PNHP

Insurers, drug makers poised to profit from Obama health plan

Insurers, drug makers poised to profit from Obama health plan

By Timothy P. Carney
DC Examiner
Beltway Confidential blog
2/25/09

Although President Barack Obama promised that he would freeze out the lobbyists in order to finally reform our broken health-care system, his nascent push to overhaul the industry already shows signs of becoming a lobbying feeding frenzy, with health insurers, drug makers and employers all poised to benefit from government’s expanded role.

We don’t yet have the specifics of Obama’s plan, but we do know its centerpiece: an individual mandate on health insurance. Obama has said — and corporate-labor lobbying coalitions have agreed — that Washington should require Americans to buy health insurance. When healthy people opt out of the insurance pool, the theory goes, risk is not adequately spread.

You can guess who’s most enthusiastic about the individual mandate: the insurance companies. Sure enough, The New York Times reported last week that America’s Health Insurance Plans, the trade association representing health maintenance organizations, has been working with Sen. Edward Kennedy, D-Mass., to help draft a plan that includes a mandate.

Another player in Kennedy’s backroom meetings is the Pharmaceutical Research and Manufacturers of America, usually a bete noire for liberals because it represents the drug companies. PhRMA’s primary stake in this fight is also obvious. It wants mandates and subsidies, and it wants to limit cost-control measures that would favor cheaper generic drugs.

La Merie, a “business intelligence” publisher, wrote in a recent pharmaceutical industry report: “Obama’s new universal health-care program will increase demand for drugs, both branded and generic, reduce the need for free drug programs due to universal health-care coverage, and boost pediatric drug and vaccine programs.” Sounds like a good deal for drug makers.

Groups lobbying on health-care policy include the Coalition to Advance Healthcare Reform, led by Safeway Chief Executive Officer Steve Burd, who actively backed Arnold Schwarzenegger’s plan to require all California businesses to cover their workers or face a new 4 percent tax. The coalition’s lobbyists include Judith Lemons, the former chief of staff for House Speaker Nancy Pelosi.

Lobbying powerhouse General Electric is a champion of Obama’s proposals to create a national health database — a database GE plans to build, manage or both.

What about the small-business coalitions that were crucial to killing HillaryCare in 1993? “They’re going to have to buy off small business,” says Cato Institute health-care expert Michael Tanner. Subsidies for small employers to afford health insurance are likely to do the trick.

To be sure, drug makers and insurers will have to bear the brunt of new regulations that come with increased government involvement. A priority for Kennedy and Obama is the pair of policies called “guaranteed issue” and “community rating.” The latter means insurers may not charge customers different premiums based on their health or age. Because this would encourage insurers to simply refuse to insure older customers or those with pre-existing conditions, government would require “guaranteed issue,” meaning that insurers could not turn down applicants.

Requiring insurers to charge one price and accept all comers would boost prices and drive away younger customers, who would find it cheaper to pay medical expenses out of pocket. Then only sick people, old people and families with kids would buy insurance — a high-risk pool, requiring even higher premiums. That’s why government will force younger and healthier people to join the pool with the individual mandate. Even so, the addition of high-risk and newly insured people will drive up the cost of health insurance — and taxpayers will get stuck with the bill.

Regulations spur mandates, which spur regulations, which spur subsidies. Insurers love the subsidies and the mandates, and the regulations don’t bother them too much — huge regulatory burdens, after all, keep out competition.

The great irony is that Kennedy and Obama, when calling for universal health care, have portrayed themselves as battling big business and freezing out the lobbyists. But it’s not as if Obama’s victory has cowed big business to the point of surrender. Many big businesses have long called for a greater government role in health care.

Insurers, drug makers, General Electric, regulators and employers will all benefit, and Obama will declare it a great group effort and a win-win solution. In truth, not everyone wins. “In the end, the taxpayers are going to lose,” says Tanner, “because the taxpayers are going to pay to buy everyone off.”

Tell Baucus single-payer is best

by Bob Balhiser
Queen City News, Montana
Wednesday, February 11, 2009

To the Editor:

Now that Tom Daschle is out of contention for HHS secretary, Sen. Baucus seems to think he has an inside track and is teaming up with Sen. Kennedy to push through his plan for health care reform. I cannot imagine a worse outcome.

As bad as things are now, it would be better to do nothing than to hurriedly implement the complex Baucus plan. How can Max reasonably expect to have a worthwhile outcome by simply tweaking our existing system which, by his own admission, costs twice as much as other industrialized nations and delivers worse outcomes?
We need to ask Max why he is so deathly afraid to see a single-payer plan given a fair hearing. I suspect it is because he knows a well-designed system of Medicare for all U.S. citizens will “pencil out” far better, be more user-friendly, and be less complex than his plan.

Most people recognize that private health insurers add no value to our health care system and just complicate the process of delivering health care and paying health-care bills. Single-payer systems are far simpler, more user-friendly, and have a track record for reliably paying health care bills with far fewer hassles for far less cost.
If you want real health care reform, I suggest you write or call Max. Tell him, before we do anything with health care, it is important that we know what we are doing is right. That means first showing how his plan stacks up in all respects against a well-designed single-payer system before doing anything.

