PNHP

Physicians support health reform bill

Physicians support health reform bill

From Staff Reports
Cumberland Times-News
Saturday, March 28, 2009

CUMBERLAND, MD — A single-payer health reform bill introduced in the U.S. Senate last week could cover 46 million Americans who lack coverage and improve benefits for others by eliminating co-pays and deductibles.

“The proposal in the Senate and its counterparts in the House are sure to be branded as socialized medicine,” said Dr. Wayne Spiggle, local doctor and member of the Physicians for a National Health Program. “They are nothing of the kind. Medicare is a single-payer program and it is not socialized medicine. Doctors are clearly less hassled by Medicare than by private insurance companies, and patients are better served.”

The proposed bill was introduced Wednesday by Independent Sen. Bernie Sanders of Vermont. The American Health Security Act of 2009 would cut private insurance overhead and bureaucracy in medical settings, with an estimated savings of more than $400 billion that could be directed to clinical care.

“This is excellent news for the nation’s health,” said Dr. Quentin Young, national coordinator of PNHP. “There is now an affordable cure for our dysfunctional health care system. In the face of our present economic calamity, this is an urgent necessity.”

The proposed program would be paid for by combining current sources of government health spending into a single fund with modest taxes that amount to less than what people pay for insurance premiums and out-of-pocket expenses.

It would be administered by the states, with hopes that would reduce the paperwork that people in the health care industry deal with.

Patients would be able to go to their own doctors and community health centers would be fully funded.
The program would provide resources to the National Health Service Corps to train an additional 24,000 health professionals to deal with the shortage of primary care physicians and dentists.

“We are confident that Sen. Sanders’ bill will accelerate the national drive for the only reform that we know will work,” Young said. “A majority of physicians endorse such an approach. … We remember well that President Obama once acknowledged that single-payer national health insurance was the best way to go. It still is.”

Copyright (c) 1999-2008 cnhi, inc.

Move to single-payer system is crucial

By Richard C. Dillihunt, M.D.
Bangor Daily News
4/8/09

As America prepares to reform our health care system, I wish to add some convictions reached while practicing surgery for nearly a half-century. Until about 15 years ago, doctors were powerful leaders in the health care system, taking their responsibilities seriously, and the system worked well. Then, dark clouds began to assemble and physicians began to lose their grip.

As the system faltered, physicians were not part of any changes except as pawns and bystanders. In short supply, we had crushing demands due to patient loads and were required to run practices of increasing complexity.

New arrivals appeared, calling themselves “health care professionals.” Seemingly overnight, they were “stakeholders,” and a metamorphosis occurred as medicine became big business. A new gold rush was on, lured by the attraction of the health care dollar.

The language of medicine changed with the arrival of HMOs, PPOs, surgicenters, for-profit hospitals and other schemes popping up like dandelions, fertilized by health care dollars totaling more than 15 percent of our GDP. Special interests arrived in the form of the health insurance and pharmaceutical industries, distributing lobby dollars in all directions and receiving free range in return. Multimillion-dollar salaries and billions in stock options were awarded while the steely-gray clenched faces of bankruptcy adorned middle America.

Hospitals joined in, finding a way to control pesky doctors — they hired them — spawning an undesirable side effect of antagonistic competition. Hospital bills joined inflation in the health care sector, and ear-popping predictions were heard that health care soon would become 20 percent of gross domestic product — up from 7.2 percent in 1970. The cost of all U.S. health care surged to top $8,000 per person annually while Canada’s cost for universal health care was half that, and our outcomes were no better than theirs.

Our system lacks social justice for some 45 million Americans without health insurance and more who are underinsured. Huge layoffs due to the current recession are adding to these alarming numbers daily, with workers and dependents suddenly uninsured. Another surge is expected soon, when unemployed new college graduates hit the streets. We are ready to improve this situation by passage of universal health care legislation now.

Beyond that is a way to really fix the health care system. It is called “single payer.” Call upon our federal government to implement such a program, recalling that it already runs some of the world’s best and most efficient health care programs including Medicare, the National Institutes of Health, the Centers for Disease Control and Prevention and military medicine.

Be aware that single-payer is not socialized medicine. Single payer just means the government is acting as an administrator and best understood as being “Medicare for all.” Note that only about 5 percent of Medicare dollars are used in administering the program, while private cost for the same service consumes 30 percent of premium dollars — largely due to profit.

The new administration seems set on reducing health care costs and instituting a system of universal health care while leaving the current system in place, and adding a new federal health care insurance option. This is not adequate. The prior administration wanted an income tax deduction for health care insurance costs, plus health savings accounts — both are flawed and inadequate.

