PNHP

EPO and market competition

EPO and market competition

Doctors Reap Millions for Anemia Drugs

By Alex Berenson and Andrew Pollack
The New York Times
May 9, 2007

Two of the world’s largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses.

The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at levels that might increase patients’ risks of heart attacks or strokes.

Industry analysts estimate that such payments — to cancer doctors and the other big users of the drugs, kidney dialysis centers — total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers. The payments have risen over the last several years, as the makers of the drugs, Amgen and Johnson & Johnson, compete for market share and try to expand the overall business.

The rebates are related to the amount of drugs that doctors buy, and physicians that agree to use one company’s drugs exclusively typically receive higher rebates.

Neither Amgen nor Johnson & Johnson has disclosed the total amount of the payments. But documents given to The New York Times show that at just one practice in the Pacific Northwest, a group of six cancer doctors received $2.7 million from Amgen for prescribing $9 million worth of its drugs last year.

The medicines — Aranesp and Epogen, from Amgen; and Procrit, from Johnson & Johnson — are among the world’s top-selling drugs, with combined sales of $10 billion last year. In this country, they represent the single biggest drug expense for Medicare and are given to about a million patients each year to treat anemia caused by kidney disease or cancer chemotherapy.

Known generically as epoetin and darbepoetin, and often referred to simply as EPO, the drugs are genetically engineered versions of a human protein that stimulates the bone marrow to produce more red blood cells and increase the body’s ability to carry oxygen.

Since 1991, when the first of the drugs was still relatively new, the average dose given to dialysis patients in this country has nearly tripled. About 50 percent of dialysis patients now receive enough of the drugs to raise their red blood cell counts above the level considered risky by the F.D.A.

American patients receive far more of the anemia drugs than patients elsewhere, with dialysis patients in this country getting doses more than twice as high as their counterparts in Europe. Cancer care shows a similar pattern. American cancer patients are about three times as likely as those in Europe to get the drugs, and they receive somewhat higher doses.

Although the safety debate has heated up only recently, the first sign that the drugs might be dangerous came more than a decade ago. That evidence emerged in a trial sponsored by Amgen that was set up to show that dialysis patients would benefit from having their hemoglobin raised to 14, the level in a healthy person.

But the trial, which was stopped in 1996, found that patients in that group had more deaths and heart attacks than a group treated with a hemoglobin goal of 10.

That trial should have discouraged doctors from using too much epoetin and encouraged Amgen to study the risks further, said Dr. Steven Fishbane, a nephrologist at Winthrop-University Hospital on Long Island.

Instead, use of epoetin continued to soar. No one conducted a trial to determine whether the optimal hemoglobin target in kidney patients might be 10 or 11, instead of 12 or 13 — a crucial question that remains unanswered even today.

Dr. Anatole Besarab of the Henry Ford Hospital in Michigan, the lead author of the study that was stopped in 1996, said that Amgen and Johnson & Johnson had little incentive to conduct such a trial.

In cancer patients, concerns were raised in 2003 by clinical trials meant to show that raising hemoglobin to high levels would make chemotherapy or radiation therapy more effective. Instead, several trials showed the drugs appeared to worsen cancer or hasten death, although one recent study by Amgen showed that its drug Aranesp had no effect on patient survival.

Dr. Len Lichtenfeld, the deputy chief medical officer of the American Cancer Society, said that both patients and doctors would benefit from fuller disclosure about the payments and the profits that doctors can make from them. “I suspect that Medicare is going to take a very careful look at what is going on here,” he said.

Federal laws bar drug companies from paying doctors to prescribe medicines that are given in pill form and purchased by patients from pharmacies. But companies can rebate part of the price that doctors pay for drugs, like the anemia medicines, which they dispense in their offices as part of treatment. The anemia drugs are injected or given intravenously in physicians’ offices or dialysis centers. Doctors receive the rebates after they buy the drugs from the companies. But they also receive reimbursement from Medicare or private insurers for the drugs, often at a markup over the doctors’ purchase price.

Medicare has changed its payment structure since 2003 to reduce the markup, but private insurers still often pay more. Combined with those insurance reimbursements, the rebates enable many doctors to profit substantially on the medicines they buy and then give to patients.

http://www.nytimes.com/2007/05/09/business/09anemia.html?hp

Comment:

By Don McCanne, MD

In financing health care, the United States depends more on market forces while other nations utilize greater government oversight. The EPO story demonstrates that even physicians, when offered a legal, lucrative business deal, will modify their practice patterns to increase profit, even though those market incentives may work to the detriment of their patients’ health. It is easy to ignore outcomes and talk about “healthier hemoglobins” when the financial rewards for doing so are great.

Other nations depending on government oversight use EPO in more appropriate doses that benefit the health of their patients.

Although this is an ugly, shameful story, there is good news here.

