PNHP

Pro & Con – Are tax credits the best way to cover the uninsured?

Pro & Con – Are tax credits the best way to cover the uninsured?

Pro & Con – Family Practice News, April , 2004
Are tax credits the best way to cover the uninsured?

PRO: Dr. John C. Nelson, AMA
CON: Dr. Don McCanne, Physicians for a National Health Program

Dr. John C. Nelson is president-elect of the American Medical Association.

Providing health insurance to the swelling ranks of the uninsured has become one of America’s most pressing health care issues.

As physicians, we know that when our patients don’t have insurance, their health is in jeopardy. In fact, uninsured women are twice as likely as women with insurance to die if they have breast cancer. While many states and the federal government are working to cover the uninsured, much more needs to be done to provide the majority of uninsured Americans with stable health care coverage.

To most effectively increase health care coverage, we need a national solution that builds on the strengths of our current system. The American Medical Association has long held that properly structured tax credits are the best approach to covering the uninsured.

The existing tax exclusion for employer spending on health insurance should be transitioned to a system of tax credits for individuals and families to obtain health insurance. Currently, the government provides a $100 billion subsidy for health insurance to employees who receive employer-sponsored health insurance every year. The result: Two-thirds of the tax subsidy goes to the wealthiest one-third of American families.

Tax credits should be inversely related to income and generous enough to put health insurance within everyone’s reach. They should be refundable, and advanceable, so that families who owe little or no income tax still receive the tax credit, and those who cannot afford monthly out-of-pocket premium payments can purchase coverage without waiting for a year-end tax credit.

Just as strong as the AMA’s support for tax credits is our opposition to the single-payer health system proposal. Long waits for health care services, delays in adopting new technologies and maintaining facilities, and development of a large bureaucracy that can cause a decline in the authority of patients and their physicians over clinical decision-making are all hallmarks of the single-payer system.

We need a plan that will work, and tax credits are an idea whose time has come. In 2002, tax credits for displaced workers gained bipartisan support and became available through federal legislation, and President Bush recently reaffirmed his support for tax credits with his proposal to establish refundable tax credits to help low-income workers buy health insurance coverage. In addition, the major Democratic presidential candidates have embraced tax credits as part of their health care plans.

Currently, there is little choice in health insurance plans. Most Americans have health insurance through their employers, and more than 90% of employers offer only one plan. Through tax credits, individuals and families would be able to select any plan of their choosing, and insurers would be more responsive to patient demand for access, quality, and affordability. This shift in choice and ownership would spur insurers to innovate new plans and new forms of coverage, including a wider range of affordable coverage options.

Let’s act now to better the health of our nation’s uninsured men, women, and children by working together to promote a solution that works for individual and family tax credits to purchase health insurance.

———————————

Dr. Don McCanne is immediate past president of Physicians for a National Health Program.

Tax credits are not the best way to cover the uninsured. The goal of reform should be to provide comprehensive, but affordable, coverage for everyone. Tax credits fall short on these goals.

Tax credit proposals are designed to provide financial assistance for the purchase of private health plans that are becoming less and less affordable. The problem is that private plans are an expensive, inequitable, and administratively inefficient method of funding health care. They waste resources on their own administrative excesses and especially through the tremendous administrative burden that they place on the health care delivery system. And since tax credits do not cover the entire premium, many people still will be left without coverage simply because they cannot fund their portion.

Studies have shown that tax credits for individual plans would have only a very minimal impact on the numbers of the uninsured since uptake of the plans would be mostly offset by the incentives for employers to drop coverage for their employees. As the amount of the credit increases, the rate of termination of employer-sponsored plans also increases. Shifting employees to the individual market is a problem because premiums are higher for comparable coverage, benefits are lower, and cost sharing is greater. Those with the greatest need for coverage may be excluded from the individual market because of preexisting disorders.

Other studies have demonstrated that using tax policies to assist with the purchase of group plans is the most expensive method of expanding coverage. Large employers and government purchasers such as the Federal Employees Health Benefit Program have failed to control escalating costs. Middleman health plans were able to slow cost increases through provider contracting. But that sponge was wrung dry, and they no longer are able to further slow the growth in costs. Providing more federal funding would only add fuel to this health care cost explosion.

