America is wonderful – a mixture of Disney World and Lake Woebegone. You remember Garrison Keilor’s home where all the men are good looking and all the children are above average. In a recent poll review in Provider (Sep. 2004) – a majority of baby boomers believe they are not going to need ongoing health care during their retirement years . Fact: Only 1/3 will drop dead during their first heart attack. Even Bill Clinton got caught needing health care.

Only 14 % of adults between the ages of 50 and 65 believe they will ever need day to day assistance or long term care (nursing home). Fact: Forty three percent will wind up in a nursing home – even when you go to assisted living there is probably a 50 % chance you will graduate to a nursing home – often correlated with when you run out of funds.

Sixty two percent plan to use medicare to pay for long term care services. Fact: – medicare does not pay for nursing home care other than brief rehabilitation programs. Forty per cent expect to use health insurance for their extended care – described as a total misconception of those resources – even if you were lucky enough to have insurance.

Not convinced about Lake Woebegone yet, try this! Twenty percent of the U.S. population believes they are in the top 1 % of income tax brackets. No wonder it does not bother many people when it is mentioned that nearly 50 % of the tax cut went to the upper 1%.

The poll described at the beginning of this note was done by computer on line – suggesting that the group might be above average in education and resources and are much less likely to be in the 45 million who have no health care and the 83 million who have inadequate health care or were without insurance for considerable time during the last two years.

The nation watched survival and reality shows during the conventions, just as big media predicted. This decade will decide how your children and grand children will live – even if they will live. Isn’t 18,000 deaths from lack of health care enough reality? Enough survival? These dramas are playing out every day in our non affluent homes, on the streets and in the emergency rooms. If physicians do not help the public to understand this and even remain uninformed themselves, who will help? Please remember that we pay for universal health care and do not get it! Get it?? Jerry Earll M.D.

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Teamsters President Calls for National Health Insurance
Speech to Detroit Economic Club Focuses on Taxes, Health Care, Trade, Pensions
Press Release, Teamsters web site September 13, 2004

(Detroit, MI) – International Brotherhood of Teamsters General President Jim Hoffa today outlined a four-point plan to restore the American economy in a speech to the Detroit Economic Club.

“It is based upon my experience in reaching out and talking to American workers that I come today to speak about the crisis our nation faces,” Hoffa stated. “It’s a multi-faced economic crisis that is hurting millions of Americans. It is a crisis that is destroying the unity that our nation needs in this time of global terrorism. It’s a tax policy crisis. It’s a health care crisis. It’s a trade crisis. It’s a crisis of retirement security. And, it’s a crisis of wages and jobs.”

Hoffa outlined policy solutions in each crisis area culminating with a call for the American business community to join with organized labor to change the tax system, create a national healthcare plan, revamp our trade policy and support government intervention to protect pensions and retirement security.

“It’s time to create a nationwide business-labor coalition to solve the healthcare crisis once and for all,” Hoffa said. “We need a national healthcare system and we need it now. We can’t afford to wait any longer.”

Hoffa continued on trade, “We are destroying the markets that are necessary to sustain demand. And the biggest market, we are destroying is right here in the United States where the middle class has less and less disposable income. Our trade crisis demands that labor and business forge a solution that puts the American economy first.”

“There’s too much at stake to ignore these issues. We have a responsibility as leaders to keep America strong and safe for future generations,” Hoffa concluded. “Together, we must put America back to work and secure our economic future. I call on you to join me in restoring the American Dream.”

The International Brotherhood of Teamsters represents more than 1.4 million hardworking men and women throughout North America.

Friday, September 10, 2004 (SF Chronicle)
Health care’s reality
by David Lazarus

The original article can be found on SFGate.com here:
http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2004/09/10/BUGU58MFDG1.DTL

denial noun: a psychological defense mechanism in which confrontation with a personal problem or with reality is avoided by denying the existence of the problem or reality..

Is the U.S. health care system working? Here are the facts:

— The number of Americans lacking health insurance rose last year to a record 45 million from 43.6 million in 2002, according to the latest census figures.

— About 5 million fewer jobs now provide health insurance than just three years ago, according to a newly released Kaiser Family Foundation survey.

