PNHP

Healthcare crisis countdown

Healthcare crisis countdown

By David R. Francis
The Christian Science Monitor
November 6, 2006

The healthcare system in the United States is eroding. Costs are rising too fast. More and more people lack health insurance. Companies are dumping or shrinking employee health plans. Deductibles and copayments on medical services are rising.

That’s the widely agreed-upon scene.

Yet chances are slim that Americans will go for a far less expensive “single payer” health system, as in Canada, Britain, or Australia, anytime soon.

“The issue is not likely to be given a fair examination,” says Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health, Boston. “There is a cultural resistance to even considering this very serious option.”

Since the healthcare system is “sort of collapsing,” Stephanie Woolhandler, co-founder of Physicians for a National Health Program (PNHP), expects “a lot more discussion” of a single-payer system after the congressional elections Tuesday, especially if the Democrats win at least one house in Congress. In such a system, the government pays the bills from hospitals and physicians.

Doctors Woolhandler and Blendon basically agree on why change is resisted.

Many Americans are cynical about government, distrusting its ability to provide a competent healthcare system. They prefer a market-based system with a high degree of individual choice.

Moreover, self-interested groups have political clout. Health insurance companies, pharmaceutical firms, private hospitals, and Wall Street investors in the healthcare industry “aren’t going to go quietly into the night,” says Blendon.

The drug industry usually ranks as the most profitable. In 2002, it made a 14 percent return on assets; the Fortune 500 made a median of 2.3 percent.

When voters in California and Washington considered single-payer systems for their states in the 1990s, opponents outspent proponents 12 to 1, and the proposals died by a huge majority.

Students from other industrial nations tell him that the US is unique in the degree of power that moneyed interests wield in politics, says Blendon.

“A single-payer system is inevitable,” holds Dr. John Geyman, president of the 14,000-member PNHP. “It is just a matter of time.”

Polls find at least 60 percent of Americans want public financing of the $2 trillion healthcare system, something that would work the way Medicare does for older citizens. Government would foot much of the bill from private hospitals and physicians.

But in opposition are many of the 1,500 private insurance firms. They seek to make more money for shareholders by cherry-picking healthy customers and avoiding those with costly chronic illness, Dr. Geyman charges. He cites a former editor of the New England Journal of Medicine, Dr. Arnold Relman, who warned in 1980 of the “medical-industrial complex” and its hold on Washington, echoing President Eisenhower’s reference to a “military-industrial complex.”

Those in the healthcare industry fear more government regulation, more interference. They don’t want the government to restrain prices for drugs or other medical services, as systems in other industrial countries do.

The US spends 15 percent of its gross national product on healthcare, of which 31 percent goes for administrative costs. Canada spends about 10 percent of GDP on a universal healthcare system, 1.3 percent of it for overhead..

Woolhandler is hopeful about a single-payer system because of what she calls a “slow-motion collapse” of employee-sponsored health coverage as health costs rise and competition in a globalized economy increases.

Blendon, though, figures it will take a major healthcare crisis, perhaps including hospital closings and doctors becoming unavailable to many patients, before the political powers will launch an effort at real reform.

“Will the situation get so bad we have to do something about it?” asks Daniel Callahan, international programs director at the Hastings Center, a bioethics research body in Garrison, N.Y. “We have not yet reached that point.”

There is no strong leadership in Congress or the White House for radical change in the healthcare system. Further, some 80 to 85 percent of Americans today get decent medical healthcare, Mr. Callahan estimates. Those who are satisfied with the system are unlikely to urge reforms to help the less fortunate.

Despite polls indicating sympathy for the plight of 46.6 million without health insurance, the majority “is not willing to put their wallet where their mouth is,” says Callahan.

But the system continues to weaken.

Over the past six years, family health insurance premiums have risen on average about 69 percent, more than six times the increase in the median earnings of workers (about 11 percent), finds Families USA, a Washington group championing healthcare consumers.

“This is not sustainable,” says the group’s executive director Ron Pollack. “More and more people are being driven out of healthcare insurance…. More and more people find it unaffordable.”

What may move the issue onto the front burner again is that in 2020 there will be about twice as many elderly in the nation, forcing up healthcare costs.

Healthcare will be a top issue in the 2008 election, Mr. Pollack predicts.