Medicare, a government insurance program, has recognized the perversities and has altered the payment structure. And they are not finished. At a time when most policymakers are calling for an expansion of coverage through private health plans, this experience provides yet one more important piece of evidence that private insurers should be dismissed as administrators of our health care funds. As this article states, “Medicare has changed its payment structure since 2003 to reduce the markup, but private insurers still often pay more.”

Value is often defined as greater quality at lower cost. The private insurers have perpetuated the myth that private plans provide greater value through the marketplace, even though the health policy literature has established that they increase costs while ignoring the real parameters of quality. The EPO saga has demonstrated, once again, that Medicare is a leader in value purchasing in health care.

Medicare currently purchases health care for about one-eighth of our population. Just imagine the health care value we could all have if we dumped the private insurers and established a single, improved Medicare for all of us.

National health care would solve problem

Kevin Collins
Normal, Ill
The Pantagraph
Letter to the Editor

The recent letter from Gary Christiansen (“Give no free rides for retired employees,” April 23) and the response from Elma Voorheis (“Retired employees paid for their benefits,” April 30) clearly demonstrate a fundamental problem in our health-care system.

Rising costs, increased lifespan, and population and economic shifts have placed a larger burden of health-care costs on to users of the system.

As much as I sympathize with Ms. Voorheis, it is a simple fact that the money set aside for health care will not be sufficient to pay the total cost – whether you worked for the government or the private sector. Everybody is going to need to pay more money into the system to pay the bills.

Retired private sector employees are facing rising deductibles, higher co-pays and, in some cases, are losing their health-care benefit altogether. They, too, paid into their benefit packages for, in many cases, well over 20 years.

Mr. Christiansen is merely pointing out that it would be unfair to subsidize retired government workers at the expense of everybody else when everybody is facing the same problem.

The solution to this problem is a single-payer national health insurance plan.

Access to comprehensive health care is a human right. Pursuits of corporate profit and personal fortune have no place in care-giving and create enormous waste.

The United States already spends enough to provide comprehensive health care to all Americans with no increase in total costs.

However, to achieve this, the vast health-care resources now squandered on bureaucracy, profits, marketing and useless or even harmful medical interventions must be shifted to needed care, and would be under a single-payer system.

Private insurers depleting Medicare Trust Fund

Methods Used by Insurers Are Questioned

By Robert Pear
The New York Times
May 6, 2007

Insurance companies have used improper hard-sell tactics to persuade Medicare recipients to sign up for private health plans that cost the government far more than the traditional Medicare program, federal and state officials and consumer advocates say.

Insurance agents, spurred in some cases by incentives like trips to Las Vegas, have aggressively marketed the private plans, known as Medicare Advantage plans. Enrollment in them has skyrocketed in the last year, and Medicare officials foresee continued rapid growth in the next decade.

Proponents of private plans say they are indisputably good for many older Americans because they coordinate care and may offer extra benefits, like discounts on eyeglasses, hearing aids and dental care.

But federal officials said that the fastest-growing type of Medicare Advantage plan generally does not coordinate care, does not save money for Medicare and has been at the center of marketing abuses.

These “private fee-for-service plans” allow patients to go to any doctor or hospital that will provide care on terms set by the insurer. In most cases, no one manages the care. And some patients have found that they have less access to care, because their doctors refuse to take patients in private fee-for-service plans.

Moreover, those plans may be more expensive than traditional Medicare for some patients, because the co-payments for some services may be higher. The Medicare Payment Advisory Commission says that the cost to the government is also higher because it pays the private fee-for-service plans, on average, 19 percent more than the cost of traditional Medicare.

Richard S. Foster, chief actuary for the Medicare program, said “the additional payments to Medicare Advantage plans, above and beyond the costs” of traditional Medicare, were causing higher premiums for all beneficiaries and speeding the depletion of the Hospital Insurance Trust Fund for Medicare.

http://www.nytimes.com/2007/05/07/washington/07medicare.html?pagewanted=all

Comment:

By Don McCanne, MD

Why would the private fee-for-service Medicare Advantage plans engage in abusive sales practices? The answer is obvious. There is tremendous profit in these plans.

In the traditional Medicare program, profits for health plans are not a consideration since middlemen do not even exist. Nor does the traditional Medicare program need to deal with marketing expenses and other superfluous administrative excesses.

Congress insists that private plans are necessary to help prevent the “bankruptcy” of the Medicare Hospital Insurance Trust Fund. Yet their private solution for a government problem, according to Medicare’s own actuary, is speeding up the depletion of the Trust Fund.

We are being inundated with proposals to avoid the inevitability of “Medicare for All.” Policymakers are going to extremes to devise methods of keeping the private plans in play. They keep their blinders on because they don’t want to face the reality that it is now impossible to design individual private plans that provide adequate protection while remaining affordable.

