PNHP

Australia’s Medicare and private plans

Australia’s Medicare and private plans

The private life of health care

By Ruth Pollard and Mark Metherell
The Sydney Morning Herald
April 6, 2007

In just 10 years, the health system many were dreading has arrived. Spurred by the Federal Government’s campaign to push Australians into private health insurance and exacerbated by difficulties in finding care in public hospitals, the balance has tipped in favour of private hospitals. Our system is now a genuinely two-tiered model: the wealthy and privately insured get timely health care and the rest, unless they are critically ill, can wait.

In the past decade, a clear division of labour has evolved: public hospitals are now dominant in emergency surgery and medicine, while private hospitals rule in elective surgery, accounting for 55.7 per cent of all operations.

“Since 1982-83, Australia’s hospital system has witnessed a massive shift of activity to the private sector,” Bill Nichol, an assistant director in the federal Department of Health, writes in the study.

“The private sector’s role has increased to dominant player” in several categories of care, including eye, cancer, ear, nose and throat and the male and female reproductive systems, Nichol says.

The worrying thing is that many seem to have thrown up their arms in despair, a kind of “Oh, well” about the death of equity in the health system.

Bruce Armstrong, the director of research at the Sydney Cancer Centre and a professor of public health at the University of Sydney, believes there has been no attempt to prevent a two-tier health system from developing.

“Equity is a real issue … a proportion of the Australian population which is not inconsequential is not going to get that care because if you go to a private hospital you need private health insurance and even then, there [are] always going to be gap payments.”

A disturbing trend to emerge despite the establishment of Medicare in 1983 is the widening disparity between the well-off and the poor in mortality rates from avoidable diseases. The Australian way of death means the prosperous are significantly less likely to die from avoidable disease than those on low incomes.

In 1986 the rate of death from “avoidable” causes such as treatable and preventable conditions like heart disease among the have-nots was 50 per cent higher than for the haves. By 2002 that difference had stretched to a twofold gap, according to research published in the International Journal of Epidemiology.

The report concludes that “advantaged people have obtained a disproportionate benefit of health care, contributing to widening relative health inequalities”.

“A universal health-care system does not guarantee equality in health-care-related outcomes,” says the article, whose lead author was Rosemary Korda of the National Centre for Epidemiology and Population Health at the Australian National University.

The Health Minister, Tony Abbott, having presided over multibillion-dollar infusions into the private sector through Medicare payments to private doctors and the private insurance rebate, acknowledges states are bearing a larger share of public hospital costs.

But he says that if there is an equity problem, it’s for state governments to fix. “It may sound like I am playing the blame game, but state governments are responsible for public hospitals,” Abbott says.

He would welcome further growth in private insurance, which he suggests many more people could afford given that more than 1 million people on incomes of less than $20,000 pay for cover.

“No doubt having private health insurance confers additional benefits [like avoiding public waiting lists], but you do have to pay for it,” Abbott says.

It was inevitable that we would end up at this point, says Professor Jeffrey Braithwaite, the director of the Centre for Clinical Governance Research at the University of NSW.

“This is a health system responding to policy measures – those measures are the caps in the public hospital system and the incentives provided in the private system,” he says.

“The real question is, is this the health system that we want, that people desire?”

http://www.smh.com.au/news/national/the-private-life-of-health-care/2007/04/05/1175366414296.html?page=fullpage#

Australian Health Review – Abstract (Nichol):
http://www.aushealthreview.com.au/publications/articles/issues/ahr_31_1_0407/ahr_31_1_s004.asp

International Journal of Epidemiology – Abstract (Korda et al):
http://ije.oxfordjournals.org/cgi/content/abstract/dyl282v1

Comment:

By Don McCanne, MD

Australia’s experiment with a public Medicare program and private insurance plans has provided a very important policy lesson for the United States: Establishing policies that encourage the purchase of private insurance while simultaneously limiting the funding of public insurance will inevitably result in a two-tiered system. More affluent individuals will have the best care money can buy, whereas those remaining in an underfunded public program will have impaired access and impaired health outcomes. Keep in mind that impaired health outcomes means chronic suffering and death.

The private Medicare Advantage insurance options in our Medicare program are intended to reproduce this same two-tiered system in the United States. Currently the Medicare Advantage plans are provided with more taxpayer funds so that they can attract individuals by providing better benefits. Once the private plans are well established, the government can start reducing the funding of both the traditional program and the private plans. But the private plans will be able to continue to offer greater benefits merely by increasing premiums and cost sharing. Thus more affluent individuals will select the private plans whereas individuals with more modest means will be relegated to the underfunded public program. Without a surge in political activism, this outcome is inevitable.

