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Health care: a new civil-rights movement?

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Health care: a new civil-rights movement?

Nurse Kathleen Bartholomew writes about the importance of making health care about wellness. She suggests health care might be a civil-rights movement of the 21st century.

By Kathleen Bartholomew
The Seattle Times, Friday, Oct. 7, 2011

The patient was stoic and distant as he sat on the edge of the bed waiting for me to give him the bath I had promised an hour earlier. Quickly I gathered my supplies and began by washing the old man’s back. But suddenly, he burst out sobbing.

“Did I hurt you?” I asked concerned.

“No, no!” He ordered gruffly, “Go on now.”

After several minutes of silence, he softly shared.

“I’m sorry. You see, my wife died 22 years ago and no one has touched my back since that day.” In the longest bath I’ve ever given, he told me why she liked the rain and what she always planted in her garden — but it’s nowhere in my charting.

Similarly, a physician I respect sat down and talked for 30 minutes to an elderly woman with high blood pressure. He listened to her story then counseled her to lose weight and take her meds. The current financial structure is so lean that these most fundamental and humanistic interventions are now in peril — because there is no price tag.

What’s the billing code for easing an old man’s grief, or a healing connection? What’s the billing code for holding someone’s hand as they lie dying because they have no relatives or visitors?

Or maybe a better question would be, how much would you pay? What’s it worth to you not to die alone or be heard rather than given a pill? Like pennies on a convenience-store counter there for the taking, these healing acts of care are free.

Maybe it’s time to look at our most fundamental premises in health care by following the money.

The U.S. spends twice as much for half the quality care of other industrialized countries and has poorer outcomes. Hundreds of millions of dollars were squandered lobbying for sacred cows in the 2010 federal health-care-reform law to protect vested interests (our health insurers cost us 20 cents on the dollar versus 3 cents in other countries).

Hospital leaders struggle to cut costs to protect their bottom line, while physicians and nurses try with inadequate time and resources to keep their patients from being one of the 22 who die on average every hour from preventable errors and infections.

Why? Because sick people are only profitable when there are enough of them and someone else pays the bill. “Well” people, on the other hand, generate little, if any, income. From a business perspective, the current structure is a conundrum: we need plenty of sick people to sustain a system supposedly dedicated to health.

It’s time to acknowledge the elephant in the room and make a collective decision for the betterment of all society: Is health care a business, or public service? What should it be?

If it is only a business, then acknowledge the obvious: No business can give away its resources for free. There are no billing codes for easing grief or spending time with a patient so we give them a pill. Within the business model, all the free stuff will have to go away — as much of it has already.

If health care is a business, our best hope is to create a billing code for wellness so that hospital leaders can stop focusing on revenue from disease out of dire necessity and redirect their efforts to safety, quality and prevention.

Or perhaps, embedded in the chaos and polarity, passion is an opportunity. Maybe health care is the civil-rights movement of the 21st century. It certainly has the same emotional charge as pushing blacks to the back of the bus, or refusing the vote to women.

The poor don’t deserve health care! Let them suffer! Though it is labeled as socialism by the “haves” and virtually unreachable by the “have-nots,” we have found our next frontier: improving the wellness of America. And in that quest, maybe the services we give away for free are not worthless after all, but rather the harbingers of a healthier society where every citizen has the inalienable right to be well.

Friday Harbor resident Kathleen Bartholomew is a nurse consultant and an author of books about nursing culture.

http://seattletimes.nwsource.com/html/opinion/2016439515_guest08bartholomew.html

Wall Street Comes to D.C. to Profit from Health Care; 99% Say 'Wall Street Greed Kills Those in Need'

By Margaret Flowers, M.D.
October 2011 Movement, Oct. 12, 2011

Today, the October2011.org Movement confronted Wall Street investors who came to Washington to figure out how they can make more money from health care. The Wall Street Comes to Washington Healthcare Conference underscores why people across the United States are occupying their cities to protest Wall Street greed.

The meeting was sponsored by the Peter G. Peterson Foundation which has spent decades trying to undermine our social insurances: Medicare, Medicaid and Social Security. Panelists included representatives from JP Morgan, Goldman Sachs and Citigroup.

According to Paul Ginsburg, current President of the deceivingly-named Center for Studying Health System Change, who moderated the panel, the purpose of the conference was to discuss market development and Wall Street health policy, to look at trends for an equity analysis of publicly traded health companies.

The panel started with a discussion of why people are currently using less health services. They blamed employers for clamping down on employee costs. They said this ‘trend’ may reflect the ‘new normal’ of people choosing the care that they think is the most important. There was no mention that people are self-rationing, delaying or avoiding necessary care, due to the high cost.

Then they addressed the large increase in health insurance premiums, stating that the Kaiser Family Foundation study which revealed a 9% increase in premiums was false. They stated their goal of having more people with private insurance and more people using health services. Of course, this is not because they want to make sure that people who need care can get it. For Wall Street, health corporations are businesses and they are out to maximize profit, usually by collecting premiums and then denying payment for care.

When the discussion turned to how far they could push their profit gimmicks before the public started to shame them, I stood up and walked to the microphone.  I told the Wall Street bankers that they had no place in health care, that because of them people are dying of preventable causes or going bankrupt or homeless trying to pay for needed care. They are criminals masquerading as health policy experts.

