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Reduction in disparities requires both insurance and a medical home

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Reduction in disparities requires both insurance and a medical home

Health Care Disconnect: Gaps in Coverage and Care for Minority Adults
By Michelle M. Doty and Alyssa L. Holmgren
The Commonwealth Fund
August 2006

Lack of insurance coverage and instability of coverage are persistent problems for low-income adults and racial and ethnic minorities. The Commonwealth Fund Biennial Health Insurance Survey (2005) documented that Hispanic working-age adults are particularly likely to lack basic access to medical care. This can be attributed in part to their very high uninsured rates, but it is also because of the difficulties Hispanics experience in establishing ongoing care relationships with their doctors. Findings suggest that improving coverage as well as access to a medical home would go a long way toward helping Hispanic adults connect with the health care system, receive the preventive care they need, and successfully manage and control chronic conditions.

Rates of unpaid medical bills and debt, meanwhile, are particularly high among African Americans, a consequence of the high prevalence of chronic disease and high uninsured rates found in this population. Helping to prevent the financial strain associated with unpaid medical bills and accrued debt should be a top priority area for policymakers.

Insurance alone does not ensure equal access and equal care. Having a regular doctor is important as well, in terms of timing and receipt of preventive care. Indeed, findings indicate that on certain measures of preventive care, there are few racial and ethnic disparities among Hispanics, African Americans, and whites once they have a regular doctor.

Whether insured or uninsured, or below or above poverty, people who have a regular provider are significantly more likely to get recommended preventive care, such as blood pressure and cholesterol screenings, and to feel confident about self-managing their chronic conditions. Ensuring that people have a medical home may thus be an important lever for reducing racial and ethnic disparities in care.

http://www.cmwf.org/usr_doc/941_Doty_hlt_care_disconnect_disparities_issue_bri.pdf

Comment:

By Don McCanne, M.D.

No reasonable person disputes that lack of insurance has been a major contributor to racial and ethnic disparities in care. Establishing a program of universal, comprehensive health care coverage may not be the only measure required, but it is absolutely essential. Health care access will always be impaired if there is not in place a system of paying for that care.

This study also demonstrates that lack of a medical home (primary care) also results in racial and ethnic disparities. We are currently witnessing an acceleration in the deterioration of our primary care infrastructure. Our current flawed method of funding health care has shifted financial resources from primary care to more lucrative, higher-tech services. Being able to pay for primary care is not enough if there is no primary care home to turn to.

A single payer national health insurance program not only would ensure that care would be paid for, but it also has the capability of correcting many of the structural defects in our health care system. One of the most important is that it could realign incentives to improve and expand our primary care infrastructure, ensuring that everyone would have access to a medical home.

Single payer is not only an insurance model. It is also a beneficent monopsony: a single purchaser of health care for the public good. As such, it would not only fund health care, but it would also enable much needed structural reforms such as improving the primary care infrastructure, improving pricing, reducing non-beneficial high-tech excesses, and dramatically reducing the profound administrative waste of our current, fragmented system.

Medicare more effective in controlling excess spending

The Slowdown in Medicare Spending Growth By Chapin White
Congressional Budget Office
July 2006
Working Paper Series

Abstract

The rate of so-called “excess” growth in Medicare spending per beneficiary has varied widely over the last several decades, and growth has slowed substantially in recent years. (Excess growth is defined as growth beyond the combination of the general rate of economic growth and the rate of change in the age composition among beneficiaries.) The annual rate of excess growth fell from 5.5 percent over the period from 1975 to 1983 to 0.9 percent over the period from 1992 to 2003. Changes in provider payment policies might help explain the observed slowdown. Those changes include the implementation of a prospective payment system for short-stay hospitals, and, more recently, the imposition of mechanisms to control aggregate Medicare physician spending. Possible alternative explanations-increases in managed care enrollment, changes in Medicare cost sharing, and a system-wide spending slowdown-do not account for the slowdown in Medicare spending. The slowdown is of an economically important magnitude and deserves further study.

http://www.cbo.gov/ftpdocs/74xx/doc7453/2006-08.pdf

And…

Medicare eases fee cuts
By Stephen Heuser
The Boston Globe
August 2, 2006

The Centers for Medicare and Medicaid Services, known as CMS, released a massive document dictating how much it will reimburse hospitals for hundreds of medical procedures in 2007. Medicare pays $125 billion to hospitals nationwide each year, making it the single most important payer in the American healthcare system. Changes in its policies can trigger shifts in both the American hospital system and the medical-device industry.

The changes detailed yesterday are far less dramatic than the federal agency first proposed in April, when it said it was considering slashing payments for some heart-repair procedures by one-third, and cutting reimbursement for defibrillator implants by one-fifth.

Hospitals and healthcare companies have been watching Medicare unusually closely this year because the agency has launched a major change to the way it pays hospitals. Medicare pays a fixed amount for each type of procedure, and studies had found that those payments had become highly unbalanced.
Hospitals were profiting on certain cases, such as cardiac procedures and orthopedic surgery, but losing money on others, such as stroke victims and lung patients.

The revision increases the amount Medicare pays overall by $3.4 billion.

But it shifts the money around in an effort to rebalance its payment system and clamp down on a new breed of hospitals that has emerged to take advantage of discrepancies in the system.

So-called “specialty hospitals,” owned by doctors, concentrate on the most profitable procedures, such as coronary angioplasty and orthopedic surgery, leaving the bulk of less profitable medical care to community hospitals.

http://www.boston.com/business/globe/articles/2006/08/02/medicare_eases_fee_cuts____and_boston_scientific_fears/

Comment:

By Don McCanne, M.D.

Everyone is concerned about the affordability of health care. We want the best care available, but we all realize that we cannot allow health care spending to bankrupt us. As a percent of our Gross Domestic Product (GDP), we spend far more than any other nation on health care, currently 16.5 percent. There is a general consensus that we are ever closer to the threshold that can be tolerated.