Joseph Stiglitz on Single Payer

Excerpt from Democracy Now
2/25/09

AMY GOODMAN: And healthcare? He’s called for universal healthcare, but he does not call for single-payer healthcare.

JOSEPH STIGLITZ: I think that there are some fundamental problems in the efficiency of our healthcare system. And what we’ve seen is that the private healthcare insurers do not know how to deliver an efficient way.

AMY GOODMAN: Do you support single-payer healthcare?

JOSEPH STIGLITZ: I think I’ve reluctantly come to the view that it’s the only alternative. You know, we’ve tried a lot of other things. And we’ve been–you know, I was in the Clinton administration, and we debated a lot of alternatives, and I’ve watched things as they’ve emerged and, you know, evolved over the last twelve, sixteen years, and I think there’s a growing consensus that the private market exclusion is not going to work.

AMY GOODMAN: Joe Stiglitz, I want to thank you for being with us, the Nobel Prize-winning economist, professor at Columbia University, co-author of The Three Trillion Dollar War: The True Cost of the Iraq Conflict.

Health care spending for 2009

Health Spending Projections Through 2018: Recession Effects Add Uncertainty To The Outlook

By Andrea Sisko and colleagues at Office of the Actuary, Centers for Medicare and Medicaid Services
Health Affairs
February 24, 2009
Projected spending for 2009:
$2,509.5 billion – National Health Expenditures (NHE)
$8,160.3 – NHE per capita
17.6% – NHE as percent of GDP
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w346v1

These are the most reliable numbers to use that represent our health care spending for this year. Rounding off these numbers makes them easier to remember and eases communication of the amounts:
Total health spending is two and one-half trillion dollars
Health spending per person is over 8100 dollars
That amounts to about seventeen and one-half percent of our GDP

Health care spending for 2009

Health Spending Projections Through 2018: Recession Effects Add Uncertainty To The Outlook

By Andrea Sisko and colleagues at Office of the Actuary, Centers for Medicare and Medicaid Services
Health Affairs
February 24, 2009

Projected spending for 2009:

$2,509.5 billion – National Health Expenditures (NHE)

$8,160.3 – NHE per capita

17.6% – NHE as percent of GDP

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w346v1

Comment:

By Don McCanne, MD

These are the most reliable numbers to use that represent our health care spending for this year. Rounding off these numbers makes them easier to remember and eases communication of the amounts:

Total health spending is two and one-half trillion dollars

Health spending per person is over 8100 dollars

That amounts to about seventeen and one-half percent of our GDP

Doctors urge greater caution, skepticism in prescribing drugs

EMBARGOED UNTIL:
Feb. 25, 2009

CONTACTS:
Gordon D. Schiff, M.D.
Mark Almberg, (312) 782-6006, mark@pnhp.org

Physicians should be more conservative in their drug prescribing practices and more skeptical about the benefits of drugs that don’t have a proven track record, says an article in today’s Journal of the American Medical Association, or JAMA.

Citing the “well-documented prevalence of medication-related harm and inappropriate prescribing,” and pointing to “disasters” like the Vioxx episode, in which a popular painkiller was later found to increase the risk of heart disease, the authors welcome recent proposals for the reform of pharmacology education by the Association of American Medical Colleges. But such reforms are not enough, they say.

“With all the strengths of our nation’s medical curricula, including in pharmacology, there is surprisingly little time devoted to teaching trainees how to become lifelong effective prescribers,” said Dr. Gordon Schiff, associate professor of medicine at Harvard Medical School and co-author of the JAMA commentary. “More training in pharmacokinetics and drug dosing is all to the good. But trainees also need to acquire a set of guiding principles to help them become more careful, cautious, evidence-based, and frankly skeptical prescribers throughout their careers.”

To that end, Schiff and co-author Dr. William Galanter, assistant professor of clinical medicine at the University of Illinois at Chicago and head of the UIC Medical Center’s pharmacy and therapeutics committee, offer 25 “principles for more conservative prescribing” grouped under six subheadings:

* Think beyond drugs. Prescribe non-drug alternatives first, including physical therapy, exercise and diet changes, rather than reflexively reaching for the prescription pad to treat every symptom a patient might experience.

* Practice more strategic prescribing. Take a smarter approach to initiating or changing a drug regimen. Use only a few drugs; learn to use them well. Start only one drug at a time, so if there is a side effect it will be less confusing which drug is responsible.

* Heightened vigilance regarding adverse effects. Maintain a high index of suspicion for adverse drug effects. Rather than failing to warn patients about potential side effects, educate patients to recognize them earlier so the drug can be discontinued before more serious harm occurs.

* Caution and skepticism regarding new drugs. Limit use of new drugs. New drugs always appear safer, but as pointed out in earlier research conducted by physicians associated with Physicians for a National Health Program (“Timing of new black box warnings and withdrawals for prescription medications,” JAMA, 2002), serious adverse effects can take five or more years to emerge. Instead, rely on proven drugs with long-term safety records and do not stretch indications away those supported by trial-based evidence.

