PNHP

Single-payer health care would benefit all

Single-payer health care would benefit all

By JAMES J. BARBA
Albany Times Union
Wednesday, September 3, 2008

When the topic of universal health care for all Americans is discussed, I have often felt that the space separating the United States from the rest of the industrialized nations, all of which have universal coverage, is occupied by a brick wall. The wall symbolizes ignorance — not merely ignorance of the benefits of insuring all citizens, but ignorance of the component parts of a universal system: parts that can make a critical difference in how we can establish one; in what it will cost and in the issue of convenient access to care.

Dr. John Bennett, the new CEO of Capital District Physicians’ Health Plan, is to be commended for his Aug. 22 op-ed piece, “Is single payer the right Rx?” He answers that question by asserting that universal coverage is the ideal all of our citizens. While Dr. Bennett doesn’t believe the country needs to move to a single-payer system to get there, his concession in supporting universal coverage all but knocks that wall down.

Why? First, saying universal health care is ideal moves away from the shibboleth that such coverage is socialized medicine — which, by its very term, must be evil. Next, to have a physician of Dr. Bennett’s stature adopt this position marks a departure from the days of old when the American Medical Association fought such coverage. And, finally, it is the giant political step that, once taken, leaves the remainder of the debate to mechanics: how do we pay for such coverage; what is the mechanism for such payment and how we phase it in.

Against this significant concession, the issue of a single payer versus a multiplicity of payers is an easier matter, and I think that we can resolve it rather quickly. There appears to be no debate whatever that our current means of delivering health care has become cripplingly expensive. To devote more than 16 percent (and climbing) of our gross domestic product to a single service, no matter how important, is not sustainable. Once we decide that we will have universal coverage, the only approach that will allow actual and substantial savings is a single payer. There are many reasons for this:

Multiple payers have multiple rules for authorizing services, billing and the supply of requested data on the care actually delivered. A single set of rules, which everyone in the provider community follows, will eliminate most of this costly bureaucratic expense.

A single information system would allow all providers to manage and supply data to the payer. The current system, whereby each payer requires health care providers to spend significant resources on billing information systems in order to get their bills paid, is extraordinarily expensive and wasteful.

A single-payer would have a single set of protocols for negotiating fees for services and for supplies, including drugs. Providers do not, as Dr. Bennett suggests, resent the federal government setting such fees as much as they object to having little ability to negotiate each year with dozens of private payers, each one of which has its own agenda and its own bottom lines to support. Allowing a single payer to establish reimbursements that flow from drug negotiations and similar competitive market actions can satisfy the providers and eliminate substantial expense.

Finally, and most important, nothing in Dr. Bennett’s article addressed the issue of the uninsured. Unless we are willing to deal with those 46 million citizens, we have no real hope of taking the largest single cost out of American health care.

Far too many of uninsured individuals receive no preventive care, and, instead, crowd hospital emergency rooms when their health issues have become aggravated — and much more expensive to deal with. Our experience with managed care payers over the last 20 years has demonstrated that they are incapable of providing preventive care and/or disease and case management in any meaningful way, evidenced by the fact that premiums continue to rise. A study done five years ago, indicates that if the nation were to move to a single-payer system, the cost savings would be in the $200 to $300 billion dollar range. From that savings, the highest estimate I have seen for giving adequate health insurance coverage to all uninsured Americans is $125 billion.

A single payer can both create a rational and universal system for all Americans and save significant amounts of money. Whether we call that system “Medicare” or something else is not relevant. Whether we can afford to deliver access and care to every citizen is.

Dr. Bennett has conceded that universal coverage for all citizens is “the ideal.” I know of no cost-effective way of reaching that ideal other than through a single payer.

James J. Barba is president and chief executive officer of Albany Medical Center.

Supreme Court acknowledges insurers’ conflict of interest

MetLife V. Glenn: The Court Addresses A Conflict Over Conflicts In ERISA Benefit Administration

by Timothy Stoltzfus Jost
Health Affairs
September 3, 2008

In its June 2008 decision in MetLife v. Glenn, the Supreme Court held that federal courts reviewing claim denials by Employee Retirement Income Security Act (ERISA) employee benefit plan administrators should take into account the fact that plan administrators (insurers or self-insured plans) face a conflict of interest because they pay claims out of their own pockets and arguably stand to profit by denying claims.

As a practical matter, the cost of health benefits to employers and their value to employees are first determined when the employer settles on a benefit, cost-sharing, and premium package for a benefit year. But it is also determined daily as plan administrators (either insurers, self-insured plans, or third-party administrators) make benefit determinations. Although plan coverage is sometimes clear, claims adjudication often involves application of vague terms such as “medically necessary” or “experimental” care to specific situations. Approximately 1.9 million claims are denied by employee benefit plans each year. Each denial potentially decreases the cost of coverage–immediately for self-insured and prospectively for insured employers (which usually pay an experience-rated premium). But denials also potentially decrease the value of coverage to the individual employee.

