PNHP

Gov. Bush removes insurance coverage requirements

Gov. Bush removes insurance coverage requirements

The Ledger
June 15, 2004
Gov. Bush Signs Health Insurance Bill
By Brendan Farrington

Gov. Jeb Bush signed a wide-ranging bill Monday designed to lower the cost of health insurance and reverse the growing number of Floridians without health care coverage.

The heart of the bill (Rep. Frank) Farkas sponsored attempts to create less expensive options for health care coverage.

One provision seeks to lower premiums by requiring insurers to make high deductible plans available to small employers.

Those plans would be linked to health savings accounts, which work similarly to Individual Retirement Accounts.

Another provision expands the experimental Health Flex program that permits insurers, health maintenance organizations, local governments and other entities to offer stripped-down insurance coverage to low-income people.

Health insurance companies often cite a list of more than 50 benefits they’re required to cover — from maternity care to tests for certain types of cancer — as a big reason insurance costs so much.

Low-income Floridians can now be offered a plan that doesn’t have much of the required coverage.

http://www.theledger.com/apps/pbcs.dll/article?AID=/20040615/NEWS/406150343/1004

Comment: These policies are designed to increase the numbers of individuals who are insured. But the crucial tradeoff is that they threaten the financial security of many of those who already have insurance. The reductions in benefits and increases in patient cost sharing will
exceed the ability for many moderate and low income individuals to pay for essential medical services. The net impact is clearly a negative since a much greater number of individuals will face both significant medical debt and
impaired access due to lack of affordability.

These efforts to increase coverage by decreasing the value of plans have failed anyway. The numbers of uninsured continue to increase.

We need new policies that begin with the principle that everyone will have coverage automatically. Then we can work on policies that will enable the most effective allocation of our generous health care resources.

The People's Media Reaches More People Than FOX Does

The People’s Media Reaches More People Than FOX Does
by Jim Hightower
 
While Big Media is “simply in the business of selling products, the people’s media reaches more people than FOX does.

Democratic reformer Henry Adams, who decried the decline in democracy as the robber barons rose to power in the nineteenth century, did not mince words about the failure of the news media of his day: “The press is the hired agent of a monied system,” he wrote, “and set up for no other purpose than to tell lies where the interests are involved.”

Imagine the verbal scorching Henry would give to today’s media barons, who are not merely hired agents of monied interests‹they have become the interests, fully corporatized, conglomerated and well-practiced in the art of journalistic lying to perpetuate the power and profits of the elites.

A handful of self-serving corporate fiefdoms now controls practically all of America’s mass-market sources of news and information. GE now owns NBC, Disney owns ABC, Viacom owns CBS, News Corp. owns Fox, and Time Warner owns CNN; these five have a lock on TV news. Of the 1,500 daily newspapers, only 281 are independently owned – three companies control 25 percent of the daily news circulated in the entire world.

These aloof giants openly assert that meeting their own profit needs is the media’s reason for existence – as opposed to meeting the larger public’s need for a vigorous, democratic discourse. Lowry Mays, honcho of Clear Channel Inc. (which owns more than 1,200 radio stations – a third of all the stations in America), opines that: “We’re not in the business of providing news and information We’re simply in the business of selling our customers’ products.”

The web gives us the means to bypass the corporate media, creating our own low-cost, decentralized network of news that, say, The New York Times does not consider “fit to print.”

In addition to hundreds of specialized news sites, there are “aggregators” that amount to news services for progressive content – credible outfits like Alternet.org, TomPaine.com, Buzzflash.com, and CommonDreams.org.

This single-minded mercenary focus combines with general corporate arrogance to bloat the egos of media chieftains, leading them to think that they really are the infallible gods of our daily newsfeed, with no need to be accountable to the public: “We paid $3 billion for these television stations,” said an executive with a Fox affiliate in Tampa; “We decide what the news is. The news is what we tell you it is.”

Crude, corporate censorship of our news by these boardroom types is less common than the subtle, internal self-censorship done by general managers, top editors, and some reporters who avoid topics and dilute stories that the corporate hierarchy might find offensive or simply not comprehend. A 2000 survey by the Pew Research Center for the People and the Press found that a third of local reporters admit softening a news story on behalf of the interests of their media organizations. A fourth say they have been told by superiors to ignore a story because it was dull, but the reporters suspected that the real motivation was that the story could harm the media company’s financial interests. And that’s only the reporters who confess!

If you detect a corporate bias in your news, don’t feel lonely. Two-thirds of Americans told pollsters last September that they believe special interests or a self-serving corporate-political agenda infect news coverage. We can all wring our hands and wail about this corporate, monopolistic grasp on our news sources, but here’s a better idea: Let’s do something about it. A grassroots flowering

A grassroots flowering

The Austin Motel is a refurbished, New Deal-era business on South Congress Avenue near my home. It has an old brightly-lit marquee out front that proudly boasts the credo of the current owners: “No additives, No preservatives, Corporate-free since 1938.”

Wouldn’t that make a fine slogan for a new democratic media for America?

Oh, you say, Hightower, don’t toy with us. It would take billions and billions of dollars to build a broad-based media network outside the established TV, radio, and newspaper conglomerates, so that’s just a pipe dream. Well, yes, it would take those impossible billions if we set out merely to duplicate the media Goliaths. But what if we wanted to develop a David ú a sprightly, nimble network of media outlets that are not capital-intensive and not burdened with either multimillion-dollar salaries or voracious conglomerate bureaucracies?

I have good news for you: This is already happening! Thousands of hardy, grassroots people have been working steadily and creatively over the years in every area of media, and the result of their combined efforts is that a new media force is now flowering coast to coast ú a force of hundreds of media outlets that is unabashedly progressive, fiercely independent, diverse, dispersed, and democratic. Some of these outlets are nationally known, others only locally known; some are brand new, others have been plugging away for decades. But the significant thing is that, collectively, they are a force to be reckoned with, celebrated, strategically deployed and deliberately expanded.

I’ve known and worked closely with many of these varied outlets my entire political life, but it was only last year that I realized what can happen if we learn to connect the various components and tap into the full power that they offer.

The occasion was a most modest one: The launch of my book, Thieves in High Places. In addition to being about the monied kleptocracy that has seized our people’s democratic power, the heart of this book is about the deeply-encouraging rise of you grassroots Americans out there who’re battling the thieves – and often beating them. These are inspiring stories of democratic activism that the media establishment largely ignores, and I wanted as many people as possible to know about the stories, so that others might take heart and battle on.

Call me cynical, but I knew from experience that the barons of media power were not likely to rush forward to embrace and disseminate my antiestablishment message. I was right ú none of the morning TV shows (“Today,” “Good Morning America,” etc.) allowed me to talk about it; no evening newsmagazine show (“20/20,” “Dateline,” etc.) would touch it; there were no reviews in the mass-market newspapers and magazines (New York Times, Newsweek, etc.) and even NPR and public television gave it the cold shoulder. It was a case of libra non grata. Yet, a funny (and fun) thing happened: Thieves rose into the top 10 of nearly every best-seller list across the country, including the New York Times list. You could almost hear the incredulous compilers of sales data asking: “How the hell did this thing get on our list?”

It got there, quickly reaching a mass-market audience, by way of your and my very own rag-tag, patchwork media network, which most of us don’t even know we have. I stumbled on the breadth and depth of this network because Sean Doles and Laura Ehrlich in my office had organized a guerrilla campaign to get the word out about the book. Working with community-radio stations, alternative newsweeklies, independent bookstores, web-active organizations, progressive (and aggressive) magazines, websites and publications of grassroots organizations, local organizing groups, some upstart television rebels – and, of course, you scrappy Lowdowners – we found that progressives are not voiceless in a corporate-media wasteland after all if only we recognize that we have powerful media assets of our own.

My book doesn’t matter, but the concept of connecting this patchwork of assets does matter greatly. Any particular piece of this progressive media patchwork is small (and too often scoffed at by progressives themselves as “insignificant”). But add the pieces together and we have a far-flung network of outlets that – each and every day – is reaching tens of millions of people.

Also, the people who are tuning in to our progressive outlets are not just cumulative numbers to be sold to advertisers; mostly they’re readers, listeners, online clickers, and viewers who give a damn and are looking for action. We saw an example last year of what can happen when even some of these components connect. The FCC, led by laissez-faire nutball Michael Powell, was ramming through a rules change that effectively would allow one or two media conglomerates to control the TV, radio, and newspaper outlets in every U.S. city.

Essentially, this unregulation of media ownership would lead to the full-scale monopolization of our news sources. Corporate lobbyists and government lawyers had holed up in a dark back room to whisper sweet legalese to each other, and we Joe and Joline Schmoes would have known nothing about it until after the fact, when we would’ve heard that wet, smoooooooching sound coming from Washington that tells us – uh-oh – another dirty deed has been done to us.

