PNHP

A bailout for the U.S. health-care industry

A bailout for the U.S. health-care industry

By Rose Ann DeMoro
Ottawa Citizen
August 25, 2009

The fractured U.S. healthcare debate, replete with wild distortions of Canada’s medicare, must seem incomprehensible to many north of our border.

News images of fabricated “death panels” or traumatized seniors on U.S. Medicare — a government-funded program — urging legislators to keep the government’s hands “off my Medicare” must seem especially hard to fathom.

Equally puzzling, no doubt, has been the reaction of the administration and many of its allies in Congress whose response to the attacks is to move further away from comprehensive reform.

Entering the year with a Democratic president and strong majorities in both houses of Congress, and a clear public mandate to end our long health-care nightmare, President Barack Obama and Congressional leaders decided to compromise from the outset, and not pursue the most effective reform, Medicare for all.

Gambling they could bring along conservative opponents, the administration and Congressional leaders instead advanced a more limited plan that preserves the role of the insurance industry. Prospects of broader reform were further undermined by some liberal and progressive groups and labour unions, who chose to merely endorse the proposals of the administration and top Congressional Democrats, rather than fighting for a national system like single-payer, which many of them have long endorsed.

Overnight, the left flank was effectively gutted from the beginning of the fight. Most of the pressure has thus come from the right and those who embrace the status quo — leading to further compromises by both Obama and the leading Democrats.

This retreat was clearly articulated by the former president, Bill Clinton, who chastised a conference of worried netroots activists Aug. 13, saying “I want us to be mindful we may need to take less than a full loaf.”

But mobilizing activists for a half loaf has proven to be a challenge, as the White House and Congress have learned to their dismay in recent weeks as they struggle to counter those denouncing them from the right.

Even the grassroots network built by candidate Obama that set new standards for campaign activism last year has, the New York Times noted Aug. 15, failed to produce much enthusiasm for the current health plan, and most liberal constituency groups have not fared much better.

What’s left is a proposal that will force the uninsured to buy private insurance with subsidies for low-income earners and only limited constraints on industry price gouging and care denials that characterize the collapsing insurance-based system.

In sum, it looks like another massive corporate bailout, following the earlier version for the banks, this time for an equally unpopular insurance industry, which will fuel even more public cynicism of the reform process and political system.

To residents of all other industrialized countries, terrors over a government role in promoting and protecting the health and safety of its citizenry, and the reluctance of political leaders to effectively respond to these attacks must be especially confounding. Among major nations, only in the U.S. is health care not a fundamental right, but bartered for profit by a maze of health-care corporations. The result is that the U.S. continues to fall far behind other industrial nations in a variety of measurements, from access to care to equality in treatment, and even in the much discussed issue of waiting times for medical care.

While the U.S. spends twice as much as every other nation on per capita health care, there remain more than 45 million Americans with no health coverage and tens of millions more with insurance who are routinely denied medical care because their insurer doesn’t want to pay for it.

Medical bills account for 62 per cent of personal bankruptcies. Half of all Americans skip doctor visits or immunizations for their children because of high out-of-pocket costs, troubling news indeed with the U.S. already leading the globe in swine flu infections and deaths.

The nation’s registered nurses and many doctors continue to press for real change, a national or single-payer system that would look familiar to Canadians and the rest of the industrial world. It is still possible to achieve stronger reform, but time is running out.

Rose Ann DeMoro is executive director of the 86,000-member California Nurses Association/National Nurses Organizing Committee, the largest U.S. union of nurses.

Copyright (c) The Ottawa Citizen

5 Myths About Health Care Around the World

Editor’s note: The key fact in this article is that “the United States is the only developed country that lets insurance companies profit from basic health coverage.”

By T.R. Reid
Washington Post
Sunday, August 23, 2009

As Americans search for the cure to what ails our health-care system, we’ve overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they’ve found ways to cover everybody — and still spend far less than we do.

I’ve traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as “socialist,” we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

1. It’s all socialized medicine out there.

Not so. Some countries, such as Britain, New Zealand and Cuba, do provide health care in government hospitals, with the government paying the bills. Others — for instance, Canada and Taiwan — rely on private-sector providers, paid for by government-run insurance. But many wealthy countries — including Germany, the Netherlands, Japan and Switzerland — provide universal coverage using private doctors, private hospitals and private insurance plans.

In some ways, health care is less “socialized” overseas than in the United States. Almost all Americans sign up for government insurance (Medicare) at age 65. In Germany, Switzerland and the Netherlands, seniors stick with private insurance plans for life. Meanwhile, the U.S. Department of Veterans Affairs is one of the planet’s purest examples of government-run health care.

2. Overseas, care is rationed through limited choices or long lines.

Generally, no. Germans can sign up for any of the nation’s 200 private health insurance plans — a broader choice than any American has. If a German doesn’t like her insurance company, she can switch to another, with no increase in premium. The Swiss, too, can choose any insurance plan in the country.

In France and Japan, you don’t get a choice of insurance provider; you have to use the one designated for your company or your industry. But patients can go to any doctor, any hospital, any traditional healer. There are no U.S.-style limits such as “in-network” lists of doctors or “pre-authorization” for surgery. You pick any doctor, you get treatment — and insurance has to pay.

Canadians have their choice of providers. In Austria and Germany, if a doctor diagnoses a person as “stressed,” medical insurance pays for weekends at a health spa.

As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But studies by the Commonwealth Fund and others report that many nations — Germany, Britain, Austria — outperform the United States on measures such as waiting times for appointments and for elective surgeries.

In Japan, waiting times are so short that most patients don’t bother to make an appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic clinic at Keio University Hospital to schedule a consultation about my aching shoulder. “Why don’t you just drop by?” the receptionist said. That same afternoon, I was in the surgeon’s office. Dr. Nakamichi recommended an operation. “When could we do it?” I asked. The doctor checked his computer and said, “Tomorrow would be pretty difficult. Perhaps some day next week?”

3. Foreign health-care systems are inefficient, bloated bureaucracies.

Much less so than here. It may seem to Americans that U.S.-style free enterprise — private-sector, for-profit health insurance — is naturally the most cost-effective way to pay for health care. But in fact, all the other payment systems are more efficient than ours.

U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France’s health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada’s universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.

The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

4. Cost controls stifle innovation.

False. The United States is home to groundbreaking medical research, but so are other countries with much lower cost structures. Any American who’s had a hip or knee replacement is standing on French innovation. Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

5. Health insurance has to be cruel.

Not really. American health insurance companies routinely reject applicants with a “preexisting condition” — precisely the people most likely to need the insurers’ service. They employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer’s “rescission department” digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital. The companies say they have to do this stuff to survive in a tough business.

