PNHP

Immigrants Boost Economy’s Health But Lack Access To Health Care Half Of Non-Citizens Working Full-Time Lack Health Insurance

Immigrants Boost Economy’s Health But Lack Access To Health Care Half Of Non-Citizens Working Full-Time Lack Health Insurance

New York City — While immigrants are credited with helping to fuel the nation’s long economic expansion, they aren’t sharing in all the benefits, particularly health benefits.

Among full-time workers who are non-citizens, fully half (51%) lack health insurance, according to a study in today’s American Journal of Public Health. Over 1/3 (34.3%) of the 26.2 million immigrants (citizens and non-citizens) residing in the U.S. are uninsured — 9 million people — including one million children, compared with 14.2% of U.S. born residents who are uninsured.

“The crisis in the U.S. health system — with 44.3 million people uninsured — is affecting everyone. However, that 10% of our population that is foreign-born has been particularly hard hit ” says study co-author Dr. Olveen Carasquillo, an internist at Columbia University.

“Almost half (43%) of all immigrants who are not citizens are uninsured, ” noted Carasquillo. “They are much less likely to receive health benefits at work and are also less likely to receive safety-net government-sponsored insurance programs such as Medicaid and the Children’s Health Insurance Program.”

Major findings of the study include:

* Immigrants have low-rates of employer-sponsored health coverage. Half (51%) of all non-citizen immigrants who work full-time are uninsured – 3.34 million people.

* Immigrants make up a small percentage (less than 5%) of people with government-sponsored health insurance.
43.3% of non-citizen immigrant children are uninsured – one million children. In addition, under current federal laws if these children entered the country after 1996 they are not eligible for Medicaid or the Children’s Health Insurance Program (CHIP).

* Country of origin makes a big difference. Immigrants are more like to be insured if they are from countries like Russia or Cuba (hence eligible for citizenship) or Europe or Canada. Immigrants from Central America, Haiti, Vietnam, and Korea are most likely to lack coverage. In fact, over 50% of all immigrants from Mexico and Central America did not have health insurance.

* Immigrants who are not citizens (62.9% of all immigrants) and their children are more likely to be uninsured. 43.6% of non-citizen immigrants are uninsured, compared with 18.5% of immigrants who have become US citizens. (The study used data from the 1998 Current Population Survey conducted by the Census Bureau. The CPS does not ask respondents if they are legal immigrants).

“The billions of dollars that the federal government is spending to eliminate racial and ethnic disparities in health care will only succeed when every person in this country, including all immigrants, has equal access to our health care system,” said Dr. Elena Rios, President of the National Hispanic Medical Association.

“Expecting people to work productively when they have no access to care for themselves or their children is not just inhumane, it’s bad economics,” said Dr. Quentin Young, National Coordinator of PNHP. “We need a not-for-profit, national health system that covers all residents, regardless of age, immigration status, employment, race, and ethnicity.

Copies of “Health Insurance Coverage of Immigrants Living in the United States: Differences by Citizenship Status and Country of Origin,” O. Carasquillo, A. Carasquillo and Steven Shea, American Journal of Public Health, June, 2000 are available from PNHP at (312) 554-0382.

Insurers Are Major Investors in Big Tobacco Popular Mutual Funds Also Have Billions Invested in Tobacco

PHYSICIANS URGE INSURERS TO “KICK THE HABIT”

Despite calls to divest, insurers continue to be major shareholders in tobacco firms. Prudential has actually increased its stock holdings in tobacco nearly 400% — to $892 million — in the last 4 years, according to findings published in today’s Journal of the American Medical Association. “Insurance Firms’ and Mutual Funds’ Tobacco Habit,” by three researchers at Harvard, also finds that the popular mutual fund Fidelity has major stock holdings in tobacco, including over $6.6 billion of Philip Morris stock — 8% of the entire company.

“A health insurer that buys tobacco stocks cares more about profits than the health of its patients,” said lead author Dr. Wesley Boyd. “Teachers, physicians, and those who invest their savings in mutual funds are unwitting accomplices in causing 400,000 tobacco deaths a year.”

Insurers’ tobacco holdings include:

Cigna, the giant HMO firm, owns over $38 million in Philip Morris stocks and $4 million in Loews stocks.

