Anthem, UnitedHealth, Wellpoint Pay CEO Fortunes: Graef Crystal

Oct. 6 (Bloomberg)

While 45 million Americans don’t have health insurance, the chief executive officers of the major companies that provide health coverage to much of the nation are munificently paid.

Among 12 U.S. health insurers, all with 2003 net sales of $1 billion or more, the median and average total pay came to $9 million and $15.2 million, respectively.

At the top of the compensation ladder are Anthem Inc.’s Larry Glasscock, UnitedHealth Group Inc.’s William McGuire and WellPoint Health Networks Inc.’s Leonard Schaeffer. Their respective 2003 total pay amounted to $50.9 million, $30 million and $27.4 million. To get to the fourth-most-highly-paid CEO — Aetna Inc.’s John Rowe — you would have to drop down to $16.2 million.

(Total pay consists of the sum of base salary; annual bonus; my estimate of the present value of stock options granted in 2003 and valued at the date of grant using the Black-Scholes model; the value at grant of free share awards made in 2003; payouts in 2003 under other forms of long- term incentive compensation; and miscellaneous compensation. Data for this study were obtained from Aon Consulting’s eComp database.)

What’s going on here is an extremely heavy emphasis on rewarding for size of net sales. UnitedHealth, WellPoint and Anthem occupy, respectively, the first, second and fourth slots on the net sales rankings, while Aetna came in third.

What About Performance?

Too bad the boards of these companies didn’t place more emphasis on performance, or for that matter, any emphasis at all.

The average 2003 revenue of the three highest-paid health-care executives was $22 billion, while their average total return for the single year ended Dec. 31, 2003, was 31.6 percent. For that, the three CEOs received average pay of $36 million each. Indeed, Glasscock produced the lowest total return of the group of 12, yet he earned the highest pay by far.

Yet the three best performers in terms of total return last year were none of the above. They were PacifiCare Health Systems Inc. (total return of 140.6 percent); Sierra Health Services Inc. (128.6 percent) and Humana Inc. (128.5 percent). For those magnificent performances, the three CEOs averaged $6.8 million apiece, a figure that was just 19 percent of the pay of their much bigger brothers.

Bigger Is Better

Face it, we Americans have a fixation with size. We boast about our buildings, our gross national product and our huge weaponry. Bigger is better. It seems never to have dawned on those worthies who sit on boards of directors that maybe there’s a different, more compelling mantra they should be reciting: Better performing is better.

Let’s focus more closely on Glasscock’s 2003 pay package of $50.9 million. Included in that amount was a long-term cash payment of $21.2 million, along with free shares valued at the same $21.2 million.

Anthem pointed out that the $42.4 million total was generated, not by Glasscock’s performance in 2003, but rather for his performance in the years 2001 through 2003.

It’s certainly correct that 2003 was an unusually good year for Glasscock. Still, don’t cry about his meager pay in earlier years because for 2001 through 2003, he still averaged a princely $26.3 million annually in remuneration, just a tiny bit behind McGuire’s $27.1 million. Not so for his company’s three-year average net sales, which were 48 percent lower than those of UnitedHealth.

Read the Footnote

In its proxy filed in 2002 and covering the year 2001, Anthem, following disclosure rules promulgated by the U.S. Securities and Exchange Commission, informed shareholders that Glasscock had been given the opportunity to earn $4.1 million for “target” performance in the years 2001 through 2003.

It also said his “threshold” payout — below which the next stop is zero — would be $2 million. The company went on to declare that whatever Glasscock earned at the end of the three-year performance period would be predicated on “specific strategic objectives such as growth in net income, operating margin and comparison of performance against peer companies.”

Those same proxy disclosure rules also require a company to tell shareholders what the maximum payout would be under any long-term incentive grant — the payout for hitting all the bases. Yet there was no maximum column in the case of Anthem’s long-term incentive table included in its proxy. Instead, there was a footnote.

