PNHP

OECD: Health Care Reform in the United States

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

Comment:

By Don McCanne, MD

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.

Health care bills suffer conspiracy of silence

Saul Friedman
Gray Matters
Newsday
February 21, 2009

Too often journalism ignores or belittles reports or proposals as outside the mainstream and bound to fail, thus assuring they will remain outside the mainstream and fail.

That, I believe, is what has been happening to proposals by three Democratic members of the House of Representatives to provide health care for all Americans through a system like Medicare, rather than depending, as now, on many private insurance companies.

The lawmakers, among the most senior House members, are Pete Stark of California, chairman of the health subcommittee of Ways and Means; John Dingell of Michigan, the longest-serving member of the House and chairman emeritus of Energy and Commerce, and Judiciary Committee chairman John Conyers, also from Michigan.

Last month, Stark reintroduced his proposal, called Americare, which would open Medicare Parts A and B to everyone, but allow people to keep their employer-based insurance. A few days later, Dingell and Conyers reintroduced their bills, which would expand Medicare to become the nation’s comprehensive health care program, paid for by premiums and taxes. The Conyers bill has dozens of co-sponsors and the support of most AFL-CIO unions.

On Jan. 28, a coalition of advocacy groups representing 15,000 doctors and more than 50,000 nurses, met at the Capitol to present a new study asserting that the Conyers’ bill, called the National Health Insurance Act (HR 676), could create 2.6 million new jobs and would cost far less than the private insurance currently paid for by individuals and employers.

Only Congressional Quarterly covered it. The Kaiser Family Foundation’s daily online report on health care developments at kff.org didn’t mention it. Nor has Kaiser, the most comprehensive online source of health care information, made any mention of “single-payer” (the government as the payer), or the Conyers bill since it was introduced in 2003, despite widespread support for such a plan according to Kaiser’s own polls. (After my insistent inquiries, Kaiser says it will publish charts next month comparing the Stark and Conyers bills.)

AARP, another key source of health care information, briefly mentioned single-payer in the AARP Bulletin, sent to its 35 million members. But neither single-payer nor the Conyers bill have been discussed in any of its other publications or its advocacy materials at aarp.org.

Why? Many health care writers and advocates believe it’s because single-payer and the Conyers bill would bar any role for private insurance companies, which would have central roles in all the other proposals under discussion.

The Kaiser Family Foundation was founded with insurance money, but its president, Drew Altman, says it receives no money from and has no connection with Kaiser Permanente, a large health insurer. And AARP’s chief strategist, John Rother, insists that its $700 million insurance business, mostly with UnitedHealth Group, does not affect its policies.

But reader Elaine Fox of Southampton, a physician and health care activist, contends there is evidence the health insurance industry opposition to government-sponsored health care has contributed to the effort to black out discussion of the Conyers bill.

She noted that in “An Analysis of Leading Congressional Health Care Bills, 2007-2008,” an online article posted in January by the Commonwealth Fund, a nonpartisan public policy research organization (www.commonwealthfund.org/index.htm), the Conyers bill was ignored. The Stark bill, which includes an insurance option, was analyzed. But Conyers’ bill and single-payer were not discussed in the analysis, which was done for Commonwealth by the Lewin Group, health care consultants.

As Fox pointed out, the Lewin Group had been independent and in 2005 its analysis supported passage of a single-payer bill in California. In 2007, Fox said, Lewin was purchased by Ingenix, a health information firm that helps set the rates insurance companies pay providers. Ingenix is owned by one of the nation’s largest insurers, UnitedHealth (which recently paid a $50 million fine in New York to settle a charge that Ingenix underpaid out-of-network doctors who provided service for United’s subscribers).

On Jan. 13, Fox said, the RAND Corp., a think tank, launched an online tool for policy makers to compare health care proposals called “Comprehensive Assessment of Reform Efforts,” or COMPARE. It did not include the Conyers bill or any single-payer alternative. RAND acknowledged that COMPARE is funded in part by AARP and health insurers, including UnitedHealth. A RAND spokesman said COMPARE will “get around to including” single-payer plans.