MetLife’s stockholdings total $55 million in Philip Morris and almost $7 million in Loews.

Prudential Insurance owns $435 million of Philip Morris, nearly $320 million of Loews stock, and $137 million of RJ Reynolds.

Mutual funds’ tobacco holdings include:

Fidelity owns $6.6 billion of Philip Morris stock and $23 million of RJ Reynolds.
Vanguard owns stock in all 4 major tobacco companies, including over $1.1 billion in Philip Morris and over $100 million in Loews.

TIAA-CREF also owns stock in all 4 companies, holding $732 million worth of Philip Morris stock and over $37 million worth of Loews stock.

Sanford Bernstein stockholdings amounted to $912 million of Philip Morris and over $137.3 million of RJ Reynolds.
“It’s time to push insurers and mutual funds to kick their deadly habit,” said Dr. Quentin Young, National Coordinator of Physicians for a National Health Program. “Stronger physician and public protest and yes, government action against tobacco in the form of higher taxes and bans on marketing and exports, is needed.”

Medical Errors Higher at For-Profit than Not-for-Profit Hospitals, Harvard Study Finds

March, 2000

Journal of General Internal Medicine Editorial Cites Cuts in Nursing, Focus on Profits

According to a study and editorial released today, patients at for-profit hospitals are two to four times more likely than patients at not-for-profit hospitals to suffer adverse events such as complications following surgery or delays in diagnosing and treating an ailment.

“This study is another warning for those who would trust hospital care to the marketplace,” said Dr. Gordon Schiff, author of the editorial (“Fatal Distraction” JGIM, April, 2000).

Previous research has found death rates 25 percent higher at for-profit hospitals than at teaching hospitals and 6 to 7 percent higher than at non-profit, non-teaching hospitals. In addition, for-profit hospitals employ fewer nurses, charge higher prices (costing Medicare an additional $5.2 billion annually) and spend a higher percentage of their budgets on overhead.

A study published last year in the Journal of the American Medical Association also found that for-profit HMOs are lower quality than not-for-profit HMOs on 14 quality measures.

Dr. Schiff cited a remarkable study on blood donation by Dr. Richard Titmuss (“The Gift Relationship”), published three decades ago which found that for-profit blood centers were less efficient, more costly, and more dangerous to patients than voluntary, non-profit centers.

“Hospital managers and even medical staffs are preoccupied with survival in the marketplace,” said Dr. Schiff. “This preoccupation represents a “fatal distraction” from the real business of health care — caring for patients and improving quality.”

“We’re very concerned that non-profit hospitals will be forced to adopt the same cost- and quality-cutting measures of the for-profits,” continued Dr. Schiff. “It’s much easier to measure money than quality of care.”

Public non-teaching hospitals also had higher rates of adverse events than not-for-profit hospitals and teaching institutions, which the study suggests may be due to insufficient funding during the study period. The study examined 15,000 patients hospitalized in Utah and Colorado in 1992, and many small public Colorado hospitals experienced financial losses that year.

“The competitive free market described in textbooks doesn’t and can’t exist in health care,” says Dr. Claudia Fegan, an internist in Chicago and former medical director of Michael Reese hospital in Chicago. “Seriously ill patients can’t comparison shop or accurately judge quality. We need a not-for-profit national health system to increase access for the millions of uninsured, to strengthen our nation’s health care safety net, and to improve quality for all.”

Claim That HMO's Save Money Is Little More Than "Folklore," Health Affairs Study Finds

