PNHP

Deliberate, explicit rationing of hospital beds – in the U.S.!

Deliberate, explicit rationing of hospital beds – in the U.S.!

Doctors Fight Plan to Limit Beds in ER

By Thomas M. Burton
The Wall Street Journal
February 28, 2009

A plan to curb the number of beds available to emergency-room patients at one of the nation’s most prestigious hospitals has spurred a divisive internal debate that is being closely watched by hospital physicians across the country.

At issue at the University of Chicago Medical Center, located in the South Side’s Hyde Park neighborhood, is a proposal that could limit the number of beds available to emergency-room patients. In February, two high-ranking doctors quit their administrative posts to protest the plan, saying it could lengthen already long waiting times for patients who visit the ER.

The dispute touches on one of the most critical questions facing hospitals that serve low-income populations: How many patients on Medicaid insurance, and older patients on Medicare, can a hospital afford to serve?

Many emergency physicians across the country say limiting beds for ER patients could become a means of economizing that might spread to other hospitals.

One 2007 internal report on the emergency department said, “On many afternoons/evenings, 30 or more patients are waiting with longest wait-to-be-seen times often exceeding 8-9 hours.” The same document showed that by 2007 the sickest ER patients who need intensive care waited, on average, 14 hours before being transferred to the ICU. In recent interviews, hospital doctors said those waits have been increasing.

Peer-reviewed studies suggest lengthy waits can be dangerous. “Critically ill emergency department patients with a greater than six-hour delay in intensive-care-unit transfer had increased hospital length of stay and higher intensive-care-unit and hospital mortality,” according to a 2007 study in Critical Care Medicine.

James L. Madara, the University of Chicago’s chief executive and dean of medicine, declined to comment on specific wait times at his hospital, but said the administration’s intent is to set aside more beds for specialties like oncology, gastroenterology and neurosurgery that attract patients from around the U.S.

Among other moves, the hospital is considering cutting the number of beds available to ER patients who are so acutely ill that they must be transferred to general-medicine or intensive-care wards. It plans to close, for economy reasons, a 24-bed general medicine unit and an intensive care unit of just under half that size. These units at present serve many emergency patients, hospital doctors say.

In his Feb. 1 letter to the administration, Dr. Vanden Hoek suggested that several of the changes could favor patients with private insurance. “Some patients will have rapid access to an ICU or private bed,” he wrote, but lower-income emergency patients who require admission to the hospital “will not be so lucky.”

http://online.wsj.com/article/SB123577975486997825.html

Comment:

By Don McCanne, MD

This article points out that a final decision has not been made, but it is nevertheless shocking that a non-profit university hospital has had under consideration a proposal to reduce the number of beds in an emergency room that already has a strained capacity.

The reason given for even considering rationing of emergency room beds demonstrates just how sick our health care financing system is. They would increase the overload of the emergency room to a level that would drive away low income populations so that they would not have to admit those who are “so acutely ill that they must be transferred to general-medicine or intensive-care wards” within their hospital. Just to be sure, they would reduce those acute in-patient beds as well. At the same time that they would create deliberate rationing for acutely ill, low-income individuals, they would expand their bed capacity for lucrative services for insured patients.

Sick, sick, sick!

This isn’t about a lack of money, because we already spend more than enough to pay for these services. This is about the way we finance health care. The uninsured and those in the under-funded Medicaid program are a drain on resources, and it is understandable that the administrators would want to reduce that drain. But our sick system of financing care leads them to the consideration of truly perverse methods of reducing that burden.

The current leading proposal to expand our fragmented, dysfunctional system of financing health care will not correct the perversities of a multi-tiered system. But imagine if we re-directed the $2.5 trillion that we are already spending into a single payer national health program, these perversities would be sharply curtailed. Health delivery system design would be based on patient needs rather than on the nature and distribution of the financing sources. Can’t those in Washington working on reform understand this? It’s not that complicated of a concept.

Sen. Baucus: We Need Accurate Numbers not "Creative" Figuring

Senate Finance Committee Chairman Max Baucus (D-MT), who ruled single payer “off the table” before he even started considering healthcare reform, is now trying to pressure the Congressional Budget Office (CBO) to judge the Baucus health plan financially sound.

Baucus held a Finance Committee hearing last Wednesday (2/25/09) at which the sole witness was CBO Director Douglas Elmendorf.

