By PHYLLIS BROWN
Napa Valley Register
Tuesday, October 09, 2007

While Michael Bartos is right that the tens of millions of uninsured and underinsured Americans need help (“Single-payer won’t work, but universal care is the goal,” Oct. 2), his opposition to a single-payer style, Medicare-for-all that would guarantee healthcare for all is simply an embrace of our dysfunctional status quo and a broken healthcare system that primarily benefits insurance companies at the expense of the rest of us.

Registered nurses sponsored the billboard on Highway 80 that Bartos cites precisely because we are tired of seeing our patients left behind; infants who can’t get a healthy start because mom can’t afford prenatal care, children who can’t get immunizations and proper dental care because mom and dad can’t afford it, and patients who can’t afford the medications they’ve been prescribed. It doesn’t have to be this way.

Single-payer healthcare, as would be established by HR 676 in Congress and SB 840 in California, is the only effective, genuine cure for our current healthcare nightmare. It is the only health reform that is universal, that assures uniform, comprehensive benefits for all, that guarantees patients’ choice of doctor or medical facility, and that ends the routine, callous denial of care by insurance companies. It’s also the only reform that restores health security for American families by bringing an end to ever-rising insurance premiums, deductibles, co-pays and rising drug and hospital charges.

While Bartos’ experiences with Medicare are unfortunate, they remain unique and anecdotal. The majority of private practitioners who experience difficulty in being paid for services rendered are battling not with Medicare, but with insurance companies. The heart of the claims problem is that insurance companies aim to make a profit. Medicare doesn’t. Insurance companies earn profits by denying payment, therefore, the more payment denied, the greater the profits. Insurance companies have an operating overhead of 30 percent, Medicare, 3 percent. Medicare exists to serve the healthcare needs of American citizens. Insurance companies exist to create attractive portfolios for their stockholders.

We’ve all heard the same tired anecdotes about waiting times in countries with more humane health care systems but studies show that waiting times in the U.S. are as bad as, or worse than, Canada. Unlike the U.S., in Canada no one is denied needed medical care, referrals or diagnostic tests due to cost, preexisting conditions or because it wasn’t pre-approved.

Proponents of preserving market-based healthcare like Dr. Bartos ignore the colossal failure of the system that is collapsing around us. It’s all well and good to talk about public subsidies for our lowest income, but a mountain of evidence is accumulating to document that the crisis now touches more American families every day.

A recent survey by the influential Consumer Reports organization, for example, states that four in 10 Americans can now be classified as “underinsured.” Among those, more than half of the “underinsured” postponed needed medical care due to cost and a third had to dig deep into their savings to pay for medical expenses. Another third of those over 50 said decisions about their retirement were adversely affected by healthcare costs, one quarter had outstanding medical debt, 38 percent postponed home or car maintenance repairs due to medical bills, and only 37 percent said they were prepared to financially handle unexpected major medical costs in the next year.

The point of “Sicko,” and the nurses’ endorsement of the movie, is that the people who live in the wealthiest nation in the world deserve the same standard of care that exists in all of the world’s other industrialized countries. America is a society founded upon the principle of equality, but the message sent by our current healthcare system, or lack thereof, is that you are only entitled to the healthcare you can afford. By redefining health as a commodity, as we have in this nation, we are restricting that fundamental right.

(Brown is a registered nurse who lives in Napa.)

By David Lazarus
Los Angeles Times
October 7, 2007

I write a lot about healthcare reform. Now it’s personal.

I was diagnosed this past week with diabetes. As of Friday, I was injecting myself with insulin, something I’ll be doing four or five times a day, every day, for the rest of my life. Without the injections, I’ll likely die.

Scared? You’re damn right I’m scared. What’s going to happen to me? What’s going to happen to my family?

I got past the shock pretty quickly and am now stuck somewhere between denial and anger. Depression will soon arrive, followed eventually by acceptance. Something to look forward to.

This is an uncertain time for me, but I know this much: I’m more convinced than ever that our medical system is a mess and that a single-payer insurance program is the only realistic way we can achieve universal coverage, promote preventive treatment and make healthcare affordable to all.

And if contracting diabetes is frightening for a relatively well-insured person like myself, what must it be like for any of the 47 million Americans who lack health insurance?

According to the American Diabetes Assn., nearly 21 million U.S. adults and kids have the disease — 7% of the population. About 15 million of this number have been diagnosed. The rest have no idea that they’re afflicted.

