by David U. Himmelstein, M.D.
WBUR 90.0
Posted by CommonHealth, Saturday, May 26th, 2007

If health spending continues to rise, Massachusetts’ health reform has no hope of long term success.

Every year, costs rise far faster than inflation, making health insurance less affordable for individuals, and tempting employers to stop offering coverage altogether. For city and town governments in the Commonwealth, health spending for public workers’ benefits rose 85% between 2001 and 2006, eating up most new tax revenues. And state government spending for Medicaid and other state health programs continues to skyrocket.

With unemployment low and tax revenues high, the state — as well as cities and towns – can scrape by and meet their healthcare obligations. But when the economy turns sour, tax revenues will drop and business will lay off workers and cut benefits for those who remain. The number of people needing free or subsidized coverage under Chapter 58 will balloon, just when the Commonwealth’s coffers are empty. Predictably, the subsidies and coverage will be slashed. Meanwhile, the costs of unsubsidized coverage will continue to rise, leaving fewer and fewer able to afford even the meager offerings under the Commonwealth Choice program.

Unfortunately, the cost control provisions included in Chapter 58 are laughable. No serious observer thinks the toothless “Quality and Cost Control Council” will be able to rein in costs. The computerized health records touted in the bill may improve quality — even that has yet to be proven — but there’s not an iota of evidence that they will save money. And while improved quality and increased prevention — the other pillars of cost containment in the law – are great ideas, they generally raise costs, not lower them. Americans currently receive only about 55% of recommended care, so improved quality frequently means more, not less care. Prevention often keeps people alive (and needing expensive medical care) for years, rather than allowing them to die a quick and cheap death. Indeed, when Louise Russell analyzed the cost implications of prevention some years ago, she could find few things beside immunizations that are likely to save money.

That’s the bad news.

The good news is that there is enormous fat in the current health care system that could be trimmed. By moving to a simple, single payer system we could save about half of the $5 billion we’ll spend on hospital bureaucracy in Massachusetts this year. $2 billion or more could be saved by simplifying doctors’ paperwork, eliminating the need for a huge office staff to do billing, costly billing software etc. And more than a billion could be saved on insurance overhead if we replaced our wasteful private insurance firms with a single public plan.

Additional savings could be realized by having a single payer for prescription drugs, which could bargain with drug companies and bring prices down to the levels that Canadians pay. And limiting the profusion of expensive – and often useless and even harmful — high tech care could save billions more. Doctors and hospitals may make a bundle by offering whole body CT scans to the worried well, but patients get mainly unnecessary radiation.

In sum, single payer reform could save enough to make health care affordable — for everyone. Without such reform, we’ll soon again see a rising tide of the uninsured.

David Himmelstein is an associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program

Michael Moore’s blast at medical care is hitting as U.S. seems ripe for changes

Victoria Colliver
Chronicle Staff Writer
Sunday, May 27, 2007

Michael Moore couldn’t have scheduled the release of his movie “Sicko” — an indictment of the U.S. health care system — at a more opportune time.

The film, which opens in theaters in the United States on June 29, arrives as many states, including California, have introduced health care reform proposals. In polls, health care routinely ranks among the public’s top domestic concerns. Health care reform is also expected to be an important theme in the presidential campaign for 2008.

Advocates already are trying to capitalize on the documentary, which premiered at the Cannes Film Festival in France last week, to further their political agendas.

“From the perspective of the health care reform movement, a high-profile representation of what patients commonly experience at the hands of insurers certainly adds momentum to the effort for true reform, both in California and across the country,” said Jerry Flanagan, health advocate for the Foundation for Taxpayer and Consumer Rights, based in Santa Monica.

The California Nurses Association and its national arm plans to host private premiere parties around the country and use the film’s release to distribute materials to audience members to support the union’s preferred reform models. The group, which opposes Gov. Arnold Schwarzenegger’s plan, supports the state and national single-payer proposals by state Sen. Sheila Kuehl, D-Santa Monica, and Rep. John Conyers Jr., D-Mich.

“Obviously, we’re looking at this as an opportunity to push the agenda in terms of comprehensive health reform,” said Rose Ann DeMoro, executive director of the nurses association. DeMoro was one of about 50 people who attended a screening a few days before its premiere in Cannes.

“I think it will probably do more for the health care reform movement than “(An) Inconvenient Truth” will do for global warming,” she said.

A political strategist hired by the film’s producer said he expects many more groups nationwide to use the film to advance their agendas.

“It’s serving as a call for action,” said Chris Lehane, a former consultant to President Bill Clinton. Lehane said Moore aims to promote universal coverage, get rid of the private insurance industry and regulate pharmaceutical companies.