According to CongressDaily (2/25), Baucus, other lawmakers, and “some special interest groups have not been particularly pleased with what they view as CBO’s conservative scoring of some supposed cost-cutting efforts that are needed to help offset the enormous price tag” of overhauling the health care system under the Baucus plan.

Baucus said if healthcare reform is to pass, the CBO needs to “get ever more creative to find … pathways to get the savings that we have to have.” (Edney, CongressDaily, 2/25)

Baucus told the head of CBO at last Wednesday’s hearing that the Congressional Budget Office will play a significant role in efforts to overhaul the U.S. health care system because the agency’s cost assessments will “make or break this enterprise,” CQ HealthBeat. Experienced observers assert that this is Baucus’ way of pressuring the agency to come up with figures to justify the kind of healthcare reform Baucus wants. Similar pressure in the extreme was placed upon the CBO in the early 1990’s when the Clinton health plan was being debated.

The CBO is responsible for “scoring” any legislative proposal for its true costs and savings. CBO has been recognized for the accuracy of its findings and projections and for its non-partisanship. In fact, a 1991 CBO study found that a single payer system in the US could cover all the uninsured at the (then) current level of spending or less because of reduction in administrative costs. https://pnhp.org/facts/single_payer_system_cost.php?page=all

Many recently proposed healthcare plans, similar to the one Baucus says he is drafting, keep private-for-profit health insurance companies in the mix and are based on claiming hugh savings from such things as the introduction of computerized record keeping. These so called “savings” are then touted as the way the proposed plan can be “paid for”.

The CBO has issued a series of recent studies which have found that most savings claimed, in the effort to keep private-for-profit insurance companies in the mix, do not exist. Recent CBO studies of disease management, “medical homes,” electronic medical records, comparative effectiveness research, a public plan that competes with the private insurers and others, do not save money as claimed.

Call, write or fax Senator Baucus and tell him we need accurate numbers not creative figuring. Single payer should be on the table and should be given a full and fair hearing by the Senate Finance Committee.

Senator Max Baucus
511 Hart Senate Office Bldg.
Washington, D.C. 20510
(202) 224-2651(Office)
(202) 224-9412 (Fax)

#30#

HR 676 would institute a single payer health care system by expanding a greatly improved Medicare system to everyone residing in the U. S.

HR 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, and long term care.

HR 676 ends deductibles and co-payments. HR 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

In the current Congress, HR 676 has 59 co-sponsors in addition to Conyers.

HR 676 has been endorsed by 485 union organizations in 49 states including 120 Central Labor Councils and Area Labor Federations and 39 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NY, NV & MA).

For further information, a list of union endorsers, or a sample endorsement resolution, contact:

Kay Tillow
All Unions Committee For Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551
Email: nursenpo@aol.com
http://unionsforsinglepayerHR676.org
03/02/09

To STOP receiving these emails reply with REMOVE in subject line.

Action Alert: Call The White House: Let Single Payer In

On Thursday, March 5, 2009, the White House will host a summit on how to reform the healthcare system.

The 120 invited guests include lobbyists for various interest groups including the private-for-profit insurance industry (AHIP), some members of Congress including Senate Finance Chairman Max Baucus who has already ruled single payer “off the table,” and various others concerned with healthcare.

No single payer advocates have been invited to attend.

Please urge President Obama to fulfill his promise for transparency and openness in government

Call The White House (202) 456-1414 or (202) 456-1111.

Tell them to let single payer into the White House Summit on healthcare.

Distributed by:
All Unions Committee For Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551
Email: nursenpo@aol.com
http://unionsforsinglepayerHR676.org

Not All Invited to Obama's Health Reform Forum

Email Pres. Obama: What happened to Openess and Transparency?

Published by Swing State
March 3, 2009
Washington, DC

One group is being left out of the White House’s health reform forum Thursday: supporters of single payer health care.

President Obama has promised an open discussion as he begins an aggressive push for health care reform. Obama said Monday he is “bringing together business and labor, doctors and insurers, Democrats and Republicans” to discuss.

Progressive Democrats of America and Physicians for a National Health Program, leading proponents of expanding Medicare, government-run health care to cover all Americans, have not been invited and are “seeking” an invitation.

John Conyers, Chair of the House Judiciary Committee, has become Congress’ leader for single payer. He has authored H.R. 676, the model bill for single payer advocates, which has 59 cosponsors. He too has not yet received an invitation.

