Statement of Common Purpose

Health Care for America Now!
“A choice of a private insurance plan, including keeping the insurance you have if you like it…”
http://healthcareforamericanow.org/site/content/about_us/

And…

Proposed GM/UAW VEBA: A House of Cards?

By Stephen Diamond
School of Law, Santa Clara University
October 2, 2007
This MOU (Memorandum of Understanding) makes clear that the entire VEBA (voluntary employees’ beneficiary association) structure fails to secure future health care obligations from the potential risk of GM (General Motors) bankruptcy. To put it succinctly, the VEBA structure can be said to balance like a house of cards completely subject to the ups and downs of GM’s financial future. If GM collapses into bankruptcy it is very likely that the VEBA will also collapse.
The basis of this conclusion is simple: according to the MOU GM retains unilateral power to make up to $7 billion of its potential contributions to the VEBA in cash over a twelve to twenty year period through annual payments. Since these payments are to be made in cash they depend entirely on the availability of that cash from GM. But if GM declares bankruptcy there is no means to guarantee now that the cash will be available or that GM will not use the bankruptcy process to shield itself from these future payment obligations. This compounds the problems associated with the Convertible Note whose value rises and falls with GM stock and whose annual interest payment and return of principal could be blocked in bankruptcy.
http://www.soldiersofsolidarity.com/files/relatednewsandreports07-2/GM-UAWVEBADealDescribedAsHouseofCards.html
Stephen F. Diamond, J.D., Ph.D., Associate Professor of Law:
http://www.scu.edu/law/faculty/profile/diamond-stephen.cfm

Pause for a minute. Think back to the insurance you had twenty years ago. Remember? Now… do you still have precisely that same coverage? Unless you are over 85 and have been in the traditional Medicare program for the past twenty years, it is highly likely that you do not.
Why not? After all, wasn’t the coverage then better and much less expensive than what you now have? Likely it provided you with a free choice of physicians and hospitals. It covered all reasonable health care services, maybe with small co-payments for routine services, and complete coverage for catastrophic expenses after a modest hospital deductible. Perhaps it was a non-profit Blue Cross or Blue Shield plan administered in the public interest, rather than today’s for-profit plans with a mission to maximize shareholder return by spending as little as possible on actual patient care. The fine print of the older insurance products designed to serve the patient was quite different from the fine print of today’s insurance products designed to compete in a profit-driven insurance market.
It is probable that your current coverage restricts you to a list of contracted physicians and hospitals, and assesses severe financial penalties if you obtain care outside of the plan. More plans today exclude from coverage some essential services such as obstetrical care and mental health services, and some even go so far as to exclude hospital coverage and specialist services. More of you are finding that the deductible and coinsurance in your plans are now large enough to cause financial hardship if you should develop significant health problems. Medical debt has become a major contributor to personal bankruptcy, and three-fourths of those with medical debt had health insurance when their problems started. All too commonly, health insurance now fails to perform its primary function: protecting us from financial hardship in the face of medical need.
So why do you no longer have the better coverage that you had twenty years ago? You may have changed jobs, likely more than once, and lost the coverage that your prior employer provided. Your employer may have changed plans because of ever-increasing insurance premiums. Frequently your insurer introduces plan innovations such as larger deductibles, a change from fixed-dollar copayments to higher coinsurance percentages, tiering of your cost sharing for services and products, reduction in the benefits covered, dollar caps on payouts, and other innovations all designed to keep premiums competitive in a market of rapidly rising health care costs. You may have lost coverage when your age disqualified you from participating in your parents’ plan. You may have found that health benefit programs have been declining as an incentive offered by new employers. Your children may have lost coverage under the Children’s Health Insurance Program when your income, though modest, disqualified your family from the program. Your union may not have been able to negotiate the continuation of the high-quality coverage that you previously held. Your employer may have reduced or eliminated the retirement coverage that you were promised but not guaranteed. Your employer may have filed for bankruptcy without setting aside the legacy costs of their pensions and retiree health benefit programs. You may have decided to start your own small business and found that you could not qualify for coverage because of your medical history, even if relatively benign, or maybe your small business margins are so narrow that you can’t afford the premiums. You may have been covered previously by a small business owner whose entire group plan was cancelled at renewal because one employee developed diabetes, or another became HIV infected. Your COBRA coverage may have lapsed and you found that the individual insurance market offered you no realistic options. You may have retired before Medicare eligibility, only to find that premiums were truly unaffordable or coverage was not even available because of preexisting medical problems.
Okay, so you say that your plan is an exception, and you want to keep it. You have or did have an employer that is so large and has such great resources that your plan will always be there, including throughout retirement. Well, let’s look at the largest and most successful private health program ever – that of General Motors. Twenty years ago, every General Motors employee knew that he or she had the best health plan available, and for life. Whoa. What was that about General Motors being saddled with legacy costs? This highly successful health program threatened to sink General Motors because of projected future commitments. They ducked that one by establishing a VEBA (voluntary employees’ beneficiary association) and dumped it on UAW (the auto workers union). UAW is now in a position of holding its breath, hoping that the VEBA does not collapse before we have adopted a national health program. Are you really sure that your secure lifetime coverage is stronger than that of General Motors? Don’t count on it.
The point is that hardly anyone under 85 has the same coverage that they had twenty years ago, and that has not been by choice. Factors over which you had very little or no control dictated that you could no longer keep the insurance you had. Today, the politicians promise you that you can keep the insurance you have, if that’s your choice, even though that has hardly ever been true in the past. Is there any reason to expect it to be true in the future?
The politicians propose token programs to control future health care cost increases, but none of these programs will have a significant impact. As long as we rely on a dysfunctional, fragmented system of public programs and private plans to finance health care, we will never control the true cost drivers that are making health care unaffordable for most of us. To keep insurance premiums affordable, the insurers will have no choice but to continue to introduce innovations in their products that will further diminish the capability of the plans to prevent financial hardship for those who need care. That means that you do not have the option of keeping the plan you have today, simply because the insurers will not be able to offer the same plan twenty years from now.
That applies to Medicare as well. It will not be the same in twenty years. But here there is hope. Medicare can be changed so that it works even better to allow us to have access to health care without the potential for financial ruin. If all of us were enrolled in a new and improved Medicare program, we would have the ability to address the true causes of escalating health care costs. We would dramatically reduce the profound administrative waste that is a direct result of trying to finance health care through a disconnected system of a multitude of private plans and public programs wherein none of the players has significant control over our global health care expenditures. A single Medicare-like program would be capable of realigning incentives to encourage the reinforcement of our primary care infrastructure in order to ensure that everyone has access to a system that provides higher quality care at a more reasonable cost. Incentives could also be altered to reduce ineffective and even detrimental high-tech excesses that drive up costs, while ensuring that beneficial high-tech services will always be there when we need them.
If we had a comprehensive, high quality, value-based Medicare system for everyone, then all of us would want to keep the system that we would have, not only for the next twenty years, but for the rest of our lives. In the meantime, don’t let the politicians tell you that you can keep the coverage you have. It likely won’t be there when you need it twenty years from now.

