Volunteers will staff facility in El Cajon
By Anne Krueger
San Diego Union-Tribune
May 2, 2005

Almost four years after Dr. Gresham Bayne of Point Loma heard the pitch for a clinic staffed by volunteer physicians, the medical facility is close to becoming a reality.

Bayne said the clinic will serve thousands of El Cajon residents who can’t afford medical insurance but earn too much to qualify for low-income medical programs such as Medi-Cal.

The clinic will be the first in California to be opened by Volunteers in Medicine, a national organization that works to bring together retired health professionals and patients who don’t have medical insurance. Since 1993, when the group opened its first clinic in Hilton Head Island, S.C., 31 clinics have been set up nationwide.

John Hughes, who heads social service programs for San Diego County Methodist churches, said patients at the clinic will receive “Nordstrom-quality care.” When they arrive, they will be welcomed by a greeter. All services, including medications, are provided at no cost.

Bayne said opponents were concerned the clinic would attract homeless people to the area. He said all new patients will be screened by a social worker to determine whether they are eligible for care, and homeless people will be referred to community clinics.

“We don’t anticipate seeing homeless people except once by mistake,” he said.

http://www.signonsandiego.com/news/metro/20050502-9999-1m2vols.html

Comment: What was that again? Free Nordstrom-quality care but not for those as needy as the homeless?

Apparently the founders of this clinic acknowledge that community clinics should fulfill the role of providing services to the needy, as long as they’re the homeless type. Also they would probably agree that higher-income individuals, insured or not, should receive their care in the private sector. So what is their targeted patient population? Nordstrom-quality health care shoppers who happen to be uninsured? Is there really a sector of individuals who cannot afford private care, but who are of a social class that shouldn’t stoop to utilizing community clinics when private charity can enable access to Nordstrom-quality care?

As with so many other well intentioned efforts, it appears that these individuals have designed a solution without adequately defining the problems. Community clinics already exist and provide a safety-net access to at least basic care for the uninsured who cannot afford private services. We do not need special clinics that are designed to serve an elite sector of the uninsured. Instead, we need to enact policies that would ensure that everyone has insurance.

A proper framing of the problem would lead to solutions that would restructure the way that we fund health care. The obvious solution is universal health insurance. This would not only address the problems of the elite uninsured, it would also ensure that community clinics are adequately funded so that they can provide more comprehensive services in those communities that fail to attract an adequate number of private sector providers.

Let’s get real about fixing our broken system of funding health care. We can begin by first understanding the problems.

Wells Shoemaker, M.D., responds on the Nordstrom-quality care proposal by San Diego ‘Volunteers in Medicine’

Wow.

Nordstrom sells a lot of overpriced merchandise to people who don’t need another jacket, dress, hat, or pair of shoes, and then makes them feel comfortable about their choices, if not a little superior to the Chevrolet-driving masses in the process. We have a bit of that in health care, too.

My old question would be–what happens if you get abdominal pain when the cute clinic isn’t open? What happens when the retired professional isn’t up to date, or uses the same practice principles which we know led to legion safety risks, omissions, and misjudgments?

My last dig relates to doctors who go on charity service junkets to third world countries, but who refuse to accept referrals of patients with poorly-reimbursing coverage here in their home communities. These tend to be the best heeled of American specialists, to boot.

You’re right, Don. We need a single, logical system.

Wells

Volunteers will staff facility in El Cajon
By Anne Krueger
San Diego Union-Tribune
May 2, 2005

Almost four years after Dr. Gresham Bayne of Point Loma heard the pitch for a clinic staffed by volunteer physicians, the medical facility is close to becoming a reality.

Bayne said the clinic will serve thousands of El Cajon residents who can’t afford medical insurance but earn too much to qualify for low-income medical programs such as Medi-Cal.

The clinic will be the first in California to be opened by Volunteers in Medicine, a national organization that works to bring together retired health professionals and patients who don’t have medical insurance. Since 1993, when the group opened its first clinic in Hilton Head Island, S.C., 31 clinics have been set up nationwide.