March, 2000 Lull in health inflation in mid-1990’s explained by other factors Washington, D.C. — While millions of Americans have been shunted into HMO’s over the past decade, there’s no evidence that managed care saves money, according to a study in today’s Health Affairs, the nation’s largest health policy journal. “HMO premiums are up nearly 20% in the past two years, but a lull in health inflation in the mid-1990’s is so often attributed to HMO’s as to have become ‘folklore,'” noted study author Kip Sullivan, who reviewed three decades of research for the study. “The claim that HMO’s are more ‘efficient’ than the fee-for-service (FFS) plans they replaced is typically based on one of two research errors,” said Sullivan. “Either the study didn’t take into account higher HMO administrative costs, and only looked at cuts in hospital or doctor care, or it didn’t take into account factors like cherry-picking healthier patients or cost-shifting to other payers as an explanation for lower premiums.” The study also notes that factors other than the spread of HMO’s explain the mid-1990’s lull in health inflation. These include the threat of price-controls and health reform in 1993, the well-documented insurance underwriting cycle (three years of high premiums followed by three years of low premiums), a low inflation rate in the rest of the economy, and HMO’s lowering premiums (short-term) to gain market share. “As managed care enrollment has soared so have administrative expenses,” said Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard. “The percentage of workers in the health system dealing with paperwork has increased from 18% to nearly 30%, belying the myth of HMO efficiency.” “The verdict is in on corporate control of health care. It has failed,” said Dr. Quentin Young, National Coordinator of Physicians for a National Health Program. “The US spends more on health care than any other country in the world yet leaves 45 million uninsured and ranks 37th in performance according to a recent study by the World Health Organization. It’s time for not-for-profit (single-payer) national health insurance.”

Less Than Half of Americans Have Health Insurance Paid for by Private Employers

September, 1999

New England Journal Study Finds Role of Private Employers Has Been Exaggerated: Government and Individuals Pay for Most Care

Cambridge, MA — While 61% of Americans get their health insurance on the job, private employers aren’t picking up that much of the tab, according to a study published in today’s New England Journal of Medicine. Excluding workers with insurance paid for by the government or by employees themselves, fewer than half of Americans (43%) have health insurance paid for by a private employer. Moreover, private employers pay for an even smaller share of total health spending, just over one-fifth (21.2%).
“On one hand, there’s a nearly universal misconception that private employers are paying for most Americans’ health care,” commented Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard and a co-founder of Physicians for a National Health Program. “On the other hand, it’s a well-kept secret how much health care taxes and individuals fund.”

The study found that 34% of Americans are covered by government-paid insurance, including 22 million government workers and 69 million persons with Medicare, Medicaid, Veteran’s Administration, or other government-paid insurance. In six states, more residents had government-funded insurance than had private employer-paid coverage (Alaska, D.C., Montana, New Mexico, Oklahoma, and Tennessee). Also, in only six states did more than half of the population receive coverage from a private employer (Connecticut, Illinois, Massachusetts, New Hampshire, Ohio, Wisconsin).

The percentage of residents with insurance paid for by a private employer ranged from a low of 25.6% in New Mexico to 53.8% in Wisconsin. The proportion of residents with government-paid insurance ranged from a high of 51.7% in Alaska to 28.0% in Iowa. The study analyzed data from the Census Bureau’s 1997 survey of about 50,000 households.

Seven percent of Americans buy their own insurance, including 9.1 million workers who get insurance through work but pay the entire premiums themselves. 16% of Americans are uninsured. Including insurance premiums and out-of-pocket costs for care, individuals fund over one-quarter of total health costs (26%) previous studies show. Government pays for nearly half, (47%).

“Private employers’ influence over health care is way out-of-proportion to how much coverage they pay for,” said Dr. Olveen Carrasquillo, one of the study’s authors and an internist at New York’s Columbia Presbyterian Hospital. “We need a more democratic health policy debate.”

“Most developed countries make health insurance a right, not a job benefit,” said Dr. David Himmelstein, a co-author of the study and Associate Professor of Medicine at Harvard. “We should too.”

New England Journal of Medicine Editorial Says Evidence Against For-Profit Hospitals Now Conclusive

August, 1999

For-Profit Hospitals Deliver Inferior Care at Inflated Prices and Cost Medicare an Extra $5.2 Billion Annually

An editorial and study in today’s New England Journal of Medicine (NEJM) concludes that for-profit hospitals are more expensive than not-for-profit facilities. For-profit hospitals cost Medicare an additional $732 per enrollee, or an extra $5.2 billion, in 1995 alone (“The Association Between For-Profit Hospital Ownership and Increased Medicare Spending,” NEJM, August 5, 1999). The editorial also notes that substantial prior research confirms that for-profit hospitals are 3 to 11 percent more expensive and spend more on overhead and administration while hiring fewer nurses, providing less charity care, and providing patients with fewer hospital days than not-for-profit facilities.

