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Interim Recommendations of the Citizens' Health Care Working Group

Interim Recommendations of the Citizens’ Health Care Working Group June 1, 2006

The Citizens’ Health Care Working Group was created by the Medicare Prescription Drug, Improvement and Modernization Act of 2003, Sec. 1014 to provide for the American public to “engage in an informed national public debate to make choices about the services they want covered, what health care coverage they want, and how they are willing to pay for coverage.”

Following this nationwide citizen engagement, the Working Group is required to prepare and make available to the public this interim set of recommendations on “health care coverage and ways to improve and strengthen the health care system based on the information and preferences expressed at the community meetings.” Following a 90-day public comment period on these recommendations, the Working Group will submit to Congress and the President a final set of recommendations.

Across every venue we explored, we heard a common message: Americans should have a health care system where everyone participates, regardless of their financial resources or health status, with benefits that are sufficiently comprehensive to provide access to appropriate, high-quality care without endangering individual or family financial security.

Interim report:
http://www.citizenshealthcare.gov/recommendations/interim_recommendations.pdf

Comment:

By Don McCanne, M.D.

Those who have followed and participated in this process should agree that the “common message” above represents the prevailing views of the participants. We want a universal, comprehensive, high-quality system that does not endanger financial security for anyone.

Unfortunately, some of the actual details of the report do not seem to reflect this view but rather reflect the opinions of the current administration. Following, in quotations, are a few excerpts from the report, each followed by my comment.

* “No specific health care financing mechanism is optimal.”

There was a clear preference for an equitable, progressively-funded system of insurance for everyone. The administration’s tax credit proposal was rejected by most of those who were offered that option in the sessions. This statement seems to reflect the opinion of the individuals preparing the report rather than the view of the majority of citizens participating.

* “We understand that the transition from the current system to a system that includes all Americans will take time and that multiple financing sources will need to coexist during the move to universal coverage.”

Incrementalism was not a concept discussed in the sessions. This statement, calling for an incremental process, also seems to represent the view of those preparing the report.

* “Define a ‘core’ benefit package for all Americans”

“Core” is a term selected by those preparing this report which suggests that only basic services should be covered by a universal program, and that, by inference, second-tier benefits should be provided only for those who can afford them. The “common message” in this report states that benefits should be “sufficiently comprehensive to provide access to appropriate, high-quality care.” However “core” is defined, it implies that access to other appropriate care will be impaired due to financial barriers. This does not seem to be the intent of the citizen-participants.

* “Guarantee financial protection against very high health care costs”

The report does call for financial protection for low-income individuals, but out-of-pocket health care expenses now threaten average-income Americans. Protection against “very high health care costs” is a call for high-deductible, catastrophic coverage, a policy supported by the administration. In contrast, the majority consensus of the citizen-participants is that the system should not endanger “individual or family financial security,” though many participants seemed to be uninformed about the adverse consequences of high-deductible health plans.

* “Expanding and modifying the Federally Qualified Health Center concept to accommodate other community-based health centers and practices serving vulnerable populations”

Rather than ensuring that every individual has comprehensive health care coverage, the administration supports the expansion of community health centers to serve low-income individuals, especially those who are uninsured.
Although community health centers serve a very important role, they should not be viewed as a substitute for adequate health care coverage.

* “Consumer-usable information about health care services that includes information on prices, cost-sharing, quality and efficiency, and benefits”

This statement supports the consumer-directed health care movement, the current market diversion from the need to focus on a comprehensive system of health care coverage.

It is likely that members of Congress will select those portions of this report that support their own individual agendas while ignoring the overriding message supporting an equitable, comprehensive, high-quality system for everyone. The Working Group has requested comments on this interim report before it is formally submitted to the President and Congress. You should provide those comments to help ensure that this process is not hijacked by the opponents of comprehensive reform.

Use the following link to submit your comments on the interim recommendations: http://www.citizenshealthcare.gov/speak_out/ircomment1.php

Look north for answers

By Dr. Susanne King
Thursday, June 08
LENOX

THE CANADIAN health care system hit the news again last week. A new study by Harvard Medical School researchers reported that Canadians are healthier than U.S. citizens, even though the United States spends twice as much per person for health care.