Health Care for America Now!

“A choice of a private insurance plan, including keeping the insurance you have if you like it…”

http://healthcareforamericanow.org/site/content/about_us/

And…

Proposed GM/UAW VEBA: A House of Cards?

By Stephen Diamond
School of Law, Santa Clara University
October 2, 2007

This MOU (Memorandum of Understanding) makes clear that the entire VEBA (voluntary employees’ beneficiary association) structure fails to secure future health care obligations from the potential risk of GM (General Motors) bankruptcy. To put it succinctly, the VEBA structure can be said to balance like a house of cards completely subject to the ups and downs of GM’s financial future. If GM collapses into bankruptcy it is very likely that the VEBA will also collapse.

The basis of this conclusion is simple: according to the MOU GM retains unilateral power to make up to $7 billion of its potential contributions to the VEBA in cash over a twelve to twenty year period through annual payments. Since these payments are to be made in cash they depend entirely on the availability of that cash from GM. But if GM declares bankruptcy there is no means to guarantee now that the cash will be available or that GM will not use the bankruptcy process to shield itself from these future payment obligations. This compounds the problems associated with the Convertible Note whose value rises and falls with GM stock and whose annual interest payment and return of principal could be blocked in bankruptcy.

http://www.soldiersofsolidarity.com/files/relatednewsandreports07-2/GM-UAWVEBADealDescribedAsHouseofCards.html

Stephen F. Diamond, J.D., Ph.D., Associate Professor of Law:
http://www.scu.edu/law/faculty/profile/diamond-stephen.cfm

Comment:

By Don McCanne, MD

Pause for a minute. Think back to the insurance you had twenty years ago. Remember? Now… do you still have precisely that same coverage? Unless you are over 85 and have been in the traditional Medicare program for the past twenty years, it is highly likely that you do not.

Why not? After all, wasn’t the coverage then better and much less expensive than what you now have? Likely it provided you with a free choice of physicians and hospitals. It covered all reasonable health care services, maybe with small co-payments for routine services, and complete coverage for catastrophic expenses after a modest hospital deductible. Perhaps it was a non-profit Blue Cross or Blue Shield plan administered in the public interest, rather than today’s for-profit plans with a mission to maximize shareholder return by spending as little as possible on actual patient care. The fine print of the older insurance products designed to serve the patient was quite different from the fine print of today’s insurance products designed to compete in a profit-driven insurance market.

