PNHP

Shattuck Lecture on coverage for all Americans

Shattuck Lecture on coverage for all Americans

Health of the Nation -- Coverage for All Americans

Charles D. Baker, Arthur Caplan, Ph.D., Karen Davis, Ph.D., Susan Dentzer, Arnold M. Epstein, M.D., Bill Frist, M.D., Robert S. Galvin, M.D., Ruben J. King-Shaw, Jr., Thomas H. Lee, M.D., Jonathan B. Oberlander, Ph.D., Sara Rosenbaum, J.D., Steven A. Schroeder, M.D., and Reed V. Tuckson, M.D., moderated by Arthur R. Miller, J.D.
The New England Journal of Medicine
August 21, 2008
Shattuck Lecture

Sara Rosenbaum: [Access to care is] the most basic ethical issue of all. But it is a national decision on our part. It’s not the federal decision; it’s not the state decision; it is a national social decision. And we’ve been very bad about this.

Steven Schroeder: I think that a country should be judged by how it treats its less fortunate. In that respect, I’m ashamed of our country.

Jonathan Oberlander: If there’s one lesson that we’ve learned about health reform in the last few decades, [it’s that] being right doesn’t count for very much. We can come up with lots of stories to evoke moral outrage. And it’s not just about the uninsured. There are many Americans with insurance who have inadequate protection and who file for bankruptcy every year because they’re underinsured. But if we’re going to fight this battle for health reform on moral grounds, we’re going to lose.

Jonathan Oberlander: The price tag for universal coverage really is not that much. If you talk about adding the uninsured to the existing system, you’re talking about roughly $100 billion a year. We already spend over $2 trillion, so it’s a mark-up but not much. When we cut taxes in 2001 and 2003, we found the money to do that. When we passed the Medicare Prescription Drug Benefit in 2003, we found the money to do that. When we went to war in Iraq, we found the money to do that. So this is a question of priorities. And the uninsured are not a political priority.

http://www.nejm.org/perspective/health%2Dof%2Dthe%2Dnation%2Dvideo/

Comment:

By Don McCanne, MD

It would be worth your time to either watch the video or read the transcript of this very unusual Shattuck Lecture. For one hour Arthur Miller prods this panel on a discussion of important challenges to the American health care system. Comments are invited at the link above.

You likely will be disappointed, but that is precisely why you should at least skim over the transcript. It is disconcerting to see how ineffective a select panel of noted experts can be in framing the problems, much less in approaching any real solutions. Some exceptions are represented by the individuals quoted above.

We can do it – easily. But will we? If the ethics won’t drive us, what will?

(Hint: money. Establishing a value-based single payer system that takes care of everyone would cost less than passively accepting a continuing intolerable increase in health care costs in a system that leaves so many out. We need to target those who pay the bills.)

What Do MoveOn Members Think About Health Care? Who Knows? A Reply to MoveOn's Eli Pariser

By Miles Mogulescu
The Huffington Post
Posted August 15, 2008

On Wednesday I posted a blog on Huffington Post asking readers to sign a Petition requesting that our friends at MoveOn.Org let its members vote on whether they support universal single payer health care or reforming private health insurance (while adding an optional public plan that the uninsured could purchase themselves). In less than 48 hours, nearly 3,000 people have signed the Petition and, as the Petition spreads virally, new signatures keep coming in at the rate of 50-100 per hour.

On Thursday, Eli Pariser of MoveOn responded with a blog asserting that MoveOn had already determined that by 70%-23%, a majority of its members supported reforming private health insurance with an optional public alternative instead of supporting universal single payer health care, based upon what MoveOn claimed was a “random sample” of its members.

At first this seemed strange to me. Most members of MoveOn are presumably progressive. So one would tend to assume that they would be more supportive of single payer health care than the average American voter. But while polls by major news organizations have shown a majority of Americans supporting single payer, MoveOn’s “random sample” indicated MoveOn’s member’s rejected single payer by nearly 3-1 in favor of a private insurance/public hybrid.

Meanwhile, an Associated Press poll in December, 2007 asked voters “Do you consider yourself a supporter of a single-payer health care system that is a national plan financed by taxpayers in which all Americans would get their insurance from a single government plan, or not?” 54% said “Yes” and 44% said “No”.

A CBS News poll last September asked “Which do you think would be better for the country: having one health insurance program covering all Americans that would be administered by the government and paid for by the taxpayers, or keeping the current system where many people get their insurance from private employers and some have no insurance?” 55% chose “One Program for All” and only 29% chose “The Current system”.

Something seemed strange here. Could it really be that average American voter is more progressive on universal health care than the average MoveOn member?

Then I started to look more closely at MoveOn’s “random sample” and it started to raise a lot of questions about whether it really gave an accurate reading of the opinions of MoveOn’s members.

Was this survey conducted by a professional polling organization or put together by the MoveOn staff? Will MoveOn post the polling methodology and statistical results? How many people were sampled and how were they selected? I’m not an expert on statistics, but here are some questions that one Doctor posed about the survey: “What is the power of the study, the standard deviation, the p number?” I’ve emailed these questions to my friends on the MoveOn staff, but they haven’t responded yet. I look forward to their responses, either in private or here in the Huffington Post.

