By Liza Featherstone
The Nation

Today marks the premiere of Robert Greenwald’s documentary Wal-Mart: The High Cost of Low Price, and Wal-Mart is ready with a “war room” led by Robert McAdam, who is, charmingly, the former strategist for the tobacco industry.

Wal-Mart’s spin machine is being sorely tested. Just last week, a secret internal memo recommending that the company curb healthcare costs by “dissuad[ing] unhealthy people from coming to work at Wal-Mart” was leaked to the advocacy group Wal-Mart Watch. The memo’s suggestions included designing “all jobs to include some physical activity (e.g., all cashiers do some cart-gathering).” This amounts to nothing less than a plan to discriminate against the disabled, sick and elderly. It’s contemptible, of course, but it also has serious legal implications; Wal-Mart has been forced to settle lawsuits from disabled workers in the past, and this memo will almost definitely strengthen the case of any who wish to sue the company in the future.

In the memo, whose contents were first revealed in the New York Times, Wal-Mart admits that criticism of its meager, unaffordable healthcare plan is contributing to the decline of Wal-Mart’s overall reputation and that “our critics are correct in some of their observations…our coverage is expensive for low-income families, and Wal-Mart has a significant percentage of Associates and their children on public assistance.” The memo acknowledges that 46 percent of Wal-Mart workers’ children are either on Medicaid or uninsured.

It’s very clear that criticism and public pressure are bothering Wal-Mart’s leaders. So far, they are mostly investing in spin and devising harebrained–and inhumane–schemes like those outlined in the memo. But the same memo does contain a glimmer of hope that the company could respond to pressure by doing something good–in particular, a suggestion that the company “refram[e] the debate” on healthcare, emphasizing that “this is everybody’s problem, not just Wal-Mart’s” and “establishing Wal-Mart as a leader on this critical issue.” We couldn’t agree more. The best way for Wal-Mart to curb its healthcare costs–and improve its image–would be to lobby for single-payer national health insurance; for its activist critics, all this pressure on the company to improve its health benefits should be a means to that end.

As unrealistic as that might sound–after all, Wal-Mart is a right-wing company, whose campaign contributions tend to favor antigovernment Republicans, not European-style social democracy–there is no telling what people might do when under enough political and economic pressure.

A recent study commissioned by Wal-Mart showed that from 2 percent to 8 percent of its customers had stopped shopping there because of “negative press.” All of this is having some surprising effects, including unpredictable policy recommendations from the company’s leadership.

Last week, CEO Lee Scott called for increasing the minimum wage, a suggestion that drew howls of wounded betrayal from the company’s usual defenders on the Wall Street Journal editorial page, but which Scott rightly pointed out would help the company’s customers, many of whom are low-wage workers. National health insurance would do the same, while allowing the company to save money on benefits–and on spin.

Paying former tobacco lobbyists to convince the public that Wal-Mart is a good corporate citizen is going to get expensive.

This article can be found on the web at:

http://www.thenation.com/doc/20051121/wal-mart_nation

Survey Says U.S. Patients Pay More, Get Less Than Those in Other Western Nations
By Rob Stein
Washington Post Staff Writer
Friday, November 4, 2005;

Americans pay more when they get sick than people in other Western nations and get more confused, error-prone treatment, according to the largest survey to compare U.S. health care with other nations.

The survey of nearly 7,000 sick adults in the United States, Australia, Canada, New Zealand, Britain and Germany found Americans were the most likely to pay at least $1,000 in out-of-pocket expenses. More than half went without needed care because of cost and more than one-third endured mistakes and disorganized care when they did get treated.

Although patients in every nation sometimes run into obstacles to getting care and deficiencies when they do get treated, the United States stood out for having the highest error rates, most disorganized care and highest costs, the survey found.

“What’s striking is that we are clearly a world leader in how much we spend on health care,” said Cathy Schoen, senior vice president for the Commonwealth Fund, a private, nonpartisan, nonprofit foundation that commissioned the survey. “We should be expecting to be the best. Clearly, we should be doing better.”

Other experts agreed, saying the results offer the most recent evidence that the quality of care in the United States is seriously eroding even as health care costs skyrocket.

