PNHP

IOM report: America's Uninsured Crisis

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

Seattle City Council Endorses National Single-Payer Health Program

PNHP Western Washington
Press Release

FOR IMMEDIATE RELEASE
February 17, 2009

By unanimous vote, the Seattle City Council today passed a Resolution sponsored by Councilmember Nick Licata, to ask the Washington State Congressional delegation to support two single-payer bills that would create a national health program. Congressman Jim McDermott has introduced HR 1200, the American Health Security Act, and Congressman John Conyers HR 676, the United States National Health Care Act.

Both bills would provide comprehensive health insurance for all Americans, the care provided though the existing private delivery system. They would replace private insurance with guaranteed coverage, funded through the tax system. Studies indicate these bills would cover everyone while reducing overall cost and establish a unified health care system.

Sponsor Nick Licata indicated that in this time of severe economic stress, a national solution to our health care crisis is especially important and would fulfill the Council’s duty to protect all Seattle residents from health and financial disaster.

Seattle becomes the 49th City and Municipal government to pass such a resolution.

FOR MORE INFORMATION, CONTACT:
Nick Licata, Seattle City Councilmember
David McLanahan, MD, Coordinator, PNHP Western Washington Chapter

The time for real healthcare reform is now

By City Councilmember Nick Licata
West Seattle Herald
February 20, 2009

(Editor’s note: This opinion piece was sent to this newspaper from Seattle City Council member Nick Licata as part of his Urban Politics Newsletter.)

On Tuesday, Feb. 17 the Seattle City Council affirmed their unanimous support for universal access to quality health care. In doing so, Seattle joined 24 other cities and counties and 18 states passing similar resolutions.

I authored and sponsored this resolution upon the request of the Washington chapter of Physicians for a National Health Plan (PNHP).

Resolution 31111 urges the U.S. Congress to enact legislation to establish and implement this right by adopting HR 676, the U.S. National Health Insurance Act, proposed by Representative John Conyers or HR 1200, the American Health Security Act, proposed by Representative Jim McDermott.

Both bills are the “single-payer” model, which would guarantee everyone access to all medically necessary care, including prescription drugs, with no co-pays or deductibles. Only the single-payer model contains costs by eliminating the administrative waste and bureaucracy associated with the private insurance industry, and it would assure patients their personal choice of doctor and hospital.

The resolution also requests our Washington State Congressional delegation to support these bills.

Other city councils calling for the bill’s passage include those in Baltimore, Boston, Chicago, Detroit, San Francisco and Louisville, Ky. The U.S. Conference of Mayors at its June meeting in Miami passed a similar resolution. Local government is closer to the people and their health care struggles than most elected officials.

We see the real impacts of our communities and constituents suffering. Additionally, the costs to the City of Seattle of providing health-care benefits to its employees have risen while City revenue has not kept pace. Here are some sobering facts:

An estimated 160,000, 15.6 percent of King County residents less than 65 years of age, do not have health insurance.

The number of uninsured children in Washington State has reached the highest level in more than a decade; 3 percent of children in King County are uninsured.

Seattle’s community health clinics provide treatment for individuals regardless of their ability to pay and approximately 60 percent of their new patients are uninsured costing King County $139,821,202 in 2006.

A recent letter from PNHP to the previous Secretary-designate Tom Daschle, Health and Human Services says: Candidly, we are alarmed by some comments by members of the Senate and by the Obama transition team that suggest that the single-payer option is being excluded from consideration – is ‘off the table’ – in the health reform debate…other proposals “share the fatal flaw of preserving a central role for the investor-owned health insurance industry in a private-public financing mix.

“This approach simply won’t work, as numerous state-based experiments patterned after this model have shown. These plans always fail because they are unable to control costs.”

http://www.westseattleherald.com/2009/02/19/opinion/time-real-healthcare-reform-now

Seattle City Council Endorses HR 676

The Seattle City Council has joined the growing nationwide movement of cities, counties, and state legislatures to urge Congress to pass HR 676, national single payer healthcare, introduced by Congressman John Conyers (D-MI).

