Speaker Archive - Page 1163 of 1207

Political campaigns silent on comprehensive reform

The Sacramento Bee
September 8, 2002
Low profile for health care in campaign
By Aurelio Rojas

As Gov. Gray Davis and businessman Bill Simon move into the fall stretch in
their race for governor, rising health care costs have joined education as
the most important issues on voters’ minds, according to Field Poll Director
Mark DiCamillo.

Experts have warned for years the system is headed for collapse without
wholesale changes. But neither the Democratic incumbent nor his Republican
challenger is offering a cure.

The issue is complex — involving employers, state and federal agencies,
insurers, health maintenance organizations, hospitals, physicians and other
competing interests.

But pundits say the political calculus is simple. Middle- and upper-income
workers and the elderly make up the lion’s share of the electorate. And
those groups have access to health care, either through their employers or
the government after they retire.

Polls show voters are sympathetic to the plight of the uninsured, most of
whom work. But woe to the politician who proposes raising taxes to expand
coverage.

http://www.sacbee.com/content/politics/story/4320898p-5340111c.html

Comment: Both houses of the California State Legislature are controlled by
progressives, Gov. Davis is a Democrat, and California’s health care
situation is deteriorating. Never was the moment for reform more opportune.
Yet, instead of comprehensive reform, Gov. Davis just blue penciled the
incremental step of expanding the Children’s Health Insurance Program to
include parents of covered children, even though two-thirds of the cost of
the expansion would have been paid by the federal government.

It seems that there is little hope for comprehensive reform until the
majority, who are relatively healthy and complacent with their current
coverage, decide that it is time. Will that ever happen?

A guide to changing the world

The Democracy Owners’ Manual
A Practical Guide to Changing the World
By Jim Shultz

Another false notion in initiative politics is that initiative campaigns are
grand opportunities to shift public opinion to your side, even in the face
of special interests opposing you. In fact, initiative campaigns are a poor
time to educate the public, especially while you are being outspent ten to
one or more. Initiative campaigns are often big-money battles of quick sound
bites and images aimed at manipulating voters, not educating them. Most
experienced initiative campaigners will tell you that if an initiative
doesn’t start out with support (as measured by serious polling) in the range
of at least 65 to 70 percent, it has very little chance of maintaining 51
percent by election day. In almost every case, the “yes” vote for a measure
only falls as the election approaches.

Some advocates learn this lesson the hard way. In 1994, California health
care advocates qualified an initiative to establish a state-run health care
system, despite many polls showing the public’s strong skepticism about such
a move. Instead of the grand public education effort that proponents hoped
would sway voters to their side, they were crushed three to one following a
multimillion-dollar ad blitz by health insurers that set the cause backward,
not forward.

For information on “The Democracy Owners’ Manual”:
http://www.democracyctr.org/resources/manual/index.htm

Comment: Most of us are uncomfortable when we read Jim Shultz’s words. But
reality often creates discomfort. We’d much prefer to live with our
fantasies of utopia.

But, as long as Jim Shultz has shocked us into reality, let’s look at what
he has to say. He says that it is absolutely essential for us to understand
the processes by which policy is translated into action. Without that
knowledge and understanding, many of our efforts are for naught.

Jim Shultz is a veteran of the California political scene. He understands
how the process works. We don’t like to hear about our past mistakes, but we
definitely must understand them. We must understand the processes that are
likely to bring us success and those that will assure our defeat. “The
Democracy Owners’ Manual” is must reading for those of us that want to
change the world.

The underwriting cycle is not to blame

The Kaiser Family Foundation and Health Research and Educational Trust
Employer Health Benefits
2002 Summary of Findings

Between spring of 2001 and spring of 2002, monthly premiums for
employer-sponsored health insurance rose 12.7%, the second consecutive year
of double-digit premium increases, and the largest increase since 1990.
Average annual premium costs rose to $3,060 for single coverage (up from
$2,650 in 2001) and $7,954 for family coverage (up from $7,053 in 2001).
Premiums increased substantially faster than overall inflation (1.6%) and
wage gains for non-supervisory workers (3.4%).

This high rate of growth appears to have been driven primarily by rapid
inflation in spending for health care services. Premium equivalents for
self-insured plans (the estimated cost of health care claims for an employee
whose employer self-insures) – which are a reflection of growth in
underlying health care costs – grew by 12.3% over the last year, or roughly
the same rate as premiums for insured plans. This suggests that insurers’
decisions about premiums are being influenced more by cost trends than by
catch-up pricing associated with the underwriting cycle.

