Speaker – Page 1136

Implementing a health care information exchange would save ~$87 billion

Center for Information Technology Leadership
February 23, 2004
New Findings Show that Investment in Standardized Healthcare Information Exchange Would Deliver $87 billion in Annual Healthcare Savings

“Our research shows conclusively that there are strong financial reasons for the nation to invest in standardized healthcare information exchange,” said Blackford Middleton, MD, Chairman of CITL. “Standardized information exchange would save the nation $86.8 billion each year. Clearly, we must accelerate efforts to focus national policy discussions on implementing standardized healthcare information exchange and interoperability.”

Dr. Middleton announced the results of CITL’s research into the value of Healthcare Information Exchange and Interoperability (HIEI) at the HIMSS
Annual Conference, February 23, in Orlando, Fla. The study considered four
levels of interoperability, but the conclusions focused on the financial value of moving to nonstandardized, machine-organizable data and standardized, machine-interpretable data. CITL found that the value of standardized HIEI far exceeds the value of non-standardized HIEI. The research concludes that it is not cost effective to invest in non-standardized HIEI.

HIEI generates savings by enabling automated sharing of data among the computers of participants involved in clinical treatment. Currently, 90% of data is shared manually via telephone, fax, and mail, and one study found that pertinent patient data were unavailable in 81% of patient visits to an outpatient clinic.

CITL calculated that savings would come from fewer tests and improved efficiency. CITL projected less redundancy and decreased labor costs from reduced administrative tasks. The results should be viewed as conservative estimates of the value of HIEI, since CITL considered only transactions that involve providers. In addition, it assumed that all providers would purchase new systems. Overall, CITL believes that actual financial benefits would be even higher than its projections.

http://www.citl.org/news/HIEI_Findings.pdf

Comment: One of the advantages of a single, universal system of funding health care is that it would be simpler and less costly to include an integrated information technology system. Although the benefits are not disputed there has been some concern about the costs of such a system. This report allays those fears.

The precise amount of savings would vary under different specific models, but the savings would be real if the health care information exchange and interoperability (HIEI) is standardized. In contrast, our current non-standardized approach is clearly not cost effective.

A single, universal program of social insurance is the ideal framework within which to establish a standardized HIEI. Let’s go to the drawing boards now.

The Medicare Road Show

Families USA launched its Medicare Road Show, a nationwide senior awareness campaign about the new Medicare prescription drug law. The launch featured the premiere showing of a new Families USA video, hosted by Walter Cronkite, to a group of D.C. area seniors. The video was produced to help seniors understand the new Medicare law. The launch also featured appearances by two seniors — Mildred Fruhling of New Jersey and Sydney Bild of Illinois — who were interviewed for the video. Mildred and Sydney talked candidly about the difficult time they’ve had finding the drugs they need at prices they can afford and how they expect the drug coverage offered by the new Medicare law will affect their out-of-pocket drug costs.

“Dr. Sidney Bild is a member of Physicians for a National Health Program and a retired pediatrician in Chicago. He is also the President of Metro Seniors in Action, where he has worked tirelessly for improvements in Medicare and for a single-payer national health insurance program.”

click here to view the article

Conservatives using HSAs to prevent a "socialized system"

Mon, 1 Mar 2004
Conservatives using HSAs to prevent a “socialized system”

MotherJones.com
March/April 2004
Medicare’s Hidden Bonanza
By Michael Scherer

For conservative leaders, the best part of the Medicare bill President Bush signed in December had absolutely nothing to do with Medicare. Rather, the provision that House Speaker Dennis Hastert calls “the most important piece in the bill” and former Speaker Newt Gingrich considers “the single most important change in health care policy in 60 years” is a little-noticed tax rebate set to cost the Treasury $6.4 billion over the next decade. The measure allows Americans to open tax-free “health savings accounts,” which can be used to pay medical bills-in effect removing their owners from the shared risk that has been the core of the health-insurance system since World War II.

