Speaker – Page 1176

Al Gore on Single-Payer: New Republic

DAILY EXPRESS
The Single Guy
by Jonathan Cohn
Only at TNR Online | Post date 11.22.02

It looks like Al Gore wasn’t kidding two weeks ago when he let slip his intentions to propose a single-payer health care system for the United States. In a piece about Gore published earlier this week, Ron Brownstein of the Los Angeles Times reports that Gore told him the very same thing–and in considerably more detail. Specifically, Gore told Brownstein that he would unveil his plan early next year, and that the plan would observe three principles: The actual practice of medicine would still be done through the private sector; Americans would have “choices”; and the plan would reduce spending by streamlining bureaucracy. “The system as a whole has reached a point of no return,” Gore said. “It is collapsing. It is beyond saving in its current design.”

Is Gore nuts? Not on policy grounds. In a single-payer system, the government becomes the nation’s health insurance company. Instead of paying premiums to an insurer (either directly or through an employer), each American would pay that money to the government; in turn, the government would pay the providers of medical care–i.e., mostly private doctors and hospitals–in the same way insurance companies now do.

Make no mistake: It’s a radical overhaul. But single-payer also has clear virtues: As a general rule, the more people who belong to an insurance pool, the more thinly you spread the financial burden of illness, which can be devastating if you face it alone or within a small group. By definition, single-payer spreads the risk pool across the largest number of people possible–namely, everyone in the country. In addition, while people may associate government with excessive bureaucracy, single-payer systems devote far less money to administrative overhead than private insurance. (Among other things, insurance companies spend a ton of money on advertising.)

Typically, opponents of single-payer insist it’s better to have a private insurance system that promotes more “choice.” But one of the chief advantages of single-payer is that it gives patients the kind of choice that matters–not choice of insurance plan, but choice of doctor. For example, if you switch plans today, you may discover your favorite physician doesn’t take your new insurance. But in a single-payer system, virtually every physician would take government insurance, so that would no longer be an issue.

And, of course, single-payer systems by definition make coverage universal–i.e., they give insurance to every citizen as a birthright, regardless of employment status. This isn’t just fair: It may also be more efficient, since it would allow people more freedom to change jobs and pursue better opportunities.

None of this means single-payer is ultimately the best way to go on health care. In fact, there are some pretty valid objections to it, though not necessarily the ones its critics are making today. But its virtues make it a credible alternative, one that deserves a major role in the debate over our health care system’s future.

But what about the politics? No sooner had Gore introduced the plan than conservative critics pounced on him, calling him an extreme leftist and noting that this endorsement represented another Gore “flip-flop,” given his opposition to Bill Bradley’s health care plan in 2000. “This is … Gore, the radical,” Michael Kelly wrote in his Washington Post column. He then defined single-payer as “the idea [Gore] savaged his 2000 Democratic primary opponent, Bill Bradley, for supporting.”

But the criticism about Gore’s apparent reversal on Bradley actually shows why endorsing single-payer has a certain political logic to it. Bradley didn’t propose a single-payer plan in 2000. On the contrary, the essence of Bradley’s plan (which, by the way, this author lauded at the time) was to help uninsured Americans buy into the same system that now serves federal employees. In that system, federal employees choose from among a menu of private insurance plans, then pay premiums based on what the plans offer. Yes, lots of people attacked that plan for expanding the role of government. But, if anything, it actually reduced government’s role, by getting rid of Medicaid (under which government insures the poor directly) and having those people buy private insurance instead.

The lesson is that even if you don’t actually propose a radical overhaul of the health care system, critics from the right will still have an easy time denouncing it as medical socialism. Indeed, critics from the right have been known to level that charge at even piecemeal health reform measures–from the State Children’s Health Insurance Program (S-CHIP), which merely allows states to subsidize coverage for kids living at or near the poverty line, to HMO reform, which doesn’t expand coverage at all but simply regulates the way insurance companies make treatment decisions.

So if you’re going to propose a large-scale change to the health care system and invite the “socialized medicine” charge anyway, you might be better off endorsing a single-payer system, which at least has the virtue of being easy to explain. Unlike, say, a hybrid public-private system, which involves all sorts of convoluted regulations, which then require all sorts of tortured explanations, the essence of single-payer can be reduced to three simple words: “Medicare for all.”

After all, Medicare is essentially a single-payer system, only one that operates exclusively for senior citizens. While its lack of prescription drug coverage remains a major flaw–albeit one that both parties have now sworn to fix–it is also incredibly popular with the people who have it. And why not? If you’re on Medicare, you never worry about losing your insurance. If you’re on Medicare, you can see most any doctor you want–and get most treatments the doctors recommend. Medicare has a large bureaucracy, but most physicians today will tell you it’s a more reliable payer–and a less onerous overseer–than private managed care companies. Indeed, far from true “socialism,” Medicare allows doctors and hospitals to remain privately employed.

If there’s a big problem with Medicare these days, it’s the program’s lack of long-term financial viability. But that’s a flaw of the entire health care system, and will require resolution with or without major health care reforms. Indeed, single-payer advocates argue that their system makes that resolution easier, by introducing a more efficient system and allowing people to make trade-offs democratically. Enacting single-payer wouldn’t necessarily mean expanding Medicare per se (although plenty of Democrats have proposed such schemes before). But a would-be reformer could certainly explain it that way.

This isn’t to say single-payer is an easy sell. Quite frankly, it may be impossible to sell sweeping health care reform–any sweeping health reform–right now, given the nation’s political mood and power of special interests with a stake in the status quo. But among the proposals out there, single-payer has compelling political advantages. Al Gore may turn out be wrong. But he isn’t nuts.

