Judy Dasovich, M.D
The Springfield News-Leader
Ozarks Opinions
Saturday, August 4, 2007

In your 7/25 article, Jordan Valley Community Health Center Executive Director Brooks Miller stated that “We believe we all need to pay something.” At the Kitchen Medical and Dental Clinic we see patients every week who start out at Jordan Valley but cannot afford the minimum $30 per visit. Even patients who can afford the initial fee bring us their prescriptions, which they cannot afford. This $30 doesn’t cover specialty care or testing, such as a treadmill or a CAT scan or a visit to the cardiologist.

Here is the typical scenario: People get sick, then they can’t work so they lose their jobs and their medical insurance. They have a hard time paying their bills. Under these circumstances, $30 per visit for only the basics becomes prohibitive. These are the patients who come to us after finding that the Jordan Valley safety net is full of large holes. They may not have money but they’re still sick.

We believe people should receive health care based on need, not ability to pay. As many leaders in the Springfield health care community pointed out, this problem is too big for any one group to handle alone. I believe that Medicare for all will be the most effective and affordable solution. In this form of universal care, the delivery system (hospitals, doctors, etc.) stays in the hands of private business. It is the insurance piece that is handled by the government. Currently, Medicare overhead is less than 3 percent, while private insurance averages about 12-15 percent and can be higher. Patient satisfaction with Medicare insurance is higher than it is with private insurance. Traditional Medicare doesn’t exclude people for pre-existing conditions or cancel their insurance once people become ill. Medicare insurance also allows patients the freedom of choice advocated by Donald Tucker in his 7/28 News-Leader article. They can choose any doctor or hospital they want. Medicare for all is similar to the system that gets interstate highways built — federal tax dollars pay private business to produce a common good.

It’s time to put aside reliance on incomplete safety nets like emergency rooms, free clinics, and taxpayer-funded health care centers like Jordan Valley that turn sick people away. Contact the people that work for you in Washington today.

Judy Dasovich, M.D., is volunteer medical director at the Kitchen Medical and Dental Clinic.

By Stephen J. Bergman
The Boston Globe
August 5, 2007

SOON AFTER HMO/managed care came to Massachusetts in the late ’80s, I got a call from a patient I had admitted to the 28-day alcohol unit at the hospital. He said that he was being discharged after three days because that was all that the HMO would now pay for alcoholism. He said the HMO representative told him to go out and get drunk again and they would readmit him.

How did this happen? Managed care let it be known through massive advertising that either doctors join up, or be left out — we would lose patients to HMO doctors. This seemed strange: Doctors did the work; without us, there was no “care” to manage. If we stuck together, we could get what we wanted from the insurance industry. Instead, doctors elbowed each other out of the way to make sure they would “get in.” We lost our clout in setting standards for good care for patients, and a work environment that would allow it.

Now, healthcare in America is a national disgrace. Forty-five million are uninsured, most are underinsured — one illness away from bankruptcy, poverty, or homelessness. Our private healthcare system is worse for patients and doctors and better for the insurance industry. Even the insured are suffering. Their doctors are rushed, mistakes are made, good care is hard to find. Private health insurance spends about 30 percent on administrative costs; government-run Medicare spends 3 percent. The single-payer national model seems inevitable.

Yet it has not happened. The health insurance industry is profitable, and a well-funded lobby. Only one of the presidential candidates (Dennis Kucinich) is sponsoring a single-payer system — the others are just whistling past the grave of medical care. However, elements of change are arising — scholars, politicians, media, pundits, and the public, and now Michael Moore, in his new documentary “Sicko,” pointing out the relative inadequacies of our system. But one piece, a vital piece, has been missing.

Change will not originate from the top. In any hierarchical system, the only threat to the dominant group is the quality of connection among the subordinate group. This is true of race, gender, class, ethnicity, and sexual preference. In three great movements of my lifetime — women’s rights, civil rights, and the ending of the Vietnam War — change came from my generation seeing an injustice and believing that by organizing together at the grass-roots level we could right an obvious wrong. And now?

I propose a doctors strike (or a healthcare workers strike, but I can only speak as a doctor). First, doctors would recruit enough colleagues to pledge that if, in two years (say, by July 4, 2009), there is not a federal law for a single-payer, universal coverage health system, we will go on strike.

At first we will be dismissed as idealistic or ungrateful nuts advocating that horror of horrors, “socialized medicine.” We may not have many members, and the insurance industry will mobilize in a way that makes the ads against the Clinton health bill look like musical comedy.

