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by Elizabeth Crane
The Brandeis Hoot
September 18, 2009

The last few months of the health care debate have offered a chaotic stream of political incidents that fall somewhere between entertaining and disheartening. Bitten-off fingers at town halls and catchy sound bites like “death panels” and “you lie!” have stolen the show, turning the process of health care reform into an ill-fated media circus.

Some of these outbursts appear to be political savvy, scoring hundreds of thousands of dollars for Representative Wilson and scaring Americans away from meaningful reform. Others underscore shocking misconceptions about the government and its role in health care. One refrain heard at town halls this summer seems particularly tragic: “Keep the government out of my Medicare!”

This quote defines the current debate in one short and effective sentence. Americans dislike big government on ideological grounds and continue to protest a “government take-over” of health care. The problem arises when, in practice, Americans actually love the health care that government provides. They can protest the government ideologically, but the evidence shows that Medicare, a form of (gasp!) single-payer health care, enjoys not only quality and efficiency, but also immense popularity.

In a point that has gone unacknowledged throughout the current debate, Medicare has endured as one of the most effective components of our health care system. Now, instead of decrying the role of government in health care, Americans should embrace it and expand Medicare to all citizens in an inclusive single-payer system.

As most other advanced nations have figured out, single-payer health care offers a superior and comprehensive alternative to the train wreck that is the American system. Unlike socialized medicine, where the government runs a nation’s hospitals and employs its doctors, single-payer health care simply means that the government assumes the role of one big insurance company paying health care costs to both public and private institutions.

If the U.S. were to magically make this switch, it could expect a number of unique positive results, the most important of which will be addressed in this article. First and foremost, every single citizen would have, for the first time in our history, access to the high-quality care that many insured people enjoy today.

Americans could expect their overall health to improve with the new availability of routine physicals and check-ups as well as access to specialists and hospital care. Most crucially, this would shift the focus from secondary to preventative care.

Instead of paying sky-high rates to treat the uninsured in the emergency room, the government can ensure that people have access to treatment for conditions like high blood pressure and pregnancy before their health problems threaten their lives and cause bankruptcy. By doing so, it prevents many avoidable medical catastrophes in a cost-efficient and effective way.

While focusing on preventative care cuts costs both immediately and in the long run, some of the most significant savings occur in health care administration. Switching to single-payer health care would immediately cut the percentage of money wasted on administrative costs from our high of fifteen percent to the low three-to-four percent that most other nations enjoy, effectively reducing some of the most wasteful and bureaucratic spending in the system.

The U.S. has already witnessed these savings in its current single-payer systems, particularly Medicare; Medicare spent a mere two percent of its budget on administrative costs in 2004. By eliminating America’s nationwide mess of private insurers, claims, policies, and corporate legalese, a single-payer system would eliminate red tape and bring the focus back to health care delivery. Other reforms, like advancing electronic medical records, would create even more efficiency in health care administration and ultimately hold down costs in the long run.

Businesses and employees would also get to take advantage of the single-payer system’s sweeping cost cuts. Entrepreneurs could start up their own companies with the security of guaranteed, life-long insurance. At the same time, small businesses would no longer have to spend a significant portion of their earnings on providing health insurance to employees, a costly problem that discourages wage increases and company expansion.

Finally, employees themselves could change jobs or career paths instead of getting stuck in dead-end jobs for the fear of losing insurance. No other reform option on the table offers so many unique and significant advantages to small business, but like single-payer health care itself, these have been systematically ignored throughout the health care debate.

Many people reading this article are probably shaking their heads and declaring that the U.S. will never make the move towards “socialized health care.” This seems to be accepted as fact, but why do Americans continue to oppose single-payer health care in such huge numbers? It seems preposterous that anyone would oppose what is essentially an effective, low-cost, fair, and comprehensive expansion of Medicare, a government program that enjoys an approval rating as high as 76%.

It also seems unlikely that anyone could approve of the current system, where at best, people pay sky-high premiums for below-average health care and at worst, hardworking citizens die of treatable medical problems for lack of coverage. The problem is that no matter how well a single-payer system works, Americans cannot get past the false idea that government seeks to “take over” health care. This ideological quagmire has prevented meaningful reform for years, and now we have the failed health care system to prove it.

The best idea that Republicans can offer is low-impact tort reform, and the only decent proposal from Democrats, the public option, remains woefully inadequate at addressing our system’s most fundamental cost problems. Neither of these options holds the potential to create the positive change that is so desperately needed in the system today.

Obama’s health reform speech contained the line, “I believe it makes more sense to build on what works and fix what doesn’t, rather than try to build an entirely new system from scratch.” President Obama is dead wrong about that. American health care delivery is fundamentally flawed, and nothing short of a complete overhaul will change the system.

