PNHP

Canadian socioeconomic status and utilization of imaging services

Canadian socioeconomic status and utilization of imaging services

Socioeconomic status and the utilization of diagnostic imaging in an urban setting
By Sandor Demeter, Martin Reed, Lisa Lix, Leonard MacWilliam and William D. Leslie
CMAJ
November 8, 2005

The pillars of the Canada Health Act are that health care should be comprehensive, universal, accessible and publicly administered and that coverage should be portable between provinces. Acknowledging that health care is under provincial jurisdiction, the federal government provides provinces with financial incentives to realize these goals. As such, income level should have no effect on utilization of insured medical services.

We examined over 300,000 diagnostic imaging claims (general radiology, vascular, computed tomography, magnetic resonance, and general and obstetric
ultrasound) made in the Winnipeg Regional Health Authority between Apr. 1, 2001, and Mar. 31, 2002. Using patient postal codes, we assigned socioeconomic status (SES) on the basis of average household incomes in Canada’s 1996 census.

Interpretation: We found a pattern of increased diagnostic imaging utilization in patient groups with a higher SES.

http://www.cmaj.ca/cgi/content/full/173/10/1173

Comment: This study demonstrates that an equitable system of universal health insurance alone will not ensure equitable access to health care services. Obviously, other factors not addressed in this study also play some role.

Opponents of reform will use this study to further condemn the Canadian single payer system as being incapable of providing equitable access to care. They will then renew their call for private insurance options as the solution, in spite of the fact that there is a disconnect in logic.

Canadians need only to look south of their border to see the profound inequities in access that are created by a fragmented private and public system of funding health care.

Much will need to be done in the United States to reduce the barriers to health care caused by socioeconomic status. A crucial first step would be to eliminate financial barriers by enacting universal, comprehensive national health insurance.

Medicare-for-All would save money and cover everyone

By Merton C. Bernstein
Special to The Star
Kansas City Star

Faced with daunting health insurance costs, American enterprises are eliminating coverage or passing along more of the cost to employees and retirees.

State legislatures, particularly in Missouri, are shrinking Medicaid eligibility and benefits.

There is a better way to tame health-care budgets — eliminate administrative costs by covering everyone through Medicare.

Imagine if the electronics industry used thousands of differently shaped plugs on their appliances, each requiring a matching socket before they could be used. Absurd! But this describes American health insurance: doctors, hospitals, labs and other providers must match their billions of bills with thousands of differing insurance plan provisions, many designed to promote sales rather than sound treatment. Intelligent design? Hardly.

The resulting chaos is unnecessarily costly, with as much as 30 percent of our medical care payments going to process claims. In contrast, in 2004, Medicare administrative costs were 1.9 percent. If Medicare applied to everyone, insurers and care providers would be saved most of what they spend on trying to fit their innumerable plugs into that almost-infinite number of sockets.

Medicare-for-All is the practical answer to the double-digit health-insurance cost increases we’ve faced over the last four years. What’s standing in the way is the outmoded and discredited ideology that the market will discipline health-care costs.

In reality, health-care costs rage out of control. More and more individuals and families lose insurance protection, and medical care charges constitute one of the three major causes of personal bankruptcy. Health-care costs are strangling business and threaten the very existence of many employers with costs that competitors in countries with national health insurance do not face.

State budgets are staggered by the double whammy of having to increase Medicaid outlays for the poor while confronting surging health-care costs of government employees, including teachers.

Health maintenance organizations, touted as a cure, became a disease. Many HMOs collapsed, shriveled or bugged out, stranding their participants. Tax-favored medical savings plans have proven useless, except perhaps to the wealthy.

Tax breaks and other subsidies to encourage coverage only add to total medical care costs, delaying the goal of universal coverage. And as costs escalate out of control, that goal becomes more and more unattainable.

Applying Medicare to everyone would achieve annual savings on the order of $300 billion, enough to cover everyone with a comprehensive plan that surpasses most private coverage and means-tested public programs, even Medicaid.

Establishing and periodically recertifying eligibility for tens of millions of individuals and families under Medicaid incurs administrative costs 5 percent greater than Medicare’s administrative costs. Other federal and state means-tested programs produce similarly unnecessary costs.

For example, Massachusetts operates means-tested programs that use eight different formulas for eligibility and benefits despite similar program goals. Consolidating those programs into Medicare would save tens of billions in administrative costs and give greater assurance that individuals, especially children, would receive timely medical care.

Medicare uses private insurers as intermediaries between providers and patients. These private insurers, under Medicare, operate efficiently and at low cost. Their inclusion in Medicare-for-All would prevent the allegation of “too much government.”