Most important, “Was there any validation study done beforehand to assess the wording of the questions?” The closer I looked, the more it appeared as though the wording of the MoveOn survey had a build in bias that at least appears to skew it towards eliciting the answers that the MoveOn and Health Care For American Now staff had already decided that they agreed with. Two alternatives were provided:

* “Support single payer: Work to cover all Americans by switching from their existing health coverage to free Medicare-style national health insurance and abolishing private insurance companies from our health care system.”
* “Support national public health insurance: Work to cover all Americans by offering everyone the choice to switch from their existing health coverage to free or affordable Medicare-style national health insurance, but don’t require people to switch.”

This wording is confusing. It makes it appear as though the issue is about free choice: Either you can be forced by the Feds to switch into a government program or be given the free choice to keep your present insurance or switch into a “free or affordable” Medicare-style program. I’m a strong supporter of single payer, but if you phrase the issue as one of individual free choice of whether to switch or not, I’d choose the free choice alternative, too.

There are so many ways in which, in real life, the second “appealing” free choice is a fictional alternative. It is unlikely that voluntary “Medicare-style national health insurance” would be “free or affordable” for most middle class Americans. The plan that MoveOn and HCAN is actually backing is based on the Health Care for America plan developed by Jacob Hacker and the Campaign for America’s Future. According to the financial model for this, plan prepared for the plan’s backers by the Lewin Group, the real cost for a two-parent family is $8040 a year. In addition, families could have to pay as much as $5,000 per year in out of pocket costs. Moreover, the Lewin Group’s cost projections are probably low, because they assume that 128.6 million Americans would be insured by the optional public plan, a wildly inflated number that would give the public plan bargaining power to reduce costs that it is unlikely to have. A 2007 study by the Brookings Institution estimates that the annual cost for a family of four to buy a Medicare-type plan would be $10,000 per year. Whether the number is $8,000 a year or $10,000 a year, plus co-payments, this is hardly ‘free or cheap” except for those close enough to the poverty line to receive a substantial government subsidy.

Meanwhile, for this plan to have even a chance to work as advertised, it would require a government mandate requiring everyone not covered by their employer to buy insurance. For middle class people who are not poor enough to receive a substantial government subsidy, this would be a financial backbreaker, making this plan a dead bang political loser.

Finally, MoveOn and HCAN argue that an optional public alternative would somehow provide a transition to single payer. They believe it would be so much more attractive than private insurance that more and more people would buy it until private insurance is marginalized. In fact, the opposite is true. Even given administrative savings, as a cadillac insurance program with good benefits, coverage for all medically necessary conditions, choice of doctors, and low deductibles and co-pays, it would be an expensive program. Private insurers would compete by offering low-cost stripped down programs with limited benefits and high deductibles and co-pays, but which would siphon off most of the young and healthy. The public program would become the private insurers’ dumping ground for older and less healthy people whom they don’t want to cover anyway, thus making the public program increasingly expensive. (This is known as “adverse selection”.) Far from marginalizing private insurance, this plan is likely to make the public program increasingly unaffordable for most Americans and bust the federal budget by increasing the cost of federal subsidies.

So the MoveOn “random sample” question alternative for an optional “free or affordable Medicare-style program” is not based on reality. That would explain why MoveOn’s “random sample” makes it appear that MoveOn’s members are to the right of the American public on single payer.

I truly wish there could be an easy solution that would provide good inexpensive health care for all Americans and wouldn’t involve a major political battle with the health insurance and big pharma lobbies. In his Huffpo blog, Pariser accurately warns against “the huge campaign we’ll face from private insurance companies, HMOs, and pharmaceutical companies.” He then argues that the MoveOn/HCAN proposes “the best strategy for progressives to take” because presumably it will face less political opposition from the special interests. In another Huffpo blog, HCANs Richard Kirsch even argues that the insurance lobby has “nothing to fear” from HCAN’s plan, since under HCAN’s principles, “people are free to keep their health insurance if they want. They can choose another private plan if they prefer”.

MoveOn/HCAN honestly believes that single payer supporters are politically naive, and that MoveOn/HCAN can pass a plan that provides tough new regulations on the private insurance industry, limits their profits, and offers a public plan that will seriously compete with private insurance, without the insurance lobby fighting against such a plan as hard as they will fight against single payer. Doesn’t that sound a bit naive?

So, if to have a chance of passing meaningful universal health care reform, we’re going to have to build a mass movement to take on the full force of the insurance and pharma lobbies anyway, why, as George Lakoff puts it, does MoveOn/HCAN want to “surrender in advance” by conceding on single payer and promising the continuation of wasteful private insurance system? Somewhere along the line it may be necessary to make some pragmatic political compromises. But you don’t win a political fight by giving up your most important principles before the fight even begins. In particular, the job of a progressive mass movement like MoveOn is not to pre-negotiate in advance with the insurance lobby, but to help organize a mass citizens’ movement to take it on.

I hope our friends at MoveOn will allow all of its 3.2 million members to vote, in a fairly worded professional poll, on which direction MoveOn should take in the fight for universal health care, after a full and fair debate on the issue is presented to its members.

If you agree, please sign the Petition.

What Do MoveOn Members Think About Health Care? Who Knows? A Reply to MoveOn’s Eli Pariser

By Miles Mogulescu
The Huffington Post
Posted August 15, 2008

On Wednesday I posted a blog on Huffington Post asking readers to sign a Petition requesting that our friends at MoveOn.Org let its members vote on whether they support universal single payer health care or reforming private health insurance (while adding an optional public plan that the uninsured could purchase themselves). In less than 48 hours, nearly 3,000 people have signed the Petition and, as the Petition spreads virally, new signatures keep coming in at the rate of 50-100 per hour.