The editorial also concludes that for-profit hospitals are lower in quality than not for- profit facilities, based on a review of nearly two decades of peer-reviewed literature (“When Money is the Mission -The High Costs of Investor-Owned Care,” NEJM, August 5, 1999). For example, two recent studies have found death rates 6 to 7 percent lower at private non-profit hospitals and 25 percent lower at teaching hospitals than at for-profit facilities. Other studies have found more post-operative complications and preventable adverse events at
for-profit facilities.

The editorial is authored by Harvard Medical School Associate Professors Steffie Woolhandler, MD and David U. Himmelstein, MD, co-authors of a July 14 study in the Journal of the American Medical Association showing that investor-owned HMOs are lower-quality than not-for-profits on every single one of 14 quality measures (Quality of Care in Investor-owned vs. Not-for-Profit HMOs). Dr. Himmelstein and Woolhandler are also co-founders of Physicians for a National Health Program.

The study on hospitals, performed by Dartmouth Medical School researchers Elaine Silverman, MD, MPH, Elliott Fisher, MD, MPH, and Jonathan Skinner, PhD finds substantially higher Medicare costs and more rapid price increases in communities dominated by for-profit hospitals. The authors may be reached at (802) 295-9363 x5545 (ES), (603) 550-1822 (EF), and (603) 646-2535 (JS).

According to an editorial in today’s New England Journal of Medicine, for-profit hospitals provide lower quality care while charging higher prices than not-for profit facilities. The editorial, which accompanies a study on the impact of investor-ownership on Medicare costs, comes just three weeks after the publication of research showing that investor-owned HMOs scored lower on every single one of 14 quality measures and spent 48 percent more on overhead and profits than not-for-profit HMOs.

Like their cousins in the HMO industry , “investor-owned hospitals are profit maximizers, not cost minimizers. Strategies that bolster profitability, like Columbia HCA’ s glitzy advertising, can worsen efficiency. The competitive free market described in textbooks doesn’t and can’t exist in health care,” says Drs. Steffie Woolhander . “Seriously ill patients can’t comparison shop or accurately judge quality, especially when for-profit HMOs and hospitals try to mislead consumers.

Co-author Dr. David Himmelstein notes that “for-profit medicine turns doctors and nurses into tools of Wall Street and patients into commodities . . . Our society recognizes that some things are too intimate or corruptible to trust to the market. We prohibit selling children and buying juries. Investors should not profit from suffering. For-profit hospitals and HMOs should be banned.”

“The editorial and study conclusively demonstrate -if there was any doubt left — that marketplace medicine is a failed experiment,” says Dr. Quentin Young, National Coordinator, Physicians for a National Health Program and an internist in Chicago. “We have 45 million people without any insurance and 125,000 additional people losing their insurance every month. Every day there’s more bad news about how rotten our health system is -prices rising, quality falling, and, just this month, an additional 250,000 seniors being dumped from Medicare HMOs.”

“The so-called “Patient Bill of Rights” defeated last month was so threadbare it didn’t even include the right to health care” continues Dr. Young. “The good news is, there’s an obvious solution to this chaos, and one we must study hard a single payer not-for-profit national health program like they have in Canada (our much poorer neighbor to the north) or Scandinavia {where doctors still make house calls). The American people rate “insuring everyone” their top health care priority (CBS poll, July, 1999). In the 2000 Presidential elections, let’s ensure that at least one candidate will have the courage to insist that health care be a human right and refuse to accept any campaign funding from for-profit HMOs, hospitals, physicians’ groups, nursing homes and drug companies. If that candidate emerges, he or she will be our next President.”