The study analyzed data from a joint survey carried out by U.S. and Canadian governmental agencies. The authors found that U.S. residents had higher rates of nearly all serious chronic illnesses, including chronic lung disease, arthritis, diabetes and high blood pressure. In addition, race and income disparities in health care were larger in the United States. Despite the fact that we currently spend $2.1 trillion annually on health care in the U.S., cost is the biggest barrier to care: 30.4 percent of U.S. residents reported having an unmet health care need because they could not afford it.

“Most of what we hear about the Canadian health care system is negative; in particular the long waiting time for medical procedures. But we found that waiting times affect few patients, only 3.5 percent of Canadians, vs. 0.7 percent of people in the U.S. No one ever talks about the fact that low-income and minority patients fare better in Canada,” said Dr. Karen Lasser, the study’s lead author.

AA co-author, Dr. Steffie Woolhandler, commented, “Our study, together with a recent study showing that people in England are healthier than Americans, is a terrible indictment of the U.S health care system. A single payer national health insurance system would avoid thousands of needless deaths, and hundreds of thousands of medical bankruptcies each year. In 1971, Congress almost passed national health insurance. Since then, at least 630,000 Americans have died because they failed to act. (18,000 people die each year because of lack of access to health care). “How much longer must we wait?”

We spend twice as much per person for health care in the United States as they do in Canada (in Massachusetts we spend almost three times as much), yet as the recent comparative study shows, we get much less for our health care dollar than our neighbor to the north. The percentage of the U.S. gross domestic product used for health care is almost double what is spent in Canada, taking away funds from other vital services in the U.S, like education. Yet our life expectancy is 2.5 years less in the United States, and the incidence of chronic illness is higher.

Last month, former president Bill Clinton was in Canada speaking at the World Leaders Forum. Responding to a question about the interest of some in Canada for privatization of their health care system, Clinton said the last thing they should do is “let the health care finance tail wag the health care dog.” He said our system is a mess because the U.S. spends 34 percent of its health care dollar ($280 billion) on administration “to pay two million people to go to work every day for all the providers and insurers, and play tug of war. It is insane. It is a colossal waste of money. Don’t go down that road.”

By contrast, our Medicare system spends 3 percent for administrative costs.

I was at the Democratic Convention last weekend, staffing a table for Physicians for a National Health Plan (PNHP), a group of 14,000 physicians who advocate for a single-payer health care system. Single-payer health care is just like the Canadian system, in which the government is the “single payer” for health care, eliminating the multiple insurance companies with their exorbitant profits and high administrative costs.

In Massachusetts, 62 percent of physicians have said they support single-payer. The movement for significant health care reform is growing. The extraordinarily flawed health care “reform” bill recently passed in Massachusetts will maintain our current system, which is much more expensive than Canada’s and leaves us sicker.

A change to a single-payer system is the only reform that will provide universal, affordable and comprehensive care, as well as contain rising health care costs. This is not an experiment. We have only to look to Canada to see that they not only do it cheaper, they do it better; with a healthier population that lives longer than we do.

Health-care reform is more urgent than ever

By John A. Ameriks, MD Health policy analyst
Las Cruces Sun-News

The U.S. population will rise above 300 million this year, and health care expenditures are projected to exceed $2.1 trillion. Simple arithmetic leads to the alarming realization that the price of health care in 2006 will be $7,000 for each American. Yet the Senate has failed to take up health reform and our governor vetoed funding for a similar effort in New Mexico.

Few will see the entire $7,000 taken from personal savings or paychecks. The more fortunate and healthy half of the population have small medical expenses in any given year, a circumstance that helps to insulate them from the “up close and personal” experience of health-care sticker shock. And historically only 20 percent of the population is sick enough to use 80 percent of the money, while the sickest 1 percent account for 22 percent of all expenses in the average year. The odds are that you and I are not likely to fall into the 20 percent or 1 percent this year; but the lifetime odds are that eventually we will.

So how do we respond to a problem that absorbs 16 percent of the dollars spent in our country and will demand 20 percent of the gross domestic product by 2015? The suggestions to be heard on the campaign trail will include personal choice, individual responsibility, health savings accounts and consumer-directed plans. Yet none of these provide sufficiently for the costs incurred by us when illness expenses overwhelm our personal economic resources. Simply put, the politically opportune solutions aren’t applicable.

