PNHP

AHIP's recommendation for rescissions

AHIP's recommendation for rescissions

Health Insurers Address Issue Of Nixed Policies

By Rhonda Rundle
The Wall Street Journal
February 27, 2008

The health-insurance industry is racing to defuse a growing furor over retroactive policy cancellations that have saddled some patients with big medical bills and sparked lawsuits.

America’s Health Insurance Plans, an industry group, is pushing a proposal with state regulators that would give consumers the right to appeal such policy cancellations, known as rescissions, to an external panel, whose decisions would be binding.

But some critics say that the practice of unfair policy rescissions suggests that private health insurers aren’t up to the task of ensuring that sick people maintain coverage.

“We are often viewed as having very different views from the insurance industry, but on this particular matter we think this is a step in the right direction,” said Ron Pollack, executive director of Families USA, a Washington nonprofit organization.

http://online.wsj.com/article/SB120408088594795743.html.html

Comment:

By Don McCanne, MD

Our goal is to bring everyone under the health care financing umbrella, including those with significant health care needs. The goal of the insurance industry is to bring the healthy under their umbrella, while excluding those with health care needs.

The insurers find that some do sneak in who need health care. When the underwriting process fails to exclude these individuals in the first place, they still want one more chance to throw them out. Because of the black eye they’ve received over their excessively aggressive, cruel cancellation activities, they now wish to establish a process by which they can receive an independent stamp of approval for these rescissions.

It is no surprise that the insurance industry’s response is merely to attempt to relieve themselves of the obligation to cover these individuals, when the real problem that needs to be addressed is to provide these individuals with health care.

Ron Pollack of Families USA has repeatedly rejected single payer as a model of reform, insisting that reform must be achieved in incremental steps instead. We’ve been following that incremental path for the last couple of decades, and all parameters are worse. He claims that the stamp-of-approval process is a step in the right direction, but granting private insurers authoritative approval to jerk insurance coverage from under those who need it sounds like another step backwards to me.

'Socialized medicine' loses much of its stigma

Most people no longer fear the term that has turned people off since the days of FDR

By Susan Brink
Staff Writer
Los Angeles Times
February 25, 2008

The term “socialized medicine” may be losing its boogeyman status, according to a survey of voting-age adults. Long uttered in warnings against any sort of government involvement in healthcare, today the term has largely lost its scare power.

That’s according to a study led by Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health.

“This is a term from the 1940s,” Blendon says. “We wondered if anyone even knew what it meant anymore.” To find out, his team, along with pollsters at Harris Interactive, asked more than 2,000 people in two surveys what they knew about the term. Among the findings, released Feb. 14:

* Of the respondents, 67% said they understood what “socialized medicine” meant. Of those, 79% said the term means that the government makes sure everyone has health insurance. Only 32% said it means that the government tells doctors what to do.

* Of those who said they understand the term, 45% said that if America had socialized medicine, the health care system would be better, while 39% said it would be worse.

* Not surprisingly, opinions differed according to respondents’ politics. Among Republicans, 70% thought socialized medicine would make the healthcare system worse. Among Democrats, 70% thought it would make things better.

Independents were split more evenly, with 45% saying that socialized medicine would be an improvement, and 38% saying it would be worse than the country’s current healthcare system.

“It’s still an emotionally charged term for Republicans. The phrase itself gets them very angry,” Blendon says. “But Democrats and independents don’t see it as a term that drives them away.”

The words “socialized medicine” have turned up at just about every discussion of government-sponsored health insurance in America’s history going back to Franklin D. Roosevelt, who, after unemployment insurance and Social Security passed, wanted to develop a national health insurance program. The term was used at that time by the American Medical Assn. to attack the idea.

President Truman followed in FDR’s footsteps with a national health insurance plan that once again was attacked by the AMA and some politicians using the phrase; that plan died too. The phrase had its heyday in the post-World War II years and through the 1950s and 1960s, when it was tightly linked to the threat of the Soviet Union and the postwar Red Scare.

The pejorative and loaded term almost killed the famous Framingham Heart Study, which began in the late 1940s and ultimately uncovered major risk factors for heart disease.

Dr. Thomas Dawber, then director of the study in Framingham, Mass., later said he had to work hard to convince volunteers and the town’s doctors that the study was not a form of creeping socialized medicine. He held meetings to assure them that government wasn’t going to snoop into medical records, steal patients or tell physicians how to practice their profession.

The term raised its head again through the 1960s as the American Medical Assn. used it in attempts to discredit government proposals to insure the elderly and the poor. Those proposals, Medicare and Medicaid, were finally signed into law in 1965, 20 years after Truman proposed national health insurance. Symbolically, Truman was the first to sign up for Medicare.

More recently, advertisements have warned against the prospect of government encroachment into healthcare without the actual use of the words “socialized medicine.”

The Harry and Louise ads, funded by the Health Insurance Assn. of America, showed a couple despairing over what they claim to be a government takeover of healthcare. The couple in the ads, which ran in 1993 in opposition to President Clinton’s proposed health care plan, conclude: “They choose. We lose.”

Blendon said it came as a surprise to him and other pollsters to again hear, during the 2008 presidential campaign, what sounded to them like an antiquated phrase.

Former Republican candidate Mitt Romney, talking about Sen. Hillary Rodham Clinton’s new healthcare proposal, labeled it “socialized medicine.”

And former Republican candidate Rudolph Giuliani said, “Whether it’s HillaryCare or ObamaCare or EdwardsCare, the idea that it’s not socialized medicine is a trick. It’s a massive growth of government control of medicine.”

The phrase, says Blendon, is no longer frightening to most people. “It has sort of morphed in the American mind into making sure everyone has coverage.”

susan.brink@latimes.com

What's wrong with individual health insurance mandates?

by Claudia Chaufan
San Francisco Bay Area Indymedia
Tuesday Feb 26th, 2008 5:01 PM

Individual health insurance mandates have lately been hailed as the solution to the health care crisis in America. Mandates to purchase health insurance have been included in legislative proposals at the state level — for instance, by Gov. Schwarzenegger and Speaker Nunez, in their “Health Care Security and Cost Reduction Act”, or at the federal level, by Hillary Clinton in her “American Health Choice Plan”. Can mandates achieve universal access to health care and control rising costs of medical care? This article explains why they can’t.

Lately, legislation including a universal mandate — a legal obligation that everybody purchase a health insurance policy — has been hailed as the solution to the health care crisis in America. At the state level, mandates have been included, for instance, in Gov. Schwarzenegger and Speaker Nunez’s “Health Care Security and Cost Reduction Act”, and at the federal level, by Hillary Clinton in her “American Health Choice Plan”. Yet many of us remain skeptical. Why? After all, if everybody is forced to buy a health insurance plan — maybe with a subsidy if you are “poor enough” — would this not resolve the problem of uninsurance? Maybe so. But the real question is: would mandating universal health insurance guarantee universal access to medical care? And the short answer is no.