Medicare-for-All would tame costs and make coverage universal. We can readily pay for it by pooling what we already spend on health care. That means no new taxes.

Business, government, individuals and families cannot afford the current costly chaos. It makes economic sense to cut nonbenefit outlays rather than eligibility and benefits.

Those avoidable costs are present but unseen in what we buy or cannot afford. Those unnecessarily higher prices reduce the ability to pay for other needed and desired goods and services. Healthier people incur lower health-care bills, work more productively and avoid the absences and other dislocations that sickness usually brings,

Everyone would be in better hands with Medicare-for-All.

Merton C. Bernstein is a Coles Professor of Law Emeritus at Washington University and a founding board member of the National Academy of Social Insurance.

Physicians push for universal health coverage in Indiana

Health Care Crusade
By Tom Murphy
Indianapolis Business Journal
VOL. 26 NO. 35, NOV. 7-13, 2005

Some heart muscle had already died by the time family members coaxed the 50-something uninsured man into visiting Bloomington Hospital a few weeks ago.

The patient had suffered severe chest pains two days before his hospital visit but didn’t seek treatment, said Dr. Rob Stone, an emergency-room physician there.

“It was clearly because he was afraid of the bill,” Stone said.

By the time he made it to the hospital, the man was suffering a second heart attack. Now he faces a bill even larger than the one he tried to avoid–and possible bankruptcy, Stone said.

The Bloomington doctor said he sees similar cases all the time in his emergency room. If it’s not a heart patient, it’s someone who walked around for days on a broken ankle to avoid paying for an X-ray.

Those scenarios have motivated Stone and a small group of colleagues to push for giant change in Indiana. They want to ditch private health insurance provided by companies like Indianapolis-based WellPoint Inc. and adopt a government-funded, privately administered system that covers every Hoosier.

They envision massive cuts in bulky overhead costs that come with private insurance, generating more money to provide care under the so-called single-payer plan. They see a system that doesn’t exclude people based on pre-existing conditions.

Detractors, however, question those administrative savings. From their view, the system would bog down in bureaucracy and lead to rationed care.

“You tell me one system that the government’s gotten involved with that does work well,” said Norm Springer, president of the Indianapolis chapter of the Washington, D.C.-based National Association of Health Underwriters.

Stone and his group–a half-dozen doctors and professors in Bloomington and Indianapolis–hope to introduce a bill to the Indiana General Assembly by 2007, even though they know they’ll face a fierce battle and near-impossible odds.

At the very least, they want people to start talking about this option, said Dr. Chris Stack, a retired Indianapolis surgeon.

“All people know is, they’ve got insurance or they don’t have insurance and it’s a pain in the ass,” he said. “We basically feel that if people knew the details of a single-payer plan … a majority of the population would support it.”

Coverage for everyone

The group, all members of a local chapter of the Chicago-based Physicians for a National Health Program, started meeting in Bloomington a few months ago to flesh out this Medicare-for-all idea.

“We’re trying to just get some traction, recruit more people and sort of get more leverage,” Stack said.

Currently, most people receive coverage through private insurance or the government-funded Medicaid or Medicare programs. The single-payer plan would end employer-backed insurance and put everyone under the same coverage umbrella.

“What this would gradually do is redeploy money which is currently spent on overhead and profit in the private health care segment into health care for everybody,” said Stack, who also boasts an MBA from Northwestern University.

Private companies such as WellPoint, the nation’s largest health insurer, and its subsidiaries like Anthem Blue Cross and Blue Shield in Indiana might have to shift their focus–and business model–from providing coverage to administering it.

Stack points to Canada, Australia and Japan as models for Indiana. He said his group is not asking for Great Britain’s system, where doctors and nurses are essentially government employees.

In Indiana, such a plan might be funded by blending Medicaid and Medicare money with the state Worker’s Compensation pool and taxes, Stone said. Other states have pitched a similar approach.

Although the details are still sketchy, the group sees crystal-clear reasons for change.

Cutting reams of red tape

The current, public-private system leaves roughly 46 million Americans without insurance, said Dr. Stephen Jay, chairman of the Department of Public Health at the IU School of Medicine.

In Indiana, about 800,000 people have no insurance–a total that amounts to nearly 14 percent of the population, according to the Indiana Family & Social Services Administration.

Stone’s group sees other reasons, too.

About 30 percent of a private plan’s total cost goes toward overhead or administrative expenses–things like keeping the office lights on or marketing the policy, according to Stack. The group envisions huge savings by slashing that percentage with a single payer.

“The basic contention we have is, they don’t add any value to health care,” he said. “This is just a business.”

Having a single payer also would trim the pre-authorizations and pre-certifications for care that frustrate doctors, Stack said.

