CDC National Center for Health Statistics HHS News
February 4, 2002

“In 2001, 4.8 percent of the population–up slightly over the past four years– was unable to obtain needed medical care in the past year due to financial barriers.”

http://www.cdc.gov/nchs/releases/02news/healthinsur.htm

Comment: Fortunately, most people are relatively healthy and have only nominal health care needs. For those that do need health care, nearly one out of twenty, over 13 million people, were unable to obtain care simply due to the lack of a comprehensive system that equitably funds health care. A significant proportion of those that did not need care still lacked the security that would be provided by such a system, even though they may not have realized it.

How can the wealthiest nation on earth shut the door on 13 million people that already need health care? How can the wealthiest nation on earth fail to assure health security for an even greater number of individuals that eventually also will need health care? Have we no sense of solidarity?

The Washington Post
February 3, 2002
By Mitchell E. Daniels Jr., Director of the Office of Management and Budget

“To the average citizen, shifting resources when priorities change makes simple common sense. When the new priority is the survival of Americans, the cause is even more obvious, a straightforward matter of battle stations vs. business-as-usual.

“But Washington is a capital overrun by vested interests whose livelihoods depend on extracting ever-increasing quantities of taxpayer dollars for their narrow causes. It is not clear that they will subordinate their interests even to the needs of wartime.”

“The budget debate ahead will measure our wisdom and our will to respond to this latest lethal threat to American lives and liberty. But it will also test our maturity as a democracy, our ability to put first things first… ”

http://www.washingtonpost.com/wp-dyn/articles/A11718-2002Feb1.html

Comment: The Bush administration has placed a great emphasis on testing. Can we pass the test of our maturity as a democracy by putting first things first? Or are we about to fail this one?

Uwe Reinhardt, Ph.D., James Madison Professor of Political Economy, Princeton University:

“Teachers, mothers and government are the foundation of the nation’s wealth.”

HHS Press Release
January 31, 2002
“Would Allow Use of Existing Resources to Expand Prenatal Care Immediately”

“HHS Secretary Tommy G. Thompson announced today that he plans to issue a proposed regulation soon allowing states to provide health care insurance coverage under the State Children’s Health Insurance Program (SCHIP) to pregnant women for their children who are not yet born.”

“The new regulation would clarify that states may include coverage for children from conception to age 19. This would mean that pregnant women can receive prenatal and delivery care.”

HHS Secretary Tommy G. Thompson:

“Prenatal care for women and their babies is a crucial part of the medical care every person should have through the course of their life cycle. Prenatal services can be a vital, life-long determinant of health, and we should do everything we can to make this care available for all pregnant women. It is one of the most important investments we can make for the long-term good health of our nation.”

http://www.usnewswire.com/topnews/temp/0131-118.html

Comment: You cannot be exposed to any news source this morning without hearing about the controversial nature of this benign-appearing announcement. Changing the legal status of a fetus, with its controversial implications, is cloaked by this program that would expand prenatal coverage, obviously a desirable goal.

But there is an even more ominous feature of this proposal. The flurry of activity by the media demonstrates the concern. Efforts to seriously address the number one health care problem today, the uninsured and under-insured, have been almost completely left off of the radar screens of the media. Instead, attention has been directed to much less important issues such as the patient bill of rights, or disputes over tax credits or defined contribution approaches. It is not that these issues aren’t important, but by directing attention to these issues, the politicians and the insurance industry have managed to dodge the real issue that must be addressed immediately – the plight of the uninsured. Unfortunately, the Bush administration has elected to throw this new bone out to the media to occupy them with this issue that will sell their information products, but with the great advantage of continuing the deception that these are the real issues, while the uninsured are left on the back burner.

On this one, the media must carry much of the blame. The public does not understand the scale of the terrible health care injustices taking place today. They do not understand the degree of waste of their health care resources. They do not understand that policy decisions can be made that could provide equity in access and coverage for comprehensive services for everyone, paid for merely by introducing administrative efficiencies, while returning to patients free choice of health care providers. The media have a moral responsibility to inform the public of the severity of the problems with our health care system, and the real options for reform. But then, covering a hissing cat fight over whether a fetus has rights sells better. And, like the private health plans, the media is placing profit over patients.

Beth Capell, Ph.D., of Health Access, responds to the message on insurers creating multi-tiered access to hospitals:

“If poor people needed health care, they would have it. It is plainly a luxury afforded only to the wealthy and healthy.

“California State Senate President Pro Tem John Burton once introduced legislation to make it a crime to be poor. We probably need to amend this to include needing health care.”

