PNHP

Oh, predictability, where art thou?: CMS’ Scully seeks stable Medicare funding in an unstable fiscal era

Oh, predictability, where art thou?: CMS’ Scully seeks stable Medicare funding in an unstable fiscal era

Modern Healthcare
November 5, 2001
Washington Report
by Jonathan Gardner

“To help lure investors to healthcare, the Bush administration wants to make providing Medicare services a stable and moderately profitable business. The trouble is, it’s Congress, not the administration, that turns Medicare’s financial spigot on and off.

“Thomas Scully, administrator of the Centers for Medicare and Medicaid Services, says the boom-bust cycle in Medicare payments scares Wall Street away from the healthcare sector.

“So now he’s proposing a different approach to give investors in the stock and bond markets more confidence in investing in healthcare providers and companies.”

Bill Reiland, a principal with Morgan Stanley Dean Witter who runs high-yield healthcare research:

“`He (Scully) probably has a good intention and has a good objective, and I’m sure healthcare providers around the country rise up and cheer when he says that. The important question is, in five years will the administration have the same objectives? You don’t know. You might not have the same administration.”

http://www.modernhealthcare.com/currentissue/topten.php3?refid=7998&db=mh99up&published=20011105

Comment: Let us pray.

Sorry. I had intended to avoid political comments, believing that we all need to work together. But when Thomas Scully is more worried about the health of the health plans than he is about the health of the people of this nation, it is political.

What's the Catch?

The Washington Post
November 6, 2001
by Melody Simmons

“Get ready. Those large packets beetling with details about health insurance re-enrollment will arrive soon, if they are not already on your nightstand nagging you for attention. And the bad news is, experts say that this year you really need to read them. Costs are going up and benefits are going down in nearly every plan, making this a lousy year to (go ahead, admit it) just put a check mark next to your current insurance plan and be done with it.”

http://www.washingtonpost.com/wp-dyn/articles/A32938-2001Nov2.html

Comment: The remainder of the article discusses innumerable permutations and combinations of choices that must be made during the “open season” of the health plans. The “empowered consumer” is clearly the prey during this open season since the options available are specifically designed to shift more costs to the beneficiary. Increased cost shifting reduces affordability and consequently reduces access to care, the exact opposite of what our health policy should be.

Our current national health policies are specifically designed to perpetuate and enhance the health of health plans while neglecting the health of the patients. Let’s place patients first by establishing one universal health plan that is specifically designed to assure access and affordability for everyone. The only loser would be the parasitic private health plans.

What’s the Catch?

The Washington Post
November 6, 2001
by Melody Simmons

“Get ready. Those large packets beetling with details about health insurance re-enrollment will arrive soon, if they are not already on your nightstand nagging you for attention. And the bad news is, experts say that this year you really need to read them. Costs are going up and benefits are going down in nearly every plan, making this a lousy year to (go ahead, admit it) just put a check mark next to your current insurance plan and be done with it.”

http://www.washingtonpost.com/wp-dyn/articles/A32938-2001Nov2.html

Comment: The remainder of the article discusses innumerable permutations and combinations of choices that must be made during the “open season” of the health plans. The “empowered consumer” is clearly the prey during this open season since the options available are specifically designed to shift more costs to the beneficiary. Increased cost shifting reduces affordability and consequently reduces access to care, the exact opposite of what our health policy should be.

Our current national health policies are specifically designed to perpetuate and enhance the health of health plans while neglecting the health of the patients. Let’s place patients first by establishing one universal health plan that is specifically designed to assure access and affordability for everyone. The only loser would be the parasitic private health plans.

Equity in Health Care

Few would disagree that equity, or fairness, should be a goal of our health care system. Most of us want to see fairness in the way that we allocate our health care resources and fairness in the way that we fund our system.

For the uninsured and underinsured, the benefits of an equitable system of universal health insurance are obvious. Access to affordable health care would be assured. For the purchasers of health care, including employers, the government, and more affluent individuals, the adoption of publicly administered, universal insurance would provide mechanisms for containing health care costs, a goal that has been elusive for market based health plans. And, very importantly, it would assure the return of free choice of providers of health care. But, because of our progressive tax system, those taxpayers that fund a larger portion of our national budget understandably are concerned about the impact on their contribution to an equitable system that shifts more costs to higher income individuals. So is equity in health care good or bad for the affluent, especially business owners?

Equity is to be clearly distinguished from the unrealistic and inequitable goal of equality in health care. Equal access to cosmetic surgery, to penthouse suites in ivory tower medical centers, or to detrimental high technology interventions would waste resources and introduce inequity by forcing some to pay for such excessive services that are utilized by others. That would be unfair.

