PNHP

Hudson's Chapin on health insurance

Hudson's Chapin on health insurance

We All Need Healthcare; Who Needs "Insurance"?

By Georganne Chapin, JD, MPhil, President and CEO, Hudson Health Plan
Medscape General Medicine
July 27, 2007
Webcast Video Editorials

I am a health insurance and managed care executive so you may find this editorial a bit strange. I believe that the way to fix our healthcare system is to stop relying on insurance and focus instead on healthcare.

So, what’s wrong with health insurance?

Well, first, it’s temporary. This may work for auto policies, but not for human health.

Second, health insurance is mostly contingent on where you live and whom you work for. It’s easy to transfer car insurance, but not health insurance.

Finally, insurance companies make more money by minimizing pay-outs than by keeping people healthy. Human beings — who need preventive care, who have babies, who may lack living wages and job security, and who get older–find the house rules stacked against them.

Plans in Massachusetts, California, and soon New York propose to strew the same old red tape over even more people. Members of the same family could end up with separate policies, with different benefits and different expiration dates. This will make it even harder for doctors and hospitals to figure out whom to bill, which services are covered, and – worst of all – whether coverage will last long enough to complete treatment for a sick patient.

Other developed nations have universal healthcare, not “insurance.” They give healthcare to everybody, they spend less, and they are healthier for it.

But, we have an example of success in this country, too. It’s called Medicare. And while flawed, Medicare meets the most important criteria for a universal healthcare system: it’s permanent, it’s portable, and it’s simple and inexpensive to administer.

The health insurance model is flawed because it depends on people falling between the cracks after they pay their premiums and before they collect their “benefits.” Rather than insurance, providing healthcare to everyone would cost less and deliver more in the long run.

http://medgenmed.medscape.com/viewarticle/559758

Comment:

By Don McCanne, MD

Whether we call Medicare “insurance” or “healthcare” is not really important. What is important is that we need to stop relying on private insurance and adopt a public program that is “permanent, portable, and simple and inexpensive to administer.”

Hudson’s Chapin on health insurance

We All Need Healthcare; Who Needs “Insurance”?

By Georganne Chapin, JD, MPhil, President and CEO, Hudson Health Plan
Medscape General Medicine
July 27, 2007
Webcast Video Editorials

I am a health insurance and managed care executive so you may find this editorial a bit strange. I believe that the way to fix our healthcare system is to stop relying on insurance and focus instead on healthcare.

So, what’s wrong with health insurance?

Well, first, it’s temporary. This may work for auto policies, but not for human health.

Second, health insurance is mostly contingent on where you live and whom you work for. It’s easy to transfer car insurance, but not health insurance.

Finally, insurance companies make more money by minimizing pay-outs than by keeping people healthy. Human beings — who need preventive care, who have babies, who may lack living wages and job security, and who get older–find the house rules stacked against them.

Plans in Massachusetts, California, and soon New York propose to strew the same old red tape over even more people. Members of the same family could end up with separate policies, with different benefits and different expiration dates. This will make it even harder for doctors and hospitals to figure out whom to bill, which services are covered, and – worst of all – whether coverage will last long enough to complete treatment for a sick patient.

Other developed nations have universal healthcare, not “insurance.” They give healthcare to everybody, they spend less, and they are healthier for it.

But, we have an example of success in this country, too. It’s called Medicare. And while flawed, Medicare meets the most important criteria for a universal healthcare system: it’s permanent, it’s portable, and it’s simple and inexpensive to administer.

The health insurance model is flawed because it depends on people falling between the cracks after they pay their premiums and before they collect their “benefits.” Rather than insurance, providing healthcare to everyone would cost less and deliver more in the long run.

http://medgenmed.medscape.com/viewarticle/559758

Comment:

By Don McCanne, MD

Whether we call Medicare “insurance” or “healthcare” is not really important. What is important is that we need to stop relying on private insurance and adopt a public program that is “permanent, portable, and simple and inexpensive to administer.”

Californians shift views on reform

Californians Express Greater Dissatisfaction with the State's Health Care System, but Are Skeptical about Prospects for Health Reform This Year.

By Mark DiCamillo and Mervin Field
The Field Poll
August 22, 2007

In its latest statewide survey, The Field Poll asked California voters about their overall views of the health care system and prospects for reforming the state’s health care system. Some of the questions were identical to those asked in a previous Field Poll completed last December.

Questions Asked (Responses for August 2007, with December 2006 in parentheses)

How satisfied are you with the way the health care system is working in California? Are you very satisfied, somewhat satisfied, somewhat dissatisfied or very dissatisfied?

7% (13%) – Very satisfied

21% (38%) – Somewhat satisfied

27% (24%) – Somewhat dissatisfied

42% (20%) – Very dissatisfied

Which of the following statements is closer to your view of what California should do to improve the state’s health care system: (1) Rely on free market competition to improve the current health insurance system; (2) Make reforms within the framework of the current health insurance system, by encouraging shared responsibilities by employers, government and individuals; or, (3) Replace the current system with a new system administered entirely by state government and covering all Californians.