The private insurers are bad people who are taking hugh amounts of funds that should be going toward patient care. They can no longer be dismissed with sterile comments about the market advantages of the private sector business model of financing health care. The profitable reports that the private insurers submit to Wall Street should no longer be allowed to gloss over the theft of our public Medicare funds.

And that applies to the theft of our private insurance funds as well, even if we are remaining complicit by our inaction.

HISTORIC Rally for Single-Payer Healthcare

Nurses, School Employees, Teachers, Firefighters and Patients Demand SB 840 and Genuine Healthcare Reform

Sen. Sheila Kuehl Addresses Crowd

For Immediate Release
May 7, 2007

Contact: Shum Preston, 510-273-2276 or Chuck Idelson, 510-273-2246

A broad-based coalition of some 2,000 healthcare activists will stage a historic May 8 rally in Sacramento in support Sen. Sheila Kuehl’s ground-breaking SB840, which proposes guaranteed healthcare on a single-payer model, and against Governor Schwarzenegger’s proposal to increase insurance industry revenue and control over healthcare.

The rally is sponsored by the California Nurses Association/National Nurses Organizing Committee in conjunction with the California School Employees Association, California Federation of Teachers, California Professional Firefighters, California Faculty Association, California Alliance for Retired American, California Council of Churches Church IMPACT, Consumer Federation of California, Health for All, and the California Physicians Alliance. State Sen. Sheila Kuehl will address the rally and call for the passage of her bill

SB 840 to establish a guaranteed healthcare system similar to “Medicare for All” with genuine universal coverage, comprehensive and uniform benefits, effective cost controls, and an end to insurance industry interference with delivery of care.

What: Massive Rally for Guaranteed Healthcare
When: Tuesday, May 8, 12 Noon
Where: California State Capitol North Steps, Sacramento

“Nurses have fought insurance companies, HMOs, hospital chains, and anyone else who would let our patients suffer from inadequate care. Genuine reform, like SB 840, is the only effective way to ensure we achieve the humane healthcare system Americans want and deserve,” said Deborah Burger, RN, and CNA/NNOC president.

“Sadly, many of the school employees I work with never get to see a nurse. That’s because they don’t have health insurance. Over the past two decades, thousands of school employees throughout our state have lost their school district health benefits. Our schools and colleges are being squeezed by outrageous insurance rate hikes, and like everyone else they are paying more money for fewer benefits,” said Michael Mazzanti, from CSEA. Mazzanti is the lead custodian for Cloverdale High School in Sonoma County. He serves on the board of directors of the California School Employees Association as the Area B director.

In conjunction with the event, CNA/NNOC will debut GuaranteedHealthcare.org, an online campaign that will feature videos of patients telling their stories of abuse, injury and mistreatment at the hands of a medical industry driven by corporate rather than human needs. Patients will have the power to upload and share their own stories, a crucial tool in building a grassroots movement to stand up to the powerful insiders setting the terms of our national healthcare debate.

Both the May 8 rally and the patient videos featured at www.GuaranteedHealthcare.org will reflect the view held by the nurses of CNA/NNOC and patient activists that any healthcare reform must guarantee that all patients receive a single standard of high-quality healthcare for all.

Many of the reforms proposed in today’s healthcare debate will have the opposite effect: mandating the purchase of private insurance, as has been advocated by Governors Mitt Romney and Arnold Schwarzenegger, among others, will only increase the percentage of care dollars going to industry overhead, while subjecting patients to an industry built on the denial of care. By contrast, a single-payer reform, similar to Medicare for All, will allow patients to choose from among private doctors and hospitals who are paid from a national, non-profit fund. As has been proven in developed nations around the world, this is the only way to guarantee healthcare for all. In addition to SB 840, CNA/NNOC supports U.S. Rep. John Conyers’ similar national bill H.R. 676.

Representing 75,000 RNs from California to Maine, the California Nurses Association/National Nurses Organizing Committee is the fastest-growing association of direct-care RNs in the nation. Learn more at www.CalNurses.org

Shum Preston
Communications Department
California Nurses Association/National Nurses Organizing Committee
510-273-2276

Support Single-Payer Universal Healthcare
http://www.SinglePayer.com

HEALTH CARE GAPS: Single payer is not socialized medicine

By DR. ANNE COURTRIGHT
The Pueblo Chieftan, Colorado
Sunday, May 6, 2007

We spend twice as much as any other advanced country on health care yet we rank 37th in the world on health outcomes. Catastrophic medical bills bring on bankruptcy while insurance companies spend 30 percent or their money on administration, marketing and profit. Medicare For All would mean we all contribute and we all get necessary health care. Doctors remain independent and hospital remain private and non-profit.

