Speaker Archive - Page 1120 of 1212

Is James Glassman a credible voice for free market economics?

Two nearly identical transcripts of the debate panel, “Border wars,” featuring Milton Friedman, Gil Gutknecht, Sally Pipes and Don McCanne are now available on the Internet. One is available on the website of Pacific Research Institute, which hosted the event. The other is on the website of Tech Central Station, “Where Free Markets Meet Technology,” which is hosted by James K. Glassman who also served as moderator of this panel debate.

An excerpt from the transcript posted at Pacific Research Institute:

Glassman: This is the last question from the floor and I’m going to ask it
to Dr. McCanne first. Then I’d like to hear Congressman Gutknecht’s comments, and we’ll end with Dr. Friedman’s comments. The question is this: Top-down, command and control stifles innovation, writes someone sitting in front of me. I think that’s a pretty good proposition. How does Dr. McCanne expect innovation to occur?

McCanne: Well, just not top-down control, but funding. You know, price controls and budgeting and so forth. And that really is an important issue in innovation. But if we look at the history in technological innovation, probably two of the very greatest advances in the last half century have been MRI scans and CT scans. Each of those appropriately received the Nobel Prize for those developments. Where were they developed? Well, the Nobel Prize was shared with a British scientist. England has amongst the lowest rate of funding of their health care system, but that did not stop the technological innovation that occurred in the CT scanning and MRIs, and some of the other research that has taken place.

Glassman: Let me just refine this question a little bit and hear from the congressman, and then finally from Dr. Friedman. Innovation is something I spend a lot of my time thinking about. And it’s quite clear that our system, which is relatively free in these areas despite problems with the FDA, does promote innovation in drugs. I think that would be very hard to argue against. By disrupting that system in the way that you propose, many people think you would stifle that kind of innovation. Where is this innovation going to come from if it’s not from drug companies wanting to make decent profits on developing new drugs?

McCanne: There’s no way the drug industry is going to walk away from $1.6
trillion, period.

Gutknecht: Well, first of all I want to pierce this myth that they don’t do any research in Europe with the system that they have. If you look at the major pharmaceutical companies, Glaxo is a British company. Bayer is a German company…

The Pacific Research Institute transcript:
http://www.pacificresearch.org/press/rel/2004/ma04-01-27/transcript2.pdf

For the video:
http://www.pacificresearch.org/borderwarsdebate_video.html

For the audio:
http://www.pacificresearch.org/borderwarsdebate_audio.html

And an excerpt from the same portion of the transcript as it was posted at
Tech Central Station (This is essentially the same except for the absence of
my comment about the drug industry not walking away from $1.6 trillion):

Glassman: Let me just add, this is the last question from the floor, I’m
going to ask it to Dr. McCan first. I’d like to hear Congressman Gutknecht’s
comments, and then we’ll end with Dr. Friedman’s comments. The question
is this: Top-down, command and control stifles innovation writes someone
sitting in front of me. I think that’s a pretty good proposition. How
does Dr. McCan expect innovation to occur?

Dr. McCan: Well, just not top-down control, but funding. You know,
price controls and budgeting and so forth. And that really is an important
issue in innovation. But if we look at the history in technological
innovation, probably two of the very greatest advances in the last half century have been MRI scans and CT scans. Each of those appropriately received the Nobel Prize for those developments. Where were they developed? Well, the
Nobel Prize was shared with a British scientist. England has amongst the
lowest rate of funding of their health care system, but that did not stop the
technological innovation that occurred in the CT scanning and MRIs, and
some of the other research that has taken place.

Glassman: Let me just refine this question a little bit and hear from the
congressman, and then finally from Dr. Friedman. Innovation is kind of what
I spend a lot of my time thinking about. And it’s quite clear that our system, which is relatively free in these areas despite problems with the FDA, does promote innovation in drugs. I mean I think that would be very hard to argue against. Disrupting that system in the way that you propose, many people think would stifle that kind of innovation. Where is this innovation going to come from if it’s not from drug companies wanting to make decent profits on developing new drugs?