36% (24%) – Replace current system with a new state government-run system covering all Californians

33% (52%) – Make reforms within framework of current health insurance system through shared responsibilities by employers, government and individuals

14% (18%) – Rely on free market competition to improve health insurance system

8% (2%) – None/other (volunteered)

9% (4%) – No opinion

Big differences in health reform preferences across subgroups

There is a direct relationship between dissatisfaction with the health care system and support for creating a new government-run system. Among voters very dissatisfied with the way the health care system is working, nearly half (48%) favor replacing it with a new state government-run system that would cover everyone. This compares to just 19% support for a government-run system among voters who are very satisfied with the current system.

There are partisan and ideological differences in the health reform preferences of voters. Pluralities of Democrats, non-partisans and liberals favor replacing the current system with a government-run system that would cover everyone. By contrast, creating a government-run system is the least attractive of the three alternatives to Republicans and conservatives. They favor either taking a shared responsibilities approach or relying on the free market system. Voters who identify themselves as politically moderate are evenly split between creating a new government-run health care system (34%) and reforming the system by sharing responsibilities among employers, government and individuals within the existing health insurance system (34%).

http://www.field.com/fieldpollonline/subscribers/Rls2239.pdf

Comment:

By Don McCanne, MD

This poll does demonstrate a significant increase in the perceived dissatisfaction with the health care system in California in the past eight months, with the total dissatisfied increasing from 44% to 69%.

From a policy perspective, the most dramatic change has been in the opinions of what we should do about it. In December, twice as many thought that we should reform the current health insurance system, whereas now more believe that we should “replace the current system with a new system administered entirely by state government and covering all Californians.”

Since our health care system has not changed that much in the past eight months, what could account for this shift in opinion? Simply stated, Californians have put into place the fundamentals of citizen action: grassroots, education, coalitions – in various combinations. Just a few of those involved include the California Nurses Association, Health Care for All, the OneCareNow campaign, League of Women Voters, California Physicians Alliance/PNHP, advocates for Sen. Sheila Kuehl’s SB 840, activities around Sicko, community forums, op-eds and letters in support of public insurance and in opposition to flawed policies of other publicized political approaches to reform, etc, etc. Thousands of organizations and hundreds of thousands of individuals have been involved in organizing grassroots coalitions and educating the public on the actual issues and options.

In real numbers, the support for public insurance has increased from only one-fourth to slightly over one-third. Although that represents a plurality of those polled, it falls far short of a political mandate.

We can’t let up. The issues are complex. The public needs to be educated on the fundamentals of health policy if we are to counter the misinformation campaign spewing from the non-think rhetoric tanks. We have a lot more work ahead of us, but we can do it. But it will take all of us. Start thinking now about what else you can do.

Single-payer coverage already works in U.S.

BY JAMES C. MITCHINER
The Ann Arbor News
Sunday, August 19, 2007

The recent launch of health reform in Massachusetts, centered on a joint individual-employer mandate, calls to mind the approach taken by Michigan’s road repair crews to the potholes that appear in the spring: cosmetic, incremental, and oblivious to the crumbling infrastructure that lies beneath.

The hallmark of health care reform over the last 20 years, regardless of whether it’s been done on the state or federal level, has been to fix the cracks, fill in the holes and smooth over the rough spots – basically, anything that’s needed to prop up a fundamentally flawed system. We have seen state and federal reform proposals in various iterations, generally presented with great fanfare and with promises that were either short-lived or never materialized.

The one approach we haven’t tried – because of fear, complacency, politics, apathy, or all of the above – is to wring out the inefficiencies in financing, while maintaining our basic fee-for-service delivery model. This is the basic premise behind single-payer national health insurance.

It is sad that so many people see red when they hear the term “single-payer.” One imagines them conjuring up visions of rampant socialism, with all the epithets inherent in that moniker: massive governmental bureaucracy, indiscriminate rationing, crushing tax burden, long waits for care, incompetent graft-prone civil servants.

But I would like to think that reasonable people would look beyond the inflammatory rhetoric that disparages single-payer, and at least consider the potential salutary benefits.

Consider first the enormous administrative costs inherent in our current pluralistic “system,” one that is dominated by 1,200 private health insurers. These costs use up money that is detoured from acute and preventive medical care. We spend about 31 cents of every health care dollar on administration; Canada, with its single-payer system, spends just 17 cents. Each year, we pay more and seemingly get less, as the insurance companies attempt to restrict access and impose upon employees more restrictive cost-sharing arrangements while collecting higher profits. Employers are scaling back their employee health insurance coverage, with the result that more people are being priced out of the insurance market. And the inability to pay medical bills is responsible for about half of the personal bankruptcies filed each year in the U.S.

Single-payer is not “socialized medicine,” a term that is reserved for a system where the government owns the hospitals and the physicians are civil servants. Rather, a single-payer arrangement combines a private health care delivery system with public financing and puts everyone in a common risk pool. It reduces administrative inefficiencies and severs the link between employment and health care, making health insurance truly portable.