— For jobs that do provide coverage, insurance premiums climbed 11.2 percent this year, or five times faster than both inflation and average U.S. workers’ salaries.

— Since 2001, premiums for family coverage have soared by almost 60 percent, compared with a 9.7 percent increase in consumer prices and a 12.3 percent gain in wages.

— More than half of companies with at least 200 workers say it’s very likely they will raise employee contributions to health coverage in the near future.

Yet despite such clear evidence of a health care system in crisis, neither President Bush nor Democratic challenger John Kerry has called for meaningful change in how Americans receive medical treatment.

Instead, both candidates favor keeping the current system intact while using taxpayer funds to expand the reach of the insurance industry.

“To expand a system that’s not working is absolute insanity,” said Don McCanne, a Southern California doctor and former president of Physicians for a National Health Program, a 12,000-strong organization advocating medical coverage for all Americans.

The real solution, McCanne and other health care activists believe, is creation of a so-called single-payer system in the United States.

Under such a system, similar to Canada’s state-backed insurance network, any American would be able to receive treatment from any doctor at any hospital nationwide.

It’s not so far-fetched. Federal and state taxes, along with tax subsidies for businesses, already account for about 60 percent of the nearly $1.8 trillion expected to be spent this year on health care in the United States, primarily through Medicare and Medicaid.

For the remaining 40 percent of health care spending, Physicians for a National Health Program advocates replacing private-sector insurance plans with a government-run program that would allocate funds to medical facilities.

A payroll tax of about 7 percent would replace all other employer expenses for medical costs, and an income tax of about 2 percent would replace employees’ current insurance premiums, co-pays, deductibles and other out-of- pocket expenses.

Such a system not only would work — as has been demonstrated in countries that already have single-payer plans — it would be far cheaper to administer than the existing health care system.

Harvard Medical School researchers determined earlier this year that about a quarter of all health care spending in the United States is now squandered on bureaucratic overhead, such as clerical staff at doctors’ offices to process a vast array of insurance forms.

Under a standardized single-payer system, the researchers estimated, annual administrative costs would be slashed by more than $280 billion. This represents enough money to insure all Americans now lacking coverage and to allow millions of underinsured people to improve their quality of care.

Refinements would be necessary to ensure cost controls and quality. A 2001 study, for example, found that Canadians requiring elective surgery wait an average 16 weeks before reaching an operating table. That would have to be improved upon.

But we’ll never know unless we try.

“It won’t be easy,” observed Kevin Grumbach, chairman of UCSF Medical School’s Department of Family and Community Medicine and a longtime backer of universal health care.

“You’re up against formidable special interests,” he said. “The insurance industry, the pharmaceutical industry — everybody making outrageous profits at the expense of delivering rational care to people.”

It should be noted that Canada didn’t rush into a single-payer plan. It experimented with the system on a province-by-province basis, beginning with Saskatchewan in 1946, before implementing it nationwide 25 years later.

State Sen. Sheila Kuehl, D-Santa Monica, believes California is the ideal proving ground to demonstrate that a single-payer system can work in this country as well.

She’s introduced legislation, SB921, which would insure every Californian under a single-payer plan and save the state about $14 billion in annual administrative costs. The bill was approved by the Assembly Health Committee in June by a vote of 12-5.

However, even if signed into law — which no one expects any time soon — SB921 still would require passage of federal legislation allowing state health authorities to serve as a conduit for Medicare funds.

“That’s going to be difficult under this president and this Congress,” Kuehl acknowledged. “The interests of business take precedence at the moment.”

She thinks this will change. First, though, political leaders will have to stop being in denial about the dysfunctional state of the current health care system.

“We’re often in denial about things we don’t know how to solve,” Kuehl said. “But I’m hopeful. Single-payer is so much more efficient and so much more effective. People will see that.”

When they finally accept reality, that is.

David Lazarus’ column appears Wednesdays, Fridays and Sundays. He also can be seen regularly on KTVU’s “Mornings on 2.” Send tips or feedback to
dlazarus@sfchronicle.com.

Copyright 2004 SF Chronicle

Jewish Journal of Greater Los Angeles, September 2004

Israel Has Rx for U.S. Health Careby

Mordechai Shani

Israel and the United States each have successes and failures in their respective health care systems, but the younger of the modern nations, rooted in its tradition of helping the needy, has much to teach its American ally. When it comes to some of the most important issues facing the American health care system today – universal health care, administrative costs and establishing a national health basket of services – America can look to Israel.