Foreign health insurance companies, in contrast, must accept all applicants, and they can’t cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital (or health spa), usually within tight time limits. The big Swiss insurer Groupe Mutuel promises to pay all claims within five days. “Our customers love it,” the group’s chief executive told me. The corollary is that everyone is mandated to buy insurance, to give the plans an adequate pool of rate-payers.

The key difference is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.

In many ways, foreign health-care models are not really “foreign” to America, because our crazy-quilt health-care system uses elements of all of them. For Native Americans or veterans, we’re Britain: The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we’re Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we’re Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we’re Burundi or Burma: In the world’s poor nations, sick people pay out of pocket for medical care; those who can’t pay stay sick or die.

This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we’ve blended them all into a costly, confusing bureaucratic mess.

Which, in turn, punctures the most persistent myth of all: that America has “the finest health care” in the world. We don’t. In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.

Given our remarkable medical assets — the best-educated doctors and nurses, the most advanced hospitals, world-class research — the United States could be, and should be, the best in the world. To get there, though, we have to be willing to learn some lessons about health-care administration from the other industrialized democracies.

T.R. Reid, a former Washington Post reporter, is the author of “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care,” to be published Monday.

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html

The art of the drug deal

Helen Redmond explains how the drug industry got a seat at the head of the health care reform table.

By Helen Redmond
August 13, 2009

BILLY TAUZIN, a former Republican member of Congress from Louisiana and the current president of the Pharmaceutical Research and Manufacturers of America (PhRMA), is all about the art of the deal. He’s the Donald Trump of brand-name prescription drugs, but unlike “The Donald,” “The Billy” goes to the White House and closes deals in private with the president of the United States.

In a secret, behind-the-scenes mother of all deals, the Obama administration agreed to two central PhRMA demands: no government negotiation of drug prices for Medicare beneficiaries and no re-importation of cheaper drugs from Canada or other countries. In exchange, the industry “pledged” $80 billion in cost savings over 10 years. The details of how the cost savings will be achieved and accounted for haven’t been disclosed.

To ensure it was a done deal, Tauzin, with audacity to spare, demanded in interviews with the national media that the White House publicly acknowledge “the deal.” He was reacting to health care legislation in the House of Representatives that would allow the government to negotiate drug prices and to statements by House Speaker Nancy Pelosi.

“We know we can squeeze more from the system,” Pelosi told the New York Times. “The minute the drug companies settled for $80 billion, we knew it was $160 billion.” Then, in classic doublespeak, she added, “The president made the agreements he made. And maybe we’ll be limited by them. But maybe not!”

Succumbing to the pressure of drug industry lobbyists, White House Press Secretary Robert Gibbs announced at a press conference, “We feel comfortable with the amount of money that has been talked about at this point.”

Tauzin said of the deal earlier on, “We were assured: ‘We need somebody to come in first. If you come in first, you will have a rock-solid deal.'” Later, reported the New York Times, Tauzin threw down the threat: “80 billion is the max,” he said, “no more or less, adding other stuff changes the deal. Who is ever going to go into a deal with the White House again if they don’t keep their word? You are just going to duke it out instead.”

– – – – – – – – – – – – – – – –

THE PRESCRIPTION-buying public, of course, got a raw deal. In accepting PhRMA’s demand for no price controls, the government is forgoing what could be as much as $220 billion in savings over the same period. That’s according to a report by the Institute for America’s Future that matched drug price savings the government negotiated for the Veteran’s Administration.

Americans spend a staggering $200 billion a year on prescription drugs. We pay more money for medication than people in any other advanced industrial country. The Congressional Budget Office found that drug prices in other countries are 35 to 55 percent below the prices in the U.S. Go to any online pharmacy in Canada, and the price of a month’s worth of medication is almost always lower there than it is here. But don’t purchase any medication; buying drugs from Canada is illegal.

During Obama’s campaign for president, he promised that, if he were elected, he would “allow for the safe re-importation of drugs” and that it was a “profound mistake” that Congress exempted Medicare from negotiating drug prices. He explained:

We will break the stranglehold that a few big drug and insurance companies have on the health care market…It’s become clear that some of these companies are dramatically overcharging Americans for what they offer…We’re not going to get the change unless we can overcome the resistance of the drug companies, the insurance companies, the HMOs, those who are making a major profit from the system currently. Now, I think all these industries have a roll to play…We want to listen to what they have to say. They should have a seat at the table, but they can’t buy every chair.

The pharmaceutical industry doesn’t have to buy every chair at the health care reform table, just a few. The $100 million a year that they spend lobbying members of Congress is far more important. Sen. Max Baucus (D-Mont.), Obama’s point person for health care reform, is one of the top recipients of drug company and insurance campaign contributions.

Obama’s latest flip flop will no doubt anger millions of people who despise the profit-gouging drug industry and are desperate for relief from the high cost of prescription medication.

For millions of Americans, a trip to the pharmacy to fill a prescription induces nothing short of a panic attack. Picking up a prescription is a trade-off against paying the mortgage, buying food, putting gas in the car or paying utility bills. Millions routinely skip doses of medication to make it last longer, to the detriment of their health.

A study by the Center for Health System Change (HSC), a nonpartisan health policy research organization, found that the proportion of Americans under 65 years old who reported problems affording medications increased from 10.3 percent in 2003 to 13.9 percent in 2007. Uninsured, working-age people who were unable to afford prescription drugs saw the biggest jump–from 26 percent in 2003 to nearly 35 percent in 2007.

As report authors Laurie Felland and James Reschovsky, senior health researchers at HSC, wrote:

The outlook for non-elderly Americans’ access to prescription drugs is not positive. The ability of many people to afford prescription drugs is likely to deteriorate as the economy continues to decline. The economic downturn will swell the ranks of the uninsured and place greater fiscal strains on state Medicaid budgets, likely leading to tightening of drug benefits and eligibility.

The outlook for the salaries of the CEOs of the biggest drug companies is positive, even during an economic depression. Last year, Johnson & Johnson CEO William Weldon was paid $29,127,432; Abbott Labs CEO Miles White made $28,253,387 and Merck’s Richard Clark took in $25,073,555.

The only way to bring down the cost of medicine is for the government to negotiate with the pharmaceutical industry as almost every other country does. In those countries, access to both medicine and health care is viewed as a human right. Until that happens–and the Obama administration will have to be forced to do it–Americans will continue to suffer the devastating health consequences of going without medicine and pay the highest prices in the world.

