PNHP

Health care quality destined to improve

Health care quality destined to improve

The Washington Post
February 5, 2003
Director Seeks ‘Just the Facts’ To Improve Medical Care
By David Brown

It is an embarrassing but no longer well-kept secret that despite health care spending of about $1.3 trillion a year — including about $25 billion in federally funded research — many Americans receive medical care that is not terribly good.

Agency for Healthcare Research and Quality (AHRQ) enters a new phase of its occasionally rocky journey with the appointment expected today of Carolyn M. Clancy, 49, as the fourth director since its founding in 1989.

As Clancy sees it, AHRQ has two big challenges. One is to help develop the “evidence base” of medicine — the raw material of better care. The second is to identify the best ways to get doctors and nurses to use optimal, up-to-date treatments.

The first effort acknowledges that the body of medical research on just about any important subject is vast — too big for the average practitioner to grasp. Over the past 15 years, however, there has emerged a set of rules and methods by which a team of experts examines all the studies on a given question, evaluates their validity (combining numerous ones, on occasion, to increase the statistical power of the results) and ultimately extracts conclusions — the “best evidence” — from the mass of information.

This work is expensive and laborious. Health care organizations and professional societies cannot easily do it. Consequently, AHRQ has helped establish “evidence-based practice centers” at 13 universities, and is paying researchers there to create “systematic reviews” of many topics.

She describes the second challenge as the effort to figure out “what systems or strategies make the right thing to do the easy thing to do.”

AHRQ is paying for dozens of studies of how clinics and hospital systems improve care, vaccination rates and patient satisfaction, and reduce waiting time, overlooked lab results and medication errors.

Carolyn Clancy, M.D.:

“The key is information. Making information available at the point of care when you need it.”

http://www.washingtonpost.com/wp-dyn/articles/A26125-2003Feb4.html

U.S. Department of Health and Human Services press release: http://www.ahcpr.gov/news/press/pr2003/clancypr.htm

Agency for Healthcare Research and Quality: http://www.ahcpr.gov/

Comment: The appointment of Carolyn Clancy as director of AHRQ is an important step forward for improving the quality of our health care system. She understands the issues that will make our system a better system for those who matter the most: the patients. Her strong, patient-oriented values are exemplified by the fact that she is a former president of Physicians for a National Health Program.

Equitable distribution or adequate spending?

The Kansas City Star
Jan. 26, 2003
As I See It: Single-payer system would fix health system
By Joshua Freeman

Those who observe that there are waits for some elective services in Canada are confusing how health-care resources are distributed (inequitably in the United States, equitably in Canada) and how much we spend on health care. Per capita, the United States spends twice what Canada spends and four times what Britain spends; if either country could afford to spend anything close to these levels, there would be no waits for any services in either country. What we lack is a structure that is rational and equitable, as is single payer.

The American people can demand a rational cost-effective system that provides equitable, necessary access to health care for all. Eliminating insurance industry profit and implementing a single-payer system can be a central part of this solution.

http://www.kansascity.com/mld/kansascity/5025963.htm

Joshua Freeman, MD is chairman of the department of family medicine at the University of Kansas Medical Center.

SINGLE-PAYER:  REPS. CONYERS, MCDERMOTT INTRODUCE BILL

National Journal,
February 5, 2003

Rep. John Conyers (D-Mich.), ranking member of the House Judiciary Committee, and Rep. Jim McDermott (D-Wash.), a member of the House Ways and Means Health Subcommittee, have introduced a bill that would create a national single-payer health system, CongressDaily reports.  According to McDermott, the bill would have the federal government finance but not administer the system and would keep the current system of private physicians and hospitals.  McDermott said it is “nonsense to suggest the nation cannot afford such a system,” noting that the federal government “already spends $2,600 per person” on health care through Medicare, Medicaid, other public health plans and tax exclusions for employers who provide workers’ coverage.  Conyers said, “Even the people who don’t like [a single-payer system] are moving to it.  There’s nothing else left” (Rovner, CongressDaily, 2/4).  According to a bill summary, the system would expand the current Medicare system to all U.S. residents. The system would be funded through the existing Medicare payroll tax and a new payroll tax and would provide coverage for a variety of services, including primary care, prescription drugs and dental and vision services (Bill summary).