In his June 13, 2005, column in The New York Times, “One Nation Insured,” Paul Krugman convincingly extols the virtues of single payer. Krugman, a Times writer and professor at Princeton, was recently awarded the Nobel Prize in economics. Ask Paul. If still skeptical, ask Joe. Joseph Stiglitz, when recently asked “Do you support single-payer health care?” answered. “I think I’ve reluctantly come to the view that it’s the only alternative.” Stiglitz is a Columbia professor — and also a Nobel Prize-winning economist.

Single payer could lead a powerful surge to recovery — sort of an economic wonder drug. Polls of Americans strongly favor single payer, yet our government seems reluctant to address this eye-to-eye preferring lesser action and tweaking along as before. We need to send a message to Washington, reminding it who their employers are. There is enough unemployment already, so we do not want to send pink slips to D.C. Feeling bad for the fat -cat special interests is intolerable, not after what they have done to us. Anything less may result in further collapse of a frail, teetering relic. We are near a solution of a serious issue confronting our economy. Doing the right thing now is crucial.

Richard C. Dillihunt, M.D., a retired general, vascular and transplant surgeon, lives in Portland. He may be reached at dillihunt8@aol.com.

Post office a reminder of our past successes

Pat LaMarche
Bangor Daily News
4/8/09

Ever been to Old Sturbridge Village? It’s a community in the town of Sturbridge, Mass., that has been pieced together out of the past. You can walk through buildings built when Uncle Sam was just an infant and see the way life was in Colonial America.

There is a bank that was a real bank, a law office that was a real law office, a tin shop was a real tin shop, a
tavern that was a real tavern, the home of the town’s wealthiest man that was the real home of a town’s wealthiest man. You get the picture.

The place isn’t a restoration of history but a collection of historic buildings that would have evolved or burned down or decayed out of existence if the curators had not relocated them to this re-enactment site and preserved them like snapshots in time.

If you lived then, your clothes would have been sewed by hand, you would have had limited access to books and to the light by which you could read them. The dollars in your pocket would be notes printed by a bank and could — at any time — become worthless. Banks were private businesses financed by wealthy individuals and if a bank were robbed or the backer went broke you lost the value of the scrip the bank had issued.

The fundamental premise on banking is the same today, except that now the banks are robbed from within, and the poorly run banks just stay in business.

But back to Sturbridge. This pristine village dramatizes life before modern conveniences. Fireplaces before central heating, mattresses held off the ground by ropes before box springs, outdoor cooking pits before the microwave and livestock instead of grocery stores.

Yet in the midst of all this toil and discomfort, efficiency and sensibility persisted. One of the most important features of our current lives existed back in the Sturbridge of old. In 1775, the United States Post Office was created under Benjamin Franklin by the Second Continental Congress. Government delivery of mail was considered such a priority that it was provided for in Article One of the Constitution.

Today that creation is one of our nation’s top three employers — the two larger entities are the Department of Defense and Wal-Mart, respectively. A separate arm of the government, under the jurisdiction of the executive branch, the Postal Service owns and operates 260,000 vehicles — made by either Ford or Chevrolet.

While the USPS faces healthy competition from other delivery companies such as FedEx or UPS, this government agency pays anywhere from $9,000 to $28,000 more to each of its full-time employees than the Social Security Administration’s national average of $40,405.

You can stand in the town square of Old Sturbridge Village and realize that Benjamin Franklin and his buddies who crafted our Constitution weren’t afraid of government delivering services. In fact, they wanted government to do so and used the Constitution to guarantee it. Consequently we now receive — free of charge — mail from all over the world; to include utility bills, advertisements, official correspondence and personal messages. But if we prefer to use a private currier to send our correspondence, we do not lose the right to receive our mail for free.

Too bad health care in Franklin’s time was leeches and bleedings. If health care had saved lives back then, Franklin and the other Founding Fathers would certainly have guaranteed the delivery of health care with the same enthusiasm they showed the mail.

But more smart people have been born since then. And many belong to the Maine Medical Association — an affiliate of the American Medical Association. Pick up a copy of its March-April 2009 newsletter and read about the poll it conducted of its members. It reads, “When asked the question, ‘When considering the topic of healthcare reform would you prefer to make improvements to the current public-private system or a single payer system such as a ‘Medicare for all’ system?” Members expressed a preference for a single-payer system 52.3 percent to 47.7 percent” The bill before Congress that provides this is HR 676.

Just call your members of Congress and ask for a copy. And our excellent governmental program, the Postal Service, will deliver one for you.

State lawmakers tout single-payer healthcare system

Associated Press
Sun Journal
Wednesday, April 8, 2009

AUGUSTA, Maine — Maine lawmakers have passed a resolution calling on President Obama and Congress to establish a single-payer health system that covers everyone.

