.

Patients do value very highly their right to choose their own health care professionals. Baring your most intimate mental and physical issues to another from whom you seek help requires profound confidence and trust in the professional relationship. And for the great many individuals with chronic disorders, long-term continuity of this relationship is essential.

So why would so many be willing to relinquish this fundamental moral and ethical relationship? Well, this survey does provide that answer. Out-of-pocket expenses have become such a great burden, significantly impairing affordable access to care, that people are willing to give up this right to choose their professionals in order to reduce the personal debt burden of health care.

People want to have their choice of health care providers, and they want health care to be affordable. Offering more restrictive plans is not the answer since such plans would diminish choice, and they would have only a very modest impact on costs.

A single payer system would accomplish both goals. Patients would have free choice of their providers. And costs would be effectively controlled by methods that actually improve allocation of our health care resources. Why do we keep turning to the private plans to ask for highly flawed fixes to our sick health care system? Establishing our own public plan would allow us to apply the right fixes. Or does blind faith in market ideology still trump morality and ethics?

Posted by pnhp at 11:34 AM | Permalink

Health Affairs
March 23, 2005
Change In Challenging Times:
A Plan For Extending And Improving Health Coverage

Health care for every American may be the current test of the strength of our convictions, as civil rights was in the 1960s.

By Jeanne M. Lambrew, John D. Podesta, and Teresa L. Shaw (from the Center for American Progress)

As veterans of previous policy battles, we do not underestimate the political challenge involved in making the U.S. health system accessible to all. Nor do we disagree with the assessment that moral conviction has been lacking in past health policy debates. However, we reject the claims that health reform is doomed by political paralysis and an incapacity for Americans to sacrifice for the greater good. At opportune points in U.S. history, pragmatic ideas have overcome seemingly impossible political odds and become policy. We also believe that the perceived disconnect between values and health reform reflects not a lack of conviction but a failure to express that conviction in a policy environment. In most faiths and value systems, it is wrong to tolerate pain, suffering, and even death that could be prevented with different policy choices. The challenge is to translate these deeply held values into action that ensures a better system and healthier nation.

Abstract:

Some speculate that Americans are neither politically capable of nor morally committed to solving the health system problems. We disagree. We propose a plan that insures all and improves the value and cost-effectiveness of health care by knitting together employer-sponsored insurance and Medicaid; promoting prevention, research, and information technology; and financing its investments through a dedicated value-added tax. By prioritizing practicality, fairness, and responsibility, the plan aims to avoid ideological battles and prevent fear of major change. By emphasizing the moral imperative for change, especially relative to other options on the policy agenda, it aims to create momentum for expanding and improving health coverage for all.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.119

Comment: The leadership of the Center for American Progress is to be commended for challenging the notion that “major change is politically infeasible.” They present very convincing arguments that now is the time to
move forward with a program that would provide comprehensive health insurance coverage for everyone.

Somewhat reminiscent of the Clinton attempt at reform, they have patched together a model that they believe would cross the political divide and receive the support of the various vested interests. The Clinton effort pleased no one.

As we look at a few of the features of this “politically feasible” model, please keep in mind that a critique of their model should not in any way deter us from our efforts to move forward with comprehensive reform. The selected and incomplete comments below about some of the features relate only to whether Center for American Progress has produced the definitive model for reform.

• Employer-sponsored coverage would be left in place, with current tax incentives that would encourage the continued participation of employers

Problem - Funding is regressive, providing a greater tax subsidy for higher income individuals. And this leaves in place our flawed, expensive, administratively inefficient system of funding care

• The Federal Employees Health Benefits Program (FEHBP) would supplement the employer system for those without options for group coverage (Healthy America pool)

Problem - Most FEHBP plans have cost sharing that would impair affordable access for those with modest or low incomes. And it still leaves the private health plans in place

• Medicaid would serve as a safety net for low-income people

Problem - Medicaid is chronically underfunded, reducing the number of willing providers, and that will not change when it continues to be perceived as a welfare program for the poor

• Reinsurance would be used to cover high-cost people

Problem - 20% of people use 80% of health care. Reinsurance would remove this major portion of health care spending from the risk pools of the private insurers and transfer it to the taxpayers. Why leave in place this highly flawed, expensive and wasteful system of private insurers when the taxpayer would be footing much of the bill?

• Refundable, means-tested tax credits would be used to help fund coverage for lower-income individuals

Problem - Unless the tax credit approached 100% of the premium, very few low-income individuals could participate. If the full premium is provided then, once again, why leave in place the superfluous, wasteful private plans?

• Individuals who fail to enroll in one of the programs would pay an income-related assessment and Medicaid would be the default payer

Problem - 80% of the uninsured do not have access to affordable employer-sponsored plans nor the funds to purchase insurance in the individual market. Enacting an individual mandate with the threat of financial penalties for individuals with very little if any disposable income can impact their ability to pay for other essential needs such as food and housing. Higher-income free riders utilize only a very small portion of total health care costs, and it would be more effective to have them contribute their equitable portion through a single, universal system.

• New funding would be through a value added tax (VAT)

Problem - A VAT is administratively complex and expensive to administer, but, much worse, it is highly regressive, shifting even more of the tax burden from the wealthy to the masses

The Center for American Progress proposal also includes recommendations for an emphasis on disease prevention and health promotion, developing better information about high-quality care, and utilizing the benefits of information technology. These are certainly fine. But their proposal fails to seriously address some of the major issues such as the profound administrative waste of our fragmented system of funding care, the costly and ineffective high-tech excesses related to excess capacity, the failure to negotiate excess prices, and the failure to ensure an adequate primary care infrastructure.

There is another model that would ensure that everyone would have access to comprehensive health care that would be funded equitably and that would return the health care decision-making process to the patient and his or her health care professionals. But then the single payer model is designed to spend our health care dollars on patient care rather than on the other vested interests.

The Medicare legislation demonstrated that the only way that we can please the insurance industry is to give them more money than a public system (Medicare) actually costs. Maybe it really is time to give up on bending over backwards in trying to please the insurers and get on with the important task of trying to take care of the needs of patients.

Let’s act on the Center for American Progress’s clarion call to “translate these deeply held values into action that ensures a better system and healthier nation.” But let’s make sure that all options are on the table so that there is no doubt that we are selecting the model that is best for America.

Posted by pnhp at 02:13 PM | Permalink

Albany Times-Union
New York needs a single-payer health care system
By Paul Sorum

It is shameful that residents of New York do not have easy access to needed health care. The best way to do this — indeed, the only way to do it efficiently and justly — is to institute a single-payer health care system.A single-payer system in New York would be like Medicare for all on the state level. A single board, composed of representatives of the various stake holders, would administer the system. The board would decide what goods and services would be covered, would negotiate with providers and would contract with private companies to process claims and monitor quality.

The money used by the board to pay providers would come from a variety of sources: the federal Medicare and Medicaid funds currently spent on New York residents and a combination of payroll levies and state income taxes voted by the state Legislature. Medicaid would disappear as a separate program and would no longer burden county property taxpayers.

In a single-payer system, you would come to my office, show your health card and receive the same care no matter what your profession or income, and I would, without hassle, get the same reimbursement for the same service —simple, efficient and just!

The key is that a single-payer system eliminates most of our huge, rapidly growing and enormously expensive health care bureaucracy. You — or your employers — wouldn’t need multiple insurance companies and multiple plans to choose from. Your needs and wants are, fundamentally, the same as everyone else’s: You want to be able to receive appropriate and effective care when you are sick and to receive the preventive care shown to keep people like you from getting sick.

By eliminating all these health insurance companies, everyone (except them) wins. My staff and I win because we don’t have to deal with myriad insurance companies and their regulations and regulators. I can spend my time taking care of you, rather than taking care of your insurance company.

Your employers win because they can get out of the business of providing — or not providing — you with health insurance, and because they no longer have to foot the bill for all these superfluous administrators.

You win because you are equal to everyone else in your access to care. You can receive care from the doctor and other provider of your choice. You can choose based on quality, not cost. You do not have to fear losing your health coverage or your doctor if you change jobs, are laid off or don’t have a job.

Society wins because the huge savings in administrative costs allows us to provide universal access to health care — allows us to become a more just society — while not increasing overall health care costs.

What can you do to make a single-payer system a reality in New York state? First, you can tell your state legislators to support the bill recently introduced by Assemblyman Gottfried to establish a commission to study ways to achieve universal access to health care in New York. Second, you can tell them that the most efficient and just way of achieving universal access is through a single-payer health care system.

Posted by pnhp at 01:35 PM | Permalink

Taipei Times
Mar 19, 2005
Experts call for health premium hikes
By Wang Hsiao-wen

Although the rest of the world envies Taiwan for its success in providing easy, affordable and universal healthcare, Taiwan’s NHI is suffering from a recurrent financial crisis that also besets other nations like the UK, US, Germany and South Korea. As in these countries, health insurance is a highly politicized issue in Taiwan.

“Taiwan NHI’s financial problems stem from two factors: people’s mindset and
politicians’ intervention,” said William Hsiao, a professor of economics at
Harvard University who helped design the NHI a decade ago.

“Taiwanese people think that they don’t need to pay more since they’ve got NHI. In fact, the rise of insurance rates is an inevitable trend as the society grows older, richer and demands more medical care,” Hsiao said.