Amerigroup's marketing reps commended for excluding pregnant women

Jury finds HMO bias in signing patients

Amerigroup shunned pregnant women, high-risk patients

By Rudolph Bush
Chicago Tribune
October 31, 2006

A health maintenance organization hired by the government to provide coverage for the poor in Illinois will have to pay damages of $144 million for discriminating against pregnant women and other potentially high-risk patients, a federal jury in Chicago decided Monday.

After two days of deliberations, the jury found that Amerigroup Corp. and subsidiary Amerigroup Illinois sought to fatten their profits off Medicaid dollars paid into their plans by signing up healthy clients and intentionally avoiding those who had health issues.

Amerigroup, which no longer operates in Illinois, runs managed-care plans that, because of restrictions on doctor and hospital choices to their networks, are a cheaper alternative to fee-for-service Medicaid.

Prosecutors said they also will seek almost $200 million more in penalties from the Virginia Beach, Va.-based company because it filed more than 18,000 false claims with the state.

Amerigroup trained its marketing representatives to avoid people who faced high medical bills and had a policy of “cherry-picking” healthy clients, according to testimony and documents presented during the month-long trial.

Under the Medicaid compensation system, the company pocketed more money if it paid out less in medical bills.

A series of e-mails and statements from Amerigroup executives were key elements of the plaintiffs’ case.

In a 2001 e-mail shown to the jury, Amerigroup Illinois’ director of medical management told managers, “Please keep up the good work with the marketing reps of not trying to sign up pregnant women.”

In another e-mail, the executive said the company had continued to build experience in not signing up pregnant women or people from areas where drug abuse was prevalent.

Another Amerigroup executive said in a sworn statement that it was always his policy “to go after the healthies,” prosecutors said.

Dwight Jones, Amerigroup’s corporate representative at the trial, acknowledged on the stand that a large drop in the number of pregnant women the company had as clients was due to an active effort to avoid signing them up in the first place, Cohen said.

http://www.chicagotribune.com/features/health/chi-0610310171oct31,1,5680823.story

Comment:

By Don McCanne, M.D.

Amerigroup has provided us with a prime example of why the single payer reform model is not only publicly funded but also publicly administered. Contracting to private intermediaries, such as Medicaid HMOs or Medicare Advantage plans, is an open invitation for the plans to manipulate the system to achieve their primary goal of enhancing profits.

The boards and management of these entities are absolutely obligated to place the interests of their investors above all else. Non-profits are obligated to use similar devious methods in order to compete successfully with the for-profits in the insurance marketplace.

Think of why we need to establish a single, equitably funded, universal risk pool. That’s easy. Now think of any reason to place a business model intermediary between that pool and the health care that patients receive.
Talk about drawing a blank.

Pace Poll: New Yorkers favor a government-run health insurance plan

This via the Brian Lehrer show on WNYC.

A new poll by Pace University/New York Magazine/WCBS 2 News/WNYC asked New Yorkers to compare single-payer health insurance with an individual mandate to purchase private insurance, along the lines of the Massachusetts plan. Evidently, Mr. Lehrer himself put forward the idea for the question.

This morning during his “Pacing Politics” segment Brian Lehrer struck a note of astonishment that 48% of New Yorkers support the abolition of private health insurance in favor of a solitary publicly financed government-run plan, while 35% supported a statewide mandate that individuals purchase private health insurance.

The overall poll sought to gauge public opinion on a variety of candidates and issues on the eve of the elections; there was only one question on health care.

The results do not add up to 100% – at this point we only have the data via the link above.

The actual question — as it appeared for the pollsters to ask:

Question 43:

Now I’m going to read you some statements about health insurance, which helps people pay doctors’ bills and other medical expenses. When I am done, please tell me which one you agree with more. [ROTATE]

Statement A:
Some/Other people say that New York State should require people without health insurance to buy it and that the government should help people pay for health insurance if they can’t affort it. They say that many unisured people are young, healthy, and financially well-off, so their failure to buy health insurance forces the rest of us to pay more than our fait share of the high cost of caring for the sick.

Statement B:
Some/Other people say that New York State should create a government-run health insurance program to replace private health insurance companies and provide health insurance to everyone. They say that the private insurance companies drive up the cost of health care by acting as useless middlemen between doctors and patients, and they say that people in other countries spend less money on health care while enjoying better health because they don’t waste money on insurance companies.

