PNHP

True reform remains elusive

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True reform remains elusive

By Arthur J. Sutherland III, M.D.
The Commercial Appeal (Memphis, Tenn.), Letters, Dec. 17, 2012

Dr. Scott Morris’ Dec. 13 Viewpoint guest column “Jesus, prophets couldn’t get health care” was quite clever, but we need to look “upstream” at the roots of our problems to figure out why Jesus couldn’t get care in our current health care “system.” The Patient Protection and Affordable Care Act of 2010 was just another symptom of the chaotic, costly and dysfunctional delivery system that we have lived with since World War II. We are an outlier among developed nations who all have more efficient and less costly national health programs that do a better job of delivering quality health care to all their populations.

Attempts to block implementation of the PPACA or opt out of parts of it just reflect the myopic vision our nation has in dealing with the cost and access issues in health care. The political rhetoric is one of fear and talk about the scarcity of wealth and other resources needed to transform our nation’s health care into one of the world’s best systems. That type of talk is just not true. We have an abundance of wealth, talent and medical resources, plus we already spend more than twice as much per capita as any other developed country. But we have the wrong system in place to get the job done.

Our current supply-driven health care market has no brakes on it. All the stakeholders have no incentives to control costs and improve quality. What we need is a well-thought-out and debated national health program with true national goals based on “best evidence” preventive and medical treatment standards, regional planning, and local implementation. We can best achieve these goals by improving and expanding Medicare for everyone in our country.

In a just society even those made poor have a right to health care. The PPACA will not cover everyone in America or make health care more affordable. The law just makes health insurance more affordable through a voucher system and supplements, but health insurance is not health care.

Even though the Church Health Center has done an outstanding job treating the working poor, we have a bigger problem than all the charity care in communities across the nation could possibly fix. It will require a national will to find the solution. Please look up H.R. 676, the Improved and Expanded Medicare for All Act.

Dr. Arthur J. Sutherland III resides in Memphis.

http://www.commercialappeal.com/news/2012/dec/17/letter-true-reform-remains-elusive/

Consider Medicare for everyone

By John Sytsma, M.D.
Sun Journal (Lewiston, Maine), Letters, Dec. 5, 2012

I am responding to a column by Matt Miller of the Washington Post, printed in the Sun Journal Nov. 30. He suggests that President Obama appoint a panel of experts, chaired by Mitt Romney, to solve the serious problems the nation faces in financing health care.

Rather than asking Romney to chair a panel, Obama should listen to the majority of U.S. physicians and many others who have studied the problem for years and come up with the only system that makes sense — a single-payer national health policy.

Yes, the U.S. health care system is extremely dysfunctional, with 20 to  30 percent of health care spending going into corporate pockets, while more and more dollars are being taken away from beneficiaries.

The U.S., with its profitized system of health care, is spending twice as much on health care as other industrialized countries, yet stands in 17th place in quality of care. The death toll is higher among the uninsured than among the insured. Medical bankruptcy abounds, even among the insured.

The U.S. needs to take a serious look around and consider Medicare for all — the most efficient, not-for-profit system, with administrative costs similar to those in other countries.

Dr. John Sytsma resides in Farmington.

http://www.sunjournal.com/news/letters/2012/12/05/j-sytsma-consider-medicare-everyone/1288823

Enough specialists for Medicare, but not Medicaid

Healthcare crisis: not enough specialists for the poor

By Anna Gorman
Los Angeles Times, December 15, 2012

By the end of the decade, the nation will be short more than 46,000 surgeons and specialists, a nearly tenfold increase from 2010, according to the Assn. of American Medical Colleges. Healthcare reform is expected to worsen the problem as more patients — many with complex and deferred health needs — become insured and seek specialized treatment.

Many of the newly insured will receive Medi-Cal, the government plan for the needy as administered through the state of California. Clinics already struggle to get private specialists to see Medicaid patients because of the low payments to doctors. Last week, an appellate court decision that authorized the state to move forward with 10% cuts in Medi-Cal reimbursement, which could make finding doctors for those patients even more difficult.

“Specialists are paid so poorly that they don’t want to take Medi-Cal patients,” said Mark Dressner, a Long Beach clinic doctor and president-elect of the California Academy of Family Physicians. “We’re really disappointed and concerned what it’s going to do for patient access.”

In Los Angeles County, the sheer volume of poor or uninsured patients needing specialist services has long overwhelmed the public health system, creating costly inefficiencies and appointment delays that can stretch as long as a year and half.

Patients’ conditions often must be dire for them to see a neurologist, cardiologist or other specialist quickly. Community clinics try to bypass the backed-up formal government referral system by pleading, cajoling and negotiating to get less critically ill patients moved up on waiting lists.