Claim determinations are ultimately reviewable in the federal courts. The courts’ approach to reviewing these determinations could, therefore, affect the cost of employee benefits. If, on the one hand, courts routinely overturn claim denials, the cost of coverage will increase, not just because plans will lose more appeals, but also because plans will have to litigate more appeals of adverse determinations as members see their chances of appeal improve. Moreover, plans will likely approve more claims initially instead of risking litigation. An increase in the cost of coverage may in turn lead to more employers’ abandoning coverage. On the other hand, if courts routinely defer to plan determinations, upholding most, plans will in all likelihood be more aggressive and confident in denying claims. This could make coverage more affordable but also put employees at risk.

Interpreting an earlier ERISA decision, the Court articulated the question as to what extent courts should defer to the decision of the plan administrator when the administrator faces a conflict of interest because it is essentially paying the claim out of its own pocket and stands to profit if the claim is denied. The Court decided that this conflict must be taken into account as a “factor” in judicial review. This paper analyzes the Court’s decision, the background of the decision, and its potential effect on American health policy.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.5.w430

Comment:

By Don McCanne, MD

In this important decision the Court affirmed the obvious. Employer-sponsored plans and their administrators, whether private insurers or self-insured plans, have a conflict of interest when making benefit decisions. Denial of claims benefit the employers and/or insurers, and approval of claims benefit the employees. On this, the justices were in unanimous agreement.

Much of the criticism of private insurance has been directed toward the flagrant, egregious abuses in the individual insurance market. Far more is wasted on administrative services that are designed to weight the conflict of interest heavily in favor of the insurer at the cost of patient-beneficiary. Those who support reform based on private insurance acknowledge that the individual plans would have to be replaced with options that more closely resemble employer-sponsored plans. Is that wise from a health policy perspective?

An important implication of this Supreme Court decision is that costs for employer-sponsored plans will likely increase. Legal costs may rise because of an increase in challenges to claims decisions, which may cause an increase in benefit costs because of employer/insurer decisions to avoid the effort and legal costs of challenging claims for non-beneficial and non-contract services.

Would a single payer national health program eliminate the conflict of interest between the payer of benefits (the government) and the recipient of benefits (the patient)? Of course not. But, as a society, this conflict should work to our benefit.

Our own public program would have a mission to finance all necessary care for all of us. At the same time, it would have a responsibility as stewards of our tax funds to not waste money on non-beneficial services and products. Although disputes would be inevitable in marginal circumstances, the decisions would be based on balancing the needs of the patient with efficiency in the use of our public funds.

Employers would no longer have to face the awkward decisions of saving money by denying care for their employees.

In contrast, private insurers welcome the opportunity to reduce their overhead by denying care to patients. That might be good business, but it’s terrible health policy.

Sen. Kuehl's single payer bill goes to Gov. Schwarzenegger again

Calif. Nurses Laud Passage of Single-Payer, SB 840, Seen as National Model for Guaranteed Healthcare for All

MarketWatch
September 1, 2008
The California Nurses Association/National Nurses Organizing Committee today hailed the California Legislature’s passage of a single-payer, expanded Medicare for all, style bill that would guarantee quality health care for all Californians — and called it a model for the national healthcare reform debate that is sure to emerge in 2009.
SB 840, authored by State Senator Sheila Kuehl, passed its final legislative hurdle with a vote in the State Senate today and is headed to the desk of Gov. Arnold Schwarzenegger who vetoed an earlier version of the bill two years ago.
“But a lot has changed since then, including the further implosion of our healthcare safety net, and the Governor’s own professed support for universal healthcare,” said CNA/NNOC co-president Malinda Markowitz, RN. Nurses will remind Schwarzenegger of that pledge, she said.
http://www.marketwatch.com/news/story/calif-nurses-laud-passage-single-payer/story.aspx?guid=%7B203DC8E2-395B-4836-99E8-2B1C81FFF4F2%7D&dist=hppr
Senate Bill No. 840:
http://info.sen.ca.gov/pub/07-08/bill/sen/sb_0801-0850/sb_840_bill_20080811_amended_asm_v95.pdf

And…

Governor Schwarzenegger’s Health Care Plan

Assembly Bill X1 1, the Health Care Security and Cost Reduction Act:
Requires that all Californians take responsibility for their health coverage (individual mandate).
Guarantees that no Californian will be turned away from buying insurance based on their age or medical history (guarantee issue).
Spreads responsibility across individuals, government, hospitals and employers (shared responsibility).
Makes coverage more affordable for individuals and families through tax credits and subsidies.
Helps keep hospitals and emergency rooms open by increasing Medi-Cal reimbursement rates.
Allows individuals to choose their health coverage and keep their current insurance.
http://www.fixourhealthcare.ca.gov/plan