Which statement do you agree with more?

Results:

22% strongly agree with A
13% somewhat agree with A
29% strongly agree with B
19% somewhat agree with B

Overall (by 48% to 35%) New Yorkers favor a “government-run health insurance program” to a plan that would “require people without health insurance to buy it.”

From the PNHP Capital District Blog, 10/31/06

J. Gruber on lessons from the RAND HIE

The Role of Consumer Copayments for Health Care: Lessons from the RAND Health Insurance Experiment and Beyond

By Jonathan Gruber, Ph.DKaiser
Family Foundation
October 2006

Conclusion

The RAND HIE was one of the most important and influential social experiments in our nation’s history. By tackling a contentious yet central policy issue, the HIE provided a valuable set of evidence that delivers clear lessons for health insurance design. The right way to design health insurance has three features: co-insurance for the typical patient; an income-related out-of-pocket limit; and evidence-based design of co-insurance that targets co-insurance to places where care is least effective. In practice, each of these raises administrative issues that get more daunting as one moves through the list. But in principle, at least, a clear reading of this literature gives us a natural starting point for designing appropriate health insurance benefits.

http://www.kff.org/insurance/upload/7566.pdf

Comment:

By Don McCanne, MD

Jonathan Gruber provides an excellent analysis of the RAND HIE and of more recent studies on the impact of co-insurance. His conclusions are warranted based on a sterile, broad overview of the current knowledge on the topic, but only if you accept the principle that cost sharing should be an essential component of health care cost containment simply because it has been proven to reduce spending. Dr. Gruber’s recommendations demonstrate that he is not insensitive to the potential negative impact, especially on lower-income individuals with significant health care needs, but we should question what he recommends to make cost sharing work.

1. “co-insurance for the typical patient:” The “typical patient” is the average, healthy individual. It is not the patient with significant health care needs, nor the patient who will develop major medical problems in the future. Establishing policies that reduce health care spending amongst those who are not spending very much is of little help in controlling the four-fifths of our spending on those with greater health care needs.

2. “an income-related out-of-pocket limit:” Linking means testing to access of medical services creates an administrative nightmare. This concept acknowledges that low-income individuals cannot be expected to pay large amounts out of pocket, but higher-income individuals can. But rather than creating this complex system of means testing, progressive funding can be much more easily and equitably established on the financing side through the tax system. The relatively small increase in utilization by higher income individuals can be easily off-set by appropriate minor adjustments in tax policies, though the amount would be almost negligible.

3. “evidence-based design of co-insurance that targets co-insurance to places where care is least effective:” This one is a double administrative nightmare. Imagine trying to identify services that are of lower value and then assigning a higher co-insurance rate based on the effectiveness of the service. Overuse of non-beneficial services must be addressed, but it is not realistic to place the patient in charge of that decision based on a complex system of sliding-scale co-insurance. Reducing such wasteful spending would be much more easily accomplished by establishing a national health insurance monopsony which would be more capable and effective in removing worthless services from coverage.

In his analysis, Dr. Gruber fails to acknowledge the fundamental flaw in the way that the RAND HIE has been applied to health policy. It only has intrinsic validity for a healthy sector of our population for a healthy period in their lives. It does not have extrinsic validity for our entire population from birth to death, with their full basket of medical problems.

The RAND HIE should no longer be used as a reason for keeping the private insurance industry in charge. What we need is national health insurance. Other nations spending far less than us have not had to use co-insurance to control costs.

Louisville Metro Council Supports HR676

RESOLUTION NO. 155, SERIES 2006

A RESOLUTION IN SUPPORT OF THE UNITED STATES NATIONAL HEALTH INSURANCE ACT.

SPONSORED BY: Councilwoman Mary Woolridge

Whereas, every person in Metro Louisville and in the United States deserves access to affordable, quality healthcare; and


On the left is District 3 Councilwoman
Mary Woolridge, sponsor of the
Louisville Metro Council Resolution in
support of HR 676, Congressman
John Conyers’ national single payer
health act that would assure health
care for all. On the right is Joan
Dubay, Coordinator of the Metro
Council Committee of Kentuckians for
Single Payer Health Care. The photo
was taken on Oct. 12, 2006, shortly
after the council voted in favor of the
resolution, 14 to 9 with 1 abstention
and 1 voting present.