At times, clinic staff members are forced to work against one of their key missions by sending patients to emergency rooms to increase the odds of their seeing a specialist more quickly.

http://www.latimes.com/health/la-me-clinic-specialists-20121216,0,5422442,full.story

Comment:

By Don McCanne, MD

My career in private practice began with the introduction of Medicare and Medi-Cal (Medicaid). At that time, I had no problems referring Medicare and privately insured patients to specialists, but the majority of them refused to see my Medi-Cal patients. The stigma of “welfare patient” was there right from the beginning.

Quite a few years later, my Medicare patients continued to be accepted without question, but some of the managed care patients were rejected, and, of course, Medi-Cal patients continued to be rejected, except by a few very dedicated specialists. Eventually with EMTALA, at least I could force unwanted referrals for patients requiring specialized emergency services by sending them directly to the Emergency Department. What a terrible way to practice medicine.

As stated in my last message, there will be about 10,000,000 Medi-Cal patients in California, once the Affordable Care Act is fully implemented. Can you imagine the specialists suddenly opening their doors and welcoming these patients into their practices?

I’ll say it once again. If we had an improved Medicare single payer system that treated everyone equitably, we would not have this problem.

Health care reform: the issue is equity

By Gabriel Edwards
The Pulse (OHSU Student Newsletter), Fall 2012 edition

The process of getting through medical school is fraught with uncertainty. What kind of residency will I apply to? Which lunch talks this week are offering free food? What innervates the palatoglossus muscle?

There’s another question I’ve considered as I get through the first year. I wonder what our country’s health care system (the system in which I will practice medicine) will look like in the next few years. Embedded in this question is one thing I’m certain of: our health care system is broken.

We spend double the money of every other developed nation in the world, and our health is worse for it. We are fairly unique among developed countries in the degree to which our quality of health care depends on income or employment.

Wealthy Americans receive some of the best health care ever devised by humans. Less wealthy Americans are denied care because of lack of resources, succumbing to preventable illnesses at rates higher than our industrialized counterparts.

Both major political parties say that the health care system needs to be reformed, that costs need to be contained lest they eventually bankrupt the country.

During the latest battle of reforming health care there was talk about what would happen to various stakeholders in our current systems. What would reform mean for doctors? For private insurers? For patients? For President Obama’s political prospects? For the opposition’s political prospects?

Another question is asked far less frequently: What does it say about us as a society that, compared to other countries, so many more people are dying from preventable diseases or going bankrupt due to health care costs?

Our country has already decided that every American is entitled to education, police protection, and fire protection. Prisoners have a guaranteed right to health care. Right now there are tens of millions of Americans who don’t have the right to adequate health care.

Obamacare, fully implemented, would cut the number of uninsured only by half, leaving 23 million Americans without health insurance – 23 million who can’t afford all the health care necessary to ensure a high quality of life. And the problem doesn’t stop there. Insured individuals declare the majority of medically related bankruptcies. This is not a problem of insurance versus noninsurance. This is a problem of equity.

The solution to this problem, I believe, is to create a health care system that covers everyone, without exception. Obamacare will not do this, but a single-payer system could. I believe that this is the most moral solution.

Who is healthy and who becomes ill in life is not solely determined based upon personal merit; health care shouldn’t be awarded based on what one’s salary and job happen to be.

Everyone has a right to medically necessary care. I want to care for patients in a society that maintains that right. I strongly believe that we will get there together. Not because it’s easy, but because it’s the right thing to do.

Gabriel Edwards is a first-year medical student at Oregon Science & Health University in Portland, Ore. This article was originally published under the title, “Opinion: Health Care Reform.”

Medi-Cal could implode

Court ruling could cut California spending on Medi-Cal

By Maura Dolan and Chris Megerian
Los Angeles Times, December 13, 2012

A federal appeals court decided unanimously Thursday that California may cut reimbursements to doctors, pharmacies and others who serve the poor under Medi-Cal.

A three-judge panel of the 9th Circuit U.S. Court of Appeals overturned injunctions blocking the state from implementing a 2011 law that slashed Medi-Cal reimbursements by 10%. Medi-Cal, a version of Medicaid, serves low-income Californians.

The ruling could make it harder to find doctors for as many as 2 million new patients who could become eligible for Medi-Cal under President Obama’s healthcare law — a possible 25% expansion of the program. California already provides one of the lowest rates of reimbursement in the nation for medical services to the poor, and there is a shortage of doctors to serve those patients.

According to the California HealthCare Foundation, Medi-Cal patients already have difficulty finding doctors.

A foundation study published in July 2010 said 25% of physicians provided care to 80% of Medi-Cal patients.

Although 90% of physicians told the foundation they were accepting new patients, only 57% said they were taking on new Medi-Cal patients.

http://www.latimes.com/news/local/la-me-medi-cal-20121214,0,4784104,full.story

Comment:

By Don McCanne, MD

One of the major defects in the Affordable Care Act is that it perpetuates and expands the Medicaid program – a welfare program for low-income individuals. Because of political anti-welfare bias, it is vulnerable to budget cuts that would not be tolerated in a program like Medicare that benefits all of us.