“This provides confirming evidence for what more and more health policy thinkers have been saying, which is, ‘The American health care system is quietly imploding, and it’s about time we did something about it,’ ” said Lucian L. Leape of the Harvard School of Public Health.

The new survey, the eighth in an annual series of cross-national surveys conducted by Harris Interactive for the fund, is the largest to examine health care quality across several nations during the same period. The survey was aimed at evaluating care across varying types of health care systems, including the market-driven U.S. system and those that have more government controls and subsidies.

The survey, published in the journal Health Affairs, questioned 6,957 adults who had recently been hospitalized, had surgery or reported health problems between March and June of this year.

“These patients are the canary in the coal mine of any health care system,” Schoen said.

Nearly a third of U.S. patients reported spending more than $1,000 in out-of-pocket expenses for their care, far outpacing all other nations. Canadians and Australians came next, with 14 percent of patients spending that much. The proportion reporting similarly high costs was far lower in the other countries.

Americans had the easiest access to specialists, but they experienced the most problems getting care after hours, and Americans and Canadians were the most likely to report problems seeing a doctor the same day they sought one.

Americans were also much more likely to report forgoing needed treatment because of cost, with about half saying they had decided not to fill a prescription, to see a doctor when they were sick or opted against getting recommended follow-up tests. About 38 percent of patients in New Zealand reported going without care; the numbers were 34 percent in Australia, 28 percent in Germany, 26 percent in Canada and 13 percent in Britain.

“If that’s not a reason for moral outrage, I don’t know what is,” Leape said. About one-third of U.S. patients reported problems with the coordination of their care, such as test results not being available when they arrived at a doctor’s appointment or doctors ordering duplicate tests. In the other countries, 19 to 26 percent of patients reported similar problems.

Americans also reported the greatest number of medical errors. Thirty-four percent reported getting the wrong medication or dose, incorrect test results, a mistake in their treatment or care, or being notified late about abnormal test results. Only 30 percent of Canadian patients, 27 percent of Australian patients, 25 percent of New Zealanders, 23 percent of Germans and 22 percent of Britons reported errors.

“The findings show that we have a lot to learn from our colleagues” in other countries, said Carolyn Clancy of the federal Agency for Healthcare Research and Quality during a briefing at which the results were released. She said the federal government has launched a number of initiatives to find ways to improve care, particularly for the increasing number of Americans with chronic illness.

“The findings here reinforce how difficult it is coordinating care. . . . That’s the next frontier,” Clancy said.

Fewer workers each year receive health insurance from their employers
By Ron Gettelfinger
Special to The Detroit News
Friday, November 4, 2005

In recent weeks, members and retirees of our union have confronted a new set of challenges in the field of health care.

The roots of this problem, however, are hardly new. As Walter Reuther said during an address to the American Public Health Association in 1968:

“We must first free ourselves of the illusion that we really have a health care system in America. What we have is a disorganized, disjointed, antiquated, obsolete non-system of health care. Consumers are being required to subsidize a non-system that fails to deal with their basic health care needs and the cost of that system is continuing to skyrocket.”

Unfortunately, the problems have only become more serious in the intervening years. We now have nearly 46 million Americans — including more than 8 million children — with no health insurance at all.

Current system is wasteful

The U.S. has the best doctors, nurses and health care professionals anywhere in the world. But they are hindered by an ineffective, wasteful bureaucratic system. Our nation spends approximately $1.7 trillion, or 15.4 percent of our gross domestic product, on health care. Four hundred billion of this sum is absorbed by the cost of paperwork and administration.

Additionally, prescription drugs cost more in the United States than in any other country. One reason for these high costs is that pharmaceutical companies spend more than any other industry on lobbying, with more than 1,200 lobbyists in Washington. These lobbyists are doing well for their employers, crafting laws and regulations to protect an industry which earns tens of billions in profits each year. But what are they accomplishing for the rest of us?

For all our health care spending, the United States ranks near the bottom among industrialized countries on life expectancy, infant mortality and virtually every other measure. In fact, the infant mortality rate in our nation’s capital is more than double the infant mortality rate in Beijing.

