pnhpf3a

San Diego Daily Transcript
January 25, 2002

John Baldwin, M.D., Dean of Dartmouth Medical School:

“The great majority of American people, around 85 percent, if you ask them, ‘Do you have a right to health care?’ they say yes. But that’s not true, it’s written down nowhere that you or I have the right to be cared for if we become sick.”

The crisis started eight years ago with the “businessification of medicine,” he said. When President Bill Clinton’s universal health care initiative failed and the Republication Congress of 1994 was elected, the HMO mechanism took hold.

“What we learned was that health care was not a business. It is an essential service like national defense. The Eisenhower highway system is not a business.”

Baldwin disagreed with representatives of the American Medical Association who supported flawed policies such as defined contribution, health marts, medical savings accounts, and increased consumer risk sharing:

“As marketers in medicine would say, ‘You buy what you can afford.’ What does that mean when you’re a kid with leukemia in a Hispanic neighborhood that has no insurance, and then compare that with a child from a wealthy neighborhood? Buy what you can afford.”

“The first step is to enact in legislation what most American people believe: They have a right to health care. Based on the massive amount of information, determine what ought to be done for people with evidence-based medicine. Then the economic step, how much would that cost?”

Baldwin admits his system would alter how so-called “medical business” functions. Regardless, the nation’s leaders should appropriate money based on a rational system in the context of universal access to health care, he said.

“There are some things that aren’t businesses and that’s OK. I haven’t heard anyone talk about privatizing the Marine Corps.”

http://dailynews.yahoo.com/h/sddt/20020125/lo/experts_debate_options_for_health_care_reform_1.html (For original article, cut and paste full address into your browser.)

January 18, 2002 Washington, DC

Marian Wright Edelman Founder and President of the Children’s Defense Fund

“And he (Martin Luther King) called then for a Poor People’s Campaign. And at that time, there were 11 million poor children, and he reminded us, that we have the resources, in this world’s rich nation, that we have the know-how, we have the experience. And that was the call to action. And here we are now, in the beginning of a new millennium and century, and an economy that has tripled in wealth and we have 12 million poor children.

“We’ve made a lot of progress. We’ve made a lot of incremental progress, and we’re in a little dip at the moment. But, we’re still the wealthiest nation in history and it is time to finish that call for a poor people’s campaign for an America, where everybody has enough, where every child has hope. We do have the know-how. We do have the experience. And don’t you let anybody on Capitol Hill tell you we don’t have the money.

“We don’t have a money problem; we have a morality problem. We have a political priority problem.

“I would not deny anybody, their first or second million or even billion. But, you know, there’s something out of balance when just four wealthy Americans, possess greater wealth than the GNP of the 34 least developed nations in the world, with over 650 million people. And the same Americans, possess more wealth than that of 14 million American families. Their wealth, four people, exceeds the revenues of 24 states, with 42 million citizens.

“You know, they didn’t need a tax cut last spring. They don’t need another tax cut, under the guise of economic stimulus. This money that has been given them, even small percentages of it, the individual tax rate, the estate tax, could lift every child out of poverty, could provide every child and human being in America health care.

“And they must hear our voice saying, ‘enough.’ That no more tax breaks take effect, for the wealthy, while there are homeless and uninsured children. I mean it is not–it’s un-American, to have people lined-up to get more out of greed when we have hunger and homeless children.

“So, that’s what the issue is for us before this Congress, and we should not be discouraged. We’ve got to get out there and tell those stories. We’ve got to get out there and say how much money. — Why should it be so hard to do what is right? When it saves money, saves lives, you know, holds families together. Why should it be so hard to raise children in this country?