The cities, counties, and states endorsing HR 676 (including Tuskeegee, AL; Warren County, TN; Lorain, OH; Erie, PA; Indianapolis, IN; and the Kentucky House of Representatives) are listed at http://unionsforsinglepayer.org/more

Many of the resolutions passed are available at that website. We urge everyone to take similar action in your city, county or state. This is a good way to build the support for HR 676. Our unions can lead the way to make HR 676 politically possible!

The resolution can be linked here:
http://clerk.ci.seattle.wa.us/~scripts/nph-brs.exe?s1=&s2=&s3=31111&s4=&Sect4=AND&l=20&Sect2=THESON&Sect3=PLURON&Sect5=RESN1&Sect6=HITOFF&d=RES3&p=1&u=%2F%7Epublic%2Fresn1.htm&r=1&f=G

#30#

In the 110th Congress, HR 676 had 93 co-sponsors in addition to Conyers.

HR 676 has been endorsed by 481 union organizations in 49 states including 118 Central Labor Councils and Area Labor Federations and 39 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NY, NV & MA).

For further information, a list of union endorsers, or a sample
endorsement resolution, contact:

Distributed by
All Unions Committee For Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551
Email: nursenpo@aol.com
http://unionsforsinglepayerHR676.org
02/20/09

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‚¬™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.

OECD: Health Care Reform in the United States

Economic Department Working Paper No. 665: Health Care Reform in the United States

By David Carey, Bradley Herring and Patrick Lenain
OECD (Organisation for Economic Co-operation and Development)
February 6, 2009
Abstract
In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country. While there are factors beyond the health-care system itself that contribute to this gap in performance, there is also likely to be scope to improve the health of Americans while reducing, or at least not increasing spending. This paper focuses on two factors that contribute to this discrepancy between health outcomes and health expenditures in the United States: inequitable access to medical services and subsidized private insurance policies; and inefficiencies in public health insurance. It then suggests two sets of reforms likely to improve the US health-care system. The first is a package of reforms to achieve close to universal health insurance coverage. The second set of reforms relates to payment methods and coverage decisions within the Medicare programme to realign incentives and increase the extent of economic evaluation of different medical procedures.
http://lysander.sourceoecd.org/vl=16683430/cl=20/nw=1/rpsv/cgi-bin/wppdf?file=5ksnw5ghd45c.pdf

OECD reports are important not only because of their credible studies of economic conditions throughout the world, but also because they are used for policy decisions in the thirty member nations (including the U.S.) plus more than one hundred other countries and economies. Thus it is important to understand this new OECD report, “Health Care Reform in the United States,” especially at this time when intensive reform efforts are taking place in Washington.
The thirty member nations are “countries committed to democracy and the market economy.” Although the data provided by OECD can be very helpful in addressing each nation’s economic problems, the recommendations offered must be evaluated with a recognition that there is a bias toward market solutions, with governments being relegated to a supportive role in improving the functioning of markets.
As expected, this report describes well the poor performance of our health care system in spite of the very high level of spending – by far the highest of all nations. Special attention is directed to the increasing proportion of both the uninsured and the underinsured, and the failures of the private insurance market and current government policies to correct these deficiencies.
The most serious problem with this report is that their recommendations are primarily limited to those that would improve the functioning of private insurance markets, with a government role limited to refining policies that would enable improvements in the private markets (plus minor changes in Medicare design that might have a minimal impact in improving value, but with some policy tradeoffs). Although they parenthetically hint that single payer policies in other nations have been effective in achieving some of the reform goals, at no time do they suggest that a single payer approach might benefit the United States; in fact, they specifically reject it as “radical.”
Considerable attention is directed to the work of Jonathan Gruber and his efforts to use private insurance plans as a foundation for reform, including the real-life experience of the Massachusetts plan. Although the authors of this report echo some of his suggestions, their recommendations fall short of an optimal program of social insurance based on private health plans (a model that we believe is inadequate anyway). Except for tweaks to Medicare, they remain silent on public insurance programs. Last week we provided a critique of the Massachusetts plan, explaining why it is an unsatisfactory model for reform in the United States. (https://pnhp.org/news/2009/february/massachusetts_plan_.php)
Just one example of the inadequacies of their recommendations is the inconsistency between their discussion of the financial hardships faced by the underinsured, and their recommendation to “decrease the generosity of supplemental Medicare insurance designs for beneficiaries without chronic conditions to reduce moral hazard risks, which supplemental insurance accentuates by insulating Medicare beneficiaries from Medicare’s cost-sharing provisions.” Again, they provide good data on problems with our system (underinsurance), but they provide a terrible recommendation for policy changes (prevent “moral hazard” by expanding underinsurance) based on market theory instead of social solidarity.
In sum, OECD’s credibility as an important resource on economic data does not extend to credibility for its recommendations that are based on pro-market ideology. This report is valuable for its data showing how poorly our health care financing system is functioning, but it is almost worthless as a guide for policies on how to repair our system since it reinforces the obsolete model of private health plans and ignores the more efficient and effective model of a single payer national health program.