A longer answer would include that many health reform proposals promising heaven on earth rely on fantasy numbers, not facts: for instance, there is reason to believe that Swcharzenegger’s stillborn legislation would have run out of money by the fifth year of operation (http://www.lao.ca.gov/2008/Webcasts/hcr_1-23-08/flashversion/hcr_flash.aspx). Indeed, often these proposals offer no numbers at all, fantasy or otherwise: a sound study estimating the capacity of “Hillary Care” to guarantee that those who “like” their current health insurance “will be able to keep it”, as Hillary promises (http://www.hillaryclinton.com/feature/healthcareplan), has yet to be produced. But worst of all is the tendency, popular among many health care experts, including M.I.T. professors (http://www.nber.org/papers/w13758) to commit the capital sin in health policy: confusing universal health insurance with universal access to comprehensive medical care.

Now, it could very well be that these experts are not confused, and only hope that ordinary citizens won’t be smart enough to tell the difference — that we will all be convinced if only they repeat “universal” enough times. Whichever the case may be, as political analyst Robert Kuttner recently pointed out, there is a fundamental difference between “universal” social health insurance, such as proposed by single payer health care reform, and a “universal” health insurance mandate (http://content.nejm.org/cgi/content/full/358/6/549). And it is not merely semantic, because clearly in both approaches “universal” means “everybody”. It is a difference of substance.

In a social health insurance system everybody gets insurance by virtue of being a citizen or a resident, everybody contributes to the system according to ability to pay, and everybody is guaranteed an amount and type of services. This is possible because the system, whose ultimate goal is to provide the most and best care to all participants with whatever budget it has, counts on a predictable influx of money, has as sole incentive finding the most efficient ways to spend it, is able to estimate the needs of participants, and can utilize their collective purchasing power to bargain for best prices of services and goods.

In contrast, in a system based on mandates, nobody “gets” anything, really. Rather, everybody is compelled to buy a policy, by law. Hence guaranteeing a decent amount of medical care to the population at large, that many consider a social problem, is turned into a “problem” of “every” individual or “every” family, who are forced to comparative-shop for affordable policies, while second-guessing current or future medical needs as they decide which is the best investment for their resources — a more comprehensive health policy, rent, or food.

A key assumption underlying individual mandates is that forcing an influx of “customers” into the health insurance marketplace, flooded with private insurers’ “products” made to suit a range of personal preferences will, through the powerful and reveered “invisible hand”, improve the quality of medical goods and services and bring their prices down, such that on average they will be affordable to everybody. This of course would be true, if shopping for medical services were functionally equivalent to shopping for designer shoes. Faced with an offer, you are always free to take it or leave it, depending on how good the deal is. If it is not good enough, you can always wait until the next Christmas sale. Or you can decide that you are not so crazy about those shoes after all, and shop for something else, until those recalcitrant shoe sellers realize that if they want your dollars, they have to behave reasonably, and offer the best they can at the least possible price.

But of course nobody needs a doctoral degree to understand that the need for medical care cannot be compared with the want for designer shoes. Nor does one need a doctoral degree to understand that a mandate to buy, for instance, drivers’ insurance, does not guarantee full protection against the expenses incurred if one gets into a car accident. While some policies might cover those expenses, they are unlikely to be cheap. What the current mandate to buy drivers’ insurance “guarantees”, if the word makes sense at all, is that, given the law, we won’t get in trouble with it if we are stopped by the police. Which is why nobody claims we have “universal drivers’ insurance”. Likewise, whichever health insurance policies we may afford to buy, if there is a mandate, it will only “guarantee”, aside from a steady pool of clients for private insurers, that we are in compliance with the law when we file our taxes (assuming this is how the mandate is enforced).

Under our current system, which relies heavily on private insurance, paying for medical care is insurers’ greatest “cost”. Now, like any other business, insurers’ ultimate goal is to control the costs of running their business while maximizing profits. Hence the increasingly bewildering range of “choices” of “insurance products” that make sure that insurers will not have to pay more for medical care than they collect in premiums and that there remains enough spare change to keep CEOs and shareholders happy.

And because profit is the essence of business, however much “mandate” fans boast they will force insurers to not turn people down on the basis of “pre-existing conditions”, they will not — they cannot — force them to sell policies that will not meet insurers’ profit maximizing goals. So mandate supporters remain conveniently vague whenever asked how much “consumers” will have to pay for policies offering more than minimum coverage or even what will count as minimum coverage, hoping that we won’t notice when they fail to compute out-of-pocket costs to “consumers” — deductibles, co-pays, co-insurance — as “costs”.

Or worse, they hope that by repeating scare stories backed by fanciful (and distorting) statistics Americans will end up believing that the only alternative to the current mess is a mandate’s version of “universal health coverage” and that a social insurance system will inevitably cause an invasion of alien Reds, with long lines in cold winter mornings in which everybody is given the same loaf of bread (substitute “sees the same doctor” or “receives the same medicine”), however far this scenario is from the daily reality of Canadians, Brits, Germans, Spaniards, and so forth.

Now, the point is not to force business to do business at a loss. The point is why, when it comes to health care, we should insist on a model that confuses health care with designer shoes and that has failed to deliver the goods. Because it is clear that choices that are meaningful, not of health policies but of doctors and services when and to the extent we need them are increasingly out of reach for ordinary Americans.

Which is why only a system based on the principle of social insurance, that spreads the risk over a large pool — all Californians, or even better, all Americans — to which all participants contribute an affordable proportion of their income, and where individuals are guaranteed real choice, not of policies but of medical services, constitutes meaningful universal health care reform.

And sound legislation exists: it is the single-payer model proposed by SB840, the California Universal Healthcare Act, vetoed by Schwarzenegger, who appears to dislike “big government bureaucracies” (http://www.youtube.com/watch?v=asgUP31Vf8o) but can live with the 30% mark-up of the bureaucracy of private insurers. It is also HR676, the expanded and improved Medicare for All Act, conveniently made invisible every time the major media or policy thinktanks report on the health care crisis, and disqualified by Hillary as “difficult to achieve” (http://www.democracynow.org/2008/2/8) for reasons that we are never given.

Now, will a social insurance system resolve all the problems in American medicine? Of course not. “Financing” and “delivery and organization” of medical care are different analytic categories, so securing the first will not miraculously resolve, for instance, the problems of over-reliance on expensive medical technologies, lack of uniformity of medical records, or insufficient emphasis on preventive care (or the never-settled question of whether Americans are as dutiful as others when it comes to eating our veggies). Those are internal to the system — to any health care system — and require separate attention. But a sound financial structure is a prerequisite to making improvements in the delivery and organization of a medical system possible.

At any rate, as Kuttner said, the “debate” about whether or not to have a mandate misses the point that the financial structure of the system, built on false assumptions and perverse incentives, is sick (http://www.democracynow.org/2008/2/8). The real issue is whether or not major presidential candidates are willing to “do it right” and use their formidable political power, social prestige, and precious media time to bring “public opinion around” (http://www.democracynow.org/2008/2/8), assuming they haven’t yet been informed about the increasing public support for single payer among the electorate (http://abcnews.go.com/images/pdf/935a3HealthCare.pdf), including physicians (http://www.philly.com/philly/business/20071204_Doctors_endorse_single-payer.html).

As Kuttner, supporters of single payer wish our politicians and opinion leaders “got it right” this time, stopped trying to reinvent the wheel, and stood for the only type of reform that can bring affordable and comprehensive health care to all Americans.