This time, though, was different. Several public-interest organizations picked up on the FCC’s back-room move and alerted such grassroots groups as Common Cause, which sent up red flares to engage its 200,000 members. Then, like the pamphleteers of old, dozens of community- radio stations plastered on-air broadsheets all across the country, translating the FCC’s regulatory gobbledygook into straightforward rallying cries. They pounded the issue day after day. Next came the Web-active group MoveOn.org, which gave this growing grassroots opposition the mechanism it needed for a targeted response – and some 170,000 emails poured into Washington.

The result was that, last July, the U.S. House of Representatives voted 400 to 21 in favor of an amendment by Rep. David Obey to stop the FCC’s media-monopolization rule. The decisive 400 House votes were from Congress critters (Democrats as well as Republicans) who had taken buckets full of campaign cash from the very media barons they suddenly decided they had to vote against.

The battle is not over, but the fact that this arcane issue of media-ownership regulations could, in such a short time, ignite a prairie fire of popular rebellion is a testament to the power at our disposal.
PAGEBREAK
Radio

As I’ve learned from the past dozen years of on-air experience, radio can be a very democratic little box‹in part because it’s ubiquitous (in our bedrooms, cars, showers, etc.), and also because people tend to hear what’s said on radio, as opposed to TV, where they get an image but don’t much follow the story being told. The bad news is that the radio dial is fast being bought up by Clear Channel and a couple of other conglomerates. The good news, however, is that we still have hundreds of extremely important stations in our hands, beaming out a steady progressive message to millions every day.

Since 1993, my own two-minute radio commentaries (“little pops of populism,” we call them) have aired every weekday, now being heard on a mix of 130 commercial and community stations coast to coast, plus Alaska, Hawaii, and – get this – Armed Forces Radio, as well as on the web (www.jimhightower.com). But I’m the least of it. From Amy Goodman’s sassy Democracy Now to Working Assets Radio with Laura Flanders, from New Dimensions to Latino USA, from Counterspin to RadioNation, from ACORN Radio to Alternative Radio with David Barsamian, from Media Matters with Bob McChesney to The World – there’s a wealth of national and local broadcasters putting forth progressive issues and insights every day.

Because of the corporate bias of its owners, commercial radio is the hardest nut to crack, but we have such voices as Enid Goldstein at KNRC in Denver, Sly Sylvester on WTDY in Madison, and Mitch Albom on WJR in Detroit. And now, Air America is making a bold play to bring 17 hours a day of progressive talk radio through its burgeoning network, broadcasting such live-wire hosts as Al Franken, Janeane Garofalo, Randi Rhodes, Chuck D, and Rachel Maddow. This brand-new upstart is already in 15 cities, and is drawing millions more listeners each day on the web (www.airamericaradio.com).

Then there are our community owned stations. Many people assume that these are little one-watt nothings, but that’s nonsense. Indeed, some are powerhouse blasters in big cities, such as the Pacifica Network’s five flagship stations in Berkeley, New York City, Los Angeles, Washington, DC, and Houston. Pacifica’s KPFK in LA, for example, is 110,000 watts, reaching from San Diego to Santa Barbara and stretching inland to San Bernardino. Likewise, the independent community station WMNF in Tampa is a 70,000- watt treasure that reaches from Sarasota on the Gulf Coast almost to Orlando in the middle of the state.

Even the small-town community broadcasters pack a punch. WERU in Blue Hill, Maine (pop. 700), for example, reaches clear to the state capital in Augusta and is a beloved rallying point for the whole Penobscot Bay area (“We-are-you” is how the station pronounces its call letters). The same with KAOS in Olympia, KBOO in Portland, KGNU in Boulder, and so many more‹people don’t just tune in, they count on these stations, trust them in a way no one would trust Clear Channel, and are willing to act on the information they receive.

The web

A democratic tool that Jefferson, Madison, and the other Bill of Righters could not have imagined, but would gleefully embrace today, is the world wide web. This computerized architecture of interconnected hubs and spokes allows us to link our thoughts and actions instantly in virtual space and produce tangible political results that would have taken months before.

Every progressive group (even Luddites like me) now has lively, interactive web sites through which we can share a gold mine of information, forge coalitions, hold “meetings,” and mobilize mass actions (from local to global).

The growth of the net is explosive – 68 billion emails per day, for example, and 10 million daily blogs by everyone from the kid next-door to famous pundits to me! MoveOn.org, TrueMajority.org, and the Howard Dean campaign have shown the phenomenal potential of the web, not only for fund-raising and blitzing Congress with citizen opinion, but especially for organizing people for action (a breakthrough that you’ll hear more about as the Lowdown itself develops a web-active program to link all of us Lowdowners into more grassroots civil action).

The web gives us the means to bypass the corporate media, creating our own low-cost, decentralized network of news that, say, The New York Times does not consider “fit to print.”

In addition to hundreds of specialized news sites, there are “aggregators” that amount to news services for progressive content – credible outfits like Alternet.org, TomPaine.com, Buzzflash.com, and CommonDreams.org

Some are creating their own virtual newspapers. Check out iBrattleboro.com. For more than a year now, this Vermont website lets the readers be the reporters on what’s really going on in town. Anyone can contribute, and anyone can comment on the contributions. In a town of 12,000, the virtual pages of iBrattleboro are getting 260,000 viewers a year.

Alternatives galore

If reading the daily press depresses you, get a lift by going beyond your “Daily Blather” newspaper to such spunky journals as The Nation, Mother Jones, The Progressive, In These Times, American Prospect, Ms., Harper’s, and The Progressive Populist. Also, Utne rounds up articles every month from more than 2,000 alternative media sources. And two groups, the Independent Press Association (indypress.org) and the Alternative Press Center (altpress.org), give you access to magazines, newsletters, and ‘zines that cover every political and cultural issue imaginable.

Chances are your own town has one or more independent weekly newspapers offering detailed coverage of progressive issues and events that the monopoly dailies miss or avoid. The Association of Alternative Weeklies (aan.org) plugs you into 120 of these local voices that, collectively, reach 17 million readers a week. Even television, the feeblest member of our democracy’s media mob, is perking up a bit. PBS’s Now with Bill Moyers has been a blast of fresh air (though its direction is uncertain now that he has announced his retirement), and C-SPAN continues to do a great public service by simply clicking on its cameras and letting us see events without edits or editorializing. And you can forget the network news and go directly to The Daily Show for Jon Stewart’s irreverent, on-target satires, broadcast on Comedy Central.

Especially encouraging in TV-land are the insurgents of the air, including Free Speech TV and WorldLink TV, reaching a combined 20 million homes. Grassroots rebels are also making their own TV, thanks to Cable Access Television, available on some 600 public-access channels, as well as a feisty group of Independent Media Centers (indymedia.org) that are particularly good at streaming raw footage of protests and other actions, with their media activists taking their web-driven videocams right into the center of things, bringing you news as it happens.

Finally, don’t discount the power of face-to-face networks. On any given day, thousands of people are gathered in various-sized groupings to listen, learn, discuss, interact, strategize, and organize. These forums include the nation’s 2,200 independent bookstores, which are not merely book peddlers, but also community meeting places and informal bulletin boards (go to booksense.com to find ones near you). Public libraries, progressive speakers’ series, pot-luck suppers, conversation cafes and progressive festivals (Greenfest, Bioneers, Rolling Thunder, etc.) are also part of this vibrant, high-touch outreach that goes on daily in practically every city and neighborhood.

Years ago, my momma taught me that two wrongs don’t make a right – but I soon figured out that three left turns do. We must apply that same kind of street savvy if we’re ever to find our way around the media blockages that the corporate interests have put in place to shut out our voices.

Healthcare For All

The Charleston Gazette Story:Dan Kurland

Saturday, in 100 cities across the country, thousands of people will march to “bridge the gap” in health care. From the Golden Gate Bridge to Brooklyn Bridge, people are banding together in a call for quality, affordable health care for all.  

Mention a gap in health care, and people immediately think of insurance. Without doubt, too many West Virginians lack insurance, and increasing numbers are underinsured.  

Focus on insurance, however, may not be the best approach toward assuring comprehensive, affordable health care.  

Health insurance today is a mix of disconnected programs. It currently includes individual plans, a variety of employer-based plans, need-based public plans (Medicaid) and contribution-based public plans (Medicare), and even charity and uncompensated care as de facto “insurance” for the uninsured.  

Health insurance is funded by a haphazard mix of payroll and income taxes, employer and individual contributions, as well as premiums and co-pays.

Current proposals for extending private insurance (e.g., medical savings accounts, drug discount cards) generally offer limited protection against the inherent greed of the marketplace. Proposals for the expansion of public insurance programs (e.g., CHIP, Medicaid) must compete in a tight market with other federal and state funding needs.  

