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Diagnosis for America

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Diagnosis for America

By Jonathan Tasini
October 25, 2005
TomPaine.com

It is a measure of our lowered expectations, fueled by media spin, that people shrugged and seemed to think that it was inevitable that workers for General Motors were destined to have their health care coverage slashed. After all, some seemed to think, at a time when their company is teetering on the edge of oblivion, these “privileged” auto workers had “gold-plated” coverage that almost no other workers in America have.

But let’s be clear: The loss of benefits for GM workers was not inevitable. It happened as a result of many years of bipartisan political and economic decisions and the bipartisan lack of political courage to take on dumb ideology and corporate power.

In the minds of the elites, socking workers with a larger share of the costs of health care is just a natural part of the new economic order. As the Wall Street Journal editorial board said about the health care cost-cutting deal between GM and the United Auto Workers, “We hope it’s the beginning of wisdom about the global economy for the American labor movement.” Speaking about UAW president Ron Gettelfinger, Delphi CEO Steve Miller—who took his company into bankruptcy—said, “He’s going to have to help half a million of workers get used to the idea that globalization has taken away the ability to have someone who mows the lawn or sweeps the floor get $65 an hour.”

At least one thing is refreshing: It exposes as a fraud the liberal and conservative mantra about the wonders of the global economy. Democrats and Republicans alike—from Bill Clinton to George Bush, with a supporting cast of media and academic geniuses—have repeatedly told workers that the global economy will bring great benefits to America, after a period of “adjustment.” To their credit, Steve Miller and the Journal are more honest: The global economy is a tool to drive down living standards, starting with health care. Get with it, folks: Living large is so “old economy.”

So, the first obvious point to make is that employer-provided health care coverage has failed. Workers should never face the choice between sickness and financial ruin simply because the company they work for is going under, poorly managed or because they change jobs. More important, this has become, as I pointed out some months ago, a matter of economic competitiveness for corporations based in the United States: The health care system is dragging down profits.

The second point, then, is that health insurance can never be left to those whose sole motivation is profit. The last time health care was debated, the Clinton administration lost its nerve—or, perhaps, never had any other intention to pursue a system other than one that was destined to perpetuate the existing ideological flaws. “Hillarycare” was a disaster for the public not because the mismanaged process produced an overly complex system. Rather, the Clintons made a conscious decision to leave health care in the hands of the private insurers—which allowed the HMO industry to grow, if you’ll pardon the expression, like a malignant tumor.

If we had different philosophy, GM workers’ health care would never change. As Ida Hellander, executive director of Physicians for a National Health Program (PNHP), puts it, “Political will is infinitely harder to muster, especially when Congress is owned by the drug and insurance companies.” PNHP has a very straightforward set of four principles guiding its universal health care proposal, which I think, if properly understood by the public, would send millions of people to the streets demanding immediate change:

* Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to assure this right. Coverage should not be tied to employment. Private insurance firms’ past record disqualifies them from a central role in managing health care.

* The right to choose and change one’s physician is fundamental to patient autonomy. Patients should be free to seek care from any licensed health care professional.

* Pursuit of corporate profit and personal fortune have no place in caregiving and they create enormous waste. The U.S. already spends enough to provide comprehensive health care to all Americans with no increase in total costs. However, the vast health care resources now squandered on bureaucracy (mostly due to efforts to divert costs to other payers or onto patients themselves), profits, marketing and useless or even harmful medical interventions must be shifted to needed care.

* In a democracy, the public should set overall health policies. Personal medical decisions must be made by patients with their caregivers, not by corporate or government bureaucrats.

The economics of a single-payer, universal health care system are unassailable. It would save $300 billion in administration costs. It would be financed partly by the 60 percent of taxes that already go into the health care system via Medicaid, Medicare and payments for public employee coverage. The rest of the financing, over the long term, would be easily done with modest tax increases (by a 7 percent payroll tax and a 2 percent progressive income tax) —and result in better health care for people for less money than people shell out in ever-rising deductibles. With one bold stroke, a single-payer system would do more to help the bottom line of companies than any tax break or so-called “free trade” agreement.

The troubling reality to the arguments I’ve made is that they are not particularly original: The moral and economic need for a universal health care system has been well-known for a very long time. The only question now is: How many companies will have to go belly up and how many more millions of workers will face bankruptcy and illness because we allow ideology—the deification of the so-called free market—to triumph over common sense?

