The Washington Post
November 6, 2003
Stores Follow Wal-Mart’s Lead in Labor
By Greg Schneider and Dina ElBoghdady

Wal-Mart, the world’s biggest retailer and the nation’s biggest private employer, has become so powerful that its practices reverberate throughout the U.S. economy. About as many people work for Wal-Mart — 1.3 million — as are on active duty in the U.S. military. Its most recent annual sales — $245 billion — are greater than the gross domestic product of Switzerland.

Wal-Mart’s vast, non-unionized work force earns a typical wage of about $7
to $8 an hour. Unionized workers at Kroger, by contrast, said they were making between $11 and $13 an hour, with full health benefits. About 62 percent of Wal-Mart workers are eligible for benefits, but less than half of the workforce participates. Critics say the low participation is because Wal-Mart requires steep employee contributions.

Some economists argue that the Wal-Martization of the American workforce is
simply the free-market system functioning as it should. Gary Stibel, founder
and principal of the New England Consulting Group, said Wal-Mart has saved
consumers more than $20 billion through its discount pricing. Figuring in Wal-Mart’s pressure on other retailers to lower prices, savings top $100 billion, he said.

“In this day and age, the United States needs more companies like Wal-Mart
to create jobs, even if not at the highest pay,” Stibel said. “The company
that makes its mark by taking the cost of manufacturing products and services up will lose, and the country that promotes that will lose.”

For retailers, competing with Wal-Mart means not just holding down wages, but curbing health care costs, which are becoming an increasing burden on employers nationwide.

A report by the AFL-CIO, which has tried and failed to organize Wal-Mart workers, said the retailer insures only about 45 percent of its workforce. Wal-Mart workers must pay about one-third of the cost of their health care premiums, while employees at other large companies typically pay 16 to 25 percent, the report said.

The result is that many Wal-Mart workers transfer the health care burden either to their spouse’s employer or to government agencies, the report said.

Some employees at Minneapolis-based Target Corp., a non-union company once
known for its generous employee benefits, say they believe price competition with Wal-Mart caused their employer to cut benefits as well.

In April, Target rolled out a new health care plan for 2004 that offered generous benefits, but only for employees who averaged more than 32 hours of work each week. Some Target employees say the company then hired more workers and reduced existing workers’ schedules so they no longer qualified for the plan.

The Sacramento Bee
October 29, 2003
Health plan a sign of future?
Blue Cross offers lower premiums — but higher costs down the line.
By Lisa Rapaport

The day after insurance giants Anthem Inc. and WellPoint Health Networks
Inc. announced a merger deal that could create the biggest health plan in
America, WellPoint’s largest subsidiary unveiled a new product that many say
indicates where this huge insurer may lead the health care market.

Continuing the race to create health plans that lower premiums by charging
patients higher fees for doctors and hospitals, Blue Cross of California
said Tuesday it will sell a new individual health plan called RightPlan. It
has monthly premiums as low as $70 in Sacramento, but it requires patients
to pay $40 for doctor visits and 40 percent of hospital bills.

One aspect of RightPlan that Blue Cross officials said is essential to achieving low premiums is cause for particular concern in the medical community. Blue Cross intends to market the policy to people ages 18 to 34 — the most likely to be uninsured — but the plan does not include maternity coverage.

Known as consumer-driven health plans, policies such as RightPlan have cropped up with greater frequency in recent years as insurers have responded to demands from consumers and employers to curb steep premium increases.

… many health experts believe this latest Blue Cross offering is a good
indicator of what lies ahead.

At Blue Cross, officials would not speculate on whether RightPlan was a sign
of things to come. Spokeswoman Kellie Bernell said the company’s goal in
expanding its selection of consumer-driven plans in recent years has been to
reduce the rolls of the uninsured by offering affordable premiums.

The focus on fees for doctors and hospitals in these plans misses other aspects that may appeal to consumers, Bernell said. RightPlan includes discounts on gym memberships and weight-loss programs, as well as access to acupuncture and other types of alternative medicine.

Anthony Wright, executive director of Health Access, a patient advocacy group based in Sacramento:

“In California, Blue Cross has been a leader in pushing more costs to consumers. They do this and keep diluting the value of insurance. The point of insurance is to not worry about your bank account when you go to the doctor, and insurers seem to increasingly be missing this point.”

http://www.sacbee.com/content/news/medical/story/7688509p-8628347c.html

Comment: The crisis in affordability of health care is of great concern to nearly all Americans. The most visible manifestation of this crisis for the average, relatively healthy individual is the premium paid for health insurance. The insurance industry is acutely aware of this perception and has responded by designing products with affordable premiums. Although these have been targeted to the individual market, employers are now showing interest in these consumer-driven products in order to reduce the costs to them of their health benefit programs.