Switching certainly wouldn’t be easy; it would take years of transition, policy formation, and battles with the private insurance industry to extend Medicare to millions of Americans. Even then, the system would require more cost-cutting mechanisms to help defray the inevitable rising price of high-quality care. The promises this dream holds, though, are too great to pass up.

It’s time for Americans accept that government can and should have an effective, meaningful, and central role in reform, and that their own health and welfare will improve as a result.

For that reason alone, the United States should accept the evidence at hand and pursue a full expansion of Medicare, the system that best guarantees that all Americans will gain access to the high-quality and low-cost health care that only some get to enjoy today.

Times Union (Albany, NY)
Letter to the Editor
Saturday, September 19, 2009

I am a family physician and geriatrician with 37 years of experience who attended the recent health care town hall meeting in Bethlehem. I was very impressed with Congressman Paul Tonko’s ability to field many questions in a sometimes contentious arena.

I heard two main themes, yearning and fear: People who had inadequate health care and yearned for a better system, and other people who feared that there would be a government takeover and loss of our freedom.

The most critical aspect is that physicians and patients must work together.

The rub is: Who pays for it? Very few individuals can pay for health care so a third party is involved, the government or the insurance industry.

I have much more trouble with the insurance industry. I have seen many cases where the insurance company will not cover a procedure.

We want a system that is more efficient and cost-effective, and continues to value the doctor-patient relationship. I believe we do not need insurance companies and that some type of single-payer system would be much better. Decisions within this system would have to safeguard the freedom to choose care and the assurance that policy would be made by an autonomous organization within government.

An improved Medicare system would address both the yearning and the fear.

Appleton Mason, M.D.
Physicians for a National Health Program
Glenmont, NY

Dr. Robert Golden
The Spokesman-Review (Spokane, WA)
September 12, 2009

In recent health care debates people proclaim they don’t want the government standing between them and their physician. Some have adamantly opposed a “single-payer” health plan while demanding, “Don’t touch my Medicare.” As a physician practicing in Spokane for the past 26 years, I would like to share my experiences.

I am a urologist, providing medical and surgical care to my patients with diseases of the urinary tract. Over 75 percent of my patients are on Medicare.

Medicare allows me the freedom to provide quality health care with the interests of my patients as first priority. Medicare is a single-payer, government-sponsored health insurance plan and yet imposes no restrictions or arbitrary rules between my patients and me. The health care decisions are only between my patients, their loved ones and me. Yes, there are guidelines for best practice, which I honor and embrace.

Americans support the Medicare system by paying into the program their entire working lives. At age 65, all citizens are eligible for this program and enjoy the security of knowing their health care is covered. Younger patients in special categories (end stage kidney disease, permanent physical or mental disabilities) are also covered by Medicare. I am appreciative Medicare is the force that allows people to come to my office for urologic care. Without coverage, they stay away, suffer with their usually treatable ailments, or die in pain. All American citizens deserve comprehensive health coverage and Medicare fulfills this right. My vote is “Medicare for all.”

In contrast, private insurance plans are heavy-handed and defiantly stand between patients and their health care providers. These plans ration care irrationally. Confirming coverage, obtaining prior approval for procedures, collecting money and billing these insurance companies over and over because of denials ranging in the 25 percent to 40 percent range are huge obstructions. Private “insurance” policies are cumbersome, denying and frustrating. Documented claims filed electronically with Medicare are quickly resolved.

Medicare eases my patients’ minds. Every week, I see patients without insurance, delaying treatment for fear of bankruptcy, emptying their savings, selling their houses, etc. These people are sometimes one illness away from complete financial disaster. No wonder they delay doctor visits and live with symptoms — sometimes too long — and their disease (cancer, infection obstruction) progresses to a point of uncontrollability or even mortality. I am not willing to accept this as democracy or compassion. This is wrong.

President Barack Obama and some members of Congress have earnestly tried to reform this mess we call our “health care system.” The president has consistently supported increased reimbursement to primary care physicians, while encouraging medical students to choose primary care as a specialty. He also advocates for absorption of student loans in exchange for primary care doctors practicing in underserved urban and rural areas.

That nearly 50 million citizens in our country are uninsured is a travesty and, frankly, embarrassing. Every year, more than $400 billion of private health insurance money (paid for by subscribers of the insurance company like you and me) go to profits, marketing, executives, buildings, etc. The president of United Health Care makes $102,000 an hour. Of the money flowing into for-profit private insurance, only 65 percent is used for actual health care services. This is in contrast to Medicare, where more than 95 percent is directly used to provide health services to our seniors.