As Taiwan matures from a one-party state to a vibrant democracy, the insurance rate has increasingly become a bargaining chip in party politics, according to Hsiao. When the financing of the NHI was legislated under an authoritarian system, the executive branch was empowered to raise the premium rate whenever the program faces a deficit. But when faced with the opposition-dominated Legislative Yuan that now exists, the executive branch has lost its power and political conflicts flare up.

“The solution is to revise the law to allow insurance rates to edge up automatically,” Hsiao said.

Although politicians usually follow the “no premium raise” mantra to pander to potential voters, experts from other countries suggested that a fare hike, if well managed, would not trigger strong opposition from consumers.

Uwe Reinhardt, a professor of political economy at Princeton University, agreed that a premium increase would be a good way to sustain the universal insurance plan.

“Taiwanese could pay twice the fee now without hurting its macroeconomics,”
Reinhardt said.

Official figures showed that Taiwanese people pay 15.4 visits to physicians per year and that the country spends about 6 percent of GDP on healthcare —
a relatively low figure compared to the US’ 15 percent.

Reinhardt said that the real issue is to share the insurance burden and foster a spirit of fraternity.

“While 80 percent of health spending is used on 20 percent of the population who are severely or chronically ill, it is only natural that not every one feels their money is fully spent on their own health,” he noted. On the sideline of the NHI’s financial difficulties, Reinhardt advised Taiwan to steer away from the US example where many families go bankrupt because of health costs.

“Privatization of health insurance won’t solve the financial deficit. It just sweeps the problem under the rug,” he said. “The competition between insurance companies only makes programs less affordable, [and] over 46 million Americans are not covered.”

http://www.taipeitimes.com/News/taiwan/archives/2005/03/19/2003246881

Comment: So funding of a single payer system is political. But imagine debating whether 6% of the GDP is an appropriate level of funding for an established, comprehensive national health insurance program. Contrast that with 15% of the GDP being used for a deficient, fragmented program that sweeps the problems under the rug.

The current political debate over Social Security is instructive. When the people really understand the issues, they’ll support solidarity. Now they merely need to understand single payer national health insurance. And it’s our job to make sure that they do.

Posted by pnhp at 09:56 AM | Permalink

Eighth Day
Fourth Councilmanic Year- Session Of 1999-2004
Journal
City Council Of Baltimore
March 17, 2003

http://www.baltimorecitycouncil.com/Council_Journal/03-03-17_8th.pdf

In Support of Federal Legislation - (HR 676) The United States National Health Insurance Act (“Expanded and Improved Medicare For All”)

FOR the purpose of expressing support for Representative John Conyers, Jr.’s legislation that seeks to ensure that all Americans, guaranteed by law, will have access to the highest quality, cost effective, health care regardless of an individual’s employment, income, or health care status; and urging the Maryland State Delegation to the 108 th Congress to secure final passage of the legislation.

Recitals

The United States National Insurance Act establishes a national health insurance program by creating a single payer health care system. The bill creates a publicly financed, privately delivered health care program that expands and improves upon the existing Medicare program and makes it available to all residents of the United States and the U.S. territories. Persons enrolled in the program would not be subject to co-pays or deductibles.

The legislation addresses the needs of the over 42 million uninsured and over 40 million under-insured Americans who do not benefit from the current inefficient, costly, and fragmented health care delivery system. It is expected that the United States National Health Insurance Act will reduce overall annual health care spending by $109 billion - the average cost to an employer for an employee earning $35,000 per year will be reduced to less than $100 a month and a family who pays $5-7,000 a year in health insurance will pay less than $50 a month. Total household expenditures would drop from $326.7 billion to $65.9 billion annually.

National Health Insurance will cover all medically necessary services, including primary care, in-patient care, out-patient care, emergency room care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients will have their choice of physicians, health care providers, hospitals, clinics, and group practices.

To ensure conversion to a non-profit health care system, private health insurers will be prohibited from selling coverage that duplicates the benefits of the National Health Insurance program. They will not, however, be prohibited from selling coverage for any additional benefits not covered by the Act such as cosmetic surgery and other elective and medically unnecessary surgery and treatments.

The National Health Insurance Act will set annual reimbursement rates and provide an annual lump sum allotment to each existing Medicare region that will then administer the program. Payments to health care providers will include fee for service and global budgets. The conversion to this not-for-profit health care system is expected to take place over a 15 year period and will be financed through the sale of U.S. Treasury bonds.

The United States Congress will establish annual funding appropriations for basic operating costs of the program that will operate under the auspices of the Department of Health and Human Services and be administered by the former Medicare offices. All current expenditures for public health insurance programs will be enveloped by the National Health Insurance program. Other funding for the program will come from modest payroll taxes on employers and employees and a higher health income tax on the wealthiest 5% of Americans.

There is no reason for anyone in this country to go without the basic health care coverage that sustains life when the industry has evolved to the point that vanity-driven, elective, medical procedures have become the lunchtime indulgence of middle-class America.

NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF BALTIMORE, That this Body supports Representative John Conyers, Jr.’s legislation that seeks to ensure that all Americans, guaranteed by law, will have access to the highest quality, cost effective, health care regardless of an individual’s employment, income, or health care status; and urges the Maryland State Delegation to the 108 th United States Congress to secure final passage of HR 676.

AND BE IT FURTHER RESOLVED, That a copy of this Resolution be sent to the Mayor, the members of the Maryland State Delegation to the 108 th United States Congress, the members of the Baltimore City Delegation to the 2003 Maryland General Assembly, the Baltimore City Health Commissioner, and the Mayor’s Legislative Liaison to the City Council.

Councilmember Holton made a motion, which was duly seconded, that the Rules be suspended.

The roll was called on the motion, resulting as follows:

Yeas - President and Councilmembers Cain, Garey, Branch, Carter, Young,

Curran, Harris, Mitchell, Pugh, Welch, Holton, Rawlings Blake, Spector, Abayomi, Reisinger,

Stukes - Total 17.

Nays - Councilmember Stancil - Total 1.

Out of Chambers - Councilmember D’Adamo - Total 1.

The President declared the Rules “Suspended”.

Then Councilmember Holton made a motion, which was duly seconded, that the Resolution be adopted.

The roll was called on the motion, resulting as follows:

Yeas - President and Councilmembers Cain, Garey, Branch, Carter, Young,

Curran, Harris, Mitchell, Pugh, Welch, Holton, Rawlings Blake, Spector, Abayomi, Reisinger,

Stukes - Total 17.

Nays - Councilmember Stancil - Total 1.

Out of Chambers - Copuncilmember D’Adamo - Total 1.

The President declared the Resolution “Adopted”.

Posted by pnhp at 01:25 PM | Permalink

The Santa Barbara Independent
March 10, 2005
Healthcare for All
By Peter Conn, Chairperson of the S.B. chapter of Healthcare for All

The present healthcare system in this country is in dire need of extensive rehabilitation. It bankrupts the sick - even those with insurance - as well as hospitals. Our healthcare system has an unsustainable inflation rate and is burdened by administrative waste and inefficiency. It fails to deliver proper care almost half the time and is unavailable to ever larger numbers of people. Your “choice” of plan or doctor depends on who you work for and how much you can afford. This non-system has had over 40 years to get it right. It was supposed to hold down costs through competition and give us “choice.” Yet never have so many paid so much for so little.

http://www.independent.com/opinions/voices955.htm

Comment: Simply repeating, “…never have so many paid so much for so little.” The article does then proceed with an excellent description of CHIRA, the single payer bill introduced by Sen. Sheila Kuehl.

(My selection of today’s quote is admittedly biased since we just spent four fantastic days camping with the author, Peter Conn, and his wife Paulina in California’s Anza-Borrego desert, now painted with a spectacular bloom of wildflowers.)
———————————————————————————————————————
Message: 2
Subject: qotd: Confusion over “single-payer”

The Berkshire Eagle
March 16, 2005
Insurance plan tries to promote healthy lifestyle
By Carrie Saldo

The Berkshire Health Group — whose members include municipalities such as Lenox, Great Barrington and Adams, as well as school districts like Mount Greylock Regional School District and Central Berkshire — recently approved
adopting a “consumer-driven health plan.”

Availability of a consumer-driven health plan is subject to approval by the Selectmen and various unions, said (Town Manager Gregory) Federspiel. Enrollment would be voluntary and could begin as soon as July; the traditional plans would still be available.

Federspiel said it is up to each person to weigh the pros and cons of both the available single-payer plan and the proposed consumer-driven plan, and to decide which is right for their health care needs.

http://www.berkshireeagle.com/Stories/0,1413,101~7514~2764913,00.html

Comment: In this article, the term “single-payer” is being used to refer to Blue Cross/Blue Shield coverage. It is gratifying to see that “single-payer” has now become part of the standard rhetoric about our health care system. But confusing single-payer with Blue Cross/Blue Shield indicates that we must press on ever more energetically with our education campaign.

(For those who object to the “single payer” label, please keep in mind that this is now the standard term in the health policy literature for a precisely defined model of public financing of health care. For those who prefer other terms, an effort must be made to define your model. If it is single payer, then you should state so, at least parenthetically, to clarify that we are all out there with the same message. For those who prefer other models of reform, at least you’ll understand exactly what we mean when we say “single payer.”)

