PNHP

Guest Commentary: Get rid of the for-profits

Guest Commentary: Get rid of the for-profits

Healthcare can no longer be a commodity for sale to those who can afford it

By Rep. Dennis Kucinich
Modern Healthcare
Sep 4, 2007

In a way and with an emphasis never before seen in political discourse and debate in the U.S., the issue of healthcare reform has taken center stage as one of the top priorities among Democratic presidential candidates.

At every debate and every forum, at every town hall meeting and union hall gathering, the question comes up: “What are your plans to reform our healthcare system?”

Not surprisingly, every candidate has a plan. The kindest observation that can be made regarding those plans is that they reflect an acknowledgement by the candidates that something is terribly wrong and that something needs to be done to solve the problem. For the most part, they define the problem in terms of the 47 million Americans who are uninsured, the estimated 50 million Americans who are underinsured or the millions of others who are at risk of losing whatever insurance they have because of circumstances beyond their control, such as job loss or changes in employer-paid benefits.

Those candidates are wrong. What they see as the problem is merely a sad, sometimes tragic, litany of symptoms. The real problem, I submit, is that healthcare in the U.S. is delivered by a system that is controlled and directed by for-profit insurance and pharmaceutical companies whose financial prosperity depends on providing as little healthcare as possible. We can no longer treat healthcare as a marketplace commodity for sale to those who can afford it. We must recognize that the U.S. stands alone among major industrialized nations in its failure to ensure adequate healthcare for its citizens is the problem.

There is only one “real” solution for the problem, and that solution is to remove “for-profit” from the healthcare equation. And I am the only candidate who has proposed that solution.

House Resolution 676, introduced in January and co-authored by Rep. John Conyers (D-Mich.) and myself, would establish a national, not-for-profit, single-payer insurance program that would cover all Americans for all necessary medical care. This bill, also known as the U.S. National Health Insurance Act, would provide coverage for prescription drugs, inpatient and outpatient care, primary and preventive care, emergency services, vision and dental care, mental health, home health, physical therapy, rehabilitation (including for substance abuse), chiropractic services and long-term care. There would be no premiums, no deductible and no copays.

The bill has 76 co-sponsors in the House of Representatives and has been endorsed by the California Nurses Association, National Nurses Organizing Committee, Physicians for a National Health Program, hundreds of labor union locals, and a number of local and state governmental bodies across the country. It also is the only healthcare plan endorsed by filmmaker Michael Moore, whose courageous, landmark documentary “Sicko” was a blistering expose of the for-profit healthcare system in America.

HR 676 represents a fundamental change, not only in how healthcare is financed and delivered, but in our national philosophical and moral definition of what healthcare is: a basic right of the people in an enlightened society, and a social and moral obligation of the government to its citizens.

And it is eminently affordable.

We spend more than $2.2 trillion a year on our current for-profit healthcare system. More than 30 cents of every dollar go to cover costs and expenses that have nothing to do with delivering healthcare: profits, dividends, executive salaries, stock options, bonuses, advertising, marketing, paperwork, and a host of duplicative and redundant services among legions of separate, independent, for-profit insurance and pharmaceutical companies. That’s more than $660 billion per year that doesn’t go directly to pay for healthcare.

Clearly, we are already paying for a national healthcare insurance system. We’re just not getting it. Instead, we’re paying for a ridiculously inefficient and scandalously discriminatory patchwork system that prospers more and more only when it provides less and less care. Physicians, nurses and other medical professionals who are in the best position to collaborate with patients to make healthcare decisions are at the mercy of insurance companies’ profit-driven decisions.

At the same time, while other candidates assert with seemingly zealous rhetoric that their plans will help those tens of millions of Americans who are being denied coverage or are paying too much for it, they propose no fundamental change in the current system. Rather than removing for-profit insurance companies from the system, they propose subsidizing those companies as a means of reducing premiums and costs. Some propose incentives (subsidies) to employers to help cover employees’ healthcare costs. Some propose more aggressive negotiations with insurance and pharmaceutical companies to make coverage more affordable for more people.

But the seldom-spoken reality is that every plan except mine would keep the for-profit companies in place and in control. Every plan except mine would still leave millions of Americans uninsured or underinsured. Every plan except mine reflects an unwillingness to challenge the politically and financially powerful insurance and pharmaceutical industries.

I am not afraid to challenge those interests. My campaign is not funded by them. My personal investment portfolio will not increase in value if the government begins pouring billions of dollars in subsidies into the for-profit healthcare industry. My loyalty and my commitment is to the American people. A universal, not-for-profit, single-payer health insurance plan for America is a moral and economic imperative. It is the No. 1 domestic policy issue, and reform requires more than rhetorical bandaging. It requires major surgery.

Rep. Dennis Kucinich of Ohio is a Democratic candidate for president.

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Taking care of our own: Health care in Spain has Lessons for the U.S.

