Testimony of the Washington State Ad Hoc Coalition on the Citizens Health Care Working Group/Letter to Congressman Stark

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Senate Finance Committee

Charting a Course for Health Care Reform: Moving Toward Universal Coverage

March 14, 2007

Contact:
Sarah K. Weinberg, MD
3304 81st Pl. SE
Mercer Island, WA 98040
206-236-0668
weinbergsk@msn.com

Senator Max Baucus, Chair, and Members of the Senate Finance Committee including our own Washington Senator Maria Cantwell:

Introduction

We are individuals and members of several different Washington State organizations that are committed to the creation of a high quality American health care system that is affordable and accessible to all. We came together over a year ago as an Ad Hoc Coalition in support of the Citizens Health Care Working Group (CHCWG) and its public hearing held in Seattle in February 2006. We submitted a critique and recommendations for improvement of the Interim Report last summer. We now testify before the Senate Finance Committee about the CHCWG report “Health Care That Works for All Americans”, and make further comments about implementation of reform of the American health care system.

First of all, we second the comments made by Sen. Baucus in his opening remarks. We agree that health is the first of all liberties, and that it is a responsibility of society to provide health care for all its residents. We think it is helpful to view health care as part of the essential infrastructure of our nation. Further, the use of tax dollars to guarantee the health care of American citizens is an appropriate investment in America’s future. We share Sen. Baucus’ belief that a nation-wide consensus is forming around five principles for our health care system:
1. Universal coverage - indeed an essential first step enabling the others
2. Sharing the burden - depending on employers and individuals alone is not sufficient
3. Controlling costs - only a unified system can implement evidence-based methods to control costs fairly
4. Prevention - this is a major area in which the current American system fails, with its overuse of lucrative procedures and lack of emphasis on maintenance of health
5. Sharing responsibility - everyone contributes both to paying the cost of the system and to being responsible for personal lifestyle and health care decisions.

Findings of the CHCWG

1. Strong Support for National Health Care Coverage for All Americans

The most important finding is expressed in the statement:
“Americans should have a health care system where everyone participates, regardless of their financial resources or health status, with benefits that are sufficiently comprehensive to ensure access to appropriate, high-quality care without endangering individual or family financial security.”

There was overwhelming support (94%) that there should be public policy written into law that all Americans have affordable health care. Of participants at community meetings across the nation, 68 - 98% favored guaranteeing a defined set of health care benefits to everyone. In another national poll in September 2005, 75% of U.S. adults favored health insurance that covers all Americans.

2. Financing a National Health Coverage Is Affordable

At $2 trillion per year, about $6,000 per person, or 16% of Gross Domestic Product, there is plenty of money being spent on health care in America. There was also a strong sense in the public responses that reallocation of health care dollars would provide the necessary funds for universal coverage. Nevertheless, a majority of participants in the CHCWG process were willing to pay more in taxes to ensure that all Americans are covered.

There was also strong sentiment that financing methods should be “fair”, meeting the following principles:

• No disproportionate financial burden on the sick

• Responsibility related to a household’s ability to pay

• All segments of society should contribute to funding

3. The Time to Start the Transition to National Health Coverage is NOW

The overwhelming majority of participants want the health care system change to begin now. Full implementation of national health coverage should be accomplished at least by 2012.

4. Band-Aids: Suggestions to Provide Immediate Relief from the Worst Problems of a Grossly Inadequate System

The CHCWG report devotes several pages to schemes to stabilize the failing private health insurance system and to provide help for families bankrupted by catastrophic health care costs. A few more pages were spent on supporting community health clinics as safety net providers for the poor and uninsured.

5. Preparing the Health Care Delivery System for Universal Coverage

CHCWG recommendations 3-6 all relate to this basic issue. There are several ways in which the American health care system needs to be restructured to provide the best care possible for everyone once universal coverage is established. Some of these:

• Increase the number of primary care health professionals - studies of other nations show that ready access to primary care is an essential building block for a successful, cost-effective health care system.

• Develop community-based integrated delivery systems - not just for the poor and/or uninsured. Systems like these already are delivering top quality care in the communities where they exist.

• Implement electronic medical records nation-wide - develop intercommunication among various systems. Information technology on this scale cannot be financed or integrated on the backs of individual physicians and hospitals.

