PNHP

Health care challenges in Minnesota tied to access, insurance, says physician advocates

Health care challenges in Minnesota tied to access, insurance, says physician advocates

By Andrea Parrott
Twin Cities Daily Planet, Dec. 24, 2012

After daily witnessing situations in which patients suffered or had to make decisions detrimental to their health due to difficulties in accessing health care, Dr. Elizabeth Frost and Dr. Ann Settgast had enough. They felt they had to do something that would allow everyone to have health insurance and so, access to health care. The two decided to found the Minnesota chapter of Physicians for a National Health Program (PNHP).

PNHP is a national non-profit organization whose members advocate for single payer health care. The idea of single payer health care is that instead of people paying fees to a private health insurance company, they will pay one fund. Hospitals, doctors, and other health providers would then receive payment from that one fund. Dr. Settgast explained single payer in this way: “Some people use an analogy of ‘Medicare of all’ as a synonym for single payer… It’s an example of a fund where everyone pays into the fund and then that fund pays for health care and private deliverers of health care. So Medicare is like a little micro single payer.”
 
Twin Cities Daily Planet spoke with the doctors, asking them about the state of health care in Minnesota. The edited interview is below.

What are some personal experiences that led you to advocate for a single payer health program?

Dr. Settgast: That’s a great question that could take me like 12 hours to answer. I’m a primary care doctor so I take care of patients on a daily basis. Every single day I see reasons why we need single payer. A recent one would be a woman who I took care of—a Vietnamese woman in her early 60s who came in and I diagnosed her with rheumatoid arthritis, which is terrible—she had terrible swelling of her hand joints. Really deforming joint disease. She was a full-time employee of a company and her husband worked full time as well. Got her to the rheumatologist. Got her on the right drugs. Her joints totally improved. Her pain was eliminated. She was fully functional. Everything was great.

And then, she just didn’t show up for like two or three years. One day she just shows up on my schedule… So I came into the room. She’s a tiny little woman and from the door, I could see her joint was like the size of a golf ball—like hugely swollen. I said, I’ll just change her name, I said “Lynn, what happened? Where have you been?” Since I had seen her, she got laid off from her job and her husband died. And she was only 63 at the time that this happened… She didn’t have access to health care so she just had to stop her drugs, stop seeing her rheumatologist and her joints deteriorated… I didn’t realize, but she had turned 65, so she was back. And it’s disgusting because this woman’s hand is ruined and it’s totally preventable. We see this stuff every single day. And it’s inhumane and it’s disgusting as a physician when all you care about is taking care of sick people to see people not access care.

Dr. Frost: A daily basis there are stories… Yesterday I had a patient who stopped her birth control and now is pregnant. I also today had somebody who had psoriasis… they haven’t had it treated in almost a year now because they don’t have insurance… Again, again, and again, you’re looking at somebody and apologizing for our medical system. “That’s really unfair. I’m sorry that happened to you.” You can’t just keep doing that again and again. You have to find some other outlet to feel like you’re making a difference on a larger level.

What do you see as the main health care policy issues in Minnesota?

Dr. Settgast: We are leading the nation in the number of individuals with high deductible health insurance plans. The idea is that this would somehow promote personal responsibility. You have a high deductible so you’re not going to go to the doctor unless you really need to because you’re going to be spending your own money. But what that says is that you’re relying on people who aren’t doctors to decide whether they need medical care or not—is problematic right there. That’s our job: to say, “No, this is not something serious, you’re OK.” People shouldn’t be relied on to do that at home. But then the other issue that we know, there is actually good data showing that the higher your deductible, the less care you receive. And there’s no way to know that that care isn’t needed. You’re much more likely to see conditions being under-managed or undiagnosed. People just aren’t going to the office when they’re sick…

Dr. Frost: I think a big huge policy thing that’s really going on in Minnesota right now, of course, is the exchanges and figuring out how to set up the exchanges under the Affordable Care Act—that’s huge. That’s going to take up a lot of energy in the next year or two, but I don’t know how much it’s really going to solve the problem.