What seems clear is that employees are likely to pay more for health
benefits and health care in the future. This year, 43% of all firms and 78%
of large firms (200 or more workers) report that they are very or somewhat
likely to increase the amount that employees pay in 2003. Thirty-two percent
of all firms and 42% of large firms report that they are very or somewhat
likely to increase deductibles, while 34% of all firms say they are very or
somewhat likely to raise employee costs for prescription drugs.

With a weakened economy and escalating premium inflation, the brief period
of increasing employer coverage – and concomitant drop in the number of
uninsured Americans – has come to a close.

http://www.kff.org/content/2002/20020905a/3252a.pdf

Comment: The opponents of reform will not be able to pass this off as a
transient insurance underwriting blip. The increases in medical claims
expenses are real. Employers are no longer tolerating them. The resultant
increases in cost sharing by the employee-beneficiaries are making access to
health care truly unaffordable for an ever enlarging sector of our
population. Current policies will only increase rationing by ability to pay.
Yet most Americans believe that everyone should have access to essential
health care. The status quo is not acceptable.

Comprehensive private solutions do not exist. Employment linkage has
provided only a partial solution, and that is proving to be less and less
satisfactory as the numbers above indicate. Individually purchased health
plans have even greater deficiencies than the employment linked plans.
Individually designated accounts such as MSAs will not work for those with
significant health care needs. Charity will never be adequate simply because
health care costs greatly exceed the tolerated threshold of voluntary
contributions. We have depended on combinations of these private solutions,
and they have proven to be grossly inadequate.

If Americans really do want everyone to have access to a reasonable level of
care, then we must cooperate in deciding on which public solutions we should
adopt. Now, more than ever, there is a need to understand the impact of
various public policies in health care. The science is already there. Now is
the time to use it.

QoD: Medicare+Choice guided by markets, not patient need

Mathematica Policy Research, Inc.
September 2002
Medicare+Choice Withdrawals: Experiences in Major Metropolitan Areas
by Marsha Gold and John McCoy

Recent experience highlights the importance of local market features in
shaping beneficiaries’ experience with Medicare+Choice. Medicare managed
care developed unevenly across the country and is eroding unevenly as well.

Under current policy, it is likely that Medicare+Choice will continue to
diminish
nationally, with enrollment increasingly concentrated in those markets where
conditions are most hospitable. Since markets vary, often in ways that
federal policy can only marginally influence, a market-based insurance
strategy like Medicare+Choice will almost always mean that plan choices vary
substantially across the nation.

http://www.mathematica-mpr.com/PDFs/opinsights8.pdf

Comment: Medicare+Choice was an attempt to control Medicare costs by using
private health plans competing in the marketplace. It was a dismal failure.
All studies demonstrated that costs actually increased and that access to
the plans varied greatly depending on local market conditions.

Now the Bush administration is introducing Medicare+Choice PPO plans. They
will pay the plans 99% of the costs of the traditional programs plus
one-half of the cost overruns. The plans most likely will demonstrate
initial success by directing their marketing to the healthy sector of
Medicare patients. Low cost patients will leave them with profits initially.
But, as their beneficiaries age and develop greater health care needs, the
private PPO Medicare plans also will be unable to meet the higher costs,
especially when adding in the greater administrative expenses of the PPO
plans. And the cost overruns will again be borne by the taxpayers. As the
current Mathematica study indicates, we can expect these plans to provide
unstable insurance support because of the continual need to modify their
targeted markets based on local market profitability.

It is particularly ironic that Bakersfield, California is one of the ten
worst markets for Medicare+Choice contracts since Bakersfield is the home of
William Thomas, Chairman of the House Ways and Means Committee and one of
the strongest supporters of the plans to privatize Medicare. It is fair to
ask Congressman Thomas whether he is representing the interests of the
residents of his district or representing the interests of the health plans.

All of us should be asking our candidates for elective office precisely what
policies they support. Do they support policies that enhance the markets for
private health plan profitability, or do they support policies that enhance
mechanisms that improve allocation of our health care resources for the
benefit of patients? Knowing that answer, we’ll all be better informed
voters.

Rex Morgan's prescription: socialized medicine in U.S.

