PNHP

Small Business Looks to Mexico for Healthcare Plan

Small Business Looks to Mexico for Healthcare Plan

Monday, October 03, 2005

LOS ANGELES As the cost of healthcare (search) continues to skyrocket, one businessman in Calexico, Calif., has found a solution to the problem.

Mark Holloway owns the Sam Ellis department store near the U.S. border with Mexico. He has about 50 employees and couldn’t afford health insurance (search) for them until he discovered a cross-border health plan that allows his workers to see doctors in Mexico.

“We were paying an excess of $100,000 a year to provide health insurance and that wasn’t even for all of the staff,” Holloway said. “When Blue Shield came to us and offered us an affordable way to bring down healthcare, we jumped on it.”

In Mexico (search), healthcare costs are about 40 to 50 percent lower than in California. That means patients only have to pay $10 to visit a Mexican doctor. Hospital stays, tests and medications also are more affordable south of the border.

One of Holloway’s longtime employees said the service is better in Mexico.

“I know that doctors across the border will see you that day if not in the morning, the afternoon, the evening. You will call them, they will give you their cells [phone numbers], whatever,” said Josie Llausas.

But some in the medical field in the United States are skeptical about the cross-border plans because of questions over the quality of care, specifically pointing to outdated technology like X-ray machines, ultrasound and MRI equipment.

Mexican doctors say while their equipment might not be state-of-the-art, their training is equivalent to that of American doctors.

NY Times Endorses National Health Insurance

Wrong Solution for the Uninsured
Editorial
The New York Times
October 17, 2005

As well-meaning legislation goes, it would be hard to beat the law recently approved by the New York City Council over the veto of Mayor Michael Bloomberg. It requires certain large grocers to provide health care benefits for their employees. The law – like a handful of similar efforts from Long Island to San Francisco – is a response to the growing strain on Medicaid and other government assistance programs from uninsured workers.

A major inspiration for the legislation is clearly Wal-Mart. One report showed that nearly 9,000 Wal-Mart workers needed public insurance in Wisconsin, and that more than 10,000 children of the store’s workers in Georgia were treated at taxpayer expense. The list goes on. Fed up, Maryland, New Jersey and Pennsylvania are in various stages of trying to force the big employer to take care of its own.

While it’s easy to sympathize with the frustration of local governments left holding the bag, this kind of piecemeal legislation is no answer. For one thing, it’s very possibly illegal – federal law generally protects employers from this kind of local mandate. And while it’s emotionally satisfying to take a whack at the big-box stores, it hardly addresses the real problem. In New York, caring for the city’s working uninsured costs more than $600 million annually, according to a Columbia University report. Wal-Mart can’t be blamed for any of that, as it has been unsuccessful in pursuing a site in the city.

The nation’s health care problems are too complicated to be addressed by a chock-a-block system of overzealous, homespun laws that fail to address the overarching problem of the uninsured and may not hold up in court, anyway. The problem cries out for a federal solution. Without some kind of aid, many small businesses would crumble under the cost of health care benefits – which the New York City law estimates at $5,000 per employee per year.

For right now, there is a commendable effort in Congress to post on the Internet the names of employers with large numbers of workers on public aid, the idea being that shame can be an effective weapon. The same kind of shame, however, should also be aimed at Washington lawmakers who have done nothing to solve the larger problem, the crying need for national health insurance.

PNHP's Frankel Promotes Medicare for All

Doctor prescribing national health plan
By Steve Blow
Dallas Morning News
Sunday, October 9, 2005

In the newspaper business, someone is always upset with how we play stories.

Put one on the front page, and it’s called “sensationalism.” Put it inside, and it’s “buried.”

Well, let me join the chorus. When I read a story the other day at the bottom of the business section, I wondered why in the world it wasn’t on Page 1.

The headline: “Fewer firms are providing health care, survey finds.”

OK, not very sexy, I know.

In fact, I have just divided readers into two groups. First, those of you who felt your interest sag. You have good health insurance at work – or through a spouse, a parent or Medicare.

And second, those who felt your stomachs knot. You are uninsured or on the verge of it – and you’re worried sick about getting sick.

That headline made me think about a local fellow in a small third group – those who are well insured and worried about those who aren’t.

Actually, Gerald Frankel of McKinney belongs to an even smaller group than that. He’s a doctor who favors a national health-care plan.

Dr. Frankel – “Jerry” to his friends – is a urologist on a mission. He says we’ve got to face that our country’s system of providing health coverage through employers is broken.

