PNHP

Politics of the progressive-liberal agenda – Lakoff and Dionne

Politics of the progressive-liberal agenda – Lakoff and Dionne

The Post-Katrina Era
By George Lakoff
The Huffington Post
September 8, 2005

It is impossible for me, as it is for most Americans, to watch the horror and suffering from Hurricane Katrina and not feel physically sore, pained, bereft, empty, heart-broken. And angry.

Katrina will not go away soon, and she has the power to change America.

The cause was political through and through – a matter of values and principles. The progressive-liberal values are America’s values, and we need to go back to them.

The heart of progressive-liberal values is simple: empathy (caring about and for people) and responsibility (acting responsibly on that empathy). These values translate into a simple principle: Use the common wealth for the common good to better all our lives. In short, promoting the common good is the central role of government.

The right-wing conservatives now in power have the opposite values and principles. Their main value is Rely on individual discipline and initiative. The central principle: Government has no useful role. The only common good is the sum of individual goods.

It’s the difference between We’re-all-in-this-together and You’re-on-your-own-buddy.

It’s the difference between Every citizen is entitled to protection and You’re only entitled to what you can afford.

It’s the difference between connection and separation.

It is this difference in moral and political philosophy that lies behind the tragedy of Katrina.

It is a truth that needs to be told starting now – over and over. There can be no delay. The Bush administration is busy framing it in it’s own way: bad things just happen, it’s no one’s fault; the federal government did the best it could – the problem was at the state and local level; we’ll rebuild and everything will be okay; the people being shipped out will have better lives elsewhere, and jobs in WalMart! Unless the real truth is told starting now, the American people will accept it for lack of an alternative.

The Democratic response so far is playing right into Bush’s framing. By delaying a response for fear it will be called “partisan,” the Democratic leadership is allowing Bush to frame the tragedy. And once it is framed, it is hard to reframe! It is time to start now.

http://www.huffingtonpost.com/george-lakoff/the-postkatrina-era_b_7034.html

And…

Democrats In Disarray
By E. J. Dionne Jr.
The Washington Post
September 27, 2005

Democrats and liberals are ecstatic that President Bush has finally faced his moment of accountability. The travails of Hurricane Katrina followed a bad summer for the president and have called into question his leadership style, competence and intense partisanship.

But Democrats are less ecstatic about . . . Democrats. Over the past several weeks, it was impossible not to run into Bush critics who would shake their heads and complain: “Yes, but where are the Democrats? Who are our leaders?
What do they have to say?”

But the party’s problems are structural and can be explained by three numbers: 21, 34 and 45. According to the network exit polls, 21 percent of the voters who cast ballots in 2004 called themselves liberal, 34 percent said they were conservative and 45 percent called themselves moderate.

Those numbers mean that liberal-leaning Democrats are far more dependent than conservatively inclined Republicans on alliances with the political center. Democrats second-guess themselves because they have to.

Consider that in 2004 Democrat John Kerry won 85 percent of the liberal vote and defeated Bush by a healthy 54 percent to 45 percent among moderates. But Bush prevailed because he won 84 percent of a conservative vote that constitutes more than a third of the electorate.

The core difficulty for Democrats is that they must solve two problems simultaneously — and solving one problem can get in the way of solving the other. Over time Democrats need to reduce the conservative advantage over liberals in the electorate, which means the party needs to take clear stands that could detach voters from their allegiance to conservatism. For some in the party this means becoming more moderate on cultural issues such as abortion. For others it means full-throated populism to attract lower-income social conservatives. Some favor a combination of the two, while still others worry that too much populism would drive away moderate voters in the upper middle class. The debate often leads to intellectual gridlock.

http://www.washingtonpost.com/wp-dyn/content/article/2005/09/26/AR2005092601462.html

Comment: Politics! Well, as far as health care reform is concerned, politics have certainly resulted in intellectual gridlock (plural is deliberate).

George Lakoff is both right and wrong. Allowing the conservatives to frame the debate on health care reform has prevented the liberals from communicating the efficiency and effectiveness of national health insurance.

On the other hand, framing the debate as “promoting the common good” versus “relying on individual discipline and initiative,” will only further solidify the liberal/conservative political polarization over health care reform. This approach to the debate can only enhance the position of the conservatives because it strengthens gridlock, ensuring a perpetual impasse on reform.