For conservatives, a key selling point of health savings accounts is the potential effect on the future of health care: In making their case to lawmakers, (Golden Rule Insurance Co.’s Chairman Emeritus J. Patrick) Rooney’s allies cited polls showing that two-thirds of Americans support government-run, universal health care. By giving a large segment of the population the option to withdraw from the health-insurance system, they argued, health savings accounts could serve as a poison pill preventing another “Hillarycare” debate. “It’s going to be real hard to socialize the system if everybody has their own account,” explains John Goodman, head of the conservative National Center for Policy Analysis.

http://www.motherjones.com/news/outfront/2004/03/02_401.html

Comment: There is no question that the agenda of the conservatives is to shift the responsibility for funding health care away from collective pools, whether public or private, and onto the individual patient. They correctly perceive that health savings accounts will create a formidable political body of individuals who will have been able to reduce their health insurance premiums, funds which would otherwise be lost forever, and deposit the savings into their own personal accounts.

Because of the regressive tax policies of HSAs, higher income individuals will even receive taxpayer assistance in paying for their health costs. And if they remain healthy, they can eventually use their own accounts as a retirement plan. For the large sector of our society composed of relatively young, healthy individuals who have decent incomes, HSAs are a very good deal, providing adverse medical events do not occur.

But is this really a formidable force that will inevitably oppose universal coverage? HSAs that are not depleted become almost identical to individual
retirement accounts (IRAs) at age 65. What would be the response of this group if we adopted a universal health insurance program and told these individuals that their HSAs would no longer be exposed to the risk of medical bills but would be converted into permanent IRAs? The mere establishment of HSAs does not preclude political support for universalinsurance.

In the interim, funds that will be diverted into these accounts will have been removed from the collective risk pools. Funds to provide care for those with health care needs will be even less available. The crisis in health care funding will increase in intensity. More suffering will occur as health care becomes less and less affordable for individuals with needs.

We really do need to fix the funding of our health care system now.

Conservatives using HSAs to prevent a “socialized system”

Mon, 1 Mar 2004
Conservatives using HSAs to prevent a “socialized system”

MotherJones.com
March/April 2004
Medicare’s Hidden Bonanza
By Michael Scherer

http://www.motherjones.com/news/outfront/2004/03/02_401.html

We really do need to fix the funding of our health care system now.

UFCW President Dority on the strike and health care reform

TheBakersfieldChannel.com
February 27, 2004
UFCW International President’s Statement

Excerpts from the statement of United Food and Commercial Workers international President Doug Dority on the Southern California Strike/Lockout:

Today, I am pleased to join with the officers of the seven Southern California UFCW local unions in their announcement of a tentative agreement in the longest major strike in the history of the UFCW, the largest and longest strike in the history of the supermarket industry, and the first major strike of the 21st century.

The men and women on the picket lines are genuine heroes. Their sacrifice
for affordable family health care has motivated and activated workers across
the nation. I am honored to be part of their union, and I am humbled as well
as inspired by their dedication, strength and selflessness.

Through their struggle, the striking and locked out workers have performed a
service for the whole country. They have sounded the alarm for all of America — your health care benefits at work are at risk. If the supermarket giants profitable, growing Fortune 50 mega-corporations can launch an attack on health care benefits, then every employer is sure to follow. They have sounded the alarm that the American health care system is ready to collapse.

In one year, over 2 million lost health insurance. That’s over 6,000 workers
a day. The fight here has given us a national call to action. We must have national health care reform. No one company, no one union, no industry or group of workers alone can fix the health care system. We can patch it up. We can protect our members for another contract term, but the system continues to falter, exacting an increasing cost on both workers and employers and leaving more and more families without health care.

Now is the time for action. 2004 is the year to put health care reform on the political agenda and demand that every candidate for office commits to comprehensive, affordable health insurance for every working family.

No worker should ever again be forced to choose between a paycheck and health care benefits. No worker should ever again be forced into the streets for five months to protect health care for their families.

The UFCW will lead the fight for health care reform. And, I believe, with members like our Southern California members, the UFCW will win that fight.

http://www.thebakersfieldchannel.com/news/2881620/detail.html

Comment: The UFCW can’t do it alone. Let’s all join in the effort. Each of us should use our individual talents to motivate action in our communities, religious organizations, service clubs, political parties, professional societies, and any other milieu that can move the cause forward.

Stop what you are doing right now and set aside five minutes (time it) to think of nothing else other than what you can do to support the movement for universal, comprehensive, affordable care for everyone.

Check the time. You have five minutes… Go!