That recent news story documented the continuing decline in companies offering health insurance – down to 60 percent now, a 9 percent drop in just five years.

I asked Dr. Frankel about his reaction to that story. “I had a whole mess of reactions,” he said. “First, my heart goes out to the people affected by this.

“You don’t see the devastation because you can’t put it in a photograph like you can with Hurricane Katrina. But physicians and nurses see families whose lives have been wrecked on a daily basis. The number of families who have their own Katrina every day is just phenomenal.”

Dr. Frankel’s second reaction: “It’s just another nail in the coffin of the current system,” he said. “But at what point do we say enough is enough? What’s the breaking point?”

The surgeon is frustrated that he can’t make others see what is so obvious to him: People are dying because of the broken system of delivering health care.

“How can this country, which is based on the highest principles, allow this to go on?” he asked. By one study, 18,000 people die each year solely for lack of health care. Thousands more suffer needlessly.

Dr. Frankel understands the natural reluctance to get the government involved. “Government drives everyone crazy. They say, ‘The same people who run FEMA? You’re going to let them take over health care?’ ”

But the government can do some things well, he said, and one of those is deliver decent, affordable health care to all its citizens.

It’s done that way in every other developed nation. And it’s not as foreign as it sounds. We already have it here, and I have already mentioned it – Medicare.

Good old Medicare. It may not be perfect, but older Americans look forward to the day they qualify for it. And Dr. Frankel sees no reason why such a national health plan can’t be expanded to all citizens, not just seniors.

If nothing else, the employer-based, private-insurance system offends Dr. Frankel for its inefficiency. He said about 25 percent of all premiums go to pay administrative costs. With Medicare, it’s 3 percent.

But worst of all, our system is bad medicine. We spend more on health care than any other country, but we’re the worst of developed nations in life expectancy and infant mortality, he said.

Dr. Frankel is active in Physicians for a National Health Program (www.pnhp.org). He tries to spread the message that way.

But he believes change will come only when the middle class is shaken from its comfort zone – only when enough people can’t find a job with health benefits, only when enough families are financially ruined by an illness, only when enough of “us” die unnecessarily.

Dr. Frankel wonders why we have to wait.

E-mail sblow@dallasnews.com

PNHP’s Frankel Promotes Medicare for All

Doctor prescribing national health plan
By Steve Blow
Dallas Morning News
Sunday, October 9, 2005

In the newspaper business, someone is always upset with how we play stories.

Put one on the front page, and it’s called “sensationalism.” Put it inside, and it’s “buried.”

Well, let me join the chorus. When I read a story the other day at the bottom of the business section, I wondered why in the world it wasn’t on Page 1.

The headline: “Fewer firms are providing health care, survey finds.”

OK, not very sexy, I know.

In fact, I have just divided readers into two groups. First, those of you who felt your interest sag. You have good health insurance at work – or through a spouse, a parent or Medicare.

And second, those who felt your stomachs knot. You are uninsured or on the verge of it – and you’re worried sick about getting sick.

That headline made me think about a local fellow in a small third group – those who are well insured and worried about those who aren’t.

Actually, Gerald Frankel of McKinney belongs to an even smaller group than that. He’s a doctor who favors a national health-care plan.

Dr. Frankel – “Jerry” to his friends – is a urologist on a mission. He says we’ve got to face that our country’s system of providing health coverage through employers is broken.

That recent news story documented the continuing decline in companies offering health insurance – down to 60 percent now, a 9 percent drop in just five years.

I asked Dr. Frankel about his reaction to that story. “I had a whole mess of reactions,” he said. “First, my heart goes out to the people affected by this.

“You don’t see the devastation because you can’t put it in a photograph like you can with Hurricane Katrina. But physicians and nurses see families whose lives have been wrecked on a daily basis. The number of families who have their own Katrina every day is just phenomenal.”

Dr. Frankel’s second reaction: “It’s just another nail in the coffin of the current system,” he said. “But at what point do we say enough is enough? What’s the breaking point?”

The surgeon is frustrated that he can’t make others see what is so obvious to him: People are dying because of the broken system of delivering health care.

“How can this country, which is based on the highest principles, allow this to go on?” he asked. By one study, 18,000 people die each year solely for lack of health care. Thousands more suffer needlessly.

Dr. Frankel understands the natural reluctance to get the government involved. “Government drives everyone crazy. They say, ‘The same people who run FEMA? You’re going to let them take over health care?’ ”

But the government can do some things well, he said, and one of those is deliver decent, affordable health care to all its citizens.

