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Auctioneers of medical debt

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Auctioneers of medical debt

Hospitals Put Patients' Debt Up for Auction

By Sarah Rubenstein
The Wall Street Journal
June 3, 2008

In a move that consumer groups say could increase pressure on people with unpaid medical bills, some hospitals are trying out a new tactic to recoup patients’ debts: They’re auctioning the debt online.

Hospitals have long relied on outside collection agencies to go after debtors. Under traditional arrangements, these agencies receive a percentage of any money they get from a debtor; the more they collect, the more they earn.

Now, some of the same collection agencies, as well as other firms that purchase debt outright, have begun participating as bidders in online auctions, in which they buy the debt or provide guaranteed payments to hospitals for access to the unpaid accounts. Some experts say this gives them more reason to aggressively pursue patients in arrears. Auctions can drive up the amount paid for debt, meaning a collector must recoup more money from patients to cover its initial investment and turn a profit. And the winning bidders often get to keep all the money they collect on the auctioned debt.

Many of the auctions of hospital debt have been done through Web site ARxChange.com — shorthand for “accounts receivable exchange” — owned by TriCap Technology Group. Another site is medipent.com, run by Medipent LLC.

“The hospital is an institution in the community, has a reputation, in many cases has a nonprofit mission to uphold,” says Anthony Wright, executive director of the consumer-advocacy coalition Health Access California. “Once it goes to collections, that starts a process that can get a lot more antagonistic, a lot more aggressive, and a lot more damaging to a family’s credit history and financial future.”

http://online.wsj.com/article/SB121244901525139563.html

Comment:

By Don McCanne, MD

By far, the highest per capita health care spending in the world… the money is already there… and, yet, we are unique amongst industrialized nations in forcing into debt individuals who have the misfortune of becoming ill or injured.

Of all of the problems we face, this is one of the simplest. We do not need more money. We merely need to reform our system of financing health care.

So what do we do? We continue to expand policies that make all of the numbers worse – more uninsured, more underinsured, more medical debt, greater impairment of access, greater administrative waste… while we continue to support the multitude of money-movers, trading off the health and financial security of patients.

Today’s message is particularly disturbing. Medical debt is a horrendous problem. Instead of trying to fix the financing system so that medical debt is prevented, we add yet another administrative layer that further burdens those with medical debt: the auctioneers who sell medical debt to the highest bidding collection agencies!

Have we no shame?

Sen. McCain's proposal for high-risk pools

McCain's Free-Market Health Plan Would Boost Role of High-Risk Pools

By Laura Meckler and Anna Wilde Mathews
The Wall Street Journal
June 2, 2008

John McCain’s plan for a health-care system built around consumers shopping for their own insurance comes with a significant downside: for people with a history of illness, it can be impossible to find coverage on their own.

The Republican presidential candidate’s main answer is to bolster the role of high-risk pools, which sell insurance to people with pre-existing conditions such as diabetes, cancer and AIDS.

These pools, typically created by state governments, require significant government subsidies, charge high premiums and sometimes sharply restrict benefits or enrollment. Nationally, fewer than 200,000 people are enrolled in such pools, while 47 million people in the U.S. are without insurance.

“They tend not to work particularly well,” said Sara Collins, an assistant vice president at the Commonwealth Fund, a nonprofit health-care-research group. “States have really struggled to finance these adequately.”

Sen. McCain… would rely on tax cuts, market forces and consumers themselves to broaden access to coverage, and give a smaller role to employers as a source of coverage.

To fill the gap, Sen. McCain proposed new high-risk pools that would scoop up those who can’t get insurance on their own. He called it a Guaranteed Access Plan. Premiums would be reasonable, with subsidies for low-income participants, but he has given few other details.

(Douglas Holtz-Eakin, Sen. McCain’s chief policy adviser) has suggested the federal government might need to spend $7 billion to $10 billion to subsidize these pools — an estimate he calls “extremely preliminary.” Many experts said that is nowhere near enough, particularly given the large number of people with pre-existing conditions who would need this help if employers send their workers out to the open market.

http://online.wsj.com/article/SB121236916701936663.html?mod=googlenews_wsj

Comment:

By Don McCanne, MD

Sen. John McCain’s initial proposal for health care reform was simply to change tax incentives, reducing support for moderately-regulated, employer-sponsored health plans, and providing tax credit incentives that would encourage individuals to shop in the less-regulated, individual insurance market – a market capable of providing a much greater choice of innovative health plans. It quickly became obvious that these innovative products would be designed to avoid paying for much of our health care. He had to come up with a proposal to answer critics of his plan.

Over half of us receive our coverage through employer-sponsored group plans. Although employer-sponsored plans cover a lower-cost, healthier segment of our population, health care has now become so expensive that premiums for these more comprehensive plans have become much less affordable. Employers have been attempting to reduce their costs by trimming benefits and expanding out-of-pocket expenses for their employees, but even these changes have failed to make premiums affordable.

Sen. McCain contends that a less-regulated individual insurance market is capable of offering innovative products with premiums that would be affordable for most of us if we were to use his proposed tax credit. In reality, the tax credit is not large enough to make premiums affordable for plans comparable to what most employers provide. For premiums to be competitive, the plans would have to reduce benefits and require much greater out-of-pocket cost sharing. These plans would work only for individuals who are healthy and who will remain healthy, defeating the purpose of insurance.

In a less-regulated market, more comprehensive coverage comparable to current employer-sponsored plans attracts individuals who have greater health care needs. It is unlikely that those plans would even be offered in the individual market under Sen. McCain’s proposal, but if they were, they would rapidly withdraw from the market because of the death spiral caused by the ever higher premiums that must be charged as the sick enroll and the healthy drop out. People who need care would be shut out of the individual market.

Sen. McCain could not really sit on a proposal that would cover only the 80 percent of us who are healthy. He had to propose some mechanism of paying for the 80 percent of health care that is used by the 20 percent of us who have significant health care needs. His solution is to promote state-run high-risk pools that would provide that coverage.

We do already have considerable experience with these pools, and it certainly is not good. The primary problem is that the cost per participant is extremely high. Most states severely restrict the number of participants, and many states haven’t even established such pools. The high premiums are even less affordable, and coverage is very skimpy, usually with very low lifetime caps.

In 2006, private plans, out-of-pocket expenses, and other private spending financed 54.7 percent of national personal health care expenditures (KFF/Urban Institute). CMS projects for 2008 a total personal health care expenditure of $1,999 billion. Thus private health care spending is projected to be $1,093 billion this year. The 20 percent of health care consumed by the 80 percent of us who are relatively healthy would cost about $218 billion. The 80 percent consumed by the 20 percent of individuals with significant health care needs would cost about $874 billion in private spending.

It is much of this $874 billion that would be transferred to the state high-risk pools under Sen. McCain’s proposal. His adviser, Douglas Holtz-Eakin, provides an “extremely preliminary” estimate of $7 billion to $10 billion in federal subsidies for these pools. Who pays the other $864 billion? The individual?