Dr. Settgast: It’s not going to solve it because all you’re doing is adding this level of administrative complexity when now people can go shopping in this exchange to get their private health insurance. It might help some people to get some policy, but it’s not designing the system so that it will work. It’s adding more complexity to an already chaotic system… You still have these huge billing departments having to bill multiple payers and you’re still having insurance companies take all this money off the top… for functions that have nothing to do with health care. There’s still a huge amount of waste still in the system and we haven’t done anything to change that.

What are some of the main health policy issues that you see facing the nation?

Dr. Frost: I think Minnesota is a little bit ahead of the rest of the nation in the area that we’re talking about… Like we already offer Medicaid to adults without children.

Dr. Settgast: Our Medicaid eligibility rules are much better here… I have a brother in Indiana… if he was here he would qualify for coverage…

Dr. Frost: We’re talking a lot about how health care is paid for when we do single payer… I think Minnesota has some of the largest health care disparities. I know that education is the worst in the nation in terms of disparities… I don’t know how we compare to other states in terms of health care, but I have a feeling it’s not very good. One of the things that really distresses me a lot is especially the Native Americans have terrible, terrible health care statistics… It’s really, really sad and that’s a population I work with a lot.

Dr. Settgast: The problems in the nation are the same as the problems here: uninsurance, underinsurance, people not having access to care. That’s all in all of the states.

Dr. Frost: Of course the biggest problem is the insurance industry… It’s not like the politicians are in charge and they’re guiding the system—no, they need to figure out what the [insurance] industry might accept and then work within those boundaries… Our politicians are controlled pretty much by the industry… The evidence for a single payer system is so ridiculously strong, it’s really amazing that we weren’t able to do more with the Affordable Care Act. It’s really quite astounding—that the Affordable Care Act is such a big deal and it does so little… one of things that was not allowed to be on the table, was not allowed to be discussed at all was the idea that the government would purchase drugs for our elderly… Now there’s like a gazillon Medicare Part D plans. Each one of those little plans doesn’t have the purchasing power to drive down the price of drugs.
Dr. Settgast: We see the patients who don’t take their medicines, or they take them every other day because they have to make them last.

What are some of the main challenges to making changes in health policy?

Dr. Settgast: The health insurers. Because if you look at the polling data, the public supports single payer, physicians support single payer… We know you can cover everyone for less cost and give everyone high quality coverage.

What happens in the U.S. is if I’m the doctor and I see 20 patients in a day and I diagnose them all with the same thing. Let’s say they all have diabetes or uncontrolled sugar. Every patient, depending on their payer, may pay my clinic a different fee because all the payers, the insurance companies, are negotiating with the all the clinics separately… so it’s hugely complicated, which is part of the cost—all these contract negotiations because everybody gets a different deal and so every patient pays differently… It’s so unequal. And then if you’re uninsured and you come in, you have a totally different cost than what the insurance pays in the next room.

Dr. Frost: It’s totally unfair. Because you’re uninsured, you have to pay the full price… if you’re totally uninsured you have to pay the $300 while the insurance pays $200, and Medicaid might pay $175 and Medicare might pay $215…

What progress do you see in addressing health disparities in Minnesota?

Dr. Settgast: I personally think it’s crazy to try and address health disparities without having a system that covers everyone. I mean how can you really expect to decrease disparities if you have whole portions of the population that don’t have any access to the system? You can’t do things on a population level if you’re leaving 10 percent of the people out… I mean obviously having a single payer doesn’t eliminate all health care disparities because a lot of health care disparities isn’t necessarily access to the system, but it’s the first step… I mean, how are they going to stand on equal footing in terms of their diabetes control or their hypertension control if they don’t have a doctor because they don’t have health insurance?

