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Americans' Health Priorities: Curing Cancer And Controlling Costs
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Americans’ Health Priorities: Curing Cancer And Controlling Costs
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Health Care Lesson – Letter to the Editor, NYT
The New York Times
Letters
December 28, 2001
To the Editor:
Disputes between companies and the families of the World Trade Center victims over health care coverage (front page, Dec. 26) reflect more than corporate penuriousness. They reflect America’s failure to adopt a national health care system that covers all Americans, one that is affordable and financed fairly, based on ability to pay.
The more than 40 million uninsured Americans can surely empathize with the victims’ families because they, too, need health care coverage. It’s time for our government to face this issue, not to be put off by the lobbying and campaign contributions of the insurance companies and others in the health care industry who insist that coverage exists to assure profits for companies rather than care for consumers.
RHODA H. KARPATKIN
New York, Dec. 26, 2001
Comment: Rhoda Karpatkin understands. She is the immediate past president of Consumers Union and has been an outspoken advocate of health care equity.
Closing The Gap
The Maine Hospital Association
December 2001
“A Guide to Understanding and Improving Health Insurance Coverage”
“Maine is not unique. Over 38 million Americans, or 14% of the total U.S. population, do not have health insurance. Maine’s hospitals believe that this national problem would best be resolved with a national solution: the United States should ensure that everyone has health insurance coverage as a right of citizenship. Recognizing that, for a variety of political and economic reasons, nationally guaranteed insurance coverage is not likely to occur in the foreseeable future, hospitals believe that states should take deliberate incremental steps to move us toward the goal of universal coverage.”
The full report is available at:
Comment: For the lack of a national program, the Maine Hospital Association is recommending a ten step program of incrementalism. The report suggests that enacting only a few of the measures will not be adequate. The measures include flawed policies such as tax credits, and politically impossible goals such as making Medicaid payment rates comparable to the commercial market. Unfortunately, their proposals would only perpetuate the inequities and inefficiencies of our current fragmented health care system.
Maine is well on its way to serious consideration of a state-level single payer program. The authors of the Maine Hospital Association report recognize the need for universal health insurance coverage. They should abandon the tried and repeatedly proven wrong approach of incrementalism, and join the single payer advocates in supporting an equitable, efficient health care system that includes everyone.
Beth Capell, Ph.D., California legislative representative for Health Access, responds to the Maine Hospital Association’s report on health care coverage:
Even sadder than the Maine Hospital Association’s endorsement of non-solutions such as tax credits is their proposal that health coverage be limited to citizens.
Doing that in California would deny millions health coverage—including not only legal immigrants but those whose legal status is unclear. Solutions to the problems of the uninsured in California must take into account our large immigrant population, both Latino and Asian Pacific Islander, and their grave barriers to obtaining care.
One of the lessons we have learned in California in the last decade is that almost all immigrant families have a family member whose immigration status is clouded for some reason or another.
And the ultimate goal is to get everyone the health care they need when they really need it—not just coverage.
Business Health Survey Results
(December 1, 2001)
Excerpts from a survey sponsored by the California Nurses Association, California Medical Association, American Small Business Alliance, and the Foundation for Taxpayer and Consumer Rights:
III. Your Views on the Future of Health Care
26. Currently, there are approximately 7 million Californians without health insurance. Do you believe in a universal health care system where all Californians should be guaranteed health care coverage – regardless of their employment or income status – or do you think the current system works fine?
58% – Support universal coverage 28% – Current system works fine 14% – Declined to state
27. Would you prefer a system that would guarantee benefits for all workers and dependents and establish set costs for health insurance premiums, but would require all businesses to participate?
48% – Yes 47% – No 5% – Declined to state
28. Would you prefer a system whereby employers no longer dealt with insurance companies directly, but instead gave employees paid vouchers to purchase health insurance on their own?
32% – Yes 63% – No 5% – Declined to state
29. Would you prefer a system where health insurance is not linked with employment, and instead all businesses pay to a health care fund a fixed percentage based on the company’s size?