* Shared agenda with patients. Become more skillful at handling patients’ requests for drugs that they have seen advertised. Obtain accurate medical histories. Patients themselves often favor more conservative use of drugs, so physicians should build trust based on realistic expectations and a shared desire to use the minimum drugs necessary.

* Weigh longer-term, broader impacts. Think beyond short-term effects. For example, weight-loss drugs are often promising in the short-term, but longer-term results are often disappointing.

While the authors say these principles are not novel and should not be terribly controversial, “taken together they represent a significant shift in current prescribing patterns.”

Beyond countering the massive advertising and miseducation of physicians and the public to use more and more drugs, there are other barriers to physicians adopting more conservative prescribing practices, they say. These include the time pressures doctors are under, their desire to enhance their reputations by embracing the latest medical advances, and their fear of disappointing patients who request a drug they have seen advertised. The medical literature is also biased against conservative prescribing, because studies with negative results are less likely to be published or publicized.

Given existing practices and recent experience, the authors say, it is time to swing the pendulum back from “newer and more is better” back in favor of a prescribing philosophy that states that “fewer and more time-tested is best.”

Dr. Quentin Young, national coordinator of PNHP, said, “This is yet another example of why and how we have to put patients’ needs for safe and effective treatment ahead of the profitability of the insurance and drug companies. While drug companies promote using the newest, often most expensive and aggressive treatments, we favor a more cautious patient-centered approach – one that stresses the more ‘tried and true drugs’ over the ‘latest and greatest’ drugs pushed by the industry.”

*****

The JAMA commentary was an outgrowth of a Chicago-based project funded by the Attorney General Consumer and Prescriber Education Grant Program (the Neurontin settlement) and also supported by grant U18HS016973 from the Agency for Health Care Quality and Research.

“Promoting more conservative prescribing,” Gordon D. Schiff, M.D., and William L. Galanter, M.D., Ph.D., Journal of the American Medical Association (JAMA), Feb. 25, 2009, Vol. 301, No. 8.

A copy of the study is available at www.pnhp.org/prescribing

Physicians for a National Health Program (www.pnhp.org), a membership organization of over 15,000 physicians, supports a single-payer national health insurance program. PNHP is headquartered in Chicago and has chapters across the United States.

IOM report: America's Uninsured Crisis

America’s Uninsured Crisis: Consequences for Health and Health Care

Institute of Medicine
The National Academies
February 24, 2009
Web briefing
Lawrence S. Lewin, Chair, Committee on Health Insurance Status and Its Consequences (and also founder of The Lewin Group):
We were asked… to basically answer three questions, and this was a follow-on to the IOM studies that were produced in six volumes between 2000 and 2004. The first is what are the dynamics driving an apparently persistent downward trend in health insurance coverage? The second, is being uninsured harmful to the health of children and adults? And third, are insured people affected by high rates of uninsurance in their communities, so called spill-over effect? …I think that it’s important to point out some things that we were not able to cover. The first were a whole series of economic and financial impacts of uninsurance, impact on medical debt and global competitiveness. These are issues where the data are not very sound, and where there is a lot of disagreement in any event. We were not able to, because of the non-availability of data, to look at the impact of different levels of insurance, so in a sense we treated insurance coverage as a binary issue – you either had it or you didn’t have it, and we know that there are a lot of shadings in between, but we believe that the research is clear enough – very clear indeed – about even the binary decision. And finally, we were specifically asked not to deal with the potential approaches to solving the problem. There are lots of people doing that – indeed as we speak.
****
Lawrence S. Lewin:
The conclusions are, yes indeed, health insurance coverage does matter… That question, which I think is at the heart of the debate, really should no longer be an issue… Secondly, particularly given the fact that it does make such a difference, we believe that there is a compelling need to do something to off-set this persistent decline with which we’re faced, and that there is an argument to be made that even those who currently have insurance, even if they don’t lose it which they are at greater risk of doing, should have an interest in these issues. As a consequence, the committee unanimously adopted the following recommendations… The committee recommends that the president work with Congress and other public and private sector leaders on an urgent basis to achieve health insurance coverage for everyone, and, in order to make that coverage sustainable, to reduce the cost of health care and the rate of increase in per capita health care spending.
****
A web question from Dr. Don McCanne from Physicians for a National Health Program:
Although this report is limited to the importance of being insured, shouldn’t reform efforts also be directed toward adopting policies that would ensure that coverage actually enables access and affordability? Since there are questions about the limits of the private insurance model in accomplishing this, shouldn’t all options be on the table, including a single payer national health program?
Lawrence S. Lewin:
Without taking any position implied by the very last point about a particular proposal, I think the answer is yes, of course, all options should be on the table until they’re more thoroughly analyzed, and I believe many things are being considered right now. But I think to opine on the question itself is really beyond the scope of the committee.
Links to this audio briefing, the news release, the report in brief, the project web page, and the full report:
http://www.nationalacademies.org/morenews/20090224.html