Universal, affordable, quality care requires a more focused and comprehensive revenue stream than such a panoply of insurance programs can provide. Even more to the point, a health-care model based on insuring against the cost of infrequent services simply no longer meets the need for ongoing health promotion, disease management, and illness prevention activities that ultimately affect the overall cost of the system. Health insurance directly addresses the cost of health care, but does not necessarily guarantee access to physicians or hospital care.

If insurance is not the best model, what is? Education and public safety suggest an alternative. Universal education meets both individual and societal needs. Public education fosters both civic responsibility and economic development. Similarly, police protection and public safety assure order for both the individual and society as a whole.

Health care shares these dual perspectives. It is both essential for individual well-being and critical to the stability and development of the community. Adequate, affordable health care is not simply a health issue.  It is, above all, an investment in the human infrastructure of the society.  

Yet, unlike public safety and education, health care is left to market forces. All too many must struggle to devise a personal safety net. And while health care is regulated by the government, government’s interests often lie with the health of the health industry (pharmaceutical manufacturers, hospitals, insurance companies), not the health of its citizens.

The ideas expressed above are not new. This past session, the Legislature passed a resolution declaring “that health care … be considered a primary social benefit, similar to education and police protection, essential for community stability and economic development.” The resolution goes on to assert “the goal of the state to provide all West Virginians with comprehensive, quality, affordable health care.” A subcommittee in the interim session is charged with determining the most appropriate mechanisms for reaching that goal.

Admittedly, some gaps in health-care coverage can be addressed through incremental changes in existing insurance programs. Such efforts might stay the tide of rising expenses and diminished care for a while. But they would do little to assure a stable system into the future.

A lasting solution must simultaneously address gaps in health funding, access and delivery, and lifestyle decisions that affect individual health status. It must address the ever-expanding use of expensive technology, administrative waste, and the high cost of end-of-life care.  

We must re-examine the underlying nature of how we, as a society, choose to provide, or deny, health care to our community.  

Kurland is a Charleston artist and health action coordinator of Covenant House.

The People’s Media Reaches More People Than FOX Does

The People’s Media Reaches More People Than FOX Does
by Jim Hightower
 
While Big Media is “simply in the business of selling products, the people’s media reaches more people than FOX does.

Democratic reformer Henry Adams, who decried the decline in democracy as the robber barons rose to power in the nineteenth century, did not mince words about the failure of the news media of his day: “The press is the hired agent of a monied system,” he wrote, “and set up for no other purpose than to tell lies where the interests are involved.”

Imagine the verbal scorching Henry would give to today’s media barons, who are not merely hired agents of monied interests‹they have become the interests, fully corporatized, conglomerated and well-practiced in the art of journalistic lying to perpetuate the power and profits of the elites.

A handful of self-serving corporate fiefdoms now controls practically all of America’s mass-market sources of news and information. GE now owns NBC, Disney owns ABC, Viacom owns CBS, News Corp. owns Fox, and Time Warner owns CNN; these five have a lock on TV news. Of the 1,500 daily newspapers, only 281 are independently owned – three companies control 25 percent of the daily news circulated in the entire world.

These aloof giants openly assert that meeting their own profit needs is the media’s reason for existence – as opposed to meeting the larger public’s need for a vigorous, democratic discourse. Lowry Mays, honcho of Clear Channel Inc. (which owns more than 1,200 radio stations – a third of all the stations in America), opines that: “We’re not in the business of providing news and information We’re simply in the business of selling our customers’ products.”

The web gives us the means to bypass the corporate media, creating our own low-cost, decentralized network of news that, say, The New York Times does not consider “fit to print.”

In addition to hundreds of specialized news sites, there are “aggregators” that amount to news services for progressive content – credible outfits like Alternet.org, TomPaine.com, Buzzflash.com, and CommonDreams.org.

This single-minded mercenary focus combines with general corporate arrogance to bloat the egos of media chieftains, leading them to think that they really are the infallible gods of our daily newsfeed, with no need to be accountable to the public: “We paid $3 billion for these television stations,” said an executive with a Fox affiliate in Tampa; “We decide what the news is. The news is what we tell you it is.”

Crude, corporate censorship of our news by these boardroom types is less common than the subtle, internal self-censorship done by general managers, top editors, and some reporters who avoid topics and dilute stories that the corporate hierarchy might find offensive or simply not comprehend. A 2000 survey by the Pew Research Center for the People and the Press found that a third of local reporters admit softening a news story on behalf of the interests of their media organizations. A fourth say they have been told by superiors to ignore a story because it was dull, but the reporters suspected that the real motivation was that the story could harm the media company’s financial interests. And that’s only the reporters who confess!

If you detect a corporate bias in your news, don’t feel lonely. Two-thirds of Americans told pollsters last September that they believe special interests or a self-serving corporate-political agenda infect news coverage. We can all wring our hands and wail about this corporate, monopolistic grasp on our news sources, but here’s a better idea: Let’s do something about it. A grassroots flowering

A grassroots flowering

The Austin Motel is a refurbished, New Deal-era business on South Congress Avenue near my home. It has an old brightly-lit marquee out front that proudly boasts the credo of the current owners: “No additives, No preservatives, Corporate-free since 1938.”

Wouldn’t that make a fine slogan for a new democratic media for America?

Oh, you say, Hightower, don’t toy with us. It would take billions and billions of dollars to build a broad-based media network outside the established TV, radio, and newspaper conglomerates, so that’s just a pipe dream. Well, yes, it would take those impossible billions if we set out merely to duplicate the media Goliaths. But what if we wanted to develop a David ú a sprightly, nimble network of media outlets that are not capital-intensive and not burdened with either multimillion-dollar salaries or voracious conglomerate bureaucracies?

I have good news for you: This is already happening! Thousands of hardy, grassroots people have been working steadily and creatively over the years in every area of media, and the result of their combined efforts is that a new media force is now flowering coast to coast ú a force of hundreds of media outlets that is unabashedly progressive, fiercely independent, diverse, dispersed, and democratic. Some of these outlets are nationally known, others only locally known; some are brand new, others have been plugging away for decades. But the significant thing is that, collectively, they are a force to be reckoned with, celebrated, strategically deployed and deliberately expanded.

I’ve known and worked closely with many of these varied outlets my entire political life, but it was only last year that I realized what can happen if we learn to connect the various components and tap into the full power that they offer.

The occasion was a most modest one: The launch of my book, Thieves in High Places. In addition to being about the monied kleptocracy that has seized our people’s democratic power, the heart of this book is about the deeply-encouraging rise of you grassroots Americans out there who’re battling the thieves – and often beating them. These are inspiring stories of democratic activism that the media establishment largely ignores, and I wanted as many people as possible to know about the stories, so that others might take heart and battle on.

Call me cynical, but I knew from experience that the barons of media power were not likely to rush forward to embrace and disseminate my antiestablishment message. I was right ú none of the morning TV shows (“Today,” “Good Morning America,” etc.) allowed me to talk about it; no evening newsmagazine show (“20/20,” “Dateline,” etc.) would touch it; there were no reviews in the mass-market newspapers and magazines (New York Times, Newsweek, etc.) and even NPR and public television gave it the cold shoulder. It was a case of libra non grata. Yet, a funny (and fun) thing happened: Thieves rose into the top 10 of nearly every best-seller list across the country, including the New York Times list. You could almost hear the incredulous compilers of sales data asking: “How the hell did this thing get on our list?”

It got there, quickly reaching a mass-market audience, by way of your and my very own rag-tag, patchwork media network, which most of us don’t even know we have. I stumbled on the breadth and depth of this network because Sean Doles and Laura Ehrlich in my office had organized a guerrilla campaign to get the word out about the book. Working with community-radio stations, alternative newsweeklies, independent bookstores, web-active organizations, progressive (and aggressive) magazines, websites and publications of grassroots organizations, local organizing groups, some upstart television rebels – and, of course, you scrappy Lowdowners – we found that progressives are not voiceless in a corporate-media wasteland after all if only we recognize that we have powerful media assets of our own.

My book doesn’t matter, but the concept of connecting this patchwork of assets does matter greatly. Any particular piece of this progressive media patchwork is small (and too often scoffed at by progressives themselves as “insignificant”). But add the pieces together and we have a far-flung network of outlets that – each and every day – is reaching tens of millions of people.

Also, the people who are tuning in to our progressive outlets are not just cumulative numbers to be sold to advertisers; mostly they’re readers, listeners, online clickers, and viewers who give a damn and are looking for action. We saw an example last year of what can happen when even some of these components connect. The FCC, led by laissez-faire nutball Michael Powell, was ramming through a rules change that effectively would allow one or two media conglomerates to control the TV, radio, and newspaper outlets in every U.S. city.