Liberal health consumer advocate groups such as Families USA and Health Care for America Now are invited and are attending. Neither plan to push single payer.

Even Obama’s new nominee to be Secretary of Health and Human Services, Kathleen Sebelius’ own newly implemented state agency, the Kansas Health Policy Authority, recommended single payer as one of four policy options. Despite the government agency’s determination that single payer would be the cheapest, Kansas has also decided to reject that route thus far.

Despite President Obama’s pledge for an open discussion where every position has a seat at the table, one idea seems to be off the table.

UPDATE 3: What People Said at Obama’s Health Summit

Obama to Single Payer Advocates: Drop Dead

Corporate Crime Reporter
March 3, 2009

President Obama’s White House made crystal clear this week: a Canadian-style, Medicare-for-all, single payer health insurance system is off the table.

Obama doesn’t even want to discuss it.

Take the case of Congressman John Conyers (D-Michigan).

Conyers is the leading advocate for single payer health insurance in Congress.

Last week, Conyers attended a Congressional Black Caucus meeting with President Obama at the White House.

During the meeting, Congressman Conyers, sponsor of the single payer bill in the House (HR 676), asked President Obama for an invite to the President’s Marchy 5 health care summit at the White House.

Conyers said he would bring along with him two doctors — Dr. Marcia Angell and Dr. Quentin Young — to represent the majority of physicians in the United States who favor single payer.

Obama would have none of it.

This week, by e-mail, Conyers heard back from the White House — no invite.

Why not?

Well, believe it or not, the Obama White House is under the thumb of the health insurance industry.

Obama has become the industry’s chief enforcer of its key demand: single payer health insurance is off the table.

Earlier this week, Obama named his health reform leadership team — Kansas Governor Kathleen Sebelius and Nancy-Ann DeParle.

Single payer advocates were not happy.

Since leaving Medicare, DeParle cashed in as a director at major for profit health care corporations, including Medco Health Solutions, Cerner, Boston Scientific, DaVita, and Triad Hospitals.

Now, what does the health insurance industry make of the Sebelius/DeParle team?

Here is Karen Ignagni, president of the lead health insurance lobbying group, America’s Health Insurance Plans:

“Today the President is putting in place a team that is ready on day one to provide the leadership necessary to achieve health care reform. Governor Sebelius is the right person to move the President’s health care agenda forward. She is a proven leader with extensive knowledge of health care issues and a long history of working effectively across the political aisle. As a former CMS administrator, Nancy-Ann DeParle brings considerable experience and a strong track record working on all of the health care issues facing the nation.”

Karen sounds really upset, right?

Dr. David Himmelstein is a founder and spokesperson for Physicians for a National Health Program.

Himmelstein’s take — Obama is caving to the insurance industry.

“The President once acknowledged that single payer reform was the best option, but now he’s caving in to corporate healthcare interests and completely shutting out advocates of single payer reform,” Himmelstein said. “The majority of Americans favor single payer, and it’s the most popular reform option among doctors and health economists, but no single payer supporter has been invited to participate in the administration’s health care summit. Meanwhile, he’s appointed as his health reform czar Nancy-Ann DeParle, a woman who has made her living advising health care investors and sits on the board of many for-profit firms that have made billions from Medicare. Her appointment — and the invitation list to the healthcare summit — is a clear signal that the administration plans to propose a corporate-friendly health reform that has no chance of actually solving our health care crisis.”

Obama to single payer advocates: drop dead.

Sen. Baucus: We Need Accurate Numbers not “Creative” Figuring

Senate Finance Committee Chairman Max Baucus (D-MT), who ruled single payer “off the table” before he even started considering healthcare reform, is now trying to pressure the Congressional Budget Office (CBO) to judge the Baucus health plan financially sound.

Baucus held a Finance Committee hearing last Wednesday (2/25/09) at which the sole witness was CBO Director Douglas Elmendorf.

According to CongressDaily (2/25), Baucus, other lawmakers, and “some special interest groups have not been particularly pleased with what they view as CBO’s conservative scoring of some supposed cost-cutting efforts that are needed to help offset the enormous price tag” of overhauling the health care system under the Baucus plan.