• Fund nation-wide research to document the evidence needed for recommended diagnostic and treatment approaches for common diseases.

• Develop population-based strategies for many health services, especially support for healthy lifestyles, preventive care, and management of common chronic diseases.

• Create a transparent and independent process for defining benefits to be included in universal coverage, and for updating benefits as technology and knowledge change.

• Create a multidisciplinary system to coordinate and deliver end-of-life care.

Washington State Ad Hoc Coalition Opinions

1. Fundamental Reform: Universal Health Coverage for All Americans

We cannot emphasize strongly enough how important it is for Congress to declare its intent to design and implement a universal health coverage system that guarantees affordable health care with dignity to every American. Without this essential first step, other reforms are too expensive, unfair, or simply won’t work. The time to do this is NOW.

A multitude of national polls demonstrate that the public is strongly in favor of guaranteed health coverage, that government should make it happen, and that it should be tax-supported.

2. A Single National Health Coverage Program Will Save Enormous Sums

The CHCWG report did not dwell on the tremendous waste inherent in the current fragmented system, but a large amount of the annual $2 trillion paid for American health care is waste:
* The administrative bureaucracy of hundreds of private and public insurers plus the costs to health providers of their own bureaucracies needed to navigate the billing and collection process of the fragmented payment system costs at least 1/3 of total health care expenditures. (That’s $600 billion per year!) The administrative cost of a single national coverage plan would be less than 10% of total costs, a conservative estimate, - a savings of at least $400 billion per year.

• Without any way to control costs, the U.S. has overbuilt high technology diagnostic and treatment options, and developed too many expensive specialists, while underpaying primary care health professionals.

• Without any organized way to educate and support health professionals, nationally agreed upon evidence-based guidelines for appropriate diagnostic and treatment choices are rarely used, resulting in overuse of some, underuse of others. Unnecessary waste and avoidable suffering result from wrong decisions.

• Lack of health insurance drives millions to seek health care from the most expensive place possible - emergency rooms - when they are sick and/or scared.

• Demand driven by advertising to the general public leads to overuse of medications and devices, with resulting waste of dollars as well as unnecessary suffering from side effects of medications that were not needed in the first place.

The report does state: “…a significant portion of all health care expenditures produce no added health value.” And: “Concentrated efforts in some integrated health care systems have demonstrated care can be improved and waste eliminated.”

3. We Urge Congress to Start the Work of Preparing the Health Care Delivery System for Universal Coverage.

Lulled by the common myth that Americans have “the best health care in the world”, little attention has been given to the delivery system improvements that must be made for our health care system to work as an efficient integrated system once everyone has coverage.

The seven bullets under heading #5 above list a minimum of what is needed. Congress needs to convene another working group to review these areas, think of more problem areas, and develop solutions with funding for implementation. None of these is difficult, and we can use work already done in other nations to find the necessary solutions.

Improving American health care delivery will cost money, but investment in an improved delivery system, in combination with universal coverage, should result in substantial sustained monetary savings and improved health outcomes in the future.

4. Designing a Sufficiently Comprehensive Benefit Package

We believe it is crucial that a national health coverage plan be sufficiently comprehensive to provide good protection for all Americans from excessive out-of-pocket costs. Terms like “basic” and “core” imply skimpiness (who would want just the core of an apple, for example). Americans are not going to be willing to give up what they have now, as imperfect as it is, if they think the new system is going to have skimpy benefits. Public opinion, as tabulated by the CHCWG, is very clear: Americans want to be able to get the health care they need, when they need it, and without risking financial ruin.

The independent committee charged with the transparent, publicly accountable process for determining the benefits package must use evidence-based science demonstrating medical effectiveness as well as cost effectiveness. The process must also assure over time that the benefits package remains current and continues to be both medically effective and cost effective. The benefits must cover wellness care, preventive services, primary care, acute care, prescription drugs and devices, patient education, treatment and management of health problems - physical, mental and dental - with care decisions made by patients and their doctors together. The members of the committee and their families will get the same excellent quality care expected for all Americans.

Conclusion

We wish to re-emphasize the overwhelming support evident in all the public input to the CHCWG for a national health program, financed by taxes, covering all Americans for a sufficiently comprehensive package of health services.