Jonathan Cohn is a senior editor at TNR and a 2002-2003 Kaiser Family Foundation media fellow.

SINGLE PAYER BILL WILL BE REINTRODUCED ON DECEMBER 4, 2002

From MassCARE:

The Massachusetts Health Care Trust will be resubmitted on December 4, 2002. Activists will be in the State House gathering signatures of legislative cosponsors on:

Tuesday, December 3rd – 10am to 4pm – call the office at 800-383-1973 if you would like to join us. We will meet at the 4th Floor cafeteria

Wednesday, December 4th – 9am to 1pm in Room 222 at the State House. Join us if you can.

Senator Steve Tolman (D-Brighton) and Representative Frank Hynes (D-Marshfield) are the new lead sponsors for the bill. Both legislators agree that the best strategy is to file the bill only in the Senate, this makes it easier to move. Frank Hynes will be listed as the lead House sponsor and will sign right under Steve Tolman. Representatives can sign onto a Senate bill, I am assured that Reps are used to doing this.

CALL YOUR STATE SENATOR AND STATE REPRESENTATIVE AND TELL THEM THAT YOU EXPECT THEM TO SIGN ON AS A COSPONSOR.

THANK YOU.

Problem of Lost Health Benefits Is Reaching Into the Middle Class

This article was reported by John M. Broder, Robert Pear and Milt Freudenheim and was written by Mr. Broder.

By JOHN M. BRODER
November 25, 2002

Diane MacPherson, of Lowell, Mass., lost her job at a relocation management company last November, and with it the health insurance for herself, her husband and their 4-year-old daughter. Her husband works in construction and does not have access to health care coverage at work.

Continuing her family health insurance under the federal Cobra program would have cost $931 a month, so the couple decided to insure only their daughter, at a cost of $270 a month. Two months ago, when Ms. MacPherson’s unemployment compensation payments ran out, they dropped their health insurance altogether. Although her husband earns about $75,000 a year, construction work is seasonal and they could not be assured of enough income every month to pay for health insurance.

Then their daughter came down with strep throat. “That was rather humiliating, being in the doctor’s office without insurance,” Ms. MacPherson said. “You become very obvious to everyone.”

The family represents a changing portrait of the 41 million Americans who do not have health insurance today. Once thought to be a problem chiefly of the poor and the unemployed, the health care crisis is spreading up the income ladder and deep into the ranks of those with full-time jobs.

According to recently released Census Bureau figures, 1.4 million Americans lost their health insurance last year, an increase largely attributed to the economic slowdown and resulting rise in unemployment. The largest group of the newly uninsured — some 800,000 people — had incomes in excess of $75,000. They either lost their jobs, or were priced out of the health care market by rapidly rising insurance premiums, or, like Ms. MacPherson, both.

While it is true that the number of uninsured people rises when unemployment goes up, it is also true that the rolls of the uninsured can expand even when joblessness is going down, as it did through most of the 1990’s.

The numbers of uninsured during the last recession from 1990-92 jumped to 35.4 million from 32.9 million. But the number continued to rise even in the boom years of the mid- to late 1990’s, reaching 40.7 million in 1998 before dipping slightly in 1999 and 2000.

Labor economists say that much of the job growth during the expansion of the 1990’s came in small businesses and in service industries, low-wage, nonunion sectors that are much less likely to offer health insurance as a benefit to new workers. There was also a demographic bulge of young people and recent immigrants entering the work force during the decade, with many of them willing to take jobs that did not offer rich benefit packages.

The problem has long been acute among minorities, immigrants, part-time workers and employees in low-wage service jobs. What is different this time, analysts say, is that the problem is hitting middle-income and upper-income families harder because many of the job losses are in high-wage industries like technology and telecommunications.

Thirty million Americans in working families today — 16 percent of all those in families headed by a worker — lack health care coverage, according to a four-year tracking study by the Center for Studying Health System Change, a nonprofit research group financed by the Robert Wood Johnson Foundation. An additional 16 million Americans — mostly low-income workers — are offered health insurance through their jobs but decline because they get health care from government programs or it is too expensive, the study found.

“The failure of the economic boom to expand employer-based coverage for working families significantly is ominous,” the center said in a recent study. It found that the current slowdown and the rising cost of providing health care to employees produced a double whammy: fewer companies are now willing to offer their workers health care coverage, and those that do will demand that employees shoulder a far higher share of the cost.

Rising Concerns

Policy makers and health care analysts say the United States is again confronting a crisis in its medical delivery system.

“The number of uninsured will continue to grow as long as health insurance premiums rise more rapidly than earnings, as they have for a decade,” said Drew E. Altman, president of the Henry J. Kaiser Family Foundation, which tracks health coverage trends.

“Losing health benefits is becoming a middle-class issue,” Mr. Altman said. “If it had not been for expansions in the child health program and Medicaid, we would have 10 million more uninsured.”

The growing number of uninsured and the rising cost of health insurance have stimulated Congressional interest on a scale not seen since 1993 and 1994, when President Bill Clinton tried to remake the health care system and guarantee coverage for all Americans.

The major proposals being debated now fall into two main categories. One approach, favored by Republicans and some Democrats, would provide tax breaks to help individuals, families and small businesses buy health insurance in the open market. The other, preferred by many Democrats, would expand eligibility for Medicaid or the Children’s Health Insurance Program to include the parents of some children who are already eligible.