There is an even more important lesson from the Australian experience. We now have a consensus that we must reform health care in America. The two main options are to either establish an equitable national health insurance program, or build on the current fragmented system to achieve universality. Numerous attempts at patching our current system have fallen short, so some politicians and policymakers are now supporting a public Medicare-like program as a safety-net alternative. Because health care costs are a leading concern of virtually everyone, efforts will be made to keep the funding of the Medicare-like option to a minimum. Imagine a minimally funded program that attracts people with low incomes and with significant health care needs; talk about stretching resources. Anyone who can buy their way out of that program will. Like Australia, a two-tiered system would be inevitable.

As Professor Braithwaite says, “The real question is, is this the health system that we want, that people desire?”

Uninsured have increased rates of stroke and death

Risk of Cardiovascular Events and Death -- Does Insurance Matter?

By Angela Fowler-Brown, Giselle Corbie-Smith, Joanne Garrett and Nicole Lurie
Journal of General Internal Medicine
April, 2007

OBJECTIVE: To determine the relationship between insurance and cardiovascular outcomes and the relationship between insurance and selected process measures.

DESIGN AND PARTICIPANTS: We used data from 15,792 participants in the Atherosclerosis Risk in Communities Study, a prospective cohort study.

RESULTS: Persons without insurance had higher rates of stroke and death, but not myocardial infarction, than those who were insured. The uninsured were less likely to report routine physical examinations; more likely to be unaware of hypertension and hyperlipidemia; and more likely to have poor blood pressure control.

CONCLUSIONS: Lack of health insurance is associated with increased rates of stroke and death and with less awareness and control of cardiovascular risk conditions. Health insurance may improve cardiovascular risk factor awareness, control and outcomes.

http://www.springerlink.com/content/f4301627w3354417/?p=80d6e4d4ae67466fbb1022b9f1a725a1&pi=12

Beth Israel Deaconess release:
http://www.bidmc.harvard.edu/?node_id=1000&mainFrameSrc=/tools/newsnow/pr_out.asp?pr_id=1552

And…

Universal healthcare’s dirty little secrets

By Michael Tanner and Michael Cannon (Cato Institute)
Los Angeles Times
April 5, 2007

Simply saying that people have health insurance is meaningless.

Supporters of universal coverage fear that people without health insurance will be denied the healthcare they need. Of course, all Americans already have access to at least emergency care. Hospitals are legally obligated to provide care regardless of ability to pay, and although physicians do not face the same legal requirements, we do not hear of many who are willing to deny treatment because a patient lacks insurance.

http://www.latimes.com/news/opinion/la-oe-tanner5apr05,0,2227144.story?coll=la-opinion-rightrail

Comment:

By Don McCanne, MD

Lack of health insurance maims and kills. How can anyone with the slightest sense of decency state that that is meaningless?

Locals want an 'audacity of action'

By Deborah McDermott
Portsmouth Herald
04-05-07
dmcdermott@seacoastonline.com

PORTSMOUTH — Clif Horrigan wanted answers. The Portsmouth resident came to hear Illinois Sen. Barack Obama for her children, all of whom have faced unemployment, all of whom have been without health insurance.

She wants a single-payer, “prenatal to death” health care system, and she said that she was a tough customer before Obama even strode in the room at Seacoast Media Group on Tuesday .

“I haven’t heard what he stands for. I need details,” she said.

Two hours later, after Obama had listened to dozens of people relay a litany of problems and issues with their health insurance, Horrigan declared herself unconvinced.

“He gave no specifics; I have no firm idea where he’s going,” she said. “I’m disappointed. I did not hear what I wanted.”

Horrigan was among a small group of people who spoke with the Herald both before and after Obama’s appearance from among the 200-plus who attended Tuesday’s town meeting-style event on health care .

Friends Natalie White of Portsmouth and Rose Ruffin of Dover were also “frustrated” with the event afterward.

“I wanted to hear more specifics,” said Ruffin. “I don’t think he answered the questions.”

White said she understood he was there to listen, but is concerned he is not going to have enough time to put together a cohesive plan in time for the primary season. “He doesn’t have a plan,” she said.

Not everyone was disappointed with the senator. Helen Shaw of Portsmouth is a self-employed former nurse who bemoaned the rising cost of premiums “” especially after she turned 60. But she’s worried about more than herself. Younger self-employed people, she said before the forum began, were simply going without.

She hoped the senator would hear a story like hers, and a number of self-employed did speak about high-deductible, high premium coverage.