Reforming health care is a troubling prospect. The only group unquestionably in favor is the 16 percent uninsured segment of the population. The remaining 84 percent with current access to insurance view reform with anxiety. They fear losing their existing level of protection or increasing the cost of what they presently have. And they remain unaware that a stealth version of insurance reform is already occurring by the introduction of higher deductibles, increased co-pays, limits on employer contributions and restrictions on provider choice. Yes, even those insured are gradually, and in many cases unknowingly, becoming underinsured. The discomforting truth is that most of us have already lost this game; but few have yet experienced the pain.

This is an election year, and voters have increasing reason to demand meaningful health care reform. We should not be diverted from that demand by the delaying tactic of promises to reform health care once the candidate discovers a uniquely American way to do it. Profound change of our health-care system is not only inevitable but desirable. We do not suffer from distinctly American diseases that require strictly American treatments. While there is no perfect health-care system on this planet, the systems in France, Japan, Germany and the Scandinavian countries are cheaper, provide universal coverage and result in easier access and better outcomes. These are the same countries whose automobiles and electronics appear to be cheaper, better built and more fuel efficient than the domestic choices. We can learn from them. The United States stands alone in not providing health care to all its citizens; and because of that policy, America is finally encountering economic disadvantage in world markets. Without change, this will remain our fate. Our market-based approach has failed to deliver on its promises to provide higher quality at lower cost.

Health-care reform makes greater economic and common sense than ever. It need not cost more than we are already spending; and reform of the entire system offers the only realistic path to future cost containment. In a world with open borders and global economic competition the involvement of elected officials in this issue is unavoidable and even desirable. Under these circumstances the public has every right to know the candidates’ position on health care. We should not give them a pass in 2006. The lives and dollars we save will be our own.

John Ameriks, a retired physician who lives in Las Cruces, is a health policy analyst for the New Mexico chapter of Physicians for a National Health Program, a national advocacy group.

Paul Krugman speaks on Single Payer and HR 676

Listen here: http://archive.wbai.org/pls.php?mp3fil=6207

Paul Krugman

New York Times columnist and Princeton University economics professor Paul Krugman spoke May 30 at an event sponsored by the NY Chapter of Physicians for a National Health Program (PNHP). His talk was entitled “A Prescription for U. S. Health Care”. Krugman is one of the nation’s leading liberal columnists and a proponent of a Single Payer/Medicare For All health care system.

“Building Bridges” a weekly radio program of WBAI-FM broadcast the talk on June 5. The radio show starts with a short Jazz interlude.

It can be found at: http://archive.wbai.org/pls.php?mp3fil=6207

The music that follows Krugman’s speech is Anne Feeney singing “We Need National Health Care Now” (www.annefeeney.com) from her “Union Maid” CD.

HR 676 now has 70 congressional co-sponsors in addition to John Conyers, Jr. (D-MI). 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 143 union organizations including 25 central labor councils, two state AFL-CIO’s (KY and PA), and two area labor federations.

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

Need for single-payer health care growing

The list of reasons why the current system and its attempted fixes are failing grows longer

MAINE VOICES: Richard Dillihunt, M.D.
Wednesday, May 17, 2006

Six years ago I wrote here favoring a national single-payer health care system.

Since then, little has changed – and given the content of President Bush’s State of the Union address and subsequent campaigning, it seems that nothing positive can be expected from this administration.

Shame on us for allowing 47 million people to go without health insurance and countless others to be underinsured. Meanwhile, health care costs inflate in a category by themselves – well above the general inflation rate.

Some facts that might clarify this problem:

We are the only major nation without government insurance.

According to the World Health Organization, we do not have the best health care in the world – we are far down the list.

An authoritative article in the New England Journal of Medicine on March 6 discloses that, on average, Americans get mediocre care.

The cost of medical care per capita here is much higher than in other nations.

The people of Canada for example are happy with their relatively inexpensive system – despite propaganda to the contrary.

The new federal drug benefit program is poorly understood, unwieldy and fashioned to enrich drug companies.

The public relations efforts of the insurance and drug companies have succeeded in scaring average Americans away from single payer through an enormous expenditure on advertising and lobbying.