The Senate passed the nonbinding resolution by a 20-15 vote on Wednesday, a day after the House did the same by a 91-52 vote.

The resolution cites the high costs of the present system and says managed care, health maintenance organizations and other reforms have failed to contain health costs.

The resolution was passed months after a poll of nearly 600 Maine physicians showed a majority in favor of a single payer or “Medicare for all” approach. The survey, conducted in November and December, showed 52 percent in favor and 48 percent against.

http://www.sunjournal.com/story/311640-3/MaineNews/State_lawmakers_tout_singlepayer_health

Lewin report on the public option

The Cost and Coverage Impacts of a Public Plan: Alternative Design Options

Prepared by John Sheils Randy Haught
The Lewin Group
April 6, 2009
President Obama has proposed to create a “public plan” that would compete for enrollment with the private insurance industry.
The public plan is difficult to evaluate because no one has specified in legislation how it would work.
Consequently, in this paper, we present impact estimates under several variations on the public plan model.
If Medicare payment levels are used in the public plan, premiums would be up to 30 percent less than premiums for comparable private coverage. On average, the monthly premium in the public plan for a typical benefits package would be $761 per family compared with an average of $970 per family in the private market for the same coverage.
If the public plan is opened to all employers as proposed by Senators Clinton and Edwards, at Medicare payment levels we estimate that about 131.2 million people would enroll in the public plan. The number of people with private health insurance would decline by 119.1 million people.
Medicare premiums would be lower than private premiums because of the exceptional leverage Medicare has with providers. Medicare pays hospitals about 30 percent less than private insurers pay for the same service. Physician payments are about 20 percent less than under private coverage. Also, because Medicare has no allowance for insurer profits or broker/agent commissions, administrative costs for this population are about one-third of administrative costs in private health plans.
Assuming Medicare reimbursement rates and eligibility for all individuals and employers, provider net income would decline under this public plan proposal, even after accounting for reduced uncompensated care and increased utilization for the newly insured. Net hospital revenues would fall by $36 billion (4.6 percent), and physician net income would fall by $33 billion (6.8 percent).
http://www.lewin.com/content/publications/LewinCostandCoverageImpactsofPublicPlan-Alternative%20DesignOptions.pdf

No details have been released by either Congress or the administration about the specifics of a potential public insurance option that could be offered in competition within a market of private health plans. Nevertheless, to provide an analysis of how such a plan might work, The Lewin Group used certain assumptions to prepare this simulation.
Under this analysis, hospitals would be paid 30 percent less than the reimbursement rates of private insurers, and physicians would be paid 20 percent less. Using these and other assumptions, premiums for the public plan would be 30 percent less than comparable coverage by private plans.
Supporters of the public option are likely to claim that it is an essential component of reform since it will lower the cost of insurance while expanding coverage to over 100 million more people.
Opponents of the public option are already claiming that the government would be an unfair competitor to the private plans because of its ability to dictate rates that are lower than what the private plans must charge.
This simulation may very well also increase the opposition by physicians and hospital administrators because of concern about the possibility of shifting large numbers of patients from the private plans to the government plan with its considerably lower reimbursement rates. In the heat of the debate, it may be forgotten that these fee reductions were an assumption made by the authors of this report for simulation purposes, and not a feature of any actual legislative proposal.
Unfortunately, this study only fuels a debate that has diverted us from the discussion that we should be having. Instead of arguing over a controversial, yet-to-be-defined measure that cannot possibly lead to the efficiencies, equity and effectiveness of the single payer model, we should be discussing what actually would work – true single payer reform.

Lewin report on the public option

The Cost and Coverage Impacts of a Public Plan: Alternative Design Options

Prepared by John Sheils Randy Haught
The Lewin Group
April 6, 2009

President Obama has proposed to create a “public plan” that would compete for enrollment with the private insurance industry.

The public plan is difficult to evaluate because no one has specified in legislation how it would work.

Consequently, in this paper, we present impact estimates under several variations on the public plan model.

If Medicare payment levels are used in the public plan, premiums would be up to 30 percent less than premiums for comparable private coverage. On average, the monthly premium in the public plan for a typical benefits package would be $761 per family compared with an average of $970 per family in the private market for the same coverage.

If the public plan is opened to all employers as proposed by Senators Clinton and Edwards, at Medicare payment levels we estimate that about 131.2 million people would enroll in the public plan. The number of people with private health insurance would decline by 119.1 million people.

Medicare premiums would be lower than private premiums because of the exceptional leverage Medicare has with providers. Medicare pays hospitals about 30 percent less than private insurers pay for the same service. Physician payments are about 20 percent less than under private coverage. Also, because Medicare has no allowance for insurer profits or broker/agent commissions, administrative costs for this population are about one-third of administrative costs in private health plans.