Jonathan Tasini is president of the Economic Future Group and writes his “Working In America” columns for TomPaine.com on an occasional basis. His blog Working Life chronicles the labor movement and other issues affecting American workers.

www.tompaine.com/articles/20051025/diagnosis_for_america.php

Wal-Mart creates pseudo-insurance

Wal-Mart to Expand Health Plan for Workers
By Michael Barbaro
The New York Times
October 24, 2005

Wal-Mart, which has long been criticized for the benefits it offers to its workers, is introducing a cheaper health insurance plan, with monthly premiums as low as $11 (available in a handful of areas), that the company hopes will greatly increase the number of its employees who can afford coverage.

Jumping into a new area, Wal-Mart is also offering health savings accounts, which the federal government introduced last year. Few employers offer them.

The new benefits, which Wal-Mart calls the Value Plan, follow years of complaints that at Wal-Mart, the nation’s largest employer, health insurance is out of reach for many of its 1.2 million workers in the United States, forcing thousands of them to turn to state-sponsored programs or forgo health coverage altogether.

Health insurance specialists generally praised the new plan, saying its lower premiums were likely to attract more employees and thereby reduce the ranks of the uninsured. They also noted, however, that the plan’s $1,000 deductible would be high for Wal-Mart workers…

But the plan is unlikely to cover a complicated illness or expensive hospital stay during the first year, when there is a $25,000 insurance cap. (The cap is lifted for the second year.) Out-of-pocket payments range from $300 for prescriptions to $1,000 for hospital stays.

The company’s health savings accounts will combine low monthly premiums with a requirement that individuals cover a substantial part of their own health care costs.

Several health insurance specialists questioned whether the company, which is working to burnish its public image, was trying to quickly increase the number of workers who use its health insurance at the expense of the coverage’s quality.

http://www.nytimes.com/2005/10/24/business/24mart.html

Comment: Although we do not yet have the details of Wal-Mart’s Value Plan, enough information has been released to raise very serious questions about whether this coverage provides financial security for those with medical needs.

Although the premiums will be very low, they likely would not be affordable for an individual that has no discretionary income, which is the case for most Wal-Mart employees.

Health savings accounts are advantageous for higher-income individuals since they are subsidized by the taxpayer. But most Wal-Mart employees would not receive any tax subsidy for these accounts because their incomes are too low to pay income taxes. Why would they place personal funds in an account that provides no advantage but that would be penalized if they used their funds for other essential needs, such as food or rent? Besides, they simply do not have the extra income to fund a savings account even if they wanted to.

Although three visits are covered before the deductible kicks in (to encourage preventive services), a $1000 doughnut hole so early in accessing the benefits creates a chasm which most would not be able to ford.

And a major catastrophic event would leave many individuals exposed since the costs typically would exceed the $25,000 cap.

We already know that under-insurance perpetuates many of the problems experienced by the uninsured, such as impaired access due to lack of affordability, with resultant impaired health outcomes. But this degree of under-insurance in an employee population with very low incomes creates yet a new category of insurance: pseudo-insurance. It looks like insurance, but it isn’t.

UAW statement on tentative agreement with GM

UAW statement on tentative agreement with GM
UAW
October 20, 2005

UAW President Ron Gettelfinger and Vice President Richard Shoemaker:

“The tentative agreement asks every UAW-GM member, active and retired, to make sacrifices so that everyone can continue to receive excellent health care coverage today and in the future.

“We believe the tentative agreement is an innovative and equitable way to address the health care cost issue at GM.

“However, as we have said many times before, no one union and no one company can solve America’s health care crisis. America is the only advanced nation in the world without some form of national health care – and U.S. businesses and America’s working families are paying a high price for this nation’s uncompetitive public policies. Indeed, GM, Ford and DaimlerChrysler are benefiting from Canada’s national health care system.

“The UAW has long advocated single-payer national health insurance as the most cost-effective and fairest way to fix America’s health care crisis.
Today, we are more determined than ever to make single-payer national health insurance a reality.”

http://www.uaw.org/news/newsarticle.cfm?ArtId=359

Comment: So are we.

Significance of the GM/UAW deal

GM DEAL: Cries of pain mix with sighs of relief
By Michael Ellis
Detroit Free Press
October 21, 2005

The UAW unveiled details of the much-anticipated health plan Thursday. Under it, retirees would have to pay monthly premiums and annual deductibles.

