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How to Write an Op-Ed and Letter to the Editor

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How to Write an Op-Ed and Letter to the Editor

Guide to Editorial Placement

Most newspapers feature an “Op-Ed” and “Letters to the Editor” section in which readers and public figures can express viewpoints and/or respond to particular news events. An Op-Ed is generally a short (600 – 750 words) article expressing an opinion or viewpoint on a timely news topic. A letter to the editor is a very short (150 – 200 words) response to an article that recently appeared in the publication.

The Op-Ed and Letters to the Editor sections are among the most widely read sections of the newspaper. Publication of an op-ed or letter will assure your views will reach many people.

Op-Eds

The following pointers will help you get your op-ed piece published:

* Find a timely news hook. Editors need a reason why your viewpoint should be given attention right now. The release of a significant study by PNHP or some other source, annual events (such as new health spending figures or the yearly release of the number of uninsured), or responses to recently published articles are all good reasons.

* Know the word limit. Newspapers have limited space, and editors don’t have the time to cut your piece down to size. In general, 600 to 750 words will do, but check the paper’s online opinion page to find out its submission guidelines. A fairly up-to-date list of such guidelines (for the top 100 papers in the country) can be found at bit.ly/cacVBi, a valuable but slow-loading page from The Op-Ed Project (www.theopedproject.org).

* Make a single point. You only have 600 to 750 words. Make one point clearly and persuasively.

* Use short paragraphs. Make sure there’s a space between each paragraph. Avoid complex sentences.

* Avoid jargon. Simple language ensures that all readers, even non-experts, can understand your point. For example, don’t use acronyms or “policy wonk” language.

* “Humanize” your article. Illustrations, anecdotes and personal stories help explain and bring complicated issues to life. Think about your personal experiences as a physician in the community or as a physician-in-training and how a single-payer system would improve things.

* Make a specific recommendation. This is an opinion piece. State your opinion on how to improve matters.

* Draw the reader in, but get to the point. Your first paragraph should draw the reader in by using a dramatic vignette or a well-stated argument. If you choose to open with an anecdote or other device, make sure you quickly get to the point.

* End with a bang. Your final paragraph is as important as your opening paragraph. Be sure to summarize your argument in one strong final paragraph.

* Provide your contact information. List your name, address, phone, fax and e-mail contact information at the bottom of the piece.

* Submit your op-ed via e-mail, as a rule. Copy and paste the text of your op-ed into the body of an e-mail message. Don’t send it as an attachment. Instructions for submitting an op-ed are usually on the opinion page of the paper’s website. Most papers like them e-mailed. For detailed instructions, see bit.ly/cacVBi.

* Follow up. Most op-ed editors will respond to you within a week. If you haven’t heard back from them by then or if your piece is particularly time-sensitive, you can follow up with an e-mail message or phone call to ask if it was received and ask about its status.

Letters to the Editor

These tips will help:

* Make one clear argument. The piece should be in favor of or critical of a particular position taken by the paper or described in an article.

* Be specific. The letter should focus on a specific issue that was raised in an article or opinion piece.

* Cite the article. Be sure to mention the title and date of the article you’re responding to in one of your first two sentences. For example “Dear editor, Your recent coverage of the issue of the uninsured (“Health care in America,” May 11, 2012) was a thoughtful piece…”

* Be brief. Generally, 150 to 200 words in three to four paragraphs are ideal. If you can’t contain the letter to that length, consider asking someone to help you edit it or write a 700-word op-ed instead.

* Follow up. If you have sent your letter to the editor and haven’t heard anything within a week, feel free to send a note or make a follow-up call to check on its status. Be aware that editors receive hundreds of letters and may not respond to you immediately, if at all.

You must include your name, address and daytime phone number in your letter. Instructions for submitting a letter to the editor are usually at the bottom of the page where they appear or on the paper’s website. Find out from your local paper the best way to send a letter. Most prefer e-mail. A handy summary of the submission guidelines of the country’s top 100 papers can be found at bit.ly/cacVBi.

Click here for a printable handout version (pdf)

Another view: SB 840 will cure state's struggles with health care

By Sheila Kuehl — Special to The Bee
Published 12:01 am PDT Sunday, August 20, 2006

I couldn’t agree more with the editorial that health care reform must start on the common ground that our current system is failing everyone involved.