For too long investors have put profit ahead of human needs.  This is particularly clear in health care where more than 100,000 Americans die each year from preventable causes.  The United States spends more per person than any other country, but gets very poor results.  Countries that spend less provide health care to all and have better health outcomes.  Countries that have universal health systems do not have people losing their homes because of health crisis while in the U.S. two-thirds of foreclosures are due to a health care crisis.

Marriott security officers took me out of the hotel and I sat in front of the entrance where I was joined by 2 more protesters, including Adara who shared the story of her father’s suicide which happened because of a health problem and the inability to afford care.  Dozens of October2011.org people were outside the hotel protesting.  They were chanting “Wall Street Greed Kills Those in Need,” “No More Wall Street Health Care” and “We Are the 99%.”

The protest lasted for several hours blocking the entrance to Marriott. Police did not make arrests. In fact, DC police have agreed to a 4 year wage freeze in order to maintain health benefits. That’s why we are the 99% and we are standing together to make the country and the world a better place for all of us.

The October2011.org continues to occupy Freedom Plaza in Washington, DC seeking to shift power to the people and end corporate rule.

http://october2011.org/blogs/margaret-flowers/wall-street-comes-dc-profit-health-care-99-say-wall-street-greed-kills-those-

Reinhardt and McCanne on Goodman's claim that free health care causes disparities

Why Are There Disparities In Health Care? Because It’s Free.

By John Goodman
National Center for Policy Analysis, October 12, 2011

(Excerpts)

The latest issue of Health Affairs is devoted to racial and ethnic disparities in the consumption of health care. Naturally, they found some. Why are they there?

Let’s consider another necessity: food. Suppose you get a Double Quarter Pounder with cheese and a large order of fries, my favorite fast food indulgence when I put all considerations about healthy eating aside. Do you think your burger would have less cheese if you were a black customer? Would your fries be less crispy if you were Hispanic? Would the meat be less juicy if you earned a poverty level wage?

The answer to these questions is obvious. Just about anybody in America can have the same fast food dinner anyone else in America is having — usually with very little inconvenience. If there is any disparity in this market, it is due solely to individual preference and choice.

So what makes health care different? I am happy to report that increasingly, it isn’t different. MinuteClinics, RediClinics and other walk-in establishments around the country offer standardized services that are comparable to the market for cheeseburgers and fries. In fact, almost one of every five people who got a flu shot last year got it at a supermarket or a drugstore. At a walk-in clinic, your flu shot costs the same as my flu shot. Your allergy prescription is just as inexpensive and just as accessible as mine. If there is any difference between us it is solely due to differences in needs and preferences. Nothing more.

****

Without looking at any empirical data, economic theory alone predicts that if minimum wage laws and other labor market restrictions create a labor surplus, the black unemployment rate will be greater than the white unemployment rate. If policies that promote first-dollar coverage create a shortage of medical care, economic theory alone would predict that unmet needs will be greater among black patients than among whites.

If the demand for medical care exceeds the supply, for example, providers can discriminate based on racial, ethnic or sexual preferences and not pay a price for doing so.

For the entire article:
http://healthblog.ncpa.org/why-are-there-disparities-in-health-care-because-its-free/

Comments on the Goodman blog:

Don McCanne says:

There are a great number of complex variables that result in disparities in health care, and efforts should be made to reduce the impact of all of them. Perhaps the easiest measure would be to reduce financial barriers that result in disparities by providing first dollar coverage for everyone.

Central planning would also be important to ensure adequate health care facilities in low-income regions – areas that do not tend to be attractive to private providers of health care services.

Perhaps the biggest challenge would be to reverse trickle-up economics so that every household can maintain a decent standard of living, as much as is humanly possible.

And…

Uwe Reinhardt says:

I think John is on to something here.

If white and non-white Americans get the same Big Macs in the free market place, they would get the same CABG’s in a free market place.

I am assuming here that anyone who can afford to pay for a Big Mac can also afford to pay for a CABG out of pocket.

Lest someone on this blog — e.g., Don McCanne — argues that it isn’t so in the real world, let me tell you that I am an economist and thus entitled to make assumptions. Our whole profession depends on it.

Uwe

And…

John Goodman responds to Uwe Reinhardt:

I thought economists were supposed to be able to think abstractly. Do I have to walk through every single medical service and show there is an alternative to nonprice rationing in each case? It appears so.

Okay, let’s take CABGs. One way to allocate them is to make them free and deter access with various forms of nonprice rationing. This is how other countries do it, and it appears to be really bad if you are poor or if you are a racial or ethnic minority.

The other way is to empower patients, make them legitimate consumers and invite providers to compete for their patronage. What I call the casualty model of insurance and what others call reference pricing or value based purchasing gives the patient purchasing power, but leaves the market free to determine prices and realize the benefits of competition.