Active hourly workers at GM would defer $1 an hour from pay increases they were due in 2006, or about $2,000, into a fund to pay for their health care. By the end of 2006, that deferral would increase by 2 cents an hour every quarter.

With the concessions, GM hourly retirees would pay a maximum of $752 per family each year for health care, or $370 annually for an individual, plus co-payments for prescription drugs.

The package would create a defined contribution plan to help pay for health care costs. GM plans to contribute $3 billion — with $1-billion payments in 2006, 2007 and 2011. Wage deferrals by hourly workers would help fund the plan, which the UAW would administer.

“It’s a concrete demonstration of the health care crisis in our country,” said Richard Block, a labor professor at Michigan State University. “Everybody’s getting poorer because of health care.”

http://www.freep.com/money/autonews/gm21e_20051021.htm

Comment: This is the end of an era. The auto industry is the largest and the last of private employers to have provided complete health care coverage as a benefit of employment. They have now introduced cost sharing and defined contribution funding which transfers to the employee some of the responsibility for funding care.

The changes are quite modest compared to what has already happened to employer-sponsored coverage in other industries and services. Larger deductibles, the shift to coinsurance from co-payments, defined contributions in segregated accounts, innovative reductions in benefits, and other measures have all served to shift more and more of the costs from the employer to the individual.

All of this is in the name of making health coverage more affordable to the employer. The obvious trade-off is that it makes health care less affordable to the individual. This shift addresses the employers’ concerns over escalating health care costs, but in shifting those costs to the employees, it does absolutely nothing to address the fundamental underlying problem. Health care costs continue to skyrocket. Shifting those costs to the hapless employee can have only one outcome: the employee and his or her family members will be empowered to not receive the health care that they can no longer afford.

Although it seems that this is simply the end of the era of 100% coverage, we are really witnessing a process that will end the role of the employer as the guarantor of health care services. As the cost of coverage continues to rise, employers will further reduce or even eliminate benefits. The financial burden shifted to individual employees will be truly excessive and the entire employment-based system will collapse.

Anticipating this, many policymakers are encouraging a shift to the individual insurance market, a market that is characterized by underwriting requirements, greater administrative costs, Spartan coverage, higher cost sharing, and a relaxed regulatory environment. Individual coverage, as a universal or near-universal system, will never fly because it will be so heavily weighted down with financial burdens that it cannot possibly get off the ground. The reason that our fragmented system of individual and group plans is doomed is that they are unable to address the overriding issue: escalating health care costs.

To control costs, a system must be in place that is targeted to cost excesses. The tremendous administrative waste can be dramatically reduced by using a single, efficient administrative payer. Wasteful high-tech excesses can be reduced by ensuring appropriate capacity through planning of capital improvements, budgeted by a single payer. Greater efficiency can be established by strengthening our primary care infrastructure through incentives established by a single payer. Excessive pricing can be reduced through negotiation with a single payer.

Although the employment-based system is self-destructing, and the individual market will never get off the ground, the good news is that we can achieve affordable access to comprehensive care for everyone. As the current system continues to implode, the logic of a single payer becomes ever more apparent.

Group urges universal health care system

Payroll, income taxes would cover costs
By David Wenner
The Patriot-News (Harrisburg, PA)
Tuesday, October 18, 2005

A grassroots organization yesterday proposed tearing down the health insurance system in Pennsylvania and building a new one that would cover everyone.

The proposal calls for universal coverage through a single-payer system that would pay 100 percent of medical and prescription drug costs while involving no direct charges to patients.

It would cost an estimated $43 billion annually and be funded through a 10 percent tax on business payrolls and a three percent tax on personal income.

Supporters says the winners would be state residents and businesses who can’t afford the high cost of health care, and the losers would be drug companies and health insurers.

Drug companies would lose because the system would obtain bulk discounts on drugs, and insurers would lose because they would no longer be needed, said Steve Larchuk, a Pittsburgh-area lawyer and a leader of Pennsylvania Healthcare Solutions Coalition, which has proposed the system.

The insurance industry, including Pennsylvania’s four Blue Cross-Blue Shield plans, will fight to preserve the existing system, Larchuk said.

“I expect the Blues will fight to the death to stop any kind of health care reform. But that’s a battle we have to fight sooner or later; and if we’re unwilling to fight that battle, we might as well hand the keys to the Capitol to the Blues right now,” he said.

