HealthCare access Resolution – House Concurrent Resolution 99
America’s Health Together (
April 30, 2002
Washington, DC
Rima Cohen,Vice President at the Greater New York Hospital Foundation and Director of the Insurance Options for the Uninsured Project, whose mission is to devise and implement strategies for expanding health insurance coverage in New York:
… we know for sure that the market has not taken care of the problem. Indeed, about a million people every single year since the census began collecting these statistics, have been added to the ranks of the uninsured. So, that’s a difficult thing for me to grapple with looking back on so many years working on health insurance coverage.
So, I jumped at the chance to move into the state health policy arena, thinking that this is where the action is going to be in the coming years, and to a certain extent, I was right. And I was very fortunate when I moved to New York to be involved with an effort that started off with a coalition of organizations where we developed a health insurance plan that was meant to build on our Child Health Plus Program. It was for parents and childless adults, and within a couple of years of my arrival in New York, that legislation passed into law. And, it was the single biggest expansion in New York’s history since–or I should say, since the creation of Medicare and Medicaid in 1965.
So, having been through that experience, you would think that I might be a big advocate of states as the laboratories of democracy, states experimenting with health insurance coverage initiatives, maximum state flexibility to develop locally tailored solutions to the health insurance crisis, but actually, I came away with exactly the opposite sense.
… health insurance coverage is really something that should not be thrown onto the states. And indeed, New York, with all the fanfare of this huge health insurance expansion, we really have not seen a drop in the uninsured. I think all we’ve done is managed to keep people–more people from losing their coverage.
So, let me just tie this all together with a couple of pearls of wisdom that I think can be used to think about strategies going forward. And the most important one is the one that I call, “Bigger is better when it comes to health insurance coverage.” And what I mean by that is, the lens through which I look at every health reform solution is always, “Does it pool the greatest number of people in the largest pool and the greatest number and the most diverse in terms of their ages and illnesses and so forth?” Because that’s the only way that health insurance works.
Health insurance does not work when people can segment themselves into tiny groups and divide themselves based on their illnesses or even geography or their age. And the system now really divides people, and what we really should be doing is pooling people. That’s the principle of health insurance and that’s why–one of the reasons why I think a resolution like this is so important. It’s saying, “Everybody needs health insurance coverage. Let’s pool the largest number of people together,” and a corollary of that is, “Don’t be fooled by calls for more choice.” I think all Americans want choice of their health care providers. I don’t see individuals clamoring as much for their choice of health plans, their–lots of other kinds of choices that you hear set up. Choices of benefit packages. That only allows people to segment themselves again. We need to be thinking about large solutions, comprehensive solutions. That’s the only way we’re really going to–to see a real program for all Americans.
And that’s why I think a Resolution like this is so important (H Con Res 99). Because it doesn’t say that this is exactly the way the health–the health care solution has to be built, but it says, regardless of the method, it has to be done. And the appropriate place to start is in the U.S. Congress passing this resolution, saying that by a date certain, the feds will come up, hopefully in partnership with the states and with lots of organizations that care about this issue, will come up with a solution but it cannot be done by states alone.
For the transcript:
For House Concurrent Resolution 99:
The resolution calls for legislation by October 2004 that would guarantee that every person has access to health care that meets fourteen specific criteria that we all support. Read it, and then contact your Congressional representative to enlist his or her endorsement.
Doctors, Ideals and Bottom Lines
The New York Times
May 3, 2002
As a private psychiatrist with about 45 percent of my patients on Medicaid or Medicare, I agree with Marc Siegel (Op-Ed, May 1) that Medicare should be expanded. But let’s not stop with prescription drugs. The program should cover all Americans. We could change its name to National Health Insurance. Were this to happen, I’d gladly accept a pay cut.
J. WESLEY BOYD, M.D. Northampton, Mass. The writer is a lecturer in religion at Smith College and in psychiatry at Harvard Medical School.