Dr. Frost: I think it’s important to differentiate between health disparities and health care disparities because health disparities are, a lot of them are socially determined. So if you don’t have a grocery store in the area… that will make it a lot harder to eat well… So I think separating those two things are important, but in terms of access to health care, I see again and again and again… somebody gets out of Medicaid and gets a job and loses their insurance so they can’t see you anymore. So once you get back… on your feet, you get back into the system, you can’t treat those diseases that you’ve been treating… So it’s that inequality in the health care system, the injustice in the health care system is what makes me so angry, and it’s because I see it every day.

© 2012 Andrea Parrott

http://www.tcdailyplanet.net/news/2012/12/23/mn-voices-health-care-challenges-minnesota-tied-access-insurance-says-physician-advo

GAO report on USPS Retiree Health Benefits Fund

U.S. POSTAL SERVICE
Status, Financial Outlook, and Alternative Approaches to Fund Retiree Health Benefits

GAO (U.S. Government Accountability Office), December 4, 2012

The Postal Service Retiree Health Benefits Fund (PSRHBF) covered about 49 percent of the U.S. Postal Service’s (USPS) $94 billion retiree health benefit liability at fiscal year-end 2012. USPS’s deteriorating financial outlook, however, will make it difficult to continue the current prefunding schedule in the short term, and possibly to fully fund the remaining $48 billion unfunded liability over the remaining 44 years of the schedule on which the 2006 Postal Accountability and Enhancement Act (PAEA) was based.

USPS is intended to be a self-sustaining entity funded almost entirely by postal ratepayers, but its financial losses are challenging its sustainability. GAO has testified that USPS should prefund its retiree health benefit liabilities to the maximum extent that its finances permit, but none of the funding approaches may be viable unless USPS has the ability to make the payments. USPS’s default on its last two required PSRHBF payments and its inability to borrow further make the need for a comprehensive package of actions to achieve sustainable financial viability even more urgent.

USPS agreed that comprehensive reform is necessary to achieve financial sustainability. It also recognized its obligation to provide effective, affordable health benefits to its employees and retirees, but said that it does not have the financial resources to make prefunding payments required by current law.

http://www.gao.gov/products/GAO-13-112

Comment

By Don McCanne, MD

Linking health insurance to employment has contributed greatly to the dysfunction of health care financing within the United States. If it were a good method, you would think that the United States Postal Service would provide an exemplary model for such financing.

This GAO report confirms that none of the proposed funding approaches for the Postal Service Retiree Health Benefits Fund may be viable unless USPS has the ability to make the payments. The USPS has responded in writing that “it does not have the financial resources to make prefunding payments required by current law.”

It is long past time to take the employer out of health care coverage and financing decisions. Instead, we should establish our own single universal risk pool funded equitably through the tax system. Employers could get on with the task of managing their own businesses, while our public stewards would take charge of managing more efficiently and more assuredly health care financing for all of us.

GAO report on USPS Retiree Health Benefits Fund

U.S. POSTAL SERVICE
Status, Financial Outlook, and Alternative Approaches to Fund Retiree Health Benefits

GAO (U.S. Government Accountability Office), December 4, 2012
The Postal Service Retiree Health Benefits Fund (PSRHBF) covered about 49 percent of the U.S. Postal Service’s (USPS) $94 billion retiree health benefit liability at fiscal year-end 2012. USPS’s deteriorating financial outlook, however, will make it difficult to continue the current prefunding schedule in the short term, and possibly to fully fund the remaining $48 billion unfunded liability over the remaining 44 years of the schedule on which the 2006 Postal Accountability and Enhancement Act (PAEA) was based.
USPS is intended to be a self-sustaining entity funded almost entirely by postal ratepayers, but its financial losses are challenging its sustainability. GAO has testified that USPS should prefund its retiree health benefit liabilities to the maximum extent that its finances permit, but none of the funding approaches may be viable unless USPS has the ability to make the payments. USPS’s default on its last two required PSRHBF payments and its inability to borrow further make the need for a comprehensive package of actions to achieve sustainable financial viability even more urgent.
USPS agreed that comprehensive reform is necessary to achieve financial sustainability. It also recognized its obligation to provide effective, affordable health benefits to its employees and retirees, but said that it does not have the financial resources to make prefunding payments required by current law.
http://www.gao.gov/products/GAO-13-112