Charlie Crystle, a Lancaster business owner and member of the coalition board, predicted businesses will support the single-payer system because the proposed payroll tax would be less than they now pay to provide health insurance for workers.

Larchuk said organizers have been working at the grassroots level for about a year, and avoiding involvement of politicians because the issue is so political.

The idea of universal, single-payer health insurance isn’t new.

Proposals exist in several states, Larchuk said.

Yesterday, supporters began visiting state legislators and passing out a draft of a bill to create the single-payer system.

Amy Kelchner, a spokeswoman for Gov. Ed Rendell’s Office of Health Care Reform, said Rendell is interested in any proposal to provide universal health insurance.

The administration recently received a federal grant it will use to explore universal coverage, she said.

The Pennsylvania Medical Society, the lobbying group for doctors, received the proposal yesterday and wasn’t ready to comment, spokesman Chuck Moran said.

State Sen. Pat Vance, R-Cumberland, a leader on health care issues in Pennsylvania, also said she had just heard of the proposal and hadn’t formed an opinion.

Cliff Shannon, president of SMC Business Councils and a leading advocate for health insurance reform in Pennsylvania, said no reform will succeed unless it includes a way to limit the cost of health care.

An uncapped, mandatory tax on businesses would have “no chance” of acceptance from businesses, he said.

Mike Fiachetti, a senior vice president for Highmark Blue Shield, said that with the high cost of health care, it’s no surprise that people are proposing a single-payer system.

But he said there’s no “silver bullet” solution for out-of-control health care costs.

“This all sounds good on paper, but there are so many things missing, it’s hard to even comment,” he said.

DAVID WENNER: 255-8172 or dwenner@patriot-news.com

Drug Business Prescribes a Novel Cure for Its Ills

by Lloyd Grove
New York Daily News
October 17, 2005

Who knew that the multibillion-dollar U.S. pharmaceutical industry was so keen on publishing pulp fiction?

In a tale worthy of a zany Washington satire – except for the lamentable fact that it’s true – the rich and powerful pharmaceutical lobby secretly commissioned a thriller novel whose aim was to scare the living daylights out of folks who might want to buy cheap drugs from Canada.

When the project fell through in July, I’m told the drug lobby offered $100,000 to the co-authors and publisher in a vain effort to sweep it under the rug.

Talk about thinking outside the box!

“This is the most outrageous example of deception and duplicity on the part of a Washington lobby in the history of the country,” said Capitol Hill denizen Jeff Weaver, chief of staff to Rep. Bernie Sanders (I-Vt.), a diehard foe of the pharmaceutical industry.

Drug-lobby mouthpiece Ken Johnson, executive vice president of the Pharmaceutical Research and Manufacturers of America, acknowledged the hare-brained scheme but shifted blame.

“We did not commission a book,” Johnson argued. “The idea was brought to us by an outside consultant. We explored it, provided some background information … but in the final analysis, decided it wasn’t the right thing for us to do.”

I’m told that Mark Barondess, a well-known divorce lawyer in Washington, D.C., was the so-called outside consultant and approached L.A.-based Phoenix Books with the novel idea.

Phoenix honcho Michael Viner, who happens to be Barondess’ publisher, struck a six-figure deal. I’m told PhRMA made at least one payment to Phoenix.

Viner declined comment, and Barondess didn’t respond to my detailed message.

Work began in April, after Viner hired veteran ghostwriter Julie Chrystyn. Her story concerned a Croatian terrorist cell that uses Canadian Web sites to murder millions of unwitting Americans looking for cut-rate pharmaceuticals.

PhRMA has vigorously fought all efforts to legalize the purchase of cheap drugs from Canada. Even though the lobby has found some success, the underground business still takes an estimated $1 billion in annual profits from American drug behemoths.

Chrystyn titled her thriller-in-progress “The Spivak Conspiracy,” an homage to her friend Kenin Spivak, an L.A. telecomm entrepreneur and onetime Hollywood exec.

Spivak said he became Chrystyn’s co-writer after she delivered the first 50 pages, and PhRMA made several editorial suggestions.

“They said they wanted it somewhat dumbed down for women, with a lot more fluff in it, and more about the wife of the head Croatian terrorist, who is a former Miss Mexico,” Spivak told me.

Apparently, women are among the most loyal buyers of Canadian drugs.

“They also wanted to change the motivating factor of the terrorists to greed, because they didn’t want it to be politics,” Spivak said. “They wanted lots of people to die.”

