pnhpf3a

Survey of health care opinion leaders

The Commonwealth Fund
Health Care Opinion Leaders Survey
Harris Interactive, Inc.
Dates: November 22, 2004 – December 8, 2004

The Commonwealth Fund Health Care Opinion Leaders Survey was conducted
by Harris Interactive on behalf of the Fund, with a broad group of more than
300 opinion leaders in health policy and innovators in health care delivery and finance. The survey focused on health policy priorities for Congress over the next five years.

There is broad consensus among leaders that expanding coverage to the uninsured is the top priority that should be addressed by Congress. This is the top priority for all groups represented in this study, with a large majority of academic/research institutions, health care delivery, business/insurance/other health care industry, and government/labor/advocacy identifying this issue as the top priority. There is also considerable agreement about the reforms that should be enacted in order to achieve this priority. Allowing individuals and small businesses to buy into the Federal Employees Health Benefits Program or similar federal group option receives the highest support overall and a majority of votes across all groups.

Also, expanding existing state-based public insurance programs, Medicaid and
the State Children’s Health Insurance Program, is supported by more than half of leaders overall and across groups, except for the health care delivery sector. This suggests a more incremental approach, with a national health system (universal coverage) receiving very little attention as a priority now.

http://www.cmwf.org/surveys/surveys_show.htm?doc_id=254281

From the survey:

Q700 Below is a list of possible reforms to expand coverage for the uninsured. Which of the following should be the top priorities for action?
(Please select up to five priorities.)

65% – Allow individuals and small businesses to buy into the Federal Employees Health Benefits program or similar federal group option

55% – Expand existing state-based public insurance programs, Medicaid and SCHIP

48% – Let near-elderly adults buy into Medicare

45% – Single-payer system of health insurance through a new program or Medicare-for-all

43% – Incentives or requirements to expand employer-based health insurance

37% – Reinsurance for small business insurance plans

31% – Eliminate two-year waiting period for the disabled for Medicare

22% – Create new tax credits for the uninsured to purchase insurance in the individual insurance market

22% – Expand tax-free health savings accounts

20% – Create new tax credit for the uninsured but limit to purchase of group
coverage through state public programs or employers

04% – Other

01% – Mandate

01% – Not Sure

http://www.cmwf.org/usr_doc/Opinion_leaders_topline.pdf

Note that the single payer result was skewed downward by a 29% response of the Business/Insurance/Other Health Care Industry sector – Table 4a:
http://www.cmwf.org/usr_doc/CMWF_Opinion_Leaders_summary.pdf

Comment: Another interesting result is that the Government/Labor/Consumer
Advocacy sector expressed 63% support of a single payer system as compared
to 57% support for expanding eligibility for the Federal Employees Health Benefits Program (FEHBP). It appears that some of those who have “the coverage that members of Congress have” would rather be covered under a single payer system.

The good news is that tax credits and HSAs bombed as choices for expanding
coverage.

The unfortunate news is that The Commonwealth Fund continues to characterize
the results as representing support of incremental approaches, with a national health system “receiving very little attention.” Although there is support for FEHBP, simultaneously there is opposition to tax credits that would make FEHBP premiums affordable for the individual (but with a greater tax burden). And correcting for the insurance/business bias against single payer, brings the support to 51%, making it one of the leading options for reform.

The only real conclusion that can be reached from this survey of health care
opinion leaders is that they do want universal health care coverage, but that they are divided over whether that should be through a single payer system or through private health plans with a safety-net public program.

We need to further expand the dialogue.

——————————————————————————————-
Message: 2
Date: Fri, 7 Jan 2005 16:55:23 -0800
Subject: qotd: Karen Davis on the survey of health care opinion leaders

In my comment on the health care opinion leaders survey, I stated, “The unfortunate news is that The Commonwealth Fund continues to characterize the
results as representing support of incremental approaches, with a national health system ‘receiving very little attention.'” Although that comment was taken from their release and from their report, I believe that the comments of Karen Davis present a much more objective assessment of the survey. This is an excerpt from her message.

Karen Davis, President of The Commonwealth Fund:

“Although tapped as the top policy priority for Congress, there was only limited consensus among opinion leaders on the best way to address this difficult problem, but the top two approaches were clearly allowing individuals and small businesses to buy into the Federal Employees Health Benefits Program (FEHBP), and expanding Medicaid/CHIP. Opinion leaders within the health insurance industry appear to prefer Medicaid/CHIP expansions and find the FEHBP buy-in notion less attractive, as do consumer and advocacy group leaders. Allowing the uninsured to buy into Medicare and implementing some kind of “Medicare-for-all” system had a surprising degree of support, not just in the academic/research sector but also in the health care delivery sector, although an incremental approach to reducing the number of Americans lacking health coverage seems far more likely than a more basic overhaul of the system. Perhaps the most surprising finding, again given the amount of public and political attention the concept has received, is the lack of enthusiasm in this survey for health savings
accounts or tax credits to buy individual health insurance.”

