PNHP

Bush touts community health centers as a common-sense approach

Bush touts community health centers as a common-sense approach

Bush touts community health centers as a common-sense approach

The White House
May 25, 2004
Fact Sheet: Expanding Access to Health Care for Millions of Americans The President’s budgets are on track to fulfill his promise to open or expand 1,200 Community Health Centers to serve an additional 6.1 million Americans by 2006. The President’s budget for FY 2005 continues to fulfill this promise with a request of $1.8 billion for Community Health Centers — a 57% increase since 2001 — enabling the program to serve an additional 1.6 million individuals and open or expand over 330 more health centers.

Community Health Centers are an important part of the President’s agenda to
make America’s world-leading health care more accessible, and more affordable.

http://www.whitehouse.gov/news/releases/2004/05/20040525-5.html

Los Angeles Times
May 26, 2004
Bush Highlights Community Health Centers in 2005 Plan
By Edwin Chen and Vicki Kemper

In a campaign-style “conversation” at Youngstown State University, Bush touted neighborhood clinics, a centerpiece of his healthcare agenda, as a primary way to expand access to medical services.

The National Assn. of Community Health Centers, a nonprofit organization that represents the clinic network, welcomed Bush’s support for the centers but said still more funding was needed.

In 2002 and 2003, about 1,250 clinics applied for federal funds, but only 411 applications were approved, the group said. The association reported earlier this year that 36 million Americans lacked access to basic medical care. There are about 3,500 community health centers across the country, serving up to 13 million people, most of whom live in low-income urban neighborhoods or underserved rural areas. About 40% of those people have no health insurance, and many more are underinsured and cannot afford to meet the cost of their high deductibles and co-payments.

Most of the clinics, which provide primary medical care and basic dental services, receive little or no federal funding.

Neighborhood clinics are “a common-sense approach to making sure the healthcare system works . without centralizing the decision-making process in Washington, D.C.,” Bush said.

http://www.latimes.com/news/nationworld/nation/la-na-bush26may26,1,3004657.story

Comment: Providing federal support for community health centers is the centerpiece of President Bush’s program to “make sure the healthcare system
works.”

How well is it working? 411 of 3500 or only 12% of community health centers
have received funding under his program. $1.8 billion has been budgeted to serve 13 million individuals, or $138 per individual. Realizing that our per capita health expenditures for 2004 are $6167, it is clear that $138/year will buy very little health care, especially considering the greater needs of this sector of our society.

Sadly, it looks like President Bush’s centerpiece doesn’t even have a table to hold it up.

Bush's health care scam

Bush’s health care scam
By Robert Kuttner  |  May 27, 2004

IF THE MESS in Iraq and the high price of oil were not crowding out other election year issues, health care would top the list. Premium costs keep increasing, out-of-pocket charges keep being shifted onto consumers, and the number of uninsured is at an all-time high.

President Bush, speaking Tuesday at a Youngstown, Ohio, community health center, promised to help more uninsured Americans obtain affordable health care. But his key proposals are dubious health policy, waste taxpayer dollars, and are unlikely to increase coverage. They deserve more attention because they epitomize Bush’s utterly cynical approach to governing.

Here’s what Bush would do.

First, he relies on tax credits. A family earning $25,000 or less could receive a “refundable tax credit” (that is, a government payment) of up to $3,000 toward the purchase of health insurance. The trouble is that the average family health insurance policy provided by employers in 2003 cost $9,000, and individually purchased policies cost even more.

A family with $25,000 income, even with a $3,000 subsidy from Bush’s plan, would still have to pay $6,000 out of pocket. Families with $25,000 or less are just scraping by. How many can afford to spend almost a quarter of their total income on health insurance?

Worse, individual health insurance policies are the least efficient way to provide health coverage because they are more costly than group plans to administer. And they leave families with any history of illness vulnerable to denial of insurance on grounds of a “preexisting condition.” (About half of the uninsured have histories of serious medical problems.) So, few people currently without insurance would actually benefit from Bush’s tax credit scheme.

About two-thirds of workers earning under $25,000 already have employer-provided insurance. For them, the tax credit would be a windfall; it would not reduce the number of insured. Younger and healthier workers would opt out into low-cost individual plans, raising the cost to other workers. A study by the Kaiser Family Foundation suggests that the net effect would be a loss of employer-provided insurance.

Second, the president, working with the National Federation of Independent Businesses (the very conservative small-business lobby), proposes something called Association Health Plans. The idea is that small businesses can organize themselves into associations to purchase health insurance collectively at lower rates.

This sounds like a good idea, except that small businesses are already free to do that. The magazine that I edit, with 23 employees, has long been a member of just such an association so we can purchase affordable insurance for our staff.

The new and insidious wrinkle in the Bush proposal is that it would exempt such associations from regulations that currently prohibit discrimination against individuals based on health status. With this new provision, insurers could offer very favorable rates for health plans whose members were limited to the young and the healthy.

As younger workers bail out of larger insurance pools, middle-aged workers and their dependents, as well as those with histories of illness, would face huge rate increases. The bipartisan Congressional Budget Office has estimated that some 20 million Americans would face higher insurance costs if this proposal were enacted. Both The Wall Street Journal and Forbes magazine, not exactly lefty news organs, have published articles pointing out the serious flaws in this approach.