AARP’s Rother cites other reasons than the insurance industry for the blackout. He’s in favor of a single-payer system, he says, but insists he’s not encouraging such proposals because they’re outside the mainstream and are not likely to pass. Despite broad support for national health insurance and Medicare, Rother says, “This is simply a matter of pragmatism. Single-payer advocates could play a destructive role in the coming debate.”

Fox argues: “There cannot be a credible debate when one side disappears.”

WRITE TO Saul Friedman, Newsday, 235 Pinelawn Rd., Melville, NY 11747-4250, or by e-mail at saulfriedman@comcast.net.

Members of Congress Offer Prescription for General Motors' Competitive Disadvantage

Washington D.C. (February 19, 2009) — Congressman Dennis Kucinich (D-OH) and two other Members of Congress today sent a letter to the CEO of General Motors, Mr. Richard Wagoner, Jr., to propose a different kind of auto industry rescue plan that eliminates the competitive disadvantage of inflated health care costs.

As health care costs continue to spiral out of control, the brunt is borne in large part by employers that provide health care. General Motors and other U.S. automakers have significantly higher health care costs than their international competitors — as much as $1400 per car. In the letter, Members of Congress point out that the adoption of H.R. 676, the United States National Health Care Act, would level the playing field and stimulate the economy.

Under H.R. 676, 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.

Representatives Marcy Kaptur (D-OH) and John Conyers (D-MI) also signed the letter.

The full text of the letter follows:

February 19, 2009
G. Richard Wagoner, Jr.
Chief Executive Office, General Motors
300 Renaissance Center
Mail Code 482-C39-B50
Detroit, MI 48265

Dear Mr. Wagoner:

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.

Please consider meeting with us at your earliest convenience to discuss the issue further. We look forward to your response.

Sincerely,

Dennis J. Kucinich
Member of Congres

John Conyers, Jr.
Member of Congress

Marcy Kaptur
Member of Congress

America's Economic Future Requires Health Care Reform

Dr. Margaret Flowers
Maryland Commons
February 23, 2009

We are told reforming health care is impossible in tough economic times. However, it is not only possible, it is necessary for economic recovery.

Health care costs are rising 2.5 percent faster than the nation’s gross domestic product. At this rate, health care will consume as much as half of household income by 2018.

In a global economy, American businesses cannot compete when the cost of health care is so high. Does it make sense for the auto industry to spend more for health care than for steel?

The current situation is unsustainable; we must enact fundamental, comprehensive reform to create a system that works.

Let’s look at some of the reasons why Americans spend two to three times more for health care than other industrialized nations. These nations have better health outcomes with longer life expectancy, fewer infant and maternal deaths and fewer preventable deaths. Yet in America, we spend more.

* Private health insurance companies spend 31 percent of their dollars on administration, much of it to deny or restrict needed health care. In the private, investor-owned health insurance world, profits come before health care. As a result, from 2000 to 2004, the top 14 health insurance corporations in the United States had profits of 117 percent, greatly outstripping the 5 percent profits seen by the Standard & Poor’s 500 corporations. In contrast, public programs, such as Medicare, spend 3 percent on administration.

* Americans pay up to nine times more for medications because prices are not negotiated. Other industrialized nations use bulk purchasing to make medications affordable while allowing pharmaceutical companies to make healthy profits.

* Because of co-pays and deductibles, Americans often delay getting medical care early in an illness, when it is usually easier and less expensive to treat. Many wait so long that their illness becomes life-threatening.

* Americans do not get adequate preventive care. Even those with health insurance only receive about half of recommended preventive care. Prevention is the key to keeping people healthy and saving money.

How did this situation happen?

With health insurance tied to employment, the U.S. is unique. To attract and keep employees during World War II, when wages were fixed, employers offered extra benefits, such as health insurance. Around that time, other nations created health systems independent of employment.