The debate does need to be reframed, but in a highly credible, non-partisan manner. We need to address the leading health care concerns of most Americans, including affordability, access, higher quality, choice, reliable coverage, and simple fairness in funding health care. Although there are many models of reform, only national health insurance can guarantee all of these. (The very few other models that might come close lose out on affordability.) These are not partisan issues. All Americans agree on them.

This reframing of the debate is not a concession to moderates. Liberals will still be promoting the common good, but they can do that better by publicly supporting these issues, rather than by shoving “Health Care is a Right!” placards into the faces of the conservatives.

There is evidence that this approach is already having a positive effect. A survey by The Pew Research Center demonstrated that 65% of Americans “favor a government guarantee of health insurance for all Americans, even if it means raising taxes.” This includes 59% of Republicans who are social conservatives and 63% of Republicans who are pro-government conservatives. Only Republican enterprisers remain opposed.

We need to reframe, but not as a Red versus Blue debate. Let’s have an all Purple debate, and we can do that without any compromise in the principles of the Blue, albeit without the support of a minority sector of the Red. That sector is hopeless anyway.

The Pew Research Center report, “Beyond Red vs. Blue”:
http://people-press.org/reports/display.php3?ReportID=242

Health insurance churning

Entrances and Exits: Health Insurance Churning, 1998-2000
By Kathryn Klein, Sherry Glied, and Danielle Ferry
The Commonwealth Fund
September 2005

Abstract:

Analysis of 1998-2000 health insurance data from the Medical Expenditure Panel Survey shows large numbers of people with unstable health insurance coverage.Young adults, Hispanics, people with low levels of education, those who transition into and out of poverty, and those with private non-group insurance are most likely to have unstable coverage. In addition, demographic factors and type of insurance interact to determine stability of coverage.Young adults and Hispanics with Medicaid or private insurance, for example, were relatively likely to lose their coverage. And less than half of people who transitioned into and out of low income and were initially uninsured were able to obtain coverage. Policies must target these high-risk groups in order to provide them with stable health insurance coverage.

http://www.cmwf.org/usr_doc/klein_855_entrancesexits_ib.pdf

Comment: Numerous studies have shown that individuals with unstable, intermittent insurance coverage are exposed to the same risks as the uninsured: financial hardship, impaired health outcomes, and even death. Policies should target not only the uninsured, but the victims of insurance churning as well. Targeting policies to the latter can be difficult since these are moving targets.

Obviously insurance churning would disappear, as would the problems of the uninsured and the under-insured, if we adopted a universal, single payer system. It is astounding that we continue to reject a simple, affordable, highly effective solution, while we continue to tinker with more carefully targeted but fragmented programs that are more expensive and relatively ineffective. Whatever happened to common sense?

Beth Capell responds on the Medicaid waivers

Beth Capell, Ph.D., Policy Consultant for Health Access California, responds on the Medicaid waivers:

Don:

As bleak as your assessment is, it is not bleak enough.

In Utah as elsewhere, the cuts envisioned under the waivers approved by the Bush Administration occurred but NOT the expansions of coverage; so as bad as the original deal was, the reality is worse.

In California, for the moment, we have stopped the proposal to move seniors and persons with disabilities into mandatory Medi-Cal HMOs. This was a hard fight won in the last days of the legislative session; it may be revisited next year. California like a number of other states was held hostage for essential hospital funding.

Hurricane victims need help now, not months from now. It can take not just months but years to negotiate waivers, especially for states that have under-funded Medicaid programs to begin with.

Beth Capell, Ph.D.

"Choice" in Health Care: What Do People Really Want?

“Choice” in Health Care: What Do People Really Want?
By Jeanne M. Lambrew, Ph.D.
The Commonwealth Fund
September 2005

Abstract:

Proposals to expand the individual health insurance market and promote health savings accounts are intended to provide consumers with more “choice.” The types of choices people prefer, however, are not well understood. This analysis of survey data finds that having a choice of health care providers matters more to people than having a choice of health plans. Dissatisfaction among adults with no choice of providers was more than twice as high as among those with no choice of plan. Moreover, a large majority of Americans who have had experience with employer-based health insurance believe that employers do a good job of selecting quality plans.

Two of three preferred an employer-selected set of plans over an employer-funded account that they would use to find coverage on their own.