“And so, I think this is a moment of enormous opportunity for us, and so, just do not lose heart. What’s going to happen in this country is going to depend far more on what we do, than on what people on the Hill do. We can make them find the same money they found for the tax break… for children… if we mobilize and organize.”

http://www.kaisernetwork.org/health_cast/uploaded_files/kff011802d.pdf

The American Prospect
Volume 13, Issue 3.
February 11, 2002
by Robert D. Putnam

“In the aftermath of September’s tragedy, a window of opportunity has opened for a sort of civic renewal that occurs only once or twice a century. And yet, though the crisis revealed and replenished the wells of solidarity in American communities, those wells so far remain untapped. At least, this is what that gap between attitudes and behavior suggests. Civic solidarity is what Albert Hirschman called a “moral resource”–distinctive in that, unlike a material resource, it increases with use and diminishes with disuse. Changes in attitude alone, no matter how promising, do not constitute civic renewal.”

“Americans today, our surveys suggest, are more open than ever to the idea that people of all backgrounds should be full members of our national community. Progressives should work to translate that national mood into concrete policy initiatives that bridge the ethnic and class cleavages in our increasingly multicultural society.”

http://www.prospect.org/print/V13/3/putnam-r.html

January 21, 2002
Dr. David Satcher

RAY SUAREZ: Well, you grew up in the deep South during the years that Dr. King was trying to change the country’s view of race relations. You were still a student when he was killed. How far are we from reaching some of the goals he articulated 40 years ago?

DR. DAVID SATCHER: Well, we’ve made a lot of progress since I was a child. I was 12 years old when the Montgomery bus boycott started, and I remember going into town and not being able to buy ice cream. You may say, “Well, that’s no big deal,” but what it did to you as a person to feel that you were shut out was very significant. But I think because of the work of Dr. King and many others, many of those barriers have been broken. But in medicine and in public health, we also have dreams. And those dreams relate to eliminating disparities in health and health care, making sure that everybody in this country has access to quality health care. That’s an extension of Dr. King’s dream, but it’s really critical for the future of this country.

RAY SUAREZ: Is it all about money at this point or is it something a little bit more challenging than simply being able to write a check?

DR. DAVID SATCHER: I think first and foremost, it’s about commitment. I really believe that as a nation, we need to make a commitment to universal access. The fact that one out of three Latinos in this country is uninsured, one in four African Americans are uninsured and the fact that so many people live in communities where they don’t have access to care, as a nation we ought to make a decision that we’re going to work to eliminate those barriers to care. And I’m convinced that we can do it if we make that commitment.

http://www.pbs.org/newshour/bb/health/jan-june02/satcher_1-21.html

Uwe Reinhardt responds to the David Satcher interview:

I found the following exchange from the same interview truly stunning:

RAY SUAREZ: So as you sift through your time as surgeon general, what would you identify as some of the high points of your term?

DR. DAVID SATCHER Well, clearly, you know, we did a major report on mental health, and I believe the response of the American people to that report and to the report on suicide prevention has really been amazing. It’s led to several follow-up reports and activities and, of course, we contributed to the world health report on mental health that came out recently.

Comment: Here the Surgeon General of the United States tells us that the high point of his career in that portfolio was a report on mental health that, basically, led to the issuance of yet other reports (aside from some unidentified “activities” probably too trivial to warrant explicit naming.)

Finally I understand what we mean by the dictum: “It’s the thought that counts.” If only low-income, uninsured people could grasp it. (But, then, perhaps they do grasp it, which may be why they don’t bother to scream en masse and in fury at the ballot box).

Best,

Uwe

(http://www.kaisernetwork.org/health_cast/uploaded_files/BushAdmn.pdf)

“Mr. Scully is the Administrator of the Centers for Medicare and Medicaid Services. And when one reads his remarks on the above cited website, he sounds like a caring and concerned man who truly wants to see the various problems plaguing U.S health care addressed properly.

“BUT, I wonder if Mr. Scully would be so glib about the length of time it may take to ‘fix’ the problems of the elderly, the poor, and the uninsured if he were one of them. With all due respect and honor and sensitivity to the tragic events of September 11th and the aftermath, it did not take us 10 years, or 25 years to get around to responding to the threat and the attack upon our soil and our citizens and residents. The will was there. Miraculously, so was the money.