On Thursday, Eli Pariser of MoveOn responded with a blog asserting that MoveOn had already determined that by 70%-23%, a majority of its members supported reforming private health insurance with an optional public alternative instead of supporting universal single payer health care, based upon what MoveOn claimed was a “random sample” of its members.

At first this seemed strange to me. Most members of MoveOn are presumably progressive. So one would tend to assume that they would be more supportive of single payer health care than the average American voter. But while polls by major news organizations have shown a majority of Americans supporting single payer, MoveOn’s “random sample” indicated MoveOn’s member’s rejected single payer by nearly 3-1 in favor of a private insurance/public hybrid.

Meanwhile, an Associated Press poll in December, 2007 asked voters “Do you consider yourself a supporter of a single-payer health care system that is a national plan financed by taxpayers in which all Americans would get their insurance from a single government plan, or not?” 54% said “Yes” and 44% said “No”.

A CBS News poll last September asked “Which do you think would be better for the country: having one health insurance program covering all Americans that would be administered by the government and paid for by the taxpayers, or keeping the current system where many people get their insurance from private employers and some have no insurance?” 55% chose “One Program for All” and only 29% chose “The Current system”.

Something seemed strange here. Could it really be that average American voter is more progressive on universal health care than the average MoveOn member?

Then I started to look more closely at MoveOn’s “random sample” and it started to raise a lot of questions about whether it really gave an accurate reading of the opinions of MoveOn’s members.

Was this survey conducted by a professional polling organization or put together by the MoveOn staff? Will MoveOn post the polling methodology and statistical results? How many people were sampled and how were they selected? I’m not an expert on statistics, but here are some questions that one Doctor posed about the survey: “What is the power of the study, the standard deviation, the p number?” I’ve emailed these questions to my friends on the MoveOn staff, but they haven’t responded yet. I look forward to their responses, either in private or here in the Huffington Post.

Most important, “Was there any validation study done beforehand to assess the wording of the questions?” The closer I looked, the more it appeared as though the wording of the MoveOn survey had a build in bias that at least appears to skew it towards eliciting the answers that the MoveOn and Health Care For American Now staff had already decided that they agreed with. Two alternatives were provided:

* “Support single payer: Work to cover all Americans by switching from their existing health coverage to free Medicare-style national health insurance and abolishing private insurance companies from our health care system.”
* “Support national public health insurance: Work to cover all Americans by offering everyone the choice to switch from their existing health coverage to free or affordable Medicare-style national health insurance, but don’t require people to switch.”

This wording is confusing. It makes it appear as though the issue is about free choice: Either you can be forced by the Feds to switch into a government program or be given the free choice to keep your present insurance or switch into a “free or affordable” Medicare-style program. I’m a strong supporter of single payer, but if you phrase the issue as one of individual free choice of whether to switch or not, I’d choose the free choice alternative, too.

There are so many ways in which, in real life, the second “appealing” free choice is a fictional alternative. It is unlikely that voluntary “Medicare-style national health insurance” would be “free or affordable” for most middle class Americans. The plan that MoveOn and HCAN is actually backing is based on the Health Care for America plan developed by Jacob Hacker and the Campaign for America’s Future. According to the financial model for this, plan prepared for the plan’s backers by the Lewin Group, the real cost for a two-parent family is $8040 a year. In addition, families could have to pay as much as $5,000 per year in out of pocket costs. Moreover, the Lewin Group’s cost projections are probably low, because they assume that 128.6 million Americans would be insured by the optional public plan, a wildly inflated number that would give the public plan bargaining power to reduce costs that it is unlikely to have. A 2007 study by the Brookings Institution estimates that the annual cost for a family of four to buy a Medicare-type plan would be $10,000 per year. Whether the number is $8,000 a year or $10,000 a year, plus co-payments, this is hardly ‘free or cheap” except for those close enough to the poverty line to receive a substantial government subsidy.

Meanwhile, for this plan to have even a chance to work as advertised, it would require a government mandate requiring everyone not covered by their employer to buy insurance. For middle class people who are not poor enough to receive a substantial government subsidy, this would be a financial backbreaker, making this plan a dead bang political loser.

Finally, MoveOn and HCAN argue that an optional public alternative would somehow provide a transition to single payer. They believe it would be so much more attractive than private insurance that more and more people would buy it until private insurance is marginalized. In fact, the opposite is true. Even given administrative savings, as a cadillac insurance program with good benefits, coverage for all medically necessary conditions, choice of doctors, and low deductibles and co-pays, it would be an expensive program. Private insurers would compete by offering low-cost stripped down programs with limited benefits and high deductibles and co-pays, but which would siphon off most of the young and healthy. The public program would become the private insurers’ dumping ground for older and less healthy people whom they don’t want to cover anyway, thus making the public program increasingly expensive. (This is known as “adverse selection”.) Far from marginalizing private insurance, this plan is likely to make the public program increasingly unaffordable for most Americans and bust the federal budget by increasing the cost of federal subsidies.

So the MoveOn “random sample” question alternative for an optional “free or affordable Medicare-style program” is not based on reality. That would explain why MoveOn’s “random sample” makes it appear that MoveOn’s members are to the right of the American public on single payer.

