PNHP

Voters eye health-care option

Voters eye health-care option

A November measure would create universal coverage.

SUSAN TOM
Statesman Journal
October 11, 2002

A sweeping initiative on the November ballot will test just how frustrated Oregonians are with the health care system.
Measure 23 would create a universal health care finance plan to provide medically necessary services to every Oregonian. If passed, Oregon will be the first state to offer free health care to all its residents. The measure would replace insurance premiums, copayments, deductibles and other out-of-pocket patient expenses with a single payer state system financed by payroll and personal income taxes.
Mark Lindgren, chairman of Health Care for All Oregon, the group backing the measure, said the initiative was deliberately written to be vague to avoid potential court challenges. A 15-member board would be created to set limits on health care services and to administer the program.
Laurie Sobel, attorney for Consumers Union, publisher of Consumer Reports, said the measure would reduce hidden costs and time wasted filing claims by cutting out the middle people, the insurance companies.
“We believe everyone has the right to health care,” Sobel said. “It makes for a healthier community and ultimately leads to lower costs.”
The measure sounds like an improvement over the current system, said Garth Keir of Salem, a former state worker retired on disability.
“It’s not just what you need now but what you may need,” said Keir, 56. “I always subscribe to the idea that we’re all in one big rowboat and we need to row together or sink together.”
But a growing number of opponents, including business, insurance, labor and medical groups like the Oregon Medical Association and Associated Oregon Industries, call the measure poorly written and financially unsustainable. They say it would force repeal of cost-saving worker compensation reforms and reduce money for schools. Estimates are that Measure 23 could cost up to $20 billion annually.
A coalition of health care insurers, including ODS Health Plans, Regence BlueCross BlueShield of Oregon, Kaiser Permanente, PacifiCare and Providence Health Plan, raised $402,692 so far to defeat the measure.
By comparison, Health Care for All Oregon raised $22,023, mostly from small donations.
David Fiskum, a lobbyist for Oregonians Against UnHealthy Taxes, said the measure not only would give the board unlimited power in issuing bonds and rationing health care, but will create another bureaucracy.
The timing also is bad given the state’s high unemployment rate and sagging economy.
An additional payroll tax will make Oregon a less attractive place for business, said Ken Rutledge, spokesman for the Oregon Association of Hospital and Health Systems.
“They’re being very naive to think there’s going to be adequate money to pay for all services,” Rutledge said.
Barbara Cummings, a Salem small business owner, said more people will abuse the system because there is no incentive to take personal responsibility for one’s health. She expects longer waits, more crowding and a lower quality of health care as a result.
“What happens when money runs out? Will I have to wait six weeks for an MRI?” Cummings said.
Rob Wagner, government relations director of the American Federation of Teachers-Oregon, said the measure is not an ideal fix, but it is a good first step toward.
“I see our members at the bargaining table having to choose between salary increases to keep up with the cost of living or picking up a greater portion of health care costs,” Wagner said.
Universal health supporters Oregon State Public Interest Research Group and Oregonians for Health Security are taking more conservative approaches because they say Oregonians aren’t ready to toss out the current system.
“We’re looking for smaller steps along the way and they’re looking for a leap,” said Rob Manning, spokesman for Oregonians for Health Security. “But if it were to pass, we would definitely be in support of it.”
The reason: more than 400,000 Oregonians don’t have health insurance. One in five lack prescription coverage.
Oregonians aren’t alone in their frustration with sharply rising premiums, lower reimbursements and reduced access. Fourteen states, including California and most recently Texas, are pursuing a single-payer system, according to the Universal Health Care Action Network in Cleveland, Ohio. Oregon could become the testing ground for a health care overhaul.
The problem isn’t new; the Clinton administration tried, but failed to expand health care coverage.
And Gov. John Kitzhaber’s promise of a more expansive system than the Oregon Health Plan to be financed in part by a business tax never materialized.
Critics say the current system provides too few services, costs too much, makes money off the young and healthy and dumps the sick and old.
Dr. Don McCanne, president of Physicians for a National Health Program, said the measure allows more efficient use of health care funds and establishes equity in finance and access.
“It provides more comprehensive services at a cost that is no greater than what Oregon is spending,” McCanne said.
But Dr. Colin Cave, OMA president-elect, said while the organization favors universal health care — it supported the Oregon Health Plan — it won’t back the measure because its approach is unreasonable.
Measure 23 has no limits on what type of health care is necessary, no incentive to coordinate access and no residency requirement.
There’s also no guarantee that 15 people have the necessary sophistication to deal with complex health care issues and manage a budget at least double that of Oregon’s general fund. Getting a federal waiver also is very unlikely.
“It’s very lopsided,” Cave said. “This is not the way to do it.”
But Hanteng Dai of Salem, a 38-year-old state employee, said he supports the measure despite its flaws because it’s the first step toward improving health care for society in the long run.
“Accept the concept first, improve the procedure later,” Dai said. “Don’t kill an idea in its infancy.”
Susan Tom can be reached at (503) 399-6744.

The Forgotten Domestic Crisis

By MARCIA ANGELL

CAMBRIDGE, Mass. — If it weren’t for the steady beat of war drums, health care would be front and center in this fall’s political debate. And war or no war, politicians will not be able to avoid it much longer. As John Breaux of Louisiana, long one of the most conservative Senate Democrats, recently told the press, “The system is collapsing around us.”

That is not hyperbole. Private health insurance premiums are rising at an unsustainable average of about 13 percent per year — and as much as 25 percent in some areas of the country. Coverage is shrinking, as more employers decide to cap their contributions to health insurance plans and workers find they cannot pay their rapidly expanding share. And with the rise in unemployment, more people are losing what limited coverage they had. Last month, the Census Bureau reported that nearly 1.5 million Americans lost their insurance in 2001.

The fatal flaw in the system is that we treat health care as a commodity. That has been the case for a long time, but the effects were masked during the economic boom of the 1990’s. Now, with the recession, the irrationality of that approach is exposed.

