PNHP

Behind Closed Doors, Repeating Mistakes from the Past on Health Care Reform

Behind Closed Doors, Repeating Mistakes from the Past on Health Care Reform

James Floyd, M.D.
Huffington Post
February 27, 2009

Last week, the New York Times reported that Senator Ted Kennedy has been holding secret meetings with lobbyists to reach “consensus” on a proposal for national health care reform. Included in the list of participants were America’s Health Insurance Plans, the National Federation of Independent Business, and the Pharmaceutical Research and Manufacturers of America — some of the same players who defeated the Clinton health care reform effort 15 years ago. Notably absent was Physicians for a National Health Program, the California Nurses Association, Healthcare-Now, and other advocacy groups that oppose the private insurance industry and support the creation of a national single-payer program.

According to the Times, lobbyists have discussed increasing health care coverage by subsidizing the purchase of private insurance and expanding public programs. This was the approach taken in Massachusetts following the passage of the Massachusetts Health Reform Law in 2006. Touted as providing universal health care, it expanded and modified Medicaid, subsidized skimpy coverage for those not poor enough to qualify for Medicaid, and imposed financial penalties against those who didn’t purchase insurance. This reform has been hailed as a bipartisan success and appears to be favored by both President Obama and Senator Kennedy.

But what has been the result of the Massachusetts reform? A report released last week by Physicians for a National Health Program and Public Citizen documents that as much as 5 percent of the state remains uninsured — a decrease of only half from the baseline rate of 10 percent and a far cry from universality. New financial barriers, such as co-payments for medications and office visits, have led some of the poorest patients to interrupt care for life-threatening illnesses. The additional cost of the reform has topped $1 billion annually, forcing the state to cut funding to the public hospitals and community clinics that provide a crucial safety net for those who cannot afford health care.

Over the past 20 years, similar reform efforts have been attempted in other states — Oregon, Minnesota, Tennessee, Vermont, Washington, and Maine. Because these incremental reforms did not address the problems and waste created by private insurers, they all failed to significantly reduce the number of uninsured while costs continued to outpace inflation.

The Times reported that a key feature of the Massachusetts reform that has been embraced in the Kennedy meetings is the requirement that every American have insurance, with financial penalties for those who don’t. This mandate is a backwards formula for universality, one that can be arrived at only by starting with the premise that the financial interests of the insurance and pharmaceutical corporations are to be protected. According to James Gelfand of the United States Chamber of Commerce, “Forcing individuals to purchase insurance in the current market would be a disaster. Before we even have that discussion, we need to make health care more affordable and improve its quality.”

In other words, we shouldn’t force people to buy a flawed and unaffordable product. The only fair way to mandate universal coverage is to automatically enroll everyone in a program that provides a single, high standard of care and allows them to pay based on what they can afford, through progressive taxation. Even Nobel laureate and former Clinton economic advisor Joseph Stiglitz “has reluctantly come to the view that it’s the only alternative.”

There are troubling parallels between Kennedy’s secret meetings and the meetings of the Task Force on National Health Care Reform chaired by Hillary Clinton in 1993. Although special interests were officially excluded from the Clinton task force, documents obtained through a lawsuit filed by the National Legal and Policy Center revealed that more than 300 individuals who participated in task force working groups came from the private sector, and included representatives of the insurance industry and small business groups. In addition, a report from the Center for Public Integrity revealed that around the time of the task force, 80 former government officials — including 12 former members of Congress — had gone through the “revolving door” to work for health care interests, many of whom actively lobbied on health care reform.

Fast-forward to 2009 and former-Senator Tom Daschle’s failed appointment as Secretary of Health and Human Services. The official story focused on his failure to pay his taxes, but what angered most health care reform activists most was his previously undisclosed work as a health insurance lobbyist.

In post-mortems on the Clinton health care reform effort, pundits concluded that it was overly ambitious and too complicated to garner the necessary public support. They also recognized the impact of the highly successful lobbying effort by the health insurance industry — the “Harry and Louise” television ads — and the anemic response from the White House. Perhaps what doomed the Clinton effort to failure at an early stage was the inclusion of the very interests that must be fought to guarantee comprehensive and universal coverage to every American.

Yesterday, President Obama released a budget proposal that includes $634 billion to fund health care reform, days before a White House summit on health care reform begins. Like the Kennedy meetings, this summit currently does not include advocates for single-payer but is well-represented by lobbyists for the insurance industry and other groups who oppose fundamental reform.