In six previous reports, published from 2001 to 2004, the Institute of Medicine concluded that “being uninsured was hazardous to peopleā€™s health and recommended that the nation move quickly to implement a strategy to achieve health insurance coverage for all.”
After a five year lapse, the Institute is issuing an update which concludes, “Health insurance coverage matters. Expanding health coverage to all Americans is essential. Action to reduce health care expenditures and the rate of increase in per capita health care spending is also of paramount importance if health insurance coverage for all is to be achieved and sustained.”
Is this earthshaking news or what? Having health insurance can be beneficial for your health, and everyone should have it, especially since it makes communities healthier as well. Uh, I think we all knew that.
What is surprising is Lawrence Lewin’s statement that there is “disagreement” on the economic and financial impacts of uninsurance, and the data on this “are not very sound.” Is he suggesting that we should discard a couple of decades of extensive, highly credible studies demonstrating that those without health insurance face impaired access to care, financial hardship, and often personal bankruptcy, not to mention physical suffering and perhaps even death?
Just as astounding is his statement that there is a “non-availability of data to look at the impact of different levels of insurance.” Again, is he recommending that we discard the plethora of highly credible studies, which demonstrate that the explosion in underinsurance products is also causing much of the same suffering as that experienced by the uninsured?
Lewin’s statements provoked me enough to submit the question on whether we should include on the table a consideration of single payer as a financing model that would enable access and affordability. He did let slip out the obvious answer, “yes,” before retreating to the position that he should not “opine” on it.
The answer is YES! Single payer definitely needs to be on the table.
Lewin may not want to opine, but that shouldn’t stop us from opining that we should remove from the table any reform model that would leave us short of providing all necessary care for everyone without exposing anyone to financial hardship. That would really clear the table. Then we could get serious about working on a single payer national health program.

IOM report: America's Uninsured Crisis

America's Uninsured Crisis: Consequences for Health and Health Care

Institute of Medicine
The National Academies
February 24, 2009

Web briefing

Lawrence S. Lewin, Chair, Committee on Health Insurance Status and Its Consequences (and also founder of The Lewin Group):

We were asked… to basically answer three questions, and this was a follow-on to the IOM studies that were produced in six volumes between 2000 and 2004. The first is what are the dynamics driving an apparently persistent downward trend in health insurance coverage? The second, is being uninsured harmful to the health of children and adults? And third, are insured people affected by high rates of uninsurance in their communities, so called spill-over effect? …I think that it’s important to point out some things that we were not able to cover. The first were a whole series of economic and financial impacts of uninsurance, impact on medical debt and global competitiveness. These are issues where the data are not very sound, and where there is a lot of disagreement in any event. We were not able to, because of the non-availability of data, to look at the impact of different levels of insurance, so in a sense we treated insurance coverage as a binary issue – you either had it or you didn’t have it, and we know that there are a lot of shadings in between, but we believe that the research is clear enough – very clear indeed – about even the binary decision. And finally, we were specifically asked not to deal with the potential approaches to solving the problem. There are lots of people doing that – indeed as we speak.

****

Lawrence S. Lewin:

The conclusions are, yes indeed, health insurance coverage does matter… That question, which I think is at the heart of the debate, really should no longer be an issue… Secondly, particularly given the fact that it does make such a difference, we believe that there is a compelling need to do something to off-set this persistent decline with which we’re faced, and that there is an argument to be made that even those who currently have insurance, even if they don’t lose it which they are at greater risk of doing, should have an interest in these issues. As a consequence, the committee unanimously adopted the following recommendations… The committee recommends that the president work with Congress and other public and private sector leaders on an urgent basis to achieve health insurance coverage for everyone, and, in order to make that coverage sustainable, to reduce the cost of health care and the rate of increase in per capita health care spending.

****

A web question from Dr. Don McCanne from Physicians for a National Health Program:

Although this report is limited to the importance of being insured, shouldn’t reform efforts also be directed toward adopting policies that would ensure that coverage actually enables access and affordability? Since there are questions about the limits of the private insurance model in accomplishing this, shouldn’t all options be on the table, including a single payer national health program?

Lawrence S. Lewin:

Without taking any position implied by the very last point about a particular proposal, I think the answer is yes, of course, all options should be on the table until they’re more thoroughly analyzed, and I believe many things are being considered right now. But I think to opine on the question itself is really beyond the scope of the committee.

Links to this audio briefing, the news release, the report in brief, the project web page, and the full report:
http://www.nationalacademies.org/morenews/20090224.html

Comment:

By Don McCanne, MD

In six previous reports, published from 2001 to 2004, the Institute of Medicine concluded that “being uninsured was hazardous to peopleĆ¢ā‚¬ā„¢s health and recommended that the nation move quickly to implement a strategy to achieve health insurance coverage for all.”

After a five year lapse, the Institute is issuing an update which concludes, “Health insurance coverage matters. Expanding health coverage to all Americans is essential. Action to reduce health care expenditures and the rate of increase in per capita health care spending is also of paramount importance if health insurance coverage for all is to be achieved and sustained.”

Is this earthshaking news or what? Having health insurance can be beneficial for your health, and everyone should have it, especially since it makes communities healthier as well. Uh, I think we all knew that.

What is surprising is Lawrence Lewin’s statement that there is “disagreement” on the economic and financial impacts of uninsurance, and the data on this “are not very sound.” Is he suggesting that we should discard a couple of decades of extensive, highly credible studies demonstrating that those without health insurance face impaired access to care, financial hardship, and often personal bankruptcy, not to mention physical suffering and perhaps even death?