Over the past few decades, innumerable efforts have been made to attempt to control the “excess” growth in spending, excess being defined as a rate of growth in health care spending in excess of the rate of growth of our GDP (corrected for demographics, etc.). This CBO study of the success of Medicare cost containment provides us with some very important lessons.

Some will be surprised to see what has not been effective. Managed care has had an insignificant impact within the Medicare program, and actually resulted in an increase in spending because of the higher rates paid for a lower-risk sector of patients. Cost sharing, the tool being touted by the consumer-directed health care advocates, also has not had any significant impact in reducing excess spending.

Perhaps the most important theory dispelled by this study is that the slowdown in Medicare spending represents a general slowdown of spending in our entire health care system. This analysis confirms that Medicare spending slowed while system-wide spending continued to increase at an excessive rate.

So what has worked? Adoption and continual refinement of provider payment policies such as the prospective payment system for hospitals and the sustainable growth rate formula for physicians have been effective. These are not perfect systems. Refinements have been made, and further changes are essential. The point is that they are designed specifically to provide value to the taxpayer while ensuring that our health care delivery system is adequately and fairly funded.

The Medicare payment document just released by CMS demonstrates how well this can work. Policies are being adopted that will reduce excess spending in some sectors while shifting funds to important services that were losing money, and further modifications were made based on input during the public comment period. Isn’t that what we should expect from the stewards of our tax funds?

How does the private sector approach excess spending? It uses the blunt instrument of managed care: ratcheting down provider rates, erecting barriers to access, and now shifting often unaffordable costs to patients with needs. What is really ironic is that these mechanisms have failed to slow the increase in excess costs (except for the one-time impact of private-sector price controls).

What do you want: a government program that has a dynamic system of achieving the best value for our finite health care dollars, or a private, fragmented system that provides poor value and isn’t even effective in controlling excess spending?

Health insurance for all, for real

By Susan Duerksen
Op-Ed
San Diego Union-Tribune
July 21, 2006

Nobody likes to hear the health care horror stories: emergency rooms clogged with sick people who otherwise can’t see doctors, patients skipping treatments to afford food for their children, deaths from easily curable diseases that weren’t detected. We don’t want this in America.

Universal health coverage has become almost a universal goal across the political spectrum. There’s a growing recognition that covering the uninsured – besides directly helping millions of people – would be good for business, the economy and the taxpayers and premium-payers who now pick up the tab.

But that unity of purpose is hollow. The “how” is what matters, and that’s where we are deeply divided.

The celebrated Massachusetts health-care plan is almost as convoluted and unworkable as our current system, because it doesn’t change the one thing that most needs to be changed: the reliance on profit-driven insurance companies. In fact, those companies lobbied hard for this “reform.” What could be sweeter? The whole state is required to buy their products, no matter how substandard or overpriced, with taxpayers chipping in to ensure 100 percent sales.

The Massachusetts example, shaky as it is, brought a similar bill to life in the California Legislature. As numerous analysts immediately pointed out, however, a mandate to buy insurance has even less chance of success in this immense state, which has almost double the percentage of uninsured people, fewer employers providing coverage and less state regulation of the insurance money-grab.

Again and again, independent financial studies have shown that health insurers waste 25 percent to 30 percent of the dollars we mean to spend on health care. They have gigantic profits and eye-popping executive salaries, and they spend huge sums on “administrative costs” such as screening out the unhealthy, fighting claims and other maneuvers to keep from covering people. They make their money by denying rather than facilitating services.

Why don’t we get rid of these unneeded and costly middlemen? Because:

(1) Insurance companies don’t want to be eliminated, and they have the power to get their way. The source of their power is the wealth they have amassed from our health care dollars over the decades.

(2) As a nation, we revere the market system. We adhere unquestioningly to the belief that “the marketplace” can handle everything, even an endeavor as ill-suited to market forces as health care.

The natural market-driven behavior of insurers is to compete to cover only healthy people, to pay as little as possible of whatever medical costs they have and to jack up prices for anyone likely to be unhealthy. No matter how you twist it and patch it, this is a lousy basis for providing health care to a population.

Nonpartisan experts who crunch the numbers generally agree the best way to achieve universal coverage is with a single, nonprofit health plan covering everyone. Then they dismiss the idea, saying it’s not politically feasible. (See reasons No. 1 and 2 above.

True, that is our political reality in 2006. It is time to change it.

The math has been done. California could save roughly $20 billion in bureaucracy by pooling everyone from the thousands of health insurers and government programs now covering Californians. That’s enough to give every state resident first-class coverage: doctors of your choice, hospitals, vision, dental, mental health, drug coverage, even orthodontia and skilled nursing care.

Instead of paying premiums and deductibles, people would pay a graduated income tax to fund the plan. “Tax” is a dirty word in the United States, but try explaining the distinction to Massachusetts residents mandated to pay thousands of dollars a year to insurance companies. Sometimes a tax is the most efficient (read cheapest) and fairest way to get something done.

A single, nonprofit health plan is based on the original concept of insurance – create a large buying pool (a “risk pool” in industry language) to spread the financial risk of illness so families don’t face bankruptcy when a health crisis strikes. The government agency would simply negotiate and pay the bills, not employ the doctors or own the hospitals.

Certainly the big insurers and pharmaceutical companies, who have the most to lose, would not like this plan. And they have the expensive lobbying and marketing operations to ensure their viewpoint is heard loud and often. Ordinary taxpayers and 45 million uninsured people have no such lobby, but with straight facts and enough voices, we can drown out their self-serving objections.

A statewide volunteer organization, Health Care for All, is building a grass-roots movement to do just that, with a campaign called OneCareNOW. The California Democratic Party has put single-payer health care on its platform, and the League of Women Voters California, the California Nurses Association and many other organizations are working hard for passage of a single-payer bill in Sacramento.

