PNHP

Health forum hears from uninsured

Health forum hears from uninsured

By Mark Binker
Greensboro News & Record
Wednesday, April 1, 2009

GREENSBORO — When she lost her job a decade ago, Kirby Heard joined the N.C. Farm Bureau so she could get health insurance. But when one of her payments arrived late, her coverage was terminated.

That, the High Point graphic designer told the Regional White House Forum on Health Care Reform on Tuesday, was when she joined the growing ranks of uninsured. Between 750 and 1,000 people attended the forum at the N.C. A&T Alumni Foundation Event Center on Benbow Road.

The event was one of five regional health reform forums that the White House says will build on a national gathering in Washington earlier this year.

Since losing her insurance, Heard, 52, said she has gotten treatment from a community care network, a group of local health providers that tries to coordinate medical care for people without insurance. Gov. Bev Perdue, who moderated the event, praised those networks as something the federal government should help expand.

“If you need a specialist, they can’t cover that,” Heard said, adding she was grateful for the care she could get. “I have a lot of achy-painy kind of things that are specialist oriented and I have learned to live with them. … I’ve been on a waiting list to see a dentist after losing a filling for eight months now.”

Also on hand Tuesday was Nancy-Ann DeParle, director of the White House Office for Health Reform. She told the audience that President Barack Obama has set two main health care goals: lowering the cost of services and making sure that everyone has some sort of health insurance coverage.

DeParle and Perdue called on people who had been pre-selected to tell their stories as well as people in the audience such as Heard who raised their hands.

Obama addressed the gathering by video.

“Through your own experience, you know what works, what doesn’t,” Obama said in the message. “I look forward to hearing your ideas.”

After the forum, DeParle said the federal government was in the “sausage-making process” of trying to craft a new national health care strategy, a task that has befuddled presidents going back more than a century.

When asked how forums such as Tuesday’s would play into that crafting, DeParle said it was important for the administration to see different ways states are helping to provide health coverage to those without.

“The personal stories are really something you take back,” she said, recalling Heard’s story as something that would stick with her. “You don’t lose that story, so it makes you understand the problem better. … On the good side, I heard more first-hand and saw more first-hand about the community care network and how that is working.”

As participants made their way to the forum, about a dozen protesters waved signs and chanted slogans in favor of a single-payer health care system, one that would be run by the federal government.

“Because the people say so, insurance companies got to go,” protester Marcia Everett, 46, yelled into a bullhorn.

“We are trying to encourage them to take a serious look at single payer,” Everett said. Advocates for that viewpoint felt they were initially excluded from the first White House forum and still say it’s an option the Obama administration should consider more closely.

“Single payer is the only way we can provide health care for everyone and save money,” said Jonathan Kotch, who heads Health Care for All N.C.

That viewpoint had sympathy inside the forum, and at least one presenter explicitly made the point. In the audience, Albertina McGirt said she wasn’t sure single-payer was the way to go but said something needed to be done.

A breast cancer survivor who describes herself as fiftyish, McGirt said she had health insurance when she got ill. But she still had to pay 20 percent of what it cost to beat back her disease.

“That 20 percent was monumental. After treatment, I was teetering,” she said. “Instead of being poor I was just ‘po.’ ”

McGirt said she hoped changes could be made to help people avoid those kind of financial trials.

“Whatever we do, we need to approach it carefully,” she said. “You must talk to those people who are in it, who have been affected by it.”

Contact Mark Binker at (919) 832-5549 or mark.binker@news-record.com

Media Advisory: Single-payer supporters to rally at April 6 health forum in Los Angeles

Physicians, nurses and health reform advocates to urge enactment of an improved ‘Medicare for All,’ decry outsized influence of corporate medicine in health reform debate

FOR IMMEDIATE RELEASE
April 2, 2009

Contacts:
John Shearer, M.D.
Roberto Ramos, California Physicians’ Alliance, (510) 665-8523
Mark Almberg, Physicians for a National Health Program, (312) 782-6006, cell: (312) 622-0996, mark@pnhp.org

What

Press conference and rally to express support for single-payer national health insurance and to protest the “marginalization of majority opinion” at Monday’s White House Forum on Health Care Reform at the California Endowment, 1000 North Alameda St., Los Angeles, at 9 a.m. PDT.

The health forum will be hosted by California Gov. Arnold Schwarzenegger and Washington Gov. Christine Gregoire. Senior White House policy officials will also participate and help moderate a discussion involving diverse stakeholders in health care reform, according to the Obama administration. People in San Diego, Clovis and Oakland will also participate in the Los Angeles event via satellite.

Advocates of single-payer national health insurance, sometimes called an improved “Medicare for All,” will be inside and outside, urging that single payer be “on the table” as a full-fledged option for reform. They will also decry the outsized role of the private health insurance industry, Big Pharma and other representatives of corporate medicine at the forum.

Physicians wearing their white coats, nurses in their scrubs, and other health reform advocates will assert that national health insurance is being accorded a minor, marginalized role at the forum, even though surveys show two-thirds of Americans and 59 percent of U.S. physicians support it.

They will demand that the single-payer model be given pride of place in the health care debate in view of that model’s effectiveness in providing universal, comprehensive care; its ability to contain costs; and the fact that the annual savings in administrative costs — $400 billion — would mean that a U.S. single-payer system would require no increase in overall health spending.

The pro-single-payer rally is co-sponsored by the California Physicians’ Alliance, the state chapter of Physicians for a National Health Program (PNHP); the California Nurses Association/NNOC; the California School Employee Association; Health Care for All — California; California Student Health Professional Alliance for Universal Health Care; the Labor Task Force for Universal Healthcare; Singlepayer Now; Progressive Democrats of America; and Healthcare-Now; among others.

Who

Stephen Tarzynski, M.D., pediatrician, Los Angeles
Parker Duncan, California Student Health Professional Alliance for Universal Health Care (CaSHPA)
Speakers from other sponsoring organizations.

When

9 a.m. PDT, Monday, April 6

Where

California Endowment, 1000 North Alameda St., Los Angeles

Why

Dr. Stephen Tarzynski: “Physicians are sick and tired of jumping over barriers to caring for our patients created by for-profit insurance companies. They really have no meaningful role in medical care. All we need to take care of people is the doctors, the hospitals, and one publicly funded, fair and speedy payment system where doctors have a powerful voice.”

The California Physicians’ Alliance (http://www.capa.pnhp.org/) is the California chapter of Physicians for a National Health Program (www.pnhp.org), a membership organization of over 16,000 physicians, supports a single-payer national health insurance program. PNHP is headquartered in Chicago and has chapters across the United States. To contact a physician-spokesperson in your area, contact info@pnhp.org or call (312) 782-6006.