More than 46.5 million people in the United States are uninsured, 770,000 in Colorado and millions more are underinsured. According to the Kaiser Family Foundation, family premiums averaged $11,500 in 2006 while a full time worker, at minimum wage, earns $10,712.

Almost half of personal bankruptcies in this country are filed because of catastrophic medical bills. Seventy-five percent of these families had health insurance when illness struck. Colorado health insurance premiums for families rose 102 percent (more than doubled) between l996 and 2003. High health insurance premiums are making our companies less competitive on the world market, as we are the only advanced country in the world without a universal healthcare system.

Most Americans think we have the best health care in the world. Sadly, the only place we are number one is the amount of money we spend. In health outcomes we rank 37th worldwide.

Why? Because too many of our health care dollars go to administration and profit. The multiple insurance companies, policies and regulations have greatly increased the overhead and frustration of both doctors and hospitals. Health insurance companies spend almost 30 percent of their income on administration, marketing, huge salaries and stock options for their CEOs and dividends for their stockholders. Medicare spends just over 3 percent on administration.

We need to reform the health care delivery system, with the goal of delivering quality health care to every resident of the United States. Care rather than profit should be the driving force. Our current system is not working for the good of our citizens.

Many current proposals for universal health care are only a reshuffling of the present system and will not solve the problem. We need to remove private health insurance companies from the system and have everyone in a single, national risk pool.

A tax-supported single payer program – a modified, expanded Medicare type of system – would save us about $300 billion per year in administrative costs, which could then be spent on direct health care. This is not socialized medicine. Doctors would remain independent and hospitals would be privately owned and non-profit.

They would not bill patients for care, but would negotiate a yearly global budget with the local health board. Doctors would have a single form to fill out and send to one central location. The doctor and patient would again make the decisions about needed care. Everyone contributes. Everyone gets health care. HR676 would create such a national plan. Urge its support!

For a speaker or more information call 719-544-4956, go to www.healthcare-now.org , www.healthcareforallcolorado.org or www.pnhp.org , or attend a free public forum from 5:30-8 p.m. May 14 at the County Conference Room, 1001 N. Santa Fe.

Anne Courtright, a psychiatrist retired from the Colorado Mental Health Institute at Pueblo, is a member of numerous community organizations, including the Pueblo County Medical Society and the League of Women Voters.

Democrats Escalate Attack on Single Payer

Snuff Politics

By CORPORATE CRIME REPORTER

The Corporate Democratic Party is into snuff politics.

The target this month–single payer, Medicare for all.

The motive–protect the corporate health insurance industry.

Democratic snuff politics was on display yesterday on Capitol Hill.

Senator Ron Wyden was on the Hill surrounded by his corporate supporters–Steve Burd, CEO, Safeway Inc., Art Collins, CEO of Medtronic, Inc, H. Edward Hanaway, CEO, CIGNA, Steve Sanger, CEO, General Mills, and Ronald Williams, CEO, Aetna, Inc.

Wyden has introduced legislation that is similar to that introduced by Republican Massachusetts Governor Mitt Romney and Republican California Governor Arnold Schwarzenegger.

All claim to create universal health care.

None can, do or will.

What’s the common denominator between Wyden-care, and Romney-care and Schwarzenegger-care?

Individual mandates.

The individual must get insured or the individual is violating the law.

As opposed to single payer.

Which says to the health insurance companies–get out.

We will take care of our people.

If you sell basic health insurance, you are violating the law.

Everyone is in one insurance pool.

Nobody is out.

All are covered.

No bills, no co-pays, no deductibles.

No losing your health insurance when you change jobs.

No escalating premiums when you get sick.

Cheaper than the current system.

With better outcomes.

One approach sets up a system that outlaws individual wrongdoing.

The other sets up a system that outlaws corporate wrongdoing.

The corporate executives were at the press conference to support Wyden’s plan and to push their own newly created Coalition to Advance Healthcare Reform.

The key element focused on by the CEOs–market-based healthcare system.

The goal–derail publically funded single payer legislation that will cut administrative waste.

The single payer bill has 70 sponsors in the House of Representatives and is supported by 52 percent of the American people.

When asked why he doesn’t support single payer when 52 percent of the American people do, Wyden didn’t blush.

“The people of my state, not a poll, but at the ballot box in 2002, they voted by about 3-1 against a single payer proposal,” Wyden said.

Well yeah, after the insurance industry dumped millions to scare people into believing the government was going to take over their lives.

“If you go to a community meeting and take a poll in my state, what people want is coverage like their member of Congress gets,” Wyden said. “They want benefits like their members of Congress. They want the quality of care that their members of Congress get.”

But can’t single payer deliver exactly that?

Mildly irritated by this question, Wyden reminds reporters in the room that single payer is not the topic of this press conference.

(No, the topic is snuffing out single payer.)