Just as astounding is his statement that there is a “non-availability of data to look at the impact of different levels of insurance.” Again, is he recommending that we discard the plethora of highly credible studies, which demonstrate that the explosion in underinsurance products is also causing much of the same suffering as that experienced by the uninsured?

Lewin’s statements provoked me enough to submit the question on whether we should include on the table a consideration of single payer as a financing model that would enable access and affordability. He did let slip out the obvious answer, “yes,” before retreating to the position that he should not “opine” on it.

The answer is YES! Single payer definitely needs to be on the table.

Lewin may not want to opine, but that shouldn’t stop us from opining that we should remove from the table any reform model that would leave us short of providing all necessary care for everyone without exposing anyone to financial hardship. That would really clear the table. Then we could get serious about working on a single payer national health program.

Renew Auto Industry? Start With Real Health Reform

by John Nichols
The Nation blog
02/20/2009

General Motors, and what is left of Chrysler, are back asking for another government bailout. And Americans who recognize that an auto industry is a good deal more vital to the country’s future than those bankers who are using taxpayer billions to retrofit their executive washrooms will be inclined to sympathize with the plea.

But before another bailout check is inked, wouldn’t it make sense to get the auto giants — even if they are not so giant anymore — involved in addressing what really ails their industry?

No, it is not autoworkers. Members of the United Autoworkers union have given concession after concession after concession in order to save an industry that their union leadership called for modernizing — with the development of smaller, fuel-efficient cars — more than three decades ago.And, no, it is not entirely the visionless management of GM, Chrysler and Ford, although it frustrating to recall the opportunities missed by CEOs who rejected smart union advocacy on behalf of the industry’s long-term future in favor of ever-bulkier SUVs, schemes to turn from manufacturing to financial services and, when it came time to balance the books, factory closures and layoffs.

The truth is that U.S. auto firms are being battered by a global economic collapse that has undermined car sales everywhere, leading to demands for government bailouts in every country where cars are made. But the even greater truth is that U.S. firms have been hit harder than many of their competitors by stalling car sales.

That’s because it costs more to make cars in the United States. Even though U.S. autoworkers have accepted pay cuts and efficiency schemes that mean they make less than autoworkers in many other countries, the enormous expense imposed by this country’s for-profit health care system places an extreme burden on firms that manufacture vehicles in the U.S. How extreme? It is estimated that health care costs add as much as $1,400 to the cost of a car made in an American plant.

So a new bailout, without a serious focus on health care reform, is at best a temporary fix, as three Democratic House members from the hard-hit manufacturing states of Ohio and Michigan explain in a new letter to GM CEO Richard Wagoner, Jr.

“You have convincingly articulated the effect of health care costs on GM’s competitiveness for years. Though the Voluntary Employee Beneficiary Association agreement with the United Auto Workers (UAW) has provided some short-term relief of health care costs by relinquishing financial responsibility for retiree care, the health care costs of current employees remain. Unless those costs are controlled, financial relief will be temporary,” write Ohio Representatives Dennis Kucinich and Marcy Kaptur and Michigan Representative John Conyers.

“As the nation’s largest provider of health care in the U.S., GM is likely to have captured the majority of the efficiencies that can be gained under a system with multiple, competing insurers. If true, systemic health care reform is the remedy of choice,” explain Kucinich, Kaptur and Conyers, who add that, “There is a model for health care finance that has proven in several countries to control costs, provide health care to all, and increase the quality of care: national health insurance, which is embodied in H.R. 676.”

H.R. 676, the United States National Health Care Act, is a single-payer reform that would, the House members explain, provide “all American residents would receive a National Health Insurance card. The card would be good for health care services at all health care facilities across the country in the National Health Insurance system. Families would be able to choose any licensed doctor and any hospital. There would be no premium, deductible or co-payment. No one would receive a bill for any medically necessary health care services, and by eliminating inefficiencies, the plan would cost the same amount of money that is now spent on health care.”

That’s good for Americans.

And, in this case, what’s good for Americans is good for General Motors.

So, the members of Congress suggest that, in order to show he is serious about renewing GM and the U.S. auto industry, Waggoner should get GM on record as an endorser of H.R. 676.

Such a move, placed in the context of a discussion about another bailout for auto firms, would get attention focused on the Conyers-sponsored bill, which has attracted more than 90 cosponsors in the current Congress. And it would turn a vague discussion about the need for health care reform, and the role such reform could play in stimulating the economy, into a serious debate about the sort of changes that really are needed but that are not always discussed in media reports or White House strategy sessions.

Here’s the message Kucinich, Kaptur and Conyers sent Waggoner on Thursday:

As part of our ongoing efforts to ensure that the auto industry continues to be competitive, we write to engage you in a discussion about solutions. With a difficult economic outlook, plummeting auto sales, efforts already underway to cut costs relative to the competition, and health care costs rising faster than inflation, there has never been a more prudent time for GM to endorse H.R. 676, the United States National Health Care Act. We invite you to meet with us to discuss the matter in person.