It’s done that way in every other developed nation. And it’s not as foreign as it sounds. We already have it here, and I have already mentioned it – Medicare.

Good old Medicare. It may not be perfect, but older Americans look forward to the day they qualify for it. And Dr. Frankel sees no reason why such a national health plan can’t be expanded to all citizens, not just seniors.

If nothing else, the employer-based, private-insurance system offends Dr. Frankel for its inefficiency. He said about 25 percent of all premiums go to pay administrative costs. With Medicare, it’s 3 percent.

But worst of all, our system is bad medicine. We spend more on health care than any other country, but we’re the worst of developed nations in life expectancy and infant mortality, he said.

Dr. Frankel is active in Physicians for a National Health Program (www.pnhp.org). He tries to spread the message that way.

But he believes change will come only when the middle class is shaken from its comfort zone – only when enough people can’t find a job with health benefits, only when enough families are financially ruined by an illness, only when enough of “us” die unnecessarily.

Dr. Frankel wonders why we have to wait.

E-mail sblow@dallasnews.com

Drowning in insurance paperwork

Treated for Illness, Then Lost in Labyrinth of Bills
By Katie Hafner
The New York Times
October 13, 2005

Medical paperwork is a world of co-payments and co-insurers, deductibles, exclusions and contracted fees. Nothing is as it seems: patients receive statements that often do not reflect what is actually owed; telephone calls to customer service agents are at best time-consuming and at worst fruitless. The explanations of benefits that insurers send out – known as E.O.B.’s – are filled with unintelligible codes.

The system is so impenetrable that it mystifies even the most knowledgeable.

“I’m the president’s senior adviser on health information technology, and when I get an E.O.B. for my 4-year-old’s care, I can’t figure out what happened, or what I’m supposed to do,” said Dr. David Brailer, National Coordinator for Health Information Technology, whose office is in the Department of Health and Human Services. “I can’t figure out what care it was related to or who did what.”

Ellen Mayer, 54, an artist who lives in Chester, N.Y… has a rare type of gastrointestinal cancer that requires constant monitoring through blood work, CT scans and PET scans.

The paperwork nightmare started for Ms. Mayer when her oncologist switched hospitals. Everything suddenly seemed to need a justification, or a new piece of paper with an authorization.

The stacks of papers, folders and Post-It notes related to Ms. Mayer’s treatment have started to take over her house. They fill manila envelopes, boxes and files, which fill closets. They spill from the dining room table onto chairs.

“You can’t just be sick,” she said. “You have to be sick and be drowning in paperwork.”

Insurance companies are, by and large, unapologetic.

“Even though the amount of paperwork a patient has to deal with might seem to be a lot, it would be much worse if there wasn’t a unifying organization like a health plan easing that burden,” said Dr. Alan Sokolow, chief medical officer at Empire Blue Cross Blue Shield in New York.

http://www.nytimes.com/2005/10/13/health/13paper.html

Comment: We can thank Alan Sokolow for providing us with one of the most compelling reasons for dismissing the private insurance industry and replacing it with our own universal program of public insurance. Talk about being oblivious to the problems! At least former FEMA Director Michael Brown recognized that there was a storm. Although the health care crisis has been repeatedly labeled as “The Perfect Storm,” Sokolow’s industry continues to plow through the levees that are failing to hold our fragile health care system together.

Ironically, they’re in the process of drowning their own industry, along with the rest of us. It’s too bad that we can’t prevent more health care tragedies by shrinking the private insurance industry down to size and drowning it in a bathtub!

Big-box health insurance discounts

Big-box retail stores add health insurance to wares
By Barbara Marquand
Sacramento Business Journal
September 30, 2005

Shoppers look for deals on everything from paper towels to computers at big-box warehouse stores. Now they can get health insurance too.

Costco Wholesale Corp. and the Sam’s Club unit of Wal-Mart have been offering small-business health insurance policies to customers for the last two years. Two months ago Costco expanded its line with a pilot program in Southern California to sell individual health insurance policies.

Costco decided to offer individual health insurance policies as one more way to offer value to customers… The coverage is available only to executive members, who pay $100 a year to shop at the warehouse, versus the $45-per-year standard membership fee.

PacifiCare has about 6,000 people enrolled in its Costco small-business plan and about 800 enrolled in its individual Costco PPOs. The Costco plans have higher deductibles and slightly different benefits from other PacifiCare products, which help achieve the premium savings.