T.R. Reid's "The Healing of America"

The Healing of America

A Global Quest for Better, Cheaper, and Fairer Health Care
By T.R. Reid
My global quest demonstrated that America’s approach to health care is unique in the world for a good reason: No other country would dream of doing things the way we do. So it’s clear that we can’t fix the basic problems by tinkering at the margins of our existing system. Any proposal for “reform” that continues to rely on our fragmented structure of overlapping and often conflicting payment systems for different subsets of the population will not reduce the cost or complexity of American health care. Any proposal that sticks with our current dependence on for-profit private insurers – corporations that pick and choose the people they want to cover and the claims they want to pay – will not be sustainable.
To put it simply, the United States does well when it comes to providing medical care, but has a rotten system for financing that care. We need a health care system that permits the strong facets of American medicine to flourish, makes their benefits accessible to everybody, and does it in a cost-efficient way. As we’ve seen, this is not impossible. All other rich countries have found financing mechanisms that cover everybody and they still spend much less than we do. We’ve ignored those foreign models, partly because of “American exceptionalism” – the notion that the United States has nothing to learn from the rest of the world. In health care, at least, that old mindset is clearly losing its sway. Americans are coming to realize that the other rich countries are getting more and better medicine, for less money, than we do.
Another reason Americans tend to ignore the valuable lessons we could take from the rest of the world is that we have been in thrall to conventional wisdom about health care overseas. Thus we conclude that the foreign approaches would never work here. In fact, as I found on my global quest, much of this conventional wisdom is wrong. A lot of what we “know” about other nations’ approach to health care is simply myth.
The Healing of America:
http://us.penguingroup.com/nf/Book/BookDisplay/0,,9781594202346,00.html?The_Healing_of_America_T.R._Reid

And…

5 Myths About Health Care Around the World

By T.R. Reid
The Washington Post
August 23, 2009
1. It’s all socialized medicine out there. (Not so.)
2. Overseas, care is rationed through limited choices or long lines. (Generally, no.)
3. Foreign health-care systems are inefficient, bloated bureaucracies. (Much less so than here.)
4. Cost controls stifle innovation. (False.)
5. Health insurance has to be cruel. (Not really. The key difference is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit.)
All the other developed countries have settled on one model for health-care delivery and finance; we’ve blended them all into a costly, confusing bureaucratic mess.
(T.R. Reid, a former Washington Post reporter, is the author of “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care,” to be published August 24.)
http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html

In “The Healing of America” and in last year’s PBS Frontline presentation, “Sick Around the World,” T.R. Reid has demonstrated how other nations have higher performance health care systems that take care of everyone and at a much lower cost than in the United States.
Other nations have adopted one of a few rational models of health care financing, though with variations. The basic models are Bismarck (Germany, France, Belgium, Switzerland, Japan), Beveridge (Great Britain, Italy, Spain, most of Scandinavia), and national health insurance (Canada, Taiwan, South Korea).
The United States has combined these models into our patched-together system of financing health care. Our components are Bismarck (employer-sponsored plans), Beveridge (VA, Indian Health Service), and national health insurance (Medicare). But we’ve added one more model that Reid discusses: out-of-pocket for the uninsured (Cambodia, Burkina Faso, rural India, rural China). Reid makes a strong case that this dysfunctional, fragmented financing system is in a large part responsible for our very expensive mediocrity.
Which model for the United States?
The out-of-pocket model is certainly not suitable, and the Beveridge model would have very little support only because Americans are uncomfortable with the concept of government ownership of the health care delivery system.
National health insurance, based on an improved model of Medicare, would be very popular once established, and would enable us to reach our goal of affordable, high-quality care for everyone. It is the least expensive, most equitable, most efficient, and most effective model of reform.
T.R. Reid and others such as Uwe Reinhardt believe that Americans are more likely to support the Bismarck model based on private health plans. But they emphasize that our U.S. plans with a business mission would have to be transformed into European-style plans with a service mission. The superficial similarities between the U.S. and European private insurers belie the stark differences in their missions. Just imagine the probability of the highly-compensated U.S. insurance executives and the institutional investors that own their companies stepping up to lead this essential transformation. Fat chance. It is difficult to share the faith that T.R. Reid and Uwe Reinhardt have in the insurers doing the right thing.
But the biggest problem is not with the private insurers; it’s with Congress. They have decided to move forward with our patched-together system, primarily by expanding the use of U.S.-style, business-model private plans. We will be forced to use inadequate subsidies to purchase private plans that are too expensive and that provide inadequate protection in the face of medical need. This is a program that will expand expensive mediocrity – hardly the solution we seek.
An improved Medicare for all is what America would really want, if only the people were better versed in policy science. It’s our job to see that they become so.
(T.R. Reid will be a featured speaker at the PNHP Annual Meeting in Cambridge, MA on Saturday, October 24. Meeting information is available on the PNHP website at www.pnhp.org).

T.R. Reid's "The Healing of America"

The Healing of America

A Global Quest for Better, Cheaper, and Fairer Health Care

By T.R. Reid

My global quest demonstrated that America’s approach to health care is unique in the world for a good reason: No other country would dream of doing things the way we do. So it’s clear that we can’t fix the basic problems by tinkering at the margins of our existing system. Any proposal for “reform” that continues to rely on our fragmented structure of overlapping and often conflicting payment systems for different subsets of the population will not reduce the cost or complexity of American health care. Any proposal that sticks with our current dependence on for-profit private insurers – corporations that pick and choose the people they want to cover and the claims they want to pay – will not be sustainable.

To put it simply, the United States does well when it comes to providing medical care, but has a rotten system for financing that care. We need a health care system that permits the strong facets of American medicine to flourish, makes their benefits accessible to everybody, and does it in a cost-efficient way. As we’ve seen, this is not impossible. All other rich countries have found financing mechanisms that cover everybody and they still spend much less than we do. We’ve ignored those foreign models, partly because of “American exceptionalism” – the notion that the United States has nothing to learn from the rest of the world. In health care, at least, that old mindset is clearly losing its sway. Americans are coming to realize that the other rich countries are getting more and better medicine, for less money, than we do.

Another reason Americans tend to ignore the valuable lessons we could take from the rest of the world is that we have been in thrall to conventional wisdom about health care overseas. Thus we conclude that the foreign approaches would never work here. In fact, as I found on my global quest, much of this conventional wisdom is wrong. A lot of what we “know” about other nations’ approach to health care is simply myth.