Whereas, over 45.8 million Americans, including 85,000 residents of Metro Louisville, live daily without healthcare coverage; and

Whereas, those insured now often experience burdensome medical debt and sometimes life-threatening delays in obtaining healthcare; and

Whereas, one-half of all personal bankruptcies are due to illnesses or medical bills; and

Whereas, administrative costs for our current healthcare system consume approximately thirty percent (30%) of United States healthcare spending, with rising costs contributing to decreased international business competitiveness and massive layoffs; and

Whereas, United States Representative John Conyers has introduced House Resolution 676, (hereinafter referred to as HR 676), The United States National Health Insurance Act, which would provide healthcare to all; and

Whereas, the goal of HR 676 is to ensure that all Americans have access, guaranteed by law, to the highest quality and most cost-effective healthcare services regardless of their employment, income, or healthcare status; and

Whereas, HR 676 will cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment; and

Whereas, HR 676 will give patients their choice of physicians, providers, hospitals, and clinics with no co-pays or deductibles in a publicly financed, privately delivered system;

NOW THEREFORE, BE IT RESOLVED BY THE LEGISLATIVE COUNCIL OF THE LOUISVILLE/JEFFERSON COUNTY METRO GOVERNMENT (THE COUNCIL) AS FOLLOWS:

SECTION I: The Metro Council of Louisville, Kentucky hereby supports and endorses HR 676, “United States Health Insurance Act;” and respectfully requests our elected federal officials to endorse and adopt HR 676; and the Council Clerk is authorized and directed to forward copies of this Resolution to our federal legislators and to our area state legislators to enlist their support of this vital piece of legislation.

SECTION II: This Resolution shall take effect upon its passage and approval.


Louisville Metro Council members and members of
Kentuckians for Single Payer Healthcare (KSPH)
were all smiles on October 12 after the council
voted, 14 to 9 with 1 abstention and 1 voting
present, to urge Congress to pass HR 676,
Congressman John Conyers’ national single
payer health plan. L to R: Councilman Dan
Johnson, Harriette Seiler, Mark McKinley, Kristin
Munro Leighton, Councilwoman Vicki Welch, Kay
Tillow, Councilwoman Mary Woolridge (sponsor
of the resolution), and Joan Dubay (coordinator
of the KSPH Committee that organized for the
resolution).

Kathleen J. Herron
Metro Council Clerk

Kevin J. Kramer
President of the Council

Approval Date: October 17, 2006

Jerry E. Abramson
Mayor

APPROVED AS TO FORM AND LEGALITY:

Irv Maze
Jefferson County Attorney

View the PDF of the resolution.

Healthy skepticism

By Dr. Michael Hochman and Dr. Steffie Woolhandler
The Boston Globe
October 28, 2006

MASSACHUSETTS is in the midst of yet another healthcare experiment. By July, all residents will be legally required to have health insurance — a so-called “individual mandate.” The bill’s sponsors believe that the uninsured can buy their way out of their predicament.

As doctors in an urban hospital, we are not optimistic about this proposal. We care for uninsured and underinsured patients who often lack the resources to eat well or find proper child care, much less to buy insurance. The individual mandate is another ill-fated Band-Aid.

Under the new law, Massachusetts residents will continue to be covered by the existing patchy network of insurance groups. The options are complicated, and the costs are steep: a typical group policy in costs about $5,000 annually for an individual and more than $11,000 for a family. Many of the state’s approximately 618,000 uninsured residents will still fall through the cracks.

The answer lies in an alternative proposal: single-payer national health insurance. Australia and Canada already use this approach. Under such a system, a public agency would finance universal healthcare. It would be an improved and expanded version of Medicare.

How would a single-payer system work? According to the proposal by the Physicians for a National Health Program — which holds its annual convention in Cambridge next weekend — all US residents would receive a healthcare card entitling them to all medically necessary services from their choice of doctors and hospitals.

The program would be funded by an increase in taxes. But the tax hike would be fully offset by savings from abolishing insurance premiums and many out-of-pocket healthcare costs.

The private insurance industry, the only major group that would be harmed, has been national health insurance’s most vocal opponent. Industry lobbyists have thus far convinced legislators on Beacon Hill and Capitol Hill that a government-run system would be inefficient.