However, the increasing costs of health insurance premiums are bankrupting our state, our businesses and working families. One in five Californians has no health insurance today, and increasing numbers of businesses are planning to drop their health insurance by next year.

Nibbling around the edges with incremental change is not enough. We need courageous and thoughtful reform that provides what all Californians want — affordable access to good-quality health care. This is what SB 840 achieves.

The current health care system and attempts at “reform” fail because they simply bicker about who is going to pay instead of addressing the underlying reasons for out-of-control health care costs. The Sacramento Bee highlights the approach taken in Massachusetts, which, if applied in California, would legally require everyone to purchase private health insurance policies and pay endlessly increasing premiums into the current system that is completely broken. Proponents of the model in Massachusetts even say the reform is not workable in California.

We are spending $186 billion a year on health care right now. With caps on administrative overhead, these monies are more than enough to provide every California resident with excellent health care. We don’t need to spend more on health care; we need to stop wasting our health care dollars on insurance company administration.

Insurance companies do not improve the quality of health care we receive, and they do not provide choices. Instead, insurance companies limit the choices we have. They oppose legislation extending coverage to lifesaving health screenings for infants, hearing aids for children and effective Alzheimer’s medications. Instead of providing simple, straightforward health care coverage, they waste billions of dollars on complicated insurance schemes designed to screen out patients who need health care and to reduce payments to doctors.

Universal health care is the best answer, and it is possible now. SB 840 works by pooling our health care resources so that everyone — state and federal government, income earners and employers — all pay in, and Californians all get quality coverage. SB 840 reduces costs and guarantees your right to choose your own doctor. It saves businesses money and is affordable for families.

Polls show that a majority of Californians support universal health care — there is no more common ground than that.

About the writer: Sen. Sheila Kuehl, D-Santa Monica, is responding to The Bee’s Aug. 13 editorial “Health reform must start on common ground.” She can be reached at senator.kuehl@sen.ca.gov

Groups Form Coalition Focused on "Healthcare Crisis"

Carole Mikita Reporting
August 22nd, 2006 @ 3:34pm

Six community groups formed a coalition to bring awareness to what they call the healthcare crisis. The coalition called this event ‘CHALK IT UP’; the chalk outlines of bodies are still on the sidewalk, each one representing a Utahn.

Dozens of people stopped at Washington Square, 400 S. State St., during their lunch hours to be ‘chalked.’

Tess Bonham, Age 10: “Because people don’t have health insurance.”

Their outlines represent individuals without health insurance who will die.

Fred Gurney, age 11: “I think people should have health care because it’s not really good to die.”

Groups gathered in downtown Salt Lake today say that’s exactly what will happen in the next twelve months. By the end of the afternoon, this coalition of groups hopes to have 132 chalk outlined bodies.

Linda Parsons, Utah Jobs with Justice: “It’s probably a lot more than that. Statistics will show that, and we hope it will bring some attention to our politicians about health care and our crisis.”

Politicians and candidates did show up… using the event to promote their platforms.

Pete Ashdown, (D) U.S. Senate candidate: “This is becoming an economic issue in America. It’s not just small businesses that are suffering, big businsses like Delta and GM. We need some imagination by our federal government to deal with this problem.”

Bob Brister, Utah Green Party candidate for 2nd District: “Every other industrialized country in the world doesn’t let their citizens go without healthcare.”

Scott McCoy, (D) State Senator: “We have almost 300-thousand in the state of Utah, 70-odd-thousand of those are children. And so it should be a priority for the legislature.”

Each group believes the United States needs a national health insurance system that covers everyone.

Barbara Toomer, The Disabled Rights Action Committee: “We joined the coalition, mainly because we have healthcare problems also. And healthcare is extremely important to a person with a disability.”

The coalition members all support a bill H.R. 676, the United States National Health Insurance Act, a publicly financed, privately delivered health care program that uses already existing Medicare.

What will happen to me if I get sick or injured and can't pay my bills?