The United States is unique in its refusal to establish national policies that would contain the exploding health care costs while equitably distributing our finite resources amongst all of us. Without such policies in place, controlling premiums can only result in shifting costs to individual patients. But how many families can afford to pay 40% of the costs of a major hospitalization? The fundamental concept of insurance is being challenged by these consumer-driven programs. Policy studies supporting the importance of health insurance coverage lose their validity when cost sharing becomes unaffordable.

Unfortunately, this movement in health care reform plays into the hands of the ideologues. By shifting costs to individuals, the role of governmental public programs would be reduced. But these ideologues are not only opposed to a greater role of government, they also oppose any collective, societal effort to reduce exposure to the costs of untoward health events.

Pooling risk through nonprofit insurers is a collectivist approach that diminishes the role of individual responsibility in meeting fundamental needs. Although they use the “consumer empowerment” rhetoric, in reality they support the concept that those who “refuse” to achieve success and independence through individual effort should not share in the rewards common to the rest of us.

Let’s not fall into the trap of entering their deceptive rhetorical world which would continue to lead us down the path toward expansion of their highly flawed, inhumane policies. Our simple rhetoric of affordable, comprehensive health care for everyone instead should redirect us down the ethically-sound path toward health security for all.

The Sacramento Bee
October 29, 2003
Health plan a sign of future?
Blue Cross offers lower premiums — but higher costs down the line.
By Lisa Rapaport

The day after insurance giants Anthem Inc. and WellPoint Health Networks
Inc. announced a merger deal that could create the biggest health plan in
America, WellPoint’s largest subsidiary unveiled a new product that many say
indicates where this huge insurer may lead the health care market.

Continuing the race to create health plans that lower premiums by charging
patients higher fees for doctors and hospitals, Blue Cross of California
said Tuesday it will sell a new individual health plan called RightPlan. It
has monthly premiums as low as $70 in Sacramento, but it requires patients
to pay $40 for doctor visits and 40 percent of hospital bills.

One aspect of RightPlan that Blue Cross officials said is essential to achieving low premiums is cause for particular concern in the medical community. Blue Cross intends to market the policy to people ages 18 to 34 — the most likely to be uninsured — but the plan does not include maternity coverage.

Known as consumer-driven health plans, policies such as RightPlan have cropped up with greater frequency in recent years as insurers have responded to demands from consumers and employers to curb steep premium increases.

… many health experts believe this latest Blue Cross offering is a good
indicator of what lies ahead.

At Blue Cross, officials would not speculate on whether RightPlan was a sign
of things to come. Spokeswoman Kellie Bernell said the company’s goal in
expanding its selection of consumer-driven plans in recent years has been to
reduce the rolls of the uninsured by offering affordable premiums.

The focus on fees for doctors and hospitals in these plans misses other aspects that may appeal to consumers, Bernell said. RightPlan includes discounts on gym memberships and weight-loss programs, as well as access to acupuncture and other types of alternative medicine.

Anthony Wright, executive director of Health Access, a patient advocacy group based in Sacramento:

“In California, Blue Cross has been a leader in pushing more costs to consumers. They do this and keep diluting the value of insurance. The point of insurance is to not worry about your bank account when you go to the doctor, and insurers seem to increasingly be missing this point.”

http://www.sacbee.com/content/news/medical/story/7688509p-8628347c.html

Comment: The crisis in affordability of health care is of great concern to nearly all Americans. The most visible manifestation of this crisis for the average, relatively healthy individual is the premium paid for health insurance. The insurance industry is acutely aware of this perception and has responded by designing products with affordable premiums. Although these have been targeted to the individual market, employers are now showing interest in these consumer-driven products in order to reduce the costs to them of their health benefit programs.

The United States is unique in its refusal to establish national policies that would contain the exploding health care costs while equitably distributing our finite resources amongst all of us. Without such policies in place, controlling premiums can only result in shifting costs to individual patients. But how many families can afford to pay 40% of the costs of a major hospitalization? The fundamental concept of insurance is being challenged by these consumer-driven programs. Policy studies supporting the importance of health insurance coverage lose their validity when cost sharing becomes unaffordable.

Unfortunately, this movement in health care reform plays into the hands of the ideologues. By shifting costs to individuals, the role of governmental public programs would be reduced. But these ideologues are not only opposed to a greater role of government, they also oppose any collective, societal effort to reduce exposure to the costs of untoward health events.

