PNHP

US has worst record of death from treatable disease

pnhpf3a

US has worst record of death from treatable disease

By Nicholas Timmins
Financial Times
January 8 2008

More US patients die from diseases that could be treated by timely intervention than in any other leading industrialised country, a study by top health academics showed yesterday.

A decade ago, the US had the fourth worst record among a group of 19 industrialised countries in terms of deaths per 100,000 people from diseases that are amenable to treatment. These include infections, treatable cancers, diabetes, and heart and vascular disease, according to Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine.

Over the succeeding five years, the number of such deaths in the US fell from 115 per 100,000 to 110. But other countries improved faster, leaving the US with the worst record, behind Portugal, Ireland and the UK, where the preventable death rate runs at 103 or 104 per 100,000.

“If the US performed as well as the top three countries in the study” – France, with 65 deaths per 100,000, and Japan and Australia, both with 71 per 100,000 – “there would have been 101,000 fewer deaths per year,” the authors write in the journal Health Affairs.

The study looks at preventable deaths below the age of 75 and found that while most countries had made big strides in reducing them over the past decade, with an average fall of 17 per cent, the US experienced only a 4 per cent decline.

With the rising cost of healthcare and numbers of uninsured becoming issues in the US presidential campaign, the authors say it is “difficult to disregard the observation” that the slow fall in the US preventable death rate “has coincided with an increase in the uninsured population”.

Cathy Schoen, senior vice- president of the Commonwealth Fund, which supported the research, said: “It is starting to see the US falling even further behind on this crucial indicator.”

Copyright The Financial Times Limited 2008

Sample Letter to Labor Unions to Endorse HR 676

January 2008

Dear Sisters and Brothers:

Capable of great medicine, America’s health care system is in deep trouble. Our system of health insurance has become not only too costly but simply inadequate. Medicaid is in crisis. All of us are at risk — all but the private insurance industry. It doesn’t have to be this way.

The health care crisis facing our country explodes into every collective bargaining session. Employers drive to cut benefits. Health costs shift to individual workers. Health insurance dominates every contract consideration, killing progress in wages and other benefits.

Too many retirees, after a life of hard work, are stripped of health coverage. Health care bills cause over 50% of bankruptcies — and three out of four of those bankrupted by medical bills had health insurance at the outset of their bankrupting illness!

The U. S. spends 16% of gross domestic product (GDP) on health care, twice what any other industrialized nation spends, yet ranks 37th in performance according to the World Health Organization. We lag behind other industrialized countries in life expectancy and infant mortality.

In New York State 2.8 million people, including nearly 500,000 children, had no health coverage whatsoever in 2006. One out of three New Yorkers, roughly 7 million people, went without health insurance at some point during 2006-2007. Nearly 58,000 New Yorkers filed for personal bankruptcy in 2006.

It doesn’t have to be this way. We can do better.

HR 676 is legislation introduced by Congressman John Conyers Jr. (D-MI) and co-sponsored by 86 members of the House of Representatives including New York Representatives Yvette Clark, Eliot Engel, Maurice Hinchey, Carolyn Maloney, Michael McNulty, Gregory Meeks, Jerrold Nadler, Charles Rangel, Jose Serrano, Edolphus Towns, and Anthony
Weiner.

HR 676 would establish a single payer health care system by expanding a greatly improved Medicare system to cover everyone. It would restore our right to choose our physicians and free us from insurance company red tape and interference in medical decisions.

HR 676 would cover everyone for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, chiropractic and long term care.

HR 676 will end deductibles and co-payments. HR 676 will save billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

HR 676 has already been endorsed by 30 state labor federations, 94 Central Labor Councils, and 348 union locals and other labor organizations in 48 states.

We request that your organization join with us in endorsing HR 676.

We can help our fellow union members by taking health care off the bargaining table. By standing up for all working people, and leading the effort to provide healthcare for all, we will affirm labor’s rightful role as a leader in the fight for social justice.

The enclosed resolution is provided as a sample for your convenience. Please send us a copy of any resolution your local approves and send copies to AFL-CIO President John Sweeney (815 16th St. NW, Washington, DC 20006); New York State AFL-CIO President Dennis Hughes (50 Broad St., NYC, NY 10004); the member(s) of Congress who represent your members and Senators Clinton and Schumer. If you would like a representative of our coalition or a medical doctor from Physicians for a National Health Program to speak to your local to learn more, please let us know.

In Solidarity,

RESOLUTION ENDORSING HR 676 — Single Payer Universal Health Care

All of our unions face a healthcare crisis. We must wage an unnecessary and difficult struggle to win or to keep good health care coverage. Almost every union at every contract deadline must battle and sacrifice merely to sustain health care benefits. The rising costs of health insurance block our progress in wages and other areas.

But the crisis extends far beyond union members. More than 47 million people in the U. S. had no health insurance during all of 2006 and more than 75 million went without it for some length of time within the last two years. Millions with health insurance lack adequate coverage or risk losing coverage.

People of color, immigrants and women suffer from inequalities in access and delivery of health care, while the elderly and many others must choose between necessities and life-sustaining drugs and care. Unorganized workers have inadequate coverage or none. The Institute of Medicine reported that each year more than 18,000 in the U. S. die because they had no health insurance.

While we in the United States spend approximately twice as much of our gross domestic product as other developed nations on health care, we remain the only industrialized country without universal coverage. Our problem worsens each year as insurance costs increase and as gradual solutions have failed to make a dent in the problem.

The U. S. health system continues to treat health care as a commodity distributed according to the ability to pay, rather than as a social service to be distributed according to human need. Insurance companies and HMOs compete not by increasing quality or lowering costs, but by avoiding covering those whose needs are greatest.