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=15882

The United States National Health Insurance Act

The United States National Health Insurance Act
Executive Summary

The United States National Health Insurance Act establishes a new American national health insurance program by creating a single payer health care system. The bill would create a publicly financed, privately delivered health care program that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans, guaranteed by law, will have access to the highest quality and cost effective health care services regardless of one’s employment, income, or health care status.

And from the PNHP press release:

Quentin Young, M.D., convener of the physician panel:

“Good news. There is now a way to exit the nightmare of a collapsing health system. We no longer have to put up with the outrageous costs that keep millions of Americans from receiving medical care and needed medications. Nor will tens of thousands of families have to declare bankruptcy over medical bills. Universal national health insurance (single payer) takes the resources we have in place and deals with them in an intelligent manner, excluding the tragic hemorrhage of resources into non-health entities.”

Executive Summary of The United States National Health Insurance Act: https://pnhp.org/nhibill/nhi_execsumm.html

The full text of The United States National Health Insurance Act: https://pnhp.org/docs/nhi_bill_final.pdf

Recorded telecast of the press conference on kaisernetwork.org HealthCast: http://www.kaisernetwork.org/calendar/calendar.cfm?show=4 and click on the calendar under Feb. 4, “Physicians for a National Health Program – National Health Insurance Bill (DC)”

PNHP press release: https://pnhp.org/nhibill/nhi_press_release.html

The Coalition for a National Health Program is being launched to bring together all those who support the kind of national health plan embodied in the US National Health Insurance Act. Bookmark this site and return to it soon: http://www.cnhp.us/

Dr. MARCIA ANGELL ON INTRODUCING THE NATIONAL HEALTH INSURANCE BILL

February 4, 2003
Washington D.C.

We are here today to introduce a national health insurance program. Such a program is no longer optional; it’s necessary.

Americans have the most expensive health care system in the world. We spend about twice as much per person as other developed nations, and that gap is growing. That’s not because we are sicker or more demanding (Canadians, for example, see their doctors more often and spend more time in the hospital). And it’s not because we get better results. By the usual measures of health (life expectancy, infant mortality, immunization rates), we do worse than most other developed countries. Furthermore, we are the only developed nation that does not provide comprehensive health care to all its citizens. Some 42 million Americans are uninsured – disproportionately the sick, the poor, and minorities — and most of the rest of us are underinsured. In sum, our health care system is outrageously expensive, yet inadequate. Why? The only plausible explanation is that there’s something about our system – about the way we finance and deliver health care – that’s enormously inefficient. The failures of the system were partly masked during the economic boom of the 90’s, but now they stand starkly exposed. There is no question that with the deepening recession and rising unemployment, in the words of John Breaux, “The system is collapsing around us.”

The underlying problem is that we treat health care like a market commodity instead of a social service. Health care is targeted not to medical need, but to the ability to pay. Markets are good for many things, but they are not a good way to distribute health care. To understand what’s happening, let’s look at how the health care market works.

Most Americans receive tax-free health benefits from their employers, who pay insurers a portion of the premiums for health coverage. But not all employers offer benefits, and when they do, the benefits may not be comprehensive. It’s entirely voluntary. When employers are competing for workers, they offer good benefits; when unemployment rises, they drop them.

The insurers with whom employers do business are mostly investor-owned, for-profit managed care businesses. They try to keep premiums down and profits up by stinting on medical services. In fact, the best way for insurers to compete is by not insuring high-risk patients at all; limiting the coverage of those they do insure (for example, by excluding expensive services, such as heart transplantation); and by passing costs back to patients by denying claims or as deductibles and co-payments. We are the only nation in the world with a health care system based on dodging sick people. These practices add greatly to overhead costs because they require a mountain of paperwork. They also require creative marketing to attract the affluent and healthy and avoid the poor and sick. Not surprisingly, the U. S. has by far the highest overhead costs in the world.

It’s instructive to follow the health care dollar as it wends its way from employers toward the doctors and nurses and hospitals that actually provide medical services. First, private insurers regularly skim off the top a substantial fraction of the premiums – anywhere from 10 to 25 percent – for their administrative costs, marketing, and profits. The remainder is then passed along a veritable gauntlet of satellite businesses that feed on the health care industry, including brokers to cut deals, disease-management and utilization review companies, drug-management companies, legal services, marketing consultants, billing agencies, information management firms, and so on and so on. Their function is often to limit services in one way or another. They, too, take a cut, including enough for their own administrative costs, marketing, and profits. I would estimate that no more than 50 cents of the health care dollar actually reaches the providers – who themselves face high overhead costs in dealing with multiple insurers.