QED

And…

John Goodman responds to Don McCanne:

First dollar coverage is not the solution. It is the problem. Most people in most countries have first dollar coverage and it does not guarantee access to care. In fact, it impedes access to care.

http://healthblog.ncpa.org/why-are-there-disparities-in-health-care-because-its-free/#comments

Comment: 

By Don McCanne, MD

John Goodman promotes himself as being the “Father of Health Savings Accounts.” He has been very influential in spreading the concept that we must “empower patients, make them legitimate consumers and invite providers to compete for their patronage.” This concept has gained traction as we see more health care costs being shifted to patients, especially in the form of higher deductibles for accessing care, and higher premiums so that health consumers will shop for only the insurance that they need.

This exchange on his blog is important because it reveals that this approach is based on ideology under the guise of “economic theory” rather than being based on “empirical data” and health policy science. As Goodman states, “Without looking at any empirical data, economic theory alone predicts…” He then is free to advance his ideology based on his version of economic theory.

Uwe Reinhardt shows that he has Goodman’s number when he states, “… let me tell you that I am an economist and thus entitled to make assumptions. Our whole profession depends on it.”

Although policy wonks might find some humor in this exchange (I did), we are jolted back into reality when we realize the implications of Goodman’s manipulation of economic theory. Disparities in health care produce horrendous health care injustices for the victims. One of the more effective methods of reducing disparities, confirmed by empirical data, is to eliminate financial barriers to care through first dollar coverage. Yet Goodman insists that first dollar coverage “impedes access to care.” The basis for that statement seems to be that it does not fit with his own economic theory of consumer empowerment through bearing the costs of health care.

The tragedy of all of this is that perverse, ideology-based economic theory permeates the Affordable Care Act and has an omnipresence in ongoing political manipulations of our public programs designed to provide health and financial security, especially with the current attack on Medicare, and  the continual dismissal of single payer even though it has been proven to be one of the most efficient and effective models of financing health care for everyone.

This is not to say that we don’t have our own ideology. Ours is one of health care justice – providing needed health care for everyone – but we do use empirical health policy science to back up our recommendations.

Orrin Hatch on Obama and single payer

Orrin Hatch Forecasts Obamacare Will Morph To Single Payer Health Care

Vitals
October 11, 2011

US Senator from Utah, Orrin Hatch, spoke at Heritage Foundation about what he envisions happening to ObamaCare and the health care system if President Obama will be reelected for another term.

“If President Obama is reelected within a year or two he’ll throw his hands in the air and say, ‘it’s not working, we got to go to a single payer system.”

40 second video:
http://spotlight.vitals.com/2011/10/orrin-hatch-forecasts-obamacare-will-morph-to-single-payer-health-care/

Comment: 

By Don McCanne, MD

Don’t we wish.

Sen. Hatch’s comment does demonstrate, once again, that even the conservatives understand the compelling advantages of single payer, in spite of their ideological opposition.

‘Occupy Wall Street’ Should Also Take Aim at Health Insurance Companies

Health insurers trade group is calling the tune in Washington.

By Wendell Potter
iWatch, Oct. 10, 2011

The lobbyists for U.S. health insurers surely have to be feeling a little uneasy knowing that thousands of Occupy Wall Street demonstrators who have been marching and protesting in Washington as well as New York and other cities might target them in the days ahead. After all, the headquarters of the insurers’ biggest lobbying and PR group, America’s Health Insurance Plans (AHIP), at 601 Pennsylvania Avenue, N.W., is just blocks away from Freedom Plaza, where the demonstrators have set up camp, and problems with health insurers appear to be near the top of the list of protesters’ concerns.

Health Care for America Now, an umbrella advocacy group that played a key role in the health care reform debate, last week analyzed the 546 comments that had been posted by then on “We are the 99 percent” Tumblr site. It found that 262 of the comments mention such problems as getting denials for doctor-ordered care from their insurance companies and having to forego treatment because of hefty out-of-pocket costs.

In my book, Deadly Spin , I wrote about how the “Wall Street takeover” of the American health care system has created many of the problems mentioned in the Tumblr site. I also described how AHIP offices have often been command central for developing and implementing coordinated efforts to derail health care reform efforts in the past and how the organization helped shape major provisions of the Affordable Care Act, which Congress passed last year.

Over the past few years, many of the largest health insurance firms have converted from nonprofit to for-profit status and have been acquired by huge corporations whose stock is traded on the New York Stock Exchange. Today, more than one-third of all Americans are enrolled in a health benefit plan owned and operated by just five large insurers — a group that last year hauled in nearly $12 billion in profits. These companies have grown so big and powerful that they now often determine who has access to affordable care and who doesn’t. Their business practices, condoned by investors and Wall Street analysts alike, have contributed to the growing number of Americans without health insurance— more than 50 million of us at last count.

I worked for two of those large companies, Humana and CIGNA, during my nearly 20 years in the insurance industry, and I participated in many strategy meetings at AHIP’s offices in Washington where plans were hatched to influence public policy.

I am now watching how AHIP is getting Obama administration officials to write the regulations required by the Affordable Care Act in ways that benefit insurance companies more than consumers. And I have talked to administration officials who have quit their jobs in disgust as the White House has repeatedly sided with insurers rather than consumer advocates, as important regulations were nearing completion.

Here’s an example. Earlier this summer, the administration announced rules pertaining to new rights we supposedly now have, thanks to the Affordable Care Act, to appeal decisions made by insurers that don’t go our way. When the Department of Health and Human Services quietly released the regulations in late June, consumer advocates realized that insurers had, for all practical purposes, written them.