America deserves better.

Fewer workers covered

Our health care is based on employment, but each year, fewer employers are providing company sponsored insurance. The figure is now down to 60 percent, a decline from 69 percent in 2000. Members of our union have learned through hard experience that relying on individual employers to provide health care is inefficient and a drag on our ability to compete in the global economy.

At General Motors, for example, we recently negotiated an agreement intended to preserve the company’s ability to provide affordable health care for workers and retirees for many years to come. During this process, we had to confront GM’s staggering $61 billion liability for the cost of present and future UAW retiree health care.

Foreign firms have advantage

Global auto companies like Toyota, Honda and Volkswagen have little or no liability for retiree health care because in industrialized nations outside the United States, health insurance is a government responsibility.

With universal health insurance, no employer gains an advantage by offering lower benefits or passing higher costs onto workers. Does it make any sense for the United States to continue on a policy course — employer-based health care — which delivers inferior care to our citizens and gives foreign manufacturers a cost advantage worth tens of billions of dollars over U.S. companies that employ U.S. workers?

To be sure, no government policy will help a company that can’t make products consumers want to buy. But a modern, competitive national health insurance system would go a long way toward helping U.S. manufacturers make products at affordable prices. We need a uniquely American system, not one that tries to copy a solution from a different country. A workable American plan would be universal, covering every single man, woman and child in the United States. It would be comprehensive, offering a range of medical benefits for workers and families. And it would have only a single payer, creating the leverage needed to negotiate the cost of medical care and keep prices from rising every year.

We’ve heard time and again that national health insurance might be a good idea, but it’s not politically possible in the United States at the present time. One thing is for sure: it’s not possible to ignore our current health care crisis any longer. American workers — and American employers — can’t afford it.

http://www.detnews.com/2005/editorial/0511/04/A15-371331.htm

Ron Gettelfinger is president of the United Auto Workers union.

By Michael R. Huckleberry
Midland Daily News
10/30/2005

The recent announcement regarding General Motors plan to cut back on health care came as no surprise. The only thing America seems to “win” lately is the “race to the bottom.” Didn’t anyone realize that when “big business” started to outsource our jobs to countries that pay workers so little they cannot buy the products they make this would be inevitable? Big business has not created a trading partner that would bolster our own economy … they turned the “American Dream into the American Nightmare.”

As a small business owner I have no problem understanding that people need good paying jobs with benefits to support their families, small business, and of course, this nation. It is my hope that as we “win this race to the bottom” that my “brothers and sisters” in the business world realize what is happening to them and it isn’t good.

Corporate greed has put our entire nation in danger, and now it is starting to catch up with some of the “big businesses” that helped lead us to this dire situation. We, as a nation of entrepreneurs, skilled laborers, farmers and middle management, are being punished for leading the world in building a strong middle class. Trade agreement that only benefit a few and do not build profitable trade partners will only hasten our “race to the bottom”

There may be a solution to this free fall. First we must vote out of office those who have supported these trade agreements. They are like “Economic Suicide” and our legislators know this! They either have investments in companies that outsource, or they receive large contributions from them, or both.

Second, it is time to get serious about “single payer health insurance”. We simply cannot continue to be in denial about our current health care system. It is a national disgrace. This country has over 45 million people with no health care insurance. High insurance rates are crippling our employers, making it difficult to compete in the current global economy. Of 19 industrialized nations America is the only one without a single payer health care system. It is reported that about 18,000 people died last year in America because they had no insurance. That makes it a moral issue as well. Health savings accounts, and AHP’s and other “gimmicks” that are being promoted by some legislators don’t cut it. Some are being promoted because, once again, of heavy contributions and stock ownership. Who is against single payer health insurance? … insurance companies, drug companies, politicians who benefit, and the extreme right who scream “socialized medicine”.

We are not talking about socialized medicine, we are talking about saving America with an insurance program that is fully funded. The “far right” fought us every step of the way when we wanted Social Security, Medicare, and Medicaid. When we finally got them, we shared them with everyone. I am sure someone in your family has benefited from these insurance programs. These programs have kept us from having a third world standard of living, and they work well when properly managed and funded.