Single-payer would lead to a reduction in out-of-pocket expenses by reducing deductibles, co-payments and co-insurance. It would give you the freedom to select your own doctor and hospital, without first obtaining “preauthorization” by your current managed care plan. It would reduce health care disparities between Caucasians and under-represented minorities. And it would nurture free enterprise by ending the struggle of American companies to keep up with escalating health care costs, which makes them less competitive in a global market.

An analogy to single-payer is public education: we use federal and state tax dollars to finance K-12 education for every child regardless of parental income or job status (i.e., no means testing). If you switch jobs without moving out of the district, you don’t have to pull Johnny out of his third-grade classroom and transfer him to another school. If you lose your job, the school district does not deny Johnny an education. Parents have every right to eschew public schools and enroll their children in a private school of their choosing, financed by their own resources. And finally, the state Board of Education does not tell individual teachers how to grade the math test or what color chalk to use.

Single-payer would consolidate administrative functions, simplify billing, streamline claims management for patients and providers, and reduce costs. The Government Accountability Office has estimated that administrative savings from a single-payer system would be in excess of $200 billion annually, more than enough to cover those who are presently uninsured. Of course, a modest increase in payroll taxes would pay for it, but at the same time, individual households would be spared the average $11,500 in annual insurance premiums they are now paying for health insurance, an amount that is increasing by roughly 8 percent to 10 percent per year.

When people think of single-payer, they often think of Canada. Canada does not have a perfect health care system – no country does. Many of the problems in Canada, such as long waits and restricted access to the latest technology, have more to do with chronic under-funding by federal tax dollars, at least by American standards, than the structure of Canada’s health care system per se.

On a per-capita basis, the U.S. spent about $7,092 per person in 2005; Canada spent roughly 55 percent of that.

It would be reasonable to assume that if we pumped our per-capita expenditures into a Canadian-style system, we might not have the problems that our northern neighbors have.

Given finite resources, rationing in one form or another is inherent in any health care system. However, regardless of its flaws, the Canadian system generally allocates care according to medical need, rather than patient socioeconomic status. Over 80 percent of Canadians receive elective surgery within three months, and there is no evidence that Canadians are wait-listed for emergency surgeries. We don’t see busloads of Canadians crossing the border into Michigan every day to get expedited MRIs, nor is there evidence of a mass immigration of Canadian physicians into the U.S.

Also, polls have shown that Canadians are generally pleased with their system and an overwhelming majority of those asked would not want to replace it with American-style medicine.

Finally, to those who think single payer would never work in the U.S., consider this: the most popular health insurance program in the U.S., based on patient surveys, is a single-payer, government-run, tax-financed, administratively lean, non-means-tested, universal access program. Perhaps you’ve heard of it: Medicare. With administrative expenses of only 3 percent of annual receipts (versus 18 percent or more for some for-profit HMOs), Medicare is economically efficient.

When it was created 42 years ago, Medicare was castigated by the American Medical Association as a program of “socialized medicine” that would impede the doctor-patient relationship, destroy American health care and undermine democracy. Yet within a few years of its birth, it was a big hit with patients because it guaranteed access to hospital and medical services, while doctors (and hospitals) loved it because it guaranteed payment.

We can do better in American health care, and we should. It is time to seriously consider advocating for single-payer health insurance.

About the writer: James C. Mitchiner, an Ann Arbor resident, is an emergency physician at St. Joseph Mercy Hospital in Ann Arbor and president-elect of the Washtenaw County Medical Society. To contribute essays to Other Voices, contact Mary Morgan, opinion editor, at 734-994-6605 or mmorgan@annarbornews.com.

OECD report on private insurance impact on costs

Private Health Insurance in OECD Countries

OECD (Organisation for Economic Cooperation and Development)
Policy Brief
September 2004

Has (private insurance) helped relieve cost pressures?

Policy makers often look to private health insurance markets as an alternative or additional source of funding for publicly financed health systems, especially when these budgets are stretched to capacity. Yet health systems in OECD countries continue to be predominantly financed from public sources, which account, on average, for 72% of total health expenditure, compared to 6.3% for private health insurance and 19% for out-of-pocket payments. Only in the United States does private health insurance exceed a third of total health expenditure, at 35%, while it goes above 10% only in the Netherlands, Canada, France, Germany and Switzerland.

Whatever the role played in a health system, private health insurance has added to total health expenditure. Most OECD countries apply less government control over private sector activities and prices, compared to public programmes and providers. Private insurers tend to have less bargaining power over the price and quantity of care as compared with public systems, particularly single-payer ones. Countries that have multiple sources of primary coverage, including those with significant private health insurance market size, tend to be those with the highest total health spending levels per capita, such as the United States, Switzerland, Germany and France.

http://www.oecd.org/dataoecd/42/6/33820355.pdf

Comment:

By Don McCanne, MD

The OECD (Organization for Economic Cooperation and Development) “brings together the governments of countries committed to democracy and the market economy from around the world.” This Policy Brief, published three years ago, describes the economic impact of private health insurance in OECD countries.

As we address reform in the United States, high health care costs are a concern that we all share. This highly credible OECD report reveals that reform based on private health plans would add even more to our total health expenditure – not exactly the solution we seek.