Grocery strike settlement is a death knell for employer-sponsored coverage

Los Angeles Times
February 27, 2004
Union, Stores Reach a Deal to End Strike
By James F. Peltz, Melinda Fulmer and Ronald D. White

Negotiators reached a deal Thursday night that could end the California supermarket strike and lockout, a bitter fight that highlighted the national
debate over how much companies should pay for workers’ healthcare coverage.

… in a victory for the supermarket companies’ bid to stem rising healthcare costs, their regular per-employee contributions to the healthcare program would be capped at a set dollar limit…

http://www.latimes.com/business/la-fi-upermain27feb27,1,2819295.story?coll=la-home-headlines

Comment: Although there will be considerable diversionary discussion about
the other issues, this strike and lockout was really about only one issue. Management wanted to change to a defined contribution program in order to
cap the companies’ health care costs. Future cost increases will be the responsibility of the employees. With continuing health care cost escalation, the financial burden will be unbearable for these employees who earn less than $30,000 per year.

The past decade has witnessed an unrelenting effort to shift the costs of employer-sponsored coverage to the employees. This settlement is a landmark,
pivotal point in the history of employer-sponsored coverage.

With the success in shifting low income employees into a defined contribution system, there is no doubt that higher income employees, who can currently afford the costs, also will be shifted rapidly into defined contribution programs. We can anticipate an accelerated growth in high-deductible, managed care PPO plans because of the lower premiums offered. Use of health savings accounts (HSAs) will increase, but they are not insurance. HSAs are merely a vehicle to subsidize the health care of wealthier individuals with taxpayer funds. We are witnessing the end of the era of employer-sponsored coverage.

The healthy and wealthy will continue to do fine in this health care environment. But both moderate and low income individuals who have significant health care needs will face financial disaster along with impaired access to care because of lack of affordability.

Actually, there is some good news in this disaster. This transformation of the health care system will be extremely unstable and intolerable. It cannot last long. It will become clear to all that we will need to shift our abundant health care resources into an equitable, affordable system of social insurance.

It remains to be seen how long we will tolerate a rapidly deteriorating system and how much suffering we have to witness before we adopt a system of social insurance.

The grocery workers stuck it out for nearly five months and then lost. Can we show the nation a much better option in the next five months? Taking longer will only increase the privation and suffering.

The FDA Huffs, but Canadian Drugs are OK

The Food and Drug Administration would have consumers believe they’re taking a huge risk when they send their prescriptions to pharmacies north of the border, where the same drugs cost far less than they do here.

Hogwash. The fact is, drugs purchased through the Canadian health care system are every bit as safe as those available in the United States.

The FDA’s warning is a smokescreen thrown up to conceal the agency’s – and Congress’ – unseemly coziness with the drug industry.

The FDA warns that Canadian drugs may be outdated, subpotent, contaminated or counterfeit. The agency says that Canadian pharmacists might dispense the wrong or a contraindicated product, an incorrect dose, or a medication that isn’t accompanied by adequate directions for use.

But the agency has no justification for its cautions. To the contrary, a recent report by the Congressional Research Service supports the safety of drugs from Canada. It found that medications manufactured and distributed there meet or surpass quality-control guidelines set by the FDA.

According to this report, prepared at the request of Rep. Bernard Sanders (I-Vt.), the two countries regulate prescription drugs in virtually identical ways – from manufacturing and importation to labeling, distribution and sales. The report found that Canada’s pharmaceutical controls mimic those in the United States, with Canada tracking drugs through each distribution step.

The proof is in the pudding. Are people really being hurt by taking prescriptions filled in Canada? When asked to give examples of people who have been harmed, Tom McGinnis, the FDA’s director of pharmacy affairs, said late last year, “We don’t have that. I can’t think of one thing off the top of my head where somebody died or somebody got put in the hospital because of these medications. I just don’t know if there’s anything like that.”

Meanwhile, it’s clear that there are major problems in the drug regulatory arena right here in the United States. People were shocked to learn recently that counterfeit versions of the cholesterol-lowering drug Lipitor were surfacing in large U.S. pharmacies. Other instances of counterfeit drugs entering U.S. commerce have led to further questions about the safety of the drug supply.

The real issue, of course, is not whether the drugs from Canada are safe, but rather, why are they so much cheaper? Canadian pharmacies offer savings that average 35 percent over prices available in the United States, mostly because the Canadian government imposes price controls.