You have convincingly articulated the effect of health care costs on
GM’s competitiveness for years. Though the Voluntary Employee Beneficiary Association agreement with the United Auto Workers (UAW) has provided some short-term relief of health care costs by relinquishing
financial responsibility for retiree care, the health care costs of current employees remain. Unless those costs are controlled, financial relief will be temporary.

As the nation’s largest provider of health care in the U.S., GM is likely to have captured the majority of the efficiencies that can be gained under a system with multiple, competing insurers. If true, systemic health care reform is the remedy of choice. There is a model for health care finance that has proven in several countries to control costs, provide health care to all, and increase the quality of care: national health insurance, which is embodied in H.R. 676.

One such success story can be found in Canada, where Canadian GM, Ford and Chrysler have publicly declared their support for Canada’s health care system specifically because of the competitive advantage it gives them over their American counterparts.

If H.R. 676 was implemented, the benefits to GM would not be limited to cost control. H.R. 676 would reduce liability insurance & workers compensation costs; eliminate the cost and inconvenience of running a health benefits bureaucracy; eliminate employee concerns about rising premiums and co-pays and conflicts with labor unions over benefit cuts; free up money for consumer spending; reduce absenteeism; and produce a healthier, more productive work force.

Momentum behind H.R. 676 is increasing by the day. It garnered 93 cosponsors in the 110th Congress including multiple Chairs of committees and subcommittees of jurisdiction. Fifty-nine percent of all physicians and about 60% of the American public now support a national health insurance plan like H.R. 676. The California State Assembly has twice passed such a bill in the last three years. National health insurance is supported by the deans of prominent medical schools, a former New England Journal of Medicine editor, a Nobel Laureate, a former Surgeon General, the US Conference of Mayors, the US Presbyterian Church, the League of Women Voters, Consumer’s Union, and the UAW.

To learn more about H.R. 676 and the campaign to enact it, check out the Leadership Conference for Guaranteed Health Care site and the continuing efforts of the group with which Conyers has worked closely on this issue, Progressive Democrats of America.

http://www.thenation.com/blogs/thebeat/410184/renew_auto_industry_start_with_real_health_reform

Seattle City Council Endorses National Single-Payer Health Program

PNHP Western Washington
Press Release

FOR IMMEDIATE RELEASE
February 17, 2009

By unanimous vote, the Seattle City Council today passed a Resolution sponsored by Councilmember Nick Licata, to ask the Washington State Congressional delegation to support two single-payer bills that would create a national health program. Congressman Jim McDermott has introduced HR 1200, the American Health Security Act, and Congressman John Conyers HR 676, the United States National Health Care Act.

Both bills would provide comprehensive health insurance for all Americans, the care provided though the existing private delivery system. They would replace private insurance with guaranteed coverage, funded through the tax system. Studies indicate these bills would cover everyone while reducing overall cost and establish a unified health care system.

Sponsor Nick Licata indicated that in this time of severe economic stress, a national solution to our health care crisis is especially important and would fulfill the Council’s duty to protect all Seattle residents from health and financial disaster.

Seattle becomes the 49th City and Municipal government to pass such a resolution.

FOR MORE INFORMATION, CONTACT:
Nick Licata, Seattle City Councilmember
David McLanahan, MD, Coordinator, PNHP Western Washington Chapter

The time for real healthcare reform is now

By City Councilmember Nick Licata
West Seattle Herald
February 20, 2009

(Editor’s note: This opinion piece was sent to this newspaper from Seattle City Council member Nick Licata as part of his Urban Politics Newsletter.)

On Tuesday, Feb. 17 the Seattle City Council affirmed their unanimous support for universal access to quality health care. In doing so, Seattle joined 24 other cities and counties and 18 states passing similar resolutions.

I authored and sponsored this resolution upon the request of the Washington chapter of Physicians for a National Health Plan (PNHP).

Resolution 31111 urges the U.S. Congress to enact legislation to establish and implement this right by adopting HR 676, the U.S. National Health Insurance Act, proposed by Representative John Conyers or HR 1200, the American Health Security Act, proposed by Representative Jim McDermott.

Both bills are the “single-payer” model, which would guarantee everyone access to all medically necessary care, including prescription drugs, with no co-pays or deductibles. Only the single-payer model contains costs by eliminating the administrative waste and bureaucracy associated with the private insurance industry, and it would assure patients their personal choice of doctor and hospital.

The resolution also requests our Washington State Congressional delegation to support these bills.

Other city councils calling for the bill’s passage include those in Baltimore, Boston, Chicago, Detroit, San Francisco and Louisville, Ky. The U.S. Conference of Mayors at its June meeting in Miami passed a similar resolution. Local government is closer to the people and their health care struggles than most elected officials.

We see the real impacts of our communities and constituents suffering. Additionally, the costs to the City of Seattle of providing health-care benefits to its employees have risen while City revenue has not kept pace. Here are some sobering facts:

An estimated 160,000, 15.6 percent of King County residents less than 65 years of age, do not have health insurance.

The number of uninsured children in Washington State has reached the highest level in more than a decade; 3 percent of children in King County are uninsured.