While few health experts have seen the film, many have read media reports about “Sicko” and are familiar with the filmmaker’s provocative style in earlier films such as “Fahrenheit 9/11” and “Bowling for Columbine.”

In “Sicko,” Moore takes on the system through heath care horror stories, such as the tale of an uninsured man who lost two fingers in an accident. Hospital officials told him it would cost $12,000 to reattach his ring finger and $60,000 for his middle finger.

There are images of patients dumped back on the streets of Los Angeles by local hospitals. In the most controversial segment, Moore takes Sept. 11 workers with respiratory problems to Cuba to receive care that eluded them at home. And he takes on politicians who accept millions from insurers and drug manufacturers.

Moore’s team approached a number of California health and consumer groups, including the nurses association, the Foundation for Taxpayer and Consumer Rights and Health Access California, for individual stories about patients who were denied care or otherwise suffered at the hands of insurers, pharmaceutical companies or other health business interests.

“Rumor is they literally had hundreds, if not thousands, of stories to go through,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group.

Wright, whose group supports universal health care, said he hopes the movie draws attention to insurance industry practices that should be reformed or made illegal. For example, he pointed to lawsuits against Blue Cross of California and other insurers by consumers who were retroactively denied coverage after submitting claims.

Wright and other health experts expect the film to at least draw more national attention to the problems Americans have getting and paying for care.

“People know there’s a problem in the health care system, but most people don’t talk about it over dinner,” he said. “This (film) will engender those conversations around the country.”

Moore’s technique of portraying certain corporate or political entities as evil, as demonstrated in his earlier films, could mask some of the subtleties of a complex problem like health care, said Dr. Maren Grainger-Monsen, a filmmaker in residence at Stanford University’s Center for Biomedical Ethics.

“His work, in general, is provocative and inflammatory, but he does a good job in getting these topics in the public and getting people to talk about them,” Grainger-Monsen said. “The problem is he often oversimplifies the issue.”

Pharmaceutical Research and Manufacturers of America, the drug industry’s trade group, issued a press release earlier this month that discredited Moore’s filmmaking ability.

“A review of America’s health care system should be balanced, thoughtful and well-researched to pin down what works and what needs to be improved,” said Ken Johnson, the group’s senior vice president, in the statement. “You won’t get that from Michael Moore.”

The health insurance industry’s trade group, America’s Health Insurance Plans, said the film could bring attention to the more than 46 million Americans who don’t have health insurance.

“If, by making this movie, Michael Moore begins a conversation about the importance of getting all Americans covered, we agree with that,” said Karen Ignagni, president of the insurers’ group, adding that she had not seen the film.

Several prominent state health proposals, including ones in Massachusetts and California, have provisions that require individuals to obtain health insurance and offer government money to subsidize coverage for the poor. Proponents of a nationalized or single-payer plan have criticized reform plans that increase members for insurers.

According to media reports, the American health care system as portrayed by Moore fares poorly when compared with those of other countries, such as Canada, France and Great Britain.

Ignagni said she does not believe Americans would want the systems offered in those countries. “I don’t think people in the United States are going to be comfortable standing in line waiting to get elective surgery for almost a year,” Ignagni said.

Drew Altman, president of the Kaiser Family Foundation, questioned whether the film will really make an impact on health care reform.

Altman, who has not seen the film, said by the time needed legislation occurs on a national level the film could be long forgotten.

“The key question is how much the presidential candidates make health reform the focus of their presidential campaigns,” he said.

E-mail Victoria Colliver at vcolliver@sfchronicle.com.

Michael Moore’s blast at medical care is hitting as U.S. seems ripe for changes

Victoria Colliver
Chronicle Staff Writer
Sunday, May 27, 2007

Michael Moore couldn’t have scheduled the release of his movie “Sicko” — an indictment of the U.S. health care system — at a more opportune time.

The film, which opens in theaters in the United States on June 29, arrives as many states, including California, have introduced health care reform proposals. In polls, health care routinely ranks among the public’s top domestic concerns. Health care reform is also expected to be an important theme in the presidential campaign for 2008.

Advocates already are trying to capitalize on the documentary, which premiered at the Cannes Film Festival in France last week, to further their political agendas.

“From the perspective of the health care reform movement, a high-profile representation of what patients commonly experience at the hands of insurers certainly adds momentum to the effort for true reform, both in California and across the country,” said Jerry Flanagan, health advocate for the Foundation for Taxpayer and Consumer Rights, based in Santa Monica.

