PNHP

B. Capell responds on the importance of lobbying

B. Capell responds on the importance of lobbying

Beth Capell, Ph.D. responds on the AAHP/HIAA merger and the importance
of lobbying:

The budgets listed (in yesterday’s message on the AAHP/HIAA merger) probably do NOT include campaign contributions as your comment implies.Instead, these budgets are devoted to lobbying, providing information and “research” that supports lobbying, and activating grassroots presence (though perhaps not that either: it would depend on how these associations structure what they do: the overhead on grassroots could be modest and most of the cost of that effort could be buried within the budgets of individual companies).

Woody Allen says that 90% of life is just showing up. The same is true for moving an idea through the political process. Showing up counts. A lot. The insurers are ubiquitous on health issues–not just universal coverage, but Medicare prescription drugs and probably a dozen other key issues. And they are omnipresent: that’s what $30-$40 million in lobbying presence means: it means that every member of Congress who thinks a thought about health care knows who the insurance lobbyists are and probably what they will think about an issue.

PNHP has a plan for affordable health care for all—but members of Congress won’t know about it or take it seriously without an effective lobbying presence and without grassroots capacity to back that up. An occasional appearance on public television or an article in a medical journal (not widely read on Capitol Hill) are good but not sufficient. It is not a matter of matching the insurance industry dollar for dollar: after all, we beat them on HMO reform in California with far less capacity than that–but we (you, me, lots of other people and a number of key organizations) were there day after day for five years to win that fight. A fight at the national level requires commensurately greater capacity.

Good ideas are important but not sufficient. Just showing up counts for a lot in advocacy. Creating that presence, that showing up is what organizing is about.

Beth Capell, Ph.D., political science, lobbyist for California Physicians Alliance, Health Access California and others.

Editorial in Science calls for Debate on Single Payer National Health Insurance

Editorial in Science calls for Debate on Single Payer National Health Insurance
September 25, 2003

“Physicians have a responsibility to help solve the problem of inequities in our health care system.” (excerpt)

September 25, 2003— An editorial in this week’s issue of Science Magazine authored by former US Surgeon General Dr. Julius B. Richmond and Harvard economist Rashi Fein calls on American physicians to become active in the debate over health reform.

Dr. Richmond is a professor of Health Policy at Harvard Medical School. He served as Surgeon General in the Carter Administration. Dr. Fein is a Professor of the Economics of Medicine at Harvard Medical School. The Science Magazine editorial comes as rising health costs and premiums, and the increasing number of uninsured have stimulated a new round of health reform initiatives.

The editorial comments on the “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance” (NHI), a proposal endorsed by more than 10,000 physicians which was published last month in the Journal of the American Medical Association (JAMA, 8/13/03). The Physicians’ Proposal critiqued the health reform plans that have been offered by the Bush administration and the presidential candidates and concluded that the times call for a single-payer, government-administered, but privately-delivered system of health care.

“Our health system is deteriorating rapidly,” said Dr. Quentin Young, an author of the Physicians’ Proposal and National Coordinator of Physicians for a National Health Program. “By admonishing all professionals to become engaged, Richmond and Fein render a great service to the nation.”

# # #

Physicians for a National Health Program is an organization of 11,000 physicians that support universal access to health care. The group is headquartered in Chicago and has chapters across the United States (www.pnhp.org). A copy of the Physicians’ Proposal is available at www.physiciansproposal.org along with a list of endorsers.

To interview the authors contact Ida Hellander at tel: 312.782.6006 or pnhp@aol.com

To obtain an advance copy of the Science Magazine Health Insurance in the USA editorial, contact Kristina Smith at (202) 326-6440.

A formidable insurance lobby

The Hill
September 23, 2003
Insurance trade groups OK merger
AAHP and HIAA consolidates Hill lobbying efforts
By Michael S. Gerber

Washington, D.C.’s two largest health insurance trade groups (The American
Association of Health Plans (AAHP) and Health Insurance Association of America (HIAA)) announced Monday that their boards of directors had approved a merger…

Leading the new association in its efforts on Capitol Hill to promote
private insurers will be Karen Ignagni, who currently serves as president
and CEO of AAHP.

