PNHP

State overreach on national problems

State overreach on national problems

State Governments Overreach in Taking on Problems Best Solved at the National Level
The New York Times
April 13, 2006
By Robert H. Frank

In most of the world… the primary responsibility for ensuring access to health care, regulating environmental quality and supporting basic scientific research is exercised by national governments. But in this country, these tasks are increasingly managed by state, and even local, governments.

Last week, for instance, Massachusetts became the first state to enact legislation trying to ensure that all its citizens have access to health care. At least 19 other states considered legislation expanding health care coverage in 2005.

In each case, there are compelling economic reasons for delegating the activities to national, rather than state or local, governments. Yet in each,arena, the federal government has failed to act.

Although it is no mystery why states are beginning to take the lead in thesem domains, it is important to understand why the recently enacted programs are destined to fall far short of what could have been achieved at the federal level.

The explanation begins with the question of why we have multiple levels of government in the first place. Almost all of us are subject to taxation and regulation by governments at the local, state and national level. Although multitiered government entails substantial redundancy and inefficiency, there are good economic reasons for it.

As the economist Charles M. Tiebout explained in a seminal paper published in 1956, an important advantage of providing public services at the local level is that this enables us to better achieve our desired mix of public and private consumption.

People who like lots of parkland, well-maintained roads, large police forces and good schools can thus gather in high-tax communities that provide these amenities, while others can choose low-tax communities and spend more of their income on private consumption. Local government also minimizes the distance between citizens and the lawmakers who tax and regulate them.

But for some public services, like national defense, scale advantages rule out primary reliance on local government.

Scale advantages, however, do not explain why health care policy, environmental regulation and support for basic scientific research are best delegated to the federal government. Rather, the problem is that in each of these instances, programs at the state and local levels create perverse economic incentives.

A case in point is a proposal recently discussed in Ithaca, N.Y., where I live. Activists in this progressive upstate community (sometimes called “the

People’s Republic of Ithaca”) called for a local income tax to finance a single-payer health care system for local residents. According to health policy experts, such a system would eliminate the substantial waste associated with attempts by insurance companies to limit authorized services and avoid covering people with chronic medical conditions.

Yet, despite this advantage, a health system operated at the local level could never work. Because people are free to move, such a plan would attract uninsured people with chronic conditions from surrounding cities, substantially raising the program’s cost. In turn, the need to raise income tax rates would induce many of the community’s more affluent taxpayers to flee to neighboring cities. The resulting death spiral would quickly doom the program.

Like local borders, state borders are completely permeable. So, unless a large number of other states simultaneously enact comprehensive health care legislation of their own, the new Massachusetts program will confront the same problem.

My point is not that states are foolish for having extended their reach. Again, the federal government has completely dropped the ball in these domains. The recent state actions may not be the most efficient ways of dealing with our most pressing problems. But they are an unmistakable signal of voter impatience with ineffective government at the federal level.

(Robert H. Frank, an economist at the Johnson School of Management at Cornell University, is the co-author, with Ben S. Bernanke, of “Principles of Economics.”)

http://www.nytimes.com/2006/04/13/business/13scene.html

Comment:

By Don McCanne, M.D.

Professor Frank has provided a highly credible explanation of the principle that many are now recognizing instinctively: We need a national solution to our health care crisis. That doesn’t mean that we should abandon efforts on the state level to compensate for the failures of our federal government. Rather, it means that we must intensify our efforts to enact an efficient, comprehensive, universal program of single payer health insurance on a national level.

The New Yorker Comment: Consumption

The New Yorker
by Hendrik Hertzberg
Issue of 2006-04-17 | Posted 2006-04-10

Perhaps you have been wondering who or what is to blame for the high cost of medical care in this land of ours – and, more broadly, for the ungainly, unjust mess that is the American health-care system. If so, wonder no more. Your government has fingered the culprit: it’s “the vast majority of Americans.”

The perp having been collared, the trial held, and the verdict rendered, only the sentencing phase remains. Providentially, our leaders have come up with a punishment that fits the crime. We, the guilty, are to be condemned – or invited, but in any case for the rest of our natural lives, without possibility of parole – to turn over our bodily well-being to “consumer-directed Health Savings Accounts” in conjunction with “high-deductible health policies.”

This judgment was handed down last Monday, in the form of an article on the Op-Ed page of the Times. The piece was no Dowdy jestfest or Friedmanesque memo-to-the-mullahs, and not only because of the dreariness of its style and the banality of its content. Its author, Allan B. Hubbard, identified as “assistant to the president for economic policy and director of the National Economic Council,” has lately emerged as the White House point man on health policy, and, in subsequent days, his Op-Ed proved to have been the overture to a veritable symphony of spin conducted by President Bush himself, including an Air Force One ride to Bridgeport, Connecticut, for a stagy “Panel on Health Savings Accounts.”