Excluding those covered by Medicare, Medicaid and other public programs, 225 million of us have private insurance or are uninsured. Twenty percent of those, or 45 million people, theoretically would be in the high-risk pool if everyone were to obtain coverage under his program. If the high-risk individuals were responsible for the remaining $864 billion, each would have to pay $19,200. Obviously, that can’t work.

Others propose that high-risk pools be funded by an assessment on commercial insurers. But that moves the financing for high-risk individuals back into the private insurance risk pools. Not only would that drive up premiums, which are already unaffordable, it would also add another layer of administrative costs in a system that is already overburdened with administrative excesses.

Now you know why state high-risk pools don’t work. There is only one reason to propose them in the first place – that is to relieve the private insurance industry of its responsibility of paying for necessary health care, merely to enhance its successful business model of selling insurance primarily to the people who don’t need care now, and hopefully won’t in the future.

As John Geyman says, the private insurance industry is dying, and we shouldn’t try to resuscitate it – certainly not if we we taxpayers are the ones who are going to be indemnifying those who actually need health care.

Empty promises on health care

By Marie Cocco
Indy Star
May 31, 2008

More than halfway through a political season in which public concern about America’s porous, confusing and costly health insurance system has consistently emerged as one of the chief worries of a squeezed electorate, this is what we can expect when the new president takes office next year: not so much.

Neither presumptive Republican nominee John McCain nor Democrat Barack Obama, the likely nominee of his party, has pledged to cover all of the 47 million uninsured Americans who are falling through the cracks of a system that already is at a breaking point. Neither has proposed a health-insurance plan that would make health care more fair and equitable by putting everyone in a pool in which risks are shared among those who are healthy (but might one day get sick) and those who are not. This is how insurance — whether it be government insurance, such as Social Security, or private insurance, such as the policies we buy for automobiles — works. With everyone in the same system, everyone shares the burden of paying as well as the benefit of coverage when it is needed.
Because of the crucial failure of both candidates to acknowledge this elemental truth, the nation will likely stay on the crooked path down which it has staggered since the employer-based system of care began to unravel at least two decades ago.

But don’t both McCain and Obama say they want to fix the system, covering more people and lowering costs for everyone? Sure. But talk is cheap — much cheaper, apparently, than the political costs of more comprehensive action that would either anger ideological supporters on the right (if you’re McCain) or raise that old chestnut about “socialized medicine” (if you’re Obama).

McCain’s plan, because it seeks to placate a right wing for whom any hint of government intervention is apostasy, would effectively dismantle the current employer-based system by eliminating the tax deduction that businesses now get when they pay the health premiums for their employees. Most experts say this would quicken the pace at which employers are dropping coverage.

McCain would provide tax credits for individuals to purchase insurance, but he relies on the unproved theory that if full costs and responsibility for insurance were shifted back to individuals and families, prices would drop. “This is a ‘back to the future’ plan, returning us all to the period before the creation of employer-based group insurance in the 1930s, when individuals and families were ‘on their own’ to find ways of paying for their health care,” concludes an issue brief by Rekindling Reform, a New York-based group of religious, academic, social welfare agencies, unions and public health organizations.

Obama’s plan is a lost opportunity.

Yes, it would curtail some of the more egregious insurance industry practices and seeks some cost-containment. But it still fails to recognize that without some kind of mandate to bring everyone into the system — either an individual mandate, like his Democratic rivals Hillary Clinton and John Edwards proposed, or a nationwide requirement, such as a Medicare-for-all type of system — insurance companies still would be able to cherry-pick among those they want to insure and those they don’t.

“Where his (Obama’s) falls down is that it’s not universal,” says Aaron E. Carroll, director of the Center for Health Policy and Professionalism Research at Indiana University School of Medicine. “He’s still trying to build this on a patchwork system.”

Though Obama proposes a mandate that all children be covered, he has no clear way to enforce this beyond what many states already do for the current State Children’s Health Insurance Program (SCHIP). That is, he would do outreach at schools, day-care centers and hospitals to try to get parents to sign their kids up. “Mandates like this are incredibly inefficient,” Carroll says, and would be unlikely to enroll many more children than the state and federal governments already have.

The good news, I suppose, is that if McCain wins the White House, Democrats probably will continue to control Capitol Hill. They would be unlikely to enact anything so radical as the McCain proposal. The bad news is that if Obama wins, his party will have squandered the best opportunity in more than a decade — since the Bill Clinton era — to take a bold leap toward the universal coverage Democrats have promised since the presidency of Harry Truman.

Cocco writes for the Washington Post Writers Group. Contact her at mariecocco@washpost.com.

Sen. McCain’s proposal for high-risk pools

McCain’s Free-Market Health Plan Would Boost Role of High-Risk Pools

By Laura Meckler and Anna Wilde Mathews
The Wall Street Journal
June 2, 2008

John McCain’s plan for a health-care system built around consumers shopping for their own insurance comes with a significant downside: for people with a history of illness, it can be impossible to find coverage on their own.

The Republican presidential candidate’s main answer is to bolster the role of high-risk pools, which sell insurance to people with pre-existing conditions such as diabetes, cancer and AIDS.

These pools, typically created by state governments, require significant government subsidies, charge high premiums and sometimes sharply restrict benefits or enrollment. Nationally, fewer than 200,000 people are enrolled in such pools, while 47 million people in the U.S. are without insurance.

“They tend not to work particularly well,” said Sara Collins, an assistant vice president at the Commonwealth Fund, a nonprofit health-care-research group. “States have really struggled to finance these adequately.”

Sen. McCain… would rely on tax cuts, market forces and consumers themselves to broaden access to coverage, and give a smaller role to employers as a source of coverage.

To fill the gap, Sen. McCain proposed new high-risk pools that would scoop up those who can’t get insurance on their own. He called it a Guaranteed Access Plan. Premiums would be reasonable, with subsidies for low-income participants, but he has given few other details.

(Douglas Holtz-Eakin, Sen. McCain’s chief policy adviser) has suggested the federal government might need to spend $7 billion to $10 billion to subsidize these pools — an estimate he calls “extremely preliminary.” Many experts said that is nowhere near enough, particularly given the large number of people with pre-existing conditions who would need this help if employers send their workers out to the open market.

http://online.wsj.com/article/SB121236916701936663.html?mod=googlenews_wsj

Comment:

By Don McCanne, MD

Sen. John McCain’s initial proposal for health care reform was simply to change tax incentives, reducing support for moderately-regulated, employer-sponsored health plans, and providing tax credit incentives that would encourage individuals to shop in the less-regulated, individual insurance market – a market capable of providing a much greater choice of innovative health plans. It quickly became obvious that these innovative products would be designed to avoid paying for much of our health care. He had to come up with a proposal to answer critics of his plan.

Over half of us receive our coverage through employer-sponsored group plans. Although employer-sponsored plans cover a lower-cost, healthier segment of our population, health care has now become so expensive that premiums for these more comprehensive plans have become much less affordable. Employers have been attempting to reduce their costs by trimming benefits and expanding out-of-pocket expenses for their employees, but even these changes have failed to make premiums affordable.

