PNHP

Cancel Private Hospitals: Prominent Economists Say P3 Hospitals Threaten Medicare

Cancel Private Hospitals: Prominent Economists Say P3 Hospitals Threaten Medicare

Toronto – Four prominent economists and a former director of audit operations with Canada’s Auditor General released a report today that is sharply critical of controversial “public-private-partnership” (P3) hospital proposals.  The report commends the new provincial government for rejecting the P3 model for public hospitals, including those planned for Brampton and Ottawa.

The reports’ authors are: Lewis Auerbach, Arthur Donner Phd., Douglas D. Peters Phd., Monica Townson and Armine Yalnizyan.

In an open letter to the Ministers of Health and Long-Term Care, and Public Infrastructure Renewal, the authors describe P3 hospitals as posing “ a serious threat to the public health care system.” They urge the government “to carry through with the commitment to cancel the P3 projects proposed for the Royal Ottawa and William Osler Hospitals” and to “ensure that all future investment in public hospitals accords with the principles of public financing, ownership and not-for-profit administration.”

The authors conclude that when properly accounted for, P3 hospitals “are likely to be 10% more costly than hospitals that are publicly financed, owned and operated.”

Their report concludes that there is every reason to expect that if P3 hospitals were established in Ontario, they would result in “a deterioration of hospital services, diminished accountability, an increase in two-tier care, and needless cost.” The authors note that this is turn in likely to “discourage confidence in publicly funded health care, and weaken support for the medicare model.”
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Summary & Backgrounder

FUNDING HOSPITAL INFRASTRUCTURE: WHY P3S DON’T WORK, AND WHAT WILL

Summary

A group of prominent economists and a former director with Canada’s Auditor General have written to the Honourable Ministers of Health and Long Term Care, and Public Infrastructure Renewal commending the government for having rejected the P3 model, and encouraging the government to carry through by cancelling these outstanding projects.

In support of their position, the experts have prepared a report which examines the consequences of adopting a  “public-private partnership” or “P3″ model for providing health care infrastructure and services.  It exposes the fallacies of the rationale offered for adopting this approach, and describes the significant cost premium and accountability problems associated with the P3 model.

The experts describe the consequences of adopting the P3 for public hospitals as including:

· a substantial premium that taxpayers will pay for hospital facilities and services that are likely to be 10% more costly than hospitals that are publicly financed, owned and operated;

· the likelihood that the extent and quality of services will decline in P3 hospitals as efforts are made to sustain profit margins in an environment where efficiency gains are limited;

· the accountability problems inherent to P3 projects where confidentiality is claimed for financial and business records, preventing a proper accounting for public health-care spending, and frustrating efforts to monitor P3 hospitals for compliance with the principles and objectives of the Canada Health Act;
 
· the risk that by introducing the profit motive to public hospitals, P3s will create a platform for two-tiered service because of the co-mingling in one institution of insured health care services with those provided outside the publicly funded system.

The authors also express their support for the traditional approach to funding public infrastructure. They describe the public funding model as perfectly sound so long as accounting for such investments is improved.  To this end they call upon the new Government to adopt an accrual rather than a cash method of accounting for investment in health care infrastructure so that the costs of acquiring an asset like a public hospital can be spread over its useful life. They note that with interest rates at historically low levels, and significant unemployment in the province, the time is ideal to invest in hospitals and infrastructure.

Background

In December 2001, Ontario’s Conservative government announced plans to establish two private hospitals on sites owned by the William Osler Hospital Centre (WOHC) and the Royal Ottawa Health Care Group (ROHCG).

According to a scheme it described as a “public-private partnership” or “P3”, the Government proposed that both hospitals would be privately financed, owned, and operated.  In addition to providing hospital buildings and facilities, these P3 deals would bundle all “non-clinical” services into long-term contracts with for-profit health care companies.  According to the Government, clinical care services would remain under the control of the existing hospital boards.

In making these announcements,  the Government signalled its intention to abandon the non-profit model for providing hospital services in Ontario, where for decades public hospitals have been publicly financed, owned and operated on a non-profit basis. Capital funding for hospital infrastructure was provided by grants from the provincial and federal governments, and private charitable donations.