Thus, policymakers should be cautious about embracing the individual market and health savings accounts as a way to improve satisfaction in the system.

http://www.cmwf.org/usr_doc/lambrew_853_choice_ib.pdf

Comment: The debate over “choice” in health care is more than a rhetorical game; it drives policy.

This survey adds to the research that confirms that patients clearly do want to have choice of their providers of care, including physicians and hospitals, and that provider choice is much more important than having choice of insurers. Yet advocates of market approaches to health care funding tout choice of health plans as if that were the only choice that consumers want, and most plans do restrict choice of providers to varying degrees.

An important finding of this study is that individuals do have confidence in plans that are selected by employers. As long the plan covers the patients’ own providers, they could care less which insurer is providing the administrative services. In contrast, if the insurer takes away patients’ choices of providers, then they are displeased with that plan. (Kaiser Permanente is not an exception because patients have selected that system as their provider.)

Recently, we’ve seen an increase in political support for providing incentives to choose products in the individual insurance market. Insurers recognize that beneficiaries do want to have greater choice of their providers. Thus we are seeing larger lists of approved providers, along with coverage for out-of-network providers, albeit with financial penalties. But this relaxation of the exclusions from provider lists may represent a Hobson’s choice.

The tradeoff for having greater choice of providers is to relinquish the financial security that insurers traditionally provided. Having a choice of a physician who you cannot afford provides less choice than the first horse at the stable door. After all, Hobson did provide a horse, but the insurers are no longer providing financial security in the event of loss.

Medicaid waiver extortion

Waiting for Action
Right Words but Little Practical Help for Poor
By David S. Broder
The Washington Post
September 22, 2005

Medical care for the evacuees from Louisiana, Mississippi and Alabama is urgently required. As Mark McClellan, the top federal health official in the Department of Health and Human Services (head of CMS), said last week, “The best and fastest way to provide help to evacuees is to support the state programs in place and support the local health care providers already in place, not to take time to build major new systems.”

The way to do that, he said, is to make the evacuees eligible for Medicaid for the next few months so they will know that their hospital, doctor and medication bills will be paid.

The governors, through their national association, agreed, and a measure to make all the evacuees Medicaid-eligible for the next five months (with an option for the president to extend the time) is pending before the Senate in a bill sponsored by the leaders of both parties and the chairman and ranking Democrat on the Finance Committee.

But it appears that the Bush administration, rather than backing this simple and effective measure, is insisting on a slower, more cumbersome approach, requiring each state to negotiate its own waiver from the rules limiting eligibility for Medicaid benefits.

Officials at the National Governors Association, who back the bipartisan bill, said they are not clear why the administration is balking at this simple solution. McClellan told me in an interview that “we’re meeting all the needs” with the waiver approach. But with evacuees spread among all the states, it’s hard to believe that’s true.

http://www.washingtonpost.com/wp-dyn/content/article/2005/09/21/AR2005092102510.html

Comment: Waivers? What is so urgent about waivers that the process of providing health care coverage for the evacuees should be delayed until waivers can be negotiated? Well, let’s take a look at these Medicaid waivers.

When the government is controlled by people who don’t believe in government, one of the first priorities is to cut wasteful spending. And what could be more “wasteful” than Medicaid, a program to fund health care for a sector without a political voice, those living in poverty?

Since its enactment almost four decades ago, the government has used a passive but highly effective mechanism of controlling Medicaid spending:
inflation. Without adequate adjustments for inflation, many providers now fund part of the care for their Medicaid patients since their overhead expenses are greater than their Medicaid reimbursement. Normally, an administration looking for methods to reduce costs in a welfare program would immediately target profits, but that is not an option since profits disappeared many years ago. So what other option might there be?

When Medicaid was established, it was recognized that the individuals living in poverty did not have affordable access to any health care services (except “county,” and anyone who was around then remembers that “county” did not equate with access). Consequently, the benefit package established by the enabling legislation was very generous, including most services that were appropriate. The budget cutters of today recognized that they could sell the concept that these benefits were more generous than what the poor folks should be “entitled” to, and thus trimming benefits became another mechanism of containing Medicaid spending. The problem is that the benefits were fixed in law, and so a waiver process had to be established in order to circumvent the requirements.