Of the two aspects of equity in health care, funding of care and allocation of resources, let’s first look at equity in allocation. With our abundant health care resources, and with the excess capacity in our system, access to care should be available to everyone. But what care? Acute appendicitis, meningitis, a fractured hip, a heart attack, all require and would receive appropriate emergency services, regardless of how it is funded. Some preventive services, especially those with public health implications such as immunization programs, are, in general, readily accessible. On the other hand, management of chronic medical conditions, periodic screening for disorders with effective interventions, pharmaceuticals, and other beneficial services frequently are not accessible to those with limited funds or inadequate health care coverage, simply because of lack of affordability. In fact, this deficiency in our system is so great that, in spite of excess resources, of all industrialized nations we have the most inequitable mechanisms of allocating these resources.

What should be the basis of our decisions on allocation of our health care resources? Quite simply, services that prevent premature death and services that maintain or improve quality of life should be accessible to everyone in an equitable system. We currently have enough funds allocated to health care to assure equitable access to virtually all beneficial services for everyone. The inequities in allocation arise primarily from the financial barriers characteristic of our system, and usually not from barriers due to limited capacity.

The other issue of equity, funding of health care, is more complex than is commonly realized. What would be an equitable method of funding care? Fairness would dictate that each individual contributes his or her fair share, but that no person should suffer a financial hardship as a result of accessing the health care system. Since an equitable system would assure that the contribution of low-income individuals would be below the threshold of financial hardship, they would not be able to afford to contribute an equal amount as would higher income individuals. The result is that higher income individuals would be absorbing more costs than their sector would generate.

This concept of inequality in contributions to an equitable system has been a major stumbling block to enactment of health care reform. Inevitably, there is fear that a public funding system, whether through a tax or a premium, would “unfairly” burden higher income individuals, an irony since, in this instance, equity is falsely perceived as being unfair. The affluent sector has been successful in assuring that equitable systems are not adopted because of the distributive tax policies involved.

We currently have enough funds dedicated to our health care system, but is that funding equitable? Half of health care dollars already pass through the hands of the federal government, primarily collected as payroll taxes and general tax revenues. Payroll taxes are at a fixed percentage, creating a greater tax burden for low-income individuals who have little, if any, disposable income, and often do not have enough income to meet their most basic needs. Thus payroll taxes can be inequitable. Although general tax rates theoretically are set at levels that establish equity through their progressive bracketing, the perception of equity varies with the prevailing political element in control.

Health plan premiums tend to be inequitable. Those paying the premiums are paying costs that have been shifted to them from those that are not paying the full costs of the services they have received, even though they may be capable of doing so. Those paying premiums also are paying for expensive health plan bureaucracies that are not providing value for the health care dollars they consume. In addition, premiums “assigned” to lower income employees, whether nominally paid by the employer or the employee, constitute a significantly larger percentage of their net income than do the premiums paid on behalf of higher income employees, a gross inequity. Further, for employment-linked insurance plans, the tax system provides greater implicit discounts for higher income individuals than for those with lower incomes. This regressive tax policy is highly inequitable.

And then there is the hidden burden of funding health care through mechanisms that are often not considered when calculating the nation’s health care costs. As examples, we should consider the added costs of the medical component of homeowners’ policies, auto insurance, workers’ compensation insurance, and malpractice and other liability coverage. Contributions to medical charities are part of the funding, but the deductibility also shifts the tax burden to others. A much greater shift of the tax burden occurs with established tax policies such as the tax deductibility of employer provided insurance. Funding of community clinics also may increase local taxes. The products that we purchase include added health care related costs of the businesses involved. Several of these more obscure funding sources overlap, shifting costs to a degree that it is sometimes difficult to know who is paying what in health care. But they all perpetuate significant inequities in the overall funding of our health care system.

Thus, besides the inequity of our allocation of resources, the funding of health care in the United States is the least equitable of all other industrialized nations. Those relatively affluent individuals that are concerned about the inequality of an equitable system of funding care should look more closely at the much greater inequalities of the inequitable system that we now have. Unequal equity certainly is better than unequal inequity.

Without changing our health care delivery system, and without increasing the financial resources dedicated to health care, we can bring equity to the funding of health care, and we can bring equity to the allocation of those health care resources that provide value. Equity would be realized by the simple measure of adopting a publicly administered program of universal health insurance.