The Healing of America:
http://us.penguingroup.com/nf/Book/BookDisplay/0,,9781594202346,00.html?The_Healing_of_America_T.R._Reid

And…

5 Myths About Health Care Around the World

By T.R. Reid
The Washington Post
August 23, 2009

1. It’s all socialized medicine out there. (Not so.)

2. Overseas, care is rationed through limited choices or long lines. (Generally, no.)

3. Foreign health-care systems are inefficient, bloated bureaucracies. (Much less so than here.)

4. Cost controls stifle innovation. (False.)

5. Health insurance has to be cruel. (Not really. The key difference is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit.)

All the other developed countries have settled on one model for health-care delivery and finance; we’ve blended them all into a costly, confusing bureaucratic mess.

(T.R. Reid, a former Washington Post reporter, is the author of “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care,” to be published August 24.)

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html

Comment:

By Don McCanne, MD

In “The Healing of America” and in last year’s PBS Frontline presentation, “Sick Around the World,” T.R. Reid has demonstrated how other nations have higher performance health care systems that take care of everyone and at a much lower cost than in the United States.

Other nations have adopted one of a few rational models of health care financing, though with variations. The basic models are Bismarck (Germany, France, Belgium, Switzerland, Japan), Beveridge (Great Britain, Italy, Spain, most of Scandinavia), and national health insurance (Canada, Taiwan, South Korea).

The United States has combined these models into our patched-together system of financing health care. Our components are Bismarck (employer-sponsored plans), Beveridge (VA, Indian Health Service), and national health insurance (Medicare). But we’ve added one more model that Reid discusses: out-of-pocket for the uninsured (Cambodia, Burkina Faso, rural India, rural China). Reid makes a strong case that this dysfunctional, fragmented financing system is in a large part responsible for our very expensive mediocrity.

Which model for the United States?

The out-of-pocket model is certainly not suitable, and the Beveridge model would have very little support only because Americans are uncomfortable with the concept of government ownership of the health care delivery system.

National health insurance, based on an improved model of Medicare, would be very popular once established, and would enable us to reach our goal of affordable, high-quality care for everyone. It is the least expensive, most equitable, most efficient, and most effective model of reform.

T.R. Reid and others such as Uwe Reinhardt believe that Americans are more likely to support the Bismarck model based on private health plans. But they emphasize that our U.S. plans with a business mission would have to be transformed into European-style plans with a service mission. The superficial similarities between the U.S. and European private insurers belie the stark differences in their missions. Just imagine the probability of the highly-compensated U.S. insurance executives and the institutional investors that own their companies stepping up to lead this essential transformation. Fat chance. It is difficult to share the faith that T.R. Reid and Uwe Reinhardt have in the insurers doing the right thing.

But the biggest problem is not with the private insurers; it’s with Congress. They have decided to move forward with our patched-together system, primarily by expanding the use of U.S.-style, business-model private plans. We will be forced to use inadequate subsidies to purchase private plans that are too expensive and that provide inadequate protection in the face of medical need. This is a program that will expand expensive mediocrity – hardly the solution we seek.

An improved Medicare for all is what America would really want, if only the people were better versed in policy science. It’s our job to see that they become so.

(T.R. Reid will be a featured speaker at the PNHP Annual Meeting in Cambridge, MA on Saturday, October 24. Meeting information is available on the PNHP website at www.pnhp.org).

Where's the Wizard of Oz When We Need Him?

By Carol Miller
Taos Daily News
August 15, 2009

The people are crying-out for access to health care. The economy is in freefall with no sign yet of the bottom. It is time for bold action. Poll after poll finds that two out of every three Americans supports converting to a universal health care system similar to Medicare.

I find myself wishing there was someone like the Wizard of Oz to give courage to politicians, the courage to stand up for us–the people, the taxpayers, the voters.

So, what’s the problem?

One problem is that most elected leaders, from the president on down, are cowards when it comes to standing up to the corporations. A few recent examples: bailouts for banks while homeowners still face foreclosure and homelessness; the AIG mega-insurance corporate bailout; and the current and most cruel bailout–protecting large sickness insurance corporations rather than giving us guaranteed access to health care. This is not reform.

A truly reformed system would focus on improving health by expanding public health, prevention, wellness programs, and easy access to health care without causing fear as to how individuals will pay for it.

It is becoming obvious that there is more interest in raising current and future campaign funds than giving us access to the higher quality, lower-cost health care that the rest of the industrialized world enjoys.

How much money has corporate health care invested in politicians to protect their profits? In the past 10 years, a cool $3.4 billion. 2008 was a big investment year for health corporations: $167 million to Congressional candidates (60% to Democrats), $18.7 million to the Obama Campaign, and $7.3 million to McCain. While that sounds like a lot to us, it is pocket change for these corporations–they make billions in profit every year.

A Billion Dollars a Day

I know there are a lot of numbers in this commentary, but if you want to memorize only one, here it is: health insurance administrative costs alone waste one billion dollars a day, $365 billion dollars a year, and a trillion dollars every two and a half years. This is a trillion dollars that are sucked out of the health care system every couple of years for wasteful paperwork and corporate profit. Not one penny of this provides any health care. This is why the corporations are fighting to have the 49 million uninsured handed over to them.

Elected Politicians are Helping Government Haters Kill Health Reform

When our elected officials refuse to strongly defend the popular, lifesaving and well-run government health programs, they open the door and airways to endless government bashing. We see now how out of control these government haters have become. Some of these are even the people we have elected to represent us!

Why won’t the president stand up and defend government health programs? He has had so many opportunities, but instead he plays into the hands of the sickness insurance corporations, feeding the myth that people like their insurance companies.

U.S. Socialized Medicine Is Popular

Americans are so trained to think that socialized anything is bad that they get frightened when they hear lies in the media that the government is going to impose socialized medicine. The definition of socialized medicine is when the government owns the hospitals and clinics and all of the staff are government employees.

This system actually sounds very familiar to 20 million Americans, and almost one out of every four New Mexicans. You know why? The United States already has a very large socialized medical system that includes military health, veteran’s health, and the Indian Health Service.

Why doesn’t President Obama ever mention this? He could let people know that the VA is a great system, recently honored as having the highest patient satisfaction of all health plans for the sixth year in a row. The military has always had a socialized health system, and service members consider it the most important benefit of service.

America Already Has a Single Payer System

It is amazing that the thought of government-run health care frightens so many people, including those who already have it. The United States today has the largest single payer health care system in the world, with 103 million beneficiaries–more than one out of every three Americans.