There is a way to provide affordable, comprehensive coverage for everyone. Replacing our fragmented, wasteful system of private plans, public programs, and no programs at all with a single, publicly funded and publicly administered universal insurance program would provide enough administrative savings to pay for comprehensive care for everyone, with no increase in our current level of health care spending. This has been demonstrated not only by microsimulation models, but also by the actual experience in other nations. And the United States has the unique advantage that the $1.79 trillion that we are already spending is more than enough to ensure a capacity that would prevent excessive queues, and to continue to provide adequate incentives for future technologic innovation.

Instead of pouring more tax dollars into a wasteful, flawed, and inefficient system of funding care, let’s adopt a much more equitable and affordable system. Our current private and public health care delivery system would function much more effectively under a publicly funded and administratively efficient system of insurance that truly covers everyone.

Copyright © 2004 by International Medical News Group, an Elsevier company.

Greeley, Colo., Hospital Suffers Financial Crisis

Knight Ridder/Tribune Business News
The Miami Herald
Apr. 02, 2004
Greeley, Colo., Hospital Suffers Financial Crisis
By Tom Hacker, Greeley Tribune

Bad debt, charity care and federal reimbursement shortfalls are strangling Colorado hospitals, with Greeley’s hospital shouldering a disproportionate share of the statewide burden, an industry report released today says. And North Colorado Medical Center’s top official said Thursday the numbers show a crisis so severe that only a move toward a national health-care system would bring a solution.

“I was one of the last people, because of my political leanings, to ever see a national health plan as the way to go,” said Jon Sewell, NCMC’s chief executive officer. “But it’s becoming more and more apparent that that’s the only solution I can envision. You can’t have this growing gap between haves and have-nots.”

The widening gap had reached a crisis point that required a shift in thinking toward a national health-care solution, Sewell said. “In Greeley and the rest of the country, we’re at the breaking point as more and more people are moving from the managed-care category” into the uninsured or underinsured groups, he said.

“We need a national health plan that covers everybody to some degree. Something has to happen. We are literally at the brink.”

http://www.miami.com/mld/miamiherald/business/national/8341077.htm

Comment: “Political leanings” have little significance in the face overwhelming evidence that our system of funding health care is fatally flawed. The $1.79 trillion that we are spending this year is more than enough to fund comprehensive care for everyone. Objective assessment of the various funding options available inevitably leads to the conclusion that only a national health plan is capable of allocating our resources effectively, even if some political persuasions have resisted this conclusion.

It’s time to lay partisanship aside and proceed with the restructuring of health care funding. After all, it’s for our health.

The Puzzling Popularity Of The PPO

Health Affairs
March/April 2004
The Puzzling Popularity Of The PPO
By Robert E. Hurley, Bradley C. Strunk and Justin S. White

The PPO benefit option is assumed to offer more choice of providers, less
restrictive features for consumers, fewer impositions on caregivers, and lower administrative costs to purchasers. Less apparent is that many employers, increasingly concerned about controlling rising costs, are adopting benefit offerings that are more flexible in terms of customized design and less subject to regulatory strictures. For them, the virtue of the PPO design is its malleability, as its component parts can be shaped into an infinite set of alternative arrangements including broader or narrower networks, richer or more meager benefits, maximum or minimal medical management, and more or less consumer cost sharing.

As the drumbeat for increased consumer responsibility builds with more cost sharing, increased benefit buy-down opportunities, multi-tier provider networks, and various consumer-driven health plan designs, PPO arrangements
seem well positioned to respond to these preferences. The positioning to offer one or more of these options is apparent in every market, as employers grow more restive about what existing product designs can deliver by way of cost containment and interest shifts from supply-side to demand-side interventions. The coinsurance feature of PPO options is especially valued as a means to cultivate price-sensitivity as consumers begin to spend more of their own money for their medical care.

The fact that PPOs have grown in popularity at the same time that overall
health benefit costs have risen sharply is not a ringing endorsement; nor are the trends reported for PPO premiums different from HMO premium trends. Thus, it does not appear that PPO arrangements have played much of a role in
cost containment despite the fact that more than half of all commercially covered lives are in PPOs. What they do seem to deliver is cost displacement by moving costs from employer-sponsors to individuals, which, nonetheless, has the real effect of moderating the rate of increase in employers’
contributions for benefits. In addition, the flexible PPO design enables employers to buy down benefits by requiring more cost participation for existing benefits or to lower their premium contributions by shifting more cost to consumers in the form of user fees.