It was decided that the waiver process should be budget neutral, that Medicaid funds could be shifted to the growing numbers of low-income uninsured individuals, as long as the process did not increase total Medicaid spending. As an example, then-Governor Michael Leavitt obtained a waiver for Utah from HHS (federal Health and Human Services) that would expand coverage to more individuals, but exclude coverage for hospitalization and specialist services. Although this was disastrous for Medicaid beneficiaries, it suited the administration’s agenda so well that Michael Leavitt was appointed Secretary of HHS.

Now the administration would like to provide waivers (i.e., cut benefits) in every state. As another example, California Gov. Schwarzenegger’s administration has been negotiating a waiver in which HHS would require that California’s high-cost patients with severe chronic disabilities be moved into HMOs. Currently they are receiving as appropriate care as possible by well qualified, dedicated private sector providers who have a mission to do their best in an environment of limited financial resources. Under the waiver, these Medicaid beneficiaries would be shifted from their current continuing care, which is working for them, to HMOs, regardless of whether they’re even accessible, and which must make a profit with the paucity of Medicaid funds provided. Obviously, these unfortunate individuals would lose their essential supportive medical services. The California legislature rejected this requirement, and negotiations on waivers are currently at a realtive impasse.

So why are waivers more urgent than providing health care coverage for the victims of Katrina? Well, of course, they aren’t. But what an opportunity! Got those states right where we want them! You want us to help you pay for health care for those “underprivileged” evacuees? We have just the answer, and it is budget neutral. We’ll authorize you to quit wasting money on all of the unnecessary care for those other welfare folks so you can spend it on the evacuees.

Any after the Katrina crisis is over? Hey, you signed on to the waiver, Buddy!

“Choice” in Health Care: What Do People Really Want?

“Choice” in Health Care: What Do People Really Want?
By Jeanne M. Lambrew, Ph.D.
The Commonwealth Fund
September 2005

Abstract:

Proposals to expand the individual health insurance market and promote health savings accounts are intended to provide consumers with more “choice.” The types of choices people prefer, however, are not well understood. This analysis of survey data finds that having a choice of health care providers matters more to people than having a choice of health plans. Dissatisfaction among adults with no choice of providers was more than twice as high as among those with no choice of plan. Moreover, a large majority of Americans who have had experience with employer-based health insurance believe that employers do a good job of selecting quality plans.

Two of three preferred an employer-selected set of plans over an employer-funded account that they would use to find coverage on their own.

Thus, policymakers should be cautious about embracing the individual market and health savings accounts as a way to improve satisfaction in the system.

http://www.cmwf.org/usr_doc/lambrew_853_choice_ib.pdf

Comment: The debate over “choice” in health care is more than a rhetorical game; it drives policy.

This survey adds to the research that confirms that patients clearly do want to have choice of their providers of care, including physicians and hospitals, and that provider choice is much more important than having choice of insurers. Yet advocates of market approaches to health care funding tout choice of health plans as if that were the only choice that consumers want, and most plans do restrict choice of providers to varying degrees.

An important finding of this study is that individuals do have confidence in plans that are selected by employers. As long the plan covers the patients’ own providers, they could care less which insurer is providing the administrative services. In contrast, if the insurer takes away patients’ choices of providers, then they are displeased with that plan. (Kaiser Permanente is not an exception because patients have selected that system as their provider.)

Recently, we’ve seen an increase in political support for providing incentives to choose products in the individual insurance market. Insurers recognize that beneficiaries do want to have greater choice of their providers. Thus we are seeing larger lists of approved providers, along with coverage for out-of-network providers, albeit with financial penalties. But this relaxation of the exclusions from provider lists may represent a Hobson’s choice.

The tradeoff for having greater choice of providers is to relinquish the financial security that insurers traditionally provided. Having a choice of a physician who you cannot afford provides less choice than the first horse at the stable door. After all, Hobson did provide a horse, but the insurers are no longer providing financial security in the event of loss.

Aetna makes it easier to buy "under-insurance"

Aetna Launches New Health Insurance Website with Online Enrollment Capability for Individuals and Their Families
Aetna Press Release
September 20, 2005

“Aetna is making it as simple as possible for individuals to choose the appropriate, affordable plans that match their health care coverage needs,” said Laurie Brubaker, Aetna’s national general manager for Individual Markets. “The website guides individuals to consider their current life stages – for example, graduating from college, getting married, raising a family, becoming a sole proprietor, being between jobs or retiring early. We know that people’s priorities change and life circumstances determine the type of health care coverage individuals need.”

