By Antonia Maioni
The Globe and Mail (Toronto), Oct. 3, 2013 Despite the partisan war in Washington that shut down the federal government this week, President Barack Obama has succeeded in implementing the first major health reform in the United States in nearly 50 years, as the Patient Protection and Affordable Care Act goes into effect. Even though its most virulent critics raise the spectre of “Canadian-style” health care, “Obamacare” does little to change the enduring differences between the two health care system. What, exactly, does “Obamacare” look like compared to Canada? Not single-payer: Canadian critics tend to rail against “two-tiered” medicine, but in fact, the U.S. has a multi-tiered system. And despite the hype on both sides of the Congressional aisles, Obamacare keeps the same complex structure in place, while adding another layer through the introduction of health care “exchanges” for uninsured Americans. But the majority of Americans will continue to access care through a variety of health insurance plans made available or subsidized by their employer; nearly 50 million elderly and disabled through the federal Medicare program; another 60 million lowest-income through state-federal Medicaid arrangements. Not universal coverage: Health care in Canada is based on a simple proposition: every legal resident is covered through a publicly-financed provincial or territorial plan. The individual mandate, derived from a Republican precedent in Massachusetts, stands in stark contrast to Canada’s universality principle. Even though Obamacare broadens coverage, the individual mandate relies on a fundamental insurance principle – care depends on type of coverage – and compels Americans to purchase insurance to access care. Americans now have more affordable insurance options and subsidies to cover their costs, and the lowest-income may be eligible for public coverage through the expansion of Medicaid. Still, despite the crush of online traffic as enrolment began Tuesday, only half of the estimated 40-plus million uninsured will be affected by Obamacare. Not “national” health insurance: One of the hallmarks of health care in Canada is that, although each province and territory administers a health plan, everyone can expect to be covered for a comprehensive range of services, no matter where they live. And the federal government is expected to chip in to provincial coffers to make this happen. There’s plenty of intergovernmental friction as a result, but nothing like the fractured federalism of the United States. The implementation of Obamacare will further exacerbate regional and state differences, mainly as a result of the Supreme Court decision to curtail the federal government’s obligation for states to expand their Medicaid coverage. As a result, only about half of the states have chosen to sign on to the new Medicaid program. Not equal access: There’s been some controversy in Canada lately over wait times and access to timely care, but this pales in comparison to the wide gulf that exists in access to care in the United States. Obamacare tries to address this in its provisions for insurance reform, such as lifting pre-existing conditions and limits on co-payment. But for all of the emphasis on affordable care, the new law reinforces the notion that access depends on how much you can afford, not how much you need. In the health insurance exchanges, the price of premiums will depend on your age, health, income, and on whether you opt for a bronze, silver, gold or platinum coverage. In Canada, access to necessary health care services is not a competitive sport. Not cost containment: The sharpest critics of Obamacare argue it does little to address the fundamental challenge of cost control. The new law includes a review of Medicare reimbursement and the expansion of Accountable Care Organizations to reward cost-effective care. But it doesn’t grapple in a systematic fashion with the overall inefficiencies in health care delivery and financing, the administrative burden of multiple payers, providers and plans, and the cost pressures of defensive medicine. Governments in Canada know that health care is a searing financial responsibility, but they have at their disposal cost containment measures – monopoly fee negotiations with providers, global budgets for hospitals – that remain unfathomable in the American context. Obamacare is a huge step in American health reform and, if it seen to improve the system, will represent a major victory for Democrats. Like other major reforms of the past, however, it will entrench the private nature of the system, and likely render national health insurance, or anything remotely like “Canadian-style” health care, impossible to attain. Antonia Maioni is an associate professor at McGill University. http://www.theglobeandmail.com/commentary/obamacare-vs-canada-five-key-differences/article14657740/