On the eve of the recent election, both the WOHC and ROH signed “framework agreements” with the same consortium of domestic and foreign investors.  Neither the provincial government nor the hospitals were willing the disclose the details of these arrangements.  However the WOHC has indicated that in its case the P3 contract has a value of $1.28 billion, and a term of twenty-eight years.

However the framework agreements signed by the Hospitals are contingent upon provincial approvals which have not yet been granted.  Moreover, during the election campaign, the Premier indicated that he would not, if elected, carry through with these P3 initiatives.

for a copy of the full report, go to  www.policyalternatives.ca

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Blue Cross’ RightPlan is terribly wrong

The Sacramento Bee
October 29, 2003
Health plan a sign of future?
Blue Cross offers lower premiums — but higher costs down the line.
By Lisa Rapaport

The day after insurance giants Anthem Inc. and WellPoint Health Networks
Inc. announced a merger deal that could create the biggest health plan in
America, WellPoint’s largest subsidiary unveiled a new product that many say
indicates where this huge insurer may lead the health care market.

Continuing the race to create health plans that lower premiums by charging
patients higher fees for doctors and hospitals, Blue Cross of California
said Tuesday it will sell a new individual health plan called RightPlan. It
has monthly premiums as low as $70 in Sacramento, but it requires patients
to pay $40 for doctor visits and 40 percent of hospital bills.

One aspect of RightPlan that Blue Cross officials said is essential to achieving low premiums is cause for particular concern in the medical community. Blue Cross intends to market the policy to people ages 18 to 34 — the most likely to be uninsured — but the plan does not include maternity coverage.

Known as consumer-driven health plans, policies such as RightPlan have cropped up with greater frequency in recent years as insurers have responded to demands from consumers and employers to curb steep premium increases.

… many health experts believe this latest Blue Cross offering is a good
indicator of what lies ahead.

At Blue Cross, officials would not speculate on whether RightPlan was a sign
of things to come. Spokeswoman Kellie Bernell said the company’s goal in
expanding its selection of consumer-driven plans in recent years has been to
reduce the rolls of the uninsured by offering affordable premiums.

The focus on fees for doctors and hospitals in these plans misses other aspects that may appeal to consumers, Bernell said. RightPlan includes discounts on gym memberships and weight-loss programs, as well as access to acupuncture and other types of alternative medicine.

Anthony Wright, executive director of Health Access, a patient advocacy group based in Sacramento:

“In California, Blue Cross has been a leader in pushing more costs to consumers. They do this and keep diluting the value of insurance. The point of insurance is to not worry about your bank account when you go to the doctor, and insurers seem to increasingly be missing this point.”

http://www.sacbee.com/content/news/medical/story/7688509p-8628347c.html

Comment: The crisis in affordability of health care is of great concern to nearly all Americans. The most visible manifestation of this crisis for the average, relatively healthy individual is the premium paid for health insurance. The insurance industry is acutely aware of this perception and has responded by designing products with affordable premiums. Although these have been targeted to the individual market, employers are now showing interest in these consumer-driven products in order to reduce the costs to them of their health benefit programs.

The United States is unique in its refusal to establish national policies that would contain the exploding health care costs while equitably distributing our finite resources amongst all of us. Without such policies in place, controlling premiums can only result in shifting costs to individual patients. But how many families can afford to pay 40% of the costs of a major hospitalization? The fundamental concept of insurance is being challenged by these consumer-driven programs. Policy studies supporting the importance of health insurance coverage lose their validity when cost sharing becomes unaffordable.

Unfortunately, this movement in health care reform plays into the hands of the ideologues. By shifting costs to individuals, the role of governmental public programs would be reduced. But these ideologues are not only opposed to a greater role of government, they also oppose any collective, societal effort to reduce exposure to the costs of untoward health events.

Pooling risk through nonprofit insurers is a collectivist approach that diminishes the role of individual responsibility in meeting fundamental needs. Although they use the “consumer empowerment” rhetoric, in reality they support the concept that those who “refuse” to achieve success and independence through individual effort should not share in the rewards common to the rest of us.

Let’s not fall into the trap of entering their deceptive rhetorical world which would continue to lead us down the path toward expansion of their highly flawed, inhumane policies. Our simple rhetoric of affordable, comprehensive health care for everyone instead should redirect us down the ethically-sound path toward health security for all.