The original Op-Ed by Marc Siegel (“… choosing not to take Medicare patients should not be seen as simply a neutral business decision.”):
Comment: “National Health Insurance” or “NHI” is a neutral term that can be used for broad audiences. Now that health reform is back in the news and on many agendas, it is helpful to have a term that represents comprehensive reform but without invoking concepts for which organized opposition already exists. “Medicare for All” provokes negative responses from those that are unhappy with the affects of neglect and political damage done to our Medicare program. “Single payer” provokes responses from those that have been saturated with misinformation about the Canadian system. These terms are certainly acceptable for selected, targeted audiences, but might not be the best terms for large, broad audiences.
“National Health Insurance” suggests the option of comprehensive reform, a concept that is now being accepted as an alternative to our current incremental approaches, now that the public is showing concern about the failures of incrementalism (skyrocketing premiums, excessive cost-sharing, and more uninsured). Once the forum is opened up to National Health Insurance, we can use this opportunity to explain to the public the beneficial features such as equity in funding, comprehensiveness, improved access, and elimination of financial barriers while containing costs.
Although no single terminology would be appropriate for all circumstances, National Health Insurance, or NHI, should be in our tool box as we communicate to the nation the advantages of reform that would provide affordable, comprehensive care for everyone.
PRI's "Marketplace"
May 2, 2002
Academics, analysts, lawmakers and the public: from all sides there are complaints that the country’s health care system isn’t working. More than 40 million are uninsured. Costs are soaring and so are premiums, nowhere more than in California, where many will see their rates rise 25% in the next year.
James Kahn, M.D., an epidemiologist and health services researcher at the Institute for Health Policy Studies at the University of California, San Francisco:
“We spend ($15 billion in California) every year to administer the health care system, and what do we get for that? Are people pleased that they have to change health plans? Are they pleased that they have to change doctors, that they have to fight with insurance plans about what’s covered and what isn’t?”
… single payer advocates claim that they can give more people more services for less money, a claim substantiated by an independent review of California’s single payer proposals from the Lewin Group.
In order to overhaul the system there needs to be broad political backing and extensive public education and support, but California advocates of a single payer system point to the increasing premiums, dwindling benefits, and the growing number of uninsured. The time is right for change, they say, and California, with its history of political independence, stands the best chance of making it happen.
This audio report is available through a link at KFF’s Daily Health Policy Report at:
James Kahn’s co-authors of the UCSF single payer proposal for the California Health Care Options Project include Thomas Bodenheimer, Kevin Grumbach, Vishu Lingappa, Krista Farey and Don McCanne. All proposals and the analyses of them are now available at:
PRI’s “Marketplace”
May 2, 2002
Academics, analysts, lawmakers and the public: from all sides there are complaints that the country’s health care system isn’t working. More than 40 million are uninsured. Costs are soaring and so are premiums, nowhere more than in California, where many will see their rates rise 25% in the next year.
James Kahn, M.D., an epidemiologist and health services researcher at the Institute for Health Policy Studies at the University of California, San Francisco:
“We spend ($15 billion in California) every year to administer the health care system, and what do we get for that? Are people pleased that they have to change health plans? Are they pleased that they have to change doctors, that they have to fight with insurance plans about what’s covered and what isn’t?”
… single payer advocates claim that they can give more people more services for less money, a claim substantiated by an independent review of California’s single payer proposals from the Lewin Group.
In order to overhaul the system there needs to be broad political backing and extensive public education and support, but California advocates of a single payer system point to the increasing premiums, dwindling benefits, and the growing number of uninsured. The time is right for change, they say, and California, with its history of political independence, stands the best chance of making it happen.
This audio report is available through a link at KFF’s Daily Health Policy Report at:
James Kahn’s co-authors of the UCSF single payer proposal for the California Health Care Options Project include Thomas Bodenheimer, Kevin Grumbach, Vishu Lingappa, Krista Farey and Don McCanne. All proposals and the analyses of them are now available at:
Aetna Ends a Drought in Health Care Profit
The New York Times
April 26, 2002
By Milt Freudenheim
Aetna reported a turnaround in its troubled health insurance business yesterday, reflecting sharply higher premiums and the loss of millions of members that it said had been money losers.