Either plan could have eased the situation of Brian and Anna Brooks, who run a small electrical contracting business in Westminster, Colo. They gave up their health insurance for themselves and their 8-year-old daughter this year to keep their business afloat.

They had already let go four of their five workers and wanted to maintain health coverage for their remaining employee.

Ms. Brooks said that they dropped their health coverage in July after the family premium jumped to $989 a month from $489 a month. Business was slow, and their previous income of more than $60,000 a year had fallen by half.

The effect has been immediate. Mr. Brooks, 50, has stopped taking Lipitor to control high cholesterol and has started taking over-the-counter herbal supplements. Ms. Brooks no longer takes Singulair for asthma and has adopted an exercise program intended to regulate her breathing. Ms. Brooks estimates they are saving $150 a month by not using prescription drugs.

“We changed our diets a lot in order to help the effectiveness of the supplements, and maybe that’s a good thing,” she said. They are setting aside $30 a month for their daughter’s medical needs, but one ear infection would quickly empty the pot.

The federal Cobra program, enacted as part of the Consolidated Omnibus Budget Reconciliation Act of 1986, is devised to provide a cushion for those who have recently lost their jobs. It allows workers to maintain their health care coverage for up to 18 months if they assume the full cost of the health coverage provided by their former employer. But many find the cost prohibitive, and only a quarter of workers say they would keep up their coverage under Cobra because of its high cost, according to a new survey from the Commonwealth Fund, a private research group.

Betting on Good Health

The high cost of Cobra coverage presents many people who have recently been laid off with a cruel choice. Audrey Robar of Milwaukee, 63, who lost her job at a private social services agency in September, decided to skip the $300 a month Cobra package in the expectation that she would soon find another job.

It was a gamble, and she lost.

“She was thinking she could get away with it,” her daughter, Eva Robar-Orlich, said in an interview last week.

In the early hours of Oct. 23, Ms. Robar began to suffer chest pain and dizziness. She called her sister to ask whether she could seek medical care immediately and sign up for Cobra later. Her sister, Alden Egan, urged her to call an ambulance right away, but Ms. Robar set down the phone to look for the Cobra documents. Ms. Egan then heard over the open phone line the sound of her sister falling to the floor and quickly called 911. By the time paramedics arrived a few minutes later, Ms. Robar was dead of a heart attack.

“I think the fact that she hadn’t paid for Cobra very well could have cost her her life,” said Ms. Robar-Orlich. “She deliberated over calling an ambulance at a time when every minute was urgent.”

Because the insurance crisis has hit high-income families and millions of middle-class Americans with jobs, advocates for the uninsured have expressed hope that Washington will finally resolve the problem. High-wage workers and small-business owners are a much more effective lobbying force than the unemployed, children and the poor.

Mary R. Grealy, president of the Healthcare Leadership Council, an industry coalition seeking coverage for the uninsured, said: “We are very optimistic. More and more people say that the uninsured will be a big issue in the next Congress.”

“Lawmakers have seen the new face of the uninsured — it’s not a welfare population — and will seek solutions for the employed uninsured,” the many working families who lack insurance, Ms. Grealy said. “This is now an issue for Republicans,” she added. “It’s not just a one-party issue.”

Ronald F. Pollack, executive director of Families USA, a consumer group, said that Republicans and Democrats could agree on proposals combining tax credits with some expansion of Medicaid and the Children’s Health Insurance Program.

On the other hand, proposals to aid the uninsured could easily touch off a partisan brawl, in which lawmakers fight over the merits of government programs versus the private market.

President Bush has already proposed tax credits and is expected to offer more proposals to help the uninsured as part of his budget early next year.

In his first two budgets, Mr. Bush earmarked a large amount of money for health insurance tax credits: $89 billion over 10 years, for people who are not covered by an employer’s plan and not eligible for public programs. The proposal languished in Congress, but Mr. Bush will have a greater incentive to push for action this year.

“The president wants to develop a record on health care to neutralize this issue going into the 2004 elections,” Mr. Pollack said.

The issue is of particular concern to small-business owners, who say they would like to offer their employees health insurance but cannot keep up with the fast-rising premiums. They are a large and influential lobby and an important base for the Republican Party.

Martyn Hopper, the California state director for the National Federation of Independent Business, said that 42 percent of the state organization’s 37,000 member businesses did not offer their employees health care coverage. He blames rising premiums and the high cost of doing business in California, which has imposed a number of expensive mandates on employers. Big companies, Mr. Hopper said, can move operations to cheaper locations or offshore, but mom-and-pop businesses are forced to lay off workers or make their employees pay an ever-increasing share of health care costs.

Tom Lucas, who owns two plant nurseries outside Los Angeles, said that he provided health coverage to his 70 employees until the mid-1990’s, when the cost became crushing. Mr. Lucas said that some of his workers have spouses with jobs that provided insurance, some drove to Mexico to seek cheap treatment and drugs, and some did without.

He said that health coverage was particularly expensive in California because the legislature had imposed a number of mandates on the policies that employers must offer, including coverage for mental illness, comprehensive cancer screening, substance abuse treatment and weight loss programs.

“Health insurance is a luxury I can’t afford for my people,” he said. “It’s a great perk, but in an industry like my own, it’s not reality. There’s not enough dollars to go around.”

Roadblocks to a Solution

While there is continuing public concern about health care and gathering sentiment in Washington to do something about it, a number of constraints are limiting the likelihood that the growth in the numbers of the uninsured will be reversed any time soon.