FRONTLINE’s “Sick Around America”

Sick Around America

FRONTLINE
March 31, 2009

Investigating the stories of Americans whose lives have become a quest to find and keep health insurance…

Join the Discussion

Dear FRONTLINE,

I am disappointed that this long-awaited special on healthcare did not address the single payer option. There were ample interviews with insurance company lobbyists but no discussion of this obvious choice. Our nation’s people are in crisis and the shameful greed displayed in other industries is replicated in the for profit hospital corporations, insurance companies and pharmceutical industries. We cannot afford profit in healthcare, as we will continue to have a chaotic, threadbare system riddled with donut holes and pitfalls for those who can least navigate: patients and their families. I’d like to see equal time — a Frontline on the single payer option.

Grace Gifford
Conway, SC

FRONTLINE’s editors respond:

Many viewers have written criticizing this report for not looking at solutions, in particular, a single payer system. Certainly, the topic is another important piece of any examination into the health care system and how it can be improved. And it would warrant a separate program of its own. We would like to point out that we did examine how the single payer system works in many European countries in our program last season, Sick Around the World. You can view this online.We believe that our report this week, Sick Around America, was equally of value in focusing on our current private health insurance system and showing how many Americans are only one or two events away from financial disaster or total ruin because they can’t afford this insurance, or because it offers inadequate coverage, or because it suddenly can be rescinded by the insurer for alleged omissions or errors. We also felt it important in this report to look at another major problem with the private insurance system: America’s for-profit medical system means that insurers have a fiscal duty to avoid risk and make profits for investors. Thus, insuring people who already have serious, chronic illnesses works against the interests of stockholders.

FRONTLINE: Sick Around America
http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/

Join the Discussion
http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/talk/

PNHP: “‘Sick Around America’ disappoints” – selected responses
https://www.pnhp.org/blog/2009/04/01/Ć¢ā‚¬Ėœsick-around-americaĆ¢ā‚¬™-disappoints/

Columbia Journalism Review: “Sick Around America” by Trudy Lieberman
http://www.cjr.org/campaign_desk/sick_around_america.php?page=all

Comment:

By Don McCanne, MD

T.R. Reid had hosted FRONTLINE’s “Sick Around the World,” an important documentary describing successful health programs in several other nations that provide care for everyone at a fraction of the costs of our fragmented, inefficient health care system that leaves so many out.

We were looking forward to T.R. Reid’s sequel, “Sick Around America,” describing the problems with our private insurance system. Many of us were disappointed with the format of the program, believing that they missed a great opportunity to educate the nation on several health policies that would work well for all of us. Thus it was no surprise to us that T.R. Reid was not mentioned during the program, nor in the credits.

What happened? Reid left the show this February in a dispute with FRONTLINE. Trudy Lieberman of Columbia Journalism Review quotes Reid as saying, “When I saw it, I didnĆ¢ā‚¬™t agree with it. It took a different view of health policy than I have.”

The program did use anecdotes effectively, demonstrating some of the problems with private insurance. Examples included medical underwriting, rescission, lapses in coverage, financial burdens due to underinsurance, and other deficiencies that most Americans now understand.

Watching this program, it is very clear that change is required. But the message for reform was outrageous. Throughout the program, many executives of the private insurance industry were featured, and they confirmed that these deficiencies were very real and needed to be addressed. That’s good. What was outrageous is that they were in no way contrite, but instead they implied that they would provide the leadership to make sure that private insurance will continue to manage the financing for health care in America, beginning with an individual mandate for every American to buy their lousy products.

We can only speculate on the motives of the producers. My opinion is that they wanted to provide support for the current efforts of the Democrats in Congress and in The White House to build reform based on private health plans. A publicly-administered and publicly-financed program would require a total restart on the reform process, and so it wasn’t offered as a potential solution. In deference to the insurance executives, the producers didn’t even promote a public Medicare-like option.

Remember, these insurance executives are not contrite. They can never provide the moral leadership that we need to create a health care system that serves all of us well.

Whatā€™s Race Got to Do with It?

A startling new analysis of the difference between Canadian and U.S. healthcare funding

By Gregory P. Marchildon
Literary Review of Canada, April 2009

BOOK REVIEW

ā€œNational Health Insurance in the United States and Canada: Race, Territory and the Roots of Differenceā€

By Gerard W. Boychuk
Georgetown University Press, 234 pages, softcover

The word ā€œraceā€ divides us ­ā€“ primarily according to skin colour and secondarily according to ethnicity. While the concept of race lacks a biological basis, categorization by race continues to shape relations within societies, particularly in those countries where slavery was a central institution for centuries or where settlement involved the displacement of large numbers of indigenous peoples. For example, because of the legacy of slavery, the racial division between African Americans and white Americans is the single most important theme in the national narrative of the United States. In his famous speech on race in March 2008 in Philadelphia, Barack Obama said it was time for America to confront the accumulated anger, resentments, stereotypes and distortions in order to get beyond the race divide. Only then, he said, would it be possible to fix the most broken parts of American public policy, including health care.

I suspect that this connection between race and healthcare policy must seem a little peculiar to most Canadians. In his new book, National Health Insurance in the United States and Canada: Race, Territory and the Roots of Difference, Gerard Boychuk, a political science professor at the University of Waterloo, explains why the politics of race prevented the introduction of universal health care in the United States. He also introduces a bold new hypothesis as to why Canada did the opposite. Boychukā€™s surprising explanation for the introduction of universal health care in Canada, while not rooted in race, is nonetheless based on the politics of identity and the competition between the federal government and the provinces (particularly Quebec) for the hearts and minds of its citizens.

The different paths taken by the two countries have fascinated and perplexed commentators and social scientists on both sides of the 49th parallel for decades, particularly given the fact that the two countries once had congruent health systems. However, after universal hospitalization was implemented in Canada in the late 1950s and universal medical care insurance in the 1960s, two things changed.[1] First, access to health care (or at least that portion deemed medically necessary) would now be based on need rather than ability to pay. Second, payment for such services would now be administered through provincial and territorial single-payer systems, thereby avoiding the overhead associated with private health insurance carriers and their need to assess risk, calculate premiums and administer claims.

As a consequence of this change, Canadians increasingly perceived health care as a collective right rather than an individual benefit, a social service rather than a commodity to be bought and sold on the marketplace. This policy divergence produced a different way of viewing the world, a difference reflected in everyday languageā€”health care is generally described as an industry by Americans and as social policy by Canadians. However, the consequences of this policy divergence go beyond the philosophic. Before medicare, Canadians spent almost as much as Americans on health care. After medicare, Canadians began to spend less than Americans on both private and public health care thanks in part to the cost control exerted by single-payer administration in Canada and the escalating cost of public and private health care insured by private insurance carriers in the United States. Today, we spend less than one half of what Americans spend on private and public health care combined. Even when it comes to public health care alone, we spend less per capita, prompting some to ask why American taxpayers pay for European-style universality but get only partial coverage in return.