The two associations’ similar agendas in Washington make it easy to merge
the policy shops. Both have been pressing for a larger role for private insurers in the Medicare prescription drug package as well as increased
payments to HMOs.

AAHP and HIAA spent a combined $9.3 million on lobbying last year,according
to records filed with the Senate.Each group’s budget is around $20 million, according to the Government Affairs Yellow Book published by Leadership Directories.

AAHP currently employs a staff of 120 and HIAA 80, Ignagni said.(AAHP Chairman William) McCallum said the new organization’s budget would be about 40 percent greater than AAHP’s.

http://www.hillnews.com/business/092303_merger.aspx

Comment: So what? Well, AAHP/HIAA and its membership owns a controlling
interest in Congress. That’s what.

When our goal is to try to provide everyone with health insurance, why should we be concerned that this industry has a favored position with Congress? It’s because our current fragmented system of funding care through private and public programs has resulted in unacceptable waste, deficiencies and inequities in our system. Congress continues to perpetuate policies that protect and enhance private health plans at the cost of health care equity for all of us.

AAHP/HIAA’s $40 million budget can secure its position quite solidly in the
hallways and lobby rooms of Congress. In contrast, we have no significant
sources of funds. All we can offer is a plan to provide affordable, comprehensive health care for everyone. Unfortunately, policy position papers don’t have the color and smell of fresh U.S. Treasury ink that serves as an effective attractant to too many of the creatures of Congress.

MASS-CARE

The Committee for Health Care for Massachusetts is a statewide effort being led by the people of Massachusetts, including health professionals, community leaders, organizations, patients and their families to ensure that no state resident go without affordable, comprehensive and equitably financed health insurance.

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Medicaid becoming merely a means tested certification

Kaiser Commission on Medicaid and the Uninsured (KCMU)
News release on Medicaid reductions
September 22, 2003

In the Past Three Years, Two-thirds of States Have Reduced Eligibility and
Restricted Health Care Benefits for Families and Low-Income Seniors-Not Just
Curbing Payments

With most states coping with their fourth year of fiscal stress, all 50 states and the District of Columbia (DC) have planned or implemented Medicaid cost containment actions for fiscal year (FY) 2004.

Diane Rowland, executive director of KCMU:”The duration of the state fiscal crisis is impacting Medicaid coverage broadly and deeply-and it’s not just actions curbing provider payments or controlling prescription drug costs that we have heard about consistently.

When 34 states have reduced eligibility and even more have restricted needed
health care benefits in at least one of the last three years and there is little short-term hope of states recovering their revenue losses, we have to be concerned about low-income seniors and families getting less health care or losing it altogether.”

http://www.kff.org/content/2003/20030922/prls922.pdf

Comment: As long as Medicaid remains a welfare program for very low income individuals, it will always be used as tool to balance budgets in difficult economic times, even though it is a chronically underfunded program.

Having a Medicaid card alone does not ensure access to adequate health care.

Medicaid is becoming less and less a form of insurance, and more and
more a certification process declaring the individual has been subjected to
means testing and is incapable of paying for medical care. Providers are now
in a position of either accepting losses because of their belief that everyone
should have medical care, or refusing to provide care because the insurer
(state and federal government) has failed to adequately fund the actual costs of care.

If we had an egalitarian system of social insurance, the political will
would be there to ensure that the system would be adequately funded for all
of us. Wouldn’t that be better?

50 percent employee contribution to health care!?

The Providence Journal
September 21, 2003
There’s no shelter from this storm
By John Kostrzewa

Employees used to contribute about 15 percent of the cost of health care. Now, the contribution has risen to 25 percent to 35 percent. And health-care consultants forecast it will grow to 50 percent at some companies.