Sen. McCain contends that a less-regulated individual insurance market is capable of offering innovative products with premiums that would be affordable for most of us if we were to use his proposed tax credit. In reality, the tax credit is not large enough to make premiums affordable for plans comparable to what most employers provide. For premiums to be competitive, the plans would have to reduce benefits and require much greater out-of-pocket cost sharing. These plans would work only for individuals who are healthy and who will remain healthy, defeating the purpose of insurance.

In a less-regulated market, more comprehensive coverage comparable to current employer-sponsored plans attracts individuals who have greater health care needs. It is unlikely that those plans would even be offered in the individual market under Sen. McCain’s proposal, but if they were, they would rapidly withdraw from the market because of the death spiral caused by the ever higher premiums that must be charged as the sick enroll and the healthy drop out. People who need care would be shut out of the individual market.

Sen. McCain could not really sit on a proposal that would cover only the 80 percent of us who are healthy. He had to propose some mechanism of paying for the 80 percent of health care that is used by the 20 percent of us who have significant health care needs. His solution is to promote state-run high-risk pools that would provide that coverage.

We do already have considerable experience with these pools, and it certainly is not good. The primary problem is that the cost per participant is extremely high. Most states severely restrict the number of participants, and many states haven’t even established such pools. The high premiums are even less affordable, and coverage is very skimpy, usually with very low lifetime caps.

In 2006, private plans, out-of-pocket expenses, and other private spending financed 54.7 percent of national personal health care expenditures (KFF/Urban Institute). CMS projects for 2008 a total personal health care expenditure of $1,999 billion. Thus private health care spending is projected to be $1,093 billion this year. The 20 percent of health care consumed by the 80 percent of us who are relatively healthy would cost about $218 billion. The 80 percent consumed by the 20 percent of individuals with significant health care needs would cost about $874 billion in private spending.

It is much of this $874 billion that would be transferred to the state high-risk pools under Sen. McCain’s proposal. His adviser, Douglas Holtz-Eakin, provides an “extremely preliminary” estimate of $7 billion to $10 billion in federal subsidies for these pools. Who pays the other $864 billion? The individual?

Excluding those covered by Medicare, Medicaid and other public programs, 225 million of us have private insurance or are uninsured. Twenty percent of those, or 45 million people, theoretically would be in the high-risk pool if everyone were to obtain coverage under his program. If the high-risk individuals were responsible for the remaining $864 billion, each would have to pay $19,200. Obviously, that can’t work.

Others propose that high-risk pools be funded by an assessment on commercial insurers. But that moves the financing for high-risk individuals back into the private insurance risk pools. Not only would that drive up premiums, which are already unaffordable, it would also add another layer of administrative costs in a system that is already overburdened with administrative excesses.

Now you know why state high-risk pools don’t work. There is only one reason to propose them in the first place – that is to relieve the private insurance industry of its responsibility of paying for necessary health care, merely to enhance its successful business model of selling insurance primarily to the people who don’t need care now, and hopefully won’t in the future.

As John Geyman says, the private insurance industry is dying, and we shouldn’t try to resuscitate it – certainly not if we we taxpayers are the ones who are going to be indemnifying those who actually need health care.

Message trumps policy?

How to Talk About Health Care Reform: Summary of Research on Health Care Messaging

Celinda Lake and Drew Westen
Families USA, Herndon Alliance, Westen Strategies, Lake Research Partners
May 22, 2008

If you want to see universal health care enacted, stop using that phrase.

Message development: Using focus groups of swing voters and online dial-groups

Conservative message:

Families should be in charge of their health care dollars. Rising health care costs are a problem, and the best way to bring them down is to increase competition among health care providers and put an end to these million dollar lawsuits that drive up insurance costs and put doctors out of business. The best solution to our health care problems is to let the free market work, foster more competition, and help people deal with the rising costs of coverage with health savings accounts that allow people to manage their own health care decisions. The last thing we need is the government taking over health care and creating a massive bureaucracy that will cost us billions of dollars a year. Sure, we have problems, but what the naysayers always seem to forget is that Americans still have the best health care in the world. Europe and Canada have government run health care, and their patients come here for treatment due to long waits and poor quality care. The answer to our health care problems is a freer market, not socialized medicine.
MEAN DIAL RATING (0-100) = 55

Progressive message I:

I believe that people who work for a living ought to be able to take their kids to a doctor, and people who are retired, ill, or temporarily out of work shouldn’t risk losing their life savings because of one illness. We’re not just talking about poor people. We’re talking about middle class Americans who are getting squeezed. Too many people have to think twice before switching jobs or starting a business because they’re worried they won’t be able to get insurance. We need comprehensive reform, not a band-aid. That means putting government to work for taxpayers again, not for special interests, by requiring insurance companies to put more money into patient care and less into efforts to deny it. It means preventing insurance companies from excluding patients because of “pre-existing conditions” and overriding doctors’ decisions about what their patients need. It means giving us choices among plans so we can decide what’s best for our own families, including the choice to keep our current doctor. It means limiting the amount anyone has to spend out of pocket, so no one loses their life’s savings because of a sick child or a hospital bill. And it means giving small businesses tax breaks to offset the costs of covering their employees, and requiring big businesses to offer coverage to their employees instead of sticking middle class taxpayers with the tab.
MEAN DIAL RATING (0-100) = 71

Progressive message II:

I believe in a family doctor for every family. It’s not right that hard-working Americans are struggling to afford health care and prescription drugs, while we’re strangling small businesses with the cost of their employees’ health care. The market hasn’t solved this problem, and it’s not going to as long as big insurance and drug companies are profiting at our expense. But we don’t need to replace managed care bureaucracy with government bureaucracy. We need common sense reform that gives people more choices, not less, including the choice to stay with the doctor they have now. We need to make insurance companies compete with each other to keep costs down and quality up, and give people the option to buy into the same plan members of Congress get, because if it’s good enough for Congress, it’s good enough for the people they represent. And we need government to set high standards to keep deductibles low, stop insurance companies from cherry-picking patients by excluding people with “pre-existing conditions,” and guarantee preventive care like cancer screening that cuts long-term costs and saves lives.
MEAN DIAL RATING (0-100) = 69

This link will download the Lake/Westen PowerPoint presentation, but you will be able to open it only if you have an appropriate program on your computer:
https://wadmin5.getactive.com/system/ga/redirect.jsp?redirectURL=http%3A%2F%2Fwww.familiesusa.org%2Flink-redirect.jsp%3FitemID%3D39611471%26domain%3Dfamiliesusa&hostgroupID=27078647

And…

Key Highlights from Herndon Alliance research

Celinda Lake, David Mermin, Dan Spicer
Lake Research Partners
November 15, 2007

A strong majority of voters favor Guaranteed Affordable Choice (GAC), and voters prefer it to other health care reform alternatives tested like HSAs, tax credits, or a single payer plan.

(Note: In the survey, the rhetoric of “Guaranteed Affordable Choice” was paired with the rhetoric of each of the other three options: “Health Savings Account,” “Tax Credits,” and “Single Payer.” In each pairing, Guaranteed Affordable Choice was preferred by about two-thirds of the participants, whereas each of the other options was preferred by about one-fifth. Only their rhetoric of “Guaranteed Affordable Choice” and “Single Payer” are included here since they relate to today’s message.)