Two years ago California’s Governor Arnold Schwarzenegger vetoed a prior version of this single payer bill stating, “I must veto SB 840 because I cannot support a government-run health care system.”
He then initiated an intensive effort to create legislation that would provide coverage for all Californians, but crafted to comply with his policy principles listed above. His efforts fell short and resulted in AB X1 1 – legislation that would better be characterized as a take-it-or-leave-it package of incremental reforms. There were many beneficial reforms in the package that have broad support, but there were many other severe deficiencies that provoked considerable opposition. The legislative battle was very painful for all of us who believe that everyone should have affordable access to all necessary health care. The bill essentially died in the Senate Health Committee when supporters could muster only one vote in favor of it.
In passing SB 840 once again, the California State Legislature is giving Gov. Schwarzenegger another opportunity to sign legislation that actually would provide health care for everyone through a model that would use our health care dollars much more efficiently. It will be a test to see if his goal of ensuring health care for all Californians is more important to him than his personal anti-government ideology. Let’s hope that he leaves his intellectual exercises on ideology in his cigar tent as he comes out and signs a bill that benefits the health of the people.

Sen. Kuehl's single payer bill goes to Gov. Schwarzenegger again

Calif. Nurses Laud Passage of Single-Payer, SB 840, Seen as National Model for Guaranteed Healthcare for All

MarketWatch
September 1, 2008

The California Nurses Association/National Nurses Organizing Committee today hailed the California Legislature’s passage of a single-payer, expanded Medicare for all, style bill that would guarantee quality health care for all Californians — and called it a model for the national healthcare reform debate that is sure to emerge in 2009.

SB 840, authored by State Senator Sheila Kuehl, passed its final legislative hurdle with a vote in the State Senate today and is headed to the desk of Gov. Arnold Schwarzenegger who vetoed an earlier version of the bill two years ago.

“But a lot has changed since then, including the further implosion of our healthcare safety net, and the Governor’s own professed support for universal healthcare,” said CNA/NNOC co-president Malinda Markowitz, RN. Nurses will remind Schwarzenegger of that pledge, she said.

http://www.marketwatch.com/news/story/calif-nurses-laud-passage-single-payer/story.aspx?guid=%7B203DC8E2-395B-4836-99E8-2B1C81FFF4F2%7D&dist=hppr

Senate Bill No. 840:
http://info.sen.ca.gov/pub/07-08/bill/sen/sb_0801-0850/sb_840_bill_20080811_amended_asm_v95.pdf

And…

Governor Schwarzenegger’s Health Care Plan

Assembly Bill X1 1, the Health Care Security and Cost Reduction Act:

Requires that all Californians take responsibility for their health coverage (individual mandate).

Guarantees that no Californian will be turned away from buying insurance based on their age or medical history (guarantee issue).

Spreads responsibility across individuals, government, hospitals and employers (shared responsibility).

Makes coverage more affordable for individuals and families through tax credits and subsidies.

Helps keep hospitals and emergency rooms open by increasing Medi-Cal reimbursement rates.

Allows individuals to choose their health coverage and keep their current insurance.

http://www.fixourhealthcare.ca.gov/plan

Comment:

By Don McCanne, MD

Two years ago California’s Governor Arnold Schwarzenegger vetoed a prior version of this single payer bill stating, “I must veto SB 840 because I cannot support a government-run health care system.”

He then initiated an intensive effort to create legislation that would provide coverage for all Californians, but crafted to comply with his policy principles listed above. His efforts fell short and resulted in AB X1 1 – legislation that would better be characterized as a take-it-or-leave-it package of incremental reforms. There were many beneficial reforms in the package that have broad support, but there were many other severe deficiencies that provoked considerable opposition. The legislative battle was very painful for all of us who believe that everyone should have affordable access to all necessary health care. The bill essentially died in the Senate Health Committee when supporters could muster only one vote in favor of it.

In passing SB 840 once again, the California State Legislature is giving Gov. Schwarzenegger another opportunity to sign legislation that actually would provide health care for everyone through a model that would use our health care dollars much more efficiently. It will be a test to see if his goal of ensuring health care for all Californians is more important to him than his personal anti-government ideology. Let’s hope that he leaves his intellectual exercises on ideology in his cigar tent as he comes out and signs a bill that benefits the health of the people.

For-profit health insurance has outlived its usefulness

By Oliver Fein, MD
The Philadelphia Inquirer
Posted on Sun, Aug. 31, 2008

The Census Bureau reported Tuesday that the estimated number of Americans who lack health insurance had dropped to 45.7 million, compared to 47 million in 2006.

The slight improvement is entirely due to an increase in the number of people covered by government health insurance programs such as Medicare and Medicaid.

Even so, the lower number remains a national scandal, yet the Bush administration tends to discount such reports. The president says that many of the uninsured are young and healthy people who don’t want to buy insurance, presumably because they think they don’t need it.