In a free-market society, people’s blood boils at the thought of imposing price controls. But is the health care industry part of a true free-market economy? When purchase decisions are ultimately made by the prescriber without much input from the patient, as is the case here, the drug industry is not a free-market economy.

The FDA’s froth about Canadian drugs are indicators of a much larger problem: the inability of the current administration to lower the outrageous cost of prescription drugs. Viewed through that lens, the FDA’s recent rantings are intended to deflect criticism from Congress’ inability to come up with a meaningful program to reduce the costs of drugs and to conceal its toasty warm relationship with the industry.

Cash-strapped health programs from cities and states around our nation are beginning to embrace the idea of taking their business north. Surely, responsible government officials from around the nation would not thumb their collective noses at the FDA if they felt it would put citizens at risk.

Make no mistake about it: Buying drugs from licensed brick-and-mortar pharmacies in Canada is an altogether different proposition from buying drugs from so-called rogue Web sites. Anytime consumers are offered the opportunity to buy prescription drugs without a prescription, they should be suspicious. It is illegal to do so, and more importantly, it’s a risky proposition. But it’s not the same as getting a properly written prescription filled by a licensed and regulated pharmacy through the mail.

The sound of FDA’s sabers rattling is reverberating from Vermont to Florida and from California to Washington.

I am not sure what the answer is, but it is time we shifted our focus from Canada to Washington – where the real problem lies.

Gail Shearer's JEC testimony on "consumer-driven" health care

United States Congress
Joint Economic Committee
February 25, 2004

Impact of “Consumer-Driven” Health Care on Consumers Testimony of Gail Shearer, Director, Health Policy Analysis Washington Office of Consumers Union

Excerpts:

One way to reduce the employer premiums for health insurance, and to make
payments more predictable, is to switch to a “defined contribution” approach
to health insurance… In the employer health insurance market, a key dstinguishing feature of its effort to move toward a defined contribution model is high-deductible coverage. As indicated by the title of the Joint Economic Committee hearing, the term that insurers and employers have coined to name this new trend in the marketplace is “consumer-driven health care.” Consumers Union… is troubled by this trend in the marketplace. In our testimony, we plan to explain why we believe this type of coverage is misnamed, misguided from a policy perspective, and a dangerous distraction from the health insurance crisis that faces 43.6 million uninsured consumers and tens of millions of underinsured consumers.

The focus of the President’s Economic Report chapter on health insurance is
more on the alleged problems of over-insurance rather than the problems associated with the lack of insurance and underinsurance. The chapter could
be a primer for a Health Economics 101 course on the virtues of an unfettered free market for health insurance: the reader learns about different consumption choices that consumers make when they have insurance. It posits that patients might over-consume services if they face too little cost-sharing.

Nowhere in this chapter is there recognition of the reality that faces millions of Americans every year: For the most part, people are not uninsured out of choice, but because they can not afford to pay health insurance premiums. Every day, uninsured and underinsured Americans are dying because of the lack of insurance.

When the marketplace shifts to one characterized by pricing to risk, as suggested by the President’s Economic Report, this leads to escalating premiums for the very people who can least afford them – people who face serious health challenges.

The Administration’s proposals, which boost “consumer-driven” health care,
by design, shift more costs to those who are sick. The result will ultimately be a health care system that distributes costs of health care even less fairly than it does today.

Based on survey data from the Medical Expenditure Panel Survey (MEPS) and
adjusted to 2000 levels (by the Lewin microsimulation model), the average
health care costs of those with employer based coverage was $2,628 in 2000.
However, the average masks a large degree of variation: those in the lowest
fifth of spending incurred on average $30 of health care expenditures, while
those in the top tenth of spending incurred costs of $16,710. This variation
of risk goes to the heart of the need to find a way to spread costs broadly
in order to keep costs affordable to those at the highest risk level. Yet the Economic Report of the President suggests that instead of spreading risks broadly so that health coverage will be affordable to those with existing conditions, “pricing to risk” is a primary goal of the health insurance marketplace. This approach sacrifices any notion of community and sharing of our neighbor’s burden, in favor of marketplace efficiency.