“I was pretty impressed,” she said later. “He seems to have a grasp on the issues.” She was particularly intrigued with the senator’s plan to gain comments from Americans via his campaign Web site. Obama encouraged the audience to submit their health care stories and ideas, which in turn will be reviewed and perhaps incorporated into a plan which Americans will in turn also be invited to address online.

Judith Silver of Portsmouth will be among those watching that Web site. She said health insurance was the single most important issue for her besides the war in Iraq, and she wanted to hear Obama proclaiming his approval for a single-payer system.

She later called Obama’s appearance “a wonderful dialogue,” but she’s still waiting to be convinced. “He says he’s going to come up with a plan, and I’m hoping he’ll do it,” she said.

Referring to the title of his most recent book, Silver said, “The question is, does he have more than an audacity of hope? Does he have audacity of action?”

Public Forums

Tuesday’s “Community Meeting on Health Care” with Sen. Barack Obama was the first of what the Portsmouth Herald hopes will be many forums it will host leading up to the 2008 New Hampshire primary. Seacoast Media Group has extended an open invitation to all the major presidential candidates to take part in single-issue focused meetings.

Locals want an ‘audacity of action’

By Deborah McDermott
Portsmouth Herald
04-05-07
dmcdermott@seacoastonline.com

PORTSMOUTH — Clif Horrigan wanted answers. The Portsmouth resident came to hear Illinois Sen. Barack Obama for her children, all of whom have faced unemployment, all of whom have been without health insurance.

She wants a single-payer, “prenatal to death” health care system, and she said that she was a tough customer before Obama even strode in the room at Seacoast Media Group on Tuesday .

“I haven’t heard what he stands for. I need details,” she said.

Two hours later, after Obama had listened to dozens of people relay a litany of problems and issues with their health insurance, Horrigan declared herself unconvinced.

“He gave no specifics; I have no firm idea where he’s going,” she said. “I’m disappointed. I did not hear what I wanted.”

Horrigan was among a small group of people who spoke with the Herald both before and after Obama’s appearance from among the 200-plus who attended Tuesday’s town meeting-style event on health care .

Friends Natalie White of Portsmouth and Rose Ruffin of Dover were also “frustrated” with the event afterward.

“I wanted to hear more specifics,” said Ruffin. “I don’t think he answered the questions.”

White said she understood he was there to listen, but is concerned he is not going to have enough time to put together a cohesive plan in time for the primary season. “He doesn’t have a plan,” she said.

Not everyone was disappointed with the senator. Helen Shaw of Portsmouth is a self-employed former nurse who bemoaned the rising cost of premiums “” especially after she turned 60. But she’s worried about more than herself. Younger self-employed people, she said before the forum began, were simply going without.

She hoped the senator would hear a story like hers, and a number of self-employed did speak about high-deductible, high premium coverage.

“I was pretty impressed,” she said later. “He seems to have a grasp on the issues.” She was particularly intrigued with the senator’s plan to gain comments from Americans via his campaign Web site. Obama encouraged the audience to submit their health care stories and ideas, which in turn will be reviewed and perhaps incorporated into a plan which Americans will in turn also be invited to address online.

Judith Silver of Portsmouth will be among those watching that Web site. She said health insurance was the single most important issue for her besides the war in Iraq, and she wanted to hear Obama proclaiming his approval for a single-payer system.

She later called Obama’s appearance “a wonderful dialogue,” but she’s still waiting to be convinced. “He says he’s going to come up with a plan, and I’m hoping he’ll do it,” she said.

Referring to the title of his most recent book, Silver said, “The question is, does he have more than an audacity of hope? Does he have audacity of action?”

Public Forums

Tuesday’s “Community Meeting on Health Care” with Sen. Barack Obama was the first of what the Portsmouth Herald hopes will be many forums it will host leading up to the 2008 New Hampshire primary. Seacoast Media Group has extended an open invitation to all the major presidential candidates to take part in single-issue focused meetings.

Death by no insurance?

Doctor and patient had colon cancer. She was uninsured and died. He is alive, convinced she could be too.

By Lindsey Tanner
Associated Press
Published April 4, 2007

Dr. Perry Klaassen lived to tell about his frightening ordeal with colon cancer.

His patient did not.

Same age, same state, same disease. Striking similarities, Klaassen thought when Shirley Searcy came to his clinic in Oklahoma City. It was July 2002, a year after his own diagnosis.

But there was one huge difference: Klaassen had health insurance, Searcy did not.

His treatment included surgery two days after diagnosis and costly new drugs. He is alive six years later despite disease that has now spread to his lungs, liver and pelvis.

“I received the most efficient care possible. I was 61 years old and had good group health insurance through my workplace,” he wrote in a medical journal essay that contrasts his care with that of his uninsured patient.