The bill, SB 840, which creates a statewide single-payer health care system, has already passed the California Senate. Now the Assembly and the governor need to hear that the people are ready for a major change: a sensible and fair way to finance health care. California can show the nation how to do it right.

——————
Duerksen is co-director of Health Care for All-San Diego. She can be reached via e-mail at sduerksen@onecarenow.org.

States Push Healthcare Reform While Activists Demand Overhaul

In healthcare debate, single-payer still 800-pound gorilla

by Shreema Mehta

Aug. 1 — Across the nation, states have made headlines this year for innovative approaches to expanding residents’ access to health insurance. But when the publicity has cleared and the reality sets in, the uninsured are finding these plans fall short of the fanfare that surrounded their announcement.

What was billed in Massachusetts as the nation’s first universal healthcare plan turned out to be legislation strong arming moderate-income residents without employer-funded health insurance into buying expensive healthcare plans.

A plan touted in Arkansas to help small businesses extend insurance to low-wage workers lacks clear incentives for employers and provides workers with scant coverage: six clinician visits and seven hospital days per year, two outpatient or ER visits per year and two prescription fillings per month.

While some healthcare advocates praise these and other attempts to widen access, others are calling for a more fundamental overhaul of the nation’s healthcare system. Instead of plans that rely on increasing enrollment insurance offered by for-profit companies, they would like to see these companies replaced with a progressive tax system that pays for everyone’s health care.

San Francisco recently passed a measure that would provide access to healthcare for uninsured residents, which the city has estimated to be 82,000. The plan would require businesses with 20 or more employees to either provide health insurance to workers or contribute to a fund that would pay for healthcare services within city limits to uninsured residents.

The plan will take effect on January 1, 2007. Jim Lazarus, vice president of the San Francisco Chamber of Commerce, told the San Francisco Chronicle that members of the business community will likely sue the city in an attempt to block the measure.

Don Bechler, director of the San Francisco chapter of Healthcare for All, supports the plan.

“It’s good that 82,000 San Franciscans have some form of healthcare access,” he told The NewStandard. “It holds the line on employers dumping health coverage.”

According to an annual survey on employment-based insurance released last year by the Kaiser Family Foundation, the percentage of businesses of all sizes offering health insurance has been on a “steady decline.” While 69 percent of all firms offered health benefits in 2000, 60 percent offered benefits in 2005.

The San Francisco bill, however, only gives people who enroll in the program access to subsidized healthcare at facilities within city limits. “If I drive ten miles out of the city, I’m not covered,” said Bechler. “It’s not as good as a nationally paid healthcare system.”

Like the Massachusetts and Arkansas plans, the San Francisco scheme looks to employer-purchased insurance as the preferred method of coverage. Rachel DeGolia, director of the Universal Health Care Action Network, said ideally, governments should not rely on employers to meet health needs. As health costs increase, employers are ever-more reluctant to provide health insurance.

“The fewer people insurance companies cover, the fewer benefits they pay out, the more money they make … It’s a disincentive to provide benefits.”

“That system is really crumbling,” she said. “There’s a lot of people who don’t have jobs.”

For instance, “children don’t have jobs,” she said, adding that many people are delaying retirement to stay insured. “To have an insurance system based on jobs doesn’t make sense.”

Still, with states seen as taking the lead in experimenting with new ways to address the insurance crisis, some health advocates are pushing for “partnership projects” that would provide federal funding for states to design their own method of universalizing healthcare coverage.

Senator George Voinovich (R-Ohio) has proposed a bill that would enable states to pursue their own plans to bring healthcare to all residents. The proposal would set up a commission of governors, mayors and other government officials to determine which states should receive federal funding.

DeGolia said allowing states to create their own health-insurance plans is the most politically feasible way to increase access to health care. But she also predicted that giving states wide leeway would likely encourage them to pursue plans that coverage advocates find ineffective, such as funding “health savings accounts” tied to high-deductible insurance plans.

Instead, DeGolia and other universal-healthcare advocates would like to see the abolition of insurance companies, which they see as the main reasons behind millions of Americans lacking coverage and millions of dollars lost in the bureaucratic costs and profits.

Many healthcare advocates would like to see insurance companies replaced by a single payer system in which the government would use tax money to pay healthcare providers directly for patients’ care.

“The fewer people they cover, the fewer benefits they pay out, the more money they make,” she said. “It’s a disincentive to provide benefits… They only try to cover people who are healthy, and they want the government to cover the chronically sick.”

Many healthcare advocates would like to see insurance companies replaced by a single payer system in which the government would use tax money to pay healthcare providers directly for patients’ care.
Bills that would enact a single-payer system have been proposed in both the US House of Representatives and the California state senate.

George Savage is director of Healthcare for All-Los Angeles, which helped draft a California bill to implement a single-payer system. Savage said most healthcare facilities, both public and private, would stay intact under the overhaul proposed by his group.

The bill requires both employers and individuals to pay a health tax in lieu of insurance policies and co-payments. Private and public healthcare providers would both stay open in the system and would bill the government rather than different insurance companies for healthcare costs.

In addition to providing medical coverage for everyone, advocates say healthcare costs would be far lower because the government – not numerous, competing for-profit insurance companies – would “negotiate” prices with hospitals, drug companies and other healthcare providers.

According to the Kaiser Family Foundation, the cost of healthcare has consistently grown at a higher rate than the Gross Domestic Product and makes up 16 percent of the national economy, up from 7.2 percent in 1965. Out-of-pocket expenses have increased alongside overall health costs. In 2006, healthcare expenditures are expected to reach $2.6 trillion.