Seattle’s community health clinics provide treatment for individuals regardless of their ability to pay and approximately 60 percent of their new patients are uninsured costing King County $139,821,202 in 2006.

A recent letter from PNHP to the previous Secretary-designate Tom Daschle, Health and Human Services says: Candidly, we are alarmed by some comments by members of the Senate and by the Obama transition team that suggest that the single-payer option is being excluded from consideration – is ‘off the table’ – in the health reform debate…other proposals “share the fatal flaw of preserving a central role for the investor-owned health insurance industry in a private-public financing mix.

“This approach simply won’t work, as numerous state-based experiments patterned after this model have shown. These plans always fail because they are unable to control costs.”

http://www.westseattleherald.com/2009/02/19/opinion/time-real-healthcare-reform-now

Seattle City Council Endorses HR 676

The Seattle City Council has joined the growing nationwide movement of cities, counties, and state legislatures to urge Congress to pass HR 676, national single payer healthcare, introduced by Congressman John Conyers (D-MI).

The cities, counties, and states endorsing HR 676 (including Tuskeegee, AL; Warren County, TN; Lorain, OH; Erie, PA; Indianapolis, IN; and the Kentucky House of Representatives) are listed at http://unionsforsinglepayer.org/more

Many of the resolutions passed are available at that website. We urge everyone to take similar action in your city, county or state. This is a good way to build the support for HR 676. Our unions can lead the way to make HR 676 politically possible!

The resolution can be linked here:
http://clerk.ci.seattle.wa.us/~scripts/nph-brs.exe?s1=&s2=&s3=31111&s4=&Sect4=AND&l=20&Sect2=THESON&Sect3=PLURON&Sect5=RESN1&Sect6=HITOFF&d=RES3&p=1&u=%2F%7Epublic%2Fresn1.htm&r=1&f=G

#30#

In the 110th Congress, HR 676 had 93 co-sponsors in addition to Conyers.

HR 676 has been endorsed by 481 union organizations in 49 states including 118 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:

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
02/20/09

IOM report: America’s Uninsured Crisis

America’s Uninsured Crisis: Consequences for Health and Health Care

Institute of Medicine
The National Academies
February 24, 2009

Web briefing

Lawrence S. Lewin, Chair, Committee on Health Insurance Status and Its Consequences (and also founder of The Lewin Group):

We were asked… to basically answer three questions, and this was a follow-on to the IOM studies that were produced in six volumes between 2000 and 2004. The first is what are the dynamics driving an apparently persistent downward trend in health insurance coverage? The second, is being uninsured harmful to the health of children and adults? And third, are insured people affected by high rates of uninsurance in their communities, so called spill-over effect? …I think that it’s important to point out some things that we were not able to cover. The first were a whole series of economic and financial impacts of uninsurance, impact on medical debt and global competitiveness. These are issues where the data are not very sound, and where there is a lot of disagreement in any event. We were not able to, because of the non-availability of data, to look at the impact of different levels of insurance, so in a sense we treated insurance coverage as a binary issue – you either had it or you didn’t have it, and we know that there are a lot of shadings in between, but we believe that the research is clear enough – very clear indeed – about even the binary decision. And finally, we were specifically asked not to deal with the potential approaches to solving the problem. There are lots of people doing that – indeed as we speak.

****

Lawrence S. Lewin:

The conclusions are, yes indeed, health insurance coverage does matter… That question, which I think is at the heart of the debate, really should no longer be an issue… Secondly, particularly given the fact that it does make such a difference, we believe that there is a compelling need to do something to off-set this persistent decline with which we’re faced, and that there is an argument to be made that even those who currently have insurance, even if they don’t lose it which they are at greater risk of doing, should have an interest in these issues. As a consequence, the committee unanimously adopted the following recommendations… The committee recommends that the president work with Congress and other public and private sector leaders on an urgent basis to achieve health insurance coverage for everyone, and, in order to make that coverage sustainable, to reduce the cost of health care and the rate of increase in per capita health care spending.

****

A web question from Dr. Don McCanne from Physicians for a National Health Program:

Although this report is limited to the importance of being insured, shouldn’t reform efforts also be directed toward adopting policies that would ensure that coverage actually enables access and affordability? Since there are questions about the limits of the private insurance model in accomplishing this, shouldn’t all options be on the table, including a single payer national health program?

Lawrence S. Lewin:

Without taking any position implied by the very last point about a particular proposal, I think the answer is yes, of course, all options should be on the table until they’re more thoroughly analyzed, and I believe many things are being considered right now. But I think to opine on the question itself is really beyond the scope of the committee.

Links to this audio briefing, the news release, the report in brief, the project web page, and the full report:
http://www.nationalacademies.org/morenews/20090224.html

Comment:

By Don McCanne, MD

In six previous reports, published from 2001 to 2004, the Institute of Medicine concluded that “being uninsured was hazardous to peopleĆ¢ā‚¬™s health and recommended that the nation move quickly to implement a strategy to achieve health insurance coverage for all.”

After a five year lapse, the Institute is issuing an update which concludes, “Health insurance coverage matters. Expanding health coverage to all Americans is essential. Action to reduce health care expenditures and the rate of increase in per capita health care spending is also of paramount importance if health insurance coverage for all is to be achieved and sustained.”