A recent Quote of the Day discussed a report from WHO (World Health Organization), also on private health insurance. Although OECD is oriented more towards economic considerations (a concern for all of us), and WHO is oriented more towards the health of the people (a concern for advocates of social justice), both reports came to similar conclusions on the impact of private insurance.

From the WHO report:

“Evidence shows that private sources of health care funding are often regressive and present financial barriers to access. They contribute little to efforts to contain costs and may actually encourage cost inflation.”

How much more evidence do we need that private insurance models of reform should be rejected as we proceed with health care financing reform in the United States?

Remember Universal Health Care?

Ads In Iowa Target Democratic Front-Runners On Health Insurance

By Kevin Friedl
National Journal Group Inc.
Tuesday, Aug. 21, 2007

For a few weeks this summer, it looked as though health care was shaping up to be the most important issue of the Democratic presidential primary, aside from Iraq. Michael Moore’s “Sicko” was still in theaters and candidates were stumbling over themselves to release detailed policy proposals explaining how they would expand medical coverage to more Americans.

But while the ongoing battle over the State Children’s Health Insurance Program has kept health care in the news, recent sparring between the candidates over foreign policy experience and fundraising from lobbyists has helped bury it below the fold.

A new ad campaign running in Iowa seeks to put universal health care back in the spotlight and into the speeches of the three leading Democratic contenders. The National Nurses Organizing Committee, a group representing some 45,000 nurses nationwide, and Physicians for a National Health Program launched the series of minute-long ads last week in a buy that included two airings during the Democratic debate in Des Moines on Sunday.

The spots feature individuals talking directly into the camera about problems plaguing the health care system and explaining why the country needs “single-payer guaranteed health care.” In each ad, the camera cuts back to reveal the speaker has been addressing a cardboard cutout of either Hillary Rodham Clinton, John Edwards or Barack Obama. “Don’t be silent,” says an announcer at the end of each spot. “Let the Democratic candidates for president know that real leadership on health care doesn’t mean just being better than the Republicans.”

While the basic message of the individual ads is the same, each takes a slightly different tack in arguing for universal insurance coverage. “Speechless John Edwards” features a businessman arguing for the economic advantages of a single-payer system. The woman in “Speechless Barack Obama” tells a personal story of the hardships that private insurance companies can cause. And in “Speechless Hillary Clinton”, a registered nurse makes an emotional appeal, saying, “I don’t want to be forced to choose between which patients get the best care, between who lives and who dies.”

Each spot argues very specifically for universal coverage, and although questions about health insurance featured more prominently in Sunday’s Democratic debate than in previous forums, the groups sponsoring the “Speechless” ads say they want more policy specifics and bigger changes.

As opposed to the Republicans, “the Democrats are at least talking about health care reform,” said Charles Idelson, a spokesman for the NNOC. “Regrettably, most major proposals do not solve the crisis. What they do is reinforce the existing insurance-based system.”

With a universal health care bill floating around the House, Bush promising to veto both versions of the SCHIP bill once Congress reconvenes and Republican candidates like Rudy Giuliani already preparing their own insurance policy proposals, the health care issue appears to be heating up once again.

Questions, comments or suggestions concerning Ad Spotlight can be sent to adspotlight@nationaljournal.com.

Medicare fee reduction for ASCs

Doc group says new ASC rate would be 'death blow'

By Jennifer Lubell
Modern Physician
August 20, 2007

Ambulatory surgery centers (ASCs) are trying to figure out how they’ll cope with a new Medicare payment system that threatens to drastically reduce their reimbursement rates.

The CMS last month issued a series of regulations to revise the payment system for ASCs, setting a new compensation rate of 65% of what hospital outpatient departments get paid under Medicare. While some centers may seek to benefit under the rule, others–particularly single-specialty ASCs, whose payments are expected to drop dramatically–will be left with some tough decisions on whether to keep their Medicare patient base or to close their doors altogether.

The new payment rate was included in the annual proposed rulemaking for the hospital outpatient prospective payment system, or OPPS, whose final rulemaking is usually issued in November and goes into effect the following calendar year.

The CMS’ procedures bring the total number of covered surgical procedures under the revised payment system to about 3,300. The agency stipulates that ASCs will get paid for any procedure that is determined by the CMS not to pose a safety risk to Medicare beneficiaries, and will not require an overnight stay.

“The system we are announcing today will promote the goals of quality and efficiency in care furnished to people with Medicare in ambulatory surgery centers,” said Leslie Norwalk, who resigned last month as the CMS’ acting administrator, in a written statement. The revised system will also take a “major step forward” toward eliminating financial incentives for choosing one care setting over another, she said.

(David Johnson, M.D., president of the American College of Gastroenterology) and others in the industry dispute that fact. If anything, the rule “will force Medicare patients to migrate back into the more expensive hospital outpatient setting, ultimately costing the federal government more,” he says.

http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20070820/MODERNPHYSICIAN/308200004/-1/newsletter06

Comment:

By Don McCanne, MD

Why should Medicare pay higher prices for procedures done in a hospital outpatient setting than it does for procedures done in an efficient, free-standing ambulatory surgery center (ASC)? This is our tax money. Shouldn’t we be receiving a better value?