Growing federal and state budget deficits will make it difficult to find money to subsidize coverage for the uninsured. The president and members of both parties have promised prescription drug benefits to the elderly, who vote in large numbers, and fulfilling that commitment is a higher political priority for most lawmakers than addressing the problem of the uninsured.

In addition, doctors, hospitals, nursing homes and other health care providers are demanding higher Medicare payments, which will eat up money that could be used to cover people with no insurance. Medical providers are much more effective lobbyists than are the uninsured.

A number of proposals on Capitol Hill would at least incrementally address the problem. One, sponsored by Senators Susan Collins, Republican of Maine, and Mary L. Landrieu, Democrat of Louisiana, would provide tax credits for the health insurance expenses of individuals, families and small businesses; allow small businesses to take a tax deduction for the full cost of their premiums; and allow states to cover low-income parents and legal immigrants under Medicaid and the Children’s Health Insurance Program, know as CHIP. The bill would also provide federal money to the states to establish insurance purchasing cooperatives for small businesses and high-risk pools for people who cannot get insurance in the private market because of chronic illnesses.

As Congress debates, however, employers and workers continue to struggle with higher costs and more difficult access to health care.

Mitch Flinchum, the controller at a highway paving company in Burlington, N.C., sees the problems from both ends — as an executive in charge of benefits and as a consumer.

Mr. Flinchum pays more than 10 percent of his $65,000 annual salary for health insurance for his family, but he considers himself better off than most of his company’s 350 workers. Only 119 of the employees accept the coverage, and two-thirds of those pay only for themselves and not their dependents. Mr. Flinchum says most of the workers who decline insurance do so because the premiums are costly and the coverage is so meager.

“When you look at your benefits, you’ve got massive deductibles, massive co-pays, and unless you have a heart attack or cancer, which would be devastating in itself, it’s like you don’t have any insurance,” he said.

“I don’t know where it stops,” Mr. Flinchum added. “With a 20 percent increase each year, over time the only two people in this country who will be able to have health insurance are Bill Gates and Warren Buffett. No one else can afford it.”

Healthcare System Is Due for Transformation

By Margaret Heldring, PhD
President and CEO, America’s HealthTogether

At the top of the healthcare agenda for the 108th Congress could be the transformation of our present healthcare system. According to a recent issue of Health Affairs, nearly 60 percent of the national healthcare dollar is now financed through taxes-for such programs as Medicare, Medicaid, SCHIP, the Veterans Administration, tax-subsidies for workers, and public employee benefit plans. The new Congress will be working hard to reduce that percentage-by squeezing program revenues, cutting benefits, and forcing individuals to pay for more of their own healthcare expenses.

At America’s HealthTogether/Coalition Health First, we believe that there’s a better way. All Americans deserve quality, affordable healthcare. Healthcare should be an essential service, such as public education and national security that we all can count on. There is one insurance program that includes everyone, regardless of income, race, ethnicity, gender, and health status. One program that is administered efficiently and is simple to understand and use. One program that guarantees choice of provider, and is rated highly by a large proportion of its members. That program is called Medicare for Americans aged 65 and older and millions of the disabled.

As more Americans are forced to drop their health insurance coverage because of higher premium costs or to pay more out-of-pocket for their current coverage, we predict that a new and improved Medicare program for all Americans may start sounding like a winning solution in 2004.

Dr. Margaret Heldring served as the Director of Health Policy for former Sentor Bill Bradley’s 2000 presidential campaign. She is a clinical psychologist with more than 30 years experience in health care.

America’s HealthTogether is a public policy organization devoted to assuring affordable health care for all, unencumbered access to essential health care services, and a belief that mental health is fundamental to good health.

Gore favors 'single-payer' health plan

CNN/AP
Former vice president talks about 2000 race

WASHINGTON (AP) — Noting that 40 million Americans now have no health insurance, Al Gore says he now favors “single-payer” national health coverage, a proposal that would require a massive change in the health insurance system.

With single-payer coverage, money to pay for health care — such as insurance premiums and tax dollars — would be collected by a single agency, which would then pay for comprehensive coverage for all citizens.

Gore, the 2000 Democratic presidential nominee and a potential candidate in 2004, offered his views in response to a question at a synagogue in New York during a tour promoting his book “Joined at the Heart,” written with his wife, Tipper.

“I was planning to wait and make a major speech on this and I probably should, but I’ll just answer your question candidly,” Gore told the moderator.

Gore’s comments Wednesday night were first reported by ABC News’ Internet political report “The Note” and were confirmed by Gore spokesman Jano Cabrera, who said any details would come in a future speech on health care.

“I think we’ve reached a point where the entire health care system is in impending crisis,” Gore said. “I have reluctantly come to the conclusion that we should begin drafting a single-payer national health insurance plan.”

Depending on the details, calling for a single-payer plan could be a very dramatic step for Gore. During the 2000 primary campaign, Gore attacked Democratic rival Bill Bradley’s central proposal — universal health care — calling it too expensive and not expansive enough to help poor people afford full coverage.

Another potential Democratic candidate for president, Vermont Gov. Howard Dean, pushed for health care for all Americans in a speech Thursday night to an education group in Washington. He wants to expand coverage under Medicare and Medicaid to cover people who don’t have insurance.

Chastising Democrats for promoting limited goals, Dean said: “On health care, we argue about the patients’ bill of rights when we should be pushing for health care for all Americans. On economic development, we talk about tax reform, but then Democrats support tax cuts which do little to help middle-class families afford college tuition and decent health care, when we should be moving away from subsidizing corporate America, and completely revamping American economic development policy to help small businesses grow.”