These findings are pertinent to the current debate regarding the suitability
of the PPO as a policy option for major public-sector programs such as Medicare.

Much of the appeal of the PPO option lies in its asserted superiority relative to HMOs in terms of choice, limited medical management, accommodation of providers’ preferences, and lower administrative expenses. However, the PPO arrangement enjoys none of these advantages relative to traditional Medicare. Moreover, as current trends indicate, much of the recent growth of the PPO is driven by its flexibility to enable employers to shift more costs to consumers and shrink benefit packages, not augment them. Finally, the fact that most PPO networks harbor limited aspirations to manage care, reward provider behavior, and promote aggressive quality improvement for participants makes it far from clear what it is that Medicare hopes to obtain from the PPO product.

The popularity of the PPO is subject to much misunderstanding. The confusion is attributable in part to the diversity of forms in which PPO offerings
appear in the market. It is also related to the fact that PPO participation growth resulted from flight from the undesirable features of the HMO and widespread skepticism about the value of managed care, rather than from a migration to the attractive features of the PPO. Seen from a slightly different angle, however, PPO growth also represents a retreat from the era of benefit expansion of the 1990s because financing these benefits, particularly via provider discounts, has proved unsustainable. In this vein, the PPO option is an instrument for private purchasers to realign what they wish to pay for health benefits with what they believe they can afford to pay. For consumers, the continued “success” in PPO growth almost certainly translates into paying more to try to hold onto what they have.

http://content.healthaffairs.org/cgi/content/abstract/23/2/56

Comment: With the loss of indemnity plans and the dissatisfaction with
network model HMOs, PPOs have become the favored model, both for employer
sponsored coverage and for individual plan purchasers. High deductible PPOs
will be the primary model to fulfill the catastrophic requirement for the new health savings accounts. And Medicare + Choice was converted into Medicare Advantage primarily to shift Medicare into the private PPO market.

PPOs will continue to expand as benefits and affordability contract. We need to understand that as we shift more into PPO “insurance” products, we are
relinquishing the financial security that insurance should be providing to protect us against the risk of excessive health care costs.

There are better options. A universal, single payer system of social insurance would ensure affordability and financial security in the face of potential health care risks. Why should we lend support to the PPOs at the cost of our own financial and health security?

It's time to look again at single-payer

It’s time to look again at single-payer
Capital Times – Madison, WI
By Dave Zweifel
April 2, 2004

Marjie Colson, Madison’s passionate champion for the rights of the powerless, shipped me an e-mail a few days ago saying it is time to talk about single-payer health coverage again.

Colson is convinced, like many of us, that we’re never going to solve our health care problems by continuing down the same path that has left an estimated 42 million Americans, many of them children, without any insurance coverage and tens of millions more sacrificing pay raises to keep the coverage they have.

She’s been invited to a meeting in Washington in early May that’s aimed at drumming up support for Michigan Rep. John Conyers’ proposal that would establish national single-payer health insurance by extending Medicare coverage to everyone in the country. The meeting will bring together for the first time two major organizations that have long been pushing single-payer: Physicians for a National Health Program and the Universal Health Care Action Network.

The organizations are optimistic that the tide is finally turning in favor of a national health program as more and more people are becoming fed up with the current mess.

Conyers envisions paying for his plan, known as the U.S. National Insurance Act, with a 3.3 percent payroll tax that employers would pay Medicare on each of their employees. The employer would pay less than $1,200 per year – $100 a month – for an employee earning $35,000 annually, for example. Full private health insurance is now costing employers who provide it an average of $755 per employee per month.

Conyers figures that a single-payer system based on Medicare would save Americans about $150 billion on paperwork per year and another $50 billion by pooling drug purchases. It is estimated that our current private insurance and HMO plans are eating up close to 18 cents of every health dollar just for administrative costs. Medicare administration, meanwhile, runs less than 3 cents on every dollar.

The problems with our health system today are being felt not only by the 42 million Americans who have no coverage, but by small business owners who simply cannot afford to continue providing their workers with coverage.

“We’ve got to get the profiteers out of health care,” Colson wrote. “They don’t belong. They never did.”

Colson is concerned, though, that so far there are no Wisconsin members of Congress among the 29 co-sponsors of the Conyers bill.

“I can’t believe that,” she said. Neither can I.