Economic necessity and moral conscience compel us to seek a better way. Congressman John Conyers, Jr. (D-MI) (joined by 86 co-signers) has introduced HR 676, the United States National Health Insurance Act, also called Expanded and Improved Medicare for All.

This single-payer health care program proposes an effective mechanism for controlling skyrocketing health costs while covering all 47 million uninsured Americans. The bill also restores free choice of physicians to patients and provides comprehensive prescription drug coverage to seniors, as well as to younger people.

HR 676 would cover every person in the U. S. for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, chiropractic and long term care.

HR 676 ends deductibles and co-payments. HR 676 would save billions annually by eliminating high overhead and profits of the private health insurance industry and HMOs. The transition to national health insurance would apply the savings from administration and profits to expanded and improved coverage for all.

A single payer program as provided by HR 676 is the only affordable option for universal, comprehensive coverage.

Resolved:

That __________________________________ wholeheartedly endorses Congressman Conyers’ bill HR 676, “Expanded and Improved Medicare for All,” a single payer health care program.

That __________________________________ will work with other unions and community groups to build a groundswell of popular support and action for single payer universal health care and HR 676 until we make what is morally right for our nation into what is also politically possible.

That __________________________________ will take other actions to mobilize our members and our community at the grassroots to encourage other members of the House to sign on as co-sponsors of HR 676 and to encourage Senators to introduce a companion bill in the Senate.

Our local union/district council/labor council has endorsed HR 676:

Union______________________________________International__________________

Address_________________________________________________________________

City__________________________ State _______________________ Zip__________

Phone:__________________ Fax:_____________________ email:_____________________

Signed by__________________________________Title______________________________

Date____________________

Missing the Boat on Health Care?

Missing the Boat on Health Care?

By John P. Geyman
Tikkun
Jan/Feb 2008

… instead of taking a progressive view of the responsibility of government to help solve our increasing problems of access, cost, quality, and equity of health care, we have the leading Democratic candidates perpetuating market approaches, with the already discredited notion that the insurance industry will respond to competition. Despite conservative public policies favoring health care markets, as illustrated by continued over-payments and lack of oversight of private Medicare plans, these leaders remain unwilling to confront the insurance industry in the public interest.

The public health policy choice facing us is whether or not to replace a failing private financing system with public single-payer financing. Making the right choice is the only way to gain affordable universal coverage of necessary care for everyone. It is that simple. This is not an issue to be compromised away by politicians. We need a new structure to heal many of the problems of U.S. health care. We have an opportunity now to galvanize a grassroots movement for real health care reform that may not come again for a long time. The Democrats are poised to regain the Presidency in 2008, together with both houses of Congress. We need activist government and leaders, as we have had earlier in our history, to confront our health care crisis. It is a matter of moral, economic, and social urgency.

http://www.tikkun.org/magazine/tik0801/frontpage/missing/

And…

The Democratic Debate in New Hampshire (transcript)

The New York Times
January 5, 2008

Sen. Barack Obama: I have been entirely consistent in my position on health care. What I said, and I have said on the campaign trail this time, is if I were designing a system from scratch, I would set up a single-payer system because we could gain enormous efficiencies from it. Our medical care costs twice as much per capita as any other advanced nation. But what I’ve also said is that given that half of the people are getting already employer-based health care, that it would be impractical for us to do so…

http://www.nytimes.com/2008/01/05/us/politics/05text-ddebate.html?ref=politics&pagewanted=all

And…

The Republican Debate in New Hampshire (transcript)

Rudolph Giuliani: To go in the direction that the Democrats want to go – much more government care, much more government medicine, socialized medicine – is going to mean a deteriorated state of medicine in this country. I mean, I said jokingly in one debate, if we go in the direction of socialized medicine, where will Canadians come for health care? (Laughter.)

http://www.nytimes.com/2008/01/05/us/politics/05text-rdebate.html?_r=1&oref=slogin&pagewanted=all

Comment:

By Don McCanne, MD

John Geyman’s Tikkun article on whether we are about to miss the boat on health care reform is an important piece that you may want to share with others. The policies that we need to enact are clear, but they are taking a back seat to politics, being an election year.

Barack Obama’s comment demonstrates that he does understand health policy principles and specifically which policies would best serve our nation. But he also understands politics. The other leading Democratic candidates do as well. In a political year, politics prevails, but that does not mean that we should let up on our efforts to make sound policy drive the politics.

It is not clear to me that the Republicans understand the physical suffering and financial hardships that their health policies would cause. Though it is no surprise that Rudolph Giuliani would treat health care reform as a joke, it did cause me considerable anguish to watch his Republican audience laugh at it. I am going to assume the best by viewing this as an awkward response to a staged pratfall since I cannot believe that most Republicans would truly believe that reform is a joke.

At any rate, read and distribute John Geyman’s article. The health care reform boat is ready to pull up its anchors, and we need to be on board. As John Geyman says, “It is a matter of moral, economic, and social urgency.”

Advocates push new hospital care funding

By DANIEL BARLOW
Vermont Press Bureau
Article published Jan 4, 2008

MONTPELIER — While legislative leaders talk about a slow expansion of Catamount Health and Gov. James Douglas eyes reforms to stem jumps in insurance premiums, a wide-reaching proposal for the health care crisis is gaining steam among advocates.

The Vermont Hospital Security Plan would create a new statewide hospital budget to pay for all visits to the 14 nonprofit facilities, essentially creating a single-payer health insurance system for hospital care.

“As a state we need to deal with the rising cost of health care and a big part of that is the cost of hospital care,” said Rep. Francis “Topper” McFaun, R-Barre Town, one of the three lead supporters of the bill. “With this proposal, no one would have to worry if they can afford an important trip to the hospital.”

The bill was proposed during the 2007 legislative session, but seems to be gaining traction among single-payer advocates as lawmakers return to Montpelier for the 2008 session.

