PNHP

Study: Minnesota doctors prefer single-payer universal health system

Study: Minnesota doctors prefer single-payer universal health system

by Carissa Wyant
Staff Writer
Minneapolis / St. Paul Business Journal
Monday, February 12, 2007

A new study by the University of Minnesota has found that most of the state’s physicians surveyed prefer a single-payer universal health insurance system.

The study, conducted by the University of Minnesota School of Public Health and the Universal Health Care Action Network-MN and published in the February issue of Minnesota Medicine, found that 63.4 percent of state physicians believe that a single-payer universal health insurance system would offer the best health care to the greatest number of people. According to a press release, almost 25 percent of Minnesota physicians thought health savings account systems were best, and 11.8 percent were in favor of managed care.

Dr. Charles Oberg, the study’s co-author and associate professor at the University of Minnesota School of Public Health, commented, “Many doctors are becoming increasingly disappointed and frustrated with the health care system as it stands. Insurance hassles, heavy paperwork, and patients’ inability to get the care they need make it very problematic.”

The study also found that 71 percent of Minnesota doctors said they would accept a 10 percent reduction in fees for a “very significant” reduction in paperwork, and 63.8 percent favored physician payment under a salary system.

Researchers mailed surveys with questions on health care financing and medical practices to a random sample of 1,061 Minnesota physicians drawn from the Minnesota Board of Medical Practice. Thirty-nine percent of the surveys were completed and returned. Data was compiled and analyzed by the University of Minnesota School of Public Health.

cwyant@bizjournals.com | (612) 288-2108

Timid ideas won’t fix health mess

By Marie Cocco
Columnist
Sacramento Bee
Published 12:00 am PST Saturday, February 10, 2007

John Edwards is trying to get ahead of the political curve, but he would send us back to the future. To 1993, to be exact.

Edwards would repeat the mistake that was at the heart of Hillary Rodham Clinton’s misadventure in trying to fix a health insurance system that was then, and is now, so out of whack that it manages to cover fewer and fewer Americans at higher and higher cost.

Like Clinton did, Edwards seems to believe that you can get the private insurance industry to do something it refuses to do because, in essence, doing what Edwards wants would put the industry out of business. He wants insurers to cover everyone, no matter how sick and expensive they are. He wants employers to continue to carry on their ledgers a cost that is ever more burdensome to them and to their workers, onto whose shoulders more of the health-insurance tab is being shifted.

The 2004 Democratic vice presidential nominee and 2008 presidential hopeful knows that no matter how many times our health insurance crazy quilt is ripped up and stitched back together, it still will fail to cover millions of Americans.

So Edwards wants them to be able to buy a new public insurance plan that would be like Medicare, but not exactly. And he wants affluent people to pay more taxes to support coverage of the less fortunate, but not directly.

Instead of simply asking for a straightforward tax to pay for covering the uninsured, Edwards falls back on that popular circumlocution, the tax credit. The credits are indirect subsidies that would be given to individuals so they could then purchase insurance. The political virtue of tax credits is that their cost is always half-hidden beneath a pile of budget documents — unlike tax hikes that show up as money withheld from paychecks, but pay directly for a government service. Because of this obfuscation, politicians in both parties love tax credits.

Edwards wants congratulations for being the first serious presidential candidate to offer a comprehensive idea for universal health insurance coverage, something every Democratic aspirant is bound to do eventually. Edwards is a smart man and a cunning politician. But his health insurance plan suffers from an odd combination of ailments.

One is political amnesia. This Clinton-like plan that would have both individuals and employers buy into closely regulated health insurance pools failed more than a decade ago — in part because it was so complicated as to be incomprehensible. Another is timidity.

Edwards won’t acknowledge that the current system of private insurance is irreparably broken.

It has failed to expand coverage to millions of workers who are employed by small business, or who work part time, or who toil at low wages — companies with high proportions of low-wage workers are far less likely to offer insurance than those whose employees earn more, according to research by the Kaiser Family Foundation. Since 2000, the portion of businesses that offer any insurance to even part of their work force has fallen from 69 percent to 61 percent.

Over the past year, a solid majority of those who do have coverage — 60 percent — experienced an increase in the amount they are responsible for paying under their plan, the Employee Benefit Research Institute says. Almost a third of covered workers reported difficulty in paying for basic necessities such as food, heat and housing because of rising health-care costs.

This isn’t much of a foundation upon which to construct a new system. In the years since Clinton tried to build on this inhospitable terrain, the ground has eroded further. It makes no sense to try to shore it up with an awkward hybrid of public requirements and private insurance that would keep in place unnecessary complexity and bureaucratic expense.

Edwards’ advisers say the candidate didn’t push public, single-payer insurance — like Medicare — because the employer-based system is what we have today and therefore, it would provide the quickest way to cover the uninsured.

But we also have Medicare today. The elderly still get care from private doctors and hospitals, and administrative costs are a fraction of what they are in the private insurance industry. And people tend to like it.

It would be just as easy — and certainly simpler — to use Medicare as the foundation for a new insurance system to eventually cover everyone. But that would require candidates to be leaders — and show more courage than those politicians who simply say they have a plan.

Expanding uninsurance through premiums

Insurance Premium Cost-Sharing and Coverage Take-up

Kaiser Family Foundation
February 2007

One of the many reasons an individual may be uninsured is that she or he decides an employer’s offer of health insurance is too expensive. Several studies have noted the likelihood that a worker will decline an employer’s offer of health insurance increases with the amount he or she is required to contribute. Alternatively, employees may obtain coverage through a spouse, opt for publicly provided coverage if eligible, or decide to do without coverage entirely. This issue brief looks at the connection between premiums and the percent of workers who enroll in employer plans using the two most recent years of the Kaiser/HRET Employer Health Benefits Survey (EHBS). Several of these analyses suggest that the required worker share of the premium can be an obstacle to coverage that raises concerns about the affordability of private health coverage.

http://www.kff.org/insurance/snapshot/chcm020707oth.cfm

Comment:

By Don McCanne, MD

As long as individuals are required to pay some portion, if not all, of the premium for health insurance, take-up will never be 100 percent. Even with an individual mandate to purchase insurance, take-up will still not be 100 percent since too many individuals simply do not have the funds to pay the required contribution.