Uwe Reinhardt, Ph.D., of Princeton University, responds to Dr. Capell’s comments on health care being a luxury afforded to the wealthy:

Well, we do ration justice by ability to pay, and education as well. It is only natural that we shall do the same in health care.

In fact, health care could be viewed the odd-one out in our scheme of things, but only for a few decades after WWII. The post WWII decades were, in the main, an aberration from our nation’s ingrained, class-based approach to the distribution of human services. After having gone through the Depression and WWII, our grandparents probably began to appreciate the virtues of a Rawlsian society–a so-called socialist market economy. The Baby Boomers and their issue, the GenXers, have few such sentiments (unless they themselves are in a pickle). Close your eyes and ask yourself this question:

A year ago, when Enron was still sailing high, would its proud employees not have spat at people who shill for universal national health insurance? Now they cry into the TV set every night, ruining my supper. As I have said before, I have zero compassion for them.

We are inexorably marching toward a society in which the best advice one can give young people is this: Forget serving the nation. Before you do that, first get rich. Then you have the leisure of serving the nation, if you still wish it.

Of course, our youngest thumbed his nose at his Dad’s sage advice. He is in the Marines. I admire his guts, but I did warn him loudly that this nation will never thank him for the sacrifices and risks he is taking on his shoulders. He will be respected only if he gets well to do. Still, he went. You go figure.

Best

Uwe

San Francisco Chronicle
January 31, 2002
By Victoria Colliver

“Blue Shield of California yesterday introduced a two-tiered system with hospitals on the ‘choice’ list less costly than those on the ‘affiliated’ list.”

“The tiered system is one of the most immediate ways insurers and employers can pass on to consumers some of the rising costs in health care.”

Larry Levitt, vice president of the Kaiser Family Foundation:

“One of the real values of employer-provided health insurance was it was pretty simple for people. You signed up for a package and every employee –from the janitor to the CEO — got the same benefits. As we get into this tiering, low-wage employees are getting a different benefit than high-wage employees.”

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2002/01/31/BU209140.DTL

Comment: The shifting of health care costs to individuals that have the greatest need for care is increasing with a vengeance. The inevitable tiering results not only in fewer benefits for lower income individuals, but it will actually prevent access to care because of lack of affordability.

With our great resources dedicated to health care, using global budgeting to fund facilities would contain costs for hospitals without the necessity of tiering access to care. It is time that we recognize the inhumanity of controlling costs by creating financial barriers to access. Instead, we should control the funds that create excess capacity in our system.

The $1.4 trillion that we are spending on health care would fund all of the capacity that we need, if we merely adopted the administrative efficiencies of a single, publicly administered insurance program, and dismissed the egregiously wasteful private health plans. $1.4 trillion amounts to about $5000 for each man, woman and child in the United States. For a family of four, placing $20,000 into a universal risk pool would provide very nice health care coverage indeed. And public funding with public administration would assure equity both in the way that we pay for and the way that we access health care.

Steven Wolfson, M.D. responds to John Baldwin, M.D., Dean of Dartmouth Medical School who said, “There are some things that aren’t businesses and that’s OK. I haven’t heard anyone talk about privatizing the Marine Corps.”

Dr. Wolfson:

Can’t you just see “Managed Marine Care”

Your request for a rifle is denied. Diagnosis does not fit this treatment.

No air support will be authorized unless applied for prior to use.

Our 800 line is always open for claims for reinforcements, ammunition, etc.

Sorry, our operators are serving other customers.

We do not provide M-16 rifles; crossbows are equally effective and less costly.

The Washington Post
January 30, 2002
By Laura Meckler, Associated Press

“President Bush will ask Congress for new tax credits to help people buy health insurance, an idea that conservatives champion.”

“Conservatives typically prefer a free-market approach, which would have families choose their own health insurance packages in the open market. Bush’s plan, first made when he was running for president and included in his budget last year, will offer tax breaks to help pay premiums.

“This year’s proposal will be essentially unchanged and will be worth up to $1,000 per person a year, or $2,000 per couple, according to an administration official speaking on condition of anonymity.”

San Diego Daily Transcript
January 25, 2002

John Baldwin, M.D., Dean of Dartmouth Medical School:

“The great majority of American people, around 85 percent, if you ask them, ‘Do you have a right to health care?’ they say yes. But that’s not true, it’s written down nowhere that you or I have the right to be cared for if we become sick.”

The crisis started eight years ago with the “businessification of medicine,” he said. When President Bill Clinton’s universal health care initiative failed and the Republication Congress of 1994 was elected, the HMO mechanism took hold.

“What we learned was that health care was not a business. It is an essential service like national defense. The Eisenhower highway system is not a business.”

