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Why Americans settle for a broken health-care system

Stanford School of Medicine
Stanford Medicine Magazine
Winter 2005

OK, you say you want a revolution Why Americans settle for a broken health-care system
By Michelle Brandt

“The whole thing is broken,” says David Magnus, PhD, director of the Stanford Center for Biomedical Ethics. “The core problem is that we have a completely irrational way of paying for and delivering health care.”

Our national leaders haven’t adequately addressed the issues, and- despite survey after survey showing that Americans believe our health-care system needs reform – the public hasn’t taken them to task for it. Health care hasn’t
reached critical mass as a political issue, experts say, because Americans are worried about the future but not concerned enough with their current situation to clamor for change.

Yet many continue to push for reform, including medical student (Graham) Walker, who is hoping to soon begin a documentary on the health-care system.
He’s among those who feel confident that change is coming. Says another believer in change, advocate (Don) McCanne: “I personally suspect it will happen in years, rather than decades.

“We want our technology, we want great advances in health care. When we see
only the wealthy can get them, that’s not going to be acceptable.” Sociology professor (Donald) Barr agrees and predicts that increasing numbers of “horror stories” will eventually cause people to vote only for those politicians who address the health-care issue. And that’s exactly what we need to have happen: only when the public puts the pressure on legislators – and becomes entrenched in the fight like Walker and others – will the nation get real reform.

http://mednews.stanford.edu/stanmed/2005winter/healthcare-main.html

Comment: Michelle Brandt is the Media Relations Manager of the Office of Communication and Public Affairs at Stanford University Medical Center. In this article she has captured the essence of our broken system of funding care and the oxymoronic unstable inertia of reform. Although the article is somewhat long, it makes for a great Sunday read.

Idaho State Journal, (lead editorial)

Our View: It’s time to revisit national health care

Idaho, like virtually every other state, can’t figure out how to cope with the black hole of Medicaid. The state’s Medicaid spending has grown 935 percent since 1990 with no end in sight for escalating costs. Lawmakers recently refused to pump an added $15 million into the program for health care of the poor and disabled until reforms are enacted.

But what reforms? Stop paying health care providers is one option; another is to tell them they cannot accept any new patients. Too drastic, by far. It is not just the poor who are running up bills for health care.

Some 4,500 personal bankruptcies resulted from unpaid medical bills in Idaho last year. And many of those were people who thought they were protected by having health care insurance, only to find that high deductibles and co-pays cost them several thousand dollars out of pocket. “The people out there who are middle class and have health insurance believe that it will keep them from financial ruin if they should get sick,” says Dr. Bill Woodhouse, a physician for Pocatello Family Medicine. “The reality is that ain’t so.”

And when people can’t pay medical bills, they may wind up in the Bannock County indigent office -some 400 to 450 cases a year. That’s a hardship not only for local government, but for individuals, who can find a lien placed on their property to repay the county.

Furthermore, about one in five adults in Idaho does not have health insurance because of its cost. Typically, the young and healthy members of the population drop out. As a result, the rest of us -who are more likely to be sick or laid up-pay ever higher premiums for insurance. Some small employers find they cannot afford insurance for employees, or they skimp on benefits.

Not surprisingly, the federal government is not immune from the problem. Within a decade, the government will be footing the bill for nearly half the nation’s medical costs, its share propelled higher by the hugely expensive Medicare drug legislation enacted in 2003. To win its passage, the Bush administration told wavering lawmakers that the program would cost $400 billion; the latest estimate of costs when the program goes into effect next year is more than $720 billion.
The president has touted health savings accounts, which in theory would work in conjunction with a health insurance policy to help pay off the deductible, co-pay or services above a coverage limit. But that would not help the growing number of people who cannot afford medical insurance.

The administration of President Bill Clinton pushed hard for a national health insurance system a decade go. Vested interests torpedoed that effort, making Hillary Clinton the scapegoat for its demise. But that was then, and this is now.

Here’s what Dr. Woodhouse says in a well-written, thorough Journal story by reporter Elizabeth Ziegler:
“While many claim that we have the best health care system in the world, I know of nobody who believes we have the best way of paying for health care, as evidenced by the high number of the uninsured and medical bankruptcies,” Woodhouse says. “I feel our health care financing system has failed everyone, including the providers. It’s an extractive industry right now. I’ve reluctantly come to believe in the single payer, national health program. I am a pretty conservative person, but this is one thing in which the free market has failed.”

The mounting evidence, in doctor’s offices, in legislative halls, in the bankruptcy courts, and in households shattered by medical debt, is that this doctor knows best.