Some workers are cutting back on health care and elective Surgeries, deciding to live with the bad knee rather than get a replacement. Or they are deciding to postpone the eye exam to avoid the copay. Or they are going without health insurance.
No relief is on the horizon.

http://www.projo.com/business/content/projo_20030921_jk21x.777bd.html

Comment: Current health care reform efforts continue down this path of shifting costs to patients. But is this really reform? Reform is defined as a change for the better. Reducing affordable access to beneficial health care services is a change for the worse.

Let’s dump this movement to shift costs to patients and get on with the process of real reform!

OPM director lauds FEHBP increases

The Washington Post
September 17, 2003
Health Plan Costs Up 10.6%
By Christopher Lee

Health insurance premiums for federal employees and retirees (under the Federal Employees Health Benefits Program) will rise an average of 10.6 percent next year, the fourth consecutive year of double-digit increases, the Bush administration said yesterday.

Kay Cole James, director of the Office of Personnel Management:”This is great news for the federal employees, and we’re excited today on their behalf.”

Alwyn Cassil, spokeswoman for the Center for Studying Health System Change:Although federal workers’ premium increases have been comparatively
smaller,10.6 percent “is still a very high rate of growth. It’s growing much faster than increases in wages, increases in growth of the economy and increases in inflation. That means that more and more money will be coming out of people’s pockets to pay for health care.”

The administration also announced that, for the first time in five years,the government will expand the number of health plan choices under the Federal Employees Health Benefits Program. The program will offer 205 plans nationwide next year, up from 188 in this year.

http://www.washingtonpost.com/wp-dyn/articles/A21909-2003Sep16.html Comment: The largest purchaser of health care coverage, the Federal Employees Health Benefits Program, has not been able to slow the rise in health care costs to anywhere near the rate of inflation. That is not good news.

The fact that more plans wish to participate in the program indicates that our national policies are designed to enhance the business model of private health plans at the cost of higher health care expenses for the employees and their families.

Should we continue with national policies that are designed to protect the health plans of the members of Congress, or should we change to policies that are designed to ensure access to affordable care for everyone?

Rhetoric of universal insurance

The Washington Post
September 16, 2003
Proposals for Expanding Health Care Coverage
By Julie Ishida

While the uninsured are left to deal with the consequences of being uninsured, policymakers have designed a variety of proposals to expand access to health insurance. The majority of Americans polled in a 2003 survey by the Kaiser Family Foundation and the Harvard School of Public Health support increasing the number of people in the United States covered by health insurance, but there is no consensus on how to accomplish this.

Karen Davis, president of the Commonwealth Fund:

“The proposals that are now being talked about are more pragmatic and less ideological and more focused on building [on] what works currently. How can we find out what’s working now and add more people?”

Paul Ginsburg, president of the Center for Studying Health System Change:”The reason why individuals are uninsured differs so much that it is unlikely that a single provision is going to cover them all. We need different approaches for different segments of the population.”

Here’s a summary of the major approaches under discussion.

Universal Coverage Proposals:

* Single payer

* Employer mandate

* Individual mandate

Incremental Proposal:

* Expansion of Medicaid and Children’s Health Insurance Program (CHIP)
eligibility

* Subsidization of private insurance

* Creation of a system similar to the Federal Employees Health Benefits
(FEHB) Program

http://www.washingtonpost.com/wp-dyn/articles/A15812-2003Sep15_2.html

Comment: The messages of individuals such as Karen Davis and Paul Ginsburg have dominated the national dialogue on health care reform. They imply that only piecemeal measures are feasible.

But the failure to control increasing costs, combined with a failure to reduce the numbers of uninsured have created an awareness that we need a more aggressive approach toward reform.

The recent publicity surrounding the physicians’ proposal for national health insurance published in JAMA, and the administrative efficiency achievable by a single payer system published in NEJM, have regenerated an interest in looking again at truly universal models of health care coverage.

