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Garamendi Stumps for Single-Payer Health Care System

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Garamendi Stumps for Single-Payer Health Care System

Lt. Gov. John Garamendi (D) is touring California to gather support for a state-run, single-payer health care system, the Fresno Bee reports.

Garamendi on Monday stumped for universal health care in Los Angeles and Fresno. The lieutenant governor then was headed to Sacramento and Alameda to tout a single-payer, state-run health system similar to Medicare or the insurance plans provided to California teachers and federal employees.

Garamendi said health care legislation will be passed this year “but the question is what will it be.” He added, “If it’s for children only, that’s good, but it’s far and away from what needs to be done.”

He added, “We have seven days ahead of us to take a gigantic step forward for universal health care. We’ll either succeed or stall out, but the fight isn’t over” (Lloyd, Fresno Bee, 9/4).

Nuñez's unhealthy bill

No reform at all would be better than giving Schwarzenegger a political victory and leaving insurance companies in charge.

By Deborah Burger
Los Angeles Times
September 6, 2007

In alliance with Gov. Arnold Schwarzenegger, Democratic leaders of the state Legislature, led by Assembly Speaker Fabian Nuñez (“Healthcare reform — now,” Opinion, Aug. 28), are rushing to enact a substandard health reform plan that will not reduce the health insecurity of California families.

They’re apparently even willing to jeopardize Sen. Barbara Boxer and their own party’s slim hold on the United States Senate along the way.

Here’s the deal: Nuñez and some other Democrats are actively working with Schwarzenegger to put together a “compromise” healthcare package.

Schwarzenegger, the main architect of that plan, gets to claim credit for supposedly solving the state’s healthcare crisis using “bipartisan consensus.” As collateral damage to Democrats, Schwarzenegger can tout this deal to boost his candidacy against Boxer in 2010.

Nuñez could then get the governor’s support for extending his term as speaker.

This constellation of events may be dandy for a career politician or two, but it leaves behind a lot of other Californians, who will have to contend with a poor healthcare bill full of holes.

AB 8 does nothing to rein in rising insurance premiums — up 87% nationally this decade — or rising co-pays, deductibles and other health fees. Which means that costs, already unaffordable for far too many, would continue to spin out of control.

The bill fails to limit rising prescription drug costs, especially notable at a time when Schwarzenegger has just eliminated funding for his “voluntary” drug price restraints that were so ballyhooed last year by the governor and the authors of AB 8.

It is not universal, as many of the currently uninsured would remain without access to care. It fails to assure uniform, comprehensive benefits, and therefore perpetuates an increasingly multi-tiered health system based on the ability to pay.

It fails even to require insurance companies to provide insurance. They would not have to offer coverage to those with serious medical conditions — those people would instead be dumped into a publicly funded high-risk pool, earning big insurance companies millions in additional profits while bankrupting the public pool with the sickest, costliest patients.

The bill does not even protect patients’ choice of physicians, hospitals or other providers.

And, most critically, the plan reinforces and expands an insurance-based system — the source of much of the present crisis — thereby subverting real reform for years to come.

At the center of the plan is a mandate on businesses to either provide health coverage or pay taxes into a fund to buy it for their employees. The new tax would fall between the 7.5% of payroll costs favored by Nuñez and the 4% Schwarzenegger proposes.

No matter where the compromise figure ends up, it will be far less than many employers now pay for health benefits. One-fourth of all California businesses that provide health benefits currently pay more than 15% of their payroll for health premiums, according to the California Healthcare Foundation. As a result, businesses that now provide health coverage to employees would have an incentive to drop it.

Moreover, the mandate on employers is unlikely to survive a legal challenge; a similar Maryland bill was thrown out by the federal courts for violating federal benefits law.

Schwarzenegger continues to push his proposal to force most uninsured people to buy insurance or face severe penalties. So far, Democrats have resisted this proposal, but many expect them to accept some form of individual mandate as the final price for Schwarzenegger’s blessing for the term limits initiative.

Last year, Democrats united behind SB 840, a single-payer-style, enhanced “Medicare for all” bill that would have provided guaranteed healthcare for everyone, controlled costs, eliminated co-pays and deductibles, guaranteed choice of provider, and gotten the insurance companies out of the way.

Similar systems are succeeding in every other industrialized democracy — including Schwarzenegger’s homeland, Austria. If the politicians in Sacramento are concerned about patient care, they will not now settle for a bad healthcare bill that will further degrade our healthcare safety net. A bad healthcare bill is worse than no bill.

Deborah Burger, RN is president of the California Nurses Association.

MachinistsÂ’ Union (IAM) Ninth International to Endorse HR 676

The International Association of Machinists and Aerospace Workers (IAM) is the ninth international union to endorse HR 676, single payer healthcare legislation introduced by Congressman John Conyers (D-MI). The union represents 720,000 active and retired members.

In a letter conveying the endorsement, IAM Assistant Legislative Director, Hasan Solomon, said, “…we strongly endorse Congressman John Conyers’ bill HR 676, ‘Expanded and Improved Medicare for All.’” Solomon further states in his letter, “We have and will continue to urge members of Congress to support this much needed health care reform.”