Quality of Care Lower in For-Profit HMOs than in Non-Profits

July, 1999

Harvard Study in Journal of American Medical Association Finds Investor-owned HMOs Worse on All Quality Measures

A study published in today’s Journal of the American Medical Association (JAMA) finds that investor-owned HMOs scored worse than non-profit HMOs on all 14 quality indicators reported to the National Committee for Quality Assurance in 1997. The quality measures ranged from routine preventive care (e.g. childhood immunizations, pap smears, prenatal care, and mammography) to care for patients with serious illness (e.g. eye examinations to prevent blindness in diabetics, follow-up visits for patients released from psychiatric hospitals, and prescriptions of life-saving beta blocker drugs for patients surviving heart attacks).
Between 1985 and 1998 the proportion of HMO members enrolled in investor-owned plans increased from 26% to 62%. Until now little has been known about the quality of care in investor-owned plans. Previous research comparing HMOs with fee-for-service care has generally found similar outcomes for healthy enrollees, but sick patients have fared poorly in managed care. Most of this older research examined non-profit HMOs, whose quality is far higher than the newly dominant for-profit plans. Hence, the new research indicates that average HMO quality is lower than previously believed, and significantly worse than fee-for-service care.

Some of the biggest quality differences between investor-owned and non-profit plans were in the care of seriously ill patients. As compared to non-profit plans, investor-owned HMOs had a 27% lower rate of eye examinations for diabetics; a 16% lower rate of appropriate drug treatment for heart attack survivors; and a 9% lower rate of follow-up for patients released from mental hospitals. Childhood immunization rates were 12% lower, pap smear rates 9% lower and mammography rates 8% lower in investor-owned plans.

“Investor-owned HMOs pay more attention to their profits than to their patients,” said Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard and one of the authors of the study. “Mammography rates in investor-owned plans are 8% lower. If all American women were enrolled in for-profit HMOs instead of non-profits, 5,925 more would die from breast cancer.”

While the study found that costs in investor-owned and non-profit plans were similar ($128 per member, per month, vs. $127.50), investor-owned plans spent 48 percent more of their revenues on administrative costs and profits (19.4% of revenues vs. 13.1%). Hence, investor-owned HMOs spent significantly less for patient care.

“It’s a simple equation,” said study co-author Dr. Sidney Wolfe, Director of the Public Citizen Health Research Group. “The quest for profit endangers medical care. The more money that goes for profit, the less goes on health care.”

The study analyzed 1996 quality-of-care data from 248 investor-owned and 81 not-for-profit HMOs that provided coverage to 56% of all Americans enrolled in HMOs that year. The data were submitted in 1997 to the National Committee for Quality Assurance (NCQA) from the Health Plan Employer Data and Information Set (HEDIS) Version 3.0. Fewer data are likely to be available in the future. The number of plans refusing to allow release of their data grew from 41 in 1997 (the data analyzed for the JAMA study) to 155 in 1998. The NCQA reports that lower quality plans are most likely to refuse public release of their data.

“Our decade-old experiment with market medicine is a failure,” said study co-author Dr. Ida Hellander, Executive Director of Physicians for a National Health Program. “Investor-owned plans have worse quality than non-profits, and non-profits are increasingly forced to mimic the for-profits. It’s time to end our race to the bottom in health care and implement nationwide quality improvement and universal coverage through single-payer national health insurance.”

For-Profit HMOs Invading Latin America with Help From World Bank

Aetna, CIGNA Expanding South of the Border, New England Journal Study Finds

Some of the nation’s largest managed care companies have started looking south in search of greater profits, according to a study in this week’s New England Journal of Medicine. Unfortunately, say the authors, they’re bringing their problems with them — like “cherry picking” healthy patients, increased bureaucracy, and reduced access to health care for vulnerable patients.

In contrast to the United States, most Latin American countries have social security systems that include health care benefits. They also have free public hospitals and clinics, and, while spending far less on health care per capita than the U.S., have achieved important successes, such as improving infant mortality and life expectancy.

“Two factors are leading to the rise of managed care in Latin America,” according to Dr. Howard Waitzkin, co-author of The Exportation of Managed Care to Latin America and a Professor of Family and Community Medicine at the University of New Mexico.

“First, the World Bank is pressuring governments to turn health care — and their multi-billion-dollar social security pension funds — over to the private sector, regardless of the consequences. Secondly, there is growing economic inequality in the region. With an expanding upper-middle class eager for more services, but governments forced to cut back on public spending as a condition of new loans by the International Monetary Fund, managed care executives are seeing dollar signs.”

