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Single-payer advocates push cause in states; challenges likely

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Single-payer advocates push cause in states; challenges likely

At least 18 states have introduced universal health care bills, most based on a single-payer model
By Amy Snow Landa
AMNews correspondent
Oct. 24/31, 2005

From Vermont to California, proponents of single-payer health care have been busy introducing legislation, circulating ballot petitions and broadening their coalitions — all with the hope that at least one state will enact legislation that can be used as a model for national health care reform.

But opponents of single-payer health care, including state medical societies, say they are not worried that all of the activity means that government-run health care will be enacted any time soon.

“We’re not ringing the alarm bell yet,” said Tim Maglione, senior director of legislative affairs at the Ohio State Medical Assn.

Although Ohio has one of the most active single-payer movements in the country, there is little chance that a single-payer bill will pass the state’s Republican-controlled Legislature or be signed into law by Republican Gov. Bob Taft.

“We feel pretty confident the Legislature doesn’t have any interest in pursuing this,” Maglione said.

Single-payer advocates, having drawn the same conclusion, have turned their efforts to a petition drive, said Johnathon Ross, MD, a Toledo internist and a leader of the Single-Payer Action Network of Ohio.

The group is attempting to collect about 100,000 signatures on its petition, which directs the Legislature to vote on the Health Care for All Ohioans Act. So far, they have collected “tens of thousands” of signatures, Dr. Ross said.

If the Legislature then refuses to take action on the bill, supporters will collect a second round of signatures to put single-payer legislation directly on the ballot.

“Our target [for putting it on the ballot] is November 2006 at the earliest,” Dr. Ross said. But the group may put it off if they need more time to prepare for what is likely to be a formidable challenge waged by the insurance industry and other opponents, he said. Single-payer ballot initiatives have been tried in Oregon and California but were unsuccessful when they faced the opposition’s overwhelming resources.

Single-payer advocates don’t want to see that happen in Ohio. “We have to make sure we have a movement” established before taking single-payer health care to the ballot box, Dr. Ross said. “We’re using the petition to drive this movement.”

In addition to Ohio, at least 17 other states have introduced universal health care measures, most of them based on a single-payer model, according to the National Conference of State Legislatures. But so far, none of the bills has been enacted.

The American Medical Association has opposed the establishment of single-payer health care both at the state and federal levels. It has long advocated for using tax credits and other market-based reforms to make health care coverage more affordable.

Vermont’s close call

The state that came closest this year was Vermont, where the Legislature passed a bill in June that would put the state on the road to establishing a single-payer system called Green Mountain Health.

The measure, called an Act Relating to Universal Access to Health Care in Vermont, would have phased in a single-payer system funded through taxes levied on individuals and employers. But Republican Gov. James Douglas vetoed the legislation.

Despite the veto, the Legislature was able to appropriate funds for the Commission on Health Care, a legislative panel that is studying a number of issues related to health care reform, such as governance and financing.

Both the commission and Douglas are holding hearings to solicit recommendations on health care reform. The Vermont Medical Society has been developing its own proposal, which it plans to submit in mid-October, Executive Director Paul Harrington said.

Rather than promote a single-payer system, the VMS proposal would keep in place existing insurance coverage paid for by employers, Medicare and Medicaid. It would offer residents in the individual market a basic benefit plan at an affordable cost through the Office of Vermont Health Access, the agency responsible for the state’s Medicaid and other health programs. The proposal also would subsidize premiums for low-income Vermonters and provide new incentives to encourage employers to offer health insurance to their employees.

Eyes on the prize

Of all the states where single-payer supporters are most active, California is considered the biggest prize because of its sheer size, both in terms of population and health care spending. Nearly $200 billion is spent in California each year — about 13% of the entire nation’s spending on health care, according to the UCLA Center for Health Policy Research.

Activists there have been working for years to enact single-payer legislation, but supporters and opponents have differing views on whether the movement has crested or continues to grow.

“As far as we know, their efforts are not any more prevalent today than they were a year ago or 10 years ago,” said Larry Akey, a spokesman for America’s Health Insurance Plans.

But that’s not the view of Ida Hellander, MD, executive director of the Chicago-based Physicians for a National Health Program. The single-payer movement in California “just continues to grow,” she said. “They have a pretty broad-based movement; they’ve educated a lot of people, and very large, well-organized groups like the California Nurses Assn. are on board.”

In the California Legislature, a single-payer bill passed the Senate in May but faces an uncertain future in the General Assembly. Even if the full Legislature approves the bill, Republican Gov. Arnold Schwarzenegger is likely to veto it.