Yet insurance companies spend several times as much on administrative costs as public programs do. A 2003 study published in the New England Journal of Medicine found that the average overhead of US insurance companies is 11.7 percent, compared with 3.6 percent for Medicare and 1.3 percent for Canada’s national health insurance program. Two studies commissioned by the Massachusetts Medical Society concluded that a single-payer system could save so much on paperwork that it would be more cost-effective than the present system.

Some worry that the quality of healthcare might decline. But there is no reason to suspect this would happen. Healthcare providers and hospitals would continue to have the same incentives they have now to provide high-quality care. For the most part, doctors and hospitals would continue to be paid as they have been, except that rather than submitting their bills to private insurance companies — a difficult and time-intensive process — they would send their bills to the national health insurance program.

And despite fears of long waits for life-saving services, that would be unlikely with appropriate funding. In countries such as Canada, where patients experience long waits, a much lower percentage of GDP is devoted to healthcare than in the United States.

A national insurance program also would not hurt medical research. Most basic research in the United States is publicly funded by grants from the National Institutes of Health (NIH). According to a recent book by a former editor of the New England Journal of Medicine, the vast majority of new classes of medications are discovered using NIH funding.

Single-payer healthcare is the only long-term answer to our ailing healthcare system. No other proposal — including a healthcare mandate — could provide health insurance to all Americans, cut costs, and simplify the healthcare system in one broad stroke.

Others feel this way as well. In a survey of more than 900 Massachusetts physicians published in the Archives of Internal Medicine in 2004, almost two-thirds supported single-payer healthcare.

Over the next few years, the nation will be watching the Massachusetts experiment closely. The silver lining may be that what we learn will move us closer to the universal, comprehensive single-payer system that Americans deserve.

Dr. Michael Hochman is an intern in internal medicine at Cambridge Hospital. Dr. Steffie Woolhandler is a co-founder of Physicians for a National Health Program and an internist at Cambridge Hospital.

The public believes that the Democrats would reform healthcare?

USA TODAY/Gallup poll
Conducted October 20-22, 2006

1. Suppose the Democrats win control of both houses of Congress in this year’s elections. Do you think Congress would be likely – or not likely — to do each of the following after the Democrats take control in January?

Pass legislation to provide healthcare insurance to those who do not have it

60% – Likely
37% – Not likely
3% – No opinion

2. Suppose the Democrats win control of both houses of Congress in this year’s elections and try to do each of the following after they take control in January. Please say whether you would approve or disapprove of that action.

Pass legislation to provide healthcare insurance to those who do not have it

79% – Approve
17% – Disapprove
4% – No opinion

http://www.usatoday.com/news/polls/tables/live/2006-10-25-poll.htm

Comment:

By Don McCanne, MD

Would a Democratic Congress be likely to pass legislation to provide coverage for the uninsured? With the exception of improving outreach for children through the SCHIP program, the Democratic leadership has made it clear that comprehensive reform will not be on the agenda. The 60 percent of Americans who believe reform is likely in 2007 simply haven’t been listening.

The more important finding in this poll is that four-fifths of Americans do approve of legislation that would provide health insurance to those who do not have it. So could a Democratic Congress move the process forward?
Emphatically, yes!

Most of the Democrats do support universal coverage, and many of them specifically support a program of national health insurance. They have introduced many bills that have never had a hearing because the agenda has been controlled by the Republican leadership. With the Democrats in control, comprehensive proposals for universal coverage would have high profile hearings. Although President Bush would veto any proposal with significant government funding, the two years would provide the opportunity to better inform the public on their options. Many political analysts believe that health care will be a leading issue in the 2008 presidential elections.

It is regretted that this message is partisan, but Republican partisanship has kept reform off of the agenda. We need a new approach. The Democrats could lead by joining with the Republicans in an agreement to set ideology aside and tackle the problems based on the major advances that have been made in health policy science. The common political ground should not be based on a partisan process that trades away beneficial health policies in the name of compromise. Instead, the process should be based on a precise definition of the problems and a consideration of the various policies that would rectify those problems.

We can abbreviate this process. The homework has already been done. Single payer is the answer.