In the 1980’s, Wall Street investors were trained to take on health care as a profit-making venture, thus causing the shift to viewing health care as a commodity and patients as consumers. Since then, health care costs have skyrocketed and the health of our society has plummeted.

The U.S. is ranked 37th in the world; Maryland, despite its wealth, is ranked 32nd in the nation for health outcomes.

Currently, when a person becomes seriously ill or injured and loses his or her job, health insurance is lost. This may mean dying from lack of care or suffering great financial hardship. If the goal of having health insurance is to get health care when it’s needed, the market approach has failed.

We need bold reform, not tinkering around the edges. The government must play a larger role, not to correct the market, but to remove medically necessary care from the market; it didn’t belong there in the first place. Access to health care is a public good. A healthy society is a productive society, and a productive society can turn the economy around.

Private health insurers function to finance health care. Instead of trying to regulate private insurers, which is costly, the most efficient way to finance health care is to use a single public payer, such as Medicare. Medicare for all would pay health care providers directly and providers would remain the same. A single public payer would save around $400 billion per year in administrative costs and allow bulk purchasing of medications, further reducing costs.

Did I say remove health care from the market? Yes, that is, for medically necessary care. Private insurers would still provide supplemental plans for the rest, such as elective surgery.

There are more reasons why using a single public payer is better. The existence of hundreds of different insurers and plans costs the average doctor’s office 20 percent of its overhead for paperwork. And private insurers undermine the integrity of the physician-patient relationship by refusing to pay for care, essentially practicing without a medical license. This is causing physicians to go into “boutique practices,” or leave clinical medicine altogether.

Maryland has a serious physician shortage. Insurers also restrict where patients can go, charging more if the patient goes “out of network.” Under a single public payer, patients would choose their health care provider without penalty, leading to healthy competition among providers.

For businesses, many of which are crushed by health care costs, removing this burden would allow wage increases and the hiring of more employees. There would be less incentive for American businesses to move offshore, where health care costs are lower, such as Europe or Canada.

There is a state bill called the Maryland Health Security Act (HB 1186, SB 881) and a national resolution called HR 676. Both would create a health system based on a single public payer. To learn more or become involved, go to www.mdsinglepayer.org and www.guaranteedhealthcare4all.org

It is time to set aside ideology and enact health care reform to provide everyone with continuous access to health care from birth to death, simply and less expensively. This is what a civilized society does.

Massachusetts' 2006 Health Insurance Law Not A Good Model for National Health Care System Reform, Physicians Say

Kaiser Daily Health Policy Report
Feb 23, 2009

Modeling the U.S. health care system after Massachusetts’ health insurance law would leave many residents without affordable health coverage, according to analysis by three Harvard Medical School physicians and a letter signed by 500 state physicians sent to Sen. Edward Kennedy (D-Mass.), the Boston Globe’s “Political Intelligence” blog reports. According to “Political Intelligence,” portions of the insurance law — which requires most state residents to obtain health coverage and provides subsidies for some residents who cannot afford coverage — have been praised by President Obama and Senate Finance Committee Chair Max Baucus (D-Mont.), “making it likely to influence any effort to overhaul the national system.”

While the letter urges Kennedy to consider proposing a Medicare-for-all style national health care system, the Globe reports that this “something Congressional leaders and the White House have rejected as politically unworkable.” According to the letter, “Any plan that retains private insurers will add layers of bureaucracy and fail to control costs, dooming the noble effort to assure good care for all.”

In an analysis, Rachel Nardin, a neurologist and an assistant professor, and Steffie Woolhandler and David Himmelstein, both primary care physicians and associate professors, question the quality of state data that show all but 2.6% of Massachusetts’ residents are insured, saying that the number is probably 5% or more. In addition, they claim that insurance coverage under the new law has created unaffordable out-of-pocket costs for lower- and middle-class residents, particularly those with chronic illnesses. The new law also is more costly than expected, which has resulted in reductions to state funding of “safety net” providers that offer no-cost care to low-income residents, the physicians said.