The Right to Health Care

Congressman Pete Stark
March 3, 2005
Stark Introduces Constitutional Amendment to Establish Right to Health Care

Today, Rep. Pete Stark (D-CA) announced his introduction of a proposed amendment to the US Constitution to guarantee health care as a right for every American. The amendment, H.J. Res. 30, is cosponsored by Rep. Jesse Jackson, Jr. (D-CA) and 27 other House members.

“The health of every American is vital to their unalienable rights of ‘life, liberty, and the pursuit of happiness,'” said Rep. Pete Stark. “To ensure these rights are fully enjoyed, we must be certain that every American can access quality health care – regardless of their income, race, education or job status. This Constitutional amendment is aimed at achieving this fundamental goal.”

Today, there are 45 million uninsured Americans, including 8 million children. Millions more are underinsured, excluded from certain types of health coverage or being quickly priced out of the health insurance market altogether. Additional disparities in access, treatment, and outcomes exist for people of color.

Facing skyrocketing costs, many employers are cutting benefits or dropping coverage for their employees, chipping away at the very foundation of health care insurance in the United States. Proposed cuts in Medicaid now endanger coverage for the over 50 million Americans that currently rely on the program for medical care.

“We face a health care crisis where equal opportunity and basic fairness in our nation are at stake,” said Rep. Stark. “I’m frustrated, as many Americans are, that the President and Congress continue to ignore the problems we face. A Constitutional guarantee of health care for all will force Congress to take action to ensure that health coverage is there for all Americans.”

H.J. Res. 30 would amend the Constitution to say “all persons shall enjoy the right to health care of equal high quality.” It would require ratification by three-fourths of the States and so-called implementing legislation must be passed by Congress to ensure compliance with the amendment.

“I firmly believe that until we can guarantee that all people have the right to equal, high-quality health care through the Constitution, the interests of the people will continue to play second fiddle to the corporate bottom-line,” said Rep. Stark. “It’s time we put the health care of the people first. Our Constitution should be amended to promote that common interest.”

http://www.house.gov/stark/news/109th/pressreleases/03-02_healthamendment.htm

Comment: We are already spending more than enough to provide high quality health care for everyone. But only the government can mandate that those funds be used to ensure that everyone has the right of access to affordable care.

We have long given lip service to the right to health care. But now it’s finally time to have a serious, definitive national debate on the constitutional right to quality health care for all. Let’s rally around H.J. Res. 30.

Canada moves forward with 10-year plan

Canada
Department of Finance
February 7, 2005
Minister of Finance Tables Legislation to Implement 10-Year Plan to Strengthen Health Care

Minister of Finance Ralph Goodale today tabled legislation in the House of Commons to implement the Government of Canada’s 10-Year Plan to Strengthen
Health Care, which was signed by all 14 first ministers at their September 2004 meeting.

“This plan illustrates very clearly how all Canadians benefit when governments work together in common purpose,” stated Minister Goodale. “The legislation to implement this historic agreement is a priority for the Government.”

http://www.fin.gc.ca/news05/05-011e.html

Canada’s 10-year plan:
http://pm.gc.ca/eng/news.asp?id=260

Comment: No health care system will be free of problems. But Canada demonstrates that a publicly administered and publicly financed program is capable of responding to its problems. In contrast, in the United States, our costs are out of control while our problems grow much worse. Why do we continue to tolerate our outrageously expensive and highly dysfunctional system?

Health advocates push for ‘single-payer’ universal health care

Rita Villadiego, Dec 01, 2004 NEWARK, N.J. — A few months ago, Filipino American Rico Genaro, 42, who earns a minimum wage, as a staff of a video shop in New York City, got the flu and couldn’t work for a week.

He went to a doctor and spent over $350 for check-up and medication.

“I feel so worried without health insurance. If I have a serious illness, I don’t know how to survive,” said Genaro who was interviewed in a party in Jersey City. Genaro is one of millions of Americans who bear the brunt of the government’s lack of health-insurace policy.

Health advocates and policy makers have agreed to continue their efforts to push for universal health care amid concerns that escalating medical costs and prescription have endangered the lives of patients.

Speaking to advocacy groups, Dr. Charles Granatir of the Physicians for a National Health Program lamented that 18,000 deaths each year in the U.S. are due to lack of health insurance. With 45 million uninsured Americans or about a million uninsured in New Jersey, this has dangerous implications to patients. “The rise of the uninsured is not the cause of the healthcare crisis, it is the result,” said Granatir.

During the forum, a video was shown highlighting the suffering of Roslyn Schwartz of Fort Lee, N.J. who died of breast cancer in 2000 without health insurance. Faced with the bitter reality of dying without health care, she walked from Fort Lee to Trenton to dramatize her protest on the plight of the uninsured.