Six months pass; we remind the public that in 18 months we will go on strike. Our ranks increase — patients, realizing that it is in their interest to directly support the strike, join us — and more attention gets paid. Twelve months until the strike, we are growing in membership — other healthcare workers join, maybe even a company like General Motors that is sick and tired of paying more for health insurance than for the steel for their cars — and we spell out exactly what we won’t provide and the resulting chaos in our hospitals, emergency rooms, outpatient clinics, etc. Perhaps those in the government start to notice.

At six months, with tens of thousands pledging to strike, we may be taken quite seriously — the public understands that the consequences of a strike would be disastrous. What irony: To protect patients, doctors have to go on strike!

I predict that it will never come to that. We will put real health insurance on the books.

We are the ones who do the work. If we care for our patients, and for our Hippocratic ideals, we have no choice but to try. Our efforts, in sync with the rising tide of public and political movements, might just lift us all, leading America into the fold of those rich nations who put first things first: the health security of their citizens.

*Stephen J. Bergman, *under the pen-name “Samuel Shem,” is author of the novels “The House of God” and “Mount Misery” and co-author of the play “Bill W. and Dr. Bob.”

(c) Copyright 2007 Globe Newspaper Company.

Toronto June 26, 2007 — While there has been significant progress to improve and manage centralized information on wait times for targeted health care procedures, the data needed to see changes over time and compare wait times on a national level is not available from all jurisdictions, the Health Council of Canada says in its wait times report, released today.

Wading through Wait Times: What Do Meaningful Reductions and Guarantees Mean? reviews progress by provinces and territories in reducing wait times for non-emergency care from a patient’s perspective through a true story about Frank, a hip replacement patient.

This report is a look at one of the key public concerns about health care, set in the context of the national commitment to achieve meaningful reductions in wait times in five priority areas — cancer, heart, diagnostic imaging, joint replacements and sight restoration — by March 31, 2007.

“Clearly there has been progress, and we can see many areas where jurisdictions are doing more and reporting in more accessible ways to citizens,” said Dr. Jeanne Besner, Chair, Health Council of Canada. “Reporting wait time information to citizens on the Internet has been no small task. These information systems have considerable potential to improve patients’ experiences with waits for care.”

Approximately one in 10 Canadians sees a health care specialist each year, with many patients reporting delays in accessing care. On average, Canadians reported waiting four weeks to see a specialist, according to surveys done in 2003 and 2005. Although provinces and territories report wait times in different ways, information shows median wait times for non-emergency care have clearly declined for some services. For example:

* In British Columbia the wait time for cataract surgery has been reduced to 7.6 weeks from 9.9 weeks;
* In Ontario the wait time for radiation for cancer care has been reduced to 4.4 weeks from 6.4 weeks;
* In Alberta the wait time for hip replacement has been reduced to 12 weeks from 16 weeks and for knee replacement has dropped to 17 weeks from 22 weeks.

These and other positive developments come at the same time the volume of services has increased in targeted areas. For some services, in some parts of the country, more people are getting care more quickly.

While the information now available for wait times is not sufficient for Canada-wide monitoring, having this data in the public realm is a significant step forward and means wait lists are beginning to be managed centrally in a fair and logical way. Until recently most surgeons kept their own waiting lists and data were rarely compiled at the provincial, regional or hospital level. Unfortunately, gaps remain in the availability of wait times information and the Health Council of Canada continues to call for accelerated investments in the development of comparable data systems across the country.

Developed, in part, through interviews with leaders of innovative programs (see backgrounder), Wading through Wait Times identifies a number of factors that are critical for success in reducing health care wait times. They are:

* Support from government leaders;
* Strong program leadership;
* Full-time program staff;
* Information systems to centralize and track waiting lists;
* Adequate funding for information systems and program leadership;
* A comprehensive approach to all the changes required to reduce wait times.

In addition to reporting on progress in reducing wait times for care as agreed to in the 2004 10-Year Plan to Strengthen Health Care, this update provides Canadians with information on the new patient wait time guarantees.

“Ideally, the best guarantee is one that rarely, if ever, needs to be invoked,” said Councillor Les Vertesi, an emergency physician from British Columbia. “Jurisdictions have chosen to implement guarantees for services they already provide, or are well on their way to delivering, within the guaranteed time frame.”

As Wading through Wait Times concludes, international experiences with wait time guarantees may be instructive, but they cannot tell us what impact Canadians can expect from these policies until they are coupled with reliable and comparative data. Guarantees may play a valuable role in resolving Canada’s wait time problem. But unless access also improves for other health services, the guarantees by themselves may fall short of meeting the expectations of Canadians.