“[A single payer] would not screen out anybody because they’ve been sick,” he said. “There would not be any disqualifying feature.”

The idea of efficient spending for the private insurer, he contends, involves weeding out the sick and unhealthy.

The business emphasis in the current system also undermines the trust between patient and provider, IU’s Jay said.

“Health care is viewed as a business just like any other,” he said. “There are worries about whether the people in that business are looking after my health concerns.”

Clunky bureaucracy

Those who don’t love the idea of universal coverage–insurance industry representatives, for instance–see several flaws.

Anthem spokesman Tony Felts doesn’t buy the great overhead savings predictions. He contends the competitive private market compels insurers to work efficiently and breeds innovation.

He offers up the new health savings account plans as a prime example of how insurers react to demand from employers.

“When you have a large bureaucracy that is running a health care system, it’s not nimble and isn’t as responsive to changing market forces,” he said.

Single-payer systems like Canada’s also can lead to rationing of care, especially for expensive treatments, Felts said.

“There’s no guarantee, even in a single-payer system, that promises universal care … that a certain medical procedure won’t be eliminated or rationed to reach the savings that are projected,” he said.

A single insurance provider also would limit the number of coverage options a person can choose from, Anthem Vice President Dr. David Lee noted at a panel discussion hosted this fall by IBJ.

Medicaid and Medicare also reimburse providers at rates lower than private health insurance, the National Association of Health Underwriters’ Springer said. He’s not sure many doctors would back the pay cut that might come from a single-payer system.

Indeed, Stone and members of his group are in the minority among doctors. Specialty surgeons might see a pay cut under this system, while doctors who treat a large number of poor patients could come out ahead.

However, he believes the single-payer system is growing.

“I think more and more physicians are realizing the current system really interferes with the doctor-patient relationship and is just full of headaches,” he said.

A popular idea in some circles

Single-payer proponents have kept a low profile so far, but the idea has attracted some high-level attention in central Indiana.

Health care needs to undergo big changes to its market-driven system–or something drastic like a switch to a single payer, said Alex Slabosky, president and CEO of The HealthCare Group LLC, which owns and operates the state’s second-largest insurer, M-Plan Inc.

Slabosky cited the number of uninsured Americans as proof the current system doesn’t work.

“I personally believe in a single-payer system, but if you want to preserve the market, we need to change the way the market system works,” he said during the IBJ-sponsored panel discussion.

A single-payer system that cares for everyone is the inevitable answer, said Robert J. Brody, president and CEO of Beech Grove-based St. Francis Hospital & Health Centers. Most hospitals or providers make up for the money they lose on Medicaid, Medicare and the uninsured by hiking charges to private insurance.

That leads to double-digit insurance premium increases, which leads to more people dropping coverage, which leads to more uninsured.

“I don’t see how we can maintain the status quo and expect any good result,” he said.

A tall order

At least 18 states introduced legislation this year advocating a universal, coverage-for-everyone health care system, according to Physicians for a National Health Program. None of those proposals made it out of their respective legislatures.

Still, the state level remains the best place to build traction for this push, said Dr. Ida Hellander, the program’s executive director. Neither political party has taken the leadership reins nationally on this issue.

She noted that Canada’s national health care system started in the province of Saskatchewan and spread. In the States, Wisconsin gave birth to Social Security.

“There is precedent for both health care and our other safety-net programs to start in one state and spread from there,” she said.

Just don’t look for that precedent to come from Indiana.

A single-payer system involving the government would be “very difficult” to work through the General Assembly, said State Sen. Patricia Miller, R-Indianapolis, who chairs the Senate’s health finance committee and health and provider services committee.

The idea raises too many questions for her about funding and whether people would want to give up their private benefits. She sees much more support for measures that focus solely on helping the uninsured.

“The single-payer issue to me makes it much more complicated than just getting people who don’t have health insurance covered,” she said.

State Rep. Charlie Brown, D-Gary, pitched a bill for universal coverage in the late 1980s. It didn’t survived the Legislature.

Brown said he still doesn’t see enough support there.

“But that does not mean it should not be tried,” he said, “and I am willing to carry that banner again.”

Medicare endorsement equals cash for AARP

Letters to the Editor
Des Moines Register
November 7, 2005

As the cries of outrage over the new Medicare drug plan grow louder, the shadow cast over the AARP grows darker.

It was AARP’s endorsement in 2003 that propelled the plan through Congress. The organization told members that the need to expand Medicare to cover prescription drugs was sufficiently urgent to outweigh the law’s faults. What few understood at the time was that the law went far beyond drugs and provided for the dismantling of Medicare in favor of taxpayer-supported, private-profit health plans. And AARP’s “nonprofit” arm stood to make big bucks off the plan.