In New Mexico, 800,000 people have single payer health care, through Medicare and Medicaid. Add in the more than 400,000 in the socialized system, and two out of every three New Mexicans is already in government run health care. The truth is, most of them like it and are more satisfied with their coverage and care than people in corporate sickness insurance.

Here is why Medicare is popular–it keeps the private delivery system intact and leaves it to the government to pay the bills. If people want “choice,” they will find more choice of doctors and hospitals in Medicare than any other insurance plan.

The president has said time and again that if we were starting the system from scratch, he would favor a single payer system. He is clear that he knows it is the best. But he always follows this up with the comment that a lot of people like what they have, so we will build on the current system. But 123 million people already have government health care, 41% of the country. Why not get to universal health care by building on these systems?

At a recent AARP Forum on Health Reform, President Obama was unable to convince a Medicare beneficiary that Medicare is actually a government-run program. The person refused to believe that the government could operate such a great program.

Rather than standing up for the government, the president missed the perfect opportunity to educate and move the country. He could have explained that reform will not be about taking away anything from the 45 million seniors in Medicare, but instead would welcome their children and grandchildren to join them in the most popular government program.

Compare that to the current system which has grandma in Medicare, mom and dad either uninsured or in another plan, and often the children in yet another, each with annual enrollment, changing rules, and benefits unknown until you are sick and an insurance company bureaucrat tells your doctor what care you can get. Imagine the whole family in one health system, with the same rules, benefits, and enrollment for life–this is an idea worth fighting for!

People Like Their Insurance?

Really? Who are these people? This is a huge lie. The president says it over and over. Our members of Congress say it over and over, but repeating this lie will never make it true.

For the most part, people like their doctors and the hospitals and clinics where they get care, but in my many years of working in health care, I have never met anyone who told me they love their insurance company.

Insurance companies collect money every month, supposedly to pay for health care, but their profits are based on denying and rationing as much care as possible. The rationing starts before someone even signs up for an insurance plan, because sales agents are trained to discourage or deny coverage to sick people or people who they think might become sick.

With corporate for-profit insurance, you never know in advance what will be paid for and how much they will leave for you to pay. Too many people have learned the absolute heartlessness of ruthless insurance companies. More than 500,000 people in the United States go bankrupt every year as a result of medical bills or illness. Most who declare medical bankruptcy are “insured,” or so they thought. They paid their premiums every month, but when they or a family member became sick, they learned that they were not protected from financial ruin.

Who benefits from this system? Insurance executives and CEOs with sky-high compensation packages reaching to the tens and hundreds of millions of dollars. The former CEO of United Health Care holds the record, receiving over one billion dollars in a single year in salary and stock options. This is the same corporation that just “won” the contract to run the behavioral health system in the State of New Mexico.

Continuing the for-profit sickness insurance industry and using tax dollars to expand it further is yet another unaffordable corporate bailout. This is a nonessential industry that makes profits from rationing health care to people who need it and, even worse, it rations the care to people who have already paid for it!

My challenge to the New Mexico Congressional delegation and the president is this: even if you don’t have the courage to support a transformation of the health care system that would let everyone into a restored Medicare program, why not at least let the 49 million uninsured enroll in this most popular government program? This is the easiest and least costly way to cover the uninsured.

There are two bills in Congress to create a Medicare-for-All program, House Bill 676 and Senate Bill 703. On July 30th, U.S. House of Representatives Speaker and California Congresswoman Nancy Pelosi committed to a vote on HB676 when Congress comes back from vacation in September.

The outcome of that vote depends on us making sure that all of our representatives know we oppose the looming corporate bailout and want health care, not health insurance.

What we want is simple: one system, everyone in, nobody out.

Medicare-for-all option would cover everyone, reduce costs

By DR. THOMAS CLAIRMONT
New Hampshire Union Leader
Friday, Aug. 21, 2009

Speaker Pelosi has pledged to hold a floor debate and vote on single-payer health reform this fall. This vote on an amendment to HR 3200 (the 1,000-plus page bill favored by the House leadership) would substitute the 27-page HR 676 as the new health care policy of the United States.

This is good news after months of suppression of a bill that should be the gold standard for comparison of plans. This is important to everyone because passage would bring simplicity and stability into your health care planning.

For about 4.5 percent of income, matched by your employer, you would receive a lifetime policy with no co-payments, no deductibles, no out-of-pocket expenses and, most important, no pre-existing conditions exclusions. Your policy would cover your choice of physician and appointments with them, hospital care, diagnostic imaging, laboratory tests, prescriptions, vision care, preventive care, dental care, chiropractic care, emergency care and ambulance transportation, podiatry, speech, physical and occupational therapy, mental health care, substance abuse care, health education, hospice care, adult day care, skilled nursing care, long-term care and dialysis. This policy would be portable, continuous and never could be canceled regardless of your employment status.

Please note that passage of this plan covers everyone with the same basic policy. Medicaid would be eliminated; Medicare would be considerably improved. Medical bankruptcy would be eliminated, and the President’s goals of universal, affordable, choice and cost controls would be met. the dreaded doughnut hole in Medicare D would be an unpleasant memory.

Costs would be contained by dramatically reducing administrative expenses, global budgeting, bulk purchasing of prescription drugs, medical supplies and equipment, mandating transparency in pricing and reducing fraud. No other plan has cost controls built in and, therefore, would be much more expensive.

Although the President keeps saying you can keep the insurance you have, it is the small businessman buying this policy for you. And with insurance premiums rising every year way above the inflation rate, providing this coverage for many is not possible anymore. A fixed percentage of payroll would be a much more affordable option.

The city of Portsmouth paid $9,615 for a family policy in 2000, and this year it’s $24,145, representing 10 percent of the property tax bill. Without reform, similar increases of this magnitude would lead to a premium of $60,362 in 2020 and $150,906 in 2030. This clearly demonstrates the need for reform.

Doctors are complaining about insurance company interference with their practice of medicine and the paperwork related to this oversight. This is minimally present in Medicare today and would disappear in the single-payer program.

Please visit Physicians for a National Health Program’s Web site, pnhp.org, for more information. Don’t discount the Medicare-for-all option without a full understanding of this program. Our principles are automatic enrollment, comprehensive coverage, public financing, eliminating administrative waste, maximum choice of physician and hospital, and delivery through a nonprofit, privately controlled system. What does your ideal system look like?

Don’t be put off by the lies and distortions blaring across your radio and television. HR 676 covers you for life; it is affordable; and it is simple to understand and implement. And it pays for itself. What does your plan do?