I truly wish there could be an easy solution that would provide good inexpensive health care for all Americans and wouldn’t involve a major political battle with the health insurance and big pharma lobbies. In his Huffpo blog, Pariser accurately warns against “the huge campaign we’ll face from private insurance companies, HMOs, and pharmaceutical companies.” He then argues that the MoveOn/HCAN proposes “the best strategy for progressives to take” because presumably it will face less political opposition from the special interests. In another Huffpo blog, HCANs Richard Kirsch even argues that the insurance lobby has “nothing to fear” from HCAN’s plan, since under HCAN’s principles, “people are free to keep their health insurance if they want. They can choose another private plan if they prefer”.

MoveOn/HCAN honestly believes that single payer supporters are politically naive, and that MoveOn/HCAN can pass a plan that provides tough new regulations on the private insurance industry, limits their profits, and offers a public plan that will seriously compete with private insurance, without the insurance lobby fighting against such a plan as hard as they will fight against single payer. Doesn’t that sound a bit naive?

So, if to have a chance of passing meaningful universal health care reform, we’re going to have to build a mass movement to take on the full force of the insurance and pharma lobbies anyway, why, as George Lakoff puts it, does MoveOn/HCAN want to “surrender in advance” by conceding on single payer and promising the continuation of wasteful private insurance system? Somewhere along the line it may be necessary to make some pragmatic political compromises. But you don’t win a political fight by giving up your most important principles before the fight even begins. In particular, the job of a progressive mass movement like MoveOn is not to pre-negotiate in advance with the insurance lobby, but to help organize a mass citizens’ movement to take it on.

I hope our friends at MoveOn will allow all of its 3.2 million members to vote, in a fairly worded professional poll, on which direction MoveOn should take in the fight for universal health care, after a full and fair debate on the issue is presented to its members.

If you agree, please sign the Petition.

Insurance falls as medical bills rise

Losing Ground: How the Loss of Adequate Health Insurance Is Burdening Working Families

By Sara R. Collins, Ph.D., Jennifer L. Kriss, Michelle M. Doty, Ph.D., and Sheila D. Rustgi
The Commonwealth Fund
August 20, 2008

Using data from four years of the Commonwealth Fund Biennial Health Insurance Survey, this report examines the status of health insurance for U.S. adults under age 65 and the implications for family finances and access to health care. Insurance coverage deteriorated over the past six years, with declines in coverage most severe for moderate-income families. As result, more families are experiencing medical bill problems or cost-related delays in getting needed care. In 2007, nearly two-thirds of U.S. adults, or an estimated 116 million people, struggled to pay medical bills, went without needed care because of cost, were uninsured for a time, or were underinsured (i.e., were insured but not adequately protected from high medical expenses).

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=700872

And…

Seeing Red: The Growing Burden of Medical Bills and Debt Faced by U.S. Families

By Michelle M. Doty, Ph.D., Sara R. Collins, Ph.D., Sheila D. Rustgi, and Jennifer L. Kriss
The Commonwealth Fund
August 20, 2008

Analysis of the 2007 Commonwealth Fund Biennial Health Insurance Survey finds the proportion of working-age Americans who struggled to pay medical bills and accumulated medical debt climbed from 34 percent to 41 percent, or 72 million people, between 2005 and 2007. In addition, 7 million adults age 65 and older had these problems, bringing the total to 79 million adults with medical debt or bill problems. All income groups reported an increase. Families with low or moderate incomes were particularly hard hit, as were adults who had gaps in health coverage or those underinsured. Because of medical bills or accumulated medical debt, an estimated 28 million adults reported they used up all their savings, 21 million incurred large credit card debt, and another 21 million were unable to pay for basic necessities. Sixty-one percent of those with medical debt or bill problems were insured at the time care was provided.

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=700868

Comment:

By Don McCanne, MD

How well is our health care financing system working? Two-thirds of adults under 65 have problems with their health insurance and paying for health care. Forty-one percent have medical bill problems or are paying off medical debt, even though sixty-one percent of these individuals were insured at the time care was provided.

So what is the response of the politicians to this health care financing crisis? Sen. John McCain says that we should allow insurers to sell us more affordable plans (even though that means that the stripped-down plans would not provide adequate financial protection in the face of medical need). Sen. Barack Obama says that we should authorize only plans with adequate benefits, whether public or private plans (even though that means that even more of us would be unable to afford to purchase the plans). Sen. Max Baucus, Chair of the Senate Finance Committee which must clear all health care financing legislation, says that comprehensive reform is not feasible and that we must proceed with smaller incremental steps, beginning with expanding the children’s health insurance program, and tweaking Medicare.

Wouldn’t you think that the politicians would be interested in reform that would allow us to continue to fund the most expensive health care system of all, without the necessity of exposing individuals to financial hardship merely because they need health care?

I was interviewed by a Canadian journalist this week. He said that the Canadians could not understand how we could spend so much money on our health care system and yet leave so many without adequate protection against financial losses for health care. They think that there is something very fundamentally wrong with our health care financing system that can be fixed. If only we could get our politicians to acknowledge that there is a solution that would actually work: a single payer national health program.