President Obama, we urge you not to make the same mistake that the Clintons made. Please don’t exclude from the discussion the people who are your grassroots support for real change. Although people in your meetings may be telling you otherwise, there is tremendous support throughout the country for a single-payer system. Give us a seat at the table if you truly want to build consensus around health care reform.

Nobel Laureate Joseph Stiglitz on single payer

Nobel Prize-Winning Economist Joseph Stiglitz

Democracy Now!
February 25, 2009
We get reaction to President Obama’s speech from Nobel economics laureate and former World Bank chief economist, Joseph Stiglitz.
Amy Goodman: And healthcare? He’s called for universal healthcare, but he does not call for single-payer healthcare.
Joseph Stiglitz: I think that there are some fundamental problems in the efficiency of our healthcare system. And what we’ve seen is that the private healthcare insurers do not know how to deliver an efficient way.
Amy Goodman: Do you support single-payer healthcare?
Joseph Stiglitz: I think I’ve reluctantly come to the view that it’s the only alternative. You know, we’ve tried a lot of other things. And we’ve been — you know, I was in the Clinton administration, and we debated a lot of alternatives, and I’ve watched things as they’ve emerged and, you know, evolved over the last twelve, sixteen years, and I think there’s a growing consensus that the private market exclusion is not going to work.
Amy Goodman: Joe Stiglitz, I want to thank you for being with us, the Nobel Prize-winning economist, professor at Columbia University, co-author of The Three Trillion Dollar War: The True Cost of the Iraq Conflict.
These are the closing comments in this 28 minute video, audio and transcript:
http://www.democracynow.org/2009/2/25/stieglitz

Comment:

By Don McCanne, MD
What does Joseph Stiglitz have to say?
That’s a question we ask when we are faced with difficult issues such as the current financial crisis, and what we should do about the troubled banks. To our benefit, Amy Goodman did ask him, and we learn what he has to say.
At the end of the interview, Amy Goodman tacked on this crucial question regarding our health care crisis. Single payer?
Joseph Stiglitz’s response must be shared with the nation, and especially with those in Washington who say that single payer is not feasible. We should inundate Washington with his statement that single payer is “the only alternative.”

Nobel Laureate Joseph Stiglitz on single payer

Nobel Prize-Winning Economist Joseph Stiglitz

Democracy Now!
February 25, 2009

We get reaction to President Obama’s speech from Nobel economics laureate and former World Bank chief economist, Joseph Stiglitz.

Amy Goodman: And healthcare? He’s called for universal healthcare, but he does not call for single-payer healthcare.

Joseph Stiglitz: I think that there are some fundamental problems in the efficiency of our healthcare system. And what we’ve seen is that the private healthcare insurers do not know how to deliver an efficient way.

Amy Goodman: Do you support single-payer healthcare?

Joseph Stiglitz: I think I’ve reluctantly come to the view that it’s the only alternative. You know, we’ve tried a lot of other things. And we’ve been — you know, I was in the Clinton administration, and we debated a lot of alternatives, and I’ve watched things as they’ve emerged and, you know, evolved over the last twelve, sixteen years, and I think there’s a growing consensus that the private market exclusion is not going to work.

Amy Goodman: Joe Stiglitz, I want to thank you for being with us, the Nobel Prize-winning economist, professor at Columbia University, co-author of The Three Trillion Dollar War: The True Cost of the Iraq Conflict.

These are the closing comments in this 28 minute video, audio and transcript:
http://www.democracynow.org/2009/2/25/stieglitz

Comment:

By Don McCanne, MD

What does Joseph Stiglitz have to say?

That’s a question we ask when we are faced with difficult issues such as the current financial crisis, and what we should do about the troubled banks. To our benefit, Amy Goodman did ask him, and we learn what he has to say.

At the end of the interview, Amy Goodman tacked on this crucial question regarding our health care crisis. Single payer?

Joseph Stiglitz’s response must be shared with the nation, and especially with those in Washington who say that single payer is not feasible. We should inundate Washington with his statement that single payer is “the only alternative.”

Insurers, drug makers poised to profit from Obama health plan

By Timothy P. Carney
DC Examiner
Beltway Confidential blog
2/25/09

Although President Barack Obama promised that he would freeze out the lobbyists in order to finally reform our broken health-care system, his nascent push to overhaul the industry already shows signs of becoming a lobbying feeding frenzy, with health insurers, drug makers and employers all poised to benefit from government’s expanded role.

We don’t yet have the specifics of Obama’s plan, but we do know its centerpiece: an individual mandate on health insurance. Obama has said — and corporate-labor lobbying coalitions have agreed — that Washington should require Americans to buy health insurance. When healthy people opt out of the insurance pool, the theory goes, risk is not adequately spread.