As Sabrina Corlette of Georgetown University’s Health Policy Institute wrote, the administration narrowed the range of issues consumers can appeal, gave insurers up to 72 hours, rather than 24 hours, to made decisions on emergency care claims and weakened a provision requiring health plans to provide enrollees with information about their appeal rights in understandable language. Administration officials also cut in half the number of days patients have for appeals and allowed insurers to frequently choose their own “judge and jury” when their enrollees request an external review.

Just last week, AHIP’s muscle was on display when the Institutes of Medicine released guidelines for the Obama administration to follow in establishing the “essential benefits package” that all health plans will have to offer on the health care exchanges, or insurance marketplaces, beginning in 2014.

In January, an AHIP executive warned the IOM about making the benefits package too “rich.” Insurers want the package to be as skinny as possible, which will enable them to continue selling plans that, in many cases, are inadequate for many peoples’ needs.

The IOM’s recommendation is almost exactly what AHIP suggested.

So if the Occupy Wall Street demonstrators want to show up in front of the offices of some of the most important and influential people in Washington, whose strings are pulled by a handful of people on Wall Street, they will not want to miss 601 Pennsylvania Avenue, N.W. Trust me on this.

Wendell is a senior analyst at the Center for Public Integrity.

http://www.iwatchnews.org/2011/10/10/6923/analysis-occupy-wall-street-should-also-take-aim-health-insurance-companies

Preventing the implosion of the Los Angeles County safety-net

L.A. County expands no-cost healthcare

By Anna Gorman
Los Angeles Times, October 9, 2011

In one of the largest expansions of health coverage to the uninsured, Los Angeles County is enrolling hundreds of thousands of residents in a publicly funded treatment program and setting the stage for the national healthcare overhaul.

The county hopes to register as many as 550,000 patients and is assigning them to medical clinics for services at no cost to them.

Under President Obama’s controversial healthcare overhaul, millions more uninsured Californians will be eligible for Medicaid — the healthcare program for the poor — beginning in 2014. Even as the debate over the law continues in Washington, California is starting that expansion now and using federal dollars to do so. Altogether, the state expects to receive $2.3 billion to expand and modernize its Medicaid program, known as Medi-Cal, now available only to certain low-income residents.

In L.A. County, the stakes are high. In 2014, the newly insured county residents will be able to seek treatment wherever they want. To keep them with the county, health leaders recognize that they must make the system one of choice rather than of last resort. Otherwise, the only patients left will be illegal immigrants and others still ineligible for public coverage.

“Our survival depends on it,” said Mitchell Katz, director of the county Department of Health Services. Unless the healthcare system improves, he said, “if people have choice, they won’t choose us and the system will implode.”

Health workers began signing patients up for a program called Healthy Way L.A. in July and so far have enrolled 24,000, many of whom are receiving services. County residents are eligible if they are between the ages of 19 and 64, citizens or permanent residents of five years and earn less than 133% of the federal poverty level (about $14,500 for an individual and $29,700 for a family of four).

The coverage is not insurance and cannot be used outside of L.A. County, but it does give patients the ability to receive free primary and specialty care, mental health services, chronic disease management, medication and emergency treatment. Most of the enrollment is being done when patients go to the county’s network of hospitals and clinics.

Over the next two years, the county will pay half the cost for Healthy Way L.A. — or about $300 million — and the federal government will pay the other half. By 2014, when the patients become eligible for Medi-Cal, the federal government will pick up the entire tab, which will help bolster the financially strapped county’s health system.

http://www.latimes.com/health/la-me-health-reform-la-20111010,0,4242519.story

Comment: 

By Don McCanne, MD

This admirable effort in Los Angeles County to include more uninsured adults in its health services programs demonstrates some of the complexities that arise in trying to coordinate health care financing and health care delivery under our current dysfunctional, fragmented system that is being expanded by the Affordable Care Act (ACA).

Traditionally, the county has been the health care provider of last resort. If we had a financing system that covered everyone, there would be no need to support separate financing of a welfare program for low-income individuals, though there would still be a need to be sure that adequate facilities were available in areas with high rates of poverty that might not attract private health care providers.

Between this need to ensure adequate capacity in underserved areas, and the anticipation that there will still be tens of millions of uninsured individuals, forward thinking county health administrators are wise to try to work within the current system, with the anticipated changes under the Affordable Care Act, to be sure that care will be available for these underserved populations. The efforts in Los Angeles County can serve as a model for other counties throughout the nation, though the task is difficult because of the budget constraints that states and counties now face.

So how is Los Angeles County going to finance the safety-net in an unstable environment during the health reform transition? The first phase is to expand the safety-net to cover uninsured low-income adults. This is not an insurance program, but it relies on a contribution of federal funds that would pay about half of the expansion in clinic services for this population. Thus it expands the traditional role of the county as the provider of last resort, with the addition of much needed federal funds.

By providing these patients with a primary care medical home now, the transition to a program financed completely by the expansion of Medicaid will be much smoother.

