PNHP

My experience with British health care

My experience with British health care

It worked very well on a personal level, and is effective overall. So why the suspicion here at home?

By JOHN M. BRYSON
Minneapolis Star-Tribune, September 15, 2010

The emotional debates over health care reform in the United States last fall and again this election season are puzzling to my wife and me. We are professors who were on sabbatical leave in London from August 2009 through August 2010, so we missed last year’s debates. While in the United Kingdom we were automatically covered by the National Health Service.

For us, the NHS worked quite well. One example: The week we arrived in London we went to the NHS Choices website (www.nhs.uk), punched in our postal code and immediately got a listing of local clinics. We chose the closest one, stopped by and filled out two short forms, let the reception staff make copies of our passports and visas, and that was it: We were covered. None of this business about needing coverage by an employer’s plan, no concerns about preexisting conditions (we both have them), no rationing by what we could afford, and no excessive paperwork. All that mattered was that we were in the UK. We had a right to be taken care of by the NHS.

Another example: I badly sprained my back one evening. The next morning I was in severe pain and couldn’t get out of bed. I called the clinic, and within two minutes a doctor was on the phone. He asked if I could come in immediately, but I was in too much pain. He offered to make a house call if I could wait for a few hours. I wondered if he might do something over the phone, so he ran me through a series of questions and little exercises to make sure he understood what was wrong. He then wrote prescriptions for painkillers and a muscle relaxant. My wife picked them up, filled them at a local pharmacy (at no cost because I am over 60) and was home within the hour. I was up and walking a few hours later and was fully better in a few weeks. How many times has anyone in the United States spoken to a doctor within two minutes of calling and had the same doctor offer to make a house call?

The British have a mostly socialized health care system, meaning they handle both finance and production through the government. In the United States, we mostly socialize risk through health care insurance paid for by employer, employee, consumer and government contributions, but we also socialize much health care financing; some estimate that government pays for about 50 percent of all health care costs. We leave production mostly to businesses and nonprofits, but there is also a lot of government provision through public hospitals and clinics. The Veterans Affairs health care system is as close as we get to the NHS.

What do the British get for their money? Using 2009 figures, they spend 9 percent of GDP on health care; we spend more than 17 percent. They spend $3,150 per capita on health care each year ($2,600 of which is public money); we spend $7,500 per capita ($3,500 of which is public money). They cover everyone (even visitors from abroad); we have a long way to go. They have an average life expectancy at birth of 79.4 years; here, the average is 78.2. Their infant mortality rate is 4.8 per 1,000 live births; here, it is 6.4. Is their system perfect? No, clearly not. For example, there are issues about timely access to specialized elective care, but they also do not ration that care based on ability to pay, which we do.

Having experienced the NHS and U.S. health care systems, I think it is safe to say that no one would design our system if they could start from scratch. Ours is 50 percent more expensive than almost any other nation’s, has left way too many people out and produces many population level outcomes far worse than they should be. In addition, our system places a huge burden on company balance sheets, making it far harder for companies to compete in world markets where other nations pay for health care through taxes. I am not a health care policy analyst, but it doesn’t take one to see that we are clearly not getting what we should for what we pay. Just consider what is politically unimaginable: If we had the British system, we would have at least 8 percent of our GDP of $14.5 trillion left over — or about $1.15 trillion each year — that we could use to fix every problem with the system and still have money left to give back to employers, employees and taxpayers — and we also would have better population-level outcomes. The switch to the NHS is not going to happen, but the thought experiment does help one see the merits of moving to a system that a least guarantees health care insurance to all, that moves away from reliance on employer contributions, and that produces better overall outcomes at less cost.

John M. Bryson is a professor at the University of Minnesota.

http://www.startribune.com/opinion/commentary/103002689.html?elr=KArksc8P:Pc:U0ckkD:aEyKUiD3aPc:_Yyc:aULPQL7PQLanchO7DiUr

What a difference a year makes

By Aaron E. Carroll, M.D.
The Huffington Post, Sept. 16, 2010

Every year about this time, the census releases its yearly numbers on the uninsured. Every year, I write an op-ed or a blog post. Every year, I get a little more depressed.

It’s hard to find good news in these numbers. It’s even harder because there’s just nothing that the Patient Protection and Affordable Care Act is going to do about them this year. Or next year. Or even the next few years. And, over that time, things are going to get worse for a large number of people.

Before we even get started, let’s kill a myth. When the census reports uninsured people, they mean people who were uninsured for the entire year. Not part of the year, not on the day they were surveyed — the whole year. How do I know? Because the people who asked the question say so. The US Department of Health and Human Services, in a 2005 document entitled Understanding Estimates of the Uninsured: Putting the Differences in Context, explains that the Current Population Survey (CPS) tells us about people who were uninsured for the whole year (see Table 1). In fact, it specifically says that the CPS does not give a point in time calculation (“N/A”). It does not matter what other people “say” about it. The CPS reports uninsurance for the whole year. In this year’s report it also says:

“They were considered ‘uninsured’ if, for the entire year, they were not covered by any type of health insurance.”

Remember that when you read the rest of this. The number of people who were uninsured for at least part of the year is much higher than those who were uninsured all year. They are at risk. They often can’t get care. And we’re not measuring them at all. Nor do we take into account that so many people in the United States are under-insured. Just having insurance doesn’t necessarily mean you’re adequately covered. It doesn’t necessarily mean that you won’t go bankrupt because of illness. It doesn’t necessarily mean that you are protected. But we don’t measure under-insurance. We just don’t know.

Now that that’s out of the way, let’s hit hit the low notes on this year’s report:

The percentage of people without health insurance increased to 16.7 percent in 2009 from 15.4 percent in 2008. The number of uninsured people increased to 50.7 million in 2009 from 46.3 million in 2008.

That means that there are now more people uninsured in the United States than at any time since the passage of Medicare. Full stop. A total of 4,300,000 more people were without insurance in 2009. Remember as well, all of the 16.7% of Americans who are uninsured are less than 65 years old, because all of those older people get Medicare.

The number of people with health insurance decreased to 253.6 million in 2009 from 255.1 million in 2008.

While the percentage of people who are uninsured has gone up and down, this is the first time that the sum total of people who have insurance has gone down in 23 years. It’s also been 23 years since we’ve been looking.

The number of people covered by private health insurance decreased to 194.5 million in 2009 from 201.0 million in 2008. The number of people covered by government health insurance increased to 93.2 million in 2009 from 87.4 million in 2008.

Think about that for a second. We just passed a huge health care reform bill that, for the most part, is built on the private insurance market. And yet that market is failing us miserably. The number of people covered by government insurance increased by almost 7 million, and the number of people covered by private insurance dropped by 6.5 million. Six-and-a-half million. We’re going to build on that? Moreover, the PPACA is going to increase the number of people on Medicaid by a substantial number. That’s not until 2014. At this rate, funding Medicaid at the state (or even federal) level is going to need a large infusion of cash.

The percentage of people covered by government health insurance programs increased to 30.6 percent in 2009, from 29.0 percent in 2008.

Again, that’s the highest percentage of people on government insurance in 23 years, since we started collecting the data.

The percentage and number of people covered by Medicaid increased to 15.7 percent or 47.8 million in 2009, from 14.1 percent or 42.6 million in 2008.

Go check out the CBO report on the final PPACA bill. They estimated that in 2010, 40 million people would be covered by Medicaid and CHIP. Forty million. That’s 7.8 million less than it turns out were on Medicaid last year. How’s 2010 going from your standpoint? Is there anyone who thinks things have improved so much that that the number of people on Medicaid is going down? I think it’s possible that we’ll see 50 million people on Medicaid in 2010, which is 10 million more than the CBO thought would be on Medicaid and CHIP. And things may get worse after that.

The PPACA depends on private insurance covering a certain number of people. This will have repercussions on how much reform will cost and how much government will be involved. I can’t imagine anyone will be pleased with the changes in its outlook.

If you thought health care reform was done, prepare to be disappointed. It’s barely begun.

Aaron regularly blogs about (mostly) health policy at The Incidental Economist.

http://www.huffingtonpost.com/aaron-e-carroll/what-a-difference-a-year_b_720373.html

4.3 million more without insurance

Income, Poverty, and Health Insurance Coverage in the United States: 2009

U.S. Census Bureau
September 2010

Health Insurance Coverage in the United States

Highlights

* The percentage of people without health insurance increased to 16.7 percent in 2009 from 15.4 percent in 2008. The number of uninsured people increased to 50.7 million in 2009 from 46.3 million in 2008.

* The number of people with health insurance decreased to 253.6 million in 2009 from 255.1 million in 2008. This is the first year that the number of people with health insurance has decreased since 1987, the first year that comparable health insurance data were collected. The number of people covered by private health insurance decreased to 194.5 million in 2009 from 201.0 million in 2008. The number of people covered by government health insurance increased to 93.2 million in 2009 from 87.4 million in 2008.

* Between 2008 and 2009, the percentage of people covered by private health insurance decreased from 66.7 percent to 63.9 percent. The percentage of people covered by employment-based health insurance decreased to 55.8 percent in 2009, from 58.5 percent in 2008. The percentage of people covered by employment-based health insurance is the lowest since 1987, the first year that comparable health insurance data were collected. The number of people covered by employment-based health insurance decreased to 169.7 million in 2009, from 176.3 million in 2008.

* The percentage of people covered by government health insurance programs increased to 30.6 percent in 2009, from 29.0 percent in 2008. This is the highest percentage of people covered by government health insurance programs since 1987. The percentage and number of people covered by Medicaid increased to 15.7 percent or 47.8 million in 2009, from 14.1 percent or 42.6 million in 2008. The percentage and number of people covered by Medicaid is the highest since 1987. The percentage and number of people covered by Medicare in 2009 (14.3 percent and 43.4 million) were not statistically different from 2008.

* In 2009, 10.0 percent of children under 18, or 7.5 million, were without health insurance. These estimates were not statistically different from the 2008 estimates. The uninsured rate for children in poverty (15.1 percent) was greater than the rate for all children.

* Between 2008 and 2009, the uninsured rate and the number of uninsured for non-Hispanic Whites increased from 10.8 percent and 21.3 million to 12.0 percent and 23.7 million. The uninsured rate and the number of uninsured for Blacks increased from 19.1 percent and 7.3 million to 21.0 percent and 8.1 million.

* The percentage and number of uninsured Hispanics increased to 32.4 percent and 15.8 million in 2009, from 30.7 percent and 14.6 million in 2008.

http://www.census.gov/prod/2010pubs/p60-238.pdf

Census Bureau press release:
http://www.census.gov/newsroom/releases/archives/income_wealth/cb10-144.html

PNHP press release:
https://pnhp.org/news/2010/september/number-of-uninsured-skyrockets-43-million-to-record-507-million-in-2009

Comment:

By Don McCanne, MD

Highlights of the 2009 health insurance highlights:

* Uninsured increased to 50.7 million – 16.7 percent of the population

* Private insurance decreased to 194.5 million – 63.9 percent

* Employment-based insurance decreased to 169.7 million – 55.8 percent

* Medicaid increased to 47.8 million – 15.7 percent

* Uninsured children remain at 7.5 million

* Racial and ethnic disparities in coverage have compounded

Those who oppose government solutions to the health care crisis will likely pass these worsening numbers off as an expected consequence of the sputtering economy and the new age of unemployment. They will pay little heed to the fact that the numbers are still intolerable when the economy is thriving; that isn’t their concern.

Supporters of the Patient Protection and Affordable Care Act (PPACA) will no doubt be disturbed by these numbers, but it is very likely that they will make the most of them in selling PPACA by showing how it will dramatically reduce the numbers of uninsured. That is true. Many will be covered by Medicaid and by private health plans, even if far too many will still remain uninsured.

This Census Bureau report remains silent on one of the most important issues in health insurance – the numbers who are underinsured – those who will face financial hardship should medical needs arise.

PPACA is an underinsurance program. Employers will see little relief and will expand their present trend of shifting more insurance and health care costs onto their employees. Individuals buying plans in the new insurance exchanges will select underinsurance products with low actuarial values (30 to 40 percent of costs to be paid by the patient) with subsidies that are inadequate to avoid financial hardship. Many will move into the Medicaid program which has more expansive coverage, but which reimburses providers at such a low rate that far too many will not be willing to accept patients under this program. With Medicaid chasing away providers, it too has become another form of underinsurance.

Thus the touted increase in insurance enrollment under PPACA will be more than offset by the explosion in underinsurance – affecting the majority of Americans. At this point looking forward, this nefarious outcome is not obvious to most. But as underinsurance sneaks up on us, and more and more individuals are feeling the pain, they’ll be ready. Ready for what? Ready for an improved Medicare that will always be there for us – in both good and bad economic times.

The PNHP press release (link above) provides a reality-based perspective of just what these numbers mean.

Number of uninsured skyrockets 4.3 million to record 50.7 million in 2009

Big leap points to urgency of enacting single-payer Medicare for all: national doctors' group

FOR IMMEDIATE RELEASE
Sept. 16, 2010
 
Contact:
Quentin Young, M.D.
Olveen Carrasquillo, M.D.
Margaret Flowers, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org
Local physicians in almost all 50 states available for comment (See historical table of uninsured by state below).

Official estimates by the Census Bureau showing a dramatic spike of 4.3 million in the number of Americans without health insurance in 2009 – to a record 50.7 million – underscore the urgency of going beyond the Obama administration’s new health law and swiftly implementing a single-payer, improved Medicare-for-all program, according to Physicians for a National Health Program, a 17,000-member physician group.

The Census Bureau reported that 16.7 percent of the population lacked health insurance coverage in 2009, up from 15.4 percent in 2008, when 46.3 million were uninsured.

Lack of health insurance is known to have deadly consequences. Last year researchers at Harvard Medical School showed that 45,000 deaths annually can be linked to lack of coverage.

“Tragically, we know that the new figures of uninsured mean a preventable annual death toll of about 51,000 people – that’s about one death every 11 minutes,” said Dr. Quentin Young, national coordinator of PNHP. Young is a Chicago-based retired physician whose private medical practice once counted President Obama among its patients.

Young said that even if the administration’s new health law works as planned, the Congressional Budget Office has projected about 50 million people will be uninsured for the next three years and about 23 million people will remain uninsured in 2019.

“Today’s report suggests those projections are likely too low,” he said.

The jump of 4.3 million uninsured is the largest one-year increase on record and would have been much higher – over 10 million – had there not been a huge expansion of public coverage, primarily Medicaid, to an additional 5.8 million people.

The rise in the number of uninsured was almost entirely due to a sharp decline in the number of people with employer-based coverage by 6.6 million. In 2009, 55.8 percent of the population had such coverage, having declined for the ninth consecutive year from 64.2 percent in 2000.

The record-breaking number of uninsured – exceeding 50 million for the first time since the Census Bureau started keeping records – includes 7.5 million children.

The biggest jumps in the percentage of uninsured were in Alabama, Oklahoma, Ohio, Missouri, Georgia, Delaware, North Carolina and Florida. In terms of absolute numbers, the biggest increases were in California, Florida, Texas, Ohio, Georgia, North Carolina, Illinois, Alabama, Michigan and Pennsylvania. In Massachusetts, 295,000 people remain uninsured despite that state’s 2006 reform. (See link below for historical tables of the uninsured by state.)

“The only way to solve this problem is to insure everyone,” Young said. “And the only way to insure everyone at a reasonable cost is to enact single-payer national health insurance, an improved Medicare for all. Single payer would streamline bureaucracy, saving $400 billion a year on administrative overhead, enough to pay for all the uninsured and to upgrade everyone else’s coverage.”

Dr. Olveen Carrasquillo, a PNHP board member and chief of general internal medicine at the University of Miami’s Miller School of Medicine, noted that the Census Bureau was once again silent on the pervasive problem of “underinsurance.”

“Not having health insurance, or having poor quality insurance that doesn’t protect you from financial hardship in the face of medical need, is a source of mounting stress and poor medical outcomes for people across our country,” Carrasquillo said.  New research has found that about 14.1 million children and 25 million non-elderly adults were underinsured in 2007, a figure that is likely much higher today.

“The government subsidies under the new health law will not be sufficient to provide quality and affordable coverage to the vast majority of Americans,” he said. “Tens of millions will remain uninsured, underinsured and without access to care. We need more fundamental reform to a single-payer national health insurance program.”

*****
State-by-state data on the uninsured from 2006-2009 can be found here: www.pnhp.org/system/assets/drupal/docs/2010/Uninsured-by-state-2006-2009.pdf

Physicians for a National Health Program (www.pnhp.org) is an organization of more than 17,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

4.3 million more without insurance

Income, Poverty, and Health Insurance Coverage in the United States: 2009

U.S. Census Bureau
September 2010
Health Insurance Coverage in the United States
Highlights
* The percentage of people without health insurance increased to 16.7 percent in 2009 from 15.4 percent in 2008. The number of uninsured people increased to 50.7 million in 2009 from 46.3 million in 2008.
* The number of people with health insurance decreased to 253.6 million in 2009 from 255.1 million in 2008. This is the first year that the number of people with health insurance has decreased since 1987, the first year that comparable health insurance data were collected. The number of people covered by private health insurance decreased to 194.5 million in 2009 from 201.0 million in 2008. The number of people covered by government health insurance increased to 93.2 million in 2009 from 87.4 million in 2008.
* Between 2008 and 2009, the percentage of people covered by private health insurance decreased from 66.7 percent to 63.9 percent. The percentage of people covered by employment-based health insurance decreased to 55.8 percent in 2009, from 58.5 percent in 2008. The percentage of people covered by employment-based health insurance is the lowest since 1987, the first year that comparable health insurance data were collected. The number of people covered by employment-based health insurance decreased to 169.7 million in 2009, from 176.3 million in 2008.
* The percentage of people covered by government health insurance programs increased to 30.6 percent in 2009, from 29.0 percent in 2008. This is the highest percentage of people covered by government health insurance programs since 1987. The percentage and number of people covered by Medicaid increased to 15.7 percent or 47.8 million in 2009, from 14.1 percent or 42.6 million in 2008. The percentage and number of people covered by Medicaid is the highest since 1987. The percentage and number of people covered by Medicare in 2009 (14.3 percent and 43.4 million) were not statistically different from 2008.
* In 2009, 10.0 percent of children under 18, or 7.5 million, were without health insurance. These estimates were not statistically different from the 2008 estimates. The uninsured rate for children in poverty (15.1 percent) was greater than the rate for all children.
* Between 2008 and 2009, the uninsured rate and the number of uninsured for non-Hispanic Whites increased from 10.8 percent and 21.3 million to 12.0 percent and 23.7 million. The uninsured rate and the number of uninsured for Blacks increased from 19.1 percent and 7.3 million to 21.0 percent and 8.1 million.
* The percentage and number of uninsured Hispanics increased to 32.4 percent and 15.8 million in 2009, from 30.7 percent and 14.6 million in 2008.
http://www.census.gov/prod/2010pubs/p60-238.pdf
Census Bureau press release:
http://www.census.gov/newsroom/releases/archives/income_wealth/cb10-144.html
PNHP press release:
https://pnhp.org/news/2010/september/number-of-uninsured-skyrockets-43-million-to-record-507-million-in-2009

Highlights of the 2009 health insurance highlights:
* Uninsured increased to 50.7 million – 16.7 percent of the population
* Private insurance decreased to 194.5 million – 63.9 percent
* Employment-based insurance decreased to 169.7 million – 55.8 percent
* Medicaid increased to 47.8 million – 15.7 percent
* Uninsured children remain at 7.5 million
* Racial and ethnic disparities in coverage have compounded
Those who oppose government solutions to the health care crisis will likely pass these worsening numbers off as an expected consequence of the sputtering economy and the new age of unemployment. They will pay little heed to the fact that the numbers are still intolerable when the economy is thriving; that isn’t their concern.
Supporters of the Patient Protection and Affordable Care Act (PPACA) will no doubt be disturbed by these numbers, but it is very likely that they will make the most of them in selling PPACA by showing how it will dramatically reduce the numbers of uninsured. That is true. Many will be covered by Medicaid and by private health plans, even if far too many will still remain uninsured.
This Census Bureau report remains silent on one of the most important issues in health insurance – the numbers who are underinsured – those who will face financial hardship should medical needs arise.
PPACA is an underinsurance program. Employers will see little relief and will expand their present trend of shifting more insurance and health care costs onto their employees. Individuals buying plans in the new insurance exchanges will select underinsurance products with low actuarial values (30 to 40 percent of costs to be paid by the patient) with subsidies that are inadequate to avoid financial hardship. Many will move into the Medicaid program which has more expansive coverage, but which reimburses providers at such a low rate that far too many will not be willing to accept patients under this program. With Medicaid chasing away providers, it too has become another form of underinsurance.
Thus the touted increase in insurance enrollment under PPACA will be more than offset by the explosion in underinsurance – affecting the majority of Americans. At this point looking forward, this nefarious outcome is not obvious to most. But as underinsurance sneaks up on us, and more and more individuals are feeling the pain, they’ll be ready. Ready for what? Ready for an improved Medicare that will always be there for us – in both good and bad economic times.
The PNHP press release (link above) provides a reality-based perspective of just what these numbers mean.

Hawaii teachers' health benefits threatened

Teachers sue over health plan

By Susan Essoyan
Star Advertiser
September 15, 2010

Hawaii public school teachers filed suit yesterday in Circuit Court to block changes in their health coverage, saying that the state’s plan to do away with their health benefit trust fund is unconstitutional.

The suit, Kono et al. v. Lingle et al., seeks to represent more than 15,000 active and retired school teachers with health benefits in the Hawaii State Teachers Association Voluntary Employees’ Beneficiary Association Trust.

The teachers are objecting to the state’s plan to transfer their health benefit plans from “the financially sound” VEBA to the “insolvent or nearly insolvent” Employer-Union Health Benefits Trust Fund, according to the lawsuit.

“The forced transfer of the teachers into EUTF is designed to prop up that failing system on the backs of the teachers,” said Paul Alston, attorney for the plaintiffs. “What they will get if they are forced to transfer is higher costs and inferior benefits. It is clearly unconstitutional to take away the valuable benefits the teachers have.”

The suit contends that the change amounts to a breach of contract and violates the Hawaii Constitution by “diminishing or impairing” accrued benefits in the employees’ retirement system. After the switch, teachers will face higher co-payments and curtailed drug coverage and services, it said.

The lawsuit also alleges that the state improperly took $3.96 million from the VEBA trust surplus, which otherwise would have been used as reserves, and put it into the general fund.

The Legislature passed a law to phase out the VEBA trust on Dec. 31, and assign teachers to Employer-Union Health Benefits Trust, which covers more than 94,000 state and county employees and retirees.

The court filing included an April 12 letter from Gov. Linda Lingle to legislators in which the governor called the Employer-Union Health Benefits Trust “insolvent,” adding that “its governance is untenable.” She noted that Aon Consulting, the trust’s consultant, warned on March 31 that the trust fund would likely run out of money to cover expenses later this year.

Aon Consulting recommended a 26 percent increase in premiums as of July 1, but the Employer-Union Health Benefits Trust’s board of trustees has voted to keep rates and benefits the same through December of this year.

http://www.staradvertiser.com/news/hawaiinews/20100915_Teachers_sue_over_health_plan.html

Comment: 

By Don McCanne, MD

During Q&A at some of my speaking engagements, a common question from the audience: “Under a single payer, Medicare for all program, would I have to give up my excellent retired teachers’ health benefit program that we fought so hard for all of these years?”

That’s a very good question. These programs are often more comprehensive than Medicare. In fact, that is why we specify an improved Medicare as the framework for a single payer national health program. All essential health benefits would be included; deductibles, co-payments and coinsurance would be eliminated, and the administration of the program would be streamlined. There would be no need to maintain the teachers’ health benefit program as a separate entity.

What is alarming about this report from Hawaii is that these sacrosanct programs are now vulnerable. The teachers’ well-funded voluntary employees’ beneficiary association trust (VEBA) is about to be dumped into the near-bankrupt health benefit trust established for other government employees. The double tragedy is that the teachers lose, and other government employees who should have the most secure of health benefit plans are also losing as more of their health care costs inevitably will be dumped on them.

If our best and most stable health insurance programs are facing this uncertain future, what does that say about the security of other private insurance programs within our fragmented system of financing health care?

The Patient Protection and Affordable Care Act (PPACA) rewards employers who dump their health benefit programs by requiring health care assessments that are only a fraction of what they pay in premiums for their existing insurance programs. Their employees then are forced, by mandate, to purchase plans within the exchanges. Though purchased through exchanges, these plans are merely a slightly more regulated reincarnation of the individual market – the least stable and least reliable of private insurance plans. The subsidies for these plans are the equivalent of vouchers, providing a mechanism for shifting ever more of health care costs to those individuals with the greatest health care needs.

The teachers of Hawaii are right to be concerned. They need to fight hard to protect their VEBA, at least long enough for us to enact an even better program for them and everyone else – an improved Medicare for all.

Hawaii teachers’ health benefits threatened

Teachers sue over health plan

By Susan Essoyan
Star Advertiser
September 15, 2010

Hawaii public school teachers filed suit yesterday in Circuit Court to block changes in their health coverage, saying that the state’s plan to do away with their health benefit trust fund is unconstitutional.

The suit, Kono et al. v. Lingle et al., seeks to represent more than 15,000 active and retired school teachers with health benefits in the Hawaii State Teachers Association Voluntary Employees’ Beneficiary Association Trust.

The teachers are objecting to the state’s plan to transfer their health benefit plans from “the financially sound” VEBA to the “insolvent or nearly insolvent” Employer-Union Health Benefits Trust Fund, according to the lawsuit.

“The forced transfer of the teachers into EUTF is designed to prop up that failing system on the backs of the teachers,” said Paul Alston, attorney for the plaintiffs. “What they will get if they are forced to transfer is higher costs and inferior benefits. It is clearly unconstitutional to take away the valuable benefits the teachers have.”

The suit contends that the change amounts to a breach of contract and violates the Hawaii Constitution by “diminishing or impairing” accrued benefits in the employees’ retirement system. After the switch, teachers will face higher co-payments and curtailed drug coverage and services, it said.

The lawsuit also alleges that the state improperly took $3.96 million from the VEBA trust surplus, which otherwise would have been used as reserves, and put it into the general fund.

The Legislature passed a law to phase out the VEBA trust on Dec. 31, and assign teachers to Employer-Union Health Benefits Trust, which covers more than 94,000 state and county employees and retirees.

The court filing included an April 12 letter from Gov. Linda Lingle to legislators in which the governor called the Employer-Union Health Benefits Trust “insolvent,” adding that “its governance is untenable.” She noted that Aon Consulting, the trust’s consultant, warned on March 31 that the trust fund would likely run out of money to cover expenses later this year.

Aon Consulting recommended a 26 percent increase in premiums as of July 1, but the Employer-Union Health Benefits Trust’s board of trustees has voted to keep rates and benefits the same through December of this year.

http://www.staradvertiser.com/news/hawaiinews/20100915_Teachers_sue_over_health_plan.html

Comment: 

By Don McCanne, MD

During Q&A at some of my speaking engagements, a common question from the audience: “Under a single payer, Medicare for all program, would I have to give up my excellent retired teachers’ health benefit program that we fought so hard for all of these years?”

That’s a very good question. These programs are often more comprehensive than Medicare. In fact, that is why we specify an improved Medicare as the framework for a single payer national health program. All essential health benefits would be included; deductibles, co-payments and coinsurance would be eliminated, and the administration of the program would be streamlined. There would be no need to maintain the teachers’ health benefit program as a separate entity.

What is alarming about this report from Hawaii is that these sacrosanct programs are now vulnerable. The teachers’ well-funded voluntary employees’ beneficiary association trust (VEBA) is about to be dumped into the near-bankrupt health benefit trust established for other government employees. The double tragedy is that the teachers lose, and other government employees who should have the most secure of health benefit plans are also losing as more of their health care costs inevitably will be dumped on them.

If our best and most stable health insurance programs are facing this uncertain future, what does that say about the security of other private insurance programs within our fragmented system of financing health care?

The Patient Protection and Affordable Care Act (PPACA) rewards employers who dump their health benefit programs by requiring health care assessments that are only a fraction of what they pay in premiums for their existing insurance programs. Their employees then are forced, by mandate, to purchase plans within the exchanges. Though purchased through exchanges, these plans are merely a slightly more regulated reincarnation of the individual market – the least stable and least reliable of private insurance plans. The subsidies for these plans are the equivalent of vouchers, providing a mechanism for shifting ever more of health care costs to those individuals with the greatest health care needs.

The teachers of Hawaii are right to be concerned. They need to fight hard to protect their VEBA, at least long enough for us to enact an even better program for them and everyone else – an improved Medicare for all.

Hawaii teachers' health benefits threatened

Teachers sue over health plan

By Susan Essoyan
Star Advertiser
September 15, 2010
Hawaii public school teachers filed suit yesterday in Circuit Court to block changes in their health coverage, saying that the state’s plan to do away with their health benefit trust fund is unconstitutional.
The suit, Kono et al. v. Lingle et al., seeks to represent more than 15,000 active and retired school teachers with health benefits in the Hawaii State Teachers Association Voluntary Employees’ Beneficiary Association Trust.
The teachers are objecting to the state’s plan to transfer their health benefit plans from “the financially sound” VEBA to the “insolvent or nearly insolvent” Employer-Union Health Benefits Trust Fund, according to the lawsuit.
“The forced transfer of the teachers into EUTF is designed to prop up that failing system on the backs of the teachers,” said Paul Alston, attorney for the plaintiffs. “What they will get if they are forced to transfer is higher costs and inferior benefits. It is clearly unconstitutional to take away the valuable benefits the teachers have.”
The suit contends that the change amounts to a breach of contract and violates the Hawaii Constitution by “diminishing or impairing” accrued benefits in the employees’ retirement system. After the switch, teachers will face higher co-payments and curtailed drug coverage and services, it said.
The lawsuit also alleges that the state improperly took $3.96 million from the VEBA trust surplus, which otherwise would have been used as reserves, and put it into the general fund.
The Legislature passed a law to phase out the VEBA trust on Dec. 31, and assign teachers to Employer-Union Health Benefits Trust, which covers more than 94,000 state and county employees and retirees.
The court filing included an April 12 letter from Gov. Linda Lingle to legislators in which the governor called the Employer-Union Health Benefits Trust “insolvent,” adding that “its governance is untenable.” She noted that Aon Consulting, the trust’s consultant, warned on March 31 that the trust fund would likely run out of money to cover expenses later this year.
Aon Consulting recommended a 26 percent increase in premiums as of July 1, but the Employer-Union Health Benefits Trust’s board of trustees has voted to keep rates and benefits the same through December of this year.
http://www.staradvertiser.com/news/hawaiinews/20100915_Teachers_sue_over_health_plan.html

During Q&A at some of my speaking engagements, a common question from the audience: “Under a single payer, Medicare for all program, would I have to give up my excellent retired teachers’ health benefit program that we fought so hard for all of these years?”
That’s a very good question. These programs are often more comprehensive than Medicare. In fact, that is why we specify an improved Medicare as the framework for a single payer national health program. All essential health benefits would be included; deductibles, co-payments and coinsurance would be eliminated, and the administration of the program would be streamlined. There would be no need to maintain the teachers’ health benefit program as a separate entity.
What is alarming about this report from Hawaii is that these sacrosanct programs are now vulnerable. The teachers’ well-funded voluntary employees’ beneficiary association trust (VEBA) is about to be dumped into the near-bankrupt health benefit trust established for other government employees. The double tragedy is that the teachers lose, and other government employees who should have the most secure of health benefit plans are also losing as more of their health care costs inevitably will be dumped on them.
If our best and most stable health insurance programs are facing this uncertain future, what does that say about the security of other private insurance programs within our fragmented system of financing health care?
The Patient Protection and Affordable Care Act (PPACA) rewards employers who dump their health benefit programs by requiring health care assessments that are only a fraction of what they pay in premiums for their existing insurance programs. Their employees then are forced, by mandate, to purchase plans within the exchanges. Though purchased through exchanges, these plans are merely a slightly more regulated reincarnation of the individual market – the least stable and least reliable of private insurance plans. The subsidies for these plans are the equivalent of vouchers, providing a mechanism for shifting ever more of health care costs to those individuals with the greatest health care needs.
The teachers of Hawaii are right to be concerned. They need to fight hard to protect their VEBA, at least long enough for us to enact an even better program for them and everyone else – an improved Medicare for all.

Hawaii teachers’ health benefits threatened

Teachers sue over health plan

By Susan Essoyan
Star Advertiser
September 15, 2010

Hawaii public school teachers filed suit yesterday in Circuit Court to block changes in their health coverage, saying that the state’s plan to do away with their health benefit trust fund is unconstitutional.

The suit, Kono et al. v. Lingle et al., seeks to represent more than 15,000 active and retired school teachers with health benefits in the Hawaii State Teachers Association Voluntary Employees’ Beneficiary Association Trust.

The teachers are objecting to the state’s plan to transfer their health benefit plans from “the financially sound” VEBA to the “insolvent or nearly insolvent” Employer-Union Health Benefits Trust Fund, according to the lawsuit.

“The forced transfer of the teachers into EUTF is designed to prop up that failing system on the backs of the teachers,” said Paul Alston, attorney for the plaintiffs. “What they will get if they are forced to transfer is higher costs and inferior benefits. It is clearly unconstitutional to take away the valuable benefits the teachers have.”

The suit contends that the change amounts to a breach of contract and violates the Hawaii Constitution by “diminishing or impairing” accrued benefits in the employees’ retirement system. After the switch, teachers will face higher co-payments and curtailed drug coverage and services, it said.

The lawsuit also alleges that the state improperly took $3.96 million from the VEBA trust surplus, which otherwise would have been used as reserves, and put it into the general fund.

The Legislature passed a law to phase out the VEBA trust on Dec. 31, and assign teachers to Employer-Union Health Benefits Trust, which covers more than 94,000 state and county employees and retirees.

The court filing included an April 12 letter from Gov. Linda Lingle to legislators in which the governor called the Employer-Union Health Benefits Trust “insolvent,” adding that “its governance is untenable.” She noted that Aon Consulting, the trust’s consultant, warned on March 31 that the trust fund would likely run out of money to cover expenses later this year.

Aon Consulting recommended a 26 percent increase in premiums as of July 1, but the Employer-Union Health Benefits Trust’s board of trustees has voted to keep rates and benefits the same through December of this year.

http://www.staradvertiser.com/news/hawaiinews/20100915_Teachers_sue_over_health_plan.html

During Q&A at some of my speaking engagements, a common question from the audience: “Under a single payer, Medicare for all program, would I have to give up my excellent retired teachers’ health benefit program that we fought so hard for all of these years?”

That’s a very good question. These programs are often more comprehensive than Medicare. In fact, that is why we specify an improved Medicare as the framework for a single payer national health program. All essential health benefits would be included; deductibles, co-payments and coinsurance would be eliminated, and the administration of the program would be streamlined. There would be no need to maintain the teachers’ health benefit program as a separate entity.

What is alarming about this report from Hawaii is that these sacrosanct programs are now vulnerable. The teachers’ well-funded voluntary employees’ beneficiary association trust (VEBA) is about to be dumped into the near-bankrupt health benefit trust established for other government employees. The double tragedy is that the teachers lose, and other government employees who should have the most secure of health benefit plans are also losing as more of their health care costs inevitably will be dumped on them.

If our best and most stable health insurance programs are facing this uncertain future, what does that say about the security of other private insurance programs within our fragmented system of financing health care?

The Patient Protection and Affordable Care Act (PPACA) rewards employers who dump their health benefit programs by requiring health care assessments that are only a fraction of what they pay in premiums for their existing insurance programs. Their employees then are forced, by mandate, to purchase plans within the exchanges. Though purchased through exchanges, these plans are merely a slightly more regulated reincarnation of the individual market – the least stable and least reliable of private insurance plans. The subsidies for these plans are the equivalent of vouchers, providing a mechanism for shifting ever more of health care costs to those individuals with the greatest health care needs.

The teachers of Hawaii are right to be concerned. They need to fight hard to protect their VEBA, at least long enough for us to enact an even better program for them and everyone else – an improved Medicare for all.

PNHP E-Alert: Updates and Congressional briefing on Medicare for All and the Deficit Commission

September 14, 2010

Dear PNHP members and friends,

Good news!

Economist and international single-payer expert Tsung-Mei Cheng of Princeton University will join PNHP board member Dr. Olveen Carrasquillo and others at a Sept. 23 congressional briefing on Capitol Hill hosted by PNHP and others. The “honorary hosts” of the meeting are the co-chairs of the Congressional Progressive Caucus, Reps. Raul Grijalva and Lynn Woolsey.

The briefing will target the Deficit Commission’s proposals to cut Medicare and highlight the ability of single payer, Medicare for All to provide universal coverage, reduce health disparities, and significantly reduce the deficit.

Please encourage your member of Congress and their staff to attend the briefing “An analysis of proposed changes to Medicare before the Deficit Commission and a better alternative: Improved Medicare for all” on Thursday, Sept. 23, 2:30 – 4 p.m., 1334 Longworth House Office Building. The full invitation is below. The congressional switchboard is (202) 224-3121.

Thank you for your continued support and especially your priceless efforts for reform.

Cordially,

Quentin Young Signature

Quentin Young, M.D.
National Coordinator

Ida Hellander Signature

Ida Hellander, M.D.
Executive Director

P.S. Every member counts! Renew your membership online today and help support our work. Over 350 overdue PNHPers have renewed in recent weeks in response to our membership renewal campaign.

1. PNHP member and Harvard neurologist Dr. Rachel Nardin is the co-author of an editorial in this week’s issue of Neurology on the black-white mortality gap in muscular dystrophy. African Americans with muscular dystrophy die 10-12 years younger than whites, one of the largest gaps ever observed in the annals of research into health disparities.

The widening mortality gap is likely caused by inequities in the delivery system as well as coverage disparities: African Americans are 1.5 times more likely to be uninsured and about twice as likely to rely on Medicaid, which falls short in providing access to care for conditions like muscular dystrophy.

PNHPers are encouraged to forward the press release to their media contacts.

2. The Census Bureau will announce its latest estimate of the number of uninsured persons in the United States this Thursday, Sept. 16. The expectation is that the number will be higher than last year, perhaps substantially so. PNHP is planning to issue a news release providing comment on the report shortly after the announcement; the release will include state-by-state figures. PNHPers are encouraged to be in touch with their local media contacts and to offer our perspective on the new numbers.

3. Dr. Quentin Young, PNHP’s national coordinator, will be joined by Sen. Bernie Sanders, Rep. John Conyers Jr., Bennett College president Dr. Julianne Malveaux and the NAACP’s Ben Jealous at a panel titled “Health care reform: Where do we go from here?” at the Congressional Black Caucus Foundation’s annual legislative meeting this Thursday, Sept. 16, in Washington. The panel will be moderated by MSNBC’s Ed Schultz.

4. California, which has twice voted to pass single-payer legislation at the state level (subsequently vetoed by the governor), was on the eve of another historic vote for single payer when their Assembly’s leadership held back the bill (S.B. 810) on the last night of their legislative session, thereby killing it until next year.

“Let this temporary detour enliven us to work even harder to see single payer become a reality in California,” wrote the lead sponsor, state Sen. Mark Leno, to supporters. Leno pledged to reintroduce the legislation next year, when there will be a new governor and Legislature.

With the focus now turned to the November elections, single-payer activists in California are educating candidates about the benefits of single payer at both the state and national level. PNHP’s California chapter has a great new website and other ambitious plans for the future that may be a model for other chapters. Check it out here and stay tuned to www.pnhp.org/news/state-single-payer-news for ongoing news from Vermont (where Peter Shumlin, an outspoken single-payer advocate, just won the Democratic primary  race for governor) and other states pursuing state-level single-payer plans.

5. Labor unions and economic justice groups are organizing a march in Washington, D.C., on Saturday, October 2, for jobs and justice (www.onenationworkingtogether.org). A single-payer contingent will be marching under a large “Improved Medicare for All” banner with activists from Single Payer New York, PNHP and others. If you’d like to join the single-payer delegation at the event, please contact PNHP Congressional Fellow Dr. Margaret Flowers at margaret@pnhp.org with “October 2 March” in the subject line.

6. Please join PNHP in Denver for our Annual Meeting on Saturday, November 6, at the Sheraton Denver Downtown Hotel. The Annual Meeting is PNHP’s most important, energizing and inspiring gathering of the year. This year’s theme is “From PPACA to Single Payer: Next Steps for Single-Payer Activists in the Wake of the Obama Health Plan.” Speakers will include Amy Goodman, PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler, and more. A limited numbe
r of travel scholarships are available for medical students.

Are you ready for Leadership Training? New PNHP members – and longtime members who want to take the next step and get active – are invited to come to Denver the day before the Annual Meeting to participate in PNHP’s popular crash course in health policy and politics starting on Friday, November 5, at 1:00 p.m. We look forward to working with you! Contact Matt Petty at matt@pnhp.org or 312-782-6006 to register.

Blacks with muscular dystrophy die 10-12 years younger than whites: new study

Widening mortality gap likely caused by inequities in care, insurance coverage

EMBARGOED until
Monday, Sept. 13, 2010, at 4 p.m. Eastern time    

Contact:
Nicte I. Mejia, M.D.
Rachel Nardin, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

African Americans with muscular dystrophy die 10 to 12 years younger than their white counterparts, according to research published in today’s (Tuesday, Sept. 14) issue of Neurology, the medical journal of the American Academy of Neurology.

The black-white mortality gap, which was calculated on the basis of 20 years of data, is among the largest ever observed in the annals of research into racial disparities in health care, say Dr. Nicte Mejia and Dr. Rachel Nardin, co-authors of the editorial. “Furthermore,” they write, “white patients with MD [muscular dystrophy] enjoy increasing survival, while survival of black patients with MD barely budges,” leading to an ongoing widening of that gap.

Muscular dystrophy is a group of inherited muscle diseases that lead to early death due to respiratory or cardiac failure. Various types of MD affect about 50,000 Americans.

“Inequities in the health delivery system – and the multiple ways in which race constrains access to care – seem the most likely explanation for the observed MD black-white mortality gap,” Mejia and Nardin write in their editorial. But they add that inadequate access to care due to lack of good quality health insurance may also be part of the picture.

“Nonelderly African Americans are 1.5 times more likely than whites to lack any type of insurance and about twice as likely to rely on Medicaid,” they write, noting that lack of health insurance is linked to lack of access to care.

And while Medicaid, the public health program for the poor, compares favorably with private insurance in providing access to primary care, it falls short when it comes to providing access to the standard-of-care treatments needed to manage conditions like muscular dystrophy, they say.

These shortcomings of Medicaid coverage are “particularly worrisome because more than half of the new health coverage under the 2010 National Health Reform will be Medicaid.”

In a separate comment made today, Nardin said, “Replacing the current U.S. health care financing system with a single-payer system that would ensure comprehensive insurance coverage for every American, regardless of race, would go a long way toward reducing this type of disparity.”

Mejia and Nardin’s editorial, titled “Dying young: Eliminating racial disparities in neuromuscular disease outcomes,” is based on a research paper by Aileen Kenneson, Ph.D., Ajay Vatave, M.D., and Richard Finkel, M.D., titled “Widening Gap in age at muscular dystrophy-associated death between black and whites, 1986-2005,” which is being published simultaneously in the same issue of Neurology, the world’s leading clinical neurology journal. For copies of the research study and editorial, contact the press room at the journal by calling Angela Babb at (651) 695-2789 or Rachel Seroka at (651) 695-2738 or by visiting http://www.aan.com/go/pressroom.

###

Physicians for a National Health Program (www.pnhp.org) is an organization of more than 17,000 doctors who support single-payer national health insurance. PNHP had no role in funding or otherwise influencing the articles mentioned above. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Leadership Conference for Guaranteed Health Care

Dear Members of the House of Representatives and Health Staff,
 
You are cordially invited to attend a congressional briefing:

“An analysis of proposed changes to Medicare before the Deficit Commission and a better alternative: Improved Medicare for all”

Thursday, Sept. 23, 2:30 – 4 p.m., 1334 Longworth House Office Building

Panelists:

Tsung-Mei Cheng, distinguished health economist and expert on comparative health systems at Princeton University. Professor Cheng writes and lectures internationally on such topics as single-payer systems, health care quality, financing, pay-for-performance and technology assessment. She also hosts Princeton’s television program, “International Forum.”

Olveen Carrasquillo, M.D., nationally recognized authority on health disparities, minority health, health services research, health policy, access to care and national health insurance. He is presently chief of the Division of General Internal Medicine in the Department of Medicine at the Miller School of the University of Miami and a board member of Physicians for a National Health Program

Michele Evermore, legislative advocate for National Nurses United.  Prior to working for NNU, she was a senior legislative officer in the Office of Congressional and Intergovernmental Affairs at the Department of Labor.  She also has 10 years of experience as a congressional staffer for Sen. Tom Harkin in his personal office and on the Health, Education, Labor and Pensions Committee and for then-Ranking-Member George Miller on the House Education and Labor Committee.

The Honorable Raúl M. Grijalva (Honorary Host),co-chair, Congressional Progressive Caucus

The Honorable Lynn Woolsey (Honorary Host), co-chair, Congressional Progressive Caucus

The panelists will explain changes to Medicare that are being explored by the National Commission on Fiscal Responsibility and Reform and how these changes could weaken the Medicare program. They will describe the strengths of our current Medicare, in particular as it pertains to reducing poverty and health disparities, and how an improved Medicare for All would effectively assure truly universal care, cost controls and financial solvency.

With more than 46 million uninsured Americans, 45,000 deaths a year due to lack of health insurance, and 62 percent of personal bankruptcies linked to medical debt, it is clear even more thoroughgoing health care reform is needed and must be part of any economic recovery plan.

Please attend and participate in the discussion. Light refreshments will be provided.

This briefing is intended for Members and staff. RSVP is appreciated, not required. Contact Dr. Margaret Flowers at margaret@pnhp.org, (410) 591-0892.

The Leadership Conference for Guaranteed Health Care is a coalition of doctors, nurses and other health care providers; labor unions; nonprofit agencies; reform advocates and faith-based
organizations working to achieve comprehensive, high quality, and affordable health care coverage for everybody in the United States. The coalition specifically advocates for a publicly funded and privately delivered national health care system structured around a single-payer financing mechanism. Co-sponsors of this event include Physicians for a National Health Program, National Nurses United, Healthcare-Now, Progressive Democrats of America, All Unions Committee for Single Payer, Labor Campaign for Single Payer, RESULTS, Prosperity Agenda, Code Pink, Gray Panthers and Social Security Works.

Racial disparities a death sentence for muscular dystrophy patients

Blacks with muscular dystrophy die 10-12 years younger than whites: new study

PNHP
September 13, 2010

African Americans with muscular dystrophy die 10 to 12 years younger than their white counterparts, according to research published in today’s (Tuesday, Sept. 14) issue of Neurology, the medical journal of the American Academy of Neurology.

The black-white mortality gap, which was calculated on the basis of 20 years of data, is among the largest ever observed in the annals of research into racial disparities in health care, say Dr. Nicte Mejia and Dr. Rachel Nardin, co-authors of the editorial. “Furthermore,” they write, “white patients with MD [muscular dystrophy] enjoy increasing survival, while survival of black patients with MD barely budges,” leading to an ongoing widening of that gap.

“Inequities in the health delivery system – and the multiple ways in which race constrains access to care – seem the most likely explanation for the observed MD black-white mortality gap,” Mejia and Nardin write in their editorial. But they add that inadequate access to care due to lack of good quality health insurance may also be part of the picture.

“Nonelderly African Americans are 1.5 times more likely than whites to lack any type of insurance and about twice as likely to rely on Medicaid,” they write, noting that lack of health insurance is linked to lack of access to care.

And while Medicaid, the public health program for the poor, compares favorably with private insurance in providing access to primary care, it falls short when it comes to providing access to the standard-of-care treatments needed to manage conditions like muscular dystrophy, they say.

These shortcomings of Medicaid coverage are “particularly worrisome because more than half of the new health coverage under the 2010 National Health Reform will be Medicaid.”

In a separate comment made today, Nardin said, “Replacing the current U.S. health care financing system with a single-payer system that would ensure comprehensive insurance coverage for every American, regardless of race, would go a long way toward reducing this type of disparity.”

https://pnhp.org/news/2010/september/blacks-with-muscular-dystrophy-die-10-12-years-younger-than-whites-new-study-0

Neurology: Widening gap in age at muscular dystrophy–associated death between blacks and whites, 1986–2005
http://www.neurology.org/cgi/content/abstract/75/11/982

Comment:

By Don McCanne, MD

It is shameful that we have tolerated for so long a health care system that has failed to address the inequities and injustices exemplified by a widening black-white mortality gap in patients with muscular dystrophy – an inherited disorder inflicted on blameless victims.

Opponents of true reform (based on principles of health care justice) often blame the victim, implying that it is not the deficiencies in our health care system that are to blame, but it is the patients’ own personal failures that result in their predicaments, and we have no responsibility to intervene.

Even the most callous opponents of reform may acknowledge that there are exceptions in which the victims cannot be blamed, but even in those instances, the unfavorable outcome is often attributed to other socioeconomic factors over which we have no control. The “leave me out of this” mentality certainly contributes to our national inertia.

Maybe we can’t fix everything that’s wrong with our health care system and with society in general, but what we can do is reject the message of the passive obstructionists who contend that we’re each on our own, and join together in solidarity to address our societal deficiencies that have permitted terrible injustices such as sentencing muscular dystrophy patients to die a decade early merely because of their personal circumstances associated with being black.

The Patient Protection and Affordable Care Act will provide many of these unfortunate individuals with access to an insurance program, Medicaid, but as a chronically underfunded welfare program, that in no way ensures access to the actual medical care that they need. Many of them are already on this program, yet it doesn’t prevent them from dying a decade earlier than they might otherwise.

Although we have much to repair in this nation, a very good place to start would be to enact a health care financing system that would ensure that all of us receive the health care that we need – an improved Medicare for all. Furthermore, since collectively we are multi-tasked, we can revitalize and expand simultaneously our work on all of the other social justice issues as well.

Racial disparities a death sentence for muscular dystrophy patients

Blacks with muscular dystrophy die 10-12 years younger than whites: new study

PNHP
September 13, 2010
African Americans with muscular dystrophy die 10 to 12 years younger than their white counterparts, according to research published in today’s (Tuesday, Sept. 14) issue of Neurology, the medical journal of the American Academy of Neurology.
The black-white mortality gap, which was calculated on the basis of 20 years of data, is among the largest ever observed in the annals of research into racial disparities in health care, say Dr. Nicte Mejia and Dr. Rachel Nardin, co-authors of the editorial. “Furthermore,” they write, “white patients with MD [muscular dystrophy] enjoy increasing survival, while survival of black patients with MD barely budges,” leading to an ongoing widening of that gap.
“Inequities in the health delivery system – and the multiple ways in which race constrains access to care – seem the most likely explanation for the observed MD black-white mortality gap,” Mejia and Nardin write in their editorial. But they add that inadequate access to care due to lack of good quality health insurance may also be part of the picture.
“Nonelderly African Americans are 1.5 times more likely than whites to lack any type of insurance and about twice as likely to rely on Medicaid,” they write, noting that lack of health insurance is linked to lack of access to care.
And while Medicaid, the public health program for the poor, compares favorably with private insurance in providing access to primary care, it falls short when it comes to providing access to the standard-of-care treatments needed to manage conditions like muscular dystrophy, they say.
These shortcomings of Medicaid coverage are “particularly worrisome because more than half of the new health coverage under the 2010 National Health Reform will be Medicaid.”
In a separate comment made today, Nardin said, “Replacing the current U.S. health care financing system with a single-payer system that would ensure comprehensive insurance coverage for every American, regardless of race, would go a long way toward reducing this type of disparity.”
https://pnhp.org/news/2010/september/blacks-with-muscular-dystrophy-die-10-12-years-younger-than-whites-new-study-0
Neurology: Widening gap in age at muscular dystrophy–associated death between blacks and whites, 1986–2005
http://www.neurology.org/cgi/content/abstract/75/11/982

It is shameful that we have tolerated for so long a health care system that has failed to address the inequities and injustices exemplified by a widening black-white mortality gap in patients with muscular dystrophy – an inherited disorder inflicted on blameless victims.
Opponents of true reform (based on principles of health care justice) often blame the victim, implying that it is not the deficiencies in our health care system that are to blame, but it is the patients’ own personal failures that result in their predicaments, and we have no responsibility to intervene.
Even the most callous opponents of reform may acknowledge that there are exceptions in which the victims cannot be blamed, but even in those instances, the unfavorable outcome is often attributed to other socioeconomic factors over which we have no control. The “leave me out of this” mentality certainly contributes to our national inertia.
Maybe we can’t fix everything that’s wrong with our health care system and with society in general, but what we can do is reject the message of the passive obstructionists who contend that we’re each on our own, and join together in solidarity to address our societal deficiencies that have permitted terrible injustices such as sentencing muscular dystrophy patients to die a decade early merely because of their personal circumstances associated with being black.
The Patient Protection and Affordable Care Act will provide many of these unfortunate individuals with access to an insurance program, Medicaid, but as a chronically underfunded welfare program, that in no way ensures access to the actual medical care that they need. Many of them are already on this program, yet it doesn’t prevent them from dying a decade earlier than they might otherwise.
Although we have much to repair in this nation, a very good place to start would be to enact a health care financing system that would ensure that all of us receive the health care that we need – an improved Medicare for all. Furthermore, since collectively we are multi-tasked, we can revitalize and expand simultaneously our work on all of the other social justice issues as well.