The White House
January 20, 2004
State of the Union Address
President George W. Bush

On the critical issue of health care, our goal is to ensure that Americans can choose and afford private health care coverage that best fits their individual needs. To make insurance more affordable, Congress must act to address rapidly rising health care costs. Small businesses should be able to band together and negotiate for lower insurance rates, so they can cover more workers with health insurance. I urge you to pass association health plans. (Applause.) I ask you to give lower-income Americans a refundable tax credit that would allow millions to buy their own basic health insurance. (Applause.)

By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care. To protect the doctor-patient relationship, and keep good doctors doing good work, we must eliminate wasteful and frivolous medical lawsuits. (Applause.) And tonight I propose that individuals who buy catastrophic health care coverage, as part of our new health savings accounts, be allowed to deduct 100 percent of the premiums from their taxes. (Applause.)

A government-run health care system is the wrong prescription.(Applause.) By keeping costs under control, expanding access, and helping more Americans afford coverage, we will preserve the system of private medicine that makes America’s health care the best in the world. (Applause.)

http://www.whitehouse.gov/news/releases/2004/01/20040120-7.html

Comment: Other than his comments on the recently enacted Medicare bill, the above is the entire section of his speech that covered his health care proposals.

President Bush’s proposals:
* “…ensure that Americans can choose and afford private health care coverage that best fits their individual needs…”

(Affordable coverage means plans stripped of benefits with excessive cost sharing)

* “…Congress must act to address rapidly rising health care costs.”

(Rhetoric without a substantive proposal)

* “Small businesses should be able to band together… (in) association health plans.”

(Association health plans enable the marketing of inadequate plans that escape adequate state insurance regulatory oversight)

* “… give lower-income Americans a refundable tax credit that would allow millions to buy their own basic health insurance.”

(Privatizing Medicaid while increasing the cost sharing of lower-income individuals!)

* “… computerizing health records…”

(An essential inevitability, made less possible by the perpetuation of our current fragmented method of funding health care)

* “… eliminate wasteful and frivolous medical lawsuits.”

(Malpractice reform is important, but “frivolous” lawsuits are hardly even a negligible portion of the health care cost problem)

* “… individuals who buy catastrophic health care coverage, as part of our new health savings accounts, be allowed to deduct 100 percent of the premiums from their taxes.”

(Regressive tax policy that disproportionately benefits higher-income individuals)

A government-run health care system is the wrong prescription. (Applause.)

By keeping costs under control, expanding access, and helping more Americans afford coverage, we will preserve the system of private medicine that makes America’s health care the best in the world. (Applause.)”

(Innumerable studies have confirmed that we rank first only in the cost of our health care system but that our system fails miserably in health care outcomes, especially considering our resources. America’s health care is clearly not the best in the world. Health policy experts across the political spectrum agree that we need a federal solution to our problems in funding health care. Our president, in condemning government involvement, is not demonstrating the political leadership that we desperately need.

Nor are the politicians who applauded these comments. Shouldn’t we be considering a regime change

The White House
January 20, 2004
State of the Union Address
President George W. Bush

On the critical issue of health care, our goal is to ensure that Americans can choose and afford private health care coverage that best fits their individual needs. To make insurance more affordable, Congress must act to address rapidly rising health care costs. Small businesses should be able to band together and negotiate for lower insurance rates, so they can cover more workers with health insurance. I urge you to pass association health plans. (Applause.) I ask you to give lower-income Americans a refundable tax credit that would allow millions to buy their own basic health insurance. (Applause.)

By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care. To protect the doctor-patient relationship, and keep good doctors doing good work, we must eliminate wasteful and frivolous medical lawsuits. (Applause.) And tonight I propose that individuals who buy catastrophic health care coverage, as part of our new health savings accounts, be allowed to deduct 100 percent of the premiums from their taxes. (Applause.)

A government-run health care system is the wrong prescription.(Applause.) By keeping costs under control, expanding access, and helping more Americans afford coverage, we will preserve the system of private medicine that makes America’s health care the best in the world. (Applause.)

http://www.whitehouse.gov/news/releases/2004/01/20040120-7.html

Comment: Other than his comments on the recently enacted Medicare bill, the above is the entire section of his speech that covered his health care proposals.