Baucus said if healthcare reform is to pass, the CBO needs to “get ever more creative to find … pathways to get the savings that we have to have.” (Edney, CongressDaily, 2/25)

Baucus told the head of CBO at last Wednesday’s hearing that the Congressional Budget Office will play a significant role in efforts to overhaul the U.S. health care system because the agency’s cost assessments will “make or break this enterprise,” CQ HealthBeat. Experienced observers assert that this is Baucus’ way of pressuring the agency to come up with figures to justify the kind of healthcare reform Baucus wants. Similar pressure in the extreme was placed upon the CBO in the early 1990’s when the Clinton health plan was being debated.

The CBO is responsible for “scoring” any legislative proposal for its true costs and savings. CBO has been recognized for the accuracy of its findings and projections and for its non-partisanship. In fact, a 1991 CBO study found that a single payer system in the US could cover all the uninsured at the (then) current level of spending or less because of reduction in administrative costs. https://www.pnhp.org/facts/single_payer_system_cost.php?page=all

Many recently proposed healthcare plans, similar to the one Baucus says he is drafting, keep private-for-profit health insurance companies in the mix and are based on claiming hugh savings from such things as the introduction of computerized record keeping. These so called “savings” are then touted as the way the proposed plan can be “paid for”.

The CBO has issued a series of recent studies which have found that most savings claimed, in the effort to keep private-for-profit insurance companies in the mix, do not exist. Recent CBO studies of disease management, “medical homes,” electronic medical records, comparative effectiveness research, a public plan that competes with the private insurers and others, do not save money as claimed.

Call, write or fax Senator Baucus and tell him we need accurate numbers not creative figuring. Single payer should be on the table and should be given a full and fair hearing by the Senate Finance Committee.

Senator Max Baucus
511 Hart Senate Office Bldg.
Washington, D.C. 20510
(202) 224-2651(Office)
(202) 224-9412 (Fax)

#30#

HR 676 would institute a single payer health care system by expanding a greatly improved Medicare system to everyone residing in the U. S.

HR 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, and long term care.

HR 676 ends deductibles and co-payments. HR 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

In the current Congress, HR 676 has 59 co-sponsors in addition to Conyers.

HR 676 has been endorsed by 485 union organizations in 49 states including 120 Central Labor Councils and Area Labor Federations and 39 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NY, NV & MA).

For further information, a list of union endorsers, or a sample endorsement resolution, contact:

Kay Tillow
All Unions Committee For Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551
Email: nursenpo@aol.com
http://unionsforsinglepayerHR676.org
03/02/09

To STOP receiving these emails reply with REMOVE in subject line.

Not All Invited to Obama’s Health Reform Forum

Email Pres. Obama: What happened to Openess and Transparency?

Published by Swing State
March 3, 2009
Washington, DC

One group is being left out of the White House’s health reform forum Thursday: supporters of single payer health care.

President Obama has promised an open discussion as he begins an aggressive push for health care reform. Obama said Monday he is “bringing together business and labor, doctors and insurers, Democrats and Republicans” to discuss.

Progressive Democrats of America and Physicians for a National Health Program, leading proponents of expanding Medicare, government-run health care to cover all Americans, have not been invited and are “seeking” an invitation.

John Conyers, Chair of the House Judiciary Committee, has become Congress’ leader for single payer. He has authored H.R. 676, the model bill for single payer advocates, which has 59 cosponsors. He too has not yet received an invitation.

Liberal health consumer advocate groups such as Families USA and Health Care for America Now are invited and are attending. Neither plan to push single payer.

Even Obama’s new nominee to be Secretary of Health and Human Services, Kathleen Sebelius’ own newly implemented state agency, the Kansas Health Policy Authority, recommended single payer as one of four policy options. Despite the government agency’s determination that single payer would be the cheapest, Kansas has also decided to reject that route thus far.

Despite President Obama’s pledge for an open discussion where every position has a seat at the table, one idea seems to be off the table.

UPDATE 3: What People Said at Obama’s Health Summit

Sen. Baucus wants CBO to be "creative"