These issues are complex — financially and ethically. Standing by and listening to the verbiage by the profit-seeking, fear-mongering insurance and pharmaceutical industries is no longer an option for me. What makes this country great is our willingness to sacrifice our excesses for the general greatness of the whole.

Personally, I became a medical doctor to serve with compassion and love — to relieve pain and suffering. At the end of the day, I do not ruminate about money. Rather, I hope I’ve contributed to my patients’ journey toward a greater understanding of the wonder and blessings of life.

The Canadian physician William Osler stated this simply, “We are here to add what we can to life, not to get what we can from life.”

Dr. Robert Golden is a urologist in Spokane.

By Susan Heavey
Reuters
Thu Sep 17, 2009

WASHINGTON (Reuters) – Nearly 45,000 people die in the United States each year — one every 12 minutes — in large part because they lack health insurance and can not get good care, Harvard Medical School researchers found in an analysis released on Thursday.

“We’re losing more Americans every day because of inaction … than drunk driving and homicide combined,” Dr. David Himmelstein, a co-author of the study and an associate professor of medicine at Harvard, said in an interview with Reuters.

Overall, researchers said American adults age 64 and younger who lack health insurance have a 40 percent higher risk of death than those who have coverage.

The findings come amid a fierce debate over Democrats’ efforts to reform the nation’s $2.5 trillion U.S. healthcare industry by expanding coverage and reducing healthcare costs.

President Barack Obama’s has made the overhaul a top domestic policy priority, but his plan has been besieged by critics and slowed by intense political battles in Congress, with the insurance and healthcare industries fighting some parts of the plan.

The Harvard study, funded by a federal research grant, was published in the online edition of the American Journal of Public Health. It was released by Physicians for a National Health Program, which favors government-backed or “single-payer” health insurance.

An similar study in 1993 found those without insurance had a 25 percent greater risk of death, according to the Harvard group. The Institute of Medicine later used that data in its 2002 estimate showing about 18,000 people a year died because they lacked coverage.

Part of the increased risk now is due to the growing ranks of the uninsured, Himmelstein said. Roughly 46.3 million people in the United States lacked coverage in 2008, the U.S. Census Bureau reported last week, up from 45.7 million in 2007.

Another factor is that there are fewer places for the uninsured to get good care. Public hospitals and clinics are shuttering or scaling back across the country in cities like New Orleans, Detroit and others, he said.

Study co-author Dr. Steffie Woolhandler said the findings show that without proper care, uninsured people are more likely to die from complications associated with preventable diseases such as diabetes and heart disease.

Some critics called the study flawed.

The National Center for Policy Analysis, a Washington think tank that backs a free-market approach to health care, said researchers overstated the death risk and did not track how long subjects were uninsured.

Woolhandler said that while Physicians for a National Health Program supports government-backed coverage, the Harvard study’s six researchers closely followed the methodology used in the 1993 study conducted by researchers in the federal government as well as the University of Rochester in New York.

The Harvard researchers analyzed data on about 9,000 patients tracked by the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics through the year 2000. They excluded older Americans because those aged 65 or older are covered by the U.S. Medicare insurance program.

“For any doctor … it’s completely a no-brainer that people who can’t get health care are going to die more from the kinds of things that health care is supposed to prevent,” said Woolhandler, a professor of medicine at Harvard and a primary care physician in Cambridge, Massachusetts.

(Editing by Xavier Briand)

By Elizabeth Cooney
Boston Globe
September 18, 2009

As medical care has improved for people with health insurance, the consequences of being uninsured have worsened, according to a new study that says the lack of coverage translates into nearly 45,000 deaths each year among working-age Americans.

Researchers from Cambridge Health Alliance reported yesterday in the American Journal of Public Health on a study that followed 9,005 adults under 65 years old who took part in a national survey conducted by the Centers for Disease Control and Prevention from 1986 through 1994. After 12 years, 351 people had died. Sixty of them were uninsured, and 291 were insured.

After accounting for differences in age, education, income, and other factors, the researchers found that people without private insurance had a 40 percent higher risk of dying than people with private insurance.

An earlier study by the Institute of Medicine based on 16 years of data through 1993 found that uninsured people had a 25 percent higher risk of dying than insured people, which translated into 18,000 additional deaths.

“Being uninsured is more lethal relative to being insured than it was 20 years ago,” coauthor Dr. Steffie Woolhandler said in an interview.

According to US Census figures released earlier this month, the number of uninsured people rose from 45.7 million in 2007 to 46.3 million in 2008.

Woolhandler, who advocates a single-payer form of universal health coverage, blamed three factors for the widening gap between those with and without insurance. More people are uninsured and the safety net for those people has eroded, she said. But the gap has also grown because the care that insured people are more likely to get has gotten better.