Don McCanne

Universal health insurance makes 'business sense'

November 2, 2001
By Robert F. Smith, Herald Correspondent

BELLOWS FALLS — Single-payer universal health coverage could save Vermonters more than $118 million a year over current medical insurance costs and cover every Vermonter in the process, according to a new report.

The study, paid for by a federal grant and prepared for the Office of Vermont Health Access by John Sheils and Randall Haught of the Lewin Group, was the center of discussion Thursday night during a Health Care for All forum. The forum was organized by Windham County Democratic Reps. Michael Obuchowski and Carolyn Partridge, and was held at the New Falls Cinema in Bellows Falls.

About 75 people attended, many of them local doctors, health-care practitioners, mental health counselors and politicians. Several spoke out in favor of the single-payer universal health coverage concept, and no one disputed its value.

The guest speaker was Dr. Deborah Richter, a family physician with the Cambridge, Vt., health center, who said the main problem with the U.S. health system is not that millions of citizens are uninsured or that it costs too much. The problem with the country’s health system is that it doesn’t really have a system, she said.

The U.S. has what she termed a “loose arrangement” that wastes billions of dollars in administrative costs created by the vast number of different health insurance companies offering various health plans and all requiring different types and amounts of paperwork.

“It’s cheaper to pay directly for the medical costs than to pay insurance premiums,” said Richter, who is a member of Physicians for a National Health Program. “Every other industrialized country realized this long ago.”

Several health professionals agreed that administrative costs had gotten out of hand. A woman who manages a clinic said that nearly every patient the clinic serves has a different kind of insurance coverage requiring its own special paperwork, and one mental health professional said she spends half of her working time filling out forms instead of treating patients.

Richter explained that 70 percent of health care costs are spent on just 10 percent of the population, while the majority of people, 80 percent, account for only 15 percent of health care costs. Healthcare administration, which involves mainly paperwork, overhead and bureaucracy expenses, is responsible for 24 percent of all healthcare costs she said. In the past 30 years there has been a 2500 percent increase in the number of healthcare administrators, while the number of healthcare practitioners – doctors and nurses – only increased by 159 percent during the same period.

The Lewin Report showed that under the current system, Vermont residents will spend $2.2 billion on health care in 2001. The report estimated that a single-payer program would provide coverage for everyone in the state — including the 51,000 estimated to be presently uninsured — and still save $118 million, mostly by reducing the administrative costs of health insurance programs.

Under a single-payer program health coverage would be paid for by a payroll or income tax. This arrangement would mean that taxpayers making less than $75,000 a year would see an average yearly decrease of more than $1,000 per family over current health insurance costs, while those earning $75,000 to $100,000 a year would see a nominal increase of about $58 over what they currently spend for insurance. Hardest hit would be families earning over $150,000 a year. Universal health coverage could cost them as much as $4,500 more per year.

Rockingham physician Dr. Matthew Peake asked Richter who in Vermont would oppose universal health care and such dramatic cuts in healthcare costs.

“Did you miss the parts about getting rid of insurance companies?” Richter replied. She said that universal health care administered by the state would eliminate the need for insurance companies, and these companies are very wealthy and influential.

“Every poll taken shows that two-thirds of the American people are in favor of this,” Richter said. “The problem is that insurance and pharmaceutical companies have more money than we do.” But Richter said that it is inevitable that universal insurance coverage will be adopted, and she said that she is confident Vermont will lead the way within the next five years.

And while there have been problems with the program in some countries, she said that Vermont and the nation could examine all the universal coverage programs now in use around the world and find out what has worked and what hasn’t.

The bottom line for Richter was that she felt single-payer universal coverage would allow her to concentrate on medicine and not on paperwork. “The good side of this is that I’d be able to focus on practicing medicine without having to worry if my patient could afford it,” she said.

Richter and several others at the forum agreed that the key to creating a national universal health care system was to educate the public on its benefits. “In general, this is a better deal for businesses,” she said, “and they know it. It’s common sense, and it makes business sense.”

For more information about universal healthcare, and especially how it affects Vermont, go to http://www.vthca.org.

Comment: Dr. Richter, a former president of Physicians for a National Health Program, is right on target when she is delivering her message to the business community. As with yesterday’s Quote of the Day message, if business owners recognized the significant benefits of universal health insurance for both them and for their employees, then we would have a crucial ally in our efforts to bring equity to health care in America.

Universal health insurance makes ‘business sense’

November 2, 2001
By Robert F. Smith, Herald Correspondent

BELLOWS FALLS — Single-payer universal health coverage could save Vermonters more than $118 million a year over current medical insurance costs and cover every Vermonter in the process, according to a new report.