Linking health insurance to employment has contributed greatly to the dysfunction of health care financing within the United States. If it were a good method, you would think that the United States Postal Service would provide an exemplary model for such financing.
This GAO report confirms that none of the proposed funding approaches for the Postal Service Retiree Health Benefits Fund may be viable unless USPS has the ability to make the payments. The USPS has responded in writing that “it does not have the financial resources to make prefunding payments required by current law.”
It is long past time to take the employer out of health care coverage and financing decisions. Instead, we should establish our own single universal risk pool funded equitably through the tax system. Employers could get on with the task of managing their own businesses, while our public stewards would take charge of managing more efficiently and more assuredly health care financing for all of us.

New America Foundation implicitly endorses single payer

Social Contract Budgeting: Prescriptions from Economics and History

By Peter H. Lindert, Distinguished Research Professor of Economics, University of California – Davis
New America Foundation, December 2012

America has yet to accept the insurance solution that has worked relatively well in other countries: let the government serve as a dominant payer, with mandatory universal coverage and mandated pure community rating. (Note that international experience recommends single-payer insurance, but is indifferent to government provision of health care.) Instead, American state and federal insurance systems embody an unavoidably messy political compromise, one in which the public is forced to buy coverage choosing from a menu of private insurers. As it stands, the government will act as single regulator, not as single payer. This has the political advantage of keeping government budgets from raising taxes to cover insurance, but the disadvantage of perpetuating, and still subsidizing, a costly private insurance industry.

http://growth.newamerica.net/sites/newamerica.net/files/policydocs/Lindert_Peter_NAF_SocialContractBudgeting_2012.pdf

And…

New America Foundation

About New America

The New America Foundation is a nonprofit, nonpartisan public policy institute that invests in new thinkers and new ideas to address the next generation of challenges facing the United States.

With an emphasis on big ideas, impartial analysis and pragmatic solutions, New America invests in outstanding individuals whose ability to communicate to wide and influential audiences can change the country’s policy discourse in critical areas, bringing promising new ideas and debates to the fore.

http://newamerica.net/about

Comment

By Don McCanne, MD

This statement implicitly supporting single payer is of great importance because of its source. The New America Foundation was established to move beyond partisan politics. “The foundation’s mission is animated by the American ideal that each generation will live better than the last.”

In his article, “Social Contract Budgeting,” UC Davis Professor Peter Lindert discusses four fronts: education, health insurance, pensions, and broad taxes. Although he attempts to move beyond politics, most of us will still reflect on his concepts under the cloud of our own biases. As an example, although some of us are uncomfortable with the concept of a VAT (value added tax, a consumption tax), he discusses a variation in which the VAT can be progressively redistributive.

For those of us who have campaigned so long and so hard for health care justice, Lindert states what we perceive to be the obvious: we need to move beyond politics and “accept the insurance solution that has worked relatively well in other countries,” noting that “international experience recommends single-payer insurance.”

New America Foundation implicitly endorses single payer

Social Contract Budgeting: Prescriptions from Economics and History

By Peter H. Lindert, Distinguished Research Professor of Economics, University of California – Davis
New America Foundation, December 2012
America has yet to accept the insurance solution that has worked relatively well in other countries: let the government serve as a dominant payer, with mandatory universal coverage and mandated pure community rating. (Note that international experience recommends single-payer insurance, but is indifferent to government provision of health care.) Instead, American state and federal insurance systems embody an unavoidably messy political compromise, one in which the public is forced to buy coverage choosing from a menu of private insurers. As it stands, the government will act as single regulator, not as single payer. This has the political advantage of keeping government budgets from raising taxes to cover insurance, but the disadvantage of perpetuating, and still subsidizing, a costly private insurance industry.
http://growth.newamerica.net/sites/newamerica.net/files/policydocs/Lindert_Peter_NAF_SocialContractBudgeting_2012.pdf