It is important to understand that the extra payment to hospitals is not wasted. That extra buffer helps to fund charity care, money-losing services such as emergency centers, and other essential hospital services that may not be directly reimbursed. The hospital balance sheet does require the input from profit centers to balance the losses that are inevitable in other services. Hospitals cannot remain solvent if they allow profitable services to be outsourced while continuing to provide only services that result in losses. Thus the taxpayers are receiving value for the Medicare fees being paid to hospitals for ambulatory services.

What about the fees paid to ASCs? Although they are already lower than the fees paid to hospitals, they are much higher than their actual costs since the ASCs do not have to pay for all of the ancillary services and money-losing services that hospitals must provide. Also, since ASCs do not provide charity services, they don’t have to make up those losses with higher fees. CMS has determined, through the outpatient prospective payment system (OPPS), that profits are excessive, and that they can and should be reduced. Thus the lower fees will provide greater taxpayer value.

In a way, this is poetic justice. The ASCs were established primarily to dramatically enhance the fees paid to procedure-oriented physicians. By building and owning these centers, the physicians would receive not only their high, procedure-oriented professional fees, but they would also share in the generous profits of the free-standing ASCs. The profits were further enhanced by cream-skimming the profitable patients and dumping the others on the hospitals. (The fees for each paying patient that displaces a charity patient primarily go directly to the profit line, because fixed costs remain the same.) Though the prices of the procedures have been lower, the total costs to the taxpayer actually have been higher than they should have been because we still had to support the losses in our hospitals. It was only appropriate that the OPPS be used to improve taxpayer value in purchasing these services.

A previous Quote of the Day message on the book, “Medicare Prospective Payment and the Shaping of U.S. Health Care,” by Rick Mayes, Ph.D. and Robert A. Berenson, M.D., explained how Medicare is far more effective than the private insurance industry in setting fees that are based on legitimate costs and fair profits. The experience with ASCs provides us with yet one more example of why we should replace our fragmented, dysfunctional system of financing health care with a single public system that serves all of us well – the patients (affordable access), the providers (fair profits), and the taxpayers (value purchasing).

Canada's public health care system holds answers to surgery wait times

Canadian Centre for Policy Alternatives and the BC Health Coalition.
Press Release

(Ottawa) Surgical waitlists can be dramatically cut if governments develop a strategy to scale up innovations already underway in the public health care system, says a new study released today.

Why Wait? Public Solutions to Cure Surgical Waitlists looks at groundbreaking projects in BC, Alberta, Saskatchewan and Ontario that have significantly reduced wait times for procedures such as hip and knee replacements, cataract surgery and others.

The Saskatchewan Surgical Care Network, Canada’s first province-wide surgical patient registry, has used pro-active strategies to reduce wait times. “Accurate data is essential for creating management strategies and targeting resources for achieving long term success in wait list management,” says network Chair, Dr. Rob Weiler. The network doesn’t just report waitlists–regional health authorities are expected to actively manage them in partnership with surgeons.

The study also examines Alberta’s Hip and Knee Replacement Project and Ontario’s Wait Time Strategy, both successful initiatives. Five projects in British Columbia are profiled, including the Joint Replacement Access Clinic (JRAC) at Lions Gate Hospital in North Vancouver, where waits for the first surgical consult have dropped from almost a year to between two and four weeks. Without any additional resources, the project implemented common waitlits and a one-stop booking service that streamlines all aspects of patient screening and care before, during and after surgery.

The projects point to two key reforms needed in the surgical system:

* Team-based care in specialized clinics: Surgeons moved from working mainly on their own to working in teams in specialized clinics. The shift to team-based care means patients are better prepared for surgeries, operations are less likely to be cancelled, operating rooms function more efficiently and hospital stays are shorter. These projects also make greater use of nurses and other health care workers at every stage of the process.

* Pro-active waitlist management: Shifting responsibility for managing waitlists from individual surgeons to health authorities means patients can access the first available surgeon. Health authorities in turn can make sure efficiencies and best practices from individual hospitals are applied across the system.

“Canadians don’t need superficial wait time guarantees,” says study co-author Dr. Michael Rachlis. “We need a strategy that helps provinces implement the kinds of public sector innovations featured in this study. The federal government’s wait time guarantee fails to provide that leadership, and leaves the door open to private delivery.”

“Solving the waitlists problem will require some major cultural shifts in how our surgical system functions,” says co-author Marcy Cohen. “We need more collaboration, not a competitive private model that will siphon precious health care professionals out of the public system.”

“There’s this myth out there that only the private sector can innovate, but this study shows that is false,” says Rachlis.

-30-

Why Wait? Public Solutions to Cure Surgical Waitlists was released today by the Canadian Centre for Policy Alternatives and the BC Health Coalition.

To arrange an interview, call Terra Poirier, 604-801-5121 x229 or Shannon Daub, 604-801-5121 x226 (cell 604-836-9372).

For BC Health Coalition interviews only, call Leslie Dickout at 604-681-7945.