The study, paid for by a federal grant and prepared for the Office of Vermont Health Access by John Sheils and Randall Haught of the Lewin Group, was the center of discussion Thursday night during a Health Care for All forum. The forum was organized by Windham County Democratic Reps. Michael Obuchowski and Carolyn Partridge, and was held at the New Falls Cinema in Bellows Falls.

About 75 people attended, many of them local doctors, health-care practitioners, mental health counselors and politicians. Several spoke out in favor of the single-payer universal health coverage concept, and no one disputed its value.

The guest speaker was Dr. Deborah Richter, a family physician with the Cambridge, Vt., health center, who said the main problem with the U.S. health system is not that millions of citizens are uninsured or that it costs too much. The problem with the country’s health system is that it doesn’t really have a system, she said.

The U.S. has what she termed a “loose arrangement” that wastes billions of dollars in administrative costs created by the vast number of different health insurance companies offering various health plans and all requiring different types and amounts of paperwork.

“It’s cheaper to pay directly for the medical costs than to pay insurance premiums,” said Richter, who is a member of Physicians for a National Health Program. “Every other industrialized country realized this long ago.”

Several health professionals agreed that administrative costs had gotten out of hand. A woman who manages a clinic said that nearly every patient the clinic serves has a different kind of insurance coverage requiring its own special paperwork, and one mental health professional said she spends half of her working time filling out forms instead of treating patients.

Richter explained that 70 percent of health care costs are spent on just 10 percent of the population, while the majority of people, 80 percent, account for only 15 percent of health care costs. Healthcare administration, which involves mainly paperwork, overhead and bureaucracy expenses, is responsible for 24 percent of all healthcare costs she said. In the past 30 years there has been a 2500 percent increase in the number of healthcare administrators, while the number of healthcare practitioners – doctors and nurses – only increased by 159 percent during the same period.

The Lewin Report showed that under the current system, Vermont residents will spend $2.2 billion on health care in 2001. The report estimated that a single-payer program would provide coverage for everyone in the state — including the 51,000 estimated to be presently uninsured — and still save $118 million, mostly by reducing the administrative costs of health insurance programs.

Under a single-payer program health coverage would be paid for by a payroll or income tax. This arrangement would mean that taxpayers making less than $75,000 a year would see an average yearly decrease of more than $1,000 per family over current health insurance costs, while those earning $75,000 to $100,000 a year would see a nominal increase of about $58 over what they currently spend for insurance. Hardest hit would be families earning over $150,000 a year. Universal health coverage could cost them as much as $4,500 more per year.

Rockingham physician Dr. Matthew Peake asked Richter who in Vermont would oppose universal health care and such dramatic cuts in healthcare costs.

“Did you miss the parts about getting rid of insurance companies?” Richter replied. She said that universal health care administered by the state would eliminate the need for insurance companies, and these companies are very wealthy and influential.

“Every poll taken shows that two-thirds of the American people are in favor of this,” Richter said. “The problem is that insurance and pharmaceutical companies have more money than we do.” But Richter said that it is inevitable that universal insurance coverage will be adopted, and she said that she is confident Vermont will lead the way within the next five years.

And while there have been problems with the program in some countries, she said that Vermont and the nation could examine all the universal coverage programs now in use around the world and find out what has worked and what hasn’t.

The bottom line for Richter was that she felt single-payer universal coverage would allow her to concentrate on medicine and not on paperwork. “The good side of this is that I’d be able to focus on practicing medicine without having to worry if my patient could afford it,” she said.

Richter and several others at the forum agreed that the key to creating a national universal health care system was to educate the public on its benefits. “In general, this is a better deal for businesses,” she said, “and they know it. It’s common sense, and it makes business sense.”

For more information about universal healthcare, and especially how it affects Vermont, go to http://www.vthca.org.

Comment: Dr. Richter, a former president of Physicians for a National Health Program, is right on target when she is delivering her message to the business community. As with yesterday’s Quote of the Day message, if business owners recognized the significant benefits of universal health insurance for both them and for their employees, then we would have a crucial ally in our efforts to bring equity to health care in America.

HEALTH CARE REFORM BREAKTHROUGH!

The San Diego Union-Tribune
Oct. 30, 2001
“Threats expose health care problems”

By Jamie Court, Executive Director of the Foundation for Taxpayer and Consumer Rights, Kay McVay, President of the California Nurses Association, and Steve Thompson, Vice-President of the California Medical Association

“Employers believed that HMO control over medicine would reduce costs. Instead, employers have been bedeviled by the twin vices of double digit premium increases and increasing gripes from employees about obstacles to medical care. Employers concerned about the welfare of their employees face a market that allows them diminishing options for coverage, all gravitating to the lowest common denominator, and ever-increasing costs with no end in sight.