“We believe we can make an impact on reducing this nation’s population of uninsured – and under-insured – people,” Brubaker added. “We have researched consumers’ needs and created a range of health plans that provide choice, simplicity and affordability. Our cost-effective plans are designed to fit a variety of personal situations.”

In addition, Aetna offers individuals and their families high-deductible health plans that are compatible with the Aetna HealthFund(R) HSA (health savings account) in (eleven states and D.C.). These plans offer members similar benefits to the Aetna Advantage PPO plans… paired with an HSA.

http://www.aetna.com/news/2005/pr_20050920.htm

And…

Health Products for Individuals
Aetna

Life Stages in California (as an example)

New graduate
Getting married
Raising a family
Self employed
Between jobs
Empty nest
Retiring early

Frequently Asked Questions

The Aetna Advantage plans are voluntary plans that are medically underwritten; they are not conversion plans.

http://www.aetna.com/members/individuals/

Brochure for California Aetna Advantage Plan options:
http://www.aetna.com/members/individuals/health/data/
memberbrochure_California.pdf

Comment: The trends represented by the Aetna Advantage plans portend disaster for the future of health care coverage. This discussion barely touches on some of the alarming aspects of their program.

These plans are being marketed as a mechanism of selecting out only the coverage that you believe you will need, thereby avoiding contributing to risk pools that include coverage that you believe you won’t need.

Individuals will be enticed by the lower premiums of the limited coverage they select. Since no healthy person can predict future major health care needs, those individuals who select the limited plans will find themselves financially vulnerable with a significant change in their health status.

This unpredictability is precisely why everyone needs to have comprehensive coverage through a common risk pool.

Since these plans are “voluntary plans that are medically underwritten,” they will be sold exclusively to healthy individuals. People with preexisting disorders will have to find their coverage elsewhere. In the individual market, those plans would have to charge very high premiums because they concentrate risk. In actuality, those plans have been priced out of the market, leaving these vulnerable individuals without coverage.

The state-sponsored high-risk pools have not been able to make a dent in this problem. Only nefarious insurers/policymakers would target those with the greatest needs for exclusion from coverage.

These plans for various life stages “are not conversion plans.” Simply stated, as you move from a low-risk life stage, to one with greater risks, you must again pass underwriting standards to be covered by a plan that better meets your needs. What a clever idea. Aetna has figured out a way to drop coverage of many of those individuals who do develop chronic problems.

A problem for traditional plans is that, through the years, many of their clients develop chronic problems, and that results in higher, less-competitive premiums. This life stage concept circumvents that problem. Wall Street should really like this.

One of the most serious defects is that these are being marketed as plans that provide catastrophic coverage. If you look at the brochure describing plan options, you will see that they all offer an “out-of-pocket maximum,” ranging from $5000 to $25000. So if you chose the most comprehensive coverage, your maximum out-of-pocket expense, as an individual, would be $5000 plus the premiums paid for the year, or so they would have you believe. But what is the “out-of-pocket maximum”? It is merely the deductible plus the coinsurance paid to in-network providers. It does not include deductible and coinsurance penalties for using out-of-network providers. It does not include the balance of fees and charges required by non-contracted providers, which can be in the thousands or tens of thousands of dollars. It does not include charges for services not covered by your individual plan, often the very coverage you declined because you wouldn’t need it. You would think that there would be regulations prohibiting insurers from using the term, “out-of-pocket maximum,” unless a full, clearly stated disclosure of the true risks were simultaneously provided.

Aetna also reveals the fallacy of the HSA plans. The high-deductible health plan that covers everything after the deductible is met is a fiction. The Aetna HealthFund(R) HSA plans “offer members similar benefits to the Aetna Advantage PPO plans.” Clearly, the HSA plans work only if you don’t get sick.

Under-insurance has become epidemic in America. Insured individuals are financially vulnerable in the face of significant medical need. The Aetna Advantage program represents a perverse expansion of this epidemic of under-insurance.

Aetna’s press release on the Aetna Advantage program, states that “we can make an impact on reducing this nation’s population of… under-insured people.” They could, but apparently they have no intention of doing so.