If you were a shareholder at Anthem at the time, you might have missed that footnote. Nonetheless, it stated, quite plainly, that “Under the LTIP (long-term incentive plan), there is no maximum limitation.”

Some Understatement

That sure turned out to be an understatement. With his ultimate payout of $42.4 million, Glasscock ended up earning 10.5 times his target award.

Anthem’s income statement did look fabulous during the three-year period. Yet its total return of 23.1 percent a year for the two years ended Dec. 31, 2003, ranked it only ninth among the companies in the study whose stock had been publicly traded for at least two years. (A three-year total return couldn’t be computed because Anthem didn’t go public until Oct. 29, 2001.)

Exhibiting more prudence this time out, Anthem told its shareholders in its 2004-filed proxy that, under a new long-term incentive grant, there wouldn’t be just threshold-award and target levels, but also a maximum-award one.

The imposition of a maximum-award level demonstrates what the lawyers call “consciousness of guilt” on the part of Anthem’s board compensation committee.

Cake or Crumbs?

Glasscock and Schaeffer are trying to merge their two companies. Both have been high-performers. When I look at the pay of the two CEOs and consider that each company has a long tradition of rich compensation, I begin to wonder if the shareholders of the combined company will be eating cake — or just crumbs on the cake plate.

Below is a table showing for each of the 12 CEOs in the study the company’s total return for the single year ended Dec. 31, 2003, the 2003 total pay of the CEO and the percentage by which that pay was higher or lower than a hypothetical “going rate” of pay adjusted for the relative size of the company.

Company / CEO / 1-Year Return / 2003 Pay (millions) /Above or Below Market
Anthem Inc. / Larry Glasscock / 19% / $50.9 / 138%
Coventry Health / Allen Wise / 122% / $14.6 / 81%
Wellpoint Health / Leonard Schaeffer / 36% / $27.4 / 11%
Sierra Health / Anthony Marlon / 129% / $3.6 / 2%
UnitedHealth Grp. / William McGuire / 39% / $30.0 / -6%
Amerigroup Corp. / Jeffrey McWaters / 41% / $2.9 / -21%
Wellchoice Inc. / Michael Stocker / 44% / $6.9 / -24%
Aetna Inc. / John Rowe / 64% / $16.2 / -28%
Pacificare Health / Howard Phanstiel / 141% / $10.2 / -35%
Oxford Health / Charles Berg / 19% / $5.4 / -41%
Health Net Inc. / Jay Gellert / 24% / $7.9 / -50%
Humana Inc. / Michael McCallister / 129% / $6.6 / -61%

Low / 19% / $2.9 / -61%
Median / 42% / $9.0 / -23%
Average / 67% / $15.2 / -3%
High / 141% / $50.9 / 138%

To contact the writer of this column:
Graef Crystal in San Diego at graefc@bloomberg.net.

To contact the editor responsible for this column:
Bill Ahearn at bahearn@bloomberg.net.

From the Oct. 11, 2004 issue of TIME magazine
Viewpoint / Health

Americans are burdened with a costly, hugely dysfunctional health-care system. In a new book, a pair of investigative reporters offers a fresh remedy based on a successful model we’re all familiar with.
By Donald L. Barlett; James B. Steele

This is the picture of health care in America. We spend more money than anyone else in the world — and yet have less to show for it than other developed countries. That’s one reason we don’t live as long. We don’t adequately cover half the population. We encourage hospitals and doctors to perform unnecessary medical procedures on people who don’t need them, while denying procedures to those who do. We charge the poor far more for medical services than we do the rich. We force senior citizens with modest incomes to board buses to Canada to buy drugs they can’t afford in America. We clog our emergency rooms with patients because they can’t get in to see their doctors. We spend more money treating disease than preventing it. We are victims of rampant fraud and overbilling. We stand a good chance of dying from a mistake if we are admitted to a hospital, and we kill more people with prescription drugs than with street drugs like cocaine and heroin. We have an endless choice of health-care plans, but most people have few real choices. We are forced to hold bake sales, car washes and pancake breakfasts to pay the medical bills of family members and friends when a catastrophic illness strikes.