Assuming Medicare reimbursement rates and eligibility for all individuals and employers, provider net income would decline under this public plan proposal, even after accounting for reduced uncompensated care and increased utilization for the newly insured. Net hospital revenues would fall by $36 billion (4.6 percent), and physician net income would fall by $33 billion (6.8 percent).

http://www.lewin.com/content/publications/LewinCostandCoverageImpactsofPublicPlan-Alternative%20DesignOptions.pdf

Comment:

By Don McCanne, MD

No details have been released by either Congress or the administration about the specifics of a potential public insurance option that could be offered in competition within a market of private health plans. Nevertheless, to provide an analysis of how such a plan might work, The Lewin Group used certain assumptions to prepare this simulation.

Under this analysis, hospitals would be paid 30 percent less than the reimbursement rates of private insurers, and physicians would be paid 20 percent less. Using these and other assumptions, premiums for the public plan would be 30 percent less than comparable coverage by private plans.

Supporters of the public option are likely to claim that it is an essential component of reform since it will lower the cost of insurance while expanding coverage to over 100 million more people.

Opponents of the public option are already claiming that the government would be an unfair competitor to the private plans because of its ability to dictate rates that are lower than what the private plans must charge.

This simulation may very well also increase the opposition by physicians and hospital administrators because of concern about the possibility of shifting large numbers of patients from the private plans to the government plan with its considerably lower reimbursement rates. In the heat of the debate, it may be forgotten that these fee reductions were an assumption made by the authors of this report for simulation purposes, and not a feature of any actual legislative proposal.

Unfortunately, this study only fuels a debate that has diverted us from the discussion that we should be having. Instead of arguing over a controversial, yet-to-be-defined measure that cannot possibly lead to the efficiencies, equity and effectiveness of the single payer model, we should be discussing what actually would work – true single payer reform.

Universal health coverage in spotlight at L.A. forum

But the White House-organized event is light on details

By Lisa Girion and Noam Levey
Los Angeles Times
April 7, 2009

Reporting from Washington and Los Angeles — Even as President Obama toured Europe his administration pressed its healthcare reform campaign Monday in Los Angeles with a forum co-hosted by Gov. Arnold Schwarzenegger, who lost his bid in California to make many of the changes now on the table in Washington.

Reform is overdue, the governor said. “No one can look at our healthcare system and say that the system is fair or a good return on what we spend, and this consensus can help us pass significant bipartisan reforms into law.”


Andy Evano of the California School Employees
Association leads chanting by protesters
outside the forum.

A wide array of forum participants, including hospital and insurance company executives and the mother of a teenager who died from a preventable hospital-acquired infection, gave voice to the grow- ing desire for change. But the presentation was light on details.

Universal coverage — health insurance for all Americans — was widely touted, but there was no discussion of how to achieve that goal.

The forum, the fifth in a series the White House organized around the country over the last month, comes as senior Democrats on Capitol Hill move ahead on drafting legislation to be introduced later this spring to overhaul the nation’s healthcare system.

The president and his congressional allies have pledged that the bill will expand coverage to some 46 million uninsured people, rein in costs and improve the quality of care.

The White House billed the five forums as a way to get public input. But the invitation-only event in Los Angeles was clearly programmed to showcase the broad goals Obama has said he wants included in the legislation, including an emphasis on prevention, as well as secure and affordable coverage for everyone, regardless of age or preexisting conditions.

Schwarzenegger, who hosted the event with Washington Gov. Chris Gregoire, marveled at the White House support for reform. “Isn’t it nice to have a president who is passionate about healthcare?” Schwarzenegger said. “I love it.”

In making his case for a healthcare overhaul, Schwarzenegger took a swipe at the insurance company practice of canceling members’ coverage after they get sick over purported application misstatements about preexisting conditions. “That is unacceptable,” the governor said.

Schwarzenegger’s $14.9-billion proposal intended to provide medical insurance for nearly all Californians died in the state Senate last year.

Outside the forum, the California Nurses Assn., Physicians for a National Health Program and other groups drew hundreds to a rally in support of the so-called single-payer option, which would put government in charge of organizing and purchasing healthcare and leave the private insurance market in tatters.

Deborah Burger, co-president of the California-based nurses union, a Schwarzenegger foe, said she feared that the single-payer approach would not be considered in Washington because of heavy lobbying by the insurance industry. She said the forum, where no single-payer proponent spoke, was just more “window dressing.”

With the forums concluded, the action now shifts to Washington, where members of Congress also are working toward universal coverage through legislation that would modify the current private insurance market rather than replace it.