And…

“We fully expect some of our results, especially those that may seem surprising at first blush, to be parsed, questioned, and criticized. And that’s fine. The goal here is to expand and inform a healthy public and professional debate, not reinforce established notions or limit useful options.”

http://www.cmwf.org/aboutus/aboutus_show.htm?doc_id=254655

Cover the Uninsured Week

A project of The Robert Wood Johnson Foundation

Opinion: Week-long Series Details Need for Health Care Reform. St. Louis Post advocates for government-regulated, single-payer plan Source(s): The St. Louis Post-Dispatch (Dec. 26-Jan. 2)

An in-depth, week-long series of editorials in the St. Louis Post-Dispatch builds a case for a government-regulated, single-payer system in the U.S…

The final editorial concludes that, in a wealthy nation such as ours, “it stains our national conscience that we tolerate a medical system which casts out [the uninsured] and makes them choose between food and medicine … It is time for America to provide all its citizens with health coverage they cannot lose, even if they lose their jobs.” The article notes that this is a rational idea, but not a radical one, because between Medicaid, Medicare and other programs, the government already pays between 45 and 60 percent of the nation’s health care bill. Furthermore, Medicare is a successful model that runs with less than a third of the overhead costs of private coverage.

A single-payer system financed through a higher personal income tax and a gross receipts tax on business would be less costly than the current employment-based system. In addition, the outcome would not be socialized medicine if hospitals remain private and doctors control their own practices. While the editorial warns not to expect change soon, it does “expect to see a single-payer system eventually” because “cold business logic favors the efficiency” of such a plan.

http://covertheuninsuredweek.org/news/index.php?NewsID=1034

Comment: The St. Louis Post-Dispatch editorial conclusion that cold business logic will eventually lead to a single payer system requires no further comment.

But an important development in the Covering the Uninsured Week (CTUW) process mandates our comment. Prior efforts of this annual week of events have been aimed at publicizing the problems of the uninsured in an attempt to educate the public that something must be done. Advocates of various models of reform have been annoyed by the fact that advocacy for their preferred models was essentially prohibited at the CTUW events.

The following announcement indicates that the 2005 CTUW events will move the process forward:

“Building off the success of Cover the Uninsured Week 2004, The Robert Wood Johnson Foundation has announced dates for the 2005 effort. From April 30-May 8, 2005, Cover the Uninsured Week forums will inform our nation’s leaders, including elected officials, about policy proposals to expand coverage to the uninsured and to make coverage more affordable and stable for those who have it. Check back soon for more details and updates.”

http://covertheuninsuredweek.org/

In case you skimmed through that too fast, the 2005 CTUW forums:

* will inform our nation’s leaders, including elected officials

* about policy proposals
* to expand coverage to the uninsured and
* to make coverage more affordable and stable for those who have it

Considering the purpose of the forums, it is quite clear that advocates of the other flawed models cannot hold a candle to ours. We have been presented with a victory before the process has begun. It is only ours to lose.

Your homework assignment:

1. Go to the CTUW website and sign up for the weekly news digest and regular
updates on the campaign: http://covertheuninsuredweek.org/

2. Begin thinking about how you can play a roll in informing the nation on the policy proposals that will cover the uninsured and improve coverage for those who already have it. Then refine your efforts as more details and updates become available.

After all, the editorial staff of the St. Louis Post-Dispatch does “expect to see a single-payer system eventually.” Let’s see if we can expedite that.

Social Medicine

Social Medicine Portal
A project developed by faculty members of the Department of Family and Social Medicine of the Albert Einstein College of Medicine

The portal contains over a hundred links to websites, documents and presentations devoted to Social Medicine.

Our goal in creating this site is to link together the diverse international community of people working in social medicine and health activism.

What is social medicine?

It is possible to argue that all medicine by its very nature is social. The way we define diseases and health, the methods we use for diagnosis and treatment, how we finance health care, all these cannot help but reflect the social environment in which medicine operates.

Social medicine, however, looks at these interactions in a systematic way and seeks to understand how health, disease and social conditions are interrelated.