Americans tend to believe they have the best health care in the world, but in truth it is a second-rate system and destined to get a lot worse and much more expensive.

It need not be this way.

The simplest and most cost-effective remedy is one that is considered untouchable in the U.S. because of the huge lobbying forces arrayed against it. Indeed, neither presidential candidate has come close to offering such a comprehensive solution. The remedy: provide universal coverage and create one agency to collect medical fees and pay claims. This would eliminate the staggering overlap, bureaucracy and waste created by thousands of individual plans. Under a single-payer system, all health-care providers — doctors, hospitals, clinics — would bill one agency for their services and would be reimbursed by the same agency. Every American would receive basic health care, including essential prescription drugs and rehabilitative care. Anyone who needed to be treated or hospitalized could receive medical care without having to wrestle with referrals and without fear of financial ruin.

Radical? We already have universal health care and a single-payer system for everybody age 65 and over: it’s called Medicare. For years, researchers and health-care professionals have advocated a similar plan for the rest of the population, but no plan has ever got far in the legislative process because of fierce opposition by the health-care industry. To discredit the single-payer idea, insurers, HMOs, for-profit hospitals and other private interests play on Americans’ long-standing fears of Big Government. In truth, it is the private market that has created a massive bureaucracy, one that dwarfs the size and costs of Medicare, the most efficiently run health-insurance program in the U.S. in terms of administrative costs. Medicare’s overhead averages about 2% a year. In a 2002 study for the state of Maine, Mathematica Policy Research Inc. concluded that administrative costs of private insurers in the state ranged from 12% to more than 30%. That isn’t surprising because unlike Medicare, which relies on economies of scale and standardized universal coverage, private insurance is built on bewildering layers of plans and providers that require a costly bureaucracy to administer, much of which is geared toward denying claims.

What kind of agency would administer this Medicare-like plan for the rest of us?

The idea of a single-payer plan run by the U.S. government carries with it far too much political baggage to ever get off the ground. What’s needed is a fresh approach, a new organization that is independent and free from politics. For in addition to covering the basic costs of all Americans, a new system would need to institute programs to improve America’s overall health that focus on preventing illness and disease as well as on treatment and do so without breaking the bank. How does the U.S. come up with such a mechanism?

One possible answer: loosely copy and then expand on what already exists in another setting — the Federal Reserve System, which oversees the nation’s money and banking policies. The Fed is one of America’s most ingenious creations, a public agency that is largely independent of politics. The Fed’s board members are appointed to 14-year terms by the President with the consent of the Senate, meaning that neither the White House nor Congress can substantively influence the Fed’s policies.

Call this independent agency the U.S. Council on Health Care (USCHC). Like the Fed, the council would set overall policy for health care and influence its direction by controlling federal spending — from managing research grants to providing medical coverage for all citizens. Unlike the Fed, it would be funded by taxpayers. The money could come from two taxes: a gross-receipts levy on businesses and a flat tax, as with Medicare, on all individual income, not just wages.

This would not represent an additional cost to society but would rather replace existing taxes and write-offs. It would cut costs for corporations and raise taxes slightly on individuals at the top of the income ladder. The council’s mission: implement policies that improve health care for everyone, not just those suffering from certain diseases. In short, make the unpopular decisions that the market cannot make. The council could establish regions similar to those of the Fed.

The geographic subdivisions could take into account cultural and regional differences. That would allow for health-care delivery to be fine-tuned at the local level and ensure that regulations take into account the differences between metropolitan and community hospitals. That is not to suggest that a single-payer system overseen by a Fed-like independent organization would instantly correct everything that’s wrong with market-driven health care. What it would do is provide the framework to reach that goal. For starters, it would:

Guarantee that all Americans receive a defined level of basic care, including a fixed number of visits to doctors, routine lab work, immunizations for children, coverage for all childhood illnesses and all hospital charges.