But then what? The 100 percent federal financing of the Medicaid program applies only to the expansion of coverage for these newly enrolled low-income adults, and it is only temporary, designed as an enticement to states to roll out their Medicaid expansions under ACA. States are already facing severe fiscal problems in trying to finance their Medicaid programs, so what will they do when the extra federal subsidies end for these state programs with greatly expanded enrollments?

This policy nightmare was created by our politicians who decided above all to protect the markets for the private insurance industry catering to all of the population sectors that are above poverty levels. For those in poverty, they decided to use chum money to get the states to expand their Medicaid programs, but then revert to the chronic underfunding that characterizes this program, but which would now be compounded by expanded enrollment.

What would have happened had our legislators instead enacted a single payer national health program? Full federal funding would have been provided for these low-income individuals on an equal basis as with everyone else. Income would play no role in a person’s ability to clear the financial barriers to health care. The safety-net facilities provided by the counties would be fully funded by the program.

Because of a lack of interest by the private health care sector in serving regions with high poverty levels, it is likely that the counties would continue as administrators of these institutions, but they would do so knowing that adequate federal funding would always be there through the single payer national health program.

Think of how much easier the task would be, under a single payer system, for Mitchell Katz, the director of the Los Angeles County Department of Health Services, to prevent the implosion of the county administered health facilities, which we will need regardless of whatever financing system we end up with. But then, Mitchell Katz isn’t looking for a way to make his job easier; he is looking for a way to be sure that health care will always be there for everyone who needs it.

Union women urge push for single-payer health care

By All Unions Committee For Single Payer Health Care – H.R. 676

The Coalition of Labor Union Women (CLUW), meeting in September 2011 in Orlando, Fla., for its 16th biennial convention, voted to “wholeheartedly renew its endorsement of H.R. 676, Expanded and Improved Medicare for All.” CLUW first endorsed H.R. 676 at its 2003 convention, leading the way for many unions to join in pushing for national, single-payer health care.

“Workers, their families and their unions are still waging an increasingly difficult struggle to win or to keep good health care coverage,” states the CLUW resolution. “Almost every union at every contract deadline must battle and sacrifice merely to sustain health care benefits. The rising costs of health insurance are blocking workers’ progress in wages and other areas.”

The resolution was submitted by Vera Newton, president of the Derby City chapter of CLUW and a member Local 862 UAW, which represents workers at two major Ford plants in Louisville, Ky.

Helen Ramirez-Odell, RN, of Chicago, co-chair of national CLUW’s Women’s Health and Wellness Committee, commented on the resolution: “CLUW has a long record of support for health coverage for all with single payer being the most efficient way to provide it. CLUW believes that health care is a basic human right and that quality health care must be accessible to all, not only to the wealthy or those able to afford an expensive insurance plan.”

The CLUW resolution points out that “More employers are forcing high deductible plans onto workers, resulting, according to Dr. Steffie Woolhandler, in a $1,000 annual pay cut for women due to the higher average health expenditures of women.”

The resolution notes that “About 50 million people in the U.S. are currently without health insurance and the high cost of premiums, deductibles, and co-pays forces even the insured to go without needed care.”

CLUW states the “a single-payer program as provided by H.R. 676 is the only affordable option for universal, comprehensive coverage” and commits “to mobilize our members, our unions, and our communities at the grassroots to encourage other members of the House to sign on as co-sponsors of H.R. 676.”

On September 15, 2011, Rep. Terri A. Sewell of Alabama’s 7th Congressional District signed on to H.R. 676, bringing the number of co-sponsors to 66 in addition to the sponsor, Rep. John Conyers of Michigan.

The full CLUW resolution is at the CLUW website here: http://tinyurl.com/3b5avnk

H.R. 676 would institute a single-payer health care system by expanding a greatly improved Medicare system to everyone residing in the U.S.

H.R. 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental (including oral surgery, periodontics, endodontics), mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care and correction, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, podiatric care, and long-term care.

H.R. 676 ends deductibles and co-payments. H.R. 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

By All Unions Committee For Single Payer Health Care – H.R. 676

The Coalition of Labor Union Women (CLUW), meeting in September 2011 in Orlando, Fla., for its 16th biennial convention, voted to “wholeheartedly renew its endorsement of H.R. 676, Expanded and Improved Medicare for All.” CLUW first endorsed H.R. 676 at its 2003 convention, leading the way for many unions to join in pushing for national, single-payer health care.

“Workers, their families and their unions are still waging an increasingly difficult struggle to win or to keep good health care coverage,” states the CLUW resolution. “Almost every union at every contract deadline must battle and sacrifice merely to sustain health care benefits. The rising costs of health insurance are blocking workers’ progress in wages and other areas.”

The resolution was submitted by Vera Newton, president of the Derby City chapter of CLUW and a member Local 862 UAW, which represents workers at two major Ford plants in Louisville, Ky.

Helen Ramirez-Odell, RN, of Chicago, co-chair of national CLUW’s Women’s Health and Wellness Committee, commented on the resolution: “CLUW has a long record of support for health coverage for all with single payer being the most efficient way to provide it. CLUW believes that health care is a basic human right and that quality health care must be accessible to all, not only to the wealthy or those able to afford an expensive insurance plan.”