The doctor didn’t name Shirley Searcy in his March 14 article. After all he’d been through, he couldn’t remember her name. But he dug for days through old medical files searching for her identity after he was interviewed by The Associated Press, hoping to shine a more powerful light on the plight of the uninsured.

The widowed mother of eight grown children, Searcy had little money. When she began to sense she might be sick, she put off going to the doctor for a year because she knew she couldn’t pay the medical bills. Deeply religious, she put her faith in God, according to her family.

By the time she saw Klaassen, her cancer had spread from her colon to her liver. She had surgery but rejected chemotherapy.

“She just really didn’t feel like she wanted to endure what that would cost physically or financially,” said her daughter-in-law, Karen Searcy.

Shirley Searcy died Dec. 22, 2003, about 18 months after her diagnosis.

Searcy’s is a story that’s far from unique. An estimated 112,000 Americans with cancer have no health insurance, according to Physicians for a National Health Program.

Klaassen’s essay in the Journal of the American Medical Association illustrates the issue “close and personal,” said the publication’s editor, Dr. Catherine DeAngelis.

It underscores that insurance can be a life or death issue, said Paul Ginsburg, president of the Center for Studying Health System Change, a non-partisan policy research organization.

Klaassen, now 67, no longer sees patients but works part-time as medical director of an Oklahoma City group that recruits doctors to give free care to needy patients.

Always healthy and vigorous, his diagnosis in 2001 came as a shock.

Klaassen had a colonoscopy within two weeks after seeing his doctor for pain in his lower abdomen. When the specialist with the results asked, “Is your wife with you?” Klaassen wrote, “I knew immediately that I had colon cancer.”

Surgery two days later showed the disease had spread outside the colon wall and to nearby lymph nodes. It was not as advanced as Searcy’s, whose disease had spread to the liver.

Searcy married young and had her first child in her teens. Her mechanic husband died in a 1978 car crash, leaving her to raise the family alone. Social Security helped, but the Searcys never had anything extra, family members said.

“Life dealt her more I guess than some people have been dealt,” Karen Searcy said.

She didn’t work outside the home, didn’t venture often beyond her 4 acres and the ranch house where she raised her children in Blanchard, about 30 miles from Oklahoma City. In her later years, reading stories to her dozens of grandchildren was a favorite pastime. She’d figured she’d live long enough to qualify for Medicare at age 65, family members said; she missed it by a year.

“She put off [seeing a doctor] because of no health insurance, and she wanted to trust the Lord. She was hoping to be healed,” said her daughter, Melba Spalding.

Klaassen knew immediately that it was colon cancer when she saw him. A colonoscopy weeks later confirmed the diagnosis and that it was incurable.

It was “heartbreaking to all of us,” Spalding said. The family had always been close, and Searcy “was pretty well the hub of it,” she said.

With insurance, Searcy would have sought treatment sooner, family members said.

“I believe with all my heart that if she had gone to a doctor early on, that she would still be living,” Karen Searcy said.

Klaassen also thinks things would have turned out differently if she’d been insured.

“If she had survived at least a year more, she would have had new pills available to her,” the same ones that have helped control his disease, Klaassen said.

“People say … nobody ever dies because they don’t have insurance, and I say, ‘Yeah, they do.”

Copyright (C) 2007, Chicago Tribune

Health care front, center

By Shir Haberman
Portsmouth Herald
shaberman@seacoastonline.com

When potential Democratic Party voters in New Hampshire, Iowa, Nevada and South Carolina think about who would be the best presidential candidate to address the health-care crisis in America, 35 percent say Hillary Clinton’s name comes to mind.

Even Republicans appear to sense the New York senator’s leadership on the issue. Eighteen percent of Republicans surveyed by the Washington, D.C.-based Lake Research Group for the Service Employees International Union named the former first lady as the candidate who is speaking most about health care.

During a telephone interview with Herald Sunday on Thursday, Clinton said those numbers are an indication of her discussions of health care during this presidential campaign and her history of advocacy.

“I think a lot of people are aware of what I’ve done in the last 10 years on this issue,” Clinton said. “Most of the plans being discussed by candidates this year are based on the work I did in 1993 and ’94 during the first Clinton administration.”

She said the reason the plan she helped develop during those years failed was that most residents of the country were covered by employer-paid health insurance plans.

“People were concerned that bringing in the uninsured would decrease the amount of coverage they had,” she said. “And that was certainly a valid concern.”

However, times have changed and Clinton said she believes there is a better chance for an all-inclusive health-care system in the country, because more people are without insurance and many of those with coverage are under-insured.