Spivak told me that since PhRMA pulled out – and he and his colleagues rejected the lobby’s offer of $100,000 to kill the project – he and Chrystyn have finished a revised version, “The Karasik Conspiracy,” due early next year.

First Joint Canada-US Health Survey Shows Both Countries Report High Level of Health

For Immediate Release: June 2, 2004

Contact:
NCHS/CDC Public Affairs, (301) 458-4800
E-mail: nchsquery@cdc.gov

The Joint Canada-United States Survey of Health (JCUSH)
View/download PDF 496 KB

The overwhelming majority of Americans and Canadians rate their health as good, very good or excellent, but there are differences in key risk factors and patterns of health care in the two countries, according to the first joint U.S.-Canadian health survey released today by the Centers for Disease Control and Prevention (CDC) within the U.S. Department of Health and Human Services. Overall, Americans were more likely than Canadians to report that they were very satisfied with health care (53 percent compared to 44 percent), but findings for uninsured Americans accounted for significant differences between the countries in a number of categories.

The Joint Canada/U.S. Survey of Health, conducted by Statistics Canada and CDC’s National Center for Health Statistics, covered measures of health status, risk factors, health disparities, access to health care, and quality of and satisfaction with health care services. Because the survey contacted a representative sample of adults in each country and asked for exactly the same information in the same manner in a one-time telephone interview, this survey achieves a degree of comparability never before attained.

In the survey, people were asked to rate their health from poor to excellent, and 85 percent of Americans and 88 percent of Canadians reported that they were in good, very good or excellent health. Americans were slightly more likely than Canadians to rate their health as excellent (26 percent compared to 24 percent). This was particularly true for senior citizens; almost twice as many Americans 65 and over (15 percent compared to 8 percent) reported they were in excellent health. Americans were also slightly more likely to indicate that their health was only poor or fair (15 percent compared to 12 percent). Among low-income respondents, 31 percent of Americans said they were in fair or poor health, compared with 23 percent of low income Canadians.

The survey looked at measures of physical and mental health. Overall, 25 percent of Americans and 24 percent of Canadians reported some level of mobility limitation (problems with walking, standing or climbing). More Americans, particularly American women (7 percent compared to 4 percent), report highly severe mobility limitations. Approximately 8 percent of adults and 10 percent of women in both countries had experienced a major depressive episode in the past year.

Two key risk factors – smoking and obesity – were examined. Canadians were more likely than Americans to be current daily smokers (19 percent compared to 17 percent) and this difference was more pronounced among older women. However, a significantly higher proportion of Americans than Canadians are obese, primarily because among U.S. women the rate of obesity is nearly twice that of Canadian women. In both countries, those with the lowest incomes report poorer health and higher rates of severe mobility limitations as well as higher levels of smoking and obesity.

Since the health systems and the role of public and private insurance differ in each country, another important aspect of the report compares access to health care and people’s satisfaction with the health care they receive. Americans were more likely to report that the quality of their health care services in general was excellent compared with Canadians (42 percent compared to 39 percent.) Among uninsured American respondents, 28 percent said the quality of the health care services they received was “excellent,” 44 percent “good,” and 28 percent “fair” or “poor.” When asked about their satisfaction with health care services in general, 53 percent of Americans and 44 percent of Canadians said they were “very satisfied,” while 37 percent of Americans and 43 percent of Canadians said they were “somewhat satisfied.” Among uninsured Americans, 39 percent were “very satisfied” with the services they received, and 40 percent were “somewhat satisfied.”

Unmet medical needs during the past 12 months were reported by 13 percent of Americans and 11 percent of Canadians. Among those with an unmet need, Americans were more likely to identify cost as the primary barrier to health care (53 percent of unmet needs cases), while Canadians cited waiting for care as the primary barrier (32 percent of cases). Among the 11 percent of American respondents who were uninsured, four out of every ten reported an unmet medical need. Likewise, only 43 percent of the uninsured respondents said they had a regular medical doctor, compared with 80 percent of total American respondents and 85 percent of Canadian respondents.

The overall pattern of the use of prescription medicine was similar in the two countries, with use higher among those 65 years of age and older and among women. However, there was higher prescription drug use among Americans aged 45-64 than Canadians in this same age group.