It is probable that your current coverage restricts you to a list of contracted physicians and hospitals, and assesses severe financial penalties if you obtain care outside of the plan. More plans today exclude from coverage some essential services such as obstetrical care and mental health services, and some even go so far as to exclude hospital coverage and specialist services. More of you are finding that the deductible and coinsurance in your plans are now large enough to cause financial hardship if you should develop significant health problems. Medical debt has become a major contributor to personal bankruptcy, and three-fourths of those with medical debt had health insurance when their problems started. All too commonly, health insurance now fails to perform its primary function: protecting us from financial hardship in the face of medical need.

So why do you no longer have the better coverage that you had twenty years ago? You may have changed jobs, likely more than once, and lost the coverage that your prior employer provided. Your employer may have changed plans because of ever-increasing insurance premiums. Frequently your insurer introduces plan innovations such as larger deductibles, a change from fixed-dollar copayments to higher coinsurance percentages, tiering of your cost sharing for services and products, reduction in the benefits covered, dollar caps on payouts, and other innovations all designed to keep premiums competitive in a market of rapidly rising health care costs. You may have lost coverage when your age disqualified you from participating in your parents’ plan. You may have found that health benefit programs have been declining as an incentive offered by new employers. Your children may have lost coverage under the Children’s Health Insurance Program when your income, though modest, disqualified your family from the program. Your union may not have been able to negotiate the continuation of the high-quality coverage that you previously held. Your employer may have reduced or eliminated the retirement coverage that you were promised but not guaranteed. Your employer may have filed for bankruptcy without setting aside the legacy costs of their pensions and retiree health benefit programs. You may have decided to start your own small business and found that you could not qualify for coverage because of your medical history, even if relatively benign, or maybe your small business margins are so narrow that you can’t afford the premiums. You may have been covered previously by a small business owner whose entire group plan was cancelled at renewal because one employee developed diabetes, or another became HIV infected. Your COBRA coverage may have lapsed and you found that the individual insurance market offered you no realistic options. You may have retired before Medicare eligibility, only to find that premiums were truly unaffordable or coverage was not even available because of preexisting medical problems.

Okay, so you say that your plan is an exception, and you want to keep it. You have or did have an employer that is so large and has such great resources that your plan will always be there, including throughout retirement. Well, let’s look at the largest and most successful private health program ever – that of General Motors. Twenty years ago, every General Motors employee knew that he or she had the best health plan available, and for life. Whoa. What was that about General Motors being saddled with legacy costs? This highly successful health program threatened to sink General Motors because of projected future commitments. They ducked that one by establishing a VEBA (voluntary employees’ beneficiary association) and dumped it on UAW (the auto workers union). UAW is now in a position of holding its breath, hoping that the VEBA does not collapse before we have adopted a national health program. Are you really sure that your secure lifetime coverage is stronger than that of General Motors? Don’t count on it.

The point is that hardly anyone under 85 has the same coverage that they had twenty years ago, and that has not been by choice. Factors over which you had very little or no control dictated that you could no longer keep the insurance you had. Today, the politicians promise you that you can keep the insurance you have, if that’s your choice, even though that has hardly ever been true in the past. Is there any reason to expect it to be true in the future?

The politicians propose token programs to control future health care cost increases, but none of these programs will have a significant impact. As long as we rely on a dysfunctional, fragmented system of public programs and private plans to finance health care, we will never control the true cost drivers that are making health care unaffordable for most of us. To keep insurance premiums affordable, the insurers will have no choice but to continue to introduce innovations in their products that will further diminish the capability of the plans to prevent financial hardship for those who need care. That means that you do not have the option of keeping the plan you have today, simply because the insurers will not be able to offer the same plan twenty years from now.

That applies to Medicare as well. It will not be the same in twenty years. But here there is hope. Medicare can be changed so that it works even better to allow us to have access to health care without the potential for financial ruin. If all of us were enrolled in a new and improved Medicare program, we would have the ability to address the true causes of escalating health care costs. We would dramatically reduce the profound administrative waste that is a direct result of trying to finance health care through a disconnected system of a multitude of private plans and public programs wherein none of the players has significant control over our global health care expenditures. A single Medicare-like program would be capable of realigning incentives to encourage the reinforcement of our primary care infrastructure in order to ensure that everyone has access to a system that provides higher quality care at a more reasonable cost. Incentives could also be altered to reduce ineffective and even detrimental high-tech excesses that drive up costs, while ensuring that beneficial high-tech services will always be there when we need them.

If we had a comprehensive, high quality, value-based Medicare system for everyone, then all of us would want to keep the system that we would have, not only for the next twenty years, but for the rest of our lives. In the meantime, don’t let the politicians tell you that you can keep the coverage you have. It likely won’t be there when you need it twenty years from now.