What are the signs of the imminent collapse of this system? Private health insurance premiums are now rising at an unsustainable rate of about 13 percent per year – and as much as 25 percent in some areas of the country. Coverage is shrinking, as more employers decide to cap their contributions to health insurance and workers find they cannot pay their rapidly growing share. And finally, with the rise in unemployment, more people are losing what limited coverage they had. This is not a system that can be tinkered with. It needs to change.

The program we are introducing today is the very soul of simplicity and efficiency, compared with our private health care system. It is a single-payer system – that is, health care funds would be distributed by a single, public entity, so that health care could be coordinated to eliminate both gaps and overlap. In many ways, our program would be tantamount to extending Medicare to the entire population. Medicare is, after all, a government-financed single-payer system embedded within our private, market-based system. It’s by far the most efficient part of our health-care system, with overhead costs of less than 3 percent, and it covers virtually everyone over the age of 65, not just some of them. Medicare is not perfect, but it is by far the most popular part of the U. S. health care system, and in my opinion its problems would be relatively easy to remedy – but that is another subject.

What are the usual objections to the sort of national program we are calling for today? They are mostly based on a number of myths.

Myth #1 is that we can’t afford a national health care system, and if we try it, we will have to ration care. My answer is that we can’t afford not to have a national health care system. A single-payer system would be far more efficient, since it would eliminate excess administrative costs, profits, cost-shifting and unnecessary duplication. Furthermore, it would permit the establishment of an overall budget and the fair and rational distribution of resources. We should remember that we now pay for health care in multiple ways – through our paychecks, the prices of goods and services, taxes at all levels of government, and out-of-pocket. It makes more sense to pay just once.

According to Myth #2, innovative technologies would be scarce under a single-payer system, we would have long waiting lists for operations and procedures, and in general, medical care would be threadbare and less available. This misconception is based on the fact that there are indeed waits for elective procedures in some countries with national health systems, such as the U. K. and Canada. But that’s because they spend far less on health care than we do. (The U. K. spends about a third of what we do per person.) If they were to put the same amount of money as we do into their systems, there would be no waits and all their citizens would have immediate access to all the care they need. For them, the problem is not the system; it’s the money. For us, it’s not the money; it’s the system.

Myth #3 is that a single-payer system amounts to socialized medicine, which would subject doctors and other providers to onerous, bureaucratic regulations. But in fact, although a national program would be publicly funded, providers would not work for the government. That’s currently the case with Medicare, which is publicly funded, but privately delivered.

As for onerous regulations, nothing could be more onerous both to patients and providers than the multiple, intrusive regulations imposed on them by the private insurance industry. Indeed, many doctors who once opposed a single-payer system are now coming to see it as a far preferable option.

Myth #4 says that the government can’t do anything right. Some Americans like to say that, without thinking of all the ways in which government functions very well indeed, and without considering the alternatives. I would not want to see, for example, the NIH, the National Park Service, or the IRS privatized. We should remember that the government is elected by the public and we are responsible for it. An investor-owned insurance company reports to its owners, not to the public.

Some people say that a single-payer system is a good idea, but politically unrealistic. That is a self-fulfilling prophecy. In my opinion, the medical profession and the public would be enthusiastic about a single-payer system if the facts were known and the myths dispelled. Yes, there would be powerful special interests opposing it and I don’t underestimate them, but with courageous leadership, such as Representative Conyers is providing, and the support of the medical profession and public, I believe there is nothing unrealistic about a National Health Insurance Program.

I want to mention one final and very important reason for enacting a national health program. We live in a country that tolerates enormous disparities in income, material possessions, and social privilege. That may be an inevitable consequence of a free market economy. But those disparities should not extend to denying some of our citizens certain essential services because of their income or social status. One of those services is health care. Others are education, clean water and air, equal justice, and protection from crime, all of which we already acknowledge are public responsibilities. We need to acknowledge the same thing for health care. Providing these essential services to all Americans, regardless of who they are, helps ensure that we remain a cohesive and optimistic country. It says that when it comes to vital needs, we are one community, not 280 million individuals competing with one another. In seeking to ensure adequate health care for all our citizens, we have an opportunity today to reassert that we are indeed a single nation.