President Bush’s proposals:
* “…ensure that Americans can choose and afford private health care coverage that best fits their individual needs…”

(Affordable coverage means plans stripped of benefits with excessive cost sharing)

* “…Congress must act to address rapidly rising health care costs.”

(Rhetoric without a substantive proposal)

* “Small businesses should be able to band together… (in) association health plans.”

(Association health plans enable the marketing of inadequate plans that escape adequate state insurance regulatory oversight)

* “… give lower-income Americans a refundable tax credit that would allow millions to buy their own basic health insurance.”

(Privatizing Medicaid while increasing the cost sharing of lower-income individuals!)

* “… computerizing health records…”

(An essential inevitability, made less possible by the perpetuation of our current fragmented method of funding health care)

* “… eliminate wasteful and frivolous medical lawsuits.”

(Malpractice reform is important, but “frivolous” lawsuits are hardly even a negligible portion of the health care cost problem)

* “… individuals who buy catastrophic health care coverage, as part of our new health savings accounts, be allowed to deduct 100 percent of the premiums from their taxes.”

(Regressive tax policy that disproportionately benefits higher-income individuals)

A government-run health care system is the wrong prescription. (Applause.)

By keeping costs under control, expanding access, and helping more Americans afford coverage, we will preserve the system of private medicine that makes America’s health care the best in the world. (Applause.)”

(Innumerable studies have confirmed that we rank first only in the cost of our health care system but that our system fails miserably in health care outcomes, especially considering our resources. America’s health care is clearly not the best in the world. Health policy experts across the political spectrum agree that we need a federal solution to our problems in funding health care. Our president, in condemning government involvement, is not demonstrating the political leadership that we desperately need.

Nor are the politicians who applauded these comments. Shouldn’t we be considering a regime change

The New York Times
January 20, 2004
Broader Health Coverage May Depend on Less
By Milt Freudenheim

With the number of uninsured Americans rising to new heights, some policy makers and influential health care experts are saying that the best way to give health coverage to more people is to give some people less.

Experiments in several states are establishing stripped-down packages of basic benefits intended to be affordable for employers and uninsured workers, including young, middle-class people who have dropped out of the health insurance pool. Some officials say that government health benefits could be extended to more people, too, if the benefit package were narrower.

Some experts warn that cutting back mandated benefits will neither yield enormous savings nor slow the increase in costs associated with medical advances.

“There is very little in health care that you can trim off,” said John Sheils, a health policy expert at the Lewin Group, a consulting firm based in Falls Church, Va., that has advised health care advocacy groups in several states. “If you develop a new procedure that does some good,” he added, “ultimately all the insurers are going to have to recognize it and pay for it.”

Comment: John Sheils is one of the nation’s most noted authorities in the analyses of health care reform proposals. His microsimulation models have demonstrated that little savings can be achieved by reducing the level of services covered, if the resulting product continues to protect individuals from the excessive financial burdens of health care.

Many proposals today call for ensuring “basic” coverage for everyone, as if that were a lower-cost, isolated segment of health care that people “really need.” But when attempts are made to define what should or should not be covered, the process falls apart. Theoretically, beneficial services should be covered and ineffective services should not. But, in fact, much of health care cannot be readily assigned to one of these two categories.

Thus, the concept of “basic” services really should mean that patients must have unimpeded access to physicians and other providers and to the institutions and services that they control. The ultimate decision for appropriate services should be made jointly by the patient and his or her health care professional. This process is not amenable to meat cleaver economics.

If eliminating non-basic services is not an effective option, then how can we control costs? Placing the entire health care system under a global budget will determine the capacity of the system. The budget allocation process will determine capacities for segments of the health care system.

That process may well limit the number of total knee replacements in nonagenarians. But isn’t that process better than depriving many of us of beneficial services merely because they fail to meet an arbitrary threshold of just what a basic service is?

The New York Times
January 20, 2004
Broader Health Coverage May Depend on Less
By Milt Freudenheim

With the number of uninsured Americans rising to new heights, some policy makers and influential health care experts are saying that the best way to give health coverage to more people is to give some people less.

Experiments in several states are establishing stripped-down packages of basic benefits intended to be affordable for employers and uninsured workers, including young, middle-class people who have dropped out of the health insurance pool. Some officials say that government health Benefits could be extended to more people, too, if the benefit package were narrower.

Some experts warn that cutting back mandated benefits will neither yield enormous savings nor slow the increase in costs associated with medical advances.

“There is very little in health care that you can trim off,” said John Sheils, a health policy expert at the Lewin Group, a consulting firm based in Falls Church, Va., that has advised health care advocacy groups in several states. “If you develop a new procedure that does some good,” he added, “ultimately all the insurers are going to have to recognize it and pay for it.”

Comment: John Sheils is one of the nation’s most noted authorities in the analyses of health care reform proposals. His microsimulation models have demonstrated that little savings can be achieved by reducing the level Of services covered, if the resulting product continues to protect individuals from the excessive financial burdens of health care.

Many proposals today call for ensuring “basic” coverage for everyone, as if that were a lower-cost, isolated segment of health care that people “really need.” But when attempts are made to define what should or should not be covered, the process falls apart. Theoretically, beneficial services Should be covered and ineffective services should not. But, in fact, much of health care cannot be readily assigned to one of these two categories.

Thus, the concept of “basic” services really should mean that patients must have unimpeded access to physicians and other providers and to the institutions and services that they control. The ultimate decision for appropriate services should be made jointly by the patient and his or Her health care professional. This process is not amenable to meat cleaver economics.

If eliminating non-basic services is not an effective option, then how can we control costs? Placing the entire health care system under a global budget will determine the capacity of the system. The budget allocation process will determine capacities for segments of the health care system. That process may well limit the number of total knee replacements in nonagenarians. But isn’t that process better than depriving many of us of beneficial services merely because they fail to meet an arbitrary threshold of just what a basic service is?

The New York Times
January 20, 2004
Broader Health Coverage May Depend on Less
By Milt Freudenheim

With the number of uninsured Americans rising to new heights, some policy makers and influential health care experts are saying that the best way to give health coverage to more people is to give some people less.

Experiments in several states are establishing stripped-down packages of basic benefits intended to be affordable for employers and uninsured workers, including young, middle-class people who have dropped out of the health insurance pool. Some officials say that government health Benefits could be extended to more people, too, if the benefit package were narrower.

Some experts warn that cutting back mandated benefits will neither yield enormous savings nor slow the increase in costs associated with medical advances.

“There is very little in health care that you can trim off,” said John Sheils, a health policy expert at the Lewin Group, a consulting firm based in Falls Church, Va., that has advised health care advocacy groups in several states. “If you develop a new procedure that does some good,” he added, “ultimately all the insurers are going to have to recognize it and pay for it.”

Comment: John Sheils is one of the nation’s most noted authorities in the analyses of health care reform proposals. His microsimulation models have demonstrated that little savings can be achieved by reducing the level Of services covered, if the resulting product continues to protect individuals from the excessive financial burdens of health care.

Many proposals today call for ensuring “basic” coverage for everyone, as if that were a lower-cost, isolated segment of health care that people “really need.” But when attempts are made to define what should or should not be covered, the process falls apart. Theoretically, beneficial services Should be covered and ineffective services should not. But, in fact, much of health care cannot be readily assigned to one of these two categories.

Thus, the concept of “basic” services really should mean that patients must have unimpeded access to physicians and other providers and to the institutions and services that they control. The ultimate decision for appropriate services should be made jointly by the patient and his or Her health care professional. This process is not amenable to meat cleaver economics.

If eliminating non-basic services is not an effective option, then how can we control costs? Placing the entire health care system under a global budget will determine the capacity of the system. The budget allocation process will determine capacities for segments of the health care system. That process may well limit the number of total knee replacements in nonagenarians. But isn’t that process better than depriving many of us of beneficial services merely because they fail to meet an arbitrary threshold of just what a basic service is?

Institute of Medicine
January 14, 2004
Committee on the Consequences of Uninsurance

Insuring America’s Health: Principles and Recommendations

Principles to guide the extension of coverage

1. Health care coverage should be universal.
2. Health care coverage should be continuous.
3. Health care coverage should be affordable to individuals and families.
4. The health insurance strategy should be affordable and sustainable for society.
5. Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.

Using the principles

The Committee concludes that health insurance coverage for everyone in the United States requires major reform initiated as federal policy.

The Committee recommends that these principles be used to assess the merits of current proposals and to design future strategies for extending coverage to everyone.

To illustrate how the principles should be used to evaluate reform proposals, the Committee sketches four prototypes for major reform in a simplified format so that the main incentives are clear. It then assesses ach prototype against each of the principles, highlighting the model’s strengths and weaknesses.

The prototypes

1. Major public program extension and new tax credit
2. Employer mandate, premium subsidy, and individual mandate
3. Individual mandate and tax credit
4. Single payer

Each of the four prototypes satisfies the principles better than does the status quo. Each model does so through different mechanisms and realizes each principle to a different degree. The Committee does not recommend one approach over another.

The Committee recommends that the President and Congress develop a strategy to achieve universal coverage and to establish a firm and explicit schedule to reach this goal by 2010.

It is time for our nation to extend coverage to everyone.

http://books.nap.edu/books/0309091055/html/index.html

Comment: The Committee has provided a great service by demonstrating, in previous reports, the severe deficiencies in our system related to uninsurance, and now by providing an unqualified recommendation for universal coverage.

In the interest of objectivity, the Committee has not recommended a specific model of universal coverage, but the crucial importance of examining the specific impacts of each model is appropriately stressed. Table 5.2 in the report (page 150) does demonstrate that the single payer model is the most effective in ensuring continuous, universal coverage, and that the coverage would remain affordable for individuals and for society.

Single payer advocates will find much in this report to continue to fuel our passion for reform.

Institute of Medicine
January 14, 2004
Committee on the Consequences of Uninsurance

Insuring America’s Health: Principles and Recommendations

Principles to guide the extension of coverage

1. Health care coverage should be universal.
2. Health care coverage should be continuous.
3. Health care coverage should be affordable to individuals and families.
4. The health insurance strategy should be affordable and sustainable for society.
5. Health insurance should enhance health and well-being by promoting access to high-quality care that is effective, efficient, safe, timely, patient-centered, and equitable.

Using the principles

The Committee concludes that health insurance coverage for everyone in the United States requires major reform initiated as federal policy.

The Committee recommends that these principles be used to assess the merits of current proposals and to design future strategies for extending coverage to everyone.

To illustrate how the principles should be used to evaluate reform proposals, the Committee sketches four prototypes for major reform in a simplified format so that the main incentives are clear. It then assesses ach prototype against each of the principles, highlighting the model’s strengths and weaknesses.

The prototypes

1. Major public program extension and new tax credit
2. Employer mandate, premium subsidy, and individual mandate
3. Individual mandate and tax credit
4. Single payer

Each of the four prototypes satisfies the principles better than does the status quo. Each model does so through different mechanisms and realizes each principle to a different degree. The Committee does not recommend one approach over another.

The Committee recommends that the President and Congress develop a strategy to achieve universal coverage and to establish a firm and explicit schedule to reach this goal by 2010.

It is time for our nation to extend coverage to everyone.

http://books.nap.edu/books/0309091055/html/index.html

Comment: The Committee has provided a great service by demonstrating, in previous reports, the severe deficiencies in our system related to uninsurance, and now by providing an unqualified recommendation for universal coverage.

In the interest of objectivity, the Committee has not recommended a specific model of universal coverage, but the crucial importance of examining the specific impacts of each model is appropriately stressed. Table 5.2 in the report (page 150) does demonstrate that the single payer model is the most effective in ensuring continuous, universal coverage, and that the coverage would remain affordable for individuals and for society.

Single payer advocates will find much in this report to continue to fuel our passion for reform.