Aetna said its premiums would rise 18 percent this year, ahead of medical costs, which are expected to grow 15 to 16 percent.
Dr. John W. Rowe, chief executive of Aetna, said that as premiums rose many employers were passing some costs to employees. Workers, who are paying more in premiums, deductible amounts and copayments, may hesitate before going to a hospital emergency room for, say, a sprained ankle, he said.
Comment: It is reassuring to learn that everyone now knows how to determine whether an ankle injury is a tear of the anterior talo-fibular ligament or a fracture of the distal fibula. If it is a tear, they also know the degree of the tear and the management of each level of severity. Not only that, they also know how to prevent the prolonged disability that results from an enlarging hematoma typical of these injuries. They also understand the rehabilitation measures that will optimize their return to normal function. Or do they? Have we come to the point that any medical problem that is not a life-threatening event is to be considered an abusive use of our health care system by a woose and therefore not worthy of being funded by health insurance?
Dr. Rowe’s insensitive comments confirm that he and others like him should no longer control our health care funds. Let’s throw out this egregiously wasteful middleman industry that is now abandoning its essential role of funding health care.
We know that we can replace this abusive system with a program of national health insurance which would provide truly comprehensive coverage for everyone at a lower cost. What are we waiting for?
Jack Lewin, M.D., EVP and CEO of the California Medical Association, responds on the quote of AMA President Richard Corlin
On the need a pragmatic solution for the uninsured: “irreducible minimum, probably about 15 million”:
Don and other Folks—Corlin has been misunderstood here. I talked with him. He supports doing SOMETHING to get as many people covered as possible, rather than waiting forever for a universal solution—which he nonetheless fully supports also. Please make sure Barbara (author of response) gets this too—I don’t have an e-mail address for her.—-Jack Lewin
Comment: Dr. Lewin is absolutely correct. Dr. Corlin has repeatedly stated that he supports covering the uninsured, and he supports expanding coverage through pragmatic approaches. The “Quote of the Day” messages are intended to provoke constructive thought on health policy issues facing us today. Dr. Corlin’s isolated comment accomplished this, but failed to communicate the sincere dedication of Dr. Corlin to creating a better health care system for all of us.
But our concepts of pragmatism in health care reform are in sharp contrast. The difference can be illustrated by comparing the recent actions of the House of Delegates of the California Medical Association (a leader in influencing AMA policies) with the recent results of the California Health Care Options Project.
In March, 2002, the CMA House adopted a resolution (Report B-1-02) that “CMA participate in health care reform efforts by creating, convening and/or joining coalitions… whose purpose will be to create necessary national and state legislative packages designed to achieve health insurance coverage for all Californians.” But in the same resolution, they called for establishing policy “supporting defined contributions,” “expanded choices of health care financing,” continuing to “provide charitable care,” and combining “economic incentives and reasonable regulations.”
The intent of the CMA House is quite apparent in the concomitantly adopted Resolution 209a-02, “Consumer-Driven Financing of Health Care.” The CMA House resolved “That CMA assert a leadership role in the support, expansion, and design of consumer-driven and consumer-controlled health care financing programs that bring patient choice to health care financing such as Medical Savings Accounts, Flexible Savings Accounts, Personal Care Accounts, Health Freedom Accounts, Health Savings Accounts, and other versions of consumer-driven health care purchasing, and forward same for national action; and be it further resolved: That CMA assert a leadership role in the support, expansion, and design of refundable tax credit programs for the purchase of health insurance, and forward same for national action; and be it further resolved: That CMA work with California’s Congressional delegation to support the right of all patients to use pre-tax dollars for the purchase of their medical care; and be it further resolved: That CMA help physicians bring such recommendations directly to our patients for their education and political support; and be it further resolved: That CMA work with the AMA to support federal legislation to provide a refundable tax credit for the purchase of catastrophic health insurance, consistent with Report B-1-02.”