By Pius Kamau
The Denver Post
9/5/07

We watched the running of the bulls in Pamplona from the safety of a balcony off a physician’s office. A crashing crowd of thousands and half a dozen bulls ran down the narrow street below us.

Then we saw a bull make an about-turn and attack several people, among them Lawrence and Michael Lenahan, brothers from Philadelphia. One suffered a deep wound to his buttocks; the other a less serious leg wound. Both required hospitalization.

I visited the ultra-modern University Hospital where the Lenahans were taken, a facility where heart and kidney transplants are routinely performed. I believe their care was as good as that offered in many American trauma centers.

Considering the current debate about health care reform in the U.S., I wondered what the Lenahans’ care would cost in Spain. All Spaniards’ health care is covered by Seguro Social, the state’s medical insurance, I learned. Hospital physicians told me that emergency care for all patients — regardless of citizenship — is provided without charge.

“Why would they do so?,” I asked. “Es lo justo,” I was told. It’s the right thing to do.

Until Francisco Franco’s death in 1975, fascist Spain was “the sick man” of Europe. After democracy and capitalism took root, the country’s economic fortunes reversed. Like other European countries, Spain has universal health care. Part of its success results from the fact that employers, industry and businesses are not shackled to their employees’ health care.

Most Spaniards I talked to are very happy that everyone is saved from being uninsured. They also were quick to point out that there is also private medical insurance for those who want it or can afford it. They consider our health care system a travesty and can’t understand why we can’t devise a system that works for all.

In Spain, France and the United Kingdom, illness condemns no one to penury. Every child is guaranteed immunization and basic health care. Every citizen in the European Union has the one thing 47 million Americans lack: universal health insurance. Contrary to what one hears, I found medical care in Europe to be as good as in the U.S.

In his book, “The United States of Europe,” T.R. Reid — a Colorado resident and former London bureau chief of The Washington Post — shows that health care in Europe is economically and socially a much better system than our own. Unburdened by a top-heavy health care system, Europe, he says, is bound to overtake the U.S. economically.

Americans don’t know that we can quite economically cover everyone without raising taxes or jeopardizing the quality of care. Furthermore, we can copy those parts of the Canadian and European systems that best suit us, to attain universal coverage.

What we need is a Medicare-like health care for all Americans, something similar to the federal system used by our senators and congressmen, a system divorced of the profit-seeking middlemen.

What’s abhorrent is the travesty of Americans losing their savings and livelihoods from illness because they are uninsured, of children dying from easily preventable conditions. The number of the uninsured in America has risen to 47 million as we argue about semantics, and our people are dying unnecessarily. Surely we can take care of our own citizens.

Pius Kamau of Aurora is a thoracic and general surgeon. He was born and raised in Kenya and immigrated to the U.S. in 1971.

Garamendi Stumps for Single-Payer Health Care System

Lt. Gov. John Garamendi (D) is touring California to gather support for a state-run, single-payer health care system, the Fresno Bee reports.

Garamendi on Monday stumped for universal health care in Los Angeles and Fresno. The lieutenant governor then was headed to Sacramento and Alameda to tout a single-payer, state-run health system similar to Medicare or the insurance plans provided to California teachers and federal employees.

Garamendi said health care legislation will be passed this year “but the question is what will it be.” He added, “If it’s for children only, that’s good, but it’s far and away from what needs to be done.”

He added, “We have seven days ahead of us to take a gigantic step forward for universal health care. We’ll either succeed or stall out, but the fight isn’t over” (Lloyd, Fresno Bee, 9/4).

Nuñez's unhealthy bill

No reform at all would be better than giving Schwarzenegger a political victory and leaving insurance companies in charge.

By Deborah Burger
Los Angeles Times
September 6, 2007

In alliance with Gov. Arnold Schwarzenegger, Democratic leaders of the state Legislature, led by Assembly Speaker Fabian Nuñez (“Healthcare reform — now,” Opinion, Aug. 28), are rushing to enact a substandard health reform plan that will not reduce the health insecurity of California families.

They’re apparently even willing to jeopardize Sen. Barbara Boxer and their own party’s slim hold on the United States Senate along the way.

Here’s the deal: Nuñez and some other Democrats are actively working with Schwarzenegger to put together a “compromise” healthcare package.

Schwarzenegger, the main architect of that plan, gets to claim credit for supposedly solving the state’s healthcare crisis using “bipartisan consensus.” As collateral damage to Democrats, Schwarzenegger can tout this deal to boost his candidacy against Boxer in 2010.

Nuñez could then get the governor’s support for extending his term as speaker.

This constellation of events may be dandy for a career politician or two, but it leaves behind a lot of other Californians, who will have to contend with a poor healthcare bill full of holes.

AB 8 does nothing to rein in rising insurance premiums — up 87% nationally this decade — or rising co-pays, deductibles and other health fees. Which means that costs, already unaffordable for far too many, would continue to spin out of control.