With obesity rates soaring, as many as 54 million others are strongly at risk of contracting diabetes in the future.

In my case, diabetes struck not because I stuff my face with Big Macs and fried chicken, which I don’t. I take good care of myself and am not overweight — considerably less so since unexpectedly dropping about 15 pounds over the past couple of months.

No, it’s almost certain I got nailed because a genetic time bomb finally exploded.

My father, Paul N. Lazarus III, who produced the movies “Westworld” and “Capricorn One,” has Type 1 diabetes and is now nearly blind. My younger brother has Type 1 and is doing well enough. My aunt had Type 1 before it blinded and then killed her.

The doctors say diabetes — almost certainly Type 1 — has been lurking in my DNA since I was a child, waiting for its time to strike.

But why now? I’ve lived 46 fairly healthy years, except for certain pharmaceutical pursuits during college. I don’t drink. I don’t smoke. I exercise as regularly as I can. What did I do wrong?

Probably nothing. The stress of my recent move to L.A. and starting a new job didn’t help, but it’s not to blame. This was going to happen no matter what.

I had a good idea something was wrong when I noticed that my weight kept going down no matter what I ate, and that I was consumed with a thirst of biblical proportions (accompanied by a commensurate increase in bathroom breaks).

I visited my doctor and had a blood test. The bad news came just days later. I was immediately referred to a specialist, whom I’ll call Dr. B.

Dr. B was great — knowledgeable, sensitive, empathetic. Problem was, Dr. B didn’t take insurance.

Excuse me? I said.

Dr. B explained that it just wasn’t cost-effective for him to seek reimbursement from insurance companies. It was too much hassle, he said, and he didn’t get paid enough for his efforts. Dr. B said an increasing number of doctors were cutting ties with insurers for the same reasons.

If I wanted to see him at his private practice, which was most convenient to my home, each visit could cost me hundreds of dollars — not the most appealing prospect when one’s facing a chronic disease.

Dr. B said I could try to deal with insurance reimbursements on my own, but that’s the last headache I wanted to inflict on myself at this point.

So I had to quickly find a doctor who would take insurance. My insurer’s website had a directory of possible choices, but you’re essentially pulling a name out of a hat — not the best way to make decisions when your blood-sugar level is three or four times normal.

This led me to Dr. W, who was equally knowledgeable if perhaps a bit lacking in the empathy department. He also had what seemed to me unconventional ideas about how diabetes can be treated with certain drugs and a rigidly monastic diet of his own devising.

This ultimately led me to Dr. D at UCLA’s Gonda (Goldschmied) Diabetes Center, whom I’m very fortunate to have found. Not only does he know what he’s doing, but he also has the resources of a world-class medical facility that focuses exclusively on what’s trying to put me under dirt.

It was Dr. D who finally made the call that I needed to start insulin injections, and it was he who made sure I knew how to handle that first, life-changing moment when needle touched skin.

Clearly I’m receiving the best available treatment, and I’d rather be here than anywhere in the world.

But the quirks and complexities of the insurance system border on madness. Through my employer, I have about as much insurance coverage as anyone. Yet that wasn’t good enough for Dr. B.

I have to wonder where else my private-sector insurance will fail me in years ahead.

And what happens if I get fired tomorrow? With a preexisting condition, I’m virtually uninsurable in the individual insurance market. Will diabetes leave my family destitute?

In the past, I always wrote about the uninsured in a largely abstract way — a faceless mass of millions of people confronted with a broadly defined medical challenge. I know better now.

The terrifying possibility of my own loss of coverage gives me an acute sense of what the uninsured must deal with, the dreadful awareness that you and your loved ones are only one medical misstep from catastrophe.

That’s unacceptable for any person who lives in the wealthiest, most advanced nation in the history of the world.

I’ll have a lot more to say about this in the future, especially as my own situation takes shape. But this much at least is evident:

* Universal coverage must be our goal, and it must allow ready access to all aspects of the medical system at affordable prices.

* The emphasis must be on treatment, not bureaucracy. As it stands, researchers at Harvard University estimate that about a third of the $2 trillion in annual healthcare spending is squandered on bureaucratic overhead.

* Employer-based healthcare is obsolete. As costs continue climbing, businesses can no longer meet their historical obligation of being the primary provider of coverage to American families.