— Marcia Angell, M. D.
Senior Lecturer, Department of Social Medicine, Harvard Medical School
Former Editor-in-Chief, New England Journal of Medicine
February 4, 2003
Washington, D.C.

No health care for AMA's janitors

News from the Metro Washington Council,
AFL-CIO February 3, 2003

SHOW YOUR LOVE FOR JANITORS: DC janitors will march to the American Medical Association on Valentine’s Day to highlight their need for health care. Contracts covering more than 4,000 DC janitors (members of SEIU 82) expire April 30th and health care is a top issue on the table. AMA headquarters are cleaned by janitors who receive no health care benefits, despite AMA claims to be working on addressing the disparity between the world’s most advanced health care system and the lack of health care among many minority groups in the United States. SEIU Local 82 members will join janitors and other supporters in spotlighting their fight for health care for all janitors in the nation’s capitol.

Disconcerting facts about DC janitors from SEIU Local 82:
http://www.seiu82.org/linked_pages/master_contract_2003.cfm

Weighing Privatization

Critics say private drug plans leave seniors paying more for less

By Deborah Barfield Berry
WASHINGTON BUREAU

February 3, 2003

Washington – Over the years, Diane Paulson has watched managed care plans promise seniors in Massachusetts cheaper health insurance complete with prescription drug coverage, only to pack up and leave.

“It was a shame that so many people were misled. Misled by the plans and in some ways misled by the government – that this was the best thing since sliced bread,” said Paulson, managing attorney at the Medicare Advocacy Project, a Boston- based program representing Medicare beneficiaries. “It’s been a mixed bag. But mostly negative.”

Paulson, like many other advocates for seniors, doctors and some health experts, is now questioning why President George W. Bush would propose a plan that relies on private health plans to deliver a Medicare prescription drug benefit to seniors when the track record in an existing federal program, Medicare+Choice, has been shaky.

Citing Medicare+Choice as an example, advocates argue that private plans have abandoned seniors, leaving them scrambling to find new health care plans or paying higher premiums and co-payments for fewer benefits. In some cases, seniors have had to return to the more costly traditional Medicare, the federal insurance program for the elderly and disabled, which doesn’t offer drug coverage.

“The whole privatization scheme is the wrong direction,” said Don McCanne, president of the Phy- sicians for a National Health Program. “It will shift patients into an industry that has a much higher administrative cost … and will do it at the cost of decreasing the benefit for Medicare beneficiaries.”

Bush and Republican lawmakers support Medicare drug plans that rely on the private sector to deliver benefits. They contend that competition would drive down drug costs and offer seniors more coverage and choice.

“I believe seniors, if they’re happy, should stay on the current Medicare system,” Bush said last week in Grand Rapids, Mich., where he touted his plan. “Medicare must be more flexible … They ought to be able to choose their own health care plan.”

In 1997, Congress approved cost-cutting provisions that allowed HMOs to provide health care benefits to Medicare beneficiaries. Two years later, the program had enrolled 6.3 million people.

But from 1998 to 2002, the number of managed care plans contracting with Medicare dropped from 340 to 147, according to the General Accounting Office, the government’s investigative arm. By last summer, the number of enrollees had fallen to about 5 million, or 12 percent of the 40 million Medicare beneficiaries. As a result, 1.6 million beneficiaries had to switch plans or go back to traditional Medicare.

Managed care plans complained that the federal government hadn’t reimbursed them enough, leaving them with few options but to abandon unprofitable markets, reduce benefits or increase premiums.

This year, 33 managed care plans withdrew from the program or reduced their service area, affecting about 217,000 people, according to federal figures.

“We’ve been saying since 1997 there was a problem with the [funding] formula … that led to unintended consequences,” said Karen Ignagni, president of the American Association of Health Plans, a trade group.

Federal officials acknowledge the challenge is to attract more managed care plans and entice others to remain in some areas, particularly rural communities. Federal health officials are proposing that Congress increase reimbursements by 6.2 percent.

In 1999, Congress increased reimbursements from 3 percent to 5 percent in some rural areas. HMOs complained that the reimbursements didn’t keep pace with rising health costs.