The bill fails to limit rising prescription drug costs, especially notable at a time when Schwarzenegger has just eliminated funding for his “voluntary” drug price restraints that were so ballyhooed last year by the governor and the authors of AB 8.

It is not universal, as many of the currently uninsured would remain without access to care. It fails to assure uniform, comprehensive benefits, and therefore perpetuates an increasingly multi-tiered health system based on the ability to pay.

It fails even to require insurance companies to provide insurance. They would not have to offer coverage to those with serious medical conditions — those people would instead be dumped into a publicly funded high-risk pool, earning big insurance companies millions in additional profits while bankrupting the public pool with the sickest, costliest patients.

The bill does not even protect patients’ choice of physicians, hospitals or other providers.

And, most critically, the plan reinforces and expands an insurance-based system — the source of much of the present crisis — thereby subverting real reform for years to come.

At the center of the plan is a mandate on businesses to either provide health coverage or pay taxes into a fund to buy it for their employees. The new tax would fall between the 7.5% of payroll costs favored by Nuñez and the 4% Schwarzenegger proposes.

No matter where the compromise figure ends up, it will be far less than many employers now pay for health benefits. One-fourth of all California businesses that provide health benefits currently pay more than 15% of their payroll for health premiums, according to the California Healthcare Foundation. As a result, businesses that now provide health coverage to employees would have an incentive to drop it.

Moreover, the mandate on employers is unlikely to survive a legal challenge; a similar Maryland bill was thrown out by the federal courts for violating federal benefits law.

Schwarzenegger continues to push his proposal to force most uninsured people to buy insurance or face severe penalties. So far, Democrats have resisted this proposal, but many expect them to accept some form of individual mandate as the final price for Schwarzenegger’s blessing for the term limits initiative.

Last year, Democrats united behind SB 840, a single-payer-style, enhanced “Medicare for all” bill that would have provided guaranteed healthcare for everyone, controlled costs, eliminated co-pays and deductibles, guaranteed choice of provider, and gotten the insurance companies out of the way.

Similar systems are succeeding in every other industrialized democracy — including Schwarzenegger’s homeland, Austria. If the politicians in Sacramento are concerned about patient care, they will not now settle for a bad healthcare bill that will further degrade our healthcare safety net. A bad healthcare bill is worse than no bill.

Deborah Burger, RN is president of the California Nurses Association.

MachinistsÂ’ Union (IAM) Ninth International to Endorse HR 676

The International Association of Machinists and Aerospace Workers (IAM) is the ninth international union to endorse HR 676, single payer healthcare legislation introduced by Congressman John Conyers (D-MI). The union represents 720,000 active and retired members.

In a letter conveying the endorsement, IAM Assistant Legislative Director, Hasan Solomon, said, “…we strongly endorse Congressman John Conyers’ bill HR 676, ‘Expanded and Improved Medicare for All.’” Solomon further states in his letter, “We have and will continue to urge members of Congress to support this much needed health care reform.”

The IAM joins the UAW, NEA, ILWU, NALC, UE, AFM, UA Plumbers & Pipefitters, and CNA/NNOC which have all endorsed HR 676.

Nuñez’s unhealthy bill

No reform at all would be better than giving Schwarzenegger a political victory and leaving insurance companies in charge.

By Deborah Burger
Los Angeles Times
September 6, 2007

In alliance with Gov. Arnold Schwarzenegger, Democratic leaders of the state Legislature, led by Assembly Speaker Fabian Nuñez (“Healthcare reform — now,” Opinion, Aug. 28), are rushing to enact a substandard health reform plan that will not reduce the health insecurity of California families.

They’re apparently even willing to jeopardize Sen. Barbara Boxer and their own party’s slim hold on the United States Senate along the way.

Here’s the deal: Nuñez and some other Democrats are actively working with Schwarzenegger to put together a “compromise” healthcare package.

Schwarzenegger, the main architect of that plan, gets to claim credit for supposedly solving the state’s healthcare crisis using “bipartisan consensus.” As collateral damage to Democrats, Schwarzenegger can tout this deal to boost his candidacy against Boxer in 2010.

Nuñez could then get the governor’s support for extending his term as speaker.

This constellation of events may be dandy for a career politician or two, but it leaves behind a lot of other Californians, who will have to contend with a poor healthcare bill full of holes.

AB 8 does nothing to rein in rising insurance premiums — up 87% nationally this decade — or rising co-pays, deductibles and other health fees. Which means that costs, already unaffordable for far too many, would continue to spin out of control.

The bill fails to limit rising prescription drug costs, especially notable at a time when Schwarzenegger has just eliminated funding for his “voluntary” drug price restraints that were so ballyhooed last year by the governor and the authors of AB 8.