Entering “universal coverage” into Google just now produced over 23 million responses. Everyone is calling for universal coverage. Yet when you look at the new proposals and the various coalition efforts, none of them would result in universal coverage. Either the proposals have serious flaws such as the individual mandate requirement, or, worse, many of the hyped coalition efforts have no substantial proposals at all.

Right now many are calling for solutions that involve “shared responsibility.” That is code language for reducing the employers’ responsibilities for funding care and shifting more of it to individuals, especially in the form of individual mandates to purchase insurance and in greater cost-sharing when accessing care.

If we are serious about achieving universal coverage, we will have to adopt policies that will make enrollment completely automatic for absolutely everyone. That means that we cannot make enrollment dependent on partial or full payment of a premium.

There is only one proposal that would automatically achieve 100 percent enrollment: single payer. And, oh yes, it’s also the only proposal that would make both health care coverage and health care access affordable as well.

When these coalitions and pseudo-reform advocates claim that they are supporting “universal coverage,” there seems to be an aura of political correctness that prevents us from using the four-letter “l” word that would describe them precisely. But at least we could tell them that their pants are on fire!

(Is anyone up for a national “PANTS ON FIRE” campaign?)

Urban Institute report on SCHIP

Coverage Patterns Among SCHIP-Eligible Children and Their Parents

By Genevieve M. Kenney and Allison Cook
Urban Institute
February 9, 2007

SCHIP was enacted in 1997 to expand health insurance coverage to low-income uninsured children. Under SCHIP, states could use enhanced federal matching dollars to expand public coverage for children beyond Medicaid eligibility levels.

This study finds that most SCHIP enrollees do not have access to employer-sponsored insurance through their parents.

In addition, our analysis indicates that just 25 percent of all SCHIP enrollees live in families where one parent (in single-parent families) or both parents (in two-parent families) have employer coverage.

Following the implementation of eligibility expansions under SCHIP and the significant investments in outreach and enrollment simplification under both Medicaid and SCHIP, uninsurance rates have fallen for low-income children. Coverage gains have slowed, however, and the most recent CPS even indicated that uninsurance may be on the rise for children.

This brief has three important implications for SCHIP as it faces reauthorization. First, federal funding will have to be increased substantially if the allotments are to include coverage for the close to 2 million uninsured children who are eligible for SCHIP but not yet enrolled. Second, many children stand to lose coverage altogether if federal funds are inadequate to meet existing program need. Finally, addressing the insurance coverage needs of low-income parents through SCHIP would likely improve the lives of both low-income children and their parents but would require a substantial expansion in the federal funding commitment to the program.

http://www.urban.org/publications/311420.html

Full report: http://www.urban.org/UploadedPDF/311420_Coverage_Patterns.pdf

And…

HHS Proposes Nearly $700 Billion Budget for Fiscal Year 2008

U.S. Department of Health & Human Services
February 5, 2007

The President’s budget proposes to reauthorize State Children’s Health Insurance Program (SCHIP) for five more years, to increase the program’s allotments by $5 billion over that time, and to target SCHIP funds more efficiently to those most in need.

http://www.hhs.gov/news/press/2007pres/20070205.html

Comment:

By Don McCanne, MD

The State Children’s Health Insurance Program (SCHIP) continues to fall far short of its goal to insure all lower-income children who qualify. The fact that uninsurance in children is on the rise again suggests that the SCHIP program may have reached its fully predictable steady state in which attrition in enrollment offsets new gains.

An increase in outreach and enrollment efforts might be able to slightly shift the steady state threshold, but it can never be effective in enrolling all eligible children and keeping them enrolled.

Nevertheless, current efforts at reform are targeted to expanding the coverage of children, and perhaps even their uninsured parents. At a minimum, there does seem to be a consensus that the SCHIP program does need to be reauthorized this year, or it will be terminated.

What does the Bush administration propose? No funds for expansion of eligibility, inadequate funds to maintain even the deficient current level of enrollment, and, most ominously, targeting SCHIP funds “more efficiently to those most in need.” What does that mean? In testimony before Congress this week, HHS Secretary Michael Leavitt explained that existing state expansions of SCHIP eligibility would no longer be partially funded by the federal government because it is more important to apply those funds to the budget deficit.

The 2 million children currently eligible for SCHIP but not enrolled are only one-fifth of the uninsured children in the United States. While ignoring the other four-fifths of the children plus everyone else without insurance, the politicians are entering a debate to show which of them are the least heartless in their efforts to salvage, in a somewhat tattered state, this program that falls so far short of our goals to remove financial barriers to health care.

SCHIP does need to be reauthorized, but only as an urgent stopgap measure while we move forward briskly toward reform that would automatically enroll absolutely everyone in a comprehensive national health insurance program. But if the past few decades are any indication, we can anticipate the celebration of the reauthorization of SCHIP, and then… nothing further. That would be heartless.

SEIU President Andy Stern Rams Ahead with Corporate Partnerships in Healthcare Industry

By ALAN BENJAMIN

Reprinted from January-February 2007 issue of Unity & Independence, a supplement to The Organizer Newspaper, San Francisco.

A few weeks ago, The Wall Street Journal ran yet another glowing article about SEIU President Andy Stern and his drive to press the unions to carry out “an attitude adjustment.”

The Journal asked Stern if he thought the unions would ever be able to organize Wal-Mart in the United States. Stern’s answer was revealing. “We have not been trying to organize them but to change their business model. A traditional organizing drive is not going to be successful because the laws are so tilted on behalf of a company as big as Wal-Mart, not to mention the fact that Wal-Mart has an emergency-response team that flies out of Bentonville at the moment the word ‘union’ is used in the store. I think Wal-Mart has the opportunity to create an entirely new model of worker representation. The question is, do they want partners?” (Jan. 22, 2007)

Working people across the country understand full well that corporate America, beginning with Wal-Mart, is on a search-and-destroy mission to dismantle the unions and lower their labor costs. If unions are to survive as instruments to defend the interests of their members and of the working-class majority in this country, they have to challenge all the unjust laws and return to the fighting stance and traditional organizing drives that built the unions in the first place.