Hubbard’s article, headlined “The Health of a Nation,” begins with a frank-sounding acknowledgment that “in the past five years” – that is, since the present Administration took office – “private health insurance premiums have risen 73 percent,” with the result that “some businesses” have dropped coverage altogether. “What is driving this unsustainable run-up in health insurance costs,” Hubbard asks, “and how can we make things better?” Then comes what bloggers call the money quote:

Health care is expensive because the vast majority of Americans consume it as if it were free. Health insurance policies with low deductibles insulate people from the cost of the medical care they use – so much so that they often do not even ask for prices.

Can this really be the Administration’s view of the health-care crisis? That its root cause is that Americans are (a) malingerers and (b) freeloaders who perversely refuse to go comparison shopping when illness strikes? That wefre overinsured? Hard as it is to believe that this is what they say, it’s even harder to believe that this is what they believe.

Health care is indeed expensive, but not because people are too quick to call the doctor when they experience a scary symptom or merely an annoying one, and not because some of them may bridle at entrusting their health to the lowest bidder. Throughout the Western world, health care is expensive, first of all, because it is expensive, and is bound to get more so as populations age and medical technology advances. Indeed, it should get more expensive, both in absolute terms and as a proportion of national income, because what it aims to provide – healing, the relief of suffering, the staving off of death – is of such inestimable value.

American health care is the most expensive on earth, but this, too, has little to do with overindulgence in seeking medical attention. (Overindulgence in cheeseburgers is another matter.) It has a lot to do with the waste built into what Paul Krugman calls our crazy-quilt health-care system, which has a lot to do with the fact that so much of that system is private rather than public, which in turn has a lot to do with two other factors. One is historical: during the Second World War, industry (with prodding from organized labor) got around wage controls by offering workers health benefits in place of cash, thus saddling the United States with “employer-based” private health insurance – a system now in slow-motion collapse under the competitive pressures of globalization. The other is institutional: even though there has long been popular support here for universal, government-run health care, as there is in Europe and Canada, America’s fragmented political system – riddled with weak points where well-organized, well-financed minorities can thwart the unfocussed will of a majority – has been able to deliver only for seniors and, less generously, for the poor.

Medicare – a mixed system, under which the insurance function is socialized while the care itself remains in private hands – dedicates two per cent of its resources to administration. By contrast, the private health-insurance industry spends a fortune – more than ten per cent of its income – on administrative dreadnoughts devoted largely to vetoing treatments, sloughing off sick or potentially sick clients, and scheming to stick someone else with the bill. In the United States, we spend fifteen per cent of our gross domestic product on health care, close to six thousand dollars per person. The French and the Canadians spend ten per cent of G.D.P., about three thousand dollars per head. Yet their “health outcomes,” measured by indices like longevity, are better than ours. If they spent the kind of money we do, they’d live forever.

Hubbard – who, by the way, is a finalist to be Bush’s next Secretary of the Treasury – is an initiate of the cult of the market, which he evidently regards as the fundamental model for all human relations. For him, sick people who require care are “consumers.” That word and its derivatives appear ten times in the eight hundred and fifty words of his Times piece. (“Patient” appears once. “Sick,” “ill,” and “under the weather” do not appear at all.) Accordingly, the solution that he and Bush are pushing – so-called health savings accounts – puts the onus on “consumers” to fend for themselves in the medical gmarketplace.h Itfs probably unnecessary to add that this solution would solve nothing. It would be yet another gift to people in the higher tax brackets, would undermine traditional insurance by pulling young and healthy people out of risk pools, and, with a fine evenhandedness, would discourage people from going to the doctor for real and imaginary illnesses alike. This is a worthy follow-up to the Administration’s prescription-drug program for seniors, another excrescence of market cultism. The elderly had hoped for a straightforward benefit that would have allowed them to acquire, at some affordable price, the medicines their doctors prescribed. What they got was a parody of “choice,” sadistic in its complexity, which forces them or their children or caretakers to game out which of dozens of private “plans” might give them access both to the medicines they need now and the ones they might unpredictably need in the future. The solicitude their government might have bestowed on them was reserved instead for the insurance and pharmaceutical industries. The Administrationfs message to the old and sick is the same as its message to the country after the September 11th attacks: Go shopping. Well, caveat emptor.

Massachusetts Bill Fact Sheet from MASS-CARE

DID YOU KNOW THAT:

•Most uninsured people will now have to buy their own insurance without any or with very little financial support?