Visit www.healthcouncilcanada.ca to download Wading through Wait Times: What Do Meaningful Reductions and Guarantees Mean? and the backgrounder highlighting regional success stories in reducing wait times.

Background

The Health Council of Canada, created by the 2003 First Ministers’ Accord on Health Care Renewal following the recommendations of the Romanow and Kirby reports, is mandated to monitor and report on the progress of health care renewal in Canada. The 26 Councillors were appointed by the participating provinces, territories and the Government of Canada and have expertise and broad experience in community care, Aboriginal health, nursing, health education and administration, finance, medicine and pharmacy.

David Felix, economist
Bangor Daily News
Wednesday, August 1, 2007

John Goodman summarizes his critique of Michael Moore’s documentary on health care reform (“Sicko is no model for health care reform,” BDN, July 21), as follows: “So what are we to make of Moore and his ‘documentary’? Economists, like other scientists, study reality in order to adapt to it. Artists, by contrast, selectively focus on some facts and ignore others in order to recreate reality.” Bad economics is thus Goodman’s basic charge against “Sicko.”

This charge prompted me, an economist, to see the documentary. My conclusion? Moore is far less guilty of flawed economics and disregard of relevant facts than is Goodman. Moore is also straightforward about his values and ideology, whereas Goodman masks his as scientific economics. This impels me to defend my profession by exposing the falsity of his claims, and some of the salient facts that he ignores.

Goodman rejects single payer universal coverage health systems, which Moore favors, because they require bureaucratic rationing of medical care, and impose longer waiting periods than do private market health systems. The rationing complaint as such is irrelevant; markets also ration, mostly by the purse. What they have been unable to do is provide universal coverage.

The incentive for private health insurance companies is to maximize profits by insuring low-risk clients and rejecting high risk ones. That incentive promotes /private /bureaucratic rationing of services and intensified screening of applicants. The U.S. public sector and private charities have thus been pressured to finance treatment of some sort for the rapidly rising millions of U.S. uninsured and underinsured. “Sicko” illustrates various aspects of the problem. Goodman gives it no mention whatsoever.

Waiting time is emphasized by Goodman, although he ignores some important dimensions of the waiting issue, and presents biased treatment of others.

Thus the socialized systems of Britain, Canada, Australia and New Zealand assign lower priorities and longer delays to elective (e.g., cosmetic) and non-emergency (e.g., hip replacement) surgery than to emergency (e.g., cardiac or cancer) surgery.

The U.S. has the shortest average waiting time for elective and non-emergency surgery, but is merely in the middle of the Anglo-Saxon group for emergency surgery. The same for delay in seeing a specialist.

Goodman combines the two priorities, lowering the overall U.S. waiting time to first place, which allows him to claim it indicates the extra risk of death that government rationing imposes in emergency cases.

He disregards that the U.S. is the most difficult of the Anglo-Saxon group in getting same-day doctor appointments; shares with Canada the most difficulty in getting treatment on nights and weekends; and that France, Germany, Japan and the Scandinavians have still shorter delays than the Anglo-Saxon group in almost all dimensions of waiting. Implication? Bureaucratic rationing is unavoidable in universal coverage government health programs, but longer waits are not.

Goodman’s data manipulation and his assumption that longer waits have deadly consequences imply that the U.S. should have longer life expectancy and a lower rate of infant mortality than the industrial countries with socialized medicine.

But he doesn’t test that implication, enabling him to ignore that the U.S. has the lowest life expectancy and highest infant mortality rate of the industrialized democracies. Instead, he puzzles over why national health insurance seems so popular in these countries, concluding it’s because their citizenry, unaware that they pay by taxes, think they’re getting something for nothing.

And so to another of Goodman’s major omissions. The overall cost of health, taxes and all, is far higher in the U.S. than in any of the countries with universal coverage socialized health systems. U.S. overall spending on health is pushing 16 percent of its GDP and rising, as are its millions of uninsured. The overall health spending of the countries with socialized health insurance averages around 10 percent of GDP, with none reaching 12 percent, and all providing universal coverage. We pay the most to cover the least.

Can we cover more while paying less? Kenneth Thorpe, perhaps the top U.S. health economist, was recently commissioned by a broad coalition of 90 corporations, unions and advocacy groups to answer the question statistically. His report estimates the annual cost of moving to universal coverage at $75 billion in constant U.S. dollars, but this could be more than offset by reducing administrative costs to the Canadian level, acquiring pharmaceuticals at Canadian prices, and by earlier detection and treatment of patients now priced out of the current health system.

The annual savings in 10 years would reach $125 billion, with the current health system preserved, up to $182 billion if transformed to a single payer insurance system. These numbers estimate what economists call deadweight losses, inefficient uses of resources that reduce national welfare. “Sicko” illustrates such losses in the U.S. system; Goodman ignores them.