Dr. Martin Luther King, Jr., and the Civil Rights Movement did not shy away from challenging the unjust Jim Crow laws because these laws were so tilted on behalf of a system of racism and oppression against Blacks. They did not seek to become partners with the Ku Klux Klan in the hope the Klan could be brought around to a new model of race relations in this country.

But isn’t this what Stern is proposing?

“Healthcare Partnership” with Wal-Mart

In his interview with The Wall Street Journal, Stern explained his reasons for seeking healthcare partnerships with the employers.

“We must try to be partners with our employers, who have told us we should change and understand their competitive issues and try to add value, not create problems,” Stern said. “Unions need to appreciate there are ways in which we add value and can be helpful. This is especially the case in relation to healthcare. The employer-based healthcare system is dead. It’s a relic of the industrial economy, and it makes corporations unable to compete fairly when America is the only country that asks its employers to put the price of healthcare on the cost of its products.”

These are not just empty words. Stern has been working overtime offering his “helpful” services to some of the most anti-union and retrograde sectors of Big Business in this country.

As we go to press, Stern and Wal-Mart have just announced a healthcare partnership “aimed at attaining universal healthcare coverage.” The partnership also includes Intel Corp., AT&T Inc. and Kelly Services Inc., a temporary staffing agency. According to the Associated Press release of Feb. 7, “no specific policies were proposed to achieve this goal. Wal-Mart CEO Lee Scott said that Wal-Mart is not committed to spending more on healthcare or making any immediate promises to provide health coverage to more workers.”

Labor activist Marnie Goodfriend of Labor Beat in Chicago lambasted Stern for “rubber stamping” Wal-Mart’s empty-rhetoric support for universal healthcare. “Stern should be putting intense public scrutiny and pressure on Wal-Mart for its exploitative and degrading work conditions,” Goodfriend noted, “not using Wal-Mart’s paper-thin public support for healthcare to undermine his own campaign against the company.”

It is hard to believe that just two years ago, SEIU leader Anna Burger publicly denounced the Congressional Black Caucus for organizing a joint fundraiser with Wal-Mart.

The Washington Post on May 15, 2005, reported that Burger wrote caucus members “to express SEIU’s disappointment that the Congressional Black Caucus has given Wal-Mart an opportunity to fashion a false image as a friend of African Americans and of working people generally by organizing the April 27 joint fundraiser.”

“As the largest employer in the world,” Burger wrote, “Wal-Mart’s labor relations model is now undermining standards for all American workers. The average salesclerk makes below the poverty line, and a majority of Wal-Mart workers cannot afford the company’s health insurance plan. … Wal-Mart has forced its more than 600 suppliers to shift operations overseas to exploit workers there at even lower wages while destroying good American jobs.”

How true. At the time, SEIU was still part of the AFL-CIO and its campaign to organize Wal-Mart employees into genuine unions. But as Stern revealed in his new book, “A Country that Works: Getting America Back on Track,” it was necessary for the SEIU to break with the AFL-CIO, “because of the failure on the part of the AFL-CIO to modernize its strategic approaches to employers in order to take into account their competitive business needs.”

Today, instead of organizing Wal-Mart workers into unions, Stern’s goal is to “change Wal-Mart’s business model” by doing exactly what Anna Burger accused the Congressional Black Caucus of doing two years ago — giving Wal-Mart an opportunity to fashion a false image as a friend of working people, when in fact Wal-Mart is one of its main enemies.

Any more doubts as to the nature of Stern’s split from the AFL-CIO?

From the Business Roundtable to Safeway

The Wal-Mart partnership is only one of many so-called “healthcare partnerships” Stern has been building of late.

On Jan. 12, 2007, Stern announced the launching of a partnership with AARP and the Business Roundtable called Divided We Fail. Their purpose, as a press release puts it, “is to work together to urge action from political leaders to attain health and long-term financial security for all Americans.”

The Los Angeles Times (Jan. 16) noted that, “two seemingly strange bedfellows, the president of SEIU and the director of the Business Roundtable, which represents the nation’s leading corporations, have joined hands with AARP to overhaul healthcare along the lines of the Massachusetts Plan, the only comprehensive state proposal that has been enacted.”

The Times continues, “Divided We Fail relies primarily on a requirement that individuals must purchase private health insurance. The state would redirect funding that had been used to cover hospital care for the uninsured to subsidize health-insurance premiums. The plan also levies a token fee on employers that do not provide coverage.”

One month earlier, on Dec. 13, 2006, Stern joined up with Safeway CEO Steve Burd and Oregon Democratic Senator Ron Wyden to unveil the “Healthy Americans Act.” The details of this plan are worth examining, as they illustrate everything that is wrong with all the partnerships that Stern is putting together with these giant corporations.

The Healthy Americans Act would mandate individuals to purchase private insurance — just as the Divided We Fail plan does — and it would slash and cap costs to business. Depending on size and income, businesses would be required to pay a tax of 2% to 25% of the average private insurance premium. The tax would be used to subsidize private insurance premiums for low-income people. (At this time, employers pay an average of 75% of health insurance premiums.)

Individual workers would then be required to buy private insurance. Employers who offered health insurance prior to enactment of Wyden’s legislation would contribute lump-sum wage payments to their employees equal to the cash value of the health insurance they provided. In this scenario, the burden of rising healthcare costs is thus shifted from the employer to the worker. This means that the employee is now left to his or her own to buy their own healthcare insurance package.

This is a major shift of wealth from working families to corporations.

Don Bechler, chair of the California Universal Health Care Organizing Project and a former UAW and IAM negotiator, said: “The Wyden proposal is not something labor can support. It eliminates the collective bargaining tool for working people and leaves them to the mercy of insurance industry. It destroys the concept of defined benefits. It sells the plan with a capped wage payment to workers with no caps on insurance costs. It is a windfall for the employers and a new economic burden on workers. It is a plan that no labor negotiator should ever try to sell to the workers of America. I do not know why Stern is supporting this, but I would not want him negotiating my health plan.”