AARP has collected hundreds of millions for use of its logo by private firms, including, under the new law, United Health Care. It makes millions more skimming profits from premiums it collects for private insurers. Its defenders contend that AARP’s nonprofit and for-profit segments are totally independent. Yeah, right. But it’s impossible to dispute that the nonprofit activities that supposedly champion retirees’ causes are what makes its endorsements profitable.

Former Gov. Terry Branstad, in an Oct. 22 Register essay that sounded as if it were composed by the pharmaceutical lobby, defended the Medicare drug plan as providing relief to the elderly who now pay huge drug bills. Some of the elderly may enjoy some benefits, but far from enough to justify the cost to taxpayers imposed by the drug makers.

One of the law’s most outrageous provisions prohibits Medicare from negotiating drug prices – meaning the pharmaceutical industry will set the price, subject to change without notice.

And, in what appears to be an effort to panic Medicare users into buying into this nonsense, the law imposes a penalty of 1 percent per month on the premiums of those who don’t sign on promptly.

Why are drugs cheaper in Canada? Because Canada negotiates the price. So does Veterans Affairs. So does Medicaid. And the pharmaceutical industry would like to force them and all other buyers into line.

The answer? Congress should shift into reverse and kill the 2003 Medicare revisions now, before the roots of this noxious weed get firmly established.

-Bill Leonard, Des Moines

Krugman's solution for employment-based health insurance

Pride, Prejudice, Insurance
By Paul Krugman
The New York Times
November 7, 2005

Employment-based health insurance is the only serious source of coverage for Americans too young to receive Medicare and insufficiently destitute to receive Medicaid, but it’s an institution in decline. Between 2000 and 2004 the number of Americans under 65 rose by 10 million. Yet the number of nonelderly Americans covered by employment-based insurance fell by 4.9 million.

The funny thing is that the solution – national health insurance, available to everyone – is obvious. But to see the obvious we’ll have to overcome pride – the unwarranted belief that America has nothing to learn from other countries – and prejudice – the equally unwarranted belief, driven by ideology, that private insurance is more efficient than public insurance.

The U.S. system is much more bureaucratic, with much higher administrative costs, than those of other countries, because private insurers and other players work hard at trying not to pay for medical care.

The economic and moral case for health care reform in America, reform that would make us less different from other advanced countries, is overwhelming.
One of these days we’ll realize that our semiprivatized system isn’t just unfair, it’s far less efficient than a straightforward system of guaranteed health insurance.

http://select.nytimes.com/2005/11/07/opinion/07krugman.html?hp

Comment: Although most are familiar with Paul Krugman’s column in The New York Times, some may not be aware that he is a Professor of Economics at Princeton. He received his Ph.D. from MIT, and has taught at Princeton, Yale, MIT and Stanford. The point is that he thoroughly understands the economic case for national health insurance. Our task is to make sure that everyone else does too.

Spin Control at Wal-Mart

By Liza Featherstone
The Nation

Today marks the premiere of Robert Greenwald’s documentary Wal-Mart: The High Cost of Low Price, and Wal-Mart is ready with a “war room” led by Robert McAdam, who is, charmingly, the former strategist for the tobacco industry.

Wal-Mart’s spin machine is being sorely tested. Just last week, a secret internal memo recommending that the company curb healthcare costs by “dissuad[ing] unhealthy people from coming to work at Wal-Mart” was leaked to the advocacy group Wal-Mart Watch. The memo’s suggestions included designing “all jobs to include some physical activity (e.g., all cashiers do some cart-gathering).” This amounts to nothing less than a plan to discriminate against the disabled, sick and elderly. It’s contemptible, of course, but it also has serious legal implications; Wal-Mart has been forced to settle lawsuits from disabled workers in the past, and this memo will almost definitely strengthen the case of any who wish to sue the company in the future.

In the memo, whose contents were first revealed in the New York Times, Wal-Mart admits that criticism of its meager, unaffordable healthcare plan is contributing to the decline of Wal-Mart’s overall reputation and that “our critics are correct in some of their observations…our coverage is expensive for low-income families, and Wal-Mart has a significant percentage of Associates and their children on public assistance.” The memo acknowledges that 46 percent of Wal-Mart workers’ children are either on Medicaid or uninsured.