“These guys have been capped at 2 percent growth rate for a number of years,” said Michael O’Grady, former senior research director at the Center for Health Affairs at Project HOPE, a health care think tank in Bethesda, Md. “Do they have something there? Sure. Both sides have their points.”

Still, O’Grady said, “We have to see how much money is on the table. There is only so much money.”

With adequate federal reimbursements, Ignagni said, managed care plans would remain in the program, which she called effective. The American Association of Health Plans is calling for an additional $1 billion a year.

“There isn’t a problem in the delivery. There isn’t a problem in the model. There isn’t a problem in satisfaction,” Ignagni said. “There is only a problem in the funding formula. And we know we can fix that.”

The administration recently contracted with 35 private plans, called PPOs, to offer seniors health insurance that allows them to go to other doctors within a network. Several are in New York, including Queens, but none are in Suffolk and Nassau counties.

But consumer advocates and physicians say those private plans aren’t very effective and emphasize there are more pressing issues, particularly restoring funding to doctors who treat Medicare patients. Some have stopped taking Medicare patients. “What we need to do is take care of the traditional program where we get the most value,” McCanne said.

The Bush administration, which has yet to outline specifics on its Medicare prescription drug plan, has tried to downplay concerns about his proposal in recent days. Already the plan has drawn fire from Democrats and key Republicans who worry that seniors who don’t enroll in private health plans will not have drug coverage.

Sen. Olympia Snowe (R-Maine), a moderate, said predicating prescription drugs on whether a beneficiary enrolled in a private health plan would exclude too many people, especially those in rural states like Maine where there are no managed care plans serving Medicare patients.

“It makes me very nervous,” Paulson, of the Medicare Advocacy Project, said of Bush’s plan. “Folks have become skittish about relying on the [private] plans … It hasn’t worked so far.”

Staff writer Anne Q. Hoy contributed to this story.

Copyright (c) 2003, Newsday, Inc.

http://www.newsday.com/news/health/ny-usdrug023114656feb03.story

Physicians Propose Solution to Rising Health Care Costs and Uninsured

Introduce National Health Insurance Bill (HR676) in Washington, D.C.

FOR IMMEDIATE RELEASE
February 3, 2003, 11:00 a.m.

CONTACTS:
Kimberly Soenen, PNHP
312.782.6006
kimberlysoenen@pnhp.org

Joel Segal, Office of Rep. John Conyers
202-225-5126
joel.segal@mail.house.gov

WASHINGTON, D.C. — A group of the nation’s most prominent physicians and progressive leaders of Congress will hold a press conference briefing Tuesday, February 4, 11am, 2226 Rayburn House Office Building, to unveil a new bill, The United States National Health Insurance Act (HR676), a single-payer national health program. The legislation proposes an effective mechanism for controlling skyrocketing health costs while covering all 42 million uninsured Americans. The bill also restores free choice of physician to patients and provides comprehensive prescription drug coverage to seniors, as well as younger people.

“Good news,” says Dr. Quentin Young, convener of the physician panel. “There is now a way to exit the nightmare of a collapsing health system. We no longer have to put up with the outrageous costs that keep millions of Americans from receiving medical care and needed medications. Nor will tens of thousands of families have to declare bankruptcy over medical bills. Universal national health insurance (single payer) takes the resources we have in place and deals with them in an intelligent manner, excluding the tragic hemorrhage of resources into non-health entities.”

Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine*, is the spokesperson for the Physicians Working Group on Single-Payer National Health Insurance, an ad-hoc collaboration of the nation’s top physicians. Dr. Angell will present the proposal at the briefing.

Other members of the group include Dr. Gerald Thomson and Dr. Christine Cassel, former Presidents of the American College of Physicians, the second largest medical association in the country; Dr. Rodney Hood and Dr. Gary Dennis, former Presidents of the National Medical Association; Dr. Elinor Christiansen, immediate Past-President of the American Medical Women’s Association; and Dr. Ron Anderson, CEO of Parkland Hospital in Dallas, Texas. (*Affiliations for identification only. A full list of Working Group members is at the end of this release).

Representative John Conyers, Dean of the Congressional Black Caucus and ranking minority Member of the House Judiciary Committee will introduce The United States National Health Insurance Act on February 4. A long time advocate of national health insurance, Rep. Conyers closely collaborated with the Physicians Working Group on the bill.