In the United States, opposition to universality went well beyond an ideological preference for the market and hostility to the state. As Boychuk shows, the more deep-rooted issue was the threat posed by health reform proposals to segregated health services. Southern congressional representatives, the majority of whom were Democrats, were viscerally opposed to reforms that might have required white people to be treated in hospitals, nursing homes and medical clinics alongside black patients. Segregationist sentiment was also a pronounced feature of organized labour, and the unions worked with conservative Democrats as well as the most vocal opponent of universal health care, organized medicine. The American Medical Association was itself a segregated organization and opposed universal public health care for racial as well as political and economic reasons in the 1940s and ā€™50s.

It was only after the Civil Rights Act of 1964 forced the desegregation of all public programs funded by the American government that the racial objections to universality receded and the political and economic objections to universality and government intervention took priority. One year later, a three-layer policy cake had been baked by Lyndon B. Johnson, assisted by Democrats and Republicans in Congress. The first layer, part A of Medicare, was designed to please Democrats. It involved extending federal social security (first introduced by Franklin D. Roosevelt in the 1940s) as health insurance for contributing seniors. Republicans endorsed the second layer, part B, which introduced government-subsidized private insurance for physician care. The final layer was Medicaid, covering the poor as well as seniors who had not made sufficient social security contributions to qualify for Medicare. It was understood by all that these three layers were to supplement, not replace, employment-based private health coverage, which Democrats and Republicans, industry and labour, still viewed as the core of American health care.

Of course, this bipartisan policy did not, and could not, deliver universality. Instead, it further entrenched a system of entitlements based on employment, age and incomeā€”an old-fashioned passenger ship with clearly demarcated classes, to introduce a different metaphor. In first class, you have Medicare and comprehensive private health insurance. In second class, you have Medicaid and private health insurance plans with less than comprehensive coverage. In steerage, you have the chronically underinsured, while those without any coverageā€”the working poor without private insurance and seniors without Medicare benefitsā€”are always under threat of being thrown overboard. In eschewing universality, the U.S. displayed its exceptionalism, at least relative to the majority of wealthy nations in Europe, Australasia and Canada that have adopted some form of universal health care.

Aside from the lack of universality, the downside of the three-layer policy is the inability of federal and state governments to control the cost of Medicare and Medicaid, a constant thorn in the side of the American body politic. This generates a perpetual crisis. As private health insurance costs rise, companies cut or eliminate their employee health insurance benefits. As Americans lose benefits, they depend more heavily on the public safety net, but the more they rely on public benefits, the higher public costs grow. Not surprisingly, Americans regularly call upon their elected officials to address this recurring crisis in health care. In 1993, in response to public outcry, Bill Clinton told Congress that ā€œthis health care system of ours is badly broken, and it is time to fix itā€ only to see his administrationā€™s efforts go down to spectacular defeat.

As Barack Obama begins his presidency, expectations are high that health care will finally be repaired if not reformed. This is so despite an eco
nomic crisis that is beginning to bear a striking resemblance to the Great Depression. If 50 percent of all personal bankruptcies in more prosperous times were a consequence of the inability to pay medical bills, just imagine the situation that faces the working poor, many of whom are African American, in the next two years. Obama is also aware that 95 percent of African Americans voted for him hoping for some improvement in their lives, including the constant worry whether the next hospital visit will push them into welfare and poverty.

In contrast, health care in Canada seems less of an issue in these hard economic times in large part because medicare has eradicated the spectre of medical bankruptcy. I would go even further than Boychuk in arguing that national medicare was an inspired act of nation building, and in this sense was much more than a reaction to province buildingā€”but I am almost sure that this is a view of history not shared by Stephen Harper and most members of his government today in Ottawa. Nation building is what Boychuk calls territorial integration, a term he borrows from Canadian social policy scholar Keith Banting, from whom he quotes:

Social programs controlled by the central government can become instruments of nation-building, helping to mediate regional tensions and strengthen the state against centrifugal forces rooted in territorial politics. Alternatively, social programs designed and controlled at the regional level can become instruments for strengthening regional cultures and enhancing the significance of local communities in the lives of citizens, thereby reinforcing differentiation and centrifugal tendencies at the centre.

In other words, in response to the secessionist forces within Quebec as well as the expansionist tendencies of nationalist Quebec governments, the federal government inserted itself into healthcare policy in order to ā€œcreate a direct connectionā€ with Quebec residents and ā€œfoster a sense of attachment between them and the national polity.ā€ Boychuk argues that the federal governmentā€™s desire to exert a degree of territorial integrity is a better explanation for why Canada differs in its healthcare policy from the United States than the more commonly offered alternatives. One of these alternatives is the different ideology and values of the two countries, what Boychuk calls political culture. We can see this in terms of the social democratic ideology that led Tommy Douglasā€™s government in Saskatchewan to pioneer medicare, as well as the Red Tory influences in the old Progressive Conservative Party that allowed its members eventually to go along with medicare, however grudgingly. Another explanation is that Canadaā€™s political institutions facilitated the adoption of universal health care while Americaā€™s diffused checks-and-balances structure prevented (and may continue to prevent) a similar reform. The fusion of the legislative and executive in Canada allows for majority governments to make major policy changes without compromise while a decentralized federation permits major experiments in areas of provincial jurisdiction, thus Saskatchewanā€™s innovations in hospitalization and medical care insurance could easily be adopted in other provinces with the encouragement of cost-share financing by the federal government.

A third common explanation is ā€œpath dependencyā€ and its accompanying notion that timing is everything in public policy. Policy pathways are notoriously difficult to break from, in large part because of the financial, intellectual and ideological capital invested by individuals, organizations and institutions in the status quo. As difficult as it is, however, there are momentsā€”critical juncturesā€”when dissatisfaction with the status quo is powerful enough, or when the investments have not yet triggered a ā€œlock-inā€ of the policy status quo, when change becomes possible. These windows of opportunity are rare. If not taken advantage of, policy change may be permanently blocked. Saskatchewan, for example, introduced universal hospital and medical care before private health insurance covered the majority of the population, although the same argument seems to fall flat for most urbanized provinces, such as Ontario, that had quite high rates of public coverage before medicare was introduced.

In the United States, the window of opportunity was 1965, but legislators chose incremental improvements over universality, making major change in the future even more difficult. As Jacob Hacker explained about American health care in the New England Journal of Medicine, the sad truth is that ā€œmost Americansā€”even the underinsured and soon-to-be-insured, the potentially uninsurable and the one-illness-from-bankruptā€”can be frightened into believing that changing this entrenched and inadequate system means paying more for less.ā€ While race may not seem relevant to this explanation, the fact is that a disproportionate number of the underinsured and uninsured are African Americans. They have the most to lose in this economic downturn and therefore are the most at risk from medical bankruptcy. They have the most to lose if President Obama and Congress do not finally fix the healthcare mess, but some, as Hacker identified in 2007, may object to any major change to the status quo for fear of losing what little they have under the current system.

