PNHP

China’s lucrative group insurance market

China’s lucrative group insurance market

China View
www.chinaview.cn
Jan. 14, 2005
Overseas firms move on group insurance market

Foreign insurers are making rapid headway in China’s lucrative group insurance market, displaying strong competitiveness in this newly opened sector.

Honouring pledges it made upon joining the World Trade Organization in 2002, China lifted all geographical and business scope restrictions on foreign insurers in December, opening key businesses such as group insurance, health insurance and annuities.

There are currently 18 Sino-foreign insurance joint ventures like AVIVA-COFCO operating in China. By mostly partnering with leading local companies, these foreign insurers have gained a major foothold in the lucrative group insurance market, analysts say.

Such a model is likely to prove a powerful weapon for joint venture insurers in China’s group insurance market, and may greatly change the market’s landscape in a couple of years, they say.

http://news.xinhuanet.com/english/2005-01/14/content_2457810.htm

Comment: “… lucrative…” I’ll bet it is.

Kaiser Family Foundation

Kaiser Family Foundation
News Release
January 11, 2005

… a new post-election survey conducted by the Kaiser Family Foundation and the Harvard School of Public Health.

At the top of the list, almost two thirds (63%) of U.S. adults cite lowering the costs of health care and health insurance as a top priority for the President and Congress, followed by making Medicare more fiscally sound for the future (58%) and increasing the number of Americans with health insurance (57%).

Health care costs

Lowering the cost of health care and insurance was named as a top priority for the President and Congress by 63% of the public, and by an equal share of Republicans (61%) and Democrats (61%). Asked about the causes of rising
health care costs, 29% of Americans say that high profits made by drug and
insurance companies are the most important factor, while 22% say the number
of malpractice lawsuits and 15% say the amount of greed and waste that occurs in the health care system. In comparison, 7% cite the costs of medical technology and drugs, a factor many health care experts cite as a major driver of higher health care costs.

Expanding health coverage for the uninsured

The public places a relatively high priority on increasing the number of Americans with health insurance.

However, the public does not agree on a single best approach and is relatively evenly divided on a number of potential policy approaches. When asked to choose their most preferred option to increase the number of Americans with health insurance, 23% say offering businesses tax deductions or other financial assistance to help them provide health insurance to their employees, while 17% say offering tax deductions or other financial assistance to help individuals pay for private insurance and 17% say expanding state government programs such as Medicaid. Smaller shares (between 12% and 15%) say they most prefer other options, such as a national government health plan, expanding Medicare to cover people under age 65, and requiring businesses to offer health insurance for their employees.

Americans are also divided on whether they are willing to pay more, either in taxes or in higher health insurance premiums, to expand coverage to the uninsured – with 51% saying they would not be willing to pay more, and 45%
saying they would be willing to pay more.

http://www.kff.org/kaiserpolls/pomr011105nr.cfm

Poll Toplines

8. As you may know, the federal government has a budget deficit this year, so there will be only a limited amount of money for expanding things the government does. I’m going to read you a list of some different things the President and Congress might try to act on this year, some of which will cost money to do and some will not. As I read each one, tell me if you think it should be one of their TOP priorities, important but not a top priority, not too important, or should not be done at all. What about (INSERT)?

Should this be one of their TOP priorities, important but not a top priority, not too important, or should not be done at all?

e. Dealing with health care costs

60% – Top priority
34% – Important, but not a top priority
04% – Not too important
01% – Should not be done at all
00% – Don’t know

j. Expanding health insurance coverage for people who are uninsured

50% – Top priority
39% – Important, but not a top priority
08% – Not too important
03% – Should not be done at all
00% – Don’t know

23. I’m going to read you some different ways to increase the number of Americans covered by health insurance. As I read each one, please tell me whether you would favor it or oppose it. Here’s the (first/next) one – (INSERT). Do you favor or oppose this?

a. A national health plan, financed by taxpayers, in which all Americans would get their insurance from a single government plan

37% – Favor
55% – Oppose
08% – Don’t know

b. Requiring businesses to offer private health insurance for their employees

70% – Favor
27% – Oppose
03% – Don’t know

c. Offering uninsured Americans income tax deductions, tax credits, or other financial assistance to help them purchase private health insurance on their
own

73% – Favor
24% – Oppose
03% – Don’t know

d. Expanding Medicare to cover people between the ages of 55 and 64 who do
not have health insurance

74% – Favor
23% – Oppose
02% – Don’t know

e. Expanding state government programs for low-income people, such as Medicaid and the Children’s Health Insurance Program, to provide coverage for people without health insurance

80% – Favor
18% – Oppose
02% – Don’t know

f. Offering businesses tax deductions, tax credits, or other financial assistance to help them provide health insurance to their employees

88% – Favor
10% – Oppose
01% – Don’t know

23a. Of those options you just said you favored, which ONE do you MOST prefer?

23% – Offering business tax deductions or other financial assistance to help them provide health insurance to their employees 17% – Offering tax deductions or other financial assistance to help the uninsured pay for private insurance

17% – Expanding state government programs, such as Medicaid to provide coverage for people without health insurance

15% – A single payer government plan to provide health insurance for
all
Americans

13% – Expanding Medicare to cover people under age 65 who do not have
health
insurance

12% – Requiring businesses to offer health insurance for their
employees

01% – Don’t favor any option

02% – Don’t know

24. Would you be willing to pay more – either in higher health insurance premiums or higher taxes – in order to increase the number of Americans who have health insurance, or not?

45% – Yes, would be willing to pay more
51% – No, would not be willing to pay more
04% – Don’t know

(The following question was asked after a question on possible reasons for rising health care costs. All reasons listed were considered important by 60% or more of respondents.)

32a. Of those factors you said are very important in causing rising health care costs, which one do you think is the MOST important reason health care costs are rising?

29% – High profits made by drug companies and insurance companies 22% – The number of malpractice lawsuits

15% – The amount of greed and waste that occurs in the health care
system

09% – The aging of the population

07% – The use of expensive, high-tech medical equipment and expensive new
drugs

05% – Doctors making too much money

04% – The fact that most people with health insurance have little incentive to look for lower-priced doctors and services

01% – Other reason is most important

05% – None of these very important

01% – All same/equally important

01% – Don’t know

http://www.kff.org/kaiserpolls/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=50265

Comment: Perhaps the most important result of this survey is that 94% of
Americans believe that dealing with health care costs is important. As activists craft the message of a better system of funding health care, we will have to be certain that each individual clearly understands how the solution addresses his or her concerns about costs. No other aspects of reform will be persuasive if this issue is not clearly and emphatically addressed.