Pooling risk through nonprofit insurers is a collectivist approach that diminishes the role of individual responsibility in meeting fundamental needs. Although they use the “consumer empowerment” rhetoric, in reality they support the concept that those who “refuse” to achieve success and independence through individual effort should not share in the rewards common to the rest of us.

Let’s not fall into the trap of entering their deceptive rhetorical world which would continue to lead us down the path toward expansion of their highly flawed, inhumane policies. Our simple rhetoric of affordable, comprehensive health care for everyone instead should redirect us down the ethically-sound path toward health security for all.

Date: Tue, 4 Nov 2003 11:28:36 -0800
Subject: qotd: Is starving Medicare the fix we need?

The New York Times
November 4, 2003
White House Backs Limits on Spending for Medicare
By Robert Pear

The Bush administration joined House Republicans on Monday in pushing a Proposal that would force Congress to vote on possible cutbacks in Medicare
if the costs of the program, including new drug benefits, grow faster than
expected.

The plan would also set limits on the use of general tax revenue for Medicare.

Senate negotiators have offered a similar proposal, labeled a “bipartisan Senate staff option.” This suggests that some cost-control mechanism is likely to be in any Medicare bill that emerges from Congress, despite objections from many Democrats and advocates for the elderly.

Both proposals would fundamentally change the financing of Medicare. They would also make it more difficult for Congress to enhance drug benefits,
raise payments to doctors or provide coverage for more outpatient services.

Under the latest proposal from House Republican negotiators, Medicare would
be declared “programmatically insolvent” if its trustees found that general tax revenue would account for more than 45 percent of Medicare spending at any point in the next seven years. If the trustees made such a prediction for two consecutive years, the president would have to propose ways to reduce the dependence on general revenue.

That could be done by cutting benefits, increasing beneficiary premiums form raising payroll taxes.

…the General Accounting Office, the investigative arm of Congress, said that Medicare’s growing reliance on general revenue imposed a mortgage on future generations.

http://www.nytimes.com/2003/11/04/politics/04MEDI.html

Comment: Affordability of health care is a concern of most Americans. We need structural reform to ensure that costs will remain reasonable. A universal, integrated system would eliminate administrative excesses and provide a process to improve resource allocation by reducing inappropriate utilization. A well funded system, with structural integrity, would ensure access to comprehensive, affordable services for everyone.

But the process proposed for Medicare abandons rational cost containment, substituting flawed “starve the beast” economics. Capping the Medicare contribution from general revenues shifts funding to payroll taxes and to premiums and cost sharing paid by beneficiaries. This is both a shift towards more regressive funding of the program, and a shift towards the consumerist movement in health care.

Medicare currently pays only half of the costs of health care for the beneficiaries. Shifting more of the costs to moderate and low income individuals further threatens affordability for the majority of the beneficiaries, especially for those with greater needs. Because of the burden of higher costs, wage earners and beneficiaries would be pressured to accept even greater reductions in Medicare’s benefit package. Slowly starving the Medicare beast is cruel policy.

The fundamental premise that Medicare is no longer affordable is flawed. There are some things in life which we are quite willing to fund. And health security is one of them.

Unfortunately, it appears that the brain trust in Congress that is advancing this agenda is “programmatically insolvent.”

Boston University School of Public Health
Health Reform Program
October 31, 2003
61 Percent of Medicare’s New Prescription Drug Subsidy Is Windfall Profit to Drug Makers
By Alan Sager, Ph.D. and Deborah Socolar, M.P.H.

Congress has declared its commitment to keeping prescription drug prices high under any Medicare drug benefit. This report shows that these unrestrained prices-given the remarkably low real cost of producing the added volumes of pills that Medicare patients need-will bestow enormous windfall profits on prescription drug makers.

An estimated 61.1 percent of the Medicare dollars that will be spent to buy more prescriptions will remain in the hands of drug makers as added profits.

* This windfall means an estimated $139 billion dollars in increased profits over eight years for the world’s most profitable industry.

* At $17 billion annually, this means about a 38 percent rise in drug maker profit.

This is the main reason why the proposed legislation gives patients only a scanty drug benefit, with high continued cost-sharing. The gift to drug makers is also why the plan requires a high taxpayer subsidy-money borrowed from our children and grandchildren.

The legislation would explicitly prohibit Medicare itself from acting to negotiate or contain the drug prices paid under the new program.