SEIU Locals Resisting Stern’s New Course

When Stern tells The Wall Street Journal that unions today need an “attitude adjustment” he is saying that unions need to abandon the traditional model of trade unionism based on the notion that bosses and workers have contradictory interests due to their respective roles in the sphere of production, and instead should seek “partnerships” with the employers aimed at helping their bottom line.

But SEIU locals across the country are resisting this new course.

SEIU Local 73 in Chicago announced Feb. 7 that its 100-member executive board voted unanimously to endorse and campaign for passage of HR 676, the “Expanded and Improved Medicare for All Act” introduced by Congressman John Conyers (D-Mich). This single-payer legislation is also known as the “United States National Health Insurance Act.”

SEIU Local 73 represents over 25,000 city, state and county public workers, including school employees and bus drivers throughout Illinois and Northwest Indiana.

HR 676 would institute a single-payer healthcare system in the United States by eliminating healtcare insurance companies altogether and expanding a greatly improved Medicare system to every resident.

HR 676 would cover every person in the United States for all necessary medical care — including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, chiropractic and long term care. HR 676 ends deductibles and co-payments. HR 676 would save billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

Isn’t this what all SEIU members want and deserve? Isn’t this what all union members and all working people in this country deserve?

Edwards on Healthcare – He Should Go Back to Being a Populist

By Rose Ann Demoro
Huffington Post
02.07.2007

In his latest campaign, John Edwards has taken promising steps in an effort to burnish his credentials as an “economic populist” – as the New York Times put it – from his opening announcement in New Orleans’ devastated 9th Ward to his regular visits to picket lines to his timetable for pulling our troops out of Iraq.

But his disappointing and shortsighted healthcare proposal shows he still has a long ways to go.

It’s hard to open a newspaper today without seeing another pronouncement of a new coalition for “universal” health care or new legislative initiatives, from Capitol Hill to the state capitols.

But, with the notable exception of single payer bills, HR 676 in Congress, and SB 840 in California, virtually all of the proposals have a common thematic of expanding the role of an insurance industry already gorged on profits from denying needed care.

Sadly, Edwards has joined this camp with a “universal” healthcare plan that is neither universal nor populist.

In fact, the Edwards plan looks a lot like the healthcare plans being touted by other decidedly non-populist politicians including George Bush, Mitt Romney and Arnold Schwarzenegger, in addition to Hillary Clinton’s dismal 1993 plan.
To sum it up, the Edwards plan is a soggy mix-and-match, including tax credits (from Bush), mandates on employers to provide benefits or pay to buy insurance (Schwarzenegger), requirements that individuals buy insurance (Romney and Schwarzenegger) and health market pools for purchasing insurance (Clinton, 1994).

Universal insurance means universally more profits for the industry that has gorged itself off the pain and suffering of others, mostly by denying them care. It is not, however, universal healthcare.

And, like the varied proposals by his political counterparts, the Edwards plan fails to crack down on insurance company premiums that from 2000 to 2005 rose by 73%.

Without controls on the ever-climbing premiums, the mandate that all individuals must buy health insurance which Edwards joins Schwarzenegger and Romney in demanding, looks like little more than criminalizing the uninsured and guaranteeing that many will end up with unaffordable, substandard plans.

Consider what more and more residents of Massachusetts and California are discovering about their much touted “universal” plans forcing everyone to buy insurance.

With no controls on premium costs, even many middle-income families will be squeezed into cut-rate, bare bones plans with deductibles of up to $10,000 per family, meaning many will end up paying most for most of their medical expenses out of their pocket on top of their premiums – or simply just forgo using their plans entirely.

If that sounds like a insurance CEO’s dream come true, it is. As UnitedHealth CEO Stephen Hemsley said of Schwarzenegger’s plan, it’s “an interesting set of proposals that represent real opportunities for our business.” Presumably they’ll soon look at the $1.2 billion in profits they amassed in the last quarter of 2006 as the lean years.
Another area in which Edwards falls down the same black hole as his political comrades in arms is an uncritical embrace of new technology in healthcare and promotion of so-called evidence based medicine, without any recognition of the serious dangers in both areas. Much of the new technology, for example, is being promoted to replace the professional judgment of caregivers with standardized protocols that fail to notice that humans are not widgets and every patient has individual health needs that computers and robots are not programmed to see.
Edwards does deserve some credit for proposing that at least one plan in each health market be a public program based on Medicare.

But, if a public program, as he implies, is more likely to assure affordable alternatives to the private insurance model, why get off in Chicago when your plane is going to New York?

Repeated polls have shown that wide majority of Americans want the US to move to a universal healthcare system that guarantees quality care for all patients “like Medicare.”

A single-payer plan like Medicare is far simpler, more universal, and more comprehensive than Edwards’ proposal or any other plans that are premised on the insurance industry which created our current healthcare nightmare by placing their profits ahead of quality, access, and affordability.

When it comes to healthcare, an issue that rightfully belongs at the center of his campaign, Edwards should step away from the policy wonks and the purveyors of realpolitik who are working feverishly to sabotage the only healthcare reform that will actually work.

We’d encourage Edwards to go back to the drawing board and rework his position to stand up to the insurance industry robber barons and support HR 676 and other single payer solutions, the real populist solution to our healthcare nightmare.

Buy or die

Universal plan can cost under $300, insurers say

By Alice Dembner
The Boston Globe
February 5, 2007

Many state residents will probably be able to buy basic health insurance for less than $300 a month to meet the new state mandate that everyone obtain coverage, insurers and observers said last week.

Although it might still be too expensive for some people, that would bring the price closer to what the Legislature envisioned when it passed the universal health insurance law last April.

The state’s largest health insurer, Blue Cross Blue Shield, said that with more flexibility from the state, it could offer slimmer coverage for an average of $210 a month — near the price originally suggested by former governor Mitt Romney.

“If it’s buy or die, they could buy at $210 or $220,” said Allen Maltz, chief financial officer for Blue Cross.

That plan, however, would not satisfy requirements proposed by the state board overseeing the law’s implementation because of the plan’s high deductible and out-of-pocket limits.

http://www.boston.com/yourlife/health/other/articles/2007/02/05/universal_plan_can_cost_under_300_insurers_say/?page=full

Comment:

By Don McCanne, MD

Massachusetts is proving to the rest of the nation what we already know: the traditional model of a multitude of private insurers is obsolete.