Guaranteed Affordable Choice (GAC): An approach that would guarantee affordable health insurance coverage for every American with a choice of private or public plans that cover all necessary medical services, paid for by employers and individuals on a sliding scale. (64% preferred)

Single Payer (SP): A single government-financed health insurance plan for all Americans financed by tax dollars that would pay private health care providers for a comprehensive set of medical services. (22% preferred)

http://herndonalliance.org/pdf/PollingSummaryLRP-Nov07.pdf?PHPSESSID=51de02f649a54470d01f6e2a5ae6ccbb

Comment:

By Don McCanne, MD

There is currently an intensive effort within the progressive community to establish unity in support of a message on health care reform that will resonate with swing voters as well as progressives. Those driving that effort contend that the policy debate is over, and it is now time to move forward unified behind one message.

What is that message? CHOICE! “It means giving us choices among plans so we can decide what’s best for our own families,” according to the progressive message above. You’ve heard the Democratic candidates say repeatedly that “you can keep the insurance you have if that’s your choice.”

People like choice. The conservatives understand that. They contend that government programs take away your choice. Of course a single payer system allows you to choose your health care professionals, whereas the private plans supported by the conservatives take away your freedom to choose your physicians and hospitals. But what about the progressives? They are now using the framing of the conservatives! You can have your choice of health plans! But then why deal with the real issues when the rhetoric works so well?

Now let’s look at the survey data on Guaranteed Affordable Choice (GAC). When GAC was paired with Single Payer (SP), 64% preferred the rhetoric of GAC and 22% preferred the rhetoric of SP. Let’s look specifically at the rhetoric, from a policy perspective.

Both of the GAC and SP sentences flow very well, and even members of the policy community might not detect any bias at first glance. But when you study the statements, you can see several problems with the rhetoric. As mentioned, people like the word “choice.” It’s in the GAC description but not SP, even though the SP choice of physicians and hospitals is much more important than choice of health plans. GAC has a “guarantee,” but SP does not, even though SP is automatic for everyone – the ultimate guarantee. GAC is “affordable,” but SP is silent on this even though it is the model that actually is designed to be affordable. GAC has an option of a “public” plan, but SP is a “government” plan – meant as a rhetorical pejorative. GAC is paid on a “sliding scale,” but the even more equitable progressive nature of SP tax financing is not mentioned. Someone else (“employers”) are paying a large part of the GAC premium, whereas you pay your own (“taxes”) in the SP model. Even “paid for” (GAC) is a more comfortable phrase than the sterile term “financing” (SP). SP uses “providers” whereas GAC is silent and presumably uses physicians and other health care professionals. GAC has “all necessary” medical services, whereas SP has only “a comprehensive set.”

What happened here? The policy was set in advance, frozen in the model supported by the Democratic candidates. Then a message was developed to precisely coincide with that model. This was not a survey of which policies swing voters would prefer. This was a survey of what message produces a more supportive response of a model already fixed in concrete, at least fixed from the perspective of many of those supporting unity. The problem is that the policy debate is not over.

That said, the progressive community is right in one very important regard. It is time for unity. It is time for us to unite together in support of health policies that would ensure that every individual would have access to reasonably comprehensive health care services in an equitably funded system that is affordable for each and every individual and affordable for society. Unity is fragile. Trading away these principles would divide us, but by uniting behind them, we can finally get the job done.

AHIP's proposal to reduce costs

AHIP Outlines Plan to Reduce Health Care Costs by $145 Billion

America’s Health Insurance Plans (AHIP)
May 29, 2008

The U.S. could reduce total health care spending and improve the quality of patient care if the plan proposed today by America’s Health Insurance Plans (AHIP) was implemented. PricewaterhouseCoopers reviewed AHIP’s proposals and estimates and concluded that if these proposals are fully implemented, the nation’s total health care expenditures could be $145 billion lower than currently projected by the year 2015.

Principle #1: Patients and their doctors must have the information and tools they need to evaluate treatment options and make health care decisions on the basis of safety, quality and cost.

AHIP Proposal: Access to information that compares the effectiveness and cost of treatments: Give providers, patients and purchasers access to a trusted source where they can find up-to-date and objective information on which health care services are most effective and provide the best value.

Principle #2: Patients and doctors want an efficient, interconnected health care delivery system that reduces medical errors.

AHIP Proposal: Health information technology: Encourage widespread adoption of tools such as electronic health records (EHRs), personal health records (PHRs), secure e-visits with physicians, and e-prescribing.

Principle #3: Doctors and nurses need the freedom to practice medicine without worrying about frivolous lawsuits.

AHIP Proposal: Reforming the legal system: Replace the current medical liability system with a dispute resolution process consisting of an objective, independent administrative process to provide quick and fair resolution to disputes while promoting evidence-based medicine.

Principle #4: Health insurance plans are transitioning to a system that more closely aligns payments with the quality of care patients receive.

AHIP Proposal: Build health care reform around quality improvement by rewarding safety, value and effectiveness: Work for the broader adoption of value-based reimbursement mechanisms and provide consumers with more actionable information about health care value.

Principle #5: The nation must move towards a system of care that focuses on keeping people healthy, detects disease at the earliest possible stage and rewards chronic care management.

AHIP Proposal: Enhanced disease management, care coordination and prevention programs: Deploy a new generation of strategies that emphasize prevention, improve chronic care and tailor healthcare for patients to help them live longer and stay healthier.

AHIP press release
http://www.ahip.org/content/pressrelease.aspx?docid=23426

Full report: A Shared Responsibility: Advancing Toward a More Accessible, Safe, and Affordable Health Care System for America
http://www.ahip.org/content/default.aspx?docid=23427

Comment:

By Don McCanne, MD

Health care costs have become intolerable for most individuals, employers, and the government, and the prospect is that costs will continue to increase well in excess of the rate of inflation. Most current political proposals are focused on expanding coverage. Although the proposals include token programs for cost containment, most are not much more than rhetorical fluff except for the consumer-directed proposals that would make health care access even less affordable by shifting payment responsibility to patients in need of care. This is not the direction in which we should be headed.

The majority of Americans now receive their health care coverage through private health plans. While the private insurance industry has been in control for decades, they have been unable to restrain the escalation in health care costs. They understand that the viability of their industry is threatened if the issue of affordability is not adequately addressed. Let’s look at their proposal released today that theoretically would control health care spending.

Of their five proposals, the PricewaterhouseCoopers analysis shows that only three of them are projected to provide any significant savings: (2) Health information technology, (3) Medical liability reform, defensive medicine, and (5) Disease management, chronic care, prevention. How effective would these be?

Health information technology certainly can provide benefits such as increased efficiency and error reduction, but the problem of maintaining patient confidentiality within an integrated network has not been solved and may never be. Even if we did move forward with such a system, the private industry is poised to produce and control the technology for medical records and integrated systems. When you consider who the wealthiest person on earth is, it is difficult to imagine that such a system, which will certainly not be free, will reduce health care costs in the future. That technology will be expensive and it will be designed to continue to generate an enormous amount of user fees.