California’s Medicaid program, Medi-Cal, exemplifies this problem. It has one of the lowest payment rates in the nation, not even meeting the expenses of many of the physicians still willing to see these patients.

There are already over 7 million Californians on the program, and there will be almost a million children added as California shuts down its CHIP program (Medi-Cal pays less than CHIP). There will be about 2 million more individuals added in 2014 under the provisions of the Affordable Care Act. Further, low-income Medicare patients also eligible for Medi-Cal are being transferred into Medicaid managed care plans.

In spite of California being at the bottom in Medicaid payment rates, this 9th Circuit Court of Appeals decision upholds the additional 10 percent cut enacted because of California’s budget crisis. The reduction was challenged based on the fact that federal law requires that the state ensure that Medicaid patients have access to adequate health care services, and underpayment reduces the number of willing providers. That argument was rejected by the court, though it is difficult to see how California’s physicians will be able to care for over 10 million Medi-Cal patients when they are effectively donating their services plus subsidizing their losses resulting from overhead expenses that are greater than reimbursement rates. As more physicians turn them away, the crowd out of privately insured patients will threaten the solvency of the few remaining dedicated physicians.

This underpayment has real consequences. Access to primary care is impaired, and specialized services are especially difficult to obtain since most specialists are particularly resistant to allowing these patients in their practices, no matter how great the need. Outcomes for Medicaid patients are not as favorable as for those who have Medicare or private insurance. In some studies, the outcomes are as bad as the outcomes for the uninsured.

What good is a Medi-Cal card if it won’t provide access to health care?

If we had a single improved Medicare that covered everyone, this problem wouldn’t exist. Everyone would have the level of care that we should expect from a high-performance health care system. Are there too many politicians who still believe that we should offer only inferior health care to the poor because that is all they deserve? The rhetoric of the recent elections doesn’t bode well for a more egalitarian approach.

Single-payer activists screen film, discuss Canadian/American healthcare systems

State groups hope to raise support for a single-payer bill this winter

By Christen McCurdy
The Lund Report (Portland, Ore.), Dec. 13, 2012

Monday night a small crowd gathered at the Clinton Street Theater for a film screening of The Healthcare Movie (http://www.healthcaremovie.net/), a documentary about the history of the Canadian healthcare system that was produced by a Canadian/American couple Laurie Simons and Terry Sterrenberg to dispel myths and stereotypes about Canada’s healthcare system – specifically, that Canadian citizens dislike their healthcare system and frequently travel to the United States for care.

The film also showed interviews with Canadian activists who helped create Alberta’s single-payer system in the 1960s (before single-payer was adopted as a nationwide program). The activists interviewed in the film helped operated clinics, with the aid of British doctors (who were flown in to provide care for the province) after Alberta’s doctors went on strike.

According to the documentary, clinics occasionally had to be evacuated due to death threats from people opposed to the program (the documentary did not say from whom). Eventually, Alberta’s program became quite popular with the public as well as with doctors – due to cost savings, the lack of administrative concerns for doctors and increased access to care for the public.

Eric Lambert, who lived in Taiwan for seven years, said as a type one diabetic, he was better able to manage his health in Taiwan (which has a national healthcare program) because he was able to see doctors regularly and get medication with little out-of-pocket cost.

“I’m actually that person who’s kind of on the edge here in America,” Lambert said. “Being a diabetic is a twenty-dollar-a-day habit.”

Dr. Peter Mahr, from Physicians for a National Health Program, became involved with the movement for single-payer care after watching his patients wait too long to seek care. One patient – a man with hepatitis C – had a tumor growing out of his breast bone, which turned out to be metastatic cancer.

Richard Bruno, a medical student in his fourth year at OHSU, has been working on a video project of uninsured people talking about their experiences with the healthcare system. After showing the videos to 900 medical students, 86 percent said everyone should receive care regardless of ability to pay and 72 percent said they preferred the public system (i.e. taxes) of financing healthcare.

Mahr said he was campaigning for single-payer care because the Affordable Care Act will leave too many people uninsured and drive up costs. He also said 41 percent of Massachusetts doctors support a single-payer program, up a few points from polls conducted before the state’s current system (which is similar to what the ACA proposes) was adopted.

“What we’re talking about here is access to insurance, not access to care,” Mahr said.

Responding to an audience question about whether innovation and competition could continue in a system without a profit motive, Bruno said a lot of innovation (in the form of new treatments, drugs and devices) comes from research funded by the National Institutes of Health. As far as competition, he said: “They’ve [the insurance companies] been doing it for a few decades and it hasn’t gotten any cheaper. It’s gotten more expensive.”

Lindsay Caron, who worked on the documentary, said of insurance companies, “They’re not innovating. They’re not creating anything. They’re the ones profiting.”