The Joint Canada/US Survey of Health was conducted from November 2002 through March 2003 with a representative sample of civilian, non-institutionalized population of adults 18 and over; the sample size was approximately 3500 Canadians and 5200 Americans. For more information about the survey and a copy of the report check the Joint Canada/US Survey of Health website.

Uninsured do not receive the care they know they need

Center for Studying Health System Change October 2005 Perception, Reality and Health Insurance: Uninsured as Likely as Insured to Perceive Need for Care but Half as Likely to Get Care By Jack Hadley and Peter J. Cunningham

While considerable research shows that uninsured people are less likely to seek and receive medical care, some contend that the uninsured are uninsured by choice and can obtain care when needed. A new study by the Center for Studying Health System Change (HSC), however, undercuts the validity of this contention, finding that there is no difference between insured and uninsured people’s perception of the need to see a medical provider when they experience a serious new symptom. However, among people who believed that they needed medical care, the uninsured were less than half as likely to see or talk to a doctor, indicating that lack of insurance is a major barrier to uninsured people getting needed medical care.

http://www.hschange.org/CONTENT/790/

Comment: One again, lack of health insurance is a major barrier to care for individuals with serious symptoms. How can the opponents of reform continue to dismiss this as merely a matter of personal choice?

15th Fraser alarm on queues in Canada

Waiting Your Turn: Hospital Waiting Lists in Canada, 15th Edition
By Nadeem Esmail and Michael Walker
The Fraser Institute
October 2005

Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces surveyed, fell from 17.9 weeks in 2004 back to the 17.7 weeks last seen in 2003.

The 2005 Waiting Your Turn survey indicates that waiting times for medical treatment in Canada have fallen slightly from 2004, but remain at a very high level historically. Even if one debates the reliability of waiting list data, this survey reveals that specialists feel their patients are waiting too long to receive treatment.

The survey was conducted in all 10 Canadian provinces. Cornerstone List Fulfillment provided mailing lists, drawn from the Canadian Medical Association’s membership rolls, for the specialists polled. Specialists were offered a chance to win a $2,000 prize (to be randomly awarded) as an inducement to respond. Survey questionnaires were sent to practitioners of 12 different medical specialties: plastic surgery, gynaecology, ophthalmology, otolaryngology, general surgery, neurosurgery, orthopaedic surgery, cardiac and vascular surgery, urology, internal medicine, radiation oncology, and medical oncology.

http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=801

A question from the survey (Appendix 2):

4. From today, how long (in weeks) would a new patient have to wait for the following types of elective surgery or diagnostic procedures? What would you consider to be a clinically reasonable waiting time for these types of surgery and procedures?

Chart 14: Median Actual Wait Versus Median Clinically Reasonable Wait by Specialty for Canada: Weeks Waited from Appointment with Specialist to Treatment in 2005

(median actual wait/median clinically reasonable wait)

Plastic Surgery (20.9/10.0)
Gynaecology (7.1/5.4)
Ophthalmology (13.1/7.7)
Otolaryngology (9.0/5.9)
General Surgery (6.2/4.0)
Neurosurgery (7.8/4.3)
Orthopedic Surgery (25.3/10.0)
Cardiovascular Surgery – urgent (1.1/0.7)
Cardiovascular Surgery – elective (5.2/4.2)
Urology (5.3/3.5)
Internal Medicine (6.3/3.1)
Radiation Oncology (4.1/3.7)
Medical Oncology (2.6/2.6)

http://www.fraserinstitute.ca/admin/books/chapterfiles/wyt2005.pdf#

Comment: It is important that reform advocates understand this report. It is the primary source used by the opposition to condemn the Canadian health care system for its outrageous delays in providing access to life-saving care. It is the product of The Fraser Institute, an organization which, according to their mission statement, “has as its objective the redirection of public attention to the role of competitive markets in providing for the well-being of Canadians.”

The study was limited to Canadian specialists, heavily weighted toward procedural rather than cognitive fields. This sector of physicians represents those who have a bias toward privatization since the market allows more freedom to enhance personal income. These individuals have an interest in demonstrating that the public system is a disaster and that patients must be granted the option to buy their way to the front of the queue. Fraser understands this sector well since they knew that they could entice a greater response by offering a cash reward.

When the specialists were asked to estimate the actual wait versus the reasonable wait, they listed them in two columns, side by side. So not only were they motivated to estimate greater delays, they were also motivated to provide estimates that would confirm that these were unreasonable delays.