It is not universal, as many of the currently uninsured would remain without access to care. It fails to assure uniform, comprehensive benefits, and therefore perpetuates an increasingly multi-tiered health system based on the ability to pay.

It fails even to require insurance companies to provide insurance. They would not have to offer coverage to those with serious medical conditions — those people would instead be dumped into a publicly funded high-risk pool, earning big insurance companies millions in additional profits while bankrupting the public pool with the sickest, costliest patients.

The bill does not even protect patients’ choice of physicians, hospitals or other providers.

And, most critically, the plan reinforces and expands an insurance-based system — the source of much of the present crisis — thereby subverting real reform for years to come.

At the center of the plan is a mandate on businesses to either provide health coverage or pay taxes into a fund to buy it for their employees. The new tax would fall between the 7.5% of payroll costs favored by Nuñez and the 4% Schwarzenegger proposes.

No matter where the compromise figure ends up, it will be far less than many employers now pay for health benefits. One-fourth of all California businesses that provide health benefits currently pay more than 15% of their payroll for health premiums, according to the California Healthcare Foundation. As a result, businesses that now provide health coverage to employees would have an incentive to drop it.

Moreover, the mandate on employers is unlikely to survive a legal challenge; a similar Maryland bill was thrown out by the federal courts for violating federal benefits law.

Schwarzenegger continues to push his proposal to force most uninsured people to buy insurance or face severe penalties. So far, Democrats have resisted this proposal, but many expect them to accept some form of individual mandate as the final price for Schwarzenegger’s blessing for the term limits initiative.

Last year, Democrats united behind SB 840, a single-payer-style, enhanced “Medicare for all” bill that would have provided guaranteed healthcare for everyone, controlled costs, eliminated co-pays and deductibles, guaranteed choice of provider, and gotten the insurance companies out of the way.

Similar systems are succeeding in every other industrialized democracy — including Schwarzenegger’s homeland, Austria. If the politicians in Sacramento are concerned about patient care, they will not now settle for a bad healthcare bill that will further degrade our healthcare safety net. A bad healthcare bill is worse than no bill.

Deborah Burger, RN is president of the California Nurses Association.

More administrative services

New Services Help Unsnarl Medical Bills

By Christopher Lawton
The Wall Street Journal
September 4, 2007

MedBillManager (an online tool from health-care services company Change:Healthcare LLC that helps users organize their medical bills) is one of many online services popping up to help consumers take a more active role in their medical care. Intuit Inc., maker of the Turbo Tax software, offers software called Medical Expense Manager to help consumers deal with their medical expenses, for a cost of $50. Revolution Health Group LLC, a consumer-focused health company formed in 2005 by America Online co-founder Steve Case, charges $129 a year for a premium health-care service that includes an online application to help users handle their medical expenses.

Apart from automatic error detection, SmartMedicalConsumer also has medical-billing experts that man an online forum for members to ask questions. Revolution Health’s premium service goes one step further by calling up insurance companies and fighting over disputed claims on a user’s behalf.

The new services are springing up at a time when employers and legislators are pushing more health-care responsibilities on to workers.

“For better or for worse, people are more and more on their own in health care,” says Ron Klain, executive vice president of Revolution Health, based in Washington, D.C.

http://online.wsj.com/article/SB118886008399016278.html.html

Comment:

By Don McCanne, MD

As the government continues to ignore the health care financing crisis, the market responds – by selling us even more wasteful administrative services.

What will be the next product? A service to organize the medical bill organization services of MedBillManager, Medical Expense Manager, SmartMedicalConsumer, Revolution Health, and others?

Unions to make health care centerpiece of 2008 election

By Mark Gruenberg
Workday Minnesota
2 September 2007

WASHINGTON – Labor unions will make achievement of affordable, universal health care the centerpiece of the 2008 election drive, elevating the issue to the top of the national domestic agenda, AFL-CIO President John Sweeney announced.

Sweeney chose his annual review of the state of unions and workers Aug. 29 to lambaste the Bush administration and politicians in general for failing to tackle key problems, such as declining health insurance coverage and the lack of the right to organize.

But he spent more time talking about the future than about the past, saying the AFL-CIO, with other union allies–including Change to Win and possibly the National Education Association–will concentrate on an intensive, many-layered educational campaign on health care between now and November 2008, and stretching beyond that, to holding politicians accountable for fixing the mess in 2009.

Health care will take precedence over other worker causes, including the Employee Free Choice Act and the right to organize, Sweeney added. But those will not be ignored. Instead, they along with health care will be part of labor’s giant educational campaign on how to create an economy that works for working families.

The importance of the health care issue was highlighted by Census Bureau data issued the day before, which showed a record 47 million people are uninsured and that, for the first time, the percentage of large corporations that offer health insurance to their workers has slid below 60 percent. Millions more are underinsured and health insurance at smaller firms is spotty or non-existent.

