Portland Press Herald
July 8, 2001
by Allan Drury

An interview with Howard R. Buckley, Mercy Hospital administrator:

Q: How has your thinking evolved over time on the single-payer issue?

A: I have watched the number of uninsured in Maine grow to 150,000 or so. I have felt the atmosphere and environment of distrust grow. I am seeing the rise in concern about health-care costs from small businesses. And the people that we serve no longer trust payers or providers.

People are drawn to work in health care because of its mission – helping patients and families. They become discouraged by the bureaucracy that we have built around that fundamental provider-patient interaction. And finally, I feel that health care isn’t a privilege, but a right that belongs equally to everyone. In the end, only a single-payer system will truly change the system for the better.

Q: Maine lawmakers have gotten high marks for extending access to low-income residents, but they haven’t done much to contain costs for most people with insurance. Is there anything the state can do about insurance costs for the middle class?

A: I don’t believe that anyone can contain costs unless here is a unified delivery system, providing the same health-care program to everyone and paid for by a single payer. If you can’t control the system, you can’t control the cost.

http://www.portland.com/business/stories/010708buckley.shtml

Health Affairs
July/August 2001
by Marsha Gold

“By almost any measure, the interim grade for the Medicare + Choice program as of the start of 2001 must be judged a ‘D’ if not an ‘F.’ In contrast to the goal of expanded choice, the M + C program has reduced the range of choice that once existed, with existing plans withdrawing, few new participants entering from among the newly authorized types of options, no geographic redistribution of participants to develop choice where none existed, and an increase rather decrease in the inequities in benefits and offerings between higher- and lower-paid areas of the country.”

From the editor’s prologue to this article:

“Remarkably, the policy community’s faith in the competitive model has persisted despite the acutely disappointing performance of Medicare + Choice. Congress has amended the program and enhanced payment levels, but enrollment and plan participation continue to decline. Nor has any alternative approach to restructuring Medicare emerged.”

Comment: President Bush and the conservatives along with the “bipartisan” support of Sen. Breaux continue to support privatization of Medicare through premium support legislation that utilizes private health plans. The experience with the Medicare + Choice program has confirmed that the private plans have wasted resources while denying coverage to major segments of the eligible population. Even more outrageous is that the editor of Health Affairs, perhaps the most important publication on health policy, states that no alternative approach to restructuring Medicare has emerged. Okay everyone… Open your windows… Climb out on your rooftops… And scream… WE WANT PRESCRIPTION COVERAGE! WE WANT CARE TO BE ACCESSIBLE AND AFFORDABLE FOR EVERYONE BY ELIMINATING OUT-OF-POCKET EXPENSES!

Of course, those supporting privatization claim that we cannot afford the existing program, much less the expansions. More nonsense. We already are funding the existing program through both the tax system and cost sharing. But cost sharing has had the negative impact of impairing access to care for lower income individuals simply because that care is unaffordable for them. A program of social insurance is clearly defective if it does not assure benefits for everyone. Means testing has been suggested and utilized to a limited extent, but that increases costs, increases administrative complexity, and is demeaning. Cost sharing has been promoted as a means of reducing utilization of health care services. That has essentially no impact on the affluent, but it does cause lower income individuals to forgo beneficial services because of lack of affordability. It has been estimated that the costs of administering cost sharing and means testing programs offset the savings induced by cost sharing. If we can get past our apprehensions about “government” and “taxes,” then it would be a greatly improved system of social insurance if we were to place all funds into the same pool and eliminate out-of-pocket expenses.

The prospect of including pharmaceuticals in the Medicare program has produced the predicted outcry that we would be bankrupting Medicare since this sector of health care costs is on a rocket trajectory. But should that be? Why do we accept the fact that physicians, hospitals, laboratories, and other providers of care are mandated to accept controls on their costs, but that we should allow the pharmaceutical industry total freedom, subject only to the dubious forces of the marketplace. When Medicare was first established, physicians were allowed to charge usual, customary and reasonable fees, and what happened? The rocket trajectory. The explosion of costs had to be brought under control through fee controls. (For those that protest government fee controls, keep in mind that the only real impact of managed care has been the imposition by the private, health plan bureaucracies of… guess what… fee controls!) There is absolutely no reason that we should not apply the same cost containment strategies to the pharmaceutical industry, especially now that pharmaceuticals have become an essential, integral part of health care. Much of the research is funded by taxpayers through the NIH. We are entitled to a return on our investment in the form of lower drug prices. The industry wastes tremendous resources in marketing and in production of expensive copycat drugs that add very little value. Let’s force this industry to adopt the same efficiencies and fair pricing to which hospitals and physicians must adhere.

Medigap plans are one of the worst insurance values on the market and waste dollars that could be better spent on health care. Many are unable to afford them. If we included pharmaceuticals in the Medicare program, and eliminated cost sharing, Medigap plans would be placed in that trash heap of bad ideas. Now that we know that private Medicare managed care plans have been wasting taxpayer resources, we can throw them on the same trash heap.