When health care becomes a commodity, the criterion for receiving it is ability to pay, not medical need. Private insurers and providers compete with one another to avoid getting stuck with high-cost patients, so they can keep more of their revenues. But this game of hot potato takes a lot of oversight and paperwork. In fact, the hallmark of the system is the extent to which health funds are diverted to overhead and profits.

Look at what happens to the health-care dollar as it wends its way from employers to the doctors and hospitals that provide medical services. Private insurers regularly skim off the top 10 percent to 25 percent of premiums for administrative costs, marketing and profits. The remainder is passed along a gantlet of satellite businesses — insurance brokers, disease-management and utilization-review companies, lawyers, consultants, billing agencies, information management firms and so on. Their function is often to limit services in one way or another. They, too, take a cut, including enough for their own administrative costs, marketing and profits. As much as half the health-care dollar never reaches doctors and hospitals — who themselves face high overhead costs in dealing with multiple insurers.

One more absurdity of our market-based system: the pressure is to increase total health-care expenditures, not reduce them. Presumably, as a nation we want to constrain the growth of health costs. But that’s simply not what health-care businesses do. Like all businesses, they want more, not fewer, customers — but only if they can pay.

All piecemeal attempts to improve the system — while keeping it market-based — have run into the following dilemma: if access to services is expanded, costs rise; if costs are lowered, access is cut. That’s the way it is. The only way to avoid this dilemma is to change the system entirely.

What we need is a national single-payer system that would eliminate unnecessary administrative costs, duplication and profits. In many ways, this would be tantamount to extending Medicare to the entire population. Medicare is, after all, a government-financed single-payer system embedded within our private, market-based system. It’s by far the most efficient part of our health-care system, with overhead costs of less than 3 percent, and it covers virtually everyone over the age of 65. Medicare is not perfect, but it’s the most popular part of the American health-care system.

Many people believe a single-payer system is a good idea, but that we can’t afford it. The truth is that we can no longer afford not to have such a system. We now spend more than $5,000 a year on health care for each American — more than twice the average of other advanced countries. But nearly half that amount is wasted. We now pay for health care in multiple ways — through our paychecks, the prices of goods and services, taxes at all levels of government, and out-of-pocket fees. It makes more sense to pay only once, perhaps through a new tax on income earmarked for health care (in the same way Medicare is financed through payroll taxes).

It is sometimes argued that innovative technologies would be scarce in a national single-payer system, so we would have long waiting lists. This misconception is based on the fact that there are indeed waits for elective procedures in some countries with national health systems like Great Britain and Canada. But that’s because they spend far less on health care than we do. If they were to put the same amount of money as we do into their systems, there would be no waits. For them, the problem is not the system; it’s the money. For us, it’s not the money; it’s the system. We already spend enough for an excellent universal system.

A single-payer system is not socialized medicine. Although a new national program — like Medicare — would be publicly financed, the doctors and hospitals would not work for the government, but would remain private. Some fear onerous government regulations from a national payment system, but surely nothing could be more onerous for patients and providers than the multiple, intrusive regulations imposed on them by the private insurance industry today.

We live in a country that tolerates enormous disparities in income, material possessions and social privilege. That may be inevitable in a free-market economy. But those disparities should not extend to essential services like education, clean water and air and protection from crime, all of which we already acknowledge are public responsibilities. The same should be true for medical care — particularly since we can well afford to provide it for everyone if we end the waste and profiteering of our market-based system.

Marcia Angell, the former editor in chief of the New England Journal of Medicine, is a senior lecturer in social medicine at Harvard Medical School.

Medicaid reductions balance budgets

Kaiser Commission on Medicaid and the Uninsured
Medicaid Spending Growth: Results from a 2002 Survey
September 2002
Prepared by Vernon Smith, Ph.D., Eileen Ellis, Kathy Gifford, Rekha Ramesh,
and Victoria Wachino

In response to their overall fiscal situations and… Medicaid cost
pressures, 45 states took action to reduce their Medicaid spending growth in
Fiscal Year 2002. Forty-one states reported that they have plans underway to
take additional actions for FY 2003, which started July 1 in most states. As
the fiscal year progresses, it is likely that more states will act to reduce
their Medicaid spending. It is also notable that for each type of cost
containment strategy, more states reported planning to undertake action in
FY 2003 compared to FY 2002.

The most common cost containment action that states are undertaking are
policies to control the cost and use of prescription drugs, but states are
also limiting payments to providers, eliminating some benefits, and
restricting eligibility:

· Forty states are planning to implement prescription drug cost controls in
FY 2003, an increase over 32 states in FY 2002.
· A majority of states, 29, are either reducing or freezing some of their
provider payment rates in FY 2003. Twenty-two states reported provider rate
cuts or freezes for FY 2002.
· Fifteen states are reducing Medicaid benefits in FY 2003. Eight of these
states reduced dental benefits; states reduced other benefits, such as home
health, podiatry, and optical services as well. Nine states reduced benefits
in FY 2002.
· Eighteen states are reducing or restricting Medicaid eligibility. Eight
states implemented eligibility restrictions in FY 2002. Four states
(Missouri, New Jersey, Nebraska, and Massachusetts) eliminated eligibility
for thousands of people. States have also restricted eligibility by changing
rules related to transitional medical assistance or changing rules related
to their medically needy programs that will make fewer people eligible for
Medicaid.
· Fifteen states are increasing beneficiary co-payments for services other
than prescription drugs. Four states increased co-payments for
non-prescription drug services in FY 2002.

The same pressures that increased Medicaid costs in FY 2002 will persist in
FY 2003. State officials indicated that Medicaid enrollment is likely to
continue to increase, particularly if the economy does not improve. State
Medicaid enrollment forecasts are for increases that average 6.2 percent.
Medical costs are expected to continue to increase as well, adding to the
cost pressure, with prescription drug costs likely increasing again at
double-digit rates. The factors that affect Medicaid are largely the same as
those that increase costs for private insurance, where premiums increased by
nearly 13 percent in 2002.