Ross Lampert, an organizer with Healthcare for All Oregon, said his organization is forming chapters across the state, including eastern Oregon and in coastal communities, to raise support for a single-payer healthcare bill during the upcoming legislative session.

http://www.thelundreport.org/resource/single_payer_activists_screen_film_discuss_canadianamerican_healthcare_systems

Making the case for efficient health care

By Robert S. Levine, M.D.
The Grand Rapids (Mich.) Press, Letters, Dec. 5, 2012

Matt Miller’s column “The Business Man – Obama should use Romney to make health care more efficient” was right on target (The Press, Dec. 2). His suggestion that we “identify the major lessons and best practices” of other nations was totally ignored by Congress during the debate on the Affordable Care Act of 2010.

One feature of the health care systems in ALL other industrialized democracies is the non-profit status of the basic benefit package sold by insurers. This doesn’t mean that the government expropriates these companies, but it does define how the insurance industry must sell health care coverage products. T.R. Reid has clearly covered how this is done worldwide in his book “The Healing Of America” wherein he showed that it’s not all socialized medicine out there.

Dr. Steffie Woolhandler, a co-founder and board member of Physicians for a National Health Program, has identified six important principles for health care delivery system reform:

• Nonprofit.
• All capitation payments must be used for patient care. Surpluses are not
retained.
• Separate capital funding is based on regional planning. (eg., was a heart transplant program essential in Grand Rapids or simply approved to satisfy the growth agenda of one institution?)
• Eliminate insurance middlemen.
• Rich and poor in the same plan.
• Quality data used for improvement not financial reward.

Now we’re talking real efficiency and truly affordable universal care.

Robert S. Levine, M.D., retired, lives in Grand Rapids.

http://www.mlive.com/opinion/grand-rapids/index.ssf/2012/12/west_michigan_ceos_letter_list.html

The health care debate isn’t over: Let your voice be heard

By Samuel Metz, M.D.
Street Roots, Nov. 29, 2012

Does the specter of your family going bankrupt from a disease not covered by your health insurance keep you staring sleeplessly at the ceiling? Have you lost hope that our country will ever get the health care system we need?

There is a solution, and you can make it happen.

It is single-payer health care. Single payer applies the common characteristics of every successful health care system: (1) It includes everyone without discrimination against the sick, (2) it encourages patients to seek health care at the first suspicion of trouble, and (3) it finances health care with publicly accountable, transparent, not-for-profit agencies.

Will single-payer health care really work?

It already works. Around the world and in our own country, single-payer systems provide better care to more people for less money than our American insurance industry.

Example: Our Veterans Affairs system cares for America’s sickest patients with the best outcomes at the lowest cost with the highest patient satisfaction in the country. The VA is a single payer system.

Example: Almost every large American corporation abandons private health insurance and adopts their own single payer system (called “self-funding”).

Example: Nearly 40 percent of Americans already receive great health care through private and public single payer systems (through corporate self-funded plans, the VA, Medicare, etc.).

For those still skeptical, there are over 25 economic studies of statewide and nationwide single-payer proposals. All conclude single-payer will provide better care to its patients with better results at lower cost than any other proposal. There are no studies concluding single-payer cannot work.

Many free market advocates still cling to the desperate hope that the American private insurance industry will save us by doing more of what it has done for the past 60 years. This hope is misplaced. Never in recorded history has an American-style private insurance system reduced costs or improved health. Perhaps Neanderthals did so and simply forgot to write it down – but I doubt it.

Can you help Congress create a single payer system?

Let’s review three bill being considered right now in Washington.

HR 676, the Expanded & Improved Medicare for All Act, introduced in the House by Rep. John Conyers, would create America’s first nationwide single-payer system. Unfortunately, none of its 76 co-sponsors are Oregonians. Let’s correct that oversight with vigorous letters from readers urging them to sign on now.

Our own Sen. Ron Wyden plus Republican Sen. Scott Brown introduced the “Empowering States to Innovate Act.” The Affordable Care Act prevents states from creating any plan other than health exchanges without a waiver. Currently, states must wait until 2017 to receive one. The Wyden-Brown bill moves that date to 2014.

This is a great time to remind our Sen. Jeff Merkley to sign as a co-sponsor.

Sen. Bernie Sanders and Rep. Jim McDermott introduced more powerful legislation. The American Health Security Act of 2011 requires every state to create its own single-payer program. To sweeten the deal, the bill turns over all federal health care dollars in the state to the single payer agency. Every resident then receives publicly funded health care, prepaid with both federal and state tax dollars.

This legislation has no co-sponsors in the Senate and only nine in the House — again, none from Oregon. Every Oregon senator and representative should receive letters from readers encouraging them to sign. To learn more, please visit the Physicians for National Health Program website, pnhp.org.

As can be seen, we may have an All-Chicago World Series before Washington produces useful legislation.

Does single payer stand a better chance 3,000 miles away in Oregon?