The IAM joins the UAW, NEA, ILWU, NALC, UE, AFM, UA Plumbers & Pipefitters, and CNA/NNOC which have all endorsed HR 676.

Nuñez’s unhealthy bill

No reform at all would be better than giving Schwarzenegger a political victory and leaving insurance companies in charge.

By Deborah Burger
Los Angeles Times
September 6, 2007

In alliance with Gov. Arnold Schwarzenegger, Democratic leaders of the state Legislature, led by Assembly Speaker Fabian Nuñez (“Healthcare reform — now,” Opinion, Aug. 28), are rushing to enact a substandard health reform plan that will not reduce the health insecurity of California families.

They’re apparently even willing to jeopardize Sen. Barbara Boxer and their own party’s slim hold on the United States Senate along the way.

Here’s the deal: Nuñez and some other Democrats are actively working with Schwarzenegger to put together a “compromise” healthcare package.

Schwarzenegger, the main architect of that plan, gets to claim credit for supposedly solving the state’s healthcare crisis using “bipartisan consensus.” As collateral damage to Democrats, Schwarzenegger can tout this deal to boost his candidacy against Boxer in 2010.

Nuñez could then get the governor’s support for extending his term as speaker.

This constellation of events may be dandy for a career politician or two, but it leaves behind a lot of other Californians, who will have to contend with a poor healthcare bill full of holes.

AB 8 does nothing to rein in rising insurance premiums — up 87% nationally this decade — or rising co-pays, deductibles and other health fees. Which means that costs, already unaffordable for far too many, would continue to spin out of control.

The bill fails to limit rising prescription drug costs, especially notable at a time when Schwarzenegger has just eliminated funding for his “voluntary” drug price restraints that were so ballyhooed last year by the governor and the authors of AB 8.

It is not universal, as many of the currently uninsured would remain without access to care. It fails to assure uniform, comprehensive benefits, and therefore perpetuates an increasingly multi-tiered health system based on the ability to pay.

It fails even to require insurance companies to provide insurance. They would not have to offer coverage to those with serious medical conditions — those people would instead be dumped into a publicly funded high-risk pool, earning big insurance companies millions in additional profits while bankrupting the public pool with the sickest, costliest patients.

The bill does not even protect patients’ choice of physicians, hospitals or other providers.

And, most critically, the plan reinforces and expands an insurance-based system — the source of much of the present crisis — thereby subverting real reform for years to come.

At the center of the plan is a mandate on businesses to either provide health coverage or pay taxes into a fund to buy it for their employees. The new tax would fall between the 7.5% of payroll costs favored by Nuñez and the 4% Schwarzenegger proposes.

No matter where the compromise figure ends up, it will be far less than many employers now pay for health benefits. One-fourth of all California businesses that provide health benefits currently pay more than 15% of their payroll for health premiums, according to the California Healthcare Foundation. As a result, businesses that now provide health coverage to employees would have an incentive to drop it.

Moreover, the mandate on employers is unlikely to survive a legal challenge; a similar Maryland bill was thrown out by the federal courts for violating federal benefits law.

Schwarzenegger continues to push his proposal to force most uninsured people to buy insurance or face severe penalties. So far, Democrats have resisted this proposal, but many expect them to accept some form of individual mandate as the final price for Schwarzenegger’s blessing for the term limits initiative.

Last year, Democrats united behind SB 840, a single-payer-style, enhanced “Medicare for all” bill that would have provided guaranteed healthcare for everyone, controlled costs, eliminated co-pays and deductibles, guaranteed choice of provider, and gotten the insurance companies out of the way.

Similar systems are succeeding in every other industrialized democracy — including Schwarzenegger’s homeland, Austria. If the politicians in Sacramento are concerned about patient care, they will not now settle for a bad healthcare bill that will further degrade our healthcare safety net. A bad healthcare bill is worse than no bill.

Deborah Burger, RN is president of the California Nurses Association.

More administrative services

New Services Help Unsnarl Medical Bills

By Christopher Lawton
The Wall Street Journal
September 4, 2007

MedBillManager (an online tool from health-care services company Change:Healthcare LLC that helps users organize their medical bills) is one of many online services popping up to help consumers take a more active role in their medical care. Intuit Inc., maker of the Turbo Tax software, offers software called Medical Expense Manager to help consumers deal with their medical expenses, for a cost of $50. Revolution Health Group LLC, a consumer-focused health company formed in 2005 by America Online co-founder Steve Case, charges $129 a year for a premium health-care service that includes an online application to help users handle their medical expenses.

Apart from automatic error detection, SmartMedicalConsumer also has medical-billing experts that man an online forum for members to ask questions. Revolution Health’s premium service goes one step further by calling up insurance companies and fighting over disputed claims on a user’s behalf.

The new services are springing up at a time when employers and legislators are pushing more health-care responsibilities on to workers.