It’s very clear that criticism and public pressure are bothering Wal-Mart’s leaders. So far, they are mostly investing in spin and devising harebrained–and inhumane–schemes like those outlined in the memo. But the same memo does contain a glimmer of hope that the company could respond to pressure by doing something good–in particular, a suggestion that the company “refram[e] the debate” on healthcare, emphasizing that “this is everybody’s problem, not just Wal-Mart’s” and “establishing Wal-Mart as a leader on this critical issue.” We couldn’t agree more. The best way for Wal-Mart to curb its healthcare costs–and improve its image–would be to lobby for single-payer national health insurance; for its activist critics, all this pressure on the company to improve its health benefits should be a means to that end.

As unrealistic as that might sound–after all, Wal-Mart is a right-wing company, whose campaign contributions tend to favor antigovernment Republicans, not European-style social democracy–there is no telling what people might do when under enough political and economic pressure.

A recent study commissioned by Wal-Mart showed that from 2 percent to 8 percent of its customers had stopped shopping there because of “negative press.” All of this is having some surprising effects, including unpredictable policy recommendations from the company’s leadership.

Last week, CEO Lee Scott called for increasing the minimum wage, a suggestion that drew howls of wounded betrayal from the company’s usual defenders on the Wall Street Journal editorial page, but which Scott rightly pointed out would help the company’s customers, many of whom are low-wage workers. National health insurance would do the same, while allowing the company to save money on benefits–and on spin.

Paying former tobacco lobbyists to convince the public that Wal-Mart is a good corporate citizen is going to get expensive.

This article can be found on the web at:

http://www.thenation.com/doc/20051121/wal-mart_nation

For Americans, Getting Sick Has Its Price

Survey Says U.S. Patients Pay More, Get Less Than Those in Other Western Nations
By Rob Stein
Washington Post Staff Writer
Friday, November 4, 2005;

Americans pay more when they get sick than people in other Western nations and get more confused, error-prone treatment, according to the largest survey to compare U.S. health care with other nations.

The survey of nearly 7,000 sick adults in the United States, Australia, Canada, New Zealand, Britain and Germany found Americans were the most likely to pay at least $1,000 in out-of-pocket expenses. More than half went without needed care because of cost and more than one-third endured mistakes and disorganized care when they did get treated.

Although patients in every nation sometimes run into obstacles to getting care and deficiencies when they do get treated, the United States stood out for having the highest error rates, most disorganized care and highest costs, the survey found.

“What’s striking is that we are clearly a world leader in how much we spend on health care,” said Cathy Schoen, senior vice president for the Commonwealth Fund, a private, nonpartisan, nonprofit foundation that commissioned the survey. “We should be expecting to be the best. Clearly, we should be doing better.”

Other experts agreed, saying the results offer the most recent evidence that the quality of care in the United States is seriously eroding even as health care costs skyrocket.

“This provides confirming evidence for what more and more health policy thinkers have been saying, which is, ‘The American health care system is quietly imploding, and it’s about time we did something about it,’ ” said Lucian L. Leape of the Harvard School of Public Health.

The new survey, the eighth in an annual series of cross-national surveys conducted by Harris Interactive for the fund, is the largest to examine health care quality across several nations during the same period. The survey was aimed at evaluating care across varying types of health care systems, including the market-driven U.S. system and those that have more government controls and subsidies.

The survey, published in the journal Health Affairs, questioned 6,957 adults who had recently been hospitalized, had surgery or reported health problems between March and June of this year.

“These patients are the canary in the coal mine of any health care system,” Schoen said.

Nearly a third of U.S. patients reported spending more than $1,000 in out-of-pocket expenses for their care, far outpacing all other nations. Canadians and Australians came next, with 14 percent of patients spending that much. The proportion reporting similarly high costs was far lower in the other countries.

Americans had the easiest access to specialists, but they experienced the most problems getting care after hours, and Americans and Canadians were the most likely to report problems seeing a doctor the same day they sought one.

Americans were also much more likely to report forgoing needed treatment because of cost, with about half saying they had decided not to fill a prescription, to see a doctor when they were sick or opted against getting recommended follow-up tests. About 38 percent of patients in New Zealand reported going without care; the numbers were 34 percent in Australia, 28 percent in Germany, 26 percent in Canada and 13 percent in Britain.

“If that’s not a reason for moral outrage, I don’t know what is,” Leape said. About one-third of U.S. patients reported problems with the coordination of their care, such as test results not being available when they arrived at a doctor’s appointment or doctors ordering duplicate tests. In the other countries, 19 to 26 percent of patients reported similar problems.

Americans also reported the greatest number of medical errors. Thirty-four percent reported getting the wrong medication or dose, incorrect test results, a mistake in their treatment or care, or being notified late about abnormal test results. Only 30 percent of Canadian patients, 27 percent of Australian patients, 25 percent of New Zealanders, 23 percent of Germans and 22 percent of Britons reported errors.