Despite these cost pressures, state legislatures appropriated increased
funding for Medicaid for FY 2003 that averaged less than 5 percent. This
suggests that in many states the original legislative appropriation will be
insufficient to meet actual program expenditures. Medicaid officials
indicated that further program cuts will likely be considered and additional
funds will likely be needed in FY 2003. However, with state reserve and
rainy day funds substantially depleted, it will be more difficult to find
the funds needed to finance Medicaid this fiscal year and next.

http://www.kff.org/content/2002/4064/4064.pdf

Comment: Medicaid, being a program for low-income individuals, will always
be treated as a “welfare” program. In difficult financial times its need
will be greater, but funding sources will diminish. Politicians inevitably
will favor other programs as they reduce medical services for these less
fortunate individuals without a political voice.

We are spending $5757 per capita in health care this year. That would create
a $1.55 trillion pool of health care funds, more than enough to provide
comprehensive health care services for everyone. If we placed everyone in a
single risk pool, there would be no reason to submit a major sector of our
society to the indignities and inadequacies of a separate “medical welfare”
program.

New slideshow by Darcy Haber

PNHPers may be interested in this new Powerpoint slideshow by Darcy Harber. Download it here.

Additional text:

We had a great HC speaker training yesterday — thanks so much to all of you who participated.  As I have promised many of you, attached please find the power point presentation I used.  Of course, you are all welcome to use it and modify it to fit your needs.  And I welcome any additional suggestions/changes/additions you have so I can continue to improve my version!
  
And now for some good news for a change . . .
From today’s WSJ  (article not on website)
 
75% of respondents favor a Canadian-style health-care system in which the government pays for health care through taxes and negotiates fees directly with doctors.  73% of respondents who support that idea would still support it if their taxes increased as a result, the survey showed.
 
Nearly a third of respondents chose “controlling health care and prescription drug costs” when asked to choose the most important of six issues that need attention of state government.

Family practice as an agent for reform

The Journal of the American Board of Family Practice
September-October 2002
Family Practice in a Failing Health Care System: New Opportunities To
Advocate for System Reform
By John P. Geyman, MD

Family practice embraced reform of medical education and the health care
system in its early development, and it has the potential to become an
active and credible change agent for reform, particularly if it becomes part
of a coalition with the other primary care specialties. Family physicians
are typically close to their patients and communities and, if activated and
focused, could become major players toward system reform. Instead of
spending its energies trying to redress the problems linked to the current
disintegrating health care system, family practice could more effectively
serve the public interest and its own future self-interest if its efforts
are targeted to basic structural reform of the system.

http://www.familypractice.com/journal/abfpjournal_frame.htm and click
“2002,” then “Sep/Oct,” and then the article under “Special Communication.”

Comment: This excellent article is based on the 12th G. Gayle Stephens
Lecture delivered by Dr. Geyman. It discusses the problems of our
deteriorating health care system, the alternatives for reform, and suggests
some constructive future directions for family practice to take through a
leadership role in advocating for system reform.

Drug co-payments benefit plans, not patients

JAMA
October 9, 2002
Employer Drug Benefit Plans and Spending on Prescription Drugs
By Geoffrey F. Joyce, PhD; José J. Escarce, MD, PhD; Matthew D. Solomon, MA;
Dana P. Goldman, PhD

We found that many of the tools used to influence pharmaceutical use were
effective in reducing drug expenditures for working-age enrollees with
employer-provided drug coverage. Adding an additional level of co-payment,
increasing existing co-payments or coinsurance rates, and requiring MGS
(paying co-payments plus differences in cost between the brand and generic
drugs) all reduced health insurance plan payments significantly.

Patient out-of-pocket spending did not change substantially within a
specific benefit design, because the reduction in overall drug use due to
higher patient cost-sharing largely offset the effects of higher co-payments
per prescription.

Several studies have found that spending caps and formulary restrictions
reduced use of both essential and nonessential medications among low-income
and elderly populations.

Conclusions: Adding an additional level of co-payment, increasing existing
co-payments or coinsurance rates, and requiring mandatory generic
substitution all reduced plan payments and overall drug spending among
working-age enrollees with employer-provided drug coverage. The reduction in
drug spending largely benefited health insurance plans because the
percentage of drug expenses beneficiaries paid out-of-pocket rose
significantly.

http://jama.ama-assn.org/issues/v288n14/abs/joc21507.html

Comment: We continue on the path of developing and expanding policies that
benefit health insurance plans, to the detriment of patient coverage. When
will we finally accept the concept that health policy should be designed to
benefit patients?

Universal care hinges on cost

http://www.oregonlive.com/elections/oregonian/index.ssf?/xml/story.ssf/html_standard.xsl?/base/news/103399171483813.xml

Cast against a national backdrop of eroding health coverage, Oregon moves into the spotlight next month with a ballot measure that would create a single statewide health plan for virtually all residents.

Consumer activists, senior citizen groups and church organizations have spent years trying to advance similar “single payer” health changes in state legislatures from Oregon to Vermont. But their grass-roots organizing efforts have been defeated repeatedly, with the opposition primarily led by the powerfully funded insurance and hospital industries.

This time, they’re using a different approach, and because Oregon’s Measure 23 is the first single-payer proposal to go directly before voters since 1994, it’s drawing national attention to the campaign.

“It’s the only state where people are going to get to vote in November on universal health care,” said Dr. Ida Hellander, executive director of Physicians for a National Health Care Program in Chicago. The group represents about 9,000 doctors.

“If the Oregon measure passes, it’s just the beginning,” Hellander said. “It shows that it can be done, that it can work.”

Supporters of Measure 23 say it would solve the problems of rising health costs, uncertain access to caregivers and haphazard limits on coverage. The plan would pay for practically all health services, and extend coverage to the 444,000 children and adults in Oregon who now go without health insurance, according to the latest Census estimates.

Opponents say the plan’s billions of dollars in added taxes on personal income and employer payrolls would undermine Oregon’s already faltering economy. The agency created by the measure would command a $20 billion annual budget and have the power to impose up to $10.8 billion in new taxes in the first year of implementation, which would be 2005.