Citing the Republicans’ strong election gains, Dean said: “Last week the American people sent the Democratic party a powerful message: It is no longer enough for us as Democrats to blur the distinctions between our party and the Republicans. We need to offer a clear choice, an agenda that is our own. It’s time for our party to once again stand for ideas that touch every American.”

Gore, meanwhile, spoke about his failed presidential race in an interview with Barbara Walters that will air Friday night. He talked about his decision not to call on former President Clinton to campaign for him in the 2000 campaign. Some advisers felt Clinton’s past sex scandals were a liability for Gore, while others in the party wanted Gore to take advantage of Clinton’s political skills and popularity with the party’s base voters.

“I felt that I had to sell myself,” Gore said. Asked whether he would call on Clinton in a future campaign, Gore said, “I might very well … because I think it would be a different situation.”

-=-=-=
Followup Letter to the Editor:
“Gore’s health plan idea”

Letter to the Editor, USA TODAY, 11/22/02

While sitting down for a bite of lunch recently, I read a newspaper report about Al Gore that was intriguing (“Gore wants feds to run health care for all,” News, Nov. 15).

While certainly not a Gore fan, I’m impressed with his idea to have all Americans covered for health insurance under a single-payer, government-sponsored plan.

As a middle-class, self-employed professional with a wife newly diagnosed with a lifelong disease, I face numerous challenges in the years to come. The irony here is that shortly after lunch, I opened my mail to discover that my current health-insurance carrier is planning to increase premiums nearly 50% next year, along with doubling the co-pay and quadrupling the prescription co-pay.

You can imagine what happened to my lunch.

Bruce G. Levitta
Phoenix

Gore favors ‘single-payer’ health plan

CNN/AP
Former vice president talks about 2000 race

“I was planning to wait and make a major speech on this and I probably should, but I’ll just answer your question candidly,” Gore told the moderator.

-=-=-=
Followup Letter to the Editor:
“Gore’s health plan idea”

Letter to the Editor, USA TODAY, 11/22/02

While sitting down for a bite of lunch recently, I read a newspaper report about Al Gore that was intriguing (“Gore wants feds to run health care for all,” News, Nov. 15).

While certainly not a Gore fan, I’m impressed with his idea to have all Americans covered for health insurance under a single-payer, government-sponsored plan.

You can imagine what happened to my lunch.

Bruce G. Levitta
Phoenix

Romanow on "private" solutions

The Canadian Club of Winnipeg
November 20, 2002
Speech: Creating a National Health Care System for Canadians
Roy Romanow, Commissioner
Commission on the Future of Health Care in Canada

Friends, early in my mandate, I challenged those advocating radical
“private” solutions for reforming health care– user-fees, medical savings
accounts, de-listing services, greater privatisation, a parallel private
system — to come forward with evidence that these approaches would improve
and strengthen our health care system.

The evidence has not been forthcoming.

I have also carefully explored the experiences of other jurisdictions with
co-payment models and with public-private partnerships, and have found these
lacking.

There is no evidence these solutions will deliver better or cheaper care, or
improve access (except, perhaps, for those who can afford to pay for care
out of their own pockets). More to the point, the principles on which these
solutions rest cannot be reconciled with the values at the heart of medicare
or with the tenets of the Canada Health Act that Canadians overwhelmingly
support.

It would be irresponsible of me to jeopardize what has been, and can remain,
a world-class health care system and a proud national symbol, by accepting
anecdote as fact, or on the dubious basis of “making a leap of faith”.

Tossing overboard the principles and values that govern our health care
system would be betraying a public trust. Canadians will not accept this,
and without their consent, these so-called “new” solutions are doomed to
fail. Canadians want their health care system renovated; they don’t want it
demolished.

Some have described it as a perversion of Canadian values that they cannot
use their money to purchase faster treatment from a private provider for
their loved ones. I believe it is a far greater perversion of Canadian
values to accept a system where money rather than need, determines who gets
access to care.

My final report will address this issue in very direct terms, and in a way
that is consistent with what Canadians want and expect from their health
care system.

http://www.healthcarecommission.ca/default.asp?DN=cn=1380,cn=17,cn=3,cn=2,ou=Stories,ou=Suite247,o=HCC

Study urges single-payer health system

The Providence Journal
http://www.projo.com/health/content/projo_20021121_ccjstudy.5bf90.html

Administrative costs alone could be cut in half from their current $1.47 billion by establishing one source of financing, says the report by the Health Reform Program at the Boston University School of Public Health.

11/21/2002

BY FELICE J. FREYER
Journal Medical Writer

PROVIDENCE — Rhode Island’s expensive health-care system has enough money to provide for everyone’s needs — from the elderly who cannot afford medications to the low-paid worker who can’t afford dental care — according to a study released yesterday.

But redistributing the system’s $7.2 billion to care for everyone will require a radical overhaul of financing, eliminating insurance companies and having all money flow to and from a central authority.

Such a “single payer” system, resembling those used in most Western countries, has been talked about for decades as a solution to U.S. health-care ills, but the political will for such vast changes in a long-entrenched system has never been mustered. This month, voters in Oregon overwhelmingly rejected a proposal to establish a taxpayer-financed single-payer system in that state.

The $10,000 study, by the Health Reform Program at the Boston University School of Public Health, was financed with a grant from the General Assembly and commissioned by the Coalition for Consumer Justice.

By coincidence, the study comes two days after Blue Cross & Blue Shield of Rhode Island released a $3-million report showing that Rhode Islanders are heavy users of health care and that the demand for nursing homes, hospitals and nurses will exceed supply by 2006.