The study focuses on the growth of managed care in four countries: Chile, Argentina, Brazil, and Ecuador. In Chile, for-profit HMOs started under Pinochet’s dictatorship are now partially owned by Aetna. CIGNA is also involved in managed care in Chile, as well as Brazil, Argentina, and Ecuador.

HMOs in the region seem to be emulating the “bad” side of managed care over the “good” aspects, the article finds. By and large, the Latin American ventures are for-profit, physicians receive financial incentives to reduce services, and there is little emphasis on preventive health care. HMO co-payments and bureaucratic confusion have created barriers to care, increasing the strain on public hospitals and clinics. Administrative and promotional costs are rising, diverting funds from clinical services.

Chile has the longest history of for-profit, publicly-subsidized managed care in the region – and some big problems. Every year, about 24 percent of the patients in Chile’s HMOs receive services in public clinics and hospitals because they cannot afford their HMO’s co-payments.

“Like tobacco companies exporting cigarettes, the HMOs are rushing into Latin America now that their rate of profit is falling in the U.S.,” said Dr. Waitzkin. “In the process, there’s a real fear that Latin Americans will lose their constitutional right to health care.”

Majority (57%) of Academic Medicine Physicians Favor Single-Payer

March, 1999

Study in New England Journal of Medicine Finds Medical School Deans, Faculty, Residents and Students Favor Single-Payer 3 to 1 Over Managed Care

Managed care is bad for your health, according to the first comprehensive survey of physicians involved in research and teaching published in this week’s New England Journal of Medicine. But the nation’s best and brightest physicians don’t want to return to the old fee-for-service system, either.

So what does this prestigious group think would make a good health system? According to the study, “all groups [Deans, department chairs, residency training directors, physician faculty at medical schools, resident physicians, and medical students] expressed a preference for a single-payer health care system over both managed-care and fee-for-service systems. Overall, 57.1 percent thought that a single-payer system with universal coverage was the best health care system…. A total of 21.7 percent favored managed care, and 18.7 percent preferred a fee-for-service system.”

“I’m not surprised at all by these findings,” said Dr. Douglas Robins, Chair of the D.C. chapter of Physicians for a National Health Program. “A survey of all physicians members of the D.C. medical society found that 69 percent support single payer. The academic medicine physicians are just the tip of the iceberg.”

In an accompanying editorial in the Journal, Dr. Robert Michels strongly disagreed with the view that the purpose of medical education should be to “prepare students to fit into the new world of health care, to work in it effectively and presumably happily.” Dr. Michels noted that “the unhappiness of academic physicians…reflects the recognition that managed care threatens medicine’s core values,” and that “medical education is working well…by underlining the urgent need to change managed care [emphasis added].” He also noted that physicians support single payer national health insurance even though physicians know that “a single-payer system would be unlikely to increase the financial rewards of medical practice.”

“We know physicians support single-payer national health insurance because of the increasing numbers of medical associations and prominent physicians that are endorsing it,” said Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard.

They include: The D.C. branch of the American Medical Association (AMA), the American Medical Women’s Association (AMWA), the National Medical Association (NMA), the Gay and Lesbian Medical Association (GLMA), the American Medical Student Association (AMSA), the American Public Health Association (APHA), the Islamic Medical Association (IMA), the American Association of Community Psychiatrists (AACP), the American Family Therapy Association, and others. The Maryland and Massachusetts branches of the AMA are studying single payer, and the American College of Surgeons’ Dr. David Murray testified before Congress in 1994 that single payer would “probably provide the best assurance that patients would be able to seek care from any doctor of their choice.”

Dr. Christine Cassel, the first woman president of the American College of Physicians, the nation’s second-largest medical association, is a strong advocate of single payer and a founding member of Physicians for a National Health Program.

Voucher Proposal Wrong Prescription for Medicare

Study Blasts Medicare Commission’s Pro-HMO Recommendations Calls for Universal System to Include Young and Old

San Francisco — Seniors, beware. That’s the conclusion of an advance study of the National Medicare Commission’s recommendations due out next month. The Commission is expected to propose raising the eligibility age for seniors to 67 and replacing the existing program with a voucher program.