Medicare for All is a smart decision for business world

By DR. RICHARD PROPP
Times Union
Sunday, October 22, 2006

Every day across New York, doctors, their employees and hospital workers spend much valuable time anxiously dealing with health insurance company employees. And every day, businesses begin the multimonth process of evaluating old and new insurance plans, investing more and more to provide decent health insurance in an attempt to retain good employees and keep them healthy. Increasingly, businesses give up providing health insurance because they can’t afford it.

The United States is the last country in the industrial world without a universal health care system. We spend more per capita ($6,102) yet cover a smaller proportion of the population than Canada ($3,165), France ($3,159), Germany ($3,005) or the United Kingdom ($2,546). At least 47 million Americans lack health insurance. Our outcomes for infant mortality and life span are worse than in these other countries, the Organization for Economic Cooperation and Development reported this year.

The universal health care movement seeks a practical way to solve the health care needs of all Americans. Because the business of America is business, and with apologies to the Letterman staff, here are the top five reasons the business community should care about expanding the federal Medicare program for seniors and those who are disabled to provide Medicare for All: (5) More capable employees: Fully insured part-time and full-time employees mean improved wellness, less absenteeism and better retention. (4) Reduced auto, truck and business insurance costs: Businesses will pay less for upfront insurance because most of the medical portion of bodily injury or chronic disability care needs of an injured party will be covered by Medicare For All. (3) Reduced administrative responsibilities. Expansion of Medicare to cover all citizens, financed by the government but run privately, would eliminate costly employer time and energy to explain benefits each time a new plan is purchased or an old plan is changed. All bills would be paid from a single pool, eliminating time spent dealing with multiple bills from multiple vendors of multiple services using multiple forms. Improved employee morale would follow and labor management expenses would decrease as negotiations on health care benefits would be off the table. Providers and consumers on a payment council would negotiate fair and affordable reimbursements. (2) New money for investments and payroll. The money that responsible large and small businesses pay for health care costs represents a substantial portion of their annual overhead. The modest tax increases that would be required to cover Medicare For All will leave substantial savings in annual overhead costs. Where will businesses spend that windfall? On better wages? Investment in new equipment to be more competitive in the global economy? To create better working conditions?

And the No. 1 reason small and large businesses will benefit from universal health care: (1) Reduced workers’ compensation costs. Workers’ compensation is a huge cost for businesses because of high rates that cover long-term health care costs. Medicare For All would include high quality standard coverage for illnesses or injuries, work related or not, thus eliminating the portion of premiums that pays for special health care under Workers’ Compensation.

The Medicare system is in place. It has a low and reasonable 3 percent overhead for administration. It is essentially nonprofit. Remuneration decisions are politically negotiable; witness the rollback of planned fee cuts for 2006 that would have decreased physician participation. Medicare quality initiatives are active and Medicare quality data are available on the New York state Health Department Web site.

It is time to end the procrastination and to expand Medicare to all citizens. Citizens are in favor of this. A recent Zogby International poll of 1,200 New York residents found 62 percent would prefer a universal health care system like Medicare. An October 2003 Washington Post/ABC poll found by a 2-to-1 ratio Americans preferred a universal system that would provide coverage to everyone under a government program as opposed to the current employer-based system. We challenge the politicians and business community to act now.

Dr. Richard Propp is chairman of the Capital District Alliance for Universal Healthcare Inc.

We deserve U.S. health care

Most citizens back national insurance. A bill in Congress would provide this

By Adam Gilden Tsai | Op-Ed
Philadelphia Inquirer
Oct. 27, 2006

Imagine if Congress passed a bill requiring national public discussions regarding the state of health care in America. Then imagine that these discussions actually happened across our country, and that across the country there was actually a consensus that we need national health insurance to ensure that everyone has access to care. Finally, imagine that when the final report, to be presented to the President and Congress, is drafted, the report makes no mention of this consensus.

There is no need to imagine these things because they have actually happened. The same act that created the Medicare prescription-drug plan mandated the Citizens’ Health Care Working Group (www.citizenshealthcare.gov). The group, which included people from medical and public-health backgrounds, held meetings in cities across the country this year. The questions asked (and voted on) at each meeting were the same, and fell into several categories: what health-care services are important; how health care should be delivered; how best to pay for care; and what trade-offs Americans are willing to make to ensure access to quality affordable health care.