“The findings show that we have a lot to learn from our colleagues” in other countries, said Carolyn Clancy of the federal Agency for Healthcare Research and Quality during a briefing at which the results were released. She said the federal government has launched a number of initiatives to find ways to improve care, particularly for the increasing number of Americans with chronic illness.

“The findings here reinforce how difficult it is coordinating care. . . . That’s the next frontier,” Clancy said.

Rx for America: a national health plan

Fewer workers each year receive health insurance from their employers
By Ron Gettelfinger
Special to The Detroit News
Friday, November 4, 2005

In recent weeks, members and retirees of our union have confronted a new set of challenges in the field of health care.

The roots of this problem, however, are hardly new. As Walter Reuther said during an address to the American Public Health Association in 1968:

“We must first free ourselves of the illusion that we really have a health care system in America. What we have is a disorganized, disjointed, antiquated, obsolete non-system of health care. Consumers are being required to subsidize a non-system that fails to deal with their basic health care needs and the cost of that system is continuing to skyrocket.”

Unfortunately, the problems have only become more serious in the intervening years. We now have nearly 46 million Americans — including more than 8 million children — with no health insurance at all.

Current system is wasteful

The U.S. has the best doctors, nurses and health care professionals anywhere in the world. But they are hindered by an ineffective, wasteful bureaucratic system. Our nation spends approximately $1.7 trillion, or 15.4 percent of our gross domestic product, on health care. Four hundred billion of this sum is absorbed by the cost of paperwork and administration.

Additionally, prescription drugs cost more in the United States than in any other country. One reason for these high costs is that pharmaceutical companies spend more than any other industry on lobbying, with more than 1,200 lobbyists in Washington. These lobbyists are doing well for their employers, crafting laws and regulations to protect an industry which earns tens of billions in profits each year. But what are they accomplishing for the rest of us?

For all our health care spending, the United States ranks near the bottom among industrialized countries on life expectancy, infant mortality and virtually every other measure. In fact, the infant mortality rate in our nation’s capital is more than double the infant mortality rate in Beijing.

America deserves better.

Fewer workers covered

Our health care is based on employment, but each year, fewer employers are providing company sponsored insurance. The figure is now down to 60 percent, a decline from 69 percent in 2000. Members of our union have learned through hard experience that relying on individual employers to provide health care is inefficient and a drag on our ability to compete in the global economy.

At General Motors, for example, we recently negotiated an agreement intended to preserve the company’s ability to provide affordable health care for workers and retirees for many years to come. During this process, we had to confront GM’s staggering $61 billion liability for the cost of present and future UAW retiree health care.

Foreign firms have advantage

Global auto companies like Toyota, Honda and Volkswagen have little or no liability for retiree health care because in industrialized nations outside the United States, health insurance is a government responsibility.

With universal health insurance, no employer gains an advantage by offering lower benefits or passing higher costs onto workers. Does it make any sense for the United States to continue on a policy course — employer-based health care — which delivers inferior care to our citizens and gives foreign manufacturers a cost advantage worth tens of billions of dollars over U.S. companies that employ U.S. workers?

To be sure, no government policy will help a company that can’t make products consumers want to buy. But a modern, competitive national health insurance system would go a long way toward helping U.S. manufacturers make products at affordable prices. We need a uniquely American system, not one that tries to copy a solution from a different country. A workable American plan would be universal, covering every single man, woman and child in the United States. It would be comprehensive, offering a range of medical benefits for workers and families. And it would have only a single payer, creating the leverage needed to negotiate the cost of medical care and keep prices from rising every year.

We’ve heard time and again that national health insurance might be a good idea, but it’s not politically possible in the United States at the present time. One thing is for sure: it’s not possible to ignore our current health care crisis any longer. American workers — and American employers — can’t afford it.

http://www.detnews.com/2005/editorial/0511/04/A15-371331.htm

Ron Gettelfinger is president of the United Auto Workers union.

Getting serious about the economy

By Michael R. Huckleberry
Midland Daily News
10/30/2005

The recent announcement regarding General Motors plan to cut back on health care came as no surprise. The only thing America seems to “win” lately is the “race to the bottom.” Didn’t anyone realize that when “big business” started to outsource our jobs to countries that pay workers so little they cannot buy the products they make this would be inevitable? Big business has not created a trading partner that would bolster our own economy … they turned the “American Dream into the American Nightmare.”

As a small business owner I have no problem understanding that people need good paying jobs with benefits to support their families, small business, and of course, this nation. It is my hope that as we “win this race to the bottom” that my “brothers and sisters” in the business world realize what is happening to them and it isn’t good.