Take Back Vermont Healthcare, a new statewide lobbying network of single-payer advocates, intends to apply some pressure on lawmakers to support the Hospital Security Plan. The group will kick off its efforts with a rally on the Statehouse lawn on Jan. 9 at 11 a.m.

“This is a bill that would do something for all Vermonters,” said Dr. Deb Richter, a Cambridge physician who founded the Take Back Vermont Healthcare network. “No other bill out there would reduce premiums by 40 percent.”

Advocates point to potential cost-savings of such as system: While Vermonters would still need insurance for doctor visits and prescriptions, cutting hospital care out of the equation should reduce premiums by 40 percent.

The cost of creating a state-run hospital system is pegged at $710 million a year, which would require implementing new taxes. But Richter said this is really a cost shift from people paying their premiums for insurance to paying the state, a move which is estimated to reduce the costs by 9 percent (Vermont now spends about $776 million annually on hospital care).

How to create a state-funding mechanism for the single-payer hospital system is something lawmakers need to decide, Richter said, but she added that one option would be a 5.5 percent payroll tax, split between employers and employees, and an annual $225 fee for each Vermonter.

“We are already paying more than this,” she said. “And this is one way to get our arms around the hospital budgets.”

But the state’s hospitals have some serious concerns about the plan, according to Beatrice Grause, the president and CEO of the Vermont Association of Hospitals and Health Systems.

She praised McFaun for raising the issue of payment reform in the medical field, but added that “this seems to be the wrong approach.”

She added she doesn’t think this will reduce costs on hospitals; in fact it may increase costs if Vermonters put off day-to-day health maintenance in favor of going to the hospital when a crisis occurs because the trip will be free.

“The devil is in the details, but I don’t think this will offer a peace of mind for the hospitals,” Grause said. “This could really result in some cash flow problems for the hospitals.”

Meanwhile, top elected officials in Montpelier also are not embracing the single-payer hospital proposal.

The Democratic leaders of the Vermont House and Senate are proposing an expansion of Catamount Health, the state’s new insurance program for uninsured residents, to also include small businesses, which are in a pinch with employee health insurance cost increases that for many are hitting the double digits.

Senate President Pro Tem Peter Shumlin, D-Windham, said Wednesday at a Statehouse press conference that he is a supporter of a single-payer system — but that smaller reforms, such as the proposed Catamount expansion, are needed to get there.

“If you are asking me if we will be passing a $1.2 billion health care bill in this session, the answer is no,” Shumlin said.

House Speaker Gaye Symington, D-Jericho, said during her press conference Thursday that a single-payer hospital system was discussed in the legislature in 2006. But, that option was dropped in favor of tackling the problem with the uninsured — a move that led to the creation of Catamount Health, she explained.

And Gov. James Douglas said in his meeting with reporters Thursday that stemming the tide of health insurance premium increases is one of his top issues this year, but added that he could not support proposals that relied on new taxes.

Still, Rep. Steven Maier, D-Middlebury, the chair of the House Health Care Committee, said McFaun’s proposal is one of the options that he will hold hearings on this year — even though he himself has some reservations as well.

“Once we start, there will probably be lots of debate over this one,” he said. “And I have some of my own questions. We all agree on the goals, but the disagreement seems to be how to get there.”

Maier added that the name of Richter’s new network left him feeling cold. The phrase, “Take Back Vermont,” was a slogan used by those who opposed gay rights during the civil union debate seven years ago and has become a symbol of the divisiveness and animosity of those times.

“The name unfortunately invokes that time in Vermont,” Maier said.

Richter acknowledged the name is intended to provoke. She explained it reflects the movement to take the health care system in Vermont away from the insurance companies.

Richter added that she and other supporters are facing an uphill battle on the single-payer hospital plan. But she is hopeful that hearings under the Golden Dome will result in a stronger groundswell of support.

“We at least want this proposal to see the light of day,” she said. “Let’s explore this idea and see what Vermonters think about it.”

During the months between the end of the 2007 legislative session and the start of the new one, McFaun traveled across the state to hold town hall-style meetings on his proposal — and said he received many welcoming and supportive comments.

“I’m grateful that this has gone from being a piece of paper stuck on the committee room wall to the promise that there will actually be hearings,” he said.

Contact Daniel Barlow at daniel.barlow@rutlandherald.com.

To Our Health, in the New Year

New York Times
LETTERS
December 21, 2007

To the Editor:

Re ”I Am Not a Health Reform,” by David U. Himmelstein and Steffie Woolhandler (Op-Ed, Dec. 15):

While the authors make a compelling economic argument for a single-payer health care system, they do not address a fundamental underlying question: why should a government provide health care for its citizens?

I believe that the answer to that question rests on two notions.

First, we need to accept the idea that a right to good health is essential in a democratic society. Pursuing democracy’s noble goals of life, liberty and happiness is problematic for people dealing with serious health care problems.

Second, we must put aside the idea that our health care system responds to ”market forces.” Patients needing critical care cannot bargain for the best deal.

When I had a heart attack several years ago, I was in no position to ask my cardiologist if he was inserting the least expensive stent into my blocked artery.

Rivers Singleton Jr.
Newark, Del., Dec. 15, 2007
The writer is an associate professor of biological sciences and English at the University of Delaware.

To the Editor:

As a physician in a state in which all of its citizens are now supposed to have health insurance, I am continually dismayed at the number of individuals I see who do not have health insurance or whose ”insurance” plans barely cover anything.

And among those lucky enough to have reasonably good health insurance, I am constantly confused by the various insurance plan rules about how often I can see patients or what drugs I can prescribe.

The single-payer plan that David U. Himmelstein and Steffie Woolhandler put forward would not only cost less than our current expenditures on health care and simultaneously cover everyone, but it would also be far simpler for both patients and physicians to navigate.