The CLUW resolution points out that “More employers are forcing high deductible plans onto workers, resulting, according to Dr. Steffie Woolhandler, in a $1,000 annual pay cut for women due to the higher average health expenditures of women.”

The resolution notes that “About 50 million people in the U.S. are currently without health insurance and the high cost of premiums, deductibles, and co-pays forces even the insured to go without needed care.”

CLUW states the “a single-payer program as provided by H.R. 676 is the only affordable option for universal, comprehensive coverage” and commits “to mobilize our members, our unions, and our communities at the grassroots to encourage other members of the House to sign on as co-sponsors of H.R. 676.”

On September 15, 2011, Rep. Terri A. Sewell of Alabama’s 7th Congressional District signed on to H.R. 676, bringing the number of co-sponsors to 66 in addition to the sponsor, Rep. John Conyers of Michigan.

The full CLUW resolution is at the CLUW website here: http://tinyurl.com/3b5avnk

H.R. 676 would institute a single-payer health care system by expanding a greatly improved Medicare system to everyone residing in the U.S.

H.R. 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental (including oral surgery, periodontics, endodontics), mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care and correction, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, podiatric care, and long-term care.

H.R. 676 ends deductibles and co-payments. H.R. 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

Health care is why Canadians can spend

By Richard C. Dillihunt, M.D.
Letters, The Portland Press Herald, Sept. 21, 2011

The Press Herald’s Sept. 5 piece describing an increase in Canadian spending in Maine was good and timely economic news.

Attributing this to advertising and good bilingual skills deserves the credit received, but there is a more important factor here that needs to be emphasized because it is fundamental to our economy.

It is the matter of health care costs. Canada, with its universal health care and single-payer system, spends only about half what we do on health care. Canadians enjoy more money in their budgets for other things. Naturally, shopping and travel enter this picture.

This is another example of our need for health care reform. Unlike in Canada, our nation sits around in fear of getting sick and going bankrupt. The situation is now worse than ever as depicted by the recently released statistic by The Commonwealth Fund documenting that 44 percent of American adults were either uninsured or underinsured last year – an appalling increase.

The bottom line is that huge numbers of everyday Canadians are visiting here, having fun and spending statewide, to our delight. Meanwhile, for Americans, stifling health costs orchestrated by greedy special interests prevent our economy from turning around.

The fact that this situation is perpetuated by a Congress that seems more concerned about themselves than its people earns a 10 on the discouragement index.

All Americans are urged to address our own broken-down system and consider joining to develop one like that of Canada – where life might just be good again.

Richard C. Dillihunt, M.D., a retired general, vascular and transplant surgeon, lives in Portland, Maine.

http://www.pressherald.com/opinion/health-care-is-why-canadians-can-spend_2011-09-21.html

Corporate control of drug pricing and distribution

Walgreen battle over drug prices will limit consumer choice

By David Lazarus
Los Angeles Times, October 7, 2011

Beginning Jan. 1, Walgreens will no longer fill prescriptions for Anthem Blue Cross members, meaning that they’ll have to switch to another drugstore if they want their insurance to keep covering their meds.

In this case, though, it’s not the insurance giant calling the shots. Instead, it’s Anthem’s pharmacy benefit manager, a St. Louis company called Express Scripts Inc.

The dispute between Walgreens and Express Scripts highlights how consumers can find their healthcare choices limited by the money-minded business decisions of big corporations.

(Express Scripts) is spending about $29 billion to acquire rival Medco Health Solutions Inc. If the deal passes regulatory muster, it would give Express Scripts control over about a third of the market for pharmacy benefits. Nearly 4 billion prescriptions are dispensed in the U.S. annually.

Obviously steps should be taken to keep medical costs down. Both Express Scripts and Walgreen say that’s what they’re trying to do.

But it’s hard not to think all we’re really seeing here is two large, profit-hungry corporate behemoths fighting over as much of our healthcare dollars as they can get their hands on.

Inevitably, prices will go up for consumers and choices will be further limited.

http://www.latimes.com/business/la-fi-lazarus-20111007,0,2128189,full.column

Comment:

By Don McCanne, MD

Congress turned the Medicare prescription business over to private pharmacy benefit managers under the fiction that they would increase choices and reduce costs. What did we get? Reduced choices in drugs covered, reduced choices in pharmacies, and prices much higher than the government obtains for the Medicaid and the VA drug programs. It’s only going to get worse, unless we finally decide that we’re ready to take over the financing of health care in America by establishing our own public insurance program.

Gettysburg panel discusses pros and cons of Pa. single-payer health care

A proposed system would give coverage to all.

By JACQUELINE PALOCHKO
The Evening Sun (Hanover, Pa.), Oct. 6, 2011

A few years ago, Dr. Dwight Michael would have said he was not in favor of a universal health care system in Pennsylvania.

He believed, like many of colleagues, that a person has the right to choose their health care provider. But the Gettysburg physician said his views changed after he saw so many of his patients face the “unfairness” of the system – especially during the economic downturn when so many lost their jobs and had no health insurance.

“We’re lead to believe that we have a great system in this country,” Michael said. “But we don’t.”