Why would the business federation support such a scheme? One reason is that it stands to make more than $100 million a year organizing and selling such plans.

Bush would also increase the tax benefits of so called Health Savings Accounts. Under this scheme, taxpayers can set up tax-sheltered accounts similar to IRAs and then use the proceeds to pay out-of-pocket health costs. Bush wants to expand these so they can also be used to pay premiums.

But very few low-income people use such accounts. They are beneficial mainly to people in higher tax brackets. They also create incentives for people to buy policies with very high deductibles, which defeats the goal of preventive medical care.

Taken together, Bush’s new plans would cost the Treasury more than $100 billion over 10 years in lost revenues. He proposes to make up that loss by cutting two proven programs that actually do help more people get health care — Medicaid and the State Children’s Health Insurance Program.

So this is how our president proposes to “help the uninsured.” If the United States is a democracy worthy of the name, we the voters owe it to ourselves to look beyond the photo-ops and misleading rhetoric to the real details.

Robert Kuttner’s is co-editor of The American Prospect. His column appears regularly in the Globe. 
© Copyright 2004 Globe Newspaper Company.
 

U.K. NHS more efficient than Kaiser(HMO)

Dr Alison Talbot Smith, Dr Shamini Gnani, Prof Allyson M Pollock, Sir Denis Pereira GrayBritish Journal of General Practice 01 June 2004

A key document in UK government policy making for the NHS has been evaluated by Dr Alison Talbot Smith and her co-authors Dr Shamini Gnani and Prof Allyson Pollock of UCL’s School of Public Policy, and Sir Denis Pereira Gray in the British Journal of General Practice published on 01 June 2004. The original paper purports to show that Kaiser Permanente (a US HMO or health maintenance organisation) “achieved better performance at roughly the same costs as the NHS”.

An evaluation will show that the paper has four major areas of error. Crucially like was not being compared with like. Kaiser covers around eight million people in the US, mainly the working well. In contrast the NHS provides universal coverage to around 60 million citizens including the unemployed, the poor, and older people. Richard Feachem et al, the authors of the original paper, were not able to adjust for the differences in the populations, thereby negating comparisons of bed use and costs.

Similarly Feachem et al also used an unorthodox approach to adjusting for level of service when calculating costs. They did not include the additional charges that Kaiser members incur, currently £28 for each primary care consultation, £56 to attend an accident & emergency centre, and £285 for childbirth, and they omitted the 12% of Kaiser members who take out supplementary cover for services which are not included as part of the plan (‘coinsurance’).

They also wrongly applied a double currency conversion which added no less than 40% to their calculation of the NHS’s costs. They converted pounds into dollars at the general exchange rate, and then took this dollar rate and multiplied it again by the special rate that applies to the health sector. As the chief economist for the Department of Health pointed out, “it is simply wrong to adjust for health care prices over and above adjusting for general differences in prices”. In spite of systematically inflating NHS costs and deflating Kaiser’s, the NHS still comes out ahead. Undoing it puts NHS costs at $1,102 per capita compared to Kaiser’s $1,951.

Prof Allyson Pollock and Sir Denis Pereira Gray said today:
“When the Lancet published a paper on MMR, which threatened to undermine public health programmes, the DH and other major medical journals lost no time in entering into the scientific debate. Now we have a paper being widely adopted by policy makers, the claims of which concerning Kaiser are not supported by the evidence.”

James Lancaster
Public Health Policy Unit 
School of Public Policy  
UCL  
29-30 Tavistock Square
London WC1H 9QU     
t:  44 (0)20 7679 4985 (UCL: 24985)
f:  44 (0)20 7916 8536
email: j.lancaster@ucl.ac.uk

http://www.ucl.ac.uk/spp/about/health_policy/index.php

Bush’s health care scam

Bush’s health care scam
By Robert Kuttner  |  May 27, 2004

IF THE MESS in Iraq and the high price of oil were not crowding out other election year issues, health care would top the list. Premium costs keep increasing, out-of-pocket charges keep being shifted onto consumers, and the number of uninsured is at an all-time high.

President Bush, speaking Tuesday at a Youngstown, Ohio, community health center, promised to help more uninsured Americans obtain affordable health care. But his key proposals are dubious health policy, waste taxpayer dollars, and are unlikely to increase coverage. They deserve more attention because they epitomize Bush’s utterly cynical approach to governing.

Here’s what Bush would do.

First, he relies on tax credits. A family earning $25,000 or less could receive a “refundable tax credit” (that is, a government payment) of up to $3,000 toward the purchase of health insurance. The trouble is that the average family health insurance policy provided by employers in 2003 cost $9,000, and individually purchased policies cost even more.

A family with $25,000 income, even with a $3,000 subsidy from Bush’s plan, would still have to pay $6,000 out of pocket. Families with $25,000 or less are just scraping by. How many can afford to spend almost a quarter of their total income on health insurance?

