by Blake Fleetwood
The Huffington Post – Apr 23, 2006

Statistics don’t lie.

Figures from the World Health Organization clearly show that The United States lags behind 36 other countries in overall health system performance ranging from infant mortality, to adult mortality, to life expectancy.

20 countries in Europe and four countries in Asia have a better life expectancy than the U.S. If you are a male between the ages of 15 and 59, your chances of dying are higher in the U.S. (140 per thousand) than in Canada, 95, Costa Rica 127, Chile 134, and Cuba, 138.

The U.S. Health system looks especially dysfunctional when you consider how much money we spend per capita on healthcare — $6,000 plus per year, twice as much as any other country– and how little we get for it.

Canada spends $2,163 and boasts a life expectancy of 79.8 years, two and a half years longer than the US. Their infant mortality rate per thousand is also better than ours, as is their adult mortality rate.

Switzerland spends about 11% of its Gross Domestic Product on universal health care for all its citizens, while the U.S. (with 50 million uninsured this year) spends 15% of GDP with embarrassing results.

One grand irony, Cuba whose economy has been bankrupt for the last decade – food shortages, drug shortages, chronic unemployment, etc. — and which annually spends a miserly $185 per person on health care, has better infant and adult mortality rates than the US, and has a life expectancy nearly equal to ours.

Why has our vaunted free enterprise system – which has produced such great benefits in delivery of most goods and services — failed so completely with regard to this most fundamental need?

Simple, buyers don’t shop for health care. Sick people don’t negotiate with doctors or hospitals or drug companies. They don’t care what it costs; insurance or the government will pay. This vulnerability has been exploited and
hijacked by greedy doctors, drug companies, insurers, personal injury lawyers, HMOs, and hospitals. About 50% of health care funds never even get to doctors or hospitals — which themselves run bloated operations.

Maybe we have finally reached the “Tipping Point”. Not because people are needlessly dying, but because big business is being crippled by astronomical health costs.

US companies — with employer funded health plans — are having a hard time competing in world markets. General Motors spends more on worker health care ($1,400 per vehicle) than they spend on steel for each car they produce. “The three big auto makers are “HMOs on wheels” says Goldman Sachs analyst Gary Lapidus.

Employer funded health insurance is a relic of the past according to the growing clamor by big business. We don’t want to pay for it any more and the added costs make our products uncompetitive in world markets.

The new Massachusetts law mandating health insurance – just as the state requires auto insurance – is a bold leap into an uncertain future, but it is an ad hoc band-aid which hopefully will lead to something more.

The long-term answer is obvious. Adopt a single payer system like Canada’s. Not socialized medicine. Doctors would remain private. By cutting out the bureaucracy, needless lawsuits, and curbing greed, the US could save 50% of the monies now being squandered, more than enough to cover the 50 million uninsured, according to a General Accounting Office and Congressional Budget Office report.

Ironically, we already have a successful single-payer healthcare program. Medicare, which covers people over 65, has an administrative and overhead cost of just 2%. Compare this low figure with the $399 billion spent on administrative middleman services in the free-market sector of health care last year. The simple step of data sharing of medical records could save $140 billion per year according too a recent Federal study.

Critics charge than a single payer system would lead to a rationing of medicine and long waits. But we already ration medicine, not by need, or efficacy of the treatment, but by how much money you have. If you are rich, you can have all you want. If you are poor, unemployed, self employed, sorry. 18,000 Americans die each year for lack of care according to the Institute of Medicine.

The right says that single-payer systems have not been adequately tested. But this is an obvious pretext by for-profit interest groups. Single-payer systems have been worked for many decades in 20 countries around the world.

The facts are clear: single-payer systems work and they save money. The Germans, French, Australians, Swiss, and Canadians all benefit from universal healthcare at less than half the cost that Americans pay for an incomplete system. Our for-profit healthcare system is a gambling scheme with the explicit goal of excluding the sick.

Good luck Massachusetts. Maybe your example, big business, and growing outrage will goad the dithering federal government into action.

Someday, inevitably, America will join the civilized world and provide universal care. It should be sooner rather than later.