Is starving Medicare the fix we need?

Date: Tue, 4 Nov 2003 11:28:36 -0800
Subject: qotd: Is starving Medicare the fix we need?

The New York Times
November 4, 2003
White House Backs Limits on Spending for Medicare
By Robert Pear

The Bush administration joined House Republicans on Monday in pushing a Proposal that would force Congress to vote on possible cutbacks in Medicare
if the costs of the program, including new drug benefits, grow faster than
expected.

The plan would also set limits on the use of general tax revenue for Medicare.

Senate negotiators have offered a similar proposal, labeled a “bipartisan Senate staff option.” This suggests that some cost-control mechanism is likely to be in any Medicare bill that emerges from Congress, despite objections from many Democrats and advocates for the elderly.

Both proposals would fundamentally change the financing of Medicare. They would also make it more difficult for Congress to enhance drug benefits,
raise payments to doctors or provide coverage for more outpatient services.

Under the latest proposal from House Republican negotiators, Medicare would
be declared “programmatically insolvent” if its trustees found that general tax revenue would account for more than 45 percent of Medicare spending at any point in the next seven years. If the trustees made such a prediction for two consecutive years, the president would have to propose ways to reduce the dependence on general revenue.

That could be done by cutting benefits, increasing beneficiary premiums form raising payroll taxes.

…the General Accounting Office, the investigative arm of Congress, said that Medicare’s growing reliance on general revenue imposed a mortgage on future generations.

Comment: Affordability of health care is a concern of most Americans. We need structural reform to ensure that costs will remain reasonable. A universal, integrated system would eliminate administrative excesses and provide a process to improve resource allocation by reducing inappropriate utilization. A well funded system, with structural integrity, would ensure access to comprehensive, affordable services for everyone.

But the process proposed for Medicare abandons rational cost containment, substituting flawed “starve the beast” economics. Capping the Medicare contribution from general revenues shifts funding to payroll taxes and to premiums and cost sharing paid by beneficiaries. This is both a shift towards more regressive funding of the program, and a shift towards the consumerist movement in health care.

Medicare currently pays only half of the costs of health care for the beneficiaries. Shifting more of the costs to moderate and low income individuals further threatens affordability for the majority of the beneficiaries, especially for those with greater needs. Because of the burden of higher costs, wage earners and beneficiaries would be pressured to accept even greater reductions in Medicare’s benefit package. Slowly starving the Medicare beast is cruel policy.

The fundamental premise that Medicare is no longer affordable is flawed. There are some things in life which we are quite willing to fund. And health security is one of them.

Unfortunately, it appears that the brain trust in Congress that is advancing this agenda is “programmatically insolvent.”

Medicare's blank check for the drug companies

Boston University School of Public Health
Health Reform Program
October 31, 2003
61 Percent of Medicare’s New Prescription Drug Subsidy Is Windfall Profit to Drug Makers
By Alan Sager, Ph.D. and Deborah Socolar, M.P.H.

Congress has declared its commitment to keeping prescription drug prices high under any Medicare drug benefit. This report shows that these unrestrained prices-given the remarkably low real cost of producing the added volumes of pills that Medicare patients need-will bestow enormous windfall profits on prescription drug makers.

An estimated 61.1 percent of the Medicare dollars that will be spent to buy more prescriptions will remain in the hands of drug makers as added profits.

* This windfall means an estimated $139 billion dollars in increased profits over eight years for the world’s most profitable industry.

* At $17 billion annually, this means about a 38 percent rise in drug maker profit.

This is the main reason why the proposed legislation gives patients only a scanty drug benefit, with high continued cost-sharing. The gift to drug makers is also why the plan requires a high taxpayer subsidy-money borrowed from our children and grandchildren.

The legislation would explicitly prohibit Medicare itself from acting to negotiate or contain the drug prices paid under the new program.