Until 1995, health insurance in Israel was voluntary, although 99 percent of the Jewish population and 97 percent of the Arab population were covered by four HMOs, the first of which was established at the end of 1911. This was a system wherein the insured members paid the HMO, and the employer made a compulsory payment to the National Insurance Institute.

Today in Israel, everyone is covered by health insurance. In 1994, the Israeli parliament passed a groundbreaking health insurance bill that made every Israeli resident automatically insured, no matter their age, financial status or religion. In the United States today, more than 43 million people, including 12 million children, are uninsured.

Israel’s universal health care is characterized by its “national health care basket,” which defines the range of services to which every resident is equally entitled. Residents can petition a labor court if they believe an HMO has ignored their rights to a medical service.

Universal access to Israel’s national health care basket means that there is no underinsurance in Israel, which happens when there are gaps in coverage. In the United States, more than 100 million citizens are underinsured, including 40 million with Medicare, 50 million with Medicaid and at least 10 million who are employed in large companies that have self-insurance.

The main health care delivery system for all Israelis is through primary and secondary clinics. These clinics, which are present throughout the country, provide easy and efficient access to care.

The clinics that belong to the HMOs enable quick access to primary medical care and also easy referral to specialists without waiting lists. There is continuity of care, while there is now a tremendous effort to computerize all the medical data.

Ninety-five percent of general care hospitals in Israel are public. There is no wait for diagnostic examinations such as MRI and CT or for procedures such as open-heart surgery. Payment for hospitalization is the responsibility of the HMO, and there is no deductible or co-insurance payment required of the patient.

There is a $3 co-payment for each prescription on the approved drug list covering acute and chronic diseases.

High unemployment and the Israeli economic recession make it difficult for about 10 percent of the population to pay even this, even though there is a $50 biannual co-payment cap.

Caring for the elderly is a core social policy and an integral part of health care in Israel. While in the United States geriatric care is handled by Medicare, in Israel it is part of the health basket and is the responsibility of the HMOs.

Only hospitalization in nursing homes is the responsibility of the Ministry of Health for those who cannot afford to pay for private insurance or from their own means. Geriatric care, being an integral part of health care in Israel, is of high quality.

I do hope that one of the Israeli government’s priorities in an improved economic situation will be to reflect the nation’s social values by exempting the poorest 5-10 percent of the population from drug co-payments.

Israel’s health indicators for longevity and infant mortality are better than those of the United States. This aspect is not unique to Israel, but many Western countries are better in the various indicators of health than the United States. Yet while Israel spends 8.8 percent of its Gross National Product on caring for the elderly, the United States spends 15 percent of its GNP.

In international comparisons of health care systems, Israel ranks among the top 20 in the world. But, even with its favorable standing, Israel faces many challenges, such as the financial limitations of introducing new technologies and prescription drugs to the health basket and the high taxes Israelis pay. Also of concern are high out-of-pocket expenses for cost sharing and for health care services that are covered only by complementary insurance.

Israel’s health care system, while based on the core value of access for all, is still evolving. The establishment of a “health parliament,” a private initiative endorsed by the government, enabled input from ordinary Israelis to help set priorities for the future, including the challenges of limited resources and the growing gap between rich and poor.

Obviously, Israel and the United States differ vastly in size, making full comparisons limited. But with the exception of four large states, Israel is similar in size to most U.S. states. The American health system can be improved only if states take responsibility for health care, or, in the case of the four largest states, if there is regional responsibility within the state.

In 2003, the United States spent at least 30 percent of its national health expenditures on administration, while Israel spent less than 10 percent. The United States could have saved at least $280 billion of the $400 billion spent in administrative expenditures in 2003 to cover the uninsured and to close the gap of the underinsured, strengthening the democratic principles it holds dear.

Professor Mordechai Shani is the director general of Sheba Medical Center at Tel Hashomer, Israel’s largest hospital. He served twice as director general of the Ministry of Health, including 1994, when the Insurance Bill and the Patients Bill of Rights were passed by the Knesset.