Congressional leaders are crafting a budget resolution that could allow Democrats to pass major healthcare legislation this year with a simple majority in the Senate, rather than the 60-vote supermajority necessary to head off a Republican filibuster.

House Democrats and some in the White House are pushing for this approach, though some senior Senate Democrats are more wary of employing a tactic that is sure to provoke a Republican revolt. Congress will take up the budget resolution when lawmakers return from spring recess in two weeks.

Doc organization pushes 'Medicare-for-all' system

By Andis Robeznieks
Modern Healthcare
April 6, 2009

Sarcastically describing them as “brilliant,” Physicians for a National Health Program National Coordinator Quentin Young warned that the legislative proposals currently being considered to improve access to healthcare are “a catastrophe in the making” and would rival the collapse of the financial markets.

Speaking at an outdoor rally today in downtown Chicago’s Federal Plaza, Young advocated for a publicly funded, privately operated “Medicare-for-all” health system, and he mocked proposals to mandate that everyone buy private insurance or face a fine.

The rally was timed to coincide with the White House forum on healthcare reform taking place in Los Angeles and was co-sponsored by the California Nurses Association/National Nurses Organizing Committee. Young noted that single-payer advocates were denied a seat at the table at today’s forum and that–in Los Angeles–“thousands were protesting outside because they could not get inside.”

Another source, however, estimated a smaller crowd. A news release issued by the Leadership Conference for Guaranteed Healthcare, a coalition that includes both the PNHP and CNA, noted that “hundreds” had gathered around a giant table representing how single-payer advocates had been shut out of the forum.

The Chicago rally was attended by about 30 people, and the California Nurses Association was represented by Frank Borgers, who told how the Los Angeles forum was being hosted by “our friend–not so much–Gov. Schwarzenegger.” Borgers also mocked proposals mandating the purchase of private insurance as “foolhardy” and “doomed.”

“The nation cannot afford to subsidize private health insurance,” Borgers said.

Young described the current political climate as a good-news/bad-news proposition, explaining that public support for a single-payer system has never been stronger, but that insurance companies have been working harder than ever to maintain their control. “They have not been asleep at the wheel,” he said.

Young also noted the “bitter realities” facing the city of Chicago’s healthcare system, including how the 553-bed University of Chicago Medical Center was working to redirect a significant number of its emergency department visitors to other facilities and how the 364-bed Michael Reese Hospital and Medical Center–whose staff he joined in 1952–is closing down.

University of Chicago Medical Center spokesman John Easton defended his institution’s program to reduce emergency room traffic and described it as an effort to find medical homes for patients who use the hospital’s emergency department as their main source of primary care rather than for treatment of true medical emergencies.

Doc organization pushes ‘Medicare-for-all’ system

By Andis Robeznieks
Modern Healthcare
April 6, 2009

Sarcastically describing them as “brilliant,” Physicians for a National Health Program National Coordinator Quentin Young warned that the legislative proposals currently being considered to improve access to healthcare are “a catastrophe in the making” and would rival the collapse of the financial markets.

Speaking at an outdoor rally today in downtown Chicago’s Federal Plaza, Young advocated for a publicly funded, privately operated “Medicare-for-all” health system, and he mocked proposals to mandate that everyone buy private insurance or face a fine.

The rally was timed to coincide with the White House forum on healthcare reform taking place in Los Angeles and was co-sponsored by the California Nurses Association/National Nurses Organizing Committee. Young noted that single-payer advocates were denied a seat at the table at today’s forum and that–in Los Angeles–“thousands were protesting outside because they could not get inside.”

Another source, however, estimated a smaller crowd. A news release issued by the Leadership Conference for Guaranteed Healthcare, a coalition that includes both the PNHP and CNA, noted that “hundreds” had gathered around a giant table representing how single-payer advocates had been shut out of the forum.

The Chicago rally was attended by about 30 people, and the California Nurses Association was represented by Frank Borgers, who told how the Los Angeles forum was being hosted by “our friend–not so much–Gov. Schwarzenegger.” Borgers also mocked proposals mandating the purchase of private insurance as “foolhardy” and “doomed.”

“The nation cannot afford to subsidize private health insurance,” Borgers said.

Young described the current political climate as a good-news/bad-news proposition, explaining that public support for a single-payer system has never been stronger, but that insurance companies have been working harder than ever to maintain their control. “They have not been asleep at the wheel,” he said.

Young also noted the “bitter realities” facing the city of Chicago’s healthcare system, including how the 553-bed University of Chicago Medical Center was working to redirect a significant number of its emergency department visitors to other facilities and how the 364-bed Michael Reese Hospital and Medical Center–whose staff he joined in 1952–is closing down.

University of Chicago Medical Center spokesman John Easton defended his institution’s program to reduce emergency room traffic and described it as an effort to find medical homes for patients who use the hospital’s emergency department as their main source of primary care rather than for treatment of true medical emergencies.