Rita Gibson doesn’t think the big-box phenomenon will have a big impact for most traditional brokers. The big-box stores are selling insurance as a commodity, she said, and the benefits for those policies are not as strong as they are for other policies sold through brokers.

“In the short run it brings more competition to the market, and as an economist I think that’s good,” said Glenn Melnick, director of the University of Southern California Center for Health Policy and Management. “It makes it easier to have access to a lower-cost market.”

But he doesn’t expect a big impact in the long term unless insurers get more innovative…

http://sacramento.bizjournals.com/sacramento/
stories/2005/10/03/focus3.html

Comment: So now the big-box discount stores are entering the competitive market for health insurance. And how do they compete? By reducing benefits and require greater cost sharing than the competing products that have already reduced benefits and required greater cost sharing. It’s a race to the bottom!

How long has it been since you’ve seen a new insurance product that offers greater benefits and lower out-of-pocket costs? Well, you won’t see any because the competition is with premiums charged rather than with the quality of the insurance product. By far the largest sector of the market is composed of healthy individuals who have only relatively negligible current needs for health care. That sector finds it very difficult to devote a large portion of income to a “commodity” that they aren’t using.

Deterioration in the value of insurance products has already created financial hardships for those who do develop significant acute and chronic problems. As these innovative trends expand, more and more middle income individuals will be impacted. But for the affluent, who have a political voice, health care will never become unaffordable, so there will be little pressure for change.

Besides, look at the potential for new revenue opportunities. Right next to the insurance desk, the big-box stores can set up Chapter 13 agents. And that is destined to be a very high volume business!

Senator Sold Stock Before Price Dropped

By Jonathan M. Katz
Washington Post
September 21, 2005

Senate Majority Leader Bill Frist, a potential presidential candidate in 2008, sold all his stock in his family’s hospital corporation about two weeks before it issued a disappointing earnings report and the price fell nearly 15 percent.

Frist held an undisclosed amount of stock in Hospital Corporation of America, based in Nashville, the nation’s largest for-profit hospital chain. On June 13, he instructed the trustee managing the assets to sell his HCA shares and those of his wife and children, said Amy Call, a spokeswoman for Frist.

Frist’s shares were sold by July 1 and those of his wife and children by July 8, Call said. The trustee decided when to sell the shares, and the Tennessee Republican had no control over the exact time they were sold, she said.

HCA shares peaked at midyear, climbing to $58.22 a share on June 22. After slipping slightly for two weeks, the price fell to $49.90 on July 13 after the company announced its quarterly earnings would not meet analysts’ expectations. On Tuesday, the shares closed at $48.76.

The value of Frist’s stock at the time of the sale was not disclosed. Earlier this year, he reported holding blind trusts valued at $7 million to $35 million.

Blind trusts are used to avoid conflicts of interest. Assets are turned over to a trustee who manages them without divulging any purchases or sales and reports only the total value and income earned to the owner.

To keep the trust blind, Frist was not allowed to know how much HCA stock he owned, Call said, but he was allowed to ask for all of it to be sold.

Frist, a surgeon first elected to the Senate in 1994, had been criticized for maintaining the holdings while dealing with legislation affecting the medical industry and managed care. Call said the Senate Select Committee on Ethics has found nothing wrong with Frist’s holdings in the company in a blind trust.

“To avoid any appearance of a conflict of interest, Senator Frist went beyond what ethics requires and sold the stock,” Call said. Asked why he had not done so before, she said, “I don’t know that he’s been worried about it in the past.”

An HCA spokesman said the company had no part in Frist’s decision.

Frist’s father, Thomas, founded the company, and his brother, Thomas Jr., is a director and leading stockholder. The family is worth $1.1 billion, according to Forbes magazine.

HCA — formerly known as Columbia HCA Healthcare Corp. — has been a top contributor to the senator’s campaigns, donating $83,450 since 1989, according to the Center for Responsive Politics.

The sale of the shares was first reported by Congressional Quarterly.

Privatisation will wreck NHS, say campaigners

Hospitals may close, says letter to Guardian
Timing seems designed to foment conference revolt

John Carvel, social affairs editor
Guardian
Saturday September 24, 2005

A campaign to halt the government’s drive to commercialise the NHS is being launched today by the former Labour health secretary Frank Dobson with the support of leading figures from the British medical establishment.