And…

New America Foundation
About New America
The New America Foundation is a nonprofit, nonpartisan public policy institute that invests in new thinkers and new ideas to address the next generation of challenges facing the United States.
With an emphasis on big ideas, impartial analysis and pragmatic solutions, New America invests in outstanding individuals whose ability to communicate to wide and influential audiences can change the country’s policy discourse in critical areas, bringing promising new ideas and debates to the fore.
http://newamerica.net/about

This statement implicitly supporting single payer is of great importance because of its source. The New America Foundation was established to move beyond partisan politics. “The foundation’s mission is animated by the American ideal that each generation will live better than the last.”
In his article, “Social Contract Budgeting,” UC Davis Professor Peter Lindert discusses four fronts: education, health insurance, pensions, and broad taxes. Although he attempts to move beyond politics, most of us will still reflect on his concepts under the cloud of our own biases. As an example, although some of us are uncomfortable with the concept of a VAT (value added tax, a consumption tax), he discusses a variation in which the VAT can be progressively redistributive.
For those of us who have campaigned so long and so hard for health care justice, Lindert states what we perceive to be the obvious: we need to move beyond politics and “accept the insurance solution that has worked relatively well in other countries,” noting that “international experience recommends single-payer insurance.”

Bruce Bartlett's Christmas gift to all of us

Though it is not our policy to distribute a Quote of the Day message on Christmas Day, we have to make an exception this year and thank Bruce Bartlett for his Christmas present to PNHP and to all of us who dream of a future with health care justice throughout the nation.

A Conservative Case for the Welfare State

By Bruce Bartlett
The New York Times, December 25, 2012

(Bruce Bartlett held senior policy roles in the Reagan and George H.W. Bush administrations and served on the staffs of Representatives Jack Kemp and Ron Paul.)

At the root of much of the dispute between Democrats and Republicans over the so-called fiscal cliff is a deep disagreement over the welfare state. Republicans continue to fight a long-running war against Social Security, Medicare, Medicaid and many other social-welfare programs that most Americans support overwhelmingly and oppose cutting.

Republicans in Congress opposed the New Deal and the Great Society, but Republican presidents from Dwight D. Eisenhower through George H.W. Bush accepted the legitimacy of the welfare state and sought to manage it properly and fund it adequately. When Republicans regained control of Congress in 1994 they nevertheless sought to repeal the New Deal and Great Society programs they had always opposed.

Republicans are now using the fiscal impasse to try to raise the age for Medicare and reduce Social Security benefits by changing the index used to adjust them for inflation. They know that such programs will be easier to abolish in the future if the number of people who qualify can be reduced and benefits are cut so that privatization becomes more attractive.

This is foolish and reactionary. Moreover, there are sound reasons why a conservative would support a welfare state.

One problem with this conservative view is its lack of an empirical foundation. Research by Peter H. Lindert of the University of California, Davis, shows clearly that the welfare state is not incompatible with growth while providing a superior quality of life to many of those left to sink or swim in America.

In a new paper for the New America Foundation, Professor Lindert summarizes his findings. He points out that there are huge efficiencies in providing pensions and health care publicly rather than privately. A main reason is that in a properly run welfare state, benefits are nearly universal, which eliminates vast amounts of administrative overhead necessary to decide who is entitled to benefits and who isn’t, as is the case in America, and eliminates the disincentives to work resulting from benefit phase-outs.

A 2003 study in the New England Journal of Medicine found that Canada’s single-payer health system had less than a third of the per-capita administrative cost of the United States system, with its many private insurance companies and overlapping government programs.

Americans believe that their health system is the best in the world, but in fact it is not.

The one area where the United States tops all other countries in terms of health is cost. According to the Organization for Economic Cooperation and Development, the United States spent more than any other country – 17.4 percent of gross domestic product on health in 2009. By contrast, Britain spent only 9.8 percent of G.D.P. on health.