* Quality medical treatment is a right, not a benefit.

Unfortunately, nearly all healthcare-reform proposals on the table center on expanding the existing system and pushing the uninsured into high-cost individual policies that will make private insurers even more profitable.

That can’t be the answer.

Single-payer isn’t perfect. Critics say it can involve long waits for treatment and can stifle innovation.

My belief is that Americans can get it right. We can learn from the examples of other nations and refine things so that our healthcare is second to none. It won’t be easy. Then again, how much worse could it be than the way things are now?

As of this moment, I’m completely dependent on the U.S. healthcare system to keep me alive. I, and you, shouldn’t have to settle for anything but the best.

By David Lazarus
Los Angeles Times
October 7, 2007

I write a lot about healthcare reform. Now it’s personal.

I was diagnosed this past week with diabetes. As of Friday, I was injecting myself with insulin, something I’ll be doing four or five times a day, every day, for the rest of my life. Without the injections, I’ll likely die.

Scared? You’re damn right I’m scared. What’s going to happen to me? What’s going to happen to my family?

I got past the shock pretty quickly and am now stuck somewhere between denial and anger. Depression will soon arrive, followed eventually by acceptance. Something to look forward to.

This is an uncertain time for me, but I know this much: I’m more convinced than ever that our medical system is a mess and that a single-payer insurance program is the only realistic way we can achieve universal coverage, promote preventive treatment and make healthcare affordable to all.

And if contracting diabetes is frightening for a relatively well-insured person like myself, what must it be like for any of the 47 million Americans who lack health insurance?

According to the American Diabetes Assn., nearly 21 million U.S. adults and kids have the disease — 7% of the population. About 15 million of this number have been diagnosed. The rest have no idea that they’re afflicted.

With obesity rates soaring, as many as 54 million others are strongly at risk of contracting diabetes in the future.

In my case, diabetes struck not because I stuff my face with Big Macs and fried chicken, which I don’t. I take good care of myself and am not overweight — considerably less so since unexpectedly dropping about 15 pounds over the past couple of months.

No, it’s almost certain I got nailed because a genetic time bomb finally exploded.

My father, Paul N. Lazarus III, who produced the movies “Westworld” and “Capricorn One,” has Type 1 diabetes and is now nearly blind. My younger brother has Type 1 and is doing well enough. My aunt had Type 1 before it blinded and then killed her.

The doctors say diabetes — almost certainly Type 1 — has been lurking in my DNA since I was a child, waiting for its time to strike.

But why now? I’ve lived 46 fairly healthy years, except for certain pharmaceutical pursuits during college. I don’t drink. I don’t smoke. I exercise as regularly as I can. What did I do wrong?

Probably nothing. The stress of my recent move to L.A. and starting a new job didn’t help, but it’s not to blame. This was going to happen no matter what.

I had a good idea something was wrong when I noticed that my weight kept going down no matter what I ate, and that I was consumed with a thirst of biblical proportions (accompanied by a commensurate increase in bathroom breaks).

I visited my doctor and had a blood test. The bad news came just days later. I was immediately referred to a specialist, whom I’ll call Dr. B.

Dr. B was great — knowledgeable, sensitive, empathetic. Problem was, Dr. B didn’t take insurance.

Excuse me? I said.

Dr. B explained that it just wasn’t cost-effective for him to seek reimbursement from insurance companies. It was too much hassle, he said, and he didn’t get paid enough for his efforts. Dr. B said an increasing number of doctors were cutting ties with insurers for the same reasons.

If I wanted to see him at his private practice, which was most convenient to my home, each visit could cost me hundreds of dollars — not the most appealing prospect when one’s facing a chronic disease.

Dr. B said I could try to deal with insurance reimbursements on my own, but that’s the last headache I wanted to inflict on myself at this point.

So I had to quickly find a doctor who would take insurance. My insurer’s website had a directory of possible choices, but you’re essentially pulling a name out of a hat — not the best way to make decisions when your blood-sugar level is three or four times normal.

This led me to Dr. W, who was equally knowledgeable if perhaps a bit lacking in the empathy department. He also had what seemed to me unconventional ideas about how diabetes can be treated with certain drugs and a rigidly monastic diet of his own devising.