“The bill is dead for the moment,” said Michael Sexton, MD, president of the California Medical Assn., which opposes the legislation. “We don’t think there should be an ability to ration care based on a global budget,” he said.

Instead, the CMA is working to advance its own proposal, which would cover the uninsured but preserve a public-private system of health care coverage, he said. The plan includes refundable tax credits for the purchase of health care.

ADDITIONAL INFORMATION:

The Vermont Legislature, for information on H 524, an Act Relating to Universal Access to Health Care (www.leg.state.vt.us)

California legislative information page, for information on SB 840, the California Healthcare Insurance Reliability Act (www.leginfo.ca.gov)

The Ohio General Assembly, for information on, HB 263 and SB 263, the Health Care for All Ohioans Act (www.legislature.state.oh.us)

Instability of employer-sponsored coverage

Big Changes for Health Plans
By Kathy M. Kristof
Los Angeles Times
October 9, 2005

Every year, workers are advised to look closely at their benefits package during open enrollment season. This year, they have even more reasons to read the fine print.

Companies are increasingly requiring “active enrollment” – meaning that if employees don’t check the right boxes, they could end up without health insurance, or find themselves enrolled in a “default” plan.

“More and more companies won’t allow passive enrollment, which is when they don’t hear from you, they give you what you had last year,” said Tom Billet, senior consultant with benefits firm Watson Wyatt Worldwide. “Companies are increasingly demanding active enrollment.”

One reason is that benefit choices are changing significantly this year. That’s partly because laws have changed to allow new options such as health savings accounts. It’s also because employers are experimenting with ways to cut costs, which have more than doubled in the last eight years, according to benefit consulting firm Hewitt Associates.

“We are seeing increased deductibles, but also more of a consumer-oriented focus to healthcare,” said Sarah Taylor, annual enrollment leader at Hewitt. “There are a lot of plans that weren’t offered in the past – like health savings accounts and build-your-own plans.”

“You mix and match, and your premium would be based on the things that you choose,” (Taylor) said. “It’s really up to the employee to figure the benefits that have the most value to them.”

“It’s the rare plan today that has no change from year to year,” Billet said. “So making the same election that you made last year may not be the best decision. It’s a really good idea to evaluate the situation with a fresh eye.”

http://www.latimes.com/business/la-fi-perfin9oct09,1,6806534.column?coll=la-headlines-business

Comment: The lesson? The mainstay of private health care coverage, employer-sponsored plans, no longer provides the security of affordable, comprehensive benefits. Rather than deciding for their employees how much insecurity is acceptable, employers are shifting this difficult decision onto their employees.

The conflict is obvious. The employers’ concern is the affordability of health insurance; the employees’ concern is the affordability of health care. As long as health plans are sponsored by employers, there will be a continual effort to drive down insurance costs in the face of escalating health care costs. The burden of the increased health care costs are then shifted to the employees. This dynamic creates instability for our prevalent mechanism of funding health care: employer-sponsored plans.

Although a universal public insurance system would be under continual attack by libertarians, it would be vastly more stable than our current fragmented system of funding health care. Even libertarians don’t want their Medicare messed with.

Small Business Looks to Mexico for Healthcare Plan

Monday, October 03, 2005

LOS ANGELES As the cost of healthcare (search) continues to skyrocket, one businessman in Calexico, Calif., has found a solution to the problem.

Mark Holloway owns the Sam Ellis department store near the U.S. border with Mexico. He has about 50 employees and couldn’t afford health insurance (search) for them until he discovered a cross-border health plan that allows his workers to see doctors in Mexico.

“We were paying an excess of $100,000 a year to provide health insurance and that wasn’t even for all of the staff,” Holloway said. “When Blue Shield came to us and offered us an affordable way to bring down healthcare, we jumped on it.”

In Mexico (search), healthcare costs are about 40 to 50 percent lower than in California. That means patients only have to pay $10 to visit a Mexican doctor. Hospital stays, tests and medications also are more affordable south of the border.

One of Holloway’s longtime employees said the service is better in Mexico.

“I know that doctors across the border will see you that day if not in the morning, the afternoon, the evening. You will call them, they will give you their cells [phone numbers], whatever,” said Josie Llausas.

But some in the medical field in the United States are skeptical about the cross-border plans because of questions over the quality of care, specifically pointing to outdated technology like X-ray machines, ultrasound and MRI equipment.

Mexican doctors say while their equipment might not be state-of-the-art, their training is equivalent to that of American doctors.

NY Times Endorses National Health Insurance

Wrong Solution for the Uninsured
Editorial
The New York Times
October 17, 2005

As well-meaning legislation goes, it would be hard to beat the law recently approved by the New York City Council over the veto of Mayor Michael Bloomberg. It requires certain large grocers to provide health care benefits for their employees. The law – like a handful of similar efforts from Long Island to San Francisco – is a response to the growing strain on Medicaid and other government assistance programs from uninsured workers.