Yes. In March of 2011, the Oregon House Health Committee held a hearing on House Bill 3510, the “Affordable Health Care for All Oregon Plan,” submitted by State Rep. Michael Dembrow. This hearing attracted statewide testimony and attention. Although the bill did not move out of committee, it gained widespread exposure and was endorsed by more than 40 organizations. Rep. Dembrow will resubmit his bill again in the 2013 legislative session. Wouldn’t it be great if your state representative knew how you feel about this bill?

To find out how I feel about the bill, please see my written testimony.

What can readers do right now? A lot. It’s time to get fired up.

Step 1: Write!

Write your senators and representatives a simple, three sentence letter. First – this is how our current health care system is destroying my life, my family, my business, or my clients. Second — I want Oregon to have publicly funded health care. Last – I want you to make it happen. Then sign it, “Sincerely, your constituent. PS. If you want my vote in the next election, you’ll tell me what you’ll do about it.”

Don’t be shy about writing again in a few months.

Imagine every legislator in Salem getting 10 letters like that in a week. And every week after that for the rest of their term. It certainly gets the message across that health care reform cannot be ignored.

Step 2: Join!

Join groups working for single-payer health care. Fortunately, Oregon is blessed with an exemplary organization: Health Care for All Oregon. HCAO represents more than 60 Oregon groups who advocate publicly funded universal care. I highly recommend readers visit the site and discover what they can do personally to make universal care a reality in Oregon.

Full disclosure: I represent the Portland Chapter of Physicians for a National Health Program to HCAO.

Step 3: Don’t accept “No”!

If your state legislator complains they are helpless, tell them to contact Health Care for All Oregon. We’ll tell them what they need to do, and in no uncertain terms.

Oregon legislators cannot ignore their constituents. Every reader is someone’s constituent. If you think single-payer health care in Oregon is vitally urgent, make sure your state legislator understands this clearly. Oregon is riding a crest of activism and we want the waves to wash across the Capitol floors.

We can make a difference.

We can leave our children a better world.

And we can bring to our families the health care we need and deserve.

Samuel Metz is a Portland anesthesiologist active in health care reform. He is also a member of two organizations advocating publicly funded universal health care: Mad As Hell Doctors and Physicians for a National Health Plan. He is the local chapter representative of Health Care for All Oregon, an umbrella organization of over 50 groups working for better health care in Oregon. He can be reached at 3Q9A@samuelmetz.com.

How to rein in Medicare costs

By Carl Berdahl, M.D.
Los Angeles Times, Letters, Dec. 13, 2012

Aside from partial measures like allowing Medicare to negotiate with drug companies for lower prices, the best way to assure Medicare’s fiscal stability is to improve and expand the program to cover all Americans. The resulting single-payer system would slash wasteful paperwork and bureaucracy, yielding savings of up to $400 billion annually. Furthermore, young and old alike would have a clearer stake in sustaining a single, equitable system.

With the amount our nation spends each year on healthcare, we can afford to provide universal coverage. However, we choose not to. Instead, we waste money on private health insurance companies. While Medicare allocates just a few percentage points of its revenue to overhead, private companies spend about 15% on overhead and profits.

We should expand Medicare, the nation’s most efficient health insurance system, rather than cutting it.

Carl Berdahl, M.D., resides in Los Angeles.

http://www.latimes.com/news/opinion/letters/la-le-1213-thursday-medicare-costs-20121213,0,4441374.story

Defending Public Healthcare in Madrid

Interview with Dr. Marciano Sanchez Bayle

By Andrew D. Coates, M.D.
Counterpunch, Dec. 13, 2012

Madrid’s physicians, nurses and other health professionals have been marching in the streets with their patients for over a month, protesting the government’s plan to privatize and sharply reduce public health services.

Spain’s National Health System (SNS), established in 1986, fulfills a mandate included in Spain’s national constitution. Article 43 guarantees healthcare to all Spaniards, including the right to adequate public health services.(1,2)

The attack on the SNS is being led by the government in Madrid. (Administration of the SNS is decentralized; each of Spain’s 17 semi-autonomous regions sets health budgets and priorities.)(3) At the beginning of November Madrid moved to privatize ten percent of public health centers as well as the administration of six hospitals – half of the hospitals in the region. Of the hospitals to be privatized, all were recently built.

The response: an unprecedented and massive mobilization of people in Madrid, now making mainstream news across the world.(4,5) Caregivers and patients together have joined protests at every public health clinic and hospital in Madrid. Marches have involved hundreds of thousands.(6) Caregivers have gone on strike and stopped traffic outside their workplaces.(7)

The Partido Popular, in power nationally as well as in Madrid, also proposed to convert La Princesa Hospital, a tertiary care center serving about 300,000 patients annually, into a specialty care center for patients over the age of 75. In addition to mass meetings and sit-ins at La Princesa Hospital, a petition in protest gained over 200,000 signatures.(8) The Mayor of Madrid, herself a member of the Partido Popular, signed on. The government has retreated from its plans at La Princesa Hospital yet the struggle continues.(9)

Last week a group of patients, nurses and physicians disrupted a speech at the Madrid regional Assembly, where the government’s economic counselor was explaining the hospital privatization plans. In this short news video (11), Dr. Marciano Sanchez Bayle chants for public healthcare beside a woman who unfurls a banner, the first to be led out by police. Note the Assembly members who stood to applaud the protesters.