You can guess who’s most enthusiastic about the individual mandate: the insurance companies. Sure enough, The New York Times reported last week that America’s Health Insurance Plans, the trade association representing health maintenance organizations, has been working with Sen. Edward Kennedy, D-Mass., to help draft a plan that includes a mandate.

Another player in Kennedy’s backroom meetings is the Pharmaceutical Research and Manufacturers of America, usually a bete noire for liberals because it represents the drug companies. PhRMA’s primary stake in this fight is also obvious. It wants mandates and subsidies, and it wants to limit cost-control measures that would favor cheaper generic drugs.

La Merie, a “business intelligence” publisher, wrote in a recent pharmaceutical industry report: “Obama’s new universal health-care program will increase demand for drugs, both branded and generic, reduce the need for free drug programs due to universal health-care coverage, and boost pediatric drug and vaccine programs.” Sounds like a good deal for drug makers.

Groups lobbying on health-care policy include the Coalition to Advance Healthcare Reform, led by Safeway Chief Executive Officer Steve Burd, who actively backed Arnold Schwarzenegger’s plan to require all California businesses to cover their workers or face a new 4 percent tax. The coalition’s lobbyists include Judith Lemons, the former chief of staff for House Speaker Nancy Pelosi.

Lobbying powerhouse General Electric is a champion of Obama’s proposals to create a national health database — a database GE plans to build, manage or both.

What about the small-business coalitions that were crucial to killing HillaryCare in 1993? “They’re going to have to buy off small business,” says Cato Institute health-care expert Michael Tanner. Subsidies for small employers to afford health insurance are likely to do the trick.

To be sure, drug makers and insurers will have to bear the brunt of new regulations that come with increased government involvement. A priority for Kennedy and Obama is the pair of policies called “guaranteed issue” and “community rating.” The latter means insurers may not charge customers different premiums based on their health or age. Because this would encourage insurers to simply refuse to insure older customers or those with pre-existing conditions, government would require “guaranteed issue,” meaning that insurers could not turn down applicants.

Requiring insurers to charge one price and accept all comers would boost prices and drive away younger customers, who would find it cheaper to pay medical expenses out of pocket. Then only sick people, old people and families with kids would buy insurance — a high-risk pool, requiring even higher premiums. That’s why government will force younger and healthier people to join the pool with the individual mandate. Even so, the addition of high-risk and newly insured people will drive up the cost of health insurance — and taxpayers will get stuck with the bill.

Regulations spur mandates, which spur regulations, which spur subsidies. Insurers love the subsidies and the mandates, and the regulations don’t bother them too much — huge regulatory burdens, after all, keep out competition.

The great irony is that Kennedy and Obama, when calling for universal health care, have portrayed themselves as battling big business and freezing out the lobbyists. But it’s not as if Obama’s victory has cowed big business to the point of surrender. Many big businesses have long called for a greater government role in health care.

Insurers, drug makers, General Electric, regulators and employers will all benefit, and Obama will declare it a great group effort and a win-win solution. In truth, not everyone wins. “In the end, the taxpayers are going to lose,” says Tanner, “because the taxpayers are going to pay to buy everyone off.”

Tell Baucus single-payer is best

by Bob Balhiser
Queen City News, Montana
Wednesday, February 11, 2009

To the Editor:

Now that Tom Daschle is out of contention for HHS secretary, Sen. Baucus seems to think he has an inside track and is teaming up with Sen. Kennedy to push through his plan for health care reform. I cannot imagine a worse outcome.

As bad as things are now, it would be better to do nothing than to hurriedly implement the complex Baucus plan. How can Max reasonably expect to have a worthwhile outcome by simply tweaking our existing system which, by his own admission, costs twice as much as other industrialized nations and delivers worse outcomes?
We need to ask Max why he is so deathly afraid to see a single-payer plan given a fair hearing. I suspect it is because he knows a well-designed system of Medicare for all U.S. citizens will “pencil out” far better, be more user-friendly, and be less complex than his plan.

Most people recognize that private health insurers add no value to our health care system and just complicate the process of delivering health care and paying health-care bills. Single-payer systems are far simpler, more user-friendly, and have a track record for reliably paying health care bills with far fewer hassles for far less cost.
If you want real health care reform, I suggest you write or call Max. Tell him, before we do anything with health care, it is important that we know what we are doing is right. That means first showing how his plan stacks up in all respects against a well-designed single-payer system before doing anything.