A major inspiration for the legislation is clearly Wal-Mart. One report showed that nearly 9,000 Wal-Mart workers needed public insurance in Wisconsin, and that more than 10,000 children of the store’s workers in Georgia were treated at taxpayer expense. The list goes on. Fed up, Maryland, New Jersey and Pennsylvania are in various stages of trying to force the big employer to take care of its own.

While it’s easy to sympathize with the frustration of local governments left holding the bag, this kind of piecemeal legislation is no answer. For one thing, it’s very possibly illegal – federal law generally protects employers from this kind of local mandate. And while it’s emotionally satisfying to take a whack at the big-box stores, it hardly addresses the real problem. In New York, caring for the city’s working uninsured costs more than $600 million annually, according to a Columbia University report. Wal-Mart can’t be blamed for any of that, as it has been unsuccessful in pursuing a site in the city.

The nation’s health care problems are too complicated to be addressed by a chock-a-block system of overzealous, homespun laws that fail to address the overarching problem of the uninsured and may not hold up in court, anyway. The problem cries out for a federal solution. Without some kind of aid, many small businesses would crumble under the cost of health care benefits – which the New York City law estimates at $5,000 per employee per year.

For right now, there is a commendable effort in Congress to post on the Internet the names of employers with large numbers of workers on public aid, the idea being that shame can be an effective weapon. The same kind of shame, however, should also be aimed at Washington lawmakers who have done nothing to solve the larger problem, the crying need for national health insurance.

PNHP's Frankel Promotes Medicare for All

Doctor prescribing national health plan
By Steve Blow
Dallas Morning News
Sunday, October 9, 2005

In the newspaper business, someone is always upset with how we play stories.

Put one on the front page, and it’s called “sensationalism.” Put it inside, and it’s “buried.”

Well, let me join the chorus. When I read a story the other day at the bottom of the business section, I wondered why in the world it wasn’t on Page 1.

The headline: “Fewer firms are providing health care, survey finds.”

OK, not very sexy, I know.

In fact, I have just divided readers into two groups. First, those of you who felt your interest sag. You have good health insurance at work – or through a spouse, a parent or Medicare.

And second, those who felt your stomachs knot. You are uninsured or on the verge of it – and you’re worried sick about getting sick.

That headline made me think about a local fellow in a small third group – those who are well insured and worried about those who aren’t.

Actually, Gerald Frankel of McKinney belongs to an even smaller group than that. He’s a doctor who favors a national health-care plan.

Dr. Frankel – “Jerry” to his friends – is a urologist on a mission. He says we’ve got to face that our country’s system of providing health coverage through employers is broken.

That recent news story documented the continuing decline in companies offering health insurance – down to 60 percent now, a 9 percent drop in just five years.

I asked Dr. Frankel about his reaction to that story. “I had a whole mess of reactions,” he said. “First, my heart goes out to the people affected by this.

“You don’t see the devastation because you can’t put it in a photograph like you can with Hurricane Katrina. But physicians and nurses see families whose lives have been wrecked on a daily basis. The number of families who have their own Katrina every day is just phenomenal.”

Dr. Frankel’s second reaction: “It’s just another nail in the coffin of the current system,” he said. “But at what point do we say enough is enough? What’s the breaking point?”

The surgeon is frustrated that he can’t make others see what is so obvious to him: People are dying because of the broken system of delivering health care.

“How can this country, which is based on the highest principles, allow this to go on?” he asked. By one study, 18,000 people die each year solely for lack of health care. Thousands more suffer needlessly.

Dr. Frankel understands the natural reluctance to get the government involved. “Government drives everyone crazy. They say, ‘The same people who run FEMA? You’re going to let them take over health care?’ ”

But the government can do some things well, he said, and one of those is deliver decent, affordable health care to all its citizens.

It’s done that way in every other developed nation. And it’s not as foreign as it sounds. We already have it here, and I have already mentioned it – Medicare.

Good old Medicare. It may not be perfect, but older Americans look forward to the day they qualify for it. And Dr. Frankel sees no reason why such a national health plan can’t be expanded to all citizens, not just seniors.

If nothing else, the employer-based, private-insurance system offends Dr. Frankel for its inefficiency. He said about 25 percent of all premiums go to pay administrative costs. With Medicare, it’s 3 percent.

But worst of all, our system is bad medicine. We spend more on health care than any other country, but we’re the worst of developed nations in life expectancy and infant mortality, he said.