Covering the uninsured receives much support; 89% of Americans believe that
it is important. But 51% do not believe that is important enough to pay for it. So the driving issue is not covering the uninsured; it is making health care affordable.

There is no consensus on how we should achieve universal coverage.

Question
23a confirms that opinions are all over the board.

A comment should made about question 23. Prof. Robert Blendon of Harvard has
proven by innumerable surveys that he can elicit a negative response to single payer by phrasing the choice as, “A national health plan, financed by taxpayers, in which all Americans would get their insurance from a single government plan.” Many other surveys that include the same choice, but phrased slightly differently, produce a more positive response, placing single payer in competition with other models of reform. Although employer-sponsored plans remain the most popular form of coverage, mandating such coverage does not rank any higher than single payer as a first choice for expanding coverage.

The responses to Question 23a are very important. The results demonstrate that Americans do have opinions on the flaws in our health care system, but their opinions are incorrect! If we expect the most important opinion survey of all – the vote of the American people – to reflect their true values on health care reform, we are going to have to greatly intensify our efforts in grassroots education.

To end the inertia in the reform movement, Americans will have to understand
what is wrong with our system and what we can do to fix it so that health care will always be affordable.

Will your next step be to start contemplating your expanded role in the movement, or will it be to click the delete button?
—————————————————————————————–
Subject: Gov. Bush & Gov. Schwarzenegger empowering Medicaid patients with health care ownership

Agency for Health Care Administration (Florida)
empoweredcare.com
January 11, 2005
Governor Bush Announces Plan to Transform Medicaid

Governor Bush today unveiled his plan to ensure Florida’s most vulnerable families continue to receive the quality health care they need, recommending
reforms that will empower Medicaid patients to direct their own health care as never before.

“To fulfill our commitment to Florida’s Medicaid program, we must transform it completely so that the number one priority is patient wellbeing and the last consideration is government control,” said Governor Bush. The transformation begins by empowering Medicaid participants to make choices about their own care. Health care providers will create benefit packages falling into a combination of three components: basic care, catastrophic care and flexible spending.

Participants – with the help of choice counselors – will choose the plan that best meets their needs.

http://www.empoweredcare.com/press01112005.aspx

St. Petersburg Times
January 12, 2005

“We can turn Medicaid beneficiaries into informed consumers,” (Gov.) Bush said. He said it is wrong to assume “that poor people can’t make choices for themselves.”

http://www.sptimes.com/2005/01/12/State/Gov_Bush_proposes_Med.shtml

Contra Costa Times
January 11, 2005
Governor proposes monthly Medi-Cal premiums
By Sandy Kleffman

For the first time, California would require hundreds of thousands of Medi-Cal recipients to pay a monthly premium for health care benefits under Gov. Arnold Schwarzenegger’s budget proposal released Monday.

Paying a modest sum would emphasize personal responsibility and enable families to take ownership of their health care, (Health and Human Services
Agency Secretary Kim) Belshé said.

“We believe that this will cause a lot of those families to fall off of the program,” said Anthony Wright, executive director of Health Access California

http://www.contracostatimes.com/mld/cctimes/news/state/10616511.htm

Comment: “Empowering” patients through “consumer directed health care”
is merely euphemistic code language for the policy shift from shared risk though insurance pools to direct assumption of financial risk by the individual with health care needs. Stated in simpler terms, if you’re sick, you pay!

Gov. Bush and Gov. Schwarzenegger are reducing Medicaid costs by erecting
financial barriers to care for this unfortunate sector with great needs and little funds. People will go without needed care; many will suffer and some will die. If the governors truly believe that the fiscal crises in their Medicaid programs are so severe that we must accept suffering and death to solve the problem, then they should show leadership by frankly stating so. But to bury cruel policy decisions in euphemisms is the height of dishonesty.

The tax and fiscal policy decisions may be difficult. But there are plenty of other options that would emphatically reject cruelty as an essential ingredient to health policy reform. And some of the most affordable and beneficial options are achievable through government action. Aren’t governors supposed to govern their governments?

Sen. Kennedy's call for Medicare for All

Democratic Blueprint for America’s Future
An Address by Senator Edward M. Kennedy at the National Press Club
January 12, 2005

To revitalize the American dream, we also need to renew the battle to make health care affordable and available to all our people. In this new century of the life sciences, breakthrough treatments and miracle cures are steadily
revolutionizing the practice of medicine and the quality of life. The mapping of the human genome enables us to understand far more about the molecular basis of disease, and to plan far-reaching cures that were inconceivable only a few years ago.

Sadly, in America today, the miracles of modern medicine are too often the province only of the wealthy. We need a new guarantee for the years ahead that the cost of these life-saving treatments and cures will not be beyond the reach of the vast majority of the American people.

An essential part of our progressive vision is an America where no citizen of any age fears the cost of health care, and no employer refuses to create new jobs or cuts back on current jobs because of the high cost of providing health insurance.

The answer is Medicare, whose 40th birthday we will celebrate in July. I propose that as a 40th birthday gift to the American people, we expand Medicare over the next decade to cover every citizen – from birth to the end of life.

It’s no secret that America is still dearly in love with Medicare. Administrative costs are low. Patients’ satisfaction is high. Unlike with many private insurers, they can still choose their doctor and their hospital.

For those who prefer private insurance, we will offer comparable coverage under the same range of private insurance plans already available to Congress. I can think of nothing more cynical or hypocritical than a Member of Congress who gives a speech denouncing health care for all, then goes to his doctor for a visit paid for by the Federal Employees Health Benefit Plan.

I call this approach Medicare for All, because it will free all Americans from the fear of crippling medical expenses and enable them to seek the best possible care when illness strikes.

The battle to achieve Medicare for All will not be easy. Powerful interests will strongly oppose it, because they profit immensely from the status quo. Right wing forces will unleash false attack ads ranting against socialized medicine and government-run health care.