At the same time, insurers and big providers’ profits have taken big leaps in the past few years. According to Weiss Ratings, a financial analysis firm, HMOs experienced a 21 percent increase in profits during the first few months of 2005 over profits made during the same period the prior year. Other recent first-quarter jumps include 153 percent in 2002 and 61 percent in 2003.

Advocates say that with an increase in government funds, a single-payer system would distribute more funds to often-troubled health clinics in low-income communities. They also insist patients would be free to choose any physician they want without the restrictions most insurance companies enforce.

But Mohit Ghose, a spokesman for the Health Insurance Association of America, says that a single-payer system would restrict patients’ prerogative to choose a healthcare plan that works for them.

“We do not believe that a one-size-fits-all answer is the answer,” he said. “If I’m purchasing healthcare as an individual, I may not want coverage for 30 different things that are mandated by that state, so as a result, the mandates can price me out of the market,” he said. “Americans continue to want to preserve choice. It’s based on the idea that I should be able to make decisions for myself… [and] find the coverage that suits me the best.”
Supporters of a single-payer system say it would save taxpayers millions of dollars by eliminating the high administrative costs of private insurance companies.

According to a 1991 report released by the Government Accountability Office, 14 percent of the typical private insurance company’s budget goes to administrative costs. Just 3 percent of government-run plans, such as Medicare, is spent on overhead.

“This is the biggest bureaucracy buster,” Bechler said.

Savage noted that insurance companies spend many healthcare dollars on advertising and promotion, expenditures that a single-payer system would totally eliminate.

Considering the political power of insurance companies and the public’s view on universal health insurance, however, DeGolia says bills such as Voinovich’s and the San Francisco initiative are positive despite their flaws.
“There’s a huge amount of money invested in maintaining the status quo,” she said, referring to lobbyists for insurance companies. “Because the federal government has not acted, states and cities are exploring ways to cover more people.”

DeGolia said measures to expand access should be based on “current political realities.”
But Savage said such steps were not productive. “There’s almost hundreds of incremental plans,” he said. “That doesn’t add efficiencies to the system. We need a holistic change, and [single-payer] is a system… that [would] provide real benefits to everyone and not just a segment of the population.”

Published by The New Standard, newstandardnews.net

Shorter waiting times in Ireland's public system

Private not much quicker for treatment
By Susan Mitchell and Nicole Matthews
The Sunday Business Post (Ireland)
July 30, 2006

Hospital consultants have questioned the benefits of paying for private health insurance. Some claim going private does not necessarily ensure a fast-track to the operating table and that chronically ill patients are often better off in the public system.

Citing the reduction in procedure waiting times under the National Treatment Purchase Fund (NTPF), the private sector’s inability to treat patients and the escalating cost of health insurance, they believe the benefits of having private health insurance are diminishing.

Consultant neurologist Dr. Orla Hardiman, director of neurology at Beaumont, and a medical adviser to the Neurological Alliance of Ireland, said that in some instances her public waiting list is actually shorter than her private waiting list.

“For some neurological conditions people can actually be seen more quickly in the public sector. Most neurologists have small private practices, so the number of private patients we can take is quite small. If someone has a problem that requires ongoing management and multi-disciplinary care they are better off in the public system,” she said.

“There are times when the private sector can offer quicker access for patients looking for specific procedures, but the benefits are not as clear-cut for chronically ill patients. There is no huge advantage in these patients having private cover as the services are not available in private hospitals,” said Hardiman.

Other consultants have had similar experiences. Professor John Crown, consultant oncologist at St Vincent’s Hospital in Dublin, said of patients with cancer: “We have had a much bigger waiting list for patients with private health insurance trying to get chemotherapy in St Vincent’s Private Hospital.

“That has been the case for a number of years. The public waiting list has been a lot shorter.”

Crown said he and his colleagues often move private patients who need urgent treatment into the public system.

In a recent interview with the Irish Medical News, Brendan Healy, orthopaedic surgeon in Sligo and an elected member of the Medical Council, said the NTPF was getting patients off the lengthy outpatient lists.

Established in 2002 to try to tackle long-term waiting lists for surgical procedures, the NTPF finds spare capacity in the system – both public and private – and uses it to arrange operations for patients who have been waiting three months or more before contacting the fund.

Healy said patients were being treated for free in the same private beds as fee-paying insured patients. He stressed that he was not suggesting people shelve their private health insurance, but that they consider their cover needs.

“I’m wondering should people bother having insurance, and having double taxation, unless they have a fast-track.

“Because if you are waiting for three months, you can get into the same hospital under the NTPF and end up in a bed alongside somebody who has paid thousands in extra taxes (subscriptions),” he said.

http://www.sbpost.ie/post/pages/p/story.aspx-qqqt=NEWS%20FEATURES-qqqs=news-qqqid=16048-qqqx=1.asp

Comment:

By Don McCanne, M.D.

The policy lesson is that directing efforts to simple queue management will reduce waiting times, whether in the public or private sector. Those who state that excessive queues are inevitable in publicly funded programs and are eliminated with private funding are flat-out wrong.

Effective queue management is dependent on the diligence of the stewards of the health care system and not on whether the source of funding is private or public.

The infrastructure of a single payer system for the United States would include queue management and is ideally suited to do so, especially when compared to our current fragmented system of funding care. You should emphatically reject the claim of those who state that excessive delays are inevitable in a single payer system and non-existent in the privately insured market.

eHealthInsurance exposes the false promise of cheaphigh-deductible insurance

Monthly Health Insurance Premiums Highest in Spokane, Wash., Among 69 Cities, Survey Finds
kaisernetwork.org
Daily Health Policy Report
July 21, 2006

Health insurance costs the most in Spokane, Wash., and costs the least in Grand Rapids, Mich., according to a survey of 69 cities released on Wednesday by eHealthInsurance, the Miami Herald reports. The survey examined monthly premiums for health insurance for a family of four nonsmokers with a maximum deductible of $2,000 and 20% coinsurance. According to the survey, Spokane had the highest monthly premiums at $962, and Grand Rapids had the lowest at $159.06. The New York City and Boston areas had monthly premiums that ranged from $865 to $916, the survey finds. Bob Hurley, a vice president with eHealthInsurance, said that state health insurance mandates accounted for a large share of the differences in monthly premiums among the cities surveyed. He added, “In very heavily regulated states, prices are horrendous.”