But this flies in the face of a new study by a team of Harvard researchers who report that 11.4 million of the nation’s uninsured are working-age adults with one or more chronic illnesses, including hypertension, heart disease, diabetes, asthma and cancer. These millions hardly fit the young-and-healthy profile.

These are high-risk individuals whom the private insurance industry strives to avoid. Many of them, were they to seek insurance in the individual market, would face sky-high premiums and severe pre-existing-condition clauses, excluding coverage for their chronic conditions. Many of them are simply “uninsurable,” yet they badly need care.

According to Dr. Andrew Wilper and his team, whose research appears in the Aug. 5 edition of Annals of Internal Medicine, working-age adults with one or more chronic physical illnesses were much more likely than their insured counterparts (by a factor of 3.6 to 1) to report that they had not seen a health professional within the last year.

Many no doubt stayed away from the doctor’s office because they could not afford it. A disproportionate number end up in emergency rooms with worsened conditions, risking serious complications or death.

The United States ranks highest in preventable deaths among 19 developed nations, and the Institute of Medicine estimates that 18,000 Americans die unnecessarily each year because they lack health insurance.

The problem of uninsurable Americans has surfaced in the presidential campaign. Sen. John McCain’s proposals would undermine employer-sponsored health plans and push millions, including some with chronic illnesses, onto the individual insurance market. This is a sure-fire formula for increasing the number of uninsured and uninsurable adults.

McCain counters that uninsurable Americans can turn to government-sponsored high-risk pools. While 35 states currently offer such quasi-public insurance pools, the premiums sometimes cost two or more times the amount charged to healthy young people. As a result, only a few hundred thousand people participate nationwide. And because of rising costs, many of these plans are failing financially.

The frequency of chronic illness among the uninsured also poses challenges for individual mandate proposals, including those associated with Sen. Barack Obama. While Obama’s plan includes a requirement that insurance companies accept anyone who applies for coverage and sets up a new public plan to provide another coverage option, several states that have adopted this kind of model (Massachusetts being the most recent example) have invariably abandoned them, citing uncontrollable costs.

The plight of the uninsured and uninsurable shows how the for-profit, private health insurance model of financing health care has outlived its usefulness. Originally conceived as a nonprofit enterprise (e.g. Blue Cross), the industry is now bent on maximizing profits by screening out the sick and minimizing claim payments.

It’s time we move to a single-payer national health insurance program, an improved Medicare for all. By putting an end to private insurance company overhead, advertising, executive salaries and shareholder profits, estimated to be $350 billion a year, we could guarantee quality care to all.

Most industrialized nations have such a system, and their per-capita costs are one half of ours or even less. What are we waiting for?

Oliver Fein is associate dean and professor of clinical medicine and public health at Weill Cornell Medical College in New York and president-elect of Physicians for a National Health Program

Make U.S. healthier and wealthier

Provide health insurance for all Labor Day: Universal health care coverage

James V. Bertolone
Guest essayist
Rochester Democrat and Chronicle
August 29, 2008

This coming Labor Day, working people from coast to coast will be working for candidates who are ready to turn around our health care system, turn around our economy, turn around the decline of the middle class and turn around America.

Our polling shows that more than 80 percent of Americans think our country is heading in the wrong direction; that our health care system costs too much, excludes too many, covers too little and is getting worse. The drive for universal health care coverage is mobilizing thousands of working people in this year’s election cycle.

Whether measured by the World Health Organization, the medical profession or our own government’s statistics, our health care costs nearly twice as much per person as that in other industrialized societies.

Of America’s gross domestic product, health care costs totaled 17 percent in 2006, and now in 2008 totals more than $7,000 per person.

With costs continuing to rise in a contracting economy, we apparently are heading for $1 out of every $5 spent in our $14 trillion economy going to health care by about the end of this decade.

While other countries have universal health care, we have more than 47 million Americans with no health insurance and more than 25 million underinsured.

We rank 24th among industrialized countries and 37th overall in the key areas for how long we live, infant mortality and immunizations. Only in health care costs does the United States rank No. 1.

We also pay nearly 50 percent more than most industrialized countries for prescription drugs.

In most other countries, the concept of for-profit health care insurance is alien, as health care is considered a universal right.

In a for-profit system, health care companies increase profits by denying coverage to those at risk, such as the elderly and those with pre-existing conditions, and by denying medical procedures and tests.

I have yet to meet a person covered by Medicare who wishes to lose that coverage to be at the mercy of for-profit health insurance.

The 15,000 doctors who belong to Physicians for a National Health Program say that 60 percent of the uninsured and 28 percent of insured Americans go without needed care due to costs, resulting in more than 18,000 deaths per year.