Hearing: Scoring Health Care Reform: CBOā€™s Budget Options

United States Senate Committee on Finance
February 25, 2009
Closing comments
Sen. Max Baucus, Chairman: Thank you very much, Dr. Elmendorf. We have a huge problem, haven’t we? This is the most difficult public policy undertaking I’ve experienced in my Senate life here. I’ve been here thirty years, and nothing is as difficult as this. Nothing is as important as this, and I cannot think of anything that depends so much on CBO, especially at a time we’re in new territory. We’re not in the old situation where Sen. Grassley once said whatever CBO says is God, you’re God. My judgement, you’re not God.
Douglas Elmendorf, CBO Director: Correct
Sen. Baucus: My judgement is that you got the whole new era – you might be Moses, but not God – but you got the whole new era… where as I said earlier it’s not too much of an overstatement to say CBO can make or break health care reform, and I mean that because we got to go by your numbers…
Dr. Elmendorf: Senator, may I respectfully disagree that…
Sen. Baucus: I do believe that there are several different intellectually honest pathways to get from here to there. It’s not just one automatic, and so it needs – you got to be ever more creative to find intellectually honest pathways to get the savings we have to have – practically and both politically – to get health care reform.
Dr. Elmendorf: Senator, I would like to just respectfully disagree with the make or break role that you have assigned to us. We will do our very best to provide you and all of the members of this committee and the rest of the members of the Congress with the technical information that you need, the best estimates that the knowledge of the world can provide about the effects of alternative policies, but, as you understand, the hard decisions will be yours.
Sen. Baucus: No, that’s incorrect. The hard decisions will be all ours, both of us, you and me. You can’t pass the buck. The hard decisions are here, and the hard decisions are yours and the hard decisions are all of us in this country in trying to make this work. Meeting’s adjourned.
Dr. Elmendorf: Thank you, Senator
http://finance.senate.gov/sitepages/hearing022509.htm
Video of hearing – click link of 2/25/09:
http://finance.senate.gov/sitepages/hearings.htm

In this closing exchange, Sen. Max Baucus seems to be annoyed with Douglas Elmendorf, Director of the Congressional Budget Office. What is the background here?
Sen. Baucus is determined to lead the way to comprehensive health care reform. His model is basically the Hacker/Obama/Kennedy/Daschle/Massachusetts/Commonwealth model which is based on expanding the use of regulated private health plans, while continuing to expand existing public programs.
To help Congress with its efforts on reform, CBO recently released two volumes on 1) issues on analyzing health insurance proposals, and 2) budget options for health care (both available at the CBO website www.cbo.gov). It is quite clear, based on these two reports and on the innumerable analyses in the health policy literature, that Baucus’s model would be scored by the CBO as outrageously expensive while falling far short on many of the important goals for health care reform.
The CBO is noted for its impartiality in providing Congress with intellectually honest evaluations of various Congressional proposals. From Sen. Baucus’s comments, it’s obvious that this constitutes a major barrier to his ambitions to enact reform along the lines of his model. Rather than an arm’s-length analysis, Sen. Baucus is demanding that Dr. Elmendorf shift from the role of an impartial analyst to the role of a policymaker by becoming “creative,” making the “hard decisions,” to “find intellectually honest pathways to get the savings we have to have.”
We can understand Sen. Baucus’s frustration in his inability to obtain a favorable analysis of his highly flawed, “wish-they-would-work” policies. But we can fault him for demanding that Dr. Elmendorf compromise his professional integrity by participating in the policy decisions over a fundamentally flawed framework of reform, and then applying to the final product his personal stamp of endorsement. That is not and must never be the role of the CBO Director.
This also partially explains why Sen. Baucus is becoming ever more strident in his demand that single payer be totally excluded from the dialogue on reform. Innumerable analyses, including some by the CBO, have shown that the single payer model actually would achieve our goal of affordable health care for everyone. Objective, side-by-side CBO analyses would destroy any chance of convincing Congress to enact Sen. Baucus’s model.
Since reform should be based on the best data available, isn’t such an analysis exactly what we should have right now? If Sen. Baucus is sincere in wanting reform that works for all of us, he should be the first one to request that CBO do that study.
DrSteveB also covers this well in his Daily Kos blog today:
http://www.dailykos.com/story/2009/3/2/7495/94300/238/703544

Sen. Baucus wants CBO to be "creative"

Hearing: Scoring Health Care Reform: CBO's Budget Options

United States Senate Committee on Finance
February 25, 2009

Closing comments

Sen. Max Baucus, Chairman: Thank you very much, Dr. Elmendorf. We have a huge problem, haven’t we? This is the most difficult public policy undertaking I’ve experienced in my Senate life here. I’ve been here thirty years, and nothing is as difficult as this. Nothing is as important as this, and I cannot think of anything that depends so much on CBO, especially at a time we’re in new territory. We’re not in the old situation where Sen. Grassley once said whatever CBO says is God, you’re God. My judgement, you’re not God.