Washington Post reporter Julie Ishida exemplifies the changing dialogue as she now includes universal models in her list of proposals. Members of the media understand the need to broaden the debate. But we need to convince the leaders of those organizations which support comprehensive health care coverage that it is once again okay to discuss universal systems of reform.Davis and Ginsburg need to hear that message.

One more message that we need to deliver is that there are very fundamental differences between the single payer model of social insurance and other so-called universal proposals. As an example, SB 2, California’s employer mandate which passed last week (but not yet signed by Gov. Davis) will still fail to provide coverage for over four-fifths of those currently uninsured.

It will significantly increase costs because it fails to eliminate the administrative excesses and fails to provide any significant cost-containment features. It also represents flawed tax policy since it is regressively funded, providing tax advantages for the wealthy and a lower net cost of their coverage, a benefit not available to low income individuals. It falls so far short of single payer goals that it is inappropriate to consider it in the same general category of reform.

Let’s convince our policymakers that it is time to put everything on the table. But let’s also convince them that single payer needs to be in a special place on the table wherein the policies of all other models are challenged to meet the golden standard of a universal, single payer system of social insurance.

U.S. health care in 'critical condition'

U.S. health care in ‘critical condition’
September 16, 2003

BY JERRY DAVICH, Times Staff Writer

If America’s ailing health care system was a hospital patient, it would be in the intensive care unit. And a chaplain would be waiting outside the door. “The system isn’t dead yet, but it needs to be saved,” said Dr. Quentin Young, a Chicago internist who’s been practicing medicine for half a century.With no miracle cure in the works, a transplant is needed, Young and thousands of doctors agree.

The country’s current system — infected with swelled administrative costs, inflamed malpractice suits and cancerous private-pay greed — needs to be extracted and replaced with a single-payer national health insurance program, Young said. As national coordinator of Physicians for National Health Care, he is encouraged that nearly 9,000 U.S. doctors endorsed his proposal, published Aug. 13 in the Journal of the American Medical Association.

Saturday, Young hopes to encourage other doctors and lawmakers during a health care reform conference at Indiana University Northwest. The public forum is sponsored by The Northwest Indiana Coalition for Health Care for All, made up of unions and environmental, religious and community groups.”This forum is the first step in building a regionwide coalition to see a health care system that takes care of all of us,” said organizer Ruth Needleman, an IUN professor.

Sponsors like Needleman admit they don’t share a single vision for what the system should look like, but “we do understand that our current system has failed completely,” she said.The forum, open to the public, will include sessions on local, state and federal action, information on health care bargaining, facts about the successful Canadian health care system and an update by U.S. Rep. Pete Visclosky, D-Ind., about congressional action on this issue.During his 1 p.m. talk, Visclosky also will receive a widely circulated petition for health care reform from the United Steelworkers of America District 7 office.

Dr. Linda Murray, chief medical officer of the county-run clinics in Cook County, Ill., will explain why the country’s health care system has failed and what feasible alternatives there are for the future.The proposal Young coauthored states that the United States treats health care as a commodity — distributed according to the ability to pay — rather than as a social service to be distributed according to medical need.It’s a market-driven system where insurers and providers compete by avoiding patients who can’t pay and shifting costs back to patients who can. This, Young said, creates the paradox of a health care system based on avoiding the sick.

“This issue is rising to the top of the national agenda with 44 million uninsured Americans leading the way,” he said.

What’s needed, Young said, is a critical mass of legislators to lend a hand with the operation of saving one state at a time, which could lead to national reforms. About a half-dozen states are in the process of enacting health care reform legislation, Young said.

“It’s not the best solution,” Young said. “It’s the only solution.”

Jerry Davich can be reached at jdavich@nwitimes.com or (219) 933-3376.