Additionally, nearly 4,000 individual physicians have endorsed the physicians’ proposal including two former Surgeons General (Dr. David Satcher and Dr. Julius Richmond); a Nobel Laureate (Dr. Bernard Lown); the highly respected authors of major textbooks of surgery and family practice (Dr. William Silen and Dr. Robert Rakel, respectively); and a leading organizer of emergency services in NYC on 9/11(Dr. Lewis Goldfrank, Chairman of Emergency Medicine at New York University).

Also joining the physicians and Congressmen to endorse the National Health Insurance Act will be Dr. Maya Rockeymoore, Urban League Director of Health Policy; Dean Baker, Co-Director, Center for Economic and Policy Research; and Hillary Shelton, a spokesperson for Julian Bond, Chairman of the NAACP.

Original Congressional co-sponsors of the NHI bill at press time are: Dennis Kucinich (OH), Luis Guitierrez (IL), Jim McDermott (WA); Bobby Scott (VA); Donna Christensen (Virgin Islands); Barbara Lee (CA); Danny Davis (IL); Major Owens (NY); Jesse Jackson Jr.(IL); Maurice Hinchey (NY); Donald Payne (NJ); Elijah Cummings (MD); Carolyn Kilpatrick (MI); Alcee Hastings (FL); Chaka Fattah (PA); Ed Towns (NY); John Lewis (GA); BennieThompson (MS); Eleanor Holmes-Norton (delegate for DC), and Raul Grijalva (AZ) (listing in formation).

National Health Insurance Act Press Conference
February 4, 2003 11am
2226 Rayburn House Office Building, Judiciary Committee Room

*Physician Working Group Members

Marcia Angell, MD
Spokesperson
Past Editor
New England Journal of Medicine

Quentin Young, MD
Convener
National Coordinator PNHP
Former President American Public Health Association

Joel Alpert, MD
Former President
American Academy of Pediatrics

Ron Anderson, MD
President and CEO
Parkland Health &Hospital System

Peter Beilenson, MD, MPH
Commissioner
Department of Health, Baltimore

Christine Cassell, MD
Former President
American College of Physicians
Dean, Oregon University School of Medicine

Elinor Christiansen, MD
Past President
American Medical Women’s
Association

Olveen Carrasquillo, MD, MPH
Assistant Professor of Medicine
Columbia School of Medicine
Advisory Committee Member
National Hispanic Medical Assn.
Gary Dennis, MD
Former President
National Medical Association

David Himmelstein, MD
Associate Professor of Medicine
Harvard Medical School
Co-Founder, Physicians for a National Health Program

Rodney Hood, MD
Past President of the National Medical Association which represents
African-American physicians

Edith Rasell, MD, PhD
Minister for Labor Relations in Community and Economic Development for
the United Church of Christ

Helen Rodriguez-Trias, MD
Past President
American Public Health Association
(recently deceased)

Sindhu Srinivas, MD
Past President
American Medical Student Assn.

Gerald Thomson, MD
Former President
American College of Physicians

Walter Tsou, MD, MPH
Former Commissioner of Health,
Philadelphia

Steffie Woolhandler, MD, MPH
Associate Professor of Medicine
Harvard Medical School

# # #

Physicians for a National Health Program (PNHP) is a research and education organization with more than 10,000 members representing every state and specialty. PNHP was founded in 1987 and has physician spokespeople across the country. For contact information, call the national headquarters in Chicago at
(312) 782-6006. Visit us online at pnhp.org.

*The Working Group members hold a number of distinguished positions, which are not limited to those listed above. The members’ positions and affiliations listed here are provided for identification purposes only.

Editor’s note: An interview room will be available immediately following the press conference.

Contact:

Kimberly Soenen
PNHP Media Relations
tel:312-782-6006
fax:312-782-6007
mobile:312-946-0938
kimberlysoenen@pnhp.org
www.pnhp.org

Physicians for a National Health Program (PNHP) is a physician advocacy organization with 12,000 members who support single-payer health care reform.

PNHP has been working since 1987 for universal health care. The national office is in Chicago.