OECD: Health Care Reform in the United States

Economic Department Working Paper No. 665: Health Care Reform in the United States

By David Carey, Bradley Herring and Patrick Lenain
OECD (Organisation for Economic Co-operation and Development)
February 6, 2009

Abstract

In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country. While there are factors beyond the health-care system itself that contribute to this gap in performance, there is also likely to be scope to improve the health of Americans while reducing, or at least not increasing spending. This paper focuses on two factors that contribute to this discrepancy between health outcomes and health expenditures in the United States: inequitable access to medical services and subsidized private insurance policies; and inefficiencies in public health insurance. It then suggests two sets of reforms likely to improve the US health-care system. The first is a package of reforms to achieve close to universal health insurance coverage. The second set of reforms relates to payment methods and coverage decisions within the Medicare programme to realign incentives and increase the extent of economic evaluation of different medical procedures.

http://lysander.sourceoecd.org/vl=16683430/cl=20/nw=1/rpsv/cgi-bin/wppdf?file=5ksnw5ghd45c.pdf

Comment:

By Don McCanne, MD

OECD reports are important not only because of their credible studies of economic conditions throughout the world, but also because they are used for policy decisions in the thirty member nations (including the U.S.) plus more than one hundred other countries and economies. Thus it is important to understand this new OECD report, “Health Care Reform in the United States,” especially at this time when intensive reform efforts are taking place in Washington.

The thirty member nations are “countries committed to democracy and the market economy.” Although the data provided by OECD can be very helpful in addressing each nation’s economic problems, the recommendations offered must be evaluated with a recognition that there is a bias toward market solutions, with governments being relegated to a supportive role in improving the functioning of markets.

As expected, this report describes well the poor performance of our health care system in spite of the very high level of spending – by far the highest of all nations. Special attention is directed to the increasing proportion of both the uninsured and the underinsured, and the failures of the private insurance market and current government policies to correct these deficiencies.

The most serious problem with this report is that their recommendations are primarily limited to those that would improve the functioning of private insurance markets, with a government role limited to refining policies that would enable improvements in the private markets (plus minor changes in Medicare design that might have a minimal impact in improving value, but with some policy tradeoffs). Although they parenthetically hint that single payer policies in other nations have been effective in achieving some of the reform goals, at no time do they suggest that a single payer approach might benefit the United States; in fact, they specifically reject it as “radical.”

Considerable attention is directed to the work of Jonathan Gruber and his efforts to use private insurance plans as a foundation for reform, including the real-life experience of the Massachusetts plan. Although the authors of this report echo some of his suggestions, their recommendations fall short of an optimal program of social insurance based on private health plans (a model that we believe is inadequate anyway). Except for tweaks to Medicare, they remain silent on public insurance programs. Last week we provided a critique of the Massachusetts plan, explaining why it is an unsatisfactory model for reform in the United States. (https://pnhp.org/news/2009/february/massachusetts_plan_.php)

Just one example of the inadequacies of their recommendations is the inconsistency between their discussion of the financial hardships faced by the underinsured, and their recommendation to “decrease the generosity of supplemental Medicare insurance designs for beneficiaries without chronic conditions to reduce moral hazard risks, which supplemental insurance accentuates by insulating Medicare beneficiaries from Medicare’s cost-sharing provisions.” Again, they provide good data on problems with our system (underinsurance), but they provide a terrible recommendation for policy changes (prevent “moral hazard” by expanding underinsurance) based on market theory instead of social solidarity.