Clinton said she sees only two possible solutions to the problems associated with the current health-care system, but believes there is no one plan that has the necessary congressional support.

The two approaches are:

Build on the employer-based system with a provision for a government-sponsored program that would act as a safety net for those who could not get insurance through their employers.

Develop a single-payer approach, funded publicly, but delivered privately.

Clinton congratulated the N.H. House for passing a resolution in support of U.S. Rep. John Conyers’ National Health Insurance Act, which advocates for the single-payer approach using the current Medicare system as the basis for the process.

“More states have to make their desires known or create their own health-care programs, like Massachusetts has done, in order to keep up the pressure on this issue,” she said.

Clinton said while she recognizes changes to the way health care is administered require a comprehensive approach that addresses things such as drug costs, insurance company practices, physician education debt and delivery systems, the realities of the political process need to be taken into consideration.

“We have to approach it comprehensively, but it may be more politically feasible to phase in the solutions,” she said. “We need a solid base in the Senate.”

She said 60 votes are needed in that body to make any substantive change to the system, and that is just the beginning of what is required.

“We need to develop a political will that can withstand the onslaught of the special interests and the ideologues who believe the government should not play a role in providing health care,” she said.

However, Clinton said there are some things that can be done immediately. The first might be to bring the existing health-care system back to where it was prior to the Bush administration taking control.

“There is a lot of repair work to do,” she said. “This administration has been particularly bad at handling this issue,” she said.

Another step that can be taken immediately is the implementation of a national electronic medical records system, which has been estimated to save about $100 million in paperwork costs. That money could be used to cover more people, Clinton said.

New Hampshire is in the process of establishing such a system, but, the senator pointed out, when a patient leaves the state, the ability to transfer his or her medical information disappears.

Clinton believes the fact that nearly half the Republican voters surveyed by Lake Research could not name a candidate from their own party addressing health care is because of ideological differences between the two parties.

“During their primary, health care is not an issue because many of their candidates are ideologically opposed to federal involvement in health care, preferring to allow the market to set the standards,” Clinton said. “I think that is unrealistic, and in the general election it will certainly be one of the major differences between me and the candidate they chose.”

With the Lake study indicating health care has emerged as the No. 2 issue overall in this campaign, and the top domestic issue, the candidate offering the best approach to dealing with this issue is expected to have a leg up. Clinton agrees with that assessment.

“Health care is definitely going to be one of the defining issues in this campaign,” she said.

Single-Payer Primer for the Press

Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance
The Physicians’ Proposal for National Health Insurance establishes the vision and principles of a single-payer health system for the United States. The document was composed by a distinguished group of physician leaders, and secured the endorsement of 8,000 physicians by the time of its publication in the August 13, 2003 JAMA.

The text outlines the general structure of the single-payer plan: eligibility and coverage, physician and outpatient care payment, global budgeting of hospitals, the establishment of a national long-term care program, planned capital investment and single-payer financing.

Statement of Dr. Marcia Angell introducing the U.S. National Health Insurance Act
The U.S. National Health Insurance Act (also known as the Expanded and Improved Medicare for All Act), HR 676, was introduced on February 4, 2003. The following is the statement made at the introduction ceremony by Physicians’ Working Group member and former NEJM editor Dr. Marcia Angell.

Administrative Waste Consumes 31 Percent of Health Spending
PNHP Co-founders Drs. Steffie Woolhandler and David Himmelstein published this definitive study of the administrative costs of the U.S. health system in the August 21, 2003 edition of the New England Journal of Medicine. After analyzing the costs of insurers, employers, doctors, hospitals, nursing homes and home-care agencies in both the U.S. and Canada, they found that administration consumes 31.0 percent of U.S. health spending, double the proportion of Canada (16.7 percent). Average overhead among private U.S. insurers was 11.7 percent, compared with 1.3 percent for Canada’s single-payer system and 3.6 percent for Medicare. Streamlined to Canadian levels, enough administrative waste could be saved to provide compressive health insurance to all Americans.

How Much Would a Single-Payer System Cost?
The financial viability of a single-payer system has been analyzed time and again by researchers both from the U.S. government and independent consulting firms. Each time the conclusion is the same: single-payer saves enough on wasteful paperwork to provide high quality health coverage to all and contain future health spending. This paper catalogs the analyses of proposed single-payer systems at both the federal and state levels.