Joseph Stiglitz on Single Payer

Excerpt from Democracy Now
2/25/09

AMY GOODMAN: And healthcare? He’s called for universal healthcare, but he does not call for single-payer healthcare.

JOSEPH STIGLITZ: I think that there are some fundamental problems in the efficiency of our healthcare system. And what we’ve seen is that the private healthcare insurers do not know how to deliver an efficient way.

AMY GOODMAN: Do you support single-payer healthcare?

JOSEPH STIGLITZ: I think I’ve reluctantly come to the view that it’s the only alternative. You know, we’ve tried a lot of other things. And we’ve been–you know, I was in the Clinton administration, and we debated a lot of alternatives, and I’ve watched things as they’ve emerged and, you know, evolved over the last twelve, sixteen years, and I think there’s a growing consensus that the private market exclusion is not going to work.

AMY GOODMAN: Joe Stiglitz, I want to thank you for being with us, the Nobel Prize-winning economist, professor at Columbia University, co-author of The Three Trillion Dollar War: The True Cost of the Iraq Conflict.

Health care spending for 2009

Health Spending Projections Through 2018: Recession Effects Add Uncertainty To The Outlook

By Andrea Sisko and colleagues at Office of the Actuary, Centers for Medicare and Medicaid Services
Health Affairs
February 24, 2009
Projected spending for 2009:
$2,509.5 billion – National Health Expenditures (NHE)
$8,160.3 – NHE per capita
17.6% – NHE as percent of GDP
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w346v1

These are the most reliable numbers to use that represent our health care spending for this year. Rounding off these numbers makes them easier to remember and eases communication of the amounts:
Total health spending is two and one-half trillion dollars
Health spending per person is over 8100 dollars
That amounts to about seventeen and one-half percent of our GDP

Health care spending for 2009

Health Spending Projections Through 2018: Recession Effects Add Uncertainty To The Outlook

By Andrea Sisko and colleagues at Office of the Actuary, Centers for Medicare and Medicaid Services
Health Affairs
February 24, 2009

Projected spending for 2009:

$2,509.5 billion – National Health Expenditures (NHE)

$8,160.3 – NHE per capita

17.6% – NHE as percent of GDP

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w346v1

Comment:

By Don McCanne, MD

These are the most reliable numbers to use that represent our health care spending for this year. Rounding off these numbers makes them easier to remember and eases communication of the amounts:

Total health spending is two and one-half trillion dollars

Health spending per person is over 8100 dollars

That amounts to about seventeen and one-half percent of our GDP

Doctors urge greater caution, skepticism in prescribing drugs

EMBARGOED UNTIL:
Feb. 25, 2009

CONTACTS:
Gordon D. Schiff, M.D.
Mark Almberg, (312) 782-6006, mark@pnhp.org

Physicians should be more conservative in their drug prescribing practices and more skeptical about the benefits of drugs that don’t have a proven track record, says an article in today’s Journal of the American Medical Association, or JAMA.

Citing the “well-documented prevalence of medication-related harm and inappropriate prescribing,” and pointing to “disasters” like the Vioxx episode, in which a popular painkiller was later found to increase the risk of heart disease, the authors welcome recent proposals for the reform of pharmacology education by the Association of American Medical Colleges. But such reforms are not enough, they say.

“With all the strengths of our nation’s medical curricula, including in pharmacology, there is surprisingly little time devoted to teaching trainees how to become lifelong effective prescribers,” said Dr. Gordon Schiff, associate professor of medicine at Harvard Medical School and co-author of the JAMA commentary. “More training in pharmacokinetics and drug dosing is all to the good. But trainees also need to acquire a set of guiding principles to help them become more careful, cautious, evidence-based, and frankly skeptical prescribers throughout their careers.”

To that end, Schiff and co-author Dr. William Galanter, assistant professor of clinical medicine at the University of Illinois at Chicago and head of the UIC Medical Center’s pharmacy and therapeutics committee, offer 25 “principles for more conservative prescribing” grouped under six subheadings:

* Think beyond drugs. Prescribe non-drug alternatives first, including physical therapy, exercise and diet changes, rather than reflexively reaching for the prescription pad to treat every symptom a patient might experience.

* Practice more strategic prescribing. Take a smarter approach to initiating or changing a drug regimen. Use only a few drugs; learn to use them well. Start only one drug at a time, so if there is a side effect it will be less confusing which drug is responsible.

* Heightened vigilance regarding adverse effects. Maintain a high index of suspicion for adverse drug effects. Rather than failing to warn patients about potential side effects, educate patients to recognize them earlier so the drug can be discontinued before more serious harm occurs.