In sum, OECD’s credibility as an important resource on economic data does not extend to credibility for its recommendations that are based on pro-market ideology. This report is valuable for its data showing how poorly our health care financing system is functioning, but it is almost worthless as a guide for policies on how to repair our system since it reinforces the obsolete model of private health plans and ignores the more efficient and effective model of a single payer national health program.

Health care bills suffer conspiracy of silence

Saul Friedman
Gray Matters
Newsday
February 21, 2009

Too often journalism ignores or belittles reports or proposals as outside the mainstream and bound to fail, thus assuring they will remain outside the mainstream and fail.

That, I believe, is what has been happening to proposals by three Democratic members of the House of Representatives to provide health care for all Americans through a system like Medicare, rather than depending, as now, on many private insurance companies.

The lawmakers, among the most senior House members, are Pete Stark of California, chairman of the health subcommittee of Ways and Means; John Dingell of Michigan, the longest-serving member of the House and chairman emeritus of Energy and Commerce, and Judiciary Committee chairman John Conyers, also from Michigan.

Last month, Stark reintroduced his proposal, called Americare, which would open Medicare Parts A and B to everyone, but allow people to keep their employer-based insurance. A few days later, Dingell and Conyers reintroduced their bills, which would expand Medicare to become the nation’s comprehensive health care program, paid for by premiums and taxes. The Conyers bill has dozens of co-sponsors and the support of most AFL-CIO unions.

On Jan. 28, a coalition of advocacy groups representing 15,000 doctors and more than 50,000 nurses, met at the Capitol to present a new study asserting that the Conyers’ bill, called the National Health Insurance Act (HR 676), could create 2.6 million new jobs and would cost far less than the private insurance currently paid for by individuals and employers.

Only Congressional Quarterly covered it. The Kaiser Family Foundation’s daily online report on health care developments at kff.org didn’t mention it. Nor has Kaiser, the most comprehensive online source of health care information, made any mention of “single-payer” (the government as the payer), or the Conyers bill since it was introduced in 2003, despite widespread support for such a plan according to Kaiser’s own polls. (After my insistent inquiries, Kaiser says it will publish charts next month comparing the Stark and Conyers bills.)

AARP, another key source of health care information, briefly mentioned single-payer in the AARP Bulletin, sent to its 35 million members. But neither single-payer nor the Conyers bill have been discussed in any of its other publications or its advocacy materials at aarp.org.

Why? Many health care writers and advocates believe it’s because single-payer and the Conyers bill would bar any role for private insurance companies, which would have central roles in all the other proposals under discussion.

The Kaiser Family Foundation was founded with insurance money, but its president, Drew Altman, says it receives no money from and has no connection with Kaiser Permanente, a large health insurer. And AARP’s chief strategist, John Rother, insists that its $700 million insurance business, mostly with UnitedHealth Group, does not affect its policies.

But reader Elaine Fox of Southampton, a physician and health care activist, contends there is evidence the health insurance industry opposition to government-sponsored health care has contributed to the effort to black out discussion of the Conyers bill.

She noted that in “An Analysis of Leading Congressional Health Care Bills, 2007-2008,” an online article posted in January by the Commonwealth Fund, a nonpartisan public policy research organization (www.commonwealthfund.org/index.htm), the Conyers bill was ignored. The Stark bill, which includes an insurance option, was analyzed. But Conyers’ bill and single-payer were not discussed in the analysis, which was done for Commonwealth by the Lewin Group, health care consultants.

As Fox pointed out, the Lewin Group had been independent and in 2005 its analysis supported passage of a single-payer bill in California. In 2007, Fox said, Lewin was purchased by Ingenix, a health information firm that helps set the rates insurance companies pay providers. Ingenix is owned by one of the nation’s largest insurers, UnitedHealth (which recently paid a $50 million fine in New York to settle a charge that Ingenix underpaid out-of-network doctors who provided service for United’s subscribers).