… the plan itself is not durable because it is simply too costly.
Congress is simply deferring serious work to shape a sustainable drug industry.

http://www.bumc.bu.edu/www/sph/hs/images/Health_Reform/Medicare_Rx_bill_windfallprofit.pdf

Comment: Physicians, hospitals, laboratories and other providers under the Medicare program have regulated limits on the rates of reimbursement for services and products provided. But look at the language of H.R. 1, the House version of the Medicare prescription drug legislation:

(D) NONINTERFERENCE- In carrying out its duties with respect to the provision of qualified prescription drug coverage to beneficiaries under this title, the [Medicare Benefits] Administrator may not–

(i) require a particular formulary or institute a price structure for the reimbursement of covered outpatient drugs;

(ii) interfere in any way with negotiations between [the various types of private plans] and drug manufacturers, wholesalers, or other suppliers of covered outpatient drugs; and

(iii) otherwise interfere with the competitive nature of providing such coverage through such sponsors and organizations.

The pharmaceutical industry is the most profitable industry in all history, and this bill hands them a blank check to be honored by the taxpayers and beneficiaries. And yet the meager benefit provided will continue to keep prescription drugs out of the reach of millions of Medicare beneficiaries because of the lack of affordability.

What input do we have? Rep. Bill Thomas, who is crafting the final legislation, has excluded most of the Democratic members of the joint conference committee from the process. He is even overriding the input of his Republican co-chair, Sen. Charles Grassley. His attitude is expressed well in this quote (Morgan and Eilperin, Washington Post, Oct. 29):

“I don’t think it serves any purpose to attempt to misrepresent or slant or fabricate… to influence outside the negotiating structure. My goal is to make law, not to make myself look good.”

And from the same article:

… Thomas surprised fellow conferees by outlining a proposed agreement for
the bill. He and his staff had written it without outside consultation. “It was a total unilateral move,” one source said. Grassley reportedly was furious.

http://www.washingtonpost.com/wp-dyn/articles/A38004-2003Oct29.html
It’s time to contemplate those cherished words of Abraham Lincoln: … government of the people, by the people, and for the people…

Let’s not let Lincoln down.

Medicare’s blank check for the drug companies

Boston University School of Public Health
Health Reform Program
October 31, 2003
61 Percent of Medicare’s New Prescription Drug Subsidy Is Windfall Profit to Drug Makers
By Alan Sager, Ph.D. and Deborah Socolar, M.P.H.

Congress has declared its commitment to keeping prescription drug prices high under any Medicare drug benefit. This report shows that these unrestrained prices-given the remarkably low real cost of producing the added volumes of pills that Medicare patients need-will bestow enormous windfall profits on prescription drug makers.

An estimated 61.1 percent of the Medicare dollars that will be spent to buy more prescriptions will remain in the hands of drug makers as added profits.

* This windfall means an estimated $139 billion dollars in increased profits over eight years for the world’s most profitable industry.

* At $17 billion annually, this means about a 38 percent rise in drug maker profit.

This is the main reason why the proposed legislation gives patients only a scanty drug benefit, with high continued cost-sharing. The gift to drug makers is also why the plan requires a high taxpayer subsidy-money borrowed from our children and grandchildren.

The legislation would explicitly prohibit Medicare itself from acting to negotiate or contain the drug prices paid under the new program.

… the plan itself is not durable because it is simply too costly.
Congress is simply deferring serious work to shape a sustainable drug industry.

http://www.bumc.bu.edu/www/sph/hs/images/Health_Reform/Medicare_Rx_bill_windfallprofit.pdf

Comment: Physicians, hospitals, laboratories and other providers under the Medicare program have regulated limits on the rates of reimbursement for services and products provided. But look at the language of H.R. 1, the House version of the Medicare prescription drug legislation:

(D) NONINTERFERENCE- In carrying out its duties with respect to the provision of qualified prescription drug coverage to beneficiaries under this title, the [Medicare Benefits] Administrator may not–

(i) require a particular formulary or institute a price structure for the reimbursement of covered outpatient drugs;

(ii) interfere in any way with negotiations between [the various types of private plans] and drug manufacturers, wholesalers, or other suppliers of covered outpatient drugs; and

(iii) otherwise interfere with the competitive nature of providing such coverage through such sponsors and organizations.

The pharmaceutical industry is the most profitable industry in all history, and this bill hands them a blank check to be honored by the taxpayers and beneficiaries. And yet the meager benefit provided will continue to keep prescription drugs out of the reach of millions of Medicare beneficiaries because of the lack of affordability.