Health care has become too expensive to be financed by this model. Segregated insurance pools which include primarily the healthy workforce and their healthy families are the least expensive pools, with the lowest premiums. But the high costs of health care for even the healthy are now so high that comprehensive coverage is possible only with insurance premiums that are no longer affordable for most average-income Americans.

With the current drive towards universal coverage, the pools will have to accommodate those with greater health care needs. The upward pressure on premiums can no longer be tolerated, which is resulting in the trend to shift more of the responsibility of paying for care to the patient with significant needs. With segregated private risk pools, insurance premiums are affordable only when access to health care is made unaffordable.

Risk pooling is intended to shift funds from the healthy to the sick. But since the cost of health care for healthy pools is now so high, we have to accept the principle that the health care risk pools must also shift funds from the wealthy to both low- and average-income individuals with health care needs, if we expect to have effective universal coverage. Segregated private insurance pools cannot do that.

We need to remove the function of pooling risk from the control of the private insurance industry and shift that control to a universal risk pool using progressive tax policies to fund it (i.e., single payer). If we don’t, we’ll end up with a profoundly expensive administrative boondoggle of tax credits and government reinsurance, which will still perpetuate the “shared responsibility” of the sick to pay unaffordable expenses of their health care.

Blue Cross’ Allen Maltz suggests that the Massachusetts individual mandate to purchase insurance could be accomplished by forcing citizens to either buy low-premium plans or die. Unfortunately, since the coverage provided by the low-premium plans makes health care access unaffordable, Blue Cross will have to change their “buy or die” slogan. The new slogan? Buy and Die!

Migration of Canadian physicians

Supply, Distribution and Migration of Canadian Physicians, 2005

Canadian Institute for Health Information (2006)

Canada’s physician supply growth is accompanied by changes in the numbers of physicians who leave and return to the country.

Over the past five years, the proportion of Canadian physicians moving in and out of the country has decreased by 30.6%. While both the number leaving and the number returning to the country are on the decline, Canada has seen a larger decrease in the number of physicians leaving the country. As a result, the proportion of physicians returning to the country is now greater than the proportion leaving.

* In 2001, the ratio of physicians moving abroad to those returning from abroad was 62:38, compared to 43:57 for 2005.

* In 2001, 889 Canadian physicians either moved abroad (555) or returned to Canada (334) compared to 2005 where 433 Canadian physicians either moved abroad (186) or returned to Canada (247).

* When comparing the number of physicians moving abroad to the number of physicians returning from abroad, Canada registered net physician losses from 2001 to 2003. Starting in 2004, Canada began registering net gains of 85 physicians in 2004 and 61 physicians in 2005 due to international migration.

Between 2001 and 2005 the number of physicians in Canada grew by 5.3%, a rate that has kept pace with population growth (4.0%).

* In 2001, there were 188 physicians per 100,000 population and in 2005 there were 190 physicians per 100,000 population.

* However, growth in the number of physicians per 100,000 population does not look the same for both family physicians and specialist physicians.

* The number of family physicians per 100,000 population increased from 95 in 2001 to 98 in 2005.

* The number of specialist physicians per 100,000 population dropped from 93 in 2001 to 91 in 2003, and rose to 92 in 2005.

http://secure.cihi.ca/cihiweb/products/supply_distribution_migration_canadian_physicians_2005_e.pdf

Comment:

By Don McCanne, MD

How often have you heard that Canadian doctors are fleeing en masse their disastrous health care system? Besides being a gross distortion, the numbers have actually been declining, and, in the last two years, the migration has actually reversed. More Physicians are moving into Canada than are leaving. This is one more factoid of the opposition that should be promptly refuted.

From a policy perspective, the more important issue is the physician supply in Canada. The growth of the number of physicians has exceeded the population growth, and, even more important, the number of family physicians per capita has been increasing as the number of specialists remains fairly stable. The policy community is in agreement that a strong primary care base ensures higher quality care at a lower cost. Canada has been effective in reinforcing its primary care infrastructure, while primary care in the United States is rapidly deteriorating.

The point? Do not let others dismiss health care reform by diverting the debate to an attack on Canada when we have so much more to be ashamed of here in the United States. Canada is working on their system. We desperately need to fix ours.

Harry and Louise on John Edwards' plan

Universal Health Care Through Shared Responsibility

John Edwards 08
February 5, 2007

“We have to stop using words like ‘access to health care’ when we know with certainty those words mean something less than universal care. Who are you willing to leave behind without the care he needs? Which family? Which child? We need a truly universal solution, and we need it now.”
— John Edwards

John Edwards’ vision for health care reform is built on four steps:

First: Business Responsibility.

Businesses… will be required to either provide a comprehensive health plan to their employees or to contribute to the cost of covering them through Health Markets.

Second: Government Responsibility.

* Offer New Health Insurance Tax Credits: …to subsidize insurance purchased through Health Markets… …sliding scale to middle class families and refundable…

* Expand Medicaid and SCHIP: …to serve all adults under the poverty line and all children and parents under 250 percent of the poverty line…

* Require Fair Terms for Health Insurance: …community rating and guaranteed issue…

* Secure the Health Care Safety Net: …a health care safety net including public hospitals, clinics, and community health centers remains necessary.

Third: New Health Markets.

The U.S. government will help states and groups of states create regional Health Markets, non-profit purchasing pools that offer a choice of competing insurance plans. At least one plan would be a public program based upon Medicare. All plans will include comprehensive benefits, including full mental health benefits. Families and businesses could choose to supplement their coverage with additional benefits. The markets will be available to everyone who does not get comparable insurance from their jobs or a public program and to employers that choose to join rather than offer their own insurance plans.

* Freedom and Security: (Health Market plans are portable)

* Choice between Public and Private Insurers: Health Markets will offer a choice between private insurers and a public insurance plan modeled after Medicare, but separate and apart from it. Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price. Over time, the system may evolve toward a single-
payer approach if individuals and businesses prefer the public plan.