The most famous representative of early social medicine is Rudolf Virchow, the distinguished German pathologist who developed the theory of cellular pathology. Virchow was also a social reformer who remarked that “politics is
nothing more than medicine on a grand scale.” In the 20th century George Rosen would distill the Virchow’s principles into the following:

1. Social and economic conditions profoundly impact health, disease and the practice of medicine.

2. The health of the population is a matter of social concern.

3. Society should promote health through both individual and social means.

As might be gathered from these ideas, social medicine was not simply an
academic pursuit. Its practitioners were political reformers, radicals, activists. Virchow believed that the “physician was the natural advocate for the poor.” And this defense of social justice would stamp future generations of physicians and health care workers.

http://www.socialmedicine.org/

Comment: Bookmark this one! A brief visit to this website will demonstrate to you that it serves as an invaluable portal to the field of social medicine.

PNHP supporters will appreciate the January 2005 Monthly Spotlight by Leonard Rodberg and Matthew Anderson. Not only does it describe Physicians for a National Health Program as an organization dedicated to a single-payer national health program, but it also provides numerous links to single payer resources.

Though you likely don’t have the time now, nevertheless you should click on the link above and bookmark it so that you can return to their website during your next bout of boredom. The visit will be very therapeutic.

Blue Shield of California CEO on single payer

The Orange County Register
March 30, 2005
‘Vicious cycle’ of care
By Bernard J. Wolfson

Bruce G. Bodaken, the chief executive of Blue Shield of California… warned that the state’s private-sector health-care market is in deep trouble and could implode unless all the players collaborate to provide coverage for the uninsured and reduce costs that are sending premiums skyward.

Without action to overcome the problems of cost and access, Bodaken warned, “the market will get to the point where the balance of power will move from the private market to the halls of government. And when that happens, it’s hard to know what the solution coming out the door will look like.”

He warned that one possible solution “always out there,” especially in California, is a single-payer, or government-run, system – a notion that is anathema to the insurance and underwriting industries.

State Sen. Sheila Kuehl, D-Santa Monica, has introduced a single-payer bill, which Bodaken said had little chance of making it through the Legislature and past Gov. Arnold Schwarzenegger. But it could return in a few years as a ballot initiative, which might have a better chance of passing, he said.

Bodaken was the first major insurance-industry leader to propose universal health coverage, and he reiterated his support for it, though a different version of it was narrowly defeated by voters last December. In his plan, individuals who could afford insurance would be required to buy it; employers would also pay their fair share; and the government would provide a safety net for those who couldn’t pay.

Q: You’re opposed to a single-payer system, yet isn’t Medicare really just a single-payer system for part of the population? Do you oppose that single-payer system too?

A: The one that already exists is merely a financial mechanism for redistributing tax dollars from individuals and employers back to (medical)providers. That’s not what’s envisioned by most single-payer advocates. Typically, it’s a much more interventionist type of oversight in terms of benefit design and reimbursement. If you look at the details in Kuehl’s bill, there are government agencies and quasi-government agencies that are setting benefits.

Q: So, what’s wrong with government intervention in health care?

A: It’s inefficient.

Q: But Medicare has lower administrative costs than private-sector health plans, doesn’t it?

A: If you look at Medicare administrative costs and private plans, it’s an apples to oranges comparison. Medicare doesn’t do nearly what private plans do in terms of managing care and building systems of interface with patients, providers and (health-plan) members.

Q: What about expanding Medicare to a wider group of people. Would that
help?

A: A lot of people have talked about expanding Medicare to the general population. We’re not doctrinaire about how to solve the problem of the uninsured. I don’t support Medicare for everybody, but what if the Medicare age went down to 60, with the view that individuals would pick up a lot of the costs?

Q: One of your big objections to single-payer plans is that their proponents often do not acknowledge the need for taxes to pay for it. What if they were completely upfront in advocating tax increases?

A: It seems to me that those tax dollars could be used a lot more efficiently to cover people in the private market. But we’re on the record as saying that if we want to get everyone covered, there’s going to have to be some sort of tax increase or revenue increase. It’s not realistic to think you’re going to cover 45 million uninsured Americans for free. It would be som sort of sales tax or payroll tax.

Q: So you do support quite a bit of government involvement in health care in your plan. You seem a bit like a Swedish socialist.

A: The system closest to what we’ve described is probably the German program, which is a universal, publicly funded program but privately provided.

Q: In your luncheon speech, you mentioned a bare-bones insurance package, costing about $50 a month that would help address the uninsured problem. Could you elaborate?

A: There may be incremental steps that make sense and get us part of the way there.