Rep Gutknecht: Well, first of all I want to pierce this myth that they
don’t do any research in Europe with the system that they have. If you look
at the major pharmaceutical companies, Glaxo is a British company. Bayer, as
you mentioned, we call it Bayer, is a German company…

The Tech Central Station transcript:
http://www.techcentralstation.com/020204D.html

Comment: James Glassman did not allow opening statements, and he controlled
all questions. (But he did allow himself an opening statement, and Sally
Pipes added her own written statement to the beginning of the PRI transcript.)

On the video you will see that Glassman did grant me permission to make the
very brief comment about the $1.6 trillion. We can speculate as to why he
left it out of his version of the transcript. But it does seem to be a powerful argument against his point that not enough funds would be available
to provide the profits that would encourage innovation in new products.

Regardless, this is a time for open and honest discussion of the serious
problems that plague our health care system. We need to lay ideology aside
and forthrightly address the real issues. Suppressing debate and striking
out responses not to one’s liking does not add to this process.

Can employer generosity solve the health care crisis?

Los Angeles Times
February 15, 2004
Costco Sees Value in Higher Pay
By James Flanigan

Much of corporate America is driven today by the belief that to be competitive, companies must cut their employees’ wages and benefits.

Nowhere is this creed held more devoutly than among the supermarket chains that are enduring a strike and have locked out their workers in Southern and Central California. A new kind of labor agreement that cuts pay and sharply slashes employer contributions to health benefits is imperative, declares Steven Burd, chief executive of Safeway Inc., “if we’re going to stay in business.”

Jim Sinegal sees things much differently. The chief executive of Costco Wholesale Corp., a warehouse club retailer with 430 stores, likes to boast of his company’s relatively high pay and benefits for its 92,000 employees.

… Costco – where a full-time clerk or warehouse worker earns more than $41,000 annually after four years, compared with $37,232 at the upermarkets…

Unlike the supermarket workers, Costco employees have always paid a portion
of their health insurance. The co-payment is now 4.5%, or $500 to $1,000 a year. That will rise to 8% in the next four years, to keep up with soaring insurance costs.

But the benefit package that Costco employees get in return is particularly rich. The company chips in $12,000 to $19,000 per employee (depending on whether they are full- or part-time). In the end, Costco’s contribution is at least a third higher than that made by supermarket employers to their workers’ health benefit plan.

If Costco has a weak spot, it is on the bottom line. The company earns about 1.7 cents for each dollar of sales, compared with 2.5 cents or more for the supermarket chains and 3.5 cents for Wal-Mart.

Wall Street contends that one reason for this shoddy showing is Costco’s generosity to its employees. Above all, as Costco executives have watched the turmoil at the grocery chains, they have been reminded about all that they are doing right.

“I don’t see what’s wrong,” Sinegal says, “with an employee earning enough to be able to buy a house or having a health plan for the family.”

http://www.latimes.com/business/careers/work/la-fi-flan15feb15,1,7018352.column?coll=la-headlines-business-careers

Comment: The reality? In this instance, a conscientious employer, who believes that employees should be adequately covered for comprehensive health care benefits, is paying $19,000 for a $41,000 employee, and that doesn’t even include the employee’s contribution. This amounts to about one-third of compensation being received as health benefits (minus retirement benefits). Obviously, at that rate, an employer cannot remain competitive with other businesses that slash health care benefits.

Relinquishment of adequate profits cannot be considered a realistic option for funding employee health care. Reduction of employee compensation to below subsistence levels is not satisfactory either. Employer sponsored coverage inevitably is reflected in higher consumer prices. Inequitable provision of employee health benefits places the conscientious employer at an unfair competitive disadvantage with business owners who reduce prices by depriving employees of adequate compensation packages.

In 2004, we’re already spending $1.79 trillion or $6167 per person on health care. Placed in a single, universal risk pool that would amount to more than
enough to fund a comprehensive benefit package for everyone. Then,instead
of relying on the diminishing supply of conscientious employers and the diminishing clout of union negotiators, we should rely on sound tax policy to establish an equitable method of funding our universal risk pool.