* Caution and skepticism regarding new drugs. Limit use of new drugs. New drugs always appear safer, but as pointed out in earlier research conducted by physicians associated with Physicians for a National Health Program (“Timing of new black box warnings and withdrawals for prescription medications,” JAMA, 2002), serious adverse effects can take five or more years to emerge. Instead, rely on proven drugs with long-term safety records and do not stretch indications away those supported by trial-based evidence.

* Shared agenda with patients. Become more skillful at handling patients’ requests for drugs that they have seen advertised. Obtain accurate medical histories. Patients themselves often favor more conservative use of drugs, so physicians should build trust based on realistic expectations and a shared desire to use the minimum drugs necessary.

* Weigh longer-term, broader impacts. Think beyond short-term effects. For example, weight-loss drugs are often promising in the short-term, but longer-term results are often disappointing.

While the authors say these principles are not novel and should not be terribly controversial, “taken together they represent a significant shift in current prescribing patterns.”

Beyond countering the massive advertising and miseducation of physicians and the public to use more and more drugs, there are other barriers to physicians adopting more conservative prescribing practices, they say. These include the time pressures doctors are under, their desire to enhance their reputations by embracing the latest medical advances, and their fear of disappointing patients who request a drug they have seen advertised. The medical literature is also biased against conservative prescribing, because studies with negative results are less likely to be published or publicized.

Given existing practices and recent experience, the authors say, it is time to swing the pendulum back from “newer and more is better” back in favor of a prescribing philosophy that states that “fewer and more time-tested is best.”

Dr. Quentin Young, national coordinator of PNHP, said, “This is yet another example of why and how we have to put patients’ needs for safe and effective treatment ahead of the profitability of the insurance and drug companies. While drug companies promote using the newest, often most expensive and aggressive treatments, we favor a more cautious patient-centered approach – one that stresses the more ‘tried and true drugs’ over the ‘latest and greatest’ drugs pushed by the industry.”

*****

The JAMA commentary was an outgrowth of a Chicago-based project funded by the Attorney General Consumer and Prescriber Education Grant Program (the Neurontin settlement) and also supported by grant U18HS016973 from the Agency for Health Care Quality and Research.

“Promoting more conservative prescribing,” Gordon D. Schiff, M.D., and William L. Galanter, M.D., Ph.D., Journal of the American Medical Association (JAMA), Feb. 25, 2009, Vol. 301, No. 8.

A copy of the study is available at www.pnhp.org/prescribing

Physicians for a National Health Program (www.pnhp.org), a membership organization of over 15,000 physicians, supports a single-payer national health insurance program. PNHP is headquartered in Chicago and has chapters across the United States.

IOM report: America's Uninsured Crisis

America’s Uninsured Crisis: Consequences for Health and Health Care

Institute of Medicine
The National Academies
February 24, 2009
Web briefing
Lawrence S. Lewin, Chair, Committee on Health Insurance Status and Its Consequences (and also founder of The Lewin Group):
We were asked… to basically answer three questions, and this was a follow-on to the IOM studies that were produced in six volumes between 2000 and 2004. The first is what are the dynamics driving an apparently persistent downward trend in health insurance coverage? The second, is being uninsured harmful to the health of children and adults? And third, are insured people affected by high rates of uninsurance in their communities, so called spill-over effect? …I think that it’s important to point out some things that we were not able to cover. The first were a whole series of economic and financial impacts of uninsurance, impact on medical debt and global competitiveness. These are issues where the data are not very sound, and where there is a lot of disagreement in any event. We were not able to, because of the non-availability of data, to look at the impact of different levels of insurance, so in a sense we treated insurance coverage as a binary issue – you either had it or you didn’t have it, and we know that there are a lot of shadings in between, but we believe that the research is clear enough – very clear indeed – about even the binary decision. And finally, we were specifically asked not to deal with the potential approaches to solving the problem. There are lots of people doing that – indeed as we speak.
****
Lawrence S. Lewin:
The conclusions are, yes indeed, health insurance coverage does matter… That question, which I think is at the heart of the debate, really should no longer be an issue… Secondly, particularly given the fact that it does make such a difference, we believe that there is a compelling need to do something to off-set this persistent decline with which we’re faced, and that there is an argument to be made that even those who currently have insurance, even if they don’t lose it which they are at greater risk of doing, should have an interest in these issues. As a consequence, the committee unanimously adopted the following recommendations… The committee recommends that the president work with Congress and other public and private sector leaders on an urgent basis to achieve health insurance coverage for everyone, and, in order to make that coverage sustainable, to reduce the cost of health care and the rate of increase in per capita health care spending.
****
A web question from Dr. Don McCanne from Physicians for a National Health Program:
Although this report is limited to the importance of being insured, shouldn’t reform efforts also be directed toward adopting policies that would ensure that coverage actually enables access and affordability? Since there are questions about the limits of the private insurance model in accomplishing this, shouldn’t all options be on the table, including a single payer national health program?
Lawrence S. Lewin:
Without taking any position implied by the very last point about a particular proposal, I think the answer is yes, of course, all options should be on the table until they’re more thoroughly analyzed, and I believe many things are being considered right now. But I think to opine on the question itself is really beyond the scope of the committee.
Links to this audio briefing, the news release, the report in brief, the project web page, and the full report:
http://www.nationalacademies.org/morenews/20090224.html