I attended the Philadelphia meeting in April, and there was a range of opinions on some of the topics discussed. Some people voiced a need for better coverage of services such as eye and dental care; others wanted more comprehensive end-of-life care; and still others felt we needed a more rigorous system of health education. There also were differences of opinion on financing issues. For example, some people believe that only the most basic level of benefits should be covered and that everything else should be paid for out-of-pocket, while others felt that anything deemed effective by providers and patients should be covered.

One thing, however, on which there was strong consensus at the Philadelphia meeting, and across the country, was that we need a national health-care system to ensure that everyone has access to care. In fact, when given a choice of 10 reform options, participants in most cities clearly favored a national health program by a ratio of at least 3-1. At meetings where participants were asked to rank the 10 options, national health insurance was ranked first 16 of 19 times (Billings, Mont.; Denver; Des Moines, Iowa; Detroit; Eugene, Ore.; Indianapolis; Jackson, Miss.; Kansas City, Mo.; Memphis, Tenn.; Miami; New York; Philadelphia; Phoenix; Providence, R.I.; Sacramento, Calif.; and Seattle). At two meetings, participants were not polled and options were not ranked.

Despite the clear public mandate, the Citizens’ Health Care Working Group’s report makes no mention of the vast support for a national health program. Instead, the group’s official recommendations include only generic suggestions such as promoting “efforts to improve quality of care and efficiency” and finding a way to protect “against very high health costs.”

From my experience, most supporters of a national health program favor a single-payer system, which retains the private delivery of health care by physicians and hospitals, but organizes payment under a single public agency. A 2003 study in the New England Journal of Medicine found that a single-payer national health-insurance program would save enough on administrative costs – more than $300 billion per year – to cover all of the uninsured and provide full benefits for everyone else.

Public opinion polls show that Americans favor a system of tax-financed health insurance by a 2-1 ratio, as opposed to our current system linking coverage to employment. A May 2006 Keystone poll found that 66 percent of Pennsylvanians favor the U.S. government guaranteeing health insurance to its citizens even if it means raising taxes. The main obstacle to universal health care is the health-insurance industry, which has made a mint covering healthy people who don’t use very much care while avoiding the sick patients who need coverage the most.

If our politicians are listening, they’ll realize we don’t need Wall Street-controlled health-insurance plans to provide us with health care. We need a streamlined system that can provide quality affordable health care for all. U.S. Rep. John Conyers of Michigan has introduced such a bill, the U.S. National Health Insurance Act, also known as House Resolution 676. We should all be pressuring our senators and representatives to support it.

Adam Gilden Tsai, MD, of Philadelphia, is a member of Physicians for a National Health Program (www.pnhp.org), a not-for-profit group that advocates for a tax-funded, privately delivered system of national health insurance.

Americans dissatisfied with rising health care cost

2006 Health Confidence Survey:
Dissatisfaction With Health Care System Doubles Since 1998

By Ruth Helman, Mathew Greenwald & Associates, and Paul Fronstin, EBRI
Employee Benefit Research Institute (EBRI)
November 2006

Findings from the 2006 Health Confidence Survey (HCS) indicate that the public’s increasing dissatisfaction with the American health care system appears to be focused primarily on the rising cost of care. Many Americans report that rising costs have hurt their financial well-being and feel that steps should be taken to slow these increases.

The Cost of Care

More and more, people who experience an increase in health care costs report a negative effect on household finances. The majority with health coverage report they have experienced an increase in the amounts they are responsible for paying under their plan in the last year (60 percent). These Americans are more likely than in previous years to indicate the changes have caused financial difficulties. More than one-third in the 2006 HCS say they have decreased their contributions to retirement plans (36 percent, up from 25 percent in 2004), and more than one-half have decreased their contributions to other savings as a result of the cost increases (53 percent). Almost 3 in 10 indicate they have had difficulty paying for basic necessities, such as food, heat, and housing (28 percent, up from 18 percent), while nearly 4 in 10 report difficulty paying other bills (37 percent, up from 30 percent). One-third say they have used up all or most of their savings (33 percent, up from 26 percent) and more than 2 in 10 each have increased their credit card debt (22 percent) and borrowed money (21 percent, up from 15 percent).

http://www.ebri.org/pdf/notespdf/EBRI_Notes_11-20061.pdf

Comment:

By Don McCanne, MD

The opponents of reform likely will claim that the fault lies with individuals who are irresponsible in their personal financial management. They should reduce their spending on hedonistic pursuits, and use those funds more responsibly, such as the funding their retirement accounts.