On Jan. 13, Fox said, the RAND Corp., a think tank, launched an online tool for policy makers to compare health care proposals called “Comprehensive Assessment of Reform Efforts,” or COMPARE. It did not include the Conyers bill or any single-payer alternative. RAND acknowledged that COMPARE is funded in part by AARP and health insurers, including UnitedHealth. A RAND spokesman said COMPARE will “get around to including” single-payer plans.

AARP’s Rother cites other reasons than the insurance industry for the blackout. He’s in favor of a single-payer system, he says, but insists he’s not encouraging such proposals because they’re outside the mainstream and are not likely to pass. Despite broad support for national health insurance and Medicare, Rother says, “This is simply a matter of pragmatism. Single-payer advocates could play a destructive role in the coming debate.”

Fox argues: “There cannot be a credible debate when one side disappears.”

WRITE TO Saul Friedman, Newsday, 235 Pinelawn Rd., Melville, NY 11747-4250, or by e-mail at saulfriedman@comcast.net.

Members of Congress Offer Prescription for General Motors' Competitive Disadvantage

Washington D.C. (February 19, 2009) — Congressman Dennis Kucinich (D-OH) and two other Members of Congress today sent a letter to the CEO of General Motors, Mr. Richard Wagoner, Jr., to propose a different kind of auto industry rescue plan that eliminates the competitive disadvantage of inflated health care costs.

As health care costs continue to spiral out of control, the brunt is borne in large part by employers that provide health care. General Motors and other U.S. automakers have significantly higher health care costs than their international competitors — as much as $1400 per car. In the letter, Members of Congress point out that the adoption of H.R. 676, the United States National Health Care Act, would level the playing field and stimulate the economy.

Under H.R. 676, 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.

Representatives Marcy Kaptur (D-OH) and John Conyers (D-MI) also signed the letter.

The full text of the letter follows:

February 19, 2009
G. Richard Wagoner, Jr.
Chief Executive Office, General Motors
300 Renaissance Center
Mail Code 482-C39-B50
Detroit, MI 48265

Dear Mr. Wagoner:

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.

Please consider meeting with us at your earliest convenience to discuss the issue further. We look forward to your response.

Sincerely,

Dennis J. Kucinich
Member of Congres

John Conyers, Jr.
Member of Congress

Marcy Kaptur
Member of Congress

America's Economic Future Requires Health Care Reform

Dr. Margaret Flowers
Maryland Commons
February 23, 2009

We are told reforming health care is impossible in tough economic times. However, it is not only possible, it is necessary for economic recovery.

Health care costs are rising 2.5 percent faster than the nation’s gross domestic product. At this rate, health care will consume as much as half of household income by 2018.

In a global economy, American businesses cannot compete when the cost of health care is so high. Does it make sense for the auto industry to spend more for health care than for steel?

The current situation is unsustainable; we must enact fundamental, comprehensive reform to create a system that works.

Let’s look at some of the reasons why Americans spend two to three times more for health care than other industrialized nations. These nations have better health outcomes with longer life expectancy, fewer infant and maternal deaths and fewer preventable deaths. Yet in America, we spend more.

* Private health insurance companies spend 31 percent of their dollars on administration, much of it to deny or restrict needed health care. In the private, investor-owned health insurance world, profits come before health care. As a result, from 2000 to 2004, the top 14 health insurance corporations in the United States had profits of 117 percent, greatly outstripping the 5 percent profits seen by the Standard & Poor’s 500 corporations. In contrast, public programs, such as Medicare, spend 3 percent on administration.

* Americans pay up to nine times more for medications because prices are not negotiated. Other industrialized nations use bulk purchasing to make medications affordable while allowing pharmaceutical companies to make healthy profits.

* Because of co-pays and deductibles, Americans often delay getting medical care early in an illness, when it is usually easier and less expensive to treat. Many wait so long that their illness becomes life-threatening.

* Americans do not get adequate preventive care. Even those with health insurance only receive about half of recommended preventive care. Prevention is the key to keeping people healthy and saving money.

How did this situation happen?

With health insurance tied to employment, the U.S. is unique. To attract and keep employees during World War II, when wages were fixed, employers offered extra benefits, such as health insurance. Around that time, other nations created health systems independent of employment.