And it comes a day after the National Academy of Sciences declared that the U.S. health-care system is in crisis and urged the Bush administration to allow a handful of states to test solutions, including universal coverage.

The Boston University study says that health-care spending in Rhode Island is the fourth highest in the nation, 21.5 percent above the U.S. average. Each year, more than $7,000 per person is spent on health care in this state.

“Isn’t that a staggering sum?” said the report’s chief author, Alan Sager, professor of health services at the Boston University School of Public Health. “It’s four times what we spend on defense.”

Despite all that spending, many people can’t get the care they need, the report asserts, including insured people who can’t afford dental care and elderly people who can’t find adequate home care.

Meanwhile, as much as 20 percent of the health-care dollar is spent on clerical tasks. Sager talked of a hospital administrator in Massachusetts who said he had to fire a nurse to hire two clerks to chase down overdue reimbursements from the various insurers and government agencies.

“We have three choices in health care,” Sager said. “We can suffer and die for lack of needed care. Or we can pay more year after year if we can somehow find the money. Or we can change the way we do things.”

The study estimates that it would cost an additional $1 billion to cover all the people who have no insurance or whose insurance doesn’t pay for all their needed care. But those additional costs can be more than offset by savings in a newly structured system.

Administrative costs could be cut in half from their current $1.47 billion by establishing one source of financing. That source could be the government, which would raise the money through taxes. Or it could be a separate central authority or trust fund. Everyone who now pays for health care — employers, individuals, the government — would funnel that money to this single entity, which would disburse payments to providers.

If there was one source of financing and all people were covered, providers would no longer need to hire staff to determine which patients are eligible for which services and to seek reimbursements from an array of private and governmental payers.

Additionally, the report says, cost savings could be realized if the state negotiated discounts on drugs for all its citizens and if doctors were charged with managing care responsibly. Sager proposes that doctors, as a group, be guaranteed 20 percent of health-care costs, with the understanding that they will direct the appropriate use of the remaining 80 percent, within a prescribed budget.

“These are not numbers we made up,” Sager said of the projected administrative savings. “This is the experience of countries where simplified financing exists and where doctors aren’t on the phone negotiating with managed care. If you speak with any doctor who’s not on salary, who runs a practice — the fury; you watch their blood pressure rise when they talk about this.”

Dr. Jeremiah Schuur, a resident physician in emergency medicine, said that doctors would be amenable to “health-care reform that puts the patient first.”

“The current system is swamping doctors in administrative hassle, preventing them from performing their duty of providing care to the sick,” Schuur said at a news conference held to release the report.

Christine C. Ferguson, the former state director of human services who attended the news conference as a representative of Governor-elect Donald Carcieri, said that the study’s findings about the current situation were correct, but that its proposed solution is unlikely to win a following.

“Are we in the middle of a serious problem? Yes, that is true,” she said. But adopting a single-payer plan? “Not in the foreseeable future,” Ferguson predicted. “People don’t inherently trust the government to do that.”

But Marti Rosenberg, of the Health Care Organizing Project, said that as costs keep rising and alternatives keep failing, people will be ready for fundamental change.

Romanow on “private” solutions

The Canadian Club of Winnipeg
November 20, 2002
Speech: Creating a National Health Care System for Canadians
Roy Romanow, Commissioner
Commission on the Future of Health Care in Canada

The evidence has not been forthcoming.

I have also carefully explored the experiences of other jurisdictions with
co-payment models and with public-private partnerships, and have found these
lacking.

My final report will address this issue in very direct terms, and in a way
that is consistent with what Canadians want and expect from their health
care system.

http://www.healthcarecommission.ca/default.asp?DN=cn=1380,cn=17,cn=3,cn=2,ou=Stories,ou=Suite247,o=HCC

Institute of Medicine loses credibility

The National Academies
Institute of Medicine
Fostering Rapid Advances in Health Care: Learning from System Demonstrations

State Health Insurance: Making Affordable Coverage Available to All
Americans

Demonstration projects in this category are intended to result in the availability of affordable insurance coverage to all Americans in a state.

Coverage expansions – Demonstration projects might expand insurance coverage
through either tax credits to be applied to an insurance plan, expanded eligibility for public insurance programs, or a combination of the two. Under the tax credit approach, the federal government would provide support to a demonstration site to be used for premium assistance, and the state would provide state tax credits to uninsured individuals. The state tax credit would likely be based on a sliding scale tied to income, and would need to be adequate to enable the individual to purchase a good insurance package. Under the approach of expanded eligibility for public insurance programs, the federal government would provide federal matching support for a significantly expanded eligibility program under a state Medicaid or SCHIP program.

http://books.nap.edu/books/0309087074/html/R1.html

Comment: Health and Human Services Secretary Tommy Thompson requested the Institute of Medicine to prepare a report on demonstration projects that would find ways to fix our health care delivery system, a system that is unable to meet current and future needs. It is probably no coincidence that the demonstration projects, including expansion of community health centers, and introduction of tax credits to purchase private health plans, reflect the policies already publicly supported by the Bush administration.

Recent reports have demonstrated the deficiencies of relying on community health centers, especially in their inability to provide access to adequate
specialized services, or even access to prescription drugs. And tax credits
primarily support the individual insurance market, noted for its higher costs, fewer benefits, excessive cost sharing, and especially for its underwriting practices that exclude those with the greatest health care needs. If a state were to establish a pilot project, certainly it should have the option of establishing a single insurance program that provides comprehensive services for everyone, made possible by eliminating the administrative excesses of the private insurance market.