Will the real Harry and Louise please stand up

www.harryandlouisereturn.com
August 20, 2008
Scene: In the kitchen, at the breakfast table
Harry: Health care costs are up again. Small companies are being forced to cut their plans.
Louise: Tell me about it. You know, Lisa’s husband just found out he has cancer.
Harry: But he’s covered. Right?
Louise: No. He just joined a start-up, and he can’t afford a plan.
Harry: Too many people are falling through the cracks.
Louise: Whoever the next president is, health care should be at the top of his agenda. Bring everyone to the table, and make it happen.
(This ad campaign is sponsored by the American Cancer Society Cancer Action Network (ACS CAN), the American Hospital Association (AHA), the Catholic Health Association (CHA), Families USA, and the National Federation of Independent Business (NFIB).)
2008 Harry and Louise ad:
http://harryandlouisereturn.com/
1994 Harry and Louise ad:
http://www.youtube.com/watch?v=Dt31nhleeCg&NR=1

What a refreshing change. In fourteen years, Harry and Louise’s breakfast table conversation has changed from, “If we let the government choose, we lose,” to “Bring everyone to the table and make it happen.” But what does this mean?
At today’s press conference inaugurating this ad campaign, it was clear from the diverse groups involved that the message is that we must all join together to make reform happen. But before the press conference was even over, red flags were raised.
Most disconcerting was the fact that AHIP’s Karen Ignagni was invited to express the support of the private insurance industry in this effort, even though AHIP is not a sponsor of this campaign. During the Q&A, she indicated that AHIP was prepared to support its specific proposal for reform (a model that uses private plans to insure the low-cost healthy, while shifting those with higher-cost needs to taxpayer-funded programs).
When Teddy Davis of ABC News asked about the problem of guaranteed issue without a mandate, Ron Pollack (Families USA) responded, “I don’t think that we’re prepared to answer hypothetical questions.” But really, are crucial fundamental policy issues to be dismissed as mere hypotheticals?
Sadly, this is merely another chapter in the saga of the strange bedfellow coalitions. The policy opinions supported by the participants are mutually incompatible and can only lead to a result that Ron Pollack has described repeatedly: everyone walks away, supporting their second favorite choice – the status quo (even though no one actually supports the status quo). This process is yet another recipe for political inertia.
There are some very fundamental principles which should garner broad support if we are truly serious about reform.
Costs must be contained. Projections that health care will soon consume maybe half of our GDP are totally unrealistic. Essential spending in other sectors of our economy will create a barrier beyond which no further funds would be available for health care. Tragically, the uninsured and under-insured have already crashed into that solid wall, and that includes many middle-income Americans. Cost increases will only move that barrier in front of more and more of us.
There are two fundamental approaches to controlling costs. We can withhold essential health care from people who cannot afford it, an option for the heartless, or we can demand a reduction in wasteful spending such as our profound administrative excesses and our non-beneficial high-tech services. The market has been and always will be incapable of controlling these costs since markets function to sell us more, not fewer, products and services. A monopsony operating in the public interest will be required to bring us greater value and affordability in our health care purchasing, and that can be accomplished only by enacting enabling government policies.
We can no longer accept the suffering and death that occurs amongst us merely because many individuals don’t have the resources to pay for care. Everyone must be included under the umbrella of a comprehensive financing system.
Since average-income individuals can no longer afford their pro rata share of health care financing, a transfer must be enabled through progressive tax policies. Rejection of this fundamental principle would equate with the tacit acceptance for too many of us of financial hardship and bankruptcy as a consequence of ill health.
Louise is right. We need to bring everyone to the table. That includes everyone who needs health care or may need it at some time in the future. That is everyone. Everyone.
Libertarian ideologues and moneygrubbers stand aside. Make room for the people.

Will the real Harry and Louise please stand up

www.harryandlouisereturn.com
August 20, 2008

Scene: In the kitchen, at the breakfast table

Harry: Health care costs are up again. Small companies are being forced to cut their plans.

Louise: Tell me about it. You know, Lisa’s husband just found out he has cancer.

Harry: But he’s covered. Right?

Louise: No. He just joined a start-up, and he can’t afford a plan.

Harry: Too many people are falling through the cracks.

Louise: Whoever the next president is, health care should be at the top of his agenda. Bring everyone to the table, and make it happen.

(This ad campaign is sponsored by the American Cancer Society Cancer Action Network (ACS CAN), the American Hospital Association (AHA), the Catholic Health Association (CHA), Families USA, and the National Federation of Independent Business (NFIB).)

2008 Harry and Louise ad:
http://harryandlouisereturn.com/

1994 Harry and Louise ad:
http://www.youtube.com/watch?v=Dt31nhleeCg&NR=1

Comment:

By Don McCanne, MD

What a refreshing change. In fourteen years, Harry and Louise’s breakfast table conversation has changed from, “If we let the government choose, we lose,” to “Bring everyone to the table and make it happen.” But what does this mean?

At today’s press conference inaugurating this ad campaign, it was clear from the diverse groups involved that the message is that we must all join together to make reform happen. But before the press conference was even over, red flags were raised.

Most disconcerting was the fact that AHIP’s Karen Ignagni was invited to express the support of the private insurance industry in this effort, even though AHIP is not a sponsor of this campaign. During the Q&A, she indicated that AHIP was prepared to support its specific proposal for reform (a model that uses private plans to insure the low-cost healthy, while shifting those with higher-cost needs to taxpayer-funded programs).

When Teddy Davis of ABC News asked about the problem of guaranteed issue without a mandate, Ron Pollack (Families USA) responded, “I don’t think that we’re prepared to answer hypothetical questions.” But really, are crucial fundamental policy issues to be dismissed as mere hypotheticals?

Sadly, this is merely another chapter in the saga of the strange bedfellow coalitions. The policy opinions supported by the participants are mutually incompatible and can only lead to a result that Ron Pollack has described repeatedly: everyone walks away, supporting their second favorite choice – the status quo (even though no one actually supports the status quo). This process is yet another recipe for political inertia.

There are some very fundamental principles which should garner broad support if we are truly serious about reform.