U.S. health care in ‘critical condition’

U.S. health care in ‘critical condition’
September 16, 2003

BY JERRY DAVICH, Times Staff Writer

If America’s ailing health care system was a hospital patient, it would be in the intensive care unit. And a chaplain would be waiting outside the door. “The system isn’t dead yet, but it needs to be saved,” said Dr. Quentin Young, a Chicago internist who’s been practicing medicine for half a century.With no miracle cure in the works, a transplant is needed, Young and thousands of doctors agree.

The country’s current system — infected with swelled administrative costs, inflamed malpractice suits and cancerous private-pay greed — needs to be extracted and replaced with a single-payer national health insurance program, Young said. As national coordinator of Physicians for National Health Care, he is encouraged that nearly 9,000 U.S. doctors endorsed his proposal, published Aug. 13 in the Journal of the American Medical Association.

Saturday, Young hopes to encourage other doctors and lawmakers during a health care reform conference at Indiana University Northwest. The public forum is sponsored by The Northwest Indiana Coalition for Health Care for All, made up of unions and environmental, religious and community groups.”This forum is the first step in building a regionwide coalition to see a health care system that takes care of all of us,” said organizer Ruth Needleman, an IUN professor.

Sponsors like Needleman admit they don’t share a single vision for what the system should look like, but “we do understand that our current system has failed completely,” she said.The forum, open to the public, will include sessions on local, state and federal action, information on health care bargaining, facts about the successful Canadian health care system and an update by U.S. Rep. Pete Visclosky, D-Ind., about congressional action on this issue.During his 1 p.m. talk, Visclosky also will receive a widely circulated petition for health care reform from the United Steelworkers of America District 7 office.

Dr. Linda Murray, chief medical officer of the county-run clinics in Cook County, Ill., will explain why the country’s health care system has failed and what feasible alternatives there are for the future.The proposal Young coauthored states that the United States treats health care as a commodity — distributed according to the ability to pay — rather than as a social service to be distributed according to medical need.It’s a market-driven system where insurers and providers compete by avoiding patients who can’t pay and shifting costs back to patients who can. This, Young said, creates the paradox of a health care system based on avoiding the sick.

“This issue is rising to the top of the national agenda with 44 million uninsured Americans leading the way,” he said.

What’s needed, Young said, is a critical mass of legislators to lend a hand with the operation of saving one state at a time, which could lead to national reforms. About a half-dozen states are in the process of enacting health care reform legislation, Young said.

“It’s not the best solution,” Young said. “It’s the only solution.”

Jerry Davich can be reached at jdavich@nwitimes.com or (219) 933-3376.

Health and longevity do not burden Medicare

The New England Journal of Medicine
September 11, 2003
Health, Life Expectancy, and Health Care Spending among the Elderly
By James Lubitz, M.P.H., Liming Cai, Ph.D., Ellen Kramarow, Ph.D., and
Harold Lentzner, Ph.D.

Conclusions
The expected cumulative health expenditures for healthier elderly persons, despite their greater longevity, were similar to those for less healthy persons. Health-promotion efforts aimed at persons under 65 years of age may improve the health and longevity of the elderly without increasing health expenditures.

http://content.nejm.org/cgi/content/full/349/11/1048

Comment: Since living longer doesn’t increase health care costs, those who predict “bankruptcy” of Medicare are now limited to the premises that the numbers of Medicare beneficiaries will be too great, and that the increasing
technological costs will be excessive.

The ratio of retirees to workers will shift upward with the retirement of the baby boomers, but that increase is a relatively modest, finite number that is not “unaffordable” according to any reasonable actuarial forecast.And it will stabilize as the baby boomers transition through the other end of the life cycle.

The increase in health care costs is a major issue. But that is not a problem that is limited to the Medicare program. It applies to our entire health care system. There are many factors. Just a few of these are increased use of expensive technology, higher drug costs, higher pricing in the United States, and Overutilization of our higher capacity healthcare system. These are systemic problems that cannot be addressed simply by destroying Medicare as a program of social insurance.

We need structural reform of our health care system. A good start would be to revise the way that we pay for health care, keeping in mind the importance of access, equity and affordability.