And even at the larger firms, workers are being forced to pay higher premiums and co-pays, coverage is being cut, health care costs are the No. 1 issue in bargaining and retiree coverage is being eliminated, Sweeney said.

“Health care is the top domestic issue for our members and all Americans, and the AFL-CIO is making the 2008 elections a mandate on fixing our broken system. We will hold candidates at every level responsible for supporting comprehensive, progressive national health care reform and we will elect a president and a Congress prepared to turn their campaign promises into reality,” he declared.

Though “we’ll put more of our resources than ever before” into the massive educational and political campaign on health care, the federation will not take a stand now for a particular piece of legislation or for or against a particular Democratic candidate’s health care program, Sweeney said.

In response to a question, Sweeney said a single-payer government-run health care bill, HR 676 by veteran pro-labor Rep. John Conyers, D-Mich., which would abolish the insurance companies and their role, is a possibility, along with others. The Conyers legislation has been endorsed by the Minnesota AFL-CIO and 21 other state labor federations, along with hundreds of unions and central labor councils.

The federation has previously backed Medicare-for-all legislation–which would expand the federal health care program to everyone but leave some role for private insurers–sponsored by Senate Labor Committee Chairman Edward M. Kennedy (D-Mass.), House Commerce Committee Chairman John Dingell (D-Mich.) and House Health Subcommittee Chairman Pete Stark (D-Calif.).

Sweeney also pointed out that unions will keep pushing states to act on health care, citing California, which has one-eighth of the U.S. population. California AFL-CIO Secretary-Treasurer Art Pulaski said state legislators there are in intense negotiations over a plan that would mandate all employers cover workers or pay into a state fund that does so.

Other details of the AFL-CIO plan:

* The federation will “build an army of 1 million activists” on health care, drawing them from labor organizations and Working America, the AFL-CIO affiliate for people who cannot join unions.

* The federation and the National Labor College will train activists in the issue, who in turn will be expected to train their colleagues, especially to meet attacks on health care reform from the drug industry and insurance companies.

* The first step will be to defend the State Childrens Health Insurance Program and its expansion against a Bush veto plan. “No child should go without a polio shot or a pre-school (health) exam because George Bush threatens to veto funding for a children’s health program.” Sweeney said. The Democratic-run Congress wants to expand the SCHIP program, which now covers 6-million-plus poor kids, to cover another 9 million.

Mark Gruenberg writes for Press Associates, Inc., news service. Used by permission.

For more information

See the Workday Minnesota special section: The Health Care Crisis: Growing Consensus for Change

Visit the AFL-CIO’s special webpages on health care, http://www.aflcio.org/issues/healthcare/

Innovative Health Care Solutions

Excerpt from Forbes.com

Dr. Ana Malinow
President, Physicians for a National Health Care Program

We already outspend every industrialized country by almost twice as much per person, but our outcomes are nowhere near twice as good as everybody else’s. The problem with the way our system is funded is that 30% off the top automatically goes to administration and profit. So if we take that out of the equation by creating a single payer system then we will be able to cover anyone. We would just need to pay more from our taxes, but we’d be paying zero for private health insurance.

Innovative Healthcare Solutions: Dr. Ana Malinow

Since 2002 I’ve been giving talks on health care reform to anybody who would like to listen. I tell people how much we spend on our health care, which is now almost $2 trillion per year. I say I’m going to give you $2 trillion and I want you to come up with a health care system you’d be willing to spend it on.

And for that I want you to come up with a set of guiding principles that you’re not going to negotiate on. Invariably everybody comes up with the same principles: universal, accessible, affordable, accountable and comprehensive.

The only health care system that has those principles is a single-payer system. Think of a Medicare for people over 65 and another for those under 65, covering everybody from birth to death. It would be publicly financed and privately delivered.

We already outspend every industrialized country by almost twice as much per person, but our outcomes are nowhere near twice as good as everybody else’s. The problem with the way our system is funded is that 30% off the top automatically goes to administration and profit. So if we take that out of the equation by creating a single-payer system, then we will be able to cover anyone. We would just need to pay more from our taxes but we’d be paying zero for private health insurance.

Every 10 or 15 years Congress comes up with another iteration of universal health care and every single time it’s squashed. If you look at the people who are losing health insurance at the fastest rate today it’s those people making over $70,000 per year. Those are the people who vote consistently. I think that’s what is different today. I think that is going to have a huge impact on the success of reform.

Ana Malinow, M.D., is president of Physicians for a National Health Care Program.

–Interviewed by Andy Stone

My Encounter with [insert scary music] … Socialized Medicine!

by Jim Wallis
(Our thanks to Denise Puthuff, MD, who sent us this article.)
Friday, August 10, 2007

http://blog.beliefnet.com/godspolitics/2007/08/jim-wallis-my-encounter-with-i.html#comments

My foot had been sore for a couple of weeks and it wasn’t getting better. I usually would ignore that, but we were about to leave on a two week vacation with my wife Joy’s parents to celebrate both of our big anniversaries (their 50th and our 10th). Then I have to fly to Singapore for the World Vision triennial conference. So I wouldn’t be back home for many weeks and my Washington, D.C., health care provider (over the phone) strongly urged me to see a doctor in London before we left.