Business groups and other opponents say health spending would surge under the measure. The reason, they say, is the plan adds coverage for many services that most people now pay for on their own, such as alternative medicine practitioners and prescription drugs for Medicare enrollees.

At the same time, critics say, the measure imposes no specific limits or consumer cost-sharing provisions to discourage excessive use.

“The reality is, it’s inevitable these costs are going to rise rapidly, because you are talking about virtually unlimited options where people could access care free at the point of service,” said Pat McCormick, spokesman for No Unhealthy Taxes for Oregon.

Health insurers and other opponents have given more than $400,000 to the campaign — outspending Measure 23 supporters by more than 18 to 1, according to financial disclosures filed this month. Kaiser Permanente, Regence BlueCross BlueShield of Oregon, Pacificare, PacificSource and ODS Health Plans have each contributed more than twice the total raised by supporters, $22,023.

No more HMOs? Despite heavy spending by opponents, the measure might appeal to many voters who resent managed-care companies and — with the recession — fear losing their health coverage, according to some campaign watchers.

“There is great popular unhappiness with HMOs and health care in general,” said Bill Lunch, political science professor at Oregon State University.

“If somehow, the proponents can make the connection between the problems and Measure 23 as the solution, it is not inconceivable that it could prevail,” Lunch said.

Advocates say eliminating insurance company overhead costs and profits would allow the state to provide universal coverage for less money than employers, individuals and government programs currently spend.

Mark Lindgren, chairman of Health Care for All — Oregon, the coalition behind Measure 23, said it would “vastly reduce” the existing health care bureaucracy. Administrative costs would be capped at 5 percent, compared with the 12 percent overhead typical among health insurance companies in Oregon.

“There is such huge savings possible by cutting out the middleman and bargaining aggressively with pharmaceutical makers,” Lindgren said. “Individual costs should go down, and it’s likely to be a really good deal for Oregon business as well.”

The single statewide health plan would largely replace the jumble of private and public programs that now pay for health care, including individual insurance policies, most employer-sponsored health plans, workers’ compensation medical claims, the state and federally funded Oregon Health Plan for the poor and the federal Medicare program for retirees. Oregon would have to gain approval from the federal government to tap Medicare and the federal money now going to the Oregon Health Plan.

A board with 10 elected members and five appointed by the governor would run the plan. The board’s powers would include setting the fees paid to medical caregivers — which the hospital industry and many doctors strongly oppose. The Oregon Medical Association, the state’s largest physician organization, and the Oregon Association of Hospitals and Health Systems oppose the measure.

“You’ve got a problem already with health care providers who are opting not to accept low government reimbursement,” McCormick said. “You would be providing an incentive for providers to move to other states.”

To draw union support, drafters of the measure left room for health plans run by labor-management health care trusts. Employers and union workers opting to continue such plans would be exempt from the payroll and income taxes.

Despite that provision, the Oregon AFL-CIO recently announced its opposition, citing the increased tax burden on working people.

“We believe a universal health care system is the right way to go, but the burden of responsibility for paying for this one, we believe, is inappropriate,” said the AFL-CIO’s Lynn-Marie Crider. “We believe the responsibility should be borne primarily by the employers.”

Views differ on tax burden The AFL-CIO position highlights measure supporters’ toughest sell: persuading voters to pass a multibillion-dollar tax increase while the state struggles to emerge from recession. Opponents are seizing on the tax burden to sway voters.

“You are going to drive employers out of state or close their doors by imposing an 11 percent payroll tax,” said Mark Nelson, the lobbyist heading the opposition.

According to supporters’ calculations, the plan would cost the state about $19.9 billion in its first year. Existing government programs would cover about two-thirds of the costs. The remaining third, about $6.3 billion, would come from additional taxes. Estimates by the Oregon Department of Administrative Services suggest the additional tax burden could come closer to $10 billion the first year.

Supporters say most Oregonians would pay less in taxes than they currently spend on premiums, co-payments and out-of-pocket costs for doctors, dentists, home health supplies, prescription drugs excluded by private health insurance and Medicare, and long-term care — which all would be covered by the single-payer plan.

Households earning less than 150 percent of the poverty level, currently about $27,000 for a family of four, would be exempt from the income tax increase. The tax rate would increase with income, up to a maximum of an additional 8 percent, which would nearly double the current top tax rate of 9 percent.

Supporters are appealing to voters’ worries about the security of their health care coverage when many employers are cutting benefits or raising the share of costs borne by workers.

“Premiums are going up ridiculously. People are losing jobs and health coverage. Things are getting worse every day,” Lindgren said. “It’s not just wild-eyed liberals saying this.”

Joe Rojas-Burke: 503-412-7073, joerojas@news.oregonian.com

Copyright 2002 Oregon Live. All Rights Reserved.

New Mexico Rallies for Universal Health Care

Prominent physicians, medical students and seniors unite in support of single-payer health care reform

CHICAGO, IL, October 3, 2002 � October 1-8 is Universal Health Care Awareness Week in Albuquerque, New Mexico, bringing national attention to 25% of New Mexico residents who do not have health insurance. Health Students for Social Action (HSSA) and the Gray Panthers, a senior activist group in Albuquerque, have teamed up to organize a week of events to educate people about single-payer health care reform. An independent study by the Lewin group shows that developing a universal health care system is not only affordable, it’s cost effective. Lewin calculated that New Mexico would save millions of dollars by adopting a universal single-payer system.

Event highlights include a highly anticipated October 4 debate between Dr. McCanne, M.D., president of Physicians for a National Health Program (PNHP), and Dr. David Scrase, president of Presbyterian HMO, on the topic of financing health care.

Dr. McCanne is a retired family physician in San Clemente, California. For three decades, he allotted one-half of his practice hours to indigent patients. Dr. McCanne was a tireless supporter of Proposition 186, the California single-payer initiative, defeated by $10 million in insurance industry funded opposition. He has written extensively in the lay press on single-payer and patient-oriented health care, often using the concept of �Universal Medicare” as a model for single payer that the public can understand and support. He has elected to dedicate the remainder of his productive years to full-time activism on behalf of the single-payer cause. PNHP is membership organization of doctors that supports universal health care.