Returning to Canada, I must admit that I still find aspects of the path dependency explanation more compelling than Boychukā€™s argument concerning territorial integrity. In the second half of the 1950s, the Duplessis government in Quebec was opposed to government involvement in health care, so it hardly seems logical that the St. Laurent and Diefenbaker governments would have been attempting to steal a march by establishing a connection with Quebec residents through universal hospitalization. The argument holds a little more water in the 1960s during the Quiet Revolution in Quebec, but even here it seems to me that Boychuk has not made the case. In fact, it seems that successive nationalist governments in Quebec were only too willing to accept federal principles in return for tax room and cash for universal medical care.

It is possible to reject Boychukā€™s argument yet accept his conclusion that the policy has become linked with national identity because health care has become one of the key differences between the two countries. This may be for a variety of reasons, including the very simple fact that in terms of ideology, Canada continues to be influenced by a set of social democratic values that are very much in the minority south of the border, although it remains to be seen whether Obamaā€™s election marks a move toward more liberal communitarian values. Still, a more collectivist approach to health care in the U.S. seems to fly in the face of the more highly individualistic ethos that underpins both major political parties as well as civil society. On the other hand, the American emphasis on individual rights combined with the legacy of the civil rights movement may lead to health care being declared a fundamental right by the courts. This would strengthen the hand of those political leaders who feel that it is time, finally, for all Americans to have universal access to essential health care. Race once prevented this from occurring, and now, the intersection of race and rights may allow it to happen. As Roosevelt demonstrated during the Great Depression, a crisis can actually provide the opportunity for a new policy direction, if not a new social contract.

ENDNOTE

1. Although the word ā€œmedicareā€ in Canada was originally a contraction of ā€œmedical care insurance,ā€ it soon became shorthand for both universal hospital and medical (physican) care coverage. It should not be confused with American ā€œMedicare,ā€ which is not universal.

Gregory P. Marchildon is the former executive director of the Romanow Commission, the Canada Research Chair at the Johnson-Shoyama Graduate School of Public Policy at University of Regina and a member of the Health Evi
dence Network of Canada.

Whatā€™s Race Got to Do with It?

Views on IRAs and HSAs contrast sharply

Not the Next IRA: How Health Savings Accounts Shape Public Opinion

By Jason Barabas
Journal of Health Politics, Policy and Law
April 2009
This study has documented policy feedback effects of a personal nature. The central finding is that policy feedback effects occur, but they can be domain specific. That is, participation in investment accounts for retirement or health do not lead to uniformly conservative or liberal policy opinions. As expected, IRA owners tend to favor Social Security privatization, but that does not mean that investing always or unequivocally engenders support for investment account-based policy solutions. Participation in HSAs reduces public support for health care privatization. In particular, HSA owners, owing to their wildly different programmatic experiences, are much less likely to endorse individualized health care coverage. Thus, HSAs and related forms of consumer-driven health plans are not automatically designed to become “the next IRA.” The irony is that dissatisfaction with HSAs is greatest among those who have them.
http://jhppl.dukejournals.org/cgi/content/abstract/34/2/181

Much has already been written about the wisdom, or lack thereof, of health savings accounts (HSAs) and the high-deductible health plans that are linked with them. By design, they benefit higher-income individuals who are able to take advantage of the regressive tax policies, and who remain healthy, allowing the savings to accumulate for use in their retirement years. But they don’t work for individuals with modest incomes who have significant health care needs.
You would think that HSAs would be dismissed from the current dialogue on reform, but no. Our politicians are struggling with how to pay for comprehensive reform. One goal is to reduce spending on insurance premiums, and that makes lower-cost, high-deductible plans more attractive to those attempting to make reform cost-neutral, for the government, that is.
As Congress plays games with the budgeting of health care reform, it is imperative that they understand that the “dissatisfaction with HSAs is greatest among those who have them,” whether conservative or liberal.
It is hoped that soon Congress will give up looking for magical solutions to pay for health care for everyone, and get serious about a solution that actually would work – a single payer national health program.

Views on IRAs and HSAs contrast sharply

Not the Next IRA: How Health Savings Accounts Shape Public Opinion

By Jason Barabas
Journal of Health Politics, Policy and Law
April 2009

This study has documented policy feedback effects of a personal nature. The central finding is that policy feedback effects occur, but they can be domain specific. That is, participation in investment accounts for retirement or health do not lead to uniformly conservative or liberal policy opinions. As expected, IRA owners tend to favor Social Security privatization, but that does not mean that investing always or unequivocally engenders support for investment account-based policy solutions. Participation in HSAs reduces public support for health care privatization. In particular, HSA owners, owing to their wildly different programmatic experiences, are much less likely to endorse individualized health care coverage. Thus, HSAs and related forms of consumer-driven health plans are not automatically designed to become “the next IRA.” The irony is that dissatisfaction with HSAs is greatest among those who have them.

http://jhppl.dukejournals.org/cgi/content/abstract/34/2/181

Comment:

By Don McCanne, MD

Much has already been written about the wisdom, or lack thereof, of health savings accounts (HSAs) and the high-deductible health plans that are linked with them. By design, they benefit higher-income individuals who are able to take advantage of the regressive tax policies, and who remain healthy, allowing the savings to accumulate for use in their retirement years. But they don’t work for individuals with modest incomes who have significant health care needs.

You would think that HSAs would be dismissed from the current dialogue on reform, but no. Our politicians are struggling with how to pay for comprehensive reform. One goal is to reduce spending on insurance premiums, and that makes lower-cost, high-deductible plans more attractive to those attempting to make reform cost-neutral, for the government, that is.

As Congress plays games with the budgeting of health care reform, it is imperative that they understand that the “dissatisfaction with HSAs is greatest among those who have them,” whether conservative or liberal.

It is hoped that soon Congress will give up looking for magical solutions to pay for health care for everyone, and get serious about a solution that actually would work – a single payer national health program.

Insurers waste your dollars to invade your privacy and cheat you

Insurers shun those taking certain meds

How health insurers secretly blacklist those with certain ailments.