Costs must be contained. Projections that health care will soon consume maybe half of our GDP are totally unrealistic. Essential spending in other sectors of our economy will create a barrier beyond which no further funds would be available for health care. Tragically, the uninsured and under-insured have already crashed into that solid wall, and that includes many middle-income Americans. Cost increases will only move that barrier in front of more and more of us.

There are two fundamental approaches to controlling costs. We can withhold essential health care from people who cannot afford it, an option for the heartless, or we can demand a reduction in wasteful spending such as our profound administrative excesses and our non-beneficial high-tech services. The market has been and always will be incapable of controlling these costs since markets function to sell us more, not fewer, products and services. A monopsony operating in the public interest will be required to bring us greater value and affordability in our health care purchasing, and that can be accomplished only by enacting enabling government policies.

We can no longer accept the suffering and death that occurs amongst us merely because many individuals don’t have the resources to pay for care. Everyone must be included under the umbrella of a comprehensive financing system.

Since average-income individuals can no longer afford their pro rata share of health care financing, a transfer must be enabled through progressive tax policies. Rejection of this fundamental principle would equate with the tacit acceptance for too many of us of financial hardship and bankruptcy as a consequence of ill health.

Louise is right. We need to bring everyone to the table. That includes everyone who needs health care or may need it at some time in the future. That is everyone. Everyone.

Libertarian ideologues and moneygrubbers stand aside. Make room for the people.

Maximum coverage as defined by Anthem Blue Cross

Letter
From: Anthem Blue Cross, Oxnard, California
To: Don McCanne
Dear Don,
Enclosed you will find a Part D Coordination of Benefits Survey. By completing the survey, it will help assure that you receive the maximum coverage benefits from your drug plan. …
http://www.anthem.com/

What’s this? Why would a generous offer from a health insurer to assist an insured in receiving maximum coverage benefits be included in a health policy forum? The reason is that the apparent intent of this request is very different from its true purpose, and that difference exemplifies one of the most fundamental flaws in our current health care financing system.
The three page questionnaire enclosed with the letter asks for extensive detailed information on matters such as employer, number of fellow employees, insurance company, group number, member/plan ID, Rx PCN, Rx Bin, Person Code, etc. The same questions are asked about the spouse’s employer and coverage as well. There are detailed questions about other supplemental drug coverage, about Coal Miner’s Medical Benefits, and about coverage under no-fault or automobile insurance. There is a detailed question about present or pending Workers’ Compensation claims, including the name and address of your attorney. There is another question about any illness or injury for which another party could be held liable, also including a request for the name and address of your attorney.
A quote from the forty-two page booklet on our Blue Cross of California Part D coverage (now Anthem Blue Cross): “… the prescription drug coverage you get from us will be secondary to your employer or retiree group coverage.”
This is not a process that would afford Anthem Blue Cross the opportunity to increase payment for any prescription drugs that qualify. Assuring that you receive the “maximum coverage benefits” refers to the maximum that will be paid after excluding the legitimate claims that they would shift to other potential payers. Under these circumstances, the maximum benefit frequently would be no benefit payment at all.
There could not be a more clear distinction between the business model of private health plans in the United States, and the social insurance models of private health plans used in other countries. Private plans unified in a social insurance program assist patients in paying for the care they need. Our private insurers, such as Anthem Blue Cross, use every devious method they can to avoid paying for the care that patients need. And they add more wasteful administrative complexity to the health care financing process, made even worse by the fragmentation of the financing system.
If we were to adopt a financing system using private insurers that would provide adequate affordable coverage for everyone, then we would have to totally transform the private insurance industry into a social insurance model. For that transformation to be equitable and effective, those who do not want to give up the coverage they have would have to acknowledge that their plan would be transformed anyway to comply with requirements for universal risk pooling, guaranteed issue, prevention of adverse selection, adequate benefit package, elimination of under-insurance, and other measures that define social insurance programs.
That transformation would be both politically and administratively more difficult and more expensive than replacing private insurers with a more efficient and effective single payer national health program. Besides, why do we insist on continuing to protect an industry that thrives by cheating us out of our health care benefits?

Maximum coverage as defined by Anthem Blue Cross

Letter
From: Anthem Blue Cross, Oxnard, California
To: Don McCanne

Dear Don,

Enclosed you will find a Part D Coordination of Benefits Survey. By completing the survey, it will help assure that you receive the maximum coverage benefits from your drug plan. …

http://www.anthem.com/

Comment:

By Don McCanne, MD

What’s this? Why would a generous offer from a health insurer to assist an insured in receiving maximum coverage benefits be included in a health policy forum? The reason is that the apparent intent of this request is very different from its true purpose, and that difference exemplifies one of the most fundamental flaws in our current health care financing system.

The three page questionnaire enclosed with the letter asks for extensive detailed information on matters such as employer, number of fellow employees, insurance company, group number, member/plan ID, Rx PCN, Rx Bin, Person Code, etc. The same questions are asked about the spouse’s employer and coverage as well. There are detailed questions about other supplemental drug coverage, about Coal Miner’s Medical Benefits, and about coverage under no-fault or automobile insurance. There is a detailed question about present or pending Workers’ Compensation claims, including the name and address of your attorney. There is another question about any illness or injury for which another party could be held liable, also including a request for the name and address of your attorney.

A quote from the forty-two page booklet on our Blue Cross of California Part D coverage (now Anthem Blue Cross): “… the prescription drug coverage you get from us will be secondary to your employer or retiree group coverage.”