* Promoting Affordable Care: Health Markets will negotiate low premiums through their economies of scale… …reducing the need for underwriting and marketing activities…

* Finally: Individual Responsibility. Once insurance is affordable, everyone will be expected to take responsibility for themselves and their families by obtaining health coverage. Some Americans will obtain coverage from public programs like Medicare, Medicaid, and SCHIP and others will get coverage through their jobs. Other families can buy insurance through the regional Health Markets. Special exemptions will be available in cases of extreme financial hardship or religious beliefs.

http://johnedwards.com/about/issues/health-care-overview.pdf

Comment:

By Don McCanne, MD

One of the more important reasons that John Edwards wants to be president is that he really wants to reform health care. He understands the great advantages of the single payer model. But he also understands that he cannot be elected when Harry and Louise point out to the nation that John Edwards is going to “raise our taxes in order to force socialized medicine on us.”

The health policy experts in the progressive community understand this. They understand that the polls demonstrate strong support for Medicare, but also strong support for employer-sponsored plans. Employers currently cover 59 percent of the nation. The workforce and their families are comparatively healthy and most are content with their current coverage. In spite of polls indicating strong support for single payer or Medicare for All, there is a very real reluctance to give up private plans perceived as largely funded by the employers in exchange for a government-run program, especially since many equate that with queues and rationing.

For this reason, the progressive policy community has proposed reform which would allow individuals the option of keeping their current coverage, while establishing a competing public program that would prove to be so compelling that eventually most individuals would want to trade in their private plans for Medicare for All coverage. Although an abrupt shift to a single payer system is not considered to be politically feasible at this time, this gradual shift would be, or would it?

Harry (sitting at the breakfast table, reading the newspaper): I see this guy Edwards wants to tax us to fund some nutty government “Health Markets,” whatever the heck that is.

Louise: Why can’t those politicians leave our health care alone? Why do they keep wanting to get the government involved?

Harry: Like I’ve been telling you for years, Louise, those liberals just want to “raise our taxes in order to force socialized medicine on us.”

In aiming for this highly dubious goal of political feasibility, what beneficial policies has Edwards sacrificed?

* Employer mandate: Smaller employers and those in many of the service industries will struggle with the affordability of plans that provide reasonable coverage, or with the affordability of their contributions to the Health Markets.

* Individual mandates: The requirement for individuals to buy health plans is dependent on the fiction that affordable plans that provide reasonable coverage will be available. With community rating and guaranteed issue, they can never be. Health care costs too much. Premiums can be made affordable only by making access to health care unaffordable through high out-of-pocket expenses.

* Tax credits: To work, refundable tax credits must be very generous for not only lower-income individuals, but average-income individuals as well. The amount would have to be close to what employers are already contributing. Tax credits would introduce the administrative complexity and the unnecessary demeaning intrusion of means testing. It is much more efficient to establish progressive funding of a health care system through tax revenues rather than through tailoring premiums and tax credits to each of the 300 million people in our nation.

* Medicaid and SCHIP: As welfare programs, without an adequate political voice, chronic underfunding will remain a problem. Access will remain a problem because of a lack of willing providers, perpetuating a two-tiered system.

* Health care safety net: Policies do need to be established to be certain that adequate facilities are available in underserved areas. But rather than being near the bottom of government budget priorities, the presence of safety net facilities can best be assured by by funding them through the same high-quality coverage that everyone else would have.

* Health Markets: The model of competing private plans has been thoroughly discredited. No matter what regulations are established, private plans will continue to select the healthy – especially the healthy workforce and their healthy families. The private plans cover the majority of us who are healthy and cost very little, while we taxpayers pay most of the costs for health care for those with medical needs. Even Harry and Louise should understand how absurd this is.

* Administrative inefficiencies: The program suggests that the Health Markets will provide oversight that would reduce administrative costs. Maintaining a fragmented system of public and private programs with thousands of plans and provider lists would perpetuate the excesses of the plans and the administrative burden on the providers. Keeping the plans in place and adding a new administrative intermediary, the Health Markets, is not exactly the ket to achieving administrative efficiency.

* A new public Medicare program: The current Medicare program includes higher-cost seniors and individuals with long-term disabilities, including chronic renal disease. If we were to open the existing Medicare program to everyone else, the pro rata share of the premiums would be so high that Medicare could never compete with the private plans that insure the healthy. In recognition of this, a separate new Medicare has been proposed. Early enrollees would likely include individuals with greater needs, including the currently uninsurable and those from plans terminated by employers with unfavorable claims experiences. It is likely that this separate Medicare risk pool would have much higher premiums than would the private plans insuring the healthy, resulting in the death spiral of Medicare premiums (premiums spiraling upward causing the healthy to leave and concentrating even more of the high-cost individuals in the plan, until no one can pay the premiums).

The way to avoid a Medicare death spiral would be to eliminate the current fragmentation of risk pools: low-cost pools for the healthy and high-cost pools for the sick. All pools need to be combined into one universal risk pool that really does redistribute the risk. Since average-income individuals can no longer afford a pro rata premium, the risk pool must be funded equitably through a progressive tax. Once you solve the problem of pooling risk, why keep in place superfluous private plans that serve no real function but which burn up funds in useless administrative services.

Louise (sitting at her computer, while Harry reads the newspaper): Harry, I’ve really been concerned about how much we’re spending on my health care and how little I’m getting for it. You don’t have to worry because of your Medicare, but I do. When I googled some of the problems, the computer kept taking me to Physicians for a National Health Program. So I looked over their website.

Harry: Yeah? What do they have to say?

Louise: Well, a whole lot.

Harry: Like what?

Louise: Well, it’s too much to say in one sentence. There are a lot of issues I’ve never given much thought to.

Harry: National health. Sounds like socialized medicine to me. I can’t imagine that they’re on to something.

Louise: Well, I don’t know, Harry. I think that we’ve been missing the big picture when we stopped listening because the government would be involved. But these folks have shown that we’re already paying enough taxes to pay for insurance for all of us, but we’re not getting it merely because we keep protecting the private insurance companies.

Harry: You mean WellPoint, UnitedHealth, Cigna, and them others?

Louise: Yeah.

Harry: Those crooks! They’d better not mess with my Medicare!