In a letter to the Guardian that is likely to form the focus of dissent at the Labour conference in Brighton next week, they say that reforms being introduced by the health secretary, Patricia Hewitt, threaten to destroy the character of the NHS by forcing hospitals and health professionals to compete with each other. The timing of the letter is clearly designed to foment a revolt in Brighton, where Dave Prentis, general secretary of the public service union Unison, intends to move a resolution on Wednesday calling on the government to “suspend any further expansion of the role of the private sector into the NHS”. The union was busy mobilising support yesterday among unions, MPs and constituency parties, predicting that victory for its motion could become the main flashpoint of the conference.

But the campaign’s reach extended beyond the Labour movement, with supporters of the letter including 19 professors of medicine and related disciplines, senior figures from the British Medical Association, and the poet laureate, Andrew Motion. It was also signed by Mr Prentis, the former cabinet minister Clare Short, and authors Philip Pullman, Claire Tomalin and Nick Hornby.

The letter came as the BMA published a survey of NHS medical directors across England suggesting that a third of NHS trusts are preparing to reduce services to avoid a debt crisis. The letter said: “Forced market competition will break up the NHS as a collaborating network … There will be winners and losers, with some units and even entire hospitals having to close … The NHS must be kept in public hands … We call on organisations, healthcare workers, patients and public to campaign to protect the NHS from further privatisation and fragmentation.”

Mr Dobson said: “The government’s policy of promoting competition within the NHS and franchising services out to the private sector is gathering momentum day by day. Before long we will have a health insurance system and the NHS’s role as a provider of care will be limited to picking up the difficult cases and looking after the worst off. There is great concern in the Labour party throughout the country about what is happening – and it is shared by more than 1m NHS employees. It is time we worked together to put some chocks under the wheels of this fashionable bandwagon.”

The BMA’s analysis of NHS cuts was based on a survey of 530 medical directors in England. On the basis of 120 replies, it said 73% of trusts face a funding shortfall in the current year. The required savings averaged £6.2m per trust. Almost half were proposing a recruitment freeze and 27% were considering redundancies. Some trusts are also intending to close beds.

The BMA said medical staff would be included in recruitment freezes in almost half (47.9%) of cases where this was being considered, with 14% saying redundancies would also include medical staff.

Paul Miller, chairman of the BMA’s consultants’ committee, said: “It is hard to understand why, at a time when the government has invested unprecedented funding in the health service, trusts may have to lay off staff and close wards. Something is going terribly wrong when patients pay the price for these financial problems and the government’s lack of joined-up thinking … It is madness to guarantee private providers huge volumes of work, often at a higher cost than the NHS, while NHS hospitals are deprived of essential funding.”

The NHS Confederation, representing managers and trusts, said the BMA’s findings should be treated with caution, since less than a quarter of medical directors replied to the survey.

The campaign’s website is www.KeepOurNHSPublic.com

The letter:

The future of the NHS is at stake

Saturday September 24, 2005

Guardian
The NHS stands at a crossroads. For nearly 60 years, Britain has enjoyed a National Health Service that strives to be comprehensive, accessible and high value for money. Now, government reforms threaten both the ethos of the NHS, and the planned and equitable way in which it delivers care to patients.

At the heart of the changes is the creation of a market that welcomes profit-driven international corpor-ations and will compel hospitals and health professionals to compete with each other. If these reforms continue the nature of the health system will change radically:

– Income and profit will come before clinical considerations.
– Profitable services and patients will attract money at the expense of unprofitable ones.
– Forced market competition will break up the NHS as a collaborating network of shared resources and information.
– Even more of the new money allocated to health will be diverted to shareholders and wasted on the huge administrative costs associated with a market.

There will be winners and losers, with some units and even entire hospitals having to close. We are already seeing bed closures in NHS hospitals. The end result will undermine the choice that is most important to patients – access to comprehensive, trustworthy and l ocal health services.

The situation is grave. The NHS must be kept in public hands, serving the interests of all patients and the broader public. We therefore call on organisations, healthcare workers, patients and public to campaign to protect the NHS from further privatisation and fragmentation.