]]>

By Phil Kadner
Southtown Star (Chicago), Oct. 17, 2013 The Republicans are right. The Affordable Care Act, aka Obamacare, is a mess. The Democrats are right. The nation desperately needed health care reform, and millions of Americans had no insurance. Obamacare became what it is today because of both political parties and pressure from the health insurance industry, the pharmaceutical manufacturers and the public. Reasonable people should have been able to hammer out a workable compromise. But these are not reasonable times. People are for things or against them. And even the “winners” sometimes feel like “losers.” Dr. Quentin Young falls into one of those groups, maybe both. Young, 90, is the chairman and co-founder of the Health and Policy Research Group and has been battling for a single-payer, universal health care system for more than 30 years. “It’s what every other modern industrialized country in the world has,” Young told me during a telephone conversation on Wednesday. “Health care is a human right, and I don’t understand why people in this country still refuse to accept that. In every other nation, that’s how they look at it.” Chairman of medicine at Cook County Hospital from 1972 to 1981, Young was president of the American Public Health Association in 1988 and knew President Barack Obama before he became a U.S. senator. “Back then, he favored single-payer health care,” Young said. “I don’t know what happened, but something changed his mind. By the time he was president he no longer was an advocate of single-payer health insurance, and that was a mistake. “There are 16 million to 20 million poor people in this country who will not be covered by the Affordable Care Act. You can go broke or die without health insurance. “Sixty-two percent of people who file for personal bankruptcy in this country go bankrupt not because they can’t manage their money, but because of an illness in their family.” Controlling medical costs is a key to providing national health care, as far as Young is concerned, and the Affordable Care Act isn’t going to do that. “From 1950 until now, the cost of health care in this country increased from $22 billion to $2.7 trillion,” he said. “You can’t sustain that. Every other (advanced) nation controls its health care costs through single-payer health insurance, their governments, but we don’t so we’re paying more and we’re getting less.” According to the World Health Organization, the United States spent more on health care per capita ($8,608) and more on health care as a percentage of gross domestic product (17.9 percent) than any other nation in 2011. That was before Obamacare. “And one of the reasons we spend more is that billions of dollars are made by private health insurance companies. That does nothing to improve the health of the average American,” Young said. “It’s just profit for the companies that provide health insurance. “But this thing (Obamacare) won’t change that. The private insurance companies are still going to make their profits.” Young is quick to point out that he doesn’t want to be associated with the Tea Party Republicans who have been denouncing Obamacare. “At least under this plan, millions of Americans who had no insurance will get insurance, people with pre-existing conditions can now buy insurance and children are covered longer under their parents’ policies,” Young said. “It’s better than what we had. But I’m not sure, long term, that it’s going to work because it doesn’t control the cost of health care.” That view of Obamacare’s financial picture is similar to one expressed to me this week by U.S. Rep. Dan Lipinski (D-3rd). Lipinski said that unless major changes are made to the Affordable Care Act, he fears it will not be financially sustainable. And that’s one of the core arguments of the Tea Party Republicans, who contend that Obamacare will be the economic ruin of the country. Of course, those Tea Partiers have never favored universal health care and have never talked seriously about controlling health care costs. While they blame Obamacare for employers dropping their medical insurance plans, the Tea Party faithful ignore the fact that more than 1 million working Americans had been losing their health insurance each year before Obamacare was passed. In 2012, before the U.S. Supreme Curt ruling on health care reform, 9 percent of employers planned to drop their health insurance benefit, according to a report by consulting firm Deloitte. Among those who were not dropping the coverage, most said they planned to make workers pick up more of the costs through higher premiums, co-pays and deductibles. Yet, the majority of Americans, fearful of socialized medicine, isn’t prepared to back single-payer national health care. “The insurance industry spent millions of dollars scaring the hell out of them,” Young said. There’s some truth to that, but I think most Americans are happy with their current health coverage. But they know that employers could stop offering health insurance, or they could lose their jobs and their insurance, and they wanted to hedge their bets. Obamacare sounded good, even if they didn’t understand the details, but now many have come to believe the details are a mess. Lipinski said his fellow Democrats in Congress are finally coming to the realization that the Affordable Care Act is seriously flawed and needs to be changed. But Republicans seem just as convinced that the law is fatally flawed and needs to be overturned. “I believe there are some areas of agreement between us that we can work on now,” Lipinski told me. I’m not as hopeful. All the forces that shaped this deformed law are still at work. Too few Americans understand them. Of this I’m sure, the battle over health care reform isn’t going away. pkadner@southtownstar.com http://southtownstar.suntimes.com/news/kadner/23202889-452/kadner-even-reformers-dont-like-obamacare.html