Aetna makes it easier to buy “under-insurance”

Aetna Launches New Health Insurance Website with Online Enrollment Capability for Individuals and Their Families
Aetna Press Release
September 20, 2005

“Aetna is making it as simple as possible for individuals to choose the appropriate, affordable plans that match their health care coverage needs,” said Laurie Brubaker, Aetna’s national general manager for Individual Markets. “The website guides individuals to consider their current life stages – for example, graduating from college, getting married, raising a family, becoming a sole proprietor, being between jobs or retiring early. We know that people’s priorities change and life circumstances determine the type of health care coverage individuals need.”

“We believe we can make an impact on reducing this nation’s population of uninsured – and under-insured – people,” Brubaker added. “We have researched consumers’ needs and created a range of health plans that provide choice, simplicity and affordability. Our cost-effective plans are designed to fit a variety of personal situations.”

In addition, Aetna offers individuals and their families high-deductible health plans that are compatible with the Aetna HealthFund(R) HSA (health savings account) in (eleven states and D.C.). These plans offer members similar benefits to the Aetna Advantage PPO plans… paired with an HSA.

http://www.aetna.com/news/2005/pr_20050920.htm

And…

Health Products for Individuals
Aetna

Life Stages in California (as an example)

New graduate
Getting married
Raising a family
Self employed
Between jobs
Empty nest
Retiring early

Frequently Asked Questions

The Aetna Advantage plans are voluntary plans that are medically underwritten; they are not conversion plans.

http://www.aetna.com/members/individuals/

Brochure for California Aetna Advantage Plan options:
http://www.aetna.com/members/individuals/health/data/
memberbrochure_California.pdf

Comment: The trends represented by the Aetna Advantage plans portend disaster for the future of health care coverage. This discussion barely touches on some of the alarming aspects of their program.

These plans are being marketed as a mechanism of selecting out only the coverage that you believe you will need, thereby avoiding contributing to risk pools that include coverage that you believe you won’t need.

Individuals will be enticed by the lower premiums of the limited coverage they select. Since no healthy person can predict future major health care needs, those individuals who select the limited plans will find themselves financially vulnerable with a significant change in their health status.

This unpredictability is precisely why everyone needs to have comprehensive coverage through a common risk pool.

Since these plans are “voluntary plans that are medically underwritten,” they will be sold exclusively to healthy individuals. People with preexisting disorders will have to find their coverage elsewhere. In the individual market, those plans would have to charge very high premiums because they concentrate risk. In actuality, those plans have been priced out of the market, leaving these vulnerable individuals without coverage.

The state-sponsored high-risk pools have not been able to make a dent in this problem. Only nefarious insurers/policymakers would target those with the greatest needs for exclusion from coverage.

These plans for various life stages “are not conversion plans.” Simply stated, as you move from a low-risk life stage, to one with greater risks, you must again pass underwriting standards to be covered by a plan that better meets your needs. What a clever idea. Aetna has figured out a way to drop coverage of many of those individuals who do develop chronic problems.

A problem for traditional plans is that, through the years, many of their clients develop chronic problems, and that results in higher, less-competitive premiums. This life stage concept circumvents that problem. Wall Street should really like this.

One of the most serious defects is that these are being marketed as plans that provide catastrophic coverage. If you look at the brochure describing plan options, you will see that they all offer an “out-of-pocket maximum,” ranging from $5000 to $25000. So if you chose the most comprehensive coverage, your maximum out-of-pocket expense, as an individual, would be $5000 plus the premiums paid for the year, or so they would have you believe. But what is the “out-of-pocket maximum”? It is merely the deductible plus the coinsurance paid to in-network providers. It does not include deductible and coinsurance penalties for using out-of-network providers. It does not include the balance of fees and charges required by non-contracted providers, which can be in the thousands or tens of thousands of dollars. It does not include charges for services not covered by your individual plan, often the very coverage you declined because you wouldn’t need it. You would think that there would be regulations prohibiting insurers from using the term, “out-of-pocket maximum,” unless a full, clearly stated disclosure of the true risks were simultaneously provided.

Aetna also reveals the fallacy of the HSA plans. The high-deductible health plan that covers everything after the deductible is met is a fiction. The Aetna HealthFund(R) HSA plans “offer members similar benefits to the Aetna Advantage PPO plans.” Clearly, the HSA plans work only if you don’t get sick.

Under-insurance has become epidemic in America. Insured individuals are financially vulnerable in the face of significant medical need. The Aetna Advantage program represents a perverse expansion of this epidemic of under-insurance.