Corporate greed has put our entire nation in danger, and now it is starting to catch up with some of the “big businesses” that helped lead us to this dire situation. We, as a nation of entrepreneurs, skilled laborers, farmers and middle management, are being punished for leading the world in building a strong middle class. Trade agreement that only benefit a few and do not build profitable trade partners will only hasten our “race to the bottom”

There may be a solution to this free fall. First we must vote out of office those who have supported these trade agreements. They are like “Economic Suicide” and our legislators know this! They either have investments in companies that outsource, or they receive large contributions from them, or both.

Second, it is time to get serious about “single payer health insurance”. We simply cannot continue to be in denial about our current health care system. It is a national disgrace. This country has over 45 million people with no health care insurance. High insurance rates are crippling our employers, making it difficult to compete in the current global economy. Of 19 industrialized nations America is the only one without a single payer health care system. It is reported that about 18,000 people died last year in America because they had no insurance. That makes it a moral issue as well. Health savings accounts, and AHP’s and other “gimmicks” that are being promoted by some legislators don’t cut it. Some are being promoted because, once again, of heavy contributions and stock ownership. Who is against single payer health insurance? … insurance companies, drug companies, politicians who benefit, and the extreme right who scream “socialized medicine”.

We are not talking about socialized medicine, we are talking about saving America with an insurance program that is fully funded. The “far right” fought us every step of the way when we wanted Social Security, Medicare, and Medicaid. When we finally got them, we shared them with everyone. I am sure someone in your family has benefited from these insurance programs. These programs have kept us from having a third world standard of living, and they work well when properly managed and funded.

This new prescription section of the Medicare bill that the “far right” has imposed on us has no provision to pay for it and no provision to negotiate for lower drug prices. That is socialized medicine, and more debt for our nation. Who’s tax dollars are they looking out for?

I believe that “single payer health insurance” is the number one way to kick start our economy.

We must act now, as our nation’s future depends on it.

Michael R. Huckleberryis a candidate for 4th District U.S. House. He lives in Greenville.

Krugman’s solution for employment-based health insurance

Pride, Prejudice, Insurance
By Paul Krugman
The New York Times
November 7, 2005

Employment-based health insurance is the only serious source of coverage for Americans too young to receive Medicare and insufficiently destitute to receive Medicaid, but it’s an institution in decline. Between 2000 and 2004 the number of Americans under 65 rose by 10 million. Yet the number of nonelderly Americans covered by employment-based insurance fell by 4.9 million.

The funny thing is that the solution – national health insurance, available to everyone – is obvious. But to see the obvious we’ll have to overcome pride – the unwarranted belief that America has nothing to learn from other countries – and prejudice – the equally unwarranted belief, driven by ideology, that private insurance is more efficient than public insurance.

The U.S. system is much more bureaucratic, with much higher administrative costs, than those of other countries, because private insurers and other players work hard at trying not to pay for medical care.

The economic and moral case for health care reform in America, reform that would make us less different from other advanced countries, is overwhelming.
One of these days we’ll realize that our semiprivatized system isn’t just unfair, it’s far less efficient than a straightforward system of guaranteed health insurance.

http://select.nytimes.com/2005/11/07/opinion/07krugman.html?hp

Comment: Although most are familiar with Paul Krugman’s column in The New York Times, some may not be aware that he is a Professor of Economics at Princeton. He received his Ph.D. from MIT, and has taught at Princeton, Yale, MIT and Stanford. The point is that he thoroughly understands the economic case for national health insurance. Our task is to make sure that everyone else does too.

The safety net is tattered

Kaiser Commission on Medicaid and the Uninsured
November 4, 2005

Covering the Uninsured – Growing Need, Strained Resources

In 2004, America’s 46 million uninsured received about $41 billion dollars in uncompensated care – care that was not paid for either by the uninsured themselves or by another identifiable source. Most of the care received by the uninsured is provided through the informal network of hospitals, clinics, and health centers, referred to as the “safety net,” which is supported by federal, state, and local government as well as private sources. About half of all safety net funds come from the federal government, but they still comprise less than one percent of overall federal spending.

After adjusting for medical inflation and using constant 2004 dollars, total federal spending on the safety net increased by only slightly more than one percent between 2001 and 2004. Because the number of uninsured grew by nearly 5 million people, federal spending actually decreased from $546 to $498 per uninsured person over this time – a decline of 8.9%.