Jonathan Gruber — an MIT economist and a board member of the Commonwealth Health Insurance Connector Authority, which administers the Massachusetts law — said the physicians “let the perfect be the enemy of the good.” Gruber said the Connector has capped out-of-pocket costs and premiums for low-income residents with annual incomes up to three times the poverty level at 10% of their income. However, those who earn between three and five times the poverty level may have more difficulty finding affordable health coverage, he said.

Jon Kingsdale, executive director of the Connector, also said that the physicians’ analysis did not accurately portray the cost of subsidized health coverage in fiscal year 2008, which was $800 million, not more than $1 billion (Wangsness, “Political Intelligence,” Boston Globe, 2/18).

Online The analysis is available online (.pdf). The letter also is available online (.pdf).

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=57114

Health Insurance Is Not Synonymous With Health Care

Statement of Rachel Nardin, M.D., President, Massachusetts Chapter of Physicians for a National Health Program

Feb. 18, 2009

My name is Dr. Rachel Nardin, a neurologist at Beth Israel Deaconess Medical Center in Boston and assistant professor of neurology at Harvard.

In April 2006, Massachusetts enacted a health care reform law with the stated goal of providing near-universal coverage of the Massachusetts population. Nearly three years into the reform, we know a lot about what has worked and what hasn’t. Examining this data critically is vitally important as the Obama administration considers elements of Massachusetts’ plan as a model for national health care reform.

Today we are here to release a new study on the Massachusetts reform. This study details many problems with the reform effort. We are also releasing a letter from nearly 500 Massachusetts physicians to Sen. Edward Kennedy asking him not to push for a Massachusetts-style reform nationally. My colleagues and I see the effects of the Massachusetts reform on patients every day and know that this is not a healthy model for the nation.

The Massachusetts reform is an example of “incremental” reform. It tried to fill in gaps in coverage, while leaving undisturbed existing public and private health insurance programs. It did this by expanding Medicaid and offering a new subsidized coverage program for the poor and near-poor. It also mandated that middle-income uninsured people either purchase private health insurance or pay a substantial fine ($1,068 in 2009).

The reform has reduced the numbers of uninsured, although our report shows that the state’s claim of near-universal coverage is untrue. This claim is based on a phone survey that reached few non-English speaking households and few who lacked landline phones — two groups with high rates of uninsurance. Other data also calls this claim into question. For instance, both the Massachusetts Department of Revenue and the March 2008 U.S. Census Bureau survey indicate that at least 5 percent of people in Massachusetts remain uninsured. Moreover, the use of free care services in Massachusetts has fallen by only a third, suggesting that the numbers of uninsured in the state may well be even higher than 5 percent.

Despite the reform, coverage remains unaffordable for many in our state. As a result, despite the threat of a fine, some residents remain uninsured. Others have bought the required insurance but are suffering financially. For a middle income, 56-year-old man, the cheapest policy available under the reform costs $4,872 annually in premiums alone. Moreover, it carries a $2,000 deductible and 20 percent co-payments after that, up to a maximum of $3000 annually. Buying such coverage means laying out nearly $7,000 before the insurance pays a single medical bill. It is not surprising that many of the state’s uninsured have declined such coverage.

The study we are releasing today also reminds us that having health insurance is not the same thing as having health care. Despite having coverage, many Massachusetts residents cannot afford care. In some cases, patients are actually worse off under the reform than they were under the state’s old system of free care because their new insurance has far higher co-pays for medications and care. According to a recent Boston Globe/Blue Cross Foundation survey, 13 percent of people with insurance in our state were unable to pay for some health services that they had received and 13 percent could not afford to fill necessary prescriptions. The reform does not appear to have reduced the numbers of people who were unable to get care that they needed because of the cost.