“For better or for worse, people are more and more on their own in health care,” says Ron Klain, executive vice president of Revolution Health, based in Washington, D.C.

http://online.wsj.com/article/SB118886008399016278.html.html

Comment:

By Don McCanne, MD

As the government continues to ignore the health care financing crisis, the market responds – by selling us even more wasteful administrative services.

What will be the next product? A service to organize the medical bill organization services of MedBillManager, Medical Expense Manager, SmartMedicalConsumer, Revolution Health, and others?

Unions to make health care centerpiece of 2008 election

By Mark Gruenberg
Workday Minnesota
2 September 2007

WASHINGTON – Labor unions will make achievement of affordable, universal health care the centerpiece of the 2008 election drive, elevating the issue to the top of the national domestic agenda, AFL-CIO President John Sweeney announced.

Sweeney chose his annual review of the state of unions and workers Aug. 29 to lambaste the Bush administration and politicians in general for failing to tackle key problems, such as declining health insurance coverage and the lack of the right to organize.

But he spent more time talking about the future than about the past, saying the AFL-CIO, with other union allies–including Change to Win and possibly the National Education Association–will concentrate on an intensive, many-layered educational campaign on health care between now and November 2008, and stretching beyond that, to holding politicians accountable for fixing the mess in 2009.

Health care will take precedence over other worker causes, including the Employee Free Choice Act and the right to organize, Sweeney added. But those will not be ignored. Instead, they along with health care will be part of labor’s giant educational campaign on how to create an economy that works for working families.

The importance of the health care issue was highlighted by Census Bureau data issued the day before, which showed a record 47 million people are uninsured and that, for the first time, the percentage of large corporations that offer health insurance to their workers has slid below 60 percent. Millions more are underinsured and health insurance at smaller firms is spotty or non-existent.

And even at the larger firms, workers are being forced to pay higher premiums and co-pays, coverage is being cut, health care costs are the No. 1 issue in bargaining and retiree coverage is being eliminated, Sweeney said.

“Health care is the top domestic issue for our members and all Americans, and the AFL-CIO is making the 2008 elections a mandate on fixing our broken system. We will hold candidates at every level responsible for supporting comprehensive, progressive national health care reform and we will elect a president and a Congress prepared to turn their campaign promises into reality,” he declared.

Though “we’ll put more of our resources than ever before” into the massive educational and political campaign on health care, the federation will not take a stand now for a particular piece of legislation or for or against a particular Democratic candidate’s health care program, Sweeney said.

In response to a question, Sweeney said a single-payer government-run health care bill, HR 676 by veteran pro-labor Rep. John Conyers, D-Mich., which would abolish the insurance companies and their role, is a possibility, along with others. The Conyers legislation has been endorsed by the Minnesota AFL-CIO and 21 other state labor federations, along with hundreds of unions and central labor councils.

The federation has previously backed Medicare-for-all legislation–which would expand the federal health care program to everyone but leave some role for private insurers–sponsored by Senate Labor Committee Chairman Edward M. Kennedy (D-Mass.), House Commerce Committee Chairman John Dingell (D-Mich.) and House Health Subcommittee Chairman Pete Stark (D-Calif.).

Sweeney also pointed out that unions will keep pushing states to act on health care, citing California, which has one-eighth of the U.S. population. California AFL-CIO Secretary-Treasurer Art Pulaski said state legislators there are in intense negotiations over a plan that would mandate all employers cover workers or pay into a state fund that does so.

Other details of the AFL-CIO plan:

* The federation will “build an army of 1 million activists” on health care, drawing them from labor organizations and Working America, the AFL-CIO affiliate for people who cannot join unions.

* The federation and the National Labor College will train activists in the issue, who in turn will be expected to train their colleagues, especially to meet attacks on health care reform from the drug industry and insurance companies.

* The first step will be to defend the State Childrens Health Insurance Program and its expansion against a Bush veto plan. “No child should go without a polio shot or a pre-school (health) exam because George Bush threatens to veto funding for a children’s health program.” Sweeney said. The Democratic-run Congress wants to expand the SCHIP program, which now covers 6-million-plus poor kids, to cover another 9 million.

Mark Gruenberg writes for Press Associates, Inc., news service. Used by permission.

For more information

See the Workday Minnesota special section: The Health Care Crisis: Growing Consensus for Change

Visit the AFL-CIO’s special webpages on health care, http://www.aflcio.org/issues/healthcare/

Innovative Health Care Solutions

Excerpt from Forbes.com

Dr. Ana Malinow
President, Physicians for a National Health Care Program

We already outspend every industrialized country by almost twice as much per person, but our outcomes are nowhere near twice as good as everybody else’s. The problem with the way our system is funded is that 30% off the top automatically goes to administration and profit. So if we take that out of the equation by creating a single payer system then we will be able to cover anyone. We would just need to pay more from our taxes, but we’d be paying zero for private health insurance.

Innovative Healthcare Solutions: Dr. Ana Malinow

Since 2002 I’ve been giving talks on health care reform to anybody who would like to listen. I tell people how much we spend on our health care, which is now almost $2 trillion per year. I say I’m going to give you $2 trillion and I want you to come up with a health care system you’d be willing to spend it on.