Opponents and supporters of health care reform attended a public meeting Thursday night in Gettysburg to discuss a single-payer system that would give universal coverage to all in Pennsylvania. With nearly every seat taken in a lecture room at Lutheran Theological Seminary, the panel included Michael, Dave Steil, president of the group Health Care 4 All Pennsylvania and state Rep. Dan Moul, R-Conewago Township.

A bill introduced in the state’s House and Senate in July 2009, would establish a system that is publicly funded but privately administered – similar to how Medicare works. Under the proposed system, individuals would be taxed 3 percent of their income, and businesses would be taxed 10 percent of their payroll.

Steil’s group is working to support the single-payer health care bill – known as the Family and Business Health Security Act. While no state has yet passed a single-payer health care bill, 26 do have proposals like the one in Pennsylvania.

“We cannot have a system that leaves people behind,” Steil said while talking about today’s health care problems.

And the proposed health care system would not leave anyone behind, Steil said. Even those who have no income at all and cannot be taxed would still receive health care. Or say a Pennsylvania resident is attending college out of state, Steil added – that individual would still receive care in the college’s state.

Moul, on the other hand, said the proposed system would take away a person’s right to choose what health care services they want. Additionally, the lawmaker said, he won’t support anything until he knows if it would be successful. Moul suggested an unbiased group conduct a study to see how well such a system would work in Pennsylvania.

Moul stressed that he was not expert on health care, but said he believes that if a child is sneezing and the parents bring the youngster to a doctor, taxpayers shouldn’t have to pay for that appointment.

“People who truly need health care will get it,” he said.

“It’s too bad Moul still looks at it like that,” Alan Olson, of Carroll Valley, said of Moul’s view on the proposed system.

Olson, a supporter of the single-payer health care bill, said he attended Thursday’s meeting because he’s very concerned about health care.

But even though Moul was on opposite sides with Michael and Steil, all three panelists did agree on one aspect.

“Our health care system is broken,” Moul acknowledged.

http://www.eveningsun.com/ci_19059408

IOM's disturbing report on "essential health benefits"

Essential Health Benefits: Balancing Coverage and Cost

Institute of Medicine
October 6, 2011

Abstract

The principle intent of the Patient Protection and Affordable Care Act (ACA) is to enable previously uninsured Americans to obtain health insurance. To accomplish this, in part, subsidized plans will be offered to low- and moderate-income individuals and small employers through health insurance exchanges. Plans qualified to be offered through exchanges must at minimum include “essential health benefits” (EHB). The ACA is not very specific on the definition of EHB except that such benefits shall include at least ten enumerated general categories and that the scope of the EHB shall be equal to the scope of benefits provided under a typical employer plan. The ACA requires the Secretary of the Department of Health and Human Services to define the essential health benefits.

The Institute of Medicine (IOM) was asked by the Secretary to make recommendations on the methods for determining and updating the essential health benefits. Notably, the request was to focus on criteria and policy foundations for the determination of the EHB, not to develop the list of benefits. The IOM formed a committee of volunteers with varied perspectives and professional backgrounds; the committee held four face-to-face meetings and numerous conference calls. Broad public input was obtained. In two open workshops, the committee heard from more than 50 witnesses, and 345 comments were received in response to questions posted on the web. The consensus report then underwent rigorous external review in accordance with procedures established by the Report Review Committee of the National Research Council.

As the committee examined its charge, it saw two main questions for the Secretary: (1) how to determine the initial EHB package and (2) how to update the EHB package.

Defining the initial EHB package. In considering how to determine the initial EHB package, the committee was struck by two compelling facts: (1) if the purpose of ACA was to provide access to health insurance coverage, that coverage had to be affordable; and (2) the more expansive the benefit package was, the more it was likely to cost and the less affordable it would be. How to balance the competing goals of comprehensiveness of coverage and affordability was key.

The committee concluded that it was best to begin simply by defining the EHB package as reflecting the scope and design of packages offered by small employers today, modified to include the ten required categories. This package would then be assessed by criteria and a defined cost target recommended by the committee. The committee considered how four policy domains – economics, ethics, population-based health, and evidence-based practice – could guide the Secretary in determining the EHB package in general. From these policy foundations, the committee recommends: criteria to guide the aggregate EHB package; criteria to guide specific EHB inclusions and exclusions; and criteria to guide methods for defining and updating the EHB.

To ensure affordability and protect the intent of the ACA, the committee concluded that costs must be considered both in the determination of the initial EHB package and in its updating. Thus, the cost of the initial EHB package resulting from the previous steps should be compared to a premium target defined by the committee as what small employers would have paid, on average, in 2014. Committee members believe that absent a premium target, there would be no capacity to acknowledge the realities of limited resources and the ongoing need for affordability of the package. The EHB package should be modified as necessary to meet this estimated premium, including using a structured public deliberative process. In addition, the committee recommends that states operating their own exchanges be able to design a variant of the EHB package if certain standards are met.

Updating the EHB package. Both medical science and our understanding of how best to design insurance products will change over time. Thus, the committee recommends creating a framework and infrastructure for collecting data and analyzing implementation of the initial EHB; a National Benefits Advisory Council is recommended to give the Secretary advice on the research plan and on updates to the EHB package. The committee believes that the EHB package should become more fully evidence-based, specific, and value-based over time. In addition, as with the initial package, costs must be taken into account such that any service added to the package should be offset by savings, through either medical management or the elimination of inappropriate or outmoded services.