Worse, individual health insurance policies are the least efficient way to provide health coverage because they are more costly than group plans to administer. And they leave families with any history of illness vulnerable to denial of insurance on grounds of a “preexisting condition.” (About half of the uninsured have histories of serious medical problems.) So, few people currently without insurance would actually benefit from Bush’s tax credit scheme.

About two-thirds of workers earning under $25,000 already have employer-provided insurance. For them, the tax credit would be a windfall; it would not reduce the number of insured. Younger and healthier workers would opt out into low-cost individual plans, raising the cost to other workers. A study by the Kaiser Family Foundation suggests that the net effect would be a loss of employer-provided insurance.

Second, the president, working with the National Federation of Independent Businesses (the very conservative small-business lobby), proposes something called Association Health Plans. The idea is that small businesses can organize themselves into associations to purchase health insurance collectively at lower rates.

This sounds like a good idea, except that small businesses are already free to do that. The magazine that I edit, with 23 employees, has long been a member of just such an association so we can purchase affordable insurance for our staff.

The new and insidious wrinkle in the Bush proposal is that it would exempt such associations from regulations that currently prohibit discrimination against individuals based on health status. With this new provision, insurers could offer very favorable rates for health plans whose members were limited to the young and the healthy.

As younger workers bail out of larger insurance pools, middle-aged workers and their dependents, as well as those with histories of illness, would face huge rate increases. The bipartisan Congressional Budget Office has estimated that some 20 million Americans would face higher insurance costs if this proposal were enacted. Both The Wall Street Journal and Forbes magazine, not exactly lefty news organs, have published articles pointing out the serious flaws in this approach.

Why would the business federation support such a scheme? One reason is that it stands to make more than $100 million a year organizing and selling such plans.

Bush would also increase the tax benefits of so called Health Savings Accounts. Under this scheme, taxpayers can set up tax-sheltered accounts similar to IRAs and then use the proceeds to pay out-of-pocket health costs. Bush wants to expand these so they can also be used to pay premiums.

But very few low-income people use such accounts. They are beneficial mainly to people in higher tax brackets. They also create incentives for people to buy policies with very high deductibles, which defeats the goal of preventive medical care.

Taken together, Bush’s new plans would cost the Treasury more than $100 billion over 10 years in lost revenues. He proposes to make up that loss by cutting two proven programs that actually do help more people get health care — Medicaid and the State Children’s Health Insurance Program.

So this is how our president proposes to “help the uninsured.” If the United States is a democracy worthy of the name, we the voters owe it to ourselves to look beyond the photo-ops and misleading rhetoric to the real details.

Robert Kuttner’s is co-editor of The American Prospect. His column appears regularly in the Globe. 
© Copyright 2004 Globe Newspaper Company.
 

Freelance workforce vulnerable

Freelance workforce vulnerable

PR Newswire
May 25, 2004
Educated, Working, Well Paid … and No Health Insurance: A Conundrum for
Growing Freelance Workforce in New York City

The 2004 Working Today Health Insurance Affordability Survey gauged the perceptions of more than 4,000 New York City-based freelancers,independent
contractors, temps, sole proprietors and others who make their living in a
range of industries, such as media, entertainment, financial services, marketing, IT and the arts.

There are upwards of one-and-a-half million independent workers in New York
City, and tens of millions around the country (up to 30% of the nation’s workforce), according to published reports.

Among the survey’s key findings:

* 84% of NYC’s freelancers say it’s difficult for them to afford health insurance.

* Nearly all (95%) of NYC freelancers without health insurance say the primary reason they lack it is because premiums of private carriers are too expensive.

* Nearly half (47%) of NYC freelancers say they had gaps in health insurance coverage, or no coverage at all, during the past two years – and the vast majority (88%) blame high costs.

* 85% of those who experienced gaps avoided medical care during these times.

Sara Horowitz, Executive Director of Working Today:

“The rapid growth of the Form-1099 labor pool represents a fundamental shift
in the economy, yet the health insurance system remains geared solely to the
W-2 employment model. Most freelancers are too rich for public assistance
programs, and too poor to afford the premiums demanded on the open market.
It’s really appalling that millions of productive members of our society are falling through the cracks in an area as basic as health care.”

http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=109&STORY=/www/story/05-25-2004/0002180966&EDATE=

The full Working Today report, “Educated, Employed and Uninsured”:
http://www.workingtoday.org/advocacy/affordabilityreport2004.pdf

Comment: Proposals strengthening employer-sponsored coverage will never
adequately address the access and affordability issues faced by the tens of millions of freelancers in our nation. And individual mandates cannot ever fill the need if coverage remains unaffordable for freelancers.

Both single payer and health service models of reform promise universal, equitable, comprehensive coverage within a framework of genuine affordability. Other models fail to adequately contain costs and fall short on comprehensiveness and equity. Do we really need yet more studies of how lousy our system of funding health care is before we move forward with reform that will work?

Most Americans would prefer a publicly-administered insurance model to a government-owned health care delivery system. Shall we keep wasting valuable
time looking at the other inferior options, or shall we move ahead with single payer reform now?