Baldwin disagreed with representatives of the American Medical Association who supported flawed policies such as defined contribution, health marts, medical savings accounts, and increased consumer risk sharing:

“As marketers in medicine would say, ‘You buy what you can afford.’ What does that mean when you’re a kid with leukemia in a Hispanic neighborhood that has no insurance, and then compare that with a child from a wealthy neighborhood? Buy what you can afford.”

“The first step is to enact in legislation what most American people believe: They have a right to health care. Based on the massive amount of information, determine what ought to be done for people with evidence-based medicine. Then the economic step, how much would that cost?”

Baldwin admits his system would alter how so-called “medical business” functions. Regardless, the nation’s leaders should appropriate money based on a rational system in the context of universal access to health care, he said.

“There are some things that aren’t businesses and that’s OK. I haven’t heard anyone talk about privatizing the Marine Corps.”

http://dailynews.yahoo.com/h/sddt/20020125/lo/experts_debate_options_for_health_care_reform_1.html (For original article, cut and paste full address into your browser.)

January 18, 2002 Washington, DC

Marian Wright Edelman Founder and President of the Children’s Defense Fund

“And he (Martin Luther King) called then for a Poor People’s Campaign. And at that time, there were 11 million poor children, and he reminded us, that we have the resources, in this world’s rich nation, that we have the know-how, we have the experience. And that was the call to action. And here we are now, in the beginning of a new millennium and century, and an economy that has tripled in wealth and we have 12 million poor children.

“We’ve made a lot of progress. We’ve made a lot of incremental progress, and we’re in a little dip at the moment. But, we’re still the wealthiest nation in history and it is time to finish that call for a poor people’s campaign for an America, where everybody has enough, where every child has hope. We do have the know-how. We do have the experience. And don’t you let anybody on Capitol Hill tell you we don’t have the money.

“We don’t have a money problem; we have a morality problem. We have a political priority problem.

“I would not deny anybody, their first or second million or even billion. But, you know, there’s something out of balance when just four wealthy Americans, possess greater wealth than the GNP of the 34 least developed nations in the world, with over 650 million people. And the same Americans, possess more wealth than that of 14 million American families. Their wealth, four people, exceeds the revenues of 24 states, with 42 million citizens.

“You know, they didn’t need a tax cut last spring. They don’t need another tax cut, under the guise of economic stimulus. This money that has been given them, even small percentages of it, the individual tax rate, the estate tax, could lift every child out of poverty, could provide every child and human being in America health care.

“And they must hear our voice saying, ‘enough.’ That no more tax breaks take effect, for the wealthy, while there are homeless and uninsured children. I mean it is not–it’s un-American, to have people lined-up to get more out of greed when we have hunger and homeless children.

“So, that’s what the issue is for us before this Congress, and we should not be discouraged. We’ve got to get out there and tell those stories. We’ve got to get out there and say how much money. — Why should it be so hard to do what is right? When it saves money, saves lives, you know, holds families together. Why should it be so hard to raise children in this country?

“And so, I think this is a moment of enormous opportunity for us, and so, just do not lose heart. What’s going to happen in this country is going to depend far more on what we do, than on what people on the Hill do. We can make them find the same money they found for the tax break… for children… if we mobilize and organize.”

http://www.kaisernetwork.org/health_cast/uploaded_files/kff011802d.pdf

The American Prospect
Volume 13, Issue 3.
February 11, 2002
by Robert D. Putnam

“In the aftermath of September’s tragedy, a window of opportunity has opened for a sort of civic renewal that occurs only once or twice a century. And yet, though the crisis revealed and replenished the wells of solidarity in American communities, those wells so far remain untapped. At least, this is what that gap between attitudes and behavior suggests. Civic solidarity is what Albert Hirschman called a “moral resource”–distinctive in that, unlike a material resource, it increases with use and diminishes with disuse. Changes in attitude alone, no matter how promising, do not constitute civic renewal.”

“Americans today, our surveys suggest, are more open than ever to the idea that people of all backgrounds should be full members of our national community. Progressives should work to translate that national mood into concrete policy initiatives that bridge the ethnic and class cleavages in our increasingly multicultural society.”

http://www.prospect.org/print/V13/3/putnam-r.html

January 21, 2002
Dr. David Satcher

RAY SUAREZ: Well, you grew up in the deep South during the years that Dr. King was trying to change the country’s view of race relations. You were still a student when he was killed. How far are we from reaching some of the goals he articulated 40 years ago?