“In a deepening recession, businesses have been forced either to shift more or all of the payment burdens to their employees, making their companies less competitive and their employees more vulnerable, or have health care costs eat up their profits. Those businesses that cannot afford coverage will have far more concern for their workers’ health in the post-Sept. 11 world than ever before.”

“The time has come for employers to join physicians, nurses, hospitals and patient advocates in creating a model for health care that does not pit the private health care system against the public health system, but brings them together in a more rational way.

“The needs of the nation today demand better public controls over private health care delivery and dollars, both of which have run amok in recent years. Such public oversight over private health care could better direct resources to those in need, be they uninsured, underinsured or innocent victims of a terrorist attack. The irony is that such genuine public management of care and cost would save money. Preventing illness is the most cost effective way to treat it, and today’s mismanaged system has failed miserably on this account as well.

“Our groups have reached out to corporations with an employer survey (http://www.businesshealthsurvey.org) that seeks businesses’ views on health care. If any good in health care is to come from the rubble of Sept. 11, it will only happen when employers, doctors, nurses, patients and hospitals come together to make it happen.”

For the full article: http://pqasb.pqarchiver.com/sandiego/index.html (enter title, Threats expose health care problems, into the search box)

Comment: To understand the significance of this breakthrough in the health care reform movement, you must visit the website listed above: http://www.businesshealthsurvey.org. This is a cooperative effort of the American Small Business Alliance, the California Nurses Association, the California Medical Association, and the Foundation for Taxpayer and Consumer Rights. These are mainstream organizations representing business, consumers, nurses and physicians.

Perhaps the most important item on the website is the fact sheet, “Why Businesses Should Care About Universal Health Care.” Business owners do care. The fact sheet provides them with a rational basis for reform that will assure the health security of their employees, while providing significant benefits for the employers themselves. This page should be downloaded and distributed widely to business interests. It is available at: http://www.businesshealthsurvey.org/factsheet1.html

This May Hurt

The Washington Post
October 30, 2001

“Some Doctors Are Spurning Managed Care, Giving More Time — and a Bigger Bill — to Their Patients” by Marc Borbely

“Dorothy Faul, a librarian retired from the National Gallery of Art, received a ‘Dear Patient’ letter from her doctor in August that troubled her. Internist Jane Chretien announced that as of Sept. 1, she and Audrey Corson, her partner in Bethesda Physicians, would no longer participate in any health insurance plans.”

“But for most of her patients, the change means having to pay in full, by cash, check or credit card, at the time of service. Then it’s up to them to seek whatever reimbursement they can from their insurance company, should they choose, by submitting the itemized bill they get from their physician. Because Faul is a Medicare patient, she’ll get a bit of a break: Her visit fees will be lower and her doctors are required to continue to file claims to Medicare for her; non-Medicare patients will be given the forms to file themselves.”

“Bryan Arling and David Patterson on M Street, and Beth Unger and her 10 partners on New Mexico Avenue also accept no managed care outside of Medicare.”

“Michael Newman, another internist at 2021 K St. NW, has also never had contracts with private managed care companies, though he emphasizes that he sees Medicare patients and will continue to do so.”

http://www.washingtonpost.com/wp-dyn/articles/A8111-2001Oct29.html

Comment: So physician outrage with managed care has prompted many of them to refuse to accept contracts with private managed care companies. They are even willing to penalize their own patients with higher out-of-pocket expenses since they reject fee limits imposed by insurers, and insurers, in turn, penalize patients for receiving care from out-of-plan physicians. But isn’t it ironic that these physicians, who reject fee controls and the other restrictions imposed by health plans, still accept Medicare?

What is there about Medicare that causes these renegade physicians to still accept the program? Many reasons can be given, but the fact remains that these physicians who are ardently opposed to private health plans still want to participate in our equitable, more efficient, publicly administered program of health care coverage that is universal for a given segment of our society. Obviously, they find some redeeming value in Medicare. If public insurance is good enough for the severest critics of our health care system, shouldn’t it be good enough for all of us?

Universal health insurance makes business sense

November 2, 2001
By ROBERT F. SMITH
Herald Correspondent

BELLOWS FALLS — Single-payer universal health coverage could save Vermonters more than $118 million a year over current medical insurance costs and cover every Vermonter in the process, according to a new report. The study, paid for by a federal grant and prepared for the Office of Vermont Health Access by John Shells and Random Haughty of the Lewis Group, was the center of discussion Thursday night during a Health Care for All forum. The forum was organized by Windham County Democratic Reps. Michael Obuchowski and Carolyn Partridge, and was held at the New Falls Cinema in Bellows Falls.