The federal commitment to the health care safety net has not kept pace with the growth in the uninsured, and future federal funding appears unlikely to reverse this trend. Most federal safety net spending flows through Medicare and Medicaid, both of which are under severe budgetary pressures. If safety net resources continue to decrease as the number of uninsured increases, the amount of care provided to the uninsured will be jeopardized, with further consequences on their health and the health of the country.

http://www.kff.org/uninsured/upload/Covering-the-Uninsured-Growing-Need-Strained-Resources-Fact-Sheet.pdf

The Uninsured and Their Access to Health Care

Charitable physicians and the safety net of community clinics and public hospitals do not fully substitute for health insurance. Lack of health coverage matters for millions of uninsured Americans – affecting their access to care, health status, job decisions, and financial security, as well as exacting an indirect toll on society in terms of more disability, lower productivity, and increased burden on the health care system.

http://www.kff.org/uninsured/upload/The-Uninsured-and-Their-Access-to-Health-Care-Fact-Sheet-6.pdf

Five New Reports Profile the Growing Uninsured Population and Portray the Health Care Safety Net as Increasingly Strained:
http://www.kff.org/uninsured/kcmu110405pkg.cfm

Comment: Lacking the “insurance ticket” that authorizes access to the private health care delivery system, the uninsured must depend on the safety net. When you consider that premiums for employer-based coverage for an individual averaged $3481 in 2003, it is difficult to imagine that the current safety net federal spending of $498 will pay for much care for the uninsured who typically have greater needs than the higher-income, healthier work force.

Since programs for safety net funding are considered to be welfare programs, the weak political voice for the uninsured is always drowned out by the strong political voices calling for fiscal restraint. Safety net institutions will never receive adequate funding until they are included in a single, universal risk pool.

We will always need community health centers and public hospitals. But to fund them adequately we will need to establish a program of comprehensive, universal health insurance, with everybody in, nobody out.

Health systems provide mediocrity for sicker adults

Taking The Pulse Of Health Care Systems: Experiences Of Patients With Health Problems In Six Countries
By Cathy Schoen, Robin Osborn, Phuong Trang Huynh, Michelle Doty, Kinga Zapert, Jordan Peugh, Karen Davis
Health Affairs
November 3, 2005

This paper reports on a 2005 survey of sicker adults in Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States. Sizable shares of patients in all six countries report safety risks, poor care coordination, and deficiencies in care for chronic conditions. The United States often stands out for inefficient care and errors and is an outlier on access/cost barriers.

As found in past surveys, the United States is an outlier for financial burdens on patients and patients forgoing care because of costs. Half of sicker adults in the United States said that they did not see a doctor when sick, did not get recommended treatment, or did not fill a prescription because of cost. On each access/cost question, the U.S. rate was 1.5 to double the forgone care rates reported in the next-highest country.

Moreover, the percentage of U.S. sicker adults forgoing care because of costs was much higher on all three indicators compared with the 2002 survey of sicker adults. Despite these high rates of care forgone, one-third of U.S. patients spent more than $1,000 out of pocket in the past year, a level rare in the other countries. Insured and uninsured U.S. patients were about equally likely to report expenditures this high (34 percent insured and 32 percent uninsured).

Symptoms of inadequate insurance coverage and more fragmented care in the United States emerged throughout the survey. The United States outspends the other countries, spending 14.6 percent of national income compared with Germany’s 10.9 percent, Canada’s 9.6 percent, Australia’s 9.1 percent, New Zealand’s 8.5 percent, and the United Kingdom’s 7.7 percent. Yet the United States often ranks last or tied for last for safety, efficiency, and access.

With one-third of U.S. patients reporting medical, medication, or lab errors and a similar share citing duplicate tests or medical record delays, our findings indicate widespread performance deficiencies that put patients at risk and undermine care. Moreover, a recent study finds that the United States is not systematically a leader in clinical outcomes.

Confirming spending data from the Organization for Economic Cooperation and Development (OECD), the United States also stands out for its patient cost burdens, with consequences for access. U.S. physician visit rates are already low by OECD standards. To the extent that U.S. insurance continues to move toward higher front-end patient deductibles, these rates could go up, as increasing numbers of insured patients become “underinsured,” lacking access or adequate financial protection. Contrasts between the United States and Germany, in particular, indicate that it is possible to organize care and insurance to achieve timely access without queues, while ensuring that care is affordable at the point of service. There are clear opportunities for the United States to learn from other countries’ insurance systems.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.509v1

Release from The Commonwealth Fund:
http://www.cmwf.org/publications/publications_show.htm?doc_id=313012&#doc313012

Comment: This is yet another report that confirms that the United States does not have “the greatest health care system on earth,” even though we are paying enough such that we should have it. Our lowest ratings in these international comparisons stem from our fragmented system of funding care.

We can learn much from other countries’ insurance systems. Combining optimal insurance policies with our great resources should provide the first giant step toward providing us with what would truly be the greatest health care system on earth.