(This message will be posted on the PNHP Blog at https://pnhp.org/blog/ and your responses are invited.)

Statement of Common Purpose

Health Care for America Now!

“A choice of a private insurance plan, including keeping the insurance you have if you like it…”

http://healthcareforamericanow.org/site/content/about_us/

And…

Proposed GM/UAW VEBA: A House of Cards?

By Stephen Diamond
School of Law, Santa Clara University
October 2, 2007

This MOU (Memorandum of Understanding) makes clear that the entire VEBA (voluntary employees’ beneficiary association) structure fails to secure future health care obligations from the potential risk of GM (General Motors) bankruptcy. To put it succinctly, the VEBA structure can be said to balance like a house of cards completely subject to the ups and downs of GM’s financial future. If GM collapses into bankruptcy it is very likely that the VEBA will also collapse.

The basis of this conclusion is simple: according to the MOU GM retains unilateral power to make up to $7 billion of its potential contributions to the VEBA in cash over a twelve to twenty year period through annual payments. Since these payments are to be made in cash they depend entirely on the availability of that cash from GM. But if GM declares bankruptcy there is no means to guarantee now that the cash will be available or that GM will not use the bankruptcy process to shield itself from these future payment obligations. This compounds the problems associated with the Convertible Note whose value rises and falls with GM stock and whose annual interest payment and return of principal could be blocked in bankruptcy.

http://www.soldiersofsolidarity.com/files/relatednewsandreports07-2/GM-UAWVEBADealDescribedAsHouseofCards.html

Stephen F. Diamond, J.D., Ph.D., Associate Professor of Law:
http://www.scu.edu/law/faculty/profile/diamond-stephen.cfm

Comment:

By Don McCanne, MD

Pause for a minute. Think back to the insurance you had twenty years ago. Remember? Now… do you still have precisely that same coverage? Unless you are over 85 and have been in the traditional Medicare program for the past twenty years, it is highly likely that you do not.

Why not? After all, wasn’t the coverage then better and much less expensive than what you now have? Likely it provided you with a free choice of physicians and hospitals. It covered all reasonable health care services, maybe with small co-payments for routine services, and complete coverage for catastrophic expenses after a modest hospital deductible. Perhaps it was a non-profit Blue Cross or Blue Shield plan administered in the public interest, rather than today’s for-profit plans with a mission to maximize shareholder return by spending as little as possible on actual patient care. The fine print of the older insurance products designed to serve the patient was quite different from the fine print of today’s insurance products designed to compete in a profit-driven insurance market.

It is probable that your current coverage restricts you to a list of contracted physicians and hospitals, and assesses severe financial penalties if you obtain care outside of the plan. More plans today exclude from coverage some essential services such as obstetrical care and mental health services, and some even go so far as to exclude hospital coverage and specialist services. More of you are finding that the deductible and coinsurance in your plans are now large enough to cause financial hardship if you should develop significant health problems. Medical debt has become a major contributor to personal bankruptcy, and three-fourths of those with medical debt had health insurance when their problems started. All too commonly, health insurance now fails to perform its primary function: protecting us from financial hardship in the face of medical need.

So why do you no longer have the better coverage that you had twenty years ago? You may have changed jobs, likely more than once, and lost the coverage that your prior employer provided. Your employer may have changed plans because of ever-increasing insurance premiums. Frequently your insurer introduces plan innovations such as larger deductibles, a change from fixed-dollar copayments to higher coinsurance percentages, tiering of your cost sharing for services and products, reduction in the benefits covered, dollar caps on payouts, and other innovations all designed to keep premiums competitive in a market of rapidly rising health care costs. You may have lost coverage when your age disqualified you from participating in your parents’ plan. You may have found that health benefit programs have been declining as an incentive offered by new employers. Your children may have lost coverage under the Children’s Health Insurance Program when your income, though modest, disqualified your family from the program. Your union may not have been able to negotiate the continuation of the high-quality coverage that you previously held. Your employer may have reduced or eliminated the retirement coverage that you were promised but not guaranteed. Your employer may have filed for bankruptcy without setting aside the legacy costs of their pensions and retiree health benefit programs. You may have decided to start your own small business and found that you could not qualify for coverage because of your medical history, even if relatively benign, or maybe your small business margins are so narrow that you can’t afford the premiums. You may have been covered previously by a small business owner whose entire group plan was cancelled at renewal because one employee developed diabetes, or another became HIV infected. Your COBRA coverage may have lapsed and you found that the individual insurance market offered you no realistic options. You may have retired before Medicare eligibility, only to find that premiums were truly unaffordable or coverage was not even available because of preexisting medical problems.