Dr. Thomas Clairmont is an internist in Portsmouth.

http://www.unionleader.com/article.aspx?headline=Thomas+Clairmont%3A+Medicare-for-all+option+would+cover+everyone%2C+reduce+costs&articleId=f5d7482a-0000-4e2e-b508-0179b265ca68

Beware health-industrial complex

By Jack Bernard
Opinion – Voices
Ledger-Inquirer (Columbus, Ga.)
Sunday, Aug. 23, 2009

Virtually all national polls show that health care reform is in trouble, just as it was under the Clintons. Once again, lobbyists from the health industrial complex have purposefully confused the American public, as they did with the misleading but highly effective “Harry and Louise” ads in the 1990s, and bought off our elected representatives in both parties.

I am a Republican, former chairman of the Republican Party in Jasper County, Ga., and chair of that county commission. Under our two-party system, it is easy to see why we Republicans oppose Democratic Party reform proposals. We are the opposition party and do not want them to get the political credit for solving a nasty problem. After all, some Democrats did the same thing when Richard Nixon wanted national health insurance.

Opposition to reform was not right then and it is not right now (20,000 Americans die each year because they do not have health insurance), but in the cynical world of politics, it is understandable. I guess what gets me is why Democrats do not support their own leadership.

Since the Democrats are in the driver’s seat, it is up to them to lead and bring their stragglers in line. However, the Democrats are fighting internally, failing to articulate a straightforward vision of the future or even one bill (Obamacare, if you will). Democratic leaders talk about access, but Blue Dog conservatives talk about cost, all the while receiving tremendous donations from health-related businesses. Insurance companies are buying them to prevent cutting costs via a public plan option or single payer, clearly the best way to cut costs.

Republican pundits are sitting back and chuckling, as they always do when reform is mentioned, and repeating the same self-serving platitudes: “If we only had tort reform all our problems would be solved.” Like it is just coincidence that trial lawyers happen to be one of the Democrats’ largest contributors! And how, exactly, does cutting down on unnecessary tests lead to more of the 50 million uninsured people getting coverage? But remember, this is politics and we must do what is right for the party, not the nation.

What amazes me is that no one is calling these individuals to account. In my view, it is unpatriotic to continue to lie to the American public about the situation facing us. Over the last 10 years, wages have gone up by about one-fourth. Health insurance premiums have gone up well over 100 percent. We cannot continue along this path to fiscal destruction. Inaction is not an option.

It is also against American values to mislead the public into believing that everyone can get good care even if they do not have insurance. The mark of a great nation is not how well it treats its privileged, but rather how well it treats its downtrodden. On this measure, we fail miserably; strange for a nation that prides itself on being the most religious democracy in the world. Where in the Bible did Jesus say “might makes right” or “those with the gold rule”?

Very few health or insurance professionals advocate for a single-payer system, the best way to control costs and ensure access. I hear all sorts of reasons: rationing (really, like HMOs do not do that now), paperwork (apparently insurance company bureaucracy does not count), socialism (come on — practitioners will still be independent and we all know it) and so forth. It is rare that we hear the underlying cause openly stated: greed. It will cut my income.

The members of Physicians for a National Health Plan are an exception to this rule. If you take a look at their Web site, www.pnhp.org, the rationale for a single-payer system is clearly articulated. The French have the top system in the world, with something like Medicare covering 66 percent of costs and private insurance for the rest, yet their cost per capita is half of ours. Universal Medicare will both control costs and achieve universal access to high quality care. Congressmen would get the same insurance as you and I. You better believe your coverage would be just as good as or better than what you are getting now.

The problem is not technical; it is political. It is high time we put the country ahead of ourselves and establish a single-payer system.

Jack Bernard is CEO of Monticello (Ga.) Health Care Solutions and a former chairman of the Jasper County Commission and the Jasper County Republican Party.

Healthcare insurers get upper hand

Obama's overhaul fight is being won by the industry, experts say. The end result may be a financial 'bonanza.'

By Tom Hamburger and Kim Geiger
LA Times
August 24, 2009

Reporting from Washington — Lashed by liberals and threatened with more government regulation, the insurance industry nevertheless rallied its lobbying and grass-roots resources so successfully in the early stages of the healthcare overhaul deliberations that it is poised to reap a financial windfall.

The half-dozen leading overhaul proposals circulating in Congress would require all citizens to have health insurance, which would guarantee insurers tens of millions of new customers — many of whom would get government subsidies to help pay the companies’ premiums.

“It’s a bonanza,” said Robert Laszewski, a health insurance executive for 20 years who now tracks reform legislation as president of the consulting firm Health Policy and Strategy Associates Inc.

Some insurance company leaders continue to profess concern about the unpredictable course of President Obama’s massive healthcare initiative, and they vigorously oppose elements of his agenda. But Laszewski said the industry’s reaction to early negotiations boiled down to a single word: “Hallelujah!”

The insurers’ success so far can be explained in part by their lobbying efforts in the nation’s capital and the districts of key lawmakers.

The bills vary in the degree to which they would empower government to be a competitor and a regulator of private insurance. But analysts said that based on the way things stand now, insurers would come out ahead.

“The insurers are going to do quite well,” said Linda Blumberg, a health policy analyst at the nonpartisan Urban Institute, a Washington think tank. “They are going to have this very stable pool, they’re going to have people getting subsidies to help them buy coverage and . . . they will be paid the full costs of the benefits that they provide — plus their administrative costs.”

One of the Democratic proposals that most concerns insurers is the creation of a “public option” insurance plan. The industry launched a campaign on Capitol Hill against it, grounded in a study published by the Lewin Group, a health policy consulting firm that is owned by UnitedHealth Group. The lobbyists contended that a government-run plan, which would have favorable tax and regulatory treatment, would undermine private insurers.

Opposition increased this month when boisterous critics mobilized at town hall meetings held by members of Congress home for the August recess. The attacks, supplemented by conservative critics on talk radio and other forums, drew national attention.

Leading insurers, including UnitedHealth, urged their employees around the country to speak out. Company “advocacy hot line” operations and sample letters and statements were made available to an army of insurance industry employees in nearly every congressional district.

Some insurers supplemented the effort with local advertising, often designed to put pressure on specific members of Congress. Late in the spring, Blue Cross Blue Shield of North Carolina — the home state of several conservative Blue Dog Democrats — prepared ads attacking the public option.

Leading Democrats have fought back, with House Speaker Nancy Pelosi (D-San Francisco) last month calling the industry “immoral” for its past treatment of customers and suggesting insurers were “the villains” in the healthcare debate.

Still, recent support for the public option has declined, and the stock prices of health insurance firms have been rising.