What did the results show? For most specialties, the differences were not that unreasonable. When correcting for bias, the only real differences were in orthopedic surgery, plastic surgery and ophthalmology. (Internal medicine is a special case, not addressed here.) There is a need to increase capacity for orthopedics and ophthalmology, and efforts to do so are already underway.

One of the most disconcerting claims that we see in the conservative literature is that people are dying because they can’t gain timely access to urgent cardiovascular surgery or to treatment of their newly diagnosed malignancies. Even this biased study confirms that such claims are pure fiction.

Health insurance imploding

Wednesday, October 19, 2005
San Francisco Chronicle
Page C1

By David Lazarus

And so the demolition derby that is the U.S. health care system shifts into high gear.

Mighty General Motors, the world’s largest automaker and biggest private-sector purchaser of health insurance, said this week that it’ll slash its $5.6 billion annual health care spending for workers, retirees and their families by about $1 billion a year.

For its part, the United Auto Workers, one of the nation’s most powerful unions, is apparently prepared to swallow this hit to organized labor’s most sacrosanct benefit to forestall additional job cuts.

We have reached a critical turning point in the decline of health care in the United States, one almost certain to expand the already appalling figure of 45 million people lacking health coverage nationwide.

“It’s not just a breaching of the social contract that’s existed between companies and workers,” said David Autor, an associate professor of economics at the Massachusetts Institute of Technology. “It’s a reflection of how health care costs are out of control.

“Hopefully this will be an opportunity for government and companies to rethink how health care is provided,” he added. “The old system is clearly breaking down.”

Since World War II, the old system has been predicated on the notion that employers will bear the primary cost of insuring U.S. workers and their families.

That system, as the GM announcement plainly illustrates, is no longer viable in the face of double-digit annual increases in health care costs. Businesses have responded by insisting that workers — and especially retirees — shoulder more of the burden of their health coverage.

To be sure, GM has been rewarding its more than 750,000 union members, retirees and their dependents with an uncommonly generous benefits package. The company also faces numerous other issues that affect its profitability (or lack thereof; GM reported a staggering $1.6 billion loss for the latest quarter).

But health care is undeniably one of the automaker’s biggest headaches. GM estimates that health care adds about $1,500 to the cost of every vehicle it sells in North America.

The company’s chief exec, Rick Wagoner, told employees on Monday that health care is an issue “of great importance for the future of overall U.S. competitiveness.”

He also all but pleaded with political leaders to do something about the situation.

“We would welcome a more proactive role from elected officials at the national and state levels in broad-based strategies to address the U.S. health care crisis,” Wagoner said.

Helen Darling, president of the National Business Group on Health, a nonprofit organization composed of some of the country’s largest employers, told me that more and more companies will follow GM’s example and significantly scale back health coverage for workers.

For example, Ford and DaimlerChrysler are already negotiating similar concessions from the UAW.

“There’s no one in the business world who doesn’t share the position that the U.S. health care system has a crisis,” Darling said. “The issue here isn’t General Motors. The issue is the unaffordability of health care.”

So what do we do about it?

I’ve written repeatedly about how a single-payer health care system could provide universal coverage for all Americans at a long-term cost to taxpayers well below what’s now paid annually by employers and workers.

Single-payer systems are the norm in virtually all other developed democracies. While far from perfect — long waits for treatment are a frequent complaint — such systems ensure that any citizen can receive care from any doctor at any hospital.

There are no co-pays or deductibles, no private-sector premiums soaring year after year.

“The basic system is quite good,” said Steffie Woolhandler, an associate professor of medicine at Harvard University. “We just need to fund it adequately.”

As it stands, she said about a third of all health care spending in this country is now squandered on bureaucratic overhead. Under a single-payer system, savings from streamlined paperwork alone would be sufficient to provide coverage for all Americans.

“The meaning of GM’s announcement is that even people working for a powerful company can have their health care cut,” Woolhandler said. “Anyone who gets health insurance from an employer or former employer should be worried.”

The right message: Speaking of the auto industry, senior execs at Delphi, the largest automobile supplier, have said they’ll take voluntary pay cuts until the company emerges from bankruptcy.

The company’s CEO, Robert Miller, will reduce his base salary from $1.5 million to just $1 annually and won’t receive any bonuses. Delphi’s president, Rodney O’Neal, will take a 20 percent pay cut, and other execs will forgo 10 percent of their salaries.

Declared Miller: “Delphi’s transformation message must be unambiguous and marked indelibly by the commitment of Delphi’s leadership.”