I will close with the story of one Massachusetts patient who has suffered as a result of the reform. Kathryn is a young diabetic who needs 12 prescriptions a month to stay healthy. She told us, “Under Free Care I saw doctors at Mass General and Brigham and Women’s hospital. I had no co-payments for medications, appointments, lab tests or hospitalization … Under my Commonwealth Care Plan my routine monthly medical costs include the $110 premium, $200 for medications, a $10 appointment with my primary care doctor, and $20 for a specialist appointment. That’s $340 per month, provided I stay well.” Now that she’s “insured,” Kathryn’s medical expenses consume almost one-quarter of her take home pay and she wonders whether she’ll be able to continue taking her life-saving medications.

Time for Universal Care

By Pat LaMarche
Bangor Daily News
2/17/09

Very few people in the United States remember the Great Depression. And to our discredit, we don’t spend much media time hearing from those seniors. Most of us have to learn the details from history books or even novels on the subject.

Put “The Grapes of Wrath” back on your reading list. Even if you read it back in high school, you’ll find it eerily poignant reading it again. Especially the early chapters where Steinbeck goes into great detail discussing the powerful banks, how much more important they are than people and how much sway they have over government officials.

Oddly enough, most of the scary conditions in the book already were in place before our own great depression hit this past fall. Millions homeless, hundreds of thousands of them our military veterans, people dying for want of medical attention, smart kids unable to pursue an education because the price tag has outstripped their earning potential: we’ve got it all.

The one remarkable thing about our times is that our economic collapse may have brought us to the tipping point. Our society and our individual consciences have long tolerated a certain amount of tragedy when it happens to somebody else. But now that the rest of us — from fat cats to the middle class — are losing wealth, homes and health insurance, it appears that everyone is headed for the Dumpster. Consequently, our economy, our society and our government are finally prepared to make corrective changes, hoping to avoid universal calamity.

Perhaps you watched the president’s speech from Elkhart, Ind., on Feb. 9.

I have to watch; it’s my job. And anyway, it’s like a car wreck — except that this mess we’re in right now was no accident. We picked a fight halfway around the world, hired no-bid contractors with money we borrowed from often unfriendly foreign countries and removed the safeguards from our financial system. All so we could lull ourselves into believing that we would become a more flourishing and robust nation by doing so.

With unrighteous hands we cracked the whip on “terrorism” and now the lash has recoiled and struck us in the back. And that backlash hurts.

The president told us that 598,000 U.S. jobs were lost in January. All these newly unemployed workers won’t create homelessness or food insecurity or health care shortages in the U.S. They’ll just swell the ranks of the millions already experiencing those nightmares.

That’s when the tipping point appears. And it’s the tipping point that the folks in charge want to avoid, no matter what.

So the president stood in Elkhart and enumerated the many ways the stimulus money would stave off further cataclysm, including millions and millions of dollars to pay COBRA bridge health insurance premiums for the workers who recently lost their jobs.

U.S. taxpayers, many of them from the same pool as the nearly 50 million Americans currently without health insurance, will be borrowing money from their grandchildren — after first indebting them to China — to pay insurance premiums.

And it’s not because a half-million more people without health insurance matter one fig when put up against 100 times that many who already live in fear of illness or injury.

And it’s not that the insurance companies and drug companies and all the rest of the for-profit medical establishment don’t want to lose the revenue the recently laid-off generated as workers.

And it’s not even that insurance companies who sell COBRA make so many campaign contributions that they can pretty much tell Congress what to do.

No, it’s because our bloated, costly exclusionary and at times deadly health care financing system is teetering at the brink and may tip over.

It’s because this year, as he has for many years, Michigan Rep. John Conyers has introduced HR 676, which already has garnered nearly 50 co-sponsors — a bill that restructures our health care system much like the rest of the civilized world and guarantees health care for all Americans.

And it’s because poll after poll, like the October 2008 ABC News poll, shows that two-thirds of Americans support changing our current system to a universal system.

Call Congress and the White House. Tell them to pass HR 676. The tipping point has come.