Aetna’s press release on the Aetna Advantage program, states that “we can make an impact on reducing this nation’s population of… under-insured people.” They could, but apparently they have no intention of doing so.

Spending on biomedical and health services research

Financial Anatomy of Biomedical Research
By Hamilton Moses III, MD; E. Ray Dorsey, MD, MBA; David H. M. Matheson, JD, MBA; Samuel O. Thier, MD
JAMA
September 21, 2005

The United States spent an estimated 5.6% of its total health expenditures on biomedical research, but less than 0.1% for health services research.

Biomedical research funding increased from $37.1 billion in 1994 to $94.3 billion in 2003. Principal research sponsors in 2003 were industry (57%) and the National Institutes of Health (28%).

The federal government and foundations spent $1.4 billion on health policy research and health services research in 2002. Federal funding for health services research came primarily from the NIH ($787 million in fiscal year 2002) and the Agency for Healthcare Research and Quality ($299 million in fiscal year 2002). The Robert Wood Johnson Foundation accounted for nearly 63% of the $359 million foundations gave for health policy in 2002.

This limited investment in health services research has occurred despite growing concern about the cost (eg, double digit growth in health insurance premiums) and quality (eg, errors in medicine and failure to implement best practices) of health care in the United States.

http://jama.ama-assn.org/cgi/content/abstract/294/11/1333?etoc

Comment: Many astute observers of the health care scene are now questioning the value of much of our expensive new technological and pharmaceutical products. Although new drugs may show a slight, statistically significant superiority in clinical trials, there is genuine concern that most of these new products do not have much of an overall favorable impact on the health of the target populations, especially when compared with established, less expensive products. Also, regions which have a greater capacity for providing higher tech care have failed to demonstrate a commensurate improvement in health care outcomes (though there are isolated examples of the benefits of some interventions). The point is that our research has been targeted toward creating more profitable products rather than toward more beneficial products that provide much greater value.

In contrast, consider what improvements could be made in the overall health of our entire population if only we put in place the policies already demonstrated to be effective through health policy and health services research. The impact could be readily measured in just the number of lives saved, not to mention the reduction in human suffering. Most of these policies would cost very little and could actually result in a reduction of our global health care spending.

This is not to say that we should not be investing in biomedical research, but we should be demanding that health care consumers, who are footing the bill, receive greater value than they currently are.

Government and foundation spending in health policy and health services research has been a bargain considering the rich body of beneficial policy options that it has produced. So why aren’t we putting these policies into place?

That’s not really meant to be a rhetorical question. Perhaps we could use one more survey of the policy literature addressing this question. The political scientists could help us with the “why,” but who can help us with the “how to”?

Business leaders support single-payer

Business leaders lean toward dramatic health-care changes
Friday, September 16, 2005

By Rick Haglund
Detroit Bureau
MLive.com

TRAVERSE CITY — Frustrated over seemingly never-ending hikes in health care costs, some 40 percent of Michigan business executives polled in a new survey say they support nationalized health care or a privately run, single-payer system financed by the federal government.

The poll of 350 business people, released here Thursday at the Michigan Chamber of Commerce’s annual Future Forum conference, found that 42 percent of those surveyed supported a national health care system. Answering a second question, 40 percent said they supported a single-payer system.

In the wide-ranging survey by pollster Steve Mitchell, business leaders also expressed a deep pessimism about the state’s business climate and Democratic Gov. Jennifer Granholm’s leadership.

Sixty-nine percent said the state’s business climate is on the wrong track, while only 43 percent approved of the job Granholm is doing.

“We have not seen numbers like this since the early 1990s,” Mitchell said.

That was a time when unemployment in the state topped 15 percent. Unemployment currently is at 6.7 percent.

But Mitchell said Granholm’s low approval rating wasn’t too surprising, given the Republican leanings of most business owners surveyed. President Bush got a 70 percent approval rating in the poll.

Also the national economy is doing well, while Michigan’s manufacturing-based economy is struggling, he said.

Granholm’s spokeswoman Liz Boyd said the governor’s 43-percent approval rating by members of a group with close ties to the state Republican Party was “just great.”

Support for universal health care among most Republican business executives was surprisingly high, even in the face of rapidly rising costs.

“This finding that four in every 10 business decision-makers are willing to look at a different way of delivering health care is something you wouldn’t have seen 10 years ago,” said Mitchell, president of Mitchell Research and Communications Inc. in East Lansing.