Katrina vanden Heuvel
BLOG | Posted 08/22/2006 @ 11:13am

On the domestic front, that’s a key question on voters’ minds as the November elections approach. A poll of working women, released on August 8 by the AFL-CIO, indicated that concern about access to quality medical coverage was rated the top issue by 97 percent of respondents, outpolling the income gap between women and men for the first time. MoveOn members, asked to vote on issues that they believe should define a “new positive agenda” ranked healthcare for all persons at the top of the list.

In California, one of the country’s largest states and a decisive election-year battleground, the growing momentum behind healthcare reform is pushing two sharply different approaches into public view.

The first, a proposal for universal healthcare coverage, is presented in Senate Bill 840, authored by Southern California’s State Senator Sheila Kuehl (D-23). SB 840 would provide universal, comprehensive healthcare insurance to Californians while protecting consumers’
ability to choose their own doctors. Under the SB 840 model, consumers and businesses would pay an income or payroll-based premium for a “solid, comprehensive plan” that includes medical, dental, vision, prescription drug, hospitalization and emergency coverage. Medical care provision would remain as the mix of private and not-for-profit business that it is now. SB 840 would also mandate that California use its purchasing power to negotiate bulk rates for prescription drugs and medical equipment. (The administrative costs for medical care in California would drop below 5 percent of total costs, compared to the whopping 25 to 30 percent currently being spent.)

On the other side, on June 16, Sandra Shewry, Governor Schwarzenegger’s Director of the Department of Health Services hosted a meeting of journalists to discuss the possibility of “Massachusetts-style health reform” in California. As it turned out, uninvited healthcare experts and advocates showed up, as well, to deliver an early warning: Massachusetts’ so-called universal healthcare plan is already bad news for the people of Massachusetts and would be a disaster for California.

The heart of the Massachusetts plan is this: every resident of Massachusetts must have health insurance by July 1, 2007 or pay a fine–but costs of health insurance and medical care itself are not controlled, nor are there adequate standards for what health insurance is supposed to cover. Big insurance wins; consumers lose.

The Massachusetts plan offers subsidies for the very poor–as it should, and allows those who can afford it to buy insurance pre-tax–but this plan squeezes middle class people who don’t qualify for subsidies and can’t afford to buy insurance pre-tax. The plan subsidizes people who earn up to 300 percent of the poverty level. But a typical group policy in Massachusetts costs about $4,500 annually for an individual and more than $11,000 for family coverage. Many families and business would be forced to choose between complying with the law and other vital necessities. Young and healthy people might be able to buy low premium plans, but even these are now typically considered affordable only to people whose income is greater than 499 percent of the poverty level. Furthermore, such high-deductible, low-coverage plans often don’t offer even adequate coverage.

The sort of plans available to middle-class consumers– those with deductibles that run into the thousands of dollars–mean that most consumers would wind up footing the bill for most of their own yearly healthcare in addition to the premiums that such a law would force them to pay. If such consumers found themselves truly needing extensive coverage–if they get hit by a car or contract a serious illness–they may find out that their cut-rate plan will leave them in terrible financial trouble. (About half of all bankruptcies sustained in the United States today are the result of medical expenses incurred by people who had health insurance they thought they could trust). Middle class consumers will not be able to choose the doctors they most trust but will be forced to decide among the doctors whose services are covered by the plan they can afford.

The sad joke is that plans like this are being marketed as “consumer driven.” Healthcare consumers (that is to say, everybody) please take note: any so-called ‘consumer-driven’ health plan is really an anti-consumer hit and run. California State Senator Sheila Kuehl is offering a real alternative. Her bold legislative initiative would bring truly affordable healthcare to all.

SB 840 has already been passed by the California State Senate and the Assembly Appropriations Committee. It will likely be up for a floor vote by the Assembly later this week or next Monday. Ask your California friends to support this bill–and to contact their Assembly representatives to vote “yes’ on SB 840. And urge your own state legislators to put forth similarly bold proposals.