Conservative and progressive economists agree that these policies can never result in universal health care coverage and will erect greater financial barriers to care for precisely those individuals that have a greater need for care. Pragmatism? Solutions that control costs by preventing access to necessary care may be pragmatic, but they are also inhumane.
(Physicians for a National Health Program provided information to the Technical Advisory Committee of the CMA that produced the report on financing health care. Although the proposals of the Heritage Foundation were enthusiastically endorsed, PNHP’s proposals were cursorily dismissed with the false statement that a single payer system could not control health care costs. Obviously, the committee did not understand the fundamentals of single payer reform since a major advantage of single payer is to establish a structural mechanism of containing costs in an equitable system. The only other possible conclusion is that the committee did understand the proposal but denied the truth because of their own ideology. Regardless, the CMA and AMA have a pressing need to inject more objectivity into their process.)
In contrast, our concept, a model supported by the results of the California Health Care Options Project, would provide comprehensive care to everyone and reduce costs. Pragmatic? The CMA calls for taking recommendations to patients for education and political support. Our position is that ALL models should be taken to all patients and potential patients for their education. Once they understand which model serves physicians well at the cost of health care access, and which model serves the public well with the benefit of access and coverage for all, then the public will tell us which is the “pragmatic” approach.
CMA resolutions:
California Health Care Options Project:
LANDMARK STUDY OF OPTIONS FOR HEALTH CARE REFORM
The final results of the California Health Care Options Project have been posted:
Two page summaries of the nine options:
Cost and coverage analysis by the Lewin Group:
Qualitative analysis by AZA Consulting:
Now that Harry and Louise are no longer under contract with the Health Insurance Association of America, just imagine the possibilities…
“Harry, did you see this article on the California study on single payer?”
“Is that like that terrible Clinton plan?”
“No, honey. This one’s really different. This study was done by reputable health policy researchers, including many from the University of California. It shows that absolutely everyone could have truly comprehensive health care while saving Californians billions in health care costs.”
“Now Louise, that’s impossible.”
“No. Really. By replacing the hodgepodge of health plans with a single insurance program, enough administrative waste would be eliminated to pay for comprehensive health care for everyone. And we wouldn’t be limited to that list of doctors that our current plan requires. We’d have free choice again.”
“Wow. It sounds like the voters should be checking this out.”
“And our legislators too.”
Donald W. Light, Ph.D., responds on the increased funding for the British National Health Service:
The NHS reforms under Tony Blair go much farther than to make up for years of underfunding, which previous Prime Ministers denied was the case. Mr. Blair and Mr. Milburn have open acknowledged central flaws in the NHS that resulted from compromises that Bevan had to make to the medical profession in 1948, and they are rectifying them all.
Severe shortages in nearly every subspecialty are coming to an end. The lack of quality standards is being addressed more systematically than here. The coordination of training of all clinical staff is starting up (like the vision out of PEW in the 1990s here but unlikely to be realized). The hospital-centric system is being systematically transformed into the obverse, with community-based primary care as the center of the system and with GPs and community nurse teams holding the budgets for nearly all health care. These will be population-based and risk-adjusted, roughly what David Kindig envisions in Population-Based Purchasing (Wisconsin 1996). The waiting lists are being transformed. They will be taken away from consultants and coordinated through referral centers. Patients will be given appointments as much as possible. The conflicts of interest in the consultants’ contract are being replaced with productivity-based terms. This is a reform I have been working to bring about for several years, and the Blair Government has accepted most of the recommended changes.
There are serious problems in implementing all this, but the design and vision are worth serious attention by anyone interested in a population-based, community-centered model of health care like that envisioned in the Dawson Report of 1920. I have written several short pieces on aspects of all this as I have worked on the reforms every quarter since 1990.