Dr. Frankel is active in Physicians for a National Health Program (www.pnhp.org). He tries to spread the message that way.

But he believes change will come only when the middle class is shaken from its comfort zone – only when enough people can’t find a job with health benefits, only when enough families are financially ruined by an illness, only when enough of “us” die unnecessarily.

Dr. Frankel wonders why we have to wait.

E-mail sblow@dallasnews.com

PNHP’s Frankel Promotes Medicare for All

Doctor prescribing national health plan
By Steve Blow
Dallas Morning News
Sunday, October 9, 2005

In the newspaper business, someone is always upset with how we play stories.

Put one on the front page, and it’s called “sensationalism.” Put it inside, and it’s “buried.”

Well, let me join the chorus. When I read a story the other day at the bottom of the business section, I wondered why in the world it wasn’t on Page 1.

The headline: “Fewer firms are providing health care, survey finds.”

OK, not very sexy, I know.

In fact, I have just divided readers into two groups. First, those of you who felt your interest sag. You have good health insurance at work – or through a spouse, a parent or Medicare.

And second, those who felt your stomachs knot. You are uninsured or on the verge of it – and you’re worried sick about getting sick.

That headline made me think about a local fellow in a small third group – those who are well insured and worried about those who aren’t.

Actually, Gerald Frankel of McKinney belongs to an even smaller group than that. He’s a doctor who favors a national health-care plan.

Dr. Frankel – “Jerry” to his friends – is a urologist on a mission. He says we’ve got to face that our country’s system of providing health coverage through employers is broken.

That recent news story documented the continuing decline in companies offering health insurance – down to 60 percent now, a 9 percent drop in just five years.

I asked Dr. Frankel about his reaction to that story. “I had a whole mess of reactions,” he said. “First, my heart goes out to the people affected by this.

“You don’t see the devastation because you can’t put it in a photograph like you can with Hurricane Katrina. But physicians and nurses see families whose lives have been wrecked on a daily basis. The number of families who have their own Katrina every day is just phenomenal.”

Dr. Frankel’s second reaction: “It’s just another nail in the coffin of the current system,” he said. “But at what point do we say enough is enough? What’s the breaking point?”

The surgeon is frustrated that he can’t make others see what is so obvious to him: People are dying because of the broken system of delivering health care.

“How can this country, which is based on the highest principles, allow this to go on?” he asked. By one study, 18,000 people die each year solely for lack of health care. Thousands more suffer needlessly.

Dr. Frankel understands the natural reluctance to get the government involved. “Government drives everyone crazy. They say, ‘The same people who run FEMA? You’re going to let them take over health care?’ ”

But the government can do some things well, he said, and one of those is deliver decent, affordable health care to all its citizens.

It’s done that way in every other developed nation. And it’s not as foreign as it sounds. We already have it here, and I have already mentioned it – Medicare.

Good old Medicare. It may not be perfect, but older Americans look forward to the day they qualify for it. And Dr. Frankel sees no reason why such a national health plan can’t be expanded to all citizens, not just seniors.

If nothing else, the employer-based, private-insurance system offends Dr. Frankel for its inefficiency. He said about 25 percent of all premiums go to pay administrative costs. With Medicare, it’s 3 percent.

But worst of all, our system is bad medicine. We spend more on health care than any other country, but we’re the worst of developed nations in life expectancy and infant mortality, he said.

Dr. Frankel is active in Physicians for a National Health Program (www.pnhp.org). He tries to spread the message that way.

But he believes change will come only when the middle class is shaken from its comfort zone – only when enough people can’t find a job with health benefits, only when enough families are financially ruined by an illness, only when enough of “us” die unnecessarily.

Dr. Frankel wonders why we have to wait.

E-mail sblow@dallasnews.com

Drowning in insurance paperwork

Treated for Illness, Then Lost in Labyrinth of Bills
By Katie Hafner
The New York Times
October 13, 2005

Medical paperwork is a world of co-payments and co-insurers, deductibles, exclusions and contracted fees. Nothing is as it seems: patients receive statements that often do not reflect what is actually owed; telephone calls to customer service agents are at best time-consuming and at worst fruitless. The explanations of benefits that insurers send out – known as E.O.B.’s – are filled with unintelligible codes.

The system is so impenetrable that it mystifies even the most knowledgeable.

“I’m the president’s senior adviser on health information technology, and when I get an E.O.B. for my 4-year-old’s care, I can’t figure out what happened, or what I’m supposed to do,” said Dr. David Brailer, National Coordinator for Health Information Technology, whose office is in the Department of Health and Human Services. “I can’t figure out what care it was related to or who did what.”