Posted by pnhp at 10:38 AM | Permalink

By
Arnold S. Relman

Please click here to download file

Posted by pnhp at 10:46 AM | Permalink

By Gwendolyn Owens
Special to the Sentinel
March 13, 2005

MONTREAL — There was a joke making the rounds here a few years ago that went like this:
Question: What’s a Canadian?
Answer: An American with a health-care card and no gun. The way Canadians view the United States is a much more complicated matter — roughly analogous to how one might view a rich, overbearing cousin.

Canada sits on the United States’ northern border with a population roughly twice that of Florida, but with a culture and mentality that melds together Europe and the United States.

Having lived in Canada since 1991, I spend a lot of time explaining the differences and similarities to my neighbors here and to friends at home. My professor husband and I moved our family to France for the 2003-04 academic year, and one byproduct was a new perspective on the differences and similarities of the United States, Canada and Europe.

Canada looks more like the United States than it does Europe. Cities in Canada often resemble those to the south that date from the same era: Montreal looks a lot like New York; Toronto looks Midwestern, almost like Chicago. Vancouver, British Columbiais a lot like Seattle, and Calgary, an energy center in the West, has been compared to Dallas with snow.

Everywhere the roads are filled with fast-driving Canadians, largely in trucks and sport utility vehicles, far larger and less energy efficient than those peppy little European cars.

However, in every one of those big cars will be a person with a health-care card entitling him or her to government-paid health care from the doctor of his or her choice. Canada, like European countries, is facing tough choices about how to manage the spiraling costs.

Just how dear this system is to Canadian hearts was brought out last fall when the Canadian Broadcasting Corp., the public television of Canada, held a contest for the greatest Canadian. Tommy Douglas (1904-86), the “father” of the Canadian Health Care Act, won.

Though the belief in a public-health system unites Canadians, it is a nation that is often described not as a melting pot of immigrants, but a patchwork. New Canadians are expected to learn French or English — preferably both — but they are encouraged not to forget their roots, their customs and their language; they don’t have to give up their other citizenship.

For business, it is a positive attribute; you can find people who speak the language to help you to do business in just about any part of the world.

A union of many nations

It also makes for wonderful ethnic food as immigrants open businesses, not just to cater to people looking for exotic food, but for people from their own community who want to eat just like they did at home in, for example, India, Morocco or Peru. It is as if the country is a kind of union of many nations, not unlike the new European Union or a small United Nations.

When it comes to sports, Canadians love their homegrown sport, hockey, but they also love the American sports of football, basketball and baseball, even if the Montreal Expos had few real fans left in the end.

The wardrobe malfunction of last year’s Super Bowl, seen by millions of Canadians as well as Americans, was not a big story; the story was the U.S. outrage about the malfunction.

In the subway in downtown Montreal is a billboard advertising a DVD with a photograph showing a dancer in a similar state of undress as Janet Jackson, and no one seems to mind or even notice, although in some more conservative parts of the country, it might raise some eyebrows.

Canadians eat fast food like their southern neighbors do, but the concept of a private college or university for students getting a college degree does not really exist in Canada.

Labor unions are stronger here than across the border — just ask Wal-Mart, which is trying to close a store outside Montreal in which the employees voted to unionize, and is facing unionization, which Wal-Mart regards as a threat, in several other Quebec stores.

Country without a revolution

What’s at the root of Canada’s position as a middle ground? Canada never had a revolution or broke forcibly away from Great Britain as did the United States. It became a confederation in 1867, but it was not until 1982 that Canada got its own constitution with its own powerful version of the Bill of Rights, called the

Charter of Rights and Freedoms.

This is not a country made up of rebels, which is most likely where the jokes come about Canadians being law-abiding. Quebec was allowed by the conquering English in 1759 to stay French-speaking, and while tension has risen and fallen through the years about the place of French in Canadian life, the decision in the first place to let French colonists keep their language now seems very Canadian: It was a decision, while political on the part of Great Britain, that allowed for the beginnings of acceptable differences, the patchwork model.

Geography has had a lot of influence on how Canada works. In a country so vast with relatively few people, delivery of services is a more complex problem. So the government, on the provincial and federal level, has always had a more visible hand in setting up and providing for citizens far afield from one another.

In bed with an elephant

Former Canadian Prime Minister Pierre Trudeau described living next to the United States as being like sleeping in the same bed as an elephant: You cannot avoid knowing that the elephant is there, even if the elephant is being very quiet.
So to give Canadian artists, singers, writers, publishers, et cetera, a chance to be heard and seen, the Canadian government supports the arts in Canada and promotes including Canadian content with rules governing the number of cable channels that must be offered with Canadian content and how many songs an hour on the pop stations should be Canadian.

About 35 percent of the music on the radio and 60 percent of the programs on television are required to be Canadian, but there are no such rules for movies in theaters. However, the Canadian government provides generous tax credits to Canadian film producers to encourage the homegrown film industry.

Americans still welcome

In discussions since 2001, the question of whether Americans are being singled out for bad treatment abroad usually comes up. Our experience, in Canada and Europe, has been positive; outside the United States, American foreign policy is often seen as misguided or downright wrong, but individual Americans still welcome visitors to Canada, France and the other places we have visited in the past year.

Are Americans ready to be as welcoming to people from abroad? Many people we met in Europe were planning to visit North America — not the United States, only Canada — just because they were not sure how they would be treated. They felt comfortable about coming to Canada; it was not as different, not as far a trip metaphorically as the United States.

Originally from Baltimore, Gwendolyn Owens is a writer and historian of American art who lives in Montreal.

Posted by pnhp at 01:13 PM | Permalink

Stanford School of Medicine
Stanford Medicine Magazine
Winter 2005
Letter from the Dean

It’s hard to fathom why our nation, with its great financial and intellectual capital, has a health-care system that’s so far from world class. Much of the trouble comes from the belief that health care must be run like a business - as if personal health were a commodity. This notion, promoted over the past two decades by our leaders in Washington, posits that the free market will restrain costs and bring high-quality care to all. Obviously, this strategy has failed miserably.

I do not believe that modifications around the edges of our health-care quagmire are going to do it. We need sweeping change. I personally favor a single-payer model incorporating support for medical training, innovation and discovery. But I’m not convinced that our political leaders can muster the will to overcome the obstacles from special interests with stakes in supporting the status quo.

Philip A. Pizzo, MD
Dean, Stanford University School of Medicine

http://mednews.stanford.edu/stanmed/2005winter/letter.html

Posted by pnhp at 10:28 AM | Permalink

Store Owner Pleads For It
By Gary E. Lindsley, Staff Writer

ST. JOHNSBURY — His voice quivering, businessman Tom Hurst pleaded Monday for the creation of a universal health care system.

Hurst, who is his family’s fifth generation to run Willey’s Store in Greensboro, asked state Rep. Steve Larrabee, R-Danville, to push for such a system for all Vermonters.

He made his plea during a special meeting called by the National Federation of Independent Business Monday afternoon at the Comfort Inn & Suites in St. Johnsbury.

NFIB representatives were in town to urge business owners to get engaged in debates regarding health care, energy and minimum wage.

The purpose of the “Act Now or Pay Later” meeting was to highlight the “anti-small-business legislation” making its way through the Legislature, according to NFIB information.

Hurst focused on health care.

“I’ve got two four-hour periods a day I can function,” he said, his left hand shaking. “The rest of the time my arms don’t work. The rest of the time I am unable to help.”

Sitting with a number of prescription bottles and two piles of money in front of him, he spoke about how he is suffering with a serious illness. He declined to reveal what the illness is.

“I am unable to hug my daughter,” Hurst said, “but she hugs me.”

He offered $1 and $5 bills to Larrabee and others who might be able to muster a universal health care system through the state Legislature.

“Take $1 because tonight I will not be able to use my hand,” Hurst said. “Please take a $5 bill so you can say I bribed you to really consider universal health care.”

He said his store provides his 17 employees 100 percent health insurance coverage. The employees’ family members are also covered. This year, the store’s health insurance premium went up $20,000, he said.

“Now we are in financial trouble,” he said. “So Steve, I want you to become a person behind universal health care.”

He spoke about how his grandfather Robert Willey had first been a Greensboro state representative and later a state senator.

“He had a passion for education,” he said. “Steve, I would like you to work on health care.”

George Pratt of Bradford Oil said he also would like to see NFIB officials back a universal health care system.

“I don’t understand why they are not,” Pratt said.

Hurst bemoaned the fact that having health insurance coverage is dependent on being employed.

“It favors the wealthy,” he said. “Health care should be like education. It should not be just for full-time [employees].”

Mary Grant, executive director of Rural Community Transportation Inc., agreed.

Grant said she believes everyone should have access to health care. And she believes there should be a universal health care system. She said her son cannot afford to buy health insurance for himself and his family because it would cost about $1,200 a month.

“Our state has to look at the true costs,” Grant said. “Vermont is small enough. We are always doing new stuff. Why not?”

Jim Harrison, president of the Vermont Grocers’ Association, said it is very important for business owners to get involved as well as to learn about the issues. He said there are a lot of business owners interested in the universal health care issue because they cannot afford 20 percent increases in their health insurance costs each year.