HARLOT plc: an amalgamation of the world’s two oldest professions

HARLOT plc:an amalgamation of the world’s two oldest professions David L Sackett, Andrew D Oxman on behalf of HARLOT plc Tired of being good but poor, the authors have amalgamated the world’s two oldest professions in a new niche company, HARLOT plc, specialising in How to Achieve positive Results without actually Lying to Overcome the Truth

We’ve been good. DLS has prohibited sponsors’ stockholders, much less employees, from seats on his data safety and monitoring boards and has enforced the banning of pharmaceutical reps from the medical wards at McMaster University. ADO has exposed problems with experts and has promulgated rigorous reviews of research to inform decisions about health care. In sum, we have established impeccable reputations for protecting the validity of randomised trials and systematic reviews, and for exposing lapses in methods, validity, therapeutic claims, and professional conduct.

To read the interesting article please click here

Advocates propose right to health care

Advocates propose right to health care
Bill’s backers haven’t estimated cost or suggested funding
GARY D. ROBERTSON
Associated Press

RALEIGH – Advocates and patients strapped by medical costs urged Tuesday that state voters be given a chance to decide whether health care is a constitutional right like religious liberty, jury trials or education.

In what has become an annual tradition, Rep. Verla Insko, D-Orange, filed legislation proposing a constitutional amendment that would make health care a fundamental right in North Carolina.

The bill also would order legislators to pass a plan by 2006 that would provide “access to appropriate health care on a regular basis” to every state resident by 2010.

An estimated 1.3 million North Carolinians were without health insurance in 2002. The same year, the state was tied with Mississippi for the largest percentage growth in uninsured residents since 2000, according to the N.C. Committee to Defend Health Care.

Some workers who lost jobs at shuttered manufacturing plants during the latest economic downturn have found themselves without affordable insurance.

Sandra Bailey of Lumberton, who worked at a Guilford Mills plant for 13 years before it closed, said she can’t get health insurance. She needs medicine for a thyroid condition.

“Losing my job, not having any income and no health insurance, it’s been devastating to me,” said Bailey, one of the people who spoke at a news conference and committee meeting held Tuesday at the legislature. “You have to be well to go out in the workplace and find a job.”

Those who don’t have insurance often end up in hospital emergency rooms, where the costs end up much higher than if the patient had seen a family doctor before their condition worsened.

“The United States has the best health care in the world, but among industrialized nations we have one of the worst health care systems,” said Insko, who said she has filed similar legislation every year since 1999.

States such as California and Oregon have considered similar amendments. Maine is starting a program to insure 160,000 people without private insurance or Medicaid.

The bill doesn’t offer any explanation of how to pay for universal coverage. Private insurance premiums to cover the uninsured would likely cost billions of dollars.

Insko said pinning the proposed amendment on a single funding mechanism would generate opposition before the amendment could be debated on its merits, she said.

Germany downplays drive for health insurance reform

Reuters
May 21, 2004
Germany downplays drive for health insurance reform

The German government dampened expectations on Friday that it was planning
the rapid overhaul of its national health system with the launch as early as next year of a “citizen insurance” for which all Germans would pay.

Health Minister Ulla Schmidt and Franz Muentefering, chairman of the ruling Social Democrats (SPD) have in the past week appeared to be driving the project forward, with a view to introducing the new insurance system next year.

The system would extend funding of national health insurance to civil servants and the self-employed as well as those on higher salaries, who have so far been able to opt for private coverage.

The proposal is one of the few government reform plans that is popular with its core voters and would spread the burden of health insurance costs, helping trim high non-wage labor costs which the industry says is a factor driving firms broad.

But the ruling SPD is set to make the citizen insurance a main campaign issue in the 2006 elections, Welt newspaper reports in its Saturday edition.

While popular with the public, the citizen insurance would cause pain for private health care insurers who stand to lose business from wealthier and self-employed people, who currently have the option of public or private health care.

Germany has the third highest spending per capita on health care after the United States and Switzerland.

http://www.alertnet.org/thenews/newsdesk/L21636410.htm

Comment: Germany’s system of funding health care is one of the world’s most
expensive, yet does not adequately address many of the inequities in health
care. “Universal coverage” is not enough. Many German leaders now seem to
recognize that adopting more principles of the single payer model is the answer to making comprehensive care affordable for everyone.

Watching nations struggle with their “successful” universal programs is instructive for us. It is evermore clear that our highly deficient system of funding care should be replaced by a single payer program.

British queues provide profit opportunity

The Daily Mail
May 24, 2004
More pay up to beat NHS queue
By Jo Thornhill

Long waiting lists are forcing more people to turn their backs on the NHS and pay for major operations such as hip replacements and cataract surgery, according to a new report.

Research by YouGov has found that 53% of people are prepared to pay for a hip replacement operation – which can cost as much as £9,000 in a private hospital – rather than wait for free treatment from the state. It is not unusual to wait 12 months for a hip replacement operation on the NHS.

Neil Armitage, marketing director at Exeter Friendly Society, which commissioned the research, says people are often willing to give up luxuries such as a holiday or a new car to pay for treatment.

Private healthcare is expensive, but there are ways to cut costs for those who do not have health insurance and do not want to pay top prices. For example, Go Private, owned by Exeter Friendly Society, will find the cheapest deal. For an annual subscription of £34.95, it can help patients find treatment at the lowest price from private hospitals nationwide.

http://www.thisismoney.com/20040524/in78621.html

Exeter Friendly Society Limited:
http://www.exeterfriendly.co.uk/

Comment: Private markets work, for some. When unacceptable queues develop
in a government-run national health service, private market medicine allows
you to buy your way to the front of the queue… if you have the money.

Many nations have demonstrated that queues are best managed by controlling
capacity. Ensuring adequate capacity prevents excessive queues, while avoiding excess capacity prevents the waste and adverse outcomes of over-utilization.

If the wealthier, politically influential sector is allowed private access to services covered by the public program, then political support for the public program declines significantly. A chronically underfunded public program cannot ensure that there will be enough capacity to prevent excessive queues.

But then lucrative private health markets in parallel with public programs exemplify the magic of the marketplace. Even with inadequate capacity in an
under-funded health care delivery system, the private market provides timely
access that the public program can’t… if you have the money.

Fortunately, in the United States, the $1.8 trillion that we are spending on health care is enough to ensure adequate capacity for everyone. But we still need a universal, public insurance program to make it work. Turning our health care dollars over to the private plans in the marketplace just isn’t doing it.

Pharmacy Benefits and the Use of Drugs by the Chronically Ill

RAND study on drug co-payments

JAMA
May 19, 2004
Pharmacy Benefits and the Use of Drugs by the Chronically Ill
By Dana P. Goldman, PhD, et al

Objective: To determine how changes in cost sharing affect use of the most commonly used drug classes among the privately insured and the chronically ill.

Results: Doubling co-payments was associated with reductions in use of 8 therapeutic classes. The largest decreases occurred for nonsteroidal anti-inflammatory drugs (NSAIDs) (45%) and antihistamines (44%).

Reductions
in overall days supplied of antihyperlipidemics (34%), antiulcerants (33%),
antiasthmatics (32%), antihypertensives (26%), antidepressants (26%), and
antidiabetics (25%) were also observed. Among patients diagnosed as having a
chronic illness and receiving ongoing care, use was less responsive to co-payment changes. Use of antidepressants by depressed patients declined by
8%; use of antihypertensives by hypertensive patients decreased by 10%. Larger reductions were observed for arthritis patients taking NSAIDs (27%) and allergy patients taking antihistamines (31%). Patients with diabetes reduced their use of antidiabetes drugs by 23%.

Conclusions: The use of medications such as antihistamines and NSAIDs, which are taken intermittently to treat symptoms, was sensitive to co-payment changes. Other medications-antihypertensive, antiasthmatic, antidepressant, antihyperlipidemic, antiulcerant, and antidiabetic agents-also demonstrated significant price responsiveness. The reduction in use of medications for individuals in ongoing care was more modest. Still, significant increases in co-payments raise concern about adverse health consequences because of the large price effects, especially among diabetic patients.

RAND is solely responsible for the article’s content.

http://jama.ama-assn.org/cgi/content/abstract/291/19/2344

Comment: A previous RAND study demonstrated that cost sharing by the patient results in a significant reduction in utilization of health care services when compared with patients who do not have cost sharing.

That RAND study has been used to rationalize shifting more costs to patients in an attempt to control total health care costs by reducing demand. Further analysis of the RAND data has shown that this does reduce the utilization of beneficial services. Advocates of consumer-directed health care use their rhetoric to turn this problem of establishing financial barriers to beneficial care into a “benefit” of allowing the consumer to take charge of his or her own health care. More objective advocates of cost sharing dismiss it as a necessary tradeoff for the “more important” goal of controlling costs.

This new RAND study confirms that individuals with chronic disorders will decrease their use of drugs when co-payments are increased. The reduction is
even greater for drugs that do not specifically treat their chronic conditions but that are used to relieve distressing symptoms. Although some may contend that these drugs are unimportant, symptom relief does remain a primary goal of health care.

This study will be misrepresented in the rhetorical debate over reform. Supporters of creating price sensitivity for patients will laud this study. They will contend that co-payments cause patients to reject unnecessary prescriptions while continuing to purchase those medications that they really need. In our debates we will be confronted with this claim. We will need to either take the initiative or rephrase their misleading claim by stating that co-payments reduce the utilization of essential drugs for chronic conditions, and they reduce even more the use of drugs that can provide significant relief of pain and suffering!

There are far more effective and patient-friendly mechanisms of containing health care costs. We don’t need to adopt policies that would perpetuate pain and suffering, especially for those patients with the greatest needs.

Though Far From Poor, a Family Struggles Daily

Los Angeles Times
May 18, 2004
Though Far From Poor, a Family Struggles Daily
Two incomes put the Basurto clan well above the poverty line. Yet despite frugal living, they’re middle class in name only.
By Geoffrey Mohan

(Rudy) Basurto is 48 years old. He makes about $20 an hour building cabinets
but can’t afford to buy a home in his Highland Park neighborhood. He has no health insurance, no pension plan and little savings.

Basurto’s family is far from poor, by the official measure. The federal poverty level for a family of five is $21,959. Last year, Rudy and his wife, Maryellen, together earned more than twice that: $45,000.

By the local cost of rent, by what it takes to commute to work, by the price of food at the local store, by the cost of clothing and healthcare, a family like the Basurtos would need more than $40,000 to make ends meet in Los Angeles. Families with younger children and day-care expenses would need closer to $70,000.

That estimate, called a self-sufficient income, is an emerging measure of economic health seldom used in the calculus of poverty.

Policymakers still measure progress in the war on poverty using the federal
poverty level, despite decades of quarrels over its shortcomings. Developed
in the 1960s, the poverty level is based on a food survey from 1955. It tells only how much is too little to live on, not how much is enough to get by on.

“What it means is there are a lot more people without an adequate income in
California than the federal poverty level would indicate,” said Diana Pearce, director of the Center for Women’s Welfare at the University of Washington and a pioneer in calculating self-sufficiency.

By the federal benchmark, 13% of Californians are poor, according to the Census Bureau. By the self-sufficiency standard, 30% don’t make enough to get by.

One reason why the wage-earning middle class increasingly can’t afford California is that wages, adjusted for inflation, have been stagnant for two
decades. In the same time, the percentage of income needed to pay for rent,
healthcare and child care has spiraled.

Economists call this “alligator economics,” because wages are a horizontal or falling line, while costs rise like an alligator’s upper jaw.

The Basurtos, and many thousands of others, live in that jaw.

http://www.latimes.com/news/local/la-me-middle18may18,1,1991378.story?coll=la-home-local

Comment: Our current policies on health care coverage and access fail to adequately serve those caught in the jaw of alligator economics. Numerous simulations have shown that tax credits designed to expand the current system of private plans will never ensure that everyone falling short on self-sufficiency standards would be covered. It is possible to mandate coverage through a public program for those not covered by private plans. But that is the most expensive way to ensure universal coverage, and it falls far short on equity in both funding and access. We can do much better at a significantly lower cost.

Let’s extricate health care from the jaws of alligator economics by establishing our own universal, comprehensive and equitable public program of health insurance. That would bring us much closer to the goal of self-sufficiency for everyone.

An Interview with Quentin D. Young M.D.

An Interview with Quentin D. Young M.D.
Director, Health and Medicine Policy Research Group
By Karen Ide and Clinton Stockwell, PRAGmatics
PRAGmatics
Spring 2004
————————————————————————
PRAGmatics—Will you please share with us a highlight from your long and successful career as a physician and as a human rights/health care activist?

Dr. Young—I guess my answer would be the civil rights movement medical arm. When the southern movement started activating, the medical community for human rights would show up spontaneously. We all know the climax with major changes in the legal status of Blacks in the South and the de facto status segregation in the North. The medical community was a do-good expression of liberal nurses and doctors who wanted to be part of the action. At first, we just thought we would be there like Red Cross workers and take care of people who had heat stroke or got beat up or bitten by a dog or whatever. We had people on staff down there for the long term but we also got volunteers who would come down from another part of the country, some for a week, or a month, or two. The function was to bear witness to the struggles of the people who are fighting for their rights and our presence was testimony to their legitimacy and our willingness to share their burdens. It sounds a little highfalutin, but that’s what it’s supposed to be. The doctors did turn out to have several functions. I’ll give you one example. The public demonstrations were like a Japanese opera. There would be a demonstration called to protest the exclusion of eating places or school segregation or hospital segregation. The people would turn out, mostly young people, and demonstrate. The police would tell them to disperse. They wouldn’t disperse and different things would happen—houses would get torn up—people would get arrested and taken to the hospital and taken to jail and very soon our task was evident. After the protesters were booked, we would go to the jail. A doctor with a tie and white coat, even though he was considered a “nigger lover” was treated with respect and deference by the police. We could go around and very ostentatiously say, “You’re looking really good,” and the whole point was to have a doctor see these people before they got out of jail because the specialty of the house was very often to brutalize the protestors. But a doctor there having seen them was pretty close to expert testimony, so bruises that were there the next day would clearly and unarguably be due to something that happened overnight. So that was one of the functions that was interesting to note. The whole effort was probably a high point of my career in terms of mixing my activism with medicine.

PRAGmatics—Today, March 4, has been designated “Health Care Action Day” by many activist groups across the country. Do you feel this movement is picking up steam? Do you see any prospects for its realization in this country in some form in the near future?

Dr. Young—Well, it’s definitely picking up steam. And the reason turns out to be not the good one: that do-good solitary social justice consciousness in the country, but rather, I’m sorry to say—it’s because the system is so disorganized, so chaotic, so costly, and so harmful, that it is garnering enemies. But maybe that is the obvious way that most social change takes place. Human slavery was abolished after a bloody civil war and because it was incompatible with our nation’s continuing existence. So the abolitionists and many wonderful people who had strong ideological and moral objections took great risks, gave their lives. But the vast majority who participated in the rejection of slavery did it for elementary, mundane, materialistic reasons and I think that is what is happening now, and it’s happening very fast. Today is “Universal Health Care Day.” Our group, Physicians for a National Health Program, is dedicated to that single issue—even though there is not a lot of enthusiasm for the concept of
universal health care out there. But, we know that everybody should have it. The most evil elements in the health system are the Hospital Insurance Association and the Group Health Association. These are the holding companies for the big corporate interests that are taking over. They really don’t care whether it is universal health care just as long as they control it and get the money. We are much more explicit and worry about the universal aspect because other forces are precluding explicit solutions like ours, which is single payer national health insurance, government-run, based on the tax system. We feel universal health care is no longer the best answer; it’s the only answer. There was a time when there were alternatives that might have worked, but that day is passed. We’ve had too much of a transfer of power from patients and physicians, for that matter, to giant corporate interests that are dedicated to the goal of maximizing profits, which accounts for much of the distress in the American health system.

PRAGmatics—In the U.S. as elsewhere, there is a debate as to whether quality health care is a right or a commodity. Is it possible to reconcile these opposing values, and is the goal of quality health care as a right for all people attainable?

Dr. Young—I certainly believe it’s attainable. It has been attained in certain countries that aren’t very different from us. I totally come down on the side of health care being a human right. It’s very hard for me to see a coherent, let alone a moral or decent argument against it, because illness doesn’t distribute itself according to the ability to care for yourself and be cared for. It strikes children. It strikes the poor. It strikes the most needy and most ill-protected disproportionately. That’s the correlation. Cardinal Bernardin said it best. He said, “Health care is so important to human life and dignity that it is the responsibility of society to offer access to decent health care to every person.” I was pleased that he didn’t say “every citizen” but “every person.” So the answer is that it should be considered a right guaranteed by society, which means it must be a responsibility of the government.

We’ve had a failed experiment in marketplace medicine over the last fifteen years. People forget that 20 years ago, there was no such thing as a for-profit hospital. One of the greater achievements in this country in the Tocquevillian sense of nongovernmental organizations and the American penchant for organizing to solve problems was our hospitals. They were invariably nonprofit, secular or religious entities, based on community; and, the hospital board of directors was always the elite leaders in the community.

Our argument is that the record of America’s hospitals under that circumstance was impeccable. But a lot of it wasn’t. There was a lot of legal segregation in the south and de facto segregation in the northern hospitals. However, at the end of the day, they were community-responsive and responsible, and they got great support for that great subsidy. They got low taxes. They got free services from the city. In many circumstances, Chicago for example, big urban developments surrounded them that made their environment more attractive and more functional, and it was a deal. They would in return meet community needs; around the clock emergency services, obstetrical services, specialized services for kids with mental illness or venereal disease. The government played a huge role but it was essentially a volunteer communitarian kind of thing. That has been put on the back burner during the growth of for-profit hospitals. One of the most serious consequences of the for-profit health system is that there is a significant and dangerous decline of nurses, from what was once two million. Very few people are going into nursing and many are leaving. And this is not just a luxury item.
They are the caring in the health care system. So we have to reject ommodification. We think it’s an abomination and should not be tolerated. It should be eliminated from the health care transaction. We’ve had the experiment. It’s failed. And we must stop the damage it’s doing.

PRAGmatics—What is your assessment of the recently passed Medicare legislation? Since it is not due to go into effect until January 2006, can something else be drafted to amend or replace the Medicare bill before it is enacted?

Dr. Young—It’s an abomination. It’s a terrible, terrible bill and we’re in favor of its repeal. I’m happy to see that the best leaders in Congress, starting with Jan Schakowsky, have adopted that strategy. We regrouped after it was forced across the line. Many organizations are calling for the law to be rescinded because they now have a better understanding of what the bill contains. It is a scam.

PRAGmatics—What is your opinion about the costs of prescription drugs? What should be done about that?

Dr. Young—First, we must insist that doctors do not give unnecessary drugs. An example is the use of antibiotics for the common cold—a huge multi-billion dollar event. It shouldn’t happen. This is the wasting of drugs and the creation of resistant organisms. Second, we must use many more generic drugs. The amount that we spend on brand name “aspirin-like” drugs alone is ridiculous and unnecessary. That money could be spent on drugs for far more beneficial purposes. And it will take more patient education. It takes peer review. For health reasons, I would also restrict the kind of advertising allowed for medications.

And of course, it’s obvious I want to negotiate the lowest price and I would be for price controls if they were recalcitrant. I want the multi-billion dollar trading and profiting of companies from federal tax revenue-supported research ended. This health system has what I call three running sores. One is the absence of a generous, comprehensive drug benefit. That’s a terrible thing and there’s all kinds of ways that it hurts patients, including killing them. The second one, of course, is mental health. The system operates with an idiotic limitation on mental health services on almost every contract you have—six visits a year—as if someone is going to get sick on that basis. And then you have the exclusions. And the third one and possibly the most serious one, is the failure to plan for long term care. We have a time-line in our system in terms of the seniority of the baby boomers and there’s a major central issue in terms of the nature of our society. Are we going to stockpile all of our old disabled people in institutions at great cost or are we going to find ways to have community and family surround them and make life more decent and foster communitarian reality? Those are the things that are just totally neglected among marketplace solutions for profit making. So I think the reason we say that single payer is the only solution is because there is no other way to find the many billions you need to solve these problems, and we could do it because the money is there. We would get the money by ending the 15 to 30 percent administrative costs. And if 1 percent of the total costs for administration equals $17 Billion savings, that is quite impressive. It can be saved. Other countries do it. We have done it with the Medicare system.

Quentin Young graduated from Northwestern Medical School and did his residency at Cook County Hospital in Chicago. From 1972-1981, he served as Chairman of the Department of Medicine at Cook County. From 1943-1945, he served in the U.S. Army and later in the U.S. Public Health Service.

PRAGmatics—A few years ago, Community Renewal Society was an advocate of a theme called “building healthy communities.” What needs to be done so that economically depressed and marginalized communities in urban centers, such as Chicago, can have a more acceptable standard of health?

Dr. Young—Up until now I’ve been talking exclusively about a technical solution, mainly the financing of health care. My heart is in the last question. Rudolph Virchow, the remarkable mid-19th Century physician, who is considered the founder of modern public health, modern psychology and modern pathology, understood the centrality of social conditions to health status and preached it, and his preachments have stood the test of time. What I think CRS was addressing, was a solution to the causes of ill health and that it was not only with doctors but in resolving a variety of afflictions of social problems in the oppressed or depressed poverty community. In this country this is often synonymous with situations facing racial minorities and it’s everything you can think of—clean air, decent housing, good nutrition, social stability, good education—all the good things that we know are necessary. Those are the correlates to good health. When we solve those problems, then how good a heart and lung apparatus you have or how skilled you are at operating on different organs fades because it’s the environmental stresses that are the big of health. We’re very, very enthusiastic about this. Within our physicians group, we see the importance of social justice issues in enhancing the health status of people. We see the present system with heavy emphasis on treatment and profit-making as absolutely anathema or at war with the issues we mentioned. We see many diseases that can only be susceptible to control or elimination by a public health model. We see a frightening and not as yet understood surge of life-threatening asthma in the inner city. We see new diseases all the time that don’t respond to or antibiotics and are then heightened by the bioterrorist brouhaha. We’re talking about Mad Cow, SARS and HIV/AIDS. All these things are there and more keep coming and we have to increasingly say, “What are the strategies? What are the long term strategies that can allow us to rid these threats as they come and then control them?” So I’m interpreting that this is what CRS advocated and we identify with that very closely.

PRAGmatics—Chicago recently built a new facility—Stroger Hospital. Our question is, as you look at this city with respect to others in the country, where is Chicago in terms of its symbolic and real place in delivering health care and how real is the symbol of the new public hospital with respect to health care?

Dr. Young—The answer is a good news-bad news answer. I and many others, ultimately the elite in the business community, were convinced that with the old hospital being nonfunctional for many reasons—most of them structural—what the pathway was we would take. It was very sharply divided with harsh debate, at least initially, and the hospital council, or private hospitals were saying to just give them the money and they would absorb the count. I was on several committees that examined the problem and ultimately made the case successfully that by far the best way to go was to build a new hospital. Unfortunately, the maximum bonding available would only allow the building of one with about 450 beds. You should have 3400 beds. That was the same kind of hospital you have today, but at the time they made that decision, the hospital was running with about 1200. The bad news is, although it is a marvelous state-of-the-art hospital, it is going to be overwhelmed by sheer numbers with the status quo. But it’s a great achievement. There hasn’t been a new public hospital in this country, I would say, for the last 30 years, and so to get a major one is significant. Charity in New Orleans, Philadelphia General, and other public hospitals were closed.

However, the greatest achievement is the establishment of 32 high grade solid buildings as excellent facilities in many communities and the suburbs, and that is the real safety net and certainly is a cushion against the growing need for public services. So that gives you some comfort but people still pay inordinate rates for getting prescriptions filled. So the system constantly gets overwhelmed by the limitations of the private sector. Where is Chicago relative to other cities? It’s probably better than most, but it isn’t that much better. We have this really sharp cleavage between people who are poor without insurance but are not ready for Medicare, and then Medicaid, which is designed for them, being the wild card in the budget crunched economy. Most of the states have serious budget deficits and the biggest budget item is Medicaid. It always looks tempting to the pols, and the hungrier they get the more they slash. But it doesn’t have to be this way. We have the money. We have the workforce, a health workforce that is the envy of the world in terms of scientists, doctors, technicians, nurses, and basic health workers. We have physical plants, hospitals, and all the high-tech equipment. So the system is all there. In countries like Canada or England, the problem isn’t the system, it’s the money! In the U.S., it isn’t the money, it’s the system!

In addition to his distinguished career as a physician, Dr. Young has been a leader in public health policy and medical and social justice issues for more than fifty years. In 1951 he was a founder of the Committee to End Discrimination in Chicago medical institutions. In the 1960s he served as National Chairman of the Medical Committee for Human Rights.

In 1980, Dr. Young founded the Chicago-based Health & Medicine Policy Research Group, a group that addresses health needs in Illinois. He is currently Chairman. Dr. Young volunteers as National Coordinator of Physicians for a National Health Program (PNHP), a national research and education organization with more than 10,000 members representing every state and specialty.

PNHP was founded in 1987 and has physician spokespersons across the country who advocate for a single-payer national health program see www.hmprg.org & www.pnhp.org