Ellen Mayer, 54, an artist who lives in Chester, N.Y… has a rare type of gastrointestinal cancer that requires constant monitoring through blood work, CT scans and PET scans.

The paperwork nightmare started for Ms. Mayer when her oncologist switched hospitals. Everything suddenly seemed to need a justification, or a new piece of paper with an authorization.

The stacks of papers, folders and Post-It notes related to Ms. Mayer’s treatment have started to take over her house. They fill manila envelopes, boxes and files, which fill closets. They spill from the dining room table onto chairs.

“You can’t just be sick,” she said. “You have to be sick and be drowning in paperwork.”

Insurance companies are, by and large, unapologetic.

“Even though the amount of paperwork a patient has to deal with might seem to be a lot, it would be much worse if there wasn’t a unifying organization like a health plan easing that burden,” said Dr. Alan Sokolow, chief medical officer at Empire Blue Cross Blue Shield in New York.

http://www.nytimes.com/2005/10/13/health/13paper.html

Comment: We can thank Alan Sokolow for providing us with one of the most compelling reasons for dismissing the private insurance industry and replacing it with our own universal program of public insurance. Talk about being oblivious to the problems! At least former FEMA Director Michael Brown recognized that there was a storm. Although the health care crisis has been repeatedly labeled as “The Perfect Storm,” Sokolow’s industry continues to plow through the levees that are failing to hold our fragile health care system together.

Ironically, they’re in the process of drowning their own industry, along with the rest of us. It’s too bad that we can’t prevent more health care tragedies by shrinking the private insurance industry down to size and drowning it in a bathtub!

Big-box health insurance discounts

Big-box retail stores add health insurance to wares
By Barbara Marquand
Sacramento Business Journal
September 30, 2005

Shoppers look for deals on everything from paper towels to computers at big-box warehouse stores. Now they can get health insurance too.

Costco Wholesale Corp. and the Sam’s Club unit of Wal-Mart have been offering small-business health insurance policies to customers for the last two years. Two months ago Costco expanded its line with a pilot program in Southern California to sell individual health insurance policies.

Costco decided to offer individual health insurance policies as one more way to offer value to customers… The coverage is available only to executive members, who pay $100 a year to shop at the warehouse, versus the $45-per-year standard membership fee.

PacifiCare has about 6,000 people enrolled in its Costco small-business plan and about 800 enrolled in its individual Costco PPOs. The Costco plans have higher deductibles and slightly different benefits from other PacifiCare products, which help achieve the premium savings.

Rita Gibson doesn’t think the big-box phenomenon will have a big impact for most traditional brokers. The big-box stores are selling insurance as a commodity, she said, and the benefits for those policies are not as strong as they are for other policies sold through brokers.

“In the short run it brings more competition to the market, and as an economist I think that’s good,” said Glenn Melnick, director of the University of Southern California Center for Health Policy and Management. “It makes it easier to have access to a lower-cost market.”

But he doesn’t expect a big impact in the long term unless insurers get more innovative…

http://sacramento.bizjournals.com/sacramento/
stories/2005/10/03/focus3.html

Comment: So now the big-box discount stores are entering the competitive market for health insurance. And how do they compete? By reducing benefits and require greater cost sharing than the competing products that have already reduced benefits and required greater cost sharing. It’s a race to the bottom!

How long has it been since you’ve seen a new insurance product that offers greater benefits and lower out-of-pocket costs? Well, you won’t see any because the competition is with premiums charged rather than with the quality of the insurance product. By far the largest sector of the market is composed of healthy individuals who have only relatively negligible current needs for health care. That sector finds it very difficult to devote a large portion of income to a “commodity” that they aren’t using.

Deterioration in the value of insurance products has already created financial hardships for those who do develop significant acute and chronic problems. As these innovative trends expand, more and more middle income individuals will be impacted. But for the affluent, who have a political voice, health care will never become unaffordable, so there will be little pressure for change.

Besides, look at the potential for new revenue opportunities. Right next to the insurance desk, the big-box stores can set up Chapter 13 agents. And that is destined to be a very high volume business!

Senator Sold Stock Before Price Dropped

By Jonathan M. Katz
Washington Post
September 21, 2005

Senate Majority Leader Bill Frist, a potential presidential candidate in 2008, sold all his stock in his family’s hospital corporation about two weeks before it issued a disappointing earnings report and the price fell nearly 15 percent.

Frist held an undisclosed amount of stock in Hospital Corporation of America, based in Nashville, the nation’s largest for-profit hospital chain. On June 13, he instructed the trustee managing the assets to sell his HCA shares and those of his wife and children, said Amy Call, a spokeswoman for Frist.