Dave Zweifel has been editor of The Capital Times since 1983. A native of New Glarus, Wis. and a graduate of the University of Wisconsin-Madison, his life-long goal was to be the editor of this newspaper. He has had more luck achieving that than his other fondest hope watching the Chicago Cubs win the World Series. He served for many years as president of the Wisconsin Freedom of Information Council and served two years as a juror for the Pulitzer Prizes.

Supreme Court to Decide if HMO's Can Deny Care

The Corporate Truth Squad (CTS) Alert is a project of USAction. The CTS Alert highlights how our civil justice system gives ordinary citizens the power to stand up against corporations that commit fraud, abuse or other wrongdoing. We will
distribute the CTS Alert regularly to all state legislators, Members of Congress and the media, with documentary evidence of corporate indifference to predictable illness, injury and death, uncovered by ordinary citizens seeking justice through the courts.

please read the full article here

It’s time to look again at single-payer

It’s time to look again at single-payer
Capital Times – Madison, WI
By Dave Zweifel
April 2, 2004

Marjie Colson, Madison’s passionate champion for the rights of the powerless, shipped me an e-mail a few days ago saying it is time to talk about single-payer health coverage again.

Colson is convinced, like many of us, that we’re never going to solve our health care problems by continuing down the same path that has left an estimated 42 million Americans, many of them children, without any insurance coverage and tens of millions more sacrificing pay raises to keep the coverage they have.

She’s been invited to a meeting in Washington in early May that’s aimed at drumming up support for Michigan Rep. John Conyers’ proposal that would establish national single-payer health insurance by extending Medicare coverage to everyone in the country. The meeting will bring together for the first time two major organizations that have long been pushing single-payer: Physicians for a National Health Program and the Universal Health Care Action Network.

The organizations are optimistic that the tide is finally turning in favor of a national health program as more and more people are becoming fed up with the current mess.

Conyers envisions paying for his plan, known as the U.S. National Insurance Act, with a 3.3 percent payroll tax that employers would pay Medicare on each of their employees. The employer would pay less than $1,200 per year – $100 a month – for an employee earning $35,000 annually, for example. Full private health insurance is now costing employers who provide it an average of $755 per employee per month.

Conyers figures that a single-payer system based on Medicare would save Americans about $150 billion on paperwork per year and another $50 billion by pooling drug purchases. It is estimated that our current private insurance and HMO plans are eating up close to 18 cents of every health dollar just for administrative costs. Medicare administration, meanwhile, runs less than 3 cents on every dollar.

The problems with our health system today are being felt not only by the 42 million Americans who have no coverage, but by small business owners who simply cannot afford to continue providing their workers with coverage.

“We’ve got to get the profiteers out of health care,” Colson wrote. “They don’t belong. They never did.”

Colson is concerned, though, that so far there are no Wisconsin members of Congress among the 29 co-sponsors of the Conyers bill.

“I can’t believe that,” she said. Neither can I.

Dave Zweifel has been editor of The Capital Times since 1983. A native of New Glarus, Wis. and a graduate of the University of Wisconsin-Madison, his life-long goal was to be the editor of this newspaper. He has had more luck achieving that than his other fondest hope watching the Chicago Cubs win the World Series. He served for many years as president of the Wisconsin Freedom of Information Council and served two years as a juror for the Pulitzer Prizes.

Supreme Court to Decide if HMO’s Can Deny Care

The Corporate Truth Squad (CTS) Alert is a project of USAction. The CTS Alert highlights how our civil justice system gives ordinary citizens the power to stand up against corporations that commit fraud, abuse or other wrongdoing. We will
distribute the CTS Alert regularly to all state legislators, Members of Congress and the media, with documentary evidence of corporate indifference to predictable illness, injury and death, uncovered by ordinary citizens seeking justice through the courts.

please read the full article here

How Federalism Could Spur Bipartisan Action On The Uninsured

Health Affairs
March 31, 2004
How Federalism Could Spur Bipartisan Action On The Uninsured
By Henry J. Aaron and Stuart M. Butler

… we share the belief that federally supported state experimentation is apromising way to make progress. States should be allowed to try widely differing solutions with federal financial support under legislated guidelines, including specific protections and measurable goals.