No health care for AMA’s janitors

News from the Metro Washington Council,
AFL-CIO February 3, 2003

SHOW YOUR LOVE FOR JANITORS: DC janitors will march to the American Medical Association on Valentine’s Day to highlight their need for health care. Contracts covering more than 4,000 DC janitors (members of SEIU 82) expire April 30th and health care is a top issue on the table. AMA headquarters are cleaned by janitors who receive no health care benefits, despite AMA claims to be working on addressing the disparity between the world’s most advanced health care system and the lack of health care among many minority groups in the United States. SEIU Local 82 members will join janitors and other supporters in spotlighting their fight for health care for all janitors in the nation’s capitol.

Disconcerting facts about DC janitors from SEIU Local 82:
http://www.seiu82.org/linked_pages/master_contract_2003.cfm

Conyers supports comprehensive care for all, while Bush supports greater rationing

Department of Health and Human Services
News Release
Jan. 31, 2003
Bush Administration Will Propose Innovative Improvements in States’ Health
Coverage for Low-Income Americans

HHS Secretary Tommy G. Thompson announced today that the President will
propose a sweeping new plan to enable states to improve health insurance
coverage for low-income Americans.

Secretary Thompson is consulting with governors in developing the new plan,
which would be optional for states. The plan would:
* Provide an estimated $3.25 billion in extra federal funding for Medicaid
in fiscal year 2004, with $12.7 billion in extra funding over seven years.
* Preserve comprehensive benefits for “mandatory” groups, while giving
states expanded flexibility to tailor coverage for “non-mandatory”
recipients and services.
* Encourage coverage for whole families, not just the children in a
low-income family.
* Support increased use of home and community based services for Americans
with disabilities.

Based on the successful SCHIP model that Congress adopted in 1997, as well
as successful innovations developed by states in their Medicaid programs
through federally-approved waivers, the proposal would give states
flexibility to simplify eligibility rules and tailor benefits to better meet
current beneficiary needs. For example, as in SCHIP, states could work with
private insurers and provide premium support for beneficiaries enrolled in
private plans.

http://www.hhs.gov/news/press/2003pres/20030131d.html

Comment: In tough economic times, the Bush administration is offering a 2%
“bonus” as a carrot to entice states to increase “flexibility” in their
programs for low income individuals. (The “bonus” is a loan that will have
to be paid back in years 8 through 10.) The rhetoric of the press release
fails to reveal the deviousness of this nefarious proposal. This is a
proposal to advance the administration’s efforts to shift the costs of
health care directly to patients, not only in the Medicare program but now
also in the Medicaid and SCHIP programs.

“Flexibility” allows the states to cover individuals and benefits that are
not mandated by the Medicaid program, without significantly increasing the
overall costs (a goal necessitated by current state budget deficits). These
non-mandated individuals desperately need the coverage, but how can a larger
number of individuals be covered without significantly increasing funding?
It’s simple; reduce benefits, and increase premiums, co-payments and
deductibles. In fact, for the two-thirds that are not mandated, provide a
“premium support” and turn them over to the private health plans with their
Spartan benefit packages and high patient cost-sharing.

So the Bush administration is adopting, as our national policy, a program to
ration health care for our highly vulnerable, low-income population by
erecting new financial barriers to that care! The current trend to shift
financial risk to patients will hardly be tolerated by average-income
individuals. But for these low-income patients, this scheme will effectively
block care for even the most modest of medical problems.

We suffer the disgrace of being the only nation that rations care based on
the ability to pay. And those with the least ability to pay now are to have
the greatest amount of rationing!

But there is a solution. Medicaid, being a publicly funded program for the
poor, will never have the political support it needs and will always be
underfunded. It must be eliminated. Including everyone in a single,
universal, public insurance program would assure continuous political
support with adequate funding to provide affordable, comprehensive care for
all of us.

On February 4, Congressman John Conyers will hold a press conference to
introduce the United States National Health Insurance Act. This bill
provides the solution we need.

United States National Health Insurance Act:
https://pnhp.org/docs/nhi_bill.pdf

Executive Summary of the Act:
https://pnhp.org/nhibill/nhi_execsumm.html

Bob LeBow says that it is time to create a movement for reform

A special update from Bob and Gail LeBow

(For those new to the list, Bob LeBow is a very special person. He is former president of Physicians for a National Health Program and author of “Health Care Meltdown,” published at the time of his bicycle accident six months ago. Although he is now a respirator-dependent quadriplegic, he vows to continue to use what energy he still has on behalf of the cause of health care justice.)