The direct costs of medical liability are only a very small part of our national health expenditures. If totally eliminated, it would have only a negligible impact on reducing spending. The important question is whether or not defensive medicine is wasting resources. When physicians decide to order tests to prevent lawsuits, they are not tests that couldn’t possibly provide any information that might help the patient. Most defensive medicine tests are ordered to be certain that a less likely but very real threat does not exist. These tests may be approaching the flat of the curve, but they are tests which occasionally do reveal a threat for which intervention can be effective, even life saving. Do we really want to abandon the use of lower-yield tests merely because they also happen to provide liability protection from having missed a serious disorder?

Substituting our current tort approach to malpractice with a dispute resolution process may be a good idea, but we should not expect major cost savings from that change. Currently, the overwhelming majority of medical-injury victims do not sue and never receive compensation for their injuries. If we were to establish a process in which medical injury is automatically compensated, it is likely that it would be considered to be an entitlement program, much like workers compensation. Imagine the costs of a program in which almost all medical injury is compensated. Even if it’s a good idea, based on the number of individuals to be compensated, it would increase rather than decrease health care costs.

Much has been written about disease management, chronic care, and prevention. Appropriate disease management and chronic care should be provided by our primary care professionals rather than by wasteful third-party administrators. An advantage of introducing processes that improve care is that ongoing needs for diagnostic and therapeutic interventions are more readily identified and acted upon. Prior studies have shown that even people with the best of care are not receiving all of the services that they should be. Improving care by providing these additional, appropriate services will not reduce costs, it will increase costs.

Prevention is important, but most important preventive measures fall outside of the realm of the health care delivery system. Even AHIP states that recommended steps include the “development of a national approach to consumer education and physical fitness, leading with a national discussion aiming to develop new strategies to promote early intervention of preventable disease.”

The insurance industry’s proposals to make health care affordable will more likely increase costs, so we should ask ourselves if they really provide us with any services that actually are of value. In this report they list services that they say are worth the extra cost that we pay over and above the publicly-administered Medicare program. According to AHIP, in contrast to Medicare, “private insurers develop a range of products, sell them to an under-65 population, develop and support provider networks, promote wellness and prevention, offer disease management services, access to health information, and offer consumer support services related to choice of providers and treatment plans.”

Well let’s break this out. They “develop a range of products,” which means that they market undesirable products that reduce benefits and increase cost sharing – measures that make access to health care less affordable. They sell their products to the “under-65 population,” certainly a healthier population than those over 65, but does that mean that we should be paying more for these marketing services that Medicare doesn’t face? They “develop and support provider networks,” which take away your freedom to choose your hospitals and health care professionals. They “promote wellness and prevention,” but who doesn’t? They “offer disease management services,” which are a costly administrative intrusion into primary care. They provide “access to health information,” as if they haven’t heard of the Internet. They “offer consumer support services related to choice of providers and treatment plans,” which are decisions to be made by patients and their health care professionals, not by an intrusive private bureaucracy.

So AHIP is attempting to legitimize the continued existence of the private health insurance industry by proposing cost containment measures that can’t work, and by trying to convince us that their expensive, detrimental administrative services are worth the extra we are paying. Why should we be paying extra for services that make affordability and access worse?

This report from AHIP is a desperate attempt to convince us that the worthless services of the private insurance industry somehow provide us with value. John Geyman is right. The insurance industry is in its death throes, and we should not attempt to resuscitate it.

John Geyman, “Do Not Resuscitate:”
http://www.commoncouragepress.com/index.cfm?action=book&bookid=396

Insurers don't like to 'share'

Dr. Susanne King
Berkshire Eagle, MA
Saturday, May 24

The current mantra of those who support our private insurance model for health care is “shared responsibility.” Their goal is to ratchet up the amount that individuals will have to pay for medical costs, by buying insurance policies that have higher deductibles, larger co-payments, and higher costs for prescription drugs. What “shared responsibility” is about is maintaining insurance company profits.

Under pressure from Wall Street for disappointing earnings during the first quarter of 2008, CEOs from the two largest health insurance plans, United Health Group and Wellpoint, told investors last week that they would “continue to protect their (profit) margins” and “not sacrifice profitability for membership” i.e., they aren’t going to hold down premium increases to keep members on their rolls. Wellpoint’s CEO, Angela Braly, also said that her company’s market power would give it the ability to lean hard on its network doctors to accept lower reimbursements. What she didn’t add was that her predecessor, retired CEO Larry Glasscock, left Wellpoint in 2007 with a $23.9 million farewell package. The private insurance model benefits neither patients nor doctors.

The truth is that when we examine who ultimately pays for health care, it is neither employers nor the government, but the individual. Employed individuals are paying for employer-sponsored health insurance plans rather than getting wage increases. Employees pay out-of pocket expenses for their share of premiums and health care costs that aren’t covered by insurance. And employed individuals also pay taxes to the government. We, as working people, provide the financial support for our current private insurance-based system.

Meanwhile, insurance companies aren’t working for us. They are busy working for their investors, and distributing our hard-earned dollars to them, as well as stoking the fortunes of their CEOs, like Wellpoint’s retired CEO Glasscock.

If we had a single-payer health care system, a national health insurance system that covered everyone and was administered by the government, there would truly be shared responsibility. The system would be funded by a modest tax on earnings, which would be an affordable, progressive tax. National health insurance would be real insurance, in which everyone is covered and the risk is distributed across the entire group, rather than the cherry-picking of healthy, working individuals that now occurs with private insurance. Everyone would have access to medical care. Coverage would be comprehensive, and would include medical care, dental care, mental health care, medications, and long term care. Patients could choose their own doctors and hospitals. There would be no co-payments or deductibles, and no denials or hidden costs when a patient needed his insurance.

Polls show that the majority of people support national health insurance. The obstacle to health care reform is corporate special interests that profit from the current health care system, and their tenacious grip on the political process, through their lobbying efforts and political donations. This leads some to say that significant health care reform, like replacing our private health insurance system with national single-payer health insurance, is not politically feasible.

But there is a growing grassroots movement for single payer health care. More and more doctors are joining the organization Physicians for a National Health Program (www.pnhp). There is legislation at the federal level for a national health insurance program, HR 676, currently sponsored by 90 legislators, including Rep. John Olver and seven other representatives from Massachusetts.

Recently, in his New York Times column, Thomas Friedman wrote this about his mother and her perseverance. Every time life knocked her down, she got up, dusted herself off, and kept marching forward, motivated by the saying that pessimists are usually right, optimists are usually wrong, but most great changes were made by optimists. Health care reform activists are optimistic and marching forward; please join us to reform the health care system.

Susanne L. King, M.D., is a Lenox practitioner.

AHIP’s proposal to reduce costs

AHIP Outlines Plan to Reduce Health Care Costs by $145 Billion

America’s Health Insurance Plans (AHIP)
May 29, 2008

The U.S. could reduce total health care spending and improve the quality of patient care if the plan proposed today by America’s Health Insurance Plans (AHIP) was implemented. PricewaterhouseCoopers reviewed AHIP’s proposals and estimates and concluded that if these proposals are fully implemented, the nation’s total health care expenditures could be $145 billion lower than currently projected by the year 2015.