Finally, the committee noted that even with the use of a premium target, the affordability of the EHB package is threatened by rising medical costs in the United States overall and recommends that the Secretary, in collaboration with others, develop a strategy to reduce health care spending growth across all sectors.

http://iom.edu/Reports/2011/Essential-Health-Benefits-Balancing-Coverage-and-Cost.aspx

And from the IOM Report Brief:

One way to think about the EHB package is to compare HHS’s task to going grocery shopping. One option is to go shopping, fill up your cart with the groceries you want, and then find out what it costs. The other option is to walk into store with a firm idea of what you can spend and to fill the cart carefully, with only enough food to fit within your budget. The committee recommends that HHS take the latter approach to developing the EHB package and to keep in mind what small employers and their employees can afford. Employers who offer insurance packages make such choices now.

http://iom.edu/~/media/Files/Report%20Files/2011/Essential-Health-Benefits-Balancing-Coverage-and-Cost/essentialhealthbenefitsreportbrief.pdf

Comment: 

By Don McCanne, MD

From the start of the reform process it was understood that defining which essential benefits should be covered by the exchange plans would be controversial. What is no surprise is that, just as the process of writing the Affordable Care Act (ACA) was guided by the private insurance industry, this recommendation for establishing a process for determining essential benefits has the private insurance industry’s fingerprints all over it.

When ACA was developed, the large group employer health plans were functioning fairly well, so it was decided to include policies that would encourage the continuation of these plans. It was the market of small group and individual plans that was not functioning well. Benefits were quite skimpy, and underwriting practices prevented many from obtaining coverage in this market. Thus it was decided to establish state health insurance exchanges in which a market of better regulated and more standardized insurance products would be available.

When the Institute of Medicine tried to balance the essential health benefits package (EHB) with affordability what did they choose? They decided that affordability must come first, and then benefits selected to match the affordable premiums.

Wait a minute! What is being made affordable? Health care or health plans? Skimpy benefits equate with unaffordable health care since much of health care has to be paid out-of-pocket simply because it is not part of the benefit package. By establishing the current benefits of existing small group plans as the standard essential benefits in the plans offered by the exchanges, the IOM has made a deliberate choice of making private health insurance pro
ducts affordable at the cost of making health care itself unaffordable for those purchasing their plans in the exchanges.

This is precisely what the private insurance industry wanted when it came to defining the essential health benefit packages. By making the austere small business packages the new standard, the insurers could keep their premiums low enough to ensure that they still had a market for their products. The insurers could care less what happens to patients when they actually need care, as long as their own market is protected.

It isn’t the insurers’ problem now since they have the prestigious Institute of Medicine telling the nation that we can’t have more than skimpy, spartan health care unless we are willing and able to pay for it out-of-pocket. Since most middle-income families can’t, they’ll just have to do without.

(Single payer systems do not cut benefits. They control spending through administrative efficiencies, global budgeting, price negotiations, elimination of coverage for detrimental services, and by planning and separate budgeting of capital expenditures.)

The Occupy Wall Street movement and single payer

By Katie Robbins

I am writing this on the bus to Washington, D.C., for the launch of the October 2011 movement. The past few weeks have been exhilarating to watch the growing Occupy Demonstrations gain momentum with increased solidarity from labor, faith groups, peace and justice organizations, and of course the health justice community.

Some people have been asking about how to engage with the Occupy Wall Street solidarity actions around the country, particularly around health care. I will share our experience in New York City.

The Occupy Wall Street Demo at Zuccotti Park is happening across the street from the offices of WellPoint, the largest health insurance company in the U.S. Two years ago, we held a sit-in at the offices of WellPoint to protest the obscene profits and patient abuse, while pointing to the need for single-payer health care.

Healthcare-NOW! NYC members have been petitioning, leafleting, and talking to human beings about single-payer health care regularly. The response has been excitement about our positive message and how to improve our society in a just and equitable way. People approach us to talk about our signs that say “Medicare for All” and “Health Care is a Human Right.”

Last night, a contingent of single-payer health care supporters joined 20,000 New Yorkers in a solidarity march with the Occupy Wall Street demonstration. [PNHP note: a 1-minute video showing the participation of physicians in yesterday’s action is available here, courtesy of Dr. SteveB at Daily Kos.] Some of the Wall Street demonstrators then made it to our public forum on single-payer health care at Church of the Ascension on the Upper West Side.

You don’t have to participate in civil disobedience to join the Occupy Demonstrations or sleep outside. You do have a responsibility to educate and share information about the movement for health justice and talk to people about how the health crisis affects them and their families.

You might consider bringing food, clothes, and card board for signs for those who are sustaining this peaceful occupation.

Together, we can show solidarity and create the kind of movement to meet the needs of the 99 percent, including winning a just and equitable health care system. Let me know if you’d like to talk about any other ideas to link up single-payer health care advocacy and #OccupyTogether actions. There are 503 cities participating in this movement as of right now. Find an event near you here: http://www.occupytogether.org/

Katie Robbins is national organizer for Healthcare-NOW! She can be reached at katie@healthcare-now.org.