Okay, so you say that your plan is an exception, and you want to keep it. You have or did have an employer that is so large and has such great resources that your plan will always be there, including throughout retirement. Well, let’s look at the largest and most successful private health program ever – that of General Motors. Twenty years ago, every General Motors employee knew that he or she had the best health plan available, and for life. Whoa. What was that about General Motors being saddled with legacy costs? This highly successful health program threatened to sink General Motors because of projected future commitments. They ducked that one by establishing a VEBA (voluntary employees’ beneficiary association) and dumped it on UAW (the auto workers union). UAW is now in a position of holding its breath, hoping that the VEBA does not collapse before we have adopted a national health program. Are you really sure that your secure lifetime coverage is stronger than that of General Motors? Don’t count on it.

The point is that hardly anyone under 85 has the same coverage that they had twenty years ago, and that has not been by choice. Factors over which you had very little or no control dictated that you could no longer keep the insurance you had. Today, the politicians promise you that you can keep the insurance you have, if that’s your choice, even though that has hardly ever been true in the past. Is there any reason to expect it to be true in the future?

The politicians propose token programs to control future health care cost increases, but none of these programs will have a significant impact. As long as we rely on a dysfunctional, fragmented system of public programs and private plans to finance health care, we will never control the true cost drivers that are making health care unaffordable for most of us. To keep insurance premiums affordable, the insurers will have no choice but to continue to introduce innovations in their products that will further diminish the capability of the plans to prevent financial hardship for those who need care. That means that you do not have the option of keeping the plan you have today, simply because the insurers will not be able to offer the same plan twenty years from now.

That applies to Medicare as well. It will not be the same in twenty years. But here there is hope. Medicare can be changed so that it works even better to allow us to have access to health care without the potential for financial ruin. If all of us were enrolled in a new and improved Medicare program, we would have the ability to address the true causes of escalating health care costs. We would dramatically reduce the profound administrative waste that is a direct result of trying to finance health care through a disconnected system of a multitude of private plans and public programs wherein none of the players has significant control over our global health care expenditures. A single Medicare-like program would be capable of realigning incentives to encourage the reinforcement of our primary care infrastructure in order to ensure that everyone has access to a system that provides higher quality care at a more reasonable cost. Incentives could also be altered to reduce ineffective and even detrimental high-tech excesses that drive up costs, while ensuring that beneficial high-tech services will always be there when we need them.

If we had a comprehensive, high quality, value-based Medicare system for everyone, then all of us would want to keep the system that we would have, not only for the next twenty years, but for the rest of our lives. In the meantime, don’t let the politicians tell you that you can keep the coverage you have. It likely won’t be there when you need it twenty years from now.

(This message will be posted on the PNHP Blog at https://www.pnhp.org/blog/ and your responses are invited.)

From A National, Centrally Planned Health System To A System Based On The Market: Lessons From China

By Jin Ma, Mingshan Lu and Hude Quan
Health Affairs
July/August 2008
No other country has undergone health care reforms as dramatic as China’s. Starting in 1978, China reformed its health system from a governmental, centrally planned, and universal system to a heavily market-based one. Now, three decades later, the Chinese government openly acknowledges that the reforms failed and seeks new directions. This paper adds to the literature by examining China’s health care from a system perspective, describing its health services delivery, access, outcomes, and population health in the post-reform era. It also identifies the main issues in the current system and highlights the key lessons learned from China’s reform process.
http://content.healthaffairs.org/cgi/content/abstract/27/4/937

When Incentives And Professionalism Collide

By William C. Hsiao
As Jin Ma and colleagues observe, an unfettered market approach in China has reduced access to care, increased patients’ financial burden, and reduced emphasis on prevention and may have caused declines in quality and outcomes. A major driving force was that perverse incentives altered physicians’ behavior toward self-interest at the expense of patients, even where professional ethics dictated otherwise. Other nations, including India, are grappling with the profit motive and its consequences. Chinese leaders are attempting to deal with these problems by expanding public investment and reducing perverse incentives. However, profit motives remain a powerful, potentially offsetting feature of a reformed system.
http://content.healthaffairs.org/cgi/content/abstract/27/4/949

Fundamental human ethics and mores are the same the world around.
There are those of us who believe that the people of the United States possess some sort of a superior intellect that allows us to use the sterile tools of market economics to provide a better life for all of us, at least for those of us who are willing to put in a greater effort, without any compromise whatsoever in our ethical and moral principles.
Some of the intellectuals in China had decided that using market dynamics was just the solution that they needed to help modernize the Chinese health care system. Sterile, amoral business decisions allow the leeway to bring out the best in us… and the worst. China got the best for a few, and the worst for the many.
Our health care system represents both the best and the worst, but now is so expensive that we have reached a point that we must realign incentives to promote the best for everyone, and discourage the worst that is draining our resources while benefiting primarily those who are capitalizing on the market.
China’s great experiment with free market health care demonstrates, once again, that mankind’s mores and ethics are best supported by social solidarity, rather than by the market, when establishing policies designed to benefit us all. It is a lesson that most other nations have learned, but one with which we are still struggling.