Essentially, this unregulation of media ownership would lead to the full-scale monopolization of our news sources. Corporate lobbyists and government lawyers had holed up in a dark back room to whisper sweet legalese to each other, and we Joe and Joline Schmoes would have known nothing about it until after the fact, when we would’ve heard that wet, smoooooooching sound coming from Washington that tells us – uh-oh – another dirty deed has been done to us.

This time, though, was different. Several public-interest organizations picked up on the FCC’s back-room move and alerted such grassroots groups as Common Cause, which sent up red flares to engage its 200,000 members. Then, like the pamphleteers of old, dozens of community- radio stations plastered on-air broadsheets all across the country, translating the FCC’s regulatory gobbledygook into straightforward rallying cries. They pounded the issue day after day. Next came the Web-active group MoveOn.org, which gave this growing grassroots opposition the mechanism it needed for a targeted response – and some 170,000 emails poured into Washington.

The result was that, last July, the U.S. House of Representatives voted 400 to 21 in favor of an amendment by Rep. David Obey to stop the FCC’s media-monopolization rule. The decisive 400 House votes were from Congress critters (Democrats as well as Republicans) who had taken buckets full of campaign cash from the very media barons they suddenly decided they had to vote against.

The battle is not over, but the fact that this arcane issue of media-ownership regulations could, in such a short time, ignite a prairie fire of popular rebellion is a testament to the power at our disposal.
PAGEBREAK
Radio

As I’ve learned from the past dozen years of on-air experience, radio can be a very democratic little box‹in part because it’s ubiquitous (in our bedrooms, cars, showers, etc.), and also because people tend to hear what’s said on radio, as opposed to TV, where they get an image but don’t much follow the story being told. The bad news is that the radio dial is fast being bought up by Clear Channel and a couple of other conglomerates. The good news, however, is that we still have hundreds of extremely important stations in our hands, beaming out a steady progressive message to millions every day.

Since 1993, my own two-minute radio commentaries (“little pops of populism,” we call them) have aired every weekday, now being heard on a mix of 130 commercial and community stations coast to coast, plus Alaska, Hawaii, and – get this – Armed Forces Radio, as well as on the web (www.jimhightower.com). But I’m the least of it. From Amy Goodman’s sassy Democracy Now to Working Assets Radio with Laura Flanders, from New Dimensions to Latino USA, from Counterspin to RadioNation, from ACORN Radio to Alternative Radio with David Barsamian, from Media Matters with Bob McChesney to The World – there’s a wealth of national and local broadcasters putting forth progressive issues and insights every day.

Because of the corporate bias of its owners, commercial radio is the hardest nut to crack, but we have such voices as Enid Goldstein at KNRC in Denver, Sly Sylvester on WTDY in Madison, and Mitch Albom on WJR in Detroit. And now, Air America is making a bold play to bring 17 hours a day of progressive talk radio through its burgeoning network, broadcasting such live-wire hosts as Al Franken, Janeane Garofalo, Randi Rhodes, Chuck D, and Rachel Maddow. This brand-new upstart is already in 15 cities, and is drawing millions more listeners each day on the web (www.airamericaradio.com).

Then there are our community owned stations. Many people assume that these are little one-watt nothings, but that’s nonsense. Indeed, some are powerhouse blasters in big cities, such as the Pacifica Network’s five flagship stations in Berkeley, New York City, Los Angeles, Washington, DC, and Houston. Pacifica’s KPFK in LA, for example, is 110,000 watts, reaching from San Diego to Santa Barbara and stretching inland to San Bernardino. Likewise, the independent community station WMNF in Tampa is a 70,000- watt treasure that reaches from Sarasota on the Gulf Coast almost to Orlando in the middle of the state.

Even the small-town community broadcasters pack a punch. WERU in Blue Hill, Maine (pop. 700), for example, reaches clear to the state capital in Augusta and is a beloved rallying point for the whole Penobscot Bay area (“We-are-you” is how the station pronounces its call letters). The same with KAOS in Olympia, KBOO in Portland, KGNU in Boulder, and so many more‹people don’t just tune in, they count on these stations, trust them in a way no one would trust Clear Channel, and are willing to act on the information they receive.

The web

A democratic tool that Jefferson, Madison, and the other Bill of Righters could not have imagined, but would gleefully embrace today, is the world wide web. This computerized architecture of interconnected hubs and spokes allows us to link our thoughts and actions instantly in virtual space and produce tangible political results that would have taken months before.

Every progressive group (even Luddites like me) now has lively, interactive web sites through which we can share a gold mine of information, forge coalitions, hold “meetings,” and mobilize mass actions (from local to global).

The growth of the net is explosive – 68 billion emails per day, for example, and 10 million daily blogs by everyone from the kid next-door to famous pundits to me! MoveOn.org, TrueMajority.org, and the Howard Dean campaign have shown the phenomenal potential of the web, not only for fund-raising and blitzing Congress with citizen opinion, but especially for organizing people for action (a breakthrough that you’ll hear more about as the Lowdown itself develops a web-active program to link all of us Lowdowners into more grassroots civil action).

The web gives us the means to bypass the corporate media, creating our own low-cost, decentralized network of news that, say, The New York Times does not consider “fit to print.”

In addition to hundreds of specialized news sites, there are “aggregators” that amount to news services for progressive content – credible outfits like Alternet.org, TomPaine.com, Buzzflash.com, and CommonDreams.org

Some are creating their own virtual newspapers. Check out iBrattleboro.com. For more than a year now, this Vermont website lets the readers be the reporters on what’s really going on in town. Anyone can contribute, and anyone can comment on the contributions. In a town of 12,000, the virtual pages of iBrattleboro are getting 260,000 viewers a year.

Alternatives galore

If reading the daily press depresses you, get a lift by going beyond your “Daily Blather” newspaper to such spunky journals as The Nation, Mother Jones, The Progressive, In These Times, American Prospect, Ms., Harper’s, and The Progressive Populist. Also, Utne rounds up articles every month from more than 2,000 alternative media sources. And two groups, the Independent Press Association (indypress.org) and the Alternative Press Center (altpress.org), give you access to magazines, newsletters, and ‘zines that cover every political and cultural issue imaginable.

Chances are your own town has one or more independent weekly newspapers offering detailed coverage of progressive issues and events that the monopoly dailies miss or avoid. The Association of Alternative Weeklies (aan.org) plugs you into 120 of these local voices that, collectively, reach 17 million readers a week. Even television, the feeblest member of our democracy’s media mob, is perking up a bit. PBS’s Now with Bill Moyers has been a blast of fresh air (though its direction is uncertain now that he has announced his retirement), and C-SPAN continues to do a great public service by simply clicking on its cameras and letting us see events without edits or editorializing. And you can forget the network news and go directly to The Daily Show for Jon Stewart’s irreverent, on-target satires, broadcast on Comedy Central.

Especially encouraging in TV-land are the insurgents of the air, including Free Speech TV and WorldLink TV, reaching a combined 20 million homes. Grassroots rebels are also making their own TV, thanks to Cable Access Television, available on some 600 public-access channels, as well as a feisty group of Independent Media Centers (indymedia.org) that are particularly good at streaming raw footage of protests and other actions, with their media activists taking their web-driven videocams right into the center of things, bringing you news as it happens.

Finally, don’t discount the power of face-to-face networks. On any given day, thousands of people are gathered in various-sized groupings to listen, learn, discuss, interact, strategize, and organize. These forums include the nation’s 2,200 independent bookstores, which are not merely book peddlers, but also community meeting places and informal bulletin boards (go to booksense.com to find ones near you). Public libraries, progressive speakers’ series, pot-luck suppers, conversation cafes and progressive festivals (Greenfest, Bioneers, Rolling Thunder, etc.) are also part of this vibrant, high-touch outreach that goes on daily in practically every city and neighborhood.

Years ago, my momma taught me that two wrongs don’t make a right – but I soon figured out that three left turns do. We must apply that same kind of street savvy if we’re ever to find our way around the media blockages that the corporate interests have put in place to shut out our voices.

Buying Private Health Insurance

SmartMoney.com
Buying Private Health Insurance
By Stacey L. Bradford

One of the hardest things about leaving a job is walking away from the benefits package. Once you’re out on your own… you must cough up a lot of dough for what will feel like inferior health coverage.

Before you start your search, brace yourself. The private health-insurance market isn’t pretty. “It’s a difficult, difficult road to go down,” says Kathleen Stoll, Director of Health Policy for consumer-advocacy group Families USA.

Here’s what you have to look forward to: steep monthly premiums, higher co payments, outrageous deductibles and fewer benefits.