What input do we have? Rep. Bill Thomas, who is crafting the final legislation, has excluded most of the Democratic members of the joint conference committee from the process. He is even overriding the input of his Republican co-chair, Sen. Charles Grassley. His attitude is expressed well in this quote (Morgan and Eilperin, Washington Post, Oct. 29):

“I don’t think it serves any purpose to attempt to misrepresent or slant or fabricate… to influence outside the negotiating structure. My goal is to make law, not to make myself look good.”

And from the same article:

… Thomas surprised fellow conferees by outlining a proposed agreement for
the bill. He and his staff had written it without outside consultation. “It was a total unilateral move,” one source said. Grassley reportedly was furious.

http://www.washingtonpost.com/wp-dyn/articles/A38004-2003Oct29.html
It’s time to contemplate those cherished words of Abraham Lincoln: … government of the people, by the people, and for the people…

Let’s not let Lincoln down.

Americans support health care as a public good

Harris Interactive
Health Care News
Volume 3, Issue 16
October 27, 2003

Table 3
Should Health Care be a Public Good (Entitlement) or a Private Economic Good?

Do you think public policy should treat health care and health insurance more as an entitlement like education, police and fire protection and highways or more as a kind of product or service, like cars, house, food and clothes, or homeowners insurance where you get what you can afford and want to pay for?

65% – Entitlement
23% – As a kind of product
12% – not sure

In all western democracies, there are substantial public sector and private sector health care providers and insurers. Of course, all the other western democracies provide some form of universal health insurance. What is less well known in America is that they also allow people (with some exceptions) to buy additional health insurance and medical care with their own money.

However, in every other western democracy a reasonable level of health insurance is seen as a right, something to which citizens are entitled. So in every country including the United States, health care is of course both an entitlement (for some people) as well as a private economic good. The question is should it tilt more one way or the other. In other countries, it clearly tilts heavily toward being more of an entitlement. Most Americans clearly agree with most Europeans and Canadians that health care could be thought of more as an entitlement or public good than as a private economic good.

http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2003Vol3_Iss16.pdf

Comment: The opponents of comprehensive health care proposals frequently
argue that Americans are fundamentally different, that Americans reject the
egalitarian concept that everyone should have reasonable access to affordable health care. They contend that we are a nation of individuals, each driven to provide for his or her own individual needs. Only the rare individual who is totally incapable of being a productive individual is entitled to support through a collective government or private charity channel, they argue.

This poll and last week’s ABC News/Washington Post poll both confirm that
Americans are not fundamentally different. The majority of us do believe
that the government should ensure that everyone has access to an adequate
level of health care services.

Never again can we allow a debate to end with the argument that we are different, that we are less caring for our fellow Americans than are the people of other nations for their own. That specious argument has been refuted.

The debate must instead start with the premise that we do care. The debate now must center over the various models of comprehensive reform which might accomplish our goals.

Payout from for-profit conversion

The New York Times
October 28, 2003
Acquisition Would Create Nation’s Largest Health Insurer
By Milt Freudenheim

In a marriage of Blue Cross giants, Anthem Inc. agreed yesterday to buy WellPoint Health Networks for $16.4 billion in stock and cash, creating a company that would be the nation’s largest health insurer, with 26 million health plan members in 13 states.

Anthem and WellPoint were pioneers in converting Blue Cross plans into for-profit companies…

WellPoint’s chief executive, Leonard D. Schaeffer, who created the company on the foundation of a successful turnaround of Blue Cross of California, will hand the reins to Larry Glasscock, Anthem’s chief executive.

Mr.Glasscock, 55, will be president and chief executive of the new company, and Mr. Schaeffer, 58, a former government health care official, will be chairman.

Mr. Schaeffer’s WellPoint holdings – 3.3 million shares, according to a Securities and Exchange Commission filing last month – jumped in value by more than $70 million yesterday, to over $300 million. He would also receive $27.5 million under a change-of-control clause in his contract and about $10 million more in executive retirement benefits, according to the WellPoint proxy and other filings.