But those attacks are a generation out of date – retreads of the failed campaign that delayed Medicare in the 1950s and 1960s. Today, we are immunized against such attacks by the obvious success of Medicare. It is long past time to extend that success to all.

The Democratic Party’s proudest moments and greatest victories have always come when we stand up against powerful interests and fight for the common good – and this coming battle can be another of our finest achievements.

To make the transition from the current splintered system, I propose to phase in Medicare for All, age group by age group, starting with those closest to retirement, between 55 and 65. Aside from senior citizens themselves, they have the greatest health needs and the highest health costs, and need our help the most.

The first stage of the phase-in should also guarantee good health care to every young child. We made a start with the Children’s Health Insurance Program in 1997. It does a major part of the job, and it’s time to complete the job now.
As we implement this reform, financing must be a shared responsibility. All will benefit, and all should contribute. Payroll taxes should be part of the financing, but so should general revenues, to make the financing as progressive as possible.

We can offset a large part of the expense by a single giant step – bringing health care into the modern age of information technology.

By moving to electronic medical records for all Americans when they go to the hospital or their doctor, we can save hundreds of billions of dollars a year in administrative costs while improving the quality of care.

Equally important, we should pay for health care based on value and results, not just the number of procedures performed or days in a hospital bed. We must also expand our investments in medical research, so that we can realize even more of its extraordinary promise. We must confront and defeat the misguided ideology that – in the name of life – denies life-saving cures by blocking stem cell research.

http://kennedy.senate.gov/~kennedy/statements/05/1/2005112713.html

For the C-SPAN archived video of the speech:
http://www.c-span.org/videoarchives.asp?CatCodePairs=,&ArchiveDays=100
(Go to the archived programs of 1/12/05 and click on “Sen. Edward Kennedy (D-MA), Vision for the Democratic Party”)

Comment: (At this time, it would be highly inappropriate to provide a critique of the specifics of Sen. Kennedy’s proposal since such comments would detract from his crucial clarion call “to make health care affordable and available to all our people.” That’s the one salient message that we need to hear today.)

Sen. Kennedy’s call for Medicare for All

Democratic Blueprint for America’s Future
An Address by Senator Edward M. Kennedy at the National Press Club
January 12, 2005

To revitalize the American dream, we also need to renew the battle to make health care affordable and available to all our people. In this new century of the life sciences, breakthrough treatments and miracle cures are steadily
revolutionizing the practice of medicine and the quality of life. The mapping of the human genome enables us to understand far more about the molecular basis of disease, and to plan far-reaching cures that were inconceivable only a few years ago.

Sadly, in America today, the miracles of modern medicine are too often the province only of the wealthy. We need a new guarantee for the years ahead that the cost of these life-saving treatments and cures will not be beyond the reach of the vast majority of the American people.

An essential part of our progressive vision is an America where no citizen of any age fears the cost of health care, and no employer refuses to create new jobs or cuts back on current jobs because of the high cost of providing health insurance.

The answer is Medicare, whose 40th birthday we will celebrate in July. I propose that as a 40th birthday gift to the American people, we expand Medicare over the next decade to cover every citizen – from birth to the end of life.

It’s no secret that America is still dearly in love with Medicare. Administrative costs are low. Patients’ satisfaction is high. Unlike with many private insurers, they can still choose their doctor and their hospital.

For those who prefer private insurance, we will offer comparable coverage under the same range of private insurance plans already available to Congress. I can think of nothing more cynical or hypocritical than a Member of Congress who gives a speech denouncing health care for all, then goes to his doctor for a visit paid for by the Federal Employees Health Benefit Plan.

I call this approach Medicare for All, because it will free all Americans from the fear of crippling medical expenses and enable them to seek the best possible care when illness strikes.

The battle to achieve Medicare for All will not be easy. Powerful interests will strongly oppose it, because they profit immensely from the status quo. Right wing forces will unleash false attack ads ranting against socialized medicine and government-run health care.

But those attacks are a generation out of date – retreads of the failed campaign that delayed Medicare in the 1950s and 1960s. Today, we are immunized against such attacks by the obvious success of Medicare. It is long past time to extend that success to all.

The Democratic Party’s proudest moments and greatest victories have always come when we stand up against powerful interests and fight for the common good – and this coming battle can be another of our finest achievements.

To make the transition from the current splintered system, I propose to phase in Medicare for All, age group by age group, starting with those closest to retirement, between 55 and 65. Aside from senior citizens themselves, they have the greatest health needs and the highest health costs, and need our help the most.

The first stage of the phase-in should also guarantee good health care to every young child. We made a start with the Children’s Health Insurance Program in 1997. It does a major part of the job, and it’s time to complete the job now.
As we implement this reform, financing must be a shared responsibility. All will benefit, and all should contribute. Payroll taxes should be part of the financing, but so should general revenues, to make the financing as progressive as possible.

We can offset a large part of the expense by a single giant step – bringing health care into the modern age of information technology.

By moving to electronic medical records for all Americans when they go to the hospital or their doctor, we can save hundreds of billions of dollars a year in administrative costs while improving the quality of care.

Equally important, we should pay for health care based on value and results, not just the number of procedures performed or days in a hospital bed. We must also expand our investments in medical research, so that we can realize even more of its extraordinary promise. We must confront and defeat the misguided ideology that – in the name of life – denies life-saving cures by blocking stem cell research.

http://kennedy.senate.gov/~kennedy/statements/05/1/2005112713.html

For the C-SPAN archived video of the speech:
http://www.c-span.org/videoarchives.asp?CatCodePairs=,&ArchiveDays=100
(Go to the archived programs of 1/12/05 and click on “Sen. Edward Kennedy (D-MA), Vision for the Democratic Party”)

Comment: (At this time, it would be highly inappropriate to provide a critique of the specifics of Sen. Kennedy’s proposal since such comments would detract from his crucial clarion call “to make health care affordable and available to all our people.” That’s the one salient message that we need to hear today.)

Health Care? Ask Cuba

Health Care? Ask Cuba
By Nicholas D. Kristof
Published: January 12, 2005

Here’s a wrenching fact: If the U.S. had an infant mortality rate as good as Cuba’s, we would save an additional 2,212 American babies a year.