David R. Scrase, MD, is a Board Certified Internist and Geriatrician who has been involved in market-driven managed care for almost two decades. Dr. Scrase practices in Albuquerque, New Mexico.

�As a fourth-year medical student,� says Michael Walta, of HSSA, �I see patients everyday, facing hardship, bankruptcy, or just plain being turned away at the door. We are taking this issue away from the politicians, who are failing us, and bringing the message of universal coverage to those who are being abused by the health care crisis: the working poor, the elderly, and the middle-class.�

Linda Peeno, M.D., nationally known for exposing problems in corporate managed care, will be the keynote speaker at a panel discussion October 5. Peeno is a family practioner, a medical ethicist, and advisor on legal cases against giant for-profit HMOs. Peeno was recently the subject of the Showtime feature film �Damaged Care,� starring Laura Dern (Jurassic Park.)

The week concludes on Sunday with a “Run to Cover Everyone,” sponsored by HSSA, followed by a rally at the National Hispanic Cultural Center.

“New Mexicans deserve comprehensive affordable health insurance,” said Jaime Aagaard, of HSSA. �Medical students are demanding change from our elected leaders”.

More than one-third of Hispanics are uninsured; in some cities the figure is as high as one-half. New Mexico now joins Vermont, Maine, Massachusetts, California, and Oregon in the ever-growing movement supporting single-payer health care reform. For more information about the Run to Cover Everyone go to: www.runtocovereveryone.net

# # #

Physicians for a National Health Program has been advocating for health care reform for 15 years with more than 10,000 members across the United States.
PNHP is headquartered in Chicago.

www.pnhp.org

Universal Health Care Week October 1- 8, 2002
Albuquerque, New Mexico

TUESDAY,OCTOBER 1 & THURSDAY, OCTOBER 3

FUN RUN
Noon: register to sign up for “Run to Cover Everyone” and buy raffle tickets. Outside BMSB, sponsored by Health Students for Social Action (HSSA), noon-1pm.
Contact: 505-907-6655
Email: funrun@twignation.com
http://runtocovereveryone.net

FRIDAY, OCTOBER 4

Grand Rounds
8am: Ob/Gyn Grand Rounds, Dr. Don McCanne, president of Physicians for a National Health Program (PNHP). HSSB 105.

Q&A with Dr. Don McCanne
Noon: Informal Question/Answer Session with Dr. Don McCanne, expert on the single-payer healthcare system.
BMSB basement room 53.

Health Care Financing Debate
5pm: Healthcare Financing Debate, Dr. David Scrace, president of Presbyterian Health Program vs. Dr. Don McCanne.
Nursing and Pharmacy Bldg, auditorium.

Reception
6:30pm: Reception for Dr. Don McCanne, sponsored by local PNHP chapter.
SATURDAY, OCTOBER 5

Universal Health Care Panel
7pm Universal Healthcare Panel, Santa Fe. Sponsored by Green party. Keynote speaker Dr. Linda Peeno, famous whistleblower on corporate managed care, and Dr. Don McCanne.
Call 505-992-3335 for info.
SUNDAY, OCTOBER 6

Reception
10am Reception for Nick Unger of Universal Healthcare Action Network (UHCAN). Contact: 505-899-0392

Run to Cover Everyone
1-5pm Run to Cover Everyone, followed by Rally with free food, live music (Tobias Rene), raffle, plus more. National Hispanic Cultural Center, 4th and Bridge SE. Contact: 907-6655 for info.

Canadian Auto Works Support Medicare

Sep. 21, 01:00 EDT
Carol Goar
THERE’S ALWAYS a surprise when Buzz Hargrove negotiates a contract with one of the country’s auto giants.

Three years ago, it was a generous child care subsidy. Ford of Canada agreed to provide parents of preschoolers with up to $2,000 a year to help defray their child care expenses. Nothing like that had ever been achieved at the bargaining table.

This time, it was a corporate endorsement of medicare. Hargrove persuaded Michael Grimaldi, president of General Motors of Canada, to praise publicly funded health care and call for its expansion to include prescription drugs and home care. No high-profile business leader has done this.

It was a gratifying week for the president of the Canadian Auto Workers. Not only did he reach a trendsetting deal with General Motors five hours before the strike deadline, he played a role in the health-care debate.

He can’t declare victory yet. Workers at GM’s five plants have to ratify Tuesday’s tentative agreement and Hargrove has to win comparable settlements for his members at Ford and DaimlerChrysler.

But he has achieved his goal on medicare. The top executives of the Big Three automakers have all signed a letter endorsing Canada’s publicly funded health-care system and asking that it be enlarged. “The system needs a secure multi-year funding base from the government and must be expanded to cover an updated range of services including prescription drugs and home care,” the statement says.

It would be naïve to believe that senior auto executives — particularly Grimaldi who is American — would stand up for socialized medicine out of a sense of public spiritedness.

They did it because it cost them nothing, it improved the bargaining climate and it clearly mattered to the CAW.

But that is not the whole story. Hargrove had tried to put medicare on the table in past bargaining rounds, but had always been rebuffed. The heads of the car companies would admit privately that Canada’s public health-care system was a godsend, sparing them the expense of providing comprehensive medical insurance to their employees. But they would never say it in public.

This time, they agreed. Several factors changed their attitude:
*
The CAW was able to quantify, using credible corporate data, the competitive advantage that medicare provides to the Canadian auto industry.

The union compared the hourly labour costs of vehicle assembly in Canada and the United States. The Canadian rate, including wages, benefits and payroll taxes, was $29.90 per hour. The American rate was $45.60. (All figures are in American dollars.)

Health care accounted for more than a quarter of the difference. It saved Canadian employers $4 per hour per worker.