“This is absolutely the wrong prescription for Medicare,” said the study’s lead author, Dr. Thomas Bodenheimer, a Professor of Family Medicine at UC San Francisco and a founder of the California Physicians Alliance (CaPA). “Giving seniors coupons to try to buy private insurance is a prescription for massive confusion, fraud and abuse. Just a few months ago over 400,000 seniors were dumped from private insurers. This is a proposal to funnel billions of taxpayer dollars into the coffers of HMOs, not protect health care for seniors.”

The voucher proposal, or “premium support” plan as it is referred to by the commission, would increase out-of-pocket costs for the elderly, who already spend more than 20% of their incomes on health care, according to the study. The explanation is that the value of the vouchers falls over time, as health care costs rise faster than the value of the coupons.

“Vouchers don’t control costs, they shift them to sick people,” noted senior health economist Dr. Edie Rasell, who is also a family practitioner.

Among the study’s other findings:

HMOs have raised, not lowered, Medicare’s costs as HMOs selectively recruit healthier seniors who have lower medical expenses. HMOs also have much higher administrative costs, CEO salaries, etc.

In 1998, Medicare’s costs increased 1.5%, a rate lower than private insurance, and Medicare costs are expected to rise more slowly than private insurance through 2007.

There are quality problems with HMOs for the chronically ill and poor

Seniors’ health is more likely to decline in an HMO than in traditional Medicare
HMOs limit seniors’ choice of physician and hospital

Raising the eligibility age to 67 would create more than 1,750,000 newly uninsured

“The only way to genuinely control costs is to do the same thing other industrialized countries do (e.g. Sweden and Denmark) — put young and old together into a universal health program with a global budget,” said Rasell, an economist with the Economic Policy Institute. “Their populations are aging faster than ours and yet they have controlled their overall health spending, while ours continues to skyrocket.”

Rasell also noted that Medicare should cover prescription drugs. “Medication costs are a major burden for seniors. 79% of seniors have incomes under $25,000 a year and can’t afford expensive medications. Medicare could get them at a big discount.”

Raising the eligibility age for Medicare to 67 is a “cruel trick,” according to Dr. Olveen Carrasquillo, an internist and health services researcher at New York’s Columbia Presbyterian. “It would add millions to the ranks of the uninsured at a time in people’s lives when they are starting to face age-related illnesses and unemployment. In the long run, it would just add to health costs as people try to put off pressing health needs until they are insured.” Carrasquillo is the author of “Going Bare,” a recent study of the growing epidemic of uninsurance that appeared in the January issue of the American Journal of Public Health.

“Our number one goal in any Medicare reform must be to improve the quality of health care for seniors,” said Dr. Christine Cassel, Chair of the Department of Geriatrics at Mt. Sinai Medicial Center in New York. “It turns out that the best way to improve quality for seniors is also the best way to improve quality for the 45 million Americans who are uninsured and the over 200 million Americans who are underinsured –by creating a genuine national health system with coverage for long-term care.”

“This study will be, I hope, the nail in the coffin of pushing seniors into HMOs in the guise of “saving Medicare,” said Dr. Quentin Young, Past President of the American Public Health Association and National Coordinator of Physicians for a National Health Program. The best solution to the Medicare crisis is a not-for-profit, single payer national health program for all Americans.”

Copies of “Rebuilding Medicare for the 21st Century: A Challenge for the Medicare Commission and the Congress” (February, 1999, 36 pages with references) are available from the California Physicians Alliance at (510) 832-7134 or Health Access/The National Campaign to Protect, Improve, and Expand Medicare at (415) 395-7959.

Click here for an online version of the report.

U.S. Doctors to Seek Asylum in Canada

November, 1998

WHAT: Physicians march and rally to seek “health care asylum” at Canadian Embassy in Washington, D.C. Sponsored by Physicians for a National Health Program (PNHP).

WHEN: Tuesday, November 17, 1998

TIME: 12:00 p.m.- 1:30 p.m.

WHERE: March from Washington Convention Center (9th and H Streets) to Canadian Embassy, 501 Pennsylvania Avenue. Rally at Canadian Embassy.

WHO: Over 500 physicians, nurses, and public health experts attending the 126th annual meeting of the American Public Health Association (APHA), other health care professionals, local residents and patients.