Expansion of medical savings accounts (MSAs) under the new name of Health
Savings Accounts (HSAs) adds a new wrinkle to “consumer-driven health care”
plans by making the contributions to the health reimbursement account tax
deductible. This new tax policy, combined with high deductible health coverage, is likely to appeal disproportionately to the healthy and wealthy.

Because of the variation of risks, and different selections made by people of different health status, high deductible plans can not exist in the long-term in a marketplace that offers low-deductible plans as well. Ultimately, low-deductible plans will be driven out of the market, with “premium spirals” driving out comprehensive coverage.

“Fundamentally, those who would likely win from shifting to MSA/catastrophic
arrangements are the healthy who will ‘take back’ some of their ‘excess’ contributions that effectively help to subsidize others.”

“The great savings will be for the employees who have little or no health care expenditures. The greatest losses will be for employees with substantial health care expenditures.”

A recent study of “consumer-directed health benefits” concluded that the young and healthy are potential winners, and that older people are less likely to choose high deductible plans.

In sum, high deductible coverage, combined with the new tax shelter, drive up premiums for those wanting low deductible coverage, are likely to lead to elimination of low-deductible coverage, strain the federal treasury, and will lead to shifting of costs to those who are sick while benefiting the healthy and those in high tax brackets.

As the President’s Economic Report clearly points out, high-deductible (and “consumer-driven”) health care plans are designed to increase out-of-pocket
costs for those who have health care expenditures.

Focusing on transforming our health care marketplace into a high-deductible marketplace is a dangerous distraction from the urgent national goal of extending affordable, quality health coverage to all.

For the full testimony:
http://www.consumersunion.org/pub/0225JECTestimonyNoSummary.pdf

Comment: High-deductible coverage, health savings accounts, defined contributions, and plans with Spartan benefits and greater cost sharing are all methods of “empowering the consumer” in the health care marketplace. In health care, an “empowered consumer” means that he or she feels the pain of health care costs. Current trends are intensifying this pain by “pricing to risk.” Those with greater health care risks are being required to pay higher prices if they “choose” to have access to health care. Those who cannot afford the higher prices will “choose” to have impaired health care outcomes (though no other real option is being offered).

Gail Shearer’s testimony should be downloaded and distributed widely. The
nation needs to understand why we should reject current policies that provide the healthy and wealthy with the option of not participating in the risk pools that help to fund care for the sick and poor.

Gail Shearer’s JEC testimony on “consumer-driven” health care

United States Congress
Joint Economic Committee
February 25, 2004

Impact of “Consumer-Driven” Health Care on Consumers Testimony of Gail Shearer, Director, Health Policy Analysis Washington Office of Consumers Union

Excerpts:

“The great savings will be for the employees who have little or no health care expenditures. The greatest losses will be for employees with substantial health care expenditures.”

A recent study of “consumer-directed health benefits” concluded that the young and healthy are potential winners, and that older people are less likely to choose high deductible plans.

For the full testimony:
http://www.consumersunion.org/pub/0225JECTestimonyNoSummary.pdf

18,000 premature deaths: one individual

The Boston Globe
2/24/2004
Vocal critic of abuse by clergy found dead
By Brian MacQuarrie

Patrick McSorley, a victim of defrocked priest John J. Geoghan who became one of the most visible critics of clergy sexual abuse, was discovered dead early yesterday in a North End apartment, his lawyer said yesterday.

A close friend said McSorley, 29, occasionally went to the apartment to take drugs owing to a chronic substance-abuse problem that had plagued him for several years.

“To think he had come this far and just to have it end so abruptly — it’s a tragic ending,” said the friend, Alexa MacPherson, 29,…

“I spent a lot of last summer and fall trying to help him get into a drug- rehabilitation program. He definitely was in need of some serious help,” MacPherson said. “There were days when we would spend 10, 12, 14 hours at . . . hospitals, trying to get him in. He wanted their help so badly, and we basically got turned away because he had no health insurance.”

http://www.boston.com/news/local/massachusetts/articles/2004/02/24/vocal_critic_of_abuse_by_clergy_found_dead/

Comment: “… turned away because he had no health insurance.”
Patrick McSorley may or may not be one of the 18,000 young adults who will
die this year merely because of the lack of health insurance. It is quite possible that his disease of chemical dependency may have been lethal even if he were insured. But now we’ll never know.