In six previous reports, published from 2001 to 2004, the Institute of Medicine concluded that “being uninsured was hazardous to peopleā€™s health and recommended that the nation move quickly to implement a strategy to achieve health insurance coverage for all.”
After a five year lapse, the Institute is issuing an update which concludes, “Health insurance coverage matters. Expanding health coverage to all Americans is essential. Action to reduce health care expenditures and the rate of increase in per capita health care spending is also of paramount importance if health insurance coverage for all is to be achieved and sustained.”
Is this earthshaking news or what? Having health insurance can be beneficial for your health, and everyone should have it, especially since it makes communities healthier as well. Uh, I think we all knew that.
What is surprising is Lawrence Lewin’s statement that there is “disagreement” on the economic and financial impacts of uninsurance, and the data on this “are not very sound.” Is he suggesting that we should discard a couple of decades of extensive, highly credible studies demonstrating that those without health insurance face impaired access to care, financial hardship, and often personal bankruptcy, not to mention physical suffering and perhaps even death?
Just as astounding is his statement that there is a “non-availability of data to look at the impact of different levels of insurance.” Again, is he recommending that we discard the plethora of highly credible studies, which demonstrate that the explosion in underinsurance products is also causing much of the same suffering as that experienced by the uninsured?
Lewin’s statements provoked me enough to submit the question on whether we should include on the table a consideration of single payer as a financing model that would enable access and affordability. He did let slip out the obvious answer, “yes,” before retreating to the position that he should not “opine” on it.
The answer is YES! Single payer definitely needs to be on the table.
Lewin may not want to opine, but that shouldn’t stop us from opining that we should remove from the table any reform model that would leave us short of providing all necessary care for everyone without exposing anyone to financial hardship. That would really clear the table. Then we could get serious about working on a single payer national health program.

IOM report: America's Uninsured Crisis

America's Uninsured Crisis: Consequences for Health and Health Care

Institute of Medicine
The National Academies
February 24, 2009

Web briefing

Lawrence S. Lewin, Chair, Committee on Health Insurance Status and Its Consequences (and also founder of The Lewin Group):

We were asked… to basically answer three questions, and this was a follow-on to the IOM studies that were produced in six volumes between 2000 and 2004. The first is what are the dynamics driving an apparently persistent downward trend in health insurance coverage? The second, is being uninsured harmful to the health of children and adults? And third, are insured people affected by high rates of uninsurance in their communities, so called spill-over effect? …I think that it’s important to point out some things that we were not able to cover. The first were a whole series of economic and financial impacts of uninsurance, impact on medical debt and global competitiveness. These are issues where the data are not very sound, and where there is a lot of disagreement in any event. We were not able to, because of the non-availability of data, to look at the impact of different levels of insurance, so in a sense we treated insurance coverage as a binary issue – you either had it or you didn’t have it, and we know that there are a lot of shadings in between, but we believe that the research is clear enough – very clear indeed – about even the binary decision. And finally, we were specifically asked not to deal with the potential approaches to solving the problem. There are lots of people doing that – indeed as we speak.

****

Lawrence S. Lewin:

The conclusions are, yes indeed, health insurance coverage does matter… That question, which I think is at the heart of the debate, really should no longer be an issue… Secondly, particularly given the fact that it does make such a difference, we believe that there is a compelling need to do something to off-set this persistent decline with which we’re faced, and that there is an argument to be made that even those who currently have insurance, even if they don’t lose it which they are at greater risk of doing, should have an interest in these issues. As a consequence, the committee unanimously adopted the following recommendations… The committee recommends that the president work with Congress and other public and private sector leaders on an urgent basis to achieve health insurance coverage for everyone, and, in order to make that coverage sustainable, to reduce the cost of health care and the rate of increase in per capita health care spending.