Claudia Chaufan teaches sociology of health and medicine and health policy at the University of California at Santa Cruz. She has written extensively on social inequalities in the diabetes epidemic, for general and specialized audiences, nationally and internationally. She is the Vice President of California Physicians Alliance, the Californa Chapter of Physicians for a National Health Program, an organization that supports single-payer health care reform.

AHIP’s recommendation for rescissions

Health Insurers Address Issue Of Nixed Policies

By Rhonda Rundle
The Wall Street Journal
February 27, 2008

The health-insurance industry is racing to defuse a growing furor over retroactive policy cancellations that have saddled some patients with big medical bills and sparked lawsuits.

America’s Health Insurance Plans, an industry group, is pushing a proposal with state regulators that would give consumers the right to appeal such policy cancellations, known as rescissions, to an external panel, whose decisions would be binding.

But some critics say that the practice of unfair policy rescissions suggests that private health insurers aren’t up to the task of ensuring that sick people maintain coverage.

“We are often viewed as having very different views from the insurance industry, but on this particular matter we think this is a step in the right direction,” said Ron Pollack, executive director of Families USA, a Washington nonprofit organization.

http://online.wsj.com/article/SB120408088594795743.html.html

Comment:

By Don McCanne, MD

Our goal is to bring everyone under the health care financing umbrella, including those with significant health care needs. The goal of the insurance industry is to bring the healthy under their umbrella, while excluding those with health care needs.

The insurers find that some do sneak in who need health care. When the underwriting process fails to exclude these individuals in the first place, they still want one more chance to throw them out. Because of the black eye they’ve received over their excessively aggressive, cruel cancellation activities, they now wish to establish a process by which they can receive an independent stamp of approval for these rescissions.

It is no surprise that the insurance industry’s response is merely to attempt to relieve themselves of the obligation to cover these individuals, when the real problem that needs to be addressed is to provide these individuals with health care.

Ron Pollack of Families USA has repeatedly rejected single payer as a model of reform, insisting that reform must be achieved in incremental steps instead. We’ve been following that incremental path for the last couple of decades, and all parameters are worse. He claims that the stamp-of-approval process is a step in the right direction, but granting private insurers authoritative approval to jerk insurance coverage from under those who need it sounds like another step backwards to me.

‘Socialized medicine’ loses much of its stigma

Most people no longer fear the term that has turned people off since the days of FDR

By Susan Brink
Staff Writer
Los Angeles Times
February 25, 2008

The term “socialized medicine” may be losing its boogeyman status, according to a survey of voting-age adults. Long uttered in warnings against any sort of government involvement in healthcare, today the term has largely lost its scare power.

That’s according to a study led by Robert Blendon, professor of health policy and political analysis at the Harvard School of Public Health.

“This is a term from the 1940s,” Blendon says. “We wondered if anyone even knew what it meant anymore.” To find out, his team, along with pollsters at Harris Interactive, asked more than 2,000 people in two surveys what they knew about the term. Among the findings, released Feb. 14:

* Of the respondents, 67% said they understood what “socialized medicine” meant. Of those, 79% said the term means that the government makes sure everyone has health insurance. Only 32% said it means that the government tells doctors what to do.

* Of those who said they understand the term, 45% said that if America had socialized medicine, the health care system would be better, while 39% said it would be worse.

* Not surprisingly, opinions differed according to respondents’ politics. Among Republicans, 70% thought socialized medicine would make the healthcare system worse. Among Democrats, 70% thought it would make things better.

Independents were split more evenly, with 45% saying that socialized medicine would be an improvement, and 38% saying it would be worse than the country’s current healthcare system.

“It’s still an emotionally charged term for Republicans. The phrase itself gets them very angry,” Blendon says. “But Democrats and independents don’t see it as a term that drives them away.”

The words “socialized medicine” have turned up at just about every discussion of government-sponsored health insurance in America’s history going back to Franklin D. Roosevelt, who, after unemployment insurance and Social Security passed, wanted to develop a national health insurance program. The term was used at that time by the American Medical Assn. to attack the idea.

President Truman followed in FDR’s footsteps with a national health insurance plan that once again was attacked by the AMA and some politicians using the phrase; that plan died too. The phrase had its heyday in the post-World War II years and through the 1950s and 1960s, when it was tightly linked to the threat of the Soviet Union and the postwar Red Scare.

The pejorative and loaded term almost killed the famous Framingham Heart Study, which began in the late 1940s and ultimately uncovered major risk factors for heart disease.

Dr. Thomas Dawber, then director of the study in Framingham, Mass., later said he had to work hard to convince volunteers and the town’s doctors that the study was not a form of creeping socialized medicine. He held meetings to assure them that government wasn’t going to snoop into medical records, steal patients or tell physicians how to practice their profession.

The term raised its head again through the 1960s as the American Medical Assn. used it in attempts to discredit government proposals to insure the elderly and the poor. Those proposals, Medicare and Medicaid, were finally signed into law in 1965, 20 years after Truman proposed national health insurance. Symbolically, Truman was the first to sign up for Medicare.

More recently, advertisements have warned against the prospect of government encroachment into healthcare without the actual use of the words “socialized medicine.”

The Harry and Louise ads, funded by the Health Insurance Assn. of America, showed a couple despairing over what they claim to be a government takeover of healthcare. The couple in the ads, which ran in 1993 in opposition to President Clinton’s proposed health care plan, conclude: “They choose. We lose.”

Blendon said it came as a surprise to him and other pollsters to again hear, during the 2008 presidential campaign, what sounded to them like an antiquated phrase.

Former Republican candidate Mitt Romney, talking about Sen. Hillary Rodham Clinton’s new healthcare proposal, labeled it “socialized medicine.”

And former Republican candidate Rudolph Giuliani said, “Whether it’s HillaryCare or ObamaCare or EdwardsCare, the idea that it’s not socialized medicine is a trick. It’s a massive growth of government control of medicine.”

The phrase, says Blendon, is no longer frightening to most people. “It has sort of morphed in the American mind into making sure everyone has coverage.”

susan.brink@latimes.com

What’s wrong with individual health insurance mandates?

by Claudia Chaufan
San Francisco Bay Area Indymedia
Tuesday Feb 26th, 2008 5:01 PM

Individual health insurance mandates have lately been hailed as the solution to the health care crisis in America. Mandates to purchase health insurance have been included in legislative proposals at the state level — for instance, by Gov. Schwarzenegger and Speaker Nunez, in their “Health Care Security and Cost Reduction Act”, or at the federal level, by Hillary Clinton in her “American Health Choice Plan”. Can mandates achieve universal access to health care and control rising costs of medical care? This article explains why they can’t.

Lately, legislation including a universal mandate — a legal obligation that everybody purchase a health insurance policy — has been hailed as the solution to the health care crisis in America. At the state level, mandates have been included, for instance, in Gov. Schwarzenegger and Speaker Nunez’s “Health Care Security and Cost Reduction Act”, and at the federal level, by Hillary Clinton in her “American Health Choice Plan”. Yet many of us remain skeptical. Why? After all, if everybody is forced to buy a health insurance plan — maybe with a subsidy if you are “poor enough” — would this not resolve the problem of uninsurance? Maybe so. But the real question is: would mandating universal health insurance guarantee universal access to medical care? And the short answer is no.