Here is a short interview I conducted with Dr. Sanchez Bayle of the Federation of Associations for the Defense of Public Health (FADSP) this week.  He is a pediatrician who practices in Madrid.  (Any error in translation is my own.)

***

Dr. Andrew D. Coates: Many of us in the United States have difficultly imagining health care delivered by a public system. Would you please describe how patients in Madrid get their medical cares?

Dr. Marciano Sanchez Bayle: In Spain the health system is public and coverage is universal. This means that when a person thinks he or she has a health problem, they go their public health center. There they are attended by a doctor and/or a nurse who will make the appropriate decision whether to diagnose and treat, ask for diagnostic tests, refer the patient to a specialist or admit them to a hospital.

Of course, if the situation is serious or occurs outside regular treatment hours, patients can go to a hospital emergency room. Hospitals are also mostly public. Thus far all of these services are free, including the tests. A patient does have to pay a share of the cost of their prescriptions, however.

On a per capita basis, the Spanish system is four times less costly than in the U.S. Yet we achieve much better outcomes, according to basic health indicators.

Dr. Coates: How has the government proposed to change this in Madrid?

Dr. Sanchez Bayle: The proposal in Madrid is to privatize some of the hospitals and health centers, turning them over to private businesses.

Dr. Coates: How will this affect patients?

Dr. Sanchez Bayle: There will be an immediate and significant downsizing of personnel, resulting in diminished access to care. It will undermine the quality of care. It will substantially lengthen waiting lists.

In addition, these changes will result in what we call risk selection, whereby private entities will seek out the most profitable pathologies, i.e. those persons who are less sick. As a result, people will face more obstacles to getting the care they need, following the Tudor Hart law of inverse care (11) – medical attention will be dispensed in inverse proportion to the needs of the population.

These will be the short-term results, because it is clear to us that the Partido Popular, the conservative party, hopes to install a health care model based on private insurance. The disastrous results of such a model as the United States, are well known.

Dr. Coates: What will it mean to doctors and nurses?

Dr. Sanchez Bayle: First of all, there will be fewer of them employed, with layoffs and fewer facilities to practice in. For those remaining, it will result in overwork and a worsening of professional working conditions.

Dr. Coates: Please describe the protests that have emerged in response.

Dr. Sanchez Bayle: It would take a very long time to fully answer your question because there have been such a multitude of actions. Briefly, it has produced a strike by the staff of the centers — doctors, nurses, administrators, auxiliaries, etc. — which has been organized according to a rotating schedule, e.g. specific days a week. Health worker sit-ins, sometimes joined by patients, have also occurred. These started first in the hospitals, then in the health care centers. These protests have been going on for 30 days.

In addition, massive demonstrations have been held in Madrid, some with more than 100,000 people, professionals and patients. Every day there are demonstrations blocking traffic in front of the health centers. Last week an action was carried out under the slogan “Hug your Hospital,” in which human chains circled all the public hospitals of Madrid.

The most interesting thing is the supportive reaction of the citizenry. People are very committed to the defense of the public health care system. Of course, we Spanish continue to have a bit of the guerillero and anarchist spirit in us, so to speak, and many initiatives have been sprouting up like mushrooms.

Dr. Coates: What is the significance of the La Princesa Hospital in this struggle?

Dr. Sanchez Bayle: La Princesa Hospital is located in the center of Madrid. It has 600 beds and a high level of specialization. It is the referral center for many of the peripheral centers of Madrid and beyond.

The attempt to convert La Princesa into a geriatric center was the spark that lit the movement: the unions of the center started a sit-in which still continues. The sit-in has mobilized more that 90 percent of the facility’s workers. Citizens in the zone it serves have also joined in. The hospital’s governing council negotiated with some of the doctors, i.e. department heads, and the two sides arrived at an agreement which doesn’t seem bad. Yet the struggle to withdraw all the measures that affect health care in Madrid, including this issue, continues.

Dr. Coates: We have been hearing about many protests against austerity in Europe, in Spain, in Madrid. What is the justification used by the government to move to privatize the public system?

Dr. Sanchez Bayle: The government says that it’s the crisis and that there is no money, but it’s a lie. They have allocated 215,695 million pesetas to bail out the banks, and with these measures they say that they will save
7,000 million pesetas in health care. What they want to do is to use the excuse of the crisis to privatize health care, to put it in private hands in order to make a profit on the health of the people.

Dr. Coates: What is your view of this demand for austerity?

Dr. Sanchez Bayle: I have already said that they want to take away peoples’ rights in favor of the banks and private businesses.