Come on! Let’s fix our traditional Medicare program by adding pharmaceuticals and eliminating out-of-pocket expenses. And then let’s let everyone participate in the single payer plan that’s as close to perfect as humanly possible, Medicare for All.

Newsday
July 6, 2001
Letters

The Patients Bill of Rights debate in Washington fails to address the day-to-day fears and concerns of patients. The bill would force them to go through an internal appeal, an external appeal, find and pay for an attorney and then spend more time waiting to be heard in our overcrowded court system.

They could literally die in the process.

Having the right to sue an HMO is an attempt to seek justice after the HMO has inflicted the harm. We have to prevent the harm.

Even if the Democrats win this battle, it would be the equivalent of applying a Band-Aid to treat a cancer, and will still perpetuate a system that allows patient care to be at the mercy of an industry that has a built-in incentive to deny care. Every dollar of care an HMO can deny to a patient increases the HMO’s bottom line. It’s time we faced up to this obvious anti-patient structural defect.

Why not use the mechanism that has worked successfully for the patient for 35 years, while performing with a mere 2-percent cost ratio for administration? Extend Medicare to the non-seniors.

Joe Kane

Editor’s Note: The writer serves on the executive board of the Long Island Coalition for a National Health Plan

The New York Times
July 6, 2001
Letters

To the Editor:

In a June 30 letter, a former chairman and chief executive of Aetna Inc. suggests that people pay for procedures not covered by their insurance plan or health maintenance organization. Maybe he can afford this, but most of us cannot. Therefore, insurers are making medical decisions when they deny coverage.

The United States outspends every nation on health care, yet health care here is ranked 37th in quality by the World Health Organization. Most Canadian and British citizens are satisfied with their national health care systems. While Canada often has long waiting lists, this is caused by a small population to share the costs and a shortage of physicians, which the United States does not have.

A single-payer plan is long over-due in the United States. Health care is a basic human right and an essential service well within the scope of government to provide.

ROBERTA PALMER, M.D. Tigard, OR

Comment: The New York Times has published innumerable letters advocating for single-payer health care reform. Isn’t it time for their editorial board to sit down with representatives of the single payer movement to consider their own endorsement of this imperative for health care justice?

As the economy slows down, and more Americans are facing the potential financial burdens of inadequate health insurance coverage or no coverage at all, it is urgent that a common plan be formulated to initiate a popular campaign that can finally move society to take action in support of universal health care.

As we have seen, the road to health care reform has had many turns, including many dead ends. Various campaigns and many initiatives have been tried; we traveled in many different directions but have not found the way. Although our vision and determination to make quality health care a right of every citizen is just and unwavering, we have been unable to formulate a plan and unleash a campaign that could move society to take action in support of universal health care. In contrast to past movements for social justice, our efforts to find an effective approach have eluded us for over half a century. Let no one be in doubt – there has been no predominant social movement for universal health care, merely sporadic and episodic campaigns and demands for health care justice, allowed to ignite, flame brightly, sputter, and die out.

The vital approach begins with our willingness to recognize and accept the lessons of past movements for social justice, equality and rights which require that those who support reform must finally agree to seek common ground, unite, plan and act together and move in the same direction in building a uniform popular movement for universal health care. It is only through strategically using combined talents and resources and a central plan that the isolated cries for health care reform can enlist the support and mighty roar of many Americans from coast to coast, thus initiating a true movement.

The whole answer, the whole truth, is no different from before. Our struggle for rights in health care is a part of America’s unfinished work; it should be perpetuated in accordance with the nation’s long historic journey for justice, and demands – as with past movements -that those whose rights are being denied must take part.

We are trying to determine if you might be interested in being involved in this new effort to seek common ground in order to build a nationwide grassroots movement for universal health care.

Philip Pollner, M.D. Nancy Wooten, Ph.D. Don McCanne, M.D.

Those who are interested please respond by email to leadcoal@aol.com or call Dr. Pollner at 302-266-7373 evenings (EST).

Please forward this message to friends, colleagues and to the leadership of organizations that might share our vision.

As the economy slows down, and more Americans are facing the potential financial burdens of inadequate health insurance coverage or no coverage at all, it is urgent that a common plan be formulated to initiate a popular campaign that can finally move society to take action in support of universal health care.

As we have seen, the road to health care reform has had many turns, including many dead ends. Various campaigns and many initiatives have been tried; we traveled in many different directions but have not found the way. Although our vision and determination to make quality health care a right of every citizen is just and unwavering, we have been unable to formulate a plan and unleash a campaign that could move society to take action in support of universal health care. In contrast to past movements for social justice, our efforts to find an effective approach have eluded us for over half a century. Let no one be in doubt – there has been no predominant social movement for universal health care, merely sporadic and episodic campaigns and demands for health care justice, allowed to ignite, flame brightly, sputter, and die out.