By John Dorschner
The Miami Herald
March 28, 2009
Some insurers will automatically reject applicants who are using certain prescription drugs.
The medications, of course, are indications of specific health problems. To make sure that applicants are not lying, insurers hire a data-gathering service — Medical Information Bureau, Milliman’s Intelliscript or Ingenix Medpoint.
Intelliscript and Medpoint do computerized searches of a person’s drug use, gleaned from pharmacy benefits managers and other databases. The two companies say they comply with privacy laws. “Ingenix requires each Medpoint client to obtain the authorization of the individual applicant or insured person,” said Ingenix spokeswoman Karin Olson.
http://www.miamiherald.com/living/health/costs/story/973158.html

The health care financing systems in other nations are designed to assist patients in paying for their health care. Computerized searches of personal drug use as described in this article is yet one more example of how our private insurance industry adopts policies that are designed to avoid paying for the patients’ health care.
It is no surprise that UnitedHealth’s Ingenix is a player in this scheme to protect the insurers’ finances to the detriment of patients. They recently reached a settlement for cheating patients and physicians through another scheme to underpay for legitimate services, again protecting the insurers finances.
There are two issues here, about which we should all be concerned. First is that this is still another example of health care costs that are wasted on excessive administrative services. It is particularly egregious that these services, for which we are the payers, are detrimental rather than beneficial for the patients. That’s the opposite of what we should expect from our health care financing system.
The second concern is perhaps more ominous. Right now Congress and the administration are pushing the expansion of information technology (IT) systems when it is not at all clear that privacy and confidentiality issues are being adequately addressed. Pharmacy benefit managers (PBMs) are already using IT systems, and look at what is happening. Private insurers are doing computerized searches of your personal drug use gleaned from the PBM databases. Not only are they invading your privacy, but the intent is to defeat the purpose of insurance by denying you coverage.
Intelliscript (Milliman) and Medpoint (Ingenix/UnitedHealth) say that they comply with privacy laws, yet how many people in this gigantic private administrative bureaucracy have access to your personal information? The Fair Credit Reporting Act requires the companies to let you see your personal information if you so request, and how many more administrators are there to peek at your private records as the information is transmitted back to you? Merely passing laws against invasion of medical privacy is not enough. If invading your privacy in an IT system can be done, it will be done.
Isn’t there a theme here? We pay a whole lot of extra money to a private health care financing industry that uses our funds to cheat us out of the health care that we should have. And Congress and the administration are calling for an expansion of this very sick system of financing health care?
Congress should have the common sense, integrity, and decency to jettison the private insurance industry and provide us with our own public health care financing system that would save us money so it could be used where we want it to be used – on our health care. What is so difficult about this concept?

Insurers waste your dollars to invade your privacy and cheat you

Insurers shun those taking certain meds

How health insurers secretly blacklist those with certain ailments.

By John Dorschner
The Miami Herald
March 28, 2009

Some insurers will automatically reject applicants who are using certain prescription drugs.

The medications, of course, are indications of specific health problems. To make sure that applicants are not lying, insurers hire a data-gathering service — Medical Information Bureau, Milliman’s Intelliscript or Ingenix Medpoint.

Intelliscript and Medpoint do computerized searches of a person’s drug use, gleaned from pharmacy benefits managers and other databases. The two companies say they comply with privacy laws. “Ingenix requires each Medpoint client to obtain the authorization of the individual applicant or insured person,” said Ingenix spokeswoman Karin Olson.

http://www.miamiherald.com/living/health/costs/story/973158.html

Comment:

By Don McCanne, MD

The health care financing systems in other nations are designed to assist patients in paying for their health care. Computerized searches of personal drug use as described in this article is yet one more example of how our private insurance industry adopts policies that are designed to avoid paying for the patients’ health care.

It is no surprise that UnitedHealth’s Ingenix is a player in this scheme to protect the insurers’ finances to the detriment of patients. They recently reached a settlement for cheating patients and physicians through another scheme to underpay for legitimate services, again protecting the insurers finances.

There are two issues here, about which we should all be concerned. First is that this is still another example of health care costs that are wasted on excessive administrative services. It is particularly egregious that these services, for which we are the payers, are detrimental rather than beneficial for the patients. That’s the opposite of what we should expect from our health care financing system.

The second concern is perhaps more ominous. Right now Congress and the administration are pushing the expansion of information technology (IT) systems when it is not at all clear that privacy and confidentiality issues are being adequately addressed. Pharmacy benefit managers (PBMs) are already using IT systems, and look at what is happening. Private insurers are doing computerized searches of your personal drug use gleaned from the PBM databases. Not only are they invading your privacy, but the intent is to defeat the purpose of insurance by denying you coverage.

Intelliscript (Milliman) and Medpoint (Ingenix/UnitedHealth) say that they comply with privacy laws, yet how many people in this gigantic private administrative bureaucracy have access to your personal information? The Fair Credit Reporting Act requires the companies to let you see your personal information if you so request, and how many more administrators are there to peek at your private records as the information is transmitted back to you? Merely passing laws against invasion of medical privacy is not enough. If invading your privacy in an IT system can be done, it will be done.

Isn’t there a theme here? We pay a whole lot of extra money to a private health care financing industry that uses our funds to cheat us out of the health care that we should have. And Congress and the administration are calling for an expansion of this very sick system of financing health care?

Congress should have the common sense, integrity, and decency to jettison the private insurance industry and provide us with our own public health care financing system that would save us money so it could be used where we want it to be used – on our health care. What is so difficult about this concept?

The way forward on health care reform

By CORNELIUS HOGAN
Rutland Herald
Published: March 25, 2009

President Obama and Budget Director Peter Orzag are “on the money” in their views about controlling the cost of health care as the key to future health care access and quality, plus the role that controlling health care costs plays in our economic recovery. Without controlling cost, all changes and initiatives currently in motion and contemplated will not work and will quickly make things worse.

For example, in the two states of Massachusetts and Vermont, which were highlighted at the president’s health care forum at the University of Vermont on March 17, well-meaning programs and actions taken to date, are doomed to failure because they do not begin to address the cost issue.

In Vermont subsidizing health care has perhaps helped a very few people, but it is fiscally unsustainable in an environment where the cost of health care is rising at two to three times inflation. Nor will “disease management,” although good public policy, have an impact on controlling health care cost within our lifetime.

In Massachusetts, if it were not for the temporary and major largesse of the federal government, the mandate program would be dead in its tracks.

Both of these experiments, even though positioned as paradigms of progress, don’t come close to being remotely sustainable.

If we are to have even a chance at controlling the overall cost of health care, we need to put in place several basic practices, which at this point are not in evidence, or even being contemplated. They are: an integrated, enforceable budget (what other human enterprise doesn’t have one?); fair financing where we all contribute and all are in; health care planning based on the need of the population; and elimination of unnecessary and costly utilization review, benefit review, eligibility review, advertising, and the gross transaction costs of billing, collecting, generally chasing the money, much of it from people who cannot afford it.