* Editorial: Public Solutions Could be Undermined by Private Interests
* Press Release: Innovative surgical projects show how waitlists can be solved: Submission to BC ‘conversation on health’

Download the Report/Study:

* Why Wait? Public Solutions to Cure Surgical Waitlists – PDF File, 747 Kb
* SUMMARY: Why Wait? Public Solutions to Cure Surgical Waitlists – PDF File, 569 Kb

Insurance doesn't make you feel secure

By Rose Ann DeMoro
South Florida Sun-Sentinel
August 12, 2007

News that some doctors in South Florida will now be charging patients annual “administrative fees” like credit card companies or banks is a sober reminder of how out of control our increasingly dysfunctional healthcare system has become, and in need of genuine, comprehensive reform.

On the same day the South Florida Sun-Sentinel reported the latest trend of doctors’ fees — on top of the other out-of-pocket charges for co-pays and deductibles — a Wall Street Journal/NBC News poll August 2 found that “costs of health care” is the top economic concern for Americans. Those findings echoed what has become a steady drumbeat this year. What is now evident is the problem is no longer just the 45 million Americans without health coverage, but increasingly the health insecurity for those already insured.

In January, a vice president of the Kaiser Family Foundation testified to the House Ways and Means Committee that one in six adults who are privately insured have “substantial problems paying their medical bills.”

In February, the journal /Health Affairs /projected out-of-pocket costs for consumers would jump 76 percent within the next decade.

In March, the journal of the American Academy of Pediatrics noted that families with high deductible health plans are far more likely to put off needed care due to the cost.

In April, Harvard researchers found that higher healthcare costs place a particularly harsh burden on women who typically have greater medical needs than men.

In July, a Rand study in the /Journal of the American Medical Association /reported that for each 10 percent hike in out-of-pocket costs, patients stop buying up to 6 percent of needed prescription drugs.

Some doctors may well feel squeezed by a health care industry where higher revenues and increased market share seem to be the new Hippocratic oath. But every additional tax and fee only exacerbates the crisis for patients and families.

And public anger is increasing at those who are profiting off their pain and health insecurity. The /Journal//NBC poll on Americans’ views on the economy also asked respondents to rate their confidence in 16 varied institutions. The bottom rung was firmly held by health insurance companies.

Those polled may not know the numbers, but they would probably not be surprised to learn that insurance industry profits jumped from $20.8 billion in 2002 to $57.5 billion in 2006. In the same period, drug company profits went from $64.4 billion to $94.8 billion, according to a June report by the Institute for Health and Socio-Economic Policy, the research arm of the California Nurses Association/National Nurses Organizing Committee.

Americans have had enough. Several recent polls have documented that two-thirds believe the government should guarantee healthcare for everyone, even if it means an increase in taxes.

There is one reform that accomplishes that goal — HR 676 in Congress, a single-payer system in the form of an expanded and enhanced Medicare for all. It would cover everyone with comprehensive benefits, choice of physician and hospitals, and end the thousand daily cuts of co-pays, deductibles, and new administrative fees. Perhaps best of all, it gets the insurance companies out of the way.

The public is ready. Now we just need our legislators and presidential candidates to follow.

Rose Ann DeMoro is executive director of the California Nurses Association/National Nurses Organizing Committee, www.calnurses.org.

In search of vision on health care

Presidential candidates talk about it, but their plans fall short.

Editorial
Des Moines Register
August 19, 2007

“Millions of our citizens do not now have a full measure of opportunity to achieve and to enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.”

Who spoke those words?

A. Hillary Clinton, at the Iowa State Fair.

B. Mitt Romney, in a town-hall meeting.

C. President Harry Truman, in a 1945 speech to Congress proposing a national health-care system, and President Lyndon Johnson, who quoted Truman when he signed Medicare and Medicaid into law in 1965.

Those words sound like statements made by today’s candidates, but if you chose C, you get an A in health-care history.

Unfortunately, the words of Truman are as true today as they were 62 years ago. An estimated 47 million Americans are uninsured and don’t have the opportunity to enjoy good health. They aren’t protected against the financial disaster an illness can bring. This country is facing a health-care crisis. In poll after poll, Americans list health care as the most important domestic issue.

What’s needed: a president with the vision and passion to reform this country’s health-care system the way Johnson and Congress eventually did.

It’s up to Iowans – who are in the unique position of being visited by droves of presidential candidates – to demand that kind of vision and passion from our visitors.

It’s time for this country to do something historic. The creation of Medicare and Medicaid were historic. Poor and elderly Americans needed health care. Congress responded.

Now it’s time for Congress to respond again by creating a system that provides basic coverage to all Americans at an affordable cost. This editorial page has long argued that the best option would be to finance the system through tax dollars, similar to the popular Medicare program for seniors. Under so-called “single-payer” systems, the government is the payer for services delivered by private-sector hospitals, doctors and clinics. Patients would still choose their own doctors.

Such a system would dramatically cut red tape and administrative costs. Medicare’s administrative costs run less than 5 percent, compared to double-digit administrative costs in the private sector.

