Monterey County – The Herald
Mar 21, 2003
Doctors lament Natividad woes
By Joe Livernois

Dr. Pedro Moreno is frustrated.

Among the hundreds of patients he sees as a family practice physician at Natividad Medical Center is a 35-year-old man diagnosed with diabetes two years ago.

But the patient can’t afford the $50 monitor he needs to check his blood sugar. He can’t even afford the $4 to buy the test strips to place in the monitor.

“I haven’t been able to get him the care he needs,” said Moreno. “I feel completely powerless.”

Moreno and other doctors at Natividad Medical Center are hitting the streets to discuss the problems suffered by uninsured patients — and the problems the rest of society encounters because of the health-care crisis.

Natividad Medical Center, the county-operated hospital in Salinas, provides much of the health care to many of the approximately 80,000 Monterey County residents who are uninsured and the thousands of others covered by the state Medi-Cal program.

Natividad itself is in serious financial trouble and is expected to end its fiscal year with a $13 million operating deficit. On Tuesday, the Board of Supervisors will hold a public hearing on a proposal to close two clinics in Salinas affiliated with Natividad.

Moreno said the problems at Natividad are aggravated by the lack of insurance coverage. And he said the problems will only get worse for uninsured residents if the county is forced to shut down clinics or cut services at the county hospital.

The drain on Natividad is worsened because uninsured patients are flooding the hospital’s emergency room because they can’t afford to see regular physicians or specialists, (Dr. Marc) Tunzi said.

Moreno urged about 75 people at the Latino Network luncheon to lobby legislators to support national and state health-care reform proposals, including a single-payer insurance program now being consider by state Legislators.

http://www.montereyherald.com/mld/montereyherald/news/local/5448148.htm

Comment: The threat to the safety-net infrastructure is greater than ever. We can no longer dismiss the growing numbers of uninsured because, “They can go to County.”

Dr. Moreno clearly understands. The solution is comprehensive reform of health care funding through a single-payer insurance program.

Star-Telegram
Mar. 16, 2003
Indigent care network envisioned
By Mitch Mitchell

A new group, the Healthy Communities Coalition, has been working for two years to develop a plan to organize the loose network of health care workers who help Denton County’s poor.

Coalition members maintain that creating a structured system would mean that the work could be spread out among a larger group of physicians. It would also mean that indigent patients would have a better chance of receiving care from a physician they knew, instead of being shunted from clinic to clinic, from emergency room to emergency room.

The Healthy Communities Coalition may consider the establishment of a network of clinics throughout Denton County, but the costs make that option unlikely, officials said.

Financial concerns also make it unlikely that a partnership to care for Denton County’s indigent could be forged between Denton County and an adjacent county, such as Tarrant or Dallas, that has a public hospital.

Coalition members are searching the Federal Register and state funding sources for available grants but have found none so far. Meanwhile, providing health care for poor and uninsured people in Denton County has been financially taxing for all who are involved.

But members of the Healthy Communities Coalition contend that they can improve access to health care for Denton County and that all they need is a little time and money and a finished plan. The alternative is doing nothing while watching the system become more haphazard.

http://www.dfw.com/mld/dfw/5406354.htm

Comment: Futility. This noble effort, taking place in many regions in the country, to establish a voluntary network providing access to health care for the indigent, is doomed to failure because of the crisis in health care funding. Those willing to provide enough care to meet the need are no longer able to fund their losses by shifting costs to insured patients, since insurers now dictate allowable fees.

The irony is that we are already spending more than enough to fully fund this care. But we need to stop spending it on the worthless administrative excesses of the insurers and the administrative burden they place on the system, and spend the money on patients instead.

Public Opinion Strategies
March 13, 2003
Survey of Small, Medium and Large Businesses

When asked about the most important goal for reforming our health care
system, business leaders focus on “making health care more affordable” and
“providing basic health insurance coverage to all Americans.” Of the five
health care goals tested, the most important for business leaders is “making
health care more affordable” (51%), followed by “providing basic health
insurance coverage to all Americans” (28%). The remaining three goals are
well below the top two: “maintaining the high quality of American health
care” (11%), “making sure people can select the doctor or hospital of their
choice” (6%), and “making sure the system allows the development and
adoption of new medical technologies” (2%).

http://covertheuninsuredweek.org/media/BusinessSurveyReport.pdf

Comment: Previous polls have confirmed that 98% of the general public is
concerned about making health care more affordable. This survey confirms
that affordability is also the most important concern for businesses of all
sizes.

Perhaps the most frequent argument advanced against establishing a mechanism
that contains costs is that innovation and development of new technologies
would be suppressed. This survey confirms that this is the least concern of
businesses.

If business interests had a better understanding of the single payer model,
support would increase. Of all options under consideration, the single payer
model is the only one than can effectively contain costs, and it does so by
its specific design – using a global budget. It would also meet the other
major goal supported by businesses – providing coverage for all Americans.
It would improve quality by improving access and by adoption of an
integrated information technology system. It would ensure free choice of
providers. And it would actually improve innovation and technology by
freeing up funds currently wasted on administrative excesses which would
then increase funding of the health care delivery system which utilizes the
newer technologies.