Prof David Hunter
University of Durham

Dr Mac Armstrong
Ex-Chief Medical Officer, Scotland

Sir Sandy Macara
ex-BMA council chair

Dr John Marks
ex BMA council chair

Professor Brian Jarman
Ex BMA president and head of the Dr Foster unit at Imperial College

Sir Iain Chalmers
Director, UK Cochrane Centre NHS Research and Development Programme

Professor Julian Tudor Hart
Medic, academic and writer

Frank Dobson MP
Ex Secretary of state for Health

Professor John Yudkin
Professor of Medicine Director, International Health and Medical Education Centre University College London

Professor Martin White
Chair of Public Health and Director Public Health Research Group School of Population & Health Sciences Faculty of Medical Sciences University of Newcastle upon Tyne

Professor George Davey Smith
(Professor of Epidemiology) Dept Social Medicine, Bristol

Professor Martin McKee
European Centre on Health of Societies in Transition London School of Hygiene and Tropical Medicine

Professor Allyson Pollock
Academic and writer

Peter Kilfoyle MP

Professor Colin Crouch
Chair of the Institute of Governance and Public Management Warwick University Business School

Professor Martin White
Chair of Public Health and Director, University of Newcastle upon Tyne

Professor Sara Arber
Department of Sociology, University of Surrey, Guildford

Dave Prentis
Unison, General Secretary

Prof Vincent Marks
Professor of clinical biochemistry at the University of Surrey

Professor Dame June Clark
Professor Emeritus at the University of Wales member of the Royal Commission into long term care of the elderly

Claire Rayner
writer, broadcaster

Phillip Pullman
author

Neal Lawson
Chair, Compass

George Monbiot
Writer, journalist

Clare Short MP

Professor Sir Andy Haines
Professor of Public Health and Primary Care

Mr Nick Astbury (personal capicity)
President of the Royal College of Ophthalmologists

Nick Hornby
author

John Bird
comedian

Andrew Motion
Poet Laureate

Prof Charles Webster
NHS historian academic, writer

Francis Wheen
Journalist

Claire Tomalin
winner of Whitbread book award

Prof Harry Keen CBE
President NHS Support Federation National Pensioners Convention

Frank Cooper

Professor Rodney Reznek
Professor of Diagnostic Imaging

Prof Emeritus Ron Taylor

Prof Emeritus David Metcalfe

Keep our NHS public

Keep our NHS public

You may be aware of a major campaign which is being launched, Keep our NHS public.

I would like to encourage you to visit its website
http://www.keepournhspublic.com/
where you can sign to support the campaign. You may wish to read the letter in The Guardian on 24 September 2005 calling for the campaign, signed by health practitioners, writers, and other leading figures:
http://www.guardian.co.uk/letters/story/0,,1577222,00.html

I would also encourage you to contact the campaign if you wish to help or if you are organising a relevant meeting or other activity. Please contact info@nhscampaign.org

You may be interested to know that there will be a meeting organised by the NHS Consultants’ Association on Saturday 08 October at 3.00pm in the Wilkins Old Refectory in UCL, Gower St, London. Please contact nhsca@pop3.poptel.org.uk if you are interested in attending.

Dr James Lancaster
Centre for International Public Health Policy
University of Edinburgh

VA/Canada have lower prices than Medicare Plan

New Report Finds Medicare Drug Prices are 58.2 Percent Higher than VA Prices

49 of 50 Top-Prescribed Drugs Are More Expensive in Medicare than Through the Department of Veterans Affairs (VA)

Washington, D.C. – A new report released today found that seniors using Medicare drug discount cards are paying considerably more for 49 of the top-50 most frequently prescribed drugs than they would through the Department of Veterans Affairs (VA). The median price difference for the 50 drugs was $220.44.

The report, released by the consumer health organization Families USA, found that, for half of the top-50 drugs, the lowest Medicare discount card price is at least 58.2 percent higher than the best available VA price.

The Families USA report was issued at a time when many conservatives and liberals are concerned about the expense of the new Medicare drug program. A key controversial feature of the legislation that created the new program prohibits Medicare from bargaining for cheaper drug prices like the VA already does.

“The best way to make medicines affordable for seniors is to allow Medicare to negotiate for better prices directly with drug companies, the way the VA successfully does,” said Ron Pollack, Executive Director of Families USA. “The continued prohibition against such bargaining will not only hurt seniors, but it will also fleece the American taxpayer.”

This study about the temporary Medicare drug discount card program provides the best current forecast of the drug prices we will see in the new drug benefit program. It shows that, despite the cost-savings promises made by the Bush Administration and congressional leaders when the new Medicare law was enacted, the Medicare discount cards routinely failed to result in drug prices as low as the VA.

For the five drugs most frequently prescribed for seniors, the report found that the best price under the Medicare drug discount card is considerably higher than the best VA price:

– For Plavix (75 mg.), a blood-clot reducing agent that is the most heavily prescribed medication for seniors, the best VA price is $887.16 per year, compared to the best Medicare drug discount price of $1,230.36—a difference of $343.20, or 38.7 percent.