About 75 people attended, many of them local doctors, health-care practitioners, mental health counselors and politicians. Several spoke out in favor of the single-payer universal health coverage concept, and no one disputed its value. The guest speaker was Dr. Deborah Richter, a family physician with the Cambridge, Vt., health center., who said the main problem with the U.S. health system is not that millions of citizens are uninsured or that it costs too much. The problem with the country’s health system is that it doesn’t really have a system, she said.

The U.S. has what she termed a ‘loose arrangement’ that wastes billions of dollars in administrative costs created by the vast number of different health insurance companies offering various health plans and all requiring different types and amounts of paperwork.

“It’s cheaper to pay directly for the medical costs than to pay insurance premiums,” said Richter, who is a member of Physicians for a National Health Program. “Every other industrialized country realized this long ago.”

Several health professionals agreed that administrative costs had gotten out of hand. A woman who manages a clinic said that nearly every patient the clinic serves has a different kind of insurance coverage requiring its own special paperwork, and one mental health professional said she spends half of her working time filling out forms instead of treating patients.

Richter explained that 70 percent of health care costs are spent on just 10 percent of the population, while the majority of people, 80 percent, account for only 15 percent of health care costs. Healthcare administration, which involves mainly paperwork, overhead and bureaucracy expenses, is responsible for 24 percent of all healthcare costs she said. In the past 30 years there has been a 2500 percent increase in the number of healthcare administrators, while the number of healthcare practitioners – doctors and nurses – only increased by 159 percent during the same period. The Lewin Report showed that under the current system, Vermont residents will spend $2.2 billion on health care in 2001. The report estimated that a single-payer program would provide coverage for everyone in the state � including the 51,000 estimated to be presently uninsured � and still save $118 million, mostly by reducing the administrative costs of health insurance programs.

Under a single-payer program health coverage would be paid for by a payroll or income tax. This arrangement would mean that taxpayers making less than $75,000 a year would see an average yearly decrease of more than $1,000 per family over current health insurance costs, while those earning $75,000 to $100,000 a year would see a nominal increase of about $58 over what they currently spend for insurance. Hardest hit would be families earning over $150,000 a year. Universal health coverage could cost them as much as $4,500 more per year.

Rockingham physician Dr. Matthew Peake asked Richter who in Vermont would oppose universal health care and such dramatic cuts in healthcare costs.

“Did you miss the parts about getting rid of insurance companies?” Richter replied.

She said that universal health care administered by the state would eliminate the need for insurance companies, and these companies are very wealthy and influential.

“Every poll taken shows that two-thirds of the American people are in favor of this,” Richter said. “The problem is that insurance and pharmaceutical companies have more money than we do.”

But Richter said that it is inevitable that universal insurance coverage will be adopted, and she said that she is confident Vermont will lead the way within the next five years. And while there have been problems with the program in some countries, she said that Vermont and the nation could examine all the universal coverage programs now in use around the world and find out what has worked and what hasn’t.

The bottom line for Richter was that she felt single-payer universal coverage would allow her to concentrate on medicine and not on paperwork.

“The good side of this is that I’d be able to focus on practicing medicine without having to worry if my patient could afford it,” she said.

Richter and several others at the forum agreed that the key to creating a national universal health care system was to educate the public on its benefits.

“In general, this is a better deal for businesses,” she said, “and they know it. It’s common sense, and it makes business sense.”

For more information about universal healthcare, and especially how it affects Vermont, go to http://www.vthca.org.

Embattled Columnist Christy Quits Hollywood Reporter

Reuters

LOS ANGELES, Oct. 31 — “Veteran Hollywood Reporter columnist George Christy quit the showbiz trade paper today after probes into health benefits he received from the Screen Actors Guild brought his integrity into question and ignited a management upheaval at his paper.”

“Speculation centered on whether Christy, a sometime actor, was giving movie producers and others favorable mentions in his widely read column in return for being listed in film credits, thus qualifying for SAG benefits. Christy denied any wrongdoing.”

http://www.washingtonpost.com/wp-dyn/articles/A21268-2001Oct31.html

Comment: Surely this nation can devise less devious methods of accessing health care coverage. George Christy would still be sitting at his desk if we had a publicly administered program of universal health insurance.