Don Light
Prof. Donald W. Light
Fax: 1-609-924-1830
Tel: 1-609-924-9220
AMA President Richard Corlin’s insensitive remark on the uninsured provoked more responses than any prior “Quote of the Day” message. Barbara Rylko-Bauer eloquently expresses the innate emotional response that most of us felt on reading his words. My comments follow hers.
Barbara M. Rylko-Bauer:
Dear Don:
According to your “quote of the day,” Dr. Richard Corlin, president of the AMA, during a trip to Cedar Rapids last week, was supposed to have said the following with regards to the uninsured:
“We need a pragmatic, not an ideological solution. Reduce the number from 39 million to its irreducible minimum, probably about 15 million, and consider that a victory and not a terrible tragedy.”
If Dr. Corlin truly did say these very words, then I think that all responsible physicians should call for his resignation…for he has served medicine and the physicians he represents, as AMA president, very poorly, to say the least.
By responsible physicians I mean those :
* who consider that their role is not just to treat a disease that walks in the door, but also to be concerned about larger health care issues facing communities and populations,
* who are compassionate,
* who are concerned with what is happening in health care delivery in this country… NOT just in relation to how it affects medicine’s autonomy, not just in relation to how it is affecting doctor-patient relations, not just in relation to how it affects their pocket book…(ALL valid things to be concerned about.)… but also in terms of how it is affecting the patients they are privileged to treat,
* and who are concerned about all the other people who ARE NOT patients because they have no real access to care…..in other words, those pesky uninsured folks that Dr. Corlin so readily dismisses.
Dr. Corlin should also do a little reading about the state of affairs of health care in the United States. He might discover that it’s not just those 40 million that are the “problem.” There are also another 40 million or so who are unstably insured (with gaps during the year) or underinsured. What, oh what, are we going to do with them?
Of course, the bigger question is why, in the wealthiest country in the world, which in the year 2000 spent $1.3 trillion on health care — that averages to $4,637 per person….(but of course, not distributed evenly) — we even have to be discussing problems like:
* the large and growing number of people who are uninsured,
* the fact that despite all our advanced biotechnology, we are plagued with serious safety and quality problems in health care delivery,
* the large racial and ethnic disparities in health care delivery,
* and the fact that our headlong race to embrace a market-oriented health care system (of which managed care is just one part) has undermined the “health care safety net” which so many of the poor and vulnerable populations rely on?
These are all topics that the prestigious Institute of Medicine of the National Academy of Science has been exploring. Within the last few years there have been in-depth reports published on all these topics. We are not talking here about some tangential problems, but rather things that are AT THE CORE of health care delivery in the United States. I would be happy to order copies of these for Dr. Corlin… to help him get “up to speed” about the state of affairs for health care in the United States.
I am not a physician. I have, however, studied U.S. health care for many years, as a social scientist. I am frankly astounded that in this day and age, a physician could so glibly erase 15 million people, could stand up and publicly say that if we got the numbers down to 15 million, we could pat ourselves on the back and say, “job well done.” And then to have the insensitivity (and amorality) to consider that having ONLY 15 million uninsured would be a victory, not a tragedy…it boggles the mind. I am also, as a scholar-of-sorts, curious as to how he came to this magical number of 15 million as the “irreducible” denominator. Not from studying health care delivery in other industrialized countries; from where, then?
Dr. Corlin should do even more reading and find out WHO these uninsured folks are….
* he would find out that most of them are employed, hard-working citizens who are in lower paying jobs or with small firms that can’t afford health insurance;
* he would find out that 5.9 million of them are mothers;
* he would find out that about 1/4 of them are children;
* he would find out that many of them are members of minority groups.
I would be willing to bet that herein lies one of Dr. Corlin’s problems. I am looking at a picture of Dr. Corlin as I write…and I can tell you that he:
* is not one of the hard-working poor, not even one of the hard-working middle income Americans who simply can’t afford health insurance,
* is not one of those 5.9 million mothers with small children,
* is not, obviously, a child,
* and is most likely not a member of a minority group.