Thus, for no more than the United States already spends through government, we could have a national health-insurance system equal to that in Britain. The 7.6 percent of G.D.P. difference between American and British total health spending is about equal to the revenue raised by the Social Security tax. So, in effect, having a single-payer health system like Britain’s could theoretically give Americans 7.6 percent of G.D.P. to spend on something else – equivalent to abolishing the payroll tax.

This is a powerful conservative argument for national health insurance.

http://economix.blogs.nytimes.com/2012/12/25/a-conservative-case-for-the-welfare-state/#more-158917

Comment

By Don McCanne, MD

Thank you, Bruce Bartlett, for perhaps the greatest Christmas gift of all – a rationale for why we all have to join together to provide health care for everyone.

(The 2003 NEJM article cited is that of PNHP co-founders Steffie Woolhandler and David Himmelstein, plus Terry Campbell of the Canadian Institute for Health Information.)

Bruce Bartlett’s Christmas gift to all of us

Though it is not our policy to distribute a Quote of the Day message on Christmas Day, we have to make an exception this year and thank Bruce Bartlett for his Christmas present to PNHP and to all of us who dream of a future with health care justice throughout the nation.

A Conservative Case for the Welfare State

By Bruce Bartlett
The New York Times, December 25, 2012

(Bruce Bartlett held senior policy roles in the Reagan and George H.W. Bush administrations and served on the staffs of Representatives Jack Kemp and Ron Paul.)

At the root of much of the dispute between Democrats and Republicans over the so-called fiscal cliff is a deep disagreement over the welfare state. Republicans continue to fight a long-running war against Social Security, Medicare, Medicaid and many other social-welfare programs that most Americans support overwhelmingly and oppose cutting.

Republicans in Congress opposed the New Deal and the Great Society, but Republican presidents from Dwight D. Eisenhower through George H.W. Bush accepted the legitimacy of the welfare state and sought to manage it properly and fund it adequately. When Republicans regained control of Congress in 1994 they nevertheless sought to repeal the New Deal and Great Society programs they had always opposed.

Republicans are now using the fiscal impasse to try to raise the age for Medicare and reduce Social Security benefits by changing the index used to adjust them for inflation. They know that such programs will be easier to abolish in the future if the number of people who qualify can be reduced and benefits are cut so that privatization becomes more attractive.

This is foolish and reactionary. Moreover, there are sound reasons why a conservative would support a welfare state.

One problem with this conservative view is its lack of an empirical foundation. Research by Peter H. Lindert of the University of California, Davis, shows clearly that the welfare state is not incompatible with growth while providing a superior quality of life to many of those left to sink or swim in America.

In a new paper for the New America Foundation, Professor Lindert summarizes his findings. He points out that there are huge efficiencies in providing pensions and health care publicly rather than privately. A main reason is that in a properly run welfare state, benefits are nearly universal, which eliminates vast amounts of administrative overhead necessary to decide who is entitled to benefits and who isn’t, as is the case in America, and eliminates the disincentives to work resulting from benefit phase-outs.

A 2003 study in the New England Journal of Medicine found that Canada’s single-payer health system had less than a third of the per-capita administrative cost of the United States system, with its many private insurance companies and overlapping government programs.

Americans believe that their health system is the best in the world, but in fact it is not.

The one area where the United States tops all other countries in terms of health is cost. According to the Organization for Economic Cooperation and Development, the United States spent more than any other country – 17.4 percent of gross domestic product on health in 2009. By contrast, Britain spent only 9.8 percent of G.D.P. on health.

Thus, for no more than the United States already spends through government, we could have a national health-insurance system equal to that in Britain. The 7.6 percent of G.D.P. difference between American and British total health spending is about equal to the revenue raised by the Social Security tax. So, in effect, having a single-payer health system like Britain’s could theoretically give Americans 7.6 percent of G.D.P. to spend on something else – equivalent to abolishing the payroll tax.

