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The Washington Post
December 21, 2003
Dean’s Care For All, Built Part by Part
By Ceci Connolly

(In 1994, Vermont Governor Howard) Dean, a doctor by training, would be the nation’s first governor to guarantee health coverage to every state resident. And he would do it in a single legislative session, with one enormous bill.

It was ambitious, bold — and an utter failure.

But it wasn’t the end. Like a pragmatic physician who tries a new therapy when the first fails, Dean devoted much of the next decade to smaller, incremental changes aimed at filling the state’s health care gaps.

It was a slower strategy, but by the close of his tenure, Dean came very close to achieving universal health coverage. Vermont now has one of the nation’s highest rates of health insurance coverage, providing care to virtually every child and more than 90 percent of adults. The national average is 83.7 percent.

As some Democratic presidential rivals are quick to note, Dean’s embrace of
balanced budgets led him to flirt with the Medicare-reduction plans of then-U.S. House Speaker Newt Gingrich (R-Ga.), and Dean sometimes trimmed his own state health programs.

These opponents also said that his policies have exacerbated the financial problems for Vermont hospitals, and despite Dean’s efforts to expand health
care coverage, there remains a yawning insurance gap for residents ages 18
to 29. Most important, Dean’s heavy emphasis on government-run programs,
with their low reimbursement rates, has saddled the business community with
higher costs, according to some health care officials.

“Gov. Howard Dean has presided over a constant expansion in government health programs, without a commensurate increase in funding,” the Burlington Free Press editorialized in December 2000.

Another criticism of Dean’s health care record is that his heavy reliance on
government programs hurt the private sector. Because government reimbursement rates are so low, doctors and hospitals in Vermont have been forced to charge more to private clients — individuals and businesses — to make up the difference. As Dean encouraged families to enroll their children in Dr.Dynasaur, corporate insurance pools were left with a larger proportion of high-risk, more expensive adults.

Dean’s tactics and style could inflame tensions, lawmakers said. On several
occasions, he proposed trimming the very health benefits he instituted, including dental, foot and eye care for Vermont’s low- and moderate-income adults. He fiercely defends this approach.

“I promised the people of Vermont I would not take one person off the program,” he said. “So we did eliminate certain benefits. But that’s better than cutting people.”

http://www.washingtonpost.com/ac2/wp-dyn?pagename=article&node=&contentId=A17383-2003Dec20¬Found=true

Comment: The current emphasis on reducing the numbers of uninsured has created an explosion in the rate of under-insurance. Reducing benefits, increasing cost sharing, inequitably funding risk pools, shifting public program costs to providers which drives up fees for private payers, concentrating high-cost patients in separate risk pools making the premiums unaffordable, are only a few of the problems exacerbated by implementing a policy of incremental expansions of program enrollment without ensuring adequate funding of those programs.

Being insured may not mean much if care remains unaffordable because necessary benefits are not covered or the out-of-pocket expenses are too high. But limited insurance is better than none at all. Is there an alternative? Of course. Comprehensive coverage can be provided for everyone at no significant increase in cost if we were to eliminate the administrative inefficiencies of our multi-payer and non-payer system, and establish a single, universal health program.

Dr. Dean initially supported single payer reform but found that it wasn’t politically feasible. He then demonstrated that a pragmatic, incremental approach was feasible, even though it falls short on many goals. Dr.Dean has said that, as president, he would sign a single payer bill if it made it to his desk. But whoever is president, a single payer bill will never pass Congress without overwhelming public support. That won’t happen until the public really understands the various options. We have a lot of work to do.

There is risk for us. We may discover that the real reason for the lack of reform is that the United States is a nation that does, in fact, uniquely reject egalitarianism. Are you prepared to accept that possibility?

The New York Times
December 20, 2003
The Ownership Society
By David Brooks

In his State of the Union address, the president will announce measures to foster job creation. In the meantime, he is talking about what he calls the Ownership Society.

This is a bundle of proposals that treat workers as self-reliant pioneers who rise through several employers and careers. To thrive, these pioneers need survival tools. They need to own their own capital reserves, their own retraining programs, their own pensions and their own health insurance.

President Bush has a proposal to combine and simplify the confusing morass
of government savings programs and give individuals greater control over how
they want to spend their tax-sheltered savings. Administration officials hope, in a second term, to let individuals control part of their Social Security pensions and perhaps even their medical savings accounts.

Talking with staff, Bush emphasizes that he wants to use these policies to move from an “anything-goes culture” to a “responsibility culture.” By giving individuals control of their own retraining, their own savings and their own homes, he hopes to inculcate self-reliance, industriousness and responsibility.