Dr. Corlin can’t relate to these folks. What I can’t tell from the picture, but can tell from his remarks of last week, is that Dr. Corlin is not a true physician. And he has shamed his profession and his professional position with the irresponsible remarks he made in Cedar Rapids last week. He owes all the uninsured people of this country an apology….and he also owes one to the physicians he is supposed to be representing, as president of one of the major medical associations.
With Dr. Corlin at its head, organized medicine is beginning to look a bit like a ship adrift, these days. Doctors dropping Medicare, opting out of Medicaid, setting up boutique practices, complaining loudly about the abuses of managed care (and there certainly is plenty to complain about, that I agree with) but going along with the for-profit program for the most part, and largely remaining silent about the ways in which big business is shaping health care delivery for its own interests. Its time for more courageous, visionary leadership….and some better ideas for how to solve the problems of health care delivery in this country.
Sincerely,
Barbara Rylko-Bauer
Comment: Dr. Corlin’s apparent insensitivity mandated responses such as Barbara’s. But Dr. Corlin is not the evil person implied by his isolated comment. He is a very fine person, representing the best of the Hippocratic traditions in medicine. So how could he have made such an awful statement?
Health policies that the members of the AMA leadership support include tax credits, MSAs, shifting costs (risk) to individual patients, multiple health plan products (multi-tiered benefits), and eliminating the employment link for health insurance. Dr. Corlin is aware that these policies can never provide true universal coverage. His comment was based on his belief that the AMA policies are in the nation’s interest, and that we have to accept the consequences of these “great” policies. We accept that employment rates will never be 100%, and, likewise, we should accept that health insurance coverage will never be 100%. From his perspective, his comment was a very benign remark on the realities of health care reform.
But what a remark! The AMA leaders are so sold on the righteousness of their approach that they cannot see the cruelty and inhumanity that would be inflicted on those for whom they should be leading the charge: the patients that are most in need of health care! The outrage expressed in response to Dr. Corlin’s comment should bring the AMA Board of Trustees out from their board room to find out what the ruckus is about.
Actually, Dr. Corlin and other members of the AMA leadership, in their tours of the communities, are hearing more and more from many members of the medical profession that we should be taking a very serious look at single payer reform. It is time for the AMA and state and county medical associations to set aside their conservative political ideology and rhetoric, and place on the table all options for reform. It is essential that all policy implications be clearly understood and discussed objectively. The single payer model would provide equitable, comprehensive coverage for absolutely everyone while providing free choice of providers of care and controlling costs. The policies currently supported by the AMA would accomplish none of those goals. But they are goals truly worthy of pursuit.
Don McCanne
Cedar Rapids Gazette
April 19, 2002
By David DeWitte
American Medical Association President Dr. Richard Corlin drop-kicked the notion that national health insurance will ever solve the health insurance crisis during a visit to Cedar Rapids on Thursday.
Finding a system that will cover all Americans is both costly and politically hamstrung, Corlin said.
Richard Corlin, M.D., AMA president:
“We need a pragmatic, not an ideological solution. Reduce the number from 39 million to its irreducible minimum, probably about 15 million, and consider that a victory and not a terrible tragedy.”
Comment: Dr. Corlin leaves virtually no doubt as to why Physicians for a National Health Program should supersede the American Medical Association as the legitimate physician organization representing the cause of health care justice.
From Karen Palmer, who is currently on a sabbatical at the World Health Organization in Switzerland, commenting on the findings of The Lewin Group in the California Health Care Options Project:
I was skimming through a textbook written by two of my colleagues here at WHO, and I came across this quote, which so supports the findings of the Lewin group. Maybe folks are starting to get the picture, which is so well-known in the rest of the world that it is part of a standard college level text book on public health:
“The United States of America epitomises the problems wealthy countries experience when public health is neglected. The major dilemma facing public health in the United States continues to be its relationship with the organisation and delivery of medical care services. Until a national and equitable system of medical care is achieved, public health will be neglected and receive an inadequate share of the vast resources devoted to “health” in the United States. The tremendous amount spent on medical care limits the availability of funds for a whole range of public services, not just public health.”