“It’s a strategic advantage for Canada,” said Grimaldi, at a joint press conference with Hargrove.
*
Management was concerned about the escalating cost of workplace health benefits.

Drug costs were rising rapidly. Acutely ill patients were being sent home to recover, needing private nursing and home care. More and more medical services were being “delisted” by provincial governments, forcing employers to step in.

The union did not have to make the case that the erosion of medicare had real consequences for business. The car companies were feeling the effects.
*
The health-care outlook worried corporate accountants.

With an aging population, ever-more sophisticated medical technology and a global bidding war for doctors and nurses, it was clear that health costs could only climb.

The less governments covered, the more individuals and their employers would have to pick up. What had once looked like a costly social program to auto executives began to have bottom-line appeal.

It would be a mistake to read too much into a simple endorsation of medicare.

The auto executives did not agree to do anything specific to support or strengthen medicare. They did not challenge other business leaders to speak out. They did not grapple with the difficult question of how to pay for a pharmacare plan or a national home-care program. They certainly did not say that they’d be open to a tax increase to sustain Canada’s publicly funded health-care system.

But they did take a stand. They did acknowledge that medicare is good for business.

Hargrove contends that their intervention came at a perfect time to influence the Romanow Commission, which is now drafting its final report on the future of medicare.

In fact, the automakers’ statement probably came too late — and said too little — to affect Roy Romanow’s prescriptions in any material way.

But it was well-timed to suit Hargrove’s agenda. The CAW president is pondering a run for the leadership of the New Democratic Party. He has said he will make up his mind when he completes this round of auto bargaining.

The 58-year-old labour leader has been highly effective at getting good deals for his members, while nudging the country’s social agenda forward.

But he’s had the resources of the country’s largest private-sector union behind him. He’s dealt with rich, pragmatic employers. He’s known the drama of late-night dealmaking and the euphoria of winning.

Hargrove might find politics a comedown.

GREG KEENAN
AUTO INDUSTRY REPORTER

Canada’s system of government-financed health care represents about
half the cost advantage General Motors of Canada Ltd.’s assembly
plants have over U.S. plants, GM Canada president Michael Grimaldi
says.

The health care system is a “strategic advantage,” for Canada, Mr.
Grimaldi said yesterday as he and Canadian Auto Workers union
president Buzz Hargrove unveiled a joint letter that the union and all
Big Three auto makers are sending to Ottawa.

“The public health care system significantly reduces total labour
costs for automobile manufacturing firms, compared to the cost of
equivalent private insurance services purchased by U.S.-based auto
makers; these health insurance savings can amount to several dollars
per hour of labour worked,” the union, GM, DaimlerChrysler Canada Inc.
and Ford Motor Co. of Canada Ltd. said in the joint statement.

“The erosion of publicly funded health care — through measures such
as the delisting of currently covered services, the imposition of user
fees, the failure of the public system to keep up with the changing
nature of health care and new costs such as prescription drugs and
home care — will impose significant costs on automotive employers and
undermine the attractiveness of Canada as a site for new automotive
investment,” the letter said.

The public health care system also makes Canadian workers healthier
and more productive, the letter added.

Mr. Grimaldi said preserving and enhancing the health care system will
make it more attractive for GM Canada to continue making investments
here.

He cited the addition of a third shift at one of the company’s car
plants in Oshawa, Ont., and a $500-million investment at Cami
Automotive Inc., a joint venture assembly plant operated with Suzuki
Motor Co. Ltd.

The joint statement comes as the CAW is locked in contract talks with
the Big Three. At the moment, it is negotiating with GM Canada with a
deadline of next Tuesday night for a new contract.

Those talks are going well, both Mr. Hargrove and Mr. Grimaldi said,
while tossing compliments at each other.

Mr. Hargrove said he’s hoping for a first wage offer from the company by as early as today.

“A lot of money and a lot of jobs will get you an agreement, Mike,” he
told Mr. Grimaldi.

But the focus yesterday was on health care, including during the
talks.

Mr. Hargrove said a presentation from GM Canada’s health care provider
showed that “some of the increases we’re facing in drugs are
astronomical.”

GM Canada’s parent, General Motors Corp., is facing similar
challenges, Michael Bruynesteyn, an analyst for Prudential Securities
Inc., noted in a recent report.

“We understand from GM that it is the world’s largest purchaser of
Viagra, a benefit not usually covered by many U.S. employers’ health
care plans,” Mr. Bruynesteyn noted.

Between employees, retirees and their dependents, GM pays for health
care benefits for about 1.25 million Americans, roughly the population
of Manitoba, Stephen Girsky, an auto industry analyst for Morgan
Stanley, noted in a report on GM last year.

The costs of that service amounted to $3.9-billion (U.S.) in 2000, Mr.
Girsky noted.

That in turn, represented a little more than $900 on every vehicle GM
assembled in the United States in 2000.

United stand on health care
CAW, GM leaders urge Ontario, Ottawa to increase public funding
By Steve Arnold
The Hamilton Spectator

Corporate and union leaders of Canada’s auto industry have issued a united
call for increased government health care funding.
In an unprecedented move yesterday, the presidents of the Canadian Auto
Workers union and the Big 3 auto makers signed a joint letter urging the
federal and provincial governments to recognize the important role publicly
financed health care plays in the country’s economy.
“The success of (the auto) industry has been crucial to Canada’s economic
progress over the past decade,” the letter states. “Canada’s health care
system has been an important ingredient in the auto industry’s performance.”