]]>

By Dr. Philip Caper
Bangor (Maine) Daily News, Oct. 17, 2013

The lead story in the Oct. 13 New York Times details the ongoing problems of the Affordable Care Act’s websites intended to facilitate access by individuals to the law’s hallmark online health insurance marketplaces. Those problems continue. To summarize, many of the state-run and all of the 36 federally run websites are currently experiencing significant problems providing access to the exchanges, and nobody seems willing or able to predict when they will be fixed. This failure to launch President Barack Obama’s signature domestic achievement is hugely embarrassing for the administration, and will undoubtedly provide a great deal of fodder for late-night comedians. It will also provide an almost unlimited source of talking points for tea partiers and other government-haters, who will cite this unfolding fiasco as more evidence that “government can’t get anything right.” That would be incorrect. In 1965 and the years following, I witnessed the implementation of Medicare, which enrolled 19 million beneficiaries almost seamlessly in less than a year, despite the formidable opposition of Southern hospitals wary of its requirements that they desegregate their wards. As I wrote last month, the problem with the ACA is not that the federal government is involved, but that literally thousands of private insurers have their fingers in the cookie jar, resulting in a law that is much too complicated for what it needs to accomplish, and too complex for anybody to administer efficiently and effectively. Together, Medicare and Social Security — both run by the federal government — have been successfully providing access to private health care and income security for millions of seniors and the disabled for almost 50 years. They have been a major factor in keeping seniors in our country out of poverty. Both programs are overwhelmingly popular with doctors, patients, the general public and most politicians. Medicare is also much more successful than private, for-profit insurance in holding down the prices paid for medical services and products and overhead costs — 6 percent compared with 20 percent or more. But Medicare is still not doing nearly enough to control costs. It is estimated that there is at least $750 billion worth of waste in the U.S. health care system. Politics is the only credible reason for retaining the complex and confusing web of private insurance plans in a health care system that aspires to cover everybody. In order to gain congressional approval, the ACA had to first accommodate the interests of the corporate medical-industrial complex, putting the interests of the American people in a distant second place. Congress’ approval rating now hovers around five percent. We can do better. It took over 50 years from the time President Theodore Roosevelt first proposed national health insurance until Medicare and Medicaid were enacted. It took almost another 50 years for the ACA to be enacted, expanding insurance coverage and enacting some protections against some of the insurance industry’s predatory practices. We have had to endure almost 100 years of acrimonious political debate, name-calling, disinformation and outright lies — much of it designed to protect and defend some doctors’ incomes and corporate health care companies’ windfall profits — to even approach what all other wealthy countries take for granted: health care as a human right. We need expanded and improved Medicare-for-All. And we need to vote any politician who won’t advance us toward that goal out of office. We’re moving in the right direction. But we can’t afford to take another 100 years to get there. Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com. http://bangordailynews.com/2013/10/17/health/acas-bungled-rollout-aside-government-health-insurance-works/

]]>

By Elizabeth R. Rosenthal, M.D.
The New York Times, Letters, Oct. 15, 2013 Re “The Soaring Cost of a Simple Breath” (“Paying Till It Hurts” series, front page, Oct. 13): Your excellent article about the soaring costs of prescription drugs reveals how successful Big Pharma has been in protecting its bottom line even if it leaves millions gasping for breath because they cannot afford their asthma medicine. Through its tremendous lobbying power, this consistently profitable industry has punished American consumers with drug prices way above those of any other country. As a volunteer Medicare rights counselor, I have seen elderly people who must choose between buying their prescription medications and buying food. It is shameful that our government allows this to continue. If all members of Congress had to pay top dollar for their prescription drugs and those of their spouses and children, maybe they would understand. Maybe then we would have sensible negotiation of drug prices. Dr. Elizabeth Rosenthal is a dermatologist. She resides in Larchmont, N.Y. http://www.nytimes.com/2013/10/16/opinion/the-high-cost-of-asthma-in-america.html?_r=0

]]>

A new film project tries to capture the life of the physician who takes care of Chicago

By Ben Joravsky
The Reader (Chicago), October 15, 2013

In his long and distinguished career as an activist and doctor, Quentin Young has fought to integrate the medical staff at Cook County Hospital, treated the wounds of Dr. Martin Luther King Jr., and infuriated Mayor Rahm Emanuel by thwarting his attempt to waste taxpayer dollars on Wrigley Field.

He’s a living illustration that the fight for fairness is full of setbacks as well as victories, but that it continues to this day.

I’ve had Dr. Young on my mind since filmmaker Al Nowakowski called to tell me about the Kickstarter campaign he and his filmmaking partners have undertaken. They need to raise $30,000 to finish “The Good Doctor Young,” a documentary about Young’s life.

It sounded to me like a noble endeavor. So last week I took a break from Mayor Emanuel’s school closings, budget cuts, and TIF deals and headed south to Hyde Park to visit the doctor, who’s 90 years old.

It was the first time we’d met and I wasn’t disappointed. As Nowakowski’s partners—Cat Jarboe and Jeff Bivens—filmed us, Young chatted amiably for over an hour, charming, good-humored, and gracious.