Actions short of these will continue to promote uncontrolled cost rises (health care costs have doubled over the last eight years) which will result, at some point in the near future, in a collapse of our hospitals, physician practices, and other vital health care services. It will also result in pricing tens of thousands more Vermonters out of care. Federal bailouts won’t last forever.

Let us help our president control these costs. Put some bigger options, such as Medicare for all, hospital benefit for all, or even single-payer on the table. These broad-based approaches are our only chance at up-righting health care, which is now ever ripe for a collapse.

Cornelius Hogan was secretary of human services under Govs. Richard Snelling and Howard Dean. He was coauthor of “At the Crossroads: The Future of Health Care in Vermont.”

Faith groups: health care is a moral right

Albany, N.Y., forum shows support for single payer

By Single Payer New York

ALBANY, N.Y. — The Presbyterian Church joined today with local community, labor and medical groups to sponsor a Congressional Town Hall forum in support of a single-payer health care system that would provide health care to all Americans regardless of the economic or employment status. The forum drew about 300 people who jammed the Westminster Presbyterian Church.

The keynote speaker was Rep. John Conyers (D-Mich.), the lead sponsor of H.R. 676, the U.S. National Health Care Act, also titled Expanded and Improved Medicare for All. Joining Conyers on the platform was Rep. Paul Tonko (D-N.Y.).

Conyers’ bill, which would replace private health insurance with a single public financing system to provide comprehensive coverage for everyone in the nation, has the most support of any universal health care proposal now in Congress. It also is the plan that is most favored by the American public, doctors, nurses and researchers
Conyers participated in the recent White House Summit on Health Care Reform to advocate for single-payer health care.

“Serious reform of the health care system is the first step towards economic recovery,” Conyers told the assembly. “I am pleased to take part in this critical discussion on health care reform with the president, medical professionals, healthcare scholars, patients’ advocates and labor leaders. Those who have been working so tenaciously for single-payer reform to our health care system will finally have their voices heard. Our goal: quality health care for all.”

Single-payer legislation is also pending in both houses of the New York State Legislature and a state study on various universal health care options is due shortly after the budget is released. A majority of Assembly members and a majority of Democratic state senators have sponsored single-payer legislation; Gov. David Paterson was a sponsor as a member of the state Senate. A state-funded study on various universal health care options is due shortly after the budget is released.

The Town Hall Meeting, sponsored by the Albany Presbytery, is one of 10 nationwide meetings funded by the Presbyterian Church USA to open discussion of single-payer health care for the United States. A major focus of the event was the moral right of all Americans to have health care. Faith representatives include Rev. Cass Shaw, the General Presbyter of the Albany Presbytery; Chandlee Gill of the Albany Presbytery; Dr. Richard Propp of the B’nai Sholom Reform Congregation (Albany) and Yussouf Mir of the Islamic Center of the Capital District.

Co-sponsors of the event included the Albany Presbytery, Capital Area Council of Churches, Interdenominational Ministers Conference, Fifth Avenue AME Zion Church of Troy, Labor Religion Coalition of N.Y. State, Single Payer New York, Capital District Area Labor Federation, Capital District Alliance for Universal Health Care, Solidarity Committee of Program (PNHP) Capital District Chapter, Albany Medical College Student PNHP Chapter, Hunger Action Network of NYS and Faith and Hunger Network.

The groups urged President Obama and Congress to reject a Massachusetts-style plan that mandates that individuals purchase health insurance.

“America deserves the health benefits offered to the people of every other country in the industrialized world, all medically necessary care and freedom from the fear of economic ruin due to illness,” said Mike Keenan, president of the Troy Area Labor Council. “The bottom line is that single payer is the one proposal that guarantees quality, affordable health care to every American. This would also be a great benefit to our economy in our time of crisis, helping to control costs for taxpayers, consumers and employers.”

Single payer merely means that one program pays all bills, like Medicare does for senior citizens. It eliminates the paperwork, high administrative costs and profits of the for profit private insurance system. An article in the New England Journal of Medicine concluded the single-payer approach would save $350 billion a year in costs; somewhat smaller savings estimates have been made by the Congressional Budget Office. A study done for the state of California estimated that a state single-payer plan would reduce health costs by $38 billion annually over a 10-year period.

President Obama has also been a supporter of single payer health care in the past and acknowledged its benefits during his election campaign. While he said recently that he would enact single payer if he were “starting from scratch,” he has so far failed to put the issue on the table as part of his forums on health care.

The federal single payer bill (H.R. 676) has gained the support of 94 representatives in the last session of the U.S. House, 480 union bodies, 39 state AFL-CIOs (including New York’s), 117 central labor councils, 20 international unions, the U.S. Conference of Mayors, the Houses of Representatives in Kentucky, New Hampshire and N.Y. (State Assembly), and hundreds more cities, counties, faith groups and organizations. Rep. Tonko is a sponsor in the new session. (Seventy-two sponsors have co-sponsored in Congress this session, with more being added every week. New York sponsors so far include Reps. Clarke, Engel, Hinchey, Maloney, Massa, Meeks, Nadler, Tonko and Velazquez.)

A recent national survey by Indiana University of 2,193 doctors found almost 60 percent in favor of national health insurance (NHI) — a 10 percent increase in support since 2002. A March 2007 poll by CBS/ N.Y. Times found that 64 percent of respondents said the government should guarantee health insurance for all; 27 percent said it should not. An overwhelming majority in the poll said the health care system needed fundamental change or total reorganization.

“America’s health care system is in deep trouble,” said Mark Dunlea, executive director of the Hunger Action Network of NYS. “Nearly 50 million Americans are currently without health insurance, more than 75 million went without insurance for some length of time within the past two years, and tens of millions more have inadequate coverage. More than 18,000 Americans die annually due to a lack of insurance.”

A 2008 study published in the journal Health Affairs concluded that as many as 101,000 deaths a year could be prevented by ensuring that all patients receive quality care in a timely manner.

The United States spends 16 percent of gross domestic product on health care ($7,129 per capita), twice what any other industrialized nation spends, yet ranks 37th in performance according to the World Health Organization. We lag behind other industrialized countries in life expectancy and infant mortality. Health care bills cause over 50 percent of bankruptcies and three out of four of those bankrupted by medical bills had health insurance.

The reason the U.S. spends more and gets less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes about one-third (31 percent) of Americans’ health dollars.

The groups urged President Obama to reject the idea of mandating that individuals purchase insurance. The recent insurance mandate in Massachusetts is already running into problems due to higher taxpayer costs than anticipated; inadequate coverage being offered; and many residents deciding to pay the penalty rather than buying insurance they can’t afford.

“We’ve done many experiments tweaking private health insurance,” said Dr. Paul Sorum, chairperson of the Capital District chapter of the Physicians for a National Health Program. “It doesn’t work. Two decades of state-level reform efforts have demonstrated that mandate plans don’t reduce costs or the number of uninsured. They add bureaucracy and regulation, not health care value.