“My guess is that single payer is more government than Americans want, number one,” he says. (The CEOs nod their
heads in approval.)

“And number two–how do you get there from here?” he asks.

How do you get there from here?

Pass single payer.

Wyden actually means–how do you get there from here if you anger the CEOs of Aetna and CIGNA and all of the other CEOs standing behind him at the press conference by supporting single payer?

Well, one way you get there from here is by building political support for single payer.

Hold a press conference with ordinary Americans and announce an attack on the corporate health care system that results in 31 percent of healthcare spending on administrative costs, that triggers half of all personal bankruptcies, that leaves 45 million uninsured and 16 million underinsured.

None of this by the way was a surprise to long-time Wyden watchers.

Greg Kafoury is a public interest lawyer based in Portland.

“That Wyden would host a health care news conference surrounded by corporate CEOs is typical of his career in politics,” Kafoury told Corporate Crime Reporter. “Most of his public life has been dedicated to serving big money. With his constituency in Oregon, he could be a hero of the people and support single payer. The tragedy is that there is no need for him to serve power rather than confront it.”

So that’s one tragedy–the corporate Democrats.

The other tragedy is the so-called progressive Democrats.

They held a one day conference in Washington, D.C. last week–titled–The Big Con–The Failure of American Conservatism.

It was sponsored by the Campaign for America’s Future–the outfit directed by Robert Borosage and Roger Hickey–and The American Prospect magazine.

The day-long event featured a debate between American Prospect editor Robert Kuttner and neocon William Kristol.

The title–Can Conservatives be Trusted to Govern?

Everyone in the room understood the answer to be no.

The unanswered question, only touched on by Kuttner, was whether Democrats could be trusted to govern.

Kuttner grazed by it when he said the $64,000 question was whether the Democratic Party could throw off its corporate funders.

“As the income distribution becomes more concentrated, so does the distribution of political power,” Kuttner said. “For the Republicans, that’s not a contradiction. Wealthy Republicans pay Republicans to be Republicans and to carry out conservative ideology. Wealthy Democrats for the most part, except on social issues, pay Democrats to be less like Democrats. So, one party starts out with one hand tied behind its back. The cure for that is leadership.”

Which was severely lacking at the conference.

Democratic pollster Stanley Greenberg told the conference that one recent poll of likely voters showed that 52 percent want a Canadian-style single payer system. And fully 70 percent of Democratic primary voters want such a system.

If that’s true, how come even the progressive leaders at the conference who work on health care, like Hickey and Yale University Professor Jacob Hacker, don’t support single payer?

“The problem is that you can’t just tell people–you are going to have to change all of your arrangements overnight,” Hickey told Corporate Crime Reporter. “The problem is telling people that have good health insurance–you have to shift to something else.”

The other problem with single payer, Hickey says, is that the insurance companies would fight it tooth and nail.

Hickey says that if you take a pro-single payer stance, “you will be relegated to the sidelines and you won’t have any leverage over the political debate that goes on this year.”

“The question people have to ask is–are we going to get the political debate heading in a single payer direction, or do we abdicate the field and let Hillary and Edwards and the best of them end up with something like Schwarzenegger’s plan, which is all private insurance, or Romney’s plan.”

But if Edwards had come out for single payer, he would have energized the 70 percent of Democratic Party primary voters who want it, right?

“And if elephants could fly, you would have a flying circus,” Hickey says dismissively.

Hacker is the progressive Dems academic guru on health care.

At the conference, we asked him–why not single payer?

“I am someone who is quite appreciative of single payer,” Hacker said. “But countervailing that political story, which is certainly a true story, are the political risks of displacing the private insurance of highly paid workers and the fiscal costs of creating the system in one fell swoop.”

“The seventy House Democrats who support single payer are a powerful force for major reform,” Hacker says. “They should keep pressing for bold action. They only should be willing to talk about compromise at a point in which they think something could really happen and be valuable. My role as a policy analyst is to try and craft something that could be that compromise, something that could be Medicare for many. Keep in mind, nearly 60 percent of all Americans would be in this Health Care for America plan. And projections show at least ten more percent within a decade. So, we are talking about 70 percent of Americans.”

Hacker says that insurers and employers will initially resist anything that reduces their role entirely.

“But once you get the system in place, both actors will see incentives to work with it instead of against it,” Hacker said.

“With insurers, it’s a little more iffy.”

So, the political reality of health care in America can be summed up as a tale of Two Big Cons.

Big Con One–the conservatives offering prosperity for all and delivering cronyism and favoritism for the rich.

And Big Con Two–the progressive Democrats, promising universal health care, and then joining with corporate Democrats and corporate America to snuff out single payer.

Corporate Crime Reporter is located in Washington, DC. They can be reached through their website.