If we fail to change to an equitable system of funding health care, we will force concerned employers into an untenable position. In order to survive in a competitive market, they will have to trim their contributions to the health plans. Then what will we have? Unaffordable care for those who really do need it.

But the rest of us will be fine… as long as we stay healthy.

Denying foreigners health care coverage in Japan

The Japan Times
February 12, 2004
Visaless foreigners to be denied national health cover
By Tomoko Otake

After the Supreme Court ruled last month that it is illegal to bar Visaless foreigners from the national health insurance scheme, the health ministry is mulling the creation of an ordinance to do just that.

The top court for the first time recognized that foreigners who Overstay their visas have the right to join the national health insurance plan as long as they are likely to maintain a stable living, have registered with the municipalities where they reside and have applied for special residency permits.

The Supreme Court ruled as illegal a 1992 notice issued by the head of The health ministry’s national insurance plan section that excluded Foreigners with visas valid for less than a year from the nation health insurance plan.

http://www.japantimes.co.jp/cgi-bin/getarticle.pl5?nn20040212b3.htm

Comment: A debate also rages on in the United States as to whether undocumented residents should be covered. But there is a major, glaring difference between the United States and Japan in the fundamentals of this debate. Japan actually has a national health insurance system which theoretically could cover visaless foreigners; we don’t.

Health care spending for 2004

Health Affairs
February 11, 2004
Health Spending Projections Through 2013
By Stephen Heffler, Sheila Smith, Sean Keehan, M. Kent Clemens, Mark
Zezza, and Christopher Truffer

Projected spending for 2004:

National Health Expenditures (NHE): $1.7936 trillion

NHE per capita: $6,167

NHE, as percent of GDP: 15.5%

The current combination of sharply accelerating health spending, labor markets that have yet to fully recover, and rising budget deficits may be reviving thoughts about cost containment. Although it is unclear what direction new efforts to restrain health costs might take, historical behavior suggests that a continued escalation in health spending of the magnitude of recent experience will likely spur efforts to contain ths growth. The form that these efforts take can be expected to shape the nature of health care financing and delivery over the coming decade.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w4.79

Comment: Health care spending continues to increase well in excess of the rate of inflation. Dramatic changes in health care financing are already taking place as each sector attempts to contain its own health care costs. The sector with the least control is also the most vulnerable: patients with significant health care needs.

Rather than shifting funding to individual patients, making health care less and less affordable, let’s adopt a system that will remove financial barriers to beneficial care. A single, publicly administered system could contain costs while ensuring that care would always be there for those who need it.

Health insurance for all is possible

The New York Times
February 10, 2004

Health Insurance for All

To the Editor:

The Senate majority leader, Bill Frist, states that “it is impossible” to have all Americans covered by health insurance (news article, Feb. 7). Infact, it would be impossible if we were to follow the incremental strategies that have dominated the health care reform process in the past decade.

But that process has been broadened to include consideration of the single-payer model. Numerous studies have shown that a publicly administered, single insurance system would not only cover everyone but also provide comprehensive benefits. And it would provide economic mechanisms that would address the nation’s greatest concern about health care: ensuring affordability for each individual and for society as a whole.

We should no longer allow our politicians and policy makers to dismiss the most effective and affordable model of reform simply because of concerns about political feasibility.

DON McCANNE, M.D.
San Juan Capistrano, Calif.
Feb. 7, 2004
The writer is a former president of Physicians for a National Health
Program.

http://www.nytimes.com/2004/02/10/opinion/L10HEAL.html

Physicians believe that single-payer would provide the best care

Archives of Internal Medicine
February 9, 2004
Single-Payer National Health Insurance
Physicians’ Views
By Danny McCormick, David Himmelstein, Steffie Woolhandler, David Bor

We surveyed a random sample of physicians in Massachusetts… When asked which structure would provide the best care for the most people for a fixed amount of money, 63.5% of physicians chose a single-payer system; 10.7%, managed care; and 25.8%, a fee-for-service system.