Yes, Cuba’s. Babies are less likely to survive in America, with a health care system that we think is the best in the world, than in impoverished and autocratic Cuba. According to the latest C.I.A. World Factbook, Cuba is one of 41 countries that have better infant mortality rates than the U.S.

Even more troubling, the rate in the U.S. has worsened recently.

In every year since 1958, America’s infant mortality rate improved, or at least held steady. But in 2002, it got worse: 7 babies died for each thousand live births, while that rate was 6.8 deaths the year before.

Those numbers, buried in a recent report from the Centers for Disease Control and Prevention, didn’t get much attention. But they are part of a pattern of recent statistics dribbling out of the federal government suggesting that for those on the bottom in America, life in our new Gilded Age is getting crueler.

“America’s children are at greater risk than they’ve been in for at least a decade,” said Dr. Irwin Redlener, associate dean at the Mailman School of Public Health at Columbia University and president of the Children’s Health Fund. “The rising rate of infant mortality is an early warning that we’re headed in the wrong direction, with no relief in sight.”

It’s too early to know just what to make of the increase in infant mortality in 2002 for American babies. Reliable data for 2003 and 2004 are not out yet. Sandy Smith of the Centers for Disease Control says that the statisticians are pretty sure there was not a further deterioration in 2003, but that it’s too soon to know whether there was an improvement or just a leveling off at the higher rate.

Singapore has the best infant mortality rate in the world: 2.3 babies die before the age of 1 for every 1,000 live births. Sweden, Japan and Iceland all have a rate that is less than half of ours.

If we had a rate as good as Singapore’s, we would save 18,900 babies each year. Or to put it another way, our policy failures in Iraq may be killing Americans at a rate of about 800 a year, but our health care failures at home are resulting in incomparably more deaths – of infants. And their mothers, because women are 70 percent more likely to die in childbirth in America than in Europe.

Of course, deaths in maternity wards occur one by one, and don’t generate the national attention, grief and alarm of an explosion in Falluja or a tsunami in Sri Lanka. But they are far more frequent: every day, on average, 77 babies die in the U.S. and one woman dies in childbirth.

Bolstering public health isn’t as dramatic as spending $300 million for a single F/A-22 Raptor fighter jet, but it can be a far more efficient way of protecting Americans.

For example, during World War II, the employment boom meant that many poor Americans enjoyed regular health care for the first time. So even though 405,000 Americans died in the war, life expectancy in the U.S. actually increased between 1940 and 1945, rising three years for whites and five years for blacks.

True, infant mortality and many other American health problems are largely intertwined with poverty, and experience suggests that neither the left nor the right has easy solutions for intractable poverty. But some of the steps the government is now taking or talking about – like cutting back further on entitlements, particularly those giving children access to health care – would aggravate the situation. Last year, a study by the Institute of Medicine, a branch of the National Academy of Sciences, estimated that the lack of health insurance coverage causes 18,000 unnecessary deaths a year.

As readers know, I complain regularly about the Chinese government’s brutality in imprisoning dissidents, Christians and, lately, Zhao Yan, a New York Times colleague in Beijing. Yet for all their ruthlessness, China’s dictators have managed to drive down the infant mortality rate in Beijing to 4.6 per thousand; in contrast, New York City’s rate is 6.5.

We should celebrate this freedom that we enjoy in America – by complaining about and working to address pockets of poverty and failures in our health care system. It’s simply unacceptable that the average baby is less likely to survive in the U.S. than in Beijing or Havana.

Wellpoint/Blue Cross finds profits in high deductibles for young and healthy

American Medical News
Jan. 17, 2005
California Blues markets a hipper health plan to young adults
By Robert Kazel

WellPoint subsidiary Blue Cross of California’s… new suite of PPO products for the individual market, collectively dubbed Tonik, is intended to attract young people who are essentially healthy and haven’t felt a need for insurance, think it’s too expensive or just don’t understand what coverage is all about.

Of the more than 6 million uninsured residents of California, about 1.6 million are between ages 19 and 29, Blue Cross said. That represents between 30% to 40% of everyone in the age group, said Steve Synott, general manager for individual services at Blue Cross.

“We really saw a window of opportunity,” he said. “We knew we really had to get to know these kids — why they weren’t buying — and design the product around their lifestyle.”

The Tonik plans range from $64 to $80 per month. Deductibles are high compared with most health plans, ranging from $1,500 for the most expensive Tonik plan to $5,000 for the least expensive.

Applicants for a Tonik policy will be able to get an “instant response” on acceptance by answering several online questions about past hospital stays, prescription drugs they take and medical conditions. The company’s standard underwriting policies apply, so any applicant with a chronic illness could be rejected, Synott said. The plan is intended to appeal to generally healthy young people who may experience a sudden illness or injury, such as appendicitis or a broken limb, not to cover those with existing,serious health problems, he said.

The plan does not cover standard maternity expenses…

The high deductibles of Tonik mean that the products “are obviously geared to the hip and healthy, with access to at least some income,” said Sara R. Collins, PhD, senior program officer at the Commonwealth Fund, a New York-based research foundation that studies health issues.

Because two-thirds of young adults who are uninsured have a family income of 200% of the poverty threshold or less, many people in this age group stand to gain no benefit from the new product, she said, because it’s still out of their financial reach.

http://www.ama-assn.org/amednews/2005/01/17/bisb0117.htm

Comment: WellPoint/Blue Cross, one of the nation’s leaders in innovative insurance products, has recognized a great market in California: the 1.6 million between 19 and 29 without health insurance.

Feature’s carefully designed to target this young, healthy sector:

* If you need health care, don’t waste your time applying.

* Don’t expect any significant level of benefits to be paid since hardly any of you will exceed the deductible amount.

* Although you are in your peak reproductive years, it’s unfair to ask other insureds to contribute to care of a pregnancy that is a result of your personal choice.

* And for the two-thirds of you without money, please don’t waste our time in processing applications for coverage that you can’t afford anyway.

* And, oh yes, the shareholders of Anthem, now merged with WellPoint/Blue Cross, thank you for purchasing these pseudo-insurance products that are
designed to empower you as health care consumers, making you more responsible Americans, while supporting an insurance model that is designed to place the premiums in the pockets of shareholders so that they can be reinvested in America’s economy. Isn’t America great!?