Family bankruptcy is most commonly related to healthcare debt, and now big corporations such as the automotive industry may suffer this fate.

Polls show that the majority of our population and their physicians support national health insurance.

Programs such as Dirigo are stop-gap initiatives serving few in need and engulfed in controversy. The insurance and drug companies must relish this diversion while lining up at the trough.

Activists usually favoring universal health care and single-payer coverage have compromised their goals by supporting Dirigo – perhaps feeling a few slices are better than a loaf that is still out of reach.

The new “solution’ offered by the governor in Massachusetts has a fatal flaw – no money.

Our government already demonstrates its administrative ability by paying over 50 percent of our entire health care costs.

Virtually everyone opposing single-payer already has insurance and is not faced with inadequate coverage.

Remember we are talking about nonprofit government-administered insurance here – not socialized medicine where all caregivers are employed by the government.

What of the new “solutions” being offered? Health Savings Accounts are another in a long line of inadequate fixes.

They would spawn a new layer of bureaucracy leading to more personal debt, with high interest rates suggesting predatory lending to the sick. Shifting costs to workers results in higher deductibles – discouraging needed care.

Tax credits to help buy coverage are meager and would not cover even the skimpiest plans. Only the wealthy would benefit significantly.

We cannot expect states to handle this national problem individually for the same reasons that we do not have 50 armies. Imagine the confusion in moving from state to state.

Let’s try a single-payer system and call it ” Universal Medicare.” How does it work? You pay premiums according to wealth and income – like a graduated tax.

You seek care as usual – giving your Social Security number to enter the system. Marketplace factors decide how care is dispersed. A warm relationship develops with your caregivers. You smile at your pharmacist.

Winston Churchill said “Americans will always do the right thing – after they’ve exhausted all alternatives.” We can hope we are nearly there.

About the Author: Richard Dillihunt, M.D. (e-mail: dillihunt8@aol.com) is a resident of Portland.

– Special to the Press Herald

Fix health care. Give Medicare to Everyone

Click here to read PNHP Executive Director Ida Hellander’s Spring 2003 Ms. Magazine article. (pdf file)

Canadians Healthier than Americans, Study Finds

By Maggie Fox, Health and Science Correspondent
May 30, 2006

WASHINGTON, May 30 (Reuters) – Despite complaints about long waits for services, Canadians are healthier than their U.S. neighbors and receive more consistent medical care, according to a report released on Tuesday.

A telephone survey of more than 8,000 people showed that even though Americans spend nearly twice as much per capita for health care, they have more trouble getting care and have more unmet health needs than Canadians do.

The survey was done by Harvard Medical School researchers who include members of Physicians for a National Health Program, which advocates for a national health program in the United States.

“These findings raise serious questions about what we’re getting for the $2.1 trillion we’re spending on health care this year,” said Dr. David Himmelstein, an associate professor of medicine at Harvard.

“We pay almost twice what Canada does for care, more than $6,000 for every American, yet Canadians are healthier, and live two to three years longer,” Himmelstein added in a statement.

“Canadians had better access to most types of medical care (with the single exception of pap smears),” Himmelstein and colleagues wrote in the study, published in the American Journal of Public Health.

“Canadians were 7 percent more likely to have a regular doctor and 19 percent less likely to have an unmet health need. U.S. respondents were almost twice as likely to go without a needed medicine due to cost (9.9 percent of U.S. respondents couldn’t afford medicine versus 5.1 percent in Canada),” they added.

UNMET NEEDS

“After taking into account income, age, sex, race and immigrant status, Canadians were 33 percent more likely to have a regular doctor and 27 percent less likely to have an unmet health need.”

The researchers analyzed data from a telephone survey of 3,505 Canadian and 5,103 U.S. adults.

They wanted to see if there were any differences in health between Canadians, who have a tax-supported national health care system, and Americans, whose health care largely depends on private insurers, employers or the free market, with older Americans and the very poor cared for by Medicare, Medicaid and other joint federal-state health insurance plans.

The researchers found that U.S. residents had higher rates of diabetes, arthritis, chronic lung disease, high blood pressure and obesity.

“Most of what we hear about the Canadian health care system is negative; in particular, the long waiting times for medical procedures,” Dr. Karen Lasser an instructor of medicine at Harvard who worked on the study, said in a statement.