Q: What would such a plan include?

A: Approximately six physician visits, three hospital days, and generic drug coverage with a limit. Those would be the main elements. You’d obviously burn through that very quickly if you had a chronic illness, but it would cover about 90 percent of what the uninsured need.

Q: You talked about all the complexity in health benefits, and how even you had trouble following it. Could you repeat that?

A: I enrolled in a product we call Active Choice – Blue Shield Active Choice. It has $750 of first-dollar coverage, before you hit your deductible. But only certain things apply toward that coverage, and I was not very well educated on what counts and what doesn’t. I’m no different than anybody else: I didn’t look at my information until I had the (prescription), and that’s when I found out that some of it applied and some of it didn’t. I’m not proud of it, but it’s the reality. So I understand when people say they’re confused.

http://www.ocregister.com/ocr/2005/03/30/sections/business/business/article_461453.php

Comment: Bruce Bodaken, CEO of Blue Shield of California, like single payer advocates, acknowledges the fact that, in order to achieve the important goal of universal coverage, the government must play a role and financial support must be provided through the tax system. The primary disagreement is that he believes funding should be through both public programs and private plans, whereas single payer advocates believe that we should have only one universal, publicly administered program. So how strong is his case for leaving private plans in place?

From his comments, it is quite clear that he believes that the current approach is unstable, and without intervention the private plans will be replaced with a government system, most logically a single payer system.

Wading through his anti-government rhetoric, this is clearly a concession that a single payer system would be more capable than our current fragmented system of providing both universal coverage and affordability, not to mention the establishment of an equitable system of funding care.

In support of the role of private plans, he dismisses Medicare as “inefficient” in spite of the much lower administrative costs. He suggests that private plans are providing a benefit for their non-medical spending in the form of “managing care and building systems of interface.” But most health care consumers would find little health care value in these wasteful administrative interventions that diminish choice of health care providers.

Although Mr. Bodaken touts his bare bones policy that covers a maximum of six physician visits and three days in the hospital, it’s quite clear that such coverage would result in an unbearable financial burden for the 20% of people who consume 80% of health care. And what healthy individual can predict that he/she will not become one of the 20%? Since private plans are stripping
benefits to make insurance premiums more competitive, they are losing their function of preventing financial hardship in the face of medical loss.

Perhaps Mr. Bodaken’s strongest argument that should make everyone question the future role of private plans is his own personal experience with his own plan from his own company. Although high-deductible private plans are being touted by some as the be-all and end-all of health care coverage, he says that he “has $750 of first-dollar coverage, before you hit your deductible.

But only certain things apply toward that coverage, and I was not very well educated on what counts and what doesn’t. I’m no different than anybody else.”

Do you suppose that Mr. Bodaken might be a closet single payer supporter held captive as a CEO in the corporate insurance world?

Message 2: The fiction of health plan competition

American Medical News
April 4, 2005.
Editorial
Health plans’ dominance: More muscle in more markets

… in the four years the AMA has released its annual report, “Competition in Health Insurance: A Comprehensive Study of U.S. Markets,” health plan market concentration has continually grown worse, as measured by the Dept. of Justice’s own scale.

Of the 92 metropolitan areas in 21 states studied, 93%, or 86, would be considered “highly concentrated” HMO/PPO markets using Justice Dept. Guidelines, according to the 2004 version of the report, released in February. Of the 27 other states where reliable metropolitan-level data were not available, the result was the same — 93%, or 25, of those states would be considered “highly concentrated” in the HMO/PPO market.

For PPOs alone, the metropolitan and state data reveal that fully 100% of them would be considered “highly concentrated.” That’s a first for the AMA study.

Keep in mind that these numbers are only as of Jan. 1, 2003. They don’t even take into account last year’s multibillion-dollar health plan megamergers: Anthem and WellPoint Health Networks, and UnitedHealth Group and Oxford Health Plans. But they do reflect the bulk of the 400 mergers between 1995 and 2003 involving health insurers and managed care organizations, few of which drew substantial Justice Dept. scrutiny.

http://www.ama-assn.org/amednews/2005/04/04/edsa0404.htm#relatedcontent

Comment: Let’s see. Why is it that we continue to insist that private plans instead of a government program be used to fund health care?

Is it because the private sector is so much more efficient than government bureaucracies? This doesn’t seem to be the reason since private plans utilize a much greater percentage of funds in providing administrative services, not to mention the profound administrative burden that their fragmented system places on the health care delivery system. So it’s not the efficiency of the private marketplace.