Principle #1: Patients and their doctors must have the information and tools they need to evaluate treatment options and make health care decisions on the basis of safety, quality and cost.

AHIP Proposal: Access to information that compares the effectiveness and cost of treatments: Give providers, patients and purchasers access to a trusted source where they can find up-to-date and objective information on which health care services are most effective and provide the best value.

Principle #2: Patients and doctors want an efficient, interconnected health care delivery system that reduces medical errors.

AHIP Proposal: Health information technology: Encourage widespread adoption of tools such as electronic health records (EHRs), personal health records (PHRs), secure e-visits with physicians, and e-prescribing.

Principle #3: Doctors and nurses need the freedom to practice medicine without worrying about frivolous lawsuits.

AHIP Proposal: Reforming the legal system: Replace the current medical liability system with a dispute resolution process consisting of an objective, independent administrative process to provide quick and fair resolution to disputes while promoting evidence-based medicine.

Principle #4: Health insurance plans are transitioning to a system that more closely aligns payments with the quality of care patients receive.

AHIP Proposal: Build health care reform around quality improvement by rewarding safety, value and effectiveness: Work for the broader adoption of value-based reimbursement mechanisms and provide consumers with more actionable information about health care value.

Principle #5: The nation must move towards a system of care that focuses on keeping people healthy, detects disease at the earliest possible stage and rewards chronic care management.

AHIP Proposal: Enhanced disease management, care coordination and prevention programs: Deploy a new generation of strategies that emphasize prevention, improve chronic care and tailor healthcare for patients to help them live longer and stay healthier.

AHIP press release
http://www.ahip.org/content/pressrelease.aspx?docid=23426

Full report: A Shared Responsibility: Advancing Toward a More Accessible, Safe, and Affordable Health Care System for America
http://www.ahip.org/content/default.aspx?docid=23427

Comment:

By Don McCanne, MD

Health care costs have become intolerable for most individuals, employers, and the government, and the prospect is that costs will continue to increase well in excess of the rate of inflation. Most current political proposals are focused on expanding coverage. Although the proposals include token programs for cost containment, most are not much more than rhetorical fluff except for the consumer-directed proposals that would make health care access even less affordable by shifting payment responsibility to patients in need of care. This is not the direction in which we should be headed.

The majority of Americans now receive their health care coverage through private health plans. While the private insurance industry has been in control for decades, they have been unable to restrain the escalation in health care costs. They understand that the viability of their industry is threatened if the issue of affordability is not adequately addressed. Let’s look at their proposal released today that theoretically would control health care spending.

Of their five proposals, the PricewaterhouseCoopers analysis shows that only three of them are projected to provide any significant savings: (2) Health information technology, (3) Medical liability reform, defensive medicine, and (5) Disease management, chronic care, prevention. How effective would these be?

Health information technology certainly can provide benefits such as increased efficiency and error reduction, but the problem of maintaining patient confidentiality within an integrated network has not been solved and may never be. Even if we did move forward with such a system, the private industry is poised to produce and control the technology for medical records and integrated systems. When you consider who the wealthiest person on earth is, it is difficult to imagine that such a system, which will certainly not be free, will reduce health care costs in the future. That technology will be expensive and it will be designed to continue to generate an enormous amount of user fees.

The direct costs of medical liability are only a very small part of our national health expenditures. If totally eliminated, it would have only a negligible impact on reducing spending. The important question is whether or not defensive medicine is wasting resources. When physicians decide to order tests to prevent lawsuits, they are not tests that couldn’t possibly provide any information that might help the patient. Most defensive medicine tests are ordered to be certain that a less likely but very real threat does not exist. These tests may be approaching the flat of the curve, but they are tests which occasionally do reveal a threat for which intervention can be effective, even life saving. Do we really want to abandon the use of lower-yield tests merely because they also happen to provide liability protection from having missed a serious disorder?

Substituting our current tort approach to malpractice with a dispute resolution process may be a good idea, but we should not expect major cost savings from that change. Currently, the overwhelming majority of medical-injury victims do not sue and never receive compensation for their injuries. If we were to establish a process in which medical injury is automatically compensated, it is likely that it would be considered to be an entitlement program, much like workers compensation. Imagine the costs of a program in which almost all medical injury is compensated. Even if it’s a good idea, based on the number of individuals to be compensated, it would increase rather than decrease health care costs.

Much has been written about disease management, chronic care, and prevention. Appropriate disease management and chronic care should be provided by our primary care professionals rather than by wasteful third-party administrators. An advantage of introducing processes that improve care is that ongoing needs for diagnostic and therapeutic interventions are more readily identified and acted upon. Prior studies have shown that even people with the best of care are not receiving all of the services that they should be. Improving care by providing these additional, appropriate services will not reduce costs, it will increase costs.

Prevention is important, but most important preventive measures fall outside of the realm of the health care delivery system. Even AHIP states that recommended steps include the “development of a national approach to consumer education and physical fitness, leading with a national discussion aiming to develop new strategies to promote early intervention of preventable disease.”

The insurance industry’s proposals to make health care affordable will more likely increase costs, so we should ask ourselves if they really provide us with any services that actually are of value. In this report they list services that they say are worth the extra cost that we pay over and above the publicly-administered Medicare program. According to AHIP, in contrast to Medicare, “private insurers develop a range of products, sell them to an under-65 population, develop and support provider networks, promote wellness and prevention, offer disease management services, access to health information, and offer consumer support services related to choice of providers and treatment plans.”

Well let’s break this out. They “develop a range of products,” which means that they market undesirable products that reduce benefits and increase cost sharing – measures that make access to health care less affordable. They sell their products to the “under-65 population,” certainly a healthier population than those over 65, but does that mean that we should be paying more for these marketing services that Medicare doesn’t face? They “develop and support provider networks,” which take away your freedom to choose your hospitals and health care professionals. They “promote wellness and prevention,” but who doesn’t? They “offer disease management services,” which are a costly administrative intrusion into primary care. They provide “access to health information,” as if they haven’t heard of the Internet. They “offer consumer support services related to choice of providers and treatment plans,” which are decisions to be made by patients and their health care professionals, not by an intrusive private bureaucracy.

So AHIP is attempting to legitimize the continued existence of the private health insurance industry by proposing cost containment measures that can’t work, and by trying to convince us that their expensive, detrimental administrative services are worth the extra we are paying. Why should we be paying extra for services that make affordability and access worse?

This report from AHIP is a desperate attempt to convince us that the worthless services of the private insurance industry somehow provide us with value. John Geyman is right. The insurance industry is in its death throes, and we should not attempt to resuscitate it.

John Geyman, “Do Not Resuscitate:”
http://www.commoncouragepress.com/index.cfm?action=book&bookid=396

Insurers don’t like to ‘share’

Dr. Susanne King
Berkshire Eagle, MA
Saturday, May 24

The current mantra of those who support our private insurance model for health care is “shared responsibility.” Their goal is to ratchet up the amount that individuals will have to pay for medical costs, by buying insurance policies that have higher deductibles, larger co-payments, and higher costs for prescription drugs. What “shared responsibility” is about is maintaining insurance company profits.