The vital approach begins with our willingness to recognize and accept the lessons of past movements for social justice, equality and rights which require that those who support reform must finally agree to seek common ground, unite, plan and act together and move in the same direction in building a uniform popular movement for universal health care. It is only through strategically using combined talents and resources and a central plan that the isolated cries for health care reform can enlist the support and mighty roar of many Americans from coast to coast, thus initiating a true movement.

The whole answer, the whole truth, is no different from before. Our struggle for rights in health care is a part of America’s unfinished work; it should be perpetuated in accordance with the nation’s long historic journey for justice, and demands – as with past movements -that those whose rights are being denied must take part.

We are trying to determine if you might be interested in being involved in this new effort to seek common ground in order to build a nationwide grassroots movement for universal health care.

Philip Pollner, M.D. Nancy Wooten, Ph.D. Don McCanne, M.D.

Those who are interested please respond by email to leadcoal@aol.com or call Dr. Pollner at 302-266-7373 evenings (EST).

Please forward this message to friends, colleagues and to the leadership of organizations that might share our vision.

July 2, 2001
Patients’ Rights

RAY SUAREZ: Dr. Angell (Marcia Angell, former editor of the New England Journal of Medicine), let me close with you. You’ve talked a little bit about where incentives, in your view, are misled. What about liabilities?

DR. MARCIA ANGELL: We have to look at the motivations, the incentives that cause care to be denied. If you talk, if you focus too much on the suits after the care has been denied, it’s like trying to put a band-aid on a gaping wound. You have to look at why the care was denied in the first place. It’s a little late in the day when you get to the point of suing. Now, let me answer Mr. Moffit (Robert Moffit, Heritage Foundation) because while he and I agreed on the diagnosis of patients’ rights bills and the fact that it would increase the number of uninsured we certainly disagree on the remedy. And I’m appalled to hear him imply that Medicare is somehow inefficient. It has far lower overhead costs than the private managed care system, far lower, 2 or 3 percent as compared with about 30 percent, and in fact, his solution that you would throw individuals out into this treacherous private healthcare insurance market is a recipe for disaster. What we need, in essence, is Medicare for everyone. We need a single payer system, Medicare for everyone. Medicare is the most efficient part of our health care system and it’s certainly the most popular. That’s what we ought to be looking toward.

RAY SUAREZ: Well, that places the debate on a very, very different footing, and we’re not going to be able to have that one right now, but thank you all for joining us tonight.

The entire transcript and audio is available at: http://www.pbs.org/newshour/bb/health/july-dec01/patients_7-2.html

July 2, 2001
Patients’ Rights

RAY SUAREZ: Dr. Angell (Marcia Angell, former editor of the New England Journal of Medicine), let me close with you. You’ve talked a little bit about where incentives, in your view, are misled. What about liabilities?

DR. MARCIA ANGELL: We have to look at the motivations, the incentives that cause care to be denied. If you talk, if you focus too much on the suits after the care has been denied, it’s like trying to put a band-aid on a gaping wound. You have to look at why the care was denied in the first place. It’s a little late in the day when you get to the point of suing. Now, let me answer Mr. Moffit (Robert Moffit, Heritage Foundation) because while he and I agreed on the diagnosis of patients’ rights bills and the fact that it would increase the number of uninsured we certainly disagree on the remedy. And I’m appalled to hear him imply that Medicare is somehow inefficient. It has far lower overhead costs than the private managed care system, far lower, 2 or 3 percent as compared with about 30 percent, and in fact, his solution that you would throw individuals out into this treacherous private healthcare insurance market is a recipe for disaster. What we need, in essence, is Medicare for everyone. We need a single payer system, Medicare for everyone. Medicare is the most efficient part of our health care system and it’s certainly the most popular. That’s what we ought to be looking toward.

RAY SUAREZ: Well, that places the debate on a very, very different footing, and we’re not going to be able to have that one right now, but thank you all for joining us tonight.

The entire transcript and audio is available at: http://www.pbs.org/newshour/bb/health/july-dec01/patients_7-2.html

The New York Times
July 2, 2001

Uwe Reinhardt, Princeton University, on the patients’ rights legislation:

“I think it was a ridiculous diversion of political energy that distracts from the truly shocking problems of the American health care system — the uninsured, the elderly without drugs and the medical error problem.”

http://www.nytimes.com/2001/07/02/politics/02AGEN.html

The New York Times
July 2, 2001

Uwe Reinhardt, Princeton University, on the patients’ rights legislation:

“I think it was a ridiculous diversion of political energy that distracts from the truly shocking problems of the American health care system — the uninsured, the elderly without drugs and the medical error problem.”

http://www.nytimes.com/2001/07/02/politics/02AGEN.html