This new prescription section of the Medicare bill that the “far right” has imposed on us has no provision to pay for it and no provision to negotiate for lower drug prices. That is socialized medicine, and more debt for our nation. Who’s tax dollars are they looking out for?

I believe that “single payer health insurance” is the number one way to kick start our economy.

We must act now, as our nation’s future depends on it.

Michael R. Huckleberryis a candidate for 4th District U.S. House. He lives in Greenville.

Health Care Economics
By Rich Daly
Psychiatric News
October 21, 2005
Volume 40, Number 20, page 16
© 2005 American Psychiatric Association

A study finds the largest number yet of Americans struggling with medical bills and medical debt. The burden deters many from seeking preventive care and chronic disease treatment.

Nearly one-third of working-age Americans struggle to pay their medical bills, according to a recent report, with African Americans and women the most financially strained.

A recently released analysis of the 2003 Commonwealth Fund Biennial Health Insurance Survey concluded that an estimated 77 million adult Americans-both insured and uninsured-have difficulty paying medical bills, have accrued medical debt, or both. The latest findings support the conclusions of earlier studies that have found medical debt to be a significant problem, even for those with health insurance (Psychiatric News, March 18).

“Medical bill and debt problems not only create financial hardship but can deter people from seeking further health care,” said Michelle McEvoy Doty, Ph.D., a study author and senior analyst at the Commonwealth Fund. “In the long run that situation puts a bigger burden on the health care system because you are missing out on preventive medicine and not managing chronic conditions.”

Working-age adults are much more likely to face medical bill problems than Americans aged 65 and older, since pensions and Medicare offer protections for older Americans. The survey found that nearly one-third of the working-age respondents (32 percent) reported struggles with medical bills, while just 14 percent of elderly respondents reported the same. Medical debt was reported by 16 percent of working-age adults compared with 4 percent among adults over 64 years old.

Doty said the larger impact of medical bills on working-age adults stems from private insurers’ “much more fragmented” approach to coverage, compared with Medicare’s “very reliable” assistance in paying medical bills.

The challenge for working adults trying to pay for health care was even greater than for seniors among those with low incomes. The report found that 48 percent of low-income, working-age adults reported medical bill problems in the 12 months prior to the survey, while only 20 percent of low-income seniors reported such problems.

Working-age women were strongly impacted by the cost of medical care, and 39 percent reported medical bill problems, compared with 25 percent of men.

The survey found that 52 percent of African Americans reported medical bill problems, in contrast to 34 percent of Hispanics and 28 percent of whites, according to the report.

The data stem from a national telephone survey conducted from September 3, 2003, through January 4, 2004, among a random, nationally representative sample of 4,052 U.S. adults. The survey had a 50 percent response rate.

Access Under Increasing Threat

Health care reform advocates, such as Physicians for a National Health Program (PNHP), said the data support long-held beliefs that the rising cost of health care reduces access to that care, especially among working-age Americans, who lack the Medicare or pension coverage that buffers costs for older Americans.

“Though some protection for the retired is afforded by pension funds, the much larger incomes of the workforce are not adequate to compensate for the deficiencies of private coverage,” according to a statement on the results issued by PNHP, which advocates a national, single-payer health system. “Obviously a universal Medicare program with expanded benefits would be much more effective in preventing medical debt.”

Crisis Acute for Uninsured

Those without health insurance coverage during the study period had significantly higher rates of medical bill problems and debt (60 percent) than did the continuously insured (35 percent).

Rates of medical bill problems for the uninsured were more than twice those of the insured, with 35 percent of those without insurance at some point in the year contacted by collection agents compared with 15 percent of the continuously insured.

However, the possession of health insurance was not enough to prevent large numbers of Americans from incurring a large burden of medical debt. Researchers found that 57 percent of adults with medical bill problems and 70 percent with medical debt were insured at the time their financial obligation was incurred.

“As employers continue to pass on health care costs to their employees, you are going to see more people struggling with their medical bills and accruing debt,” Doty said.