He also said individuals are interested as well because they cannot afford co-pays and deductibles.

“We encourage you to get engaged,” Harrison said. “It’s a huge, huge issue.”

Shawn Banfield, state director of NFIB, said the health care issue has been “percolating” since the beginning of the current Legislative session.

Banfield believes there is a lot of momentum behind establishing a single-payer system.

“The business community for the most part has not taken the bull by the horns,” she said. “There’s a lot of dollars at stake.”

Posted by pnhp at 10:11 AM | Permalink

Health Affairs
March/April 2005
Overcoming Disparities In U.S. Health Care
By William H. Frist

…the best way to eliminate health disparities is through improvements in the care we deliver to each patient, emphasizing patient dignity and empowerment.

Patients must be central to our efforts to improve health care. For instance, a person with a chronic illness such as diabetes must essentially “own” that illness if he or she is to have any hope of effectively managing it. Providers can help with high-quality treatment and the best recommendations, but patients must act on those recommendations. They must stop smoking, eat right, exercise, take their medication, and monitor their blood sugar, based on their own volition and usually outside of the clinical setting. Public policies must encourage patients to embrace personal responsibility.

Policies that promote dignity and personal responsibility will help decrease individuals’ risky behavior. The major causes of death among African Americans, for instance, are heart disease, cancer, stroke, accidents, and diabetes. Most of these are chronic diseases rather than acute illnesses, and all of these causes of death are at least arguably preventable.

Further, the top three can be reduced by decreasing tobacco use alone. We must
promote policies that help people address individual behavior, such as smoking.
Some have voiced concerns that health care is somehow different: that the
therapeutic relationship between doctor and patient should not be subject to
competitive forces. Further, many argue that quality chasms and health disparities cannot be fixed by fostering competition. Certainly, competition does not provide all of the answers. We will need a strong safety net and vigorous attention to vulnerable populations. But all of our immediate health care system problems-rising costs, questionable quality, patient safety, rising numbers of uninsured people, and, yes, health disparities-are interrelated and can be improved by empowering patients and providers.

We simply cannot afford to forgo the lower costs and increased quality and value that the right kind of competition will drive.
http://content.healthaffairs.org/cgi/content/abstract/24/2/445

Health Affairs
March/April 2005
The Role Of The Federal Government In Eliminating Health Disparities
By Edward M. Kennedy

The state of U.S. minority health is an embarrassment to the nation. Minority communities are struggling with rising numbers of uninsured citizens, festering epidemics, and lower health care quality, all of which mean increased rates of diseases and preventable deaths. To end the minority health crisis, Congress and the Bush administration need to step up to the plate by increasing health insurance coverage and investing in cultural competence, workforce diversity, minority data collection and reporting, and overall public health. Greater resources should be given to the HHS Office for Civil Rights and Office of Minority Health, both of which lead the fight to reduce disparities. All of these efforts must be integrated into the larger effort to increase access and improve quality of care, since we face not only a minority problem, but a national problem. In addition, the country must be mindful that health is inextricably tied to educational opportunities for children, job security and living wages for families,
safe and affordable community housing, and pension stability and social security
for seniors. Elimination of disparities in health depends in part on progress in each of these critical areas.

Health insurance for all is still my overarching goal, so that the basic right to health care can become a reality for all citizens.
http://content.healthaffairs.org/cgi/content/abstract/24/2/452

Comment: Perhaps the most appropriate comment comes from an article in this
same issue of Health Affairs: The Role Of Health Insurance Coverage In Reducing Racial/Ethnic Disparities In Health Care, by Marsha Lillie-Blanton and Catherine Hoffman:

“To assess whether insurance expansions could be expected to reduce racial/ethnic disparities in access to care, this paper reviews evidence from studies specifically designed to quantify the contribution of health insurance to racial/ethnic disparities in access. The studies provide evidence that a sizable share of the differences in whether a person has a regular source of care could be reduced if Hispanics and African Americans were insured at levels comparable to those of whites.”

http://content.healthaffairs.org/cgi/content/abstract/24/2/398

Posted by pnhp at 11:33 AM | Permalink

The Commonwealth Fund
March 8, 2005
News Release
New Health Care Opinion Leaders Survey: Uninsured Rate Could Be Reduced
by Half in Ten Years

The proportion of Americans without health insurance can and should be reduced to 8 percent in ten years, less than half the current rate, according to the Commonwealth Fund Health Care Opinion Leaders survey, an online survey of widely-recognized experts in health care practice and policy.

Three-quarters (75%) of respondents say that employer-sponsored insurance should not be permitted to decline. There was also wide support from respondents for a range of policy efforts to improve coverage. About four-fifths (82%) favor incentives for employers to provide insurance that meets minimum standards, and tax credits or other subsidies for low-wage workers (79%). Other popular policy options included requiring employers who do not provide health benefits to pay into a fund to insure workers and their families (70%), allowing employers to buy into Medicaid or CHIP for their employees (60%), and employer mandates to help finance benefits (52%).

Respondents expressed lower rates of support for replacing employer coverage with a single-payer plan, with about two-fifths supporting (42%) or opposing (40%) this policy.

In contrast, three-fifths (62%) of respondents oppose making HSAs the centerpiece of efforts to cut health care costs (combined with making high- deductible plan coverage more widely available).

http://www.cmwf.org/usr_doc/HCOL_survey2_release.pdf

The survey questions and results:
http://www.cmwf.org/usr_doc/HCOL_survey2_topline.pdf

Comment: The good news about this survey is that health care opinion leaders support protecting the coverage that we do have, and they support improving coverage. The bad news is that this survey was designed to support the current path of incrementalism, an approach that has been ineffective in expanding coverage.

As an example, the very first question: “Health care costs, market pressures, and public and private policies are changing insurance coverage in the U.S. For each of the following, please indicate what you would see as both an achievable and a desirable target or goal for policy action for the next ten years: (1) The proportion of under-65 population that has no health insurance (now about 18%).”

The median answer given was a goal of 8% without insurance. Thus the survey begins with a concession on the part of the respondents that 100% coverage is not an achievable goal. Obviously that makes it very easy to reject 100% solutions as lacking political feasibility.

The third question: “About 160 million Americans get health insurance coverage through their employers who spend more than $400 billion on such benefits. Would you favor or oppose each of the following options for such coverage in the future? Please consider each option in isolation.” (Seven options are offered, in randomized order.) One option: “Employer coverage should be replaced with a single-payer plan, with current employer premium contributions redirected to help pay for coverage.”

Results: 42% in favor, 40% opposed, and 17% not sure. But this was not a question about abolishing the current fragmented system of funding care, including employer-sponsored coverage, and replacing it with a single,
publicly-administered program. Instead, this was a question about preference for a universal insurance program in which employers must bear much of the burden of the funding of health care for everyone. It makes the assumption that employer sponsorship would continue to be the mainstay of health care funding, thereby losing the support that much of the business community would have for a single payer system.

The political consequences of rejecting a 100% solution before beginning negotiations are exemplified by the comments of Charles Kahn in an accompanying commentary. He is the president of the Federation of American Hospitals, an advocacy organization for investor-owned hospitals. He is also the “strange bedfellow” of Ron Pollack, the executive director of Families USA. Although of different ideological persuasions, they had joined together to drive consensus on the development of public policy to address the problem of the uninsured.

Kahn’s comments:

“Up to this point, it has been my belief that the best way to proceed on this front is to bring together people with varying ideas about health policy and to work within the current context.”

“I still have great hope for this approach… But after many years of coalition building and consensus development, the number of uninsured Americans continues to grow, dramatically. Rather than risk inactivity and allow this number to escalate, perhaps we should adapt this approach to better reflect current political reality.”

“Republicans, who control the White House and both Houses of Congress, dominate the current political landscape. Therefore, if health policy advocates want to see progress on the uninsured, we have to look to President Bush and the GOP majority to take the lead.”

“Rather than trying to achieve a sufficiently broad consensus, there is a compelling argument to be made that, to begin reducing the number of uninsured Americans, we instead ought to reach for what is already within our grasp.”

“I recognize that tax credits and expanded health savings accounts are not the preferred policy approaches for some members of our ‘strange bedfellows’ coalition. However, these are the approaches most likely to be approved by Congress. Given the rising number of uninsured Americans, we owe it to them, and to ourselves, to work to pass what can be passed, and then allow these approaches sufficient time to work.”

http://www.cmwf.org/publications/publications_show.htm?doc_id=262376

Further comment: When you wake up in the morning and find your bedfellow gone, you suddenly realize that your self-esteem left with him. But all is not lost. There is no better way to recover your self-respect than to pick yourself up, reject the siren song of incrementalism, and move forward with great certitude toward a fully achievable 100% solution in health care.

Fortunately, we can find more inspirational guidance in another commentary by Michael Rodgers, interim president of the Catholic Health Association:

“Most important, those working to amplify the voice of the uninsured and the marginalized are well served to remember that the cause for which they fight is nothing short of a moral imperative.