While there are some benefits you can live without, others are important. A maternity rider is one of them, advises Ellen Corwin, an individual health-insurance broker from West Des Moines, Iowa. “I advise all of my female clients to get one,” she says. Unlike employer-sponsored plans, which usually cover birthing expenses, private plans don’t unless you pay for it upfront. Even if you decide to start a family in a few years, it may be too late to add the coverage. Blue Cross Blue Shield of Tennessee, for example, won’t let a woman add the benefit after she initially purchases a policy unless she submits an official “notification of change in status” and gets married.

http://www.smartmoney.com/consumer/index.cfm?story=20030929

Comment: According to advocates of consumer-driven health care, one of the benefits is that consumers save on health care costs by choosing to purchase only the coverage that they really need. But that requires either the ability to predict future health care needs, an impossibility, or the necessity of purchasing truly comprehensive coverage.

In the example given, the coverage decision is based on the acquisition of a marriage certificate. Everyone should have comprehensive coverage. Why do we leave health care decisions in the control of an industry that profits by making coverage decisions based on such ridiculous requirements as to how fresh the date is on a marriage certificate?

It really is time for us to establish our own universal, public program of health insurance.

Let’s not get tangled up in America’s red tape

Let’s not get tangled up in America’s red tape
By ANDRÉ PICARD
PUBLIC HEALTH REPORTER
Thursday, June 10, 2004 – Page A21

It is fashionable these days to badmouth public services, and medicare in particular. From pothole repair through to open-heart surgery, it is virtually accepted as gospel that taxpayer-funded services are second-rate, delivered grudgingly by underworked fat cats comfortably ensconced in a bloated bureaucracy.

Bring in some market discipline, the rallying cry goes, and medicare’s woes will disappear: There will be no more wait lists, costs will plummet and services will be delivered with a smile to a society of satiated Methuselahs. Contrast the dream with the findings of two studies published during the past week. The first, a head-to-head comparison of U.S. and Canadian health indicators, found that, despite markedly different delivery systems, health outcomes and satisfaction rates are virtually the same in the two countries.

The second, conducted by researchers at McMaster University, found that the costs of services delivered by for-profit hospitals were 19-per-cent higher than those in not-for-profit facilities. At the same time, the death rate in private, for-profit institutions was about 8-per-cent higher. Sandwiched between these two research papers was the annual compilation of health spending from the Organization for Economic Co-operation and Development that showed the U.S. spends $5,297 (U.S.) per capita on health care, compared to $2,931 per capita in Canada — $2,366 more per person.

So why does Canada’s supposedly stodgily bureaucratic system get so much more bang for the buck than the lean, mean entrepreneurs who control the U.S. free-market health system?

The answer—at least one answer—can be found in a paper published last year in the New England Journal of Medicine, research that got virtually no attention because it was released during the SARS crisis.

The study, by Harvard University professors Steffie Woolhandler and David Himmelstein, concluded that the much-vaunted U.S. health system is choking in red tape.

The authors found that, in 1999, Americans spent $1,059 per capita on health-care administration, compared to $307 per capita for Canadians. Put another way, bureaucracy gobbles up 31 per cent of U.S. health dollars, compared to 17 per cent in Canada.

The authors of the Harvard study said this was due to a number of factors. For example, with Canada’s single-payer system, doctors bill a single provincial insurance plan using a single simple form, and hospitals receive lump-sum payments. In the United States, a hospital can deal with up to 800 insurance plans.

Private insurers, which dominate the U.S. system, have overhead costs averaging 11.7 per cent. That compares to 3.6 per cent for U.S. Medicare, and 1.3 per cent for provincial health plans in Canada. And for-profit institutions must provide a healthy return to investors, so they charge more. They also pay large bonuses to administrators.

Dr. Himmelstein said the stark differences between the U.S. and Canada were driven home during a visit to Toronto General Hospital. He searched long and hard for the billing office—a prominent feature of all U.S. hospitals—before locating two people whose job it is to bill U.S. patients who need treatment while visiting Toronto.

According to the authors, if the U.S. were to adopt Canada’s single-payer system, it would save approximately $286-billion a year in administrative costs ($982 per capita). The thorny problem of 43 million Americans without health insurance—whom it would cost about $69-billion a year to insure—could be eliminated, with money to spare.

Delaware Hospital CEO says consider single-payer

Beebe chief: Health-care industry is sick
By Bruce Pringle
Delaware Coast Press Reporter

Like a doctor warning a patient to change his lifestyle today to avoid pain and suffering in years to come, the president of Beebe Medical Center says the nation’s health-care industry should act now to ensure it will be strong in future decades.

Jeffrey Fried, Beebe’s top executive since 1995, admits he doesn’t have easy solutions to existing problems caused by steadily rising health-care prices — or to challenges posed by an increasingly elderly population. But he does offer one prescription: a serious search for an alternative to a health-care system that, he says, cannot survive as it is.

“I don’t know all the answers, and I don’t know what the eventual solution is,” Fried said in a recent interview at his office on Beebe’s campus in Lewes. “But what I feel most strongly about is, the current system simply is not sustainable. So we ought to be looking at all the different possibilities and all the options right now.”

Current conditions — from millions of workers without health insurance to millions who have insurance that fails to provide comprehensive preventive medicine — may seem severe, but Fried said worse could be on the way as the number of retirement-age Americans rises. He noted federal statistics showing that in the year 2000 there were 3.9 tax-paying workers for every person on Medicare, but in the year 2030 the ratio will be just 2.4-to-1 — nearly 40 percent lower.

Already, he said, the federal government fails to fully reimburse any Delaware hospital for its Medicare expenses. Other patients’ payments make up the difference, a situation that could be exacerbated unless the health-care system is overhauled.

“So you’ve got an aging population, and we know an aging population uses more health-care services than younger people. And you’re going to have fewer people working to provide those services,” Fried said. “To me, that’s a train wreck waiting to happen.”

But little, he said, is being done to head off the collision. “The thing that frustrates me is that these statistics aren’t somebody’s private information,” he said. “They’re available to anybody. I don’t understand why people don’t see what’s looming on the horizon.”

Government’s role

He calls for government to lead the way. But one prominent government attempt at such leadership, during Bill Clinton’s first term as president, failed to spark dramatic change.

“You’ve got all kinds of people (in health care) who want to make the system better for (themselves), and nobody wants to give up anything,” Fried said. “Hillary Clinton tried to put everybody around the table. The problem is, everybody comes to the table trying to make the system better for themselves.”

But another effort should be made, he said, because the free-enterprise system isn’t geared to meeting the challenge on its own.

“I used to believe that the competitive model that works for the rest of the world would work for health care. The more time I spent in health care, the more I realized it doesn’t work,” said Fried, who was an executive at Lancaster (Pa.) General Hospital for 12 years before moving to Beebe. “The reason it doesn’t work is that, first of all, you don’t have a level playing field.

“You have hospitals providing all the services needed in a community, regardless of (patients’) ability to pay,” he said. But there also are “niche players who go after certain kinds of patients with certain kinds of services and aren’t really interested in serving the uninsured and the underinsured. You’ll see imaging centers going up, you’ll see surgery centers going up and you’ll see endoscopy centers going up. But these facilities aren’t interested in taking care of the uninsured.

“And pharmaceutical companies are developing new medications all the time. Medical-equipment companies are developing new technologies. But nobody’s really interested in providing services for people who can’t pay for them.”

Meanwhile, he said, insurance companies continually strive to enhance their profits by paying health providers less for services received by those who do have coverage. And that coverage isn’t always comprehensive; not everyone who is covered is assured of undergoing medical testing that would save money in the long run.

“So much of our system — I’m not saying it’s bad — is driven by the stock market, the capital markets and what’s happening on Wall Street and similar places around the world,” Fried said. “The market goes up and down based upon quarterly performance reports. The problem is, preventive medicine isn’t based on quarterly reports. You’ve got to make some investment over time to really see any benefit.”

Covering everyone

While the American Medical Association and many other forces within the health-care industry insist radical change isn’t necessary, Fried is among those calling for serious consideration of instituting the “single-payer universal” system common to many other industrialized nations.

Under single-payer, a government-run organization would collect all health-care fees and pay all medical bills. Advocates such as Physicians for a National Health Care Program say that replacing today’s complex billing system would save money that could be used to provide care for those who currently don’t get it. Under single-payer, all Americans would be covered and current health services would continue. Private insurance no longer would be necessary.

Some opponents of single-payer say the government would spend too much. Others predict the opposite, saying government wouldn’t spend enough to ensure patients received all the care they needed.

“I’m not sure single-payer is the right answer,” Fried said. “Maybe we’ll come up with a solution nobody has thought of. One of the great things about this system is that the entrepreneurial spirit has always allowed us to come up with new discoveries and look at things differently. Just to say ‘This won’t work’ or ‘That won’t work’ is not acceptable to me.