Louise: That’s the point, Harry. If we’d throw them out we could all have Medicare and save money while we’re doing it.

Harry: Like I was telling you, Louise. You can’t listen to those liberals like Edwards. He wants to leave the private plans in control. Those liberals will never get it right.

Will Healthcare Timidity Trip Up Hillary Clinton?

by Jeff Cohen

It’s conventional wisdom that if Hillary Clinton’s presidential campaign falters with Democratic activists in places like Iowa and New Hampshire, it will be over the issue of the Iraq war. And her vacillations on the war.

Yet the dividing-line issue in the upcoming primaries may turn out to be not Iraq, but healthcare. And just like on Iraq, the Democratic base is in no mood for timidity and half-way measures and vague rhetoric. Most rank-and-file Democrats support government-provided national health insurance: enhanced Medicare for All.

And that’s no secret to the candidates. This is how the Washington Post described Hillary Clinton’s recent, maiden voyage into Iowa as a candidate:

In keeping with her expressed desire to hold a “conversation with Iowans,” Clinton asked at one point for a show of hands from the audience, asking them to declare whether they preferred an employer-based system of insurance, a system that mandates all individuals to purchase insurance, with help from the government if necessary, or one modeled on the Medicare system. Overwhelmingly the audience favored moving toward a Medicare-like system for all Americans.

A show of hands in almost any roomful of Democratic activists will produce the same result: they want a single-payer “Medicare-like system for all Americans.” According to the Post, Clinton told the Iowa group: “I’m not ready to be specific until I hear from people.”

Pressure from the base on Clinton and other Democratic contenders to get specific will intensify in the early states — mobilized by groups such as Progressive Democrats of America, Healthcare Now, National Nurses Organizing Committee and Physicians for a National Healthcare Program. So far, none of the sitting Senators seeking the nomination are supporting Medicare for All, though former Sen. John Edwards may be coming close. Rep. Dennis Kucinich for years has been a leading supporter in the House.

That single-payer is the rational, cost-effective way to reform healthcare is an easy case to make — and was eloquently argued last month by respected Democratic party activist and lawyer Guy T. Saperstein. Despite spending twice as much money on healthcare as other industrialized nations, our system fails to cover 47 million people and generally performs poorly. Experts point to the main cause of the failure — a private insurance bureaucracy that soaks up nearly one-third of all healthcare dollars in waste, profits, paperwork, commissions and advertising.

Insurance companies don’t treat or heal patients; they just suck the healthcare system dry of hundreds of billions of dollars.

Adding pressure on Democratic presidential candidates was last month’s reintroduction of “The U.S. National Health Insurance Act,” HR 676, authored by Rep. John Conyers and soon expected to have 80 Congressional cosponsors. This “Expanded & Improved Medicare for All Bill” would fully cover every American, thanks to cost-savings. In its first year, single-payer would save over $150 billion on paperwork alone, and $50 billion though rational bulk order purchasing of medications. Care will be privately-delivered by healers and hospitals, but publicly-financed — with no bills, co-pays, deductibles, denials or medically-induced bankruptcies.

Every Democratic aspirant will be asked where they stand on HR 676, which is endorsed by 225 labor organizations. Over the years, a common-sense single-payer approach has been endorsed by Consumers Union, some corporate CEOs and 20,000 physicians. Only one force in society stands in the way: the insurance industry. And that sector donates heavily to many “top tier” Democrats.

As healthcare emerges as a dividing-line issue among Democratic candidates, expect mainstream media to tell us the story of Hillary Clinton’s healthcare initiative as “First Lady” in 1993. And expect every fact in the re-telling to be wrong. Why? Because they got almost every fact wrong at the time. Clinton did not support single-payer; she resolutely stood against popular legislation led by Sen. Paul Wellstone, Conyers and Rep. Jim McDermott, then one of two “doctors in the House.”

Indeed, Clinton’s proposal was aimed at “reforming” healthcare while keeping a handful of huge insurance companies in the center of the system. No surprise since those firms helped draw up her complicated and bureaucratic “managed competition” scheme, through the industry-dominated Jackson Hole Study Group. A Mother Jones writer in 1993 described the assignment given Hillary by the White House: Build us a better, leaner, cheaper mousetrap (healthcare system) — but make sure you include a player piano (private insurance giants) in the middle of your contraption

In late 1993, Hillary’s plan came under attack by devious TV ads sponsored by an outfit called the Health Insurance Association of America, acting on behalf of smaller and medium-sized insurance companies. These smaller firms were furious that the Clinton plan would wipe them out and concentrate the industry in a handful of insurers like Aetna and Cigna. (Not unlike what happened to broadcasting under Clintonite media “reform.”)

Last November’s election has already changed the terms of the national debate on Iraq. If progressives mobilize, we can also use this moment (and the upcoming presidential primaries) to transform the healthcare debate.

And one day soon we may get what other advanced countries already have: a healthcare system that works, with nonprofit insurance for all.

Jeff Cohen is the author of “Cable News Confidential: My Misadventures in Corporate Media.” He is a consultant with Progressive Democrats of America. In 2003, he worked with Kucinich for President.

Profits Before People — Again?

Bill Falzett
American Chronicle
February 2, 2007

California Governor Schwarzenegger’s health insurance proposal is a bad one. I suspect that it might get passed but it shouldn’t. It puts the load on providers, hospitals, small businesses, and the consumers once again. Guess who gets off the hook? That one is easy — the health insurance industry. Along with fossil fuel and pharmaceutical corporations, the health insurance bunch has enjoyed record profits and exorbitant executive salaries.

A recent health insurance CEO left his post with over $200 million in benefits. He hasn’t been the exception. There are 10 times as many administrative employees in the health insurance industry since the inception of managed care. The number of providers has remained relatively constant. That alone is a troubling statistic. What it says is that the health career is not seen as the desirable option it was years ago.

The United States is the only industrialized nation without universal health care. We rank very low relative to these other countries in life expectancy and quality of care according to recent studies. We continue to assume that health care is a business like any other. But, think about that for a moment — do you really want bean counters to determine your health care decisions and which medications you can take? Is your health a commodity to be managed by an administrator like deciding how many shoes the factory should make today?