It’s up to the next president to lead Congress down the road to an affordable health-care system that covers everyone. All of the candidates spend time on the stump criticizing the current system. And several have rolled out reform plans. Unfortunately – with a few exceptions – the plans are tepid or misguided or half-baked. They’re too safe. They lack vision.

Some plans wouldn’t really cover everyone. Others are vague about the price tag or include no realistic mechanisms to control costs. Most gloss over the tough questions about what a “basic” plan would really cover.

Maybe they fear offending the insurance industry and powerful special interests that make campaign contributions. Or they’re afraid a plan will be labeled “socialized medicine.” Or they push ideas such as “electronic medical records” – which amount to tinkering with the system.

What they should be pushing is vision – the vision of doing what’s right.

Leaving millions of Americans without health insurance isn’t right. Forcing people into bankruptcy because they’re sick isn’t right. Living in a country that offers great medical advances and life-saving treatments but to only some of the people isn’t right.

Twentieth-century American history is littered with failed health-care reform plans. The next president must have a clear vision for doing right by Americans on health care – and the passionate persistence to see a reform plan enacted.

Standing up for what’s right starts on the campaign trail.

Single-pay system would slash costs

By CINDY PURVIS
GoErie.com
August 10, 2007

In 2004, General Motors announced that liabilities for employee health care topped $60 billion. In November 2005, GM laid off 30,000 employees. In January 2006, Ford cut 25,000 jobs. In February, Chrysler announced that it faces $21.1 billion in future retiree health-care liabilities. The majority of the obligation is not funded.

The fortunate employees of companies that have made health care part of a benefits package are seeing an ever-decreasing benefit. Small businesses find it impossible to afford health-care benefits for their employees, and many can’t afford to purchase health-care insurance for themselves.

Our entire country is walking around in fear of getting sick; in fear of the annual increase in health insurance; in fear of changing jobs; in fear of being denied coverage because of a pre-existing condition.

In Pennsylvania, some very brave people have come out to confront our collective fear.

They have written a bill and found a group of braver Pennsylvania senators and representatives who have introduced the Family & Business Health Security Act.

This is SB300 in the Senate and HB1660 in the House.

It provides for total coverage for every Pennsylvanian and includes medical, dental, vision, mental health, prescription drugs and long-term care. There are never any co-pays, never any applications and never any denials.

It is funded by the cost-saving, single-payer system. No, this is not socialized medicine, though socialized medicine works well for Veterans Administration medical centers, which are owned by the federal government, and staffed by government employees.

The Family & Business Health Care Security Act is instead funded by a change in how we all pay for health care. Instead of purchasing health insurance, health care would be financed mainly through a new 10 percent employer payroll tax.

Most businesses would save money. Several examples that are near and dear to us taxpayers are our local taxing bodies.

With the cost of health-care coverage for the employees being reduced to just 10 percent of payroll, the city of Erie would save more than $5 million per year, the Erie County almost $5 million per year and the the Erie School District $9 million per year. It would save smaller school districts, such as Harbor Creek, almost $900,000, and Corry more than $1.3 million per year.

Instead of paying into a health-insurance plan or purchasing their own, Pennsylvanians would pay a 3 percent of earnings payroll tax. For a family making $50,000 per year, the cost would be $1,500. But remember: There is never a co-pay or a fee for prescriptions or out-of-pocket expenses.

These funds would go into a trust called the Pennsylvania Health Care Trust Fund.

All money collected and received by the plan are by law to be used exclusively to finance the plan. In other words, no other state agency or legislative body could dip into this fund for use in other areas. Pennsylvanians are assured that the funds are put into “a lock box” to be used only for health care.

This plan gives us the freedom to choose our own doctors, dentists, hospitals and any other decision affecting our health.

This plan eliminates the greed-ridden insurance system that chooses for us what care we are allowed to receive.

This system is of the people, by the people, for the people. We will no longer need to live in fear of getting sick or changing jobs or retiring.

This plan also eliminates the need for companies to pay retiree health-care benefits. Whatever Medicare does not cover would be automatically covered under this plan.

For more information, to read the entire bill or to get a petition to distribute to garner support from our area Pennsylvania legislators: www.healthcare4allpa.org.

CINDY PURVIS is an Erie resident. She is a member of Lake Erie Alliance for Democracy and co-chairwoman of HealthCare4All Pa, an organization focused on providing health care for every American.

World's Best Medical Care?

Editorial
New York Times
Published: August 12, 2007

Many Americans are under the delusion that we have “the best health care system in the world,” as President Bush sees it, or provide the “best medical care in the world,” as Rudolph Giuliani declared last week. That may be true at many top medical centers. But the disturbing truth is that this country lags well behind other advanced nations in delivering timely and effective care.

Michael Moore struck a nerve in his new documentary, “Sicko,” when he extolled the virtues of the government-run health care systems in France, England, Canada and even Cuba while deploring the failures of the largely private insurance system in this country. There is no question that Mr. Moore overstated his case by making foreign systems look almost flawless. But there is a growing body of evidence that, by an array of pertinent yardsticks, the United States is a laggard not a leader in providing good medical care.