“What Mr. Scully, and others in this Administration need to do is to simply be honest with the American public. Just admit that the people who have to suffer the consequences of no insurance, no access to care, or have to go without needed drugs because of lack of money to pay for them, these are people who are easily erased from our national consciousness. The above-cited remarks loudly imply that one can ignore these people, MANY OF THEM CHILDREN, with impunity; one can ignore them with little political consequence…after all, they don’t donate thousands of dollars to campaign coffers, they don’t have lobbyists fighting for their cause with money, favors, and patronization.

“But in actuality, we ignore them at great peril to our country and its future. In the process of dismissing the plight of 42 million uninsured, of stating that maybe we can try ‘knocking that down in 10 years’ – down to what, one may ask? – we are institutionalizing a morally outrageous type of dehumanization. Social and economic rights….the right to decent housing, to a basic education, the right to NOT be hungry, and yes, the right to basic health care…are not options … these are necessities for survival. The right to survival is the most basic right of every human being born on this earth. And in the wealthiest country in the world, with the most sophisticated medical technology, and the highest expenditures on health and medical care…this should not even be an issue, it should be a given.

“The number, 40-some million uninsured, is the one that has been getting the most attention recently … as well it should. But that is only part of the U.S. health care system-story. The number is even larger, as many as 55 million, when one counts those who lack health insurance for some part of the year. Another 50 million or so are said to be underinsured, many of them elderly people for whom Medicare only pays about half of medical expenses. All total, somewhere between 35% and 40% of the U.S. population has woefully inadequate or nonexistent financial access to health care. This constitutes a moral, ethical, political, economic, and social crisis for the country as a whole; and if it were ‘fixed overnight,’ that would not be soon enough!”

Barbara Rylko-Bauer, PhD basiarylko@juno.com

New e-mail address for Don McCanne:

don@mccanne.org

Use this address to be added to or removed from the “Quote of the Day” list, as well as for personal communications. Replying directly to a “Quote of the Day” message also will access this address.

(http://www.kaisernetwork.org/health_cast/uploaded_files/BushAdmn.pdf)

“Mr. Scully is the Administrator of the Centers for Medicare and Medicaid Services. And when one reads his remarks on the above cited website, he sounds like a caring and concerned man who truly wants to see the various problems plaguing U.S health care addressed properly.

“BUT, I wonder if Mr. Scully would be so glib about the length of time it may take to ‘fix’ the problems of the elderly, the poor, and the uninsured if he were one of them. With all due respect and honor and sensitivity to the tragic events of September 11th and the aftermath, it did not take us 10 years, or 25 years to get around to responding to the threat and the attack upon our soil and our citizens and residents. The will was there. Miraculously, so was the money.

“What Mr. Scully, and others in this Administration need to do is to simply be honest with the American public. Just admit that the people who have to suffer the consequences of no insurance, no access to care, or have to go without needed drugs because of lack of money to pay for them, these are people who are easily erased from our national consciousness. The above-cited remarks loudly imply that one can ignore these people, MANY OF THEM CHILDREN, with impunity; one can ignore them with little political consequence…after all, they don’t donate thousands of dollars to campaign coffers, they don’t have lobbyists fighting for their cause with money, favors, and patronization.

“But in actuality, we ignore them at great peril to our country and its future. In the process of dismissing the plight of 42 million uninsured, of stating that maybe we can try ‘knocking that down in 10 years’ – down to what, one may ask? – we are institutionalizing a morally outrageous type of dehumanization. Social and economic rights….the right to decent housing, to a basic education, the right to NOT be hungry, and yes, the right to basic health care…are not options … these are necessities for survival. The right to survival is the most basic right of every human being born on this earth. And in the wealthiest country in the world, with the most sophisticated medical technology, and the highest expenditures on health and medical care…this should not even be an issue, it should be a given.

“The number, 40-some million uninsured, is the one that has been getting the most attention recently … as well it should. But that is only part of the U.S. health care system-story. The number is even larger, as many as 55 million, when one counts those who lack health insurance for some part of the year. Another 50 million or so are said to be underinsured, many of them elderly people for whom Medicare only pays about half of medical expenses. All total, somewhere between 35% and 40% of the U.S. population has woefully inadequate or nonexistent financial access to health care. This constitutes a moral, ethical, political, economic, and social crisis for the country as a whole; and if it were ‘fixed overnight,’ that would not be soon enough!”