This ultimately led me to Dr. D at UCLA’s Gonda (Goldschmied) Diabetes Center, whom I’m very fortunate to have found. Not only does he know what he’s doing, but he also has the resources of a world-class medical facility that focuses exclusively on what’s trying to put me under dirt.

It was Dr. D who finally made the call that I needed to start insulin injections, and it was he who made sure I knew how to handle that first, life-changing moment when needle touched skin.

Clearly I’m receiving the best available treatment, and I’d rather be here than anywhere in the world.

But the quirks and complexities of the insurance system border on madness. Through my employer, I have about as much insurance coverage as anyone. Yet that wasn’t good enough for Dr. B.

I have to wonder where else my private-sector insurance will fail me in years ahead.

And what happens if I get fired tomorrow? With a preexisting condition, I’m virtually uninsurable in the individual insurance market. Will diabetes leave my family destitute?

In the past, I always wrote about the uninsured in a largely abstract way — a faceless mass of millions of people confronted with a broadly defined medical challenge. I know better now.

The terrifying possibility of my own loss of coverage gives me an acute sense of what the uninsured must deal with, the dreadful awareness that you and your loved ones are only one medical misstep from catastrophe.

That’s unacceptable for any person who lives in the wealthiest, most advanced nation in the history of the world.

I’ll have a lot more to say about this in the future, especially as my own situation takes shape. But this much at least is evident:

* Universal coverage must be our goal, and it must allow ready access to all aspects of the medical system at affordable prices.

* The emphasis must be on treatment, not bureaucracy. As it stands, researchers at Harvard University estimate that about a third of the $2 trillion in annual healthcare spending is squandered on bureaucratic overhead.

* Employer-based healthcare is obsolete. As costs continue climbing, businesses can no longer meet their historical obligation of being the primary provider of coverage to American families.

* Quality medical treatment is a right, not a benefit.

Unfortunately, nearly all healthcare-reform proposals on the table center on expanding the existing system and pushing the uninsured into high-cost individual policies that will make private insurers even more profitable.

That can’t be the answer.

Single-payer isn’t perfect. Critics say it can involve long waits for treatment and can stifle innovation.

My belief is that Americans can get it right. We can learn from the examples of other nations and refine things so that our healthcare is second to none. It won’t be easy. Then again, how much worse could it be than the way things are now?

As of this moment, I’m completely dependent on the U.S. healthcare system to keep me alive. I, and you, shouldn’t have to settle for anything but the best.

Allyson Pollock
Monday September 24, 2007
The Guardian

Viewers of Michael Moore’s new film will come away convinced that the public healthcare system in this country is superior to its privatised American counterpart, where more than 50 million people are without any kind of care at all. But does the government agree? Or has it instead been taking ideas from the very system revealed in Sicko to be so iniquitous?

The film is very much made for a US audience. Moore does not go into the huge changes that are taking place in European healthcare – and the new, privatising project going on here. It might surprise many British people who see the film to know that, for example, the British government has for years been in contact with Kaiser Permanente, one of the big US healthcare corporations, and is actively trying to remodel the NHS along American lines. All the reforms carried out by the government over the past few years have been aimed at that.

In 1995, civil servants from the Department of Health, fresh from visits to the US, thought they had found the future of the NHS. They invited Kaiser Permanente to look at whether it could deliver health services as part of the new Private Finance Initiative in the NHS. The PFI is a building programme of public infrastructure that brings with it a long-term debt that the government takes out from a private company. But as the medical director of Kaiser Permanente, which is both an insurer and healthcare provider, told me at the time in her marbled headquarters in California, the NHS was not yet ready for Kaiser. Such a system, built on public ownership, control and accountability, was closed to commercial companies. And it was the same story for the whole of Europe. But Kaiser Permanente, which, along with the rest of the US healthcare industry, was known as one of the “darlings of Wall Street” because it made so much money, was restless. It wanted to make more, and had its eye on the rich pickings of European tax funds. And where better to begin than by conquering the UK’s “socialised” NHS, so long the model for much of the world?

Kaiser Permanente didn’t have long to wait. In 1997, the Labour administration swept away the last remaining obstacles to PFI and, in so doing, established the laboratory for the great market experiment in public services.