Crafting a single-payer experiment:

ERISA, which exempts self-insured plans from state regulation, is the primary technical obstacle to testing single-payer plans. The political sensitivity to modifications in ERISA is difficult to exaggerate. Anyattempt to carve out an exception from ERISA for state programs to extend coverage would probably doom federal legislation. But states could create”wraparound” plans to cover all who are not currently insured, or even to cover all who are not insured under plans exempted by ERISA from state regulation. While such n arrangement would not be a single-payer plan, it could achieve universal coverage, which is one defining characteristic of single-payer plans, and arguably be sufficient for a valid test. After all, the U.S. health care system is characterized by different subsystems for certain populations and has a form of single-payer coverage for militaryveterans. But of course the real test is whether advocates of single-payer plans regard such a limited arrangement as a fair trial.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.168

ERISA compliance:

http://www.dol.gov/ebsa/compliance_assistance.html

Comment: The Employee Retirement Income Security Act of 1974 (ERISA)requires employers to meet certain minimum standards in the administration of employee pension and welfare benefit plans.

An important provision of the ERISA regulations is that self-insured plans of large employers be exempt from state regulation. In fact, comprehensive reform proposals, such as the single payer model, are often rejected simply because the design would not comply with existing ERISA regulations since exempt programs would be folded into a state regulated system.

Because of ERISA’s importance in protecting benefit programs, it has achieved the status of being written in stone. Rather than modifying ERISA to comply with new programs, new programs are designed to comply with ERISA regulations. Aaron and Butler are even making the ridiculous suggestion that a proposal that has absolutely no resemblance to the single payer model be tested as a single payer model, in name only, merely to comply with ERISA regulations.

But any law or regulation can be modified. Even the United States Constitution can be amended. Since a single payer system would fulfill essentially all of the reasons that ERISA health benefit regulations exist, while providing even greater additional advantages, modifying ERISA to enable enactment of a single payer system certainly would be a step forward.

The Affordability Crisis in U.S. Health Care

(From the slide presentation of Gerald Shea, Assistant to the President for
Governmental Affairs, AFL-CIO)

Bill Dreher, Deutsche Bank Securities:

“From the perspective of investors, Costco’s benefits ($10/hour starting wage, 90% paid health benefits after 3 months for full-timers, after 6 months for part-time) are overly generous. Public companies need to care for shareholders first. Costco runs its business like it is a private company.” (Wall Street Journal, 3/26/04)

http://www.cmwf.org/programs/insurance/collins_affordability_723.asp

Comment: The Wall Street solution of eliminating employer generosity may be good for business, but it fails to address the problem of ensuring employee access to affordable health care.

A universal, publicly funded and publicly administered health insurance
program would ensure that access while relieving business administrators of this clear conflict of interest, allowing them to more appropriately concentrate their efforts on maximizing profits.

Health Care Reform a Major Campaign Issue for Voters: New Survey

The Commonwealth Fund
March 29, 2004
Health Care Reform a Major Campaign Issue for Voters: New Survey

Percent of adults ages 19-64 with any medical bill problem or outstanding Debt (Problems paying/not able to pay medical bills, contacted by a collection agency for medical bills, had to change way of life to pay bills, or has medical debt being paid off over time)

Income less than $35,000:
62% of uninsured have problems
45% of continuously insured have problems

Income over $35,000:
57% of uninsured have problems
29% of continuously insured have problems

http://www.cmwf.org/media/releases/collins723_hisurvey_release03292004.asp

For the full report:

http://www.cmwf.org/programs/insurance/collins_biennial2003_723.pdf

Comment: For those who are still not convinced that we have a crisis in health care funding, these numbers should be an awakening. Perhaps the most shocking number is the group that is least impacted, those with incomes over $35,000 who are continuously insured. This is mainstream America. These individuals have been relatively complacent since many of them have believed that the crisis in health care coverage has not affected them. But it has. 29% of mainstream America, in spite of continuous health care coverage, have financial problems due to medical bills!

The outrageously wasteful, expensive, and ineffective private health plan industry is no longer providing us with adequate financial security for medical costs. Let’s throw them out and establish our own publicly financed and publicly administered program of health insurance. Now!

Does universal comprehensive insurance encourage unnecessary use?

Canadian Medical Association Journal
January 20, 2004
Does universal comprehensive insurance encourage unnecessary use?
Evidence from Manitoba says “no”
By Noralou P. Roos, Evelyn Forget, Randy Walld and Leonard MacWilliam

Many have argued that escalating health care costs in Canada are exacerbated by the fact that patients face no costs when they visit doctors or use hospital services. A zero price, it is said, leads to unnecessary use of the system.