Conclusions: Most physicians in Massachusetts, a state with a high managed care penetration, believe that single-payer financing of health care with universal coverage would provide the best care for the most people, compared with a managed care or fee-for-service system. Physicians’ advocacy of single-payer national health insurance could catalyze a renewed push for its adoption.

http://archinte.ama-assn.org/cgi/content/abstract/164/3/300

Doctors Support National Insurance- Boston Globe

Doctors Support National Insurance
63% inMass.Survey Support Single-Payer Care
By Liz Kowalczyk, Globe Staff,2/10/04

A majority of Massachusetts doctors support national health insurance, and most said they would be willing to accept a 10 percent cut in fees in return for less paperwork, according to a new study about physicians’ attitudes toward health insurance.

While the four physicians who conducted the survey — all of whom are affiliated withHarvardMedicalSchool– are members of a nonprofit organization that has long pushed for universal health coverage, their results were published today in a respected medical journal, the Archives of Internal Medicine. The study is part of a growing body of research into physicians’ views toward national health insurance that is sparking debate on the topic as the number of uninsured Americans has grown to 41 million.

A study published three years ago in the New England Journal of Medicine showed a majority of medical school faculty and doctors-in-training believed a “single-payer system”– where one government entity manages and pays for everyone’s medical care — would provide the best care to the most patients for a fixed amount of money. They chose that option over managed care or fee-for-service, in which insurance companies pay doctors and hospitals based on the treatment. Managed care and fee-for-service are the two most common types of private insurance.

The study published today was based on a survey of 904Massachusettsdoctors and included doctors at teaching hospitals as well as those who see patients in private offices.

About 63 percent chose single-payer as the best system; 26 percent picked fee-for-service, and just 11 percent favored managed care. About 67 percent of doctors agreed somewhat or agreed strongly that they’d take a 10 percent reduction in fees in return for “a very substantial reduction in my paperwork.” And 57 percent said they agreed with a salary system if salaries are “guaranteed to be within 10 percent of their previous incomes.”

Psychiatrists and primary care doctors showed the strongest support for a single-payer system, while surgeons favored it the least. Just 47 percent of surgeons believed a single-payer system would provide the best healthcare to the most patients. Dr. Steffie Woolhandler, one of the authors and a physician at Cambridge Hospital, said surgeons earn 50 to 100 percent more than other doctors. “This may explain their lower support for tinkering with the payment system,” she said.

Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health, said the study has a key weakness: The authors did not give doctors enough choices. In other words, the terms “single-payer” could mean different things to different physicians. The authors remarked in their study that they believe most physicians are familiar with the general term as referring to some type of national government health insurance system.

But a study three months ago published in the Annals of Internal Medicine reported that 49 percent of 1,650 doctors surveyed support government legislation to establish national health insurance. But only 26 percent of the physicians favored a program in which government would pay for all healthcare. Instead, doctors wanted tax credits or employer mandates to achieve universal coverage. Blendon also points out that managed care and a single-payer system are not mutually exclusive. A single-payer system could include a managed care component to tightly manage and control care and costs.

“Physicians would like to see people covered, but given a choice how to do it, they might pick other ways,” he said. “There’s no question, though, that they’d like to get rid of managed care.”

Why Canadians Are Healthier

Why Canadians Are Healthier
By Judy Foreman 2/10/04

My fellow Americans: Want a health tip? Move toCanada.

An impressive array of comparative data shows that Canadians live longer and healthier lives than we do. What’s more, they pay roughly half as much per capita as we do — $2,163 versus $4,887 in 2001 — for the privilege.

Exactly why Canadians fare better is the subject of considerable academic debate. Some policy wonks say it’sCanada’s single-payer, universal health coverage system. Others point to Canadians’ different ethnic mix. Some think it’s because they use fewer illegal drugs and shoot each other less with guns, though they do smoke and drink with gusto.

Still others think Canadians are healthier because their medical system is tilted more toward primary-care doctors and less toward specialists. And some believe it’s something more fundamental—a smaller gap between rich and poor. Perhaps it’s all of the above. But there is no arguing the basics.