A longer answer would include that many health reform proposals promising heaven on earth rely on fantasy numbers, not facts: for instance, there is reason to believe that Swcharzenegger’s stillborn legislation would have run out of money by the fifth year of operation (http://www.lao.ca.gov/2008/Webcasts/hcr_1-23-08/flashversion/hcr_flash.aspx). Indeed, often these proposals offer no numbers at all, fantasy or otherwise: a sound study estimating the capacity of “Hillary Care” to guarantee that those who “like” their current health insurance “will be able to keep it”, as Hillary promises (http://www.hillaryclinton.com/feature/healthcareplan), has yet to be produced. But worst of all is the tendency, popular among many health care experts, including M.I.T. professors (http://www.nber.org/papers/w13758) to commit the capital sin in health policy: confusing universal health insurance with universal access to comprehensive medical care.

Now, it could very well be that these experts are not confused, and only hope that ordinary citizens won’t be smart enough to tell the difference — that we will all be convinced if only they repeat “universal” enough times. Whichever the case may be, as political analyst Robert Kuttner recently pointed out, there is a fundamental difference between “universal” social health insurance, such as proposed by single payer health care reform, and a “universal” health insurance mandate (http://content.nejm.org/cgi/content/full/358/6/549). And it is not merely semantic, because clearly in both approaches “universal” means “everybody”. It is a difference of substance.

In a social health insurance system everybody gets insurance by virtue of being a citizen or a resident, everybody contributes to the system according to ability to pay, and everybody is guaranteed an amount and type of services. This is possible because the system, whose ultimate goal is to provide the most and best care to all participants with whatever budget it has, counts on a predictable influx of money, has as sole incentive finding the most efficient ways to spend it, is able to estimate the needs of participants, and can utilize their collective purchasing power to bargain for best prices of services and goods.

In contrast, in a system based on mandates, nobody “gets” anything, really. Rather, everybody is compelled to buy a policy, by law. Hence guaranteeing a decent amount of medical care to the population at large, that many consider a social problem, is turned into a “problem” of “every” individual or “every” family, who are forced to comparative-shop for affordable policies, while second-guessing current or future medical needs as they decide which is the best investment for their resources — a more comprehensive health policy, rent, or food.

A key assumption underlying individual mandates is that forcing an influx of “customers” into the health insurance marketplace, flooded with private insurers’ “products” made to suit a range of personal preferences will, through the powerful and reveered “invisible hand”, improve the quality of medical goods and services and bring their prices down, such that on average they will be affordable to everybody. This of course would be true, if shopping for medical services were functionally equivalent to shopping for designer shoes. Faced with an offer, you are always free to take it or leave it, depending on how good the deal is. If it is not good enough, you can always wait until the next Christmas sale. Or you can decide that you are not so crazy about those shoes after all, and shop for something else, until those recalcitrant shoe sellers realize that if they want your dollars, they have to behave reasonably, and offer the best they can at the least possible price.

But of course nobody needs a doctoral degree to understand that the need for medical care cannot be compared with the want for designer shoes. Nor does one need a doctoral degree to understand that a mandate to buy, for instance, drivers’ insurance, does not guarantee full protection against the expenses incurred if one gets into a car accident. While some policies might cover those expenses, they are unlikely to be cheap. What the current mandate to buy drivers’ insurance “guarantees”, if the word makes sense at all, is that, given the law, we won’t get in trouble with it if we are stopped by the police. Which is why nobody claims we have “universal drivers’ insurance”. Likewise, whichever health insurance policies we may afford to buy, if there is a mandate, it will only “guarantee”, aside from a steady pool of clients for private insurers, that we are in compliance with the law when we file our taxes (assuming this is how the mandate is enforced).

Under our current system, which relies heavily on private insurance, paying for medical care is insurers’ greatest “cost”. Now, like any other business, insurers’ ultimate goal is to control the costs of running their business while maximizing profits. Hence the increasingly bewildering range of “choices” of “insurance products” that make sure that insurers will not have to pay more for medical care than they collect in premiums and that there remains enough spare change to keep CEOs and shareholders happy.

And because profit is the essence of business, however much “mandate” fans boast they will force insurers to not turn people down on the basis of “pre-existing conditions”, they will not — they cannot — force them to sell policies that will not meet insurers’ profit maximizing goals. So mandate supporters remain conveniently vague whenever asked how much “consumers” will have to pay for policies offering more than minimum coverage or even what will count as minimum coverage, hoping that we won’t notice when they fail to compute out-of-pocket costs to “consumers” — deductibles, co-pays, co-insurance — as “costs”.

Or worse, they hope that by repeating scare stories backed by fanciful (and distorting) statistics Americans will end up believing that the only alternative to the current mess is a mandate’s version of “universal health coverage” and that a social insurance system will inevitably cause an invasion of alien Reds, with long lines in cold winter mornings in which everybody is given the same loaf of bread (substitute “sees the same doctor” or “receives the same medicine”), however far this scenario is from the daily reality of Canadians, Brits, Germans, Spaniards, and so forth.

Now, the point is not to force business to do business at a loss. The point is why, when it comes to health care, we should insist on a model that confuses health care with designer shoes and that has failed to deliver the goods. Because it is clear that choices that are meaningful, not of health policies but of doctors and services when and to the extent we need them are increasingly out of reach for ordinary Americans.

Which is why only a system based on the principle of social insurance, that spreads the risk over a large pool — all Californians, or even better, all Americans — to which all participants contribute an affordable proportion of their income, and where individuals are guaranteed real choice, not of policies but of medical services, constitutes meaningful universal health care reform.

And sound legislation exists: it is the single-payer model proposed by SB840, the California Universal Healthcare Act, vetoed by Schwarzenegger, who appears to dislike “big government bureaucracies” (http://www.youtube.com/watch?v=asgUP31Vf8o) but can live with the 30% mark-up of the bureaucracy of private insurers. It is also HR676, the expanded and improved Medicare for All Act, conveniently made invisible every time the major media or policy thinktanks report on the health care crisis, and disqualified by Hillary as “difficult to achieve” (http://www.democracynow.org/2008/2/8) for reasons that we are never given.

Now, will a social insurance system resolve all the problems in American medicine? Of course not. “Financing” and “delivery and organization” of medical care are different analytic categories, so securing the first will not miraculously resolve, for instance, the problems of over-reliance on expensive medical technologies, lack of uniformity of medical records, or insufficient emphasis on preventive care (or the never-settled question of whether Americans are as dutiful as others when it comes to eating our veggies). Those are internal to the system — to any health care system — and require separate attention. But a sound financial structure is a prerequisite to making improvements in the delivery and organization of a medical system possible.

At any rate, as Kuttner said, the “debate” about whether or not to have a mandate misses the point that the financial structure of the system, built on false assumptions and perverse incentives, is sick (http://www.democracynow.org/2008/2/8). The real issue is whether or not major presidential candidates are willing to “do it right” and use their formidable political power, social prestige, and precious media time to bring “public opinion around” (http://www.democracynow.org/2008/2/8), assuming they haven’t yet been informed about the increasing public support for single payer among the electorate (http://abcnews.go.com/images/pdf/935a3HealthCare.pdf), including physicians (http://www.philly.com/philly/business/20071204_Doctors_endorse_single-payer.html).