I realized then that I was about to have my first encounter with SOCIALIZED MEDICINE! Now it’s one thing to advocate health care reform in America and even to be politically sympathetic to the idea of a single-payer government-supported system like they have in most of the world’s developed and civilized countries (such as Canada, Germany, and Great Britain). But it was another thing to actually go to the emergency room (or ER, but in the U.K. they call it Accident and Emergency) of a hospital in the British National Health Service. After all, I had heard the horror stories–long waits in incompetent, dirty, and substandard medical facilities; bad doctors and faulty diagnoses; and, of course, incredible bureaucracies like everything in “socialist systems.” Rush Limbaugh and every other conservative pundit have warned us all in America about the horrific practices of British socialized medicine.

So I prepared myself. I brought a big novel to read, along with my eyeglasses, a bottle of water (no telling what they would not have in socialized medicine), and emotionally steeled myself for the ordeal. Ann Stevens, the Anglican vicar with whom we stay in London (she’s my son Luke’s godmother and Joy’s old pal) took me to St. George’s hospital, dropped me off at “A and E,” and wished me luck at 9 a.m. Hoping I would be home that night for dinner, I took a deep breath, walked across the street, and made my way into socialized medicine.

The waiting room was actually quite peaceful and not crowded, I noticed, as I walked up to reception. The woman at the reception desk smiled. I didn’t expect that. “Can I help you?” “Yes,” I replied, “you see, I am an American–I guess you can tell–and I’m visiting family here–my wife is British–and we’re staying with our friend the vicar, and I have a sore foot, which I normally wouldn’t worry about but we’re going away for several weeks on vacation, and I called my health care provider in the U.S., and they told me to come in here, and thought I should get an X-ray or something.” (I wondered for a moment if it would help to tell them that I was a friend of the prime minister, but decided not.) “What do you need from me?” I asked hesitantly. “Just your name and address,” she replied with another smile. “Oh …OK.” She told me it would be about 10 minutes to see the nurse. “Yeah right,” I thought to myself.

I settled into the waiting room chair, looked around at all the people who didn’t seem to be in any distress, and opened my book for a good long read. It was five minutes before the nurse called me in to a little office adjacent to the waiting area, which seemed to be an intake room. She was pleasant and professional as she asked me what was wrong, and how long I had felt the soreness. She gently examined my foot and then told me I would be called in to see a doctor in about 10 minutes. “Sure thing,” I thought. So I went back out to the waiting room and settled in again to read my novel.

It was five minutes before a young woman appeared and called my name, “Mr. Wallis?” She was a young Asian doctor named Dr. Gillian Kyei. She was also very pleasant and professional, taking time to ask me lots of questions about how I might have hurt my foot, etc. She examined the injured foot carefully, told me that it didn’t necessarily look broken, but that we should get an X-ray to make sure. I waited in her examining room for a couple of minutes while she called down to the X-ray department to say that I was on the way. Then she came back and escorted me herself.

When I got to X-Ray, I checked in by just saying my name and took a seat in the waiting area. Finally, I was going to get to read my book! But five minutes later, the technician came out to bring me in. She took her time with me, taking several different angles of my foot. When I was done, she sent me back to my young doctor, with another smile.

This time the wait was a full ten minutes because, I later learned, Dr. Kyei was reading the results of my X-ray, which had already been sent to her computer. She showed me what looked to her like a fracture of my fourth metatarsal bone, but said she wanted to consult with the orthopedic specialist. I waited about ten minutes more while she did that and so got a few more pages read.

Dr. Kyei then came back with the definitive diagnosis–my fourth metatarsal bone was indeed fractured. She went over their preferred treatments and my options with me. Normally, if this injury had just happened, they would put me in a cast to hold the broken bone in place and give me crutches. They were still happy to do that now. But since I had been already walking on it for over a week and the bone was still in the right place, I could also have the option to just using a therapeutic soft boot to keep the weight on my heel and off my fourth and fifth metatarsals. While the fracture was at the base of the fourth metatarsal, as she carefully explained and showed me on the X-ray, the pain was being felt lower down–across both my fourth and fifth metatarsals area. If I chose the boot, I could still swim with my kids and get around a little easier, but I would have to really try to keep my weight off the injured area. I chose the boot and she told me she would be back in a minute.