Compare that with the top brass at PG&E, who last year handed themselves $83 million in bonuses while the San Francisco utility was still mired in Chapter 11 proceedings.

“It’s become standard to reward executives for sticking around during bankruptcy,” said Kirk Hanson, executive director of the Markkula Center for Applied Ethics at Santa Clara University.

“Cutting your pay sends a strong message to employees that management understands they’re suffering,” he said.

David Lazarus’ column appears Wednesdays, Fridays and Sundays. Send tips or feedback to dlazarus@sfchronicle.com.

Copyright 2005 SF Chronicle

Americans value employment-based health coverage, but…

2005 Health Confidence Survey: Cost and Quality Not Linked
By Ruth Helman, Mathew Greenwald & Associates, and Paul Fronstin, EBRI
Employment Benefit Research Institute
EBRI Notes
November 2005

Increasing health care costs continue to be strongly related to dissatisfaction with the health care system, and those who have experienced increased costs within the past year are more likely than those who have not to be dissatisfied their current health plan and other aspects of the health care.

A majority of Americans with health coverage have experienced health care cost increases in the past year. Those with employment-based coverage and those who report their health status has gotten worse over the past five years are more likely to report these cost increases.

Those who have experienced cost increases have compensated by making changes in the way they use health care. (54 percent) say they now go to the doctor only for more serious conditions or symptoms. (40 percent) have delayed going to the doctor. (21 percent) report cost increases have caused them to not take their prescribed medication. Lower-income Americans and those in poorer health are more likely to report making each of these changes.

Increased health care costs have also affected household finances, and many of those who have experienced cost increases have coped by reducing the amount they save or by depleting their savings. One-quarter report they have decreased their contributions to a retirement plan as a result of the increased cost of health care (26 percent), and almost half report they have decreased their contributions to other savings as a result of the increases (45 percent). One-quarter say they have had difficulty paying for basic necessities, like food, heat, and housing (24 percent), while one-third report difficulty paying other bills (34 percent). Three in 10 indicate they have used up all or most of their savings (29 percent), and 18 percent have borrowed money.

Despite the increasing amount of cost sharing that employers are asking of their workers, most Americans appear to value employment-based health coverage above the actual dollar amount that employers pay toward the care. When employed Americans with health coverage are asked whether they would prefer $6,700 in employment-based health insurance coverage or an additional $6,700 in taxable income, 8 in 10 choose the employment-based health coverage (80 percent). Two-thirds would prefer employment-based coverage to an increase in income even if an employer paid $10,000 toward the coverage(66 percent). Furthermore, this preference for employment-based coverage emerges regardless of demographic characteristics.

http://www.ebri.org/pdf/EBRI_Notes_11-2005.pdf

Comment: (Not addressed in the excerpts nor in these comments is the finding that Americans still have relative confidence in the quality of our health care system.)

The selected excerpts above confirm what we already knew. Americans are very concerned about increasing health care costs, and affordability is having a very significant negative impact on access and on their personal finances.

An important conclusion of this report is that Americans strongly support employment-based health coverage, and would relinquish comparable income increases in order to maintain employer-sponsored coverage. Advocates of reform based on employer-sponsored plans will surely jump on this study as an affirmation of the validity of their model of reform. But is that conclusion really warranted?

Individuals are very concerned about the risk of unanticipated health care costs. Right now, they have up to three options: coverage through their employment, individual coverage, or no coverage at all. Responsible individuals would never accept doing without coverage as being an acceptable option. The greater value and comprehensiveness of employer-sponsored coverage makes it a preferred option to individual coverage. So it is quite logical that most individuals would support plans offered through their employment.

But what if they were offered another option? What if they were told that they could always have coverage regardless of what might happen to their employment? What if they were told that they would need to relinquish only an equitable portion of their income, through a payroll tax, rather than relinquishing an arbitrary amount such as the $10,000 in this survey? What if they were told that comprehensive benefits would always be provided since other more efficient mechanisms, rather than benefit reductions, would be used to maintain affordability?

Today, even General Motors employees might be interested in hearing about such an option. Even the New York Times, in an editorial yesterday, broke new ground by stating “…shame should also be aimed at Washington lawmakers who have done nothing to solve the larger problem, the crying need for national health insurance.”

New York Times editorial:
http://www.nytimes.com/2005/10/17/opinion/17mon3.html