By Jin Ma, Mingshan Lu and Hude Quan
Health Affairs
July/August 2008

No other country has undergone health care reforms as dramatic as China’s. Starting in 1978, China reformed its health system from a governmental, centrally planned, and universal system to a heavily market-based one. Now, three decades later, the Chinese government openly acknowledges that the reforms failed and seeks new directions. This paper adds to the literature by examining China’s health care from a system perspective, describing its health services delivery, access, outcomes, and population health in the post-reform era. It also identifies the main issues in the current system and highlights the key lessons learned from China’s reform process.

http://content.healthaffairs.org/cgi/content/abstract/27/4/937

When Incentives And Professionalism Collide

By William C. Hsiao

As Jin Ma and colleagues observe, an unfettered market approach in China has reduced access to care, increased patients’ financial burden, and reduced emphasis on prevention and may have caused declines in quality and outcomes. A major driving force was that perverse incentives altered physicians’ behavior toward self-interest at the expense of patients, even where professional ethics dictated otherwise. Other nations, including India, are grappling with the profit motive and its consequences. Chinese leaders are attempting to deal with these problems by expanding public investment and reducing perverse incentives. However, profit motives remain a powerful, potentially offsetting feature of a reformed system.

http://content.healthaffairs.org/cgi/content/abstract/27/4/949

Comment:

By Don McCanne, MD

Fundamental human ethics and mores are the same the world around.

There are those of us who believe that the people of the United States possess some sort of a superior intellect that allows us to use the sterile tools of market economics to provide a better life for all of us, at least for those of us who are willing to put in a greater effort, without any compromise whatsoever in our ethical and moral principles.

Some of the intellectuals in China had decided that using market dynamics was just the solution that they needed to help modernize the Chinese health care system. Sterile, amoral business decisions allow the leeway to bring out the best in us… and the worst. China got the best for a few, and the worst for the many.

Our health care system represents both the best and the worst, but now is so expensive that we have reached a point that we must realign incentives to promote the best for everyone, and discourage the worst that is draining our resources while benefiting primarily those who are capitalizing on the market.

China’s great experiment with free market health care demonstrates, once again, that mankind’s mores and ethics are best supported by social solidarity, rather than by the market, when establishing policies designed to benefit us all. It is a lesson that most other nations have learned, but one with which we are still struggling.

From A National, Centrally Planned Health System To A System Based On The Market: Lessons From China

By Jin Ma, Mingshan Lu and Hude Quan
Health Affairs
July/August 2008

No other country has undergone health care reforms as dramatic as China’s. Starting in 1978, China reformed its health system from a governmental, centrally planned, and universal system to a heavily market-based one. Now, three decades later, the Chinese government openly acknowledges that the reforms failed and seeks new directions. This paper adds to the literature by examining China’s health care from a system perspective, describing its health services delivery, access, outcomes, and population health in the post-reform era. It also identifies the main issues in the current system and highlights the key lessons learned from China’s reform process.

http://content.healthaffairs.org/cgi/content/abstract/27/4/937

When Incentives And Professionalism Collide

By William C. Hsiao

As Jin Ma and colleagues observe, an unfettered market approach in China has reduced access to care, increased patients’ financial burden, and reduced emphasis on prevention and may have caused declines in quality and outcomes. A major driving force was that perverse incentives altered physicians’ behavior toward self-interest at the expense of patients, even where professional ethics dictated otherwise. Other nations, including India, are grappling with the profit motive and its consequences. Chinese leaders are attempting to deal with these problems by expanding public investment and reducing perverse incentives. However, profit motives remain a powerful, potentially offsetting feature of a reformed system.

http://content.healthaffairs.org/cgi/content/abstract/27/4/949

Comment:

By Don McCanne, MD

Fundamental human ethics and mores are the same the world around.

There are those of us who believe that the people of the United States possess some sort of a superior intellect that allows us to use the sterile tools of market economics to provide a better life for all of us, at least for those of us who are willing to put in a greater effort, without any compromise whatsoever in our ethical and moral principles.

Some of the intellectuals in China had decided that using market dynamics was just the solution that they needed to help modernize the Chinese health care system. Sterile, amoral business decisions allow the leeway to bring out the best in us… and the worst. China got the best for a few, and the worst for the many.

Our health care system represents both the best and the worst, but now is so expensive that we have reached a point that we must realign incentives to promote the best for everyone, and discourage the worst that is draining our resources while benefiting primarily those who are capitalizing on the market.