“By all measures, Canadians’ health is better,” said Dr. Barbara Starfield, a university distinguished professor at Johns Hopkins Medical Institutions. Canadians “do better on a whole variety of health outcomes,” she said, “including life expectancy at various ages — 1, 15, 20, 45, 65, 80, you name it.”

According to a World Health Organization report published last year, life expectancy at birth in Canada is 79.8 years versus 77.3 in the United States (Japan’s is 81.9.). Canada now ranks fifth in life expectancy at birth (after Japan, Sweden, Hong Kong and Iceland), while theUnited States ranks 26th, according to the United Nations Human Development Report.

“There isn’t a single measure in which the US excels in the health arena,” said Dr. Stephen Bezruchka, a senior lecturer in the School of Public Health at the University of Washington in Seattle. “We spend half of the world’s health care bill and we are less healthy than all the other rich countries.

“Fifty-five years ago, we were one of the healthiest countries in the world. What changed? We have increased the gap between rich and poor. Nothing determines the health of a population [more] than the gap between rich and poor.”

Infant-mortality rates also show striking differences between theUnited States and Canada, according to Dr. Clyde Hertzman, associate director of the Centre for Health Services and Policy Research at the University of British Columbiain Vancouver. To counter the argument that racial differences play a major role, Hertzman compared infant mortality for all Canadians with that for white Americans between 1970 and 1998. The white US infant mortality rate was roughly six deaths per 1,000 babies, compared to slightly more than five for Canadians.

Maternal mortality shows a substantial gap as well. According to data published last year by the Organization for Economic Cooperation and Development, an international think-tank, there were 3.4 maternal deaths for every 100,000 births among Canadians compared to a 9.8 among all Americans.

And more than half of Canadians with severe mental disorders received treatment, compared to little more than a third of Americans, according to the May-June 2003 issue of Health Affairs.

Dr. Steffie Woolhandler, an associate professor at Harvard Medical School, general internist at Cambridge Hospital and staunch advocate of a single-payer system, said she believes “the summary of the evidence has to be that national health insurance has improved the health of Canadians and is responsible for some of the longer life expectancy.”

On the other hand, there are some causes of death that wouldn’t be much affected by having the government pick up the health care tab—like homicide. And theUnited States, Bezruckha said, has “the highest homicide rate of all the rich countries.”

“Other things might be differences in seat-belt usage,” said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. “We are also disproportionate consumers of illegal drugs, much more than Canada, so it’s cultural. The health of Americans would be better if we had universal health care, but there are some things that a single-payer system wouldn’t fix, but which would leave one country looking healthier in the statistics.” In some respects, the health care system is “the tail on the dog,” said Dr. Arnie Epstein, chairman of the department of health policy and medicine at the Harvard School of Public Health. “It’s other aspects of the social fabric of different countries that seem to have a major impact on how long people live.”

Like ethnicity, In the United States, African-Americans and Latinos “face problems of housing, stress and low income which have nothing to do with a single-payer system,” Blendon said.Canada has a large number of Asian immigrants, he said, but they, like Asian immigrants in the United States, tend to do well on health care measures.

The bottom line is that Canada is doing something right, even if “the reasons are not totally understood,” said Kominski of UCLA.

So, should we all move to Canada? Probably. But it’s just too cold.

Judy Foreman is a freelance columnist who can be contacted at foreman@globe.com.

Political cowardice is stunting the dialogue on solving the nation's health-care crisis

Feb 9, 6:53 PM
FLORIDA TODAY
Health care for all

Political cowardice is stunting the dialogue on solving the nation’s health-care crisis

Weapons of mass destruction haven’t turned up in Iraq, a potential time bomb for the presidential election. But another massive problem — call it a giant fragmentation bomb — is exploding in plain sight.

The issue is out-of-control health care costs, and though polls show Americans put it right up there with national security as a priority, politicians continue to run away from it.

More than 43 million Americans lack health-care coverage across the nation, including 70,000 in Brevard County. Many of them are employed by small businesses that can’t afford to offer benefits.