35% – Yes 55% – No 9% – Declined to state
30. Would you support this if it guaranteed that all your workers and their dependents were covered, and it would cost your business less than it pays now in health care costs?
70% – Yes 22% – No 8% – Declined to state
32. Which would you prefer? A. Health insurance plans would be administered by not-for profit organizations whose mission is to provide quality care at a reasonable cost. B. Health insurance plans be run by for-profit private corporations that answer to shareholders.
55% – Not-for-profits (A) 9% – Private corporations (B) 22% – Both (A&B) 7% – Other 6% – Declined to state
33. Do you support or oppose each of the following as a way to improve access to health care for the uninsured?
A health system, financed by taxpayers, in which all Californians would get their insurance from a single plan.
37% – Support 59% – Oppose 4% – Decline to state
Requiring businesses to cover and help pay the cost of private health insurance for their employees.
45% – Support 51% – Oppose 4% – Decline to state
Increasing government funding to expand community health clinics that serve the poor.
70% – Support 24% – Oppose 6% – Decline to state
Offering uninsured Americans income tax deductions, tax credits or other financial assistance to help them purchase private health insurance on their own.
62% – Support 34% – Oppose 4% – Decline to state
The full survey is available at:
Comment: Although this survey is not scientifically valid, it does give an impression of the trends in the thoughts of small business owners on health care reform after September 11. A few tentative conclusions are warranted.
* Business owners believe that the problems of the uninsured need to be addressed. * They remain concerned about their own costs in health care. * They are concerned about the intrusion of private, for-profit corporations. * They seem to understand the defective policies behind vouchers, but fail to understand similar implications of tax policies such as tax credits. * They believe that funding of community clinics is a solution for low income individuals (though no assessment was made as to whether they understood the inadequacies of this as a sole approach). * They remain unconvinced that a tax-payer supported “health system” using a “single plan” provides a satisfactory solution for achieving universal coverage.
This survey suggests that we no longer need to expend much more effort on educating the public on the problems that exist in health care, but that there is a pressing need to educate the public on the policy implications of the various approaches to reform.
In 2001, managed care our No. 1 health crisis
MSNBC Opinion
December 21, 2001
“Bioethics: Congress needs to administer strong medicine”
By Arthur Caplan, Ph.D., Director, Center for Bioethics at the University of Pennsylvania
“Events of the past year demonstrate beyond a doubt that managed care has failed – and failed dismally. The greatest single ethical crisis facing American health care as we move into the new year is what to do about it.”
(Dr. Caplan presents “the grim statistics” and concludes as follows.)
“Managed care is acutely ill. It is not doing the job the American people asked it to do. Congress should be paying attention but it is not.
“The end result: It is costing you and me an enormous amount of money to keep the current mess afloat.”
“THE SOLUTION”
“It is time to start to treat health care for what it is – an essential public good that is not simply a business, or a perk of employment or a matter of charity.
“Congress should create a commission that meets in public and would have the power to control price increases, limit deductibles, insist on access, and ensure the quality of care that managed care provides. The commission should solicit consumer complaints and work with federal and state officials to resolve them. And the commission should have the power to mandate coverage of health care benefits.
“The Clinton plan died because it gave government too big a role in health care. Managed care is dying because government has too small a role. Congress needs to administer some very strong medicine to managed care – and fast.”
Comment: Dr. Caplan describes well the dismal failures of our health plans in establishing health care as an essential public good. His proposed solution is interesting. He recommends a government commission that controls prices, prohibits excessive cost shifting to patients, mandates access, provides quality oversight, and mandates coverage of health care benefits.
His recommended list of government controls is not dissimilar to the controls that have been placed on the Medicare + Choice options. The experience with this program is instructive. Although the plans have had some success in using marketplace tools to circumvent some of these controls, overall they have not been successful with their primary assigned purpose, controlling health care costs. So these plans are now back before Congress, with hat in hand, begging for more funds while pulling out of unprofitable markets.