Steve Burd's Coalition to Advance Healthcare Reform

Reforming health care

By Steve Burd
The Washington Times
May 7, 2007

Today, a large group of employers and business leaders are joining to form the Coalition to Advance Healthcare Reform.

We agree that any lasting solution must be based on five core principles.

First… market forces… consumer orientation and transparency…

Second… every American should be required to carry health insurance…

Third… assistance for low-income individuals…

Fourth… health-care plans must be designed to promote healthy behavior… prevention and wellness… full-care management programs for those with chronic and acute conditions…

Finally… individuals must be able to purchase health care in the same tax-advantaged way as businesses do…

Together we can force action and results from policies that create market-based solutions that solve the cost and coverage problems in this country.

http://www.washingtontimes.com/op-ed/20070506-095007-6584r.htm

Some of the coalition members: PepsiCo, General Mills, Pacific Gas and Electric, Wm. Wrigley Jr. Co., The Kroger Co., Aetna, Blue Shield of California, Cigna HealthCare, Eli Lilly and Co. and PacifiCare.

http://www.latimes.com/news/local/la-me-health7may07,0,4141456.story?coll=la-home-headlines

Comment:

By Don McCanne, MD

We emphatically welcome the business community into the national dialogue on reform. But does this effort really advance reform?

Burd’s proposal is an individual mandate to purchase unaffordable or inadequate private insurance, using regressive tax policies, with greater administrative excesses of care management programs, and it depends on the
fiction of consumer cost management through transparency.

Burd’s bird will never fly.

Prescription for health care

Single-payer system best for Colorado

By Kristen Hannum
Rocky Mountain News
May 5, 2007

Dr. Rocky White of Alamosa was seeing a growing number of patients who were without adequate insurance. The conservative rancher and physician knew many people weren’t coming in at all for the preventive care that would keep them healthy.

After studying the problem, White decided “Everybody in, nobody out,” was the answer to the U.S. health-care crisis. Universal health care, via single-payer financing, brings quality care for far less money per capita in other industrialized countries. Why not here?

His bill, with input from the Colorado Nurses Association and other groups, became the basis for Health Care for All Colorado’s proposal to the 208 Commission.

Through the Colorado Health Services plan, Coloradans’ health coverage would no longer be tied to an employer but would be continuous from birth to death.

Everyone would be covered and be funded through individual and business contributions and federal tax dollars. The plan would offer better benefits, including mental health, dental, optical, home-health and long-term care, than any single private plan does today. Each resident would choose a health-care provider and choose a hospital.

Providers would stay in private practice and compete for business, but all payments would come out of a single health fund. Everyone (except for the very poorest Coloradans) would contribute to the fund. No one would need to fear bankruptcy because of health-care costs.

Colorado Health Services would basically be a publicly owned, not-for-profit insurance company, similar to a public utility. A board, accountable to the people, would manage the program. Administration would be under five regional boards.

Colorado Health Services would reduce administrative costs since everyone would be covered by the same comprehensive plan. Physicians and patients could make health-care decisions based on patient need and not insurance company policy. Doctors, hospitals and nurses would no longer need extra staff to negotiate billing with hundreds of companies and thousands of policies. The program would provide for retraining displaced workers.

Funding is up to the legislature. Either a tax or a public insurance system could finance the Colorado Health Service plan.

Single-payer, universal health-care costs elsewhere run about half as much as in our current for-profit market-driven system. As a society, we would be paying the same or less to cover everyone.

The plan would also use an integrated information technology network. This would make tracking costs and outcomes easier, so providers could more easily adopt best practices.

Colorado Health Services would bring all Coloradans access to high-quality, cost-effective health care. Single-payer financing means better medical practices and cost savings. Universal care means more productive workers, healthier families and stronger communities. This is sensible, affordable, comprehensive reform.

Kristen Hannum is the program administrator for Health Care for All Colorado.

Working to fix the health-care crisis

By W.J. Coggins
The Tuscaloosa News
Published Sunday, May 6, 2007

Public concern about the costs and conflicts in medical care and in the larger issues of health care have indeed reached crisis levels. Not a day goes by without stories in newspapers, on radio and television and in major magazines, featuring various aspects of these issues. Recently a weekday edition of The Tuscaloosa News had seven articles on various aspects of health care including Alzheimer’s disease, shaken-baby syndrome (to go from one extreme to the other), how to pay for long-term care and four others.

Total expenditures for health care in the U.S. for 2006 were an estimated $2 trillion. It is hard to conceptualize a trillion of anything, but those of you who saw the happy faces of 92,000 football fans at the A-day game in the Sunday paper can imagine each of them having $2 million to dump into a very large container. That would pay the health- care costs, public and private, for the whole country for one year. “Public” means we pay that in taxes and “private” means salary deductions and out- of-pocket payments. Typically this cost goes up about 6 percent every year. Not trivial.