Undermining support for the public option wasn’t the only gain scored by insurance lobbyists.

In May, the Senate Finance Committee discussed requiring that insurers reimburse at least 76% of policyholders’ medical costs under their most affordable plans. Now the committee is considering setting that rate as low as 65%, meaning insurers would be required to cover just about two-thirds of patients’ healthcare bills. According to a committee aide, the change was being considered so that companies could hold down premiums for the policies.

Most group health plans cover 80% to 90% or more of a policyholder’s medical bills, according to a report by the Congressional Research Service. Industry officials urged that the government set the floor lower so insurers could provide flexible, more affordable plans.

“It is vital that individuals, families and small-business owners have the flexibility to choose an affordable coverage option that best meets their needs,” said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the industry’s Washington-based lobbying shop.

Consumer advocates argue that a lower government minimum might quickly become the industry standard, placing a greater financial burden on patients and their families.

“These are a bad deal for consumers,” said J. Robert Hunter, a former Texas insurance commissioner who works with the Consumer Federation of America.

Meanwhile, companies would probably see a benefit by providing less insurance “per premium dollar,” Hunter said.

“It would be quite a windfall,” said Wendell Potter, a former executive at Cigna insurance company who has become an industry whistle-blower.

Consumer and labor advocates acknowledged the industry’s lobbying success.

In the first half of 2009, the health service and HMO sector spent nearly $35 million lobbying Congress, the White House and federal healthcare offices, according to data from the Center for Responsive Politics.

With more than 900 lobbyists, that sector — whose top spenders are insurance giants UnitedHealth, Blue Cross Blue Shield and Aetna — was poised to spend more than in 2008, a record lobbying year.

UnitedHealth spent the most, $2.5 million in the first half of 2009, and hired some of Washington’s most prominent political players, including Tom Daschle, the former Senate majority leader who served as an informal health policy advisor to Obama.

“They have beaten us six ways to Sunday,” said Gerald Shea of the AFL-CIO. “Any time we want to make a small change to provide cost relief, they find a way to make it more profitable.”

tom.hamburger@latimes.com

Driving a Stake Through a Bad Health Policy's Heart

By David Moberg
In These Times
Aug. 21, 2009

In last year’s presidential race, Barack Obama scored points when he attacked John McCain for proposing to tax people’s employer-provided health insurance as income. Conservatives argued that the business tax deduction for health insurance distorted healthcare markets, encouraging people to overconsume healthcare.

That assumes people are doing the equivalent of choosing extra colonoscopies over a vacation at the beach. It was bad policy and bad politics.

Then, in their destructive confusion over health reform, some Democrats–especially in the Senate–began reviving McCain’s idea, and even the administration signaled openness to it. Democrats were seeking money to pay for their proposal, and some argued that current tax subsidies favored “gold-plated” policies for high-income executives, thus making a tax on benefits progressive. Strong criticism from liberals and unions has for now beat back the plan as bad politics.

Now Harvard physicians David Himmelstein and Steffie Woolhandler, co-founders of Physicians for a National Health plan, have shown that the supposedly progressive rationale for taxing employer-provided health insurance is as flawed as the conservative justification.

In an article online in The New England Journal of Medicine, they show that a tax on benefits would be regressive, taking a far higher percentage of income from low- and moderate-income taxpayers than from high-income individuals.

In absolute dollar terms, the affluent gain more, but as a percentage of income, lower-income earners receive a greater benefit and thus their tax rate–if benefits were taxed–would be higher. That’s the usual definition of tax regressivity.

For example, Himmelstein and Woolhandler calculate that the mean (or average) benefit for families earning $10,000 to $19,999 and receiving employer-paid coverage is $2,115, or 13.9 percent of their income. But families earning $100,000 or more receive a mean tax benefit of $4,498, or just 2.7 percent of their income.

Of course, lower-income families are less likely to have employer-provided insurance (13.8 percent of those earning $10,000 to $19,999 compared to 61.8 percent of those earning $100,000 or more).

So when Himmelstein and Woolhandler mapped the effects of a benefit tax on the whole population, not just those whose employers provided insurance, the mean tax rate for low-income families was low, rising to a peak for middle-income families, then falling back down for the more affluent. It was still basically regressive.

They calculated the effects assuming families paid the tax, but Himmelstein says most analysts assume that if employers were taxed instead, they would simply deduct the cost from wages. If insurers were taxed, their likely strategy is less clear, but they would probably raise rates for everyone.

If only high-priced policies were taxed, people living in states with higher medical costs would be penalized, and without indexing of the cut-off for inflation, more families would be affected each year. Also, Himmelstein says, federal law generally requires employers to offer the same benefit package to all employees. So lower-paid workers at an employer (like Harvard) with comprehensive health benefits would be hit, not just high earners.

Although the plan to tax benefits now seems off the table, Himmelstein expects it to spring up again. “We’re hoping,” he says, “to drive a small stake through its heart.”

http://inthesetimes.com/working/entry/4793/putting_a_stake_through_the_heart_of_bad_health_policy/

"Mad as Hell Doctors" Embark on Cross Country Care-A-Van to Demand Single-Payer from Congress

Published by PR Web August 14, 2009 Portland, OR

Frustrated with the health care ‘options’ coming out of Washington, D.C., six “Mad as Hell” Oregon physicians are taking an unprecedented road trip across America to lobby Congress for a single-payer health care system.

Called a “Care-A-Van,” these road-tripping Oregon physicians will leave in a used motor home from Portland, Oregon on September 8th, inviting doctors and ordinary citizens from other states to join them on their twenty-city tour across the country. Their journey will culminate in a D.C.-based event on September 30th, scheduled to take place on the steps of Congress. Demonstrating with the doctors will be thousands of fellow ‘Mad as Hell’ single-payer advocates, all adorned with the movement’s new symbol – the white ribbon. Their demand: Single-Payer Now!

“We’re mad as hell because our health care system is run by people who profit from illness” says Dr. Paul Hochfeld, lead Mad As Hell Doctor and producer of the documentary ‘Health, Money and Fear.’ “The rest of the civilized world has test driven single payer and it works. But elected officials in America won’t even allow a discussion.”

“The public option is a trap.” Hochfeld continues. “It sounds very reasonable, but the problem with it, no matter what the final bill looks like, is that it will continue to allow private medical insurance companies to dictate America’s public health policies. And that’s just plain wrong.”