Could it be that a multitude of private plans provides us with greater choice? By choice, most of us mean choice of our health care professionals and hospitals. But most private plans limit our choice and assess severe financial penalties for failing to use their preselected choices. Since a government program does allow free choice, this can’t be the reason for preferring private plans.

So why should we prefer private plans? The reason most often given is that a multitude of private plans provides competition within the health care marketplace, and competition is key to providing greater health care value. By health care value, we mean higher quality and lower prices, the magic of Adam Smith’s “invisible hand” of free markets.

But what do we have? Mediocrity for most of us, and skyrocketing health care prices. And a shift of insurance risk from the insurers to the patients. And a system that threatens average Americans with bankruptcy should they have the misfortune of developing major medical problems. (Then what is the purpose of insurance?)

Now we find that, by Justice Department guidelines, 93% of HMO/PPO markets and 100% of PPO markets are “highly concentrated.” So much for competition!

If we leave the plans in place, what options do we have? Everyone agrees that the status quo will never do since costs are skyrocketing, access is diminishing, and quality is not improving.

Should we relax regulatory oversight to allow the markets to work more effectively? We have already proven that the plans will sell to the healthy and dump the sick. That’s appropriate behavior for a business in the marketplace, but shouldn’t our policies address those who do have health care needs? Why even have an industry that caters to those who don’t need it, but neglects those who do?

Should we instead increase regulatory oversight through innumerable policies that would require plans to provide equitable financial security for everyone with significant health care needs? Once you have done that, you would have created a de facto single payer system in which the health plans would transform into vendors contracted to provide only the administrative services that we actually do need for health care financing. Instead of introducing profound regulatory complexities that would always be skirted by the industry, wouldn’t it be simpler to establish our own single payer system?

Unfortunately, it appears that the invisible hand of the health care marketplace is wearing a rectal glove.

Rural doctors ignore partisan divide

The Denver Post
January 02, 2005
Fomenting a medical-care revolution
Rural doctors eye solutions to a “broken” health system
By Karen

Rocky White is an unlikely radical.

A Nebraska-bred country boy, a Republican-voting, ranch-owning, small-town
doctor, he hardly fits the profile of a wild-eyed revolutionary. But White and a handful of cohorts are, in fact, trying to foment upheaval.

The revolution they are proposing: a national health-insurance program. Nothing short of that will fix what White calls “our god-awful broken system.”

… it may be that this valley, like other rural areas, is getting hit hard first. That the forces driving doctors and insurance companies out, squeezing hospitals to the breaking point in rural Colorado, are simply foreshadowing what is in store for metro areas.

And some suggest that by wrestling with those problems now, small communities are in the vanguard, and the solutions they craft may offer road
maps for the rest of the country.

… the problems faced by rural medicine are daunting, complicated and growing worse.

That is what drove White to join forces with Dr. Gladys Richardson, an unabashed liberal, a woman who could hardly be more different from White.

In August, they invited virtually every health care provider in the five-county valley to hear their pitch for national health insurance.

The response was so huge they had to move the evening meeting from White’s
office to the largest conference room in the largest hotel in Alamosa.

They came last August and listened as White stood at a podium, his laptop in
hand.

He triggered a PowerPoint avalanche of data, provided by Physicians for a
National Health Program in Chicago: (the article then lists a few of the highlights)

http://www.denverpost.com/Stories/0,1413,36~53~2630298,00.html

Comment: Democrats support access to affordable, comprehensive healthcare
for everyone, and Republicans support sound business principles which reduce
administrative waste and contain costs. And each side supports the agenda of
the other as long as there is no compromise in their own positions. The beauty of the single payer model is that it accomplishes these goals. It has been said that the Democrats will educate the nation on the single payer model, and then the Republicans will enact it.

Rocky White attended the PNHP Leadership Training Institute held in Chicago
last May. He was only one of several Republicans present. These were not
Republicans who had crossed over. They were Republicans who recognize
that the current system violates the most fundamental business principles by
wasting hundreds of billions of dollars on administrative excesses – dollars
that would be better spent on health care. Other nations apply sound business principles to their health care systems, resulting in more comprehensive systems at far lower costs. That has to grab the attention of Republicans, even if the Democrats already lay claim to it.

PNHP’s mission is to educate our colleagues and the nation on the advantages
of the single payer model. The purpose of the Leadership Training Institute
is to expand our mission by placing trained activists in communities throughout the nation. The 2005 training sessions will be held in Cambridge in May and in New Orleans in November. Because of the nature of the training sessions, enrollment is limited. But if you are ready to become much more actively involved in the reform movement, you may want to contact our executive director, Ida Hellander (pnhp@aol.com), to see if openings are available. (Unfortunately, the sessions do oversubscribe, so not everyone will be able to attend.)