Pat LaMarche of Yarmouth is the author of “Left Out In America: The State of Homelessness in the United States.” She may be reached at PatLaMarche@hotmail.com.

Members of Congress Offer Prescription for General Motors’ Competitive Disadvantage

Washington D.C. (February 19, 2009) — Congressman Dennis Kucinich (D-OH) and two other Members of Congress today sent a letter to the CEO of General Motors, Mr. Richard Wagoner, Jr., to propose a different kind of auto industry rescue plan that eliminates the competitive disadvantage of inflated health care costs.

As health care costs continue to spiral out of control, the brunt is borne in large part by employers that provide health care. General Motors and other U.S. automakers have significantly higher health care costs than their international competitors — as much as $1400 per car. In the letter, Members of Congress point out that the adoption of H.R. 676, the United States National Health Care Act, would level the playing field and stimulate the economy.

Under H.R. 676, 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.

Representatives Marcy Kaptur (D-OH) and John Conyers (D-MI) also signed the letter.

The full text of the letter follows:

February 19, 2009
G. Richard Wagoner, Jr.
Chief Executive Office, General Motors
300 Renaissance Center
Mail Code 482-C39-B50
Detroit, MI 48265

Dear Mr. Wagoner:

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.

Please consider meeting with us at your earliest convenience to discuss the issue further. We look forward to your response.

Sincerely,

Dennis J. Kucinich
Member of Congres

John Conyers, Jr.
Member of Congress

Marcy Kaptur
Member of Congress

America’s Economic Future Requires Health Care Reform

Dr. Margaret Flowers
Maryland Commons
February 23, 2009

We are told reforming health care is impossible in tough economic times. However, it is not only possible, it is necessary for economic recovery.

Health care costs are rising 2.5 percent faster than the nation’s gross domestic product. At this rate, health care will consume as much as half of household income by 2018.

In a global economy, American businesses cannot compete when the cost of health care is so high. Does it make sense for the auto industry to spend more for health care than for steel?

The current situation is unsustainable; we must enact fundamental, comprehensive reform to create a system that works.

Let’s look at some of the reasons why Americans spend two to three times more for health care than other industrialized nations. These nations have better health outcomes with longer life expectancy, fewer infant and maternal deaths and fewer preventable deaths. Yet in America, we spend more.

* Private health insurance companies spend 31 percent of their dollars on administration, much of it to deny or restrict needed health care. In the private, investor-owned health insurance world, profits come before health care. As a result, from 2000 to 2004, the top 14 health insurance corporations in the United States had profits of 117 percent, greatly outstripping the 5 percent profits seen by the Standard & Poor’s 500 corporations. In contrast, public programs, such as Medicare, spend 3 percent on administration.

* Americans pay up to nine times more for medications because prices are not negotiated. Other industrialized nations use bulk purchasing to make medications affordable while allowing pharmaceutical companies to make healthy profits.

* Because of co-pays and deductibles, Americans often delay getting medical care early in an illness, when it is usually easier and less expensive to treat. Many wait so long that their illness becomes life-threatening.

* Americans do not get adequate preventive care. Even those with health insurance only receive about half of recommended preventive care. Prevention is the key to keeping people healthy and saving money.

How did this situation happen?

With health insurance tied to employment, the U.S. is unique. To attract and keep employees during World War II, when wages were fixed, employers offered extra benefits, such as health insurance. Around that time, other nations created health systems independent of employment.

In the 1980’s, Wall Street investors were trained to take on health care as a profit-making venture, thus causing the shift to viewing health care as a commodity and patients as consumers. Since then, health care costs have skyrocketed and the health of our society has plummeted.

The U.S. is ranked 37th in the world; Maryland, despite its wealth, is ranked 32nd in the nation for health outcomes.

Currently, when a person becomes seriously ill or injured and loses his or her job, health insurance is lost. This may mean dying from lack of care or suffering great financial hardship. If the goal of having health insurance is to get health care when it’s needed, the market approach has failed.