As Kuttner, supporters of single payer wish our politicians and opinion leaders “got it right” this time, stopped trying to reinvent the wheel, and stood for the only type of reform that can bring affordable and comprehensive health care to all Americans.

Claudia Chaufan teaches sociology of health and medicine and health policy at the University of California at Santa Cruz. She has written extensively on social inequalities in the diabetes epidemic, for general and specialized audiences, nationally and internationally. She is the Vice President of California Physicians Alliance, the Californa Chapter of Physicians for a National Health Program, an organization that supports single-payer health care reform.

Health care spending for 2008

Health Spending Projections Through 2017: The Baby-Boom Generation Is Coming To Medicare

By Sean Keehan, Andrea Sisko, et al (Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group)
Health Affairs
February 26, 2008

Projected spending for 2008

$2,394.3 billion – National Health Expenditures (NHE)

$7,867.7 – NHE per capita

16.6% – NHE as percent of GDP

Over the projection period in this paper (2007-2017), growth is anticipated to remain steady at around 6.7 percent per year, yielding an estimated $4.3 trillion in health spending in 2017.

Gross domestic product (GDP) growth is expected to average 4.7 percent per year over the projection period. Therefore, health spending growth is expected to outpace economic growth by an average of 1.9 percentage points annually.

Factors Contributing To Growth

The primary drivers of personal health care spending growth during the projection period are medical prices and utilization, followed by smaller impacts from population growth and the age-sex mix.

Since 1995, widespread selective contracting associated with the expansion of managed care has mitigated growth in medical price inflation. During that time, this output price inflation has averaged slower growth than the CMS index of medical input prices. The slower growth in medical price inflation relative to growth in input costs also reflects declines in real physician incomes relative to those of other professional and technical occupations.

Utilization, which includes both the volume and intensity of services, is primarily influenced by trends in real household income and, to a lesser extent, the substitution effect associated with relative medical price inflation and shifts in insurance coverage. …the expectation of slower disposable income growth from 2008 to 2017 is the primary driver for the slowing growth in utilization toward the end of the projection period.

The impact of the population aging is expected to account for a relatively small share of future health care spending growth on a per enrollee basis but to have a substantial influence on the public share of spending growth, as the leading edge of the baby-boom generation becomes eligible for Medicare.

Over the remainder of the period and in response to projected slowing economic growth, employers could shift more costs to employees through benefit buy-downs and increased cost sharing, resulting in a convergence of the growth rates for out-of-pocket and private insurance spending. The impact of consumer-directed health plans on out-of-pocket spending has been, and is expected to remain, minor.

http://content.healthaffairs.org/cgi/content/full/hlthaff.27.2.w145/DC1

Comment:

By Don McCanne, MD

The projected numbers for 2008, listed above, are the most reliable estimates of our current health care spending. They are the numbers you should use in your advocacy work.

There are no surprises in this projection. Heath care costs/prices continue to increase at rates well in excess of inflation, and continue to outpace GDP growth by about two percent. The latter is of concern to many since they would rather spend more in other sectors of our economy.

Much attention will be directed to the shift of Baby Boomers from private to public financing. As a result, there will be increased political pressure to halt the “unsustainable” spending growth in entitlement programs – Medicare and Medicaid. But compared to the total NHE, this shift is quite small. Over the next decade projected growth in NHE is expected to be 6.7 percent, whereas growth in public spending is expected to be 7.2 percent, and Medicare specifically, 7.4 percent. Medicare should not be singled out as an isolated problem that needs to be fixed, while ignoring the rest of our health care spending.

The pseudo-hysteria that we will see is exemplified by the statement of Rep. Paul Ryan (R-WI) posted on the Health Affairs blog simultaneously with this report. Rep. Ryan states, “…these are not signs that the health care market has failed. In fact — and it is crucial to understand this — they are the predictable results of vast distortions imposed on the market over decades. The government is the single greatest contributor to this problem…”

Obfuscation of the issues based on personal ideology is the last thing we need right now from our political leaders. The problems of our high-cost but mediocre health care system cannot be repaired without appropriate government action. We need to elect politicians who understand this, and then they need to get to work.

Mythbusting Canadian Healthcare, Part II: Debunking the Free Marketeers

By Sara Robinson
OurFuture.org
February 11th, 2008

In the previous post, I looked at ten of the most common myths that get bandied about whenever Americans drag Canada into their ongoing discussions about healthcare. In this follow-up, I’d like to address a few of the larger assumptions that Americans make about health care that are contradicted by the Canadian example; and in the process offer some more general thinking (and perhaps talking) points that may be useful in the debates ahead.

Government-run health care is inherently less efficient — because governments themselves are inherently less efficient.

If anything could finally put the lie to this old conservative canard, the disaster that is our health care system is Exhibit A.

America spends about 15% of its GDP on health care. Most other industrialized countries (all of whom have some form of universal care) spend about 11-12%. According to the WHO, Canada spends a bit over 9% — and most of the problems within their system come out of the fact that it’s chronically underfunded compared to the international average.

Any system that has people spending more and getting less is, by definition, not efficient. And these efficiency leaks are, almost entirely, due to private greed. There is no logical way that a private system can pay eight-figure CEO compensation packages, turn a handsome a profit for shareholders, and still be “efficient.” In fact, in order to deliver those profits and salaries, the American system has built up a vast, Kafkaesque administrative machinery of approval, denial, and fraud management, which inflates the US system’s administrative costs to well over double that seen in other countries — or even in our own public systems, including Medicare and the VA system.

Not incidentally: one of the benefits of single-payer health care is that it largely eliminates the entire issue of “fraud.” You can only “cheat” a system that already views its primary business as rationing and withholding care. In Canada, where the system is set up to deliver health care instead of profits, and medical access is considered a right, this whole oversight machinery is far cheaper and more compact. In general, the system trusts doctors and patients to make the right choices the first time. As a result, people generally don’t have to lie, cheat, and grovel to get the system to deliver the care they need. They just go and get it — and walk out without a moment’s dread about the bills.

Shareholder profit, inflated CEO salaries, and top-heavy administration — all of which serve to work against the delivery of care, not facilitate it — are anti-efficiencies that siphon off 20-25% of America’s total health care spending. These are huge sums; yet it’s mostly money down a gold-plated rathole. In the end, it doesn’t provide a single bed, pay a single nurse or doctor, or treat a single patient.

We’ll have rationed care

Don’t look now: but America does ration care. And it does it in the most capricious, draconian, and often dishonest way possible.

Mostly, the US system rations care by simply eliminating large numbers of people from the system due to an inability to pay. Last year, one-quarter of all Americans didn’t go to a doctor when they needed one because they couldn’t afford it. Nearly that many skipped getting a test, treatment, prescription, or follow-up appointment recommended by a doctor. In Canada, those same numbers are in the 4-5% range; in the UK, 2-3%. Also: nearly 20% of all Americans had a hard time paying a medical bill last year; and these stresses now trigger over half of all personal bankruptcies in the country.

Furthermore, nominally having health insurance is no guarantee against financial ruin, as Sicko amply illustrated. Being cut off or denied by your insurance company is rationing, too. And there are vast numbers of fairly well-off Americans — many of them middle-aged, and too young for Medicare — who have pre-existing conditions that render them uninsurable at any price. They’re one heart attack, one diabetic event, or one bad turn away from financial disaster. Please don’t insult these people by telling them that the American system doesn’t ration care.