… the plan itself is not durable because it is simply too costly.
Congress is simply deferring serious work to shape a sustainable drug industry.

http://www.bumc.bu.edu/www/sph/hs/images/Health_Reform/Medicare_Rx_bill_windfallprofit.pdf

Comment: Physicians, hospitals, laboratories and other providers under the Medicare program have regulated limits on the rates of reimbursement for services and products provided. But look at the language of H.R. 1, the House version of the Medicare prescription drug legislation:

(D) NONINTERFERENCE- In carrying out its duties with respect to the provision of qualified prescription drug coverage to beneficiaries under this title, the [Medicare Benefits] Administrator may not–

(i) require a particular formulary or institute a price structure for the reimbursement of covered outpatient drugs;

(ii) interfere in any way with negotiations between [the various types of private plans] and drug manufacturers, wholesalers, or other suppliers of covered outpatient drugs; and

(iii) otherwise interfere with the competitive nature of providing such coverage through such sponsors and organizations.

The pharmaceutical industry is the most profitable industry in all history, and this bill hands them a blank check to be honored by the taxpayers and beneficiaries. And yet the meager benefit provided will continue to keep prescription drugs out of the reach of millions of Medicare beneficiaries because of the lack of affordability.

What input do we have? Rep. Bill Thomas, who is crafting the final legislation, has excluded most of the Democratic members of the joint conference committee from the process. He is even overriding the input of his Republican co-chair, Sen. Charles Grassley. His attitude is expressed well in this quote (Morgan and Eilperin, Washington Post, Oct. 29):

“I don’t think it serves any purpose to attempt to misrepresent or slant or fabricate… to influence outside the negotiating structure. My goal is to make law, not to make myself look good.”

And from the same article:

… Thomas surprised fellow conferees by outlining a proposed agreement for
the bill. He and his staff had written it without outside consultation. “It was a total unilateral move,” one source said. Grassley reportedly was furious.

http://www.washingtonpost.com/wp-dyn/articles/A38004-2003Oct29.html
It’s time to contemplate those cherished words of Abraham Lincoln: … government of the people, by the people, and for the people…

Let’s not let Lincoln down.

Boston University School of Public Health
Health Reform Program
October 31, 2003
61 Percent of Medicare’s New Prescription Drug Subsidy Is Windfall Profit to Drug Makers
By Alan Sager, Ph.D. and Deborah Socolar, M.P.H.

Congress has declared its commitment to keeping prescription drug prices high under any Medicare drug benefit. This report shows that these unrestrained prices-given the remarkably low real cost of producing the added volumes of pills that Medicare patients need-will bestow enormous windfall profits on prescription drug makers.

An estimated 61.1 percent of the Medicare dollars that will be spent to buy more prescriptions will remain in the hands of drug makers as added profits.

* This windfall means an estimated $139 billion dollars in increased profits over eight years for the world’s most profitable industry.

* At $17 billion annually, this means about a 38 percent rise in drug maker profit.

This is the main reason why the proposed legislation gives patients only a scanty drug benefit, with high continued cost-sharing. The gift to drug makers is also why the plan requires a high taxpayer subsidy-money borrowed from our children and grandchildren.

The legislation would explicitly prohibit Medicare itself from acting to negotiate or contain the drug prices paid under the new program.

… the plan itself is not durable because it is simply too costly.
Congress is simply deferring serious work to shape a sustainable drug industry.

http://www.bumc.bu.edu/www/sph/hs/images/Health_Reform/Medicare_Rx_bill_windfallprofit.pdf

Comment: Physicians, hospitals, laboratories and other providers under the Medicare program have regulated limits on the rates of reimbursement for services and products provided. But look at the language of H.R. 1, the House version of the Medicare prescription drug legislation:

(D) NONINTERFERENCE- In carrying out its duties with respect to the provision of qualified prescription drug coverage to beneficiaries under this title, the [Medicare Benefits] Administrator may not–

(i) require a particular formulary or institute a price structure for the reimbursement of covered outpatient drugs;

(ii) interfere in any way with negotiations between [the various types of private plans] and drug manufacturers, wholesalers, or other suppliers of covered outpatient drugs; and

(iii) otherwise interfere with the competitive nature of providing such coverage through such sponsors and organizations.

The pharmaceutical industry is the most profitable industry in all history, and this bill hands them a blank check to be honored by the taxpayers and beneficiaries. And yet the meager benefit provided will continue to keep prescription drugs out of the reach of millions of Medicare beneficiaries because of the lack of affordability.

What input do we have? Rep. Bill Thomas, who is crafting the final legislation, has excluded most of the Democratic members of the joint conference committee from the process. He is even overriding the input of his Republican co-chair, Sen. Charles Grassley. His attitude is expressed well in this quote (Morgan and Eilperin, Washington Post, Oct. 29):

“I don’t think it serves any purpose to attempt to misrepresent or slant or fabricate… to influence outside the negotiating structure. My goal is to make law, not to make myself look good.”