John Hughes, who heads social service programs for San Diego County Methodist churches, said patients at the clinic will receive “Nordstrom-quality care.” When they arrive, they will be welcomed by a greeter. All services, including medications, are provided at no cost.

Bayne said opponents were concerned the clinic would attract homeless people to the area. He said all new patients will be screened by a social worker to determine whether they are eligible for care, and homeless people will be referred to community clinics.

“We don’t anticipate seeing homeless people except once by mistake,” he said.

http://www.signonsandiego.com/news/metro/20050502-9999-1m2vols.html

Comment: What was that again? Free Nordstrom-quality care but not for those as needy as the homeless?

Apparently the founders of this clinic acknowledge that community clinics should fulfill the role of providing services to the needy, as long as they’re the homeless type. Also they would probably agree that higher-income individuals, insured or not, should receive their care in the private sector. So what is their targeted patient population? Nordstrom-quality health care shoppers who happen to be uninsured? Is there really a sector of individuals who cannot afford private care, but who are of a social class that shouldn’t stoop to utilizing community clinics when private charity can enable access to Nordstrom-quality care?

As with so many other well intentioned efforts, it appears that these individuals have designed a solution without adequately defining the problems. Community clinics already exist and provide a safety-net access to at least basic care for the uninsured who cannot afford private services. We do not need special clinics that are designed to serve an elite sector of the uninsured. Instead, we need to enact policies that would ensure that everyone has insurance.

A proper framing of the problem would lead to solutions that would restructure the way that we fund health care. The obvious solution is universal health insurance. This would not only address the problems of the elite uninsured, it would also ensure that community clinics are adequately funded so that they can provide more comprehensive services in those communities that fail to attract an adequate number of private sector providers.

Let’s get real about fixing our broken system of funding health care. We can begin by first understanding the problems.

New Study Finds Poor Medicaid Beneficiaries Face Growing Out-Of-Pocket Medical Costs
Center on Budget and Policy Priorities
May 31, 2005

A new Center report finds that out-of-pocket medical expenses for poor adult Medicaid beneficiaries have grown twice as fast as their incomes in recent years. These individuals spend more than three times as much of their income on health care as middle-class adults with private insurance, the study finds.

Increasing cost-sharing, such as through higher copayments or premiums or the elimination of certain benefits (such as dental or vision coverage), has been suggested as a way to reduce Medicaid costs and promote “personal responsibility.” As a second new Center report shows, however, a substantial body of research finds that increased copayments cause low-income beneficiaries to cut back on essential care, and higher premiums lead to fewer people being covered by health insurance.

The risks of increased cost-sharing are greatest for those with serious or chronic health conditions, such as diabetes, cancer, or mental illness, since they need the most health care services and thus would face more copayment charges or the loss of more services. Moreover, the consequences of going without a needed service can be especially severe for individuals who are in poor health.

News Release:
http://www.cbpp.org/5-31-05health-pr.pdf

Report: “Out-Of-Pocket Medical Expenses for Medicaid Beneficiaries Are Substantial and Growing” By Leighton Ku and Matthew Broaddus http://www.cbpp.org/5-31-05health.pdf

Report: “The Effect of Increased Cost-Sharing in Medicaid: A Summary of Research Findings” By Leighton Ku http://www.cbpp.org/5-31-05health2.pdf

Comment: Shifting health care costs to individuals who need health care is a seriously flawed policy in that it impairs access and outcomes. A universal, public insurance system can contain costs without the necessity of imposing financial barriers to needed care. But until we have a universal system, it is crucial that we protect access for the most vulnerable patients by reversing this trend of shifting more costs to Medicaid patients in need.

Address by Prime Minister Paul Martin to the Empire Club and Toronto Board of Trade
May 26, 2005

“I believe in a Canada that values and protects its publicly funded medical system, so care requires a health card, not a credit card.”

http://pm.gc.ca/eng/news.asp?id=501

Health Leaders Seek Consensus Over Uninsured
By Robert Pear
The New York Times
May 29, 2005

At a time when Congress has been torn by partisan battles, 24 ideologically disparate leaders representing the health care industry, corporations and unions, and conservative and liberal groups have been meeting secretly for months to seek a consensus on proposals to provide coverage for the growing number of people with no health insurance.