Another persistent (and ridiculously mendacious) rationing myth about the Canadian system is that old people are cut off from treatment and left to die. I’ve never heard about a single case of this in Canada; but it happens routinely to Americans on Medicare and many private policies, which have strict limits on how long you can stay in the hospital with an acute illness. When the benefits run out, ready or not, they send you home. If you die, you die. The Canadian plan has no such limits: you stay for as long as you need to. But in the US, these limits fit the very definition of “rationed care.”

Effectively shutting one-quarter of the population out of the medical system entirely, and putting many of the rest on short rations, certainly does make things so much nicer for those happy few who are still in it. In fact, Americans have these missing millions to thank for their system’s impressively short wait times. Only 4% of American have to wait more than six months for non-elective surgeries, while 14-15% of Canadian and Britons do. (Don’t blame this on government care, though: in Germany and the Netherlands, the number is closer to 2%.) When conservatives start bellowing about Canada’s terrifying wait times (which, by the way, are carefully triaged: it’s rare for people to die waiting, though it happens), we need to remind them that there are 75 million Americans who have been wait-listed forever. If my friend’s Aunt Millie gets her emergency hip surgery today because I’m willing to hobble along for an extra couple months before getting my knee surgery — well, for any morally serious person, that choice should be a complete no-brainer.

You can’t have medical innovation without the incentives provided by the free market.

As in the US, Canada’s government funds major medical research that has led to a continuous stream of new medical breakthroughs. (And as this link shows, the rate of innovation didn’t slow down in the least when Canada moved to single-payer in the 1960s.) All of the country’s medical schools are located within public research universities. The university that houses my local medical school, the University of British Columbia, ranked ninth in North America last year — in league with UC, Stanford, and other powerhouses — in total public and private research grants received by its labs. Among other things, it leads the way in genetics (David Suzuki is emeritus faculty), and stem-cell research (having attracted a handsome roster of American scientists whose research was thwarted by the political situation at home).

Because the Canadian health care system is driven by delivering care instead of profits, the focus of research is sometimes different — and often wider-ranging. While there’s plenty of pursuit of patents and innovations, there’s also considerable research put into questioning whether new treatments are really more effective than older ones; and in pursuing possible treatments that may not be patentable by anyone. The system is focused first on what works; and after that, on what might make someone some money.

Single-payer health care will make America less competitive.

I can’t believe people still have the gall to argue this point, but apparently, they do. There are several reasons this is flat-out wrong:

Jobs, Jobs, Jobs — It’s no secret that public health care is making Canada a more attractive business environment for large manufacturers, who typically have very high insurance overhead. Toyota and GM have both moved plants to Canada in recent years, in large part to avoid the spiraling costs of insuring American workers. (Toyota also cited Canada’s better-educated workers, but that’s another issue for another day.) As long as $900 of every car GM makes is going to supply health care to the people who make it, the US’s current system of employer-based health care is going to continue to drive skilled jobs out of the country.

A Smarter, More Entreprenurial Workforce — Being relieved of insurance worries also makes individual citizens more competitive. How would your life choices change if you didn’t have to worry about health care? Would you go back to school and get your PhD in lepidoptery? Start a blog — or a small business? Work part-time and travel? Tell your boss where he can stick it? Spend a few years at home with your kids?

Countries with universal coverage free up their citizens to take advantage of personal development opportunities that, in the long run, stimulate the economy and create a more skilled, traveled, educated, and fulfilled workforce. Americans, on the other hand, routinely stay chained to jobs they hate — and are forced to pass up on chances to expand their horizons and their fortunes — because they can’t afford to jeopardize their health care coverage. Our health care mess has reached a point where it jeopardizes not only our lives, but also our liberty and our ability to pursue happiness — as well as the long-term strength of the economy as a whole.

Increased Financial and Social Capital — When families are bankrupted by medical bills, or are thrown into poverty when a working member is disabled because they can’t afford proper care, or simply break down and fall apart under the stress of debt and illness, it’s not long before the country’s entire social fabric begins to show the wear and tear — along with the sense of optimism and the common good required for a democracy to function.

Part of what makes a country competitive is its own commitment to the common good. I’ve often been impressed by the very tangible sense of civic pride and shared effort my Canadian neighbors have in the fact that they’re taking the best possible care of their own, regardless of status, age, or ethnicity. Every encounter with the medical system reminds them that they’re all in this together. A medical system that routinely drives families into bankruptcy or divorce court is actively destroying, rather than adding to, the essential social capital that makes the whole society function.

No Deferred Maintenance — Decades of foregone medical care are starting to catch up with Americans. We’re seeing serious declines on many fronts: infant mortality, lifespan, cancer rates, heart disease rates, and increased diabetes. On most of the major markers of public health, America is nowhere near the top tier anymore. In some areas, there are a few small former Communist countries doing better than we are.

Business relies on healthy workers who aren’t distracted by their own illness or that of a family member. America’s uninsured, increasingly unhealthy workforce is in no position to compete on equal terms with the strong, healthy workers of other countries who are getting the care they deserve.

We have more important matters to tend to — like national security and the war.

Getting everyone insured is, unequivocally, a clear matter of national security.

Our every-man-for-himself attitude toward health care is a security threat on a par with unsecured ports. In Canada, people go see the doctor if they’re sick for more than a day or two. It was this easy access to early treatment, along with the much tighter public health matrix that enables doctors to share information quickly, that allowed the country’s health care system to detect the 2003 SARS epidemics in Toronto and Vancouver while they were still very localized, act within hours to stop them before the disease spread any further, and track down and treat exposed people before they got too sick to be helped. In both cases, the system worked flawlessly. The epidemic was stopped within days and quashed entirely in under a month, potentially saving of millions of lives.

In the U.S., that same epidemic might easily have gone unnoticed for critical days and weeks. If the first people to get sick were among those 75 million without adequate insurance, they probably would have toughed it out a few extra days before finally dragging their half-dead carcasses into an ER somewhere. Not only would they be much farther along in the course of the disease — and thus at greater risk of death themselves — every one of them could have infected dozens or even hundreds of other people in the meantime, accelerating the spread of the epidemic.

Worse: America’s underfunded public health system might have taken several days to piece together the whole picture of an epidemic; and perhaps another week or two might have passed before the E. Coli conservatives in charge (having thrown out the science-based management plans thoughtfully developed by the bureaucracy) cooked up some kind of half-assed ideology-driven decision about how to proceed. (It would, of course, involve spectacular amounts of lying to the public.) By that point, tens of millions could have been infected, leading to a death toll that would make 9/11 and Katrina look like minor statistical blips.

Think about superbugs and the ongoing waves of immunological imports from the world’s swamps and jungles. Think about terrorists with bioweapons. And then think again about the undeniable fact that every single underinsured American is a gaping hole in the safety net that protects us all from a catastrophic epidemic. This really is one of those cases in which none of us are safe as long as even one of us is left at risk. And from a purely economic standpoint: would you want to invest in a country where there was a significant risk that an epidemic or a bio-attack, managed by incompetent officials, might force you to shut down your business at a moment’s notice?