“We’ve also done an experiment with national health insurance,” he said. “It works. Medicare is not perfect, but Americans with Medicare are happier with their insurance than those with private insurance. Doctors have less hassle getting paid by Medicare than by private insurers.”

Variants of the mandate model, first proposed by Richard Nixon, were passed with great fanfare in Massachusetts (1988), Oregon (1989) and Washington State (1993). All failed. As costs soared, legislators backed off from enforcing the mandates or funding new coverage for the poor. Massachusetts’ recent reform, which largely excuses employers from the mandate but imposes steep fines on the uninsured, appears poised to follow a similar path. Of the middle-income uninsured that are required to pay the full premium for coverage, few have signed up. Meanwhile, the state has already announced a $147 million shortfall in funding for subsidies for the poor.

Dr. Richard Propp, chair of the Capital District Alliance for Universal Health Care, said: “We can’t afford to include bloated administrative overhead and profit in universal coverage. Administrative costs in the for-profit health insurance system consume nearly one-third of our health care spending. We will never have enough money to provide everyone with decent care until we eliminate private insurance, the main source of waste and inadequate coverage.

Propp continued: “Single payer reduces administrative costs and provides an infrastructure to supports chronic disease management, an emphasis on primary care and the use of electronic medical records. The fragmented private insurance system created the perverse incentives that have set us so far behind other countries in these areas. Mandate proposals preserve the fragmentation.”

Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.

Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO/group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.

A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled through negotiated fees, global budgeting and bulk purchasing.

Photos from the event at http://picasaweb.google.com/jonflan/SinglePayerTownHallWithJohnConyers#

Single Payer New York: http://www.singlepayernewyork.org/

A supplementary note from Mark Dunlea:

After the event, the speaker receiving was the most praise was Dr. Andy Coates of Physicians for a National Health Program, who explained single payer and its importance at the moment.

Forum participants wrote several hundred letters to their elected officials after the meeting adjourned.

Rep. Conyers also spoke about single-payer care to 100 people at a fundraiser for Rep. Tonko and had a meeting after his talk at the church with 15 local African American leaders, who asked him to come back in a few months for an event they will organize.

STAKEHOLDERS AGREE! (to block reform)

Health Reform Dialogue

March 27, 2009
A Time for Reform:
…several widely diverse, national organizations began a series of unique discussions six months ago to exchange ideas and see where their agreements and differences lay.
This health reform dialogue was never intended to cover every issue likely to arise as health reform is considered in the ensuing months. Some issues currently elude consensus.
Increasing coverage and access:
Regarding coverage, reform should build upon the key pillars of health care coverage today — employer-sponsored insurance and public safety-net programs for low-income people and families.
* Improve Medicaid and Children’s Health Insurance Program (CHIP) outreach and enrollment.
* Establish a nationwide floor for Medicaid eligibility for all adults no lower than 100 percent of the federal poverty level.
* Give individuals eligible for Medicaid and CHIP the option to utilize those dollars to purchase employer-sponsored insurance…
* Provide advanceable, refundable tax credits or other subsidies on a sliding scale for individuals and families to purchase adequate and affordable coverage…
* Provide subsidies for small businesses to provide health insurance for their employees.
* Enact reforms necessary so that all individuals will purchase or obtain quality, affordable health insurance.
Strengthening wellness and prevention:
The Centers for Disease Control and Prevention estimate that eliminating three risk factors — poor diet, inactivity, and tobacco use — would prevent 80 percent of heart disease and stroke, 80 percent of Type 2 diabetes, and 40 percent of cancer.
* Identify effective clinical preventive services.
* Encourage clinicians and providers to deliver effective clinical preventive services and follow-up treatment, as indicated.
* Ensure a sufficient primary care workforce through an ongoing, dynamic, national planning and development process.
* Continue to invest in health information technology (HIT) that supports wellness and prevention, both on the individual and community levels.
* Further encourage businesses to support healthy behaviors.
* Encourage communities to be healthy.
* Eliminate disparities in health.
* Help individuals improve their health.
Ensuring quality and value:
* Conduct comparative clinical effectiveness research (CER) studies via a public-private partnership to provide additional information that can help improve care decisions.
* Expand and accelerate the development of meaningful quality measures.
* Fund state demonstrations of alternative medical liability reform models.
* Improve billing efficiencies to reduce confusion and duplication for patients, clinicians, and providers.
* Reduce administrative costs.
* Work to reduce geographic, racial, ethnic, and gender disparities in health care delivery.
* Ensure an adequate health care delivery workforce, including funding for training and loan forgiveness programs and payment reforms directed at primary care, public health and nursing, and other high-priority areas facing imminent shortages.
Context for Financing Health Care:
* Cost efficiencies can be gained by improving health care delivery.
* Methodologies for quantifying long-term cost savings can be improved.
* To jumpstart health reform, additional investments in U.S. health care will be needed.
Enacting meaningful health reform requires a careful and balanced approach of fiscal prudence, accompanied by efforts to contain costs, increase savings, and enhance efficiencies. Such investments will enable transformational changes to be achieved — and those transformational changes will ultimately place the United States on a path toward greater financial and health care security.
Organizations endorsing this document include:
AARP
Advanced Medical Technology Association
America’s Health Insurance Plans
American Cancer Society Cancer Action Network
American College of Physicians
American Hospital Association
American Medical Association
American Nurses Association
American Public Health Association
Blue Cross and Blue Shield Association
Business Roundtable
Catholic Health Association of the United States
Families USA
Federation of American Hospitals
Healthcare Leadership Council
National Federation of Independent Business
Pharmaceutical Research and Manufacturers of America
U.S. Chamber of Commerce
http://www.advamed.org/NR/rdonlyres/42134469-D897-4AE8-B48E-DBB46B84255F/0/HRDCommonGroundFINALEMBARGOED32709.pdf