Douglas Elmendorf, CBO Director: Correct

Sen. Baucus: My judgement is that you got the whole new era – you might be Moses, but not God – but you got the whole new era… where as I said earlier it’s not too much of an overstatement to say CBO can make or break health care reform, and I mean that because we got to go by your numbers…

Dr. Elmendorf: Senator, may I respectfully disagree that…

Sen. Baucus: I do believe that there are several different intellectually honest pathways to get from here to there. It’s not just one automatic, and so it needs – you got to be ever more creative to find intellectually honest pathways to get the savings we have to have – practically and both politically – to get health care reform.

Dr. Elmendorf: Senator, I would like to just respectfully disagree with the make or break role that you have assigned to us. We will do our very best to provide you and all of the members of this committee and the rest of the members of the Congress with the technical information that you need, the best estimates that the knowledge of the world can provide about the effects of alternative policies, but, as you understand, the hard decisions will be yours.

Sen. Baucus: No, that’s incorrect. The hard decisions will be all ours, both of us, you and me. You can’t pass the buck. The hard decisions are here, and the hard decisions are yours and the hard decisions are all of us in this country in trying to make this work. Meeting’s adjourned.

Dr. Elmendorf: Thank you, Senator

http://finance.senate.gov/sitepages/hearing022509.htm

Video of hearing – click link of 2/25/09:
http://finance.senate.gov/sitepages/hearings.htm

Comment:

By Don McCanne, MD

In this closing exchange, Sen. Max Baucus seems to be annoyed with Douglas Elmendorf, Director of the Congressional Budget Office. What is the background here?

Sen. Baucus is determined to lead the way to comprehensive health care reform. His model is basically the Hacker/Obama/Kennedy/Daschle/Massachusetts/Commonwealth model which is based on expanding the use of regulated private health plans, while continuing to expand existing public programs.

To help Congress with its efforts on reform, CBO recently released two volumes on 1) issues on analyzing health insurance proposals, and 2) budget options for health care (both available at the CBO website www.cbo.gov). It is quite clear, based on these two reports and on the innumerable analyses in the health policy literature, that Baucus’s model would be scored by the CBO as outrageously expensive while falling far short on many of the important goals for health care reform.

The CBO is noted for its impartiality in providing Congress with intellectually honest evaluations of various Congressional proposals. From Sen. Baucus’s comments, it’s obvious that this constitutes a major barrier to his ambitions to enact reform along the lines of his model. Rather than an arm’s-length analysis, Sen. Baucus is demanding that Dr. Elmendorf shift from the role of an impartial analyst to the role of a policymaker by becoming “creative,” making the “hard decisions,” to “find intellectually honest pathways to get the savings we have to have.”

We can understand Sen. Baucus’s frustration in his inability to obtain a favorable analysis of his highly flawed, “wish-they-would-work” policies. But we can fault him for demanding that Dr. Elmendorf compromise his professional integrity by participating in the policy decisions over a fundamentally flawed framework of reform, and then applying to the final product his personal stamp of endorsement. That is not and must never be the role of the CBO Director.

This also partially explains why Sen. Baucus is becoming ever more strident in his demand that single payer be totally excluded from the dialogue on reform. Innumerable analyses, including some by the CBO, have shown that the single payer model actually would achieve our goal of affordable health care for everyone. Objective, side-by-side CBO analyses would destroy any chance of convincing Congress to enact Sen. Baucus’s model.

Since reform should be based on the best data available, isn’t such an analysis exactly what we should have right now? If Sen. Baucus is sincere in wanting reform that works for all of us, he should be the first one to request that CBO do that study.

DrSteveB also covers this well in his Daily Kos blog today:
http://www.dailykos.com/story/2009/3/2/7495/94300/238/703544

Single payer only route to Obama's grand vision on healthcare reform

by Chuck Idelson
California Nurses Association blog
February 26, 2009

Hours after President Obama’s speech to Congress in which he laid down a marker for achieving “comprehensive” healthcare reform, and getting it done this year, top administration aides have outlined the goals of what they want to achieve.

What Politico called “the 8 keys to his health plan,” certainly reflect a bold determination for action and a grand vision.

There’s only one problem. Virtually all the proposals being bandied about in various Congressional committees — and the administration made it clear this week they will let Congress figure out the details — fail to meet the test of those “8 keys.”

With one important exception — single payer reform, or expanding and updating Medicare to cover everyone.

So what are those lofty goals set by the administration?