The participants, ranging from the liberal Families USA to the conservative Heritage Foundation and the United States Chamber of Commerce, said they had made progress in trying to overcome the ideological impasse that has stymied action on the problem for eight years.

The group’s overarching goal is to agree, by the end of this year, on proposals that expand coverage to as many people as possible as quickly as possible. By meeting in secret, the group has tried to shield itself from political pressures.

“This effort holds as much promise as any I’ve participated in over the last decade, probably more,” said Kate Sullivan Hare, the executive director of health care policy at the United States Chamber of Commerce.

“People are uninsured for different reasons,” said Dr. Mary E. Frank, the president of the American Academy of Family Physicians and a participant in the talks. “No one solution will work for everyone. We need different solutions for different groups of the uninsured.”

E. Neil Trautwein, assistant vice president of the National Association of Manufacturers, said the consensus group was “not biased in favor of big government solutions,” and assumed that health care would continue to be provided through a mix of private insurers and public programs.

The group is applying lessons learned in the battle over the Clinton health plan. Members said they were listening carefully to one another, trying to build the trust. They are not trying to remake the health care system or guarantee insurance for every American through one big program, they said.

http://www.nytimes.com/2005/05/29/national/29insure.html?ei=5094&en=4ee7fc0aa141bf73&hp=&ex=1117339200& partner=homepage&pagewanted=print

Comment: And the options that they are considering? (My comments in
parentheses)

* Individual mandate for children (criminalizing parents who cannot afford
coverage?)

* Voluntary payroll contributions made by employees not covered by employer-sponsored plans (causing employers to drop coverage now that it is the employees’ responsibility, even if unaffordable to them)

* Tax credits sent to insurers to help pay for a portion of coverage for low-income individuals and small businesses (a direct subsidy for the flawed private plans, but which would be inadequate for these sectors surviving on very limited budgets)

* Voluntary action on the part of states to expand Medicaid to adults under the poverty level ($9600) (with the budget crises the states are facing, they would be looking for a voluntary way to go deeper in debt?)

* Small federal grants to states to establish insurance purchasing pools (funding a portion of administrative costs only, but not funding health
care)

Everyone recognizes the political ineptitude of the Clinton attempt at reform. Their process could never have ended in a consensus.

Now we are presented with a process that allegedly is firmly based on consensus. But what are they proposing? They have gone to the bottom of the health policy barrel and scraped off the stinky, slimy scum and presented that to us as politically feasible, incremental reform. These policies will increase the numbers of uninsured, reduce the effectiveness of coverage already in place, and fail to control costs. Millions of Americans will suffer and tens of thousands will die as a result of these policies.

Why does Kate Sullivan Hare of the U.S. Chamber of Commerce say that “this effort holds as much promise as any I’ve participated in over the last decade”? It’s because these policies will reduce employers’ responsibilities for requiring coverage; they will enhance business opportunities and profits for insurers; they will maximize the flow of tax dollars towards private interests while ensuring that public programs will remain profoundly underfunded; and they will shift more of the responsibility and burden of paying for care to the individual, regardless of affordability.

But this process has accomplished their unstated primary goal. They were successful in keeping single payer supporters out of this secret process.
And their greatest fear is that Americans might actually demand a program that would provide affordable, comprehensive care for everyone, if Americans only understood that we could have it merely by enacting a single payer system.

By redefining incrementalism as a process that gradually reduces comprehensive coverage, affordability and access, this group has lost all credibility as advocates of reform that would be for the benefit of patients. That’s tragic, because several of these individuals know better and should have been a part of a legitimate process. But their ******* egos got in the way!

And, oh yes, some were there to make sure that the enablement of greed was a defining element in their model of reform. Those individuals need to be banned from the bargaining table forever. But those who know better and really do care should be welcomed back into the process once they have had their personal epiphanies.

Health Leaders Seek Consensus Over Uninsured
By Robert Pear
The New York Times
May 29, 2005

At a time when Congress has been torn by partisan battles, 24 ideologically disparate leaders representing the health care industry, corporations and unions, and conservative and liberal groups have been meeting secretly for months to seek a consensus on proposals to provide coverage for the growing number of people with no health insurance.