Under pressure from Wall Street for disappointing earnings during the first quarter of 2008, CEOs from the two largest health insurance plans, United Health Group and Wellpoint, told investors last week that they would “continue to protect their (profit) margins” and “not sacrifice profitability for membership” i.e., they aren’t going to hold down premium increases to keep members on their rolls. Wellpoint’s CEO, Angela Braly, also said that her company’s market power would give it the ability to lean hard on its network doctors to accept lower reimbursements. What she didn’t add was that her predecessor, retired CEO Larry Glasscock, left Wellpoint in 2007 with a $23.9 million farewell package. The private insurance model benefits neither patients nor doctors.

The truth is that when we examine who ultimately pays for health care, it is neither employers nor the government, but the individual. Employed individuals are paying for employer-sponsored health insurance plans rather than getting wage increases. Employees pay out-of pocket expenses for their share of premiums and health care costs that aren’t covered by insurance. And employed individuals also pay taxes to the government. We, as working people, provide the financial support for our current private insurance-based system.

Meanwhile, insurance companies aren’t working for us. They are busy working for their investors, and distributing our hard-earned dollars to them, as well as stoking the fortunes of their CEOs, like Wellpoint’s retired CEO Glasscock.

If we had a single-payer health care system, a national health insurance system that covered everyone and was administered by the government, there would truly be shared responsibility. The system would be funded by a modest tax on earnings, which would be an affordable, progressive tax. National health insurance would be real insurance, in which everyone is covered and the risk is distributed across the entire group, rather than the cherry-picking of healthy, working individuals that now occurs with private insurance. Everyone would have access to medical care. Coverage would be comprehensive, and would include medical care, dental care, mental health care, medications, and long term care. Patients could choose their own doctors and hospitals. There would be no co-payments or deductibles, and no denials or hidden costs when a patient needed his insurance.

Polls show that the majority of people support national health insurance. The obstacle to health care reform is corporate special interests that profit from the current health care system, and their tenacious grip on the political process, through their lobbying efforts and political donations. This leads some to say that significant health care reform, like replacing our private health insurance system with national single-payer health insurance, is not politically feasible.

But there is a growing grassroots movement for single payer health care. More and more doctors are joining the organization Physicians for a National Health Program (www.pnhp). There is legislation at the federal level for a national health insurance program, HR 676, currently sponsored by 90 legislators, including Rep. John Olver and seven other representatives from Massachusetts.

Recently, in his New York Times column, Thomas Friedman wrote this about his mother and her perseverance. Every time life knocked her down, she got up, dusted herself off, and kept marching forward, motivated by the saying that pessimists are usually right, optimists are usually wrong, but most great changes were made by optimists. Health care reform activists are optimistic and marching forward; please join us to reform the health care system.

Susanne L. King, M.D., is a Lenox practitioner.

Perceptions of quality not related to Medicare spending

Relationship Between Regional Per Capita Medicare Expenditures and Patient Perceptions of Quality of Care

By Floyd J. Fowler Jr, PhD; Patricia M. Gallagher, PhD; Denise L. Anthony, PhD; Kirk Larsen, MA; Jonathan S. Skinner, PhD
JAMA
May 28, 2008

Context: Wide variations in Medicare expenditures exist across regions, but little is known about whether beneficiaries residing in low-expenditure regions perceive receiving lower-quality care than those in high-expenditure regions.

Objective: To evaluate how Medicare beneficiaries’ perceptions of their health care are related to per capita expenditure in the areas where they live.

Conclusion: In this representative sample of Medicare beneficiaries, no consistent association was observed between the mean per capita expenditure in a geographic area and the perceptions of the quality of medical care of the people who live in those areas.

Our survey respondents differed in their rates of use of health care in ways that parallel the aggregate analyses previously reported by Fisher et al. There is little basis for attributing those differences to access to care, concerns about costs, or the health status of the populations. Most important, the results taken together document that spending more on medical care does not improve patients’ perceptions of the medical care they receive. On average, those in the lower-expenditure areas reported no more perceived unmet needs for care and a perceived quality of ambulatory care similar to that in high-expenditure areas; furthermore, they rated the overall quality of their health care at least as highly as those in high-expenditure areas.

Ultimately, the culture that develops in particular medical communities seems to be an important factor in how much medical care is delivered and how much it costs. This study suggests that, should fundamental changes in the structure of the US health care system occur so that the lowest-expenditure quintile is viewed as the benchmark, the fraction of patients who view their care as inadequate or constrained will not, in the long term, increase above current levels. Instead, we suspect that the limiting factor in restraining cost growth or in fundamental reform will be the extent to which the medical community will be able to adjust to new standards for what constitutes appropriate medical practice.

http://jama.ama-assn.org/cgi/content/full/299/20/2406

And…

Spending on Medical Care

More Is Better?

By Gerard F. Anderson, PhD; Kalipso Chalkidou, MD, PhD
JAMA editorial

The article by Fowler et al adds to the discussion concerning whether the economic principles of “more is better,” diminishing returns, and comparison with others apply in health care. When patients are able to access good-quality objective information on the risks and benefits of the various treatment alternatives, they do not necessarily choose more aggressive or more costly interventions. Currently, the United States spends more than twice as much as most other industrialized countries on health care services, some regions of the United States spend twice as much as other regions of the country, and some institutions or clinicians are twice as expensive as others. In terms of outcomes and satisfaction, the United States may have reached the position of diminishing returns for spending on medical care.

http://jama.ama-assn.org/cgi/content/full/299/20/2444

Comment:

By Don McCanne, MD

There are now a plethora of studies that demonstrate that the current lowest-expenditure quintile may serve us well as the benchmark for optimal health care spending in the United States in that further spending produces diminishing returns.

That does not mean that we should establish a health care budget funded at that lower level and then use a meat cleaver approach to slash spending. We are seeing that in state Medicaid programs, and it is a disaster.

It does mean that we need fundamental reform of our health care financing system so that we can achieve greater value in our health care purchasing. When you look at the reform proposals of the presidential candidates, their cost containment recommendations would have very little impact in controlling spending because they fail to address the major waste resulting from our flawed, fragmented system of financing health care.

What fundamental reform do we need? Much has been said about the hundreds of billions of dollars that would be saved each and every year by simply changing to a single payer health care financing system, so we won’t address it further here, other than to state that it is essential that we make that change if we are serious about health care financing reform.

This article and others, especially the Dartmouth studies, reveal that there is a great potential for reducing wasteful spending so that the funds can be redirected to those individuals with unmet health care needs. The easier step would be to realign incentives in order to enhance our primary care infrastructure – a model that has been demonstrated to provide care at lower costs without impairing and sometimes actually improving the quality of care. Much of the cost savings is due to a reduction in the flat-of-the-curve care characterized by diminishing returns.