An additional irony of the Governor’s plan is that big business leaders are beginning to get on board with a universal plan. A recent article in the AARP Bulletin discussed their change in thinking. Many in the auto industry now see the wisdom and utility of universal health care. Of course they do, it helps the bottom line. When profits are lag because the auto industry spends more on health insurance than they do on steel, universal care looks real good. Pardon my cynicism but look at the obvious obvious. One of the reasons that Japan can make a car that is more profitable — they have universal health care.

The Lewin Group was commissioned to do a study on a universal health plan proposed some years ago and revitalized last year by California State Senator Sheila Kuehl. It’s similar to a plan outlined by Barlett and Steele in their book, “Critical Condition”. This book is both an indictment of the health insurance industry and reasonable proposals for solutions to the crisis. The Lewin Group showed across-the-board savings for providers, hospitals, businesses, and people. We would save around 20% on administrative costs that ordinarily go to the over 600 health insurance corporations in the US by streamlining to a single payer. Medicare and the VA health system have shown that it can be done. In addition, with a universal health, single payer plan, the workers’ compensation problem gets reduced significantly.

Let’s put aside for a moment the issues of money, profits, and corporate bottom line. What does this country see as the right thing to do? What do you see as the right thing to do? Is it our collective will to see people — all people — taken care of with regard to health decisions? Are we — all of us in this country — our brothers’ keepers? Is membership in this country a ticket to affordable, quality health care or are you really on your own? In the final analysis, excessive health care costs today are a reflection of devotion to corporate greed and an unwillingness to apply empathy and responsibility in our dealings with each other. If people don’t have insurance they go to emergency rooms and we all pay anyway.

In order for people to feel a sense of security in their daily lives, do they really focus on international terrorism or global warming first? Perhaps we should, but I don’t see that as a psychologist here in Northern California. What I do see is that people worry about providing for themselves and their families. They worry about health coverage and paying the bill for the last doctor visit or operation. Over 50% of bankruptcies in our country are the result of health issues and costs. Real people suffer while we worry about whether to regulate an industry that sees your health as a bottom line issue. Is that the way you want it? I don’t.

If Governor Schwarzenegger and his bean counters want to improve health care and be responsive to people, I suggest they look at the Lewin Report and the book by Barlett and Steele as I recommended last year. Both sources have all the numbers and good alternatives for quality health care. The only hurdle they have to overcome now is the insurance lobby.

Bill Falzett is a community psychologist, medical provider, and a fair-trade, fiscal responsibility, Progressive Democrat.

Focus on patients, not profits

By Rose Ann DeMoro
South Florida Sun-Sentinel
February 5, 2007

Americans expecting relief from the meltdown of our health care system should watch out for the political mugging now unfolding in the current debate on health care reform.

From President Bush’s proposals to proposals in Washington and state capitols, to a recent procession of groups. there is a lot of talk about a new “consensus” on the need for action on what everyone agrees is a crisis careening out of control.

While some have declined to identify specific proposals, there’s been a steady stream of proposals that have a similar theme. They include tax deductions to encourage people to buy insurance, tax penalties to discourage people from using too much of that insurance, mandates that everyone be required to buy insurance, new taxes on employers to pay for more insurance, and expanding existing federal or state programs to buy insurance for the low-income.

No wonder the insurance industry is standing at the front of the line leading the cheers.

For those having trouble following the arcane details, here’s a cheat sheet. All the assorted health care proposals can be boiled down to two fundamental alternatives which go down very different paths.

One is the proposals (and throw in many of the state versions, including the much hyped Massachusetts and California plans) that expand the role of the big insurers and reinforce the role of the private market in health care — those same players that created the present problem by placing increased revenues and profits above patient health.

The other approach, a single-payer system such as Medicare, works. It’s far simpler, more comprehensive and more cost effective — a patient-based, not commercially driven direction.

Under single-payer one public entity collects all revenues and pays for all medically necessary services for everyone, delivered by our present, mostly private, doctors, hospitals, and other providers.

Our failure to enact such a system is the reason the U.S. ranks just 37th in health care quality and performance, according to the World Health Organization. Every other industrialized country has either a single-payer or national health system. We’re No. 1 in one category only: costs. We lag behind in almost all other indicators, including life spans, infant mortality, childhood immunization and per capita access to doctors, nurses, hospital beds and diagnostic equipment.

The primary reason for that disparity is the intrusive role of insurers and other health care corporate giants who siphon off billions of dollars in administrative waste, bureaucracy, profits and executive compensation — sacrificing, as needed, access, quality and affordability along the way.

And they’ve been wildly successful. The 20 largest HMOs in the U.S., for example, made $10.8 billion in profits in 2005, and UnitedHealth Group alone just posted $1.2 billion in profits for the last quarter of 2006. Drug companies make even more; the world’s 13 biggest reported $62 billion in profits in 2004.

Health care corporations have effectively used their economic clout to block real reform both in Washington and in state capitols, becoming the largest spenders on lobbying and setting up a parade of people who rotate back and forth from administration posts and congressional offices to the corporate boardrooms.

But, at a time when even middle class families are holding garage sales and spaghetti suppers to pay for medical bills, more than half the nation’s low income counties lack a health center and even large businesses stagger under the weight of ever rising health care costs, those who have profited off pain and suffering know the game could be up.

A result is the fervent campaign to browbeat a public desperate for genuine reform to lower their expectations, and accept the conventional wisdom that only market-based solutions are feasible.

We’ve heard this before. From abolition of slavery to women’s suffrage to enacting Social Security and Medicare to ending legal segregation, our history is filled with achievements that the pundits and avatars of the status quo said were not realistic.

A single-payer system is not just a dream, it’s legislation — HR 676.

Under HR 676, everyone is guaranteed choice of physician and comprehensive and uniform coverage, businesses are treated fairly, costs are controlled, administrative waste is slashed, and insurers could no longer deny care or continue to price people out of access to medical services.

Let’s stop looking for the worst solutions, and demand the best.

Rose Ann DeMoro is executive director of the 75,000-member California Nurses Association/National Nurses Organizing Committee.

Copyright (c) 2007, South Florida Sun-Sentinel