“My position more than anything else is, the current system doesn’t work. It isn’t going to last forever, so we’ve got to start thinking about something else. And the longer we wait to think about something else, the less time we have to do something before it becomes a crisis. It seems to me people would do best to deal with these problems now rather than waiting 10-20 years down the road.”

E-mail Bruce Pringle at bpringle@smgpo.gannett.com.
Originally published Wednesday, June 9, 2004

Health Care for All Bike Tour -Idaho

The Bob LeBow Bike Tour – “Health Care for All” is a local event aimed at encouraging a healthy lifestyle for riders of all ages, while enjoying the beauty of rural Canyon and Owyhee Counties. The Bob LeBow Bike Tour is held on the second Saturday of June and includes 5 different routes ranging from 3 to 100 miles. All rides start and finish at Nampa High School. Proceeds of the Bob LeBow Bike Tour – “Health Care for All” benefit the Terry Reilly Health Services Zero Pay Fund. Lunch, water stops, first aid, and sag wagons will be provided. Registration fees include a 2004 tour tee-shirt, water bottle, and entry to door prizes.

Please click on the link to view the full details

Porter & Teisberg: Redefining competition in health care

Porter & Teisberg: Redefining competition in health care

The Boston Globe
June 8, 2004
A prescription for healthcare
Professor: Get industry to compete over quality instead of shifting
costs
By Robert Weisman

Michael E. Porter has a new problem to fix.

The Harvard Business School professor, often described as America’s foremost
business strategist, has never shied away from tackling intractableproblems.

…his latest challenge is one that has stumped the best and brightest business theorists, politicians, and policy makers: America’s dysfunctional healthcare system. And Porter is staking his reputation on a prescription that calls for a healthy dose of competition.

In a long essay in the June edition of Harvard Business Review, the 57-year-old Porter argues for redefining healthcare competition on the level of specific diseases and treatments, rather than on the level of health plans, networks, or hospital groups. ”The wrong kinds of competition have made a mess of the American healthcare system,” contend Porter and his coauthor, Elizabeth Olmsted Teisberg of the University of Virginia.

”The right kind of competition can straighten it out.”

The article is significant not only for its critique, but also because it bears the Michael Porter stamp. One of only 15 ”university professors” (the highest designation for faculty members) at Harvard University, his 16 books on strategy, competitive advantage, and business clusters have made him among the most sought-after business thinkers in the world. Porter consults for corporations, regions, and even nations.

Porter and Teisberg have a deceptively simple diagnosis: Healthcare competition today works on the wrong level. The players — health plans, payers, providers, and doctors — engage in what the authors call ‘zero-sum competition,” dividing value rather than creating it. They seek to transfer costs onto one another, limit access to care, hoard information, and stifle innovation, all to the detriment of patients.

The right kind of competition should occur at the level of preventing, identifying, and treating patients’ conditions and diseases, Porter and Teisberg assert. They call for collecting and disseminating information about the outcome of medical procedures, so patients can make intelligent choices about physicians and hospitals. They also recommend transparency in billing and pricing to reduce cost shifting, discrimination, and other inefficiencies. And they propose increased specialization by healthcare providers, resulting in more centers of excellence in conditions and treatments that compete for patients.

Most of the tried-and-failed healthcare reform efforts of the past decade have emphasized government playing a larger role, as it does in Canada, the United Kingdom, and other countries. By contrast, the Porter-Teisberg approach would be a largely private sector solution, with employers helping to instigate change by negotiating with health insurers and providers for quality, choice, and transparency.

Government would have a role, not as a ”single payer” or an insurer of last resort, but by blocking network restrictions, hospital consolidation, and multiple hospitalization bills, and helping to set a framework for reform through its Medicare program. The role of health plans, meanwhile, would be more akin to that of coaches and advisers, helping their members navigate the system and find the best care.

Teisberg… speaking of herself and Porter, said, ”Neither one of us has come at this as a healthcare expert. We’re out there talking to people because we care about this. It matters.”

http://www.boston.com/business/articles/2004/06/08/a_prescription_for_healthcare/?

Harvard Business Review
June 2004
Redefining Competition in Health Care
The wrong kinds of competition have made a mess of the American health
care system. The right kinds of competition can straighten it out.
by Michael E. Porter and Elizabeth Olmsted Teisberg

We believe that competition is the root of the problem with U.S. health care performance. But this does not mean we advocate a state-controlled system or
a single-payer system; those approaches would only make matters worse. On
the contrary, competition is also the solution, but the nature of competition in health care must change. Our research shows that competition in the health care system occurs at the wrong level, over the wrong things, in the wrong geographic markets, and at the wrong time. Competition has actually been all but eliminated just where and when it is most important.

The most fundamental and unrecognized problem in U.S. health care today is that competition operates at the wrong level. It takes places at the level of health plans, networks, and hospital groups. It should occur in the prevention, diagnosis, and treatment of individual health conditions or co-occurring conditions. It is at this level that true value is created-or destroyed-disease by disease and patient by patient. It is here where huge differences in cost and quality persist. And it is here where competition would drive improvements in efficiency and effectiveness, reduce errors, and spark innovation. Yet competition at the level of individual health conditions is all but absent.

To access the report (fee $16.95):
http://harvardbusinessonline.hbsp.harvard.edu/b02/en/home/index.jhtml;jsessionid=FVZ2U4LSFGSSECTEQENSELQ?_requestid=5752
and click on “Curing U.S. Health Care (HBR OnPoint Collection)”

Comment: The debate rages on as to whether the financing of health care should be guided by a government program or by competitive forces in the private marketplace. Innumerable studies have refuted the claim that, in health care, private marketplace competition improves quality and lowers costs. Professors Michael Porter and Elizabeth Teisberg concede that the existing “zero-sum competition” has “made a mess of the American health care system.” They now describe “positive-sum competition” as the solution. They contend that preserving market forces through a new model of competition would be the best means of providing value by improving quality while controlling costs.

Their article is to be followed by a book on the subject, with the intention that it be the guide to revolutionary reform of the health care marketplace. Because of the prestige and credibility of the authors, we should become well informed on their vision of reform, and be prepared to respond appropriately.

As academic leaders in the business world, it is no surprise that they are determined to make competition work in health care, with almost a religious
fervor. They concede that they are relative novices in the health care arena, but they believe that they can introduce innovative approaches to competition that would have a positive impact on the health care system. In spite of being health care novices, they have identified much in the health policy literature that confirms that competition has not provided enough value to offset the impaired quality that permeates our system, thus their “zero-sum” thesis.

As pro-competitive, free market advocates, they cannot accept a model, such
as single payer, that uses government mechanisms to achieve quality and control costs. But in their fervor to depend on private competition as the driving force for value, problems begin to appear as they develop their positive-sum” thesis. Only a small sampling of the issues will be listed here. If, in fact, their proposals gain political traction, a more detailed analysis can be prepared later, describing what is good and what is bad about their concepts.

(Quotations are from their paper.)

* They appropriately emphasize that we need greater value in health care. But most of their concepts are directed at improving quality, the more important component of value, whereas very little are directed toward controlling costs. It is true that eliminating ineffective or detrimental care does reduce costs, but an explosion in technological advances, some of dubious value, has been a major driver of cost escalation. They do not adequately address this important concern.

* Most of their recommendations for improving quality have already been covered extensively in the health policy literature. Efforts are already being made to address them, and even greater efforts will inevitably be made in the future.

* “The most fundamental and unrecognized problem in U.S. health care today is that competition operates at the wrong level. It takes place at the level of health plans, networks, and hospital groups. It should occur in the prevention, diagnosis and treatment of individual health conditions or co-occurring conditions.” What does competition have to do with this? We do recognize that many of the problems are in our approaches to prevention, diagnosis and treatment. We definitely need to continue to identify these problems and then correct them. But is that best approached by establishing an elaborate and necessarily imperfect system of measuring and reporting quality parameters for the purpose of enabling providers to be rewarded by relatively unsophisticated purchasers in the marketplace? Or would it be better to establish a single, integrated system of funding care that directs the financial resources to beneficial preventive, diagnostic and therapeutic services with incentives for higher quality? It seems that the direct approach would be more efficient and effective.

* “Under positive-sum competition, providers would have to issue a single bill for each service bundle, rather than a myriad of bills for each discrete service.” Billing abuses occur both with bundling and unbundling of charges. Suggesting that billing problems for chronic disorders would be solved by mandated bundling is simplistic reasoning at best.

* They suggest that hospitals should develop “unique expertise” and not try to “be all things to everyone.” Hospitals then could compete (nationally?) with other hospitals providing similar unique expertise. This ignores the fact that hospitals provide mostly very routine services and need to be geographically accessible in a timely manner. Also the emphasis on increased specialization has been demonstrated to decrease health care value, driving up spending without a commensurate improvement in outcomes.