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=38638

The Most Affordable Cities for Children’s & Family Health Insurance
eHealthInsurance
July 19, 2006

Most of the cities surveyed that rank near the bottom are in states with community rating and guaranteed issue laws.

http://www.miami.com/multimedia/miami/news/afford.pdf

Comment:

By Don McCanne, M.D.

eHealthInsurance is frequently cited as the resource that proves that high-deductible policies are very inexpensive. But their own report demonstrates that this is not always true. It is very important to understand why.

Mandated benefits are frequently blamed for the high insurance premiums in some states. But this accounts for only a modest variation between states, and does not explain the variation between cities within a single state. For the healthy young family described, benefits can be quite generous without much impact on premiums.

Regional variations in utilization, especially of non-beneficial high-tech services, account for part of the differences, although much of that is concentrated in the Medicare population and has less impact on the private plans that cover healthy families. But some of the costs of these excess services may be shifted to the private plans.

Neither benefit mandates nor regional variations in utilization can account for a 6-fold difference in premiums in various cities. So what does?

eHealthInsurance provides us with the answer, although they bury it in a marginal comment in their report. Defining the “bottom” as the highest premiums, they state that “most of the cities surveyed that rank near the bottom are in states with community rating and guaranteed issue laws.” In other words, those states that require insurers to provide the insurance function of pooling risk will have much higher premiums because the large health care costs for the sick are shifted to the many who are healthy. That is the fundamental principle of insurance. For the coverage described, lower premiums are possible only in those states that allow private insurers to skim off the healthy and leave the sick behind. But then how would you pay for the sick since they consume about 80 percent of our health care spending?

Another major concern about this report is that the study was of a plan with a high-deductible ($2000) and 20 percent coinsurance (as opposed to nominal copayments). The average family that develops significant medical problems will find that this level of cost-sharing creates a financial barrier to health care access, with resultant impaired health outcomes.

A universal risk pool that eliminates financial barriers to care is the only practical answer. Since the average family cannot afford the premiums that would be required, the pool must be funded equitably through progressive tax policies.

The private insurance industry will never provide coverage that pools all risks, eliminates financial barriers to care, and charges a premium based on ability to pay. Single payer national health insurance is the answer. Why do we keep evading the obvious?

Ohio State AFL-CIO Convention Endorses HR 676

Cincinnati, –The Ohio State AFL-CIO became the fourth state federation to endorse HR 676 when the 589 convention delegates unanimously passed a strong resolution endorsing HR 676 on July 19, 2006.

The Ohio AFL-CIO has long been on record in favor of a single payer health care system, but this is the first time it has endorsed HR 676, single payer legislation introduced by Congressman John Conyers (D-MI). The Buckeye state follows similar action by State AFL-CIO Federations in Kentucky, Pennsylvania and Connecticut.

The full text of the Ohio AFL-CIO resolution follows:

HR 676 – SINGLE PAYER UNIVERSAL HEALTH CARE

WHEREAS: Workers, their families and their unions are waging an increasingly difficult struggle to win or to keep good health care coverage.

WHEREAS: Almost every union at every contract deadline must battle and sacrifice merely to sustain health care benefits. The rising costs of health insurance are blocking workers’ progress in wages and other areas. All of our unions face a healthcare crisis. But the crisis extends far beyond union members. Nearly 50 million people in the United States are currently without health insurance, more than 75 million went without for some length of time within the last two years, and millions more have inadequate coverage or are at risk of losing coverage.

WHEREAS: People of color, immigrants and women are denied care at disproportionate rates, while the elderly and many others must choose between necessities and life sustaining drugs and care. Unorganized workers have either no coverage or inadequate coverage. The Institute of Medicine has found that each year more than 18,000 in the U.S. die because they had no health insurance.

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

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

WHEREAS: Economic necessity and moral conscience compel us to seek a better way.

WHEREAS: Congressman John Conyers, Jr. (D-MI) (joined by 72 co-signers including Ohio Representatives Sherrod Brown, Stephanie Tubbs-Jones, Marcy Kaptur and Dennis Kucinich) has introduced HR 676, the United States National Health Insurance Act, also called Expanded and Improved Medicare for All. This single-payer health care program proposes an effective mechanism for controlling skyrocketing health costs while covering all Americans. The bill also restores free choice of physicians to patients and provides comprehensive prescription drug coverage to seniors, as well as to younger people.

WHEREAS: HR 676 would cover every person in the U.S. for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, chiropractic and long term care. HR 676 ends deductibles and co-payments. HR 676 would save billions annually by eliminating high overhead and profits of the private health insurance industry and HMOs. The transition to national health insurance would apply the savings from administration and profits to expanded and improved coverage for all.

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

THEREFORE BE IT RESOLVED: That the Ohio AFL-CIO wholeheartedly endorses Congressman Conyers’ bill HR 676, “Expanded and Improved Medicare for All,” a single payer health care program.

BE IT FURTHER RESOLVED: That the Ohio AFL-CIO will work with other Labor Organizations and community groups to build a groundswell of popular support and action for single payer universal health care and HR 676, until we make what is morally right for our nation into what is also politically possible.

BE IT FURTHER RESOLVED: That the Ohio AFL-CIO will send a copy of this resolution to Congressman Conyers, to all members of the U.S. House and Senate, to the AFL-CIO Executive Council, and to the news media.