“But we found that waiting times affect few patients, only 3.5 percent of Canadians versus 0.7 percent of people in the U.S. No one ever talks about the fact that low-income and minority patients fare better in Canada,” she added.

“Based on our findings, if I had to choose between the two systems for my patients, I would choose the Canadian system hands down.”

The researchers said the study population was representative of 206 million U.S. adults and 24 million Canadian adults but noted that only half the Americans contacted took part in the survey, and 60 percent of the Canadians.

Healthcare-NOW Calls "National Healthcare Action Day" June 7th (6-7-06)

June 7th (6-7-06)

Healthcare-NOW, a national coalition of community, faith based, and labor groups has called for local actions on June 7th in support of HR 676 the “United States National Health Insurance Act” introduced by Congressman John Conyers (D-Mich). The date was chosen to correspond with the bill’s number, HR 676.

Coast to coast actions include picketing Blue Cross offices (Pittsburgh), press conferences outside the offices of the two remaining Massachusetts congressmen who are not yet co-sponsors of the bill (Boston), a news conference to announce a campaign to get eight city councils to endorse HR 676 (St. Louis), noon rally in Rodney Square in Wilmington, DE, plus leafleting, the showing of a specially made video “Don’t Be A Chicken” and much more in communities across the country.

To find the action near you, obtain the video, or a complete list of nationwide activities, go to www.healthcare-now.org or call 1-800-453-1305.

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HR 676 has been endorsed by 143 union organizations including 25 central labor councils, two state AFL-CIO’s (KY and PA), and two area labor federations.

Study: Canadians Healthier Than Americans

By MIKE STOBBE
Associated Press Writer
May 30, 2006, 10:53 PM EDT

ATLANTA — You can add Canadians to the list of foreigners who are healthier than Americans. Americans are 42 percent more likely than Canadians to have diabetes, 32 percent more likely to have high blood pressure, and 12 percent more likely to have arthritis, Harvard Medical School researchers found. That is according to a survey in which American and Canadian adults were asked over the telephone about their health.

The study comes less than a month after other researchers reported that middle-aged, white Americans are much sicker than their counterparts in England.

“We’re really falling behind other nations,” said Dr. Steffie Woolhandler, a co-author of the Canadian study.

Canada’s national health insurance program is at least part of the reason for the differences found in the study, Woolhandler said. Universal coverage makes it easier for more Canadians to get disease-preventing health services, she said.

James Smith, a RAND Corp. researcher who co-authored the American-English study, disagreed. His research found that England’s national health insurance program did not explain the difference in disease rates, because even Americans with insurance were in worse health.

“To me, that’s unlikely,” he said of the idea that universal coverage explains international differences.

Woolhandler said her findings were different in at least one important respect: In the Canadian study, insured Americans and Canadians had about the same rates of disease. It was the uninsured Americans who made the overall U.S. figures worse, she said.

The study, released Tuesday, is being published in the American Journal of Public Health. It is based on a telephone survey of about 3,500 Canadians and 5,200 U.S. residents in 2002-03. Those surveyed were 18 or older.

The results are based on what those surveyed said about their health. In contrast, the researchers in the American-English study surveyed participants and also examined people and conducted laboratory tests on them.

The new study found that 6.7 percent of Americans and 4.7 percent of Canadians reported having diabetes; 18.3 percent and 13.9 percent, respectively, reported having high blood pressure; and 17.9 percent and 16.0 percent said they had arthritis. The Americans also reported more heart disease and major depression, but those difference were too small to be statistically significant.

About 21 percent of Americans said they were obese, compared with 15 percent of Canadians. And about 13.5 percent of the Americans admitted to a sedentary lifestyle, versus 6.5 percent of Canadians. However, more Canadians were smokers — 19 percent, compared with about 17 percent of Americans.

About 42 percent of the Americans rated their quality of health care as excellent, while 39 percent of Canadians did.

Also, 92 percent of American women said they had a Pap test within the last five years, while 83 percent of Canadian women had. But Canadians have lower death rates from cervical cancer. “It’s a little hard to interpret,” Woolhandler said.

One more plus for the Americans: Fewer than 1 percent said they were unable to get needed care because of long waits, compared with 3.5 percent of Canadians.