What is ironic is that providing comprehensive insurance for this group would be very inexpensive since, on average, they are quite healthy and have relatively minimal health care needs. But this coverage, Topik, is designed to pay for the insurer’s costs and profits, while making every effort to avoid paying for health care.

In contrast, a program of social insurance would be designed to pay for health care services, of all things! How much longer are we going to leave this perverse industry in charge of our health care dollars?

Survey of health care opinion leaders

The Commonwealth Fund
Health Care Opinion Leaders Survey
Harris Interactive, Inc.
Dates: November 22, 2004 – December 8, 2004

The Commonwealth Fund Health Care Opinion Leaders Survey was conducted
by Harris Interactive on behalf of the Fund, with a broad group of more than
300 opinion leaders in health policy and innovators in health care delivery and finance. The survey focused on health policy priorities for Congress over the next five years.

There is broad consensus among leaders that expanding coverage to the uninsured is the top priority that should be addressed by Congress. This is the top priority for all groups represented in this study, with a large majority of academic/research institutions, health care delivery, business/insurance/other health care industry, and government/labor/advocacy identifying this issue as the top priority. There is also considerable agreement about the reforms that should be enacted in order to achieve this priority. Allowing individuals and small businesses to buy into the Federal Employees Health Benefits Program or similar federal group option receives the highest support overall and a majority of votes across all groups.

Also, expanding existing state-based public insurance programs, Medicaid and
the State Children’s Health Insurance Program, is supported by more than half of leaders overall and across groups, except for the health care delivery sector. This suggests a more incremental approach, with a national health system (universal coverage) receiving very little attention as a priority now.

http://www.cmwf.org/surveys/surveys_show.htm?doc_id=254281

From the survey:

Q700 Below is a list of possible reforms to expand coverage for the uninsured. Which of the following should be the top priorities for action?
(Please select up to five priorities.)

65% – Allow individuals and small businesses to buy into the Federal Employees Health Benefits program or similar federal group option

55% – Expand existing state-based public insurance programs, Medicaid and SCHIP

48% – Let near-elderly adults buy into Medicare

45% – Single-payer system of health insurance through a new program or Medicare-for-all

43% – Incentives or requirements to expand employer-based health insurance

37% – Reinsurance for small business insurance plans

31% – Eliminate two-year waiting period for the disabled for Medicare

22% – Create new tax credits for the uninsured to purchase insurance in the individual insurance market

22% – Expand tax-free health savings accounts

20% – Create new tax credit for the uninsured but limit to purchase of group
coverage through state public programs or employers

04% – Other

01% – Mandate

01% – Not Sure

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

Note that the single payer result was skewed downward by a 29% response of the Business/Insurance/Other Health Care Industry sector – Table 4a:
http://www.cmwf.org/usr_doc/CMWF_Opinion_Leaders_summary.pdf

Comment: Another interesting result is that the Government/Labor/Consumer
Advocacy sector expressed 63% support of a single payer system as compared
to 57% support for expanding eligibility for the Federal Employees Health Benefits Program (FEHBP). It appears that some of those who have “the coverage that members of Congress have” would rather be covered under a single payer system.

The good news is that tax credits and HSAs bombed as choices for expanding
coverage.

The unfortunate news is that The Commonwealth Fund continues to characterize
the results as representing support of incremental approaches, with a national health system “receiving very little attention.” Although there is support for FEHBP, simultaneously there is opposition to tax credits that would make FEHBP premiums affordable for the individual (but with a greater tax burden). And correcting for the insurance/business bias against single payer, brings the support to 51%, making it one of the leading options for reform.

The only real conclusion that can be reached from this survey of health care
opinion leaders is that they do want universal health care coverage, but that they are divided over whether that should be through a single payer system or through private health plans with a safety-net public program.

We need to further expand the dialogue.

——————————————————————————————-
Message: 2
Date: Fri, 7 Jan 2005 16:55:23 -0800
Subject: qotd: Karen Davis on the survey of health care opinion leaders

In my comment on the health care opinion leaders survey, I stated, “The unfortunate news is that The Commonwealth Fund continues to characterize the
results as representing support of incremental approaches, with a national health system ‘receiving very little attention.'” Although that comment was taken from their release and from their report, I believe that the comments of Karen Davis present a much more objective assessment of the survey. This is an excerpt from her message.

Karen Davis, President of The Commonwealth Fund:

“Although tapped as the top policy priority for Congress, there was only limited consensus among opinion leaders on the best way to address this difficult problem, but the top two approaches were clearly allowing individuals and small businesses to buy into the Federal Employees Health Benefits Program (FEHBP), and expanding Medicaid/CHIP. Opinion leaders within the health insurance industry appear to prefer Medicaid/CHIP expansions and find the FEHBP buy-in notion less attractive, as do consumer and advocacy group leaders. Allowing the uninsured to buy into Medicare and implementing some kind of “Medicare-for-all” system had a surprising degree of support, not just in the academic/research sector but also in the health care delivery sector, although an incremental approach to reducing the number of Americans lacking health coverage seems far more likely than a more basic overhaul of the system. Perhaps the most surprising finding, again given the amount of public and political attention the concept has received, is the lack of enthusiasm in this survey for health savings
accounts or tax credits to buy individual health insurance.”

And…

“We fully expect some of our results, especially those that may seem surprising at first blush, to be parsed, questioned, and criticized. And that’s fine. The goal here is to expand and inform a healthy public and professional debate, not reinforce established notions or limit useful options.”

http://www.cmwf.org/aboutus/aboutus_show.htm?doc_id=254655

Cover the Uninsured Week

A project of The Robert Wood Johnson Foundation

Opinion: Week-long Series Details Need for Health Care Reform. St. Louis Post advocates for government-regulated, single-payer plan Source(s): The St. Louis Post-Dispatch (Dec. 26-Jan. 2)

An in-depth, week-long series of editorials in the St. Louis Post-Dispatch builds a case for a government-regulated, single-payer system in the U.S…

The final editorial concludes that, in a wealthy nation such as ours, “it stains our national conscience that we tolerate a medical system which casts out [the uninsured] and makes them choose between food and medicine … It is time for America to provide all its citizens with health coverage they cannot lose, even if they lose their jobs.” The article notes that this is a rational idea, but not a radical one, because between Medicaid, Medicare and other programs, the government already pays between 45 and 60 percent of the nation’s health care bill. Furthermore, Medicare is a successful model that runs with less than a third of the overhead costs of private coverage.