– For Lipitor (10 mg.), a cholesterol-lowering agent that is the second most heavily prescribed medication, the annual VA price is $498.84, compared to $730.56 under the Medicare discount cards—a difference of $231.72, or 46.5 percent.

– For Fosamax (70 mg.), an osteoporosis drug that is the third most heavily prescribed medication for seniors, the annual VA price is $493.32, compared to $650.52 under the Medicare discount cards—a difference of $157.20, or 31.9 percent.

– For Norvasc (5 mg.), a high-blood pressure treatment that is the fourth most heavily prescribed medication for seniors, the annual VA price is $301.68, compared to $467.042 under the Medicare discount cards—a difference of $165.36, or 54.8 percent.

– For Protonix (40 mg.), a stomach acid blocking agent that is the fifth most heavily prescribed medication for seniors, the annual VA price is $253.32, compared to $827.40 under the Medicare discount cards—a difference of $574.08, or 226.6 percent.

For the two most expensive drugs prescribed to seniors under the discount card program in the top-50 list, the report found that the best price under the Medicare drug discount card is considerably higher than the best VA price:

– For Aricept (10 mg.), an Alzheimer’s treatment that is the most expensive of the top-50 drugs prescribed for seniors, the annual VA price is $1,056.84, compared to $1,453.92 under the Medicare discount cards—a difference of $397.08, or 37.6 percent.

– For Pravachol (40 mg.), a cholesterol-lowering agent that is the second most expensive of the top-50 drugs, the annual VA price is $470.40, compared to $1,240.44 under the Medicare discount cards—a difference of $770.04, or 163.7 percent.

“A big reason why the new Medicare program is so costly is because Congress and the President chose to support the pharmaceutical lobby over the interests of America’s seniors and taxpayers,” said Pollack. “At a time when drug costs continue to skyrocket and the federal budget is in deep deficit, this needs to change.”

The Families USA report was based on a comparison of the Medicare discount card prices for the 50 drugs most frequently used by seniors with the prices the VA negotiates for those same drugs. The list of the 50 drugs most frequently prescribed to seniors is based on the drugs most frequently prescribed in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) program. This program is the oldest and largest drug assistance program for seniors in the U.S., with nearly 200,000 enrollees.

Families USA collected all Medicare discount prices for each drug using a zip code for the Cincinnati area, 45206, and the findings are based on the lowest price recorded for each drug. These prices were then compared to the lowest publicly reported prices by the VA. The Medicare drug discount prices are very similar from one locale to another.

###

Families USA is the national organization for health care consumers. It is nonprofit and nonpartisan and advocates for high-quality, affordable health care for all Americans.

A Health Care Disaster (Kristof)

A Health Care Disaster
By Nicholas D. Kristof

Kiln, Miss.

In the richest country in the world, a man named Eugene Johnson is going blind in a homeless shelter, because his eye medicine washed away in Hurricane Katrina and he can’t afford to buy more.

At one level, that’s an indictment of the official rescue effort: the authorities were sufficiently concerned about hurricanes that last year they pre-positioned 10,000 body bags in New Orleans, but they dozed as Katrina approached.

Yet at a deeper level, Mr. Johnson’s plight is a window into our broken health care system. Sure, we need to think about how to rebuild New Orleans, but we also need to reconstruct a sensible health care system.

And that task is urgent, for one study suggests that more than 18,000 Americans will die this year as a consequence of not having health insurance.

Barbara Bush thought that Hurricane Katrina worked out pretty well for the poor. (“Many of the people in the arena here, you know, were underprivileged anyway,” she said after touring the Astrodome, “so this is working very well for them.”) I’d like her to come here to the rural Mississippi town of Kiln, near the Louisiana line, and meet Mr. Johnson. A barrel-chested retired plumber, a white man of 57, Mr. Johnson suffers from diabetes that has already cost him two toes. Complications also threaten his eyesight, and so he must take nine prescription medicines, including two to preserve his vision.

But the hurricane destroyed Mr. Johnson’s house. Since then, he has been bouncing from one shelter to the next and is now sleeping on a cot in a school gymnasium, along with his wife and four of his five children (one is grown and has left home).

Once Mr. Johnson found a pharmacy that was open and had one of the medicines he needs. But it charged $119 for it, and he couldn’t afford that. So Mr. Johnson is slowly going blind.

“My eyes are starting to mess up,” Mr. Johnson explained. “I see little spots. And then sometimes they all move around, like a TV picture that’s gone bad.”