GM Canada president Michael Grimaldi and CAW leader Buzz Hargrove told a
news conference that about half of the labour cost advantage Canadian auto
plants enjoy over American competitors can be attributed to the national
health care system, and losing that advantage would cost jobs.
“Canada’s health care system is an important part of Canadian culture, a
significant factor in Canada’s economy and we must ensure it plays that role
in the future,” Grimaldi said. “Health care is important to the country and
to the auto industry and we’re looking to the policy makers … to look at
the system and make sure it addresses the needs of Canadians.”
In the letters, which were also signed by Ford Canada president Alain Batty
and DaimlerChrysler Canada head Ed Brust, the industry leaders worry that
measures such as reducing the number of services covered by the public plan,
increasing user fees, the failure to include important new treatments on the
list of covered procedures and the ever-rising cost of prescription drugs
will lead to higher employment costs as workers push for higher wages or
better benefit plans to protect their standard of living.
Those increases, in turn, would mean higher vehicle prices or less
investment in Canada as companies turn to low-wage countries like Mexico.
“For both employers and workers in the auto industry, it is vitally
important that the publicly funded health care system be preserved and
renewed,” the letter states. “The system needs a secure multi-year funding
base from government, and must be expanded to cover an updated range of
services (including prescription drugs and home-care services) that reflects
both the evolving nature of medical science and the emerging needs of our
population.”
Fear for the future of the public system has been growing for several years
as governments have struggled to offer tax cuts while also trimming debts
and eliminating deficits. A commission under former Saskatchewan Premier Roy
Romanow has been touring the country looking at that question and is to
issue a final report later in the year.
A persistent fear has been that the commission will recommend increased
private involvement in health care — creating a two-class system in which
the wealthy get preferred treatment while others suffer.
The comments in the joint letter echo those made to the commission by the
CAW and United Steelworkers of America.
In its brief, for example, the CAW recommended expanding coverage under the
Canada Health Act to include pharmacare, homecare, long-term care, the
development of national standards and programs and increased spending on
health promotion.
When USWA national director Lawrence McBrearty made his presentation in May,
he dismissed arguments of a “crisis” in the public system, calling them a
creation of “politicians, whose priority is cutting taxes rather than
preserving essential public services, commissions with tainted credentials
and think-tanks supported by the private health care industry … The crisis
is that the self-interested and profit seeking in this country are engaged
in a deliberate campaign to undermine confidence in our public health care
system, as a prelude to its destruction.”
In the U. S. steel industry, he added, health insurance costs are 18 per
cent of total employment costs compared to between 4 and 6 per cent in
Canada.
“We do not have a crisis of ability to pay,” he added. “We have a crisis …
in which a self-interested and profit seeking elite is working to prevent
Canadians from getting what they clearly want.”
The call for continued support of the public system has also been sounded by
Charles Baillie, chairman and CEO of Toronto Dominion Bank, who told an
audience in 1999, “in an era of globalization, we need every competitive and
comparative advantage we have and the fundamentals of our health care system
are one of those advantages … It is high time that we in the private
sector went on the record to make the case that Canada’s health care system
is an economic asset … that our country dare not lose.”
Yesterday’s statements came as GM and the CAW enter the final stage of
negotiations for a new three-year agreement. The contract expires Tuesday
and both Grimaldi and Hargrove said they are confident of reaching a deal
before the deadline.
“The pace of negotiations is on track,” Hargrove said. “There is a lot left
to resolve, but the mood is good, there’s no animosity, and we have plenty
of time and lots of experience on both sides.”
CAW and healthcare. Story by Steve Arnold

CAW, auto makers laud health system
By GREG KEENAN
AUTO INDUSTRY REPORTER

Friday, September 13, 2002 – Globe and Mail

Canada’s system of government-financed health care represents about half the
cost advantage General Motors of Canada Ltd.’s assembly plants have over
U.S. plants, GM Canada president Michael Grimaldi says.
The health care system is a “strategic advantage,” for Canada, Mr. Grimaldi
said yesterday as he and Canadian Auto Workers union president Buzz Hargrove
unveiled a joint letter that the union and all Big Three auto makers are
sending to Ottawa.
“The public health care system significantly reduces total labour costs for
automobile manufacturing firms, compared to the cost of equivalent private
insurance services purchased by U.S.-based auto makers; these health
insurance savings can amount to several dollars per hour of labour worked,”
the union, GM, DaimlerChrysler Canada Inc. and Ford Motor Co. of Canada Ltd.
said in the joint statement.
“The erosion of publicly funded health care — through measures such as the
delisting of currently covered services, the imposition of user fees, the
failure of the public system to keep up with the changing nature of health
care and new costs such as prescription drugs and home care — will impose
significant costs on automotive employers and undermine the attractiveness
of Canada as a site for new automotive investment,” the letter said.
The public health care system also makes Canadian workers healthier and more
productive, the letter added.
Mr. Grimaldi said preserving and enhancing the health care system will make
it more attractive for GM Canada to continue making investments here.
He cited the addition of a third shift at one of the company’s car plants in
Oshawa, Ont., and a $500-million investment at Cami Automotive Inc., a joint
venture assembly plant operated with Suzuki Motor Co. Ltd.
The joint statement comes as the CAW is locked in contract talks with the
Big Three. At the moment, it is negotiating with GM Canada with a deadline
of next Tuesday night for a new contract.
Those talks are going well, both Mr. Hargrove and Mr. Grimaldi said, while
tossing compliments at each other.
Mr. Hargrove said he’s hoping for a first wage offer from the company by as
early as today.
“A lot of money and a lot of jobs will get you an agreement, Mike,” he told
Mr. Grimaldi.
But the focus yesterday was on health care, including during the talks.
Mr. Hargrove said a presentation from GM Canada’s health care provider
showed that “some of the increases we’re facing in drugs are astronomical.”
GM Canada’s parent, General Motors Corp., is facing similar challenges,
Michael Bruynesteyn, an analyst for Prudential Securities Inc., noted in a
recent report.
“We understand from GM that it is the world’s largest purchaser of Viagra, a
benefit not usually covered by many U.S. employers’ health care plans,” Mr.
Bruynesteyn noted.
Between employees, retirees and their dependents, GM pays for health care
benefits for about 1.25 million Americans, roughly the population of
Manitoba, Stephen Girsky, an auto industry analyst for Morgan Stanley, noted
in a report on GM last year.
The costs of that service amounted to $3.9-billion (U.S.) in 2000, Mr.
Girsky noted.
That in turn, represented a little more than $900 on every vehicle GM
assembled in the United States in 2000.

Where is the health care reform debate?