Via NY Transfer News Collective * All the News that Doesn’t Fit

http://www.huffingtonpost.com/blake-fleetwood/cuba-has-better-medical-c_b_19664.html

Dr. Peter Mott
Guest essayist
Rochester Democrat and Chronicle

(April 12, 2006) — If we as a nation or state try to fill in health care gaps one at a time — first to cover those with no health insurance (more than 45 million Americans), then those with partial coverage (another 50 million), we would add new costs to the ongoing ones — a huge overall increase.

Thorough studies have been made of the costs of various national or statewide health insurance options. Economists found, and the General Accounting Office confirmed, that only one would save money. A Canadian-style, single-payer plan could save $200 billion per year, while covering all citizens for all necessary health services. As in Canada, this would include preserving private hospitals and patient choice of doctors.

How does a single-payer system cut costs so dramatically? Such a system means no competing insurance corporations, no advertising, practically no billing or collecting, no stockholder profits. Usually it also means more regional health planning to avoid wasteful duplication of equipment but adding needed services. This cooperative approach is similar to the way hospitals worked together in the Rochester region during the 1960s and 1970s, making the area a model at that time.

Why isn’t the public calling for a single-payer system? Several years ago I attended a health conference in Toronto at which a full-page advertisement in the Toronto Globe and Mail was shown to participants. It listed many complaints about Canadian “Medicare” but, in small print at the bottom, it said the ad was paid for by the U.S. health insurance industry. That was typical of the propaganda we hear about Canadian health care: long waits, doctors leaving Canada. However, according to polls, the vast majority of Canadian doctors like their system, and they have had 42 years of experience since the provincial plans merged in 1964. Waiting time in Ontario did increase when the Conservative premier cut hospital budgets, fired nurses and closed hospitals to reduce costs. It is ironic that he made that effort in a province where total health costs per capita are almost half those in the United States. Moreover, total costs are rising in Canada more slowly than in America.

Here in Rochester the Interfaith Health Care Coalition has joined the New York State Health Care Campaign to push the state Senate to fund a study of our options. If such a study shows again that all options will add enormously to total costs except for the single-payer health care plan — and that kind of statewide health insurance would save billions of dollars — then only politics could prevent a simple decision. And the people should then demand to know what are those political influences, and who pays for them.

Mott, of Pittsford, is a member, Interfaith Health Care Coalition.

Apr. 2006

The prevalence of inappropriate actions in healthcare drives additional margins in the industry’s supply, delivery and financing sectors, says contributor Fred Goldstein. It is at the root of our cost explosion and our healthcare crisis, and is based on an ingrained acceptance of unethical behaviors.

I have worked in healthcare for 20 years as a hospital administrator, an HMO senior executive and, most recently, the president of a disease management company. During this time ‘fve experienced a lot of what is right with the American healthcare system. But I have also seen enough fraud, abuse and unethical behavior to sicken even the heartiest soul. This characteristic of American healthcare is far too prevalent, and it undermines our efforts to control cost, build access and–most importantly–assure quality care. In the late 1980s, I worked for two major hospital corporations that routinely “cooked” their books. At one company it was referred to as “dialing for dollars” because the divisional CFOs would call the hospital controller each month and ask for more earnings. More recently, wefve learned these facts from mainstream news sources:

Pharmaceutical companies have paid for and published studies in distinguished professional journals, but left out results that reflected poorly on their products.

Drugs have been marketed as better than another brand when in fact there have been no head-to-head studies.

Major pharmaceutical distributors have bought drugs through middle men and, though they have been unable to determine the authenticity of the products, re-sold them.

Medical device manufacturers have knowingly distributed products with fatal flaws.

Medical device manufacturers have paid exorbitant gconsultingh fees to surgeons who decide which products their hospitals will buy for implantation into patients.

Many health plans have profited not by managing care, but by ratcheting down rates to doctors and hospitals and forcing employers to pay ever higher premiums.

Many hospitals have illegally paid doctors to increase admissions at their facilities.

Nonprofit hospitals, supposedly mission-driven, have charged uninsured patients three to four times what insurance companies pay, then sued them when they couldnft pay.