And for that I want you to come up with a set of guiding principles that you’re not going to negotiate on. Invariably everybody comes up with the same principles: universal, accessible, affordable, accountable and comprehensive.

The only health care system that has those principles is a single-payer system. Think of a Medicare for people over 65 and another for those under 65, covering everybody from birth to death. It would be publicly financed and privately delivered.

We already outspend every industrialized country by almost twice as much per person, but our outcomes are nowhere near twice as good as everybody else’s. The problem with the way our system is funded is that 30% off the top automatically goes to administration and profit. So if we take that out of the equation by creating a single-payer system, then we will be able to cover anyone. We would just need to pay more from our taxes but we’d be paying zero for private health insurance.

Every 10 or 15 years Congress comes up with another iteration of universal health care and every single time it’s squashed. If you look at the people who are losing health insurance at the fastest rate today it’s those people making over $70,000 per year. Those are the people who vote consistently. I think that’s what is different today. I think that is going to have a huge impact on the success of reform.

Ana Malinow, M.D., is president of Physicians for a National Health Care Program.

–Interviewed by Andy Stone

My Encounter with [insert scary music] … Socialized Medicine!

by Jim Wallis
(Our thanks to Denise Puthuff, MD, who sent us this article.)
Friday, August 10, 2007

http://blog.beliefnet.com/godspolitics/2007/08/jim-wallis-my-encounter-with-i.html#comments

My foot had been sore for a couple of weeks and it wasn’t getting better. I usually would ignore that, but we were about to leave on a two week vacation with my wife Joy’s parents to celebrate both of our big anniversaries (their 50th and our 10th). Then I have to fly to Singapore for the World Vision triennial conference. So I wouldn’t be back home for many weeks and my Washington, D.C., health care provider (over the phone) strongly urged me to see a doctor in London before we left.

I realized then that I was about to have my first encounter with SOCIALIZED MEDICINE! Now it’s one thing to advocate health care reform in America and even to be politically sympathetic to the idea of a single-payer government-supported system like they have in most of the world’s developed and civilized countries (such as Canada, Germany, and Great Britain). But it was another thing to actually go to the emergency room (or ER, but in the U.K. they call it Accident and Emergency) of a hospital in the British National Health Service. After all, I had heard the horror stories–long waits in incompetent, dirty, and substandard medical facilities; bad doctors and faulty diagnoses; and, of course, incredible bureaucracies like everything in “socialist systems.” Rush Limbaugh and every other conservative pundit have warned us all in America about the horrific practices of British socialized medicine.

So I prepared myself. I brought a big novel to read, along with my eyeglasses, a bottle of water (no telling what they would not have in socialized medicine), and emotionally steeled myself for the ordeal. Ann Stevens, the Anglican vicar with whom we stay in London (she’s my son Luke’s godmother and Joy’s old pal) took me to St. George’s hospital, dropped me off at “A and E,” and wished me luck at 9 a.m. Hoping I would be home that night for dinner, I took a deep breath, walked across the street, and made my way into socialized medicine.

The waiting room was actually quite peaceful and not crowded, I noticed, as I walked up to reception. The woman at the reception desk smiled. I didn’t expect that. “Can I help you?” “Yes,” I replied, “you see, I am an American–I guess you can tell–and I’m visiting family here–my wife is British–and we’re staying with our friend the vicar, and I have a sore foot, which I normally wouldn’t worry about but we’re going away for several weeks on vacation, and I called my health care provider in the U.S., and they told me to come in here, and thought I should get an X-ray or something.” (I wondered for a moment if it would help to tell them that I was a friend of the prime minister, but decided not.) “What do you need from me?” I asked hesitantly. “Just your name and address,” she replied with another smile. “Oh …OK.” She told me it would be about 10 minutes to see the nurse. “Yeah right,” I thought to myself.

I settled into the waiting room chair, looked around at all the people who didn’t seem to be in any distress, and opened my book for a good long read. It was five minutes before the nurse called me in to a little office adjacent to the waiting area, which seemed to be an intake room. She was pleasant and professional as she asked me what was wrong, and how long I had felt the soreness. She gently examined my foot and then told me I would be called in to see a doctor in about 10 minutes. “Sure thing,” I thought. So I went back out to the waiting room and settled in again to read my novel.

It was five minutes before a young woman appeared and called my name, “Mr. Wallis?” She was a young Asian doctor named Dr. Gillian Kyei. She was also very pleasant and professional, taking time to ask me lots of questions about how I might have hurt my foot, etc. She examined the injured foot carefully, told me that it didn’t necessarily look broken, but that we should get an X-ray to make sure. I waited in her examining room for a couple of minutes while she called down to the X-ray department to say that I was on the way. Then she came back and escorted me herself.

When I got to X-Ray, I checked in by just saying my name and took a seat in the waiting area. Finally, I was going to get to read my book! But five minutes later, the technician came out to bring me in. She took her time with me, taking several different angles of my foot. When I was done, she sent me back to my young doctor, with another smile.