•The Bill will not help the underinsured or those with poor quality insurance, including those on Medicare paying high out-of-pocket costs?

•It will not attempt to reduce the costs of health insurance for individuals and businesses paying the highest prices in the world?

DID YOU KNOW THAT:

•40 percent of the uninsured in Massachusetts, the 292,000 who earn more than three times the poverty level income, will be forced to purchase their own health insurance without any help or subsidies from the state? Bad insurance for someone earning three times the poverty level will cost them 20 percent of their total income.

•The Bill raises only $170 million per year in new spending to help subsidize 748,000 uninsured people in Massachusetts? This is not enough to pay for 45,000 people. All other funds used by the Bill are a shell game, most taken out of Free Care – which provides medically necessary health services for the uninsured – and moved into more wasteful plans run by commercial insurance companies.

•This Bill, which will affect the lives of hundreds of thousands, was bought and paid for by healthcare industry lobbyists? Industry lobbyists spent over $7.5 million this year to make your health care Bill work for them. Forcing uninsured people into private insurance plans will create new business and new profits for insurers, without reforming the system of waste and discriminatory health care access for Massachusetts residents.

DID YOU KNOW THAT: every developed nation in the world offers comprehensive health care for all of its residents, except the United States? And they pay less for it? Let’s organize against these attempts to shift health care costs on to low-income people. Let’s fight for the universal, quality health care that we know is possible!

Reform strategy from Harvard's greatest minds

The Harvard Interfaculty Program for Health Systems Improvement
April 2006 A Strategy for Health Care Reform:
Catalyzing Change from the Bottom Up

The American health care system seems in an accelerating downward spiral:
wasteful, unsustainably costly, inadequate in quality, and unable to protect millions against the financial burden of illness.

The Harvard Forums underscored the important notion of local communities functioning as laboratories for innovation and testing, assessing what does and does not work before broader adoption.

The authors offer a vision that is sufficiently challenging to encourage our most thoughtful, creative efforts, and also sufficiently realistic to be attainable. They propose a set of steps over a twenty-year period that will put our nation on a course towards a health care system that assures universal health insurance coverage to all Americans, provides optimal quality of care, is affordable, assures improvements in population health, and provides the greatest possible value for health care expenditures.

Stage One – Strengthening and Leveraging Existing Efforts

In this model, state and local governments will act as regulatory enablers, while private stakeholders – large anchor corporations, local health plans, major health care providers, unions, consumer groups – will provide leadership and expertise to launch local health care reform.

Specifically, over the next five years, this strategy advocates strengthening the tax credit and health savings account (HSA) approaches through careful elaboration of all the options and developing devices to mitigate possible unintended consequences and by evaluating these programs to see how well they perform in terms of reaching coverage, population health, and cost goals.

Stage Two – Phasing in a Federalist Approach to Reform

State plans must commit to achieving quantifiable, five year goals for expansion of health insurance coverage, and at least one other domain of the vision outlined above (e.g., quality, affordability, value, population health). (Don’s comment: Note that this does not require universal coverage, and, besides, which three goals would you decide to omit?)

…goals might stipulate…

…goals might include…

…states might propose…

…states could focus…

…States could put in place…

…States could take steps…

…states could undertake…

…(etc., etc.)…

Stage Three – Implementation of State-Based Programs throughout the United States

States that come late to the health care reform table will have the benefit of 15 to 20 years of systematic experimentation with local and state level health system reforms addressing the nation’s most fundamental health care problems. Those experiments will have been carefully evaluated, the results published and thoroughly vetted, and the strategies themselves will have become familiar to the American people. A cadre of experienced health policy leaders will exist in both the public and private sectors that can testify to the strengths and weaknesses of alternative approaches, and will be available to implement change throughout the United States. In other words, the intellectual and human capital necessary for effective change will be ready and waiting for a more comprehensive effort at health system change, whatever form that effort ultimately takes. We further expect that this eventual program of reform will continue to rely heavily on state management, will provide considerable autonomy to state government, and will consist of varied solutions to common problems across the United States.

Conclusion

Policy-making, like politics, should be viewed as the art of the possible.
The current climate cries for action, but the political climate determines the form such action can take. We believe that the program we have outlined will improve the lives of Americans in ways that foster learning, prepare us for all eventualities, and precludes no options as changes in our health care system unfold over the next twenty years.

Harvard University Program for Health Systems Improvement http://www.phsi.harvard.edu/

A Strategy for Health Care Reform: Catalyzing Change from the Bottom Up http://www.phsi.harvard.edu/pdfs/reform.pdf

Comment:

By Don McCanne, M.D.