McClellan asks, "What would be the point?"

Democrats seek compromise on health care plan

By Ricardo Alonso-Zaldivar
The Washington Post
April 2, 2009
Democrats are seeking a compromise on a bigger government role in insurance coverage as part of President Barack Obama’s proposed health care overhaul.
At issue is whether middle-class workers and families should have the option of a government-sponsored plan that would compete with private insurers.
Sen. Charles Schumer, who is working on the issue for the Senate Finance Committee, said Thursday one potential compromise is based on insurance plans that most states already offer their employees. Obama’s health secretary nominee, Kansas Gov. Kathleen Sebelius, likes the idea.
Schumer, D-N.Y., said such a plan would avoid expanding a federal program like Medicare and that a private insurer possibly could run it. Sebelius already administers that type of plan in Kansas.
The insurance lobby fears that a federally backed plan could drive companies out of business.
“We are taking a look at the different state employee plans to get a better understanding of how they operate,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans.
GOP lawmakers “are going to need to know what’s in the fine print,” said Craig Orfield, a spokesman for Sen. Mike Enzi, R-Wyo., a leading lawmaker in the debate.
“My goal is to find a plan that would be acceptable to large numbers of senators,” Schumer said in an interview. “Right now, the private insurers are totally opposed, but maybe there’s room.”
In California, the state sponsors three medical network plans for employees and retirees. These plans are offered alongside traditional insurance plans. The state-sponsored plans, administered by Anthem Blue Cross, account for about one-fourth of the 1.3 million people in the state employee health program, said Karen Perkins, a spokeswoman for the California Public Employees Retirement System, known as CalPERS.
The idea of using the state employee plans as a model came last month from two policy experts, Len Nichols and John Bertko.
“We were just trying to avoid nuclear war,” said Nichols, director of health policy for the nonpartisan New America Foundation. “We saw advocates of Medicare for all pushing to put the country into Medicare. And we saw the right using that to push the moderates out of engagement in the health reform debate.”
Schumer said he is looking at Nichols’ idea as a possible compromise and is beginning to sound out other Democrats and policy experts. He has room to maneuver because Obama and many Democrats did not spell out what they mean by a “public” insurance option.
But Schumer said other Democrats insist that option should look like Medicare, in which the government directly sets benefits and payment rates.
Mark McClellan, a health policy expert who ran Medicare under President George W. Bush, said Nichols’ proposal was “well meaning,” but that the government is much bigger than any state, so the effects of a federally backed plan on the insurance market would be far greater.
“At this point, I don’t know many Republicans who are confident a public option could work without making it look like another private sector choice,” said McClellan. “And then what would be the point?”
http://www.washingtonpost.com/wp-dyn/content/article/2009/04/02/AR2009040202804.html

The progressives in the House of Representatives have stated that they “will only support comprehensive health care reform legislation which includes a public plan option on a level playing field with private health insurance plans.” (http://cpc.grijalva.house.gov/index.cfm?ContentID=351&ParentID=0&SectionID=66&SectionTree=66&lnk=b&ItemID=349)
The Republicans will not support a government-run plan that competes “unfairly” with the private health plans. Specifically, they will not support a Medicare-like option.
But look at the wording of the statement from the Progressive Caucus. The public plan option must be “on a level playing field with the private plans.” The model that meets that definition is a PPO that is sponsored by the government but administered by private insurers, with a firewall separating the PPO from the government. Thus the government option will be simply another PPO, with all of its perverseness, competing in a market of private plans. The line in the sand drawn by the Progressive Caucus was washed away by their carefully worded release.
Mark McClellan has it right. The only hope for gaining the support of Republicans is to make the government option “look like another private sector choice, and then what would be the point?”
With the concession of the progressives, the strategy for a Medicare-like public option has already failed. Moving forward with what amounts to another private PPO with a government seal of approval means that the private insurance industry will maintain control of health care financing for the majority of Americans.
We have in the making yet one more example of where the Republicans will extract enough concessions from the Democrats to ruin the legislation, and then when it comes time to vote, the Republicans will vote against it anyway.
The Democrats have to give up the fantasy of a bipartisan solution since Congressional bipartisanship is a total fiction. The Democrats have to move forward with honest health care reform that works for everyone. They shouldn’t look for help from the party of NO.

McClellan asks, "What would be the point?"

Democrats seek compromise on health care plan

By Ricardo Alonso-Zaldivar
The Washington Post
April 2, 2009

Democrats are seeking a compromise on a bigger government role in insurance coverage as part of President Barack Obama’s proposed health care overhaul.