BE IT FINALLY RESOLVED: That the Ohio AFL-CIO will take other actions to mobilize our members and our community at the grassroots to encourage other members of the House to sign on as co-sponsors of HR 676 and to encourage Senators to introduce a companion bill in the Senate.

Submitted by: USWA District 1, IBEW 673 and Resolutions Committee

(Unanimously adopted July 19, 2006 by the Ohio AFL-CIO at its Cincinnati Convention)

#30#

HR 676 has been endorsed by 161 union organizations including 33 Central Labor Councils and Area Labor Federations and four state AFL-CIO’s (KY, PA, CT & OH).

For further information and a complete list of union endorsers contact:

Kay Tillow
All Unions Committee For Single Payer Health Care-HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551, (502) 459-3393
email: nursenpo@aol.com

Nation's Largest Union Endorses HR 676

Orlando, FL-The largest union in the US, the National Education Association (NEA), has endorsed HR 676, a bill introduced by Congressman John Conyers (D-MI) that would establish a national single payer health care system.

The resolution endorsing HR 676 was one of several health care resolutions adopted by the 9,000 delegates to the convention, the Representative Assembly, early in July. It was proposed by California Teachers Association delegate, David Patterson, and called upon the NEA to inform its members about HR 676 through union publications such as “NEA Today,” other union publications, and the NEA website.

The 3.2 million member NEA is the third international union to endorse HR 676 at conventions this summer. Last month the United Auto Workers (UAW) and the West Coast Longshore Union (ILWU) also endorsed the Conyers legislation.

HR 676 now has 75 congressional co-sponsors in addition to John Conyers. It would institute a single payer health care system in the U.S. by expanding a greatly improved Medicare system to every resident.

HR 676 would cover every person in the U. S. for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, chiropractic and long term care. HR 676 ends deductibles and co-payments. HR 676 would save billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

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HR 676 has been endorsed by 162 union organizations including 34 Central Labor Councils and Area Labor Federations and four state AFL-CIO’s (KY, PA, CT & OH).

For further information and a complete list of union endorsers contact:
Kay Tillow
All Unions Committee For Single Payer Health Care-HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551, (502) 459-3393
email: nursenpo@aol.com.

Kentuckians hold Citizens' Hearing on Health Care Crisis

The crisis is rooted in the current for-profit financing of health care. There is a solution. It is comprehensive reform based on non-profit, public financing with private delivery of health services.
–Garrett Adams, MD, MPH, Hearing Moderator

In everybody’s family, there’s a testimonial like those we heard today . . . what’s happening now is breaking people’s lives.
–The Hon. Gerald A. Neal, Kentucky State Senator

If anyone isn’t angry about this, they just aren’t listening!
–Gerry C., small business owner

Her out-of-pocket expenses were 77 percent of her gross income– and she had insurance!
–Edgar Lopez, MD, commenting on a neighbor’s experience.

As chair of the Health and Human Services Committee, I represent the uninsured and the underinsured in our community.
–Mary Woolridge, Metro Louisville Councilwoman

On this issue, I believe the people are out in front of the politicians.
-John Yarmuth, Congressional candidate, KY -3rd district

Co-pays are higher, coverage is decreasing–soon we will all be among the have-nots.
–J. Wayne Crabtree, Louisville Metro Health Department

The so-called “ownership society” talk is just a smokescreen. The health care supply side-the insurance companies and drug companies-they own the system and control policy.
–Mark McKinley, testifying on behalf of a friend burdened with medical debt

I thought this would be primarily an urban issue, but I was amazed at the groundswell in the rural areas.
–The Hon. Joni L. Jenkins, State Representative, sponsor of a Kentucky resolution urging Congress to enact HR 676

At a certain point I noticed the hushed attentiveness of the audience, the unique bonding among everyone there.
–Mary Ann Garnar, on the impact of the testimonials

We will pay for health care the way we pay for all the things we think important-our justice system, our roads, our common needs.
–Ewell Scott, MD, featured speaker

Kentuckians hold Citizens’ Hearing on Health Care Crisis

On Saturday morning, June 10, an estimated 140 people joined elected representatives, public health officials, and health care providers at Calvary Episcopal Church in downtown Louisville to hear the testimonials of individuals who understand the real costs of our national health care “meltdown.”

Representing diverse interests–the uninsured, the underinsured, small business owners, those coping with the increasing costs of premiums and/or medication, and those burdened by medical debt-the testifiers told their stories, hoping to move both the public and public officials to take immediate action.

The two-hour event, billed as a “Citizens’ Congressional Hearing on the Health Care Crisis,” was sponsored by Kentuckians for Single Payer Health Care (KSPH) and the Kentucky Chapter of Physicians for a National Health Program (PNHP-KY). Co-sponsors included 33 labor and social justice organizations (listed below).

The forum was one of 70 such hearings being held across the country, and one of many special events scheduled during the week of 6/7/06, a week of national action called by Healthcare-NOW.org in support of HR 676, the United States National Health Insurance Act, the single payer plan proposed by Congressman John Conyers.

Congressional candidate John Yarmuth, whose platform includes single payer, joined State Senator Gerald Neal, State Representative Joni Jenkins, Louisville Metro Councilwoman Mary Woolridge, and Metro Health Department official Wayne Crabtree, on the hearing panel.

Congresswoman Anne Northup was invited, but she responded through staff that she would be unable to attend.

Kentucky House members Darryl Owens and Jim Wayne were in the audience, and several state lawmakers–from both sides of the aisle–sent messages of support for the event.

Each testimonial addressed a different facet of our broken health care system. Gerry C., owner of a small business, had tracked the percentage rise in the employer’s share of premium costs over the past few years, finally admitting that he could no longer cover his employees and stay in business. “If anyone isn’t angry about this, they just aren’t listening,” he concluded.