Employer health-care costs, up 32 percent since 2000, are predicted to rise by double digits for the next 5 years, meaning more businesses may drop health coverage.

That will add more to the ranks of the uninsured unless serious reform is addressed and soon.

Make no mistake, anyone can fall through the cracks as affordable coverage disappears. More than 100,000 Florida children are stuck on waiting lists for the state’s KidCare program for low-income families.

And, in 2003, dozens of elderly Brevardians who lacked insurance had to be turned away at the Embers, an adult-care facility in Cocoa, administrator Sandy Rutherford says.

That caused job disruptions for their children, just one example of ripples from lack of insurance spreading to families and communities.

Employers also hold back on hiring or use part-timers when health costs skyrocket — worsening the job market and continuing the uninsured spiral. Children without medical care don’t achieve as they should at school.

Those snowballing consequences are one reason a panel at the National Academy of Sciences recently called for universal health-care coverage for all Americans by 2010.

That’s a goal achieved by every other wealthy, industrialized nation and it’s time it deserves the most serious discussion in Washington, with input from citizens.

But politicians from across the spectrum shun that hot potato, preferring the Band-Aid approach when open-heart surgery is needed.

President Bush touts a mix of tax credits, health savings accounts, and letting small businesses join pools to bargain for better insurance rates. Those proposals are inadequate, and demonstrate the administration’s failure to grasp the breadth of the nation’s health-care crisis.

The remaining Democratic contenders for the White House really aren’t any better, dodging the politically perilous question of universal coverage.

Shame on them all for creeping around this important issue, letting fear of powerful insurance and medical lobbies drive out the possibility of confronting this issue the way it must be — head on.

This election year, the public must demand clear answers from both Republicans and Democrats about the future of health care in the nation, including why universal coverage by 2010 isn’t up for debate.

Medical students investigate U.S. and Canadian health care systems

Study Tour Provides Hands-On Experience for Medical Students Reston, VA

The American Medical Student Association (AMSA), the nation’s largest, independent medical student organization, announces “Sea-Couver,” a hands-on study tour in Seattle, Wash. and Vancouver, British Columbia that provides the opportunity to compare the U.S. and Canadian health care systems. Medical students will gain first-hand knowledge of health care delivery in the two countries by touring clinics, talking with patients, and learning from physicians, medical students and policymakers.

The students will compare the Canadian single payer health care system to the multi payer, market-based U.S. system. The United States, while spending over $1.6 trillion on health care annually, remains the only industrialized nation that does not guarantee health care for all citizens. Canada spends far less on health care and guarantees coverage for all its citizens. In addition, students will discuss and compare health care quality indicators, access to care disparities, prescription drug costs, drug re-importation and medical education and physician satisfaction.

A highlight of the tour will be a discussion with Dr. Bob Evans, Professor of economics at the Centre for Health Services and Policy Research at the University of British Columbia. Dr. Evans, Director of Population Health with the Canadian Institute for Advanced Research, is considered one of the founders of the field of health care economics and is the single most influential academic in Canadian health care policy.

“Universal health care in America is long overdue,” says Lauren Oshman, M.D., M.P.H., AMSA National President. “Future physicians need to be more knowledgeable about universal health care in our own country and in Canada. By providing students with the ability to compare the positives and shortcomings of the two health care systems, they will be better positioned to educate their colleagues about the two systems, and to build a health care system that better serves our patients and the public.” At the end of the excursion, students will present their findings at their individual medical schools and facilitate additional education for future healthcare providers.

For over 50 years, AMSA has empowered medical students to continually improve our health care system locally, statewide and nationally for the benefit of our future patients. For more information on AMSA’s Universal Health Care initiative, see http://www.amsa.org/hp/uhcinitiative.cfm. For more information on AMSA’s mobilization on universal health care and the upcoming presidential election, see http://www.amsa.org/election2004.

Media Contact:
Kim Becker
Director of Public Relations
American Medical Student Association (AMSA)
1902 Association Drive
Reston, VA 20191
Phone: (703) 620-6600 ext. 207
Fax: (703) 620-5873
Email: prel@www.amsa.org