“We are a fortunate nation with plentiful resources and a community spirit rooted in equality and fairness. Now it is our monumental but unavoidable task to express the need for change, to mobilize the nation behind it, and to once and for all meet our obligation not just to the sick specifically, but to one another generally.”

http://www.cmwf.org/publications/publications_show.htm?doc_id=260394

Posted by pnhp at 10:22 AM | Permalink

Pediatrics
March 2005
Changing Conclusions on Secondhand Smoke in a Sudden Infant Death
Syndrome
Review Funded by the Tobacco Industry
By Elisa K. Tong, MD; Lucinda England, MD; and Stanton A. Glantz, PhD

Prenatal and postnatal exposure to tobacco smoke adversely affects maternal and child health. Secondhand smoke (SHS) has been linked causally with sudden infant death syndrome (SIDS) in major health reports.

In 1997, PM (Philip Morris) commissioned a consultant, Frank Sullivan, to write a review, with coauthor Susan Barlow, of all possible risk factors for SIDS. The first draft concluded that prenatal and postnatal smoking exposures are both independent risk factors for SIDS. After receiving comments and meeting with PM scientific executives, Sullivan changed his original conclusions on smoking and SIDS. The final draft was changed to emphasize the effects of prenatal maternal smoking and to conclude that postnatal SHS effects were “less well established.”

Clinicians, parents, and public health officials are most vulnerable to the changed conclusions of the SIDS review. The national SIDS “Back to Sleep” campaign has been very successful in reducing SIDS rates. However, estimates of SIDS risk from SHS (odds ratios range from 1.4 to 5.1) have considerable overlap with estimates of risk from prone sleep positioning (odds ratios range from 1.7 to 12.9). With the Back to Sleep campaign well underway, efforts to address parental smoking behavior in both the prenatal and postnatal periods should be intensified.

http://pediatrics.aappublications.org/cgi/content/abstract/115/3/e356

Comment: What does the malfeasance of toxicologist consultant Frank Sullivan have to do with national health insurance? My response may be a stretch, but the issues are fundamental.

The opponents of national health insurance have framed the debate as the efficiency of the private marketplace in providing higher quality and greater value versus the inefficiency and poor value wrought by government bureaucracies. But the overwhelming preponderance of health policy literature indicates that this framing of the ideological divide is incorrect. In the financing of health care, the private bureaucracy has been profoundly inefficient, and the failure to provide adequate coverage has negatively impacted quality by leaving in place financial barriers to care.

In contrast, government bureaucracies have been much more effective in ensuring affordable access to care with greater efficiency through streamlined administration.

If the framing of the ideological divide as efficient markets versus inefficient government bureaucracies is incorrect, then how should this ideological divide be framed? One does not need to be an astute observer to recognize that the divide is between those who support freedom in the marketplace as a means to achieve maximum personal wealth versus those who support solidarity through government action to be certain that all of us have our most basic needs met first before we enjoy our hedonistic pursuits in the marketplace. This reframing of the debate over the ideological divide is not merely rhetorical, but it is fundamental because it places the issue of solidarity ahead of money in our society.

And today’s quote? The medical literature has been used in an attempt to preserve profits of the tobacco industry at a cost of loss of lives due to SIDS. What could be more fundamental than that? We have enough solidarity to be outraged by these individuals who would sacrifice infants’ lives for personal greed.

But do we have enough solidarity to act to save the lives of the 18,000 young adults who die prematurely each year due to lack of health insurance? Or is it more important to maximize the wealth of those who have learned the ways of success in the health care marketplace? This is really the way that we need to frame the debate.

Efficient free markets versus oppressive government bureaucracies? Balderdash! Let’s quit debating their ideology and start debating polices that save lives!

Posted by pnhp at 11:20 AM | Permalink

National Association of Community Health Centers and The George Washington University
March 2005
Growing Uninsured, Budget Cutbacks Challenge President’s Initiative to Put a Health Center in Every Poor County
By Michelle Proser, Peter Shin and Dan Hawkins

Given the Bush Administration’s new goal of expanding health centers into every poor county in the country, the National Association of Community Health Centers (NACHC) and the George Washington University identified poor counties that are “unserved” in that they lack at least one health center. A total of 929 counties around the country fit these criteria. These poor, unserved counties represent almost a third of all US counties and more than half of all poor counties.

The number of communities needing a health center far exceeds available resources. For instance, available funding for FY 2002 and 2003 allowed only one out of three qualified applications for new health center sites to be approved for funding. In FY 2004, less than one in ten of qualified applications were approved. Moreover, while inflation-adjusted federal funding between 2002 and 2003 increased by 7%, the number of uninsured patients at federally-funded health centers rose by 11%. Many health centers around the country are reporting significantly higher growth in the proportion of uninsured patients. For every one uninsured, low income patient that a health center treats, there are four others needing their services, not to mention countless others lacking access to regular primary care regardless of insurance status. Compounding the need is rising poverty.

Given these multiple factors, there are not enough health centers for the people and communities who need them. Of course, in order to improve health on the greatest scale, the preservation of insurance is equally important. Expanding both insurance coverage and the health center program are needed to improve access to care,and both approaches are in fact complementary. Health centers provide services that many other providers do not, such as enabling services, making them preferred providers for many patients.

President George W. Bush (January 27, 2005, Cleveland, OH):

”.here are some practical ways for us to deal with the rising costs in health care. One is to make sure that people who can’t afford health care have got health care available to them in a common-sense way. And that’s why I’m such a big backer of expanding community health centers to every poor county in America. We really want people who cannot afford health care- the poor and the indigent - to be able to get good primary care at one of these community health centers, and not in the emergency rooms of the hospitals across the United States of America.”

http://www.nachc.com/research/Files/poorcountiesSTIB9.pdf

Comment: In 2004, over 90% of qualified applications for community health centers were rejected because of lack of available funding. Is it fair to ask the president what he means when he says that he’s “such a big backer of expanding community health centers”?

Posted by pnhp at 03:29 PM | Permalink

So, how many uninsured is too many?
By Greg Bausch, President, Kentucky Rural Health Association
From Rural Health Update, Fall 2004

“Ranks of the Uninsured Grow in 2003,” exclaims the headline.

“Rural Uninsured Continues to Rise,” notes another. And yet a third despairs that a “Report Examines Decline in Employment-based Health Coverage.”

According to these reports, a staggering 45 million Americans, 15.6 percent of our population, lacked health insurance during 2003, representing an increase of 1.5 million of our friends and neighbors since 2002. It is also alarming to note that rural Americans have an uninsured rate about 6 percent higher than our urban counterparts. So I ask you, “How many uninsured is too many?”

This decline is largely due to reductions in employer-sponsored coverage, which fell from 61.3 percent to 60.4 percent from 2002 to 2003. Unfortunately, the rates for employer-sponsored healthcare are 11.5 percent lower for the rural areas of our country as compared to urban areas, making this vulnerable population disproportionately affected.

We can point to countless businesses like lumber mills, agricultural operations, and Mom & Pop stores that offer no health benefits to even their fulltime employees. Why even at Wal-Mart, the largest employer in the country, only around 50 percent of employees have company-sponsored health insurance. So please tell me, how many people are too many without employer-sponsored health care coverage?

At my institution, we have seen our bad debt rate soar in the past couple of years, as have many other providers And while much of this problem is due to the growing number of uninsured, a whopping 40 percent of this increase at our system was from folks who have health insurance but were unable to pay the new higher co-pays and deductibles of their health plans.

That illustrates for me a significant rise in the underinsured and the financial stress that is being placed on our providers in caring for them. So I ask you again, “How many underinsured is too many?”

We cannot allow ourselves to get caught up in a numbers game about these
issues. They are just too important for that. Access to quality health care for all Americans regardless of their location, ethnicity, or ability to pay should be a right, not a privilege for a select few.

Unfortunately, it appears that only a select few will be able to afford these services in the very near future without some drastic change to the health care system.

In my view, only a system of government-sponsored universal health coverage, funded largely with the premiums we’re already paying, can hope to correct the looming crisis. The efficiencies of a single-payer, non-profit system could make the difference.

So, how many is too many? My answer is this: “One is too many.”

Oh, and while we’re at it, since William W. McGuire, chief executive officer for UnitedHealth Group Inc., personally earned $94,177,531 (including exercised stock options) in 2003, we may also want to ask how much is too much?

Greg Bausch, Pharm.D., is president of the Kentucky Rural Health Association, a member organization that educates providers and consumers on rural health issues and advocates actions by private and public leaders to assure equitable access to health care for rural Kentuckians. He also is vice president for regional services at St. Claire Regional Medical Center in Morehead.

(www.kyrha.org)

Posted by pnhp at 03:16 PM | Permalink

Rutland Herald
The voters lead
March 3, 2005

Vermont voters sent a clear message on Town Meeting Day that they are ready for the Legislature to take a serious look at the establishment of a system of universal health care coverage.

Twenty-one of 23 towns voting on the measure approved a nonbinding resolution calling for action leading toward universal care. The margins were often overwhelming. In Springfield the vote was 1,318 to 395. In Montpelier it was 1,433 to 792. Only Stockbridge and Bennington rejected the measure.

These results do not represent a scientific sampling of public opinion. Rather they are an expression of an emerging political consensus that the present health care system is caught in a hopeless cycle of higher costs and declining care. Something has to be done.

This consensus is shaped by a new awareness: that it is a mistake to view health care as a business.