This report, “Health Reform Dialogue,” contains a few modest but obvious recommendations that any reasonable reform effort must include. Much more important is that the primary theme of this report, as exemplified by the sampling of recommendations listed above, is that we should continue with the status quo, dumping more of our dollars into our dysfunctional, wasteful, inefficient, fragmented system of financing health care.
So why should we pay any attention at all to this worthless contribution to the national dialogue on health care reform? It is because it exposes the blatant lie that we are close to agreeing on reform that would bring affordable, high quality care to all residents of the United States.
This highly touted, closed door process has been taking place over the past half year. Theoretically all important stakeholders were included (except patients). They agreed that we have finally come to the time that reform is an absolute imperative. Through intensive negotiations behind closed doors in a (symbolically) smoke-filled room, they finally agreed… that smoking is bad for your health (and a couple of other points of less significance).
There is absolutely no mention of a single payer national health program, or Medicare for All. That option was discarded before anyone walked into the room.
The compromise position to which the progressives had agreed would be to offer a public, Medicare-like insurance program to compete in the market of private plans. “Health Reform Dialogue” remains silent on such an option.
In a decision to exclude the progressive community from playing any serious role in reform, moderates are now proposing a government-sponsored, managed care PPO program, insulated by a double firewall from the government, so that it must compete on a “fair playing field” with the private plans. “Health Reform Dialogue” even remains silent on the possibility of offering a government PPO that would be required to include the same perverse policies that are inherent features of the private health plan models.
Look again at the organizations that signed on to this report. Two organizations that participated in the process are conspicuously absent: American Federation of State, County and Municipal Employees (AFSCME) and the Service Employees International Union (SEIU). At the end of this process, they refused to sign on to a document that would have even less impact than a no smoking pledge.
Look again at the list and decide which organizations actually controlled the process. Yes, those are the same organizations that have an ownership position in the Congress of the United States.
Unless Americans are ready to march on Washington, both literally and figuratively, the reform process is dead. Yes, dead!

STAKEHOLDERS AGREE! (to block reform)

Health Reform Dialogue

March 27, 2009

A Time for Reform:

…several widely diverse, national organizations began a series of unique discussions six months ago to exchange ideas and see where their agreements and differences lay.

This health reform dialogue was never intended to cover every issue likely to arise as health reform is considered in the ensuing months. Some issues currently elude consensus.

Increasing coverage and access:

Regarding coverage, reform should build upon the key pillars of health care coverage today — employer-sponsored insurance and public safety-net programs for low-income people and families.

* Improve Medicaid and Children’s Health Insurance Program (CHIP) outreach and enrollment.

* Establish a nationwide floor for Medicaid eligibility for all adults no lower than 100 percent of the federal poverty level.

* Give individuals eligible for Medicaid and CHIP the option to utilize those dollars to purchase employer-sponsored insurance…

* Provide advanceable, refundable tax credits or other subsidies on a sliding scale for individuals and families to purchase adequate and affordable coverage…

* Provide subsidies for small businesses to provide health insurance for their employees.

* Enact reforms necessary so that all individuals will purchase or obtain quality, affordable health insurance.

Strengthening wellness and prevention:

The Centers for Disease Control and Prevention estimate that eliminating three risk factors — poor diet, inactivity, and tobacco use — would prevent 80 percent of heart disease and stroke, 80 percent of Type 2 diabetes, and 40 percent of cancer.

* Identify effective clinical preventive services.

* Encourage clinicians and providers to deliver effective clinical preventive services and follow-up treatment, as indicated.

* Ensure a sufficient primary care workforce through an ongoing, dynamic, national planning and development process.

* Continue to invest in health information technology (HIT) that supports wellness and prevention, both on the individual and community levels.

* Further encourage businesses to support healthy behaviors.

* Encourage communities to be healthy.

* Eliminate disparities in health.

* Help individuals improve their health.

Ensuring quality and value:

* Conduct comparative clinical effectiveness research (CER) studies via a public-private partnership to provide additional information that can help improve care decisions.

* Expand and accelerate the development of meaningful quality measures.

* Fund state demonstrations of alternative medical liability reform models.

* Improve billing efficiencies to reduce confusion and duplication for patients, clinicians, and providers.

* Reduce administrative costs.

* Work to reduce geographic, racial, ethnic, and gender disparities in health care delivery.

* Ensure an adequate health care delivery workforce, including funding for training and loan forgiveness programs and payment reforms directed at primary care, public health and nursing, and other high-priority areas facing imminent shortages.

Context for Financing Health Care:

* Cost efficiencies can be gained by improving health care delivery.

* Methodologies for quantifying long-term cost savings can be improved.

* To jumpstart health reform, additional investments in U.S. health care will be needed.

Enacting meaningful health reform requires a careful and balanced approach of fiscal prudence, accompanied by efforts to contain costs, increase savings, and enhance efficiencies. Such investments will enable transformational changes to be achieved — and those transformational changes will ultimately place the United States on a path toward greater financial and health care security.

Organizations endorsing this document include:

AARP
Advanced Medical Technology Association
America’s Health Insurance Plans
American Cancer Society Cancer Action Network
American College of Physicians
American Hospital Association
American Medical Association
American Nurses Association
American Public Health Association
Blue Cross and Blue Shield Association
Business Roundtable
Catholic Health Association of the United States
Families USA
Federation of American Hospitals
Healthcare Leadership Council
National Federation of Independent Business
Pharmaceutical Research and Manufacturers of America
U.S. Chamber of Commerce

http://www.advamed.org/NR/rdonlyres/42134469-D897-4AE8-B48E-DBB46B84255F/0/HRDCommonGroundFINALEMBARGOED32709.pdf

Comment:

By Don McCanne, MD

This report, “Health Reform Dialogue,” contains a few modest but obvious recommendations that any reasonable reform effort must include. Much more important is that the primary theme of this report, as exemplified by the sampling of recommendations listed above, is that we should continue with the status quo, dumping more of our dollars into our dysfunctional, wasteful, inefficient, fragmented system of financing health care.

So why should we pay any attention at all to this worthless contribution to the national dialogue on health care reform? It is because it exposes the blatant lie that we are close to agreeing on reform that would bring affordable, high quality care to all residents of the United States.

This highly touted, closed door process has been taking place over the past half year. Theoretically all important stakeholders were included (except patients). They agreed that we have finally come to the time that reform is an absolute imperative. Through intensive negotiations behind closed doors in a (symbolically) smoke-filled room, they finally agreed… that smoking is bad for your health (and a couple of other points of less significance).

There is absolutely no mention of a single payer national health program, or Medicare for All. That option was discarded before anyone walked into the room.

The compromise position to which the progressives had agreed would be to offer a public, Medicare-like insurance program to compete in the market of private plans. “Health Reform Dialogue” remains silent on such an option.

In a decision to exclude the progressive community from playing any serious role in reform, moderates are now proposing a government-sponsored, managed care PPO program, insulated by a double firewall from the government, so that it must compete on a “fair playing field” with the private plans. “Health Reform Dialogue” even remains silent on the possibility of offering a government PPO that would be required to include the same perverse policies that are inherent features of the private health plan models.

Look again at the organizations that signed on to this report. Two organizations that participated in the process are conspicuously absent: American Federation of State, County and Municipal Employees (AFSCME) and the Service Employees International Union (SEIU). At the end of this process, they refused to sign on to a document that would have even less impact than a no smoking pledge.

Look again at the list and decide which organizations actually controlled the process. Yes, those are the same organizations that have an ownership position in the Congress of the United States.

Unless Americans are ready to march on Washington, both literally and figuratively, the reform process is dead. Yes, dead!