I intended to zero in on my obsession—the business about Mayor Emanuel and Wrigley. But you know how it goes. You start talking about this, and you wind up talking about that. Before I knew it, Young was giving me a condensed version of his life story.

He was born and raised on the south side, not far from where he currently lives. He’s as Chicago as Augie March himself.

Young swears up and down that he was for a single-payer health system going back to when he was a 13-year-old freshman at Hyde Park High.

After high school, Young enrolled at the University of Chicago. “There was a war going on and I was antifascist,” he says. “I volunteered for the army when I was 19. I was put in the medics.”

Following the war, he earned his medical degree at Northwestern University and went to work at Cook County Hospital, eventually rising to the position of chairman of medicine.

As the years wore on, Young was on the front lines of just about every single left-of-center cause, from the antiwar movement to the drive for single-payer health care.

On his wall is a framed photo of an open-housing march in the mid-60s. Young is standing in front of Al Raby, a local civil rights activist so legendary a high school was named after him.

Just in front of Young is King and in front of King is Jesse Jackson, wearing a porkpie hat that would fit in perfectly today among the hipsters of Logan Square. In front of Jackson is Reverend James Bevel, another legendary civil rights activist, wearing his trademark yarmulke. Man, what a time.

When Dr. King brought his civil rights campaign to Chicago in 1966, Young was his personal physician. He says King was sick twice during those months from bad colds.

“I would make a 15-minute visit that would last for two hours,” Young says. “He was clearly a man with a mission.”

After King was hit in the head with a rock during the infamous open-housing march in Marquette Park, Young tended his wound. “King was not fearless,” Young says. “He felt he was going to die. But he didn’t have a sense of immortality. . . . He knew his vulnerability and exposure. He lived accordingly. That makes him even more of a hero in my book.”

Young also had the chance to see the city’s political establishment at work, including the first Boss Daley. “Old man Daley was basically a business-supported guy who tried to keep the city as it was. It was segregated and racist and blacks were at the bottom of the heap.”

Young wasn’t Mayor Harold Washington’s doctor, but they were neighbors and good friends for years. Mayor Washington appointed Young president of the Board of Health.

“Harold is the most remarkable person I’ve met,” says Young. “But he would not do what I said.”

In particular, Young urged Washington to eat better and exercise more. Alas, Washington died of a heart attack in 1987.

Eventually, we got to the story that I just had to hear—how Young and Governor Quinn teamed up to stop Mayor Emanuel from wasting good taxpayer money on Wrigley Field.

In 2012, the mayor was negotiating with the Cubs on a subsidy to rehab the ballpark. Such a handout requires approval by the Illinois Sports Facilities Authority, a body made up of four appointees by the governor and three by the mayor.

Last October Mayor Emanuel moved to take control of the authority by getting Manny Sanchez, a Quinn appointee, to join his trio in voting for a new, handpicked executive director.

At the last moment, however, Governor Quinn pulled a fast one: he replaced Sanchez with Young. Sanchez didn’t know he’d been replaced until he showed up for the meeting, ready to vote for Emanuel’s appointee.

Man, Chicago is a tough town.

“Four beats three every time,” Young says.

You should have heard the mayor’s appointees huffing and puffing at that meeting about Quinn’s low-down, dirty deeds. It was like they were shocked—shocked, I tell you—to discover that politicking goes on in this city.

I wish they’d been around to raise a ruckus as Mayor Emanuel pulled his own fast one this summer, when he officially got the City Council to move forward with his South Loop basketball arena/hotel deal on a voice vote that aldermen didn’t even know they were taking.

For the record, Mayor Emanuel says he wasn’t going to support a handout for the Cubs. If you say so, Mr. Mayor. I guess it was just a coincidence that it wasn’t until January that the Cubs officially announced they were giving up on a handout and planning to rehab Wrigley on their own.

Ironically, Mayor Emanuel has been bragging ever since about how he’s held the line on a Wrigley handout. He’s probably going to use it as one of the centerpieces of his reelection campaign—if the Cubs ever get around to starting the actual construction.

I tell you—you can go far in this world if you have no shame.

I think the mayor should take that public money he saved on Wrigley and use it to reopen some of the mental health clinics he closed in high-crime neighborhoods. He could even name one of the clinics for Dr. Young.

If he can’t bring himself to do that, he can at least make a personal contribution to Nowakowski’s Kickstarter campaign. It’s a small way to honor one of Chicago’s great crusaders of the last 60-something years.

http://www.chicagoreader.com/chicago/film-project-documents-activist-dr-quentin-young/Content?oid=11235229

]]>