This time the wait was a full ten minutes because, I later learned, Dr. Kyei was reading the results of my X-ray, which had already been sent to her computer. She showed me what looked to her like a fracture of my fourth metatarsal bone, but said she wanted to consult with the orthopedic specialist. I waited about ten minutes more while she did that and so got a few more pages read.

Dr. Kyei then came back with the definitive diagnosis–my fourth metatarsal bone was indeed fractured. She went over their preferred treatments and my options with me. Normally, if this injury had just happened, they would put me in a cast to hold the broken bone in place and give me crutches. They were still happy to do that now. But since I had been already walking on it for over a week and the bone was still in the right place, I could also have the option to just using a therapeutic soft boot to keep the weight on my heel and off my fourth and fifth metatarsals. While the fracture was at the base of the fourth metatarsal, as she carefully explained and showed me on the X-ray, the pain was being felt lower down–across both my fourth and fifth metatarsals area. If I chose the boot, I could still swim with my kids and get around a little easier, but I would have to really try to keep my weight off the injured area. I chose the boot and she told me she would be back in a minute.

It was actually about two minutes before she got back, and I was getting nowhere with this novel. She handed me a very stylish black boot (so much better than other colors for fashion coordination), and gave me my final instructions–be very cautious about the foot, try to stay off it as much as possible but keep it mobile and flex it so the blood circulates, get another X-ray as soon as I get home and, of course, then consult with my home physician. Then she wrote me a nice long letter for my home doctor, describing their diagnosis and treatment. Dr. Gillian Kyei then wished me the best of luck, hoped I would have a great vacation despite my foot, smiled, and sent me back to the front desk.

“How can I call a cab?” I asked. “Oh, I’ll do that for you,” she said. “Just take a seat over their and the cab will be here in about 10 minutes.” As I sat there, I realized something. Nobody had ever asked me to pay. Everything was FREE, including my nice new boot. How about that? They think health care is a right for all citizens, and even foreign visitors like me. Amazing.

The cab came in 5 minutes. I thought I would tell him some horror stories about my experiences in the American health care system, but decided not to. I was back at Ann’s in just over an hour from when I left–with my letter, my boot, and my tale of smiling, pleasant, and efficient health care workers. And somehow I began to believe that back in America we weren’t being given the whole truth. And guess what? Ann tells me that David Beckham and Wayne Rooney, the biggest British soccer (football) stars, have had metatarsal bone fractures, just like mine. In about six weeks, I too will be back on the field, thanks to socialized medicine! And in the meantime, I will keep my foot up … and maybe get that novel read.

Uninsured by choice?

Hispanics Push Texas to No. 1 in Uninsured Residents

By Jason Roberson
Hispanic Business
August 29, 2007

Texas again ranks No. 1 with the highest percentage of uninsured residents in the nation — primarily due to the state’s growing Hispanic population, according to a report issued Tuesday by the U.S. Census Bureau.

Because of their low wages, many Hispanics have to set priorities, said Jaime Martinez, co-chairman of the health commission for the League of United Latin American Citizens, the country’s oldest civil rights group for Latin Americans.

“They would rather put money on the table, pay the light bill, pay the rent, than buy insurance that’s very costly,” Mr. Martinez said. “That’s why we need to address the health care of the uninsured and underinsured in this country.”

The National Center for Policy Analysis, a conservative Dallas-based research group, said a growing number of households are uninsured because they want to be.

“Whether it be cultural or a matter of economics, for a growing number of households being uninsured is a matter of choice,” said Devon Herrick, a senior fellow of the NCPA.

Bill McCormick, a 55-year-old computer systems analyst from Richardson, is an example.

“I am not Hispanic and I don’t have medical insurance,” Mr. McCormick said in response to Tuesday’s news. “That was the choice I made … drop the medical insurance or go hungry.”

The NCPA is fighting the move for a single-payer, government-run health care system, saying a free-market system is best.

http://www.hispanicbusiness.com/news/newsbyid.asp?id=75135&cat=Headlines&more=/news/more-news.asp

Comment:

By Don McCanne, MD

As anticipated, the opponents of comprehensive reform are framing the increase in the numbers of uninsured as a matter of personal choice for many.

Does their outspoken insensitivity to the unmet health care needs in this nation really resonate with the public? If not, then why doesn’t our compassion translate into action?

On Life Support

By Arian Campo-Flores
Newsweek.com
web exclusive
May 9, 2007

Dr. Arthur Kellerman couldn’t believe what he was hearing. He had just begun a fellowship assignment with the House Committee on Oversight and Government Reform in January when staffer Karen Nelson invited him to attend a briefing on Capitol Hill. Dennis Smith, director of the Center for Medicaid and State Operations, would be discussing a planned rule change by the Bush administration. “Don’t say anything,” Nelson told Kellerman. “Just listen.” At the meeting, Smith said that the rule was simply an attempt to rebalance federal and state roles in financing Medicaid. But when he explained the details, Kellerman could barely contain himself. As Kellerman understood it, the rule would result in millions of dollars in funding cuts for hospitals across the country. “I’m hearing this and having a heart attack,” he recalls. Nelson and others strafed Smith with questions and the briefing came to a close. But a new battle between Congress and the administration had begun.