Barbara Rylko-Bauer, PhD basiarylko@juno.com

New e-mail address for Don McCanne:

don@mccanne.org

Use this address to be added to or removed from the “Quote of the Day” list, as well as for personal communications. Replying directly to a “Quote of the Day” message also will access this address.

Washington, DC
January 16, 2002

Thomas Scully, Administrator of the Centers for Medicare and Medicaid Services:

“… with all the best intentions, we all want to do overnight fixes and fix everything tomorrow. And the system’s too big and the finances are too big, and it just can’t happen.

“So, to some degree, we gotta figure out-we got 42 million uninsured today. How do we get to knocking that down in 10 years? It’s not gonna happen in one year. We don’t have a Medicare drug benefit today. It’s not gonna happen next year. How do we get one in 8 or 9 years that works, that doesn’t blow up the system?

“Medicaid is a wonderful program, but it’s unbelievably, as many of you know, disproportionate in the way it subsidizes people among the states. It needs to be fixed. That’s a morass that’s gonna take 25 years to fix. But I hope, as healthcare policy people, we can start thinking about longer-term goals, instead of the short-term fixes.”

http://www.kaisernetwork.org/health_cast/uploaded_files/BushAdmn.pdf

Comment: With this kind of dynamic leadership, we should have health care reform within… well… uh… maybe not after all… at least during this administration.

Newsday.com
January 17, 2002
by Marie Cocco

“The choice made in 1994 was to let it be, to reject a national solution and let every American find his own. Each employer and each individual would choose in a marketplace that would somehow bring perfect rationality to a perfectly irrational health-care system.

“For that to be true, you would have to believe that economics, and not emotion, is what drives people when they’re having a baby or some tightness in the chest. You would have to assume that people who lose their jobs, and with it their insurance, have a choice. Or that people who go without insurance because they can’t afford the premiums are making an informed decision, not a desperate one.

“Now we know all the old health-insurance problems, and some new ones, are still problems. The question is who, if anyone, will step forward to suggest a real solution.”

http://www.newsday.com/news/opinion/ny-vpcoc172554436jan17.column

Newsday.com
January 17, 2002
by Marie Cocco

“The choice made in 1994 was to let it be, to reject a national solution and let every American find his own. Each employer and each individual would choose in a marketplace that would somehow bring perfect rationality to a perfectly irrational health-care system.

“For that to be true, you would have to believe that economics, and not emotion, is what drives people when they’re having a baby or some tightness in the chest. You would have to assume that people who lose their jobs, and with it their insurance, have a choice. Or that people who go without insurance because they can’t afford the premiums are making an informed decision, not a desperate one.

“Now we know all the old health-insurance problems, and some new ones, are still problems. The question is who, if anyone, will step forward to suggest a real solution.”

http://www.newsday.com/news/opinion/ny-vpcoc172554436jan17.column

Third Edition, 2002 Lange Medical Books/McGraw-Hill By Thomas S. Bodenheimer, M.D. and Kevin Grumbach, M.D.

“Perhaps no tension within the U.S. health care system is as far from reaching a point of satisfactory equilibrium as the achievement of a basic level of fairness in the distribution of health care services and the burden of paying for those services. Despite two years of intense debate on health care reform following the 1992 presidential election, more people in the country were uninsured in 2000 than in 1994, with prospects dim for attainment of universal coverage in this century. Due to persistent financial barriers, more patients will go without early detection of potentially curable cancers, more patients with chronic diseases will be hospitalized because of lack of timely outpatient care, more hypertensive patients will forego the medications that might avert the occurrence of strokes and kidney failure, and more babies will be born prematurely and spend their first weeks of life in a neonatal intensive care unit. The poor will continue to pay a greater proportion of their income for health care than do more affluent families, and catastrophic health care costs will ravage countless middle class families.