Sample Medical Society Resolution

Resolution Introduced in the New York American College of Physicians

WHEREAS, The American College of Physicians has a long-standing commitment to making affordable health insurance coverage available to all Americans, and

WHEREAS, in October, 2000, the Board of Regents approved the ‘Core Principles On Access’ that includes an explicit goal for all Americans to be covered by an adequate health insurance plan, a goal that remains unfulfilled, and

WHEREAS 46 million Americans lack health insurance, and another 16 million more have inadequate insurance to meet their health needs, and the Institute of Medicine stated in 2004 that lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States, and

WHEREAS a lack of adequate insurance prevents many of our patients from obtaining the care they need in a timely fashion, from getting the tests required for diagnosing numerous illnesses, including cancer, and from taking their physician-prescribed medications for treating chronic illnesses such as diabetes and asthma, and obtaining preventive care, and

WHEREAS illness and medical bills contribute to 50 percent of all U.S. bankruptcies, affecting more than 2 million Americans annually, and

WHEREAS existing, skimpy insurance policies are inadequate to protect against financial ruin: 75 percent of those bankrupted by medical bills were insured at the onset of their bankrupting illness, and

WHEREAS, the United States spends twice the amount per capita on health care as industrialized nations which provide comprehensive coverage to all citizens, and

WHEREAS one-third (31 percent) of health spending is consumed by unnecessary, wasteful administrative bureaucracy, and

WHEREAS wasteful paperwork and bureaucracy severely compromises physicians’ ability to practice medicine, and

WHEREAS the Institute of Medicine identified universal health care coverage as the first principle for ensuring the health of all Americans and called on the federal government to reach this goal by 2010, and

WHEREAS, the “advanced medical home” advocated by the American College of Physicians cannot succeed in a system dominated by private insurance companies, and

WHEREAS on July 30, 1965 Congress passed the first Medicare bill, despite numerous warnings about the ‘dangers of socialized medicine’, and opposition by the AMA, and, Medicare has become one of the most popular and successful Federal programs ensuring access to healthcare and dignity for this country’s senior citizens, now therefore

BE IT RESOLVED that the Board of Governors of the New York chapter of the American College of Physicians expresses its support for universal access to comprehensive, affordable, high-quality health care through a single-payer financing mechanism, i.e., for an expanded Medicare for All in New York State and in the nation.

Letter to the Editor Examples

Letters to the Editor by PNHP Members

April 26, 2006

To the Editor:

Lori Rackl’s story on uninsured cancer patients (“Uninsured Survivors Pay With Their Lives,” 4/26/06) is yet another powerful indictment of our broken healthcare system and a reminder of the need for a Single-Payer healthcare system in Illinois.

As a family physician who has worked in Chicago’s inner city for close to ten years, I have, unfortunately, seen many examples where patient’s health has deteriorated due to their inability to access healthcare. As a resident on the West Side of Chicago working on the inpatient ward, I took care of a beautiful African-American woman named Evelyn who had no health insurance, but a mounting health concern. One year prior, she had visited a primary care doctor to inquire why an ulcer on her breast would not heal. By the time she had decided to scale the financial barrier of seeing this doctor, the ulcerating sore, which was pathologically shown to be infiltrating ductal carcinoma, had long before migrated from her breast and seeded itself in the soft tissue or her abdomen and neck. Evelyn had metastatic breast cancer. She died five days later, before our hospital was even able to print her bill.

At Cook County Hospital, where I refer all of my uninsured patients, the wait to get a diagnostic colonoscopy can be as long as 18 months. Invasive carcinoma of the colon does not wait 18 months to progress and kill our patients. Long waits for cancer care persist at public hospitals because our profit-driven healthcare system leaves sick patients behind. A Single-Payer system, by contrast, would allow these patients to receive care elsewhere, thus saving lives!

A Single-Payer system would give everyone in this country all necessary healthcare coverage for his or her entire life. In a system like this we would take care of the patients that Lori Rackl wrote about, but most importantly, we would show them the dignity they deserve.

Sincerely,

Robert C. McKersie, MD
Family Physician
Author of In the Foothills of Medicine, A Young Doctor’s Journey from the Inner City of Chicago to the Mountains of Nepal.

Contacting the Media

PNHP issues press releases for media campaigns roughly six times per year. During these campaigns, activists are encouraged to contact their local media to inform them of the development in question and encourage them to cover it in a story.