The problem of how to think about health care is examined in an insightful article in the latest New Republic magazine. Arnold S.Relman, a professor emeritus of medicine at Harvard, examines the ways that market economics make the health care system worse, rather than better and shows that new proposals applying market principles to health care are doomed to failure.

Relman cites an earlier analysis of the health care system to show several ways that the ordinary rules of market economics do not apply to health care. First, the demand for health care is seldom a matter of consumer choice; it is driven by illness or injury. Second, the supply of services comes not in response to buyers, the way the supply of automobiles does. It comes from the judgments of physicians about the needs of patients. Doctors differ from car salesmen in that they are supposed to put the interest of the customer above the need for profit.
Third, the supply of health care providers is limited by the costly process of entering the field. Fourth, prices are usually insensitive to market forces. Fifth, there is a virtual absence of price competition.

During the past decade there have been efforts to subject the health care system to market forces, but they have only made things worse. For one thing, competitive pressures put doctors in a contradictory position. They are supposed to be looking out for the patient, not trying to cut a good deal for themselves. Hospitals are supposed to be serving populations, not trying to market ever more expensive services. Insurance companies that are free to shun some patients create large populations of uninsurable people, usually the ones who need services the most.

Vermonters have seen these things happen. In the past four years the number of uninsured Vermonters has jumped by about 50 percent. A system that provides coverage in helter-skelter fashion to some people but not others puts an insupportable burden on those who do have coverage and worsens the health prospects of those who don’t.

The Vermont Legislature ought to hear the message from Vermont’s voters about universal care and consider the lessons ontained in Relman’s article. Health care is a service, not a product. It is delivered by a system that ought to be supported fairly by the broad base of Vermont’s citizens, who in turn ought to receive dependable, affordable health care. That is the direction the Legislature appears to be heading, and the voters are beginning to show that they approve.

Posted by pnhp at 02:17 PM | Permalink

Congressman Pete Stark
March 3, 2005
Stark Introduces Constitutional Amendment to Establish Right to Health Care

Today, Rep. Pete Stark (D-CA) announced his introduction of a proposed amendment to the US Constitution to guarantee health care as a right for every American. The amendment, H.J. Res. 30, is cosponsored by Rep. Jesse Jackson, Jr. (D-CA) and 27 other House members.

“The health of every American is vital to their unalienable rights of ‘life, liberty, and the pursuit of happiness,’” said Rep. Pete Stark. “To ensure these rights are fully enjoyed, we must be certain that every American can access quality health care - regardless of their income, race, education or job status. This Constitutional amendment is aimed at achieving this fundamental goal.”

Today, there are 45 million uninsured Americans, including 8 million children. Millions more are underinsured, excluded from certain types of health coverage or being quickly priced out of the health insurance market altogether. Additional disparities in access, treatment, and outcomes exist for people of color.

Facing skyrocketing costs, many employers are cutting benefits or dropping coverage for their employees, chipping away at the very foundation of health care insurance in the United States. Proposed cuts in Medicaid now endanger coverage for the over 50 million Americans that currently rely on the program for medical care.

“We face a health care crisis where equal opportunity and basic fairness in our nation are at stake,” said Rep. Stark. “I’m frustrated, as many Americans are, that the President and Congress continue to ignore the problems we face. A Constitutional guarantee of health care for all will force Congress to take action to ensure that health coverage is there for all Americans.”

H.J. Res. 30 would amend the Constitution to say “all persons shall enjoy the right to health care of equal high quality.” It would require ratification by three-fourths of the States and so-called implementing legislation must be passed by Congress to ensure compliance with the amendment.

“I firmly believe that until we can guarantee that all people have the right to equal, high-quality health care through the Constitution, the interests of the people will continue to play second fiddle to the corporate bottom-line,” said Rep. Stark. “It’s time we put the health care of the people first. Our Constitution should be amended to promote that common interest.”

http://www.house.gov/stark/news/109th/pressreleases/03-02_healthamendment.htm

Comment: We are already spending more than enough to provide high quality health care for everyone. But only the government can mandate that those funds be used to ensure that everyone has the right of access to affordable care.

We have long given lip service to the right to health care. But now it’s finally time to have a serious, definitive national debate on the constitutional right to quality health care for all. Let’s rally around H.J. Res. 30.

Posted by pnhp at 09:41 AM | Permalink

Stanford School of Medicine
Stanford Medicine Magazine
Winter 2005

OK, you say you want a revolution Why Americans settle for a broken health-care system
By Michelle Brandt

“The whole thing is broken,” says David Magnus, PhD, director of the Stanford Center for Biomedical Ethics. “The core problem is that we have a completely irrational way of paying for and delivering health care.”

Our national leaders haven’t adequately addressed the issues, and- despite survey after survey showing that Americans believe our health-care system needs reform - the public hasn’t taken them to task for it. Health care hasn’t
reached critical mass as a political issue, experts say, because Americans are worried about the future but not concerned enough with their current situation to clamor for change.

Yet many continue to push for reform, including medical student (Graham) Walker, who is hoping to soon begin a documentary on the health-care system.
He’s among those who feel confident that change is coming. Says another believer in change, advocate (Don) McCanne: “I personally suspect it will happen in years, rather than decades.

“We want our technology, we want great advances in health care. When we see
only the wealthy can get them, that’s not going to be acceptable.” Sociology professor (Donald) Barr agrees and predicts that increasing numbers of “horror stories” will eventually cause people to vote only for those politicians who address the health-care issue. And that’s exactly what we need to have happen: only when the public puts the pressure on legislators - and becomes entrenched in the fight like Walker and others - will the nation get real reform.

http://mednews.stanford.edu/stanmed/2005winter/healthcare-main.html

Comment: Michelle Brandt is the Media Relations Manager of the Office of Communication and Public Affairs at Stanford University Medical Center. In this article she has captured the essence of our broken system of funding care and the oxymoronic unstable inertia of reform. Although the article is somewhat long, it makes for a great Sunday read.

Posted by pnhp at 10:13 AM | Permalink

Our View: It’s time to revisit national health care

Idaho, like virtually every other state, can’t figure out how to cope with the black hole of Medicaid. The state’s Medicaid spending has grown 935 percent since 1990 with no end in sight for escalating costs. Lawmakers recently refused to pump an added $15 million into the program for health care of the poor and disabled until reforms are enacted.

 But what reforms? Stop paying health care providers is one option; another is to tell them they cannot accept any new patients. Too drastic, by far. It is not just the poor who are running up bills for health care.

Some 4,500 personal bankruptcies resulted from unpaid medical bills in Idaho last year. And many of those were people who thought they were protected by having health care insurance, only to find that high deductibles and co-pays cost them several thousand dollars out of pocket. “The people out there who are middle class and have health insurance believe that it will keep them from financial ruin if they should get sick,” says Dr. Bill Woodhouse, a physician for Pocatello Family Medicine. “The reality is that ain’t so.”

And when people can’t pay medical bills, they may wind up in the Bannock County indigent office -some 400 to 450 cases a year. That’s a hardship not only for local government, but for individuals, who can find a lien placed on their property to repay the county.

Furthermore, about one in five adults in Idaho does not have health insurance because of its cost. Typically, the young and healthy members of the population drop out. As a result, the rest of us -who are more likely to be sick or laid up-pay ever higher premiums for insurance. Some small employers find they cannot afford insurance for employees, or they skimp on benefits.

Not surprisingly, the federal government is not immune from the problem. Within a decade, the government will be footing the bill for nearly half the nation’s medical costs, its share propelled higher by the hugely expensive Medicare drug legislation enacted in 2003. To win its passage, the Bush administration told wavering lawmakers that the program would cost $400 billion; the latest estimate of costs when the program goes into effect next year is more than $720 billion.
The president has touted health savings accounts, which in theory would work in conjunction with a health insurance policy to help pay off the deductible, co-pay or services above a coverage limit. But that would not help the growing number of people who cannot afford medical insurance.

The administration of President Bill Clinton pushed hard for a national health insurance system a decade go. Vested interests torpedoed that effort, making Hillary Clinton the scapegoat for its demise. But that was then, and this is now.

Here’s what Dr. Woodhouse says in a well-written, thorough Journal story by reporter Elizabeth Ziegler:
“While many claim that we have the best health care system in the world, I know of nobody who believes we have the best way of paying for health care, as evidenced by the high number of the uninsured and medical bankruptcies,” Woodhouse says. “I feel our health care financing system has failed everyone, including the providers. It’s an extractive industry right now. I’ve reluctantly come to believe in the single payer, national health program. I am a pretty conservative person, but this is one thing in which the free market has failed.”

The mounting evidence, in doctor’s offices, in legislative halls, in the bankruptcy courts, and in households shattered by medical debt, is that this doctor knows best.

Posted by pnhp at 01:35 PM | Permalink

Rita Villadiego, Dec 01, 2004 NEWARK, N.J. — A few months ago, Filipino American Rico Genaro, 42, who earns a minimum wage, as a staff of a video shop in New York City, got the flu and couldn’t work for a week.

He went to a doctor and spent over $350 for check-up and medication.

“I feel so worried without health insurance. If I have a serious illness, I don’t know how to survive,” said Genaro who was interviewed in a party in Jersey City. Genaro is one of millions of Americans who bear the brunt of the government’s lack of health-insurace policy.