A single-payer system financed through a higher personal income tax and a gross receipts tax on business would be less costly than the current employment-based system. In addition, the outcome would not be socialized medicine if hospitals remain private and doctors control their own practices. While the editorial warns not to expect change soon, it does “expect to see a single-payer system eventually” because “cold business logic favors the efficiency” of such a plan.

http://covertheuninsuredweek.org/news/index.php?NewsID=1034

Comment: The St. Louis Post-Dispatch editorial conclusion that cold business logic will eventually lead to a single payer system requires no further comment.

But an important development in the Covering the Uninsured Week (CTUW) process mandates our comment. Prior efforts of this annual week of events have been aimed at publicizing the problems of the uninsured in an attempt to educate the public that something must be done. Advocates of various models of reform have been annoyed by the fact that advocacy for their preferred models was essentially prohibited at the CTUW events.

The following announcement indicates that the 2005 CTUW events will move the process forward:

“Building off the success of Cover the Uninsured Week 2004, The Robert Wood Johnson Foundation has announced dates for the 2005 effort. From April 30-May 8, 2005, Cover the Uninsured Week forums will inform our nation’s leaders, including elected officials, about policy proposals to expand coverage to the uninsured and to make coverage more affordable and stable for those who have it. Check back soon for more details and updates.”

http://covertheuninsuredweek.org/

In case you skimmed through that too fast, the 2005 CTUW forums:

* will inform our nation’s leaders, including elected officials

* about policy proposals
* to expand coverage to the uninsured and
* to make coverage more affordable and stable for those who have it

Considering the purpose of the forums, it is quite clear that advocates of the other flawed models cannot hold a candle to ours. We have been presented with a victory before the process has begun. It is only ours to lose.

Your homework assignment:

1. Go to the CTUW website and sign up for the weekly news digest and regular
updates on the campaign: http://covertheuninsuredweek.org/

2. Begin thinking about how you can play a roll in informing the nation on the policy proposals that will cover the uninsured and improve coverage for those who already have it. Then refine your efforts as more details and updates become available.

After all, the editorial staff of the St. Louis Post-Dispatch does “expect to see a single-payer system eventually.” Let’s see if we can expedite that.

Social Medicine

Social Medicine Portal
A project developed by faculty members of the Department of Family and Social Medicine of the Albert Einstein College of Medicine

The portal contains over a hundred links to websites, documents and presentations devoted to Social Medicine.

Our goal in creating this site is to link together the diverse international community of people working in social medicine and health activism.

What is social medicine?

It is possible to argue that all medicine by its very nature is social. The way we define diseases and health, the methods we use for diagnosis and treatment, how we finance health care, all these cannot help but reflect the social environment in which medicine operates.

Social medicine, however, looks at these interactions in a systematic way and seeks to understand how health, disease and social conditions are interrelated.

The most famous representative of early social medicine is Rudolf Virchow, the distinguished German pathologist who developed the theory of cellular pathology. Virchow was also a social reformer who remarked that “politics is
nothing more than medicine on a grand scale.” In the 20th century George Rosen would distill the Virchow’s principles into the following:

1. Social and economic conditions profoundly impact health, disease and the practice of medicine.

2. The health of the population is a matter of social concern.

3. Society should promote health through both individual and social means.

As might be gathered from these ideas, social medicine was not simply an
academic pursuit. Its practitioners were political reformers, radicals, activists. Virchow believed that the “physician was the natural advocate for the poor.” And this defense of social justice would stamp future generations of physicians and health care workers.

http://www.socialmedicine.org/

Comment: Bookmark this one! A brief visit to this website will demonstrate to you that it serves as an invaluable portal to the field of social medicine.

PNHP supporters will appreciate the January 2005 Monthly Spotlight by Leonard Rodberg and Matthew Anderson. Not only does it describe Physicians for a National Health Program as an organization dedicated to a single-payer national health program, but it also provides numerous links to single payer resources.

Though you likely don’t have the time now, nevertheless you should click on the link above and bookmark it so that you can return to their website during your next bout of boredom. The visit will be very therapeutic.

Blue Shield of California CEO on single payer

The Orange County Register
March 30, 2005
‘Vicious cycle’ of care
By Bernard J. Wolfson

Bruce G. Bodaken, the chief executive of Blue Shield of California… warned that the state’s private-sector health-care market is in deep trouble and could implode unless all the players collaborate to provide coverage for the uninsured and reduce costs that are sending premiums skyward.

Without action to overcome the problems of cost and access, Bodaken warned, “the market will get to the point where the balance of power will move from the private market to the halls of government. And when that happens, it’s hard to know what the solution coming out the door will look like.”

He warned that one possible solution “always out there,” especially in California, is a single-payer, or government-run, system – a notion that is anathema to the insurance and underwriting industries.

State Sen. Sheila Kuehl, D-Santa Monica, has introduced a single-payer bill, which Bodaken said had little chance of making it through the Legislature and past Gov. Arnold Schwarzenegger. But it could return in a few years as a ballot initiative, which might have a better chance of passing, he said.

Bodaken was the first major insurance-industry leader to propose universal health coverage, and he reiterated his support for it, though a different version of it was narrowly defeated by voters last December. In his plan, individuals who could afford insurance would be required to buy it; employers would also pay their fair share; and the government would provide a safety net for those who couldn’t pay.

Q: You’re opposed to a single-payer system, yet isn’t Medicare really just a single-payer system for part of the population? Do you oppose that single-payer system too?

A: The one that already exists is merely a financial mechanism for redistributing tax dollars from individuals and employers back to (medical)providers. That’s not what’s envisioned by most single-payer advocates. Typically, it’s a much more interventionist type of oversight in terms of benefit design and reimbursement. If you look at the details in Kuehl’s bill, there are government agencies and quasi-government agencies that are setting benefits.

Q: So, what’s wrong with government intervention in health care?

A: It’s inefficient.

Q: But Medicare has lower administrative costs than private-sector health plans, doesn’t it?

A: If you look at Medicare administrative costs and private plans, it’s an apples to oranges comparison. Medicare doesn’t do nearly what private plans do in terms of managing care and building systems of interface with patients, providers and (health-plan) members.