Why can’t the leading Democratic candidates muster the courage to propose real health reform that will save lives, time and money — and in addition that would be the most equitable of all options — instead of rehashing proposals that have never resulted in universal coverage and haven’t done anything to rein in the costs of health care?

We have single-payer armed services, fire prevention and road maintenance. Aren’t we long overdue for single-payer universal health care?

J. Wesley Boyd
Needham, Mass., Dec. 15, 2007

To the Editor:

David U. Himmelstein and Steffie Woolhandler present several important cases in which states that have tried to put into effect health insurance plans based on an employer or individual mandate have failed both to restrain costs and to cover the uninsured.

We agree that the crux of this failure lies in the fact that ”reliance on private insurers makes universal coverage unaffordable.”

Private insurance companies waste billions of dollars a year on marketing and administrative costs that do nothing to improve the quality of our health care. Physicians and hospitals are forced to waste money on staff hired solely for the purpose of filling out endless forms required by multiple insurers used by their patients.

That is why we are convinced, and numerous studies have shown, that a single-payer national health system is the most efficient, cost-effective way to provide universal coverage. It is time our elected officials stopped treating health care as a commercial commodity and recognized it as a public good. We all suffer if we all do not have access to quality, affordable health care.

Peter Pepper
New York, Dec. 15, 2007
The writer is president of The Workmen’s Circle/Arbeter Ring, an organization dedicated to community, Yiddish culture and social justice.

To the Editor:

Your compelling Op-Ed article cites the overwhelming evidence that the Democratic front-runners’ ”mandate model” for health care won’t work.

In 1999, we wrote a single-payer bill in Connecticut. We argued that despite being the insurance mecca, Connecticut — small and wealthy — was a good place to experiment with this, following the example of Social Security, which began in one state. Alas, despite popular support here for a publicly financed insurance plan, such an experiment was apparently too dangerous for the insurance industry.

What is truly dangerous is the vise grip corporations have on our candidates, hence our policies. Consequently, third parties like the Green Party, which advocates publicly financed elections and single-payer health insurance, are, like Dennis J. Kucinich, not given a hearing.

It appears that until our political system is transformed, neither will our health care system.

Justine McCabe & John Battista
New Milford, Conn., Dec. 15, 2007
The writers are, respectively, a clinical psychologist and a psychiatrist.

Market justice and moral compass

Market Justice and US Health Care

By Peter P. Budetti, MD, JD
JAMA
January 2, 2008

In the United States, health care competes for consumers with other items in the marketplace. Individual resources and choices determine the distribution of health care, with little sense of collective obligation or a role for government. Known as market justice, this approach derives from principles of individualism, self-interest, personal effort, and voluntary behavior. The contrasting approach, social justice, allocates goods and services according to the individual’s needs. It stems from principles of shared responsibility and concern for the communal well-being, with government as the vehicle for ensuring equity. Social justice in health care requires universal coverage and ensured access to care, whether through social insurance, private insurance, or some combination.

The End of Market Justice

The dominance of market justice as the vehicle for allocating health resources in the United States has been associated with numerous troubling characteristics of its health system. The US population has clearly rejected using pure market justice to apportion health care goods and services, yet has expressed no collective demand that society achieve equity through social justice. The general public has insisted on the buffer of insurance, but has focused on coverage for individuals and their respective families, not the population as a whole. Consequently, health care coverage, although desired by the vast majority of Americans, is incomplete. Now, the key element, employment-based insurance, is disintegrating in both the population that is covered and the benefits provided.

Simultaneously, health care has become a valuable commodity that created enormously influential vested commercial interests with little motive to abandon market justice. Medicine, which might have played a role in promoting social justice, has not done so, and has been transformed by the imperatives of market justice. Fragmented and struggling to come to terms with externally imposed pressures, medicine is losing both its political force and moral compass. The medicalization of health has simultaneously enhanced the investment in health care goods and services while distracting clinicians and policy makers from attention to the needs for health promotion and disease prevention and constraining the capacity to meet the expanding challenges to public health. Market justice may have outlived its role in US health care.

http://jama.ama-assn.org/cgi/content/full/299/1/92

Comment:

By Don McCanne, MD

The quasi-electromagnetic fields of market justice have screwed up our moral compass. Let’s take it over to the terrain of social justice and see if we can get it to work again.

Denying care or denying payment?

Take a deep breath, and read

By Steve Lopez
Los Angeles Times
January 2, 2008

Preston doesn’t have cancer, but he was born with cystic fibrosis. And the cost of the medicine that keeps him breathing just shot up like a rocket, thanks to an insurance company decision I’m still trying to decipher.

… the cost of Pulmozyme… had been running them $30 a month. Suddenly it was $784.

If a cheaper generic were available, they’d gladly switch. But they said there is no substitute for Pulmozyme, an enzyme-based medication that controls mucus secretions.

Hoping for an explanation, and reconsideration, Preston’s parents filed a grievance. Blue Cross quickly rejected it.

“Pulmozyme is no longer a Formulary medication,” said the virtually incomprehensible letter, which gallingly suggested the increase was part of Blue Cross’ commitment to providing its customers “the best possible care and access to medications.”