Geyman – Falling Through the Safety Net

Falling Through the Safety Net
Americans Without Health Insurance
By John Geyman, M.D.
Common Courage Press, 2005

It is now time to recap what we have seen in earlier chapters, and to reconsider how our failing health care system can be fixed. We saw in parts I and II that our supposed safety net for those without health insurance is in tatters. Given our economic uncertainties, widespread deficits in federal and state coffers, and the market-based, consumer choice directions in health policy further advanced since the 2002 midterm elections, we can expect that the safety net will become even more porous in the next few years. We saw in Chapter 11 that for-profit investor-owned health care corporations are beholden to their investors more than to the public interest, and in Chapter 13 that these stakeholders represent a powerful
obstacle to structural system reform. We reviewed the four major alternatives for reform in Chapter 12. Although highly contentious and polarized as the debate continues among these four alternatives, we examined solid evidence that the first three alternatives – incrementalism, strengthened employer-based health insurance, and increased consumer choice – cannot effectively reform a flawed system. Although many still cling to hopes that pluralistic “reforms” which retain a for-profit health insurance industry can be successful if given more time or tweaks, a growing body of evidence-based opinion holds that universal coverage through a publicly administered single-payer system will be required.

Falling Through the Safety Net:
http://www.commoncouragepress.com/index.cfm?action=book&bookid=254

Comment: John Geyman, M.D., is Professor Emeritus and former Chairmen of
the Department of Family Medicine at the University of Washington, Seattle, and former Editor of the Journal of the American Board of Family Practice. This week he became the 2005 President of Physicians for a National Health Program (PNHP).

At the link above, brief commentaries on this book are provided by David Satcher, Marcia Angell, Claudia Fegan, Donald Light, and Fitzhugh Mullan.

After reading this book, you’ll understand why our current efforts to expand coverage are not working. Bringing those left out up to the edge of the umbrella of coverage will only drench the needy with greater debt.

This book is yet another “must read” in the health care reform movement. Also, you’ll receive more insight to the gifted man who will be providing us with the leadership to help spread our message to a nation that is desperately seeking solutions that would ensure affordable access to high quality health care for everyone.

Uwe Reinhardt on What Makes America Great

Uwe Reinhardt, Ph.D., Professor of Economics and Public Affairs, Princeton University (personal communication):

Don:

Attached is a portrait of what makes America great. Instead of using the coercive power of government to make you and me pay for her dental care, this lady uses a pair of pliers to pull her own tooth. One just has to admire it. It keeps our tax rate (as % of GDP) the lowest in the OECD and our economy strong.

Best,
Uwe

Rather than being included as an attachment to this message, the photograph can be viewed at this link to The New York Times:
http://www.nytimes.com/2004/12/28/business/28dental.html

Comment: It is astounding that, in the world’s wealthiest nation, aversion to taxes is a more important driver of policy than is the health of its people. This is particularly troublesome as we witness the debate over the “stinginess” of our response to the unfathomable tragedy of the Tsunami.

In his Christmas message to the nation, President Bush said, “By volunteering our time and talents where they are needed most, we help heal the sick, comfort those who suffer, and bring hope to those who despair, one heart and one soul at a time.”

And today the president said, “In this case, I think it’s very important for Americans who want to give to provide cash to organizations that will be able to focus resources and assets to meet specific needs,” and, “There are many NGOs now involved that understand what is specifically needed to meet the needs of these countries.”

Volunteers and nongovermental organizations (NGO) do play an important role in society and are to be praised for their very noble efforts. But they can never replace the duty of the government to make every effort to adequately address these very vital issues. The impact of charity and volunteerism remains miniscule when compared to the capability of a wealthy nation and its government resources.

We can bring hope to one heart and one soul at a time by volunteering to lend our pliers when the need is great. Or we can adopt national policies that would bring hope to all hearts and all souls. With tax rates in line with other OECD nations, we would still have the greatest personal wealth, but would also have the capability to do much more to ensure the health of all of our citizens and of the citizens of the world.

Addendum: On a positive note, the article, “U.S. Health Care Spending In An International Context” by Uwe E. Reinhardt, Peter S. Hussey and Gerard F. Anderson, tops the list as the most frequently viewed article on the Health Affairs website. At least the health policy community is interested in learning why we spend so much and receive such mediocrity in health care. The article can be accessed at:
http://content.healthaffairs.org/cgi/content/abstract/23/3/10

There is hope.