Which brings us to the moral issue. The major religions advocate egalitarian distribution of social welfare theologically, whereas libertarian ideology prioritizes free markets and individual choice. Each can become enmeshed by policy conflicts between theology and economic reality.

Health reform is an exception. Moore has the easier advocacy task: his single-payer reform is supported by both “scientific” economics and widely held religious principles.

Goodman must show that socializing health insurance, even if it lowers economic costs while improving health, is morally bad. His critique avoids that question, other than hinting at a slippery slope argument. My conclusion: Moore wins over Goodman on economics and morality.

David Felix of Orono is professor emeritus of economics at Washington University in St. Louis.

David Felix, economist
Bangor Daily News
Wednesday, August 1, 2007

John Goodman summarizes his critique of Michael Moore’s documentary on health care reform (“Sicko is no model for health care reform,” BDN, July 21), as follows: “So what are we to make of Moore and his ‘documentary’? Economists, like other scientists, study reality in order to adapt to it. Artists, by contrast, selectively focus on some facts and ignore others in order to recreate reality.” Bad economics is thus Goodman’s basic charge against “Sicko.”

This charge prompted me, an economist, to see the documentary. My conclusion? Moore is far less guilty of flawed economics and disregard of relevant facts than is Goodman. Moore is also straightforward about his values and ideology, whereas Goodman masks his as scientific economics. This impels me to defend my profession by exposing the falsity of his claims, and some of the salient facts that he ignores.

Goodman rejects single payer universal coverage health systems, which Moore favors, because they require bureaucratic rationing of medical care, and impose longer waiting periods than do private market health systems. The rationing complaint as such is irrelevant; markets also ration, mostly by the purse. What they have been unable to do is provide universal coverage.

The incentive for private health insurance companies is to maximize profits by insuring low-risk clients and rejecting high risk ones. That incentive promotes /private /bureaucratic rationing of services and intensified screening of applicants. The U.S. public sector and private charities have thus been pressured to finance treatment of some sort for the rapidly rising millions of U.S. uninsured and underinsured. “Sicko” illustrates various aspects of the problem. Goodman gives it no mention whatsoever.

Waiting time is emphasized by Goodman, although he ignores some important dimensions of the waiting issue, and presents biased treatment of others.

Thus the socialized systems of Britain, Canada, Australia and New Zealand assign lower priorities and longer delays to elective (e.g., cosmetic) and non-emergency (e.g., hip replacement) surgery than to emergency (e.g., cardiac or cancer) surgery.

The U.S. has the shortest average waiting time for elective and non-emergency surgery, but is merely in the middle of the Anglo-Saxon group for emergency surgery. The same for delay in seeing a specialist.

Goodman combines the two priorities, lowering the overall U.S. waiting time to first place, which allows him to claim it indicates the extra risk of death that government rationing imposes in emergency cases.

He disregards that the U.S. is the most difficult of the Anglo-Saxon group in getting same-day doctor appointments; shares with Canada the most difficulty in getting treatment on nights and weekends; and that France, Germany, Japan and the Scandinavians have still shorter delays than the Anglo-Saxon group in almost all dimensions of waiting. Implication? Bureaucratic rationing is unavoidable in universal coverage government health programs, but longer waits are not.

Goodman’s data manipulation and his assumption that longer waits have deadly consequences imply that the U.S. should have longer life expectancy and a lower rate of infant mortality than the industrial countries with socialized medicine.

But he doesn’t test that implication, enabling him to ignore that the U.S. has the lowest life expectancy and highest infant mortality rate of the industrialized democracies. Instead, he puzzles over why national health insurance seems so popular in these countries, concluding it’s because their citizenry, unaware that they pay by taxes, think they’re getting something for nothing.

And so to another of Goodman’s major omissions. The overall cost of health, taxes and all, is far higher in the U.S. than in any of the countries with universal coverage socialized health systems. U.S. overall spending on health is pushing 16 percent of its GDP and rising, as are its millions of uninsured. The overall health spending of the countries with socialized health insurance averages around 10 percent of GDP, with none reaching 12 percent, and all providing universal coverage. We pay the most to cover the least.

Can we cover more while paying less? Kenneth Thorpe, perhaps the top U.S. health economist, was recently commissioned by a broad coalition of 90 corporations, unions and advocacy groups to answer the question statistically. His report estimates the annual cost of moving to universal coverage at $75 billion in constant U.S. dollars, but this could be more than offset by reducing administrative costs to the Canadian level, acquiring pharmaceuticals at Canadian prices, and by earlier detection and treatment of patients now priced out of the current health system.