In the 1980’s, Wall Street investors were trained to take on health care as a profit-making venture, thus causing the shift to viewing health care as a commodity and patients as consumers. Since then, health care costs have skyrocketed and the health of our society has plummeted.

The U.S. is ranked 37th in the world; Maryland, despite its wealth, is ranked 32nd in the nation for health outcomes.

Currently, when a person becomes seriously ill or injured and loses his or her job, health insurance is lost. This may mean dying from lack of care or suffering great financial hardship. If the goal of having health insurance is to get health care when it’s needed, the market approach has failed.

We need bold reform, not tinkering around the edges. The government must play a larger role, not to correct the market, but to remove medically necessary care from the market; it didn’t belong there in the first place. Access to health care is a public good. A healthy society is a productive society, and a productive society can turn the economy around.

Private health insurers function to finance health care. Instead of trying to regulate private insurers, which is costly, the most efficient way to finance health care is to use a single public payer, such as Medicare. Medicare for all would pay health care providers directly and providers would remain the same. A single public payer would save around $400 billion per year in administrative costs and allow bulk purchasing of medications, further reducing costs.

Did I say remove health care from the market? Yes, that is, for medically necessary care. Private insurers would still provide supplemental plans for the rest, such as elective surgery.

There are more reasons why using a single public payer is better. The existence of hundreds of different insurers and plans costs the average doctor’s office 20 percent of its overhead for paperwork. And private insurers undermine the integrity of the physician-patient relationship by refusing to pay for care, essentially practicing without a medical license. This is causing physicians to go into “boutique practices,” or leave clinical medicine altogether.

Maryland has a serious physician shortage. Insurers also restrict where patients can go, charging more if the patient goes “out of network.” Under a single public payer, patients would choose their health care provider without penalty, leading to healthy competition among providers.

For businesses, many of which are crushed by health care costs, removing this burden would allow wage increases and the hiring of more employees. There would be less incentive for American businesses to move offshore, where health care costs are lower, such as Europe or Canada.

There is a state bill called the Maryland Health Security Act (HB 1186, SB 881) and a national resolution called HR 676. Both would create a health system based on a single public payer. To learn more or become involved, go to www.mdsinglepayer.org and www.guaranteedhealthcare4all.org

It is time to set aside ideology and enact health care reform to provide everyone with continuous access to health care from birth to death, simply and less expensively. This is what a civilized society does.

Massachusetts' 2006 Health Insurance Law Not A Good Model for National Health Care System Reform, Physicians Say

Kaiser Daily Health Policy Report
Feb 23, 2009

Modeling the U.S. health care system after Massachusetts’ health insurance law would leave many residents without affordable health coverage, according to analysis by three Harvard Medical School physicians and a letter signed by 500 state physicians sent to Sen. Edward Kennedy (D-Mass.), the Boston Globe’s “Political Intelligence” blog reports. According to “Political Intelligence,” portions of the insurance law — which requires most state residents to obtain health coverage and provides subsidies for some residents who cannot afford coverage — have been praised by President Obama and Senate Finance Committee Chair Max Baucus (D-Mont.), “making it likely to influence any effort to overhaul the national system.”

While the letter urges Kennedy to consider proposing a Medicare-for-all style national health care system, the Globe reports that this “something Congressional leaders and the White House have rejected as politically unworkable.” According to the letter, “Any plan that retains private insurers will add layers of bureaucracy and fail to control costs, dooming the noble effort to assure good care for all.”

In an analysis, Rachel Nardin, a neurologist and an assistant professor, and Steffie Woolhandler and David Himmelstein, both primary care physicians and associate professors, question the quality of state data that show all but 2.6% of Massachusetts’ residents are insured, saying that the number is probably 5% or more. In addition, they claim that insurance coverage under the new law has created unaffordable out-of-pocket costs for lower- and middle-class residents, particularly those with chronic illnesses. The new law also is more costly than expected, which has resulted in reductions to state funding of “safety net” providers that offer no-cost care to low-income residents, the physicians said.

Jonathan Gruber — an MIT economist and a board member of the Commonwealth Health Insurance Connector Authority, which administers the Massachusetts law — said the physicians “let the perfect be the enemy of the good.” Gruber said the Connector has capped out-of-pocket costs and premiums for low-income residents with annual incomes up to three times the poverty level at 10% of their income. However, those who earn between three and five times the poverty level may have more difficulty finding affordable health coverage, he said.