The participants, ranging from the liberal Families USA to the conservative Heritage Foundation and the United States Chamber of Commerce, said they had made progress in trying to overcome the ideological impasse that has stymied action on the problem for eight years.

The group’s overarching goal is to agree, by the end of this year, on proposals that expand coverage to as many people as possible as quickly as possible. By meeting in secret, the group has tried to shield itself from political pressures.

“This effort holds as much promise as any I’ve participated in over the last decade, probably more,” said Kate Sullivan Hare, the executive director of health care policy at the United States Chamber of Commerce.

“People are uninsured for different reasons,” said Dr. Mary E. Frank, the president of the American Academy of Family Physicians and a participant in the talks. “No one solution will work for everyone. We need different solutions for different groups of the uninsured.”

E. Neil Trautwein, assistant vice president of the National Association of Manufacturers, said the consensus group was “not biased in favor of big government solutions,” and assumed that health care would continue to be provided through a mix of private insurers and public programs.

The group is applying lessons learned in the battle over the Clinton health plan. Members said they were listening carefully to one another, trying to build the trust. They are not trying to remake the health care system or guarantee insurance for every American through one big program, they said.

http://www.nytimes.com/2005/05/29/national/29insure.html?ei=5094&en=4ee7fc0aa141bf73&hp=&ex=1117339200& partner=homepage&pagewanted=print

Comment: And the options that they are considering? (My comments in
parentheses)

* Individual mandate for children (criminalizing parents who cannot afford
coverage?)

* Voluntary payroll contributions made by employees not covered by employer-sponsored plans (causing employers to drop coverage now that it is the employees’ responsibility, even if unaffordable to them)

* Tax credits sent to insurers to help pay for a portion of coverage for low-income individuals and small businesses (a direct subsidy for the flawed private plans, but which would be inadequate for these sectors surviving on very limited budgets)

* Voluntary action on the part of states to expand Medicaid to adults under the poverty level ($9600) (with the budget crises the states are facing, they would be looking for a voluntary way to go deeper in debt?)

* Small federal grants to states to establish insurance purchasing pools (funding a portion of administrative costs only, but not funding health
care)

Everyone recognizes the political ineptitude of the Clinton attempt at reform. Their process could never have ended in a consensus.

Now we are presented with a process that allegedly is firmly based on consensus. But what are they proposing? They have gone to the bottom of the health policy barrel and scraped off the stinky, slimy scum and presented that to us as politically feasible, incremental reform. These policies will increase the numbers of uninsured, reduce the effectiveness of coverage already in place, and fail to control costs. Millions of Americans will suffer and tens of thousands will die as a result of these policies.

Why does Kate Sullivan Hare of the U.S. Chamber of Commerce say that “this effort holds as much promise as any I’ve participated in over the last decade”? It’s because these policies will reduce employers’ responsibilities for requiring coverage; they will enhance business opportunities and profits for insurers; they will maximize the flow of tax dollars towards private interests while ensuring that public programs will remain profoundly underfunded; and they will shift more of the responsibility and burden of paying for care to the individual, regardless of affordability.

But this process has accomplished their unstated primary goal. They were successful in keeping single payer supporters out of this secret process.
And their greatest fear is that Americans might actually demand a program that would provide affordable, comprehensive care for everyone, if Americans only understood that we could have it merely by enacting a single payer system.

By redefining incrementalism as a process that gradually reduces comprehensive coverage, affordability and access, this group has lost all credibility as advocates of reform that would be for the benefit of patients. That’s tragic, because several of these individuals know better and should have been a part of a legitimate process. But their ******* egos got in the way!

And, oh yes, some were there to make sure that the enablement of greed was a defining element in their model of reform. Those individuals need to be banned from the bargaining table forever. But those who know better and really do care should be welcomed back into the process once they have had their personal epiphanies.