Is this earthshaking news or what? Having health insurance can be beneficial for your health, and everyone should have it, especially since it makes communities healthier as well. Uh, I think we all knew that.

What is surprising is Lawrence Lewin’s statement that there is “disagreement” on the economic and financial impacts of uninsurance, and the data on this “are not very sound.” Is he suggesting that we should discard a couple of decades of extensive, highly credible studies demonstrating that those without health insurance face impaired access to care, financial hardship, and often personal bankruptcy, not to mention physical suffering and perhaps even death?

Just as astounding is his statement that there is a “non-availability of data to look at the impact of different levels of insurance.” Again, is he recommending that we discard the plethora of highly credible studies, which demonstrate that the explosion in underinsurance products is also causing much of the same suffering as that experienced by the uninsured?

Lewin’s statements provoked me enough to submit the question on whether we should include on the table a consideration of single payer as a financing model that would enable access and affordability. He did let slip out the obvious answer, “yes,” before retreating to the position that he should not “opine” on it.

The answer is YES! Single payer definitely needs to be on the table.

Lewin may not want to opine, but that shouldn’t stop us from opining that we should remove from the table any reform model that would leave us short of providing all necessary care for everyone without exposing anyone to financial hardship. That would really clear the table. Then we could get serious about working on a single payer national health program.

OECD: Health Care Reform in the United States

Economic Department Working Paper No. 665: Health Care Reform in the United States

By David Carey, Bradley Herring and Patrick Lenain
OECD (Organisation for Economic Co-operation and Development)
February 6, 2009
Abstract
In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country. While there are factors beyond the health-care system itself that contribute to this gap in performance, there is also likely to be scope to improve the health of Americans while reducing, or at least not increasing spending. This paper focuses on two factors that contribute to this discrepancy between health outcomes and health expenditures in the United States: inequitable access to medical services and subsidized private insurance policies; and inefficiencies in public health insurance. It then suggests two sets of reforms likely to improve the US health-care system. The first is a package of reforms to achieve close to universal health insurance coverage. The second set of reforms relates to payment methods and coverage decisions within the Medicare programme to realign incentives and increase the extent of economic evaluation of different medical procedures.
http://lysander.sourceoecd.org/vl=16683430/cl=20/nw=1/rpsv/cgi-bin/wppdf?file=5ksnw5ghd45c.pdf

OECD reports are important not only because of their credible studies of economic conditions throughout the world, but also because they are used for policy decisions in the thirty member nations (including the U.S.) plus more than one hundred other countries and economies. Thus it is important to understand this new OECD report, “Health Care Reform in the United States,” especially at this time when intensive reform efforts are taking place in Washington.
The thirty member nations are “countries committed to democracy and the market economy.” Although the data provided by OECD can be very helpful in addressing each nation’s economic problems, the recommendations offered must be evaluated with a recognition that there is a bias toward market solutions, with governments being relegated to a supportive role in improving the functioning of markets.
As expected, this report describes well the poor performance of our health care system in spite of the very high level of spending – by far the highest of all nations. Special attention is directed to the increasing proportion of both the uninsured and the underinsured, and the failures of the private insurance market and current government policies to correct these deficiencies.
The most serious problem with this report is that their recommendations are primarily limited to those that would improve the functioning of private insurance markets, with a government role limited to refining policies that would enable improvements in the private markets (plus minor changes in Medicare design that might have a minimal impact in improving value, but with some policy tradeoffs). Although they parenthetically hint that single payer policies in other nations have been effective in achieving some of the reform goals, at no time do they suggest that a single payer approach might benefit the United States; in fact, they specifically reject it as “radical.”
Considerable attention is directed to the work of Jonathan Gruber and his efforts to use private insurance plans as a foundation for reform, including the real-life experience of the Massachusetts plan. Although the authors of this report echo some of his suggestions, their recommendations fall short of an optimal program of social insurance based on private health plans (a model that we believe is inadequate anyway). Except for tweaks to Medicare, they remain silent on public insurance programs. Last week we provided a critique of the Massachusetts plan, explaining why it is an unsatisfactory model for reform in the United States. (https://pnhp.org/news/2009/february/massachusetts_plan_.php)
Just one example of the inadequacies of their recommendations is the inconsistency between their discussion of the financial hardships faced by the underinsured, and their recommendation to “decrease the generosity of supplemental Medicare insurance designs for beneficiaries without chronic conditions to reduce moral hazard risks, which supplemental insurance accentuates by insulating Medicare beneficiaries from Medicare’s cost-sharing provisions.” Again, they provide good data on problems with our system (underinsurance), but they provide a terrible recommendation for policy changes (prevent “moral hazard” by expanding underinsurance) based on market theory instead of social solidarity.
In sum, OECD’s credibility as an important resource on economic data does not extend to credibility for its recommendations that are based on pro-market ideology. This report is valuable for its data showing how poorly our health care financing system is functioning, but it is almost worthless as a guide for policies on how to repair our system since it reinforces the obsolete model of private health plans and ignores the more efficient and effective model of a single payer national health program.