When I asked Blue Cross for an explanation, I got this by e-mail:

“As with other health plans, the decision to add or remove a drug from the formulary is done through a review committee made up of medical experts. At Blue Cross, this group is the Pharmacy and Therapeutic committee. Pulmozyme is currently considered a specialty medication and is covered for our members, but at a higher member share of the cost than other medications. The goal of these ongoing reviews is to assure access to all necessary drugs while also keeping costs as affordable as possible for all of our members.”

http://www.latimes.com/news/local/la-me-lopez2jan02,1,3588546,full.column?coll=la-headlines-california

And…

Individual and Family Health Care Plans for California

Blue Cross of California

We believe that the cost of our plans should be consistent with a member’s expected health care needs and risk factors. That’s why Blue Cross offers various levels of coverage.

http://www.bluecrossca.com/member/noapplication/plansbenefits/individualsfamilies/medicalplansummaries/pw_a082352.pdf

And…

Moves from the Cigna playbook

By Giuseppe Del Priore
Los Angeles Times
January 3, 2008

Insurers always qualify their denial letters with a sentence to the effect that the doctors must provide whatever care is necessary and that the payment is a separate issue. Insurers never deny care — only the authorization for payment. To stall the actual delivery of care, insurers hold out an insincere promise to authorize payment if the doctor provides more information. This leads the doctor on indefinitely, while insurers never say absolutely “no” until the patient gives up or dies.

http://www.latimes.com/news/opinion/web/la-oew-delpriore3jan03,1,7350723.story

Comment:

By Don McCanne, MD

Preston’s family pays $1,200 per month for their high-deductible health plan. You would think that this premium would provide a level of coverage that Blue Cross states is “consistent with a member’s expected health care needs and risk factors.”

Blue Cross has been a leader in insurance plan innovations that slow the rate of premium increases (to a smaller multiple of the rate of inflation) in order to remain competitive in the health insurance market. Blue Cross suggests that they are balancing “assuring access” with “keeping costs as affordable as possible for all of our members.” But their scales are locked in at (barely) affordable premiums, which requires that they increase financial barriers to access. Changing the copayment for Pulmozyme from $30 to $784 is a good example. They continue to have “access” since Pulmozyme is still covered in another drug tier, and they continue to have “affordable” insurance premiums.

Giuseppe Del Priore’s op-ed makes a very important point. Insurers never deny health care. They only deny payment. They have a private contract with the patient, and they have another private contract with the health care provider. They do not use those contracts to prevent health care from being accessed; they use them to escape their obligation to pay for that care.

Or do they actually have that obligation? Not really. Their obligation is to succeed as a business entity by enforcing those contracts in a manner that accrues to their own financial benefit. That’s the way the marketplace works.

What if we had a universal public insurance program, owned and financed by the taxpayers? Would we have individual contracts with patients and providers that would be used to manipulate health care payments to accrue to the benefit of the administrators of the public program? Of course not.

Would we use our public program to deny access to health care? We might if that care were demonstrated to result in impaired health outcomes and impaired quality compared to care complying with more appropriate standards. But we would do that through a process that identifies beneficial practices and then realigns incentives.

Instead of a private system that uses innovations to deny payment for appropriate care, wouldn’t it be better to have a public system that is specifically designed to finance all reasonable health care services and products? Blue Cross doesn’t think so.

Editorial: Honesty in health care

By Bangor Daily News Staff
Monday, December 31, 2007

Polls show that health care is a major issue — rivaled only by the Iraq war — in the current presidential campaign. Complaints about the present system include the mounting cost, the many left out, poor service and too much paperwork. Yet all the major candidates of both parties advocate only makeshift modifications of a system widely viewed as broken.

Republican candidates insist on keeping health care “market based,” which sounds great but has left some 47 million Americans uninsured and produces exorbitant salaries, huge advertising campaigns and enormous political contributions from the insurance and drug industries. They stoke the widespread fear of “socialized medicine” fostered by generations of propaganda.

Most Democratic candidates do the same, though without saying so, and stick to the accidental and failing linkage of health care and employment. That connection began in World War II, when employers dodged wage caps by offering health benefits instead of pay raises, and has hung on ever since. Now large as well as small businesses are finding health benefits an unsupportable burden. Only Dennis Kucinich, Mike Gravel and Bill Richardson dare to favor an active role by the federal government, and they probably have no chance of getting the nomination.

So whoever the nominees are, the presidential race looks certain to avoid any consideration of a fundamental change in the present American health care system, which costs twice per capita what is paid by virtually all other developed nations, while the United States rates 37th in overall performance according to the World Health Organization and has the highest infant mortality rate and highest prescription drug costs in the industrialized world.

Two Harvard professors, co-founders of Physicians for a National Health Program, advocated a “single payer” health plan for the United States, in the Dec. 15 New York Times. David U. Himmelstein and Steffi Woolhandler wrote that the various efforts to reduce the number of uninsured were all little different from a 1971 plan by President Nixon and did little or nothing to reduce the number of uninsured. They write that only a single payer plan could cut costs substantially and estimated the savings at $350 billion.

But the major candidates seem put off by faulty arguments such as that the Canadian plan is disliked by some doctors and involves long wait times for elective surgery. Yet polls show that most Canadians prefer their plan to ours. And wait times, which don’t interfere with emergency medicine, could be rectified by better financing.

Much of American health care is already run quite satisfactorily on a single payer basis: Medicare, Medicaid and the veterans’ health system.

Government run health plans, usually single payer plans, are good enough for Canada, Britain, France, Denmark, Sweden, Germany, Australia, New Zealand and most other developed countries. Why can’t they even be considered and debated by candidates for the U.S. presidency?

If both parties continue to avoid even mentioning a single payer plan, election day could see ballots marked “none of the above.”

Cancer is hitting uninsured harder

Associated Press
The Boston Globe
December 20, 2007

ATLANTA – Uninsured cancer patients are nearly twice as likely to die within five years as those with private coverage, according to the first national study of its kind and one that sheds light on troubling healthcare obstacles.

People without health insurance are less likely to get recommended cancer screening tests, the study also found, confirming earlier research. And when these patients finally do get diagnosed, their cancer is likely to have spread.

The research by scientists with the American Cancer Society offers important context for the national discussion about healthcare, analysts said.

The new research is being published in Cancer, the cancer society’s medical journal. In an accompanying editorial, the society’s president repeated the organization’s call for action to fix holes in the healthcare safety net.