Ebbing and Flowing: Some Gains, Some Losses as SCHIP Responds to Third Year of Budget Pressure
By Ian Hill, Brigette Courtot, and Jennifer Sullivan
The Urban Institute
May 2005

Heading into 2004, SCHIP recorded its first-ever decline in enrollment. While it represented just 1 percent of total enrollment, the drop was still a significant turning point, reflecting the cumulative impact of three years of state policy responses to the ongoing economic downturn.

(2004) saw virtually no improvement in outreach, thus dimming SCHIP’s prospects for further reducing the rate of uninsurance among children in the coming year. Further, states like Texas did nothing to reverse the raft of changes made in 2003 that cut eligibility and benefits, raised cost sharing, and made enrollment more challenging. Wisconsin maintained its highest-in-the-nation premium, even in the face of declining enrollment. And Florida, despite lifting its enrollment cap, restricted future growth by closing enrollment except during two 30- day “open” periods each year, while requiring families to play a more active role in eligibility renewal.

In the case of outreach there is no ambiguity – SCHIP outreach has for all intents and purposes ceased to exist. Evidently, states have decided that programs cannot sustain the growth rates of SCHIP’s first four years during an economic downturn. Outreach has been scaled back or eliminated in an effort to curtail growth.

Looking ahead, the future course for SCHIP is uncertain. In 2004, 36 states spent more than 100 percent of their annual allotments. Yet that same year, for the first time, unspent federal funds in the amount of $1.3 billion reverted to the treasury. Federal funds available for redistribution are expected to fall in the coming years while the number of states needing redistributions is expected to rise. The only current prospect for enhanced federal funding for SCHIP has been proposed in the Bush administration’s “Covering the Kids” outreach initiative. However, when we asked SCHIP directors what they thought of this proposal, they expressed appreciation tempered by strong trepidation. That is, federal support for outreach would be welcomed by the states, but only if allotments were increased as well to cover the services new enrollees would need. SCHIP already faces excess demand for coverage. Providing new funding for outreach, without supporting states’ ability to supply additional coverage, would only exacerbate the program’s financing challenge.

http://www.urban.org/UploadedPDF/311166_A-68.pdf

Comment: SCHIP, the children’s health insurance program, is the one bright light on the path of incremental reform. Almost 4 million children are covered by this program. Although overall health care costs and coverage continue to deteriorate, the rate of deterioration would have been significantly greater without this very important program.

But how bright is the SCHIP light? The Bush administration is offering administrative funds to sign up new enrollees, but is not providing adequate funds for the care that would be required by new enrollees. And as a program that serves lower-income individuals, it is vulnerable to the wrath of anti-tax, anti-government politicians (“…strangle the beast…”), enabled by the passivity of their milquetoast colleagues (“…I am not a tax-and-spend liberal…”). Thus the response of the states has been to enact changes that control program costs.

It is ironic that our one successful incremental program, SCHIP, is now contributing to our chronic problems of an increasing number of uninsured and of making care less affordable by shifting more costs to the individual. Incrementalism is not working. All parameters are growing progressively worse.

We need comprehensive reform. But we won’t have that until we replace our milquetoast politicians who are too timid to take on the would-be anarchists who are currently in charge.

Milliman Medical Index 2005
Milliman Inc.

Milliman Inc. has completed its first annual study of the total annual medical costs for a “Typical American Family of Four.” The Milliman Medical Index (MMI) measures the average spending by such a family if covered by an employer-sponsored PPO program.

Based on a typical PPO plan design, Milliman estimates that out of the $12,214 total medical costs for 2005, a family would pay $2,035 out of their own pocket through member cost-sharing.

Future trends, including consumer-driven health plans:

As total medical costs continue to rise, employers will continue to look for ways to reduce costs, both for themselves and their employees. Employers are looking at ways to try to improve healthcare quality and reduce costs by sharing information aimed at educating their employees about the costs and efficacy of various medical services. Employers and health plans also continue to try to negotiate favorable rates with healthcare providers.