Some may want to blame the victim. Others may blame clergy abuse. The issues
are complex, as they are in every instance of preventable premature death. But we can very easily eliminate the factor of being insured and move on with efforts to correct the other individual and societal problems that culminate in these tragedies. Just that first step alone would save 18,000 young adult lives.

Impact of “Consumer-Driven” Health Care on Consumers

Testimony of Gail Shearer
Director, Health Policy Analysis
Washington Office
CONSUMERS UNION
Before the
Joint Economic Committee
On
Impact of “Consumer-Driven” Health Care on Consumers
February 25, 2004

Employers, who provide health insurance for about 60 percent of the U.S.
population, are increasingly under pressure to constrain their spending on health
insurance premiums, which have been growing in recent years at an annual rate of 5 to 8 percent. This pressure is aggravated by the recent weakness in the economy. One way to reduce the employer premiums for health insurance, and to make payments more predictable, is to switch to a “defined contribution” approach to health insurance, similar to the shift in recent decades from defined benefit pensions to defined contribution pensions.

please click here to view the full report

Steelhead fever and health care

San Diego Trout
Accounts of Indians

Interview with Babe Ramos, a Native American of the Juaneno Band of the Acjachemen Nation, who was born in the Aguilar Adobe House (in San Juan Capistrano, CA where the Jack-in-the-Box is presently sited):

We asked Babe to talk about his life and to especially recall his or his brothers’ experiences around the steelhead in both the San Juan Creek and Trabuco Creek.

“In ’39 there was a big flood on the Trabuco, but lots of steelheads -they caught steelhead into the 1950’s. The last one I remember was in ’58.”

“I remember back oh, starting at 7 or 8 years old, with my brothers,Julian Junior, Aurelio, and Rudy, we wore uniforms to the Mission school. We weren’t supposed to – well Mother was strict about our uniforms, but one day after school before coming home we followed the creek, and jumped in – jumped in on a 30″ fish, a steelhead. We just had our pocket knife, and would jump in to them and bring them home. Mom, she saw us all wet and had that look – we were in for it, but when I took that big steelhead out from behind my back she showed a small, a little smile. They were very good to eat.”

“I guess (at age) 13 or 14 – I needed an operation right away, so my Dad took me to the closest hospital. Yes, my appendix. This was up in Anaheim, and we didn’t have money to pay for the doctor or hospital bill. Well that doctor told my Dad don’t worry about the hospital bill. Mom told me my end of the bargain was to take the doctor a steelhead once a week. Mom made sure to remind me to take that steelhead – which I did! That was in ’46.”

http://www.sandiegotrout.org/indians.html

Comment: What on earth is steelhead doing in a health policy message? Well,
first of all, steelhead fever is a life-long disorder that, unlike other diseases, dramatically improves quality of life. Any person reading this who has steelhead fever knows he or she has it and knows that the condition cannot be adequately explained to those people who don’t. It also seems to be a familial disorder since my sons have it as well.

That said, the plight of the steelhead in San Juan Capistrano exemplifies some of the dramatic changes resulting from ecological factors, especially in human ecology.

I arrived in San Juan Capistrano and San Clemente in July, 1966, the same month that Medicare and Medicaid provided coverage to many with health care
needs who could not otherwise afford to pay for it. The decimated steelhead
population could no longer serve as a source of payment for health care services, and other sources of barter were totally inadequate. Medicare
and Medicaid were a great advance forward in ensuring affordable access to
health care.

37 years later, what further advances have we made? Universality? Sustained
comprehensive coverage? Affordability? Accessibility? It seems that the dynamics of human ecology have not been very kind. We do have the resources. We do have the health policy knowledge on how to improve utilization of our resources. But we seem to lack solidarity and egalitarianism. Does it really have to remain that way?

Although a few steelhead have been spotted in Orange County in the past decade, sadly, human ecological factors will prevail. And what fate does human ecology hold for native Americans, for descendents of more recent European arrivals, and for all of the rest of us in the mix of the great American melting pot?

Maybe it’s time to turn to the sociologists to show us how to apply human ecology for the betterment of mankind, at least as it applies to health care. We can certainly continue to try to use what we have also learned from the economists, political scientists and others who have attempted to show us the light. There must be a solution. Steelhead bartering certainly won’t do it anymore.

Footer