Citation: “Public Health at the Crossroads: achievements and prospects” by Robert Beaglehole and Ruth Bonita, Cambridge University Press 1997.
Billions for the NHS
BBC News
April 17, 2002
Spending on the NHS in England will top £100 billion in five years time, Chancellor Gordon Brown has announced.
Mr. Brown has accepted the recommendations of the Wanless Report into the future needs of the health service.
Earlier, a report by former NatWest chief executive Derek Wanless had called for NHS spending to more than double by 2022.
Mr. Wanless said spending on the NHS should rise to £184 billion a year from £68 billion a year now.
His report said the health service had been underfunded by £200 billion over the last 30 years. He called for an initial five year period of high growth to catch up, followed by a lower level of sustained investment.
In his Budget speech, the Chancellor said spending would increase by an average of 7.4% in real terms for each of the next five years – in part funded by a 1% increase in national insurance contributions.
The projections in the report show the UK spending between 10.6% and 12.5% of GDP on health care by 2022. This compares with 7.7% today.
Mr. Brown dismissed calls for alternative funding methods for the health service. General taxation was the equitable option, he said.
Chancellor Gordon Brown:
“We now have the best chance in a generation to secure our national health service, not just for a year or two, but for the long term. The NHS is a British ideal, free at the point of need for everyone in every part of Britain.”
Comment: It looks like the opponents of universal health care in the United States won’t have the British NHS to kick around anymore.
Health Care Costs C-SPAN Washington Journal
April 22, 2002
Steve Scully interviewing Dr. Henry Simmons, President, National Coalition on Health Care:
Steve Scully: An e-mail form Don McCanne, who is a medical doctor and president of an organization called Physicians for a National Health Program: “Isn’t it time to include the single payer model in the debates on reform?”
Dr. Henry Simmons: Oh, I think it’s time to discuss a fair number of propositions. In fact, in Roll Call today, Morton Kondracke, the editor, made exactly that point. There are not a whole lot of different options available to this country to deal with this problem. There are some, and we’ve got to examine them all and see which one makes sense for us given the circumstance we find ourselves in now.
Roll Call April 22, 2002 Partial Fixes Won’t Solve Crisis In Health Care Costs By Morton M. Kondracke
Surging health costs and insurance premiums – and increases in the number of uninsured Americans sure to follow – cry out for Washington politicians to begin thinking comprehensively about America’s impending health care crisis.
One of these days, they will – ideally, as part of the 2004 election campaign. But for now, they are taking only piecemeal whacks at the problem.
Sometimes incrementalism in Washington produces good results, such as creation of the State Children’s Health Insurance Program that widened Medicaid benefits for lower-income families.
But often it simply results in efforts by one group in the health care industry – say, doctors or hospitals – to get the upper hand over another, such as pharmaceutical or insurance companies.
(Kondracke discusses competing interests and then the CalPERS premium increases.)
Even CalPERS, which theoretically has huge bargaining power with health insurers and providers, has been unable to hold down costs. Most employers lack that power.
So CalPERS has joined the National Coalition on Health Care in urging a new comprehensive look at the health crisis – the first since the ill-fated 1993 Clinton health care plan. The group comprises business, labor, consumer and religious groups, and large-state pension plans.
President Henry Simmons says the group has no plan of its own, but that debate should start over three basic models. One is “play or pay,” in which employers continue to provide most insurance coverage and would receive government help if they can’t do so.
A second, favored by liberals during the 1993 debate, is a single-payer system in which all citizens would get their health insurance from Medicare or another government program.
The third, proposed by some Republicans, would impose an individual requirement on all citizens to have health insurance and offer government subsidies to those who can’t afford it.
Democratic presidential contenders need to be heard on this issue soon, and they should pressure President Bush to be heard, too.
National Coalition on Health Care: