PNHP

Medicare for all needed for mental health services

Medicare for all needed for mental health services

By F. Douglas Stephenson
Citrus County (Fla.) Chronicle, March 9, 2010

One reliable indicator of health care quality in any nation is life expectancy. Unfortunately, life expectancy in the USA ranks in the bottom quartile of a list of 229 industrialized nations, according to the Organization for Economic Cooperation and Development. Many of these same 29 nations also increased their investment in mental health services while, during the same period, the U.S. slashed its expenditures for psychiatric and mental health services.

Mentally ill patients have been dumped into our communities poorly prepared for them. Thousands of the mentally ill have joined the street people in many of our cities, and, reminiscent of Elizabeth England, the county jail has become the primary community facility for housing most mentally ill people in the United States.

Over 45 million US citizens now lack any kind of health insurance, and millions more have very inadequate coverage in the policies they now carry. Among these with incomes below the federal poverty line, a third had no health insurance. Statistics show that among Americans who are inadequately insured, a significant number are sicker and die younger than those who have insurance.

It is no mystery why this is happening in this country. Because the insurance industry so thoroughly dominates our health care system, the basic concept, purpose and system of health insurance is defined by them. The U.S. subscribes to a business model of health insurance that defines insurers as commercial entities. Private insurers maximize profits by mainly limiting benefits or by not covering people with health problems. Like all businesses, their goal is to make money.

Under the business model, the greed of casual inhumanity is built in and the common good of the citizens and nation is ignored; excluding the poor, the aged, the disabled and the mentally ill is sound business policy, since it maximizes profit.

In most other developed countries, however, the aim of health insurance is simply to promote a social service for universal access to affordable health care for all citizens, and not to generate profits for stockholders, CEOs and other private business entities. The U.S. is the only advanced country in the world with a health care system based on avoiding sick people.

Mental health treatment services in general and talk therapy in particular have been negatively affected by insurance and drug company domination of the US health care system. Talk therapy includes psychotherapy, psychoanalysis, counseling, marriage therapy, family therapy, group therapy, psycho-educational groups, addiction treatment groups and programs, parent training groups, anger management programs and many others.

There are dozens of effective means to deal with human distress that involve talk between qualified professionals and people seeking help. Talk therapy is not one-size-fits-all. It is focused on emotional problems in relationship with oneself or others.

Insurers, with their focus on profit, seek to spend as little as possible on your mental health care. Talk therapy sessions have been drastically cut by insurers. Privacy has been invaded and is no longer assured. Your choice of therapist is no longer under your control.

Likewise, drug companies with profit motive want to sell you drugs. Drugs and insurance companies with profit motive want to sell you drugs. Drug and insurance companies often view talk therapy and qualified practitioners as a threat to their control over the health care system. These companies insist that mental health problems are due to “biological imbalances” which require only expensive medications.

A systematic campaign to discredit the value and competence of talk therapists exists when drug and insurance companies assert, for example, that most types of long-term therapies are not “evidence based.” Insurance coverage for talk therapy has in fact steeply declined since the mid 1980s, from 6 percent to 2 percent of all insurance payments. People seeking talk therapy increasingly must pay for those services out of pocket.

Many people with emotional and psychological problems make good progress with talk therapy or with a combination of talk therapy and medication. While drugs can indeed by helpful, they alone do not “cure” emotional distress and sometimes have uncomfortable side effects. Certainly, there are biological aspects to many emotional and psychological problems, but biology is not the only cause (or cure) for these conditions.

Consumers of health care services do not have to be intimidated into accepting inadequate mental health treatment. Citizens have a right to demand effective clinical service. Tell your health care plan that you want adequate access to qualified talk therapists if you have emotional, addiction or marriage and family problems. Let your employer or human resource department know that you want a solid mental health benefit that includes comprehensive talk therapy services.

We now have over two decades of experience with the conversion of mental health care into a business. Our health care is being rationed, its care guidelines determined by profitability and secrecy decided in private corporate boardrooms.

To realize large profits demanded by Wall Street investors, our health system must attract the healthy and turn away the sick, disabled, the poor, many of the old, and the mentally ill. A 1997 study by the New England Journal of Medicine showed that a large number of Medicare HMOs engaged in favorable selection by “cherry picking” healthier individuals. Since 1987, the number of uninsured in the U.S. has grown by a million each year.

Our mental health care system needs to get private health insurance out of it. Little of value is offered by private insurance when 15 to 25 percent of the health care dollar is skimmed off for profit and overhead. If, for example, the existing Medicare program is now extended to all citizens, universal coverage, “Medicare for all,” for both mental and physical health is possible while strongly containing costs.

The transition to full enrollment in Medicare, for example, could be achieved by gradually dropping the eligibility age over five to ten years. Any losses in phasing out private health insurance industry jobs could be will offset by job gains in other American industries, especially since they would no longer by saddled with such high health insurance costs, as is now the case. Medicare is much more efficient than private insurance, with overhead now less than 4 percent. More importantly, it cannot deny care to those who need it the most, and administration by a single-payer public entity makes controlling costs more possible.

Nobel Prize recipient Bernard Lown, M.D., of the Harvard School of Public Health sums it up nicely: “One may only hope that Winston Churchill’s quip will soon be realized: ‘You can always count on Americans to do the right thing, after they have tried everything else.’ The United States has tried any number of bad solutions for providing its people with health care. Long overdue is the recognition that medicine is a necessary social service that should be accessible to all citizens.”

F. Douglas Stephenson, LCSW, LMFT, BCD, is a graduate of The University of Chicago and was a faculty member in the Department of Psychiatry, University of Florida. A psychotherapist in private practice in Citrus County since 1990, his offices are in Meadowcrest Doctor’s Park, Crystal River, 795-7070.

http://www.chronicleonline.com/cgi-bin/c2.cgi?071+article+Health+20100308143128071071003

AMA health insurer report card

New AMA Health Insurer Report Card Finds Need For More Accuracy

AMA
June 14, 2010
The American Medical Association (AMA) today announced that one in five medical claims are processed inaccurately by health insurers, according to the AMA’s third annual check-up of the nation’s commercial health insurers and the systems they use to manage and pay claims. This was the key finding of the AMA’s 2010 National Health Insurer Report Card.
The AMA estimates that $777.6 million in unnecessary administrative cost could be saved if the health insurance industry improves claims processing accuracy by one percent. Increasing the health insurance industry’s accuracy rating to 100 percent would save up to $15.5 billion annually that could be better used to enhance patient care and help reduce overall health care costs.
http://www.ama-assn.org/ama/pub/news/news/2010-report-card.shtml
National Health Insurer Report Card
http://www.ama-assn.org/ama1/pub/upload/mm/368/2010-nhirc-results.pdf

The private insurance industry is selling us administrative services at an outrageously high price. This report card confirms that we certainly are not receiving value. Not only are we paying them too much, but they also continue to do a lousy job at their most important function – claims processing. Their error rate results in an additional $15 billion annually in administrative waste that could be used for patient care, according to this AMA report.
This year the AMA did not report Medicare’s error rate, but, in the 2008 report card, Medicare’s compliance rate was vastly superior to all of the private insurers – over 98 Percent.
But the greatest argument for changing to an improved Medicare program that covers everyone is not the reduction in waste caused by private insurer claims processing errors which would save about $15 billion, rather it is the replacement of our dysfunctional, fragmented, private/public financing system with a single payer system which would save us about $400 billion annually.
Even if the private insurers could match the claims performance of Medicare, that wouldn’t fix our problems. It’s the financing model that needs to be changed. The $4 trillion that we could recover over the next decade would pay for the needed care for the uninsured and the growing numbers of underinsured. We would have solved our health care financing problems, and that would allow us to direct more of our attention and effort to much needed health system reform.

Insurers wipe out small business credits

Insurance premium hikes hit small business hard

By John Gonzales
San Francisco Chronicle
June 12, 2010

California small-business owners expected to be early beneficiaries of health care reform, with billions of dollars in federal tax relief becoming available this month to help them purchase medical coverage for their employees.

The credit is worth up to 35 percent of a small business’ premium costs.

But many said the tax credits granted under the legislation have run up against a new hurdle: a spate of rate increases by insurance companies, including 58 to 75 percent hikes levied recently by Blue Shield of California.

The company offered other coverage without the high rate increase, but included similar deductibles and added co-pays of about 20 percent. The Blue Shield hikes are in line with increases from all major insurers on small business health savings plans, said (Tom Epstein, vice president of Public Affairs for Blue Shield of California).

“Anthem Blue Cross offered this first,” he said. “Health Net followed us. Aetna and United offered products like this. Every one of these insurers had very substantial rate increases.”

“That money is going right back to the insurance companies,” said Brad Wing, co-owner of the San Francisco Advertiser, who received notice of his 58.3 percent increase in April.

“Normally, rates go up 10 to 15 percent and you can swallow it,” he said. “But at 58 percent, there’s just no way.”

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/06/12/BUGG1DONP4.DTL

Comment: 

By Don McCanne, MD

The Patient Protection and Affordable Care Act (PPACA) is supposed to make health care affordable, primarily by subsidizing private insurance plans. It begins immediately by offering small businesses a credit worth up to 35 percent of premium costs. With Blue Shield of California increasing rates by as much as 58 to 75 percent, how is the small business owner going to find relief when the insurer takes the full subsidy and charges what amounts to another 23 to 40 percent surcharge?

Several individuals who no longer want to hear our single payer message tell us that PPACA is now the law of the land, that private plans are here to stay, and that we need to quit attacking the private insurers and get on with making PPACA work.

When non-profit Blue Shield of California is the best the industry has to offer, how can we possibly ever make that work? We can’t. We need to quit supporting PPACA and get on with making an improved Medicare for all work!

Vermont to explore single-payer option

Governor allows into law a bill calling for creation of a commission to look at overhauling the state's health system.

By Chris Silva
American Medical News, June 11, 2010.

A new Vermont health care bill could lead to significant changes in the state’s delivery and payment structures, including a possible move toward a single-payer system. Governor Jim Douglas announced May 27 that he would allow the bill to become law without his signature.

Douglas, whose term ends in January 2011, said he chose not to put his signature on the bill because of his apprehension about two particular features — the exploration of a single-payer model and the requirement that pharmaceutical companies publicly release information on expenses related to free drug samples.

The law will create a health reform commission, which has until Feb. 1, 2011, to propose to the governor and general assembly three design options for creating a single system of health care in the state. It specifies that one of those options will include the design of a government-administered and publicly financed single-payer benefits system.

Douglas called the provision “a wasteful expense of time and scarce resources,” especially as Vermont would be prohibited by the federal health reform law from implementing any new system designs until 2017 at the earliest. The governor’s office said states could seek a waiver to that rule, but their chances of approval might be limited.

The law also bolsters the state’s medical home model by requiring insurance carriers to participate in the statewide expansion of the program, the Vermont Blueprint for Health. Also, hospitals will be required to establish and maintain interoperable connectivity to the state health information exchange network to support the Blueprint’s clinical data repository. The move is designed to make laboratory, hospital discharge and other data more readily available to physicians.

The Vermont Medical Society, which was involved in the drafting of the bill, said it is in favor of it, though it has not taken a stance on the single-payer provision.

“Ninety percent of the bill continues reform efforts that the medical society has been involved with, particularly around the patient-centered medical home, the statewide adoption and use of health information technology, and the piloting of different payment reform models,” said Paul Harrington, VMS’ executive vice president.

Some of the state’s physicians said they are excited about Vermont exploring the single-payer model.

“With a qualified consultant and the right governor, this just may get us to a better health care system than what the national health care bill will provide,” said family physician Deb Richter, MD, spokeswoman for the citizens group Vermont for Single Payer.

This content was published online only.

http://www.ama-assn.org/amednews/2010/06/07/gvsd0611.htm

Prominent physician tells Portsmouth Rotary Club single-payer system would extend care to all

By Jason Claffey
Foster’s Daily Democrat
Friday, June 11, 2010

PORTSMOUTH — The health care reform bill passed earlier this year — the largest expansion of coverage since Medicare was enacted in 1965 — did not go far enough, a prominent physician told the Portsmouth Rotary Club Thursday.

Dr. Oliver Fein, president of the Physicians for a National Health Program, argued a single-payer system would extend care to all Americans, slash billions of dollars in administrative waste, broaden patients’ choices of doctors, and increase the quality of care.

“It’s a much better deal,” said Fein, a general internist and professor at Cornell University’s Weill Medical College in New York.

He said a single-payer system, or “Medicare for all.” would save $400 billion, enough to cover 50 million uninsured Americans. The health care reform bill is projected to extend coverage to 32 million Americans by 2019.

Fein attended President Obama’s health care summit before the bill was passed. His and others’ advocacy of a single-payer system was watered down to a public option that would compete with private insurers, but Congress ultimately left it out of the final version of the bill.

Physicians for a National Health Program is comprised of 17,000 physicians still fighting for the single-payer system, which offers universal coverage through one insurance pool operated by the government.

Fein and representatives of the group were scheduled to canvas the state Thursday and Friday, making additional stops in Lebanon, Hanover, Concord.

One member of Physicians for a National Health Program is Portsmouth-based Dr. Tom Clairmont, who organized Fein’s appearance Thursday afternoon at the Redhook Ale Brewery.

Clairmont claimed premiums at his practice recently skyrocketed 22 percent.

Fein said that can be attributed to out-of-control administrative costs, which represent more than 30 percent of total health care costs.

“We have to deal with this huge waste in the health care system,” he said.

Private insurers limit a patient’s choice of doctors to those within their network; Fein said a single-payer system would allow patients to choose any doctor.

One drawback of transitioning to the single-payer model is there could be a dearth of primary-care physicians, Fein said, but that would be remedied by an “enormous incentive” to train more.

He argued the quality of care in America is lower compared to other countries with the single-payer model like Canada and the United Kingdom because private companies restrict access to their data for competitive reasons.

“We need a national system that allows data to be collected so quality can be measured,” he said.

He said the U.S. needs to move away from a premium-based system because, if nothing else, “The president of a company pays the same premium as the secretary.”

http://www.fosters.com/apps/pbcs.dll/article?AID=/20100611/GJNEWS_01/706119903

Insurers wipe out small business credits

Insurance premium hikes hit small business hard

By John Gonzales
San Francisco Chronicle
June 12, 2010
California small-business owners expected to be early beneficiaries of health care reform, with billions of dollars in federal tax relief becoming available this month to help them purchase medical coverage for their employees.
The credit is worth up to 35 percent of a small business’ premium costs.
But many said the tax credits granted under the legislation have run up against a new hurdle: a spate of rate increases by insurance companies, including 58 to 75 percent hikes levied recently by Blue Shield of California.
The company offered other coverage without the high rate increase, but included similar deductibles and added co-pays of about 20 percent. The Blue Shield hikes are in line with increases from all major insurers on small business health savings plans, said (Tom Epstein, vice president of Public Affairs for Blue Shield of California).
“Anthem Blue Cross offered this first,” he said. “Health Net followed us. Aetna and United offered products like this. Every one of these insurers had very substantial rate increases.”
“That money is going right back to the insurance companies,” said Brad Wing, co-owner of the San Francisco Advertiser, who received notice of his 58.3 percent increase in April.
“Normally, rates go up 10 to 15 percent and you can swallow it,” he said. “But at 58 percent, there’s just no way.”
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/06/12/BUGG1DONP4.DTL

The Patient Protection and Affordable Care Act (PPACA) is supposed to make health care affordable, primarily by subsidizing private insurance plans. It begins immediately by offering small businesses a credit worth up to 35 percent of premium costs. With Blue Shield of California increasing rates by as much as 58 to 75 percent, how is the small business owner going to find relief when the insurer takes the full subsidy and charges what amounts to another 23 to 40 percent surcharge?
Several individuals who no longer want to hear our single payer message tell us that PPACA is now the law of the land, that private plans are here to stay, and that we need to quit attacking the private insurers and get on with making PPACA work.
When non-profit Blue Shield of California is the best the industry has to offer, how can we possibly ever make that work? We can’t. We need to quit supporting PPACA and get on with making an improved Medicare for all work!

Castlight casts light on sick U.S. health system

Bringing Comparison Shopping to the Doctor’s Office

By Claire Cain Miller
The New York Times
June 10, 2010

The lack of price information in health care has been a big driver of ballooning health care costs, analysts say, because costs are opaque to patients and heavily subsidized by employers. The patient has no incentive or responsibility to keep costs down. But many employers are switching to health plans that require patients to pay more out of their own pockets.

A start-up financed by prominent venture capitalists and the Cleveland Clinic, Castlight Health, aims to change that by building a search engine for health care prices. Patients using Castlight could search for doctors that offer a service nearby and find out how much they will charge, depending on their insurance coverage.

Castlight has received money from investment firms including Venrock, Maverick Capital, Oak Investment Partners and from an unlikely source, the Cleveland Clinic.

Ideally, transparency in health care pricing could lead to higher-quality, lower-cost health care, and more patient involvement in buying health care, said Delos Cosgrove, chief executive of the Cleveland Clinic. “Because they begin to realize that a trip to the doctor is not free, they might stay home and take the aspirin instead of getting the neurologic work-up.”

Castlight sells its service to employers and charges by employee per month.

Safeway, the grocery chain, with 200,000 employees, has signed on as its first customer.

Safeway has been experimenting with ways to cut health costs, including by using Castlight. “I’m a big believer in trying to create market forces wherever you can and then let personal accountability really drive the result,” said Steven A. Burd, the chief executive of Safeway.

Castlight is working on a mobile version of the service to introduce next year so people can access the information from the exam table.

Price transparency could significantly change the way health care is bought in the United States. The notion “seems ridiculously simple and obvious, and in any other industry, you would say, ‘Duh, we already have that.’ But in health care, it’s revolutionary,” said Alan M. Garber, a professor of medicine and the director of the center for health policy at Stanford, as well as an investor in Castlight.

http://www.nytimes.com/2010/06/11/technology/11cost.html

Comment: 

By Don McCanne, MD

Our highly dysfunctional, fragmented health care financing system has opened innumerable opportunities for entrepreneurs to glom onto funds that should be going for health care, especially by diverting them to profoundly wasteful administrative services. One of the latest iterations is Castlight, an entity that is capitalizing on the perverse notion, promoted by the right-wing element in the policy community, that we can control health care costs by making patients more sensitive to prices.

The fact that there is much more money to be made in wasteful administrative services is supported by the faith that the venture capitalists have expressed in Castlight. They have put up the financing because they believe that creating a price shoppers portal can suck up more funds out of our health care system. Our entrepreneurs are there to be sure that the United States remains the world’s leader in blowing up health care budgets through administrative waste.

Castlight’s model begins with the flawed theory that price sensitivity will control health care costs. About four-fifths of health care is provided to the one-fifth of individuals who have the greatest health care needs. Price awareness by these individuals does not influence spending much since most of their care is provided after their deductibles and maximums are met. For the other one-fifth of individuals, only a small portion of their care would be amenable to price shopping, and the discounts that they would receive would have a negligible impact on our total national health expenditures.

Of more concern, requiring out-of-pocket spending as a consequence of accessing health care has been proven to cause individuals to forgo beneficial health care services. A policy that disincentivizes beneficial care should be rejected, especially when it is a policy that wouldn’t help much in our efforts to control spending anyway.

Prices are important. The two most significant reasons that we spend much more on health care in the United States than do other nations are our profound administrative waste, and our prices that are much higher than in all other countries. Did other nations price their health care more appropriately by exposing patients to prices? Of course not. They did it by using the monopsonistic power of their governments in setting prices that were fair for patients and yet adequate to ensure that the health care delivery system receives the funds it needs to function. For controlling administrative costs, they simply adopted sane methods of financing health care.

Perhaps the greatest concern over the Castlight start-up involves ethical issues. Let’s look at Delos Cosgrove, Steven Burd, and Alan Garber.

Although Cleveland Clinic is often touted as an efficient health delivery model, it seems appropriate to criticize it for investing in an entity that is going to profit by providing more excessive administrative services that would expand application of the flawed policy of shifting more costs to patients in need. Of particular concern is the position of their chief executive, Delos Cosgrove, who glibly suggests that price sensitivity could cause a patient to decline a neurological work-up and to go home and take an aspirin instead. Such an important decision should hardly be made on the basis of price shopping.

Steven Burd, chief executive of Safeway, has a track record of touting savings through “personal accountability.” He glosses over the fact that his savings resulted from switching his employees to high-deductible health plans. Now he is becoming a customer of Castlight thereby solidifying the policy that his employees may not receive care that they should have because they have a price barrier between them and health care.

But what about the ethics of Alan Garber, a professor of medicine and the director of the center for health policy at Stanford? Although very knowledgeable about the impacts of health policy, he is personally investing in a company that wastes more resources on excess administration and that he says is “revolutionary” in bringing transparency in support of the inappropriate price barriers that are being erected on the path to health care. Is that an ethical compromise for a health policy expert? As he says, “Duh.”

Doctor makes case for single-payer care

By Jennifer Feals
Portsmouth (N.H.) Herald, June 11, 2010

PORTSMOUTH — More than 100 business owners, health care professionals, patients and elected officials gathered Thursday to learn about a single-payer health care system, many stating their support.

Dr. Oliver Fein, president of Physicians for a National Health Program, presented “Everybody In, Nobody Out, One Group, One Plan, One Rate,” touting the need for a single-payer national system.

Fein referred to the system as “Medicare for all,” and said it would save $400 billion annually — enough to cover the nation’s 46 million uninsured — and addresses issues facing the health care system like access, choice and quality.

“If you look at the logic, it’s a no-brainer,” said Rich Holzen, of Kittery, Maine. “Yet, it has not been debated in public. People hear socialized medicine — that’s the bogeyman. But what was presented today clearly isn’t socialized medicine.”

PNHP is fighting the new health care law, which Fein said has good features but doesn’t do enough. While it offers expanded coverage, it is not universal, has no definition of benefits and is a handout to the private health insurance industry, he said.

“The legislation that passed really did not go far enough in terms of what we need and health care reform,” said Fein, professor of medicine and public heath at Weill Medical College at Cornell University.

The single-payer system would eliminate pre-existing conditions, co-payments and deductibles, and would cover all who need health insurance. It reduces costs, Fein said, by creating global budgets for hospitals, negotiated fees for providers, bulk purchasing of pharmaceuticals and the elimination of billing departments and administrative waste.

In addition to meeting with the group Thursday afternoon, Fein met with members of the Portsmouth Rotary earlier in the day. On Thursday evening, Fein spoke to physicians and patients at Dartmouth Medical School and Concord Hospital.

Members of the public, like Holzen, asked how they can get involved to help change the current system. Fein said contacting congressional representatives will be important, in addition to inviting PNHP supporters and doctors to speak to local groups and organizations.

State Rep. Rich DiPentima, D-Portsmouth, said the public is ahead of policy makers in understanding what health care changes need to take place. But implementing that change, he said, is going to be “tricky.”

“Because you have the negative and misinformation about the single-payer system,” he said. “It’s going to be an education opportunity. We really have to educate the public.”

State Sen. Martha Fuller Clark, D-Portsmouth, said she’s proud of the accomplishments of the new health care bill in that it gets coverage to those who don’t have it and ensures that patients who need coverage won’t be dropped.

But time will tell, she said, if elements of a single-payer program can be implemented into the system and how that would be done.

“This seems the right way to go, but the real question is how do we go about converting enough people and elected officials to put this in place,” she said.

Fuller Clark said the single-payer system is one she would support and work toward implementing, possibly even a combined effort between Maine, New Hampshire and Vermont for a pilot program.

http://www.seacoastonline.com/articles/20100611-NEWS-6110412

Single payer news, WellPoint resolution, new slides

June 11, 2010

Dear PNHP colleagues,

We have much to report – a dramatic campaign around a shareholder resolution against WellPoint (reminiscent of the campaign against Dow over napalm), pro-single-payer op-eds and news coverage, Dr. Margaret Flowers’ receipt of an Our Bodies Ourselves “Woman Health Hero of the Year” award, and the availability of new PNHP slides on the federal health bill and the case for single-payer national health insurance.

We hope you’ll find much of interest in this online newsletter. You’ll also be receiving a 72-page print PNHP newsletter in the mail soon. We hope you’ll take a moment now or when it arrives to renew your membership or to make a donation.

If you subscribe to CREDO phone services, you can also vote for PNHP to receive one of the company’s annual grants to nonprofit organizations “working for a better world.” We’re within striking range of receiving a substantial award; please take a moment and vote here.

Thanks for your continued support and especially your priceless efforts for reform!

Cordially, 


Ida Hellander, MD
Executive Director


Mark Almberg
Communications Director

1. WellPoint shareholder resolution gets over 30 million votes

Dr. Rob Stone led a group of shareholders at WellPoint’s annual meeting in Indianapolis on May 18 who presented a resolution calling on the company to return to its nonprofit roots. Citing some of the giant insurer’s most egregious practices, he and others in Hoosiers for a Commonsense Health Plan received extensive media coverage and, they later learned, over 30 million share votes (9.4 percent) in support of their proposal, advancing it to the next phase. A spirited and well-attended rally took place the same day with Dr. Quentin Young (who writes in The Huffington Post about his participation here) and Wendell Potter, among others, followed by an impressive strategy meeting of some 50 regional activists. If you’d like to stay in the loop about shareholder resolutions, possible divestment campaigns and related issues, you can join a Google Group for this purpose here.

2. Single payer in the news

Dr. Johnathon Ross’ op-ed on why health reform needs to be built on a new foundation of public financing appeared in the Cleveland Plain Dealer (reprinted below).

PNHP President Dr. Oliver Fein received excellent press coverage for his visit to New Hampshire this week. He presented grand rounds to over 70 physicians, spoke to 120 small-business owners at a Rotary Club, and addressed a public forum that drew over 100 people, all in one day.

An editorial listing the many virtues of an improved Medicare for All (“It’s still the best idea”) appeared in the The Cap Times (Madison, WI) newspaper.

Finally, Dr. Margaret Flowers received the “Audience Choice Award” for “Woman Health Hero of the Year” in a national contest sponsored by Our Bodies, Ourselves.  Congratulations, Dr. Flowers!

3. New slides and resources for single-payer activists, including activists working on state single-payer bills

Dr. Steffie Woolhandler presented new slides to the PNHP Board on May 22. Those slides are available to PNHP members for use in grand rounds and other talks now at www.pnhp.org/slideshows.

Catch up on all the state level efforts for single payer with an overview article by PNHP journalism intern Chris Gray, “States seek to lead the way on single payer.“

Interesting in learning more about the Canadian health system and how to debate the case for single payer? Dr. Howard Dean, former head of the Democratic National Committee, recently participated in a debate in Canada on the merits of U.S. versus Canadian health care: “I’ve spent a lot of time in both countries and there is no doubt that you’re better off getting sick in Canada.” He cited the higher efficiency and effectiveness of Canada’s single-payer system and its ability to provide quality care to everybody. PNHP Senior Health Policy Fellow Dr. Don McCanne recommends watching the full two hours of this very informative debate (click on “Watch the video”).

4. Vote for PNHP to receive grant funds from CREDO

If you belong to CREDO’s phone network, you can cast a vote for PNHP in its annual contest among worthy nonprofits deserving of its financial support here.

5. What else PNHP members can do:

  1. Give a grand rounds or a talk to a local civic, faith or community group. PNHP has new slides for this purpose on our web site at www.pnhp.org/slideshows.

  2. Write a letter to the editor or an opinion piece to your local newspaper. Dr. Johnathan Ross’ op-ed (below) is an excellent model.

  3. Educate your elected officials (and candidates for the 2010 elections) about the merits of single-payer Medicare for All. (Rep. John Conyers has pledged to reintroduce H.R. 676 in the next legislative session.) Drop a note to PHNP organizer Ali Thebert at ali@pnhp.org if you’d like assistance, or to let us know about your efforts to track our progress.

Build foundation for health care on Medicare

By Johnathon Ross, M.D.
Cleveland Plain Dealer, May 30, 2010

Mrs. Brown (not her real name) was recently in to check on her blood pressure. She knows I’ve worked decades for a national health plan that would benefit individuals and businesses alike.

“So what do you think of the reform bill, Doc?”
she asked, hoping I’d be pleased.

I replied with a question of my own: “Would you add a third floor to a house that has a crumbling foundation?” Because that is what Congress just did.

The crumbling foundation is our private, for-profit, insurance-based system of financing health care. As nonprofit, community-service organizations, health insurers were once a boon to millions of workers and thousands of companies. Now, they are a very bad bargain, indeed.

Private insurers make money by denying claims. They cause us to waste enormous amounts of money on excess paperwork and bureaucracy — their own paperwork and the paperwork they inflict on hospitals, patients and doctors like me. An estimated 31 cents of every health care dollar goes toward administration in U.S. health care, at least half of it unnecessary.

The problem is getting worse. The number of administrative personnel in health care jumped more than 3,000 percent over the past three decades, while the number of doctors, nurses and other caregivers has grown by less than 200 percent.

In effect, health care has been overtaken by an army of bureaucrats whose “generals” — the CEOs — get astronomical salaries. Money-changers and paper-pushers thrive chasing the money to pay for care — not deliver it. In our complex, multipayer system, chasing money is expensive work.

Does the new law remedy this? No. “Insurance exchanges” will add yet another layer of private bureaucrats and IRS agents to determine eligibility for subsidies and enforce fines for those who fail to purchase insurance.

Private insurers in the new exchanges will continue to advertise and market their products, bill for premiums, determine eligibility for coverage, coordinate benefits, manage a multitude of yearly contracts with brokers, businesses, individuals, doctors, hospitals and other providers and, lastly, pay stockholders a high rate of return.

Each hospital and doctor will continue to track myriad contracts, discount arrangements, benefit packages, drug formularies, limited referral networks and insurance rules designed to reduce utilization of our medical resources and to increase insurance company profits.

The new law perpetuates this wasteful overhead and guarantees insurers more profits as we spend $447 billion over 10 years to subsidize the mandatory purchase of shoddy private insurance by 16 million uninsured Americans.

The exchanges are supposed to bring down prices by promoting “market competition” among various insurers. But Massachusetts and several other states have had plenty of experience with such exchanges, and the verdict is clear: They don’t control costs. In fact, Massachusetts now has the highest health care costs in the world.

As a rule, “market competition” doesn’t work well in health care. Health care is not an ordinary product that people want. Rather, it is a necessity that they must have. The most expensive care is most often not optional, predictable or negotiable.

Businesses are groaning under the burden of the rising costs of employee and retiree health care benefits. They, too, need to get out from under the heel of the private health insurance industry and the skyrocketing, volatile prices that come with it.

So what’s the alternative? It’s building on the solid foundation of our tax-financed, low-overhead Medicare system, and extending it to cover everyone without exception. The administrative savings from such a streamlined system would amount to $400 billion per year, enough to provide comprehensive coverage to all with no significant out-of-pocket expenses and with complete choice of doctor and hospital.

A single-payer system would also have the clout to negotiate drug prices and provider fees, and to allocate resources efficiently and wisely. It would possess powerful tools for improving quality and controlling costs.

Conventional wisdom suggests we have to “wait and see” how the administration’s new law plays out. But we can’t afford that: With about 50 million uninsured this year, some 50,000 people will die because they lack coverage, a recent study estimates. By 2019, those figures will only be halved, experts say.

It’s not too late to do the right thing. The sooner we adopt an expanded and improved Medicare-for-all, the better off our patients and our economy will be.

Ross is past president of Physicians for a National Health Program (pnhp.org) and a leader of the Single Payer Action Network in Ohio (spanohio.org).

Health care drama at America’s crossroads

By Dr. Quentin Young
The Huffington Post
June 9, 2010

The movement for single-payer health reform – an improved Medicare for All – is hopping in Indianapolis, “the Crossroads of America.”

I can personally vouch for this, having taken part in two events there on May 18 sponsored by Hoosiers for a Commonsense Health Plan and several other groups committed to health care justice.

The occasion? The annual shareholders meeting of WellPoint, the giant for-profit health insurance company.

For the fourth year in a row, a small group of energetic and principled shareholders led by Dr. Rob Stone of Bloomington, Ind., attended the annual meeting with the aim of speaking truth to power. They sought to direct shareholders’ and the media’s attention to some of WellPoint’s most egregious practices, including (as Dr. Stone eloquently describes here) its astronomical premium hikes on individuals and businesses, its notorious algorithm for canceling insurance policies of women predisposed to breast cancer, and – in an evasion of parts of the new health law – its relabeling of administrative expenses as “medical care.”

This year, in their latest bid to move WellPoint away from its corporate-greed and service-denial posture, Dr. Stone and others successfully introduced a shareholder resolution calling upon the company to demutualize – i.e. to return to its original, nonprofit status. (WellPoint was once a nonprofit, charitable Blue Cross company.)

The subtext was clear: WellPoint should concern itself with maximizing health care rather than profits.

It was this shareholder resolution calling on WellPoint to be socially responsible that prompted local organizers to invite me to participate in two related activities in Indianapolis that day – an afternoon health reform rally (“Health reform – we’re still for it!”) and a subsequent strategy session with regional activists – for I had played a modest role in pushing a precedent-setting, similar shareholder resolution some four decades ago.

In 1968, the Medical Committee for Human Rights (where I was then chairman), was given 10 shares of stock in the Dow Chemical Company. Dow was the leading manufacturer of napalm, a jellied gasoline, which was being used widely by the U.S. military in the war in Vietnam, including on its civilian population.

MCHR’s leadership developed a shareholder resolution calling on Dow’s board to stipulate “that napalm shall not be sold to any buyer unless that buyer gives reasonable assurances that the substance will not be used on or against human beings.”

To make a long story short, after being rebuffed by Dow’s board, the Securities and Exchange Commission, and various courts, the legitimacy of our resolution was eventually upheld and the measure was ultimately voted upon. While it got less than 3 percent of the shareholders’ votes, the effort helped to pave the way for many other “socially r
esponsible” shareholder resolutions in subsequent years – including this year’s WellPoint resolution.

I must admit that I experienced a certain sense of satisfaction in seeing MCHR’s human concerns of four decades ago finding strong expression in today’s context.

Dr. Stone briefly presented his resolution in the morning and then, a bit later in the meeting, his colleagues (and other shareholders) readied themselves to participate in the question and answer session.

But then an interesting, unanticipated event gave drama and an unexpected twist to the meeting. A member of WellPoint’s board, William “Bucky” Bush (brother of George H.W. and uncle to George W.), fainted. The immediate first aid came from Dr. Stone, a seasoned ER doc, and Mr. Bush proceeded to recover promptly.

Nonetheless, WellPoint CEO Angela Braly (whose annual compensation was recently boosted to $13.1 million), who was chairing the meeting, seized on this incident to abruptly adjourn the session, thereby short-circuiting the discussion period. This was bad, but certainly not the worst conduct of the WellPoint organization.

Even so, consider this: a subsequent tally showed that Dr. Stone’s resolution calling for WellPoint to return to nonprofit status received 9.4 percent of the shareholder votes, representing over 30 million shares!

This extraordinary development, and the well-attended rally and activists’ meeting that followed the shareholders meeting, are symptomatic of persistent national unrest with the present financing of our health care system, based as it is on private health insurers. The passage of the new health law has not addressed that unrest.

Physicians for a National Health Program argues forcefully that the central problem in our current health system is embodied in corporate giants like WellPoint. PNHP, sadly, feels that the new health law on balance actually increases the stranglehold of these corporate interests on our health system, with dire results in cost, quality and access.

For this reason, all of our endeavors seek to establish single-payer national health insurance, an improved Medicare for All: “Everybody in, nobody out.”

The Indianapolis events demonstrate the continuing vigor and commitment of single-payer health advocates nationwide.

We must continue to strive to join the rest of the world’s democratic, industrialized nations in achieving a truly universal, comprehensive health care system. Such an achievement will not only enhance the health status of our people but arguably will rescue our failing economy as well.

Castlight casts light on sick U.S. health system

Bringing Comparison Shopping to the Doctor’s Office

By Claire Cain Miller
The New York Times
June 10, 2010
The lack of price information in health care has been a big driver of ballooning health care costs, analysts say, because costs are opaque to patients and heavily subsidized by employers. The patient has no incentive or responsibility to keep costs down. But many employers are switching to health plans that require patients to pay more out of their own pockets.
A start-up financed by prominent venture capitalists and the Cleveland Clinic, Castlight Health, aims to change that by building a search engine for health care prices. Patients using Castlight could search for doctors that offer a service nearby and find out how much they will charge, depending on their insurance coverage.
Castlight has received money from investment firms including Venrock, Maverick Capital, Oak Investment Partners and from an unlikely source, the Cleveland Clinic.
Ideally, transparency in health care pricing could lead to higher-quality, lower-cost health care, and more patient involvement in buying health care, said Delos Cosgrove, chief executive of the Cleveland Clinic. “Because they begin to realize that a trip to the doctor is not free, they might stay home and take the aspirin instead of getting the neurologic work-up.”
Castlight sells its service to employers and charges by employee per month.
Safeway, the grocery chain, with 200,000 employees, has signed on as its first customer.
Safeway has been experimenting with ways to cut health costs, including by using Castlight. “I’m a big believer in trying to create market forces wherever you can and then let personal accountability really drive the result,” said Steven A. Burd, the chief executive of Safeway.
Castlight is working on a mobile version of the service to introduce next year so people can access the information from the exam table.
Price transparency could significantly change the way health care is bought in the United States. The notion “seems ridiculously simple and obvious, and in any other industry, you would say, ‘Duh, we already have that.’ But in health care, it’s revolutionary,” said Alan M. Garber, a professor of medicine and the director of the center for health policy at Stanford, as well as an investor in Castlight.
http://www.nytimes.com/2010/06/11/technology/11cost.html

Our highly dysfunctional, fragmented health care financing system has opened innumerable opportunities for entrepreneurs to glom onto funds that should be going for health care, especially by diverting them to profoundly wasteful administrative services. One of the latest iterations is Castlight, an entity that is capitalizing on the perverse notion, promoted by the right-wing element in the policy community, that we can control health care costs by making patients more sensitive to prices.
The fact that there is much more money to be made in wasteful administrative services is supported by the faith that the venture capitalists have expressed in Castlight. They have put up the financing because they believe that creating a price shoppers portal can suck up more funds out of our health care system. Our entrepreneurs are there to be sure that the United States remains the world’s leader in blowing up health care budgets through administrative waste.
Castlight’s model begins with the flawed theory that price sensitivity will control health care costs. About four-fifths of health care is provided to the one-fifth of individuals who have the greatest health care needs. Price awareness by these individuals does not influence spending much since most of their care is provided after their deductibles and maximums are met. For the other one-fifth of individuals, only a small portion of their care would be amenable to price shopping, and the discounts that they would receive would have a negligible impact on our total national health expenditures.
Of more concern, requiring out-of-pocket spending as a consequence of accessing health care has been proven to cause individuals to forgo beneficial health care services. A policy that disincentivizes beneficial care should be rejected, especially when it is a policy that wouldn’t help much in our efforts to control spending anyway.
Prices are important. The two most significant reasons that we spend much more on health care in the United States than do other nations are our profound administrative waste, and our prices that are much higher than in all other countries. Did other nations price their health care more appropriately by exposing patients to prices? Of course not. They did it by using the monopsonistic power of their governments in setting prices that were fair for patients and yet adequate to ensure that the health care delivery system receives the funds it needs to function. For controlling administrative costs, they simply adopted sane methods of financing health care.
Perhaps the greatest concern over the Castlight start-up involves ethical issues. Let’s look at Delos Cosgrove, Steven Burd, and Alan Garber.
Although Cleveland Clinic is often touted as an efficient health delivery model, it seems appropriate to criticize it for investing in an entity that is going to profit by providing more excessive administrative services that would expand application of the flawed policy of shifting more costs to patients in need. Of particular concern is the position of their chief executive, Delos Cosgrove, who glibly suggests that price sensitivity could cause a patient to decline a neurological work-up and to go home and take an aspirin instead. Such an important decision should hardly be made on the basis of price shopping.
Steven Burd, chief executive of Safeway, has a track record of touting savings through “personal accountability.” He glosses over the fact that his savings resulted from switching his employees to high-deductible health plans. Now he is becoming a customer of Castlight thereby solidifying the policy that his employees may not receive care that they should have because they have a price barrier between them and health care.
But what about the ethics of Alan Garber, a professor of medicine and the director of the center for health policy at Stanford? Although very knowledgeable about the impacts of health policy, he is personally investing in a company that wastes more resources on excess administration and that he says is “revolutionary” in bringing transparency in support of the inappropriate price barriers that are being erected on the path to health care. Is that an ethical compromise for a health policy expert? As he says, “Duh.”

The Medicare-for-all concept won't go away

Plain Talk: Medicare for all still the best idea

By Dave Zweifel, Cap Times editor emeritus
The Cap Times
June 9, 2010

But what’s still so befuddling is that health care reform could have been so much better — and easier for everyone to understand.

In fact, following the 2008 presidential election, the opportunity to finally get the United States to adopt a universal single-payer health care system seemed at hand.

Many of the Democrats who had been swept into office that fall had campaigned for single-payer and there were strong indications that the congressional leadership was ready to introduce legislation that, in effect, would reduce the eligibility for Medicare from age 65 to 0.

People were beginning to understand that there’s enough administrative waste in the existing system that extending health coverage to every American from birth to death could be accomplished without substantial added cost. Yes, the Medicare payroll tax would need to be increased, but that increase would be more than offset by the elimination of insurance premiums for both employers and employees.

Further, single-payer isn’t some kind of experimental, untested idea. It’s working all around us, has been for years. For decades the Canadians, the British, the French, the Germans and countless other so-called advanced countries have had a universal health care system that covers all of their citizens.

Yet by the time Congress fiddle-faddled its way through a bunch of meetings and pro-insurance company legislators were placed in key positions to come up with a bill that would somehow appeal to Republicans as well as so-called Blue Dog Democrats, single-payer didn’t even make it to first base. The entrenched interests — those with money to throw into campaign coffers and into lobbying — succeeded in shoving it aside.

http://host.madison.com/ct/news/opinion/column/dave_zweifel/article_fea11bd1-f781-58b0-b709-c1a02c3d97d6.html

Comment: 

By Don McCanne, MD

Just because Congress passed and the President signed a bill labeled “health care reform” doesn’t mean that the policy debate has been retired. Single payer Medicare for all is “still the best idea.”

The public will soon understand that “passing reform” did not guarantee insurance for everyone, it did not guarantee that insurance benefits will be adequate to prevent financial hardship, and it did not prevent insurers from denying patients choice by restricting care to their limited networks of providers.

But what will really convince everyone that we didn’t get real reform is that individuals, employers and the government will continue to see intolerable increases in the costs of health care. Skyrocketing insurance premiums for low actuarial value products that fail to protect personal household finances will drive the demand for the reform we need.

We don’t have to wait until 2020 or later to fix it. Before the November elections, let the candidates know that we want an improved Medicare for all now.

The Medicare-for-all concept won’t go away

Plain Talk: Medicare for all still the best idea

By Dave Zweifel, Cap Times editor emeritus
The Cap Times
June 9, 2010

But what’s still so befuddling is that health care reform could have been so much better — and easier for everyone to understand.

In fact, following the 2008 presidential election, the opportunity to finally get the United States to adopt a universal single-payer health care system seemed at hand.

Many of the Democrats who had been swept into office that fall had campaigned for single-payer and there were strong indications that the congressional leadership was ready to introduce legislation that, in effect, would reduce the eligibility for Medicare from age 65 to 0.

People were beginning to understand that there’s enough administrative waste in the existing system that extending health coverage to every American from birth to death could be accomplished without substantial added cost. Yes, the Medicare payroll tax would need to be increased, but that increase would be more than offset by the elimination of insurance premiums for both employers and employees.

Further, single-payer isn’t some kind of experimental, untested idea. It’s working all around us, has been for years. For decades the Canadians, the British, the French, the Germans and countless other so-called advanced countries have had a universal health care system that covers all of their citizens.

Yet by the time Congress fiddle-faddled its way through a bunch of meetings and pro-insurance company legislators were placed in key positions to come up with a bill that would somehow appeal to Republicans as well as so-called Blue Dog Democrats, single-payer didn’t even make it to first base. The entrenched interests — those with money to throw into campaign coffers and into lobbying — succeeded in shoving it aside.

http://host.madison.com/ct/news/opinion/column/dave_zweifel/article_fea11bd1-f781-58b0-b709-c1a02c3d97d6.html

Comment: 

By Don McCanne, MD

Just because Congress passed and the President signed a bill labeled “health care reform” doesn’t mean that the policy debate has been retired. Single payer Medicare for all is “still the best idea.”

The public will soon understand that “passing reform” did not guarantee insurance for everyone, it did not guarantee that insurance benefits will be adequate to prevent financial hardship, and it did not prevent insurers from denying patients choice by restricting care to their limited networks of providers.

But what will really convince everyone that we didn’t get real reform is that individuals, employers and the government will continue to see intolerable increases in the costs of health care. Skyrocketing insurance premiums for low actuarial value products that fail to protect personal household finances will drive the demand for the reform we need.

We don’t have to wait until 2020 or later to fix it. Before the November elections, let the candidates know that we want an improved Medicare for all now.