Finally, a first-rate aid group, Children’s Health Fund, brought doctors and a mobile clinic to Mr. Johnson’s shelter. One of the doctors, David Krol, examined Mr. Johnson, was horrified, and is working on obtaining the medications he needs. But as Dr. Krol described the mobile clinic: “We’re a stopgap. Nothing more.”

If Mr. Johnson were more mobile, more adept at working the system, and more of a complainer, he might have gotten help earlier. But the poor tend to be stuck in shelters, without vehicles, and many are busy looking after small children. And many, like Mr. Johnson, are disastrously polite, patient, deferential and even cheerful. Around here, if you have the patience of Job, you suffer like Job.

Nearly every medical worker I spoke to warned that there would be a surge in deaths from heart disease, strokes and other ailments, concentrated among the poor, because of the interruption in medicines. Dr. Jay Lemery told of treating a single mother in a shelter whose three children were bouncing off the walls because they had attention-deficit disorder and hadn’t had their medication. The mother herself was prone to depression and had run out of her own medicine as well – in an environment that would make Pangloss suicidal.

The shelter was hot and tempers were so frayed that two women were having a fistfight. Dr. Lemery added: “Even the Red Cross people, who have the patience of Mother Teresa, were in tears.”

Yet the reality is that our medical system failed this region long before Katrina arrived. One of the Children’s Health Fund doctors discovered a previously undetected hole in a 4-year-old boy’s heart. The mother said nobody had ever listened to the boy’s chest before.

In both Mississippi and Louisiana, infant mortality is worse (for every 1,000 babies born, 10 die in their first year of life) than in Costa Rica (8 die per 1,000). For black babies in either state, the picture is still more horrifying: 15 die per 1,000. In poor, war-torn Sri Lanka, where per capita medical spending is only $131, babies have better odds, with 13 dying per 1,000.

So let’s rebuild the levees, but let’s also construct a health care system that works. A dozen years after the last, failed attempt to reform health care, the system is more broken than ever. For the sake of Mr. Johnson, and for our children, it’s time to try again.

U.S. cancer expert: Canadians aren't aware of value of medicare system

Provided by: Canadian Press
Written by: JOHN COTTER
Sep. 27, 2005

EDMONTON (CP) – World-renowned cancer specialist Eduardo Bruera is homesick for Canada’s health-care system.

Dr. Bruera left Edmonton’s Cross Cancer Institute after 15 years in 1999 to become chairman of the department of palliative care at the University of Texas M.D. Anderson Cancer Center in Houston. After working in both countries, Bruera, an oncologist, has a message for people who complain about medicare or who want to expand the use of private health insurance in Canada.

“The portability and the universality of health care in Canada are unbelievably good. I think Canadians are not aware of that,” said Bruera, who was to compare care in the two countries in a speech Wednesday at the annual conference of the Canadian Hospice Palliative Care Association.

“Don’t look at the United States. The public health-care system makes it possible for patients to access palliative care in Canada earlier and more effectively.”

Since moving to Texas, Bruera said he can’t get over the spectre of crushing debt that even upper-middle-class Americans face when a family member is dying from an advanced illness.

Even premium private health insurance in the United States rarely covers all the costs, which can lead to bereaved survivors facing an almost never ending list of medical bills, he said.

Of every $100 spent by families on medical care at the M.D Anderson Centre, only $32 is paid for by private insurance, he said.

More than 41 million Americans don’t have health insurance, he said. Of those who are insured, one in three will lose all their financial assets during illness.

“To me it is an enormous impact on quality of life. The burden of dying in the U.S. of cancer is much heavier than the burden . . . in Canada.”

Bruera’s remarks come as the federal and provincial governments work to come to grips with a Supreme Court of Canada decision in a Quebec case earlier this year which approved some uses of private health insurance.

Since the ruling, provinces such as Alberta have been actively considering expanding the use of private health insurance.

The province is expected to announce by the end of October which private insurance firm will be chosen to conduct an actuarial study of the pros and cons of such a scheme.

Premier Ralph Klein has said allowing private insurance firms to sell policies would benefit Albertans who want to shorten their waiting times for non-emergency medical procedures.

However, the province has yet to define exactly what it means by “non-emergency.”

Bruera said he is “100 per cent sure” that private insurance would not improve palliative care.

“In general, services such as palliative care, that is not highly profitable or high tech, are generally not insured very well in the U.S.,” he said.

“If you privatize parts of the system, the juicy parts, the ones that are more profitable, will be taken by the private insurers. The most costly and less rewarding will be left for the government services.”