Seven years ago, the World Health Organization made the first major effort to rank the health systems of 191 nations. France and Italy took the top two spots; the United States was a dismal 37th. More recently, the highly regarded Commonwealth Fund has pioneered in comparing the United States with other advanced nations through surveys of patients and doctors and analysis of other data. Its latest report, issued in May, ranked the United States last or next-to-last compared with five other nations — Australia, Canada, Germany, New Zealand and the United Kingdom — on most measures of performance, including quality of care and access to it. Other comparative studies also put the United States in a relatively bad light.

Insurance coverage. All other major industrialized nations provide universal health coverage, and most of them have comprehensive benefit packages with no cost-sharing by the patients. The United States, to its shame, has some 45 million people without health insurance and many more millions who have poor coverage. Although the president has blithely said that these people can always get treatment in an emergency room, many studies have shown that people without insurance postpone treatment until a minor illness becomes worse, harming their own health and imposing greater costs.

Access. Citizens abroad often face long waits before they can get to see a specialist or undergo elective surgery. Americans typically get prompter attention, although Germany does better. The real barriers here are the costs facing low-income people without insurance or with skimpy coverage. But even Americans with above-average incomes find it more difficult than their counterparts abroad to get care on nights or weekends without going to an emergency room, and many report having to wait six days or more for an appointment with their own doctors.

Fairness. The United States ranks dead last on almost all measures of equity because we have the greatest disparity in the quality of care given to richer and poorer citizens. Americans with below-average incomes are much less likely than their counterparts in other industrialized nations to see a doctor when sick, to fill prescriptions or to get needed tests and follow-up care.

Healthy lives. We have known for years that America has a high infant mortality rate, so it is no surprise that we rank last among 23 nations by that yardstick. But the problem is much broader. We rank near the bottom in healthy life expectancy at age 60, and 15th among 19 countries in deaths from a wide range of illnesses that would not have been fatal if treated with timely and effective care. The good news is that we have done a better job than other industrialized nations in reducing smoking. The bad news is that our obesity epidemic is the worst in the world.

Quality. In a comparison with five other countries, the Commonwealth Fund ranked the United States first in providing the “right care” for a given condition as defined by standard clinical guidelines and gave it especially high marks for preventive care, like Pap smears and mammograms to detect early-stage cancers, and blood tests and cholesterol checks for hypertensive patients. But we scored poorly in coordinating the care of chronically ill patients, in protecting the safety of patients, and in meeting their needs and preferences, which drove our overall quality rating down to last place. American doctors and hospitals kill patients through surgical and medical mistakes more often than their counterparts in other industrialized nations.

Life and death. In a comparison of five countries, the United States had the best survival rate for breast cancer, second best for cervical cancer and childhood leukemia, worst for kidney transplants, and almost-worst for liver transplants and colorectal cancer. In an eight-country comparison, the United States ranked last in years of potential life lost to circulatory diseases, respiratory diseases and diabetes and had the second highest death rate from bronchitis, asthma and emphysema. Although several factors can affect these results, it seems likely that the quality of care delivered was a significant contributor.

Patient satisfaction. Despite the declarations of their political leaders, many Americans hold surprisingly negative views of their health care system. Polls in Europe and North America seven to nine years ago found that only 40 percent of Americans were satisfied with the nation’s health care system, placing us 14th out of 17 countries. In recent Commonwealth Fund surveys of five countries, American attitudes stand out as the most negative, with a third of the adults surveyed calling for rebuilding the entire system, compared with only 13 percent who feel that way in Britain and 14 percent in Canada.

That may be because Americans face higher out-of-pocket costs than citizens elsewhere, are less apt to have a long-term doctor, less able to see a doctor on the same day when sick, and less apt to get their questions answered or receive clear instructions from a doctor. On the other hand, Gallup polls in recent years have shown that three-quarters of the respondents in the United States, in Canada and in Britain rate their personal care as excellent or good, so it could be hard to motivate these people for the wholesale change sought by the disaffected.

Use of information technology. Shockingly, despite our vaunted prowess in computers, software and the Internet, much of our health care system is still operating in the dark ages of paper records and handwritten scrawls. American primary care doctors lag years behind doctors in other advanced nations in adopting electronic medical records or prescribing medications electronically. This makes it harder to coordinate care, spot errors and adhere to standard clinical guidelines.

Top-of-the-line care. Despite our poor showing in many international comparisons, it is doubtful that many Americans, faced with a life-threatening illness, would rather be treated elsewhere. We tend to think that our very best medical centers are the best in the world. But whether this is a realistic assessment or merely a cultural preference for the home team is difficult to say. Only when better measures of clinical excellence are developed will discerning medical shoppers know for sure who is the best of the best.

With health care emerging as a major issue in the presidential campaign and in Congress, it will be important to get beyond empty boasts that this country has “the best health care system in the world” and turn instead to fixing its very real defects. The main goal should be to reduce the huge number of uninsured, who are a major reason for our poor standing globally. But there is also plenty of room to improve our coordination of care, our use of computerized records, communications between doctors and patients, and dozens of other factors that impair the quality of care. The world’s most powerful economy should be able to provide a health care system that really is the best.