Jon Kingsdale, executive director of the Connector, also said that the physicians’ analysis did not accurately portray the cost of subsidized health coverage in fiscal year 2008, which was $800 million, not more than $1 billion (Wangsness, “Political Intelligence,” Boston Globe, 2/18).

Online The analysis is available online (.pdf). The letter also is available online (.pdf).

http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=57114

Health Insurance Is Not Synonymous With Health Care

Statement of Rachel Nardin, M.D., President, Massachusetts Chapter of Physicians for a National Health Program

Feb. 18, 2009

My name is Dr. Rachel Nardin, a neurologist at Beth Israel Deaconess Medical Center in Boston and assistant professor of neurology at Harvard.

In April 2006, Massachusetts enacted a health care reform law with the stated goal of providing near-universal coverage of the Massachusetts population. Nearly three years into the reform, we know a lot about what has worked and what hasn’t. Examining this data critically is vitally important as the Obama administration considers elements of Massachusetts’ plan as a model for national health care reform.

Today we are here to release a new study on the Massachusetts reform. This study details many problems with the reform effort. We are also releasing a letter from nearly 500 Massachusetts physicians to Sen. Edward Kennedy asking him not to push for a Massachusetts-style reform nationally. My colleagues and I see the effects of the Massachusetts reform on patients every day and know that this is not a healthy model for the nation.

The Massachusetts reform is an example of “incremental” reform. It tried to fill in gaps in coverage, while leaving undisturbed existing public and private health insurance programs. It did this by expanding Medicaid and offering a new subsidized coverage program for the poor and near-poor. It also mandated that middle-income uninsured people either purchase private health insurance or pay a substantial fine ($1,068 in 2009).

The reform has reduced the numbers of uninsured, although our report shows that the state’s claim of near-universal coverage is untrue. This claim is based on a phone survey that reached few non-English speaking households and few who lacked landline phones — two groups with high rates of uninsurance. Other data also calls this claim into question. For instance, both the Massachusetts Department of Revenue and the March 2008 U.S. Census Bureau survey indicate that at least 5 percent of people in Massachusetts remain uninsured. Moreover, the use of free care services in Massachusetts has fallen by only a third, suggesting that the numbers of uninsured in the state may well be even higher than 5 percent.

Despite the reform, coverage remains unaffordable for many in our state. As a result, despite the threat of a fine, some residents remain uninsured. Others have bought the required insurance but are suffering financially. For a middle income, 56-year-old man, the cheapest policy available under the reform costs $4,872 annually in premiums alone. Moreover, it carries a $2,000 deductible and 20 percent co-payments after that, up to a maximum of $3000 annually. Buying such coverage means laying out nearly $7,000 before the insurance pays a single medical bill. It is not surprising that many of the state’s uninsured have declined such coverage.

The study we are releasing today also reminds us that having health insurance is not the same thing as having health care. Despite having coverage, many Massachusetts residents cannot afford care. In some cases, patients are actually worse off under the reform than they were under the state’s old system of free care because their new insurance has far higher co-pays for medications and care. According to a recent Boston Globe/Blue Cross Foundation survey, 13 percent of people with insurance in our state were unable to pay for some health services that they had received and 13 percent could not afford to fill necessary prescriptions. The reform does not appear to have reduced the numbers of people who were unable to get care that they needed because of the cost.

I will close with the story of one Massachusetts patient who has suffered as a result of the reform. Kathryn is a young diabetic who needs 12 prescriptions a month to stay healthy. She told us, “Under Free Care I saw doctors at Mass General and Brigham and Women’s hospital. I had no co-payments for medications, appointments, lab tests or hospitalization … Under my Commonwealth Care Plan my routine monthly medical costs include the $110 premium, $200 for medications, a $10 appointment with my primary care doctor, and $20 for a specialist appointment. That’s $340 per month, provided I stay well.” Now that she’s “insured,” Kathryn’s medical expenses consume almost one-quarter of her take home pay and she wonders whether she’ll be able to continue taking her life-saving medications.