The California Nurses Association and its national arm plans to host private premiere parties around the country and use the film’s release to distribute materials to audience members to support the union’s preferred reform models. The group, which opposes Gov. Arnold Schwarzenegger’s plan, supports the state and national single-payer proposals by state Sen. Sheila Kuehl, D-Santa Monica, and Rep. John Conyers Jr., D-Mich.

“Obviously, we’re looking at this as an opportunity to push the agenda in terms of comprehensive health reform,” said Rose Ann DeMoro, executive director of the nurses association. DeMoro was one of about 50 people who attended a screening a few days before its premiere in Cannes.

“I think it will probably do more for the health care reform movement than “(An) Inconvenient Truth” will do for global warming,” she said.

A political strategist hired by the film’s producer said he expects many more groups nationwide to use the film to advance their agendas.

“It’s serving as a call for action,” said Chris Lehane, a former consultant to President Bill Clinton. Lehane said Moore aims to promote universal coverage, get rid of the private insurance industry and regulate pharmaceutical companies.

While few health experts have seen the film, many have read media reports about “Sicko” and are familiar with the filmmaker’s provocative style in earlier films such as “Fahrenheit 9/11” and “Bowling for Columbine.”

In “Sicko,” Moore takes on the system through heath care horror stories, such as the tale of an uninsured man who lost two fingers in an accident. Hospital officials told him it would cost $12,000 to reattach his ring finger and $60,000 for his middle finger.

There are images of patients dumped back on the streets of Los Angeles by local hospitals. In the most controversial segment, Moore takes Sept. 11 workers with respiratory problems to Cuba to receive care that eluded them at home. And he takes on politicians who accept millions from insurers and drug manufacturers.

Moore’s team approached a number of California health and consumer groups, including the nurses association, the Foundation for Taxpayer and Consumer Rights and Health Access California, for individual stories about patients who were denied care or otherwise suffered at the hands of insurers, pharmaceutical companies or other health business interests.

“Rumor is they literally had hundreds, if not thousands, of stories to go through,” said Anthony Wright, executive director of Health Access California, a consumer advocacy group.

Wright, whose group supports universal health care, said he hopes the movie draws attention to insurance industry practices that should be reformed or made illegal. For example, he pointed to lawsuits against Blue Cross of California and other insurers by consumers who were retroactively denied coverage after submitting claims.

Wright and other health experts expect the film to at least draw more national attention to the problems Americans have getting and paying for care.

“People know there’s a problem in the health care system, but most people don’t talk about it over dinner,” he said. “This (film) will engender those conversations around the country.”

Moore’s technique of portraying certain corporate or political entities as evil, as demonstrated in his earlier films, could mask some of the subtleties of a complex problem like health care, said Dr. Maren Grainger-Monsen, a filmmaker in residence at Stanford University’s Center for Biomedical Ethics.

“His work, in general, is provocative and inflammatory, but he does a good job in getting these topics in the public and getting people to talk about them,” Grainger-Monsen said. “The problem is he often oversimplifies the issue.”

Pharmaceutical Research and Manufacturers of America, the drug industry’s trade group, issued a press release earlier this month that discredited Moore’s filmmaking ability.

“A review of America’s health care system should be balanced, thoughtful and well-researched to pin down what works and what needs to be improved,” said Ken Johnson, the group’s senior vice president, in the statement. “You won’t get that from Michael Moore.”

The health insurance industry’s trade group, America’s Health Insurance Plans, said the film could bring attention to the more than 46 million Americans who don’t have health insurance.

“If, by making this movie, Michael Moore begins a conversation about the importance of getting all Americans covered, we agree with that,” said Karen Ignagni, president of the insurers’ group, adding that she had not seen the film.

Several prominent state health proposals, including ones in Massachusetts and California, have provisions that require individuals to obtain health insurance and offer government money to subsidize coverage for the poor. Proponents of a nationalized or single-payer plan have criticized reform plans that increase members for insurers.

According to media reports, the American health care system as portrayed by Moore fares poorly when compared with those of other countries, such as Canada, France and Great Britain.

Ignagni said she does not believe Americans would want the systems offered in those countries. “I don’t think people in the United States are going to be comfortable standing in line waiting to get elective surgery for almost a year,” Ignagni said.

Drew Altman, president of the Kaiser Family Foundation, questioned whether the film will really make an impact on health care reform.

Altman, who has not seen the film, said by the time needed legislation occurs on a national level the film could be long forgotten.

“The key question is how much the presidential candidates make health reform the focus of their presidential campaigns,” he said.

E-mail Victoria Colliver at vcolliver@sfchronicle.com.