Establish flexible co-pays for basic care that would vary depending on income as well as usage. Those people who seldom seek medical attention could have their co-pays waived. So too could those at the bottom of the income ladder.

Pay all costs to treat any catastrophic illness, such as cancer and other devastating diseases.

Restore freedom of choice by allowing patients to choose their doctors and their hospitals.

Redirect health-care spending by allocating money for disease prevention as well as treatment.

Provide critically important drug information to consumers to balance the promotional hype of advertising.

Concentrate health-care spending on cost-effective areas, such as stemming the increased prevalence of diabetes in children.

Halt the existing practice by which insurers squeeze doctors through unrealistically low reimbursement rates. The same for hospitals and nursing homes that squeeze nursing salaries and staffing levels.

Reverse the costly but seldom discussed health-care trend of overdiagnosis and overtreatment — something no market system will ever do. While many Americans suffer from a lack of health care, a growing number get too much.

Once the basic care package is in place, its scope could be expanded as the system realizes savings derived from standardization, more efficient computer technology and the end of market-based health-care management, with its required profits, stock options and generous executive compensation.

Individuals could supplement their basic government-supported coverage through private insurance. Wealthier citizens could continue to get whatever care they wanted and pay for it. But they would still be required to pay the earmarked taxes, just as everyone must contribute to Medicare and Social Security. Similarly, hospitals would be free to accept a certain percentage of cash-paying patients from outside the USCHC plan. As for prescription drugs, a good health-care system would strive to prescribe fewer pills, especially since the effectiveness of many drugs is questionable. The USCHC could negotiate the best possible drug prices, something that Medicare is forbidden to do by Congress.

Many Americans fear that a universal health plan would cost too much, even though the market system has already given the U.S. the world’s most expensive health care. They fear the long waits they have heard about in Canada, even though comparable waiting times for tests and procedures are commonplace in many parts of the U.S. Lastly, they fear government-decreed rationing, even though health care is already rationed in the most inequitable of ways.

Despite all the fears, change will come, ultimately from two sources: working Americans who are disenchanted with ever rising costs and shrinking care, and U.S. corporations, which are increasingly refusing to pick up the added costs. They can’t afford to, because America’s privately funded system puts U.S. companies at a disadvantage to their competitors in the industrialized world, where health care is funded by government. GM says the cost of providing health care to its workers and retirees totals $1,400 for each vehicle sold in the U.S., more than the cost of steel.

America’s health-care system is in critical condition, and we find ourselves at a turning point. We can continue to hold bake sales to finance it, or we can do what every other civilized nation on earth does — take care of our citizens.

Press Release
Embargoed until: October 7, 2004
For more information: Rand Wilson, 617 989-8045, rand@jwj.org

New “Waste Not, Want Not” report:
Study shows $245 billion savings from cutting insurance and drug industry waste could fund health care for all

Grassroots groups will release 15 state reports in 21 cities

WASHINGTON, DC – Jobs with Justice will release a report on Oct. 7 showing that approximately $245 billion is wasted on private insurance red tape and protecting drug company super-profits each year. The study concludes that by providing insurance more efficiently and making drug companies sell in a more competitive market, the savings could be used to provide secure, affordable health care for all.

The report, Waste Not, Want Not: How Eliminating Insurance and pharmaceutical Industry Waste Could Fund Health Care For All will also be released by local Jobs with Justice coalitions or other organizations in CA, FL, GA, IN, KY, MA, MN, NC, NY, OH, PA, RI, TN, TX, and VT. Local releases will have state-specific versions of the report with data showing that in every state the savings from waste is enough to cover all of the uninsured.

Waste Not, Want Not focuses on how three reforms to the current health care system could prevent billions of dollars in waste and yield enough savings to guarantee secure and affordable health care for all. Specifically:

* The fragmented system of nearly 1,300 private health insurance companies creates unnecessary red tape and administrative waste. The national Medicare program has a proven track record of providing insurance at slightly less than one-tenth the cost of private plans. Adopting Medicare’s standard of efficiency and improving and expanding it to cover everyone, would save more than $94 billion on health care every year.