* “Network restrictions” would be eliminated, and “co-pays would be the same inside and outside of the network.” Does this mean that price would no longer be a dominant factor in a competitive marketplace? Though it should be stated here that their emphasis on the goal of improving quality is to be commended.

* Although a major goal would be to keep the government out of the competitive marketplace, “antitrust authorities would scrutinize system participants” to prevent market domination. If higher quality is the goal, shouldn’t higher quality providers be allowed to dominate the market? And would we be able to stabilize the capacity of the system if the remaining providers were not able to survive financially? Wouldn’t it be more rational to adopt programs aimed at improving the quality of all providers, rather than a competitive model that automatically sacrifices those who fall on the lower part of the curve?

* To “eliminate price differentials for favored groups… the federal government could limit the spread between the most discounted price and the highest price charged by a provider for any service and then reduce this spread each year over a five year period.” How do price controls fit in with free market competition? And what happens when destabilization returns after the five years have passed?

* “For high-risk people unable to buy health plans, assigned risk pools, like those used in automobile insurance, will need to be developed.” Why didn’t we think of that?

* “Large deductibles combined with medical savings accounts would let some patients take financial responsibility for their choices.” But also under their model, the legal responsibility for bills would shift from the patients to the payers who would “bear full legal responsibility for the medical bills of paid-up subscribers.” Well, make up your mind. Is the financial responsibility that of the patient or of the payer?

* Although they give competition much credit as a potential driver of quality, they ignore the fact that a single payer system would address many of the quality issues that they describe. In fact, by design, the singlepayer system would attack the quality problems aggressively and effectively, whereas their competition model would approach them with primary attention given to the bottom line. But profits in health care have almost no correlation with quality, and their model, in spite of their rhetoric, provides negligible financial incentives to improve quality on a global basis, though it may be effective in a few isolated instances.

Professors Porter and Teisberg still have much to learn about the health care system. Let’s hope that they do not limit their exposure to their colleagues who believe that we must rely strictly on competition in free markets no matter how compelling the evidence that they simply do not work in health care. Maybe they’d like to take a closer look at the single payer model. A single payer system would provide value by enabling higher quality within the limits of the resources we have, and isn’t that what good business is all about?

Porter & Teisberg: Redefining competition in health care

Porter & Teisberg: Redefining competition in health care

The Boston Globe
June 8, 2004
A prescription for healthcare
Professor: Get industry to compete over quality instead of shifting
costs
By Robert Weisman

Michael E. Porter has a new problem to fix.

The Harvard Business School professor, often described as America’s foremost
business strategist, has never shied away from tackling intractableproblems.

…his latest challenge is one that has stumped the best and brightest business theorists, politicians, and policy makers: America’s dysfunctional healthcare system. And Porter is staking his reputation on a prescription that calls for a healthy dose of competition.

In a long essay in the June edition of Harvard Business Review, the 57-year-old Porter argues for redefining healthcare competition on the level of specific diseases and treatments, rather than on the level of health plans, networks, or hospital groups. ”The wrong kinds of competition have made a mess of the American healthcare system,” contend Porter and his coauthor, Elizabeth Olmsted Teisberg of the University of Virginia.

”The right kind of competition can straighten it out.”

The article is significant not only for its critique, but also because it bears the Michael Porter stamp. One of only 15 ”university professors” (the highest designation for faculty members) at Harvard University, his 16 books on strategy, competitive advantage, and business clusters have made him among the most sought-after business thinkers in the world. Porter consults for corporations, regions, and even nations.

Porter and Teisberg have a deceptively simple diagnosis: Healthcare competition today works on the wrong level. The players — health plans, payers, providers, and doctors — engage in what the authors call ‘zero-sum competition,” dividing value rather than creating it. They seek to transfer costs onto one another, limit access to care, hoard information, and stifle innovation, all to the detriment of patients.

The right kind of competition should occur at the level of preventing, identifying, and treating patients’ conditions and diseases, Porter and Teisberg assert. They call for collecting and disseminating information about the outcome of medical procedures, so patients can make intelligent choices about physicians and hospitals. They also recommend transparency in billing and pricing to reduce cost shifting, discrimination, and other inefficiencies. And they propose increased specialization by healthcare providers, resulting in more centers of excellence in conditions and treatments that compete for patients.

Most of the tried-and-failed healthcare reform efforts of the past decade have emphasized government playing a larger role, as it does in Canada, the United Kingdom, and other countries. By contrast, the Porter-Teisberg approach would be a largely private sector solution, with employers helping to instigate change by negotiating with health insurers and providers for quality, choice, and transparency.

Government would have a role, not as a ”single payer” or an insurer of last resort, but by blocking network restrictions, hospital consolidation, and multiple hospitalization bills, and helping to set a framework for reform through its Medicare program. The role of health plans, meanwhile, would be more akin to that of coaches and advisers, helping their members navigate the system and find the best care.

Teisberg… speaking of herself and Porter, said, ”Neither one of us has come at this as a healthcare expert. We’re out there talking to people because we care about this. It matters.”

http://www.boston.com/business/articles/2004/06/08/a_prescription_for_healthcare/?

Harvard Business Review
June 2004
Redefining Competition in Health Care
The wrong kinds of competition have made a mess of the American health
care system. The right kinds of competition can straighten it out.
by Michael E. Porter and Elizabeth Olmsted Teisberg

We believe that competition is the root of the problem with U.S. health care performance. But this does not mean we advocate a state-controlled system or
a single-payer system; those approaches would only make matters worse. On
the contrary, competition is also the solution, but the nature of competition in health care must change. Our research shows that competition in the health care system occurs at the wrong level, over the wrong things, in the wrong geographic markets, and at the wrong time. Competition has actually been all but eliminated just where and when it is most important.

The most fundamental and unrecognized problem in U.S. health care today is that competition operates at the wrong level. It takes places at the level of health plans, networks, and hospital groups. It should occur in the prevention, diagnosis, and treatment of individual health conditions or co-occurring conditions. It is at this level that true value is created-or destroyed-disease by disease and patient by patient. It is here where huge differences in cost and quality persist. And it is here where competition would drive improvements in efficiency and effectiveness, reduce errors, and spark innovation. Yet competition at the level of individual health conditions is all but absent.

To access the report (fee $16.95):
http://harvardbusinessonline.hbsp.harvard.edu/b02/en/home/index.jhtml;jsessionid=FVZ2U4LSFGSSECTEQENSELQ?_requestid=5752
and click on “Curing U.S. Health Care (HBR OnPoint Collection)”

Comment: The debate rages on as to whether the financing of health care should be guided by a government program or by competitive forces in the private marketplace. Innumerable studies have refuted the claim that, in health care, private marketplace competition improves quality and lowers costs. Professors Michael Porter and Elizabeth Teisberg concede that the existing “zero-sum competition” has “made a mess of the American health care system.” They now describe “positive-sum competition” as the solution. They contend that preserving market forces through a new model of competition would be the best means of providing value by improving quality while controlling costs.

Their article is to be followed by a book on the subject, with the intention that it be the guide to revolutionary reform of the health care marketplace. Because of the prestige and credibility of the authors, we should become well informed on their vision of reform, and be prepared to respond appropriately.

As academic leaders in the business world, it is no surprise that they are determined to make competition work in health care, with almost a religious
fervor. They concede that they are relative novices in the health care arena, but they believe that they can introduce innovative approaches to competition that would have a positive impact on the health care system. In spite of being health care novices, they have identified much in the health policy literature that confirms that competition has not provided enough value to offset the impaired quality that permeates our system, thus their “zero-sum” thesis.

As pro-competitive, free market advocates, they cannot accept a model, such
as single payer, that uses government mechanisms to achieve quality and control costs. But in their fervor to depend on private competition as the driving force for value, problems begin to appear as they develop their positive-sum” thesis. Only a small sampling of the issues will be listed here. If, in fact, their proposals gain political traction, a more detailed analysis can be prepared later, describing what is good and what is bad about their concepts.

(Quotations are from their paper.)

* They appropriately emphasize that we need greater value in health care. But most of their concepts are directed at improving quality, the more important component of value, whereas very little are directed toward controlling costs. It is true that eliminating ineffective or detrimental care does reduce costs, but an explosion in technological advances, some of dubious value, has been a major driver of cost escalation. They do not adequately address this important concern.

* Most of their recommendations for improving quality have already been covered extensively in the health policy literature. Efforts are already being made to address them, and even greater efforts will inevitably be made in the future.