Surgery Pharmaceutical Grant

In December, 2000, members of this list received a message from Olveen Carrasquillo, MD, MPH, Assistant Professor of Medicine and Public Health at Columbia University’s College of Physicians and Surgeons. The message requested support in expressing opposition to the acceptance by the Society of General Internal Medicine of a grant from the pharmaceutical firm, AstraZeneca, that challenged ethical boundaries. In this message, Dr. Carrasquillo expresses his gratitude for those that supported this successful effort.

Hi Don:

A few months ago you did us a big favor posting in your quote of the day our plea for help in opposing SGIM’s accepting money from Astra-Zeneca. Well it seems we have achieved a small victory. I do not know if it is appropriate to send this out in your site, but I am trying to thank all those who read the message and helped. The message is below. Thanks

Red Tape at Red Cross: Groups Now in a Tangle

An article referred to us by Dr. Reinhardt:

Don:

This article so clearly demonstrates the high social cost of pluralism relative to collective action. It is Le Vice Americain, as the French would put it.

I think your group may find this useful.

Best

Uwe

The New York Times
by David Barstow and Diana B. Henriques
October 28, 2001

Across metropolitan New York, bereaved spouses armed with spreadsheets, fax machines and stacks of application forms are pursuing what some call their new full- time jobs and what others resentfully refer to as a form of professional begging: asking charitable organizations for help.

Families that have lost loved ones in the World Trade Center attack say they have often been utterly overwhelmed by the multiplicity of charitable funds, aid organizations and government agencies. In dozens of interviews, widows and widowers described days spent bouncing from one bureaucracy to the next, struggling to navigate a maze of confusing rules, deadlines and requirements.

“We have to make five and six calls to each of these agencies to get someone who knows what they’re doing,” said Liz McLaughlin, 34, a mother of an infant son who lost her husband, Robert, a Cantor Fitzgerald trader.

Another woman, who did not want to be identified for fear of offending charity groups, said she had dealt with at least nine different United Way representatives who conducted three separate interviews involving the same basic set of questions.

“I was turned into a widow on Sept. 11 and a single mother, and now they’re turning me into a beggar,” she said.

Almost seven weeks after the attacks, there is no shortage of charity – at least $1.2 billion has been raised – and many people are working long hours trying to give it away.

In a former furniture store in Falls Church, Va., dozens of American Red Cross volunteers sit at desks decorated with tiny American flags, approving hundreds of relief checks to cover $4,500 mortgage checks, $500 car payments, funeral costs, school tuition, nannies, dental bills – often with no questions asked. Working 12- hour days, these volunteers have signed off on $35 million in relief checks for about 2,300 families. Tens of millions of dollars have been given to grass-roots agencies providing everything from grief counseling to small-business loans.

But what has not been provided is a simple, comprehensive way for families to apply for the full range of help. For families not blessed with legions of helpful friends and relatives, the experience of dealing with the hundreds of charitable agencies and funds can be maddening.

“I’m applying so many places and the paperwork is getting a little overwhelming,” said Jennifer Damaskinos, whose husband, Thomas, another Cantor Fitzgerald executive, was killed.

The Red Cross, the nation’s largest disaster relief organization, has been trying to distribute more than $530 million. But it has not yet had even the first contact with hundreds of families, and its ability to distribute aid promptly has also been undercut by internal turmoil and confusion.

Dr. Bernadine Healy, president of the Red Cross, clashed with New York officials over questions of coordination. On Friday, she announced that she would resign at year’s end, telling reporters that she had been forced out. In recent weeks, she had come under increasing criticism, in part because of her handling of charitable fund-raising.

Two weeks after the attack, the Red Cross seemed to offer the promise of sweeping, trouble-free relief. It announced a $100 million program to provide three months of living expenses to each victim’s family. Its officials confidently promised that checks would be mailed within 48 hours of a family’s filling out a simple one-page application.

In practice, though, many applications have been held up for several weeks or more, Red Cross officials concede. The delays have been caused by a variety of problems, which include the agency’s inability to verify quickly that applicants are in fact related to victims; disorganized records; ever-changing management directives; and the cyclical turnover among volunteers, with veterans often leaving unfinished files to untrained rookies.

What is more, the Red Cross has not even contacted scores of families because it has failed to coordinate its own efforts to identify victims with the work of other charities trying to do the same thing. Part of the problem, though, is the refusal of New York City officials to give the Red Cross access to the list of missing and dead, which city officials said is not complete.

In Falls Church, volunteers are not even certain which families on the Red Cross list of victims have been overlooked because their record- keeping systems – assembled from scratch under intense deadline pressure – are woefully incomplete. In hundreds of cases, all the Red Cross has to work with is a victim’s name, and the agency’s volunteers are not trained or equipped to track down relatives on such scant information.