The steadily rising costs of health care is a worldwide problem. In the other industrial nations where costs are rationally managed, the total burden on the economy is half as much as ours because they have a single-payer system either managed by the government or smaller governmental units. The overall quality of care in these countries, measured by life expectancy, infant mortality rates, patient satisfaction and other parameters, is better than ours.

We have fallen behind as our costs have gone up faster than theirs, principally because we have used a/smarket-based, for-profit system for health insurance, hospital ownership and for many ambulatory care services. Competition has failed to prove itself in health care, after a 50-year trial in the United States. The largest loss is not in dollars, but the steady intrusion of the for-profit motive in the actual delivery of medical care.

Doctors and their teams find themselves constrained from doing what is best for the patient by the rules of nonmedical managers. Just one of many examples is the constraint on the length of stay in the hospital. Too often patients with complicated illnesses are discharged too early unless the doctor calls a nameless, faceless person for permission to extend the stay. Likewise, return visits to the doctor are challenged, or permitted, only by time-consuming phone calls. There are many other prohibitions in providing the best care for the patient.

The eminently available answer to our failing nonsystem is a single payer plan and the successful model is Medicare. The Medicare model covering all U.S. citizens would provide hospital care, doctor visits, prescription drugs, dental care and nursing home care — with the patient’s choice of hospitals and physicians. The government would pay an intermediary, like Blue Cross Blue Shield or some other specially organized entity. The intermediary would pay physicians, hospitals and other providers. For-profit health insurance companies and for-profit hospitals would be eliminated. The cost to the taxpaying public would be a 5.8 percent tax on employers (far less than the present cost for employee benefit plans) and a 2.9 percent tax on employees.

The benefits will be immense. Our 47 million uninsured citizens will be covered. Manufacturers and other businesses will be relieved of a huge burden, making them more competitive with offshore industries.

Health care in the U.S. will be a kinder, gentler enterprise and the practice of medicine and health-care delivery in general will be more efficient and gratifying.

Those readers who are interested in helping with this problem should contact Health Care for Everyone–Alabama, 3105 Warrington Road, Birmingham, AL 35223.

W.J. Coggins, M.D, Tuscaloosa

Steve Burd’s Coalition to Advance Healthcare Reform

Reforming health care

By Steve Burd
The Washington Times
May 7, 2007

Today, a large group of employers and business leaders are joining to form the Coalition to Advance Healthcare Reform.

We agree that any lasting solution must be based on five core principles.

First… market forces… consumer orientation and transparency…

Second… every American should be required to carry health insurance…

Third… assistance for low-income individuals…

Fourth… health-care plans must be designed to promote healthy behavior… prevention and wellness… full-care management programs for those with chronic and acute conditions…

Finally… individuals must be able to purchase health care in the same tax-advantaged way as businesses do…

Together we can force action and results from policies that create market-based solutions that solve the cost and coverage problems in this country.

http://www.washingtontimes.com/op-ed/20070506-095007-6584r.htm

Some of the coalition members: PepsiCo, General Mills, Pacific Gas and Electric, Wm. Wrigley Jr. Co., The Kroger Co., Aetna, Blue Shield of California, Cigna HealthCare, Eli Lilly and Co. and PacifiCare.

http://www.latimes.com/news/local/la-me-health7may07,0,4141456.story?coll=la-home-headlines

Comment:

By Don McCanne, MD

We emphatically welcome the business community into the national dialogue on reform. But does this effort really advance reform?

Burd’s proposal is an individual mandate to purchase unaffordable or inadequate private insurance, using regressive tax policies, with greater administrative excesses of care management programs, and it depends on the
fiction of consumer cost management through transparency.

Burd’s bird will never fly.

Single-payer system would give us the world's best care

By DR. JOHN DALEY
Union Leader
Commentary
May 2, 2007

THE APRIL 25 editorial “Rationing health care: Some want that for NH” represents another attempt by members of the health insurance industry, or someone with very good insurance, to torpedo the best choice for health care reform — a single payer system, or Medicare for all — by using scare words like rationing or socialized medicine.

As a family physician on the front lines of medicine I daily see the difficulties patients face due to lack of insurance or under-insurance. Generally these patients ration their own care, disappearing for a year or two when they lose their job and insurance, only to return with sky-high blood pressures or out- of-control diabetes, effectively taking years off their lives.

In New Hampshire, approximately 135,000 citizens lack health insurance, and for those who have it many can’t get all they need. The MRI wait may not be long, but many people can’t see their doctor, much less get an MRI. Now with health savings accounts and high deductible plans I have insured patients refusing their MRIs due to the cost.

It is estimated that 18,000 Americans die annually due to lack of insurance — which is a rather harsh effect of our present method of rationing. Shouldn’t the elimination of these deaths be a national priority?