Health advocates and policy makers have agreed to continue their efforts to push for universal health care amid concerns that escalating medical costs and prescription have endangered the lives of patients.

Speaking to advocacy groups, Dr. Charles Granatir of the Physicians for a National Health Program lamented that 18,000 deaths each year in the U.S. are due to lack of health insurance. With 45 million uninsured Americans or about a million uninsured in New Jersey, this has dangerous implications to patients. “The rise of the uninsured is not the cause of the healthcare crisis, it is the result,” said Granatir.

During the forum, a video was shown highlighting the suffering of Roslyn Schwartz of Fort Lee, N.J. who died of breast cancer in 2000 without health insurance.  Faced with the bitter reality of dying without health care, she walked from Fort Lee to Trenton to dramatize her protest on the plight of the uninsured.

The effect is compounded by skyrocketing prices of prescription drugs that are usually tough for people who are under 65 years old, and not covered by Medicare, or other insurance, advocates say. Granatir is backing the passage of the United States National Health Insurance Act of H.R. 676, authored by Rep. John Conyers (D, MI), which establishes an American single-payer health care system.

The bill would create a publicly financed, privately delivered health care program that uses the already existing Medicare program by expanding and improving to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans, guaranteed by law, will have access to the highest quality and most-cost-effective health care services regardless of employment, income, or health status.

The single-payer health care proposed by the Physicians for National Health Program emphasizes that health insurance will be privately delivered by practitioners and is therefore privately-run and not state-controlled. Granatir said unlike in Canada and other developed countries in Europe, the U.S. has no health policy. He said health care costs account for 15 percent of the U.S. gross domestic product.

The U.S health care cost is expected to shoot up to $1.8 trillion this year. The high cost is due mainly to soaring administrative and overhead costs of of health care providers and physicians who spend some $294.3 billion each year on administrative cost alone. Under the proposed single-payer health care system, everybody will receive a ticket for health care to receive needed comprehensive treatment. The blue-print health package underscores the need to make health care a right and not a privilege for all Americans.

As many people lost jobs or became under-employed in the wake of weak economy, more people are getting anxious of the increasing premiums on health insurance. Trish Comstock, 65, works for about two hours a week as a part-time teacher at Montclair State University.

She slipped down while walking in Manhattan three years ago and broke her hips. Since she has a low income, she was covered by Medicaid but paid almost $3,000 out of her pocket to pay her hospital bills. “When you are working part-time, you can’t use all your money to pay for health costs and pay other bills,” said Comstock. She is now getting Medicare insurance and her premium has increased from $66 to $78 per month.

Comstock’s feeling reflects the growing frustrations on health care. She is not alone as she struggles to pay increasing health care costs. Some people have greater worries as a Medicare program that pays health insurance premiums, known as Qualifying Individual or QI-1, for the poorest of the poor expired Saturday, forcing 156,000 Americans to pay for their own premiums.

“They are exploiting people who can least afford it,” Comstock said. With the graying of the baby boomers, health care providers are seen to increase costs by 20 percent as caring for the sickly old people requires more medication and hospital care, an official of the Blue Cross and Blue Shield Association said in a previous interview.

While millions suffer without health insurance, advocates who attended the forum said high cost of health insurance and expensive prescriptions fill the coffers of most health companies. Granatir said most drug companies earned 18.5 profit margins in 2001 as compared to 3.3 percent profit margins of Top Fortune 500 companies. He said 22 percent to 35 percent of health care dollar costs go to overhead and profits of most health care companies.

But Senator Joe Vitale of District 19, N.J. said the government’s family health care program has provided insurance to millions of families or one-third of total children in N.J. The government is working to provide health insurace to working adults and not only children. The government also reimbursed hospitals of $583 million for charity care for the poor this year as compared to $383 million last year.

“We have to increase insurance eligibility to parents,” Vitale said. Legislators agreed that it would be a long way and struggle for Americans to have a meaningful health care reform. Since universal health care is generally backed by Democrats in Congress, it would be difficult to pass this law since the Republicans are in power, said Mada Liebman, senior advisor and staff N.J. Senator Jon Corzine. Corzine authored a resolution urging Congress to enact an equal access to comprehensive health call to all Americans by the year 2005.

“We have to fight to turn the situation around. We could not get health care reform in the last four years,” said Lawrence Hamm, chairman of the People’s Organization for Progress.

Posted by pnhp at 02:39 PM | Permalink

Canada
Department of Finance
February 7, 2005
Minister of Finance Tables Legislation to Implement 10-Year Plan to Strengthen Health Care

Minister of Finance Ralph Goodale today tabled legislation in the House of Commons to implement the Government of Canada’s 10-Year Plan to Strengthen
Health Care, which was signed by all 14 first ministers at their September 2004 meeting.

“This plan illustrates very clearly how all Canadians benefit when governments work together in common purpose,” stated Minister Goodale. “The legislation to implement this historic agreement is a priority for the Government.”

http://www.fin.gc.ca/news05/05-011e.html

Canada’s 10-year plan:
http://pm.gc.ca/eng/news.asp?id=260

Comment: No health care system will be free of problems. But Canada demonstrates that a publicly administered and publicly financed program is capable of responding to its problems. In contrast, in the United States, our costs are out of control while our problems grow much worse. Why do we continue to tolerate our outrageously expensive and highly dysfunctional system?

Posted by pnhp at 01:52 PM | Permalink

Congressman Pete Stark
March 3, 2005
Stark Introduces Constitutional Amendment to Establish Right to Health Care

Today, Rep. Pete Stark (D-CA) announced his introduction of a proposed amendment to the US Constitution to guarantee health care as a right for every American. The amendment, H.J. Res. 30, is cosponsored by Rep. Jesse Jackson, Jr. (D-CA) and 27 other House members.

“The health of every American is vital to their unalienable rights of ‘life, liberty, and the pursuit of happiness,’” said Rep. Pete Stark. “To ensure these rights are fully enjoyed, we must be certain that every American can access quality health care - regardless of their income, race, education or job status. This Constitutional amendment is aimed at achieving this fundamental goal.”

Today, there are 45 million uninsured Americans, including 8 million children. Millions more are underinsured, excluded from certain types of health coverage or being quickly priced out of the health insurance market altogether. Additional disparities in access, treatment, and outcomes exist for people of color.

Facing skyrocketing costs, many employers are cutting benefits or dropping coverage for their employees, chipping away at the very foundation of health care insurance in the United States. Proposed cuts in Medicaid now endanger coverage for the over 50 million Americans that currently rely on the program for medical care.

“We face a health care crisis where equal opportunity and basic fairness in our nation are at stake,” said Rep. Stark. “I’m frustrated, as many Americans are, that the President and Congress continue to ignore the problems we face. A Constitutional guarantee of health care for all will force Congress to take action to ensure that health coverage is there for all Americans.”

H.J. Res. 30 would amend the Constitution to say “all persons shall enjoy the right to health care of equal high quality.” It would require ratification by three-fourths of the States and so-called implementing legislation must be passed by Congress to ensure compliance with the amendment.

“I firmly believe that until we can guarantee that all people have the right to equal, high-quality health care through the Constitution, the interests of the people will continue to play second fiddle to the corporate bottom-line,” said Rep. Stark. “It’s time we put the health care of the people first. Our Constitution should be amended to promote that common interest.”

http://www.house.gov/stark/news/109th/pressreleases/03-02_healthamendment.htm

Comment: We are already spending more than enough to provide high quality health care for everyone. But only the government can mandate that those funds be used to ensure that everyone has the right of access to affordable care.

We have long given lip service to the right to health care. But now it’s finally time to have a serious, definitive national debate on the constitutional right to quality health care for all. Let’s rally around H.J. Res. 30.

Posted by pnhp at 09:41 AM | Permalink

FOR IMMEDIATE RELEASE                                                               
Thursday, March 3, 2005
CONTACT: Lindsey Capps (202) 225-5065

Stark Introduces Constitutional Amendment to establish right to health care

WASHINGTON, DC – Today, Rep. Pete Stark (D-CA) announced his introduction of a proposed amendment to the US Constitution to guarantee health care as a right for every American.  The amendment, H.J. Res. 30, is cosponsored by Rep. Jesse Jackson, Jr. (D-CA) and 27 other House members.

“The health of every American is vital to their unalienable rights of ‘life, liberty, and the pursuit of happiness,’” said Rep. Pete Stark.  “To ensure these rights are fully enjoyed, we must be certain that every American can access quality health care – regardless of their income, race, education or job status.   This Constitutional amendment is aimed at achieving this fundamental goal.”
 
Today, there are 45 million uninsured Americans, including 8 million children. Millions more are underinsured, excluded from certain types of health coverage or being quickly priced out of the health insurance market altogether.  Additional disparities in access, treatment, and outcomes exist for people of color.
 
Facing skyrocketing costs, many employers are cutting benefits or dropping coverage for their employees, chipping away at the very foundation of health care insurance in the United States.   Proposed cuts in Medicaid now endanger coverage for the over 50 million Americans that currently rely on the program for medical care.
 
“We face a health care crisis where equal opportunity and basic fairness in our nation are at stake,” said Rep. Stark.  “I’m frustrated, as many Americans are, that the President and Congress continue to ignore the problems we face. A Constitutional guarantee of health care for all will force Congress to take action to ensure that health coverage is there for all Americans.”  
 