****

A web question from Dr. Don McCanne from Physicians for a National Health Program:

Although this report is limited to the importance of being insured, shouldn’t reform efforts also be directed toward adopting policies that would ensure that coverage actually enables access and affordability? Since there are questions about the limits of the private insurance model in accomplishing this, shouldn’t all options be on the table, including a single payer national health program?

Lawrence S. Lewin:

Without taking any position implied by the very last point about a particular proposal, I think the answer is yes, of course, all options should be on the table until they’re more thoroughly analyzed, and I believe many things are being considered right now. But I think to opine on the question itself is really beyond the scope of the committee.

Links to this audio briefing, the news release, the report in brief, the project web page, and the full report:
http://www.nationalacademies.org/morenews/20090224.html

Comment:

By Don McCanne, MD

In six previous reports, published from 2001 to 2004, the Institute of Medicine concluded that “being uninsured was hazardous to peopleĆ¢ā‚¬ā„¢s health and recommended that the nation move quickly to implement a strategy to achieve health insurance coverage for all.”

After a five year lapse, the Institute is issuing an update which concludes, “Health insurance coverage matters. Expanding health coverage to all Americans is essential. Action to reduce health care expenditures and the rate of increase in per capita health care spending is also of paramount importance if health insurance coverage for all is to be achieved and sustained.”

Is this earthshaking news or what? Having health insurance can be beneficial for your health, and everyone should have it, especially since it makes communities healthier as well. Uh, I think we all knew that.

What is surprising is Lawrence Lewin’s statement that there is “disagreement” on the economic and financial impacts of uninsurance, and the data on this “are not very sound.” Is he suggesting that we should discard a couple of decades of extensive, highly credible studies demonstrating that those without health insurance face impaired access to care, financial hardship, and often personal bankruptcy, not to mention physical suffering and perhaps even death?

Just as astounding is his statement that there is a “non-availability of data to look at the impact of different levels of insurance.” Again, is he recommending that we discard the plethora of highly credible studies, which demonstrate that the explosion in underinsurance products is also causing much of the same suffering as that experienced by the uninsured?

Lewin’s statements provoked me enough to submit the question on whether we should include on the table a consideration of single payer as a financing model that would enable access and affordability. He did let slip out the obvious answer, “yes,” before retreating to the position that he should not “opine” on it.

The answer is YES! Single payer definitely needs to be on the table.

Lewin may not want to opine, but that shouldn’t stop us from opining that we should remove from the table any reform model that would leave us short of providing all necessary care for everyone without exposing anyone to financial hardship. That would really clear the table. Then we could get serious about working on a single payer national health program.

Renew Auto Industry? Start With Real Health Reform

by John Nichols
The Nation blog
02/20/2009

General Motors, and what is left of Chrysler, are back asking for another government bailout. And Americans who recognize that an auto industry is a good deal more vital to the country’s future than those bankers who are using taxpayer billions to retrofit their executive washrooms will be inclined to sympathize with the plea.

But before another bailout check is inked, wouldn’t it make sense to get the auto giants — even if they are not so giant anymore — involved in addressing what really ails their industry?

No, it is not autoworkers. Members of the United Autoworkers union have given concession after concession after concession in order to save an industry that their union leadership called for modernizing — with the development of smaller, fuel-efficient cars — more than three decades ago.And, no, it is not entirely the visionless management of GM, Chrysler and Ford, although it frustrating to recall the opportunities missed by CEOs who rejected smart union advocacy on behalf of the industry’s long-term future in favor of ever-bulkier SUVs, schemes to turn from manufacturing to financial services and, when it came time to balance the books, factory closures and layoffs.

The truth is that U.S. auto firms are being battered by a global economic collapse that has undermined car sales everywhere, leading to demands for government bailouts in every country where cars are made. But the even greater truth is that U.S. firms have been hit harder than many of their competitors by stalling car sales.

That’s because it costs more to make cars in the United States. Even though U.S. autoworkers have accepted pay cuts and efficiency schemes that mean they make less than autoworkers in many other countries, the enormous expense imposed by this country’s for-profit health care system places an extreme burden on firms that manufacture vehicles in the U.S. How extreme? It is estimated that health care costs add as much as $1,400 to the cost of a car made in an American plant.

So a new bailout, without a serious focus on health care reform, is at best a temporary fix, as three Democratic House members from the hard-hit manufacturing states of Ohio and Michigan explain in a new letter to GM CEO Richard Wagoner, Jr.