• 97% view the health system as in crisis or having major difficulties
• 94% believe affordable health care should be a matter of public policy, by law
• 90% think health care should cover a level of benefits for everyone.

We think numbers like these represent a consensus. Does Congress have the political will to enact a national health program supported by a consensus of public opinion? We look forward to your leadership and trust that you will make comprehensive health care reform and a commitment to a healthy future for all Americans top priorities in 2007.

Supporting Organizations

(in alphabetical order)
Alliance for Retired Americans - Puget Sound
Alliance for Retired Americans - Washington
Health Care for All - Washington
Health Care That Works (6th Congressional District)
Lutheran Public Policy Office of Washington
Northwest Federation of Community Organizations
Northwest Health Law Advocates
Physicians for a National Health Program - Western Washington
United for National Health Care (2nd Congressional District)
Service Employees International Union 1199NW
Washington Community Action Network

Letter to Congressman Stark

Physicians for a National Health Program

Western Washington Chapter

8424 California Ave SW, Seattle, Washington, 98136
Phone: 206 9377154
Email: pnhp.westernwashington@comcast.net
WebSite: www.pnhpwesternwashington.org

Congressman Pete Stark, Chairman
House Ways & Means Subcommittee on Health
239 Cannon House Office Building
Washington, DC 20515-0513

RE: Request for hearings on comprehensive health care reform

March 16th 2007

Dear Congressman Stark,

On behalf of Physicians for a National Health Program, Western Washington Chapter, we would like to respectfully request hearings on how to achieve quality, affordable health care for everyone in our country.

We congratulate you for the leadership you have shown in previous Congresses in sponsoring or co-sponsoring legislation for comprehensive health care reform, including The AmeriCare Health Care Act (HR 5886), The American Health Security Act (HR 1200), and The United States National Health Insurance Act (HR 676). We know that for years such legislation has been denied the opportunity for discussion in Congressional hearings. At last, the time has come to renew a serious national discussion on how to solve the health care crisis.

As you plan Health Subcommittee hearings, we urge you to include a review of the 2006 Report of the Citizens Health Care Working Group (CHCWG). The Medicare Modernization Act of 2003 was amended to create a Citizens’ Health Care Working Group to “engage in an informed national public debate” on health care with the American public. In 2006, nearly 30,000 demographically diverse people participated in community meetings and in-depth on-line polling. This was a remarkable, unprecedented process, spurred by widespread grass-roots participation across the country.

The CHCWG Report has some very good points and some important deficiencies. For example, it reflects the views of most participants in recommending that by 2012 “it should be public policy, established in law, that all Americans have affordable health care coverage.” At the same time, it shies away from its own finding that more than 70% of participants in the CHCWG process favored creating a National Health Plan financed by tax payers that guarantees all Americans health insurance coverage.

We are disappointed but not surprised that the Bush administration, on March 14th, rejected the key recommendations of the CHCWG Report. This action underscores the importance of Congressional hearings to further discuss the CHCWG recommendations and to implement viable solutions to the current health care crisis.
Hearings on the CHCWG Report were held this week in the Senate Finance Committee and are supposed to be held by four other committees, including Ways and Means. We believe such hearings could provide a good platform for discussion of how we can achieve quality, affordable health care for all. Our organization and many others with whom we partnered in the CHCWG process would be eager to offer testimony.

As you are well aware, the health care system in this country is unraveling with dire consequences for our economy, our moral fabric, our sense of community, and our human dignity. The current treatment of health as a market commodity denigrates our humanity and subverts our sense of the common good. While millions of Americans are struggling with the ill effects of market-driven medicine, we are committed to raising awareness that another way is possible. Change in our health care system is not only desirable it is imperative and we believe the time for change is now.

There are new signs almost every day that more and more Americans are ready to tackle this crisis. Employers, labor, health care professionals, consumer groups, faith-based communities, advocacy groups, and state and local governments are increasingly vocal about the need to find ways to provide health care for all. This is a dramatic shift compared to just a year ago.

We are grateful for your courageous leadership and we know that you will place the health of the American people as a top priority in the 110th Congress. We look forward to working with Congressman McDermott and your Subcommittee in pursuit of our common goal.