This is not a process that would afford Anthem Blue Cross the opportunity to increase payment for any prescription drugs that qualify. Assuring that you receive the “maximum coverage benefits” refers to the maximum that will be paid after excluding the legitimate claims that they would shift to other potential payers. Under these circumstances, the maximum benefit frequently would be no benefit payment at all.

There could not be a more clear distinction between the business model of private health plans in the United States, and the social insurance models of private health plans used in other countries. Private plans unified in a social insurance program assist patients in paying for the care they need. Our private insurers, such as Anthem Blue Cross, use every devious method they can to avoid paying for the care that patients need. And they add more wasteful administrative complexity to the health care financing process, made even worse by the fragmentation of the financing system.

If we were to adopt a financing system using private insurers that would provide adequate affordable coverage for everyone, then we would have to totally transform the private insurance industry into a social insurance model. For that transformation to be equitable and effective, those who do not want to give up the coverage they have would have to acknowledge that their plan would be transformed anyway to comply with requirements for universal risk pooling, guaranteed issue, prevention of adverse selection, adequate benefit package, elimination of under-insurance, and other measures that define social insurance programs.

That transformation would be both politically and administratively more difficult and more expensive than replacing private insurers with a more efficient and effective single payer national health program. Besides, why do we insist on continuing to protect an industry that thrives by cheating us out of our health care benefits?

Health care cost increases continue to plague employers

Employers Face 10.6 Percent Health Care Cost Increases, Says Aon Consulting

Aon
August 12, 2008
Health care costs are expected to increase on average 10.6 percent in the next 12 months, according to Aon Consulting Worldwide, the global human capital consulting organization of Aon Corporation.
Aon Consulting surveyed more than 70 leading health care insurers, representing more than 100 million insured individuals, and found that health care costs are projected to increase by 10.6 percent for HMOs, 10.5 percent for POS plans, 10.7 percent for PPOs and 10.5 percent for CDH plans. These represent the lowest trend rate increases since the study began in 2001.
http://aon.mediaroom.com/index.php?s=43&item=1285

And…

PwC Health and Wellness Touchstone Survey Results

PricewaterhouseCoopers
June, 2008
561 companies across the United States responded to the survey.
Self-insurance is the primary funding mechanism for respondent companies.
Over 65% of survey participants said that their medical plan cost increases for 2007 over 2006 and 2008 over 2007 (before plan design changes) will be in excess of 5%.
– Over 30% believe increases will be over 10%
– Over 7% believe increases will be over 15%
(A bar graph indicates that the ’07/’08 average trend is about 7.4% for companies with less than 5000 employees, and 6.0% for those with greater than 5000 employees.)
Future Solutions: Cost Shifting
– 41% of survey participants plan to increase employee contributions over the next two years
– 38% of survey participants plan to increase medical plan cost sharing through plan design changes over the next two years
http://www.pwc.com/extweb/pwcpublications.nsf/docid/574877A4F50E390285257483005250AE?OpenDocument

The health care cost data from these two consulting firms are important because they represent the increases in the costs of employer-sponsored coverage – the Aon survey representing the costs of private health insurance plans, and the PricewaterhouseCoopers survey representing the costs for self-insured employers. A few conclusions can be drawn from these surveys.

  • Although reports of the Aon survey celebrated the “lowest trend rate increases since the study began in 2001,” the increases continue to be far in excess of the rate of inflation. The mainstay of health care coverage for the majority of us – employer-sponsored plans – is becoming ever less affordable. Private insurers and self-insured employers have not been able to moderate this trend.
  • The increases for self-insured employers are not as great as for employers that depend on private health insurance plans. This is further evidence that the private insurers have fallen far short of their claims that they have been effective in controlling health care costs. The opposite is true. The waste of their administrative excesses is placing a greater financial burden on the purchasers of their plans.
  • Although the increases for the self-insured are not as great, they still demonstrate that employers themselves have not been successful in harnessing the excessive costs in health care.
  • The Aon survey demonstrates that the rates for consumer-directed plans (CDH) continue to increase as much as the other models of private insurance plans. CDH plans are not a solution for rising health care costs.
  • Employers are continuing to seek relief by shifting more of the costs to their employees through greater employee contributions and innovative plan designs that will only compound the rapidly growing problem of under-insurance.

Employers control health care coverage for close to 60 percent of us. In spite of this buying power, they have been unable to control cost increases. The private insurers have only made the problem worse. We do understand where much of the waste is occurring (administrative excesses, detrimental high-tech excesses, inappropriate pricing, lack of an adequate primary care infrastructure, etc.), but we haven’t established an effective financing system that would address these cost and quality problems.
The solution is simple. We merely need to combine all health care funds into a single national health program. The monopsony that would be created (a single buyer of health care services) would have the market power to reduce the waste while realigning incentives to provide us with affordable access to a high quality health care delivery system. Monopsonies in the private sector can be quite nefarious, but our own beneficent public monopsony would serve us all well.

Health care cost increases continue to plague employers

Employers Face 10.6 Percent Health Care Cost Increases, Says Aon Consulting

Aon
August 12, 2008

Health care costs are expected to increase on average 10.6 percent in the next 12 months, according to Aon Consulting Worldwide, the global human capital consulting organization of Aon Corporation.