In spite of the clear need to improve the benefits of the traditional Medicare program, 85% of Medicare beneficiaries remain in our more efficient, publicly administered program that still offers free choice of providers. No matter what demands are dictated by a government commission, marketplace plans will continue to subvert the intent to establish health care equity. The experiment has already been completed and the results are in. The plans have proven that they need to be dumped as the failed model that they are.
Dr. Caplan calls for a role of government in health care that is neither too big nor too small. Americans don’t want a system of socialized medicine, so we should leave the providers of health care in the marketplace. Let them compete for patients. But the goals that would be set by Dr. Caplan’s commission would be realized much more efficiently and effectively by a publicly administered program of universal health insurance. The traditional Medicare program has already proven this. Let’s get on with fixing Medicare and then providing it for all of us as a single payer system.
We can control costs through global budgeting and rate negotiation. Providers would compete with each other for control of the resources. But the struggle would be over efforts to provide more and better care for patients, within the constraints of a very generous budget. You do not have to be an ethicist to understand the superiority of that model over our current system that is designed to deprive care in the name of profit.
Medical oaths and declarations
BMJ 2001;323:1440-1441
December 22-29, 2001
Editorials
“The newly qualified doctors of Imperial College School of Medicine recently adopted a ceremony in which they declare their commitment to assume the responsibilities and obligations of the medical profession. The decision to create a declaration ceremony was widely supported by the final year students and it reflects a recent resurgence in interest in medical oaths in the United Kingdom.”
“The increasing complexity of healthcare arrangements and interagency collaboration, and the need to look at rationing resources, has forced the medical profession to re-examine its core values. In view of this, and with public confidence in doctors diminishing and morale at an all time low, it is perhaps unsurprising that the concept of an entire year of newly qualified doctors freely declaring their intentions to act ethically and professionally proved popular with both staff and students at Imperial College.”
An excerpt from the “Declaration of a new doctor”:
“I will strive to change laws that are contrary to my profession’s ethics and will work towards a fairer distribution of health resources.”
For the entire declaration:
Comment: With only 6% of their GDP devoted to health care, these young British physicians have a significant challenge in being certain that their resources are distributed fairly. Their efforts need to be directed to increasing the budget for health care.
With access to 14% of our GDP, our young physicians should have relatively negligible challenges in distributing our health care resources fairly, if it weren’t for the intrusive health plans with their fragmented coverage. The real challenge is to change the laws to provide a system of public administration and universal coverage that would enable fair distribution of our abundant resources. Striving for these changes would represent the finest of our Hippocratic traditions.
Investment in Global Health Will Save 8 Million Lives a Year and Generate at Least a $360 Billion Annual Gain within 15 Years, Says a New Report Presented to WHO
World Health Organization Press Release
December 20, 2001
Commission on Macroeconomics and Health
“A drastic scaling up of investments in health for the world’s poor will not only save millions of lives but also produce enormous economic gains, say experts in a landmark report presented today to the World Health Organization (WHO).
“A group of leading economists and health experts maintain that, by 2015-2020, increased health investments of $66 billion per year above current spending will generate at least $360 billion annually. About half of this will be as a result of direct economic benefits: the world’s poorest people will live longer, have many more days of good health and, as a result, will be able to earn more. The other half will be as a consequence of the indirect economic benefits from this greater individual productivity. It will mean a total economic gain of at least US $360 billion per year – a six-fold return on the investment.”
For the entire report, “Macroeconomics and Health: Investing in Health for Economic Development”:
Comment: This report demonstrates that it makes economic sense to invest in the health care of the people of poor nations. Although it is disconcerting for health care professionals to see spending on health care reduced to a mere formula for calculating dollar return on investment, there actually is good news here.
Currently, the 60 poorest countries spend $13 per person per year on health care. For comparison, the United States spends $4500 per person per year. The report shows that increasing the level of spending in poor countries to $38 per person would be adequate to fund essential health interventions.