Illness And Injury As Contributors To Bankruptcy
In 2001, 1.458 million American families filed for bankruptcy. To investigate medical contributors to bankruptcy, we surveyed 1,771 personal bankruptcy filers in five federal courts and subsequently completed in-depth interviews with 931 of them. About half cited medical causes, which indicates that 1.9-2.2 million Americans (filers plus dependents) experienced medical bankruptcy. Among those whose illnesses led to bankruptcy, out-of-pocket costs averaged $11,854 since the start of illness; 75.7 percent had insurance at the onset of illness. Medical debtors were 42 percent more likely than other debtors to experience lapses in coverage. Even middle-class insured families often fall prey to financial catastrophe when sick.

The New Massachusetts Health Reform: Half a Step Forward and Three Steps Back
Massachusetts runs in regular cycles. Every eighty-six years our Red Sox win the World Series. Once a decade Harvard hires a senior woman scientist. And every twenty years our legislature passes a universal health care bill that the governor hopes to use as a springboard to the White House.

Can we set ideology aside?

Health care system can't be fixed without teamwork

By Alice Rivlin (Brookings Institution) and Joseph Antos (American Enterprise Institute)
Post-Bulletin
March 29, 2007

We cannot stop the inexorable rise of health-care spending, but we should be able to slow it down without sacrificing the care we all want.

Progress can be made, but only if we get past the ideological debate over market-oriented versus regulatory approaches. Both markets and regulations play a necessary role in our health care system, and we must improve both. Giving consumers more understandable information about costs and effectiveness can help them choose more efficient providers and spend their health dollars more wisely, especially on routine or elective procedures. But a patient with a serious acute illness may not be in a position to make informed choices. Public and private insurers must adjust their payments to reward best practices and discourage wasteful and ineffective providers.

President Bush’s recent proposal to make employer contributions to employee health insurance taxable would discourage employers from offering over-generous health coverage that fosters wasteful health spending. The president would offer a standard deduction for health insurance to help taxpayers buy coverage either through their employer or in the market.

Congress should treat the president’s proposal as an opening bid, convert the standard deduction to a refundable tax credit available to everyone, and help the states make affordable coverage available to all through high-risk pools and more sensible regulation.

One thing is certain. Slowing the rise of health spending to a sustainable pace and getting more health for our money is going to take all of us. Patients and doctors, hospitals and insurers, governments and the private sector all have to work together. It won’t be easy, but unless we try everything and keep trying, we will have poorer than necessary health care at higher than necessary cost.

http://www.postbulletin.com/newsmanager/templates/localnews_story.asp?a=288963&z=12

Comment:

By Don McCanne, MD

The pressure is on for health care reform, and politicians and the policy community clearly understand that. The consensus seems to be that everyone should have the health care that they need, without having to face the added burden of financial hardship. That is a view from the political left that is now shared by an increasing number of moderates and even some from the right.

The right understands that changes are absolutely inevitable, and the lack of an enthusiastic reception of their concepts means that they will not be able to unilaterally dictate the policies to be adopted. The left understands that, at least until now, the rationality of a program of national health insurance has not been enough to drive reform.

Thus there has been a move to set ideology aside and to work together to tackle our health care problems. We are seeing unprecedented coalitions from across the political spectrum forming to advocate for comprehensive reform. Unfortunately, so far all that they have been able to produce is hot air, since they have not been able to agree on how reform is to be accomplished. That is, they have been unable to set ideology aside. (Massachusetts is not an exception, as it is an example of the process described in the next paragraph.)

So now we are seeing intellectuals such as Alice Rivlin and Joseph Antos trying to meet on a common ground while professing to set ideology aside. But where do they actually meet? Do they try to meet halfway between a government insurance program and private plans in the marketplace? No. They are meeting in the marketplace, deciding whether we’ll have private plans with modest regulation, or private plans controlled more by market forces. When universal health insurance is a concept from the left, why would we move over to the right to negotiate it?

The right will never give up their ideology. In insisting on market-oriented reform through private plans, they are willing to give up on covering everyone, give up on ensuring that people would get all of the care that they need, and give up on preventing financial hardship (since that is their most important tool for controlling spending).

Can the left set aside ideology? Not if we accept the position of the right that affordable, reasonably comprehensive health care for everyone is a left wing concept. But let’s try to do it anyway by redefining Medicare-for-All national health insurance as being as truly American as Mom and apple pie. American ideology is so much more comfy than partisan ideology.

ACT UP protest brings attention to heath care crisis

ACT UP commemorative protest results in 30 arrests

Michelle Garcia
The Advocate
March 30, 2007

Nearly 30 people were arrested in an act of civil disobedience Thursday after 50 body bags were lined up on a New York City street to represent the number of people who die of AIDS complications every day. Venerable activist group ACT UP–AIDS Coalition to Unleash Power–commemormorated its 20th anniversary by reenacting its first protest, which took place 20 years ago, also in New York City’s financial district. Upward of 800 people showed up to march down Wall Street, calling out to health care providers and pharmaceutical companies.