It was a sobering start for Kellerman, 52, whose regular job is chairman of the Department of Emergency Medicine at the Emory University School of Medicine. For years, he’s been sounding the alarm that hospital emergency rooms nationwide are in crisis. The stats are disconcerting: while visits to emergency departments increased by 26 percent from 1993 to 2003, hospital beds plummeted by 198,000, and 425 ERs around the country shut down, according to a 2006 report by the Institute of Medicine, a nonprofit arm of the National Academy of Sciences. Kellerman has experienced the impact firsthand at Atlanta’s Grady Memorial Hospital, which is partly staffed by Emory doctors. Burdened by a growing pool of uninsured patients and squeezed by funding cutbacks, the institution is teetering at the edge of an abyss. Yet despite Kellerman’s efforts to spur officials at all levels to action, Grady’s condition has only grown worse. Part of the challenge: talk of ERs at the breaking point has become so familiar that it’s hard to convey a sense of urgency. So last September, Kellerman headed to Washington, D.C., after winning a prestigious yearlong Robert Wood Johnson health- policy fellowship. He landed a spot working for the oversight committee now chaired by Democratic Rep. Henry Waxman, who’s concerned about emergency-care issues and has taken on the Bush administration with zeal. Over the past nine months, NEWSWEEK spent time with Kellerman in both Atlanta and Washington, as he journeyed from a blood-soaked ER to the antiseptic corridors of power.

When he started his fellowship, Kellerman heard the same advice repeatedly: don’t expect to accomplish anything substantive in a year; just come to learn. But of course, he says, “we all try to make a difference anyway.” He had no shortage of ideas. Last year, he concluded his work on an Institute of Medicine committee that took a comprehensive and probing look at the state of emergency care in the U.S. The resulting series of studies, published last June, painted a despairing portrait, but also offered a raft of recommendations. Given the approaching midterm elections, Congress and the administration did virtually nothing. But after the Democratic takeover, Kellerman imagined things might be different.

The administration’s planned Medicaid rule change, however, dashed those hopes. Kellerman realized this was no time for lofty ambitions; Congress would have to play defense. The rule, scheduled to take effect on Sept. 1, deals with the arcane world of Medicaid financing. Two provisions in particular dismay many in the health-care field. One limits states’ ability to tap certain funding sources to meet their Medicaid obligations. The other stipulates that Medicaid reimbursements cannot exceed the cost of treating the Medicaid patient. While that provision may sound reasonable, says Larry Gage of the National Association of Public Hospitals, it doesn’t account for the harsh reality confronting medical facilities that treat large numbers of the uninsured. Since these facilities don’t get reimbursed for that treatment, they rely in part on higher-than-cost Medicaid reimbursements. As a result of the new administration rule, many hospitals may need to make drastic cuts in personnel, beds and more. “There isn’t any question that if this regulation goes into effect in the ways it’s proposed, there will be reduced safety-net services in many communities,” says Gage, who considers the rule “the most important legislative or regulatory issue that we’re confronting right now.” Smith, the Medicaid official, whose center is part of the Department of Health and Human Services, responds that it defies logic to reimburse more than the cost of care and that state governments need to step up to meet their obligations. Smith argues further that some hospitals have abused the Medicaid financing system in the past–a point that even Gage concedes (although he maintains that the abuse problem has largely been eradicated).

The administration calculates that the rule change will reduce federal Medicaid expenditures by about $3.8 billion over five years. But Gage and others estimate the impact on hospitals will be much larger. At Grady, where 42 percent of revenue comes from Medicaid, Kellerman estimates that the hit could total $200 million over five years. “Grady is already struggling,” he says. “This would put it out of business.” Were Grady to close, the consequences would be far-reaching: the hospital is the only Level I trauma center (the highest designation) in a 120-mile radius of Atlanta, and one quarter of Georgia’s physicians are trained there.

In the wake of the rule announcement, lawmakers and lobbyists leapt into action. Waxman and others wrote a letter in March to the secretary of the Department of Health and Human Services, urging that the rule be withdrawn. At a time when the nation is at risk of a terrorist attack, they argued, the ERs on the front lines are more crucial than ever; yet hospitals can barely cope with the routine traffic on a Saturday night. More than 150 House members from both parties signed the letter (Kellerman helped round up signatures, shuttling from one congressman’s office to another). But the administration refused to budge. So lawmakers turned to another tactic: they inserted a provision in the Iraq supplemental-funding bill that would impose a one-year moratorium on implementing the rule. Though Bush vetoed that bill, many lawmakers are intent on including the same provision in the next attempt to craft an Iraq-spending measure. They seem to have plenty of supporters. In the oversight office, Kellerman sifted through about 450 responses to the rule sent by individuals and groups during the public comment period. “They ranged from negative to overwhelmingly hostile,” he says.