“You have convincingly articulated the effect of health care costs on GM’s competitiveness for years. Though the Voluntary Employee Beneficiary Association agreement with the United Auto Workers (UAW) has provided some short-term relief of health care costs by relinquishing financial responsibility for retiree care, the health care costs of current employees remain. Unless those costs are controlled, financial relief will be temporary,” write Ohio Representatives Dennis Kucinich and Marcy Kaptur and Michigan Representative John Conyers.

“As the nation’s largest provider of health care in the U.S., GM is likely to have captured the majority of the efficiencies that can be gained under a system with multiple, competing insurers. If true, systemic health care reform is the remedy of choice,” explain Kucinich, Kaptur and Conyers, who add that, “There is a model for health care finance that has proven in several countries to control costs, provide health care to all, and increase the quality of care: national health insurance, which is embodied in H.R. 676.”

H.R. 676, the United States National Health Care Act, is a single-payer reform that would, the House members explain, provide “all American residents would receive a National Health Insurance card. The card would be good for health care services at all health care facilities across the country in the National Health Insurance system. Families would be able to choose any licensed doctor and any hospital. There would be no premium, deductible or co-payment. No one would receive a bill for any medically necessary health care services, and by eliminating inefficiencies, the plan would cost the same amount of money that is now spent on health care.”

That’s good for Americans.

And, in this case, what’s good for Americans is good for General Motors.

So, the members of Congress suggest that, in order to show he is serious about renewing GM and the U.S. auto industry, Waggoner should get GM on record as an endorser of H.R. 676.

Such a move, placed in the context of a discussion about another bailout for auto firms, would get attention focused on the Conyers-sponsored bill, which has attracted more than 90 cosponsors in the current Congress. And it would turn a vague discussion about the need for health care reform, and the role such reform could play in stimulating the economy, into a serious debate about the sort of changes that really are needed but that are not always discussed in media reports or White House strategy sessions.

Here’s the message Kucinich, Kaptur and Conyers sent Waggoner on Thursday:

As part of our ongoing efforts to ensure that the auto industry continues to be competitive, we write to engage you in a discussion about solutions. With a difficult economic outlook, plummeting auto sales, efforts already underway to cut costs relative to the competition, and health care costs rising faster than inflation, there has never been a more prudent time for GM to endorse H.R. 676, the United States National Health Care Act. We invite you to meet with us to discuss the matter in person.

You have convincingly articulated the effect of health care costs on
GM’s competitiveness for years. Though the Voluntary Employee Beneficiary Association agreement with the United Auto Workers (UAW) has provided some short-term relief of health care costs by relinquishing
financial responsibility for retiree care, the health care costs of current employees remain. Unless those costs are controlled, financial relief will be temporary.

As the nation’s largest provider of health care in the U.S., GM is likely to have captured the majority of the efficiencies that can be gained under a system with multiple, competing insurers. If true, systemic health care reform is the remedy of choice. There is a model for health care finance that has proven in several countries to control costs, provide health care to all, and increase the quality of care: national health insurance, which is embodied in H.R. 676.

One such success story can be found in Canada, where Canadian GM, Ford and Chrysler have publicly declared their support for Canada’s health care system specifically because of the competitive advantage it gives them over their American counterparts.

If H.R. 676 was implemented, the benefits to GM would not be limited to cost control. H.R. 676 would reduce liability insurance & workers compensation costs; eliminate the cost and inconvenience of running a health benefits bureaucracy; eliminate employee concerns about rising premiums and co-pays and conflicts with labor unions over benefit cuts; free up money for consumer spending; reduce absenteeism; and produce a healthier, more productive work force.

Momentum behind H.R. 676 is increasing by the day. It garnered 93 cosponsors in the 110th Congress including multiple Chairs of committees and subcommittees of jurisdiction. Fifty-nine percent of all physicians and about 60% of the American public now support a national health insurance plan like H.R. 676. The California State Assembly has twice passed such a bill in the last three years. National health insurance is supported by the deans of prominent medical schools, a former New England Journal of Medicine editor, a Nobel Laureate, a former Surgeon General, the US Conference of Mayors, the US Presbyterian Church, the League of Women Voters, Consumer’s Union, and the UAW.

To learn more about H.R. 676 and the campaign to enact it, check out the Leadership Conference for Guaranteed Health Care site and the continuing efforts of the group with which Conyers has worked closely on this issue, Progressive Democrats of America.

http://www.thenation.com/blogs/thebeat/410184/renew_auto_industry_start_with_real_health_reform