Q: What about expanding Medicare to a wider group of people. Would that
help?

A: A lot of people have talked about expanding Medicare to the general population. We’re not doctrinaire about how to solve the problem of the uninsured. I don’t support Medicare for everybody, but what if the Medicare age went down to 60, with the view that individuals would pick up a lot of the costs?

Q: One of your big objections to single-payer plans is that their proponents often do not acknowledge the need for taxes to pay for it. What if they were completely upfront in advocating tax increases?

A: It seems to me that those tax dollars could be used a lot more efficiently to cover people in the private market. But we’re on the record as saying that if we want to get everyone covered, there’s going to have to be some sort of tax increase or revenue increase. It’s not realistic to think you’re going to cover 45 million uninsured Americans for free. It would be som sort of sales tax or payroll tax.

Q: So you do support quite a bit of government involvement in health care in your plan. You seem a bit like a Swedish socialist.

A: The system closest to what we’ve described is probably the German program, which is a universal, publicly funded program but privately provided.

Q: In your luncheon speech, you mentioned a bare-bones insurance package, costing about $50 a month that would help address the uninsured problem. Could you elaborate?

A: There may be incremental steps that make sense and get us part of the way there.

Q: What would such a plan include?

A: Approximately six physician visits, three hospital days, and generic drug coverage with a limit. Those would be the main elements. You’d obviously burn through that very quickly if you had a chronic illness, but it would cover about 90 percent of what the uninsured need.

Q: You talked about all the complexity in health benefits, and how even you had trouble following it. Could you repeat that?

A: I enrolled in a product we call Active Choice – Blue Shield Active Choice. It has $750 of first-dollar coverage, before you hit your deductible. But only certain things apply toward that coverage, and I was not very well educated on what counts and what doesn’t. I’m no different than anybody else: I didn’t look at my information until I had the (prescription), and that’s when I found out that some of it applied and some of it didn’t. I’m not proud of it, but it’s the reality. So I understand when people say they’re confused.

http://www.ocregister.com/ocr/2005/03/30/sections/business/business/article_461453.php

Comment: Bruce Bodaken, CEO of Blue Shield of California, like single payer advocates, acknowledges the fact that, in order to achieve the important goal of universal coverage, the government must play a role and financial support must be provided through the tax system. The primary disagreement is that he believes funding should be through both public programs and private plans, whereas single payer advocates believe that we should have only one universal, publicly administered program. So how strong is his case for leaving private plans in place?

From his comments, it is quite clear that he believes that the current approach is unstable, and without intervention the private plans will be replaced with a government system, most logically a single payer system.

Wading through his anti-government rhetoric, this is clearly a concession that a single payer system would be more capable than our current fragmented system of providing both universal coverage and affordability, not to mention the establishment of an equitable system of funding care.

In support of the role of private plans, he dismisses Medicare as “inefficient” in spite of the much lower administrative costs. He suggests that private plans are providing a benefit for their non-medical spending in the form of “managing care and building systems of interface.” But most health care consumers would find little health care value in these wasteful administrative interventions that diminish choice of health care providers.

Although Mr. Bodaken touts his bare bones policy that covers a maximum of six physician visits and three days in the hospital, it’s quite clear that such coverage would result in an unbearable financial burden for the 20% of people who consume 80% of health care. And what healthy individual can predict that he/she will not become one of the 20%? Since private plans are stripping
benefits to make insurance premiums more competitive, they are losing their function of preventing financial hardship in the face of medical loss.

Perhaps Mr. Bodaken’s strongest argument that should make everyone question the future role of private plans is his own personal experience with his own plan from his own company. Although high-deductible private plans are being touted by some as the be-all and end-all of health care coverage, he says that he “has $750 of first-dollar coverage, before you hit your deductible.

But only certain things apply toward that coverage, and I was not very well educated on what counts and what doesn’t. I’m no different than anybody else.”

Do you suppose that Mr. Bodaken might be a closet single payer supporter held captive as a CEO in the corporate insurance world?

Message 2: The fiction of health plan competition

American Medical News
April 4, 2005.
Editorial
Health plans’ dominance: More muscle in more markets

… in the four years the AMA has released its annual report, “Competition in Health Insurance: A Comprehensive Study of U.S. Markets,” health plan market concentration has continually grown worse, as measured by the Dept. of Justice’s own scale.

Of the 92 metropolitan areas in 21 states studied, 93%, or 86, would be considered “highly concentrated” HMO/PPO markets using Justice Dept. Guidelines, according to the 2004 version of the report, released in February. Of the 27 other states where reliable metropolitan-level data were not available, the result was the same — 93%, or 25, of those states would be considered “highly concentrated” in the HMO/PPO market.

For PPOs alone, the metropolitan and state data reveal that fully 100% of them would be considered “highly concentrated.” That’s a first for the AMA study.

Keep in mind that these numbers are only as of Jan. 1, 2003. They don’t even take into account last year’s multibillion-dollar health plan megamergers: Anthem and WellPoint Health Networks, and UnitedHealth Group and Oxford Health Plans. But they do reflect the bulk of the 400 mergers between 1995 and 2003 involving health insurers and managed care organizations, few of which drew substantial Justice Dept. scrutiny.

http://www.ama-assn.org/amednews/2005/04/04/edsa0404.htm#relatedcontent

Comment: Let’s see. Why is it that we continue to insist that private plans instead of a government program be used to fund health care?

Is it because the private sector is so much more efficient than government bureaucracies? This doesn’t seem to be the reason since private plans utilize a much greater percentage of funds in providing administrative services, not to mention the profound administrative burden that their fragmented system places on the health care delivery system. So it’s not the efficiency of the private marketplace.

Could it be that a multitude of private plans provides us with greater choice? By choice, most of us mean choice of our health care professionals and hospitals. But most private plans limit our choice and assess severe financial penalties for failing to use their preselected choices. Since a government program does allow free choice, this can’t be the reason for preferring private plans.

So why should we prefer private plans? The reason most often given is that a multitude of private plans provides competition within the health care marketplace, and competition is key to providing greater health care value. By health care value, we mean higher quality and lower prices, the magic of Adam Smith’s “invisible hand” of free markets.