“That’s one of our downfalls – we’re not real sophisticated in how to do those things,” said Nancy Smith, a senior Red Cross administrator.

But the obstacles encountered by the Red Cross only begin to hint at the range of difficulties plaguing the broader philanthropic response – a vast and largely decentralized effort involving a tangle of established and new charities, many of them straining to manage the unprecedented volume of generosity from individual and corporate donors.

Jane S. Sibley, a Red Cross disaster aid researcher, was recently asked to compile a guide to available charity programs for a Red Cross information line. After only a few days of work, she recalled, her guide was nearly three inches thick.

Veronica Juliano has made more telephone calls than she can count to get help for her sister, her sister’s best friend and her husband’s secretary, all of whom were widowed in the disaster. The response, she said, was “frustrating and humiliating.” Calls to several charities met only with confusion, misinformation or a referral to the Federal Emergency Management Agency, which did not provide any meaningful guidance, she said.

To keep track of all the relief groups, Mrs. McLaughlin, of Pelham, N.Y., has compiled an 18-page spreadsheet. She has three binders full of applications and forms.

“You have to chase it,” Mrs. McLaughlin said of the relief money. “That’s my full-time job.”

Many families, having read about the hundreds of millions being raised, and having watched benefit concerts and telethons, now have inflated expectations. On a recent morning, for example, Paula Zahn, the CNN anchorwoman, inadvertently implied that the Red Cross was doling out six-figure relief checks as she discussed the plight of a widow who lost her 31-year-old husband. “The Red Cross hooked up with her, and now she has some $200,000 that she desperately needs to take care of her family,” Ms. Zahn said.

For the next few days, volunteers answered calls in Falls Church from victims’ families who wanted to know how they, too, could collect their $200,000 checks.

One bright spot is the Family Assistance Center at Pier 94, on the Hudson River at 55th Street. Many victims’ relatives expressed amazement at the sensitive and efficient treatment they received from a wide range of agencies, including the Red Cross, represented at the center.

“Very impressive,” said Suzanne Gabriel, whose husband was an executive chef at the World Trade Center.

As many of the widows have, Mrs. Gabriel said she felt strange applying for help. “But the Red Cross people told me, `This is a gift from the American people. They want you to have it,’ ” she said. “I got a check in the mail about 10 days later.”

But for those who lack formal documentation – marriage licenses, pay stubs, birth certificates – the process is “essentially useless,” fumed Stanley Hamilton, who runs a street ministry called Hands of Hope in Wilkes-Barre, Pa., and who has been trying to guide victims through the bureaucracy.

The rewards and the burdens of the current system are apparent to Lauren S. Davitz, a human resources professional who went to Pier 94 with a Russian-born friend, a laborer who lost his wife in the disaster. “He was down there from 10 a.m. until 12 at night, and the paperwork was overwhelming, although people really reached out to do what they could,” she said. “But he walked out with the equivalent of $6,000.”

Eliot L. Spitzer, the attorney general of New York, has tried to use the example of Oklahoma City as a model of how relief could be coordinated. After the bombing there, a large committee of public and private relief agencies met each week to decide, victim by victim, how best to distribute benefits. The agencies shared access to a single database.

Mr. Spitzer has proposed creating a similar database for the Sept. 11 victims. Last Wednesday, the Red Cross agreed to take part, and other groups have since followed suit.

Mr. Spitzer also wants to let those seeking help register with this central database over the Internet, submitting applications that could list an entire menu of needs, from mental health counseling to scholarship money. “That way the charities could reach out to people as opposed to people having to reach out to all these charities,” said Mr. Spitzer’s spokesman, Scott Brown. But the database is still far from reality. Also unresolved is the question of who will operate it.

In the meantime, resentment is accumulating.

Last week, in Princeton, N.J., at a meeting of about 35 relatives of victims, there was an eruption of anger when local Red Cross representatives tried to address the support group. “Oh, they were yelled at,” Kathy Tedeschi, said a leader the group.

According to another participant, one family member called out, “When the hell are we going to get some money?”

The Red Cross representatives admitted that they were confused, but promised that they were “going to do their best,” said Bob Monetti, who attended as a representative of the Victims of Pan Am Flight 103.

“Then they got out of there.”

Copyright 2001 The New York Times Company

Comment: Just to remind you of Dr. Reinhardt’s introductory phrase, “the high social cost of pluralism relative to collective action,” a cost that is exceedingly familiar to those of us who have been working on behalf of health care equity.