As for the war: Bush’s Folly will generate upwards of half a million veterans, many of whom will require some kind of sustaining care for the rest of their lives. VA funding ebbs and flows with the national political will, and veterans often fall behind other priorities. But if they can enter the same health care system every other American depends on, then we can only forget their interests by forgetting our own as well.

I feel a lot better knowing my taxes are taking care of my fellow Canadians rather than buying bombs to drop on Iraqi towns, supporting a fully-equipped CIA gulag, or funding Baghdad pizza deliveries via Halliburton. It’s hard to become a worldwide empire when you’re putting half your tax revenue into hospitals and doctors, as Canada does. But, on the other hand, it’s hard to insure your citizens when half your tax revenue is going to feed your war machine.

In a very real sense, America has chosen to secure its oil supply at the cost of its own citizens’ health. The more we spend on the former, the less we have for the latter. And our own relative health — both physical and economic — is starting to show the consequences of that choice. Ultimately, all these things are connected: by making ourselves energy independent, we might not only make ourselves more secure, we’ll also finally be able to invest in the kind of health care that will make us truly competitive in the world community.

The Bottom Line

In America, a lucky employee with gold-plated employer-based coverage may well get access to A-level care (though that level of coverage becoming rarer by the month, even among the professional classes). On the other hand, about 50 million under-insured Americans are barely scraping by with C or D-level care; and the nearly 50 million with no insurance at all get next to no care whatsoever. Worst of all: 18,000 Americans die every year due to lack of access to healthcare. That’s one every 30 minutes, around the clock, every day of the year — the equivalent death toll of six 9/11s every single year that passes.

In Canada, everybody gets at least B-level care, pretty consistently across the board — and, on occasion, quite a bit better than that. You might not like those odds if you’re one of the shrinking handful of Americans who’s used to A-level care; but if that’s not you, you’d be getting a much better deal in Canada.

The private sector has had 20 years to prove that it could deliver low-cost, quality care using those vaunted business-style efficiencies; and it has failed us utterly and completely. This fact should be the ultimate nail in the coffin of the old conservative canard that “the free market always does it better.” If that was true, privatizing health care would have been the shining example that proved it once and for all. Instead, all we got was a colossally expensive national disaster that’s denying full coverage to a third of the country — and putting our health, competitiveness, financial and social capital, and national security at risk in the process. It’s also devastating the aspirations of our entire middle class, which is being hollowed out by our current health policies.

A famous Hebrew prophet once advised his followers to take the log out of their own eyes before trying to remove the splinter from someone else’s. As much as it hurts American pride to admit it, Canada and the rest of the industrialized world has us roundly beat on this one. Those who are so quick to criticize the Canadian system might be better off holding their fire until they’ve shown us they can do better. America, and the world, is waiting.

Bush's privatization agenda for Medicare

By LAURA S. BOYLAN
Sacramento Bee
Wednesday, February 13, 2008

The Bush administration is eating away at the heart of Medicare.

The first assault was the Medicare Modernization Act of 2003. And the second assault is the budget that President Bush just submitted to Congress.

Before looking at these two, we should recognize that Medicare is one of our nation’s most efficient, successful and popular public programs. Under this single-payer program for the elderly, people report less hassle, easier access, lower out-of-pocket expenses and more satisfaction than those with private insurance.

Let’s face it: Medicare is a public oasis in the private desert that is the health care marketplace in America. We spend more than twice as much on health care, on average, as other developed nations, all of which provide universal coverage through predominantly public financing. What’s more, their health outcomes are usually superior to ours.

Market-based health care is a minefield of “perverse incentives:” Procedures are rewarded over prevention and administrative costs are enormous. It is estimated that one-third to one-fifth of U.S. medical expense outlays don’t improve health.

As a doctor, I know that my time with patients is at the core of a humanistic practice of medicine. And it’s also the most cost-effective way to deliver primary care. It is, however, the least reimbursable of all medical events. Physicians are more likely to order questionable tests and specialty referrals when in a rush. It provides a sense of thoroughness, a hedge of bets and, frankly, a patient-pleasing way to close the visit when the lines are getting too long. But it adds immensely to the costs of health care.

The waste and inefficiency are, well, un-American.

In a triumph of ideology over fiscal sobriety, of special interests over public health, the Bush administration is trying to privatize Medicare rather than expand it.

The Medicare Modernization Act of 2003 offered prescription drug coverage, but exclusively through private companies. Bizarrely, it prohibited the government from negotiating price discounts from the drug companies. As a result, Medicare Part D drug prices are more than 80 percent higher than the prices negotiated by Medicaid and Veterans Affairs.

One important but obscure component of the Medicare Modernization Act will soon come to haunt us. And that is the creation of an arbitrary 45 percent general revenue cap, which, when reached, will trigger program cutbacks, higher premiums or further privatization. Medicare financing comes from various sources including general revenue, payroll taxes, trust fund interest, and beneficiary premiums. The cap has yet to kick in, but the drug company giveaway was funded mostly through general revenue, so it will come soon.

Then there’s the current Bush budget. It proposes reducing payments to doctors and hospitals while preserving subsidies to inefficient and sometimes corrupt private insurance middlemen, who offer plans through the Medicare Advantage program. These middlemen cost up to 19 percent more per beneficiary than traditional Medicare despite selective enrollment of the healthy.

Fiscal sobriety and public health demand that Medicare be kept affordable by getting rid of inefficient subsidies and giveaways to industry, which add cost but not value to health care.

Don’t let the Bush Administration fool you: We can afford Medicare. The $6 billion it would cut next year from public Medicare is less than the cost of two weeks of the war in Iraq.

Medicare is the proud kernel of a single-payer America, where health care is a right and not a commodity, and everyone has the same health care coverage as their president.

We can’t let the Bush administration continue to gouge it.

About the writer: Dr. Laura S. Boylan is an assistant professor of neurology at New York University and a board member of Physicians for a National Health Program (www.pnhp.org).

Bush’s privatization agenda for Medicare

By LAURA S. BOYLAN
Sacramento Bee
Wednesday, February 13, 2008

The Bush administration is eating away at the heart of Medicare.

The first assault was the Medicare Modernization Act of 2003. And the second assault is the budget that President Bush just submitted to Congress.

Before looking at these two, we should recognize that Medicare is one of our nation’s most efficient, successful and popular public programs. Under this single-payer program for the elderly, people report less hassle, easier access, lower out-of-pocket expenses and more satisfaction than those with private insurance.

Let’s face it: Medicare is a public oasis in the private desert that is the health care marketplace in America. We spend more than twice as much on health care, on average, as other developed nations, all of which provide universal coverage through predominantly public financing. What’s more, their health outcomes are usually superior to ours.

Market-based health care is a minefield of “perverse incentives:” Procedures are rewarded over prevention and administrative costs are enormous. It is estimated that one-third to one-fifth of U.S. medical expense outlays don’t improve health.

As a doctor, I know that my time with patients is at the core of a humanistic practice of medicine. And it’s also the most cost-effective way to deliver primary care. It is, however, the least reimbursable of all medical events. Physicians are more likely to order questionable tests and specialty referrals when in a rush. It provides a sense of thoroughness, a hedge of bets and, frankly, a patient-pleasing way to close the visit when the lines are getting too long. But it adds immensely to the costs of health care.