China’s great experiment with free market health care demonstrates, once again, that mankind’s mores and ethics are best supported by social solidarity, rather than by the market, when establishing policies designed to benefit us all. It is a lesson that most other nations have learned, but one with which we are still struggling.

Pro-single-payer Doctors’ Group Announces New Blog

Physicians for a National Health Program
Press Release
July 9, 2008

Physicians for a National Health Program (PNHP) today launched a new blog that looks at the politics of health care reform, the obstacles to care created by the for-profit, private health insurance industry, and the urgency of the U.S. adopting a Medicare-like, single-payer national health insurance program.

Dr. Quentin Young, the group’s national coordinator, said: “Our failing health care system weighs heavily on the minds of doctors and patients alike. In this election year, our members felt we needed to enhance the timeliness of informed commentary on the worsening crisis and on the only effective remedy – a single-payer plan, which would guarantee comprehensive, quality care for all.”

Since its founding in 1987, PNHP members have produced numerous groundbreaking, peer-reviewed articles on health policy, including studies that show 31 percent of every U.S. health care dollar goes to administrative overhead, higher than anywhere else in the world, and that half of all personal bankruptcies are caused by medical bills.

Initial contributors to the blog include Dr. John Geyman, author of the new book “Do Not Resuscitate: Why the Health Insurance Industry Is Dying, and How We Must Replace It,” writing on some of the substandard insurance products being marketed to healthier people in the individual insurance market, products that have very high deductibles or benefit caps as low as $1,000 a year.

Dr. Suzanne King writes about how Blue Cross and Blue Shield of California has decided to charge women more for health insurance than their male counterparts, reflecting the pervasive discrimination in the private health insurance industry against women because, among other things, “they are the ones who get pregnant, have babies, and use obstetrical services.”

Dr. SteveB, a health policy blogger at DailyKos.com, offers “Four Questions to Ask When Analyzing Any Health ‘Reform’ Proposal.” Dr. SteveB will be regularly tracking support for the U.S. National Health Insurance Act, H.R. 676, a single-payer bill sponsored by Rep. John Conyers of Michigan and 90 others.

Dr. David Himmelstein, a PNHP co-founder, and Dr. Don McCanne, PNHP’s senior policy fellow, offer their respective assessments of Health Care for America Now, a new coalition launched this week, which, in the words of Himmelstein, pushes “a superficially attractive health reform model that has a long record of failure.” He said that, despite good intentions, the HCAN proposal is “akin to prescribing a placebo for a serious illness when effective treatment is available,” that treatment being single payer.

Another blogger is Dr. Andy Coates of upstate New York, who will be writing on support for single payer in the labor movement and in The Empire State; and Dr. Mary O’Brien of New York City on physician support for single-payer national health insurance. A survey published in April showed 59 percent of U.S. physicians now support national health insurance, a jump of 10 percent from five years ago.

Dr. Young said, “Our aim is to provide a lively but well-grounded source of news and commentary on the hot topics of the day, trying to cut through some of the fog and myths that often accompany discussions of health care reform. We hope our readers will join in the dialogue.”

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. To contact a physician-spokesperson in your area, contact info@pnhp.org or call (312) 782-6006.

PNHP:

Physicians for a National Health Program

PNHP’s Blog:
https://www.pnhp.org/blog/

Comment:

By Don McCanne, MD

It’s your turn to contribute to the national dialogue on health care reform. Frequent postings will be made by some of the leaders in the movement for a single payer national health program. Your responses are not only invited, they are encouraged.

Quote of the Day messages also will be posted. For those who have had an urge to respond to some of my comments, you will now have that opportunity.

As Quentin Young states, “Our aim is to provide a lively but well-grounded source of news and commentary on the hot topics of the day, trying to cut through some of the fog and myths that often accompany discussions of health care reform. We hope our readers will join in the dialogue.”

HEALTH CARE FOR AMERICA NOW!

Campaign launch – July 8, 2008
For coalition members see:
http://healthcareforamericanow.org/site/content/who_we_are/
Campaign ad:
Mother with son, consulting Magic Eight Ball: Will they pay for his inhaler?
Magic Eight Ball: Not likely
Gentleman, in workshop of his garage: Is my surgery covered?
Magic Eight Ball: Don’t think so
Pregnant mother-to-be: Can I chose my child’s doctor?
Magic Eight Ball: Better not tell you
Concerned woman, too young to die: Will they cover the chemo?
Magic Eight Ball: Doubtful
Off-screen voice: Will health insurance companies ever put your health before their profits?
Magic Eight Ball: Not a chance
Off-screen voice: We can’t trust insurance companies to fix the health care mess.
http://www.youtube.com/watch?v=tirU5qpmFK4
Statement of common purpose:
Our government’s responsibility is to guarantee quality affordable health care for everyone in America and it must play a central role in regulating, financing, and providing health coverage by establishing:
A choice of a private insurance plan, including keeping the insurance you have if you like it, or a public insurance plan without a private insurer middleman that guarantees affordable coverage.
(… and nine other requirements for a regulated private insurance industry.)
http://healthcareforamericanow.org/site/content/statement_of_common_purpose