JAMES ADAMS
NATIONAL ARTS CORRESPONDENT

Supporters of socialized health care in Canada and the United States have a seemingly unlikely friend in Rex Morgan M.D., the handsome, deeply decent physician who has been a staple of newspaper comics since 1948.

So far there’s no record of the Romanow health care commission or the U.S. Secretary of Health having consulted the fictional doctor.

However, as any of the 30 million readers of the syndicated strip carried by 300 newspapers in 15 countries can tell you, Rex has come out foursquare in favour of what his creator calls “a single-payer, state-supported health care system.”

Interestingly, the man behind Rex Morgan’s position isn’t some “communist or liberal socialist” — although he has received plenty of mail calling him that, and worse. He’s Woody Wilson, a 55-year-old registered Republican from Tempe, Ariz., who voted for George W. Bush in the 2000 elections.

“I believe the country that is supposedly the richest and most powerful in the world shouldn’t be forcing its citizens to choose between paying their mortgage or saving their lives. Yet that is what is happening with millions of Americans right now,” Mr. Wilson said in an interview this week.

“What’s needed is health care for everyone instead of dividends for stockholders in pharmaceutical companies.”

Mr. Wilson has been writing Rex Morgan M.D., a sort of soap opera in comic form, since 1991, having worked as an apprentice under its originator, psychiatrist Nicholas Dallis (now deceased), since 1982.

Under Mr. Wilson, Rex Morgan hasn’t hesitated to tackle domestic violence, epilepsy, drug abuse, AIDS, organ transplants, asthma and sexual harassment.

“We’ve never made people laugh; we’re about informing and entertaining,” he likes to say, and, in fact, medical professionals and support groups have included some of his strips in their educational packages.

But in recent months Mr. Wilson has pulled his rock-jawed hero firmly into the far more dicey arena of health policy, even sending him to Washington, D.C., to testify before legislators.

The strip’s current storyline is dealing with the fallout from the death of Rex Morgan’s friend, Dick Coleman, who lost his job after being diagnosed with colon cancer. Losing the job resulted in the loss of his family’s health coverage and the threatened foreclosure on the mortgage on the Colemans’ home.

In the wake of Dick’s death — “the very week [in June this year] that Dubya got his colonoscopy,” Mr. Wilson noted — his wife Marsha became borderline suicidal and his daughter Dana started to use drugs and get involved with criminal elements.

“All because they couldn’t afford health insurance,” a sombre Rex Morgan mused in one recent strip.

It’s estimated that nearly 40 million Americans share the plight of Dick Coleman. Meanwhile, “We’re adding a million or more people to the rolls of the uninsured each year,” Mr. Wilson said.

Mr. Wilson likes to call himself “just a comic-strip guy,” but he’s a guy whose wife happens to have a PhD in health-care policy from Massachusett’s Brandeis University and who “sits and talks with me about my stories.”

Moreover, it’s a measure of Mr. Wilson’s perceived clout that he has been invited to speak in November at the annual convention of the 9,000-member U.S. Physicians for a National Health Program.

Despite the flak Mr. Wilson has received from some readers, no newspaper has pulled Rex Morgan M.D. from its comics section.

“Our problem goes to something else,” Mr. Wilson said.

“Strips like ours — they’re called continuity strips — are perceived to be old-fashioned these days. So we have to work harder to keep them fresh.”

Rex Morgan, he added,”will always have to be about hot issues, will always have to try to be a bit ahead of the curve, if only because we’re syndicated in so many countries.”

Mr. Wilson said Rex’s campaign for a national, state-financed health-care regime “is going to be a recurring theme for years to come.”

Right now the fight for a comprehensive medical program “isn’t a national priority,” he acknowledged, “nor is there the political will for it.”

But this could change in two or three years, if the ranks of the uninsured swell to, say, 50 million.

“That’s a political party, in effect, right there,” he said. “If someone can mobilize those people . . . that’s a major force.”

Unsurprisingly, those Americans critical of Mr. Wilson’s position like to ask him, “Do we want to have a Canadian health-care system? Do we want rationing? Do we want to wait in line for hip-replacement surgery?”

Mr. Wilson chuckled. “My wife and I were talking about this and she said, ‘Well, in Canada, [health care] is about waiting; in America, it’s about money.’ I want the waiting.”

Rex Morgan’s prescription: socialized medicine in U.S.