Treatments for chronic illnesses have improved, including blood pressure medications to control hypertension and statins to lower cholesterol, the authors write.

“We’re much more vigilant about care of high cholesterol, diabetes, and hypertension, which has lowered the death rate of people with insurance, which is great, but the uninsured have not shared in those benefits,” Woolhandler said.

“Uninsured people who have a chronic condition are less likely to know they have it, and even when they know they have it, they are less likely to be able to control it because control of chronic conditions involves regular visits to a primary care doctor.”

Dr. John Z. Ayanian, a professor of medicine and health policy at Harvard Medical School and Brigham and Women’s Hospital, served on the committee that issued the 2002 Institute of Medicine report. He said the newer work confirms the results of several prior studies.

It also fits with his own research analyzing what happens when uninsured people turn 65 and qualify for Medicare. In that study, published in 2007, people with diabetes or cardiovascular disease were especially likely to see dramatic improvements in their health after gaining insurance coverage through the national plan for the elderly.

“This study underscores the serious health consequences that people face when they are uninsured, as well as the potential benefit of extending coverage to all Americans so that they have access to good primary and specialty care when they need it,” Ayanian said.

HealthDay News
Atlanta Journal Constitution
THURSDAY, Sept. 17

If you doubt that lack of health insurance can have deadly consequences, consider these new findings: Americans without health insurance are 40 percent more likely to die than those with private insurance.

As many as 44,789 Americans of working age die each year because they lack health insurance, more than the number who die annually from kidney disease.

The study comes at a pivotal moment in history, as Congress considers legislation to expand health insurance coverage. The findings imply that lack of health insurance isn’t just a policy issue, it’s a significant health risk.

Being uninsured is associated with a risk of death, “and it turns out to be an elevated risk,” said Dr. Andrew P. Wilper, lead author of the study and an instructor at the University of Washington School of Medicine in Seattle.

The study appeared Thursday in the online edition of the American Journal of Public Health.

Wilper, formerly of Harvard Medical School in Boston, and his colleagues used data from the Third National Health and Nutrition Examination Survey, conducted between 1988 and 1994. Their analysis included people aged 17 to 64.

The research replicates a 1993 Institute of Medicine (IOM) study, which found a 25 percent higher death risk among the uninsured compared with privately insured adults.

Due to the margin of error in each study, Wilper can’t say whether the risk of death has increased over time. However, if there is an increased risk, he suspects it’s because treatments for insured Americans have gotten much better for certain conditions, such as hypertension, diabetes and coronary heart disease.

The study also corroborates certain predictors of mortality among the uninsured. The death risk is higher for men than women, smokers than non-smokers, heavier drinkers and people who are older, for example.

“The things that we would expect to predict death seem to,” said Wilper. “Nonetheless, even after controlling for all those things, we find this elevated risk for death among those without insurance.”

Not everyone agreed with the new findings, however. In a statement released Thursday, the National Center for Policy Analysis, which opposes nationalized health care, called the Harvard research “flawed.”

“The findings in this research are based on faulty methodology and the death risk is significantly overstated,” NCPA President John C. Goodman said. “The subjects were interviewed only once and the study tries to link their insurance status at that time to mortality a decade later. Yet over the period, the authors have no idea whether subjects were insured or uninsured, what kind of medical care they received, or even cause of death.”

But another expert supported the research. Lucien Wulsin, director of the Santa Monica, Calif.-based Insure the Uninsured Project, said that while the study does not examine how or why the uninsured died, it seems to substantiate what is already known about the lack of access to health care services.

“I saw it as very much validating the earlier [IOM] study, that being without health insurance means that you have a greater likelihood of mortality because you don’t get the care when you don’t have the health insurance until ‘too-little too-late,'” Wulsin said.

Wilper said the IOM identifies three factors that influence health outcomes: not getting care when needed, not having a regular source of care, and not getting continuity of coverage.

“If you have an illness that may have dire consequences if it’s untreated, such as hypertension or coronary artery disease, and you can’t get in to see the doctor, you’re more likely to have some serious outcome from that untreated illness,” he said.

California led the nation in excess deaths from lack of health insurance — with 5,302 deaths in 2005.

“Safety net” funding to support health care services for California’s poor and uninsured has not kept up with the growth in the ranks of the uninsured and the escalating cost of medical care, Wulsin observed. He suspects the same factors are playing out nationwide.

So what’s the solution? Policymakers should cover as many people as possible, Wulsin said, and they should focus on primary care and preventive services so that people don’t delay care and end up in the emergency department “with conditions that are hard to deal with at that point.”