As health care professionals, our first concern is preserving the maximum number of quality years of life possible, referred to by economists as disability-adjusted life years. This modest increase in spending in poor countries would save 330 million years of quality life for the 8 million lives saved each year.
Whether you are an economist looking at the dollar return, or a health care professional looking at the real value in improved health, this is an investment that the world must make.
Med schools: Application attrition
American Medical News
December 24/31, 2001
Number of applications to medical schools:
1996-1997 school year – 46,968 2001-2002 school year – 34,859
“Experts cite loss of physician autonomy and the high cost of medical education as two reasons for the decline.”
Comment: Opponents to national health insurance frequently claim that adoption of a program of government insurance would result in a decline in the number of qualified applicants for medical school. If the number of qualified applicants is to be used as a parameter of the quality of our system, then it is quite clear that we can no longer accept the status quo.
It probably is true that individuals who place the highest value on the opportunity to maximize income may not be attracted to a system in which compensation is adequate but not excessive. But then our health care system is not well served by those individuals that continually manipulate the system to maximize profit.
We would better be served by individuals that maximize the dignity and value of human life, and who are quite content to practice medicine in an environment in which the medical decisions lie within the physician-patient partnership, while financial decisions are removed from the day-to-day medical considerations.
A publicly administered program of universal health insurance would assure potential physicians of a favorable practice environment and adequate compensation, thereby assuring the rest of us that there will always be a generous pool of qualified medical school applicants.
House GOP to Push Revised Stimulus Bill
The Washington Post
December 19, 2001
by Glenn Kessler and Juliet Eilperin
“The stimulus bill has been mired in disputes between Democrats and Republicans over the best mix of tax cuts and spending, but the biggest hurdle in recent days has involved health insurance. The issue has prompted a fierce philosophical debate, with Republicans pushing individual tax credits and Democrats arguing to keep such credits within the employer-based system.”
“House-Senate negotiators had met for barely an hour last night when Rep. Bill Thomas (R-Calif.), chairman of the negotiations, left to go to a vote. Participants said he then phoned the negotiating room and informed the other negotiators he was terminating the meeting and not returning.”
Rep. Bill Thomas:
“There are people who are employed and do not get health insurance. If we get a structure, it ought to be available to them when they are working. Why would it be available to them only when they are not working?”
Comment: Whether the tax benefit of purchasing insurance coverage accrues to the employer or to the employee seems like a minor issue, especially when considering that most economists consider health coverage to be part of the employee’s compensation package anyway. Besides, as Rep. Thomas points out, tax credits could also assist employed but uninsured individuals to purchase health care coverage. What could be wrong with this? Well, plenty.
Employers are looking for ways to escape the burden of escalating costs of their health benefit programs. Many are switching to partial payment through defined contribution approaches to coverage, if not outright terminating employee coverage. Granting tax credits to employees will encourage employers to shift the responsibility of purchasing health care coverage to the employee in order to take advantage of the tax benefit. Since tax policy carries the endorsement of our government, employers would be relieved of much of the guilt they might have by making this change.
By converting to the equivalent of vouchers or cash, employers will have fulfilled their responsibility, and employees are left to fend for themselves in the health care marketplace. The defined contribution received by the employee would be inadequate to purchase comprehensive coverage, and so the employee is left with either an inadequate plan, or very likely, pocketing the allowance and taking a chance on not having catastrophic health care losses. Thus tax credits for individuals will severely damage or destroy the link between health care coverage and employment, resulting in dramatic increases in the numbers of uninsured and under-insured.
There are other issues. Individuals in the health insurance market are vulnerable, having to pay higher premiums than with group coverage, and not being able to obtain affordable coverage if they have pre-existing disorders. This is great for insurance industry profits, but terrible for beneficiary-patients.
By making the patient the decision maker in health care purchasing, tax credits support the consumerism movement in health care. As we have seen previously, consumerism shifts costs to those that need care, threatening affordability and access for those with major acute and chronic disorders.