Many doctors practice medicine based on their own beliefs, feel that evidence-based medicine is too “cookbook,” and often prescribe procedures based more on financial self-interest than clinical necessity.

Many doctors, hospitals and other providers have consistently and, with little fear of penalty, stolen from Medicaid and Medicare.

Doctors often relent when patients pressure them to provide unnecessary services, even when the physicians know the procedures are inappropriate and costly.

Some “disease advocacy” associations–patients with the disease in question often look to them for unbiased advice–accept large contributions from drug companies, and then do not fully disclose details about their sponsorsf contributions or their drugsf impacts.

Healthcare corporations invest in lobbying because it works, spinning public policy and dollars disproportionately in favor of healthcarefs strongest interests.

Many healthcare executive have enjoyed extraordinary compensation while fraud and abuse occurs, and is even encouraged under their watch.

Unethical behavior exists among healthcare organizations and professionals of all types. Organizations that try to do the right thing are often outmaneuvered by those that do not. Self-interest is often hidden behind a façade of patient concern. “We do this for the patient. If you withhold our services, you will hurt the patient.” Worse, these self serving behaviors have become so common that professional outrage has been dulled. But to save healthcare, we canft just take these acts for granted.

The prevalence of inappropriate actions in healthcare drives additional margins in the industryfs supply, delivery and financing sectors. It is at the root of our cost explosion and our healthcare crisis. And, it is based on an ingrained acceptance of unethical behaviors. The recent movement toward transparency and quality reporting will shine a bright light on some of these practices, and should tone down the environment of opportunism. But many of these behaviors have been well known for years. I have little faith that, with so much money at stake, any reforms can be substantial enough to turn around the industry.

This is especially true if change does not support and engage much more participation from payers and consumers. In 2005, then-Federal Reserve Chairman Alan Greenspan spoke with MBA students at Wharton. He said, “Material success is possible in this world, and far more satisfying when it comes without exploiting others.” He also said, “In virtually all our transactions, whether with customers or with colleagues, with friends or with strangers, we rely on the word of those with whom we do business. If we could not do so, goods and services could not be exchanged efficiently.”

I am not naïve and do not expect that a plea for ethics will have much impact. I believe that a free market, with openly available information, offers a healthier path to a better society for all our citizens. Healthcare is an industry in which, perhaps above all others, we must strive for and reward integrity. However, unless we find a way back to honesty and decency in our commerce–the ethical behaviors that have been the basis of the healthiest civilizations–we wonft achieve the solutions our healthcare system needs. The common interest will continue to be exploited, our market-based system will falter and our healthcare system could well collapse.

________________________________________
Fred Goldstein is founder and president of Specialty Disease Management, a disease management firm based in Jacksonville, Fla. He may be reached at fgoldstein@specialtydisease.com.

Ottawa opposed Third Way strategy

By DAWN WALTON AND BILL CURRY
Originally Published 04/21/06

CALGARY and OTTAWA – Bowing to public pressure at home and opposition in Ottawa, Alberta has shelved its controversial health-care reforms that would have allowed doctors to collect paycheques in both the private and public systems and patients to buy private insurance.

An “aggressive” work-force policy to bring more health-care workers to Alberta cities and rural areas to alleviate waiting lists will be adopted rather than allowing patients to pay for certain services to speed access, the province announced yesterday.

“The most important thing is to build a stronger public health-care system where an Albertan’s ability to pay will never influence the type of care or the design of care that they can receive,” Health Minister Iris Evans told reporters in Calgary after an all day caucus meeting.

Both Prime Minister Stephen Harper and federal Health Minister Tony Clement had expressed concern in recent weeks that Alberta’s proposed reforms, which Premier Ralph Klein had dubbed the Third Way, could violate the Canada Health Act — something Ottawa could address by withholding transfer payments.

Mr. Klein took the federal government to task yesterday, saying it offered no alternatives. He said those who opposed the province’s plan had confused the public about what it would mean.

“It has always been expedient to be the protector of medicare as we know it today,” he said.

Alberta will move ahead with a Health Care Assurance Act this spring, which is a framework for future health-care legislation. It will also call for more consultation with Albertans, which could revive the debate, Ms. Evans said.

But that may not happen for another year as Alberta’s Progressive Conservative Party prepares to pick a new leader this fall.

Mr. Klein said he is disappointed he will not be able to see the matter through because he will be out as premier by the end of the year.

“It’s being postponed, but someone is going to have to deal with it,” he said. When asked what advice he had for those who take up the torch for medicare reform, he replied, “Good luck.”

Ms. Evans insisted that the Third Way is not dead. “Far from being dead, it’s alive, and we have created an opportunity for Albertans to give us even more feedback,” she said.

Ms. Evans, who met with Mr. Clement this week, said he left the door “slightly ajar” for more discussions about potential reforms.

Mr. Clement could not be reached yesterday, but an official in the Prime Minister’s Office said Mr. Harper had made Ottawa’s position clear on the Third Way proposal.

“The Prime Minister was clear in a private meeting he had with Premier Klein that anything Alberta wishes to propose to reform health care is great as long as it respects the Canada Health Act,” he said.

The change of heart was hailed as a victory by those opposed to the Third Way.

The province received more than 4,000 letters and 2,000 calls on the reforms — the vast majority of them expressing concern about two-tier medicine and the prospect of paying for services.

“This is clearly a defeat for the government,” said Alberta’s New Democratic Leader Brian Mason. “. . . I think Iris Evans pushed very hard for this legislation. The Premier pushed for the legislation and the people of Alberta pushed back.”

Harvey Voogd, co-ordinator of the Friends of Medicare, which has been lobbying against the Third Way, said dramatic reforms died when Mr. Klein’s party embarrassed him with only 55 per cent support of his leadership.

Karl Belanger, the press secretary to federal NDP Leader Jack Layton, expressed cautious optimism: “It sounds like it could come back in a year, so we will keep pushing for a fully public health-care system.”

Mr. Layton had demanded a federal law banning doctors from operating in both the public and private systems as the price for his continued support of the Liberal government last fall. When a deal could not be reached, the NDP joined the Bloc Québécois and the Conservatives and triggered a federal election.

A spokesperson for federal Liberal Leader Bill Graham was pleased with the decision, adding that innovation in health must take place within the framework of a universal health-care system.

Ms. Evans said Alberta is still looking for ways to cut costs to its health-care spending, which currently eats up more than a third of the province’s budget, but acknowledges that focusing on recruitment could cost the province even more.

The province figures it will spend $10.3-billion on health care in 2006-07, which is $735-million or 7.7 per cent more than the government expected it would spend during the last fiscal year.

Since 1995-96, health spending in Alberta has grown by an average of 10 per cent a year. Now, itboasts among the country’s highest per capita spending for health care.

Alberta Health and Wellness hopes to rein in costs over three years through reforms, but it expects another 7.7 per cent hike in program spending in 2007-08, before it cuts the spending increase to 3.7 per cent in fiscal 2008-09.

By DINAH WISENBERG BRIN and VANESSA FUHRMANS
Wall Street Journal
Originally published April 18, 2006

UnitedHealth Group Inc. Chairman and Chief Executive William W. McGuire said Tuesday he is recommending that the insurer, which is under scrutiny for the timing of past stock-options awards, forgo equity-based payments and grants for most senior executives.

The company also said it posted higher-than-expected first-quarter earnings but lowered its guidance for next year. Earnings at the country’s second-biggest health insurer climbed 21% to $899 million, or 63 cents a share, in the quarter, from $743 million, or 55 cents per share, a year earlier. UnitedHealth’s acquisition of PacifiCare Health Systems Inc., which it completed late last year, and its new Medicare drug-benefit plans helped fuel profits, as a well as a 58% jump in first-quarter revenues to $17.59 billion.

As a result, Dr. McGuire said the company now expects full-year earnings between $2.88 and $2.92 a share — a 22% to 24% increase from 2005 — compared with its earlier projection of between $2.85 to $2.90 a share.

Dr. McGuire prefaced his discussion of the company’s performance with his first comments on the controversy over his massive financial windfall from stock options, now totaling $1.6 billion in unrealized gains. In a move that could prove to be a significant pullback from what has been an enormously generous remuneration package, Dr. McGuire said he was recommending that the company eliminate change-in-control severance payments and “noncash perquisites,” for the most senior executives, as well as capping supplemental retirement plans and eliminating further equity-based grants “for the foreseeable future.” UnitedHealth’s board will consider that idea at its next meeting in May, he said.

Dr. McGuire’s suggestion does not restrict him or other executives from exercising options they’ve already received, and a company spokesman declined to specify what perks Dr. McGuire suggested be eliminated.

Earlier this month, UnitedHealth said a committee of its independent directors would review the company’s options-grant practices in light of Securities and Exchange Commission scrutiny of options grants at numerous companies, including UnitedHealth.

The Wall Street Journal reported last month that Dr. McGuire’s options grants were regularly dated just before substantial run-ups in share price and after a sharp fall.

Monday, Comverse Technology Inc. said that after a preliminary review of its stock-option practices, it expects to restate more than five years of financial results because the grant dates used in its accounting “differed” from the actual grant date.

Several UnitedHealth executives frequently received stock-options grants dated at or near quarterly low points in the company’s share price, raising questions about how the Minnetonka, Minn., health insurer timed options grants, the paper reported this week.

“I and all of us at UnitedHealth Group take these concerns seriously,” Dr. McGuire said. “It is extraordinarily difficult and frustrating not to respond to media reports” about company options practices, especially those that “impugn” management, Dr. McGuire said.

“To my knowledge, every member of management in this company believed at the time that we followed appropriate practices” for granting options executives and other employees, he said. The CEO, questioned by an analyst, wouldn’t specify whether he had received backdated stock options, saying the company didn’t want to bias the independent review committee. “We sleep with good conscience,” he added.

By the quarter’s end, UnitedHealth had signed up about 70 million consumers, an increase of 27% over the prior year. The company said it had 4.5 million seniors using its Medicare Part D prescription drug benefit, generating $1.2 billion in revenue for the quarter. The company’s Part D plans saw their margins squeezed due to the costs of assimilating new members, but it said it expects to see margins expand by year’s end.

Dr. McGuire was the subject of a Page One article in The Wall Street Journal today that looked at how an elite group of companies is getting rich from the nation’s fraying health-care system. Many of them are middlemen who process the paperwork, fill the pill bottles and otherwise connect the pieces of a $2 trillion industry.

UnitedHealth directors in the late 1990s allowed Dr. McGuire the rare freedom to time his stock-option grants. In several cases the grants carried dates when the company’s share price was particularly low, allowing him to profit when it recovered.

The Journal’s analysis of 12 options grants to Dr. McGuire from 1994 to mid-2002 found that if the options had been randomly dated, the odds of their occurring at such propitious times were about 1 in 200 million. It raised the possibility that the options grants were backdated. Backdating an options grant isn’t necessarily illegal, but civil or criminal actions could be brought if disclosure of the practice was inadequate, securities lawyers say.

Write to Dinah Wisenberg Brin at dinah.brin@dowjones.com10 and Vanessa Fuhrmans at vanessa.fuhrmans@wsj.com11

MORE ON MCGUIRE
• Option grants to Dr. McGuire in 1997, 1999 and 2000 carried dates on which UnitedHealth’s stock hit its low for the year. Read more about the grants and those made to other companies’ executives in The Perfect Payday (March 18, 2006) and see charts of the option grants.

Multiple Insurers, Multiple Plans Create Expensive, Draining Hassle

THE DOCTOR’S OFFICE

By BENJAMIN BREWER, M.D.
THE WALL STREET JOUNRAL
April 18, 2006

A recently approved Massachusetts plan designed to force all residents to get health insurance was a step in the right direction, but it doesn’t go far enough.

Under the Massachusetts approach, there will still be a maze of plans provided by any number of insurers. That multiplicity is the problem. Multiple insurers and multiple plans create layers of unneeded expense and bureaucracy related to billing, collections and the entire assembly line of middlemen between the service rendered and the payment.

It took me a while to conclude that a single-payer health system was the best approach. My fear had been that government would screw up medicine to the detriment of my patients and my practice. If done poorly, the result might be worse than what I’m dealing with now.

But increasingly I’ve come to believe that if done right, health care in America could be dramatically better with true single-payer coverage; not just another layer — a part D on top of a part B on top of a part A, but a simplified, single payer that would cover all Americans, including those who could afford the best right now. Representatives and senators in Washington should have to use the same system my patients and I do were they to vote it in.

Doctors in private practice fear a loss of autonomy with a single-payer system. After being in the private practice of family medicine for 8 1/2 years, I see that autonomy is largely an illusion. Through Medicare and Medicaid, the government is already writing its own rules for 45% of the patients I see.

The rest are privately insured under 301 different insurance products (my staff and I counted). The companies set the fees and the contracts are largely non-negotiable by individual doctors.

The amount of time, staff costs and IT overhead associated with keeping track of all those plans eats up most of the money we make above Medicare rates. As it is now, I see patients and wait between 30 and 90 days to get paid. My practice requires two full-time staff members for billing. My two secretaries spend about half their time collecting insurance information. Plus, there’s $9,000 in computer expenses yearly to handle the insurance information and billing follow up. I suspect I could go from four people in the paper chase to one with a single-payer system.

It would be simpler and better for the patient, and for me, if the patient could choose a doctor, bring their ID card with them, swipe it in a card reader at the time of service and have the doctor get paid on the spot with electronic funds transfer.

Instead, patients have to negotiate a maze of deductibles, provider networks, out-of-network costs, exclusions, policy riders, ER surcharges, etc. Wouldn’t a card swipe be simpler? No preexisting conditions to worry about. No indecipherable hospital bills. One formulary to deal with and one set of administrative rules to learn instead of 300.

With a single-payer system, there are concerns about waiting times for procedures and not getting access to the “best doctors.” These are real issues, but not unsolvable ones. We have these disparities now. Fact is, they are mostly a matter of geography, insurance status and personal wealth.

A single-payer system would increase access to care for the uninsured and the underinsured, including the working poor. It would lower total health costs, in part by replacing 50 different state Medicaid programs and umpteen insurers with one system. This approach has the potential to improve quality and lower costs by improving care for chronic illnesses such as diabetes, high blood pressure and heart disease.

Such a system of care would rely on evidenced-based interventions, that is, providing the right care at the right time to the right patients, according to generally accepted best practices, and it would reduce the disparities in access to and quality of care among ethnic groups. Better tracking of chronic diseases, outbreaks and identification of bioterrorism would also be benefits.

There are powerful forces that oppose a single-payer system — the health insurance industry for one. The insurance industry got its share of the Medicare drug benefit pie, as did the pharma industry. It would have been better and simpler for the government to design one plan with a standard drug fee schedule that everyone could understand, as the government does with care that doctors provide to Medicare patients. But that’s not the way it happened.

Doctors have been supportive of the idea of universal access to care, but not necessarily a single-payer system. Some fear delays in obtaining necessary testing and surgeries. What I suspect they fear most is a loss of income and the fear of the unknown.

A single-payer system would admittedly lower fees for subspecialty care, such as radiology and cardiology. But if more doctors went into family medicine or obstetrics and fewer into subspecialties like plastic surgery, that shift might help correct the physician manpower imbalances that exist now. That wouldn’t necessarily break my heart.

I suspect doctors would be more likely to support a single-payer system if national malpractice reform was part of the package — which it should be.

I used to think a single-payer system would keep my income down and inject bureaucracy into my medical decision-making. But with the efficiency it could bring, it would at worst be an economic wash; more likely, the trimmed costs would more than make up for any foregone revenue. As for autonomy, I’m already struggling to maintain it amid the interference of insurers.

On the whole, the efficiency — and equality — that a single-payer system would provide would more than compensate for its shortcomings.

Write to Dr. Benjamin Brewer at thedoctorsoffice@wsj.com