Dr. Coates: Why did you disrupt the Madrid Assembly? Who was with you?

Dr. Sanchez Bayle: What we did was to try to demonstrate within the Assembly professionals’ and citizens’ rejection of this blatant act of aggression against health care. The elected representatives should not have deaf ears to the opinion of the immense majority. Keep in mind that the Partido Popular, now in government, didn’t include these measures in its election program. They gained their votes through trickery and are now attacking our public health care system.

Dr. Coates: What else would you like to share with people in North America about this struggle? What can we do to help?

Dr. Sanchez Bayle: The right to health care is a peoples’ right and should be defended as such. What is happening in Spain today may seem far-off to the people of the United States, but the world is globalized and interconnected. Every advance or retreat which happens in one part of the world has a repercussion for us all. Help can come in spreading word of the struggle so the problem is known, and also demonstrating solidarity through demonstrations in front of Spanish embassies and sending signed protest letters to entities and people in the government of Madrid.

Solidarity is very important, not only for those who receive it but also for those who practice it, because it makes us better people and benefits our common, concrete struggles.

Andrew D. Coates, M.D., will be president of Physicians for a National Health Program in 2013.

Notes:

(1) http://www.servat.unibe.ch/icl/sp00000_.html
(2) http://en.wikipedia.org/wiki/Spanish_National_Health_System
(3) http://www.spainthenandnow.com/spanish-travel/general-map-of-spain/default_92.aspx
(4) http://www.timesunion.com/news/article/Thousands-protest-Spain-s-health-care-austerity-4103126.php
(5) http://www.adelaidenow.com.au/news/breaking-news/thousands-protest-spains-health-care-cuts/story-e6frea7u-1226533310603?from=public_rss
(6) http://www.reuters.com/article/2012/12/09/us-spain-health-march-idUSBRE8B809H20121209
(7) http://www.thenation.com/blog/171670/how-strike-back-14n-dispatch-madrid
(8) http://www.larioja.com/videos/actualidad/espana/1951507741001-madrileno-hospital-princesa-lucha.html
(9) http://elpais.com/elpais/2012/11/13/inenglish/1352818341_939984.html
(10) http://www.telecinco.es/informativos/sociedad/Protestas-recortes_en_Sanidad-Sanidad-Asamblea_de_Madrid_2_1519905142.html
(11) http://en.wikipedia.org/wiki/Inverse_care_law

http://www.counterpunch.org/2012/12/13/defending-public-healthcare-in-madrid/

United Nations passes resolution supporting universal coverage

US backs United Nations measure in favor of universal health coverage

By Elise Viebeck
The Hill, December 12, 2012

The United States has backed a United Nations draft resolution favoring universal healthcare coverage.

The nonbinding measure calls on U.N. member states to ensure citizens’ access to health insurance, and was approved by the U.N. General Assembly on Wednesday.

http://thehill.com/blogs/healthwatch/public-global-health/272625-us-backs-un-measure-on-universal-health-coverage

And…

Adopting Consensus Text, General Assembly Encourages Member States to Plan, Pursue Transition of National Health Care Systems Towards Universal Coverage

General Assembly
United Nations, December 12, 2012

Recognizing the intrinsic role of health in achieving international development goals, the General Assembly today – through the unanimous adoption of a resolution on global health and foreign policy – encouraged Governments to plan or pursue the transition towards universal access to affordable and quality health-care services.

By that text, the Assembly, calling for more attention to health as an important cross-cutting policy issue, urged Member States, civil society and international organizations to incorporate universal health coverage in the international development agenda and in the implementation of the internationally agreed development goals, including the Millennium Development Goals.

The Assembly also recognized that improving social protection towards universal coverage “is an investment in people that empowers them to adjust to changes in the economy and the labour market and helps support a transition to a more sustainable, inclusive and equitable economy”.  As such, while planning or pursuing the transition towards universal coverage, Member States were encouraged to continue investing in health-delivery systems to increase and safeguard the range and quality of services and meet the health needs of their populations.

Further, Member States were encouraged to recognize the links between the promotion of universal health coverage and other foreign policy issues, such as the social dimension of globalization, inclusive and equitable growth and sustainable development.

http://www.un.org/News/Press/docs//2012/ga11326.doc.htm

And…

Agenda item 123

United Nations
General Assembly, Sixty-seventh session

Global Health and Foreign Policy

IV. Universal health coverage

56. Universal health coverage captures the aspiration that everyone will be able to obtain the high-quality health services they need without the risk of suffering severe financial hardship when using them. The goal of achieving universal health coverage has two important and interrelated components: coverage for everyone who needs health services (including prevention, promotion, treatment and rehabilitation) and coverage with financial risk protection.