With health care, the opponents will claim that patients aren’t paying enough, and that more responsible health care spending will occur only when patients are required to pay more of the costs (consumer-directed health care).

In response, we must contend with two realities: (1) Current national policies are resulting in the transfer of wealth from average-income Americans to the wealthy, and (2) health care costs are continuing to increase at a rate well in excess of inflation.

Suppressing our hedonistic inclinations will never be adequate to resolve the negative financial impact of these two realities.

Policies that create obscene wealth for the few, while threatening access to fundamental needs for the many, do not represent the values that I was taught at home, and in elementary school and Sunday School. But then those were the days when I thought that everyone received medical care when they needed it. How naive.

Does insurance money buy Congressional votes?

Insurance Contributors Favor Republicans; Santorum, Clinton, McGavick Top Recipients

Insurance Journal
October 25, 2006

According to the non-partisan Center for Responsive Politics, insurance political action committees and individuals in the industry had given a total of $22.8 million to candidates in House and Senate races as of Sept. 11, with 66 percent or $15.1 million of that going to Republicans.

The CRP tally of top beneficiaries of insurance giving places two politicians not found together on many of the same lists in the top spots and a former insurance executive in the third position.

The top 10 recipients of insurance political donations (based on FEC data released Oct. 11) are Sen. Rick Santorum, R-Pa. ($416,000); Sen. Hillary Rodham Clinton, D-N.Y. ($340,000); Michael McGavick, Republican former Safeco Insurance executive running for Senate in Washington ($280,000); Sen. Ben Nelson, D-Neb., $262,000); Sen. Mike DeWine, R-Ohio ($253,000); Sen. John Kyl, R-Ariz. ($241,000); Sen. Joseph Lieberman, I-Conn. ($239,000); Rep. Nancy Johnson, R-Conn. ($229,000); Rep. Deborah Pryce, R-Ohio ($218,000); and Rep. Mark Kennedy, Republican Senate candidate in Minnesota.

http://www.insurancejournal.com/news/national/2006/10/25/73546.htm

Hillary Clinton in 1993:

Dead on arrival: why Washington’s power elites won’t consider single payer health reform

By Tom Hamburger, Ted Marmor
Washington Monthly
Sept, 1993

In a separate session with Hillary Rodham Clinton, Dr. David Himmelstein of Harvard Medical School (a close colleague of Quentin Young’s), also pressed the single-payer point. Canada’s solution, he said, made sense for the United States. Himmelstein’s studies, published in The New England Journal of Medicine since 1986, show that the U.S. could save as much as $67 billion in administrative costs alone by cutting out the 1,500 private insurers and going to a single government insurer in each state – easily enough to pay to cover every uninsured American.

Hillary Clinton had heard it all before. How, she asked Himmelstein, do you defeat the multi-billion dollar insurance industry? “With presidential leadership and polls showing that 70 percent of Americans favor [the features of] a single-payer system,” Himmelstein recalls telling Mrs. Clinton. The First Lady replied: “Tell me something interesting, David.”

http://findarticles.com/p/articles/mi_m1316/is_n9_v25/ai_13276711

Hillary Clinton in 2006:

Wounds Salved, Clinton Returns to Health Care

By Robin Toner and Anne E. Kornblut
The New York Times
June 10, 2006

Mrs. Clinton has not pushed a comprehensive coverage plan in her first term in the Senate. As part of the Democratic minority, she says she has primarily focused on defending existing programs from cuts by conservatives.

She also continues to shy from the ultimate challenge: describing what a comprehensive Democratic health care plan would look like. When pressed, for example, on how to control costs, usually the thorniest issue, she replied:
“It depends on what kind of system you’re devising. And that’s still not at all clear to me, what the body politic will bear.”

http://www.nytimes.com/2006/06/10/washington/10hillary.html?ei=5070&en=fd6c7fa7e87f2a78&ex=1162008000&pagewanted=all

Comment:

By Don McCanne, MD

What will the body politic bear? Can a politician maintain objectivity on an issue that can have a major impact on a large donor? Does the appearance of a conflict necessarily translate into an actual conflict? Maybe the voters should tell Senator Clinton “something interesting” when it is time to select the next Democratic candidate for president.