Comment: Implicit in the shift to a “responsibility culture” through the establishment of the “Ownership Society” is the principle that opportunity is available to all. But universal opportunity means that we must have employment opportunities, living wages, affordable housing, affordable health insurance, enough disposable income to fund retirement accounts, and all of the other affordable opportunities that will make us “self-reliant pioneers.”

It is safe to say that for far too many of us, those opportunities do not exist. It is highly unlikely that the individuals without opportunities can create them by mere volition using their pioneering spirit. These deeply-rooted societal problems cannot be solved by merely praising the virtues of a utopian Ownership Society. These problems require a component of public policies and public programs to give us the “survival tools” needed to accomplish these goals.

We can use health care as an example. Just as mega-corporations are jointly
owned by shareholders, a universal program of health insurance can be jointly owned by the citizens. That would provide everyone with the survival tool for health care.

We can approach the goals of a utopian Ownership Society providing that we
properly balance private and public ownership by adopting public policies
that will accomplish these goals. President Bush needs to show us real policies that will provide all citizens with the survival tools they need to “own their own capital reserves, their own retraining programs, their own pensions and their own health insurance.” But to be effective, some of these will require joint public ownership within our Ownership Society.

The New York Times
December 20, 2003
The Ownership Society
By David Brooks

In his State of the Union address, the president will announce measures to foster job creation. In the meantime, he is talking about what he calls the Ownership Society.

This is a bundle of proposals that treat workers as self-reliant pioneers who rise through several employers and careers. To thrive, these pioneers need survival tools. They need to own their own capital reserves, their own retraining programs, their own pensions and their own health insurance.

President Bush has a proposal to combine and simplify the confusing morass
of government savings programs and give individuals greater control over how
they want to spend their tax-sheltered savings. Administration officials hope, in a second term, to let individuals control part of their Social Security pensions and perhaps even their medical savings accounts.

Talking with staff, Bush emphasizes that he wants to use these policies to move from an “anything-goes culture” to a “responsibility culture.” By giving individuals control of their own retraining, their own savings and their own homes, he hopes to inculcate self-reliance, industriousness and responsibility.

Comment: Implicit in the shift to a “responsibility culture” through the establishment of the “Ownership Society” is the principle that opportunity is available to all. But universal opportunity means that we must have employment opportunities, living wages, affordable housing, affordable health insurance, enough disposable income to fund retirement accounts, and all of the other affordable opportunities that will make us “self-reliant pioneers.”

It is safe to say that for far too many of us, those opportunities do not exist. It is highly unlikely that the individuals without opportunities can create them by mere volition using their pioneering spirit. These deeply-rooted societal problems cannot be solved by merely praising the virtues of a utopian Ownership Society. These problems require a component of public policies and public programs to give us the “survival tools” needed to accomplish these goals.

We can use health care as an example. Just as mega-corporations are jointly
owned by shareholders, a universal program of health insurance can be jointly owned by the citizens. That would provide everyone with the survival tool for health care.

We can approach the goals of a utopian Ownership Society providing that we
properly balance private and public ownership by adopting public policies
that will accomplish these goals. President Bush needs to show us real policies that will provide all citizens with the survival tools they need to “own their own capital reserves, their own retraining programs, their own pensions and their own health insurance.” But to be effective, some of these will require joint public ownership within our Ownership Society.

Benemax (A Benefit Management Company)
Consumer Driven Health Care (CDHC)
CDHC presentation slides (excerpts)

“Unleashing the power of free market economics on the healthcare
industry”

Why CDHC: Consumering
Patients shop for quality & price
Providers compete for patient traffic
Patients subject treatment options to cost/benefit analysis

What a CDHC plan does
Varies member cost based on health care behavior
Rewards members with below median health care costs

http://www.benemax.com/presentation-cdhc/cdhc1.html

The American Heritage Dictionary of the English Language
Fourth Edition

“Consumering”: No documents match the query

http://www.bartleby.com/61/

Comment: Although “consumering” apparently rewards patients “with below
median health care costs,” conversely it seems to punish patients with above median health care costs. The opposite of insurance, “consumering” protects the healthy from the costs of those with legitimate health care needs, and further punishes the sick by adding the financial burden of accessing health care.

“Consumering” doesn’t seem to be a very good idea. Let’s not add it to
our dictionaries.