And from the same article:

… Thomas surprised fellow conferees by outlining a proposed agreement for
the bill. He and his staff had written it without outside consultation. “It was a total unilateral move,” one source said. Grassley reportedly was furious.

http://www.washingtonpost.com/wp-dyn/articles/A38004-2003Oct29.html
It’s time to contemplate those cherished words of Abraham Lincoln: … government of the people, by the people, and for the people…

Let’s not let Lincoln down.

Harris Interactive
Health Care News
Volume 3, Issue 16
October 27, 2003

Table 3
Should Health Care be a Public Good (Entitlement) or a Private Economic Good?

Do you think public policy should treat health care and health insurance more as an entitlement like education, police and fire protection and highways or more as a kind of product or service, like cars, house, food and clothes, or homeowners insurance where you get what you can afford and want to pay for?

65% – Entitlement
23% – As a kind of product
12% – not sure

In all western democracies, there are substantial public sector and private sector health care providers and insurers. Of course, all the other western democracies provide some form of universal health insurance. What is less well known in America is that they also allow people (with some exceptions) to buy additional health insurance and medical care with their own money.

However, in every other western democracy a reasonable level of health insurance is seen as a right, something to which citizens are entitled. So in every country including the United States, health care is of course both an entitlement (for some people) as well as a private economic good. The question is should it tilt more one way or the other. In other countries, it clearly tilts heavily toward being more of an entitlement. Most Americans clearly agree with most Europeans and Canadians that health care could be thought of more as an entitlement or public good than as a private economic good.

http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2003Vol3_Iss16.pdf

Comment: The opponents of comprehensive health care proposals frequently
argue that Americans are fundamentally different, that Americans reject the
egalitarian concept that everyone should have reasonable access to affordable health care. They contend that we are a nation of individuals, each driven to provide for his or her own individual needs. Only the rare individual who is totally incapable of being a productive individual is entitled to support through a collective government or private charity channel, they argue.

This poll and last week’s ABC News/Washington Post poll both confirm that
Americans are not fundamentally different. The majority of us do believe
that the government should ensure that everyone has access to an adequate
level of health care services.

Never again can we allow a debate to end with the argument that we are different, that we are less caring for our fellow Americans than are the people of other nations for their own. That specious argument has been refuted.

The debate must instead start with the premise that we do care. The debate now must center over the various models of comprehensive reform which might accomplish our goals.

The New York Times
October 28, 2003
Acquisition Would Create Nation’s Largest Health Insurer
By Milt Freudenheim

In a marriage of Blue Cross giants, Anthem Inc. agreed yesterday to buy WellPoint Health Networks for $16.4 billion in stock and cash, creating a company that would be the nation’s largest health insurer, with 26 million health plan members in 13 states.

Anthem and WellPoint were pioneers in converting Blue Cross plans into for-profit companies…

WellPoint’s chief executive, Leonard D. Schaeffer, who created the company on the foundation of a successful turnaround of Blue Cross of California, will hand the reins to Larry Glasscock, Anthem’s chief executive.

Mr.Glasscock, 55, will be president and chief executive of the new company, and Mr. Schaeffer, 58, a former government health care official, will be chairman.

Mr. Schaeffer’s WellPoint holdings – 3.3 million shares, according to a Securities and Exchange Commission filing last month – jumped in value by more than $70 million yesterday, to over $300 million. He would also receive $27.5 million under a change-of-control clause in his contract and about $10 million more in executive retirement benefits, according to the WellPoint proxy and other filings.

http://www.nytimes.com/2003/10/28/business/28care.html

Comment: When the deal is approved, besides the payouts listed, Leonard Schaeffer will receive 3.3 million shares of the combined company, WellPoint
Inc., plus an additional $78 million in cash. His total reported gain, not including his high salary, will be $116 million in cash plus the 3.3 million shares of WellPoint Inc., valued at about $257 million, for a total of $335 million. In spite of all of the other rhetoric, this one-third of a billion dollars is precisely why Leonard Schaeffer led the conversion of California Blue Cross into a for-profit insurer, establishing WellPoint as the parent company.

Although many become angry at the thought that these are funds that should
be going to health care, several economists point out the fact that these funds come from the shareholders who own the companies. They credibly contend that Wall Street investors rather than patients are footing this bill. But what is the traditional method of establishing the price per share? It’s the price-earnings ratio. Those earnings would be patient care funds in a public insurance program. And, of course, earnings are increased by hiking prices (premiums) and by reducing expenditures (health care benefits). Leonard Schaeffer’s wealth was gained by sacrificing value that would have accrued to purchasers and patients (insurance beneficiaries).

Social insurance anyone?