Frist’s shares were sold by July 1 and those of his wife and children by July 8, Call said. The trustee decided when to sell the shares, and the Tennessee Republican had no control over the exact time they were sold, she said.

HCA shares peaked at midyear, climbing to $58.22 a share on June 22. After slipping slightly for two weeks, the price fell to $49.90 on July 13 after the company announced its quarterly earnings would not meet analysts’ expectations. On Tuesday, the shares closed at $48.76.

The value of Frist’s stock at the time of the sale was not disclosed. Earlier this year, he reported holding blind trusts valued at $7 million to $35 million.

Blind trusts are used to avoid conflicts of interest. Assets are turned over to a trustee who manages them without divulging any purchases or sales and reports only the total value and income earned to the owner.

To keep the trust blind, Frist was not allowed to know how much HCA stock he owned, Call said, but he was allowed to ask for all of it to be sold.

Frist, a surgeon first elected to the Senate in 1994, had been criticized for maintaining the holdings while dealing with legislation affecting the medical industry and managed care. Call said the Senate Select Committee on Ethics has found nothing wrong with Frist’s holdings in the company in a blind trust.

“To avoid any appearance of a conflict of interest, Senator Frist went beyond what ethics requires and sold the stock,” Call said. Asked why he had not done so before, she said, “I don’t know that he’s been worried about it in the past.”

An HCA spokesman said the company had no part in Frist’s decision.

Frist’s father, Thomas, founded the company, and his brother, Thomas Jr., is a director and leading stockholder. The family is worth $1.1 billion, according to Forbes magazine.

HCA — formerly known as Columbia HCA Healthcare Corp. — has been a top contributor to the senator’s campaigns, donating $83,450 since 1989, according to the Center for Responsive Politics.

The sale of the shares was first reported by Congressional Quarterly.

Privatisation will wreck NHS, say campaigners

Hospitals may close, says letter to Guardian
Timing seems designed to foment conference revolt

John Carvel, social affairs editor
Guardian
Saturday September 24, 2005

A campaign to halt the government’s drive to commercialise the NHS is being launched today by the former Labour health secretary Frank Dobson with the support of leading figures from the British medical establishment.

In a letter to the Guardian that is likely to form the focus of dissent at the Labour conference in Brighton next week, they say that reforms being introduced by the health secretary, Patricia Hewitt, threaten to destroy the character of the NHS by forcing hospitals and health professionals to compete with each other. The timing of the letter is clearly designed to foment a revolt in Brighton, where Dave Prentis, general secretary of the public service union Unison, intends to move a resolution on Wednesday calling on the government to “suspend any further expansion of the role of the private sector into the NHS”. The union was busy mobilising support yesterday among unions, MPs and constituency parties, predicting that victory for its motion could become the main flashpoint of the conference.

But the campaign’s reach extended beyond the Labour movement, with supporters of the letter including 19 professors of medicine and related disciplines, senior figures from the British Medical Association, and the poet laureate, Andrew Motion. It was also signed by Mr Prentis, the former cabinet minister Clare Short, and authors Philip Pullman, Claire Tomalin and Nick Hornby.

The letter came as the BMA published a survey of NHS medical directors across England suggesting that a third of NHS trusts are preparing to reduce services to avoid a debt crisis. The letter said: “Forced market competition will break up the NHS as a collaborating network … There will be winners and losers, with some units and even entire hospitals having to close … The NHS must be kept in public hands … We call on organisations, healthcare workers, patients and public to campaign to protect the NHS from further privatisation and fragmentation.”

Mr Dobson said: “The government’s policy of promoting competition within the NHS and franchising services out to the private sector is gathering momentum day by day. Before long we will have a health insurance system and the NHS’s role as a provider of care will be limited to picking up the difficult cases and looking after the worst off. There is great concern in the Labour party throughout the country about what is happening – and it is shared by more than 1m NHS employees. It is time we worked together to put some chocks under the wheels of this fashionable bandwagon.”

The BMA’s analysis of NHS cuts was based on a survey of 530 medical directors in England. On the basis of 120 replies, it said 73% of trusts face a funding shortfall in the current year. The required savings averaged £6.2m per trust. Almost half were proposing a recruitment freeze and 27% were considering redundancies. Some trusts are also intending to close beds.

The BMA said medical staff would be included in recruitment freezes in almost half (47.9%) of cases where this was being considered, with 14% saying redundancies would also include medical staff.

Paul Miller, chairman of the BMA’s consultants’ committee, said: “It is hard to understand why, at a time when the government has invested unprecedented funding in the health service, trusts may have to lay off staff and close wards. Something is going terribly wrong when patients pay the price for these financial problems and the government’s lack of joined-up thinking … It is madness to guarantee private providers huge volumes of work, often at a higher cost than the NHS, while NHS hospitals are deprived of essential funding.”