The U.S. Conference of Mayors, representing 1,100 mayors, in June endorsed HR 676, single-payer Medicare for all. Back in 2003, an article in The New England Journal of Medicine reported that nearly one-third of U.S. health care costs, $2,300 per person, were due to administration and profits. The article concluded that a single-payer system would reduce administrative costs by $1,150 per person, saving $350 billion a year, enough to insure all uninsured Americans. We know these costs have risen in the past five years.

In our state, there is a large concern about the high cost of property and school taxes. Imagine covering all health care costs for all our police, fire, state, county, city, town and school district employees for less than $4,000 per person, the average cost of universal health care coverage in other industrialized nations. The thousands saved per employee would result in real tax savings.

Companies’ health care costs put us at a competitive disadvantage in the global economy. Health care costs thwart startup businesses. And they hinder workers’ mobility if a potential job excludes coverage for a spouse’s or child’s pre-existing serious or chronic condition.

This issue is also about family values. We know the primary cause of divorce and family breakup is financial strain. Nearly half of all bankruptcies are due to medical issues, while the other half are due to job loss. In our system, job loss and loss of health insurance are the same issue.

For-profit, deregulated health care is a wound on our country’s soul. Labor, with this election cycle and our advocacy after the election, will not stop until universal health care is achieved for all — and we turn around America.

Happy Labor Day.

Bertolone is president, Rochester and Genesee Valley Area Labor Federation, AFL-CIO; and, president, American Postal Workers Union, Local 215.

Calif. Nurses Laud Passage of Single-Payer, SB 840, Seen as National Model for Guaranteed Healthcare for All

California Nurses Association / National Nurses Organizing Committee

For Immediate Release
August 31, 2008

Contact: Donna Gerber, 916-919-1226 or Charles Idelson, 510-273-2246, 415-559-8991

The California Nurses Association/National Nurses Organizing Committee today hailed the California Legislature’s passage of a single-payer, expanded Medicare for all, style bill that would guarantee quality health care for all Californians — and called it a model for the national healthcare reform debate that is sure to emerge in 2009.

SB 840, authored by State Senator Sheila Kuehl, passed its final legislative hurdle with a vote in the State Senate today and is headed to the desk of Gov. Arnold Schwarzenegger who vetoed an earlier version of the bill two years ago.

“But a lot has changed since then, including the further implosion of our healthcare safety net, and the Governor’s own professed support for universal healthcare,” said CNA/NNOC co-president Malinda Markowitz, RN. Nurses will remind Schwarzenegger of that pledge, she said.

“Our healthcare crisis today has become a clear and present danger to the health, safety, and economic security of all Californians and all Americans. We need comprehensive reform that will genuinely fix this broken system and end this national nightmare, starting in California and then in Washington,” said Markowitz. CNA/NNOC is the principal sponsor of the bill.

SB 840 establishes a state-administered system to provide comprehensive coverage to all Californians, delivered by our current mostly private network of physicians, hospitals, doctors’ offices, and other providers. Coverage would no longer be tied to job status or health condition or subject to ever rising premiums, co-pays and deductibles.

In her statement today, Kuehl explained that SB 840 “takes the money we’re already spending and uses it more efficiently to cover everyone. We’re wasting a third of our health care dollars on bureaucracy because insurance companies makes the system too complicated, premiums are skyrocketing and thousands of Californians are dying every year because of preventable medical errors. If the Governor again fails to sign this bill, our health care system will just continue its slide toward becoming a second world health care system.”

“Poll after poll shows an overwhelming public yearning for comprehensive healthcare reform with a government guarantee of healthcare for all,” said Markowitz.

SB 840, and a similar bill in Congress, HR 676, are the only reforms, said Markowitz, that cure the two central components of the healthcare crisis — insurance companies’ denials of needed medical care, and the financial crisis faced by many families due to soaring medical bills.

Pennsylvania Healthcare Conference

http://www.progressives4pennsylvania.com/

Click here for a flyer for this event.

Progressives for Pennsylvania Presents

Healthcare conference:

Single-Payer Guaranteed Healthcare For All:
A Mainstream Solution!

Make it happen first in Pennsylvania

Thursday, September 18, 2008, 7-9 PM

Franklin & Marshall College
Roschel Performing Arts Center
628 College Ave., Lancaster PA, 17603

A limited number of RSVP’s for reserved seating will be accepted. Seats will be held until 30 minutes prior to the start of the event.

RSVP at progressives4pa@gmail.com. Or call Jerry Policoff at 717-295-0237 to RSVP or for further information.

Sen. Kuehl’s single payer bill goes to Gov. Schwarzenegger again

Calif. Nurses Laud Passage of Single-Payer, SB 840, Seen as National Model for Guaranteed Healthcare for All

MarketWatch
September 1, 2008

The California Nurses Association/National Nurses Organizing Committee today hailed the California Legislature’s passage of a single-payer, expanded Medicare for all, style bill that would guarantee quality health care for all Californians — and called it a model for the national healthcare reform debate that is sure to emerge in 2009.