If these efforts are insufficient to keep employer cost trends at affordable levels, employers will continue to adjust employee contributions (both cost-sharing and premium sharing). While this has happened gradually in the recent past, some employers have concluded that this can only be done with a significant change in the traditional benefit plans being provided. This has led to increased interest in consumer-driven health plans (CDHPs), where members are given a spending account to pay for their own routine care, plus a high deductible plan to pay costs in catastrophic cases. Going from a traditional PPO plan to a high deductible plan can have a substantial impact on the portion of annual costs paid by the member through cost sharing,

A key question regarding CDHPs is whether they will result only in a shift of costs from the employer to the employee, or whether they will affect the total annual cost of healthcare.

http://www.milliman.com/mmi/Milliman_Medical_Index_Final.pdf

Comment: From the Milliman website: “One of the largest consulting and actuarial firms in the United States, we are recognized leaders who have helped shape significant changes in the markets we serve.”

When Milliman speaks, we listen. That doesn’t mean that we like what we hear.

This study reports that a typical family of four, enrolled in an employer-sponsored PPO pays $2,035 for out-of-pocket cost sharing of $12,214 in covered expenses. It is important to realize that the $2,035 does not include the employee’s contribution to the insurance premium, nor payments for non-covered products and services. When those are included, it is quite clear that average-income individuals would have difficulty affording the total out-of-pocket health care costs even though insured through the employer-sponsored PPO plan. Since PPO plans in the individual market are even less comprehensive, out-of-pocket expenses would be even more burdensome, not to mention the fact that the individual usually pays the full premium.

Also, since the study was limited to employer-sponsored PPO plans, the patient population is composed of relatively healthy, gainfully-employed individuals and their relatively healthy families. Just imagine the greater potential financial burden faced by those with more significant health care needs.

Thus the question posed by Milliman regarding the impact of the trend toward consumer driven health plans does not bode well for ensuring future affordable access to health care. In shifting more costs to the employees, either individuals will have the formidable task of reducing spending in other sectors of their already tight budgets, or, more likely, they will have to do without beneficial health care services.

Then, of course, in theory this could reduce total health care costs by motivating patients to reject unnecessary health care services. But first would someone show me all of those patients who are out seeking so much unnecessary care? I certainly don’t know who they are, or if they even really exist. When was the last time that you went to a doctor to try to obtain all of the unnecessary care that you could get?

New Projections From Nation’s Largest Health Care Coalition Show Health Care Reform Would Produce Huge Savings
National Coalition on Health Care
Press Release
May 23, 2005

System-wide health care reform would save much more money than it would cost, according to economic projections released today by the National Coalition on Health Care.

In four scenarios for reform analyzed by Professor Kenneth Thorpe of Emory University, the investment needed to achieve universal health coverage would be more than offset by savings. In each case, the cost of a reformed system would be much less than the cost of continuing with the current system.

Announcing these new findings, the Coalition’s president, Dr. Henry E. Simmons, said, “What this economic modeling shows unambiguously is that done right, health care reform will save America a great deal of money – while at the same time assuring health coverage for all Americans and dramatically improving health care.”

From Professor Thorpe’s PowerPoint presentation:

Total change in spending for years 2006 through 2015 under four scenarios (in comparison with the status quo):

$320 billion reduction – Employer mandate supplemented by individual mandate

$320 billion reduction – Expand existing programs to expand coverage

$370 billion reduction – Develop new program modeled after the FEHB (federal employees’ program)

$1136 billion ($1.136 trillion) reduction – Universal publicly financed program (“single payer”)

National Coalition on Health Care:
http://www.nchc.org/

Press Release:
http://www.nchc.org/news/press_releases/2003/2005_05_23.pdf

KFF video HealthCast of the press conference:
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?create=high_windows&linkid=1&display=detail&hc=1439

Kenneth Thorpe’s PowerPoint:
http://www.nchc.org/materials/nchcpressclub-final%20copy.pdf

Comment: The Honorary Co-Chairs of the National Coalition on Health Care are former presidents George Bush, Jimmy Carter and Gerald Ford. The member organizations of the Coalition represent about 150 million Americans and include business, labor, consumer, religious, provider, and health and pension fund interests. Every effort has been made to remove any partisan agenda from the process. Our former presidents can attest to that.

A highly objective process was used to evaluate the models of reform which would provide comprehensive coverage and higher quality care for everyone.
Which model would you choose?