The accumulated neglect and backlog in maintenance and repair became an excuse to sell off NHS land and assets at knockdown prices. The NHS is now a tenant in hospitals it once owned, leasing back buildings and services from private sector landlords at astronomical rents that are currently consuming £500m a year and will increase exponentially. The diversion of scarce funds from hospital revenues to bankers and shareholders has starved the NHS of cash, and the result has been a major downsizing. For almost every PFI hospital built, three hospitals close. Bed closures and staff reductions occur on an unprecedented scale.

Back in 1997, the NHS had major capacity problems. Waiting lists kept rising, accident and emergency wards were overflowing, public discontent was growing and staff morale plummeting. Tony Blair found a solution one night in 2000 as he was leaving the smart River Cafe. He was introduced to Tim Evans, external affairs director of the Independent Health Care Association, the body that represented the private healthcare industry, who convinced him that the private sector had all the answers.

But the Labour government knew that a public sector NHS was close to the heart of most Britons, and a spin operation was required. So, from the start of the Labour government, ministers dismissed the NHS as Stalinist, a 1940s relic of socialism, bureaucratic and rigid. Then, in 2002, the highly respected British Medical Journal published a paper purporting to show that Kaiser Permanente (them again) was more efficient than the NHS. Within hours, hundreds of emails had poured into the BMJ exposing the flaws in the paper, from the misleading nature of the claims to the authors’ links to the company. But the BMJ’s editor, Richard Smith, declined to retract the paper, correct it or publish a proper scientific rebuttal.

The paper had done its work. Its propaganda was cited and repeated everywhere by academics and policy-makers and, most crucially, by the government in its white papers and documents, including the Wanless Report. The much-despised US healthcare industry, of which Kaiser Permanente is a part, was to be the new model for Britain.

Not long after publishing the article, Smith left the BMJ for a lucrative post as chief executive of the UK subsidiary of the US health corporation UnitedHealth. There he joined its new European president, Simon Stevens, formerly adviser to every Labour health secretary, and Tony Blair, since 1997. The flow of ideas, from him and many others like him, was all one-way: from the US to the UK.

As adviser to Alan Milburn, health secretary from 1999 to 2003, Stevens and his American colleagues helped to shape the NHS Plan 2000. It promised to provide more money, doctors, nurses, beds and capacity. But in the event the funds were directed at building a new parallel system that would be owned and operated not by the people but by the private sector on behalf of shareholders.

Using the mantra of choice, the market was thus disguised. In primary care the government negotiated a new GP contract that would allow commercial companies to run GP services. There are now more than 30 corporations running GP services in England.

It was choice that was used to bring in the highly controversial ISTC (independent sector treatment centre) programme, spearheaded by Texan Ken Anderson, which provides mini- factories for elective surgery. Anderson headed the new commercial directorate of the Department of Health and quickly set about awarding £6bn worth of contracts to healthcare corporations, thereby undermining elective surgery, diagnostics, radiology and pathology provision in the NHS.

Local people from Portsmouth to Scarborough have been protesting against ISTCs draining scarce NHS funds, which has led to service closures and staff redundancies to balance the books. There is not an area of the country where services are not being cut and closed. Protests against the closures of accident and emergency departments and hospital services are happening in Surrey, East and West Sussex, Kent, Worcester, Manchester, Leeds, Durham and Huddersfield; and against the 150 community hospitals in places such as Norfolk, Cambridge, Leicester, Devon, Marlborough and Bromley. The NHS, the government says, has had unprecedented levels of funding – so where has all the money gone if it isn’t into services? Is it really all down to bad managers and greedy doctors and nurses?

All markets need systems for pricing, billing and invoicing. Labour has introduced those: the electronic patient record, part of the £1bn IT disaster. The NHS too is being transformed from within. Foundation trusts such as University College London Hospitals Trust have been given new powers to enter joint ventures with commercial companies such as the Hospital Corporation of America and to spend millions of pounds on advertising campaigns, PR agents, mega-departments of finance and accounting, press officers, management consultants and profits. As in the US, billions of pounds, probably approaching 20% of annual NHS funds – estimated to be £20bn in England in a year – are being squandered on what are called the transaction costs of the market.

Earlier this year the US chief executive officer of UnitedHealth, Bill McGuire, was sacked along with other board members for repricing share options. His annual $126m package was not enough for him. Meanwhile more than 50 million Americans, including 10 million children, go without care – in the richest country in the world. Is this what we want?

Allyson Pollock is author of NHS plc: The Privatisation of Our Healthcare and professor and head of the centre for international public health policy at the University of Edinburgh.