SB 840, authored by State Senator Sheila Kuehl, passed its final legislative hurdle with a vote in the State Senate today and is headed to the desk of Gov. Arnold Schwarzenegger who vetoed an earlier version of the bill two years ago.

“But a lot has changed since then, including the further implosion of our healthcare safety net, and the Governor’s own professed support for universal healthcare,” said CNA/NNOC co-president Malinda Markowitz, RN. Nurses will remind Schwarzenegger of that pledge, she said.

http://www.marketwatch.com/news/story/calif-nurses-laud-passage-single-payer/story.aspx?guid=%7B203DC8E2-395B-4836-99E8-2B1C81FFF4F2%7D&dist=hppr

Senate Bill No. 840:
http://info.sen.ca.gov/pub/07-08/bill/sen/sb_0801-0850/sb_840_bill_20080811_amended_asm_v95.pdf

And…

Governor Schwarzenegger’s Health Care Plan

Assembly Bill X1 1, the Health Care Security and Cost Reduction Act:

Requires that all Californians take responsibility for their health coverage (individual mandate).

Guarantees that no Californian will be turned away from buying insurance based on their age or medical history (guarantee issue).

Spreads responsibility across individuals, government, hospitals and employers (shared responsibility).

Makes coverage more affordable for individuals and families through tax credits and subsidies.

Helps keep hospitals and emergency rooms open by increasing Medi-Cal reimbursement rates.

Allows individuals to choose their health coverage and keep their current insurance.

http://www.fixourhealthcare.ca.gov/plan

Comment:

By Don McCanne, MD

Two years ago California’s Governor Arnold Schwarzenegger vetoed a prior version of this single payer bill stating, “I must veto SB 840 because I cannot support a government-run health care system.”

He then initiated an intensive effort to create legislation that would provide coverage for all Californians, but crafted to comply with his policy principles listed above. His efforts fell short and resulted in AB X1 1 – legislation that would better be characterized as a take-it-or-leave-it package of incremental reforms. There were many beneficial reforms in the package that have broad support, but there were many other severe deficiencies that provoked considerable opposition. The legislative battle was very painful for all of us who believe that everyone should have affordable access to all necessary health care. The bill essentially died in the Senate Health Committee when supporters could muster only one vote in favor of it.

In passing SB 840 once again, the California State Legislature is giving Gov. Schwarzenegger another opportunity to sign legislation that actually would provide health care for everyone through a model that would use our health care dollars much more efficiently. It will be a test to see if his goal of ensuring health care for all Californians is more important to him than his personal anti-government ideology. Let’s hope that he leaves his intellectual exercises on ideology in his cigar tent as he comes out and signs a bill that benefits the health of the people.

WHO report on inequities that kill

Closing the Gap in a Generation: Health Equity through Action on the

Social Determinants of Health
World Health Organization
August 28, 2008
Inequities are killing people on a “grand scale” reports WHO’s Commission
“(The) toxic combination of bad policies, economics, and politics is, in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible,” the Commissioners write in Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. “Social injustice is killing people on a grand scale.”
Wealth is not necessarily a determinant
Economic growth is raising incomes in many countries but increasing national wealth alone does not necessarily increase national health. Without equitable distribution of benefits, national growth can even exacerbate inequities.
Wealth alone does not have to determine the health of a nation’s population. Some low-income countries such as Cuba, Costa Rica, China, state of Kerala in India and Sri Lanka have achieved levels of good health despite relatively low national incomes. But, the Commission points out, wealth can be wisely used. Nordic countries, for example, have followed policies that encouraged equality of benefits and services, full employment, gender equity and low levels of social exclusion. This, said the Commission, is an outstanding example of what needs to be done everywhere.
Inequities within countries
In the United States, 886,202 deaths would have been averted between 1991 and 2000 if mortality rates between white and African Americans were equalized.
Universal Health Care
Access to and utilization of health care is vital to good and equitable health. The health-care system is itself a social determinant of health, influenced by and influencing the effect of other social determinants. Gender, education, occupation, income, ethnicity, and place of residence are all closely linked to people’s access to, experiences of, and benefits from health care. Leaders in health care have an important stewardship role across all branches of society to ensure that policies and actions in other sectors improve health equity.
The Commission advocates financing the health-care system through general taxation and/or mandatory universal insurance. Public health-care spending has been found to be redistributive in country after country. The evidence is compellingly in favour of a publicly funded health-care system. In particular, it is vital to minimize out-of-pocket spending on health care. The policy imposition of user fees for health care in low- and middle-income countries has led to an overall reduction in utilization and worsening health outcomes. Upwards of 100 million people are pushed into poverty each year through catastrophic household health costs. This is unacceptable. Health-care systems have better health outcomes when built on Primary Health Care (PHC) — that is, both the PHC model that emphasizes locally appropriate action across the range of social determinants, where prevention and promotion are in balance with investment in curative interventions, and an emphasis on the primary level of care with adequate referral to higher levels of care.
Recommendations
Based on this compelling evidence, the Commission makes three overarching recommendations to tackle the “corrosive effects of inequality of life chances”:
1. Improve daily living conditions, including the circumstances in which people are born, grow, live, work and age.
2. Tackle the inequitable distribution of power, money and resources — the structural drivers of those conditions — globally, nationally and locally.
3. Measure and understand the problem and assess the impact of action.
Press release:
http://www.who.int/mediacentre/news/releases/2008/pr29/en/index.html
Executive Summary (40 pages):
http://whqlibdoc.who.int/hq/2008/WHO_IER_CSDH_08.1_eng.pdf
Full report (256 pages):
http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf

On this Labor Day weekend, a time that we celebrate the great contributions of American workers, the release of this report could not be more timely. Hard working Americans are experiencing the adverse consequences of the increasing inequities in the social determinants of health, inequities that really only society is equipped to address. Today, Hurricane Gustav is descending on our Gulf Coast, testing further whether we as a society can join together to meet our challenges, or if instead those affected are simply left on their own.
Please excuse me for a personal moment of introspection. For over ten years I’ve been a full-time volunteer for Physicians for a National Program. I remember well a conversation I had several years ago with David Himmelstein, a cofounder of PNHP. We observed that, while the task of achieving health care for everyone in the United States seemed almost arduous, it was a miniscule problem compared to the needs throughout the world. Ours was such a tiny task in comparison. We didn’t need more money. We merely needed to fix the way we finance health care as an essential first step to begin to address these inequities.
Ten years later one simple number gives us an inkling of the degree of our success. This report shows that over 800,000 African Americans have died prematurely in the United States in the past decade merely because we have failed to address these inequities in the social
determinants of health.
(moment of silence)
Hopefully we’ll do better with Gustav than we did with Katrina, having learned a lesson. But do we really need more lessons on the social determinants of health before we begin to act? Eight hundred thousand is far too many painful lessons for me.

WHO report on inequities that kill

Closing the Gap in a Generation: Health Equity through Action on the

Social Determinants of Health
World Health Organization
August 28, 2008

Inequities are killing people on a “grand scale” reports WHO’s Commission

“(The) toxic combination of bad policies, economics, and politics is, in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible,” the Commissioners write in Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. “Social injustice is killing people on a grand scale.”

Wealth is not necessarily a determinant

Economic growth is raising incomes in many countries but increasing national wealth alone does not necessarily increase national health. Without equitable distribution of benefits, national growth can even exacerbate inequities.

Wealth alone does not have to determine the health of a nation’s population. Some low-income countries such as Cuba, Costa Rica, China, state of Kerala in India and Sri Lanka have achieved levels of good health despite relatively low national incomes. But, the Commission points out, wealth can be wisely used. Nordic countries, for example, have followed policies that encouraged equality of benefits and services, full employment, gender equity and low levels of social exclusion. This, said the Commission, is an outstanding example of what needs to be done everywhere.

Inequities within countries

In the United States, 886,202 deaths would have been averted between 1991 and 2000 if mortality rates between white and African Americans were equalized.

Universal Health Care

Access to and utilization of health care is vital to good and equitable health. The health-care system is itself a social determinant of health, influenced by and influencing the effect of other social determinants. Gender, education, occupation, income, ethnicity, and place of residence are all closely linked to people’s access to, experiences of, and benefits from health care. Leaders in health care have an important stewardship role across all branches of society to ensure that policies and actions in other sectors improve health equity.

The Commission advocates financing the health-care system through general taxation and/or mandatory universal insurance. Public health-care spending has been found to be redistributive in country after country. The evidence is compellingly in favour of a publicly funded health-care system. In particular, it is vital to minimize out-of-pocket spending on health care. The policy imposition of user fees for health care in low- and middle-income countries has led to an overall reduction in utilization and worsening health outcomes. Upwards of 100 million people are pushed into poverty each year through catastrophic household health costs. This is unacceptable. Health-care systems have better health outcomes when built on Primary Health Care (PHC) — that is, both the PHC model that emphasizes locally appropriate action across the range of social determinants, where prevention and promotion are in balance with investment in curative interventions, and an emphasis on the primary level of care with adequate referral to higher levels of care.

Recommendations

Based on this compelling evidence, the Commission makes three overarching recommendations to tackle the “corrosive effects of inequality of life chances:”

1. Improve daily living conditions, including the circumstances in which people are born, grow, live, work and age.

2. Tackle the inequitable distribution of power, money and resources — the structural drivers of those conditions — globally, nationally and locally.