The members of the Health Care for America Now! (HCAN) coalition are very dedicated, altruistic individuals and organizations who share with us the goal of affordable, comprehensive, high quality care for everyone. They agree with us that the private insurance industry has failed miserably in fulfilling its responsibility to bring to all of us the affordable health care that we need.
The private insurance industry, as it functions today, clearly must be replaced with a system that works. So what is the solution proposed by the HCAN coalition? Let’s replace the private insurance industry with… the private insurance industry. Only let’s regulate it by requiring the insurers to provide us with the comprehensive coverage that we need “through the largest possible pools” – thus ensuring that their products will have premiums that only the very wealthiest of us can afford.
The HCAN coalition also would enact a public program in competition with the private plans to be sure that the private plans would sell us the comprehensive products that we need – a not-so-difficult challenge considering that the public program would be outrageously expensive due to adverse selection. So then we would have a choice of highly-regulated, unaffordable private plans, or an even less affordable public program option.
Why did the coalition insist on including private plans when the industry’s track record is so miserable? It was a political decision based not on which policies would actually work, but rather based on rhetorical framing that would resonate with a public that remains relatively uninformed on the make-or-break nuances of health policy. Focus groups and polls showed that “choice of private plans” resonated well, so they decided to abandon policy and go with messaging.
The members of Physicians for a National Health Program would take a more “doctorly” approach toward reform. While the HCAN coalition is recommending placebo therapy, we would point out that effective treatment is available: a single payer national health program.

Campaign launch – July 8, 2008
For coalition members see:
http://healthcareforamericanow.org/site/content/who_we_are/

Campaign ad:

Mother with son, consulting Magic Eight Ball: Will they pay for his inhaler?

Magic Eight Ball: Not likely

Gentleman, in workshop of his garage: Is my surgery covered?

Magic Eight Ball: Don’t think so

Pregnant mother-to-be: Can I chose my child’s doctor?

Magic Eight Ball: Better not tell you

Concerned woman, too young to die: Will they cover the chemo?

Magic Eight Ball: Doubtful

Off-screen voice: Will health insurance companies ever put your health before their profits?

Magic Eight Ball: Not a chance

Off-screen voice: We can’t trust insurance companies to fix the health care mess.

http://www.youtube.com/watch?v=tirU5qpmFK4

Statement of common purpose:

Our government’s responsibility is to guarantee quality affordable health care for everyone in America and it must play a central role in regulating, financing, and providing health coverage by establishing:

A choice of a private insurance plan, including keeping the insurance you have if you like it, or a public insurance plan without a private insurer middleman that guarantees affordable coverage.

(… and nine other requirements for a regulated private insurance industry.)

http://healthcareforamericanow.org/site/content/statement_of_common_purpose

Comment:

By Don McCanne, MD

The members of the Health Care for America Now! (HCAN) coalition are very dedicated, altruistic individuals and organizations who share with us the goal of affordable, comprehensive, high quality care for everyone. They agree with us that the private insurance industry has failed miserably in fulfilling its responsibility to bring to all of us the affordable health care that we need.

The private insurance industry, as it functions today, clearly must be replaced with a system that works. So what is the solution proposed by the HCAN coalition? Let’s replace the private insurance industry with… the private insurance industry. Only let’s regulate it by requiring the insurers to provide us with the comprehensive coverage that we need “through the largest possible pools” – thus ensuring that their products will have premiums that only the very wealthiest of us can afford.

The HCAN coalition also would enact a public program in competition with the private plans to be sure that the private plans would sell us the comprehensive products that we need – a not-so-difficult challenge considering that the public program would be outrageously expensive due to adverse selection. So then we would have a choice of highly-regulated, unaffordable private plans, or an even less affordable public program option.

Why did the coalition insist on including private plans when the industry’s track record is so miserable? It was a political decision based not on which policies would actually work, but rather based on rhetorical framing that would resonate with a public that remains relatively uninformed on the make-or-break nuances of health policy. Focus groups and polls showed that “choice of private plans” resonated well, so they decided to abandon policy and go with messaging.

The members of Physicians for a National Health Program would take a more “doctorly” approach toward reform. While the HCAN coalition is recommending placebo therapy, we would point out that effective treatment is available: a single payer national health program.