Obama has endorsed eight guiding principles for health reform, the White House officials said on the conference call. They stressed that they intend to work with lawmakers and other stakeholders on how to accomplish the goals, but the principles will lay down a marker for any congressional plan.

Drum roll, please. A healthcare plan, they told reporters, should be:

* Universal, everybody in, nobody out

* Portable, not tied to your job, if you even have one

* Maintaining choice of doctor and insurance

* Ensuring affordable coverage

* Protecting Americans financial health

* Investing in prevention and wellness

* Improving patient safety and quality of care

* Fiscally responsible and sustainable

To the administration’s credit, these should be the benchmarks of any real reform. And to give them further props, the administration is even projecting progressive tax reform as a financing mechanism.

The combined effect of the two revenue-raising proposals, on top of Mr. ObamaĆ¢ā‚¬ā„¢s existing plan to roll back the Bush-era income tax reductions on households with income exceeding $250,000 a year, would be a pronounced move to redistribute wealth by reimposing a larger share of the tax burden on corporations and the most affluent taxpayers.

But on the construct of the plan itself, a huge barrier stands in the way. The present private insurance-based system is an implacable impediment to every one of these goals.

The insurance giants, of course, are not care providers. They are big corporations. They exist to make money, primarily to return profits for their shareholders. Every aspect of their operations are geared to that end.

Private insurance plans:

* Aren’t universal because they exclude people based on pre-existing conditions or age or anyone else they think will be expensive to cover.

* Don’t guarantee choice of physician or hospital, but limit you to their network of providers.

* Won’t assure affordability because they are constantly raising premiums, deductibles, co-pays, and other fees to generate high revenues and profits.

* Can’t guarantee safety and quality because they actively discourage the delivery of care or deny treatments, diagnoses, or referrals because they don’t want to pay for it.

* Will never be fiscally responsible because there is no independent oversight, decisions are made in secret in closed board rooms or CEO offices, and, again, their priority is profits.

Thus any plan which sustains, protects, or expands the role of the insurance industry in healthcare cannot, by definition, achieve any of these worthy aims.

One bill, however, does succeed in all eight areas. That is HR 676, the U.S. National Health Care Act by Rep. John Conyers, which also happens to be the one reform that has a broad, national grassroots constituency led by nurses, doctors, patients, and health care activists.

With the administration having laid our a vision, but deferred implementation to Congress, that should be a signal to all of us to put their feet to the fire and push for real reform, like HR 676.

Millions losing jobs will mean many without health care

By James E. Dalen
Arizona Republic
Feb. 28, 2009

Due to the recession, more than 2 million Americans lost their jobs in 2008 and millions more are expected to lose their jobs in 2009.

The consequences of increasing unemployment will be much more serious in the United States than in other western countries. Our country is unique in that most of its citizens, at least 175 million, have employment-based health insurance. In most cases, loss of job means loss of health insurance.

The situation is most serious for the employee who is the only breadwinner for his or her family. Private health insurance for family coverage may be available, but is very expensive, especially for someone who is out of work.

If the employee is older or, if anyone in the family has a “prior condition,” insurance may be unavailable or have an extraordinary price tag. COBRA, a federal program that allows one to continue their employment insurance is available but also is very expensive.

Some estimate that less than 25 percent of those losing their jobs will be covered by COBRA. Many unemployed families will turn to Medicaid to provide health care. Arizona and many other states are facing budget deficits because of the recession. It is very unlikely that they will be able to increase the number of their citizens covered by Medicaid (AHCCCS in Arizona).

What happens to those who are unable obtain alternative health insurance and remain uninsured?

Not much will happen to the young invincibles, those healthy Americans age 19 to 29. Many of them only seek health care in case of accidents. Few seek primary care, and very few require medications on a regular basis.

The outlook for the family without health insurance is very different. Multiple studies have shown the uninsured are much less likely to have regular medical care or to seek care for illness.

Ongoing preventive care becomes a luxury that the uninsured cannot afford. If they do seek care, they use emergency rooms. Our already overcrowded emergency rooms will become even more over burdened as the number of uninsured Americans increases.

The health consequences of being uninsured are most severe for the nearly half of our citizens who have a chronic condition such as hypertension, diabetes, asthma, cancer and heart disease. These conditions require ongoing medical care and usually require daily medications to prevent complications that may lead to hospitalization, disability or even death.

In a study of patients with chronic conditions, one third of the uninsured with chronic conditions had an unmet need for prescription drugs, compared with 10 percent of insured.