New York Times
Letter to the Editor

Confronted too often with the sentiment so succinctly expressed by Nicholas D. Kristof when he writes that “even if a single-payer system isn’t politically possible right now” (“A Short American Life,” column, May 21), I can’t help but wonder what makes us different from the other developed nations that made the successful transition to national universal health care systems.

I’m tempted to blame the usual cast of special interests: enormously profitable commercial insurance and pharmaceutical companies; and providers who maximize revenues by promoting costly tests and procedures that deliver high margins but dubious outcomes.

But I’m beginning to wonder if it isn’t our own repetition of the defeatist notion that a national health care solution isn’t politically feasible that contributes to our inability to ultimately realize substantive health care reform.

The public needs to be disabused of the myths that portray the national health systems of other nations as inferior to ours when the reverse is demonstrably evident by measure of their health outcomes and per capita expenditures compared with ours.

If at first you don’t succeed, try, try again — and recognize that the special interests are hoping that we’ll grow weary and settle for less when we deserve better.

Ted Herman
Vice President, Communications
Hudson Health Plan
Tarrytown, N.Y., May 21, 2007

---

To the Editor:

Of course, it is pleasant to receive the recognition from Nicholas D. Kristof: “So bravo to the Physicians for a National Health Program,” which favors a single-payer system.

Let me return the accolade by informing him that Massachusetts’ recent legislation, which he found promising, is certainly not “feasible” and is already dysfunctional. This is important because a bevy of states are responding to private health insurance pressures with Massachusetts-like panaceas.

It is increasingly important for the morale of the American public that we move as promptly as possible to a Medicare-for-all solution. Time is running out.

Quentin D. Young, M.D.
National Coordinator, Physicians for a National Health Program
Chicago, May 22, 2007

Michael Moore’s new film about the US healthcare system must be seen in Europe as well as the US

Agnès Poirier
The Guardian
Monday May 21, 2007

In four tidy acts, Michael Moore spells out the facts. Act one: 50 million Americans have no health cover, and 250 million who think they do, through costly health insurance schemes ($2,000 per person a year), are often denied treatment when they need it. A guy without cover who chopped off two of his fingers in a bout of DIY was presented with an invoice for $12,000 to reattach his ring-finger and $60,000 for his forefinger. Being a romantic, and skint, he chose to get his ring-finger back.

Act two: when did it all start going wrong, asks Moore. The answer: in August 1971. President Richard Nixon and his adviser Edgar Kaiser plot to break the system. “The less care they give, the more money they make,” says Nixon, caught on tape. They? Their friends, the health industry moguls, the same ones who fund the political campaigns of US congressmen. Moore shows us the price tag on every single one of them. One in particular, Billy Tauzin, leaves Congress to become CEO of the drug industry’s top lobbying group, PhRMA, with a $2m a year salary.

Meanwhile astute national publicity campaigns have demonised the concept of universal healthcare by associating it with “socialised medicine”, which in American English translates as “Soviet medicine” – the kind such oppressive regimes as Canada, Britain and France have adopted for their citizens.

Act three: Moore pays these regimes a visit. Britain’s NHS is paid a well deserved tribute, with Tony Benn appearing as the country’s conscience. Then off to France. A mother of three explains that her state nanny does the family’s laundry while the creche down the street, with professionally trained staff, costs her 50p per hour. Moore concludes his French tour by asking: “Is there a reason why they want to make us hate the French? Are they afraid we might want to live like them?”

Act four, the most powerful: Moore decides to test the US administration’s claim that Guantanamo Bay prisoners get the best free healthcare in the world. He takes 9/11 volunteer rescue workers, whose health problems were not covered by the state because they weren’t on its payroll when they ran to help, to Guantánamo Bay in Cuba. At least he tries to. Arriving at the gates, Moore shouts through a loudspeaker: “I have 9/11 sick rescue workers, can you please open the gates?” A siren begins to wail. Moore and his troops make off as fast as they can – to Havana. Where they are treated immediately.

I know what you’re thinking, I know what you’re going to say. And so what? Yes, Michael Moore has an agenda. No, he isn’t among the giants of documentary film-making. No, he isn’t an ordinary journalist. He is, as he says, the op-ed variety, the kind who is constantly angry. He has issues with the way of the world and wants to set records straight. His goal is simply to put universal healthcare back at the centre of the American debate. And while Moore’s main objective is to reach his fellow Americans, his film should also make Europeans ponder on the system they too often take for granted. George Orwell would hate it. But forget about him for a minute. There may sometimes be such a thing as good propaganda.

Agnès Poirier, a journalist and film critic, is an independent adviser on British films for the Cannes film festival

agnescatherinepoirier@hotmail.com