A survey of 1,800 firms released in September by Mercer Human Resources Consulting found more employers are struggling with ways to cover what is expected to be a nearly 10 percent increase in health insurance costs for 2006 and plan to shift more of the burden of paying for medical care to their employees. Despite the expected 10 percent increase, employers polled plan to increase their spending by only 6.4 percent and have their employees make up the difference.

Medical bill problems and inadequate insurance, said the Commonwealth survey analysis, were also linked by inadequate or absent prescription drug coverage. Nearly half of working-age adults without prescription coverage in their insurance plan had problems covering the medical costs, compared with one-third who did have prescription drug benefits.

The study also found that medical bill burdens and medical debt reduced Americans’ access to health care, with 63 percent of adults with medical debt problems forgoing needed care within the preceding year due to cost. Only 19 percent of adults without medical bill challenges avoided seeking needed health care.

The study found 43 percent of workingage adults experiencing medical bill or debt problems failed to fill a prescription because of cost, compared with just 9 percent of adults not enduring such problems.

Even after adjusting for insurance coverage, income, health status, and other variables, the researchers found that Americans with problems paying health care bills were much more likely to leave a prescription unfilled, forgo a needed physician’s visit, or skip recommended tests or follow-up visits than were adults less challenged by medical costs.

The study found as well that 23 percent of those struggling to pay medical bills did not see a specialist when needed, compared with 6 percent without such bill-paying challenges. Thirty-seven percent with medical bill problems skipped medical tests, treatment, or follow-up, while only 6 percent of those without bill problems did so.

Additionally, 42 percent of those with daunting medical bills had a medical problem but did not visit a physician or clinic for treatment, far more than the 8 percent without difficult medical bills and did not seek needed assistance.

“People who have bills and debt are more likely to have health care access problems,” Doty said.

PRESS RELEASE

EMBARGOED UNTIL
Thursday, November 3, 2005, 9:00 A.M. EST (Washington and Ottawa) Thursday, November 3, 2005, 2:00 P.M. GMT (London) Thursday, November 3, 2005, 3:00 P.M. CET (Berlin) Friday, November 4, 2005, 1:00 A.M. (Canberra) Friday, November 4, 2005, 3:00 A.M. (Wellington)

For further information, contact:
Mary Mahon, (212) 606-3853 or (917) 225-2314, mm@cmwf.org, or Monika Ellis, (301) 652-1558, mellis@burnesscommunications.com

International Survey: U.S. Leads In Medical Errors

Patients in Six Nations Report High Error Rates, Lapses In Hospital Discharge Planning, And Lack Of Care Coordination

U.S. Has Highest Out-Of-Pocket Expenses And Rates Of Forgone Care Due To Costs

Bethesda, MD — One-third of patients with health problems in the United States report experiencing medical, medication, or test errors, the highest rate of any nation in a new Commonwealth Fund international survey. Assessing health care access, safety, and care coordination in Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States, the survey found that while no one nation was best or worst overall, the United States stood out for high error rates, inefficient coordination of care, and high out-of-pocket costs leading to barriers to access to care.

The findings are published today in a Health Affairs article, “Taking the Pulse of Health Care Systems: Experiences of Patients with Health Problems in Six Countries,” whose lead author is Commonwealth Fund senior vice president Cathy Schoen.

You can read the article at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.509.

“While the consistently high error rates and lack of coordination are disturbing, the findings also highlight the potential for each country to improve,” said Commonwealth Fund president Karen Davis. “Some countries have been able to achieve timely access to needed care while reducing financial barriers. Each country could also gain through strategies to improve the quality and efficiency of care, such as implementing modern information technology systems, supporting patient engagement in care, and improving management of chronic conditions.”

The 2005 survey of adults with health problems is the eighth in an annual series of cross-national surveys conducted by Harris Interactive for the Commonwealth Fund.

One-third (34 percent) of U.S. survey participants reported at least one of four types of errors: They believed that they experienced a medical mistake in treatment or care, were given the wrong medication or dose, were given incorrect results for a test, or experienced delays in being notified about abnormal test results. Three of ten Canadian respondents reported at least one of these errors, as did one-fifth or more of patients in Australia (27 percent), New Zealand (25 percent), Germany (23 percent), and the United Kingdom (22 percent).