Various policies focusing on reducing patient demand have been proposed to address this purported overuse – user fees and medical savings accounts being the 2 most popular. All are supposed to work by creating an incentive for people to decide whether their intended use of the health care system is really necessary. We know that user fees are effective in reducing physician visits by those with low economic status, but have little impact on physician use by the more affluent or on hospital use.

Is there any evidence that a universal health care system encourages the less affluent to see physicians more often than necessary? We have already shown that the great majority of people incur few health care expenditures while a small group incurs high expenditures. This report extends our earlier work by first examining the health and socioeconomic characteristics of those in each expenditure group. We then assess whether residents of low-income areas overuse health care services (particularly physicians) relative to their health status.

Results

Although the data suggest that the health of those with lower socioeconomic status is worse than those of higher status at every level of health care expenditure, there was no pattern of higher physician expenditures on those
whose socioeconomic status is lower.

The 70% of the population on which the province spends 10% of its health
care dollars scored well on all health indicators, and the 10% of the population on which 74% of the dollars are spent scored poorly. In each expenditure group, those with lower socioeconomic status had poorer health.

Despite their poorer health, in each expenditure group, residents of the neighbourhoods with the lowest household incomes incurred physician expenditures that were similar to those of residents of wealthier neighbourhoods.

Interpretation

Most residents of Winnipeg are healthy, infrequent users of physicians and hospitals. Those incurring high health care costs are sick by every measure used. These high-cost users are drawn from every neighbourhood and every
socioeconomic group, and their health care expenditures are driven by hospital costs. High-cost users who are residents of low-income neighbourhoods incur more hospital costs. Other research based on review of medical records has shown the acuity levels of hospitalized patients in the lowest socioeconomic group to be just as high as acuity levels of hospitalized patients in higher socioeconomic groups. Hence the greater use of hospitals by residents of low-income neighbourhoods should not be dismissed as “social admissions”; their high use is consistent with their poorer health status.

Physician visits are the one type of health care use where at least the first visit in any episode is strongly influenced by patient behaviour. The Winnipeg data confirm that physician use by low-income groups is already lower than would be expected given their health status (or physician use by high-income groups is higher than one would expect).

The patterns of health care costs that we examined are driven by poor health and hospital expenditures. Policies aimed at reducing patient demands, such as user fees and medical savings accounts, are not likely to reduce overall costs. User fees discourage physician contact, not hospital use. Thus, user fees would discourage preventive contacts, particularly among the poor, a group in which pap smears, childhood immunizations and prenatal care are already known to be underutilized. Since the RAND study demonstrated that user fees discourage patients from seeking both appropriate and inappropriate care, their effects on even the healthy poor would be pernicious.

Physicians are the gatekeepers to hospitals, and the health status of the patient largely drives the decision to admit and, hence, expenditure patterns. Although higher income patients may be more articulate in asking for high-profile surgical treatments, overall those with the poorest health status show the highest hospital use and expenditure rates. There is scope for decreasing hospital expenditures by focusing on evidence-based medicine, physician practice patterns and hospital management. However, user fees and medical savings accounts are unlikely to contribute to this process.

http://www.cmaj.ca/cgi/content/full/170/2/209?maxtoshow=&eaf

Comment: 70% of the Winnipeg population consumes only 10% of health care costs. For this healthy sector, creating sensitivity to health care costs through user fess or health saving accounts would have a negligible impact on total health care spending since only 10% of the budget would be manipulated.

It should come as no surprise that Canada spends most of its universal health care funds on people in poor health who need health care regardless of socioeconomic status. Since the health care system should be designed to enable access for those with needs, user fees are superfluous for the affluent but would create financial barriers for low income individuals with legitimate health care needs.

This and other studies show that skyrocketing health care costs are not due to healthy people demanding unnecessary care. Consequently, user fees and health savings accounts cannot possibly have a significant impact on controlling health care costs. Reasonable solutions are possible only once the real problems are more precisely defined.

For a brief discussion of some of the true reasons for cost increases and a suggestion for more rational solutions, read PNHP’s written testimony for the House Ways and Means Committee hearing on the Trustees 2004 Report for Medicare:

https://pnhp.org/news/2004/march/pnhps_written_testim.php?page=all