PNHP Press Release Mailing List PNHP distributes press releases via our main mailing lists. PNHP members are automatically subscribed to this list. (be sure to add the addresses info@pnhp.org to your “safe senders” list so our messages will not be put in your spam box.) Non-members can subscribe to the mailing list by visiting the website at www.pnhp.org

Which Media to Contact A PNHP media campaign is an ideal way to begin building a press list. Once you get a PNHP press release, think about where you get your news from: the newspapers and journals you read, the radio news or talk stations you listen to, and the broadcast news or public television programs you watch. Make a list of media sources you think would be interested in the topic. If you need more ideas, the PNHP staff maintains a list of media contacts and can help with ideas. Contact the office at 312-782-6006 or info@pnhp.org

How to Get Media Contact Information It can sometimes be difficult to find contact information for your local media. Most of the time, a Google search will find you the best way to contact the outlet in question. For newspapers, Google the name of the publication. For television and radio stations, it is usually easier if you have the call letters of the station (WFLD, for instance), but you can also search the name of the broadcast station, channel or city. (ABC 7 Chicago, for example.) Once you have found the website for the station or publication, there will usually be a link to contact information somewhere on the page. Usually these links are at the very top or bottom of the page, or in a menu bar. The links commonly say “Contact Us” or “About.” If you are still having trouble finding contact information for the publication or station in question, contact the PNHP office at 312-782-6006 or info@pnhp.org.

Making a Press Call “Pitch calls” can be intimidating but are actually quite easy. The trick is to be able to quickly convey the important points of the story in a few opening sentences. As you think about what to say on your call, use the PNHP press release as a guide. (Keep it by you when you make your press call, it can help you remember the story if you get lost, and can provide quick facts if the reporter asks for them). The most important facts are at the top, the least important at the bottom. Your opening “pitch” should look a lot like the first two or three sentences of the press release. Here is an example from the attached sample press release:

“A new study in the American Journal of Public Health has found that Canadians are healthier than Americans, and also have better access to care. Even though the U.S. spends twice as much on care, we have higher rates of nearly every chronic disease and are more likely to go without needed care or medicine.”

If you need more help or clarification, contact the PNHP office. Once you know what you’re going to say, write it down. Keep this “script” next to you along with the press release when you make your calls.

How to Find the Right Person to Talk To Even if you’ve gotten contact information for your local paper or NPR station, you may not know the right person to talk to. Some websites will have directory of staff people with personal numbers or extensions. All media outlets are different, but here are some general rules to help you identify the appropriate person to contact: * Newspapers: Some newspapers staff a health reporter, but many don’t. Even in those that don’t have a formal health person, usually there is someone in the office who is assigned to take health stories. Look for the Assignment Editor or the News Desk Editor; they should be able to tell you who it is. * Television or Radio Broadcast: Larger news stations will have individual reporters, but medium and smaller ones may not. Look for the News Director. * Television or Radio Programs: TV and Radio programs have producers who make decisions about what to cover and who to book (for local programs many times the host is the producer). Look for this person. If you don’t have a staff directory or can’t find the appropriate person:

  1. Call the main number on the website or provided by the PNHP office.
  2. Ask the person who answers the phone for the newsroom (for newspapers and broadcast news / television) or the producer of the program in question.
  3. Once you get the newsroom, ask for the person who covers health stories. They should be able to direct you to someone.

Making the Pitch Once you know you’re talking to the right person, its time to make your pitch. Tell them right of the bat that you’ve got a story for them. Also be sure to let them know that you are a physician in the community. Use your script and press release to guide you. Always offer to send the press release for more information. Here’s the idea: REPORTER: Hello, John Smith. YOU: Hi, this is Dr. Jones from Community Hospital. I have a story I think you may be interested in. REPORTER: Sure. What have you got? YOU: There’s a new study in the American Journal of Public Health that’s found Canadians are healthier than Americans and also have better access to care. Even though the U.S. spends twice as much on care, we have higher rates of nearly every chronic disease and are more likely to go without needed care or medicine. REPORTER: Interesting. This is out today? YOU: No, it is embargoed until the 30th. I can send you the press release and materials if you’d like. REPORTER: Sounds great. My e-mail is reporter@newspaper.com PNHP press releases are both e-mailed to members and posted on the PNHP website. When you send an e-mail to a reporter, it is usually best to send the text of the press release in the body of the message rather than as an electronic attachment.