Wow!

Some of the greatest minds at Harvard University have been given five years to produce a report providing us with a strategy for health care reform in the United States. While acknowledging the profound deficiencies in our very costly system, these geniuses have proposed that we sit around for another two decades waiting to see if someone can do something on the state or local level. Just what do they think the states and counties have been doing during the past century of federal inaction? And tax credits and health savings accounts? We need to bring them out of their closets!

If a freshman Harvard student were to produce this paper in response to an assignment on proposing a strategy for health care reform, the instructor would certainly grade it with an “F” as being totally non-responsive to the assignment.

Teenagers with Cancer – Survival rates better in Australia than US

Originally Published 4/4/2006

Countries that have national health services easily accessible to people of all ages are more likely to have better survival rates for their teenagers and young adults (TYAs) with cancer, than are countries where individuals have to pay for their own medical insurance.

This is the suggestion that arises from new research presented at the 4th International Conference on Teenage and Young Adult Cancer Medicine, in which the health care systems of the United States of America and Australia were compared.

Professor Archie Bleyer told the conference, organised by Teenage Cancer Trust, that Australia’s system of health insurance for all, regardless of age, meant that TYAs were more likely to survive cancer in Australia than they were in the USA.

Prof Bleyer, who is medical advisor at the Cancer Treatment Center, St Charles Medical Center, Bend, Oregon, said: “However, both countries have a lower survival rate for their TYAs than for their younger and older patients, proving that TYAs remain the most neglected group of cancer patients across the globe.

“Our previous research has shown that the survival of older teenagers and young adults with cancer in the United States has lagged behind progress in younger and older patients. We found that diagnosis was delayed in TYAs who either lacked health insurance or had inadequate insurance, and therefore this lack of progress might be due to the USA health care system and less expected in countries with national health insurance.

“During the past year we have compared survival of TYAs in the USA with those in Australia, a country similar in many demographics to the USA, but with health insurance provided to all citizens regardless of age.

“From 1982 to 1998, the rate of improvement in the five-year survival from invasive cancer in Australia exceeded that which occurred in the USA, such that by the late 1990s, TYAs in Australia had an overall five-year cancer survival that was higher than in the USA. The deficit begins at 16 and ends at 55, the same years that national health insurance is not available in the USA. It ranges from 5% for 18 to 25 year-olds to 12% for those aged 30 to 35. This difference suggests that the health care system in Australia, with universal health insurance, was able to provide better cancer care to its TYAs.

“The advantage for Australian TYAs was not apparent in their children or older adults with cancer. This suggests that the need for private health insurance in the USA is responsible for the worse survival of TYAs, in that children and older adults in the USA are more adequately insured than TYAs.”

In the USA the greatest improvement in survival occurred amongst patients aged over 65 for whom national health insurance is provided.
Prof Bleyer said: “Both countries, however, had a lower rate of improvement in the five-year cancer survival rate among TYAs than in either younger or older patients, albeit the relative deficit was greater in the USA than in Australia.

“These comparisons indicate that the relative lack of progress in cancer outcome among TYAs in the USA is due, at least in part to the lack of health insurance,” he said.

However, he warned that even in countries where there was national health insurance for all, this didn’t necessarily guarantee access to good diagnosis and treatment for cancer patients, and particularly not for TYAs.

“Good health care systems make a huge difference in prolonging survival and reducing deaths amongst TYAs with cancer,” he said. “The failure to improve survival amongst 15 to 29-year-olds over the last quarter of a century is striking and there are reasons that are common between different countries. These include the tendency for adolescents and young adults to wait longer before consulting a doctor about symptoms, lack of a regular and usual source of primary care, delays in diagnosis by doctors not used to seeing young people with cancer, the wide spectrum of cancers contracted by TYAs, physicians poorly trained in caring for TYAs with cancer, and, most importantly, the lack of participation in clinical trials for this age group.”

Some countries belatedly were waking up to this problem, he said. In the UK, the National Institute for Health and Clinical Excellence (NICE) issued new guidance for the treatment of under-19s in August 2005. “In the USA the National Cancer Institute has initiated a major review of the national status of cancer in this age group. Known as a Progress Review Group, the nation’s experts will evaluate all available data, determine the severity and potential solutions, and provide an official report of recommendations,” he said.

“In addition, the President’s Cancer Panel is working on a similar report on the survivorship of young Americans with cancer. Both efforts include a review of the role of health insurance and health care delivery systems in the new medical frontier that is TYA oncology.”