Isn’t it time for business to take a much closer look at the single payer
model?

American Medical News
March 24/31, 2003
California emergency departments close after hemorrhaging money
By Markian Hawryluk

According to a new study by the California Medical Assn., California emergency departments provided $540 million in uncompensated care in fiscal year 2001, up 24% from the previous year.

… since 1990, 60 emergency departments — nearly 15% of California’s EDs — have shut their doors.

The closures have left entire communities without emergency departments and have led to increased patient volume. Waits of more than four hours are common as physicians and nurses struggle to treat high volumes of patients, the study found.

John Whitelaw, MD, California Medical Association president:

“What we are seeing here is an astonishing growth in losses, and it shows no sign of abating. People depend on their emergency rooms to be there for them, but these losses point to a crisis of extreme proportions and underline the threat to emergency care around the state.”

http://www.ama-assn.org/sci-pubs/amnews/pick_03/gvsd0324.htm

Comment: No amount of personal wealth can protect you from the threat of the deteriorating infrastructure of our emergency system. Rich people will die, along with the poor, because of the failure of our system.

Providing comprehensive coverage for everyone, funded at our current level of spending (15.2% of our GDP), with a level of efficiency available only through public administration, would ensure that our emergency system would be well funded, always there for all of us.

The Washington Post
March 14, 2003
Editorial

Medicine for Medicare

DO NOT BE MISLED by the loud noises coming from congressional Democrats and health care activists. The Medicare modernization plan the president has finally presented to Congress, after much hemming and hawing, is not radical. It does not force anyone to leave the current system. It does not make anyone switch doctors. It adds $400 billion over the next 10 years to pay for extra drug benefits, a number far higher than some have mentioned. Unlike leaked versions of the administration’s proposal, this one does not even provide full details of what the reform would look like, instead leaving Congress to fill in many of the blanks. As a result, it’s difficult to say whether the proposal would produce much change.

In essence, it adds options, instead of removing them. For those who want it, traditional “fee-for-service” Medicare would be preserved more or less intact, with the addition of a prescription drug discount card as well as some catastrophic insurance. No extra payments would be required, it seems. At the same time, Medicare recipients would also be able to opt into a new program — “enhanced Medicare” — that would look a lot like the current federal employee health insurance plan. Those who chose this option would pay a part of the cost themselves. In return, they would get a private plan and better benefits.

Both the administration and its supporters in Congress seem to hope that over time more people (and particularly younger people, by now accustomed to a plethora of health care choices) would select this second option. If this happened, the costs of Medicare to the federal government might not come down dramatically — private insurance isn’t necessarily cheaper, particularly for the elderly — but at least Medicare recipients would have some incentive to choose plans more suited to their specific health needs. Because they pay for more than just emergency visits to the doctor, integrated plans could also care more sensibly for the chronically ill. As a recent report by the Progressive Policy Institute points out, Medicare currently will pay if you’ve been hospitalized for a stroke but will not pay for the anti-hypertension drugs to prevent it. This is the kind of absurdity that a plan designed specifically to meet the needs of older people could avoid.

“Could” and “might” are the operative words here, however. The president’s proposal is not a panacea but rather a set of suggestions that reflect the politics of the moment. Clearly, this president does not want to be accused of “abandoning” Medicare. On the contrary, he wants to be able to say that “Medicare will always be there, just how it’s always been, if you want it that way.” If Congress chooses to stick too closely to this mantra, and to keep benefits the same across the board, there will be little incentive for anyone to opt out of the current system or to contribute to the costs of his or her care. However politically difficult it appears to be, Congress must make it possible for Medicare to change with the times.

http://www.washingtonpost.com/wp-dyn/articles/A23255-2003Mar13.html

Comment: Neither of the “either-or” options behind this editorial can be good news. Either the editorial staff has failed to do its homework in understanding the fundamental principles of social insurance, or the editorial position of The Washington Post is to support a system that ensures comprehensive services for those able to afford them, but relegates lower-income beneficiaries to a program that falls short on basic health care needs. Have the editors demonstrated incompetence by failing to inform themselves adequately on the issues, or, worse, are they suggesting that personal wealth should determine whether Medicare beneficiaries should have access to all essential services?

Adding a drug discount card to the program would cost nothing, which is exactly what it is worth under this “budget-neutral” administration. And the $6000 deductible catastrophic drug coverage would benefit only the affluent. Prohibiting any other improvements in the benefit package of the traditional program would perpetuate the impaired access to care for those who are unable to afford essential services that are not currently a benefit of the program. The most immediate need is for a bona fide prescription benefit.

The Washington Post supports the FEHBP model of “enhanced Medicare,” making available a private plan, with BETTER BENEFITS, by PAYING A PART OF THE COST themselves, while still prohibiting coverage of the “better benefits” in the traditional program. This would end Medicare as an egalitarian program of social insurance.