Following-Up If you’re lucky, your reporter may write a story. Lots of mid-size and local news outlets get their national news from the Associated Press, but a call from a local physician can sometimes make the difference in getting a story noticed when it comes off the wire. If you did get a story, it’s not a bad idea to follow-up with the reporter. If she did a good job covering it, thank her. If there’s something she missed or misinterpreted, gently let her know about it. Most of all, take the opportunity to invite further contact. Let the reporter know you are a physician in the community and are available to talk about the health system and health policy. You may even find yourself called for comment on other stories. Finally, if you have a good contact with a reporter, let the PNHP office know about it at 312-782-6006 or info@pnhp.org.

Salinas throws support behind universal health care

By GEORGE B. SÁNCHEZ
Herald Salinas Bureau

The Salinas City Council this week endorsed a state Senate bill to provide universal health care for California residents.

The council voted 6-0 to support the California Health Insurance Reliability Act, which calls for the creation of a state health insurance agency that would be overseen by an elected commissioner. Councilwoman Janet Barnes abstained from the vote.

If the bill is enacted, the commissioner would be appointed by the governor and confirmed by the state Senate.

The resolution of support was brought to the council by the Salinas Action League, a local activist group, and introduced by Councilman Sergio Sanchez.

“One in five people in California do not have health insurance,” said Salinas Action League member Dr. Carolee Bull. “In a few years, it will be one in four.”

Bull said federal, state and local money already spent on health care, along with low premium rates by employees and employers, would go into a state fund proposed by Sheila James Kuehl, D-Los Angeles.

The cities of Berkeley, Santa Cruz and Watsonville, as well as Alameda, Marin and Los Angeles counties, have also passed resolutions in support of the bill.

“We need universal health care in this county,” said Councilwoman Gloria de la Rosa.

“Health care is like housing,” said Councilman Maria Giuriato, a social services worker. “It’s the foundation and infrastructure to leverage health and hold a good job.”

Giuriato asked the Salinas Action League to seek support for the bill from the Monterey County Board of Supervisors as well as other cities in Monterey County.

Carole Erickson, director of Student Health Services at Monterey Peninsula College, told the board about a Salinas student who had to be hospitalized for scabies, a skin-burrowing mite. If the student had access to preventive health care, Erickson said, the infection could have been properly diagnosed and treated.

Access to preventive health care is more cost effective than hospitalization, she said.

“If it’s cheaper to treat up front, then what are we doing?” said Erickson.

Jeff Richman, a school nurse who works in Salinas and the Pajaro Valley, said it is common to find students who need vision, dental and mental health care but have no access to a doctor other than the school nurse.

The proposed bill, he said, would help them.

George B. Sánchez can be reached at 753-6771 or gesánchez@montereyherald.com.

MedPAC on the increase in volume of physician services

Statement of Mark E. Miller, Ph.D., Executive Director, Medicare Payment Advisory Commission
U.S. House of Representatives
Subcommittee on Health, Committee on Energy and Commerce July 25, 2006 Medicare payment to physicians

Medicare expenditures for physician services are growing rapidly. In 2005 spending on physician services increased 8.5 percent, while the number of beneficiaries in FFS Medicare increased only 0.3 percent. To get good value for the Medicare program, the payment system should set the relative prices for services accurately. Providing incentives to control unnecessary growth in volume and intensity would be desirable, but it is much more difficult.

Measuring physician resource use

For Medicare beneficiaries living in regions of the country where physicians and hospitals deliver many more health care services there is no clear relationship with better quality of care or outcomes. Moreover, they do not report greater satisfaction with care than beneficiaries living in other regions. This finding, and others by researchers such as Wennberg and Fisher, are provocative. They suggest that the nation could spend less on health care, without sacrificing quality, if physicians whose practice styles are more resource intensive moderated the intensity of their practice.

MedPAC recommends that Medicare measure physicians’ resource use over time, and feed back the results to physicians. Physicians could then start to assess their practice styles, and evaluate whether they tend to use more resources than their peers. Moreover, when physicians are able to use this information with information on their quality of care, it will provide a foundation for them to improve the efficiency of the care they and others provide to beneficiaries. Once greater experience and confidence in this information is gained, Medicare might begin to use the results in payment, for example as a component of a pay-for-performance program.