Himmelstein and Woolhandler Respond to Massachusetts' New Healthcare Law

The New York Times
Published: April 9, 2006

To the Editor:
Your reports about Massachusetts’ health reform legislation treat politicians’ overblown claims as gospel.

The legislation completely ignores one-third of the uninsured, dismissing the Census Bureau’s estimate that 748,000 lack coverage in Massachusetts in favor of an estimate of 500,000 derived from a phone survey.

The linchpin of the promised coverage is a requirement that most of the uninsured buy their own coverage, and assurances that private insurers will offer affordable, comprehensive policies.

But already reports have surfaced that these new policies will be far costlier than promised, putting them out of reach of most of the uninsured and sharply raising the costs of state subsidies to help the very poor.

Predictably, rising costs will force more employers to drop coverage, while state coffers will be drained by the continuing cost increases in Medicaid. When the next recession hits, tax revenues will fall just as a flood of newly unemployed people join the Medicaid program or apply for the insurance subsidies promised in the reform legislation.

The program is simply not sustainable over the long or even short term. In contrast, a single-payer reform could save $9 billion a year on bureaucracy in Massachusetts, more than enough to cover the uninsured and to upgrade coverage for the rest of us.

David U. Himmelstein, M.D.
Steffie Woolhandler, M.D.
Cambridge, Mass., April 6, 2006
The writers, associate professors of medicine at Harvard, co-founded Physicians for a National Health Program.

Right idea, wrong tack on health-care reform

Originally Published April 8, 2006

Des Moines Register Editorial Board

On Tuesday, the Massachusetts Legislature passed a bill mandating all residents purchase health insurance. The philosophy is right: Everyone should have health insurance. It should be affordable. When people are uninsured, everyone pays.

But it’s difficult to get too excited about what Massachusetts did to cover its roughly 550,000 uninsured residents. The bill requires businesses to offer insurance or face financial penalties, but it doesn’t guarantee that insurance be adequate. Individuals must buy insurance or face tax penalties, but it doesn’t define what “affordable” health insurance means. It expands health care for lower-income residents, but much of the money comes from shuffling
existing dollars.

Worst of all, it mandates residents participate in a dysfunctional system that largely ties health care to employment. Every other industrialized country in the world knows it’s a bad idea to tie health care to jobs. It kills entrepreneurial spirit, saddles business with huge costs and forces employers to choose between their bottom lines and the best health policies for workers.

The Massachusetts bill also funnels even more dollars to private insurance companies that may waste money on administration. According to a 2003 Harvard Medical School study, nearly one-third of all U.S. health-care expenditures goes to administration and bureaucracy. That includes insurance-company paper pushers and all the people doctors offices employ to navigate the thousands of insurance plans.

Massachusetts Gov. Mitt Romney, who is considering a run for president, has boasted that the plan gets everyone covered without new taxes or a government takeover.

Yet when it comes to health care, the government is hardly the enemy. Indeed, it may be the best hope.

Medicare provides uniform coverage with low administrative costs for more than 40 million seniors and disabled people. Though it needs some fixing, a Medicare-like system for everyone would be more efficient and use fewer dollars on administration than private insurance.

Given the inaction on health-care reform at the federal level, state legislatures are trying to take on the job. While the desire by Massachusetts lawmakers to cover everyone is philosophically right, the approach isn’t.

The fix has to come from a different group of lawmakers – the ones in Washington.

Approaches to Health Care for All

Press Release

For Release: April 10, 2006
For More Info: Mark Dunlea, 518 434-7371, ext 1

New York Needs a Commission to Develop Cost-Effective Approaches to Health Care for All
New Massachusetts Health Care Plan is Seriously Flawed

Universal health care advocates said today that New York should followed the lead of the State of Massachusetts in taking action to provide quality, affordable health care coverage to all its residents.

The groups however said that the Massachusetts program is seriously flawed, focusing more on increasing payments to hospitals and insurance companies rather than on ensuring universal access to quality, affordable health care.

The groups called on NYS to join half a dozen other states in creating a Commission on Health Care Coverage to do independent cost-benefit analysis of the various ways NY could provide health care to all New Yorkers.

“Health care for all is an essential goal. We can not afford to spend one of out six dollars in our economy to prop up a patchwork, inadequate health care system that excludes tens of millions of America from coverage. Every other industrial country has already figured in out. America should be able to figure out how to put the public good ahead of campaign contributions from special interests. And with Congress stalling, individual states have to step forward to create their own universal health care plans to protect taxpayers and consumers,” stated Mark Dunlea of the Hunger Action Network of New York.