His poll surveyed Michigan Chamber of Commerce members from Aug. 15-Sept. 1. Of those surveyed, 72 percent represented businesses employing fewer than 50 workers; 16 percent were in manufacturing.

Rich Studley, senior vice president of government affairs at the chamber, said business owners may be looking to the federal government to provide health care because they’re frustrated that their efforts to control costs aren’t working.

And many of the chamber’s small-business members who can’t afford to provide health insurance for their workers, but who would like to, “see that goal just getting farther and farther away,” Studley said.

William Rustem, president of Public Sector Consultants Inc. in Lansing, said the apparently increasing support by business for universal health care could lead to radical reforms. Many business leaders have been reluctant to push for universal health care because the Bush administration and the Republican-controlled Congress are opposed.

“I think this is an amazing result,” Rustem said about the chamber poll. “This may be a recognition by the business community of a public will to do something about health care.”

On Wednesday, the annual Kaiser Family Foundation survey found it now costs U.S. employers an average $10,800 a year to provide health insurance for a family. That’s up 9.2 percent from 2004.

The chamber survey also found the top two problems limiting the hiring of workers in coming years are a lack of skilled applicants and the high cost of health care.

Among various state taxes, 56 percent of business decision-makers said the Single Business Tax was the most onerous.

Studley credited Granholm with proposing sweeping changes in the SBT earlier this year, even though the chamber has vehemently opposed Granholm’s plan to raise taxes on insurance companies in order to give manufacturing and research companies a break.

He criticized the Legislature for not yet passing SBT reform.

“Every day our members are making decisions about whether to stay in Michigan or leave,” Studley said. “The message we want to send to the Legislature is: For goodness sake, take action.”

Canadian and British researchers receive Lasker Awards

Five Pioneers Are Awarded Lasker Medical Prizes
By Lawrence K. Altman
The New York Times
September 18, 2005

The 2005 Lasker Awards for medical research are going to scientists who discovered stem cells, invented genetic fingerprinting and developed a powerful technology that played a crucial role in mapping the human genome.

The research award for stem cell work is going to Drs. Ernest A. McCulloch and James E. Till, emeritus professors at the University of Toronto and the Ontario Cancer Institute.

Sir Edwin Southern of the University of Oxford and Sir Alec J. Jeffreys of the University of Leicester in England received the Lasker Award for developing two powerful technologies, Southern blotting and DNA fingerprinting, that, the foundation said, “together revolutionized human genetics and forensic diagnostics.”

Comment: In arguing against national health insurance for the United States, pro-market advocates frequently state that a government-run program, like they have in Canada and England, will suppress innovation and technological advances that are possible only in a free-market system.

This year’s Lasker awards, presented to Canadian and British researchers, certainly demonstrate that the manner of funding health care in their nations did not suppress research and innovation. In fact, their work was conducted in an environment that spends significantly less on health care than does the United States.

Probably the two greatest technological advances of the last half century are C-T scans and MRIs. Each was appropriately awarded the Nobel Prize, which were shared with British researchers. Again, the very modest funding of Great Britain’s National Health Service did not suppress their research.

One other very important point: No matter the avenue of funds flowing into health care, whether public or private, there is absolutely no way that the health care tech industries are going to simply walk away from the $1.9 trillion that we are already spending. They will continue to do everything in their power to try to get a portion of that, including innovative research and practical applications of publicly-funded research through the NIH.

Although unrelated to this message, it is imperative that we acknowledge the fifth Lasker Award mentioned in the title: “… a nonscientist, Nancy Brinker, is the winner of the Lasker Public Service Award for creating the Susan G. Komen Breast Cancer Foundation, which has helped transform a disease once rarely mentioned in polite conversation into an international issue.”

Iraqi Constitution guarantees health insurance

Text of the Draft Iraqi Constitution
(Translated from the Arabic by The Associated Press)

Chapter Two: Rights and Freedoms

Article (30): 1st – The state guarantees social and health insurance, the basics for a free and honourable life for the individual and the family – especially children and women – and works to protect them from illiteracy, fear and poverty and provides them with housing and the means to rehabilitate and take care of them. This shall be regulated by law.

http://news.bbc.co.uk/1/shared/bsp/hi/pdfs/24_08_05_constit.pdf

Comment: Freedom and democracy brings the right of health care to everyone.

Or does it?