Paula V. spoke tearfully of her husband’s need for a liver transplant. The family, including two young children, has been caught in a bureaucratic nightmare, asked to meet competing criteria for disability benefits, the wife’s employer-based insurance, and Passport/Medicaid. Through it all, a very sick young man has been asked to jump through multiple financial and therapeutic hoops.

Michele F., a self-employed widow in her mid-forties, was paying $2000 annually for a catastrophic plan when, last summer, the catastrophe occurred. Michele suffered a stroke, spent three days in the hospital and is now trying to pay off $7,000 in out-of pocket expenses. Currently, she has a family policy with a $20,000 deductible and prays her children don’t get ill.

Carrie I., a young mother who has asthma and high blood pressure, spoke of having remained in a very unpleasant job because she feared losing her health coverage. Although she now has a better work situation, health care expenses absorb one third of her salary. She admits to skimping on her own medication, and must often renegotiate with her insurer to make certain her children are covered.

An uninsured home health aide, Francene S., age 51, told of her struggles to get specialized care after her heart attack. She worries what will happen if the stents in her heart need to be replaced. She works and has tried to get insurance but the $2000 to $3000 monthly premiums quoted are far beyond her ability to pay.

Mark McKinley relayed the story of his friend, Penny K, injured in a kayaking accident. Penny had been paying $290 a month for what she thought was adequate health insurance. She received excellent medical care for severe back and neck trauma, but she has been left with a debt of $11,000 for uncovered expenses. “The so-called ‘ownership society’ talk is just a smokescreen,” Mr. McKinley remarked. “The health care supply side-the insurance companies and drug companies-they own the system and control policy. We get stiffed and just own more debt. It’s time to say ‘no’ to the status quo! ”

Speaking for the Jefferson County Teachers’ Association (JCTA) and Jobs with Justice, Ann Walsh recalled that health care was the major issue in the teachers’ recent round of negotiations with the State. She expects it to come up again. She decried the “greed of the health insurance industry” as costs are increasingly being shifted to the worker.

The Reverend A. David Bos reminded attendees of the accumulating wealth and political power of the health care and pharmaceutical industries. Public monies that should be used to fight disease and environmental harms are being funneled instead to the profit-making health care “juggernaut.”

Dr. Edgar Lopez, a member of PNHP-KY, wore black armbands in memory of the estimated 18,000 who die each year for lack of access to care. Waving invoices as proof of the out-of-pocket costs paid by a neighbor who suffered from a chronic illness, Lopez exclaimed, “Her out-of-pocket expenses were 77 percent of her gross income–and she had insurance!”

Reflecting on the combined impact of the testimonials, KSPH member Mary Ann Garnar said, “At a certain point I noticed the hushed attentiveness of the audience, the unique bonding among everyone there.”

The featured speaker, Dr. Ewell Scott, an internist from Morehead, KY and also a PNHP member, outlined “the single payer solution.” He explained how a national nonprofit health insurance system would work, and why attempts at short-term fixes will not. “Reducing the number of health insurance companies in the US from an estimated 2,000 to one will save us 400 billion dollars a year,” he exclaimed. “No one disputes these figures.”

To those who would ask how the system would be financed, Dr. Scott offered this response: “We will pay for health care the way we pay for all the things we think important-our justice system, our roads, our common needs.”

The savings generated by the administrative efficiency of single payer, combined with the public dollars already in our system, would provide enough funds to cover everyone in the US. If supplemental financing is necessary, HR 676 proposes minimal taxes. “There will be no premiums, no co-pays,” Dr. Scott reminded his listeners, adding that any required taxes would be levied equitably: “Each of us will participate to the degree that we are able.”

“My plea is to spread the word,” Dr. Scott concluded. “Talk to your representatives about single payer. Tell them ‘It’s easy, but you’ve got to have the guts to do it!'”

Members of the hearing panel were asked to give a brief response. They thanked the testifiers for their courage in speaking out, and they pledged to redouble efforts in support of health care for all.

“In everybody’s family, there’s a testimonial like those we heard today,” observed Senator Neal. “That means there’s an army out there waiting to be organized, to be focused [on reform] . . . what’s happening now is breaking people’s lives.”

The Senator promised to support a state endorsement of HR 676, but he believes true reform must be implemented at the federal level. He urged the hearing organizers to continue efforts to raise public awareness, to educate their representatives on the merits of single-payer. Referring to the challenging task ahead, the Senator spoke bluntly: “The insurance companies are well organized and well funded. Only sustained activity by motivated volunteers can counteract the power of that ‘paid army.'”

J. Wayne Crabtree brought greetings from the Director of the Louisville Metro Health Department, Dr. Adewale Troutman who has researched the more equitable delivery of health care in countries having single-payer systems.

Public health officials view health care from a disease prevention perspective, said Mr. Crabtree. “As we have seen with HIV-AIDS and other infectious diseases, sickness can quickly spread throughout the world.”

Moving the argument for reform to the local level, Crabtree reported that an estimated 12 percent of Kentuckians are uninsured. “These individuals have names, faces, and families.” Even the insured cannot be complacent: “Co-pays are higher, coverage is decreasing–soon we will all be among the have-nots.”

“Health care for all is long overdue,” exclaimed Councilwoman Woolridge, pledging to work towards passage of a Metro Council resolution in support of HR 676. She invited area residents to sign up to speak at local Council meetings. “As Chair of the Health and Human Services Committee,” she pointed out, “I represent the uninsured and the underinsured in our community.” She closed with a quote from Dr. Martin Luther King, Jr., noting that his words are still relevant today: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Candidate Yarmuth urged voters to boldly confront candidates on health care, to track campaign donations from the health care industry, and to vote for those who support a national single payer system. Facing an incumbent well-funded by the for-profit health care sector, he acknowledged that it is not easy “to discuss a complex issue like health care reform in sound bites.” Mr. Yarmuth is, however, encouraged by the fact that “on this issue, I believe the people are out in front of the politicians.”