The Commission, endorsed by more than 250 organizations, would evaluate proposals such as Medicare for All (single payer); the new Massachusetts program; employer mandates; Medical Savings Accounts; and tax credits. This commission process was used in Maine to develop its proposal to provide health care to all residents.

Many of the groups support the proposal by the Physicians for a National Health Program to expand Medicare to cover all Americans. Such a single payer system would save hundreds of billion of dollars, starting with a major reduction in administrative costs. A recent study by the Lewin group estimated that a single payer system just for California would save $38 billion annually.

Dr. David Himmelstein, the national cofounder of PNHP, said that the recent Massachusetts proposal fell far short of providing quality affordable health care for all.

“The linchpin of the plan is the false assumption that uninsured people will be able to find affordable health plans,” observed Dr. Himmelstein. A typical group policy in Massachusetts costs about $4500 annually for an individual and more than $11,000 for family coverage. According to Census Bureau figures, only 12.4% of the 748,000 uninsured in Massachusetts are both young enough to qualify for low-premium plans (under age 35) and affluent enough (incomes greater than 499% of poverty) to readily afford them. Yet even this 12.4% figure may be too high if insurers are allowed to charge higher premiums for persons with health problems.”

“The legislation promises that the uninsured will be offered comprehensive, affordable private health plans. But that’s like promising chocolate chip cookies with no fat, sugar or calories. The only way to get cheaper plans is to strip down the coverage – boost co-payments,, deductibles, uncovered services etc. Hence, the requirement that most of the uninsured purchase coverage will either require them to pay money they don’t have, or buy nearly worthless stripped down policies that represent coverage in name only,”Himmelstein added.

“Finally, the legislation will do nothing to contain the skyrocketing costs of care in Massachusetts – already the highest in the world. Indeed, it gives new infusions of cash to hospitals and private insurers. Predictably, rising costs will force more and more employers to drop coverage, while state coffers will be drained by the continuing cost increases in Medicaid. Moreover, when the next recession hits, tax revenues will fall just as a flood of newly unemployed people join the Medicaid program or apply for the insurance subsidies promised in the reform legislation. The program is simply not sustainable over the long – or even medium – term,” he concluded.

“Access to health care is a matter of human dignity. It is about the stewardship of our resources. Our elected representatives must listen to the voices of all New Yorkers, especially those who have no access to decent medical care, whose voices are marginalized. These are the people whom we all have a special responsibility to support and protect. Enacting the Commission and the process of open hearings and public studies is an important step in ensuring that the best interests of all the people is our priority,” stated Rev. Cass Shaw, General Presbyter for the Albany Presbytery.

“Despite the fact that health care is now half of the state budget, the Governor and Legislature have failed to embrace comprehensive approaches to controlling costs while providing quality, affordable health care to all. The fact that millions of New Yorkers â€ï¿½g as many as one in three during any one year – lack adequate health care coverage is a huge factor in causing financial problems both for Medicaid and hospitals, yet state lawmakers refuse to tackle the problem due to the power of the insurance and drug companies. Instead, they continue to offer incremental changes in coverage while the overcall cost of health care continues to skyrocket,” said Mark Dunlea, Associate Director of the Hunger Action Network of New York State.

Legislation to establish such a commission has been introduced in New York by Assemblymember Richard Gottfried (A6575) and Senator John Marchi (S 4928), among others. In Illinois, the Legislature is required to adopt a universal health care program within a year after the Commissions studies are completed. Advocates want NY to adopt a similar model, with the commission to start on January 1, 2007 to meet objections by Senator Hannon that the Hospital Closing Commission should first finish its work. The groups agree with Senator Marchi that the Governor should appoint the Chairperson of the Commission.

“One of our main concerns in patient safety. What kind of patient safety do you have if you lack health insurance? 3 million people in New York State lack health insurance and patient safety. They have documented excess illness and deaths. Their preventive care is nil. Serious illness is unsafe for a family’s finances. Costly and inefficient healthcare is unsafe for the competitivensss of our economy. Society as a whole would benefit from a universal healthcare financing system that includes all citizens. The needs of patients and healthcare professionals must come first. A legislative commission is needed to study and act on our worsening healthcare non-system, concluded Richard Propp, MD, Chairperson, Capital District Alliance for Universal Healthcare.

Awaiting a home run

By Dr. Susanne L. King
Berkshire Eagle

Tuesday, April 11

LENOX

MANY PEOPLE have been cheering the new health care bill that was passed by the Massachusetts Legislature, which is supposed to provide universal health care coverage for our state. The bill has three provisions to expand health care coverage to the uninsured. The first is to expand Medicaid eligibility, by allowing more people to qualify for this government program. The second is to offer government subsidies to low-income individuals. And the third is to require those making more than three times the poverty level (about $30,000 for a single person), to buy insurance or pay a fine. The politicians want us to believe that this is a home run, but I am not cheering.