H.J. Res. 30 would amend the Constitution to say “all persons shall enjoy the right to health care of equal high quality.”  It would require ratification by three-fourths of the States and so-called implementing legislation must be passed by Congress to ensure compliance with the amendment.
 
“I firmly believe that until we can guarantee that all people have the right to equal, high-quality health care through the Constitution, the interests of the people will continue to play second fiddle to the corporate bottom-line,” said Rep. Stark.  “It’s time we put the health care of the people first. Our Constitution should be amended to promote that common interest.”

-# # # -

Congressman Pete Stark

FREMONT
39300 Civic Center Dr.
Suite 220
Fremont, CA 94538
510-494-1388

WASHINGTON, DC
239 Cannon Building
Washington, DC 20515
202-225-5065

Posted by pnhp at 10:44 AM | Permalink

Globe and Mail
March 1, 2005
Ontario hospitals chief pleads for more funds
By Oliver Moore

The head of the Ontario Hospital Association called Tuesday for a new funding arrangement, saying that the current system “would be better suited to a Monty Python movie.”

Hilary Short said that a “dramatically different” approach will be needed to prevent patient care being “cut deeply” when government rules against running a deficit come into play.

“Hospitals have until March 31, 2006 to achieve balanced budgets,” she told The Economic Club in Toronto Tuesday morning.

“The Ontario government, like most other governments, sets hospital budgets at a level it feels it can afford,” she said.

“This year, although the cost of operating hospitals increased by almost 8 per cent, the hospital sector received a 4.3 per cent base increase in funding from the provincial government. But because much of this increase was earmarked for specific initiatives, individual hospitals received an average base funding increase of 1.8 per cent.”

Not only were the increases insufficient, she said, the current funding method forces hospitals to guess how much money they will get and then spend accordingly. Only near the end of the fiscal year do they find out their actual funding, by which time they regularly have to borrow money to make up the shortfall.
“Enough is enough … the time has come to adopt a dramatically different approach. To protect patient care, Ontario needs stable, multi-year funding that is realistic in covering the real cost of providing care.”

http://www.theglobeandmail.com/servlet/story/RTGAM.20050301.whosp0301/BNStory/National/

Excerpts from Hilary Short’s speech:

The Economic Club of Toronto

Since its election in October 2003, the Ontario government has embarked on an ambitious agenda for health care reform — an agenda driven by Roy Romanow’s Royal Commission Report.

It’s come to be called the “Transformation Agenda,” and it consists of several different component parts, parts it must be added that like an engine, need to work perfectly together if they are to run smoothly.

First, the government is investing significantly in community care with the goal of easing pressure on hospitals.

Put plainly, this means shifting money to the community sector so it can serve more people. Over time, this will ease pressures on hospitals and help save money.

Second, the government is requiring hospitals to cut spending and divest themselves of certain services that, in their view, can more appropriately be delivered in the community setting.

The government is implementing this policy deliberately, to allow hospitals to focus exclusively on doing what they alone can do - providing the most complex care.

Third, the government is creating and implementing a plan to reduce waiting times for patients in five key areas - cardiac care, cancer care, diagnostic services like MRIs, hip and knee replacements and cataract surgery.

Fourth, through Family Health Teams, we also know that the government is pursuing the goal of improving access to primary care for the hundreds of thousands of Ontario families without a family doctor.

Fifth, the government is investing heavily in health promotion to ease the burden on our hospital system.

And finally, the government intends to improve the way in which the health care system works at the local and regional level, by creating Local Health Integration Networks.

Taken together, the component parts of this transformation agenda are designed to accomplish a simple goal - drive down costs, while improving access for patients to Ontario’s treasured public healthcare system. And…

To protect patient care, Ontario needs stable, multi-year funding that is realistic in covering the real cost of providing care.

We need a transformational, innovative, new funding model that would help to rejuvenate the entire health system. One idea, highlighted recently by a Senate Committee Chaired by Michael Kirby is called service-based funding.

Service-based funding would provide stable and predictable funding to hospitals.

It would fund them for the volume and complexity of care they provide, and reward them for their efficiency and performance while recognizing the real cost of providing care.

The OECD believes this model has potential. In an October 2004 report on Canada, the OECD noted that moving towards service-based funding would help improve performance and efficiency as well as reduce wait times.

And…
As I close, let me say this.

Hospitals have signed on for the “Transformation Agenda”. Progress is, and will continue to be made, by governments and healthcare providers working together.

What hospitals are asking for are the time and the resources to get it right.

Let’s move forward on primary care reform and investing in services in the community and in the home.

Let’s cooperate and support hospitals as they seek further savings in non-clinical areas like purchasing and accounting.

Let’s look at the facts, listen carefully, and move steadily to better integrate healthcare.

And finally, in the upcoming Ontario Budget, let’s reconsider the fiscal plan for hospitals to sustain our incredibly valued healthcare professionals while protecting patient care through this time of change and transition.

http://www.oha.com/Client/OHA/OHA_LP4W_LND_WebStation.nsf/page/The+Economic+Club+of+Toronto

Comment: The Canadian press seems to prefer to characterize their medicare program as a system that “would be better suited to a Monty Python movie.” Although Ms. Short did use that phrase in describing the difficulties of readjusting budgets during the fiscal year, you would think from the press coverage that the entire health care system was a Monty Python nightmare. That is unfortunate since the all-too-common, doom-and-gloom press coverage of the Canadian system is used to discredit single payer as a model for reform in the United States.

Ms. Short’s actual message is quite clear. The Canadians have an excellent health care system, and they can make it even better. We should be so fortunate.

Posted by pnhp at 12:30 PM | Permalink

Health Care Coverage in America: Understanding the Issues & Proposed Solutions

This guide was prepared by the Alliance for Health Reform with a grant from The Robert Wood Johnson Foundation, and designed by GMMB of Washington, DC. We trust that this publication will prove useful to a wide audience looking for reliable, up-to-date information on one of America’s most pressing social problems during Cover the Uninsured Week 2004 and beyond.

Please click here to read the report(pdf version)

Posted by pnhp at 01:08 PM | Permalink

Kaiser Daily Health Policy Report
February 28, 2005
Opinion
by
Arnold Relman, New Republic:

U.S. health policies “have failed to meet national needs” during “the past four decades” because “they have been heavily influenced by the delusion that medical care is essentially a business,” and current proposals to shift to a more consumer-driven health care system “are likely to make our predicament even worse,” Relman, professor emeritus of medicine and social medicine at Harvard Medical School and former editor of the New England Journal of Medicine, writes in a New Republic opinion piece. The current rate of inflation in health care costs is “unsustainable,” and it is likely that any market-based solutions will fail to address the problem, Relman says. He adds that the United States should be prepared to establish a single-payer system that addresses fundamental problems in both the “insurance and delivery sides.” Relman concludes, “A real solution to our crisis will not be found until the public, the medical profession and the government reject the prevailing delusion that health care is best left to market forces” (Relman, New Republic, 3/7).

http://www.kaisernetwork.org/daily_reports/print_report.cfm?DR_ID=28377&dr_cat=3

Comment: For some time it has been clear that the single payer model of reform would provide a real solution to our health care crisis. But many voices have remained silent or muffled because of concerns about political feasibility. We’ve known that the feasibility of the single payer model is not the problem. It’s the politics. And more and more of us now realize that we must speak up if we ever expect to change the politics.

———————————————————————————————————————————-
Health Affairs
March 1, 2005
Voters And Health Care In The 2004 Election
By Robert J. Blendon, Mollyann Brodie, Drew E. Altman, John M. Benson,
and
Elizabeth C. Hamel

…no sweeping health reform proposal or large-scale effort to expand coverage for the uninsured is likely to gain serious consideration in the administration and Congress in the next few years. Many do believe, however, that the search for savings to reduce the federal deficit could result in new efforts to limit federal spending for both Medicare and Medicaid, and possibly in proposals to fundamentally restructure the Medicaid program, which now provides health insurance to some fifty million low-income, elderly, and disabled Americans. The Medicaid debate will likely unfold as part of the budget process, but, driven by the budget process and not by public opinion, it is likely to be the most consequential health care issue addressed on Capitol Hill in the next year in terms of the number of people affected and the dollars involved.

The question for the future is whether health care will once again make the transition from being a problem about which people have deep concerns to a voting issue, as it did in the 1992 presidential election. This may depend in part on whether health care can be framed as an issue of fundamental principles, rather than a series of complex health financing plans.

That it is not now a voting issue suggests that politicians will not feel compelled to mount major health care reform efforts, at least as long as other issues dominate. But the fact that health care costs and access are such strong personal and family worries also suggests that candidates and politicians who decide to champion health care issues can win favor with the American people for doing so.

The fact that personal concern about health care costs and access is already so high also suggests that raising awareness about these issues is not the paramount challenge for supporters of health care reform. Rather, the biggest challenge is to forge consensus on policy solutions and ways to pay for them that politicians can effectively champion.

http://content.healthaffairs.org/cgi/content/full/hlthaff.w5.86/DC1

Comment: Can we forge a consensus on policy solutions and ways to pay for them? If so, how?

Posted by pnhp at 11:29 AM | Permalink