This is a powerful conservative argument for national health insurance.

http://economix.blogs.nytimes.com/2012/12/25/a-conservative-case-for-the-welfare-state/#more-158917

Comment

By Don McCanne, MD

Thank you, Bruce Bartlett, for perhaps the greatest Christmas gift of all – a rationale for why we all have to join together to provide health care for everyone.

(The 2003 NEJM article cited is that of PNHP co-founders Steffie Woolhandler and David Himmelstein, plus Terry Campbell of the Canadian Institute for Health Information.)

Rasmussen survey shows split on single payer

40% Favor Single-Payer Health Care System, 44% Oppose

Rasmussen Reports, December 17, 2012

Forty percent (40%) of Likely U.S. Voters favor a single-payer system, according to a new Rasmussen Reports national telephone survey. Forty-four percent (44%) oppose the creation of such a system. Sixteen percent (16%) are undecided.

The question asked:

Do you favor or oppose a single-payer health care system where the federal government provides coverage for everyone?

(Conducted December 10-11, 2012. Margin of Sampling Error, +/- 3 percentage points with a 95% level of confidence.)

http://www.rasmussenreports.com/public_content/politics/current_events/healthcare/december_2012/40_favor_single_payer_health_care_system_44_oppose

Comment

By Don McCanne, MD

Rasmussen telephone surveys are noted for results demonstrating right-wing bias. Understanding that, it is interesting that the results of this poll demonstrated a near even split in public support for single payer.

Several surveys from other sources have demonstrated closer to sixty percent support for single payer. Considering the likely bias in this poll, there does not seem to be any significant decline in support for single payer even though the Affordable Care Act is already being implemented.

As people observe how many will be left uninsured and how ineffective the plans will be in protecting personal finances, it can be anticipated that support for single payer will continue to grow until it reaches a threshold where it finally becomes a political imperative.

A message of hope from our economists

Statement on Healthcare

Econ4, December 2012

(Excerpts)

We are economists who think that the economy should serve people, the planet and the future.

We oppose treating health care as a commodity to be rationed on the basis of purchasing power or a privilege to be rationed on the basis of political power.

We call for a national health insurance system that provides universal access to essential health care.

We call for insurance for all Americans in a single risk pool – the efficient model already used by Medicare and the Veterans Administration – a system that can save billions of dollars while improving health and well-being.

We extend our support to all who are working to build an effective and accountable health care system that puts public health before private profit and secure health care for all regardless of income, age, or pre-existing conditions.

(Signed by over 100 economists)

http://econ4.org/statement-on-healthcare

Comment

By Don McCanne, MD

Against a background of depressing news during this Holiday Season, this group of social-minded economists is sending us a message of hope for a better health care system for all of us.

The link above will lead you to a ten minute video featuring four of the over 100 economists that signed onto this message. It is a video that you likely will want to share with others.

A message of hope from our economists

Statement on Healthcare

Econ4, December 2012
(Excerpts)
We are economists who think that the economy should serve people, the planet and the future.
We oppose treating health care as a commodity to be rationed on the basis of purchasing power or a privilege to be rationed on the basis of political power.
We call for a national health insurance system that provides universal access to essential health care.
We call for insurance for all Americans in a single risk pool – the efficient model already used by Medicare and the Veterans Administration – a system that can save billions of dollars while improving health and well-being.
We extend our support to all who are working to build an effective and accountable health care system that puts public health before private profit and secure health care for all regardless of income, age, or pre-existing conditions.
(Signed by over 100 economists)
http://econ4.org/statement-on-healthcare

Against a background of depressing news during this Holiday Season, this group of social-minded economists is sending us a message of hope for a better health care system for all of us.
The link above will lead you to a ten minute video featuring four of the over 100 economists that signed onto this message. It is a video that you likely will want to share with others.