At issue is whether middle-class workers and families should have the option of a government-sponsored plan that would compete with private insurers.

Sen. Charles Schumer, who is working on the issue for the Senate Finance Committee, said Thursday one potential compromise is based on insurance plans that most states already offer their employees. Obama’s health secretary nominee, Kansas Gov. Kathleen Sebelius, likes the idea.

Schumer, D-N.Y., said such a plan would avoid expanding a federal program like Medicare and that a private insurer possibly could run it. Sebelius already administers that type of plan in Kansas.

The insurance lobby fears that a federally backed plan could drive companies out of business.

“We are taking a look at the different state employee plans to get a better understanding of how they operate,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans.

GOP lawmakers “are going to need to know what’s in the fine print,” said Craig Orfield, a spokesman for Sen. Mike Enzi, R-Wyo., a leading lawmaker in the debate.

“My goal is to find a plan that would be acceptable to large numbers of senators,” Schumer said in an interview. “Right now, the private insurers are totally opposed, but maybe there’s room.”

In California, the state sponsors three medical network plans for employees and retirees. These plans are offered alongside traditional insurance plans. The state-sponsored plans, administered by Anthem Blue Cross, account for about one-fourth of the 1.3 million people in the state employee health program, said Karen Perkins, a spokeswoman for the California Public Employees Retirement System, known as CalPERS.

The idea of using the state employee plans as a model came last month from two policy experts, Len Nichols and John Bertko.

“We were just trying to avoid nuclear war,” said Nichols, director of health policy for the nonpartisan New America Foundation. “We saw advocates of Medicare for all pushing to put the country into Medicare. And we saw the right using that to push the moderates out of engagement in the health reform debate.”

Schumer said he is looking at Nichols’ idea as a possible compromise and is beginning to sound out other Democrats and policy experts. He has room to maneuver because Obama and many Democrats did not spell out what they mean by a “public” insurance option.

But Schumer said other Democrats insist that option should look like Medicare, in which the government directly sets benefits and payment rates.

Mark McClellan, a health policy expert who ran Medicare under President George W. Bush, said Nichols’ proposal was “well meaning,” but that the government is much bigger than any state, so the effects of a federally backed plan on the insurance market would be far greater.

“At this point, I don’t know many Republicans who are confident a public option could work without making it look like another private sector choice,” said McClellan. “And then what would be the point?”

http://www.washingtonpost.com/wp-dyn/content/article/2009/04/02/AR2009040202804.html

Comment:

By Don McCanne, MD

The progressives in the House of Representatives have stated that they “will only support comprehensive health care reform legislation which includes a public plan option on a level playing field with private health insurance plans.” (http://cpc.grijalva.house.gov/index.cfm?ContentID=351&ParentID=0&SectionID=66&SectionTree=66&lnk=b&ItemID=349)

The Republicans will not support a government-run plan that competes “unfairly” with the private health plans. Specifically, they will not support a Medicare-like option.

But look at the wording of the statement from the Progressive Caucus. The public plan option must be “on a level playing field with the private plans.” The model that meets that definition is a PPO that is sponsored by the government but administered by private insurers, with a firewall separating the PPO from the government. Thus the government option will be simply another PPO, with all of its perverseness, competing in a market of private plans. The line in the sand drawn by the Progressive Caucus was washed away by their carefully worded release.

Mark McClellan has it right. The only hope for gaining the support of Republicans is to make the government option “look like another private sector choice, and then what would be the point?”

With the concession of the progressives, the strategy for a Medicare-like public option has already failed. Moving forward with what amounts to another private PPO with a government seal of approval means that the private insurance industry will maintain control of health care financing for the majority of Americans.

We have in the making yet one more example of where the Republicans will extract enough concessions from the Democrats to ruin the legislation, and then when it comes time to vote, the Republicans will vote against it anyway.

The Democrats have to give up the fantasy of a bipartisan solution since Congressional bipartisanship is a total fiction. The Democrats have to move forward with honest health care reform that works for everyone. They shouldn’t look for help from the party of NO.

Are we safer than Natasha Richardson?

By Laura S. Boylan, M.D.
Commondreams.org
Monday, April 6, 2009

In an example of the circus of fear and hyperbole surrounding the health care debate, opponents of government involvement in health care are exploiting Natasha Richardson’s tragic death from a skiing accident.

The New York Post reports “Canadacare May Have Killed Natasha.” The blogosphere has headlines like “Canada’s Killer Healthcare.”

Here are the bare facts: Natasha Richardson died from an epidural hematoma, a condition that requires urgent evaluation and surgical treatment. When treated early enough, this injury is rarely fatal. It is, therefore, reasonable to ask how different health care systems handle this sort of emergency.