Benemax (A Benefit Management Company)
Consumer Driven Health Care (CDHC)
CDHC presentation slides (excerpts)

“Unleashing the power of free market economics on the healthcare
industry”

Why CDHC: Consumering
Patients shop for quality & price
Providers compete for patient traffic
Patients subject treatment options to cost/benefit analysis

What a CDHC plan does
Varies member cost based on health care behavior
Rewards members with below median health care costs

http://www.benemax.com/presentation-cdhc/cdhc1.html

The American Heritage Dictionary of the English Language
Fourth Edition

“Consumering”: No documents match the query

http://www.bartleby.com/61/

Comment: Although “consumering” apparently rewards patients “with below
median health care costs,” conversely it seems to punish patients with above median health care costs. The opposite of insurance, “consumering” protects the healthy from the costs of those with legitimate health care needs, and further punishes the sick by adding the financial burden of accessing health care.

“Consumering” doesn’t seem to be a very good idea. Let’s not add it to
our dictionaries.

American Medical News
Dec. 22/29, 2003
Medicare law starts clock on fixing payment formula
By Markian Hawryluk

With a stroke of his pen on Dec. 8, President Bush signed away two years of future cuts in Medicare payments to doctors. But amid the glee over the averted crisis, physician groups realized they have just those two years in which to avoid a disastrous situation.

The Medicare bill signed into law would set updates at a minimum of1.5% in 2004 and 2005. But because the payment update formula was left primarily intact, the extra spending over the next two years will have to be recouped in 2006 and beyond. Unless the pay formula is revised or eliminated by that time, physicians can expect a sharp reduction, or cliff, in payment.

“As the cliff physicians face in 2006 illustrates, a Band-Aid can only stop the hemorrhaging for so long,” said Carl Pepine, MD, president of the American College of cardiology. “The sustainable growth rate formula for making annual updates to Medicare fees is still inherently flawed and does not accurately reflect the cost of physician services…”

http://www.ama-assn.org/amednews/2003/12/22/gvl11222.htm

Comment: For an advance loan for the next two years which will have to be paid back through a reduction in future fees, the AMA agreed to support legislation that is designed to reduce federal funding of the entire Medicare program. Not only will they have to pay off this advance in fees, but they will have a relatively smaller pool of funds from which to draw future reimbursements. How is the AMA going to negotiate a better payment formula when the politicians will protest that we can’t afford to pay for both prescription drugs and physician fee increases?

Physicians who are more than two years away from retirement will find it in their interest to start supporting a universal program of social insurance that will recover $280 billion in administrative waste and spend that on patient care instead. More money for patient care means more money for physicians.

75% of physicians aren’t even AMA members. They should think about joining an organization that has a mission to dramatically improve the way we fund health care: Physicians for a National Health Program. By supporting reform that places the patient first, physicians will fare very well.

PNHP website, including membership information:

Physicians for a National Health Program

American Medical News
Dec. 22/29, 2003
Medicare law starts clock on fixing payment formula
By Markian Hawryluk

With a stroke of his pen on Dec. 8, President Bush signed away two years of future cuts in Medicare payments to doctors. But amid the glee over the averted crisis, physician groups realized they have just those two years in which to avoid a disastrous situation.

The Medicare bill signed into law would set updates at a minimum of1.5% in 2004 and 2005. But because the payment update formula was left primarily intact, the extra spending over the next two years will have to be recouped in 2006 and beyond. Unless the pay formula is revised or eliminated by that time, physicians can expect a sharp reduction, or cliff, in payment.

“As the cliff physicians face in 2006 illustrates, a Band-Aid can only stop the hemorrhaging for so long,” said Carl Pepine, MD, president of the American College of cardiology. “The sustainable growth rate formula for making annual updates to Medicare fees is still inherently flawed and does not accurately reflect the cost of physician services…”

http://www.ama-assn.org/amednews/2003/12/22/gvl11222.htm

Comment: For an advance loan for the next two years which will have to be paid back through a reduction in future fees, the AMA agreed to support legislation that is designed to reduce federal funding of the entire Medicare program. Not only will they have to pay off this advance in fees, but they will have a relatively smaller pool of funds from which to draw future reimbursements. How is the AMA going to negotiate a better payment formula when the politicians will protest that we can’t afford to pay for both prescription drugs and physician fee increases?

Physicians who are more than two years away from retirement will find it in their interest to start supporting a universal program of social insurance that will recover $280 billion in administrative waste and spend that on patient care instead. More money for patient care means more money for physicians.

75% of physicians aren’t even AMA members. They should think about joining an organization that has a mission to dramatically improve the way we fund health care: Physicians for a National Health Program. By supporting reform that places the patient first, physicians will fare very well.