Cathy Renna, a publicist who represents the group, told The Advocate that demonstrators received positive reactions from bystanders.

“Gilbert Baker, who was the creator of the rainbow flag, made this giant banner that was so big, it took nine people to hold it,” she said in a phone interview. “It said, ‘Worst President Ever,’ but had a picture of him and the flag, and it actually looked very patriotic. We got quite a few cheers from people on the street walking by.”

Renna described the marchers as diverse, reflecting the population of people who contract HIV now, including women, Latinos, and African-Americans. One of the groups involved with organizing the campaign was the Metro New York Physicians for a National Health Program, or PNHP.

Oliver Fein, chairman of PNHP, said the partnering of these two groups is crucial to furthering the cause of health care and affordable housing for HIV patients and all Americans.

Both ACT UP and PNHP are lobbying for a nationalized, single-payer health care plan for all Americans.

“Single-payer says that every resident of the U.S. should be covered, no fancy eligibility criteria based on age, or ability, or employment,” Fein said. “For instance, we have Medicare limited only to people over 65. So we would argue that if you live in the U.S., you should have a single-payer program. It would be similar to Medicare, but it would be extended to all Americans. Instead of being over 65, the only criteria is that you live here.”

In support of a single-payer system

Ann Troy, M.D., FAAP
San Rafael, Calif.
AAP News
March 2007

In his State of the Union address, President Bush acknowledged that we have a health care crisis in the United States. His plan for fixing it would keep the insurance industry in health care — to the detriment of us all.

The United States is the only developed nation without a national health program. We spend more than double per capita what any other nation spends on health care, yet we have almost 50 million people, including 9 million children, without health insurance, millions more with grossly inadequate coverage, and the worst health care statistics in the developed world.

How can this be? Approximately 50% of every health care dollar is spent on something other than health care. Insurance companies themselves admit that they spend about 30% of the money we pay in premiums on something other than health care — multimillion dollar salaries for their CEOs, profit for their shareholders, advertising and sales, screening applicants and claims, and generating mountains of paperwork and endless hassles for doctors and patients, alike. Then there is the money we have to spend dealing with them — in the creation of intermediary bodies and in hiring staff to do billing and to deal with authorizations.

In the 1960s, Canada and the United States spent about the same amount per capita on health care and had similar health care statistics. By 1971, all of Canada had a single-payer system. Thirty-five years later, it spends less than half of what we spend per capita, yet is able to provide health care for all of its citizens. Fur ther more, on almost every measure its health care statistics, like those of other developed nations, are better than ours. Our infant mortality rate is 50% higher than Canada’s, and our overall mortality rate is 30% higher.

The World Health Organization ranks the United States 37th, at the bottom of the developed world! If we get the insurance industry out of health care and establish a single-payer system, we would have more than enough money to provide health care for all and to pay doctors and hospitals fairly for their services. Under a single-payer system, patients would be able to choose their own doctors; doctors would remain private, able to practice the way they want, paid fairly and simply on a fee-for-service basis; and we would save billions of dollars.

No longer would people have to change doctors every time they change jobs or their employer finds a cheaper health plan. Nor will they have to worry about losing their access to health care if they lose their job or develop a chronic condition. No longer would families struggle to pay astronomical health insurance premiums, or worry about paying for prescription drugs. No longer will 50% of bankruptcies be due to medical debt. All patients would have a “medical home.” Continuity of care will be improved and problems will be treated earlier (when easier to treat) or prevented altogether. Rates for vaccinations and health screening will go up. Public health and productivity will improve and social problems associated with untreated mental health problems and addictions will decrease.

Single payer will be good for the economy. American companies are at a huge disadvantage when competing with companies in other developed nations, which are not burdened with the high cost of providing health care for their employees. Smaller companies and small businesses can’t afford to provide health care benefits and, thus, can’t compete for the best workers. Un happiness over health care benefits is the leading cause of labor unrest in the United States. A single-payer system would improve all of this and also decrease absenteeism and increase productivity (workers with access to health care are healthier and more pro ductive). Furthermore, worker’s comp would be reduced or even eliminated. All of these advantages would create more jobs and generate more tax revenue.

A single-payer bill, HR676, authored by Reps. Conyers (D-Mich.) and Kucinich (D-Ohio), will be introduced soon. With this bill, we have an opportunity to have the best health care system in the world and to enable all Americans to have access to health care that citizens of every other developed nation take for granted. Let’s be courageous and make it happen!

Editor’s note: At press time, the Academy had not taken a position on the single-payer bill.