We need bold reform, not tinkering around the edges. The government must play a larger role, not to correct the market, but to remove medically necessary care from the market; it didn’t belong there in the first place. Access to health care is a public good. A healthy society is a productive society, and a productive society can turn the economy around.

Private health insurers function to finance health care. Instead of trying to regulate private insurers, which is costly, the most efficient way to finance health care is to use a single public payer, such as Medicare. Medicare for all would pay health care providers directly and providers would remain the same. A single public payer would save around $400 billion per year in administrative costs and allow bulk purchasing of medications, further reducing costs.

Did I say remove health care from the market? Yes, that is, for medically necessary care. Private insurers would still provide supplemental plans for the rest, such as elective surgery.

There are more reasons why using a single public payer is better. The existence of hundreds of different insurers and plans costs the average doctor’s office 20 percent of its overhead for paperwork. And private insurers undermine the integrity of the physician-patient relationship by refusing to pay for care, essentially practicing without a medical license. This is causing physicians to go into “boutique practices,” or leave clinical medicine altogether.

Maryland has a serious physician shortage. Insurers also restrict where patients can go, charging more if the patient goes “out of network.” Under a single public payer, patients would choose their health care provider without penalty, leading to healthy competition among providers.

For businesses, many of which are crushed by health care costs, removing this burden would allow wage increases and the hiring of more employees. There would be less incentive for American businesses to move offshore, where health care costs are lower, such as Europe or Canada.

There is a state bill called the Maryland Health Security Act (HB 1186, SB 881) and a national resolution called HR 676. Both would create a health system based on a single public payer. To learn more or become involved, go to www.mdsinglepayer.org and www.guaranteedhealthcare4all.org

It is time to set aside ideology and enact health care reform to provide everyone with continuous access to health care from birth to death, simply and less expensively. This is what a civilized society does.

Massachusetts’ 2006 Health Insurance Law Not A Good Model for National Health Care System Reform, Physicians Say

Kaiser Daily Health Policy Report
Feb 23, 2009

Modeling the U.S. health care system after Massachusetts’ health insurance law would leave many residents without affordable health coverage, according to analysis by three Harvard Medical School physicians and a letter signed by 500 state physicians sent to Sen. Edward Kennedy (D-Mass.), the Boston Globe’s “Political Intelligence” blog reports. According to “Political Intelligence,” portions of the insurance law — which requires most state residents to obtain health coverage and provides subsidies for some residents who cannot afford coverage — have been praised by President Obama and Senate Finance Committee Chair Max Baucus (D-Mont.), “making it likely to influence any effort to overhaul the national system.”

While the letter urges Kennedy to consider proposing a Medicare-for-all style national health care system, the Globe reports that this “something Congressional leaders and the White House have rejected as politically unworkable.” According to the letter, “Any plan that retains private insurers will add layers of bureaucracy and fail to control costs, dooming the noble effort to assure good care for all.”

In an analysis, Rachel Nardin, a neurologist and an assistant professor, and Steffie Woolhandler and David Himmelstein, both primary care physicians and associate professors, question the quality of state data that show all but 2.6% of Massachusetts’ residents are insured, saying that the number is probably 5% or more. In addition, they claim that insurance coverage under the new law has created unaffordable out-of-pocket costs for lower- and middle-class residents, particularly those with chronic illnesses. The new law also is more costly than expected, which has resulted in reductions to state funding of “safety net” providers that offer no-cost care to low-income residents, the physicians said.

Jonathan Gruber — an MIT economist and a board member of the Commonwealth Health Insurance Connector Authority, which administers the Massachusetts law — said the physicians “let the perfect be the enemy of the good.” Gruber said the Connector has capped out-of-pocket costs and premiums for low-income residents with annual incomes up to three times the poverty level at 10% of their income. However, those who earn between three and five times the poverty level may have more difficulty finding affordable health coverage, he said.