PNHP website, including membership information:

Physicians for a National Health Program

The Henry J. Kaiser Family Foundation
December 2003
Understanding the Health-Care Needs and Experiences of People with Disabilities
By Kristina Hanson, Tricia Neuman and Molly Voris

Although most people with disabilities do have some form of health insurance
coverage, those who are both uninsured and disabled are at a particular disadvantage in the current health-care system. They are more likely than
others to forgo or delay getting necessary care, including the prescription
drugs and preventive services that would reduce their future need for health-care services.

The findings from this survey also demonstrate that all sources of insurance
are not created equal in meeting the needs of people with disabilities. Private insurance is often perceived as the most generous source of coverage, generally serving those with higher incomes. However, even those with private coverage often have significant problems paying for various services due in part to high cost-sharing requirements and the lack of coverage of specific services often needed by people with disabilities, such as personal assistance services.

Despite Medicaid’s relative generosity… specific Medicaid benefits do vary considerably by state… In addition, in the face of rising costs and budget
shortfalls, states are currently looking for ways of slowing growth in program spending, such as curtailing benefits, increasing cost-sharing requirements, and restricting eligibility.

… beneficiaries who rely on Medicare as their sole source of coverage are
far more likely than those with either Medicaid or private insurance to delay care, go without needed equipment, and forgo medicines due to costs.

In conclusion, the findings from this survey highlight the diverse needs of non-elderly adults with disabilities, while also demonstrating the need for significant improvements in the health-care coverage available to this population. Along with extending coverage to particularly disadvantaged groups of people with disabilities without insurance altogether, future policy debates should focus on strengthening the coverage currently offered through both public and private sources of insurance to improve health care and quality of life for Americans with disabilities.

http://www.kff.org/medicare/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=28401

Comment: The disconcerting news is that none of our current programs are
ensuring full access to care for people with disabilities. What should be of
concern to the rest of us is that we, likewise, have no assurances that our
needs would be met should we ever be unfortunate enough to develop a long-term disability. But isn’t that one of the major reasons why we have
health insurance?

Our current policies are aimed at shifting more of the costs to patients, and reducing funding of our risk pools whether they be public programs, employer-sponsored plans or other private plans. Isn’t this moving in the wrong direction?

Let’s now demand equitable and efficient use of our generous health care
resources. We can do this by establishing our own public program of universal health insurance. Then we would all be assured of both health security and financial security should the need arise.

The Henry J. Kaiser Family Foundation
December 2003
Understanding the Health-Care Needs and Experiences of People with Disabilities
By Kristina Hanson, Tricia Neuman and Molly Voris

Although most people with disabilities do have some form of health insurance
coverage, those who are both uninsured and disabled are at a particular disadvantage in the current health-care system. They are more likely than
others to forgo or delay getting necessary care, including the prescription
drugs and preventive services that would reduce their future need for health-care services.

The findings from this survey also demonstrate that all sources of insurance
are not created equal in meeting the needs of people with disabilities. Private insurance is often perceived as the most generous source of coverage, generally serving those with higher incomes. However, even those with private coverage often have significant problems paying for various services due in part to high cost-sharing requirements and the lack of coverage of specific services often needed by people with disabilities, such as personal assistance services.

Despite Medicaid’s relative generosity… specific Medicaid benefits do vary considerably by state… In addition, in the face of rising costs and budget
shortfalls, states are currently looking for ways of slowing growth in program spending, such as curtailing benefits, increasing cost-sharing requirements, and restricting eligibility.

… beneficiaries who rely on Medicare as their sole source of coverage are
far more likely than those with either Medicaid or private insurance to delay care, go without needed equipment, and forgo medicines due to costs.

In conclusion, the findings from this survey highlight the diverse needs of non-elderly adults with disabilities, while also demonstrating the need for significant improvements in the health-care coverage available to this population. Along with extending coverage to particularly disadvantaged groups of people with disabilities without insurance altogether, future policy debates should focus on strengthening the coverage currently offered through both public and private sources of insurance to improve health care and quality of life for Americans with disabilities.

http://www.kff.org/medicare/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=28401

Comment: The disconcerting news is that none of our current programs are
ensuring full access to care for people with disabilities. What should be of
concern to the rest of us is that we, likewise, have no assurances that our
needs would be met should we ever be unfortunate enough to develop a long-term disability. But isn’t that one of the major reasons why we have
health insurance?

Our current policies are aimed at shifting more of the costs to patients, and reducing funding of our risk pools whether they be public programs, employer-sponsored plans or other private plans. Isn’t this moving in the wrong direction?

Let’s now demand equitable and efficient use of our generous health care
resources. We can do this by establishing our own public program of universal health insurance. Then we would all be assured of both health security and financial security should the need arise.