Medicare for all would be a healthy move

By Saul Friedman
Newsday
March 31, 2007

I have not seen the case for publicly supported universal health care put any better than this, and by someone who knows what he’s talking about:

“I am proposing the federal government as the single payer of health care in this country. Only the federal government has the ability to fund one large risk pool through a payroll deduction. As the single payer, the federal government could negotiate hospital and physician payments even more effectively than it does now with Medicare.

“A single pool of funds, collected and administered by the government, would expand Medicare and replace Medicaid, SCHIP (State Children’s Health Insurance Program), the VA health-care system, and private health insurance, including the health care aspect of Worker’s Compensation. … Also eliminated would be the tax credit – or subsidy – given to companies for providing health insurance to their employees. In other words, the current, inefficient patchwork of payment systems would disappear, to be replaced by one nationwide program available to every citizen.”

The writer was Robert Gumbiner, an M.D. and a pioneer of the controversial concept of managed care, which has been a vain attempt to reduce the soaring costs of the volatile for-profit health-care system. Gumbiner founded FHP, in California, one of the nation’s earliest and largest HMOs, which was swallowed up in a merger with PacifiCare 10 years ago.

His present views, written for the Physicians for a National Health Program Web site, underscore what I’ve been reporting – that the American public, thousands of doctors and a number of business leaders, governors and members of Congress are arriving at the conclusion that it’s time the United States joined most other industrialized nations in adopting universal health care.

The issue is what path we should take.

How can we preserve what’s best in the nation’s current system and move as smoothly as possible to medicine that’s publicly financed? How can we avoid the Clintons’ mistake of 1993 in trying to please every interest and coming up with a complex, top-heavy system that could not get through even a friendly Congress and White House?

One popular answer, which we reported on nearly 10 years ago, came from Dr. Marcia Angell, in the New England Journal of Medicine, which she edited. We called it “Medicare For All.” Now a senior lecturer at Harvard Medical School, she repeated her suggestion recently in the Boston Globe.

Criticizing various proposals because they depend on private, for-profit insurance companies, Angell wrote: “They all have the same fatal flaw … no workable mechanism to control costs. … We need to change the system completely and get the insurance industry as well as employers out of it. … It would make much more sense to extend Medicare to everyone. …

“This could be done gradually by dropping the eligibility age a decade at a time, while phasing out the insurance companies. … Medicare is not perfect, but its problems are readily fixed. It is far more efficient than private insurance … and since it is administered by a single public agency, controlling costs would be possible.”

“Medicare for All,” is the subtitle of the most serious universal health-coverage bill before Congress, legislation that would turn her proposal into law: “The U.S. National Healthcare Insurance Act,” HR676, re-introduced in January by Rep. John Conyers (D-Mich.). It was supported in the last Congress by about 80 members, but the Republican leadership gave it no chance to move.

The bill isn’t yet high on the list of legislative priorities in the new Congress, primarily because most Republicans and President George W. Bush still are wedded to putting the insurance industry in charge. While every Democratic presidential candidate supports universal coverage, only Dennis Kucinich currently favors a “single-payer” solution like Medicare.

Nevertheless, Conyers and Sen. Edward M. Kennedy (D-Mass.), who favors another version of Medicare for All, now chair committees that could give their proposals some serious attention, perhaps readying for the day when they have the White House on their side. The mainstream press, and even AARP, have been ignoring their proposals, but you may study Conyers’ bill by entering its number, HR 676, at http://thomas.loc.gov/ or visit Conyers’ Web site: http://www.house.gov/conyers/.

Conyers’ brief summary of the legislation says it would establish “an American national health insurance program” that, like Medicare, would provide publicly financed but privately delivered free health care to all Americans, who would be free to choose their doctors and hospitals. Benefits, according to the Congressional Research Service summary, would include “all medically necessary care, such as primary care and prevention, prescription drugs, emergency care and mental health services.”

The legislation would put out of business the hundreds of profit-taking middlemen of the health care industry, especially insurance companies, by prohibiting “an institution from participating in the program unless it is a public or nonprofit institution.”

Conyers’ bill also would prohibit the sale of insurance that duplicates benefits provided by the legislation.

Finally, Conyers would finance the benefits mostly by adding 3.3 percent each for employees and employers to the 1.45 percent payroll tax each is now paying, thus relieving the heavy burden businesses now bear in paying expensive premiums for employee/retiree health insurance. It also would end the need for health insurance premiums for working families and provide coverage for the estimated 75 million who are uninsured or underinsured.

While Conyers’ bill has broad liberal and union support, “Medicare for All” is not the only proposal for universal health care, and we intend to look at others as well your ideas.

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