3. Measure and understand the problem and assess the impact of action.

Press release:
http://www.who.int/mediacentre/news/releases/2008/pr29/en/index.html

Executive Summary (40 pages):
http://whqlibdoc.who.int/hq/2008/WHO_IER_CSDH_08.1_eng.pdf

Full report (256 pages):
http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf

Comment:

By Don McCanne, MD

On this Labor Day weekend, a time that we celebrate the great contributions of American workers, the release of this report could not be more timely. Hard working Americans are experiencing the adverse consequences of the increasing inequities in the social determinants of health, inequities that really only society is equipped to address. Today, Hurricane Gustav is descending on our Gulf Coast, testing further whether we as a society can join together to meet our challenges, or if instead those affected are simply left on their own.

Please excuse me for a personal moment of introspection. For over ten years I’ve been a full-time volunteer for Physicians for a National Program. I remember well a conversation I had several years ago with David Himmelstein, a cofounder of PNHP. We observed that, while the task of achieving health care for everyone in the United States seemed almost arduous, it was a miniscule problem compared to the needs throughout the world. Ours was such a tiny task in comparison. We didn’t need more money. We merely needed to fix the way we finance health care as an essential first step to begin to address these inequities.

Ten years later one simple number gives us an inkling of the degree of our success. This report shows that over 800,000 African Americans have died prematurely in the United States in the past decade merely because we have failed to address these inequities in the social
determinants of health.

(moment of silence)

Hopefully we’ll do better with Gustav than we did with Katrina, having learned a lesson. But do we really need more lessons on the social determinants of health before we begin to act? Eight hundred thousand is far too many painful lessons for me.

Bernstein and Marmor on "Yes But"

Medicare-for-All: Why We Should Say Yes, Not “Yes But”

by Merton Bernstein and Theodore Marmor
Health Affairs Blog
August 28, 2008
Many health policy experts regard Medicare-for-All as a model for reform of America’s indisputably troubled and costly medical arrangements. They express admiration for its administrative efficiency and the resulting savings that could pay for extending coverage, perhaps to all. For example, in a June 2008 Health Affairs article, Commonwealth Fund authors said: “Compared to a Medicare-for-All approach, our [Building Blocks] framework does not achieve the simplicity, consolidated risk, administrative overhead, and provider payment net savings of covering nearly everyone through Medicare.”
Sometimes even Medicare-for-All admirers succumb to the “yes but” syndrome, as in “yes, but Medicare-for-All is politically impractical.” For example, after praising Medicare-for-All, The Health Care Mess concluded that “political reality compels us to ask whether there are not other ways” (besides Medicare-for-All) and answered that question “yes.” Princeton economist Paul Krugman, who had extolled Medicare-for-All in 2006, put a foot in the “yes but” camp in 2007. He welcomed the Edwards, Massachusetts, and Schwarzenegger plans to compel individuals to select from among insurance plans, thereby forgoing Medicare-for-All’s economies. The Edwards and Obama plans required a Medicare-like plan as one option. Krugman argued that such a plan’s lower cost will eventually crowd out more expensive private plans. This overlooks private insurance’s history of cutting prices to gain market share, later returning to double-digit boosts. Also, the Massachusetts program actually is not universal; it omits children, among others, and it is having real trouble meeting its costs. The California legislature as well rejected the “Governator’s” plan as too costly.
Though the political “yes, buts” surrounding Medicare-for-All prove groundless, they deserve discussion. However, the “yes, buts” should not preempt discussion of Medicare-for-All’s substantive advantages, as they all too often do. For example, the May/June 2008 issue of Health Affairs, a 200-page-plus compendium on health reform and expanding coverage, does not contain a single article devoted to Medicare-for-All. In this post, we first describe the advantages of Medicare-for-All, then demonstrate that the evidence behind the political “yes, buts” is exaggerated and flawed.
http://healthaffairs.org/blog/2008/08/28/medicare-for-all-why-we-should-say-yes-not-yes-but/

Professor Bernstein and Professor Marmor are amongst the most qualified and experienced experts on both health policy and the politics of Medicare and social insurance in general. We need to listen to what they have to say. Be sure to click the link above to read their full message.
Everyone knows that the U.S. health care financing system is in critical condition, and that we once again are entering a political window in which reform is possible. Never has it been more important to understand all of our options.
Yet where are we? Those controlling the serious dialogue on reform (e.g., Health Affairs) have limited the options to proposals that would merely tweak our dysfunctional, fragmented system of financing health care, leaving the private insurance industry as the dominant player in health care misfinancing. Perpetuation of our current system will further expand our almost unbearable costs, and leave us far short of the goal of ensuring that every single individual receives the health care that she or he needs.
Health policy is not rocket science. We know precisely what will work. Most in the policy community (including politicians), who believe that we must seize this opportunity for reform, largely agree that a universal, single payer, Medicare-like program would be the most efficient and effective model of reform. And their response?
Yes but… (UNSPOKEN: let’s not even bring that into the discussion).
Talk about health policy malpractice!