Guns and health

Press Conference

Wayne Lapierre, CEO & Executive Vice President
NRA (National Rifle Association), December 21, 2012

The ONLY thing that stops a BAD guy with a gun is a GOOD guy with a gun.

http://home.nra.org/#

Comment:

By Don McCanne, MD

BANG! BANG!

(There is a not-so-subtle message here about the health of the nation.)

Don't weaken Medicare

By Ed Weisbart, M.D.
St. Louis Beacon, Dec. 21, 2012

As I sit in the waiting room for my 83-year-old mother-in-law’s cardiac MRI, I realize I’m not a good health-care consumer. I didn’t try to find the best deal; I didn’t ask any prices; I didn’t check to see if this were “in network.”

I did the only thing I wanted to do – I found the doctors we wanted and flew her to St. Louis from Daytona, Fla. I am incredibly grateful to have found these terrific physicians.

But I’m also incredibly grateful that my mother-in-law has Medicare. She lives on her meager Social Security check; and without Medicare, the cost of dealing with her heart problem would otherwise bankrupt her.

She’d have had to sell her condo in Florida and move in with us in St. Louis, moving away from all of her friends and into our colder winters. We’d love to have her with us, but not because she’s forced to be with us.

Thankfully, she does have Medicare. She’s “entitled” to it, having paid into it for 40 years, working full-time to earn that and her Social Security check.

Medicare gives her control over her own health-care decisions. Unlike my own “private” health insurance, Medicare lets her pick from virtually every doctor and hospital in the country. That’s the kind of choice she wants.

Frankly, it’s the kind of choice we all want. We’re not so interested in selecting one insurer’s restrictive network over another’s. We want and need access to quality health care, period.

We all want the fire engines to come when our house is on fire. When we all want the same thing, it just makes sense to provide it for everybody.

That’s exactly why we should just fix the problems with Medicare (end the deductibles and co-pays; correct the inadequate physician reimbursement, etc.) and provide it to all Americans, regardless of their age. That’s essentially what every other modern nation does, typically at half the cost and with far better health outcomes.

Instead, our precious Medicare is under attack.

Some propose increasing the eligibility age from 65 to 67. Because life expectancy has increased since Medicare was passed, they believe the age of eligibility should go up, too.

They ignore the fact that life expectancy hasn’t gone up the same for all of us. While the wealthiest have added five years to their life expectancy since 1977, the bottom half of us saw an average increase of barely one year. A significant number of people would get less, not more, years of Medicare since the bill was passed. Aside from the fundamental lack of fairness, more of us would die early preventable deaths.

Our 65- and 66-year-olds would either have to keep working or use the Affordable Care Act’s new insurance exchanges. They would choose from several insurance options, each with different premiums, deductibles, copays, networks of physicians and hospitals, etc. Thanks to the ACA, insurance companies will not be able to refuse to offer a policy, but few if any of the choices would be as affordable and robust as Medicare.

Second, some lawmakers have proposed to “means test” Medicare, creating an administratively complex system that would test the fortitude of patients, providers and even the IRS. Making wealthier patients pay more for Medicare will only motivate them to look for private insurance elsewhere, undermining the original program.

Others in Congress suggest turning Medicare into a voucher toward the purchase of private insurance. Healthier seniors would start picking the cheapest, but least robust, health plans and end up in dire financial trouble if they became seriously ill.

Each of these strategies undermines Medicare’s social contract, the message that “we’re all in this together.”

Now just imagine if we had an “improved Medicare for all.” By replacing our wasteful, profit-seeking private insurance industry with a streamlined single-payer system, we could save more than $400 billion in administrative costs – enough to provide high-quality care to everyone, mothers-in-law included.

Don’t throw our mothers-in-law over the fiscal cliff. Don’t cut Medicare – protect it, improve it, and expand it to cover everyone!

Dr. Ed Weisbart is the chair and a founding member of the St. Louis chapter of Physicians for a National Health Program.

https://www.stlbeacon.org/#!/content/28562/voices_weisbart_medicare_122012?coverpage=2395