But what do we have? Mediocrity for most of us, and skyrocketing health care prices. And a shift of insurance risk from the insurers to the patients. And a system that threatens average Americans with bankruptcy should they have the misfortune of developing major medical problems. (Then what is the purpose of insurance?)

Now we find that, by Justice Department guidelines, 93% of HMO/PPO markets and 100% of PPO markets are “highly concentrated.” So much for competition!

If we leave the plans in place, what options do we have? Everyone agrees that the status quo will never do since costs are skyrocketing, access is diminishing, and quality is not improving.

Should we relax regulatory oversight to allow the markets to work more effectively? We have already proven that the plans will sell to the healthy and dump the sick. That’s appropriate behavior for a business in the marketplace, but shouldn’t our policies address those who do have health care needs? Why even have an industry that caters to those who don’t need it, but neglects those who do?

Should we instead increase regulatory oversight through innumerable policies that would require plans to provide equitable financial security for everyone with significant health care needs? Once you have done that, you would have created a de facto single payer system in which the health plans would transform into vendors contracted to provide only the administrative services that we actually do need for health care financing. Instead of introducing profound regulatory complexities that would always be skirted by the industry, wouldn’t it be simpler to establish our own single payer system?

Unfortunately, it appears that the invisible hand of the health care marketplace is wearing a rectal glove.

Rural doctors ignore partisan divide

The Denver Post
January 02, 2005
Fomenting a medical-care revolution
Rural doctors eye solutions to a “broken” health system
By Karen

Rocky White is an unlikely radical.

A Nebraska-bred country boy, a Republican-voting, ranch-owning, small-town
doctor, he hardly fits the profile of a wild-eyed revolutionary. But White and a handful of cohorts are, in fact, trying to foment upheaval.

The revolution they are proposing: a national health-insurance program. Nothing short of that will fix what White calls “our god-awful broken system.”

… it may be that this valley, like other rural areas, is getting hit hard first. That the forces driving doctors and insurance companies out, squeezing hospitals to the breaking point in rural Colorado, are simply foreshadowing what is in store for metro areas.

And some suggest that by wrestling with those problems now, small communities are in the vanguard, and the solutions they craft may offer road
maps for the rest of the country.

… the problems faced by rural medicine are daunting, complicated and growing worse.

That is what drove White to join forces with Dr. Gladys Richardson, an unabashed liberal, a woman who could hardly be more different from White.

In August, they invited virtually every health care provider in the five-county valley to hear their pitch for national health insurance.

The response was so huge they had to move the evening meeting from White’s
office to the largest conference room in the largest hotel in Alamosa.

They came last August and listened as White stood at a podium, his laptop in
hand.

He triggered a PowerPoint avalanche of data, provided by Physicians for a
National Health Program in Chicago: (the article then lists a few of the highlights)

http://www.denverpost.com/Stories/0,1413,36~53~2630298,00.html

Comment: Democrats support access to affordable, comprehensive healthcare
for everyone, and Republicans support sound business principles which reduce
administrative waste and contain costs. And each side supports the agenda of
the other as long as there is no compromise in their own positions. The beauty of the single payer model is that it accomplishes these goals. It has been said that the Democrats will educate the nation on the single payer model, and then the Republicans will enact it.

Rocky White attended the PNHP Leadership Training Institute held in Chicago
last May. He was only one of several Republicans present. These were not
Republicans who had crossed over. They were Republicans who recognize
that the current system violates the most fundamental business principles by
wasting hundreds of billions of dollars on administrative excesses – dollars
that would be better spent on health care. Other nations apply sound business principles to their health care systems, resulting in more comprehensive systems at far lower costs. That has to grab the attention of Republicans, even if the Democrats already lay claim to it.

PNHP’s mission is to educate our colleagues and the nation on the advantages
of the single payer model. The purpose of the Leadership Training Institute
is to expand our mission by placing trained activists in communities throughout the nation. The 2005 training sessions will be held in Cambridge in May and in New Orleans in November. Because of the nature of the training sessions, enrollment is limited. But if you are ready to become much more actively involved in the reform movement, you may want to contact our executive director, Ida Hellander (pnhp@aol.com), to see if openings are available. (Unfortunately, the sessions do oversubscribe, so not everyone will be able to attend.)

Geyman – Falling Through the Safety Net

Falling Through the Safety Net
Americans Without Health Insurance
By John Geyman, M.D.
Common Courage Press, 2005

It is now time to recap what we have seen in earlier chapters, and to reconsider how our failing health care system can be fixed. We saw in parts I and II that our supposed safety net for those without health insurance is in tatters. Given our economic uncertainties, widespread deficits in federal and state coffers, and the market-based, consumer choice directions in health policy further advanced since the 2002 midterm elections, we can expect that the safety net will become even more porous in the next few years. We saw in Chapter 11 that for-profit investor-owned health care corporations are beholden to their investors more than to the public interest, and in Chapter 13 that these stakeholders represent a powerful
obstacle to structural system reform. We reviewed the four major alternatives for reform in Chapter 12. Although highly contentious and polarized as the debate continues among these four alternatives, we examined solid evidence that the first three alternatives – incrementalism, strengthened employer-based health insurance, and increased consumer choice – cannot effectively reform a flawed system. Although many still cling to hopes that pluralistic “reforms” which retain a for-profit health insurance industry can be successful if given more time or tweaks, a growing body of evidence-based opinion holds that universal coverage through a publicly administered single-payer system will be required.

Falling Through the Safety Net:
http://www.commoncouragepress.com/index.cfm?action=book&bookid=254

Comment: John Geyman, M.D., is Professor Emeritus and former Chairmen of
the Department of Family Medicine at the University of Washington, Seattle, and former Editor of the Journal of the American Board of Family Practice. This week he became the 2005 President of Physicians for a National Health Program (PNHP).

At the link above, brief commentaries on this book are provided by David Satcher, Marcia Angell, Claudia Fegan, Donald Light, and Fitzhugh Mullan.

After reading this book, you’ll understand why our current efforts to expand coverage are not working. Bringing those left out up to the edge of the umbrella of coverage will only drench the needy with greater debt.

This book is yet another “must read” in the health care reform movement. Also, you’ll receive more insight to the gifted man who will be providing us with the leadership to help spread our message to a nation that is desperately seeking solutions that would ensure affordable access to high quality health care for everyone.