U.S. patients who saw four or more doctors in the past two years were especially vulnerable, with about half reporting at least one of these errors; this points toward lapses in communication during care transitions.

Although attention to patient safety has focused chiefly on care in hospitals, a majority of patients (60 percent or more) in each country who reported medical mistakes or medical errors said that these errors occurred outside the hospital, which highlights the need for policies to improve patient safety in ambulatory care settings.

“There were many symptoms of poorly coordinated care in every country, regardless of the type of delivery or financing system,” said Schoen. “Shortfalls were particularly evident for people when discharged from the hospital, and for patients seeing multiple physicians. Improved care coordination during transitions across sites of care and providers offer opportunities for significant improvement. These patients are the ‘canary in the coal mine’ of any health system.”

In all six countries, one-third or more of recently hospitalized patients reported failures to coordinate care during hospital discharge. Germany had the highest rate of patients reporting lack of follow-up care, with three-fifths (60 percent) saying that the hospital did not make arrangements for follow-up visits with a doctor or other health professional or otherwise give instructions about posthospital care, such as symptoms to watch for and when to seek further care.

The United States had the highest rate of patients reporting coordination-of-care problems that reflected inefficient care during doctor visits. One-third of U.S. respondents said that within the past two years, either their test results or records were not available at the time of a doctor’s appointment, or that a doctor had ordered a test that had already been done. Rates of care-coordination problems in the United States were higher than those in the other five countries, which ranged between about one-fifth to one-quarter reporting coordination problems.

Patients with chronic diseases in all of the countries often did not receive the care recommended to manage their condition. At best, about half of diabetics reported receiving all four recommended screening exams to manage their condition. Patients who had supports such as a self-management plan or a nurse included as part of their care management team were more likely than others to have received recommended care.

The United States was an outlier for its financial burdens on patients:
• Half of U.S. adults reported that they had gone without care because of costs in the past year
• In contrast, just thirteen percent of U.K. adults reported not getting needed care because of cost
• One-third of U.S. patients reported out-of-pocket expenses greater than $1,000 in the past year
• U.K. patients were the most protected from high cost burdens, with two-thirds having no out-of-pocket expenses. The variations were notable given the study’s design focus on sicker adults with recent intensive use of medical care.

Access—including after-hours access—and waiting times to see a doctor when sick differed markedly across the countries:
• Canadian and U.S. adults who needed medical care were the least likely to report fast access (same day) to doctors (30 percent or fewer of U.S. or Canadian patients)
• In contrast, majorities of patients in New Zealand (58 percent) and Germany (56 percent) reported that they were able to get same-day appointments, as did nearly half of patients in Australia (49 percent) and the United Kingdom (45 percent)
• Majorities of patients in Germany (72 percent), New Zealand (70 percent), and the United Kingdom (57 percent) also reported easy after-hours (nights, weekends, or holidays) access to a doctor
• In contrast, majorities of patients in the United States (60 percent), Australia (58 percent), and Canada (53 percent) said that it was very or somewhat difficult to get after-hours care
• The four countries with comparatively more rapid access to physicians—Australia, Germany, New Zealand, and the United Kingdom—also had lower rates of emergency room use, with Germany having the lowest rates
• One-fifth of Canadians and one-fourth of U.S. patients who reported going to the ER said that it was for a condition that could have been treated by their regular doctor if available

The findings highlight the need for improved access as well as coordination of care. The authors conclude that “these findings suggest that many of the problems with which policy leaders are grappling transcend specific payment or delivery systems and will require more fundamental transformation.”

The Commonwealth Fund is a private foundation supporting independent research on health care issues and making grants to improve health care practice and policy.

Health Affairs , published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org. The full text of each Health Affairs Web Exclusive is available free of charge to all Web site visitors for a two-week period following posting, after which it will switch to pay-per-view for nonsubscribers. The abstracts of all articles are free in perpetuity. Web Exclusives are supported in part by a grant from the Commonwealth Fund.

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