The annual savings in 10 years would reach $125 billion, with the current health system preserved, up to $182 billion if transformed to a single payer insurance system. These numbers estimate what economists call deadweight losses, inefficient uses of resources that reduce national welfare. “Sicko” illustrates such losses in the U.S. system; Goodman ignores them.

Which brings us to the moral issue. The major religions advocate egalitarian distribution of social welfare theologically, whereas libertarian ideology prioritizes free markets and individual choice. Each can become enmeshed by policy conflicts between theology and economic reality.

Health reform is an exception. Moore has the easier advocacy task: his single-payer reform is supported by both “scientific” economics and widely held religious principles.

Goodman must show that socializing health insurance, even if it lowers economic costs while improving health, is morally bad. His critique avoids that question, other than hinting at a slippery slope argument. My conclusion: Moore wins over Goodman on economics and morality.

David Felix of Orono is professor emeritus of economics at Washington University in St. Louis.

Naomi Lakritz
Calgary Herald
Thursday, August 02, 2007

It’s been said that during the 12 or so years they spend in medical school, doctors learn to think of themselves as gods.

Well, the gods must be crazy. Or greedy. Or both. How else to explain the Canadian Medical Association’s ridiculous support for physicians’ right to work simultaneously in both a public and private system, including the introduction of private health insurance — and the gall to label this as standing up for their patients?

It is patently obvious they are standing up for their bank accounts, not their patients. That they are so eager to place patients at the mercy of insurance companies, whose subterfuges for skipping out on claims are well-documented in the U.S., shows their patients’ best interests are the last priority.

A recent New York Times article profiled Gordon Hendrickson, 66, of Albuquerque, whose best bet to beat pancreatic cancer was risky surgery performed by a Houston specialist. His insurance company refused to pay for the surgery. Hendrickson had it done anyway. Today, he is cured, but owes $80,000 in medical bills.

Is this what the CMA wants to inflict on Canadians?

“Of the people who go bankrupt in the U.S., 50 per cent of the time it is because of medical bills. Of that 50 per cent, 75 per cent had health insurance,” says Dr. Ida Hellander, executive director of the Chicago-based Physicians For a National Health Program.

Insurance companies are putting the screws to American patients in insidious ways.

In a telephone interview, Hellander says it’s hard to find a policy with a deductible less than $1,000. Some policies have deductibles up to $5,000.

“A thousand dollars is a lot of money. So people have chest pains and they won’t go to the ER because they’ll have to pay that $1,000 deductible,” she says.

Another nasty trend is co-insurance — when you go to the hospital, you pay 20 per cent of the bill before your insurance kicks in.

Insurers have also dropped mental health coverage, so people with mental illnesses are going untreated. Only the most indigent can get their mental health care funded by the government. Also, if you have a pre-existing condition, insurance companies will do their best to link it to everything else you visit the doctor for, in order to avoid paying the bill.

And the CMA wants to subject Canadians to these kinds of nightmares?

Equally absurd is the CMA’s claim that these reforms would allow doctors to spend more time with patients. Sure, they would — with the private patients whose visits are more lucrative for the doctor.

The public patients might be fitted in if there are a few minutes left over in the doctor’s day from filling out the insurance forms for his private patients.

According to an article in the Ventura County Star, 80 per cent of doctors in California are frustrated with the huge amount of time they spend filling out insurance forms.

Don McCanne, a retired family physician and senior health policy fellow with the PNHP, says doctors will be “cream-skimming the more profitable patients,” to the detriment of the public ones.

Economist Paul Krugman, also writing in the New York Times, shatters one of the cherished myths of Canada’s proponents of private health, when he discusses hip replacements. This surgery is always seized upon by the private-health cheerleaders as something for which there is no waiting in the U.S. system:

“There’s a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.

“That’s right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare because it has more lavish funding.”

Krugman also points out that the insurers themselves cause waiting lists to grow, citing the example of Mark Kleiman, a UCLA professor, who nearly died waiting for a biopsy because his insurance company stalled approving it.

“There’s no question that some Americans who seemingly have good insurance nonetheless die because insurers are trying to hold down their ‘medical losses’ — the industry term for actually having to pay for care,” Krugman writes.

Reached at his home in San Juan Capistrano, Calif., McCanne calls the CMA’s interest in private care “self-serving” at a time when Canada really needs to repair the public system’s flaws.

“Frankly, they’re greedy,” he says. “Private insurance is the worst thing they could do.”

Amen to that, Dr. McCanne.

nlakritz@theherald.canwest.com