Dear Friends,

Each day brings its own surprises.and a lot of the surprises have been good ones. Yesterday marked six months since the day of Bob’s accident. His progress continues to be a blessing. Thanks to a wonderful friend, Bob now has 3 sets of glasses in various combinations for reading, distance and computer.

Bob’s first “reading assignment” was an email attachment from friends who sent an “executive summary” of Health Care Meltdown and an announcement about the Single-Payer legislation (the National Health Insurance Act bill) that will be introduced in Congress on February 4 (by Representative John Conyers, D, MI). Bob read one page aloud to me and followed along as I read the other pages aloud to him. He continues to be energized by the subject of health care reform. After we finished reading the email we had a wonderful conversation. Here are a few of Bob’s comments:

“I think the time has come to do what is right for us as a nation and for the American people. We have the means to do it and we can develop the will to make it happen. (I’m barely able to breathe and I’m still fighting.) We will win and we will do what’s right. (I’m running out of energy.) I think it has great potential. I’d like to see people create a movement that will inspire Americans to really do something about it. An inspiration to bring change – making people healthy – reaching the goal of improved health care for all. My energy quotient is miniscule but inspired by the goal of fair health care for all.”

Health Insurance: All Aboard

New York Times Letters to the Editor
January 31, 2003

To the Editor:

To satisfy President Bush’s call for universal health insurance, Ted Halstead wants to make it mandatory (Op-Ed, Jan. 31). He wants to enroll the uninsured “in a default private plan by the government, and either billed or subsidized accordingly.” This would be tough to enforce.

In Mr. Halstead’s model, non- insurance would be disclosed on tax returns next year; what about sick or injured scofflaws in the interim? And what about the millions who don’t file Form 1040’s?

Despite major government subsidies, Mr. Halstead shuns new regulations. Lower premiums would be only the hoped-for result of insuring more young and healthy participants. In fact, the plan’s objective seems simply to finance private insurers, whose more than 14 percent overhead compares unfavorably with Medicare’s 2 percent administrative cost.

Wouldn’t it be easier and more cost-effective to improve and expand Medicare to cover everyone?
JOHN GLASEL
Hoboken, N.J., Jan. 31, 2003

To the Editor:

Forcing all Americans to buy health coverage would not drive down coverage. As the laws of economics tell, increase the demand, and the prices will go up.

Ted Halstead’s plan (Op-Ed, Jan. 31) would force millions of Americans who have made a choice about their needs to buy coverage they may or may not need.

In addition, his suggestion that Americans would get better care from the insurance companies once everyone was forced to buy it flies in the face of experience.

If Mr. Halstead’s insurance companies want “young and relatively healthy Americans” to buy health insurance, they should focus on lowering the price rather than forcing the government to cover its shortfalls.
CHRISTOPHER BOWEN
Washington, Jan. 31, 2003

To the Editor:

I appreciate Ted Halstead’s attempt at solving our health care crisis (Op-Ed, Jan. 31). But there is a flaw in his plan.

If we require all young individuals to buy insurance, the premiums would pay for only the medical resources they use. This would have no impact on the cost of health insurance for older individuals. If we require them to pay premiums higher than the resources they use, then we are taxing them to help offset higher costs for older individuals.

It is understandable that the general public does not understand the pricing of health insurance since the cost of medical services are harder to find than Iraq’s chemical weapons. But it is becoming increasingly frustrating that most people in a position to affect public policy do not understand the financial aspects of health insurance.
CHRIS S. CARLSON
Milwaukee, Jan. 31, 2003

To the Editor:

I commend Ted Halstead’s endorsement of universal health coverage (Op-Ed, Jan. 31). However, his idea for putting it into effect is unfeasible on one major count.

Comparing mandatory health insurance to car insurance is misguided in that many Americans do not even own cars. Either they can’t afford one, or paying for insurance would cripple their quality of life.

For many, paying for this coverage would be an insurmountable task, even with a reduced cost. Why don’t we instead do away with this bureaucracy of privatized for-profit insurance companies? The powers that be could create a national health care system in which the money that was originally going to individual health costs would instead be collected in taxes, and health insurance would be provided for all. For those who cannot afford to pay for health insurance, this would allow them access to proper health care. STEVEN SOBEY
Allston, Mass., Jan. 31, 2003

http://www.nytimes.com/2003/02/03/opinion/L03INSU.html?tntemail0