“People providing and receiving care in the United States must work together to achieve a brighter future for the nation’s health care system. Changing the future will require that people look beyond their immediate self-interest to view the common good of a health care system that is accessible, affordable, and of high quality for all. A heightened level of public discourse will be needed, with a populace that is better informed and more actively engaged in shaping the future of their health care system. Abstract concepts in health policy will need to be discussed and debated in a manner that connects with the daily realities experienced by patients and caregivers. The attitudes and actions of physicians and other health professionals will play a major role in determining the future of health care in the United States. With leadership and foresight among the community of health professionals, our nation may yet achieve a system that allows the most honorable features of the healing professions to flourish.”

http://shop.mcgraw-hill.com/cgi-bin/pbg/searchresult.html?q=Understanding+Health+Policy&x=14&y=10

Comment: As we contemplate further deterioration in the most expensive but least efficient health care system in the modern world, there has never been a greater need to more thoroughly understand the fundamentals of health policy. Tom Bodenheimer and Kevin Grumbach, in this updated third edition of their classic text, provide a highly readable explanation of policy issues that must be understood by those who wish to help establish an equitable health care system for all of us. It is a great resource for those just learning about health policy. And for those that have more knowledge in the field, it is great for organizing thoughts and approaches to policy issues. It should be in the library of every health care reform activist.

American Medical News
January 21, 2002
Opinion
“The time is right to fix the problem of the uninsured” by Richard F. Corlin, M.D., President of the American Medical Association

“Let’s quickly summarize our AMA proposal:

“We endorse the concept that employers provide a defined contribution for the purchase of health expense coverage — rather than a defined benefit.

“Our proposal supports a system in which all Americans with health coverage are given tax credits — in amounts inversely correlated with their income — rather than excluding employer-provided health benefits from their taxable income.

“We also support the creation of opportunities for alternative health insurance markets — “voluntary choice cooperatives” — that would offer more choices for individuals than are presently available.

“Universally available medical savings accounts play an important role in this consumer-oriented system.”

“And the AMA plan would also help to develop in each and every individual a consciousness of the real costs involved in their health care choices.”

“Let me know what you think about our plan.” richard_corlin@ama-assn.org

http://www.ama-assn.org/sci-pubs/amnews/amn_02/edca0121.htm

Comment: Briefly, the impact of the AMA proposals:

Defined contribution – Results in under-funding of comprehensive coverage, leaving low-moderate and low income individuals with Spartan benefits and greater out-of-pocket expenses, impairing access to care because of lack of affordability

Tax credits – Result in severe under-funding of comprehensive coverage with the same consequences as defined contributions, and threatens the link of health insurance to employment, increasing the numbers of uninsured

Alternative health insurance markets – Creates multi-tiered health care by creating a marketplace for the Spartan plans that a defined contribution or tax credit could purchase, while opening access to all products for the affluent

Medical Savings Accounts – Removes funds from the risk pools for the sick and poor making the Spartan products even less affordable

The AMA proposal is a disaster for those with modest or low incomes. The proposal shifts too much of the responsibility of paying for care to the individuals who have the greatest medical needs. This defeats the fundamental purpose of health insurance, and that is to pool risk, providing security for everyone by shifting the costs of paying for care from the large numbers of healthy individuals to the smaller numbers of those with greater needs. Under the AMA proposal, the affluent can self-fund the deficits, assuring their own security, but modest income individuals will not be able to bear the burden of the costs of major medical problems.

Why would the AMA support such a cruel proposal? Two considerations come to mind. Physicians wish to escape from the restrictions on fees and services that have been characteristic of the age of managed care. Many physicians believe that the AMA proposals will remove constraints on their fees and services. They are content to care for more affluent patients, whereas those that cannot afford their services can be someone else’s problem. Thus the proposal is very self-serving for physicians. The other reason that we can speculate is that the AMA leadership is saturated with political conservatives that ideologically prefer the wealth-oriented policies of the Heritage Foundation (www.heritage.org) to the patient-oriented policies of Physicians for a National Health Program (www.pnhp.org).

Most physicians really do care about patients. Please honor Dr. Corlin’s request to let him know what you think about the AMA plan. His e-mail address is above.