* Although the federal government and other public sources already pay half the cost of research and development, drug companies receive long term patent protections that discourage competition and guarantee super profits. If the federal government paid for all of the R&D, it could eliminate the patent protections, encourage competition and generic drugs, and save $140 billion in health care costs every year.

* The Bush Administration’s recently enacted Medicare prescription drug bill gave additional subsidies for private insurers because they can’t compete with the efficiency of Medicare. Reversing these and other devastating changes to Medicare could save $83.6 billion (or $11 billion a year) over the next eight years.

Together, these savings would be more than enough to provide insurance coverage for all of the 81.8 million people who went without health insurance for all or part of last year.

“Americans are paying more for health care and getting less every year. Waste Not, Want Not is proof that we are not just spending more than any other country, we are wasting more,” said Rep. Jan Schakowsky (D-IL). “Instead of throwing away precious health care dollars on bureaucracy, fragmentation and excessive profits, we could be providing high quality medical care for all.”

“So many politicians say they support the concept of health care for all, but then hide behind the question of how a universal plan would be financed,” said Fred Azcarate, director of Jobs with Justice. “Our study shows that health care for all isn’t an economic problem; it’s a question of political will. Across the country, people are building a movement to force politicians to stand up to the special interests and pass laws for secure and affordable health care!”

Waste Not, Want Not is based on an analysis of government census and economic data done by the Center for Economic and Policy Research (CEPR), located in Washington, DC. The report was funded by six unions in conjunction with Health Care Action Week, October 3 – 10, 2004.

Health Care Action Week is sponsored by eleven unions and nine national health care reform organizations.

The report will be available on the Jobs with Justice website at www.jwj.org on October 7.

Jobs with Justice is a national campaign for workers’ rights. More than 40 local Jobs with Justice coalitions unite labor, community, faith-based and student organizations to build power for working people.

# # #

Rand Wilson
Jobs with Justice (www.jwj.org)
21 Fellows Street, Boston, MA 02119
Phone: (617) 989-8045, Fax: (617) 541-6839, Email: rand@jwj.org

Labor, Business, Medical Leaders Launch America’s Agenda: Health Care for All, Aiming To “Break the Insurance Lobby Choke-hold on Health Care”

Embargo for Oct. 7
For more information:
Larry Rubin 202-955-1250

WASHINGTON, DC, October 7 — “There will be no health care for all Americans until our political leaders are willing to take on a health insurance industry that showers them with cash,” said Douglas Dority today as he announced the launching of America’s Agenda: Health Care for All. “Insurers have proven time and time again they will spend whatever it takes to perpetuate a system of financing that makes them wealthy while restricting care only to those who can afford it.”

Dority, chair of the new organization that will help grassroots groups fighting for universal health care, is the former president of the United Food and Commercial Workers union (UFCW). He was joined by other union leaders, and by health care reform advocates from the business and medical communities and from Capitol Hill.

“The insurance companies with their scandalous profit-taking deny access to care to even those with insurance by practices of excluding pre-existing conditions, complex paperwork and uncovered benefits,” said Dr. Claudia Fegan, president of the Physicians for a National Health Program (PNHP). “Over 12,000 physicians support a national health insurance program that will cover everyone with the money we would save from the administrative waste of our current system.”

U.S. Rep. Tammy Baldwin (D-WI) said “it is time to put ‘health care for all’ at the top of our national agenda.” She has introduced a bill that would give federal funding to states that institute programs expanding access to health care. Rep. Baldwin and Dr. Fegan have agreed to serve on the Advisory Committee for America’s Agenda.

“Our medical system is dysfunctional and bad not just for our health, but for our entire economy,” said Bernard Rapoport, founder and former CEO of the American Income Life Insurance Company. Rapoport, a member of the America’s Agenda governing board, said “soaring costs are undermining the competitiveness of American business in the global economy. The U.S. is the only country in the industrialized world that doesn’t have publicly-financed health insurance, so American companies are burdened with expenses others don’t have, endangering our manufacturing base.” As examples, he cited Ford Motor Co. that spends $3.2 billion a year on health premiums and General Motors that spends more on health than on steel.