Extending health care to the uninsured so that everyone is covered (universal health insurance) is an important aspect of health care reform. However, it is unclear whether this bill will be able to achieve that goal. In addition, universality is only the first of the five criteria proposed by the Institute of Medicine for health care reform. The other four criteria are not addressed in the current bill: that health care be continuous, i.e., not tied to a job (2); affordable for individuals and families (3); affordable for society (4); and equitable and patient-centered (5).

Politicians have assumed that only 500,000 people in Massachusetts are uninsured. However, the Census Bureau reports 748,000 uninsured, 50 percent more people than were counted in the Legislature’s figure-crunching for the bill. That leaves out a lot of people from the new bill, or costs a lot more money than the Legislature anticipated.

Since health care insurance will still be tied to jobs with this health care bill, it is not possible for it to be continuous. One of the thrusts of the current legislation is to make businesses accountable in supplying health care insurance to their employees. When your health care insurance is tied to a job, it is not portable if you change jobs; and you are forced to change insurance if your employer shifts to a different carrier.

Is the current legislation affordable for Massachusetts? The funding for the bill is nebulous. The state hopes to retain the federal Medicaid dollars that were in jeopardy without an expansion of coverage, but that is a small portion of the current $59 billion health care budget, which is estimated to increase by $25 billion over the next three years. Businesses with more than 10 employees may have to pay $295 per employee if they don’t offer insurance, but Medicaid hikes to hospitals (provided in the bill) will triple the amount garnered from businesses. And the bill projects savings from “market reform” and patients being treated in doctors’ offices instead of emergency rooms. These savings may be imaginary.

Another false assumption is that people will be able to buy affordable insurance. None of the insurance companies have yet offered such plans, but the estimate from the Statehouse is that these low-cost plans may set an individual back about $325 a month. Along with the insurance plan deductible allowed by the legislation, this would work out to more than 20 percent of the income from an individual making $30,000, scarcely an affordable plan.

Is this legislation equitable and patient-centered? Patients still will not have their choice of doctors or hospitals: the insurance plans will continue to dictate who you can see and where you can go for your health care. The promises that the uninsured would be offered comprehensive care through this legislation is also an empty one: the only way to get cheaper plans, and still maintain insurance company profits, is to boost deductibles and co-payments, and provide fewer covered services. Comprehensive coverage is not a feature of this bill. It remains to be seen what devastating gaps will be created. Equitable insurance would be for everyone in the state to have the same health care benefits that our elected representatives have.

Finally, is this legislation affordable for Massachusetts? It does nothing to contain the skyrocketing costs of health care in our state. Instead, it gives new infusions of cash to the private insurers and some big hospitals. The Boston Globe reported that lobbyists for insurance companies, some hospitals, and other major players in the health care industry were paid at least $7.5 million in 2005, as the Legislature took up this bill. This is not health care reform: this is business as usual for the private health care insurance industry.

And as usual, the insurance industry will not just maintain, but will increase, its profits. The American Medical News reported that health plans made more money, and spent less on health care in 2005, than in previous years. While the insurance companies make money providing coverage for the healthy workforce and their young healthy families, we taxpayers foot the bills for those segments of the population with greater health care needs.

If we were to take the $9,100/ year per person that we spend in Massachusetts (more than any state or country in the world), and use it for health care rather than insurance company profits, we would be able to provide truly universal, affordable, continuous, equitable and comprehensive care to the citizens of the commonwealth. We need a single-payer health care system, in which the government collects and administers the funds for health care, eliminating the insurance company middlemen.

That would be a spectacular home run for the state of Massachusetts.

New advocacy organization for universal health care holds first meeting in Anniston

By Joseph Lord
Star Staff Writer
04-10-2006

Dr. Henry Duke was touched by what he saw in Mobile after Hurricane Katrina.

He saw people, lots of them, in need of medical help – many of them caught up in the stormfs destructive wake without medical insurance, or without enough of it.

Duke, a resident physician at Regional Medical Center, long had advocated for universal health care, but he was moved to greater action after he volunteered his expertise and time on the Gulf Coast.

That led to the groundwork being laid for a new advocacy group, which held its first organizational meeting on Sunday in Anniston.

Duke and a handful of local and state activists on Sunday convened the first meeting of Alabama Health Care for All, a membership group that advocates a national, single-payer, universal healthcare program – in essence, government-sponsored health insurance for everyone.

“When you stop and think about it, as rich as this nation is it is a disgrace that we have to have a forum to discuss health care,” said Debra Foster, a former Anniston City Council member.