“The truth is that our national reluctance to face these facts is condemning thousands of people to die from cancer each year,” Dr. Elmer Huerta wrote.

Hard numbers linking insurance status and cancer deaths are scarce, in part because death certificates don’t say whether those who died were insured.

An Associated Press estimate – based on hospital cancer deaths in 2005 gathered by the US Agency for Healthcare Research and Quality information and other data – suggests that at least 20,000 of the nation’s 560,000 annual cancer deaths are uninsured when they die.

That’s about 4 percent of the total cancer death toll. One reason is that most fatal cancers occur in people 65 or older – an age group covered by the federal Medicare program.

Some are enrolled in Medicaid or other programs after diagnosis, when the condition worsens and their finances erode. But such 11th-hour coverage can be too late; early detection is the key to catching many cancers before they’ve grown beyond control, analysts said.

(c) Copyright 2007 Globe Newspaper Company

Medicare For All via H.R. 676

Stephen Crockett

It is obvious that none of the major Presidential candidates of either the Democratic or Republican Parties are supporting the right approach to providing universal healthcare. Frankly, all the Republican candidates are going to be major obstacles to achieving this national goal. While the top Democratic candidates (Clinton, Edwards and Obama) do support the concept, they are all offering Band-Aid approaches for a life-threatening economic and health crisis in America.

A bill has already been introduced in The House by Congressman John Conyers that effectively addresses the issue. H.R. 676 expands Medicare to cover all citizens.

The scope of the healthcare crisis in America is huge. It has very serious economic and moral implications. It is crippling our nation in terms of protecting American manufacturing, competing in the global economy and undermines our national security. It reflects badly on us as a just and moral society. It is literally killing Americans in huge numbers.

The number of Americans without health insurance is currently 47 million and growing rapidly. The number of underinsured Americans is much larger than the number of uninsured Americans. In America, over half of all personal bankruptcies are the direct result of medical crises. Over half of those bankruptcies are from individuals who had health insurance when their medical crises started.

Industry friendly studies of the number of Americans who died because they had no health insurance place the number at around 50 per week. The number is absurdly low and illogical.

Doing without healthcare at any point in life for a significant period of time will likely create health issues and physical damage. This damage accumulates over a lifetime and shortens your lifespan. You die younger than you would have if you had always had adequate healthcare. You might die at 70 instead of 85. In addition, the last years might have much lower levels of quality. Since most people die after reaching the age where Medicare coverage is already in effect, those deaths are not counted as resulting from a lack of healthcare insurance although they can be directly traced to an earlier lack of coverage. Most of the deaths resulting from a lack of healthcare insurance are thus concealed.

Even using the fraudulent 50 per week figure, killing Americans to preserve the profits of HMO’s and insurance companies is completely immoral. Bankrupting Americans because of illness is a national disgrace. It does not happen in other industrialized nations. Out of the top 75 most industrialized nations in the world, only in the United States are citizens not provided by their government with universal healthcare.

In the United States, we saddle our businesses and corporations with the cost of providing for the healthcare needs of their employees. Our international competitors do not. This is one of the major reasons why good paying manufacturing and service sector jobs are leaving our nation. It is economic suicide.

None of the Band-Aid approaches advocated by the top Democratic Presidential candidates deal effectively with the trade implications of healthcare policy. I am personally supporting Edwards because he is more inclined to advance fair and balanced trade agreements than Clinton and Obama. For example, Clinton and Obama supported the most recent “so-called free trade” agreement with Peru while Edwards did not. However, even Edwards has not yet addressed the clear connection between international trade and healthcare.

The best solution for providing universal healthcare is expanding Medicare to cover all American citizens. Medicare is a proven program. It is popular and cost-effective. Our current private system has much higher levels of overhead costs than does Medicare. The only inefficient aspects of Medicare are the “privatized” programs added by the Bush White House and their Republican allies in the Senate. Medicare has been hugely successful despite ongoing Republican and corporate attempts to undermine it.

We can count on Republican politicians to label any move toward universal healthcare as “socialized medicine.” They attempted mightily to destroy Medicare in the past using such tactics and failed completely. Politically, providing universal healthcare by expanding Medicare will be much easier than any other approach.

The private, profit-drive healthcare system is terribly unfair and inefficient. We spend 17 percent of our total economy on healthcare while our international competitors spend only 8 percent. They cover everyone and we do not. The numbers speak for themselves!

Expanding Medicare to cover everyone will not prevent citizens from buying supplemental healthcare if they can afford it. It will greatly help doctors who are General Practitioners by making medical need become effective demand. It will help hospitals by removing the burden of providing healthcare to those who cannot pay for it. It will make our workers healthier and more productive.

There must be a grassroots movement built behind “Medicare For All.” Local activists, union leaders, businesses and politicians must all exert their efforts in a common movement. Most national union organizations and state AFL-CIO organizations are supporting H.R. 676. They are joined by many members of Congress. The legislation has 89 co-sponsors with more being added frequently. Many candidates are backing it!

Local leaders are already getting organized all over the nation. People like Amos B. McCluney, Jr. in Delaware and Alena Bandy in Maryland are actively organizing Medicare For All state chapters. Both leaders are grassroots Democratic activists with roots in the United Auto Workers. Both are reaching out into the community recruiting civil rights leaders, churches, community organizations and local politicians behind H.R. 676. They are not alone. I personally have talked with local activists from Tennessee, Massachusetts, New York, Pennsylvania and several other states who are working on building support for this legislation.

Pressure must be placed on all opinion leaders to support Medicare For All. Presidential, Senatorial and Congressional candidates should be pressured to support H.R. 676. All candidates should be placed on record that they would not veto Medicare For All nor place legislative obstacles in the way of passing H.R. 676, even if they do not actively support passage. Candidates failing to make such public pledges should not be supported by any American citizen.