Waxman now has a new plan to press the administration: an oversight committee hearing that will be held around mid-June, the one-year anniversary of the Institute of Medicine reports. Though the main purpose is “to examine the federal government’s failure to address the crisis in emergency care,” as he puts it, the new Medicaid rule will surely come up as well. Kellerman is now helping prepare for that hearing. He worries that if the administration manages to implement the rule, it may attempt other federal funding cuts that Bush has mentioned in his budget proposals. “It’s hard to imagine congressmen will just allow hospitals in their home districts to get wrecked,” says Kellerman. But as he has learned, Washington’s ways–its partisan politics, its backroom dealing–can be confounding. All he can do is continue to hammer home the message of what’s at stake. “Either we’ll figure it out and start addressing [emergency care] in a serious manner,” he says, “or the system will fail catastrophically.” Kellerman has sounded such alarms before to little avail. Now, though, he’s got a slightly bigger megaphone.

(c) 2007 Newsweek, Inc.

Guest Opinion: U.S. needs to wake up and provide universal health care

Ray Clasen
The News Press
Fort Myers, Florida
September 04, 2007

I’ve reckoned that if I did not have health insurance, the annual physical exam I receive at my family doctor’s would cost, including blood work, over $500. Without insurance I couldn’t afford these physicals, but without them my high blood pressure would still be undiagnosed, and I’d be a walking medical time bomb, a stroke waiting to happen.

Isn’t it ironic that the wealthiest nation on the planet is also the only “developed” nation that does not provide some sort of universal health care plan for its citizens? Forty-five million Americans do not have health insurance. As The News-Press pointed out in June, one in four Southwest Florida residents lives without coverage.

Some of these people are probably in good health, but many are in urgent need of medical attention and drugs they can’t pay for. This situation is a national disgrace and needs immediate attention. We must make it clear to the current crop of presidential hopefuls, be they Democrat or Republican, that health care reform must be their most important domestic issue.

Forget the hodgepodge of ideas that have been floated in different states on this issue; the only solution to this problem that makes sense is a single-payer universal health system administered by the federal government, a sort of Medicare for everyone. The argument that the government cannot be trusted to efficiently administer such a plan is ludicrous. The government already effectively runs Social Security and Medicare. Other large governments, for example Canada and Great Britain, administer universal health care programs, and do so quite efficiently.

Frankly, I’ll trust the government before I’ll trust a private entity that’s driven by greed.

Equally ludicrous is the argument that a single-payer government-run system will lead to rationing, an argument often repeated by President Bush. I’ve got news for the president: we already have rationing, and being denied health care because of an inability to pay for it is the most insidious form of rationing.

Those of us who have health insurance have no reason to be complacent on this issue. Skyrocketing premiums are forcing employers to consider dropping their coverage for employees entirely or making employees take on an ever greater share of premium costs. Larger deductibles and ruthless HMOs mean that health insurance is increasingly just a hedge against bankruptcy. It doesn’t take a catastrophic illness anymore to cause a family to be thousands of dollars out of pocket, even though they have health insurance.

It isn’t difficult to figure out why our political leaders are so reluctant to try to solve our health care crisis. Look what happened to Hillary Clinton when she tried to run point on some relatively modest reforms in 1992. The health care and pharmaceutical industries spent millions in a campaign to frighten the public into accepting the status quo, and it worked. And they’ll do it again. These industries are some of the biggest donors to the campaign coffers of our politicians and expect support in return. It will take a president of enormous courage and resolve to tackle this problem, but the problem must be tackled.

In Europe, even in Cuba, access to quality health care is considered a basic right of every citizen, not a privilege of the fortunate who work for good companies or are wealthy enough to buy insurance. It should be so in the USA. No American family should have to use the local ER for their family doctor. No American should be denied medical treatment because of an inability to pay for it. No American should have to choose between filling a needed prescription and paying utility bills.

I lived in Britain for some years and am familiar with their National Health Service. Are there problems with their version of “socialized medicine?” Yes. Waiting rooms can be crowded. Doctors and nurses are often overworked and feel underpaid.

There can be waiting periods for non-emergency procedures. But no one in Britain is worried that a catastrophic illness is going to drive their family into bankruptcy. No one ever worries about being denied medical attention or being unable to fill a prescription.

There are few issues that are literally a matter of life and death. The status quo on health care in this country is beyond unacceptable, and we need to make this clear to our presidential candidates and congressmen. It’s sad to think that the nearly $2 trillion wasted in Iraq could have provided the basis for universal health care here in America. We need to get angry and proactive on this issue.

— Ray Clasen lives in North Fort Myers.

Private Finance Initiative Costs British NHS Billions

This great free-market experiment is more like a corporate welfare scheme

A hospital in Coventry lays bare the deceit of neoliberal logic: staff cuts, ward closures and millions to the financiers

George Monbiot
The Guardian
Tuesday September 4, 2007

After my column last week, several people wrote to point out that the neoliberal project – which demands a minimal state and maximum corporate freedom – actually relies on constant government support. They are, of course, quite right. The current financial crisis, caused by a failure to regulate financial services properly, is being postponed by government bail-outs. The US federal reserve has reduced its lending rate to the commercial banks, while the Bundesbank organised a €3.5bn rescue of the lending company IKB. This happens whenever the banks suffer the consequences of the freedom they demand. But over the past week an even starker example has emerged.