It was actually about two minutes before she got back, and I was getting nowhere with this novel. She handed me a very stylish black boot (so much better than other colors for fashion coordination), and gave me my final instructions–be very cautious about the foot, try to stay off it as much as possible but keep it mobile and flex it so the blood circulates, get another X-ray as soon as I get home and, of course, then consult with my home physician. Then she wrote me a nice long letter for my home doctor, describing their diagnosis and treatment. Dr. Gillian Kyei then wished me the best of luck, hoped I would have a great vacation despite my foot, smiled, and sent me back to the front desk.

“How can I call a cab?” I asked. “Oh, I’ll do that for you,” she said. “Just take a seat over their and the cab will be here in about 10 minutes.” As I sat there, I realized something. Nobody had ever asked me to pay. Everything was FREE, including my nice new boot. How about that? They think health care is a right for all citizens, and even foreign visitors like me. Amazing.

The cab came in 5 minutes. I thought I would tell him some horror stories about my experiences in the American health care system, but decided not to. I was back at Ann’s in just over an hour from when I left–with my letter, my boot, and my tale of smiling, pleasant, and efficient health care workers. And somehow I began to believe that back in America we weren’t being given the whole truth. And guess what? Ann tells me that David Beckham and Wayne Rooney, the biggest British soccer (football) stars, have had metatarsal bone fractures, just like mine. In about six weeks, I too will be back on the field, thanks to socialized medicine! And in the meantime, I will keep my foot up … and maybe get that novel read.

Uninsured by choice?

Hispanics Push Texas to No. 1 in Uninsured Residents

By Jason Roberson
Hispanic Business
August 29, 2007

Texas again ranks No. 1 with the highest percentage of uninsured residents in the nation — primarily due to the state’s growing Hispanic population, according to a report issued Tuesday by the U.S. Census Bureau.

Because of their low wages, many Hispanics have to set priorities, said Jaime Martinez, co-chairman of the health commission for the League of United Latin American Citizens, the country’s oldest civil rights group for Latin Americans.

“They would rather put money on the table, pay the light bill, pay the rent, than buy insurance that’s very costly,” Mr. Martinez said. “That’s why we need to address the health care of the uninsured and underinsured in this country.”

The National Center for Policy Analysis, a conservative Dallas-based research group, said a growing number of households are uninsured because they want to be.

“Whether it be cultural or a matter of economics, for a growing number of households being uninsured is a matter of choice,” said Devon Herrick, a senior fellow of the NCPA.

Bill McCormick, a 55-year-old computer systems analyst from Richardson, is an example.

“I am not Hispanic and I don’t have medical insurance,” Mr. McCormick said in response to Tuesday’s news. “That was the choice I made … drop the medical insurance or go hungry.”

The NCPA is fighting the move for a single-payer, government-run health care system, saying a free-market system is best.

http://www.hispanicbusiness.com/news/newsbyid.asp?id=75135&cat=Headlines&more=/news/more-news.asp

Comment:

By Don McCanne, MD

As anticipated, the opponents of comprehensive reform are framing the increase in the numbers of uninsured as a matter of personal choice for many.

Does their outspoken insensitivity to the unmet health care needs in this nation really resonate with the public? If not, then why doesn’t our compassion translate into action?

On Life Support

By Arian Campo-Flores
Newsweek.com
web exclusive
May 9, 2007

Dr. Arthur Kellerman couldn’t believe what he was hearing. He had just begun a fellowship assignment with the House Committee on Oversight and Government Reform in January when staffer Karen Nelson invited him to attend a briefing on Capitol Hill. Dennis Smith, director of the Center for Medicaid and State Operations, would be discussing a planned rule change by the Bush administration. “Don’t say anything,” Nelson told Kellerman. “Just listen.” At the meeting, Smith said that the rule was simply an attempt to rebalance federal and state roles in financing Medicaid. But when he explained the details, Kellerman could barely contain himself. As Kellerman understood it, the rule would result in millions of dollars in funding cuts for hospitals across the country. “I’m hearing this and having a heart attack,” he recalls. Nelson and others strafed Smith with questions and the briefing came to a close. But a new battle between Congress and the administration had begun.

It was a sobering start for Kellerman, 52, whose regular job is chairman of the Department of Emergency Medicine at the Emory University School of Medicine. For years, he’s been sounding the alarm that hospital emergency rooms nationwide are in crisis. The stats are disconcerting: while visits to emergency departments increased by 26 percent from 1993 to 2003, hospital beds plummeted by 198,000, and 425 ERs around the country shut down, according to a 2006 report by the Institute of Medicine, a nonprofit arm of the National Academy of Sciences. Kellerman has experienced the impact firsthand at Atlanta’s Grady Memorial Hospital, which is partly staffed by Emory doctors. Burdened by a growing pool of uninsured patients and squeezed by funding cutbacks, the institution is teetering at the edge of an abyss. Yet despite Kellerman’s efforts to spur officials at all levels to action, Grady’s condition has only grown worse. Part of the challenge: talk of ERs at the breaking point has become so familiar that it’s hard to convey a sense of urgency. So last September, Kellerman headed to Washington, D.C., after winning a prestigious yearlong Robert Wood Johnson health- policy fellowship. He landed a spot working for the oversight committee now chaired by Democratic Rep. Henry Waxman, who’s concerned about emergency-care issues and has taken on the Bush administration with zeal. Over the past nine months, NEWSWEEK spent time with Kellerman in both Atlanta and Washington, as he journeyed from a blood-soaked ER to the antiseptic corridors of power.