When Americans lose their jobs and their health insurance, their health will suffer. The Institute of Medicine has reported that the annual mortality of the uninsured is 25 percent higher than for the insured.

In addition to jeopardizing the health of our citizens the loss of health insurance by the millions losing their jobs will further escalate U.S. health-care costs. Emergency-room visits will increase, and hospitalizations that could have been prevented with ongoing preventive care will increase. The increase in uninsured patients will further challenge the financial viability of many of our hospitals.

In the many countries that ensure access to health care to all its citizens, whether employed or not, increasing unemployment will not jeopardize the health of their citizens and will not escalate health-care costs.

Maybe the U.S. should consider national health insurance that is not dependent on employment!

James E. Dalen, M.D., MPH, is dean emeritus at University of Arizona College of Medicine.

Letter to Obama: Health care access a national scandal

By ANA M. MALINOW, MD
Houston Chronicle
Feb. 28, 2009

Dear Mr. President:

Last week, in the public clinic where I work, I treated a 6-year-old girl who had visited the emergency room for cellulitis, an infection of the skin, over her hand. Usually a relatively minor condition that is easily treated with a 10-day course of antibiotics, cellulitis can sometimes cause severe consequences, including life-threatening sepsis, if not treated promptly.

The reason this patient was notable was because she was uninsured and had been sent home with a prescription that her mother tried to fill but was unable to afford. How much did the antibiotic suspension cost? $500.

When I saw her three days after her ER visit, her hand was swollen twice the normal size, purple, tender and warm to the touch, with a red streak (signifying an extension of the infection from the skin to the bloodstream) up to her elbow. I took one look at her and quickly made the decision to admit her for IV antibiotics, including a consultation with pediatric surgery to ensure that the infection had not spread between the deep layers of her skin.

What struck me most about this visit, other than the child’s deformed hand, was the mother’s shame at not being able to afford her child’s medication. I assured her that I did not blame her, that our health care system was unconscionable, and that we needed a health care system where everyone was included and everyone paid according to his or her ability to pay. She agreed.

I’m not surprised she agreed. From 1943 to today, opinion polls consistently show that a stable majority of Americans favor a government role in the financing of health care. In the lead-up to President Truman’s national health care proposal, 82 percent of Americans agreed that something needed to be done to make health bills easier to afford.

Today, 65 percent of Americans, including 59 percent of U.S. physicians, support a tax-financed national health insurance plan. Why wouldn’t my patient’s mother support national health care?

What she probably doesn’t know is how much she already pays for the health care her child does not get, or gets late. Her uninsured family pays an extra 10 percent out of its paycheck in taxes to pay for our health care system. Her daughter’s hospitalization will be covered by emergency Medicaid, for which she pays through her sales taxes, income taxes, property taxes and other hidden taxes. She will still have many out-of-pocket costs, of course.

I was struck this week by remarks by David Axelrod, your adviser. Referring to the difference between Washington insiders and most polls over the stimulus package, Axelrod said, “This town talks to itself and whips itself into a frenzy with its own theories that are completely at odds with what the rest of America is thinking.” The moral, he said, is “not just that Washington is too insular but that the American people are a lot smarter than people in Washington think.”

I agree. As I talk about a single-payer national health program across Texas (yes, Texas!) and other states, I am repeatedly amazed by the ability of Americans to understand the complex issues of health reform if it is adequately explained to them. People quickly understand that a sustainable solution will come only when we contain costs and eliminate fragmentation.

The more I listen, the more I hear that all Americans want a health care system that is affordable, accountable, accessible, comprehensive, universal and just — not another Band-Aid that will condemn thousands of us to unnecessary pain, suffering, bankruptcy and death. Listen for yourself, and you will hear Americans clamoring for true health care reform.

By Washington standards, single payer is politically unfeasible. But step outside the beltway and you will be surprised by the genuine support that exists for a publicly funded, privately delivered, expanded and improved Medicare for all.

This mother should not be made to feel ashamed. Nor should her child be relegated to suffer like a Third World beggar. Your compromise plan that keeps the private, for-profit insurance industry in the game will perpetuate the shame and the begging. Already, there is a grass-roots movement building against private health insurance and for single payer. It will reach Washington, whether Washington is ready or not.

Sincerely yours,

Ana M. Malinow, MD

Malinow is a Houston pediatrician and co-founder of Health Care for All Texas.