However, about 80 percent of Americans had a regular doctor, while 85 percent of Canadians did. And nearly twice as many Americans said there were medicines they needed but couldn’t afford (9.9 percent versus 5.1 percent).

Study shows U.S. residents are less healthy, less able to access health care than Canadians

EMBARGOED UNTIL: May 30, 2006 – 4:00 PM EST

Contacts: Steffie Woolhandler, M.D. 617-497-1268, 671-312-2766
David Himmelstein, M.D. 617-665-1032, 617-312-0970
Nick Skala 312-782-6006

U.S. residents are less healthy, less able to access health care than Canadians

Universal coverage appears to reduce healthcare inequalities

A study by Harvard Medical School researchers in the July, 2006 issue of the American Journal of Public Health finds that U.S. residents are less healthy than Canadians. Moreover, despite spending nearly twice as much per capita for health care, U.S. residents experience more problems getting care and more unmet health needs.

The study analyzes the Joint Canada-U.S. Survey of Health, the first-ever cross national health survey carried out by the two nations’ official statistics agencies. The authors found that U.S. residents were less healthy than Canadians, with higher rates of nearly every serious chronic disease examined in the survey, including diabetes, arthritis, and chronic lung disease. U.S. residents also had more high blood pressure (18% of U.S. residents versus only 14% for Canadians). U.S. rates of obesity and sedentary lifestyle were higher; with 21% of U.S. respondents reporting obesity versus 15% of Canadians. However, U.S. residents were slightly less likely to smoke.

Canadians had better access to most types of medical care (with the single exception of pap smears). Canadians were 7% more likely to have a regular doctor and 19% less likely to have an unmet health need. U.S. respondents were almost twice as likely to go without a needed medicine due to cost (9.9% of U.S. respondents couldn’t afford medicine vs. 5.1% in Canada). After taking into account income, age, sex, race and immigrant status, Canadians were 33% more likely to have a regular doctor and 27% less likely to have an unmet health need. For each of these measures, the average Canadian did about as well as insured U.S. residents.

Race and income disparities, although present in both countries, were larger in the U.S. Nonwhites were more likely than whites to have an unmet health need in the U.S. (18.6% vs. 11.1%); while in Canada they were not (10.8% vs. 10.2%). Notably, both white and non-white Canadians had fewer unmet health needs than white U.S. residents. After taking into account income, age, sex, race and immigrant status, poor U.S. residents (making less than $20,000 per year) were 2.6 times less likely to have a regular doctor than the affluent ( those making $70,000 or more). In Canada, the poor were only 1.7 times less likely.

In the U.S., cost was the largest barrier to care. More than seven times as many U.S. residents reported going without needed care due to cost as Canadians (7.0% of U.S. respondents vs. 0.8% of Canadians). Uninsured U.S. residents were particularly vulnerable; 30.4% reported having an unmet health need due to cost.

Lead author Dr. Karen Lasser, primary care doctor at Cambridge Health Alliance and Instructor of Medicine at Harvard commented, “Most of what we hear about the Canadian health care system is negative; in particular, the long waiting times for medical procedures. But we found that waiting times affect few patients, only 3.5% of Canadians vs. 0.7% of people in the U.S. No one ever talks about the fact that low-income and minority patients fare better in Canada. Based on our findings, if I had to choose between the two systems for my patients, I would choose the Canadian system hands down.”

“These findings raise serious questions about what we’re getting for the $2.1 trillion we’re spending on health care this year,” said Dr. David Himmelstein, Associate Professor of Medicine at Harvard and study co-author. “We pay almost twice what Canada does for care, more than $6,000 for every American, yet Canadians are healthier, and live 2 to 3 years longer.”

Dr. Steffie Woolhandler, also an Associate Professor of Medicine at Harvard and study coauthor, commented: “Our study, together with a recent study showing that people in England are far healthier than Americans, is a terrible indictment of the U.S. healthcare system. Universal coverage under a national health insurance system is key to improving health. It’s striking that both whites and non-whites do better in Canada. A single-payer national health insurance system would avoid thousands of needless deaths and hundreds of thousands of medical bankruptcies each year. In 1971, Congress almost passed national health insurance. Since then, at least 630,000 Americans have died because they failed to act. How much longer must we wait?”