Ms. Richardson’s initial refusal of an ambulance cost about two hours. With 20/20 hindsight we know this was a bad decision. However, it’s also true that “feeling OK” after a minor head injury is, in fact, a powerful predictor of a good outcome. But bad things do happen. Patients with an epidural hematoma may initially feel and look well, this is referred to as a “lucid interval.”

After the ambulance was summoned for a second time, only 3 hours and 40 minutes elapsed before Ms. Richardson arrived at a neurotrauma center in Montreal. On the way she was evaluated and stabilized at a community hospital with modern imaging facilities. Apparently, however, it was still too late.

Many have asserted that Ms. Richardson would have fared better in the United States. This is far from certain. With epidural hematomas, it’s all in the timing. The intervention required is one of the simplest in neurosurgery.

Helicopter airlift, or the lack thereof, has been a focus of criticism of Ms. Richardson’s care. An immediately available helicopter might have helped Ms. Richardson if used to transfer her directly from the resort to Montreal. It’s hard to know. However, it does not follow that the profusion of medical helicopter services in the United States makes Americans safer.

As reported by the Institute of Medicine, neurosurgeons are often unavailable to provide emergency and trauma care in the U.S. Detailed data on patients referred to specialty hospitals for emergency neurosurgical evaluations is available for Cook County, Illinois. This county, which includes Chicago, is densely populated. Total time elapsed from arrival to a community hospital to arrival at the specialty hospital averaged 11 hours. The comparable time period for Ms. Richardson, who had an accident in rural Quebec, was less than 3 hours. In Cook County most patients would still be awaiting an imaging study at the first hospital.

The Austin American-Statesman reported in 2002 that a man with a vertebral fracture after a fall waited 8 hours in an Austin emergency room before being airlifted to Temple because no local neurosurgeon was available. In Temple, he waited two days for surgery and was eventually billed over $4,000 for the helicopter. In the end, it turned out that there had, in fact, been a neurosurgeon available in Austin; however, he worked at a hospital in a competing network. This is just one case, but it does illustrate how business incentives distort quality in our health care system.

U.S. helicopter medical evacuation services are extensive, but tend to address market rather than public health imperatives. Helicopters are concentrated in urban rather than rural areas. Alarming fatality rates due to accidents during medical helicopter evacuations have led to headlines such as in “Critics Say Emergency Medical Helicopters Are Overused and Offer Few Benefits to Patients” (Wall Street Journal 2005).

It’s different in Canada. In Quebec, while there is no helicopter service there is a fixed wing air ambulance service. Fixed-wing craft require a landing strip but are much faster. In addition to being used for long distance emergencies in this vast province, several times a week Quebeckers from remote regions are flown to the city to obtain non-emergency medical care not available locally. All of this is free to patients, who are covered by Canadian medicare. Other provinces do have helicopter evacuation services, and these have a better safety record than their U.S. counterparts.

A really good emergency medical system addresses the continuum of care from prevention to pre-hospital care to rehabilitation. Nova Scotia, a not-wealthy largely rural Canadian province, has created a model program of integrated services, which others have aimed to reproduce.

Dr. Ronald Stewart, who championed the program first as a legislator and then as minister of health, engineered the replacement of fragmented private services with a unified public system in the 1990s. Innovation has thrived with a profusion of influential research papers on, for example, medically appropriate helicopter triage, head injury treatment guidelines, and detailed reports of clinical characteristics and outcomes of all surgical interventions on injuries of the sort Ms. Richardson had. The average wait time for neurosurgical emergency treatment in Nova Scotia, by the way, is less than in Cook County.

I have worked for years in a variety of different sorts of U.S. health care facilities including inner city hospitals, private academic referral centers, rural community hospitals and the Department of Veterans Affairs. A uniform truth, alas, is that financial incentives play a major role in who gets what care and when. We have scarcity in the midst of excess, to the detriment of patients on both receiving ends.

If you are uninsured and socially undesirable you can die in Manhattan from an epidural hematoma, despite rapid arrival to an emergency room and what must surely be one of the world’s densest concentrations of medical subspecialty care. I’ve seen it. Trauma patients are disproportionately uninsured and are considered a high medicolegal liability risk.

Our entire emergency care system is overwhelmed, in large part, due to lack of universal access to other health care. As a result, all Americans are left to rely on a distorted emergency system. When it comes to effective clinical emergency care we should emulate Canada’s single-payer system, not congratulate ourselves on helicopter availability in Aspen.

Laura S. Boylan is clinical associate professor of neurology, New York University School of Medicine; attending neurologist, Department of Veteran’s Affairs; and board member, Physicians for a National Health Program – Metro NY.

Dr. Boylan’s institutional affiliations are provided for identification purposes only; the views expressed are hers alone.