The effect is compounded by skyrocketing prices of prescription drugs that are usually tough for people who are under 65 years old, and not covered by Medicare, or other insurance, advocates say. Granatir is backing the passage of the United States National Health Insurance Act of H.R. 676, authored by Rep. John Conyers (D, MI), which establishes an American single-payer health care system.

The bill would create a publicly financed, privately delivered health care program that uses the already existing Medicare program by expanding and improving to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans, guaranteed by law, will have access to the highest quality and most-cost-effective health care services regardless of employment, income, or health status.

The single-payer health care proposed by the Physicians for National Health Program emphasizes that health insurance will be privately delivered by practitioners and is therefore privately-run and not state-controlled. Granatir said unlike in Canada and other developed countries in Europe, the U.S. has no health policy. He said health care costs account for 15 percent of the U.S. gross domestic product.

The U.S health care cost is expected to shoot up to $1.8 trillion this year. The high cost is due mainly to soaring administrative and overhead costs of of health care providers and physicians who spend some $294.3 billion each year on administrative cost alone. Under the proposed single-payer health care system, everybody will receive a ticket for health care to receive needed comprehensive treatment. The blue-print health package underscores the need to make health care a right and not a privilege for all Americans.

As many people lost jobs or became under-employed in the wake of weak economy, more people are getting anxious of the increasing premiums on health insurance. Trish Comstock, 65, works for about two hours a week as a part-time teacher at Montclair State University.

She slipped down while walking in Manhattan three years ago and broke her hips. Since she has a low income, she was covered by Medicaid but paid almost $3,000 out of her pocket to pay her hospital bills. “When you are working part-time, you can’t use all your money to pay for health costs and pay other bills,” said Comstock. She is now getting Medicare insurance and her premium has increased from $66 to $78 per month.

Comstock’s feeling reflects the growing frustrations on health care. She is not alone as she struggles to pay increasing health care costs. Some people have greater worries as a Medicare program that pays health insurance premiums, known as Qualifying Individual or QI-1, for the poorest of the poor expired Saturday, forcing 156,000 Americans to pay for their own premiums.

“They are exploiting people who can least afford it,” Comstock said. With the graying of the baby boomers, health care providers are seen to increase costs by 20 percent as caring for the sickly old people requires more medication and hospital care, an official of the Blue Cross and Blue Shield Association said in a previous interview.

While millions suffer without health insurance, advocates who attended the forum said high cost of health insurance and expensive prescriptions fill the coffers of most health companies. Granatir said most drug companies earned 18.5 profit margins in 2001 as compared to 3.3 percent profit margins of Top Fortune 500 companies. He said 22 percent to 35 percent of health care dollar costs go to overhead and profits of most health care companies.

But Senator Joe Vitale of District 19, N.J. said the government’s family health care program has provided insurance to millions of families or one-third of total children in N.J. The government is working to provide health insurace to working adults and not only children. The government also reimbursed hospitals of $583 million for charity care for the poor this year as compared to $383 million last year.

“We have to increase insurance eligibility to parents,” Vitale said. Legislators agreed that it would be a long way and struggle for Americans to have a meaningful health care reform. Since universal health care is generally backed by Democrats in Congress, it would be difficult to pass this law since the Republicans are in power, said Mada Liebman, senior advisor and staff N.J. Senator Jon Corzine. Corzine authored a resolution urging Congress to enact an equal access to comprehensive health call to all Americans by the year 2005.

“We have to fight to turn the situation around. We could not get health care reform in the last four years,” said Lawrence Hamm, chairman of the People’s Organization for Progress.

Stark Introduces Constitutional Amendment to establish right to health care

FOR IMMEDIATE RELEASE
Thursday, March 3, 2005
CONTACT: Lindsey Capps (202) 225-5065

Stark Introduces Constitutional Amendment to establish right to health care

WASHINGTON, DC — Today, Rep. Pete Stark (D-CA) announced his introduction of a proposed amendment to the US Constitution to guarantee health care as a right for every American. The amendment, H.J. Res. 30, is cosponsored by Rep. Jesse Jackson, Jr. (D-CA) and 27 other House members.

“The health of every American is vital to their unalienable rights of life, liberty, and the pursuit of happiness,” said Rep. Pete Stark. “To ensure these rights are fully enjoyed, we must be certain that every American can access quality health care — regardless of their income, race, education or job status. This Constitutional amendment is aimed at achieving this fundamental goal.”

-# # # –

Congressman Pete Stark

FREMONT
39300 Civic Center Dr.
Suite 220
Fremont, CA 94538
510-494-1388

WASHINGTON, DC
239 Cannon Building
Washington, DC 20515
202-225-5065

Canada's "Monty Python" health care system

Globe and Mail
March 1, 2005
Ontario hospitals chief pleads for more funds
By Oliver Moore

The head of the Ontario Hospital Association called Tuesday for a new funding arrangement, saying that the current system “would be better suited to a Monty Python movie.”