Aon Consulting surveyed more than 70 leading health care insurers, representing more than 100 million insured individuals, and found that health care costs are projected to increase by 10.6 percent for HMOs, 10.5 percent for POS plans, 10.7 percent for PPOs and 10.5 percent for CDH plans. These represent the lowest trend rate increases since the study began in 2001.

http://aon.mediaroom.com/index.php?s=43&item=1285

And…

PwC Health and Wellness Touchstone Survey Results

PricewaterhouseCoopers
June, 2008

561 companies across the United States responded to the survey.

Self-insurance is the primary funding mechanism for respondent companies.

Over 65% of survey participants said that their medical plan cost increases for 2007 over 2006 and 2008 over 2007 (before plan design changes) will be in excess of 5%.
— Over 30% believe increases will be over 10%
— Over 7% believe increases will be over 15%
(A bar graph indicates that the ’07/’08 average trend is about 7.4% for companies with less than 5000 employees, and 6.0% for those with greater than 5000 employees.)

Future Solutions: Cost Shifting

— 41% of survey participants plan to increase employee contributions over the next two years
— 38% of survey participants plan to increase medical plan cost sharing through plan design changes over the next two years

http://www.pwc.com/extweb/pwcpublications.nsf/docid/574877A4F50E390285257483005250AE?OpenDocument

Comment:

By Don McCanne, MD

The health care cost data from these two consulting firms are important because they represent the increases in the costs of employer-sponsored coverage – the Aon survey representing the costs of private health insurance plans, and the PricewaterhouseCoopers survey representing the costs for self-insured employers. A few conclusions can be drawn from these surveys.

* Although reports of the Aon survey celebrated the “lowest trend rate increases since the study began in 2001,” the increases continue to be far in excess of the rate of inflation. The mainstay of health care coverage for the majority of us – employer-sponsored plans – is becoming ever less affordable. Private insurers and self-insured employers have not been able to moderate this trend.

* The increases for self-insured employers are not as great as for employers that depend on private health insurance plans. This is further evidence that the private insurers have fallen far short of their claims that they have been effective in controlling health care costs. The opposite is true. The waste of their administrative excesses is placing a greater financial burden on the purchasers of their plans.

* Although the increases for the self-insured are not as great, they still demonstrate that employers themselves have not been successful in harnessing the excessive costs in health care.

* The Aon survey demonstrates that the rates for consumer-directed plans (CDH) continue to increase as much as the other models of private insurance plans. CDH plans are not a solution for rising health care costs.

* Employers are continuing to seek relief by shifting more of the costs to their employees through greater employee contributions and innovative plan designs that will only compound the rapidly growing problem of under-insurance.

Employers control health care coverage for close to 60 percent of us. In spite of this buying power, they have been unable to control cost increases. The private insurers have only made the problem worse. We do understand where much of the waste is occurring (administrative excesses, detrimental high-tech excesses, inappropriate pricing, lack of an adequate primary care infrastructure, etc.), but we haven’t established an effective financing system that would address these cost and quality problems.

The solution is simple. We merely need to combine all health care funds into a single national health program. The monopsony that would be created (a single buyer of health care services) would have the market power to reduce the waste while realigning incentives to provide us with affordable access to a high quality health care delivery system. Monopsonies in the private sector can be quite nefarious, but our own beneficent public monopsony would serve us all well.

Doctor says U.S. needs universal health care

Birmingham physician touts bill to expand Medicare

By STEVE DOYLE
Huntsville Times
Thursday, August 14, 2008

Dr. Wally Retan knows the odds aren’t great that Congress will pass a universal health care bill anytime soon.

But the chairman of Alabama’s “Health Care for Everyone” chapter still dreams of a time when all Americans have comprehensive, low-cost health insurance provided by the federal government.

The semi-retired Birmingham physician spent Wednesday in Huntsville trying to rally public support for a controversial bill he says would accomplish that goal. Sponsored by U.S. Rep. John Conyers, D-Mich., it would expand Medicare-type coverage to everyone.

“The status quo is no longer acceptable; we’ve got to do something,” Retan told about 30 members of the city’s Peace and Democracy group at Fern Bell Recreation Center.

He said Conyers’ proposed “National Health Insurance Act” is backed by 92 other members of Congress (none from Alabama), two Nobel laureates, three former U.S. surgeons general and the 16,000-member Physicians for a National Health Care Program.

Retan, who gave a second talk Wednesday night at Crestwood Medical Center, said annual health care spending in the United States exploded from about $28 billion in 1960 to $2.8 trillion today. That’s about $6,000 for every man, woman and child.

The U.S. Census Bureau estimates 47 million people have no health insurance, and Retan said another 20 percent of the population is underinsured.

“They have what I call miniskirt insurance,” he said. “It looks good, but it doesn’t cover very much.”

Medical costs have skyrocketed so much that Starbucks now spends more on employee health care than coffee beans, said Retan, 77.

He said Conyers’ bill would rein in medical spending by shoving aside private insurance companies, whose “handsome executive salaries” contribute to their high administrative costs.

Most of the world’s industrialized nations and a few others, including Thailand, have found a way to provide universal health care, Retan said.

“What’s going to happen with all of this nobody knows, but it’s going to be interesting to find out,” he said. “Once in a while, the impossible happens.”

Retan’s talk inspired a lively debate among Peace and Democracy group members. Noor Gillani said America has the economic ability to provide universal health coverage, but people are going to have to demand it.

“If people become educated and know the truth,” Gillani said, “they’re going to fight for it.”

http://www.al.com/news/huntsvilletimes/index.ssf?/base/news/1218705432306300.xml&coll=1