The Charleston Gazette Comes On Board

Health care – Leave no one out
The Charleston Gazette
Editorial – December 28, 2004

Health-care access in America is a mess. The only sensible way to address these problems is to cover everyone – preferably in a Canada-style, single-payer, universal insurance system. America’s way of rationing health care is expensive, inefficient and, at times, unhealthy.

The United States has been behind other industrialized nations in this category long enough.

http://wvgazette.com/section/Editorials/200412277

Comment: Our drums grow ever louder.

Health care Leave no one out

The Charleston Gazette
December 28, 2004
Editorial
Health care Leave no one out

The United States has been behind other industrialized nations in this category long enough.

http://wvgazette.com/section/Editorials/200412277

Comment: Our drums grow ever louder.

Mandatory Health Insurance Is Urged

Los Angeles Times
December 20, 2004
Letters

Re “Mandatory Health Insurance Is Urged” (a proposal for an individual mandate)

Any proposal for mandatory health insurance in California that does not involve the creation of a single-payer system would serve only to increase taxpayer subsidies for private insurers. In light of California’s enormous budget deficit, the costs associated with moving the uninsured into the individual insurance market would be unsustainable.

The California Health Care Options Project found that all Californians could be covered under a single-payer program for less than we spend now. However,
it will take tremendous political leadership to counter the opposition of the insurance industry to a plan that would put it out of business.

If Gov. Arnold Schwarzenegger is sincere in his desire to cover the uninsured, he will fight to make California the first state to provide universal coverage.

Gerald Gollin MD

Redlands

http://www.latimes.com/news/opinion/letters/la-le-health20dec20,1,2569989.story?coll=la-news-comment-letters

Los Angeles Times
December 22, 2004
Letters

FOR THE RECORD:
Universal healthcare -A letter to the editor Dec. 20 incorrectly stated that
California could be the first state to have universal healthcare coverage. In fact, Maine started enrolling people in the nation’s first universal healthcare program last summer.

http://www.latimes.com/news/opinion/letters/la-le-health20dec20,1,2569989.story?coll=la-news-comment-letters

Following is a communication to the Letters Editor of the Los Angeles Times
(Dec. 22, 2004):

In your letters section today you included a “For the Record” stating that Maine has “the nation’s first universal healthcare program.” That is not correct.

Maine’s Dirigo Health program is a voluntary market-based plan. It was designed to provide small businesses with an option for coverage. In designing the program, they shifted from a 60% employer contribution for the family premium to a 60% contribution for the employee only, excluding the family. Because “groups of one” (self-employed) are viewed as higher risk, the program was capped at 4500 for groups of one. Offering a voluntary program that leaves many out is not the same as providing a mandatory program for everyone.

Maine’s intent is honorable. But they rejected a universal program and adopted the Dirigo Health program instead. Unfortunately, it will fall far short ofmproviding universal coverage.

A new report from The Commonwealth Fund on Dirigo Health:
http://www.cmwf.org/publications/publications_show.htm?doc_id=253634

The full report:
http://www.cmwf.org/usr_doc/dirigo_ib_benefitdesign_hp.pdf

Don McCanne, M.D.

Comment: On the surface, this seems like a petty issue. Maine’s Dirigo Health program has been widely touted as the nation’s first state universal health insurance program. The Los Angeles Times editors have apparently accepted this claim at face value. They have not responded to my challenge to that claim.

But the issue is of great importance. Others are looking at the “success” of
the Maine program as a model for reform for other states. It is important to
understand their process.

Another report on Dirigo Health just released discussed the opinions of those participating in focus groups and in-depth interviews. Only one group represented uninsured workers, whereas the other 15 represented business
owners, employers and representatives of the insurance industry. It is not
surprising that the results included the concepts that insurance brokers should be involved, the Chamber of Commerce should support the program, and that it should not be a single payer system. They want greater affordability and availability of coverage. They approve of state subsidies to make coverage affordable, but they are opposed to increased taxes to pay for it.
http://www.cmwf.org/usr_doc/LSPA_focusgroup_report.pdf

The plan developed, DirigoChoice, will be offered by a private insurer, Anthem Blue Cross and Blue Shield. Participation is entirely voluntary. For the $1250/2500 deductible option, the premium for a family is $11,160 per year (but will be adjusted for demographics). The employer’s contribution is $2,232, although the employer has the option to increase that. Premiums will be discounted on a sliding scale based on household income (e.g., a family of four with a household income of under $56,550, which is 300% of the federal poverty level, receives a 20% discount of the employee’s portion of the premium, making the employee’s share $7,142 or $595/month).