Hilary Short said that a “dramatically different” approach will be needed to prevent patient care being “cut deeply” when government rules against running a deficit come into play.

“Hospitals have until March 31, 2006 to achieve balanced budgets,” she told The Economic Club in Toronto Tuesday morning.

“The Ontario government, like most other governments, sets hospital budgets at a level it feels it can afford,” she said.

“This year, although the cost of operating hospitals increased by almost 8 per cent, the hospital sector received a 4.3 per cent base increase in funding from the provincial government. But because much of this increase was earmarked for specific initiatives, individual hospitals received an average base funding increase of 1.8 per cent.”

Not only were the increases insufficient, she said, the current funding method forces hospitals to guess how much money they will get and then spend accordingly. Only near the end of the fiscal year do they find out their actual funding, by which time they regularly have to borrow money to make up the shortfall.
“Enough is enough … the time has come to adopt a dramatically different approach. To protect patient care, Ontario needs stable, multi-year funding that is realistic in covering the real cost of providing care.”

http://www.theglobeandmail.com/servlet/story/RTGAM.20050301.whosp0301/BNStory/National/

Excerpts from Hilary Short’s speech:

The Economic Club of Toronto

Since its election in October 2003, the Ontario government has embarked on an ambitious agenda for health care reform — an agenda driven by Roy Romanow’s Royal Commission Report.

It’s come to be called the “Transformation Agenda,” and it consists of several different component parts, parts it must be added that like an engine, need to work perfectly together if they are to run smoothly.

First, the government is investing significantly in community care with the goal of easing pressure on hospitals.

Put plainly, this means shifting money to the community sector so it can serve more people. Over time, this will ease pressures on hospitals and help save money.

Second, the government is requiring hospitals to cut spending and divest themselves of certain services that, in their view, can more appropriately be delivered in the community setting.

The government is implementing this policy deliberately, to allow hospitals to focus exclusively on doing what they alone can do – providing the most complex care.

Third, the government is creating and implementing a plan to reduce waiting times for patients in five key areas – cardiac care, cancer care, diagnostic services like MRIs, hip and knee replacements and cataract surgery.

Fourth, through Family Health Teams, we also know that the government is pursuing the goal of improving access to primary care for the hundreds of thousands of Ontario families without a family doctor.

Fifth, the government is investing heavily in health promotion to ease the burden on our hospital system.

And finally, the government intends to improve the way in which the health care system works at the local and regional level, by creating Local Health Integration Networks.

Taken together, the component parts of this transformation agenda are designed to accomplish a simple goal – drive down costs, while improving access for patients to Ontario’s treasured public healthcare system. And…

To protect patient care, Ontario needs stable, multi-year funding that is realistic in covering the real cost of providing care.

We need a transformational, innovative, new funding model that would help to rejuvenate the entire health system. One idea, highlighted recently by a Senate Committee Chaired by Michael Kirby is called service-based funding.

Service-based funding would provide stable and predictable funding to hospitals.

It would fund them for the volume and complexity of care they provide, and reward them for their efficiency and performance while recognizing the real cost of providing care.

The OECD believes this model has potential. In an October 2004 report on Canada, the OECD noted that moving towards service-based funding would help improve performance and efficiency as well as reduce wait times.

And…
As I close, let me say this.

Hospitals have signed on for the “Transformation Agenda”. Progress is, and will continue to be made, by governments and healthcare providers working together.

What hospitals are asking for are the time and the resources to get it right.

Let’s move forward on primary care reform and investing in services in the community and in the home.

Let’s cooperate and support hospitals as they seek further savings in non-clinical areas like purchasing and accounting.

Let’s look at the facts, listen carefully, and move steadily to better integrate healthcare.

And finally, in the upcoming Ontario Budget, let’s reconsider the fiscal plan for hospitals to sustain our incredibly valued healthcare professionals while protecting patient care through this time of change and transition.

http://www.oha.com/Client/OHA/OHA_LP4W_LND_WebStation.nsf/page/The+Economic+Club+of+Toronto

Comment: The Canadian press seems to prefer to characterize their medicare program as a system that “would be better suited to a Monty Python movie.” Although Ms. Short did use that phrase in describing the difficulties of readjusting budgets during the fiscal year, you would think from the press coverage that the entire health care system was a Monty Python nightmare. That is unfortunate since the all-too-common, doom-and-gloom press coverage of the Canadian system is used to discredit single payer as a model for reform in the United States.

Ms. Short’s actual message is quite clear. The Canadians have an excellent health care system, and they can make it even better. We should be so fortunate.

Canada’s “Monty Python” health care system