By issuing a report that is designed to support the credibility of the Bush administration’s highly inadequate and grossly flawed health policies, The Institute of Medicine has severely tarnished its own credibility.

Salvadoran Social Movement Declares Historic Victory Against Privatization: ASSEMBLY RATIFIES DECREE

New Law Will Outlaw Privatization, Concession of Health Care
Strike continues as unions negotiate rehiring of illegally fired workers
Friday, November 15, 2002

The applause of thousands of doctors, nurses, healthcare workers and their supporters hushed to a respectful silence as Ricardo Monge, Secretary-General of the STISSS healthcare workers’ union, took over the bullhorn and addressed the crowd. “I want to thank each and every one of you for this historic victory,” he proclaimed, holding back tears in his eyes. “We have proven today the truth of our most important rallying cry: the people united will never be defeated. Through struggle, the Salvadoran people have stopped the privatization of health care, and struck a decisive blow against the neoliberal model which strips us of our humanity.” A deafening cheer rose up from the crowd that could hold its silence no longer. One after another, the leaders of the two-month health care strike stood up to voice the same sentiment: the people of El Salvador had won an historic victory in their struggle against privatization, one that would be remembered as the turning point in the war between the neoliberal model of human poverty and environmental destruction, and the alternative model of human equality and sustainable development.

Yesterday afternoon, the opposition parties in the Salvadoran Legislative Assembly united behind an FMLN decree outlawing the privatization of health care. They left ARENA standing alone, and voted unanimously to overturn Flores’s changes to the “State Guarantee of Health and Social Security,” effectively ratifying the original document as written by the STISSS and SIMETRISSS unions. Now, President Francisco Flores is constitutionally obligated to swallow his pride and sign the bill into law. The new law establishes as dominant legal principle the state’s obligation to provide accessible quality health care to every Salvadoran near their home, regardless of ability to pay. It prohibits the privatization, concession, subcontract, licitation, or transfer of any health care or support service to private companies, and calls for all current concessions to be cancelled by the end of the year. According to Monge, “the “State Guarantee” provides the foundation on which we can begin a real reform of the healthcare system in El Salvador, benefiting the interests not of the multinational corporations but of the Salvadoran people, and always guaranteeing that health is a human right and will not be privatized or concessioned.”

As a jubilant crowd left the Legislative Assembly and flooded the streets of San Salvador in a spontaneous celebration, strike leaders recalled that the struggle continues. Flores could take advantage of a number of procedural tricks to delay signing the decree, and unions will continue the strike until it is published in the Official Diary. Only then can real negotiations begin on the rehiring of illegally fired workers, the payment of withheld salaries, and a guarantee of no reprisals against striking workers. In order to ensure this third point, explained Monge, “[ISSS director] Mauricio Ramos will probably have to be removed.” Also, while the new law only covers health care, Flores seeks to privatize many public services, and Monge called for the hundreds of thousands of Salvadorans who participated in the three “White Marches” to join in solidarity with the STSEL union’s strike against the privatization of electricity. Finally, Monge warned the people of El Salvador of a new danger that could undo all of the work that they had done: CAFTA, a free trade agreement between the US and Central America that would supercede the new law and mandate the sell-off of public services like health care to multinational corporations.

That’s the news this morning in El Salvador.

Rhode Island Can Afford Health Care for All

EXECUTIVE SUMMARY
(the full report can be found at http://www.healthreformprogram.org/)

This report finds that complete, comprehensive health care for all Rhode Islanders is already affordable.

Complete care means coverage for people who lack insurance coverage today.

Comprehensive care means thorough insurance for prescription drugs, dental care, and other services that are omitted from many insurance policies today.

Why is complete and comprehensive health care for all Rhode Islanders affordable today? For two main reasons:

The money is already available. Current health care spending in Rhode Island is fourth-highest in the nation, 21.5 percent above the U.S. average. And U.S. average spending per person is itself more double the western European average. Those nations cover all citizens and enjoy better health outcomes than do Americans.

Cutting administrative waste, cutting drug prices, acting to prevent some medical problems, and other efficiencies save enough money to finance full insurance coverage for people who are now uninsured or inadequately insured.

This report finds that the three main alternatives to health care for all are themselves unaffordable. These alternatives are more money for business as usual (without improving coverage), efforts to cover more people with band-aid additions, and efforts to cut health costs by cutting insurance coverage or asking families to pay more.

This report estimates the costs of universal health care in Rhode Island and contrasts those costs with a continuation of the current system. It shows that universal health care for the people of Rhode Island is affordable. It offers alarming new evidence that ever-higher spending for business-as-usual in Rhode Island health care is not sustainable for people who pay for it or for people who use it, and that business-as-usual is cheating the stateï¿½s people by wasting huge sums on the private sectorï¿½s payment bureaucracy at the expense of the care that all Rhode Islanders need.

Consolidated financing is essential to cutting administrative costs. (And cutting those administrative costs is essential to financing comprehensive health care for all.) Financing can be consolidated in one of two ways.

The first is the simple single payer approach. Here, private insurance simply ends, out-of-pocket payments are virtually eliminated, and taxes are raised to replace the lost revenue. This means big tax increases.

The second is to pool all revenues in one reservoir, which allows the same administrative savings as single payer but requires much smaller tax increases. This has the advantage of capturing dollars now paid through private health insurance by employers and employees. Todayï¿½s private insurance payments are frozen in todayï¿½s dollars. Checks are written to a new health care trust fund, not to private insurers. Increased health costs in future years are covered by public spending. This means much smaller tax increases.