Creating new incentives in the physician payment system

MedPAC has consistently raised concerns about the SGR as a volume control mechanism and recommended its elimination. We believe that the other changes discussed previously-pay for performance, encouraging use of IT, measuring resource use, setting quality standards for imaging services, and improving payment accuracy-can help Medicare beneficiaries receive high-quality, appropriate services and help improve the value of the program. Although the Commission’s preference is to directly target policy solutions to the source of inappropriate volume increases, we recognize that the Congress may wish to retain some budget mechanism linked to volume. An ideal volume control mechanism would overcome the incentive under fee-for-service to increase volume and instead create incentives for physicians to practice in ways that improve care coordination and quality while prudently husbanding Medicare resources. The Congress has tasked the Commission to evaluate several alternative volume control mechanisms including differing levels of application such as group practice, hospital medical staff, type of service, geographic areas, and outliers. We will report on these alternatives in March 2007.

http://www.medpac.gov/publications/congressional_testimony/072506_Testimony_physician.pdf?CFID=2415800&CFTOKEN=28943302

Comment:

By Don McCanne, MD

One of the most important features of a well-functioning national health insurance program is that it can use budgets to slow the growth in health care costs to a level closer to the growth in GDP. But what a nightmare that creates.

In a predominantly fee-for-service system, physicians respond to a slowing of rate increases by increasing the frequency and intensity of services provided (volume of services). To maintain a growth rate near that of the GDP, the rate per unit of service must be decreased to offset the increases in the number of units of services provided. This is the flaw in MedPAC’s SGR formula (sustainable growth rate). Medicare’s fee per unit of service must be reduced to slow the growth rate to a “sustainable” level.

What has been the source of the volume increase? Part of it has been that patients are brought back for return visits more frequently, and the levels of services have been increased from basic to moderate complexity. Another very important component has been the increased utilization of high-tech services, especially medical imaging. The explosion of spending in imaging has pulled a significant amount of funds away from physicians, especially family physicians and general internists just at a time that we are trying to reinforce the primary care infrastructure.

Virtually everyone agrees that the current rate of growth is not sustainable indefinitely. Costs will not be controlled without controlling volume. How do you do that? One possibility presented in this testimony is to identify the non-beneficial excesses and then educate physicians who, in response, would likely modify their practice patterns. This can be effective as has been demonstrated by the decline in the use of antibiotics in childhood viral respiratory infections once physicians were convinced that they were of no value. That approach will help, but it alone likely will not be sufficient. New innovations will continue to present new challenges.

MedPAC is currently evaluating several volume control mechanisms and will report their findings to Congress in March, 2007. Volume will be controlled, but how will they do that, and can we live with it? This is a process that requires intensive citizen oversight by the policy community. Heads up!

Affordability concerns are moving up the income ladder

The Commonwealth Fund Commission on a High Performance Health System August 2006 Public Views on Shaping the Future of the U.S. Health System
By Cathy Schoen, Sabrina K. H. How, Ilana Weinbaum, John E. Craig, Jr., and Karen Davis
The Commonwealth Fund

Abstract:

On behalf of The Commonwealth Fund Commission on a High Performance Health System, Harris Interactive surveyed U.S. adults to determine the public’s perspectives on ways to improve patient care and on health policy priorities facing the President and Congress. Overall, the representative sample of 1,023 adults ages 18 and older revealed strong public support for efforts to improve care coordination and access to information. There is a shared belief that expanded use of information technology, care teams, and improved delivery of preventive services could improve the quality of care. Patients reported recent experiences of wasteful, inefficient, or unsafe care. In addition, half of middle-income and lower-income families reported serious problems paying for care and insurance coverage. Three-quarters of all adults said the U.S. health care system needs either fundamental change or complete rebuilding. Expanding insurance and controlling costs, they said, should be top priorities for federal action.

Affordability concerns are moving up the income ladder

Half of middle-income ($35,000-$49,999 annually) and lower-income (less than $35,000 annually) families said they have had serious problems paying for care in the past two years. With the median U.S. household income at $44,000, the findings indicate that more than half of all households are experiencing stress when paying for medical care.