When he started his fellowship, Kellerman heard the same advice repeatedly: don’t expect to accomplish anything substantive in a year; just come to learn. But of course, he says, “we all try to make a difference anyway.” He had no shortage of ideas. Last year, he concluded his work on an Institute of Medicine committee that took a comprehensive and probing look at the state of emergency care in the U.S. The resulting series of studies, published last June, painted a despairing portrait, but also offered a raft of recommendations. Given the approaching midterm elections, Congress and the administration did virtually nothing. But after the Democratic takeover, Kellerman imagined things might be different.

The administration’s planned Medicaid rule change, however, dashed those hopes. Kellerman realized this was no time for lofty ambitions; Congress would have to play defense. The rule, scheduled to take effect on Sept. 1, deals with the arcane world of Medicaid financing. Two provisions in particular dismay many in the health-care field. One limits states’ ability to tap certain funding sources to meet their Medicaid obligations. The other stipulates that Medicaid reimbursements cannot exceed the cost of treating the Medicaid patient. While that provision may sound reasonable, says Larry Gage of the National Association of Public Hospitals, it doesn’t account for the harsh reality confronting medical facilities that treat large numbers of the uninsured. Since these facilities don’t get reimbursed for that treatment, they rely in part on higher-than-cost Medicaid reimbursements. As a result of the new administration rule, many hospitals may need to make drastic cuts in personnel, beds and more. “There isn’t any question that if this regulation goes into effect in the ways it’s proposed, there will be reduced safety-net services in many communities,” says Gage, who considers the rule “the most important legislative or regulatory issue that we’re confronting right now.” Smith, the Medicaid official, whose center is part of the Department of Health and Human Services, responds that it defies logic to reimburse more than the cost of care and that state governments need to step up to meet their obligations. Smith argues further that some hospitals have abused the Medicaid financing system in the past–a point that even Gage concedes (although he maintains that the abuse problem has largely been eradicated).

The administration calculates that the rule change will reduce federal Medicaid expenditures by about $3.8 billion over five years. But Gage and others estimate the impact on hospitals will be much larger. At Grady, where 42 percent of revenue comes from Medicaid, Kellerman estimates that the hit could total $200 million over five years. “Grady is already struggling,” he says. “This would put it out of business.” Were Grady to close, the consequences would be far-reaching: the hospital is the only Level I trauma center (the highest designation) in a 120-mile radius of Atlanta, and one quarter of Georgia’s physicians are trained there.

In the wake of the rule announcement, lawmakers and lobbyists leapt into action. Waxman and others wrote a letter in March to the secretary of the Department of Health and Human Services, urging that the rule be withdrawn. At a time when the nation is at risk of a terrorist attack, they argued, the ERs on the front lines are more crucial than ever; yet hospitals can barely cope with the routine traffic on a Saturday night. More than 150 House members from both parties signed the letter (Kellerman helped round up signatures, shuttling from one congressman’s office to another). But the administration refused to budge. So lawmakers turned to another tactic: they inserted a provision in the Iraq supplemental-funding bill that would impose a one-year moratorium on implementing the rule. Though Bush vetoed that bill, many lawmakers are intent on including the same provision in the next attempt to craft an Iraq-spending measure. They seem to have plenty of supporters. In the oversight office, Kellerman sifted through about 450 responses to the rule sent by individuals and groups during the public comment period. “They ranged from negative to overwhelmingly hostile,” he says.

Waxman now has a new plan to press the administration: an oversight committee hearing that will be held around mid-June, the one-year anniversary of the Institute of Medicine reports. Though the main purpose is “to examine the federal government’s failure to address the crisis in emergency care,” as he puts it, the new Medicaid rule will surely come up as well. Kellerman is now helping prepare for that hearing. He worries that if the administration manages to implement the rule, it may attempt other federal funding cuts that Bush has mentioned in his budget proposals. “It’s hard to imagine congressmen will just allow hospitals in their home districts to get wrecked,” says Kellerman. But as he has learned, Washington’s ways–its partisan politics, its backroom dealing–can be confounding. All he can do is continue to hammer home the message of what’s at stake. “Either we’ll figure it out and start addressing [emergency care] in a serious manner,” he says, “or the system will fail catastrophically.” Kellerman has sounded such alarms before to little avail. Now, though, he’s got a slightly bigger megaphone.

(c) 2007 Newsweek, Inc.