Comment: When the deal is approved, besides the payouts listed, Leonard Schaeffer will receive 3.3 million shares of the combined company, WellPoint
Inc., plus an additional $78 million in cash. His total reported gain, not including his high salary, will be $116 million in cash plus the 3.3 million shares of WellPoint Inc., valued at about $257 million, for a total of $335 million. In spite of all of the other rhetoric, this one-third of a billion dollars is precisely why Leonard Schaeffer led the conversion of California Blue Cross into a for-profit insurer, establishing WellPoint as the parent company.

Although many become angry at the thought that these are funds that should
be going to health care, several economists point out the fact that these funds come from the shareholders who own the companies. They credibly contend that Wall Street investors rather than patients are footing this bill. But what is the traditional method of establishing the price per share? It’s the price-earnings ratio. Those earnings would be patient care funds in a public insurance program. And, of course, earnings are increased by hiking prices (premiums) and by reducing expenditures (health care benefits). Leonard Schaeffer’s wealth was gained by sacrificing value that would have accrued to purchasers and patients (insurance beneficiaries).

Social insurance anyone?

ABC News' on single payer for our "critical condition"

ABC News
Oct. 21, 2003
Critical Condition

Excerpts from Peter Jennings interview of ABC News’ Medical Editor Dr.Tim Johnson:

Jennings: The conventional wisdom is Americans like to think that we have
the best health-care system in the world.

Johnson: And we do, certainly for people that are very rich or who have very
good health insurance and who have very good connections into the health-care system. But for too large a number, 43 million, and many who are underinsured, it is not the very best system in the world.

Jennings: So what was notable in that regard in this poll this time?

Johnson: What was notable is that 62 percent of our population said that
they would favor a system of universal health insurance financed by the government, paid for by the tax payers, as opposed to the system we now
have, the employer based system where many people are uninsured. I was
stunned by that figure.

Jennings: I think conventional wisdom has it that in America, land of the free, that the marketplace is where the price is best established.

Johnson: That’s true for commodities like a car, where you can go in and make choices and you can even walk out of the showroom if you want. You can’t do that when you’re sick. You can’t do that with health care. So, for health care, you’re talking about a service and here I think the private sector has some real shortcomings. They have to spend a lot of overhead on sales and marketing and choosing the patients they’re going to serve. They shuffle a lot of paperwork.

Jennings: Now, I think that the conventional wisdom is still the single-payer system, as you and others have described it, is socialized medicine and that isn’t for the U.S.

Johnson: Socialized medicine means that the government both finances health
care and owns and operates the doctors and the hospitals.

Jennings: Like Britain?

Johnson: Like Britain. In Canada, it’s a split system. The government indeed
does collect the money and disperse it. They run the financial part of health care. But the delivery system is free. People can choose whatever doctor or hospital they want to go to. So, we have a system like that in this country. It’s called Medicare. That’s exactly what happens with Medicare. So, to call the Canadian system socialized is to call Medicare socialized. I think it’s a pejorative word and inaccurate.

Jennings: When I walk past people who know that we’re doing this series
this week and I mention the single-payer system, they just say, “Never in
America.”

Johnson: I’ve talked to elderly people who say they love Medicare but
they don’t want the government involved. They forget that the government has
a role to play in setting standards, maybe in handling the money with lower administrative costs. It would be a tragedy for the government to try to run the health-care system in terms of delivery.

Jennings: On top of which, many Americans hold it to be conventional wisdom
that private is better than public. Period.

Johnson: In fact the government does a few things well. And I’ll hold up one example in the health-care system: The NIH, the National Institutes of Health, is the shining gem of medical research in this entire world. It’s owned and run by the government. They can do some things well, especially when it comes to health care. Not everything, but some things.

Jennings: Who in the health-care industry, and by that I mean to include the
pharmaceutical companies as well, who in this industry agrees with the notion of reform that you advocate and who doesn’t ?

Johnson: Almost everybody that I know has now agreed that we have a horrendous problem with the uninsured in this country. I know of nobody who says that that’s a good thing to have 43 million uninsured. There obviously is disagreement about the solution. And it really breaks down along philosophical lines. Among those that think the marketplace can do a better job. Those that think the government at least in part can do a better job. And that’s a perennial battle. I have had health-care experts just in the past two weeks look at me and say, “I don’t care what the solution is, we have to do something about the uninsured.” It’s a national scandal.