Consolidated financing alone is essential to financing comprehensive health care for all Rhode Islanders today. Looking ahead, though, it is not enoughï¿½by itselfï¿½to ensure affordable medical security for years ahead.

That is because health care costs continue to increase as the population ages and as costly new medical advances are madeï¿½things like expensive new drugs, surgical treatments, and transplants.

But what good are these medical advances if Rhode Islanders canï¿½t afford them? Rhode Islanders deserve medical security. This first requires deciding what ï¿½medical securityï¿½ really means. It then requires making sure that we shape health careï¿½delivery and financingï¿½to reach this goal. If we donï¿½t deliberately plan to succeed, we are surely planning to fail. And that would be a tragedy.

Ultimately, no state or nation can ever spend enough to win immortality for its citizens. So immortality is not the goal. Rather, the goal should be something like this:

All Rhode Islanders should be able to get the health care they needï¿½high-quality health care that worksï¿½without having to worry about whether they can afford it.

Health care spending in the United States is vast. In the year 2000, health spending in the U.S.A. was more than four times as great as was spending on national defense. And spending in Rhode Island was 21.5 percent above the U.S. average, as noted earlier.

For the long haul, reaching the goal of affordable high-quality health care for all Rhode Islanders requires that we spend our vast but still finite health care dollars as carefully as possible. This requires going far beyond the simple but vital step of consolidating financing.

It requires that doctors, hospitals, and other caregivers be paid in financially neutral waysï¿½in ways that encourage, liberate, and require them to spend money as carefully as possible. This means, certainly, that all needed caregivers be paid enough money to allow them to remain open in Rhode Islandï¿½as long as they operate efficiently.

It requires, further, that doctorsï¿½who make the key decisions about how the great bulk of health care dollars are spentï¿½are particularly empowered to spend our money carefully. This should begin by recognizing that doctors traditionally get about one-fifth of the health care dollar. They should be assured this money, to be divided up among them in reasonable proportion to competence, kindness, effort, and other factors.

But doctors also should be encouraged, liberated, and required to marshal the bulk of the remaining 80 percent of the money (excepting only dollars needed by dentists, public health agencies, researchers, and other independent actors) to provide the care that all Rhode Islanders need. Doctors would have to spend all of that money on their patients, and could not spend more. They could not personally benefit by economizing on care. This approach encourages patients and payers to trust doctorsï¿½ decisions.

This has been called ï¿½professionalism within a budget.ï¿½ It is one sensible way to balance the books in health care. If any patient is denied a service because it would be of small benefit to them, the aim would not be to enrich a physician or a for-profit HMO. Rather, the only reason for denying a service would be to make that service available to another patient who needed it more.

This is nothing more than spending money carefullyï¿½of getting as much health care as possible to the people who need it. This is nothing more than recognizing that all Rhode Islanders need health care but that dollars are always going to be limited. This is nothing more than a way to build trust in Rhode Island health care that offers medical securityï¿½durably affordable medical securityï¿½to all residents.

We offer this report in the hope that it will help the public and policy-makers to grapple with the complexity of our health care system, and to identify the benefits of universal access to comprehensive care with simplified administration.

-=-=-=

The American Medical Student Association (AMSA) is pleased to cite a report to the Rhode Island General Assembly proving that a single-payer universal health care system would save the state $270 million in health care costs. AMSA, the nationï¿½s largest independent organization of physicians-in-training, believes that equal access to comprehensive health care is a basic human right. AMSA has supported single-payer national health insurance as a solution to the nationï¿½s crumbling health care system since 1989. The AMSA Foundationï¿½s 2002 American Health Care System Survey found that an overwhelming majority of first and fourth year medicals students believe that health care is a right.

ï¿½Healthcare is an issue that touches every American, regardless of age, race, or gender. Quality health care for all people through a single-payer system would help end the dramatic disparities that continue as long as we consider health care a privilege for those who can afford it,ï¿½ says AMSA National President Eric J. Hodgson, M.D.

The results of the Rhode Island study conducted by Alan Sager, Ph.D., of Boston University School of Public Healthï¿½s Health Reform Program found that the state could provide, with a savings of 3.6%, complete care to its 75,000 uninsured residents and comprehensive care for residents currently with insurance but lacking coverage for prescription drugs, dental care, and other services.

The Rhode Island study is the latest to confirm that single-payer reform is not only a feasible solution, but also one that is more favorable than other, incremental approaches. The study comes a week after former Vice President Al Gore announced that he favors single-payer national health insurance as a solution to the health care crisis. AMSA supports Mr. Goreï¿½s statement as a way to re-ignite the debate on needed health reform.

On November 18, four former Secretaries of Health & Human Services and former Surgeon General David Satcher described the nationï¿½s health system as ï¿½too costly, inefficient, [and] unfair,ï¿½ and in need of an ï¿½overhaul.ï¿½ (Toner, Atlanta Journal-Constitution, 11/19) The Rhode Island study shows that such an overhaul is possible with a single-payer system, providing health insurance to the uninsured and to those with insufficient coverage. The study coincides with a report from the Institute of Medicine calling for 3-5 states to begin demonstration projects providing universal health care.

Earlier this year, the AMSA Foundation conducted the first-ever study of medical student knowledge and attitudes of issues surrounding universal health care and health disparities. The study found that about 90% of first and fourth year medical students agree that every American is entitled to adequate medical care regardless of ability to pay. A majority of students believe that some form of a universal heath care system would provide the best health care to the most people for the least amount of money.

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