Jon Kingsdale, executive director of the Connector, also said that the physicians’ analysis did not accurately portray the cost of subsidized health coverage in fiscal year 2008, which was $800 million, not more than $1 billion (Wangsness, “Political Intelligence,” Boston Globe, 2/18).

Online The analysis is available online (.pdf). The letter also is available online (.pdf).

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=57114

Who is behind those closed doors in the Senate?

Health Care Industry in Talks to Shape Policy

By Robert Pear
The New York Times
February 19, 2009
Since last fall, many of the leading figures in the nation’s long-running health care debate have been meeting secretly in a Senate hearing room. Now, with the blessing of the Senate’s leading proponent of universal health insurance, Edward M. Kennedy, they appear to be inching toward a consensus that could reshape the debate.
The 20 people who regularly attend the meetings on Capitol Hill include lobbyists for AARP, Aetna, the A.F.L.-C.I.O., the American Cancer Society, the American Medical Association, America’s Health Insurance Plans, the Business Roundtable, Easter Seals, the National Federation of Independent Business, the Pharmaceutical Research and Manufacturers of America, and the United States Chamber of Commerce.
http://www.nytimes.com/2009/02/20/us/politics/20health.html?ref=politics

What?! In this time of transparency and Change, when we have an open window of opportunity to finally fix our very sick health care system, we are reverting to a closed door process dominated by the most powerful lobbyists in the nation whose interests take precedence over the American patient?!
Robert Pear reports that they are inching toward a consensus, but read his description of the memorandum prepared by director of the health staff of Senator Kennedy’s Health, Education, Labor and Pensions Committee. They have agreed on almost nothing. “…the sense of the room is that an individual obligation to purchase insurance should be part of reform…” is as close as they have come, and, even there, there is no agreement on what that coverage should be and on how you would enforce it.
At best, this process can end only with recommendations for a few tweaks in our system, just as the window slams shut and everyone walks out.
Have these people no decency?!
A few in the room do, but they are overpowered by those who… Well, you know. People can go broke and die for all they care, as long as we keep our public institutions out of their private businesses.
Stall and walk out. How’s that for CHANGE WE CAN BELIEVE IN?

Who is behind those closed doors in the Senate?

Health Care Industry in Talks to Shape Policy

By Robert Pear
The New York Times
February 19, 2009

Since last fall, many of the leading figures in the nation’s long-running health care debate have been meeting secretly in a Senate hearing room. Now, with the blessing of the Senate’s leading proponent of universal health insurance, Edward M. Kennedy, they appear to be inching toward a consensus that could reshape the debate.

The 20 people who regularly attend the meetings on Capitol Hill include lobbyists for AARP, Aetna, the A.F.L.-C.I.O., the American Cancer Society, the American Medical Association, America’s Health Insurance Plans, the Business Roundtable, Easter Seals, the National Federation of Independent Business, the Pharmaceutical Research and Manufacturers of America, and the United States Chamber of Commerce.

http://www.nytimes.com/2009/02/20/us/politics/20health.html?ref=politics

Comment:

By Don McCanne, MD

What?! In this time of transparency and Change, when we have an open window of opportunity to finally fix our very sick health care system, we are reverting to a closed door process dominated by the most powerful lobbyists in the nation whose interests take precedence over the American patient?!

Robert Pear reports that they are inching toward a consensus, but read his description of the memorandum prepared by director of the health staff of Senator Kennedy’s Health, Education, Labor and Pensions Committee. They have agreed on almost nothing. “…the sense of the room is that an individual obligation to purchase insurance should be part of reform…” is as close as they have come, and, even there, there is no agreement on what that coverage should be and on how you would enforce it.

At best, this process can end only with recommendations for a few tweaks in our system, just as the window slams shut and everyone walks out.

Have these people no decency?!

A few in the room do, but they are overpowered by those who… Well, you know. People can go broke and die for all they care, as long as we keep our public institutions out of their private businesses.

Stall and walk out. How’s that for CHANGE WE CAN BELIEVE IN?