The waste and inefficiency are, well, un-American.

In a triumph of ideology over fiscal sobriety, of special interests over public health, the Bush administration is trying to privatize Medicare rather than expand it.

The Medicare Modernization Act of 2003 offered prescription drug coverage, but exclusively through private companies. Bizarrely, it prohibited the government from negotiating price discounts from the drug companies. As a result, Medicare Part D drug prices are more than 80 percent higher than the prices negotiated by Medicaid and Veterans Affairs.

One important but obscure component of the Medicare Modernization Act will soon come to haunt us. And that is the creation of an arbitrary 45 percent general revenue cap, which, when reached, will trigger program cutbacks, higher premiums or further privatization. Medicare financing comes from various sources including general revenue, payroll taxes, trust fund interest, and beneficiary premiums. The cap has yet to kick in, but the drug company giveaway was funded mostly through general revenue, so it will come soon.

Then there’s the current Bush budget. It proposes reducing payments to doctors and hospitals while preserving subsidies to inefficient and sometimes corrupt private insurance middlemen, who offer plans through the Medicare Advantage program. These middlemen cost up to 19 percent more per beneficiary than traditional Medicare despite selective enrollment of the healthy.

Fiscal sobriety and public health demand that Medicare be kept affordable by getting rid of inefficient subsidies and giveaways to industry, which add cost but not value to health care.

Don’t let the Bush Administration fool you: We can afford Medicare. The $6 billion it would cut next year from public Medicare is less than the cost of two weeks of the war in Iraq.

Medicare is the proud kernel of a single-payer America, where health care is a right and not a commodity, and everyone has the same health care coverage as their president.

We can’t let the Bush administration continue to gouge it.

About the writer: Dr. Laura S. Boylan is an assistant professor of neurology at New York University and a board member of Physicians for a National Health Program (www.pnhp.org).

Making Medicaid patients better shoppers

CMS Proposes New Rules for Redesigning Medicaid

States Have Greater Flexibility in Benefits, Cost Sharing

Centers for Medicare and Medicaid Services (CMS)
February 21, 2008

Two new proposed rules that would give states unprecedented flexibility in designing their own Medicaid programs, including adjusting their benefit package to more closely align with beneficiary needs and requiring increased cost sharing by enrollees, were announced today by the Centers for Medicare and Medicaid Services (CMS).

The proposed rules would implement provisions of the Deficit Reduction Act of 2005 and the Tax Relief and Health Care Act of 2006. The rules are the latest in a series of regulations to implement the AdministrationĆ¢ā‚¬ā„¢s goals of aligning Medicaid more closely with private market insurance and giving states more control over their Medicaid benefits packages.

“These new rules recognize that states are in the best position to design plans that provide Medicaid beneficiaries better health care for the same or even lower cost,” Health and Human Services Secretary Mike Leavitt said. “The proposed rules will result in patients having more choices and greater control over their health care decisions.”

Individuals with family incomes between 100 and 150 percent of the FPL may see some cost sharing while monthly premiums can be charged to individuals with incomes above 150 percent of the FPL. As in SCHIP, all cost sharing must be limited to no more than five percent of the familyĆ¢ā‚¬ā„¢s income. The 2008 FPL for a family of four is $21,200.

“Until passage of the DRA, states had few options, other than through waivers, to update the health benefit packages offered through their Medicaid programs to meet the needs of the people they serve,” CMS Acting Administrator Kerry Weems said. “These proposed changes allow states to use modern methods of providing health insurance coverage and encourage families to participate in their own health care decisions.”

http://www.cms.hhs.gov/apps/media/press/release.asp
(Click release for February 21, 2008)

Comment:

By Don McCanne, MD

So under the new rules, a family of four living at the federal poverty level ($21,200) can be granted “greater control over their health care decisions” by being granted the opportunity to use $1060 of their own income in order to make them better health care shoppers.

These are families who are not facing foreclosure on their homes (since they could never qualify to purchase them in the first place). They are not facing repossession of their automobiles (since they have, at best, a clunker, or they use public transportation). They are not impacted by a mandate to buy insurance on their clunker (since they have no funds to purchase the required coverage anyway). These are families who will not have to face additional credit card debt (since any cards they have are already maxed out, and they cannot qualify for new cards). These are families who are able to regularly experience new living environments (each time they are evicted for failing to pay their past due rent). These are families who have become very adept at budgeting (since they must stretch their $407 per week to cover their rent, food, clothing, utilities, transportation, school supplies, etc., etc.).

Many studies have shown that cost sharing in health care literally can be a death sentence, especially for those living at or near the poverty level. Secretary Leavitt and Administrator Weems already know this.

What kind of nation have we become?

The Corrosion of Medicine

The Corrosion of Medicine

Can the Profession Reclaim its Moral Legacy?

By John Geyman, M.D.

Medicine can no longer deny the extent to which unbridled self-interest has eroded its professionalism. As documented in earlier chapters, these excesses are pervasive throughout the profession, for all to see, involving patient care, education and research as well as academic medical centers and many of the profession’s organizations. The extent of deprofessionalization makes clear that the cause extends well beyond a few “bad apples.” If medicine is to restore its professionalism, the profession must accept responsibility for letting down the public trust, recommit itself to service over self-interest, and build effective mechanisms of self-regulation which can gain the public’s confidence.

Whether medicine will give up its customary defensive mode and respond positively to its moral and professional challenges is an open question. Despite its long struggle to maintain its independence, the profession has lost much of its autonomy as it increasingly serves corporate interests. In a more proactive stance, medicine may recognize a larger role of government as a potential force to support the context within which it can restore its professionalism. Business as usual will not serve the profession or the public well. The profession now has a window of opportunity to expand its vision and lead toward better health care for all Americans. To do so, it must involve itself with rebuilding the capability of public health and with advocacy for real health care reform, which leads us to the last chapters.

http://www.commoncouragepress.com/index.cfm?action=book&bookid=384

Comment:

By Don McCanne, MD

This book was very difficult to read, not because of the complexity of the topic, but rather because of the anguish felt over what has happened to our profession.

Although physicians have been complicit in the processes leading to the corrosion of medicine, their blame lies not with an active role in commercializing health care, but rather with passive acceptance of their role in our current model of health care that is controlled by business and market interests.

When you ask a physician what his/her occupation is, he/she does not say that I am a businessperson in the health care industry. Almost without exception, the response is, “I’m a physician.” That has much greater meaning than merely being engaged in an occupation that takes care of sick people. It is difficult to put into words, but every health care professional knows what I mean.

Although it was painful to be reminded of the compromises being made on behalf of the business of medicine, there is also real hope in the message in this book. You realize that it doesn’t have to be this way. We do not have to passively accept the role of being workers in an industry controlled by market entrepreneurs.

We can become active advocates of reform that places our patients first. If we take health care financing out of the hands of the MBAs and place it under the control of our own universal public financing system, the patients and physicians will be able partner together in achieving the best health care possible within the confines of our finite resources.

Financing reform is only the first step, but it makes the other necessary reforms possible. Not only will we restore our pride in ourselves when we say, “I am a physician,” our patients will once again understand the special meaning of medicine as a profession rather than as a mere business.