Rep. Joni Jenkins recalled her work as sponsor of HCR 40 (a State resolution calling on Congress to enact the Conyers bill) during the recent Kentucky legislative session.” I thought this would be primarily an urban issue, but I was amazed at the groundswell in the rural areas. Several colleagues, Republicans as well as Democrats, came to me and said, ‘I need to sign on to this. I am hearing about this back home.'” The resolution went to the House floor with bipartisan support but the bill was not ultimately called for a vote.

“Don’t worry–we’ll be back in Frankfort for the next session,” said KSPH Coordinator Kay Tillow, issuing an urgent call for grassroots action. Ms. Tillow has been successful in gaining endorsements for HR 676 from labor organizations around the country.

Dr. Garrett Adams, coordinator of PNHP-KY, explained the rationale for holding such a public hearing: “It is clear that we have a very serious health crisis in this country caused by a gradual change of health care delivery from a human service, a social good, to a market-driven industry. The crisis is rooted in the current for-profit financing of health care. As Dr. Scott has said, there is a solution. It is comprehensive reform based on non-profit, public financing with private delivery of health services. The United States Health Insurance Act, HR 676 will accomplish this true reform. Our people deserve to see this bill enacted.”

Hearing co-sponsors: AFSCME Local 2629, Amalgamated Transit Union Local 1447, Citizens Against Police Abuse, Coalition for the People’s Agenda, Crescent Hill Presbyterian Church, Fairness Campaign, Fellowship of Reconciliation, Graphic Communications Union Local 619-M, Greater Louisville Central Labor Council, Interfaith Paths to Peace, Jefferson County Chapter Kentuckians for the Commonwealth, Jefferson County Teachers Association, Justice Resource Center, KY AFL-CIO, KY Alliance Against Racist & Political Repression, KY Coalition Against the Death Penalty, KY Interfaith Task Force on Latin America & the Caribbean, KY Jobs with Justice, KY Nurses Association, Laborers’ International Union Local 576, Louisville Branch of the NAACP, Louisville Peace Action Community, Louisvillians in Favor of Equality, Metropolitan Housing Coalition, National Writers Union-UAW 1981, Nurses Professional Organization, Pro-Se Plaintiffs & Litigants Association, Social Concerns Committee–First Unitarian Church, Teamsters Local 89, UAW Local 862, University of Louisville Peace and Justice Committee, Western KY Area Council AFL-CIO, Women in Transition

Submitted by Harriette Seiler, hearing coordinator. hmseil01@insightbb.com
www.kyhealthcare.org

Kentuckians for Single Payer Healthcare
(502) 636 1551

ABCs of health care

By Dr. Susanne L. King
Berkshire Eagle
Friday, July 21
LENOX

I SPOKE with two teachers from different school districts in Berkshire County this week. Both expressed their concerns about the new health care legislation that was just passed in Massachusetts. They recognize that the new law will do nothing to help teachers deal with their increasing health care expenses. Not only are health insurance premiums rising by double digits each year, but teachers and other municipal employees are also paying a larger percentage of their health insurance premiums now than they did in the past.

Meanwhile, towns and cities are strapped for funds to pay health insurance premiums for their employees, including teachers. Besides the rising costs of premiums, some people have switched from the private sector to town and city insurance plans, because municipal plans are now often better and less costly to the worker than those offered by private companies. Therefore, a couple with a spouse who works for a town will opt to be on that plan rather than the other spouse’s private sector plan, which then increases costs to the town.

The National Educational Association (NEA) has voted to allot $500,000 to support health care reform, noting that “health care for Americans benefits NEA members and children. It would help free up precious school district dollars for salary, programs and jobs.”

Unless significant health care reform occurs, that would not only support universal access but also address cost containment, things are only going to get worse. The health spending projections for 2006 predict that our national health expenditure will be over $2 trillion, with 16.5 percent of our gross domestic product going toward health care. Current trends indicate that spending growth will continue well in excess of the rate of inflation. Dr. McCanne, former head of Physicians for a National Health Plan, has said, “The greatest uncertainty is not how much we will be paying, but who will be paying it.”

Health care costs burden our towns and municipalities, and decrease the value of a teacher’s take-home pay. Yet the Fortune 500 performance report for 2005 shows that the health insurance and pharmaceutical companies continue to rack up increasing profits for their shareholders, to the tune of 51.3 percent for health insurance companies and 34.1 percent for pharmaceutical products. And what teacher or town official earned $124.8 million in 2004, like William McGuire, the CEO of the nation’s leading health insurer, UnitedHealth Group?

There is no way to make health care affordable and contain costs when the insurance and drug companies are siphoning off these kind of profits from the health care dollar, to say nothing of their “administrative costs” which include marketing and denying benefits in their “managed care plans.” Health insurance company administrative costs are 10 times higher than the government-administered Medicare plan.

Dr. Alan Sager, of the Boston University School of Public Health, just reported that health care spending in Massachusetts will increase to a stunning $62.1 billion for 2006. That is 33 percent above the national average, and more per person than any other state or country in the world.

Were we to eliminate the insurance companies, and create a “single-payer” health care system in Massachusetts, there would be enough to cover everyone, eliminate co-payments and deductibles, and provide more comprehensive benefits than we now have. (“Single-payer” refers to a single administrator of health care funds, the state government, rather than our current multiple for-profit insurance companies.)

If we had a single-payer health care system, our teachers would receive the salaries and benefits they deserve, and our towns and municipalities would have more funds for their pressing needs, like education and infrastructure. The health care “reform” legislation that was just passed does not address any of these issues.

Please talk to your legislators about supporting single-payer health care legislation. We have elections coming up for the Legislature and for the governor’s office. Ask the candidates about their position on health care reform, and whether they will work to make single-payer health care a reality if they are elected. And then, if they are elected, hold them to their promises.