The editorial mentions Canadians coming to the United States for surgery because of better and more readily available care. These numbers are rather small and the editorial fails to mention Americans going to Canada to get affordable drugs or the ever-increasing phenomenon of medical tourism where Americans travel abroad to get surgeries that are more affordable.

The bottom line is that Canadians enjoy longer, healthier lives than Americans, despite spending far less than we do, while covering every citizen. In a recent survey, only 3.5 percent of Canadians reported feeling that they waited too long for care, which is a much smaller number than our 15 percent uninsured who wait quite a bit. Long waits are a misleading myth.

Furthermore, a recent Harris Interactive poll of patients in the leading industrial societies found that Canada ranked first and the United States last in patient satisfaction with health care. You can’t just poll those with good insurance, after all!

Remember the term “single payer” as the best solution to our health care system’s problems. If one believes that health care is a human right and not a privilege, and if one wants to avoid having a health insurance company — which profits by denying care — choosing which tests you can have and which drugs you can take, it is the best answer.

The government pays for more than 50 percent of health care costs already through Medicare, Medicaid, federal employees, the military and the Veterans Administration, so it is not a radical stretch to extend Medicare to all Americans to cover the uninsured.

HR 676 has been introduced in the U.S. House of Representatives by (along with others) Democratic presidential candidate Dennis Kucinich. The New Hampshire House has shown great wisdom in introducing a resolution to study single-payer care for New Hampshire.

When discussing health care reform, don’t be scared by words like “rationed” or “socialized.” Be informed, be wise and be empathic — choose what’s best for America and all its citizens, not just those with good insurance.

If we took the money, structure and ingenuity in the current health care arena and applied it to the whole population via a single-payer system that eliminated the unfairness, complexities and waste, we truly would have the world’s best health care for our citizens.

Dr. John Daley of Londonderry is a physician in Derry and a member of Physicians for a National Health Program.

Single-payer system would give us the world’s best care

By DR. JOHN DALEY
Union Leader
Commentary
May 2, 2007

THE APRIL 25 editorial “Rationing health care: Some want that for NH” represents another attempt by members of the health insurance industry, or someone with very good insurance, to torpedo the best choice for health care reform — a single payer system, or Medicare for all — by using scare words like rationing or socialized medicine.

As a family physician on the front lines of medicine I daily see the difficulties patients face due to lack of insurance or under-insurance. Generally these patients ration their own care, disappearing for a year or two when they lose their job and insurance, only to return with sky-high blood pressures or out- of-control diabetes, effectively taking years off their lives.

In New Hampshire, approximately 135,000 citizens lack health insurance, and for those who have it many can’t get all they need. The MRI wait may not be long, but many people can’t see their doctor, much less get an MRI. Now with health savings accounts and high deductible plans I have insured patients refusing their MRIs due to the cost.

It is estimated that 18,000 Americans die annually due to lack of insurance — which is a rather harsh effect of our present method of rationing. Shouldn’t the elimination of these deaths be a national priority?

The editorial mentions Canadians coming to the United States for surgery because of better and more readily available care. These numbers are rather small and the editorial fails to mention Americans going to Canada to get affordable drugs or the ever-increasing phenomenon of medical tourism where Americans travel abroad to get surgeries that are more affordable.

The bottom line is that Canadians enjoy longer, healthier lives than Americans, despite spending far less than we do, while covering every citizen. In a recent survey, only 3.5 percent of Canadians reported feeling that they waited too long for care, which is a much smaller number than our 15 percent uninsured who wait quite a bit. Long waits are a misleading myth.

Furthermore, a recent Harris Interactive poll of patients in the leading industrial societies found that Canada ranked first and the United States last in patient satisfaction with health care. You can’t just poll those with good insurance, after all!

Remember the term “single payer” as the best solution to our health care system’s problems. If one believes that health care is a human right and not a privilege, and if one wants to avoid having a health insurance company — which profits by denying care — choosing which tests you can have and which drugs you can take, it is the best answer.

The government pays for more than 50 percent of health care costs already through Medicare, Medicaid, federal employees, the military and the Veterans Administration, so it is not a radical stretch to extend Medicare to all Americans to cover the uninsured.

HR 676 has been introduced in the U.S. House of Representatives by (along with others) Democratic presidential candidate Dennis Kucinich. The New Hampshire House has shown great wisdom in introducing a resolution to study single-payer care for New Hampshire.

When discussing health care reform, don’t be scared by words like “rationed” or “socialized.” Be informed, be wise and be empathic — choose what’s best for America and all its citizens, not just those with good insurance.

If we took the money, structure and ingenuity in the current health care arena and applied it to the whole population via a single-payer system that eliminated the unfairness, complexities and waste, we truly would have the world’s best health care for our citizens.

Dr. John Daley of Londonderry is a physician in Derry and a member of Physicians for a National Health Program.