* “The most fundamental and unrecognized problem in U.S. health care today is that competition operates at the wrong level. It takes place at the level of health plans, networks, and hospital groups. It should occur in the prevention, diagnosis and treatment of individual health conditions or co-occurring conditions.” What does competition have to do with this? We do recognize that many of the problems are in our approaches to prevention, diagnosis and treatment. We definitely need to continue to identify these problems and then correct them. But is that best approached by establishing an elaborate and necessarily imperfect system of measuring and reporting quality parameters for the purpose of enabling providers to be rewarded by relatively unsophisticated purchasers in the marketplace? Or would it be better to establish a single, integrated system of funding care that directs the financial resources to beneficial preventive, diagnostic and therapeutic services with incentives for higher quality? It seems that the direct approach would be more efficient and effective.

* “Under positive-sum competition, providers would have to issue a single bill for each service bundle, rather than a myriad of bills for each discrete service.” Billing abuses occur both with bundling and unbundling of charges. Suggesting that billing problems for chronic disorders would be solved by mandated bundling is simplistic reasoning at best.

* They suggest that hospitals should develop “unique expertise” and not try to “be all things to everyone.” Hospitals then could compete (nationally?) with other hospitals providing similar unique expertise. This ignores the fact that hospitals provide mostly very routine services and need to be geographically accessible in a timely manner. Also the emphasis on increased specialization has been demonstrated to decrease health care value, driving up spending without a commensurate improvement in outcomes.

* “Network restrictions” would be eliminated, and “co-pays would be the same inside and outside of the network.” Does this mean that price would no longer be a dominant factor in a competitive marketplace? Though it should be stated here that their emphasis on the goal of improving quality is to be commended.

* Although a major goal would be to keep the government out of the competitive marketplace, “antitrust authorities would scrutinize system participants” to prevent market domination. If higher quality is the goal, shouldn’t higher quality providers be allowed to dominate the market? And would we be able to stabilize the capacity of the system if the remaining providers were not able to survive financially? Wouldn’t it be more rational to adopt programs aimed at improving the quality of all providers, rather than a competitive model that automatically sacrifices those who fall on the lower part of the curve?

* To “eliminate price differentials for favored groups… the federal government could limit the spread between the most discounted price and the highest price charged by a provider for any service and then reduce this spread each year over a five year period.” How do price controls fit in with free market competition? And what happens when destabilization returns after the five years have passed?

* “For high-risk people unable to buy health plans, assigned risk pools, like those used in automobile insurance, will need to be developed.” Why didn’t we think of that?

* “Large deductibles combined with medical savings accounts would let some patients take financial responsibility for their choices.” But also under their model, the legal responsibility for bills would shift from the patients to the payers who would “bear full legal responsibility for the medical bills of paid-up subscribers.” Well, make up your mind. Is the financial responsibility that of the patient or of the payer?

* Although they give competition much credit as a potential driver of quality, they ignore the fact that a single payer system would address many of the quality issues that they describe. In fact, by design, the singlepayer system would attack the quality problems aggressively and effectively, whereas their competition model would approach them with primary attention given to the bottom line. But profits in health care have almost no correlation with quality, and their model, in spite of their rhetoric, provides negligible financial incentives to improve quality on a global basis, though it may be effective in a few isolated instances.

Professors Porter and Teisberg still have much to learn about the health care system. Let’s hope that they do not limit their exposure to their colleagues who believe that we must rely strictly on competition in free markets no matter how compelling the evidence that they simply do not work in health care. Maybe they’d like to take a closer look at the single payer model. A single payer system would provide value by enabling higher quality within the limits of the resources we have, and isn’t that what good business is all about?

Downward trend in costs still double the growth of the economy

Date: Wed, 9 Jun 2004 11:31:34 -0700
Downward trend in costs still double the growth of the economy

Health Affairs
June 9, 2004
Tracking Health Care Costs: Trends Turn Downward In 2003
By Bradley C. Strunk and Paul B. Ginsburg

Total health care spending per privately insured person rose 7.4 percent in 2003. This increase was 2.1 percentage points lower than the 2002 increase of 9.5 percent, which was itself slightly lower than the 2001 increase of 10 percent. Therefore, it is now clear that we have entered a period of decelerating cost trends following a steep acceleration during 1996-2001.

Nevertheless, the cost trend remained high by historical standards and continued to outpace U.S. economic growth by a sizable margin. With per capita gross domestic product (GDP) increasing 3.8 percent in 2003, the gap between it and the trend in health care spending remained larger than the average 2.5-percentage-point gap over the past thirty years.

http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.354/DC1

Center for Studying Health System Change
June 9, 2004
Health Care Spending Growth in 2003 Posts First Major Slowdown in a Decade
Despite Downtick, Health Care Spending Growth Continues to Outpace Economic
Growth

Gail Shearer, director of health policy analysis, Consumers Union:

“Despite a modest slowdown, health care costs continue to rise rapidly, threatening the affordability of health insurance for more and more people. Marketplace changes-combined with recent legislation that provides tax incentives that encourage high-deductible coverage-are steering our health care system further from the goal of spreading costs broadly across the entire population. Tragically, the long-term impact is likely to be increased financial barriers to getting needed health care, placing a growing burden on the sick and those with low-incomes.”

http://www.hschange.org/CONTENT/681/

Comment: “Downward trend” and “slowdown” have little meaning to patients to
whom costs are being shifted in order to relieve the purchasers of the burden of paying for health care costs that are increasing at twice the rate of growth of the U.S. economy.

We clearly need new policies, and single payer sounds more and more like just the right solution.

The high costs of for-profit care

The high costs of for-profit care

CMAJ (Canadian Medical Association Journal)
June 8, 2004
Commentary
The high costs of for-profit care
By Steffie Woolhandler and David U. Himmelstein

Why do for-profit firms that offer inferior products at inflated prices survive in the market? Several prerequisites for the competitive free market described in textbooks are absent in health care.

First, it is absurd to think that frail elderly and seriously ill patients, who consume most care, can act as informed consumers (i.e., comparison-shop, reduce demand when suppliers raise prices or accurately appraise quality). Even less vulnerable patients can have difficulty gauging whether a hospital’s luxurious appurtenances bespeak good care.

Second, the “product” of health care is notoriously difficult to evaluate, even for sophisticated buyers like government. Physicians and hospitals create the data used to monitor them; self-interest puts the accuracy of such data into question. By labelling minor chest discomfort “angina” rather than “chest pain,” a US hospital can garner both higher Medicare payments and a factitiously improved track record for angina treatment. It is easier and more profitable to exploit such loopholes than to improve efficiency or quality.

Even for honest firms, the careful selection of lucrative patients and services is the key to success, whereas meeting community needs often threatens profitability. For example, for-profit specialty hospitals offering only cardiac or orthopedic care (money-makers under current payment schemes) have blossomed across the United States. Most of these new hospitals duplicate services available at nearby not-for-profit general hospitals, but the newcomers avoid money-losing programs such as geriatric care and emergency departments (a common entry point for uninsured patients). The profits accrue to the investors, the losses to the not-for-profit hospitals, and the total costs to society rise through the unnecessary duplication of expensive facilities.

Finally, a real market would require multiple independent buyers and sellers, with free entry into the marketplace. Yet, many hospitals exercise virtual monopolies. A town’s only hospital cannot compete with itself, but can use its market power to inflate its earnings. Not surprisingly, for-profit hospital firms in the United States have concentrated their purchases in areas where they can gain a large share of the local market. Moreover, many health care providers and suppliers enjoy
state-conferred monopolies in the form of licensure laws for physicians and hospitals and patent protection for drugs. Additionally, government pays most health costs – even in the United States. Indeed, public funding for health care in
the United States exceeds total health spending in Canada on a per capita
basis. It’s an odd market that relies largely on public funds.

Privatization results in a large net loss to society in terms of higher costs and lower quality, but some stand to gain. Privatization creates vast opportunities for powerful firms, and also redistributes income among health workers. Pay scales are relatively flat in government and not-for-profit health institutions; pay differences between the CEO and a housekeeper are perhaps 20:1. In US corporations, a ratio of 180:1 is average. In effect, privatization takes money from the pockets of low-wage, mostly female health workers and gives it to investors and highly paid managers.

Behind false claims of efficiency lies a much uglier truth. Investor-owned care embodies a new value system that severs the community roots and Samaritan traditions of hospitals, makes physicians and nurses into instruments of investors, and views patients as commodities. Investor ownership marks the triumph of greed.

For the full commentary:
http://www.cmaj.ca/cgi/content/full/170/12/1814

For the CMAJ article, “Payments for care at private for-profit and private not-for-profit hospitals: a systematic review and meta-analysis,” by P.J. Devereaux, et al: http://www.cmaj.ca/cgi/content/full/170/12/1817

Comment: Physicians for a National Health Program is a single issue organization, advocating for the single payer model of universal health insurance. But most of us are strongly opposed to the intrusion into the health care delivery system of for-profit corporate boards and their passive investors. Both the article and commentary should be read in their entirety for a better understanding of why we are so deeply offended by the ethical compromises of investor-controlled health care.