The NHS Confederation, representing managers and trusts, said the BMA’s findings should be treated with caution, since less than a quarter of medical directors replied to the survey.

The campaign’s website is www.KeepOurNHSPublic.com

The letter:

The future of the NHS is at stake

Saturday September 24, 2005

Guardian
The NHS stands at a crossroads. For nearly 60 years, Britain has enjoyed a National Health Service that strives to be comprehensive, accessible and high value for money. Now, government reforms threaten both the ethos of the NHS, and the planned and equitable way in which it delivers care to patients.

At the heart of the changes is the creation of a market that welcomes profit-driven international corpor-ations and will compel hospitals and health professionals to compete with each other. If these reforms continue the nature of the health system will change radically:

– Income and profit will come before clinical considerations.
– Profitable services and patients will attract money at the expense of unprofitable ones.
– Forced market competition will break up the NHS as a collaborating network of shared resources and information.
– Even more of the new money allocated to health will be diverted to shareholders and wasted on the huge administrative costs associated with a market.

There will be winners and losers, with some units and even entire hospitals having to close. We are already seeing bed closures in NHS hospitals. The end result will undermine the choice that is most important to patients – access to comprehensive, trustworthy and l ocal health services.

The situation is grave. The NHS must be kept in public hands, serving the interests of all patients and the broader public. We therefore call on organisations, healthcare workers, patients and public to campaign to protect the NHS from further privatisation and fragmentation.

Prof David Hunter
University of Durham

Dr Mac Armstrong
Ex-Chief Medical Officer, Scotland

Sir Sandy Macara
ex-BMA council chair

Dr John Marks
ex BMA council chair

Professor Brian Jarman
Ex BMA president and head of the Dr Foster unit at Imperial College

Sir Iain Chalmers
Director, UK Cochrane Centre NHS Research and Development Programme

Professor Julian Tudor Hart
Medic, academic and writer

Frank Dobson MP
Ex Secretary of state for Health

Professor John Yudkin
Professor of Medicine Director, International Health and Medical Education Centre University College London

Professor Martin White
Chair of Public Health and Director Public Health Research Group School of Population & Health Sciences Faculty of Medical Sciences University of Newcastle upon Tyne

Professor George Davey Smith
(Professor of Epidemiology) Dept Social Medicine, Bristol

Professor Martin McKee
European Centre on Health of Societies in Transition London School of Hygiene and Tropical Medicine

Professor Allyson Pollock
Academic and writer

Peter Kilfoyle MP

Professor Colin Crouch
Chair of the Institute of Governance and Public Management Warwick University Business School

Professor Martin White
Chair of Public Health and Director, University of Newcastle upon Tyne

Professor Sara Arber
Department of Sociology, University of Surrey, Guildford

Dave Prentis
Unison, General Secretary

Prof Vincent Marks
Professor of clinical biochemistry at the University of Surrey

Professor Dame June Clark
Professor Emeritus at the University of Wales member of the Royal Commission into long term care of the elderly

Claire Rayner
writer, broadcaster

Phillip Pullman
author

Neal Lawson
Chair, Compass

George Monbiot
Writer, journalist

Clare Short MP

Professor Sir Andy Haines
Professor of Public Health and Primary Care

Mr Nick Astbury (personal capicity)
President of the Royal College of Ophthalmologists

Nick Hornby
author

John Bird
comedian

Andrew Motion
Poet Laureate

Prof Charles Webster
NHS historian academic, writer

Francis Wheen
Journalist

Claire Tomalin
winner of Whitbread book award

Prof Harry Keen CBE
President NHS Support Federation National Pensioners Convention

Frank Cooper

Professor Rodney Reznek
Professor of Diagnostic Imaging

Prof Emeritus Ron Taylor

Prof Emeritus David Metcalfe

Keep our NHS public

Keep our NHS public

You may be aware of a major campaign which is being launched, Keep our NHS public.

I would like to encourage you to visit its website
http://www.keepournhspublic.com/
where you can sign to support the campaign. You may wish to read the letter in The Guardian on 24 September 2005 calling for the campaign, signed by health practitioners, writers, and other leading figures:
http://www.guardian.co.uk/letters/story/0,,1577222,00.html

I would also encourage you to contact the campaign if you wish to help or if you are organising a relevant meeting or other activity. Please contact info@nhscampaign.org

You may be interested to know that there will be a meeting organised by the NHS Consultants’ Association on Saturday 08 October at 3.00pm in the Wilkins Old Refectory in UCL, Gower St, London. Please contact nhsca@pop3.poptel.org.uk if you are interested in attending.