Foster attended on behalf of the Southern Christian Leadership Conference.

The goal for the statewide organization is to educate the public on the current health-care systemfs problems, and to pressure Congress, particularly representatives from Alabama, to enact universal healthcare, said Duke.

Duke said 45 million Americans donft have health insurance. That caused the premature deaths of 18,000 people last year, according to information provided by the organization.

“We want to start making a difference,” Duke told the group.

He wore a T-shirt that quoted Martin Luther King Jr. It read, “Of all the inequalities, injustices in healthcare are the most shameful and inhumane.”

He said the group will be funded through private contributions.

The Rev. Jack Zylman, co-chair of the group with Duke, said their goal can be reached through perseverance.

The group supported House Bill 676 in Congress, which would create a single-payer, universal healthcare program. It also is pushing for passage of legislation that would allow National Guardsmen to receive affordable health-care coverage when theyfre not on active duty.

The first meeting of Alabama Healthcare for All, at the public library on 10th Street, was attended by about a dozen people, whose roles ranged from doctors and nurses to religious leaders.

Theyfll meet again at 6 p.m. on Thursday at the Seventeenth Street Baptist Church in Anniston.

Meetings also are planned for Opelika, Huntsville and other cities across Alabama.

Massachusetts to fund private insurers instead of health care

Conference Committee Report
Health Care Access and Affordability
The Commonwealth of Massachusetts
4/3/2006

This Conference Committee Report contains a comprehensive plan for increasing health insurance coverage for all residents of Massachusetts.

This bill is a bridge between principles in the House and Senate bills, H 4479 and S 2282. The bill would redeploy current public funds to more effectively cover currently uninsured low-income populations, and would make quality health coverage more affordable for all residents of the Commonwealth. The bill promotes individual responsibility by creating a requirement that everyone who can afford health insurance obtain it, while also responding to concerns about barriers to health care access. Provisions in the bill aim at achieving nearly universal health insurance coverage, but also maintain a strong safety net that has historically distinguished the state. Finally, the bill would ensure that the Massachusetts Medicaid program complies with the terms of the new federal waiver, maintaining continued receipt of annual payments from the federal Medicaid program.

http://www.mass.gov/legis/summary.pdf

House Act No. 4850
http://www.mass.gov/legis/bills/house/ht04/ht04850.htm

And…

Lobbyists took in $7.5m on health bill
By Scott Helman
The Boston Globe
April 5, 2006

The House and Senate both passed the healthcare bill overwhelmingly yesterday, sending it to Governor Mitt Romney, who is expected to sign the bill, though he may veto some components of it.

Lobbyists for hospitals, insurance companies, and other major players in the healthcare industry were paid at least $7.5 million in 2005 as the Legislature took up a major healthcare bill, records show.

The bill provides a potential boon to health plan providers such as Blue Cross-Blue Shield of Massachusetts and Harvard Pilgrim Health Care, each of whom spent six-figure sums on lobbying in 2005. The healthcare bill calls for tens of thousands of uninsured people to purchase new subsidized insurance plans, which means insurers stand to get many new customers. For lower-income people, the state will help pay for private insurance coverage.

http://www.boston.com/news/local/massachusetts/articles/2006/04/05/
lobbyists_took_in_75m_on_health_bill/?page=full

Comment: By Don McCanne, M.D.

Our goal is affordable, comprehensive health care for everyone. This bill meets the private insurers’ goal of an expanded market for their administrative excesses.

This bill supposedly promises comprehensive benefits for 99 percent of Massachusetts residents, at an affordable cost for all. But where’s the money? As an example of the nebulousness of the funding, employers who do not provide insurance for their employees will be assessed $295 per uninsured employee per year, if Gov. Romney doesn’t line-item veto even that provision. What would that buy?

Also, though they contend that benefits are comprehensive, the legislation does allow innovations such as health savings accounts and policies for the young invincibles providing “only the coverage they need,” such as coverage for skateboard fractures. There is question as to how much benefit innovation will be allowed.

No attempt will be made here to cover the many flaws in this legislation. Suffice it to say that the stand-alone goal of near-universal coverage is not adequate. The coverage must be truly universal, truly comprehensive, and truly affordable. Enlisting the private insurers will bring us far more administrative services than we can afford, but the insurers, in turn, will fail the back-of-the-envelope test. As they craft pseudo-comprehensive plans for everyone, they’ll have the same question that we have: where’s the money?

Well, it’s already there. We simply need to take it away from the insurers and spend it on health care. We could do that merely by adopting an efficient, single-payer system.