A similarly high proportion of middle- and lower-income adults reported difficulties paying for health insurance.

Affordability is a now a concern at even higher-income levels. One-third of adults with annual incomes between $50,000 and $74,999 reported serious problems in paying for care.

Shared Views, Values and Concerns

Across income groups and regions of the country, there was resounding agreement that ensuring reliable health insurance and controlling rising costs are the most pressing health policy issues for the President and Congress to tackle. The majority consistently ranked coverage and costs as their top two priorities.

http://www.cmwf.org/publications/publications_show.htm?doc_id=394606

Comment:

By Don McCanne, MD

This report is highly credible (Harris Interactive) and is current (survey conducted June, 2006). It confirms many other reports about pubic views on the U.S. health care system.

From the perspective of reforming health care financing in the United States, the most important finding in this report is that the concerns about affordability of health insurance and health care have moved up the income ladder. The concerns of average-income families are now as great as lower-income families (more than half!), and now even higher-income families are concerned (one-third!).

The other issues addressed are very important, especially the need for a medical home. But they will be very difficult to address until we fix the financing of health care by providing comprehensive coverage for everyone.

U.S. capacity for mammograms adequate, but…

United States Government Accountability Office (GAO) July 2006 Mammography Current Nationwide Capacity Is Adequate, but Access Problems May Exist in Certain Locations

Closures of certified mammography facilities outpaced openings during a recent 3-year period, and financial considerations were most often cited as the reason for facility closures.

Although key elements that make up mammography capacity have decreased and the use of screening mammography has grown, current nationwide capacity is adequate.

The loss or absence of machines in certain locations may have resulted in access problems, including problems for women who are medically underserved, such as those who have a low income or lack health insurance.

http://www.gao.gov/highlights/d06724high.pdf

Comment:

By Don McCanne, MD

So the United States has the capacity to provide every women with appropriate mammography screening, except for those who have low income or lack health insurance.

How much longer are we going to sit back and just talk about this. Have we no decency?

Aetna's "Vital Savings on Health"

Aetna to offer discount cards, starting in Denver, New Jersey The insurer’s move is part of a trend in which big health plans are looking for new ways to serve small employers.
By Jonathan G. Bethely
American Medical News
Aug. 14, 2006

Vital Savings on Health would allow companies to offer their employees prepaid cards good for 10% to 50% discounts off the cost of routine health expenses, when payment is made at the point of service. The company said the discount represents the range of discounts under Aetna’s PPO plans, and that physicians would not be expected to provide additional discounts. Physicians would call a toll-free number or check a Web site to determine the rates for various services.

Christine Skelly, Aetna’s vice president of health-related financial solutions, said Aetna will target employers who want to offer their employees some medical coverage, but just can’t afford a traditional insurance plan. Money will be deposited into the debit card via contributions from employers and/or employees.

Aetna will require its member physicians to opt out of the program if they don’t want to participate. Without that notice, they’re in.

http://www.ama-assn.org/amednews/2006/08/14/bisc0814.htm

Aetna’s release on Vital Savings on Health:
http://www.aetna.com/news/2006/pr_20060712.htm

Comment:

By Don McCanne, M.D.

So Aetna’s “Vital Savings on Health” program is the next best thing to insurance: a card ensuring that patients will receive the same discount that Aetna receives from its PPO contracted physicians. This program should appeal especially to small businesses since the cost is lower than PPO plans which small businesses are finding to be less and less affordable each year.

The most important difference from a PPO plan is that the contracted rate for services is paid from the patient’s own debit card account rather than from a risk pool maintained by Aetna. Aetna bears absolutely no risk in this program. Patients will have the same choices of physicians as in Aetna’s PPO plans since physician enrollment is automatic, unless the physician initiates an opt-out process.

So what is the product that Aetna is selling here? Aetna is selling the right to dictate which patients will receive a discount and what the amount of the discount will be. What? That is a right that belongs to the physician and not to Aetna. So they are selling a product, a discount, that doesn’t belong to them but that they have stolen from the physicians. What chutzpah!

And we still insist on national policies that leave the private insurers in charge? What chutzpah!