Dr James Lancaster
Centre for International Public Health Policy
University of Edinburgh

VA/Canada have lower prices than Medicare Plan

New Report Finds Medicare Drug Prices are 58.2 Percent Higher than VA Prices

49 of 50 Top-Prescribed Drugs Are More Expensive in Medicare than Through the Department of Veterans Affairs (VA)

Washington, D.C. – A new report released today found that seniors using Medicare drug discount cards are paying considerably more for 49 of the top-50 most frequently prescribed drugs than they would through the Department of Veterans Affairs (VA). The median price difference for the 50 drugs was $220.44.

The report, released by the consumer health organization Families USA, found that, for half of the top-50 drugs, the lowest Medicare discount card price is at least 58.2 percent higher than the best available VA price.

The Families USA report was issued at a time when many conservatives and liberals are concerned about the expense of the new Medicare drug program. A key controversial feature of the legislation that created the new program prohibits Medicare from bargaining for cheaper drug prices like the VA already does.

“The best way to make medicines affordable for seniors is to allow Medicare to negotiate for better prices directly with drug companies, the way the VA successfully does,” said Ron Pollack, Executive Director of Families USA. “The continued prohibition against such bargaining will not only hurt seniors, but it will also fleece the American taxpayer.”

This study about the temporary Medicare drug discount card program provides the best current forecast of the drug prices we will see in the new drug benefit program. It shows that, despite the cost-savings promises made by the Bush Administration and congressional leaders when the new Medicare law was enacted, the Medicare discount cards routinely failed to result in drug prices as low as the VA.

For the five drugs most frequently prescribed for seniors, the report found that the best price under the Medicare drug discount card is considerably higher than the best VA price:

– For Plavix (75 mg.), a blood-clot reducing agent that is the most heavily prescribed medication for seniors, the best VA price is $887.16 per year, compared to the best Medicare drug discount price of $1,230.36—a difference of $343.20, or 38.7 percent.

– For Lipitor (10 mg.), a cholesterol-lowering agent that is the second most heavily prescribed medication, the annual VA price is $498.84, compared to $730.56 under the Medicare discount cards—a difference of $231.72, or 46.5 percent.

– For Fosamax (70 mg.), an osteoporosis drug that is the third most heavily prescribed medication for seniors, the annual VA price is $493.32, compared to $650.52 under the Medicare discount cards—a difference of $157.20, or 31.9 percent.

– For Norvasc (5 mg.), a high-blood pressure treatment that is the fourth most heavily prescribed medication for seniors, the annual VA price is $301.68, compared to $467.042 under the Medicare discount cards—a difference of $165.36, or 54.8 percent.

– For Protonix (40 mg.), a stomach acid blocking agent that is the fifth most heavily prescribed medication for seniors, the annual VA price is $253.32, compared to $827.40 under the Medicare discount cards—a difference of $574.08, or 226.6 percent.

For the two most expensive drugs prescribed to seniors under the discount card program in the top-50 list, the report found that the best price under the Medicare drug discount card is considerably higher than the best VA price:

– For Aricept (10 mg.), an Alzheimer’s treatment that is the most expensive of the top-50 drugs prescribed for seniors, the annual VA price is $1,056.84, compared to $1,453.92 under the Medicare discount cards—a difference of $397.08, or 37.6 percent.

– For Pravachol (40 mg.), a cholesterol-lowering agent that is the second most expensive of the top-50 drugs, the annual VA price is $470.40, compared to $1,240.44 under the Medicare discount cards—a difference of $770.04, or 163.7 percent.

“A big reason why the new Medicare program is so costly is because Congress and the President chose to support the pharmaceutical lobby over the interests of America’s seniors and taxpayers,” said Pollack. “At a time when drug costs continue to skyrocket and the federal budget is in deep deficit, this needs to change.”

The Families USA report was based on a comparison of the Medicare discount card prices for the 50 drugs most frequently used by seniors with the prices the VA negotiates for those same drugs. The list of the 50 drugs most frequently prescribed to seniors is based on the drugs most frequently prescribed in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program. This program is the oldest and largest drug assistance program for seniors in the U.S., with nearly 200,000 enrollees.

Families USA collected all Medicare discount prices for each drug using a zip code for the Cincinnati area, 45206, and the findings are based on the lowest price recorded for each drug. These prices were then compared to the lowest publicly reported prices by the VA. The Medicare drug discount prices are very similar from one locale to another.

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Families USA is the national organization for health care consumers. It is nonprofit and nonpartisan and advocates for high-quality, affordable health care for all Americans.