DETAILS: Over 43 million Americans are uninsured, and 200 million more are inadequately insured, at a time when the United States spends more per capita for health care than any other nation. Health care professionals and the public alike are disenchanted with profit-driven health care. It is clear that despite the rhetoric and multi-million dollar advertising campaigns, market “solutions” in health care do not work.

All other industrialized countries, including Canada, have some kind of national health program. Creating a universal, national health care program in the United States is long overdue. Rally organizers call upon Americans to intensify their pursuit of a single-payer system similar to Canada’s. They also support Canadians in protecting their exemplary system from the threats and assaults posed by U.S. market-based health policy.

Among the speakers will be Dr. H. Jack Geiger, 1998 recipient of APHA’s Sedgwick Medal and co-recipient of the 1985 Nobel Peace Prize; Dr. Robert LeBow, PNHP president, and Dr. Quentin Young, APHA president.

Physicians for a National Health Program, organized in 1987, is a national network of over 8,000 physicians organized to work for a single payer health care system in the United States.

Number of Americans Without Health Insurance Jumps to 43.2 Million

September, 1998

Despite Booming Economy, Number Uninsured Rises 1.5 Million

Cambridge, MA — The number of Americans without health insurance climbed to 43.2 million last year, nearly one in every six persons. The number of uninsured was up 1.5 million from 41.7 million in 1996, equivalent to 125,000 people losing coverage every month, according to an analysis of raw data posted on the internet by the Census Bureau yesterday.

The 1998 Current Population Survey (CPS) data was analyzed by researchers at Harvard Medical School and Columbia University College of Physicians and Surgeons last night, and reported by Physicians for a National Health Program today.

“Sixteen percent of Americans are without insurance, a higher proportion than at any time since the passage of Medicare of Medicaid,” according to Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard and a co-founder of Physicians for a National Health Program. “What’s startling is the magnitude of the increase when the economy was booming.”

California experienced the largest jump in uninsured, up 575,000 to 7.1 million people without coverage. Other states with large increases in the number of uninsured include Michigan (up 276,000 to 1.1 million), Illinois (up 169,000 to 1.5 million), Alabama (up 108,000 to 660,000), Florida (up 96,000 to 2.8 million), Maryland (up 96,000 to 680,000), and Pennsylvania (up 76,000 to 1.2 million).

In six states, more than one out of every five persons is uninsured: Texas (24.5%), Arkansas (24.4%), Arizona (23.8%), California (21.5%), New Mexico (20.2%), and Mississippi (20.1%). The number of states with less than 10% of the population uninsured dwindled from eight in 1996 to just five in 1997. Hawaii (7.5%) and Wisconsin (7.9%) had the lowest percentages of uninsured in 1997.

“We see the terrible consequences of patients lacking insurance in my clinic every day,” said Dr. Bob LeBow, Medical Director of the Terry Reilly Health Center in Nampa Idaho and President of Physicians for a National Health Program.

“Hispanic Americans had the highest rates of uninsurance,” noted Dr. Olveen Carrasquillo of Columbia University. “Millions of middle and upper income families also were uninsured.”

Nearly 11 million people in families with incomes between $30,000 and $60,000 were uninsured in 1997, as well as 5.8 million in families with incomes over $60,000. The uninsurance rate for Hispanics climbed from 33.6% to 34.2%.

Uninsurance rates increased both for men (from 17.1% to 17.5%) and for women (from 14.2% to 14.7%). While the number of uninsured children was stable at 10.6 million, there were increases for young and middle-aged adults; 23.8% of people 18-39 were uninsured in 1997 (up from 22.7% in 1996), as were 14.6% of those between 40 and 65 (up from 14.4%).

Medicaid enrollment fell by approximately 1.8 million, apparently as a result of welfare cutbacks. Meanwhile, despite rising employment, the proportion of Americans with private coverage actually fell slightly from 70.2% to 70.0%. Medicare coverage rose slightly.

“These may be the best of times for the economy, but they are the worst of times for health care,” noted Dr. David Himmelstein of Harvard. “Uninsurance is rising, even people with coverage often can’t get the care they need, and costs will double in the next decade. It’s time to reopen debate over national health insurance.”