Several national, single-payer advocacy organizations including Physicians for a National Health Program, Health Care Now, Single Payer Action, and even groups like Progressive Democrats of America and Jobs with Justice are supporting the Oregon physicians by setting up Mad as Hell Town Halls across the country in anticipation of their arrival. “People need to understand what single-payer is–and isn’t,” says Dr. Mike Huntington, a radiologist from Corvallis, Oregon and fellow Mad As Hell Doctor. “It isn’t Socialism, any more than police and fire are Socialism. And it doesn’t require any more money. Simply put, single-payer is a way to take current premium payments that go to a thousand different private insurance companies, and redirect them into a single, public fund that insures everyone. That’s all it is. But when we do this, lots of wonderful things happen, not the least of which is to save Americans 500 billion dollars a year starting day one. That’s billion – with a ‘b.’ America needs this information. That’s why we’re taking the tour.”

Reality Television meets Political Activism

Every move the Mad as Hell Doctors make will be recorded on camera and then edited and uploaded to the Internet that same day. The uploaded segments will appear on social networking web sites such as Facebook, Twitter, YouTube, MySpace, et al, making the Mad As Hell Doctors Tour the first of its kind: an unprecedented hybrid of reality television and political activism.

“We’re doing this because we care,” declares Dr. Gene Uphoff, a family physician from Portland, Oregon and fellow Mad As Hell Doctor. “The time to demand that a Single Payer Plan be put on the table is now. We may not get another opportunity for real change like this in our lifetime. Washington needs to hear all of us right now.”

Hochfeld agrees. “This isn’t a campaign. It’s a movement. Join us.”

For more information log on @ http://www.MadAsHellDoctors.com

CONTACT: Adam Klugman 503.706.2006 adam (at) MadAsHellDoctors (dot) com visit my website www.michaelmunk.com

T.R. Reid’s “The Healing of America”

The Healing of America

A Global Quest for Better, Cheaper, and Fairer Health Care

By T.R. Reid

My global quest demonstrated that America’s approach to health care is unique in the world for a good reason: No other country would dream of doing things the way we do. So it’s clear that we can’t fix the basic problems by tinkering at the margins of our existing system. Any proposal for “reform” that continues to rely on our fragmented structure of overlapping and often conflicting payment systems for different subsets of the population will not reduce the cost or complexity of American health care. Any proposal that sticks with our current dependence on for-profit private insurers – corporations that pick and choose the people they want to cover and the claims they want to pay – will not be sustainable.

To put it simply, the United States does well when it comes to providing medical care, but has a rotten system for financing that care. We need a health care system that permits the strong facets of American medicine to flourish, makes their benefits accessible to everybody, and does it in a cost-efficient way. As we’ve seen, this is not impossible. All other rich countries have found financing mechanisms that cover everybody and they still spend much less than we do. We’ve ignored those foreign models, partly because of “American exceptionalism” – the notion that the United States has nothing to learn from the rest of the world. In health care, at least, that old mindset is clearly losing its sway. Americans are coming to realize that the other rich countries are getting more and better medicine, for less money, than we do.

Another reason Americans tend to ignore the valuable lessons we could take from the rest of the world is that we have been in thrall to conventional wisdom about health care overseas. Thus we conclude that the foreign approaches would never work here. In fact, as I found on my global quest, much of this conventional wisdom is wrong. A lot of what we “know” about other nations’ approach to health care is simply myth.

The Healing of America:
http://us.penguingroup.com/nf/Book/BookDisplay/0,,9781594202346,00.html?The_Healing_of_America_T.R._Reid

And…

5 Myths About Health Care Around the World

By T.R. Reid
The Washington Post
August 23, 2009

1. It’s all socialized medicine out there. (Not so.)

2. Overseas, care is rationed through limited choices or long lines. (Generally, no.)

3. Foreign health-care systems are inefficient, bloated bureaucracies. (Much less so than here.)

4. Cost controls stifle innovation. (False.)

5. Health insurance has to be cruel. (Not really. The key difference is that foreign health insurance plans exist only to pay people’s medical bills, not to make a profit.)

All the other developed countries have settled on one model for health-care delivery and finance; we’ve blended them all into a costly, confusing bureaucratic mess.

(T.R. Reid, a former Washington Post reporter, is the author of “The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care,” to be published August 24.)

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html

Comment:

By Don McCanne, MD

In “The Healing of America” and in last year’s PBS Frontline presentation, “Sick Around the World,” T.R. Reid has demonstrated how other nations have higher performance health care systems that take care of everyone and at a much lower cost than in the United States.

Other nations have adopted one of a few rational models of health care financing, though with variations. The basic models are Bismarck (Germany, France, Belgium, Switzerland, Japan), Beveridge (Great Britain, Italy, Spain, most of Scandinavia), and national health insurance (Canada, Taiwan, South Korea).

The United States has combined these models into our patched-together system of financing health care. Our components are Bismarck (employer-sponsored plans), Beveridge (VA, Indian Health Service), and national health insurance (Medicare). But we’ve added one more model that Reid discusses: out-of-pocket for the uninsured (Cambodia, Burkina Faso, rural India, rural China). Reid makes a strong case that this dysfunctional, fragmented financing system is in a large part responsible for our very expensive mediocrity.

Which model for the United States?

The out-of-pocket model is certainly not suitable, and the Beveridge model would have very little support only because Americans are uncomfortable with the concept of government ownership of the health care delivery system.

National health insurance, based on an improved model of Medicare, would be very popular once established, and would enable us to reach our goal of affordable, high-quality care for everyone. It is the least expensive, most equitable, most efficient, and most effective model of reform.

T.R. Reid and others such as Uwe Reinhardt believe that Americans are more likely to support the Bismarck model based on private health plans. But they emphasize that our U.S. plans with a business mission would have to be transformed into European-style plans with a service mission. The superficial similarities between the U.S. and European private insurers belie the stark differences in their missions. Just imagine the probability of the highly-compensated U.S. insurance executives and the institutional investors that own their companies stepping up to lead this essential transformation. Fat chance. It is difficult to share the faith that T.R. Reid and Uwe Reinhardt have in the insurers doing the right thing.

But the biggest problem is not with the private insurers; it’s with Congress. They have decided to move forward with our patched-together system, primarily by expanding the use of U.S.-style, business-model private plans. We will be forced to use inadequate subsidies to purchase private plans that are too expensive and that provide inadequate protection in the face of medical need. This is a program that will expand expensive mediocrity – hardly the solution we seek.

An improved Medicare for all is what America would really want, if only the people were better versed in policy science. It’s our job to see that they become so.

(T.R. Reid will be a featured speaker at the PNHP Annual Meeting in Cambridge, MA on Saturday, October 24. Meeting information is available on the PNHP website at www.pnhp.org).