The study used data from the Joint Canada/U.S. survey of Health (JCUSH), conducted jointly by Statistics Canada (the Canadian counterpart to the U.S. Census Bureau) and the U.S. National Center for Health Statistics. The JCUSH surveyed 3,505 Canadians and 5,183 U.S. residents between November 2002 and March 2003 in order to gauge health status, rates of illness, behavioral risk factors, use of health care, and access to health care services in the two counties.

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Embargoed copies of the study are available to the press at: https://pnhp.org/canadastudy/
(Please call 312-782-6006 or email nick@pnhp.org for password)

Physicians for a National Health Program is an organization of 14,000 physicians that support single-payer national health insurance. PNHP is headquartered in Chicago and has chapters and spokespeople across the U.S. To contact a physician-spokesperson in your area, contact nick@pnhp.org or call 312-782-6006. www.pnhp.org.

Read the study (pdf)

PDF version of press release (pdf)

USW's Gerard Speaks on Union Action, Single Payer Health Care and HR 676

Link: http://www.dc37.net/news/radioshows/radioshows.html

We are pleased to be able to make available a far reaching talk by Leo Gerard, International President of the United Steelworkers (USW) delivered May 18th in New York City at an event sponsored by the Central Labor Council and other progressive organizations.

Gerard’s speech, “The Labor Movement and United Action for Health Care for All,” is an important statement by the leader of America’s largest industrial union.

A shortened version of the full speech was broadcast on the weekly radio show of AFSCME District Council 37 produced by Ken Nash on WNYE.

HR 676 has been endorsed by 141 union organizations including 24 central labor councils, two state AFL-CIO’s (KY and PA), and two area labor federations.

The World Bank report on health financing

Health Financing Revisited: A Practitioner’s Guide
The World Bank
May, 2006

This report provides an overview of health financing policy in developing countries. It is a primer on major health financing and fiscal issues, intended to assist policy makers and all other stakeholders in the design, implementation, and evaluation of effective health financing reforms. The health sector is an extremely complex one, and reformers must be prepared to deal with its complexities when designing and implementing health policy reforms.

Learning from high-income countries

High-income countries have a rich history of health financing reforms as their systems have evolved from community-based voluntary insurance arrangements to formal public insurance funds to social or national health insurance-based financing systems. Nearly all high-income countries, with the exception of the United States, have achieved universal or near universal health coverage. The tax-financed systems have been in place for some time, the social insurance systems more recently. Political will was critical to achieving universal coverage, along with economic growth. As most high-income countries have achieved universal coverage, recent reform activities have tended to focus on efficiency gains through purchasing arrangements, rather than on revenue collection and pooling.

Although high-income countries operate in very different contexts from low-income countries, their experiences furnish some lessons for lower-income countries:

* Economic growth is the most important factor in the move toward universal coverage.

* Improved management and administrative capacity is critical in expanding coverage, as is strong political commitment.

* For low- and middle-income countries transitioning to universal coverage, general revenues and social health insurance contributions are the two principal sources of public funding. Both accumulate public revenues into one or several pools. Because the critical issue is pooling, whether a social health insurance or national health service system is ultimately chosen is of secondary importance.

* Voluntary and community-based financing schemes can serve as tests for countries as they seek to expand the role of prepaid health coverage schemes.

* Broader risk pooling mechanisms, instead of fragmented, smaller risk pools, can contribute significantly to effective and equitable financing of health coverage.

Products and services must be evaluated for their effectiveness and cost-effectiveness within the context of particular countries’ coverage systems. To facilitate the affordability of such efforts, cooperation among similar countries should be encouraged, possibly led by one or more international organizations.

http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTHEALTHNUTRITIONANDPOPULATION/EXTHSD/0,,contentMDK:20200211~menuPK:376811~pagePK:148956~piPK:216618~theSitePK:376793,00.html

Comment:

By Don McCanne, M.D.

As developing countries design and implement their health financing policies, they can learn from high-income countries… “with the exception of the United States.”

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Comment:

June 7th (6-7-06)

U.S. residents are less healthy, less able to access health care than Canadians

Universal coverage appears to reduce healthcare inequalities

Comment:

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