The Washington Post is supporting the shift to “consumer-directed” Medicare, not only by shifting costs to beneficiaries when offering more plan options, but also by providing “incentive to choose plans more suited to their specific health needs.” But it is impossible to select a plan that will be the best choice for medical events that cannot possibly be predicted. Also, for those with chronic disorders, providing options creates all of the inequities characteristic of risk segmentation. Lower-income beneficiaries with chronic disorders would be locked into the traditional program. The Washington Post states that covering a stroke but not covering the medications that would prevent it is “the kind of absurdity that a plan designed specifically to meet the needs of older people could avoid.” Yet The Washington Post has endorsed precisely this type of absurdity.

Is this editorial incompetence, or is it support for the concept that there is a “lower class” that is not entitled to all essential health care? Perhaps The Washington Post does not want them to have their “cake,” but, rather, “Let them have strokes.”

The Washington Post
March 14, 2003
Editorial

Medicine for Medicare

DO NOT BE MISLED by the loud noises coming from congressional Democrats and health care activists. The Medicare modernization plan the president has finally presented to Congress, after much hemming and hawing, is not radical. It does not force anyone to leave the current system. It does not make anyone switch doctors. It adds $400 billion over the next 10 years to pay for extra drug benefits, a number far higher than some have mentioned. Unlike leaked versions of the administration’s proposal, this one does not even provide full details of what the reform would look like, instead leaving Congress to fill in many of the blanks. As a result, it’s difficult to say whether the proposal would produce much change.

In essence, it adds options, instead of removing them. For those who want it, traditional “fee-for-service” Medicare would be preserved more or less intact, with the addition of a prescription drug discount card as well as some catastrophic insurance. No extra payments would be required, it seems. At the same time, Medicare recipients would also be able to opt into a new program — “enhanced Medicare” — that would look a lot like the current federal employee health insurance plan. Those who chose this option would pay a part of the cost themselves. In return, they would get a private plan and better benefits.

Both the administration and its supporters in Congress seem to hope that over time more people (and particularly younger people, by now accustomed to a plethora of health care choices) would select this second option. If this happened, the costs of Medicare to the federal government might not come down dramatically — private insurance isn’t necessarily cheaper, particularly for the elderly — but at least Medicare recipients would have some incentive to choose plans more suited to their specific health needs. Because they pay for more than just emergency visits to the doctor, integrated plans could also care more sensibly for the chronically ill. As a recent report by the Progressive Policy Institute points out, Medicare currently will pay if you’ve been hospitalized for a stroke but will not pay for the anti-hypertension drugs to prevent it. This is the kind of absurdity that a plan designed specifically to meet the needs of older people could avoid.

“Could” and “might” are the operative words here, however. The president’s proposal is not a panacea but rather a set of suggestions that reflect the politics of the moment. Clearly, this president does not want to be accused of “abandoning” Medicare. On the contrary, he wants to be able to say that “Medicare will always be there, just how it’s always been, if you want it that way.” If Congress chooses to stick too closely to this mantra, and to keep benefits the same across the board, there will be little incentive for anyone to opt out of the current system or to contribute to the costs of his or her care. However politically difficult it appears to be, Congress must make it possible for Medicare to change with the times.

http://www.washingtonpost.com/wp-dyn/articles/A23255-2003Mar13.html

Comment: Neither of the “either-or” options behind this editorial can be good news. Either the editorial staff has failed to do its homework in understanding the fundamental principles of social insurance, or the editorial position of The Washington Post is to support a system that ensures comprehensive services for those able to afford them, but relegates lower-income beneficiaries to a program that falls short on basic health care needs. Have the editors demonstrated incompetence by failing to inform themselves adequately on the issues, or, worse, are they suggesting that personal wealth should determine whether Medicare beneficiaries should have access to all essential services?

Adding a drug discount card to the program would cost nothing, which is exactly what it is worth under this “budget-neutral” administration. And the $6000 deductible catastrophic drug coverage would benefit only the affluent. Prohibiting any other improvements in the benefit package of the traditional program would perpetuate the impaired access to care for those who are unable to afford essential services that are not currently a benefit of the program. The most immediate need is for a bona fide prescription benefit.

The Washington Post supports the FEHBP model of “enhanced Medicare,” making available a private plan, with BETTER BENEFITS, by PAYING A PART OF THE COST themselves, while still prohibiting coverage of the “better benefits” in the traditional program. This would end Medicare as an egalitarian program of social insurance.

The Washington Post is supporting the shift to “consumer-directed” Medicare, not only by shifting costs to beneficiaries when offering more plan options, but also by providing “incentive to choose plans more suited to their specific health needs.” But it is impossible to select a plan that will be the best choice for medical events that cannot possibly be predicted. Also, for those with chronic disorders, providing options creates all of the inequities characteristic of risk segmentation. Lower-income beneficiaries with chronic disorders would be locked into the traditional program. The Washington Post states that covering a stroke but not covering the medications that would prevent it is “the kind of absurdity that a plan designed specifically to meet the needs of older people could avoid.” Yet The Washington Post has endorsed precisely this type of absurdity.

Is this editorial incompetence, or is it support for the concept that there is a “lower class” that is not entitled to all essential health care? Perhaps The Washington Post does not want them to have their “cake,” but, rather, “Let them have strokes.”