The more difficult step would be to identify the care that is producing diminishing returns, and, again, realign incentives to discourage wasteful, poor quality care. That won’t be easy, but it would be possible within the framework of a single payer national health program. It is almost impossible now with our fragmented system of financing care. Even Medicare would have difficulty putting into place policies that would achieve the goals of a more efficient health care delivery system because it controls spending for only about 13.7 percent of 304 million Americans and can have only a very limited impact in improving the health care delivery infrastructure.

A single national health program would have the buying power to reduce the administrative waste, to reinforce our primary care infrastructure, and to reduce excesses in the flat-of-the-curve care. Based on the current political climate, it is likely that both the Democratic and Republican platforms will fall far short on these goals.

That is not to say that there are no differences between the parties. One party understands that the government must play a major role in health care financing. The other would prefer to turn rely more heavily on the marketplace. A single payer national health program functions well in only one of these scenarios.

Democrats in Colorado, New Hampshire back single-payer health plan

FOR IMMEDIATE RELEASE
May 28, 2008

CONTACTS:
Rocky White, M.D., (719) 587-3346, whiteroc@slvrmc.org
Marcosa Santiago, M.D., (603) 786-2700, cosy@diacad.com
Quentin Young, M.D., (312) 782-6006, info@pnhp.org

State Democratic Party conventions in Colorado and New Hampshire gave strong backing this month to single-payer national health insurance, a public system of health care financing whose supporters say would guarantee quality care for everyone.

Meeting in Colorado Springs on May 16-17, the Colorado party’s 6,000 convention delegates adopted a new health care plank that reads in part: “In the United States, as a matter of social justice, we support a quality universal health care system not tied to employment, as a basic right of all citizens.

“To that end,” the plank continues, “we support guaranteed, quality, affordable and comprehensive health care for all through a not-for-profit, single-payer financed system.”

Dr. Rocky White, who attended the convention as a candidate for the Colorado Legislature, House District 62, said, “We moved the health care issue up from the eighth highest priority in the 2006 platform to the second highest priority this year, just after the Iraq war. More and more people are recognizing the current system is broken and there’s no way to fix it without radical change.”

The Colorado gathering drew a record-breaking 10,000 participants.

Meanwhile, on the same weekend, in Manchester, N.H., a gathering of 1,000 Democrats – the biggest convention in 30 years, one organizer said – also took a clear-cut stand in support of single-payer national health insurance.

“Support for single payer is much higher in New Hampshire than you might expect,” said Dr. Marcosa Santiago, a psychiatrist and member of Physicians for a National Health Program (PNHP) in Rumney, N.H. “The merits of such a system are compelling, even to a traditionally conservative state.”

The 500 voting delegates adopted a resolution introduced by Dr. Santiago that says in part, “Resolved, that the New Hampshire Democratic Party endorses and respectfully urges the United States Congress to enact the U.S. National Health Insurance Act (H.R. 676) sponsored by Representative Conyers, and adopt its goal of universal single-payer health insurance.”

As in New Hampshire, the Colorado convention also endorsed the principles of H.R. 676, the bill introduced by Rep. John Conyers Jr. of Michigan. Conyers’ bill currently has 90 congressional co-sponsors, more than any other proposal for health care reform. It has also been endorsed by over 400 labor organizations, including 33 state chapters of the AFL-CIO.

The Colorado party’s health care plank will be forwarded to the national party’s platform committee for consideration at the national convention in Denver this August.

Single-payer systems typically eliminate or substantially reduce the role of private insurance companies in the health care financing system, but still allow patients to go to the doctor or hospital of their choice. Most industrialized nations have adopted a variant of the single-payer model, and the U.S. system of Medicare is based on the same principle.

“While public attention has focused on the Democratic Party’s presidential nominating contest, following daily tallies, for example, of Barack Obama’s and Hillary Clinton’s delegate count, there is growing evidence that, down below and perhaps beneath the radar, the party’s base has been energized in new and unexpected ways,” said Dr. Quentin Young, national coordinator of PNHP.

“The position taken by the Colorado and New Hampshire conventions is more far-reaching than the positions the party’s standard-bearers take,” he said. “Both Obama and Clinton would leave private insurance companies in place as the dominant players in the U.S. health care system, although they each say they would make incremental reforms to help alleviate the current health care mess.

“But this support for single payer is in accord with public opinion polls and the views of most U.S. doctors,” Young said. “And it’s the only reform that will work.”

The full text of the Colorado and New Hampshire resolutions are available to the press at the Physicians for a National Health Program web site, www.pnhp.org/conventions.

Physicians for a National Health Program, a membership organization of over 15,000 physicians, supports a single-payer national health insurance program. PNHP is headquartered in Chicago and has chapters across the United States. To contact a physician-spokesperson in your area, contact info@pnhp.org or call (312) 782-6006.

Howard Dean on single payer

10 Questions for Howard Dean

TIME
May 22, 2008

Question: As a former physician, what are your thoughts on the Democratic candidates’ health-care plans vs. a single-payer system?

Howard Dean: I think while someday we may end up with a single-payer system, it’s clear that we’re not going to do it all at once, so I think both candidates’ health-care plans are a big step forward. Certainly compared to Senator [John] McCain, who represents a big step backward.

http://www.time.com/time/magazine/article/0,9171,1808614,00.html

Comment:

By Don McCanne, MD

Let’s assume that in 2009 we will have a Democratic president, a solid Democratic majority in the House of Representatives, and sixty filibuster-proof Democrats in the Senate. We also know that, amongst Democrats, there is tremendous support for the single payer model of health care reform. That’s all we need to enact a single payer national health program. Right?

Sorry. The Democrats are already assuming that they will be in control, and the message from them is very clear. “Although single payer may be the best way to finance health care, we can never get there in one step,” is the gospel (small g) as recited by the majority of veteran Democratic legislators (with the notable exception of John Conyers and the supporters of HR 676). The majority of Democrats believe that it would be impossible to skip the next step of first using our existing programs to expand coverage to (almost) everyone.

The consensus is that, above all, we must protect the vested interests if we are to achieve this next “big step forward.” “Vested interests” is not code language; it is the private insurance industry (and to some extent, the pharmaceutical firms, which will not be discussed here).

In health care financing, the private insurers are not the solution to our problem; the private insurers are the problem. (I would apologize to President Reagan, except in his version he got it wrong.)

Those who missed yesterday’s Quote of the Day (Memorial Day) should check it out. It discussed John Geyman’s new blog and his new book on why the private insurance industry is on a death march, and why we shouldn’t resuscitate it. The “big step forward” of the Democrats will only prolong and expand the suffering and financial hardship of our fellow Americans.

We must understand the fundamental issues if we are to avoid the big misstep forward into the health care chasm. We must leap over the chasm for a safe landing on the solid foundation of a single payer national health program.

Yesterday’s Quote of the Day from John Geyman:
https://pnhp.org/news/2008/may/geymans_do_not_resu.php

Click on the following link for information about John Geyman’s book on why the health insurance industry is (and should be) dying. You can pre-order it now to receive a copy as soon as it is printed, thereby qualifying you as an authority in the national dialogue on reform.

http://www.commoncouragepress.com/index.cfm?action=book&bookid=396