The Washington Times
September 30, 2002
Better to act than act shocked
By Greg Scandlen

President Bush has proposed legislation addressing all three ideas – tax
credits, MSA expansion and AHPs. Adopting these three ideas would be the
most serious assault on the problem of the uninsured in more than 35 years.

These are also the only viable ideas currently on the table. Some who prefer
to have the government run everything have argued for expanding Medicaid,
the government’s health care program for the poor, to include all of the
uninsured.

http://washingtontimes.com/commentary/20020930-94445632.htm

Comment: It is not surprising to see the conservative views of the National
Center for Policy Analysis published in the conservative Washington Times.
But what is of concern is that the debate over health care reform seems to
be a debate between those that favor the conservative approaches of the Bush
administration, approaches that totally lack compassion, with those that
favor tweaking our public welfare programs, Medicaid and SCHIP, as if that
would solve our problems.

Those that support public-program tweaking should realize that in their zeal
to move to the right on reform, they are being characterized as individuals
who “prefer to have the government run everything.” In reality, there is not
much difference between the conservatives and the incrementalists. Combined,
they represent one side of the health care debate, although it is to the
advantage of the conservatives to represent incrementalists as the liberal
option.

The genuine other side is represented by those who support true health care
justice: an affordable, comprehensive, equitable, publicly-administered,
universal health insurance program. Let’s all make a greater effort to be
sure that the nation understands this, the moral imperative.

Death spiral of comprehensive coverage

Los Angeles Times
September 29, 2002
Rising Costs Put Pressure on Kaiser
By Don Lee

Kaiser Permanente is having one of its brightest financial years ever, but
beneath the rosy numbers lies a harsh reality: The company is facing a
challenge that threatens the survival of the managed-care model that it
pioneered decades ago.

The nation’s leading nonprofit HMO and hospital system and its 11,000
doctors are being confronted by the rising costs of treating its aging
membership, while more bare-bones health plans are drawing away the coveted
young and healthy consumers.

As the nation heads into the third straight year of double-digit health-cost
increases, with no relief in sight, the insurance industry is devising more
plans with skinnier benefits and fatter member co-payments and deductibles.
Employers want them because they minimize premium increases, and the plans
are especially appealing to young, healthy individuals who don’t want to pay
higher premiums for comprehensive coverage they don’t think they’ll ever
use.

These changes will be increasingly visible to millions of Americans at open
enrollments this fall. Many will be offered so-called consumer-driven plans,
which will allow employees to tap into a savings account to pay for medical
services as needed.

The Oakland-based health system has been a model of managed care, providing
a basic full-coverage plan for all members…

But like those of other HMOs and health plans, Kaiser’s premiums have soared
in the last couple of years. That raises the question of whether Kaiser can
maintain its one-shoe-fits-all approach and its competitive edge, and avoid
segmenting the membership.

In a recent memo to the staff, George Halvorson, Kaiser’s new chief
executive, laid out the dilemma this way: “Those shifts [in the marketplace]
will cause many of our healthiest members to leave us for lower-cost,
lower-benefit plans. At the same time, employers will save money if their
sicker patients voluntarily migrate to us.”

http://www.latimes.com/business/la-fi-kaiser29sep29,0,845054.story?coll=la%2
Dheadlines%2Dbusiness

Comment: This is a disaster! Not just for Kaiser, but for our entire system
of funding health care through private plans.

Rising costs are being shifted from employers and the health plans to
individual employee-beneficiaries. These cost increases are not being
tolerated. The primary cost decision is being made at the time of selecting
the health plan. For the majority of individuals who are relatively healthy,
plans with the lowest premiums will be selected.

The only way the health plan industry can offer products with lower premiums
is to reduce benefits and increase cost-sharing by the beneficiaries. That
is not a major problem for the healthy, but it can result in financial ruin
for those with significant chronic disorders. Less healthy individuals will
have to select the plans with higher premiums to be sure that care will
remain affordable.

Segmentation of the market is inevitable. The healthy will move into the
Spartan plans and the sick will be concentrated in the comprehensive plans
such as Kaiser. With a concentration of high cost patients, comprehensive
plans will be forced to dramatically increase their premiums to the point
that they are unaffordable. This “death spiral” will knock comprehensive
plans out of the market.

Thus, the chronically ill will be forced into the “consumer-driven” plans
and face financial ruin because of the excessive burden of cost-sharing.
Also, some of the healthy, who gambled by selecting low premium plans, will
develop severe acute or chronic problems and likewise face financial ruin.
Unpaid medical bills are continuing to increase as a major cause of personal
bankruptcy.

And what national policies are we adopting to address this disaster? We are
“strengthening” the employer-link by increasing the menu of low premium
plans that will control the employers’ health care costs and will assure the
health plans that they will continue to have a solid market. It matters
little to the health plans that their products are of little value as long
as they continue to receive their portion of the health care dollar. And the
government is seriously considering subsidizing this process through tax
credits which can only result in perpetuation of these cruel policies.

We are spending $1.55 trillion in health care this year. That is more than
enough to provide comprehensive health care services for everyone. We could
achieve this goal merely by adopting a single, publicly administered,
national health insurance program. Yet we continue with these insane
policies because we don’t want the government involved.

But 60% of health care funding is already through the public system. Canada
has a universal system which is 70% publicly funded, and their entire public
and private funding is less than our current government funding alone. Our
government is already deeply involved. Let’s demand that we change public
policies from those that nurture health plans to those that nurture
patients.

The uninsured are back on the national agenda

Los Angeles Times
September 30, 2002
Fewer Have Coverage for Health Care
By Vicki Kemper

Altogether, the number of Americans who had no health coverage for any part
of the year increased… to 41.2 million.

Sen. Edward M. Kennedy (D-Mass.) has signaled his intention to pursue
replacing the system of largely employment-based health insurance with a
government-based system.

Sen. Kennedy:

“The large increase in the already unacceptably high number of the uninsured
should be a wake-up call for Congress and the president. Every American
deserves affordable health care.”