Average Americans must reframe the debate over healthcare. Instead of calling for universal healthcare or single-payer healthcare, we should simplify the debate. We should be calling for “Medicare For All” and supporting H.R. 676.

Written by Stephen Crockett (co-host of Democratic Talk Radio http://www.DemocraticTalkRadio.com and Editor of Mid-Atlantic Labor.com http://www.midatlanticlabor.com ). Mail: P.O. Box 283, Earleville, Maryland 21919. Email: midsouthcm@aol.com . Phone: 443-907-2367.

Feel free to publish without prior approval

CIGNA Capitulates to Patient Revolt

Following Massive Protest, Insurer Authorizes

Transplant for 17-year-old Nataline Sarkisyan

CNA/NNOC-Sponsored Protest Sparks Flood of Calls from Across U.S.

In a stunning turn around, insurance giant CIGNA has capitulated to community demands, and protests that the California Nurses Association/National Nurses Organizing Committee helped to generate, and agreed to a critically needed liver transplant for Nataline Sarkisyan, a 17-year-old girl in the intensive care unit at UCLA Medical Center.

A national web of friends and family of Nataline, CNA/NNOC registered nurses, doctors, members of the Armenian community, healthcare advocates, and netroots supporters pitched in on an unprecedented national day of action on Nataline’s behalf.

The centerpiece of the protests was an impassioned rally today sponsored by CNA/NNOC with the substantial help of the local Armenian community that drew 150 people to the Glendale offices of CIGNA. Hundreds of phone callers clogged the lines of CIGNA offices around the country, all demanding that CIGNA reverse its prior denial of care.

“This is an incredible turnaround generated by a massive outpouring around the country that proves that an enraged public can make a difference and achieve results,” said CNA/NNOC Executive Director Rose Ann DeMoro. “CIGNA had to back down in the face of a mobilized network of patient advocates and healthcare activists who would not take no for an answer.”

The netroot protest was organized by Eve Gittelson, an influential health policy blogger who writes on Daily Kos as nyceve, and many of the calls were also the product of work by the Armenian National Committee.

“Nataline is now seriously ill and still has significant hurdles in her fight for her life, but thankfully our combined voices and protests have finally given her and her family hope,” said Geri Jenkins, RN, a member of the CNA/NNOC Council of Presidents who works in a transplant unit at the University of California San Diego Medical Center.

“However, it is deplorable and appalling that CIGNA needed to have hundreds of people pounding on their doors and besieging them with calls to take the humanitarian step they should have done long before today,” said Jenkins, who spoke at the Glendale rally.

Nataline’s mother, Hilda Sarkisyan, expressed her profound thanks to CNA/NNOC. “We couldn’t have done this without you helping us to stand up against this insurance company and forcing them to finally do the right thing. It is not right in this country for it to take a rally, a protest, and a major press conference to get an insurance company to listen.”

“Every politician who thinks the answer to our healthcare crisis is more insurance should stop and think about Nataline Sarkisyan,” said DeMoro. “Insurance is not care. Paying for insurance coverage is not the same as assuring you will receive appropriate care, even when recommended by a physician as it was for Nataline. Insurance corporations profit by denying care to the sick, and that is no way to run a humane healthcare system.”

DeMoro said that CNA/NNOC will continue to encourage patient protests and publicize stories about insurance companies’ denial of care, as it has all year through its www.guaranteedhealthcare.org website, while pressing for real healthcare reform “that takes medical decisions out of the hands of insurers and places them where they belong, in the hands of healthcare professionals and their families.”

Background on case:

“My daughter survived two bouts of cancer, and against all odds has been stable even with so many of her organs not working, only to be told that she cannot get the only treatment that will save her life because some administrator in some office thinks it is too expensive,” said Hilda Sarkisyan. “We needed help in standing up against this insurance provider, and of course it was the nurses who stepped forward.”

In a Dec. 11 letter to CIGNA’s transplant department, four UCLA physicians said that Nataline “currently meets criteria to be listed as Status 1A” for a transplant and urged the company to “urgently re-review her case” and their denial. CIGNA said it denied the care because their benefit plan “does not cover experimental, investigational and unproven services,” to which the doctors replied, “Nataline’s case is in fact none of the above.”

On Dec. 14, Hilda Sarkisyan was told by the hospital that a healthy liver was available, but because CIGNA had refused authorization, the family would have had to make an immediate down payment of $75,000 to proceed, an amount the family could not afford.

CNA/NNOC is the nation’s largest and fastest-growing union of direct-care RNs, with some 75,000 members in all 50 states.

Evaluation of Colorado Blue Ribbon Commission for Health Care Reform Final Recommendations

by Michele Swenson
Board Member, Health Care for All Colorado
Co-Authors of Colorado Health Services Single Payer Proposal
January 2, 2008

Overview: Colorado Blue Ribbon Commission for Health Care Reform

(Draft) Final Report / Recommendations to the Colorado General Assembly (Due Date: 1-31-08)

During its 15-month length of service, the Colorado Blue Ribbon Commission for Health Care Reform — comprised of 27 members statewide appointed by two governors and 4 legislators — will have received 31 proposals (23 comprehensive, 7 Single Payer). Five proposals were selected to be evaluated by the Lewin Group, including an additional proposal written by a subcommittee of the Commission. The Colorado Health Services Single Payer Proposal is the only reform proposal that demonstrated any savings for the state — $1.4 billion — and also the only one capable of providing comprehensive health care for all. The Colorado Commission chose to base most of its recommendations on its own (5th) Proposal.

The 208 Commission Recommendations fail to address:

* Rising cost of health insurance premiums (82% increase in 6 years in Colorado), as well as copays, deductibles and prescriptions

* The U.S. fragmented commercial health insurance system that siphons more than 20 percent of health care dollars to profits, exorbitant CEO salaries, etc. and duplicative layers of administrative waste.

