On the need a pragmatic solution for the uninsured: “irreducible minimum, probably about 15 million”:
Don and other Folks—Corlin has been misunderstood here. I talked with him. He supports doing SOMETHING to get as many people covered as possible, rather than waiting forever for a universal solution—which he nonetheless fully supports also. Please make sure Barbara (author of response) gets this too—I don’t have an e-mail address for her.—-Jack Lewin
Comment: Dr. Lewin is absolutely correct. Dr. Corlin has repeatedly stated that he supports covering the uninsured, and he supports expanding coverage through pragmatic approaches. The “Quote of the Day” messages are intended to provoke constructive thought on health policy issues facing us today. Dr. Corlin’s isolated comment accomplished this, but failed to communicate the sincere dedication of Dr. Corlin to creating a better health care system for all of us.
But our concepts of pragmatism in health care reform are in sharp contrast. The difference can be illustrated by comparing the recent actions of the House of Delegates of the California Medical Association (a leader in influencing AMA policies) with the recent results of the California Health Care Options Project.
In March, 2002, the CMA House adopted a resolution (Report B-1-02) that “CMA participate in health care reform efforts by creating, convening and/or joining coalitions… whose purpose will be to create necessary national and state legislative packages designed to achieve health insurance coverage for all Californians.” But in the same resolution, they called for establishing policy “supporting defined contributions,” “expanded choices of health care financing,” continuing to “provide charitable care,” and combining “economic incentives and reasonable regulations.”
The intent of the CMA House is quite apparent in the concomitantly adopted Resolution 209a-02, “Consumer-Driven Financing of Health Care.” The CMA House resolved “That CMA assert a leadership role in the support, expansion, and design of consumer-driven and consumer-controlled health care financing programs that bring patient choice to health care financing such as Medical Savings Accounts, Flexible Savings Accounts, Personal Care Accounts, Health Freedom Accounts, Health Savings Accounts, and other versions of consumer-driven health care purchasing, and forward same for national action; and be it further resolved: That CMA assert a leadership role in the support, expansion, and design of refundable tax credit programs for the purchase of health insurance, and forward same for national action; and be it further resolved: That CMA work with California’s Congressional delegation to support the right of all patients to use pre-tax dollars for the purchase of their medical care; and be it further resolved: That CMA help physicians bring such recommendations directly to our patients for their education and political support; and be it further resolved: That CMA work with the AMA to support federal legislation to provide a refundable tax credit for the purchase of catastrophic health insurance, consistent with Report B-1-02.”
Conservative and progressive economists agree that these policies can never result in universal health care coverage and will erect greater financial barriers to care for precisely those individuals that have a greater need for care. Pragmatism? Solutions that control costs by preventing access to necessary care may be pragmatic, but they are also inhumane.
(Physicians for a National Health Program provided information to the Technical Advisory Committee of the CMA that produced the report on financing health care. Although the proposals of the Heritage Foundation were enthusiastically endorsed, PNHP’s proposals were cursorily dismissed with the false statement that a single payer system could not control health care costs. Obviously, the committee did not understand the fundamentals of single payer reform since a major advantage of single payer is to establish a structural mechanism of containing costs in an equitable system. The only other possible conclusion is that the committee did understand the proposal but denied the truth because of their own ideology. Regardless, the CMA and AMA have a pressing need to inject more objectivity into their process.)
In contrast, our concept, a model supported by the results of the California Health Care Options Project, would provide comprehensive care to everyone and reduce costs. Pragmatic? The CMA calls for taking recommendations to patients for education and political support. Our position is that ALL models should be taken to all patients and potential patients for their education. Once they understand which model serves physicians well at the cost of health care access, and which model serves the public well with the benefit of access and coverage for all, then the public will tell us which is the “pragmatic” approach.
California Health Care Options Project:
LANDMARK STUDY OF OPTIONS FOR HEALTH CARE REFORM
The final results of the California Health Care Options Project have been posted:
Two page summaries of the nine options:
Cost and coverage analysis by the Lewin Group:
Qualitative analysis by AZA Consulting: