PNHP

SCHIP's "success" represents incrementalism's failure

SCHIP's "success" represents incrementalism's failure

Ebbing and Flowing: Some Gains, Some Losses as SCHIP Responds to Third Year of Budget Pressure
By Ian Hill, Brigette Courtot, and Jennifer Sullivan
The Urban Institute
May 2005

Heading into 2004, SCHIP recorded its first-ever decline in enrollment. While it represented just 1 percent of total enrollment, the drop was still a significant turning point, reflecting the cumulative impact of three years of state policy responses to the ongoing economic downturn.

(2004) saw virtually no improvement in outreach, thus dimming SCHIP’s prospects for further reducing the rate of uninsurance among children in the coming year. Further, states like Texas did nothing to reverse the raft of changes made in 2003 that cut eligibility and benefits, raised cost sharing, and made enrollment more challenging. Wisconsin maintained its highest-in-the-nation premium, even in the face of declining enrollment. And Florida, despite lifting its enrollment cap, restricted future growth by closing enrollment except during two 30- day “open” periods each year, while requiring families to play a more active role in eligibility renewal.

In the case of outreach there is no ambiguity – SCHIP outreach has for all intents and purposes ceased to exist. Evidently, states have decided that programs cannot sustain the growth rates of SCHIP’s first four years during an economic downturn. Outreach has been scaled back or eliminated in an effort to curtail growth.

Looking ahead, the future course for SCHIP is uncertain. In 2004, 36 states spent more than 100 percent of their annual allotments. Yet that same year, for the first time, unspent federal funds in the amount of $1.3 billion reverted to the treasury. Federal funds available for redistribution are expected to fall in the coming years while the number of states needing redistributions is expected to rise. The only current prospect for enhanced federal funding for SCHIP has been proposed in the Bush administration’s “Covering the Kids” outreach initiative. However, when we asked SCHIP directors what they thought of this proposal, they expressed appreciation tempered by strong trepidation. That is, federal support for outreach would be welcomed by the states, but only if allotments were increased as well to cover the services new enrollees would need. SCHIP already faces excess demand for coverage. Providing new funding for outreach, without supporting states’ ability to supply additional coverage, would only exacerbate the program’s financing challenge.

http://www.urban.org/UploadedPDF/311166_A-68.pdf

Comment: SCHIP, the children’s health insurance program, is the one bright light on the path of incremental reform. Almost 4 million children are covered by this program. Although overall health care costs and coverage continue to deteriorate, the rate of deterioration would have been significantly greater without this very important program.

But how bright is the SCHIP light? The Bush administration is offering administrative funds to sign up new enrollees, but is not providing adequate funds for the care that would be required by new enrollees. And as a program that serves lower-income individuals, it is vulnerable to the wrath of anti-tax, anti-government politicians (“…strangle the beast…”), enabled by the passivity of their milquetoast colleagues (“…I am not a tax-and-spend liberal…”). Thus the response of the states has been to enact changes that control program costs.

It is ironic that our one successful incremental program, SCHIP, is now contributing to our chronic problems of an increasing number of uninsured and of making care less affordable by shifting more costs to the individual. Incrementalism is not working. All parameters are growing progressively worse.

We need comprehensive reform. But we won’t have that until we replace our milquetoast politicians who are too timid to take on the would-be anarchists who are currently in charge.

SCHIP’s “success” represents incrementalism’s failure

Ebbing and Flowing: Some Gains, Some Losses as SCHIP Responds to Third Year of Budget Pressure
By Ian Hill, Brigette Courtot, and Jennifer Sullivan
The Urban Institute
May 2005

Heading into 2004, SCHIP recorded its first-ever decline in enrollment. While it represented just 1 percent of total enrollment, the drop was still a significant turning point, reflecting the cumulative impact of three years of state policy responses to the ongoing economic downturn.

(2004) saw virtually no improvement in outreach, thus dimming SCHIP’s prospects for further reducing the rate of uninsurance among children in the coming year. Further, states like Texas did nothing to reverse the raft of changes made in 2003 that cut eligibility and benefits, raised cost sharing, and made enrollment more challenging. Wisconsin maintained its highest-in-the-nation premium, even in the face of declining enrollment. And Florida, despite lifting its enrollment cap, restricted future growth by closing enrollment except during two 30- day “open” periods each year, while requiring families to play a more active role in eligibility renewal.

In the case of outreach there is no ambiguity – SCHIP outreach has for all intents and purposes ceased to exist. Evidently, states have decided that programs cannot sustain the growth rates of SCHIP’s first four years during an economic downturn. Outreach has been scaled back or eliminated in an effort to curtail growth.

Looking ahead, the future course for SCHIP is uncertain. In 2004, 36 states spent more than 100 percent of their annual allotments. Yet that same year, for the first time, unspent federal funds in the amount of $1.3 billion reverted to the treasury. Federal funds available for redistribution are expected to fall in the coming years while the number of states needing redistributions is expected to rise. The only current prospect for enhanced federal funding for SCHIP has been proposed in the Bush administration’s “Covering the Kids” outreach initiative. However, when we asked SCHIP directors what they thought of this proposal, they expressed appreciation tempered by strong trepidation. That is, federal support for outreach would be welcomed by the states, but only if allotments were increased as well to cover the services new enrollees would need. SCHIP already faces excess demand for coverage. Providing new funding for outreach, without supporting states’ ability to supply additional coverage, would only exacerbate the program’s financing challenge.

http://www.urban.org/UploadedPDF/311166_A-68.pdf

Comment: SCHIP, the children’s health insurance program, is the one bright light on the path of incremental reform. Almost 4 million children are covered by this program. Although overall health care costs and coverage continue to deteriorate, the rate of deterioration would have been significantly greater without this very important program.

But how bright is the SCHIP light? The Bush administration is offering administrative funds to sign up new enrollees, but is not providing adequate funds for the care that would be required by new enrollees. And as a program that serves lower-income individuals, it is vulnerable to the wrath of anti-tax, anti-government politicians (“…strangle the beast…”), enabled by the passivity of their milquetoast colleagues (“…I am not a tax-and-spend liberal…”). Thus the response of the states has been to enact changes that control program costs.

It is ironic that our one successful incremental program, SCHIP, is now contributing to our chronic problems of an increasing number of uninsured and of making care less affordable by shifting more costs to the individual. Incrementalism is not working. All parameters are growing progressively worse.

We need comprehensive reform. But we won’t have that until we replace our milquetoast politicians who are too timid to take on the would-be anarchists who are currently in charge.

Milliman on shifting costs to employees

Milliman Medical Index 2005
Milliman Inc.

Milliman Inc. has completed its first annual study of the total annual medical costs for a “Typical American Family of Four.” The Milliman Medical Index (MMI) measures the average spending by such a family if covered by an employer-sponsored PPO program.

Based on a typical PPO plan design, Milliman estimates that out of the $12,214 total medical costs for 2005, a family would pay $2,035 out of their own pocket through member cost-sharing.

Future trends, including consumer-driven health plans:

As total medical costs continue to rise, employers will continue to look for ways to reduce costs, both for themselves and their employees. Employers are looking at ways to try to improve healthcare quality and reduce costs by sharing information aimed at educating their employees about the costs and efficacy of various medical services. Employers and health plans also continue to try to negotiate favorable rates with healthcare providers.

If these efforts are insufficient to keep employer cost trends at affordable levels, employers will continue to adjust employee contributions (both cost-sharing and premium sharing). While this has happened gradually in the recent past, some employers have concluded that this can only be done with a significant change in the traditional benefit plans being provided. This has led to increased interest in consumer-driven health plans (CDHPs), where members are given a spending account to pay for their own routine care, plus a high deductible plan to pay costs in catastrophic cases. Going from a traditional PPO plan to a high deductible plan can have a substantial impact on the portion of annual costs paid by the member through cost sharing,

A key question regarding CDHPs is whether they will result only in a shift of costs from the employer to the employee, or whether they will affect the total annual cost of healthcare.

http://www.milliman.com/mmi/Milliman_Medical_Index_Final.pdf

Comment: From the Milliman website: “One of the largest consulting and actuarial firms in the United States, we are recognized leaders who have helped shape significant changes in the markets we serve.”

When Milliman speaks, we listen. That doesn’t mean that we like what we hear.

This study reports that a typical family of four, enrolled in an employer-sponsored PPO pays $2,035 for out-of-pocket cost sharing of $12,214 in covered expenses. It is important to realize that the $2,035 does not include the employee’s contribution to the insurance premium, nor payments for non-covered products and services. When those are included, it is quite clear that average-income individuals would have difficulty affording the total out-of-pocket health care costs even though insured through the employer-sponsored PPO plan. Since PPO plans in the individual market are even less comprehensive, out-of-pocket expenses would be even more burdensome, not to mention the fact that the individual usually pays the full premium.

Also, since the study was limited to employer-sponsored PPO plans, the patient population is composed of relatively healthy, gainfully-employed individuals and their relatively healthy families. Just imagine the greater potential financial burden faced by those with more significant health care needs.

Thus the question posed by Milliman regarding the impact of the trend toward consumer driven health plans does not bode well for ensuring future affordable access to health care. In shifting more costs to the employees, either individuals will have the formidable task of reducing spending in other sectors of their already tight budgets, or, more likely, they will have to do without beneficial health care services.

Then, of course, in theory this could reduce total health care costs by motivating patients to reject unnecessary health care services. But first would someone show me all of those patients who are out seeking so much unnecessary care? I certainly don’t know who they are, or if they even really exist. When was the last time that you went to a doctor to try to obtain all of the unnecessary care that you could get?

NCHC – Thorpe's analysis of savings makes reform imperative

New Projections From Nation’s Largest Health Care Coalition Show Health Care Reform Would Produce Huge Savings
National Coalition on Health Care
Press Release
May 23, 2005

System-wide health care reform would save much more money than it would cost, according to economic projections released today by the National Coalition on Health Care.

In four scenarios for reform analyzed by Professor Kenneth Thorpe of Emory University, the investment needed to achieve universal health coverage would be more than offset by savings. In each case, the cost of a reformed system would be much less than the cost of continuing with the current system.

Announcing these new findings, the Coalition’s president, Dr. Henry E. Simmons, said, “What this economic modeling shows unambiguously is that done right, health care reform will save America a great deal of money – while at the same time assuring health coverage for all Americans and dramatically improving health care.”

From Professor Thorpe’s PowerPoint presentation:

Total change in spending for years 2006 through 2015 under four scenarios (in comparison with the status quo):

$320 billion reduction – Employer mandate supplemented by individual mandate

$320 billion reduction – Expand existing programs to expand coverage

$370 billion reduction – Develop new program modeled after the FEHB (federal employees’ program)

$1136 billion ($1.136 trillion) reduction – Universal publicly financed program (“single payer”)

National Coalition on Health Care:
http://www.nchc.org/

Press Release:
http://www.nchc.org/news/press_releases/2003/2005_05_23.pdf

KFF video HealthCast of the press conference:
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?create=high_windows&linkid=1&display=detail&hc=1439

Kenneth Thorpe’s PowerPoint:
http://www.nchc.org/materials/nchcpressclub-final%20copy.pdf

Comment: The Honorary Co-Chairs of the National Coalition on Health Care are former presidents George Bush, Jimmy Carter and Gerald Ford. The member organizations of the Coalition represent about 150 million Americans and include business, labor, consumer, religious, provider, and health and pension fund interests. Every effort has been made to remove any partisan agenda from the process. Our former presidents can attest to that.

A highly objective process was used to evaluate the models of reform which would provide comprehensive coverage and higher quality care for everyone.
Which model would you choose?

NCHC – Thorpe’s analysis of savings makes reform imperative

New Projections From Nation’s Largest Health Care Coalition Show Health Care Reform Would Produce Huge Savings
National Coalition on Health Care
Press Release
May 23, 2005

System-wide health care reform would save much more money than it would cost, according to economic projections released today by the National Coalition on Health Care.

In four scenarios for reform analyzed by Professor Kenneth Thorpe of Emory University, the investment needed to achieve universal health coverage would be more than offset by savings. In each case, the cost of a reformed system would be much less than the cost of continuing with the current system.

Announcing these new findings, the Coalition’s president, Dr. Henry E. Simmons, said, “What this economic modeling shows unambiguously is that done right, health care reform will save America a great deal of money – while at the same time assuring health coverage for all Americans and dramatically improving health care.”

From Professor Thorpe’s PowerPoint presentation:

Total change in spending for years 2006 through 2015 under four scenarios (in comparison with the status quo):

$320 billion reduction – Employer mandate supplemented by individual mandate

$320 billion reduction – Expand existing programs to expand coverage

$370 billion reduction – Develop new program modeled after the FEHB (federal employees’ program)

$1136 billion ($1.136 trillion) reduction – Universal publicly financed program (“single payer”)

National Coalition on Health Care:
http://www.nchc.org/

Press Release:
http://www.nchc.org/news/press_releases/2003/2005_05_23.pdf

KFF video HealthCast of the press conference:
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?create=high_windows&linkid=1&display=detail&hc=1439

Kenneth Thorpe’s PowerPoint:
http://www.nchc.org/materials/nchcpressclub-final%20copy.pdf

Comment: The Honorary Co-Chairs of the National Coalition on Health Care are former presidents George Bush, Jimmy Carter and Gerald Ford. The member organizations of the Coalition represent about 150 million Americans and include business, labor, consumer, religious, provider, and health and pension fund interests. Every effort has been made to remove any partisan agenda from the process. Our former presidents can attest to that.

A highly objective process was used to evaluate the models of reform which would provide comprehensive coverage and higher quality care for everyone.
Which model would you choose?

Genomics, bioinformatics, and single payer

Decoding Health Insurance
By Robin Cook
The New York Times
May 22, 2005

In this dawning era of genomic medicine, the result may be that the concept of private health insurance, which is based on actuarially pooling risk within specified, fragmented groups, will become obsolete since risk cannot be pooled if it can be determined for individual policyholders.

Genetically determined predilection for disease will become the modern equivalent of the “pre-existing condition” that private insurers have stringently avoided.

As a doctor I have always been against health insurance except for catastrophic care and for the very poor. It has been my experience that the doctor-patient relationship is the most personal and rewarding for both the patient and the doctor when a clear, direct fiduciary relationship exists. In such a circumstance, both individuals value the encounter more, which invariably leads to more time, more attention to potentially important details, and a higher level of patient compliance and satisfaction – all of which invariably result in a better outcome.

But with the end of pooling risk within defined groups, there is only one solution to the problem of paying for health care in the United States: to pool risk for the entire nation. (Under the rubric of health care I mean a comprehensive package that includes preventive care, acute care and catastrophic care.) Although I never thought I’d advocate a government-sponsored, obviously non-profit, tax-supported, universal access, single-payer plan, I’ve changed my mind: the sooner we move to such a system, the better off we will be. Only with universal health care will we be able to pool risk for the entire country and share what nature has dealt us; only then will there be no motivation for anyone or any organization to ferret out an individual’s confidential, genetic makeup.

There are plenty of compelling arguments for a national, single-payer, universal access plan – like every developed industrialized country has one. But those arguments have so far seemed insufficient. And none of them is nearly as cogent and persuasive as the growing impact of genomics and bioinformatics. Of course, far too many wealthy stakeholders in the current system (thanks to 15 percent of our gross domestic product being thrown at health care) are eager to lobby members of Congress to keep things as they are. The basic challenge is to blast the public and their elected representatives out of their shared apathy toward what the decipherment of the human genome has brought.

Robin Cook is a medical doctor and the author, most recently, of the novel “Marker.”

http://www.nytimes.com/2005/05/22/opinion/22cook.html?pagewanted=all

Comment: Every time that reason is introduced into the national dialogue on reform, the arguments for a single payer system become ever more compelling.

Moderate and populist Republicans favor tax-supported,government health insurance

The Pew Research Center
Survey Report
Beyond Red vs. Blue
May 10, 2005

Health Insurance

Solid majorities of every group, with the sole exception of Enterprisers, favor a government guarantee of health insurance for all Americans, even if it means raising taxes. Across the electorate, support for guaranteed health insurance ranges from 55% among Upbeats and 59% among Social Conservatives to 90% among Liberals. By contrast, Enterprisers strongly oppose guaranteed health insurance for all, if it means higher taxes (76% oppose, 23% favor).

Percent favoring government health insurance for all, even if taxes increase:

65% of the total

23% of enterprisers

59% of social conservatives

63% of pro-government conservatives

55% of upbeats

64% of disaffecteds

73% of conservative Democrats

65% of disadvantaged Democrats

90% of liberals

For profiles of the typology groups:
http://people-press.org/reports/display.php3?PageID=949

For navigating the full report:
http://people-press.org/reports/display.php3?ReportID=242

Comment: Only the enterprisers (“staunch conservatives”) are opposed to tax-supported, government health insurance. The remarkable finding is that 59% of social conservatives (“moderate Republicans”) and 63% of pro-government conservatives (“populist Republicans”) do favor tax-supported government health insurance. Now if we can only get them to communicate that to their legislators.

Waiting for C.E.O.'s to Go 'Nuclear'

Waiting for C.E.O.’s to Go ‘Nuclear’
Op-ed
By Matt Miller
New York Times
May 18, 2005

The consuming Senate slugfest over judges (vital as they are) proves how Washington remains determined to fiddle while our biggest problem burns: a broken health care system that threatens working families and national competitiveness.

President Bush – who, with 51 percent of the vote, has set 100 percent of the agenda – has taken a pass. And the terms of the debate remain surreal. After all, Margaret Thatcher would have been driven from office if she’d proposed anything as radically conservative as Bill Clinton’s health plan, which would have left millions uncovered and had private doctors deliver the care.

Is there hope? Maybe. But only if America’s chief executives exercise their “nuclear option.”

Here’s the logic. Washington will offer zero leadership on health reform until 2009. The only way we’ll get serious then is if the campaign in 2008 centers on health. The only way that will happen is if groundwork is laid in advance. And the only way this groundwork will get traction is if America’s C.E.O.’s make it their mission.

Various groups (including one I’m paid to advise) have tried, without much luck, to energize this debate. C.E.O.’s are the one group with the incentive and the clout to take it on.

So what should the chief executives do? Even if we don’t have presidential leadership now, we desperately need the “presidential perspective.” By this I mean a view of our challenges that doesn’t reflect the narrow agenda of business or labor, or the medical-industrial complex. Instead, we need a “big picture” framework, a way to engage the press and the public in the right strategic goals.

Here’s my version of the script: A dozen marquee C.E.O.’s would convene a “Manhattan Project”-style effort on the future of health care. They’d propose a new goal: instead of health costs rising from today’s 15 percent of G.D.P. to 20 percent by around 2020, as is now projected, the nation should shave two to three percentage points of G.D.P. (or more) off projected growth in ways that improve quality, even as we extend coverage to the 45 million uninsured.

Our chief executives would explain that this is doable because today’s system costs too much and delivers too little.

(Quick review: We spend 15 percent of G.D.P. on health. Other rich nations spend 10 percent or less, but they manage to insure everyone – and have equal or better public health outcomes. And we have huge variations in practice patterns and medical spending that bear no relation to quality. Bottom line: radical inefficiency.)

Our C.E.O.’s would add that a new health strategy would get excess costs off businesses’ backs – costs that competitors don’t face in countries where governments pick up the tab. It would re-engineer the delivery of care so governments would have cash left for other purposes. And it would cope with the political reality that every dollar of health care “waste” is somebody’s dollar of income.

The group would issue a report in late 2007 with a full-blown agenda for the next president. Done right, the “Jones” Report (aspiring C.E.O. statesmen or stateswomen, picture your name here!) would become the touchstone for all health care talk in the campaign.

Now my rules for participation: First, only chief executives prepared to invest real time need apply. This shouldn’t be a bar; health costs now loom so large that C.E.O.’s are destined to focus on the problem. They can’t fix it alone, so they may as well fix it for everyone. (As a lure, we might enact a 100 percent short-term capital gains tax on their stocks during the life of the group to banish speculators and free the chiefs to think long-term.)

Next, eligible C.E.O.’s have to grasp that most rhetoric in the health debate – as exemplified by the Thatcher example above – is rubbish. Republican C.E.O.’s who think “big government” is always the problem may be at special psychic risk.

Critics may shout: Why should we want some lavishly paid bosses to take the lead? Well, for starters, as the Clinton debacle proved, if business doesn’t buy in, nothing that matters here can change. But beyond this, spiraling health costs have aligned corporate interests with workers’ for the first time in ages. My hunch is that inside many car and computer and bank and energy moguls, tomorrow’s political heroes are dying to get out.

Ordinarily a bold call for a commission is a way to punt, but given today’s leadership vacuum, it’s a way to start. I’m not saying that this will end with C.E.O.’s marching on Washington to demand “Margaret Thatcher-style universal health coverage.” But I wouldn’t rule it out either.

E-mail: mattmiller@nytimes.com; Matt Miller is the author of “The 2 Percent Solution: Fixing America’s Problems in Ways Liberals and Conservatives Can Love.” Maureen Dowd is on book leave.

Waiting for C.E.O.’s to Go ‘Nuclear’

Waiting for C.E.O.’s to Go ‘Nuclear’
Op-ed
By Matt Miller
New York Times
May 18, 2005

The consuming Senate slugfest over judges (vital as they are) proves how Washington remains determined to fiddle while our biggest problem burns: a broken health care system that threatens working families and national competitiveness.

President Bush – who, with 51 percent of the vote, has set 100 percent of the agenda – has taken a pass. And the terms of the debate remain surreal. After all, Margaret Thatcher would have been driven from office if she’d proposed anything as radically conservative as Bill Clinton’s health plan, which would have left millions uncovered and had private doctors deliver the care.

Is there hope? Maybe. But only if America’s chief executives exercise their “nuclear option.”

Here’s the logic. Washington will offer zero leadership on health reform until 2009. The only way we’ll get serious then is if the campaign in 2008 centers on health. The only way that will happen is if groundwork is laid in advance. And the only way this groundwork will get traction is if America’s C.E.O.’s make it their mission.

Various groups (including one I’m paid to advise) have tried, without much luck, to energize this debate. C.E.O.’s are the one group with the incentive and the clout to take it on.

So what should the chief executives do? Even if we don’t have presidential leadership now, we desperately need the “presidential perspective.” By this I mean a view of our challenges that doesn’t reflect the narrow agenda of business or labor, or the medical-industrial complex. Instead, we need a “big picture” framework, a way to engage the press and the public in the right strategic goals.

Here’s my version of the script: A dozen marquee C.E.O.’s would convene a “Manhattan Project”-style effort on the future of health care. They’d propose a new goal: instead of health costs rising from today’s 15 percent of G.D.P. to 20 percent by around 2020, as is now projected, the nation should shave two to three percentage points of G.D.P. (or more) off projected growth in ways that improve quality, even as we extend coverage to the 45 million uninsured.

Our chief executives would explain that this is doable because today’s system costs too much and delivers too little.

(Quick review: We spend 15 percent of G.D.P. on health. Other rich nations spend 10 percent or less, but they manage to insure everyone – and have equal or better public health outcomes. And we have huge variations in practice patterns and medical spending that bear no relation to quality. Bottom line: radical inefficiency.)

Our C.E.O.’s would add that a new health strategy would get excess costs off businesses’ backs – costs that competitors don’t face in countries where governments pick up the tab. It would re-engineer the delivery of care so governments would have cash left for other purposes. And it would cope with the political reality that every dollar of health care “waste” is somebody’s dollar of income.

The group would issue a report in late 2007 with a full-blown agenda for the next president. Done right, the “Jones” Report (aspiring C.E.O. statesmen or stateswomen, picture your name here!) would become the touchstone for all health care talk in the campaign.

Now my rules for participation: First, only chief executives prepared to invest real time need apply. This shouldn’t be a bar; health costs now loom so large that C.E.O.’s are destined to focus on the problem. They can’t fix it alone, so they may as well fix it for everyone. (As a lure, we might enact a 100 percent short-term capital gains tax on their stocks during the life of the group to banish speculators and free the chiefs to think long-term.)

Next, eligible C.E.O.’s have to grasp that most rhetoric in the health debate – as exemplified by the Thatcher example above – is rubbish. Republican C.E.O.’s who think “big government” is always the problem may be at special psychic risk.

Critics may shout: Why should we want some lavishly paid bosses to take the lead? Well, for starters, as the Clinton debacle proved, if business doesn’t buy in, nothing that matters here can change. But beyond this, spiraling health costs have aligned corporate interests with workers’ for the first time in ages. My hunch is that inside many car and computer and bank and energy moguls, tomorrow’s political heroes are dying to get out.

Ordinarily a bold call for a commission is a way to punt, but given today’s leadership vacuum, it’s a way to start. I’m not saying that this will end with C.E.O.’s marching on Washington to demand “Margaret Thatcher-style universal health coverage.” But I wouldn’t rule it out either.

E-mail: mattmiller@nytimes.com; Matt Miller is the author of “The 2 Percent Solution: Fixing America’s Problems in Ways Liberals and Conservatives Can Love.” Maureen Dowd is on book leave.

Quentin Young on health care costs for business

A National Plan
Health costs making big business ill
By Quentin Young, a Chicago physician and coordinator of Physicians for a National Health Program
Chicago Tribune
May 15, 2005

On April 19, General Motors Corp. blamed its dismal first-quarter results (a $1.1 billion loss) on its $5.6 billion annual health-care tab. On top of that, the company carries $63 billion in unfunded health-benefit costs. The future certainly looks bleak.

Clearly a disaster is looming not only for GM and its workforce, but also for the entire American economy. America’s other largest corporations also face skyrocketing health-care costs; General Electric Co., Boeing Co., Lucent Technologies Inc., IBM Corp., Verizon Communications Inc., SBC Communications Inc. and Ford Motor Co. have a combined $150 billion in future health-benefit obligations. Their future looks bleak too.

Ominously, non-competitive American products are sending our jobs abroad.

From candy to autos, Canadians can produce goods more cheaply because of their markedly lower health-benefits costs. For example, in Canada a Ford costs $1,400 less to make than it does to produce in Michigan. Lifesavers shaved $4 per hour off its labor costs by boarding up its hometown factory in Holland, Mich., and heading for Canada.

Alert pundits are, at long last, calling U.S. business to account.

They are pointing out what has been obvious to all industrialized democratic nations around the world for some time now: Employer-based health-care benefits are a bottomless pit. Seventeen American steel manufacturers have declared bankruptcy and terminated their retirees’ health benefits.

Our nation recently learned that half of all personal bankruptcies are due to unpaid medical bills and illness, affecting 2 million people each year. Corporate bankruptcy of huge proportion looms due to our failure to deal rationally with health-care financing.

There goes America’s vaunted economic advantage.

The obvious remedy, single-payer national health insurance, would end the link between employment and health insurance, while recovering much of the one third of health spending now squandered on “administrative cost,” at least $400 billion in 2004.

These funds would enable our nation to cover everyone with no increase in health spending. National health insurance can cut waste and prudently control soaring costs, something business has learned it cannot do on its own.

Paradoxically, it is America’s traditionally conservative physicians who are learning that the future fortunes of the medical profession, like the success of American business, hinge on reform of health-care finances.

Hence physicians, in increasing numbers, endorse single-payer national health insurance. Single-payer would address seriously the major deficiencies in our system: 45 million people without insurance, prohibitively priced pharmaceuticals, miserable mental-health benefits and the absence of a long-term care strategy for our aging population.

Single-payer would give business a level playing field with international competitors in the global economy by relieving them once and for all of the burden of crushing health benefit costs.

This healthy prescription can cure our chaotic health-care system and, in the process, foster a strong economy.

http://www.chicagotribune.com/news/opinion/chi-0505140245may15,0,6367117.story?coll=chi-newsopinionperspective-hed

Comment: The single payer model is the most comprehensive and least expensive of all models of reform. It seems only logical that business leaders, supporting cost containment, and social progressives, supporting comprehensiveness and universality, would want to sit down and discuss this.

Health costs making big business ill

By Quentin Young
A Chicago physician and coordinator of Physicians for a National Health Program
Published May 15, 2005

On April 19, General Motors Corp. blamed its dismal first-quarter results (a $1.1 billion loss) on its $5.6 billion annual health-care tab. On top of that, the company carries $63 billion in unfunded health-benefit costs. The future certainly looks bleak.

Clearly a disaster is looming not only for GM and its workforce, but also for the entire American economy. America’s other largest corporations also face skyrocketing health-care costs; General Electric Co., Boeing Co., Lucent Technologies Inc., IBM Corp., Verizon Communications Inc., SBC Communications Inc. and Ford Motor Co. have a combined $150 billion in future health-benefit obligations. Their future looks bleak too.

Ominously, non-competitive American products are sending our jobs abroad.

From candy to autos, Canadians can produce goods more cheaply because of their markedly lower health-benefits costs. For example, in Canada a Ford costs $1,400 less to make than it does to produce in Michigan. Lifesavers shaved $4 per hour off its labor costs by boarding up its hometown factory in Holland, Mich., and heading for Canada.

Alert pundits are, at long last, calling U.S. business to account.

They are pointing out what has been obvious to all industrialized democratic nations around the world for some time now: Employer-based health-care benefits are a bottomless pit. Seventeen American steel manufacturers have declared bankruptcy and terminated their retirees’ health benefits.

Our nation recently learned that half of all personal bankruptcies are due to unpaid medical bills and illness, affecting 2 million people each year. Corporate bankruptcy of huge proportion looms due to our failure to deal rationally with health-care financing.

There goes America’s vaunted economic advantage.

The obvious remedy, single-payer national health insurance, would end the link between employment and health insurance, while recovering much of the one third of health spending now squandered on “administrative cost,” at least $400 billion in 2004.

These funds would enable our nation to cover everyone with no increase in health spending. National health insurance can cut waste and prudently control soaring costs, something business has learned it cannot do on its own.

Paradoxically, it is America’s traditionally conservative physicians who are learning that the future fortunes of the medical profession, like the success of American business, hinge on reform of health-care finances.

Hence physicians, in increasing numbers, endorse single-payer national health insurance. Single-payer would address seriously the major deficiencies in our system: 45 million people without insurance, prohibitively priced pharmaceuticals, miserable mental-health benefits and the absence of a long-term care strategy for our aging population.

Single-payer would give business a level playing field with international competitors in the global economy by relieving them once and for all of the burden of crushing health benefit costs.

This healthy prescription can cure our chaotic health-care system and, in the process, foster a strong economy.

Coverage of vaccines by private plans

Coverage Of Vaccines In Private Health Plans: What Does The Public Prefer?
By Matthew M. Davis and Kathryn Fant
Health Affairs
May/June 2005

Immunization rates for the primary series of vaccines among children and for the widely recommended influenza and pneumococcus vaccines among adults fall short of targets set in Healthy People 2010. Lack of insurance and the resulting economic barriers have been blamed in part for these low immunization rates. In addition, immunization officials and policy experts have recently turned their attention to the problem of underinsurance for vaccines. The most recent estimates indicate that as many as 15 percent of children and more than 30 percent of all adults are enrolled in health plans that do not pay for recommended vaccines.

http://content.healthaffairs.org/cgi/content/full/24/3/770

Comment: It would be unimaginable that vaccines would ever be excluded from a universal public health insurance program. Yet many private insurers fail to provide such coverage.

Why do we continue to hand over to the private insurance industry hundreds of billions of dollars when they continue to demonstrate their gross incompetence and nearly criminal negligence in their coverage decisions?
Maybe we’re more to blame since we continue to agree to fund their expensive, wasteful administrative bureaucracies that are making decisions that kill people. Obviously we would never accept that if we had our own public program.