In Britain the split loyalties of the major political parties have created a hybrid system of public provision. If it left public services intact, the party in power would be roasted by the corporate media, but if it attempted full-scale privatisation, it would be booted out of office. So the last Conservative government devised a plan that would keep both sides if not exactly happy, then at least totally bewildered. They called it the private finance initiative, or PFI. Corporations would build and run our schools, hospitals, roads and prisons, and rent them to the state. This, the Tories maintained, would enable costs to be cut, while ensuring that public services remained free of charge.

At first Labour opposed this scheme. Alistair Darling warned in opposition that “apparent savings now could be countered by the formidable commitment on revenue expenditure in years to come”. But as the 1997 election approached, Labour sought to prove that it was more sympathetic to business than the Tories were. Two months after the party took office, the health secretary, Alan Milburn, announced that “when there is a limited amount of public-sector capital available, as there is, it’s PFI or bust”. From then on, the only money the NHS could rely on for capital projects belonged to the private sector.

The problem was that much of what the NHS wanted to do was not attractive to private financiers. In Coventry, for example, it had been planning to refurbish its two hospitals at a cost of £30m. But its analysts realised that business would not be interested. The scheme was too small, and there was no scope for the financial innovation that could produce serious profits. As a confidential report by the local health authority showed in 1998, the health service redesigned its scheme to make it more attractive to private capital. Instead of refurbishing the two existing hospitals, it would ask private business to knock them down and build a new one – the University hospital. This would cost not £30m but £174m. The health experts who wrote the confidential report predicted that in order to find this money, the hospital trust would have to cut both beds and services. They have just been proved right.

Did I say £174m? I beg your pardon. By January 2002 the price had risen to £290m. A month later it reached £311m. By the end of that year it had grown to £330m. In 2003 it was estimated at £370m. In March 2007, the Birmingham Post reported that the final cost was £410m. This year the hospital trust must find £56m, covering repayments and service fees, to hand to the private consortium. The annual cost will rise in line with the retail price index for 30 years.

It is now pretty obvious that this fee is unpayable, if the hospital is to maintain a proper standard of care. Over the past few days the hospital trust has announced a £30m hole in its budget. Around £10m of the necessary cuts could be found by making staff redundant: it will lose perhaps 200 people, possibly 375. It will also rely on “revenue generating activities”. These include charging people £3 for dropping their sick relatives outside the hospital, and £10 for parking there, while cancelling the free parking scheme for disabled people. As the new hospital is on the edge of the city (against the wishes of 160,000 people who signed the Socialist party’s petition to have it built in the centre), which means that it is hard to reach without a car, this is an effective way of raising money. But it casts doubt on the government’s claim that the NHS remains free at the point of use.

The hospital trust’s press officer told me that this cost-cutting is a unique event: “We have always balanced our books up to this year.” But in 2005 – the year in which the PFI payments began – a leaked memo revealed that the trust was anticipating a deficit of £13m by the end of the financial year, and “drastic measures” were required to plug the gap. These included the closure of one ward, the removal of eight beds from another, limiting the opening hours of the surgical assessment unit and the “rationalisation of certain posts”: which meant, eventually, cutting 116 jobs.

In 2006 the local newspaper reported a shortfall of £29m. This was met partly by freezing the recruitment of district nurses. In January this year, the hospital announced that it was closing another ward, just six months after it had opened. Yet another ward – where people with acute conditions such as pneumonia and strokes were treated – was closed in June. The impact of these cuts is already being felt: three months ago the new hospital found itself in the bottom 10 in the national league table for waiting times. Where will the money come from over the rest of the 30-year PFI contract?

There is one set of costs the hospital cannot cut: the money it must pay every year to the private financiers. In September 1997 the government declared that these payments would be legally guaranteed: beds, doctors, nurses and managers could be sacrificed, but not the annual donation to the Fat Cats Protection League. The great free market experiment looks more like a corporate welfare scheme.

The government justifies all this by claiming that privately financed schemes are cheaper than comparable public schemes. Allyson Pollock showed on these pages in April that the data required to support this claim does not exist, or if it does the government refuses to release it. But as the Coventry scheme shows, there’s an even bigger deception at work. The government compares the cost of building the hospital under PFI with the imagined cost of building it with public money. But it would not have been built with public money. If public funds had been available, the two existing hospitals would have been refurbished, at around one 13th of the cost.

It was Gordon Brown who insisted that PFI became the principal means of funding capital projects in the United Kingdom. By deferring costs into the future, as Darling warned, he was able to sustain his reputation as an iron chancellor, while suppressing the constant baying of the corporate press. The BBC predicted that in his speech yesterday Brown would announce a reduction in the corporation’s involvement in the public sector. It was about the only subject he did not discuss. For all his talk of “listening and engaging”, corporate power still seems to be forbidden territory.