DR. DAVID SATCHER: Well, we’ve made a lot of progress since I was a child. I was 12 years old when the Montgomery bus boycott started, and I remember going into town and not being able to buy ice cream. You may say, “Well, that’s no big deal,” but what it did to you as a person to feel that you were shut out was very significant. But I think because of the work of Dr. King and many others, many of those barriers have been broken. But in medicine and in public health, we also have dreams. And those dreams relate to eliminating disparities in health and health care, making sure that everybody in this country has access to quality health care. That’s an extension of Dr. King’s dream, but it’s really critical for the future of this country.

RAY SUAREZ: Is it all about money at this point or is it something a little bit more challenging than simply being able to write a check?

DR. DAVID SATCHER: I think first and foremost, it’s about commitment. I really believe that as a nation, we need to make a commitment to universal access. The fact that one out of three Latinos in this country is uninsured, one in four African Americans are uninsured and the fact that so many people live in communities where they don’t have access to care, as a nation we ought to make a decision that we’re going to work to eliminate those barriers to care. And I’m convinced that we can do it if we make that commitment.

http://www.pbs.org/newshour/bb/health/jan-june02/satcher_1-21.html

Uwe Reinhardt responds to the David Satcher interview:

I found the following exchange from the same interview truly stunning:

RAY SUAREZ: So as you sift through your time as surgeon general, what would you identify as some of the high points of your term?

DR. DAVID SATCHER Well, clearly, you know, we did a major report on mental health, and I believe the response of the American people to that report and to the report on suicide prevention has really been amazing. It’s led to several follow-up reports and activities and, of course, we contributed to the world health report on mental health that came out recently.

Comment: Here the Surgeon General of the United States tells us that the high point of his career in that portfolio was a report on mental health that, basically, led to the issuance of yet other reports (aside from some unidentified “activities” probably too trivial to warrant explicit naming.)

Finally I understand what we mean by the dictum: “It’s the thought that counts.” If only low-income, uninsured people could grasp it. (But, then, perhaps they do grasp it, which may be why they don’t bother to scream en masse and in fury at the ballot box).

Best,

Uwe

(http://www.kaisernetwork.org/health_cast/uploaded_files/BushAdmn.pdf)

“Mr. Scully is the Administrator of the Centers for Medicare and Medicaid Services. And when one reads his remarks on the above cited website, he sounds like a caring and concerned man who truly wants to see the various problems plaguing U.S health care addressed properly.

“BUT, I wonder if Mr. Scully would be so glib about the length of time it may take to ‘fix’ the problems of the elderly, the poor, and the uninsured if he were one of them. With all due respect and honor and sensitivity to the tragic events of September 11th and the aftermath, it did not take us 10 years, or 25 years to get around to responding to the threat and the attack upon our soil and our citizens and residents. The will was there. Miraculously, so was the money.

“What Mr. Scully, and others in this Administration need to do is to simply be honest with the American public. Just admit that the people who have to suffer the consequences of no insurance, no access to care, or have to go without needed drugs because of lack of money to pay for them, these are people who are easily erased from our national consciousness. The above-cited remarks loudly imply that one can ignore these people, MANY OF THEM CHILDREN, with impunity; one can ignore them with little political consequence…after all, they don’t donate thousands of dollars to campaign coffers, they don’t have lobbyists fighting for their cause with money, favors, and patronization.

“But in actuality, we ignore them at great peril to our country and its future. In the process of dismissing the plight of 42 million uninsured, of stating that maybe we can try ‘knocking that down in 10 years’ – down to what, one may ask? – we are institutionalizing a morally outrageous type of dehumanization. Social and economic rights….the right to decent housing, to a basic education, the right to NOT be hungry, and yes, the right to basic health care…are not options … these are necessities for survival. The right to survival is the most basic right of every human being born on this earth. And in the wealthiest country in the world, with the most sophisticated medical technology, and the highest expenditures on health and medical care…this should not even be an issue, it should be a given.

“The number, 40-some million uninsured, is the one that has been getting the most attention recently … as well it should. But that is only part of the U.S. health care system-story. The number is even larger, as many as 55 million, when one counts those who lack health insurance for some part of the year. Another 50 million or so are said to be underinsured, many of them elderly people for whom Medicare only pays about half of medical expenses. All total, somewhere between 35% and 40% of the U.S. population has woefully inadequate or nonexistent financial access to health care. This constitutes a moral, ethical, political, economic, and social crisis for the country as a whole; and if it were ‘fixed overnight,’ that would not be soon enough!”

Barbara Rylko-Bauer, PhD basiarylko@juno.com

New e-mail address for Don McCanne:

don@mccanne.org

Use this address to be added to or removed from the “Quote of the Day” list, as well as for personal communications. Replying directly to a “Quote of the Day” message also will access this address.