* A greater than doubling of median family income spent on health insurance: 7.7% in 1987 to 19% in 2005

* As premium costs continue to increase, coverage has decreased: “Insurance does not equal health care.”

The 208 Commission’s proposed solution:

* A cornerstone of the Commission Recommendation is the Massachusetts-style ‘Individual Mandate’ to purchase private insurance, with a substantial tax penalty for failure to comply.

* The Commission counts heavily on taxpayer subsidies to private insurances.

* The Commission asserts that all cost-shifts are due to the uninsured – yet Lewin’s Graph on Cost Shift shows that the uninsured and underinsured combined (labeled ‘self-pay’) contribute less than 20% to the total cost-shift burden. John Sheils of the Lewin Group informed the Commission that half of all uninsured payer their own health care bills.

* The Commission Recommendation states: “A minimum benefit plan – a leaner health insurance package with high deductibles, annual caps or limited benefits (average monthly premium $200/individual) is considered essential for assuring availability of an affordable product.”

Shortcomings of 208 Commission Recommendations:

* The Massachusetts-style ‘Individual Mandate’ creates a captive market for commercial insurance without attaching either quality or cost controls to insurance charges. In Massachusetts, 2008 marks the 8th year of average double-digit premium increases, resulting in more who cannot afford insurance and are moved into subsidized or public insurance at taxpayer expense. (Boston Globe, 9/13/07, 12/5/07)

* The 208 Commissioin seeks to solve one problem by exacerbating another — by moving more of the uninsured into underinsurance, or Minimum Benefit Plans. Attributing all unpaid medical bills to the uninsured and to under-reimbursed public programs, the Commission disregards the rising trend of unpaid medical bills by the underinsured. The annual TrendWatch Reports of the American Hospital Association reveal that out-of-pocket costs have risen from $146.3 billion in 1995 to $249.4 billion in 2005 – a 59% increase that parallels the 60% increase in unpaid medical bills over the same period. See Graph of Increasing Out-of-Pocket Expenses.

* The Families USA Report Too Great a Burden: Colorado’s Families At Risk (12-13-07) reveals that 1,054,000 people under the age of 65 in Colorado are in families that will spend more than 10% of their family income on health care costs in 2008 before accounting for taxes. Out of these people, the vast majority, 82.6%, have insurance. Out of these Coloradans, 299,000 live in families that will spend more than 25% of their pre-tax income on health care costs in 2008. The numbers of underinsured people have increased since previous studies in 2000, and as a result, put thousands of families at risk due to a growing health care burden. Families USA: Colorado’s Families At Risk

* As premium rates continue to rise faster than the rate of inflation or wage increases, more employers will either drop health coverage or move employees into Catastrophic ‘Minimum Benefit Plans’ with high out-of-pocket costs that leave families vulnerable to increasing health and financial risk, and also contribute to over 50% of personal bankruptcies precipitated by high medical bills.

* The Commission Recommendations add many new categories of coverage, eligibility testing, and new departments of administration, as well as taxpayer subsidization, multiplying administrative and public costs of health care.

Some goals defined by the Commission — “to provide consumers with “a choice of insurances” and to “ensure the ongoing viability of Colorado’s insurance markets” — falsely equate insurance with health care access. People want a true choice of health care, not choice of ‘minimum benefit’ insurances. The Commission Report begs the question: Is reform intended to insure the bottom line of the health insurance industry, or health care access for all?

It is telling what the Commission left out of the final report — Statements from the Vulnerable Populations Task Force Report to the Blue Ribbon Commission, September 28, 2007:

* “Mandating the purchase of a minimum benfits package forces residents to pay for underinsurance and is in direct conflict with the guiding principles of the Commission. We must not exchange our uninsured for masses of underinsured.”

* “The Lewin analysis established that current expenditures in health care would finance comprehensive health insurance for all Colorado residents under the Colorado Health Services proposal with $1.4 billion in savings to the state of Colorado. We should not consider healthcare to be a commodity, as we do not choose to get sick. The Vulnerable Populations Task Force asks the legislature to have the vision to do what is best for all the residents of Colorado. If this is not possible, we offer our recommendations on elements of health reform that could benefit Vulnerable Populations.”

Single Payer merited just 4 sentences in the Commission’s final report. Single Payer: “…viewed by the Commission as being too disruptive of current coverage and also unworkable in a single state.”

Nevertheless, the Single Payer model is uniquely capable of overcoming many problems that the current system and other proposals cannot. No other proposal would create a single Health Trust Fund combining administration of all health care monies, insulated from the politics of the State General Budget (and such constraints as TABOR and Averschoug-Bird, etc.).

Single Payer transparency and accountability of data overcomes the problem of secret proprietary data of numerous private insurance companies, and permits evaluation of best practices and outcomes in a statewide Health Information Technology system. While all other proposals call for substantial increases of state Medicaid spending (funds constrained by General Budget rules that simultaneously limit spending in other areas), Single Payer alone can create a true cost-effective single-risk pool insurance by consolidating multiple categories of medical care that now fall under such categories as Auto, Workers’ Comp and Medicaid/Medicare, to eliminate administrative waste. Single payer can overcome the federal limits on provider reimbursements that hamper Medicaid/ Medicare. Only Single Payer provides true choice of providers a
nd hospitals. Currently, employees’ choice of providers is limited within an employer’s health plan; change of plans requires change of providers, disrupting health care. Improved Coverage & Cost Savings of Colorado Health Services Single Payer Proposal

The Commission’s Reform Proposal sets the stage for a continued downward spiral: As premiums increase and benefits decrease, more people can no longer afford insurance and more are moved into public programs at taxpayer expense.