Jennings: But we’ve tolerated the uninsured for a very long time, and still you have a large body of political opinions, much of it centered in the Republican Party, which says that we don’t wish to have a national single-payer system.

Johnson: And the Republicans in general are very much opposed to that. But at the same time, they realize that Medicare is an example of something that works in part. It needs to be reformed, we need to have a drug benefit, we need to improve the services. They’re behind the times. We need to probably spend more money, believe it or not. At least on some of the administration.

But, the same Republicans who don’t want a single-payer system would be loathe to say to our senior citizens, “We’re going to take away from you the one single-payer system we do have” – it’s called Medicare.

Jennings: We’re coming into an election year. It’s clearly a hot political subject. Do you think there is the political will in the country to compromise and provide a system with which all people of all political ideologies would agree?

Johnson: I would like to think so. I’m probably pessimistic about it, but with the latest poll results from our own poll, I’m more optimistic because all of a sudden we have a majority of people who are thinking in that direction. And that is what it’s going to take -a political majority to put pressure on Congress. I think the heart of the American people want to do something right, in terms of the, uninsured, and I think that the politicians will be dragged along.

http://abcnews.go.com/sections/WNT/DrJohnson/healthcare031021-1.html

Comment: Will the will of the majority be enough to drag the politicians along? Let’s see if democracy really does work.

Message: 2
Date: Wed, 22 Oct 2003 11:17:45 -0700
Subject: qotd: Video of the ABC News report on single payer

For a five-minute video of the ABC News report on single-payer reform, cut and paste the following link into the address box of your Internet browser:
rtsp://66.40.48.186/advisory/AHL/critical102103.rm
(Requires RealPlayer)

The video features Peter Jennings, Tim Johnson, Marcia Angell and Drew Altman.

Universal access to health care on ballot in Pa.

Universal access to health care on ballot in Pa.
By Christopher Guadagnino, Ph.D.
Published October 2003

Walter Tsou, M.D., MPH, is on the national board of Physicians for a National Health Program. Dr. Tsou was Philadelphia Health Commissioner from 2000 to 2002. To read the article click here

ABC News’ on single payer for our “critical condition”

ABC News
Oct. 21, 2003
Critical Condition

Excerpts from Peter Jennings interview of ABC News’ Medical Editor Dr.Tim Johnson:

Jennings: The conventional wisdom is Americans like to think that we have
the best health-care system in the world.

Johnson: And we do, certainly for people that are very rich or who have very
good health insurance and who have very good connections into the health-care system. But for too large a number, 43 million, and many who are underinsured, it is not the very best system in the world.

Jennings: So what was notable in that regard in this poll this time?

Johnson: What was notable is that 62 percent of our population said that
they would favor a system of universal health insurance financed by the government, paid for by the tax payers, as opposed to the system we now
have, the employer based system where many people are uninsured. I was
stunned by that figure.

Jennings: I think conventional wisdom has it that in America, land of the free, that the marketplace is where the price is best established.

Johnson: That’s true for commodities like a car, where you can go in and make choices and you can even walk out of the showroom if you want. You can’t do that when you’re sick. You can’t do that with health care. So, for health care, you’re talking about a service and here I think the private sector has some real shortcomings. They have to spend a lot of overhead on sales and marketing and choosing the patients they’re going to serve. They shuffle a lot of paperwork.

Jennings: Now, I think that the conventional wisdom is still the single-payer system, as you and others have described it, is socialized medicine and that isn’t for the U.S.

Johnson: Socialized medicine means that the government both finances health
care and owns and operates the doctors and the hospitals.

Jennings: Like Britain?

Johnson: Like Britain. In Canada, it’s a split system. The government indeed
does collect the money and disperse it. They run the financial part of health care. But the delivery system is free. People can choose whatever doctor or hospital they want to go to. So, we have a system like that in this country. It’s called Medicare. That’s exactly what happens with Medicare. So, to call the Canadian system socialized is to call Medicare socialized. I think it’s a pejorative word and inaccurate.

Jennings: When I walk past people who know that we’re doing this series
this week and I mention the single-payer system, they just say, “Never in
America.”