“The American people are fed up,” said Dority. “Poll after poll shows they want affordable health care that covers everyone. Why don’t we have it? Because America’s health insurance industry does everything in its power to block it . The current system may be a shambles, but it is a profitable shambles for those who run it.”

Joe Hansen, Dority’s successor as UFCW president and an America’s Agenda board member, renewed the union’s commitment to universal health care. “No one union, no one company, has a solution for the health care crisis,” said Hansen. “It has to be a political solution.”

“Out of control health care costs are a huge problem not just for workers but for employers who have health care plans,” said Marty Maddaloni, general president of the United Association of Plumbers and Pipefitters. “It puts these employers at a competitive disadvantage with those who do not have such plans.”

“I can think of no economic issue that impacts all working families in America more than the growing health care crisis,” added Morty Bahr, president of the Communications Workers of America. “It is criminal that 45 million Americans are without any health insurance and that number is projected to go to more than 51 million in 2006.” Both Bahr and Maddaloni serve on the governing board of America’s Agenda.

Dority noted that in recent years concerned citizens from Massachusetts to New Mexico have waged statewide campaigns for universal coverage. Additionally, health care reform initiatives and legislative hearings are progressing in several states, “but the industry continues to spend astronomical amounts of money to defeat them.”

Health insurers all across the nation have come together to create America’s Health Insurance Plans (AHIP) to lobby for the status quo. AHIP will run a multi-million dollar campaign with offices in 46 different states. “In the recent past, effort after effort by state-level grassroots groups to reform our broken health care system has been defeated by the well-heeled health insurance lobby,” Dority said. “We intend to help level the playing field. We must break the insurance lobby choke-hold on U.S. health care.”

To support grassroots groups, Dority said that America’s Agenda: Healthcare for All will utilize TV, radio, print media and the Internet to mount creative and coordinated “truth campaigns”. Business leaders, physicians, elected officials, labor leaders and universal health care campaign activists will be effective “messengers of truth” about the costs and benefits of specific health reform proposals. “We will counter the insurance lobbyists by taking the truth to the American people,” said Dority.

Until recently, Dority was president of the United Food & Commercial Workers (UFCW), a union whose members have been in the forefront of the battle to protect health benefits on the job. This past winter, tens of thousands of grocery workers were forced into bitter strikes in California, Ohio, Kentucky and West Virginia, in an effort to hold the line for workers across the nation whose health benefits were under attack. Dority didn’t blame the employers– he blamed the system. In March, he announced he was stepping down at UFCW “to devote my energies to a new effort to convince our political leaders that health care for all Americans is long overdue.”

— ## —

Edmonton Journal
October 5, 2004
Health-care fraud alarm sounded
Auditor criticizes Alberta gov’t for losing track of two million health cards
By Jason Markusoff and James Baxter

(Auditor General Fred) Dunn charged that Alberta Health ignored its own warning in a report from 1998. The ministry’s health-fraud watchdogs had raised the spectre of U.S. citizens using Alberta health-card numbers.

In some health regions near the U.S. border, there were double as many health numbers as there were residents. For Americans without health insurance, medical costs in the U.S. can be astronomical. Alberta health-care cards would be money in their pockets.

http://www.canada.com/edmonton/edmontonjournal/news/story.html?id=99959fde-e0db-4d46-8115-515001e92e8d#Soundoff

by Saul Friedman
October 2, 2004

It’s time Gray Matters put up or shut up, instead of merely complaining about what passes for the American health care system. And if one day we get a responsive president and Congress, what is a realistic alternative to the nation’s dependence for its health care on the private health insurance business?

I say “realistic” because presidents at least as far back as Harry S. Truman in 1948 have sought universal health care – but he had to settle for Medicare about 20 years later. In 1992 the Clintons tried with a proposal that sought to satisfy everyone, but it collapsed under its own weight and was killed by the insurance industry.