Individual tax credits are being supported by conservatives as the answer to the covering the uninsured. But it is very clear that the credits will never, never be large enough to assure affordability of health care coverage. Credits will be used primarily by those who now receive coverage through their employment or by those who can afford to purchase coverage on their own. As targeted tax policy, it entirely misses the target.
In the future, the linkage between health care coverage and employment should be terminated as we place everyone into a universal program of health insurance. But until then, it is absolutely essential that we continue with policies that encourage maximum employer participation in the health benefit programs for the employees. Failing to do so will only increase the numbers of the uninsured and under-insured.
Council hearing on health fuels ire
The Washington Times December 18, 2001 by Guy Taylor “Sparks flew yesterday at the D.C. Council’s public oversight hearing on the D.C. Health Care Alliance, a group of private health care contractors hired by the city last may to replace D.C. General Hospital as the District’s main provider of public health services.” Washington, D.C. council member David A. Catania, at-large Republican: When D.C. General closed, the residents of the District “were promised 34 percent more care at 25 percent less cost – what we’re getting instead is 18 percent less care than we were getting last year at no cost reduction.” http://www.washtimes.com/metro/20011218-27752680.htm Comment: When the conservative Washington Times quotes a Republican council member complaining about a system of privatized health care, we know that history has been made. Now that we agree that the government can increase the efficiency of our health care system, let’s get on with defining the precise role that it should play. (Hint: a publicly administered program of universal health insurance.) This message from Dr. Quentin Young to PNHP members and friends is being forwarded to the members of the “Quote of the Day” list. For many of you, this is a duplicate message, and please accept our apologies for that. Surveys suggest that there is strong support amongst physicians for replacing our defective, inefficient, inequitable, wasteful, fragmented system of health plans with a national health insurance program. The prevailing rhetoric suggests that physicians remain uncomfortable with this approach. There is a pressing need to change the rhetoric to reflect the true level of physician support for reform. This is the purpose of this campaign. For health care justice for all, Don McCanne, M.D. President-Elect, Physicians for a National Health Program ***************************************************** December 18, 2001 Dear PNHP Members and Friends, We need your help. The next issue of the PNHP newsletter (52 pages of articles, updates, and analyses of current health policy and politics) is finally put to bed and at the printer. We hope that you’ll find it as valuable as past issues. While we plan to continue our impressive coast-to-coast educational program, we believe the devastation inflicted by for-profit corporate ascendancy over the health care system has moved a critical mass of our profession into readiness to support single-payer national health insurance. The time is at hand for a major expression from America’s doctors. In 2002, PNHP intends to launch an ambitious new campaign to reach America’s 700,000 physicians with our updated proposal for national health insurance. Obviously this is a great undertaking which will require major resources. Our present funds will allow us to reach only one out of seven doctors. Our goal is to reach every physician.Your tax-deductible gift will allow us to reach more physicians. Please consider donating on-line at www.pnhp.org or through the mail to PNHP, 29 East Madison, Suite 1412, Chicago, IL 60602. Your newsletter packet will also include a card and return envelope, but with the holiday mail rush, we wanted to make sure you could donate before the end of the tax-year if you wish. Thank you in advance for your generous support. Quentin Young, MD PNHP National Coordinator pnhp@aol.com (312) 782-6006 P.S. For every $100 donated, we can reach 250 more physicians. Please help us reach out and give voice to our profession! ******************************************************* PNHP National Physician Outreach Project, 2002 – Gift Card 29 East Madison, Suite 1412, Chicago, IL 60602 Enclosed is my contribution of: _____ $1000 _____$500 ______$250 _____$100 $_______ Other Form of payment: _____ Mastercard ______ Visa ______ Check (make payable to PNHP) Card # _________________________________________ Exp._______________ Name________________________________________ (e-mail or phone)__________________________ Address ____________________________________ __________________________________________________________________ (If you wish to be removed from the “Quote of the Day” list, please return this message with the word “Unsubscribe” in the subject line.)