Johnson: I’ve talked to elderly people who say they love Medicare but
they don’t want the government involved. They forget that the government has
a role to play in setting standards, maybe in handling the money with lower administrative costs. It would be a tragedy for the government to try to run the health-care system in terms of delivery.

Jennings: On top of which, many Americans hold it to be conventional wisdom
that private is better than public. Period.

Johnson: In fact the government does a few things well. And I’ll hold up one example in the health-care system: The NIH, the National Institutes of Health, is the shining gem of medical research in this entire world. It’s owned and run by the government. They can do some things well, especially when it comes to health care. Not everything, but some things.

Jennings: Who in the health-care industry, and by that I mean to include the
pharmaceutical companies as well, who in this industry agrees with the notion of reform that you advocate and who doesn’t ?

Johnson: Almost everybody that I know has now agreed that we have a horrendous problem with the uninsured in this country. I know of nobody who says that that’s a good thing to have 43 million uninsured. There obviously is disagreement about the solution. And it really breaks down along philosophical lines. Among those that think the marketplace can do a better job. Those that think the government at least in part can do a better job. And that’s a perennial battle. I have had health-care experts just in the past two weeks look at me and say, “I don’t care what the solution is, we have to do something about the uninsured.” It’s a national scandal.

Jennings: But we’ve tolerated the uninsured for a very long time, and still you have a large body of political opinions, much of it centered in the Republican Party, which says that we don’t wish to have a national single-payer system.

Johnson: And the Republicans in general are very much opposed to that. But at the same time, they realize that Medicare is an example of something that works in part. It needs to be reformed, we need to have a drug benefit, we need to improve the services. They’re behind the times. We need to probably spend more money, believe it or not. At least on some of the administration.

But, the same Republicans who don’t want a single-payer system would be loathe to say to our senior citizens, “We’re going to take away from you the one single-payer system we do have” – it’s called Medicare.

Jennings: We’re coming into an election year. It’s clearly a hot political subject. Do you think there is the political will in the country to compromise and provide a system with which all people of all political ideologies would agree?

Johnson: I would like to think so. I’m probably pessimistic about it, but with the latest poll results from our own poll, I’m more optimistic because all of a sudden we have a majority of people who are thinking in that direction. And that is what it’s going to take -a political majority to put pressure on Congress. I think the heart of the American people want to do something right, in terms of the, uninsured, and I think that the politicians will be dragged along.

http://abcnews.go.com/sections/WNT/DrJohnson/healthcare031021-1.html

Comment: Will the will of the majority be enough to drag the politicians along? Let’s see if democracy really does work.

Message: 2
Date: Wed, 22 Oct 2003 11:17:45 -0700
Subject: qotd: Video of the ABC News report on single payer

For a five-minute video of the ABC News report on single-payer reform, cut and paste the following link into the address box of your Internet browser:
rtsp://66.40.48.186/advisory/AHL/critical102103.rm
(Requires RealPlayer)

The video features Peter Jennings, Tim Johnson, Marcia Angell and Drew Altman.

Seniors were better off before Medicare?!

The New York Times
October 22, 2003
Workers Feel Pinch of Rising Health Costs
By Milt Freudenheim

The figures for big companies reflect a broader shift in the American economy away from mechanisms that for decades have spread the burden of health care costs onto more shoulders.

Largely because of the booming cost of prescription drugs, for example, Medicare covers less of its beneficiaries’ health care expenses than at any time since the program was established in 1965, according to Robert M.Hayes, president of the Medicare Rights Center, a patient advocacy group.

As a result, the elderly paid 22 percent of their average median income, or $3,757, for health care last year – a larger proportion than the 20 percent of income they spent before the advent of Medicare.

Comment: So now seniors are worse off than they were before Medicare was
enacted. Half of their care is paid out-of-pocket, and that one-half is now a greater percentage of their income than what they were paying in 1965 without Medicare. Insane.

We need one risk pool for everyone. The $1.66 trillion that we are spending
would provide a rich benefit package for everyone, if allocated appropriately. And Americans now, by a 2:1 ratio, would favor a universal, government-run and taxpayer-financed system.

What are we waiting for?