But the polls and the deepening crisis in health care, including the loss of insurance for millions of workers and retirees, seem to be reviving the imperative for change. And if we can stop the Bush administration from killing our only national health insurance program, Medicare, it could become the vehicle for a politically feasible alternative – a universal, “single-payer” system.

Despite the assaults from the right, Medicare remains the nation’s most popular and efficient health insurance program: 90 percent of eligible beneficiaries participate, and 98 percent of non- pediatric physicians accept Medicare; so do most hospitals. According to polls, younger workers hope to join one day, but doubt there will be enough funds left for them.

Nevertheless, Medicare coverage is incomplete, without a real prescription drug benefit and too many limits to save money. And it pays too much money to private contractors that administer the benefits in each state. More important, Medicare will die of old age or be killed by HMOs unless the program is opened, perhaps gradually, to all Americans. That way, the Medicare risk pool could be strengthened by the young, and the program for the elderly would become the U.S. version of Canada’s single-payer system.

Single-payer is not socialized medicine or anything like the British model, but it is not widely understood in the United States. The best and clearest explanation can be found in a narrative or an animation by Graham Walker, a Stanford University medical student and former staff member of Physicians for a National Health Program. (Look for it at www.grahamazon.com/sp)

Briefly, Walker says, “Socialized medicine is the system in the U.K. – the government owns the hospitals, employs the doctors.” Single-payer is more like the Canadian system, where “the government pays the hospital and pays the doctor, but hospitals and doctors are still part of the private sector…. Everyone cares who their doctor is, but do you really care who pays your doctor?”

If you’re worried that the government can’t do anything right, Medicare, backed by 35 years of expertise, is far more efficient and responsive than your average insurance company. Yet its coverage reaches everywhere. Ask anyone who’s been on Medicare for years whether it works. Ask any caring physician whether he or she has more trouble dealing with Medicare or the HMOs, which doctors and hospitals have had to sue.

“Right now,” Walker says, “we ration care by the ability to pay….Single-payer rations care by health care need. There would be no more pre-existing conditions, no more hassles to see a doctor.”

Medicare, which covers more than 40 million older and disabled Americans, is dependent on congressional appropriations and is running into financial trouble; its premiums and fees are getting too expensive. How can the United States pay for a similar single-payer system to cover 300 million? “Money would come from employers and employees,” Walker says, “but most of the money is already in the system – it’s just currently going to HMOs [and other private insurers] instead of to a single payer.” He noted that several studies estimated that a single-payer system would save enough money on administration to cover the 45 million Americans who are uninsured.

An estimated $285 billion is spent on administrative and middlemen services that provide not a single aspirin. Says Walker: “The U.S. spends double what most other countries spend on health care, and Americans have shorter life spans and millions go uninsured. Many financing schemes exist…. Put most simply, the money that most businesses currently pay for health care would go to single-payer; this would make up most of the money needed.”

As Sen. Hillary Rodham Clinton (D-N.Y.) pointed out, businesses in Canada and other nations with similar health systems have the edge over the United States. Employers, including government, face increasing costs to cover their workers, as well as retirees. With single-payer, no more would a worker or retiree be left without health coverage by a bankruptcy or budget problems.

A new poll for the nonpartisan Civil Society Institute reports that 67 percent of Americans would support guaranteed health insurance, through a government program or a nonprofit source. Even when called “national health insurance,” it’s supported by 52 percent.

I’m sure any single-payer system will have its glitches and frustrations, and some for-profit hospitals and health care corporations may not survive. Nevertheless, single-payer is worth considering.

Write to Saul Friedman, Newsday, 235 Pinelawn Rd., Melville, NY, 11747-4250, or by e-mail at saulfriedman@comcast.net.

Copyright (c) 2004, Newsday, Inc.
This article originally appeared at:
http://www.newsday.com/news/health/ny-saul3991259oct02,0,6607503.column?coll=ny-health-headlines