57. Both components are critical to the fulfilment of the highest attainable level of health, a fundamental human right embedded in the WHO constitution of 1948 and in the Universal Declaration of Human Rights. At the same time, people value them for their own sake. They sleep securely at night knowing that the health services they might require are available and of good quality and that they can afford to use them.

http://www.un.org/ga/search/view_doc.asp?symbol=A/67/377

Population figures by country
http://www.nationsonline.org/oneworld/population-by-country.htm

Comment:

By Don McCanne, MD

It is terrific that the United States has voted for a United Nations resolution in support of universal health coverage for all Member States. But what about the United States? The Affordable Care Act will leave about 30,000,000 uninsured, more than the entire population of each of 183 countries and territories. Oh, of course… the U.N. resolution is nonbinding.

Delaware should move to single-payer health care

By Earl Jaques and John Kowalko
The News Journal, delawareonline.com, Dec. 11, 2012

The recent Supreme Court decision followed by the re-election of President Obama guarantees that the Affordable Health Care Act will be with us long into the future. As each day passes we have learned more about the law, what is contained in the bill and how states will play a major role in the implementation and funding of many portions of program. The Affordable Health Care Act requires everyone to have coverage but at a cost to be determined.

The ACA will not change your situation if you are currently in an employer-provided program (not exceeding 9.5 percent of a person’s income) or if you are enrolled in Medicare, Medicaid or Tricare.

The ACA will require you to purchase insurance through the Health Insurance Exchange program if you’re an individual or family with income between 139 percent-400 percent of the federal poverty level ($15,029-$43,500 for a single person and $30,844-$88,200 for a family of four) and your employer does not provide health care coverage.

Delaware has chosen the Blue Cross-Blue Shield Small Group plan as the benchmark for certification of Qualified Health Plans offered by insurers who wish to compete in the exchange that is being set up by the state. Coverage under this plan will be very basic, as determined by the insurance company as long as it meets the chosen standard. At this time, cost has not been determined. Delaware will receive 100 percent funding from the federal government through 2016. After that, Delaware’s share for newly eligible enrollees will be 5 percent in 2017, increasing to 10 percent in 2020 and beyond. Individuals who fail to have or purchase insurance will then be subject to a tax, as determined by the U.S. Supreme Court. Many experts have reported that it will be cheaper to pay the tax then to purchase insurance.

As the Affordable Care Act ultimately plays out, we know two things for certain: Millions and millions of Americans will remain uncovered; and it will leave the for-profit insurance industry in charge of prices and life-and-death treatment decisions.

So what is the answer? Many industrialized countries around the world have some type of “Healthcare-for-All” (single-payer) system. In our country, we have several of these systems: Medicare, Medicaid and Tricare, which have repeatedly received high marks for outstanding patient care at relatively low cost.

As Dr. Marcia Angell, former editor in chief of the New England Journal of Medicine put it, “Healthcare-for-All is not only the best health care reform, it’s the only health care reform that will cover everyone and control costs.”

As elected representatives, we are convinced that we need to move to a single-payer system as soon as possible. Although the Affordable Care Act has taken a step forward in health care access, it will still leave millions of Americans without coverage. Personal bankruptcies triggered by medical bills will continue to pile up. Medical bills are the No. 1 cause of personal bankruptcies in the United States.

We can’t afford to wait as health insurance costs continue to spin out of control. More and more companies are dropping health care plans for their employees because of the costs.

How long will the federal government or state governments be able to cover their share of medical costs?

It’s time to dispel the myths about a single-payer system.

It is not socialized medicine. It is guaranteed access to health care. You get a health care card and you can go to any doctor or hospital in the U.S. Doctors are not employees of the government and hospitals remain in private hands. You get free choice of doctor and hospital.

A single-payer system will not lead to rationing. In fact, currently, private health insurance companies ration care is based on cost and if you don’t have health insurance, you don’t get care. Costs will not skyrocket under single payer; in fact single payer is the only health care reform mechanism that will save enough money to insure everyone. Eliminating the health insurance industry will save millions of dollars each year in administrative costs and profits.

Drugs will be cheaper under single payer because of the advantage of bulk purchasing. The system will provide a buying power advantage similar to the health care provided veterans which includes a 40 percent discount on pharmaceuticals.

Single payer will mean a vast improvement in access to health care for a majority of Delawareans. All medically necessary care would be funded including all doctor visits, hospital care, prescriptions, mental health services, nursing home care, rehab, home care, eye care and dental with no more bills, deductibles or co-pays.

Under our proposed single-payer funding mechanism, we believe a majority of individuals and companies will save money. We have checked the numbers that are contained in our previous HB 392 and had those figures verified by the Secretary of Finance office.

Recently, pundits have said our country will eventually have a single-payer system in place, but the people cannot afford to wait. Not one more person should die from lack of access to proper health care and as representatives of the “First State,” we must move forward now.

Earl Jaques represents the 27th District and John Kowalko represents the 25th District in the Delaware House of Representatives.

http://www.delawareonline.com/article/20121212/OPINION07/312120013/State-should-move-single-payer-health-care?odyssey=mod|newswell|text|Opinion|p&nclick_check=1