Thus Maine’s “universal” program is private insurance offered in the marketplace, and depends on the voluntary participation of the employer and the voluntary participation of the employee or individual at a premium that is typical for the health insurance marketplace. How could anyone label this as universal?

The Los Angeles Times should be ashamed that they have been duped into touting this as “the nation’s first universal healthcare program.” But double shame on them for failing to apply the same critical standards on themselves that they incorrectly applied to one of their contributors, especially when it is on such an important topic as health care reform.

The crucial message here is in Gerry Gollin’s letter. We should all make an effort to be certain that Gov. Schwarzenegger hears it.

Jack puts health plan on employees' menu

The San Diego Union-Tribune
December 16, 2004
Jack puts health plan on employees’ menu
By Sarah Skidmore

In an effort to reduce employee turnover, fast-food purveyor Jack in the Box
recently began offering all its hourly restaurant employees access to health
insurance.

United HealthCare designed the program and provides the network and administration.

Employees can choose from three medical plans – the better the coverage, the
higher the cost. Premiums range from $10 to $17.50 a week. After one year of
service, the company picks up half of the premium bill.

The program addresses most medical needs but favors preventive care. For
example, doctor’s visits, immunizations and wellness checkups are covered
until, depending on the plan, costs reach $150 to $300. After that, employees pay a discounted rate.

“You can’t get a lot with $520 annually,” said Bob Belko, senior consultant of health care and group benefits practice at consulting firm Watson Wyatt. Belko said employees are largely paying for a discount on health care.

“Competitively speaking we have just put ourselves in with companies that perform very well,” Duarte said (Raul Duarte, division vice president of compensation and benefits for San Diego-based Jack in the Box).

Duarte said that until this design, the company could not find a plan that was affordable to the company and employees.

If Jack in the Box reduces turnover by 1 percent with this program, the company thinks it will recoup the $300,000 it anticipates in initial costs.

“This wasn’t all social do-good,” Duarte said. “There’s definitely a business case for it.”

http://www.signonsandiego.com/uniontrib/20041216/news_1b16jbx.html

It is of interest to note that Jack in the Box is paying $300,000 for this program ($9 for each of their 33,000 employees) shortly after paying $313,610 to oppose Proposition 72, California’s employer mandate which lost by a 49.1% to 50.9% vote.

http://www.health-access.org/2004_12_01_Sac_archives.htm#110304184728297352

Comment: Jack in the Box’s program is primarily a discount card for health
care services. Employees do have the option of selecting plans with greater
benefits, but these plans provide only extremely Spartan benefits with very
low caps on maximum coverage. It is obvious that, for low wage employees,
this program provides virtually no financial security when faced with significant health care expenses.

There may be more “social do-good” than the Jack in the Box management
realizes. The outrage over the insensitivity of the management toward the
health care needs of their employees may drive the rest of us to finally demand a comprehensive system for everyone. I hope that we don’t have to wait for the tragic stories of what happens when the Jack in the Box employees attempt to access the health care system.

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Message: 2
Date: Fri, 24 Dec 2004

PublicAffairs
The Bubble of American Supremacy
By George Soros

Markets are designed to facilitate the free exchange of goods and services among willing participants, but are not capable, on their own, of taking care of collective needs. Nor are they competent to ensure social justice.
These “public goods” can only be provided by a political process.

http://www.publicaffairsbooks.com/publicaffairsbooks-cgi-bin/display?book=1586482173

The Washington Post
December 24, 2004
Truth in Medicine
By Paul H. O’Neill

… the president should appoint a commission with a tight deadline to redesign the health care reimbursement system with the goal of making it pro-patient.

The 30 to 50 percent of national medical care spending that is currently paying for waste and errors can be captured only through deliberate action at the local level. With the health care industry and the government playing their parts, hundreds of billions of dollars can be freed up. This would make it easy to solve the so-called “access” problem of uninsured Americans and still leave large amounts for other important needs.

http://www.washingtonpost.com/wp-dyn/articles/A23570-2004Dec23.html

Comment: While George Soros and Paul O’Neil do not occupy the same point on the political spectrum, they both recognize that the government must play a
role in ensuring social justice, or, more specifically, affordable access to high quality care for everyone.

What could better represent the spirit of Christmas than to set aside partisanship and begin to seriously discuss the role of government in ensuring quality, access and affordability of health care for everyone? Even Ebenezer Scrooge eventually became enlightened.

Jack puts health plan on employees’ menu