Time for single payer?

Time for single payer?
By Ruth Rosen  San Francisco Chronicle 12/29/03

Don’t be surprised if health care turns out to be the sleeper issue in the 2004 presidential campaign and if a majority of Americans eventually decide that a single-payer system is the most cost-efficient way to provide health care for everyone.

Why? Because our health system — a fragmented hodgepodge of private and public-health plans — is broken.

HMOs — which pay huge amounts for administrative and bureaucratic costs, advertising and skyrocketing drug prices — no longer can contain costs. They have also turned the health-care system into a blizzard of paperwork.

Physicians who recently resisted a single-payer system have grown increasingly resentful of HMO bureaucrats who micromanage their medical decisions. Inadequate reimbursements are driving some out of business. They also dislike having to consult dozens of drug lists or formularies before
they can prescribe medicine for their patients. They’d rather spend time caring for sick people.

Businesses, which seek a level playing field, may also become supporters of a single-payer system. Consider the inequities they face. General Motors, which has a huge group of retired workers, must pay for their lifetime health costs. Newer companies, however, either don’t offer health-care benefits to workers or retired workers or don’t yet have any retired workers to worry about.

Labor, too, is a natural constituency for a single-payer system. The three-month long grocery workers’ strike in Southern California against major supermarkets has highlighted the burden businesses now bear for paying for their workers’ health care. How can Safeway, which has paid decent wages and benefits, compete with union-busting Wal-Mart, which pays subsistence wages and offers health-care insurance at unaffordable premiums?

It can’t. To avoid a race to the bottom, each employer should not have to pay for their workers’ health care. Instead, through an equitable tax, they should contribute to a single-payer health system.

And don’t forget the 40 million uninsured Americans. Soon after the Medicare bill passed, Senate Majority leader Bill Frist announced that Republicans would next try to address the medical needs of those who lack medical insurance. These are people whose votes could be captured by any candidate who promises to reduce their anxieties about getting health care.

The wealthy, too, may come to view single payer as a better alternative. Why? Because one of the best kept secrets in the United States, according to the American Hospital Association, is that 80 percent of our emergency rooms are overcrowded and the average wait is four hours. The poor, of course, already know this. But when middle class and wealthy Americans with heart attacks or serious injuries discover that they, too, may be diverted from one hospital to another, they may reconsider the value of their “excellent” medical insurance.

The fact is, most hospitals operate with “a just-in-time inventory” that works just fine for an average Tuesday evening in May. But on a Saturday night during the winter flu season, emergency rooms are filled with children and elderly people with high temperatures, along with heart attack victims and people bleeding from knife or gunshot wounds. (Don’t even think about what might happen after a bio-terrorist attack, a fire or an earthquake.) Triage nurses must decide who will receive medical attention. When all the emergency rooms are filled to capacity, some patients lie on gurneys in the hall, waiting for an intensive-care bed and monitor.

By contrast, a single-payer system would reduce the burden on emergency rooms by providing everyone with primary care in physicians’ offices and outpatient facilities.

A single-payer system would also cost less. The overhead for Medicare is only 2 percent; for private insurance it is up to 25 percent.

Health care is a human right, not a privilege. If you don’t believe this now, you might change your mind if and when you find yourself in need of life-saving care in a hospital emergency room.

E-mail Ruth Rosen at rrosen@sfchronicle.com
http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2003/12/29/EDGS53U1CM1.DTL
 
*****
[Extracts] Bush drug proposal enrages veterans
Plan may alienate military retirees by imposing higher fees for prescriptions
By DALE EISMAN 1/01/04Copyright 2004 The Virginian-Pilot
 
WASHINGTON — The Bush administration is considering dramatic increases in the fees military retirees pay for prescription drugs, a step that would roll back a benefit extended 33 months ago and risk alienating an important Republican constituency at the dawn of the 2004 campaign season.
 
Pentagon budget documents indicate that retirees may be asked to pay $10 — up from $3 — for each 90-day generic prescription filled by mail through Tricare, the military’s health insurance program. Tricare’s current $9 co-pay for a three-month supply of each brand-name drug would jump to $20.
 
The proposal also would impose charges for drugs the retirees now receive free at military hospitals and clinics. There would be a $10 fee for each generic prescription and a $20 charge for brand-name drugs dispensed at those facilities.
 
A Pentagon spokesman declined Wednesday to comment on the drug plan, calling it “pre-decisional.” But word of the proposal was being spread at the speed of light by veterans service organizations, who were urging their thousands of members to send calls and letters of protest to the White House and members of Congress.
 
“It’s something that we’re going to look at very closely when we return,” said Tom Gordy, chief of staff for Rep. Ed Schrock, R-Va. The House is to reconvene Jan. 20.
 
“You’re tampering with a benefit that was earned by people putting their lives on the line,” said James F. Lokovic, a retired Air Force chief master sergeant and deputy director of the Air Force Sergeants Association.
 
Lokovic’s 136,000-member association already has sent Bush a letter warning of “significant backlash from millions of retired military voters” if the plan is included in the 2005 defense budget the administration will unveil in a few weeks.
 
“Somebody just isn’t paying attention,” the Military Officers Association of America said in “special alert” sent to its 390,000 members. “The war on terrorism is reminding the nation of servicemembers’ sacrifices every night on the evening news … and yet the administration seems to continue going out of its way to penalize the military community.”
 
The officers association alert and an Internet site run by the sergeants association recall attempts by the administration to impose a $1,200 deductible for care provided to most military retirees at Veterans Affairs hospitals and the Pentagon’s long-running opposition to bills providing for “concurrent receipt” of military pension and VA disability payments.
 
The budget documents circulating Wednesday gave no hint of the current status of the plan or the thinking behind it. Military retirees — those who served 20 years or more — had no prescription drug coverage until April 2001.
 
But the documents indicate that the proposed charges would considerably ease the burden of prescription drug costs on the defense budget. The new co-pays would generate more than $728 million in 2005, the Pentagon estimated, and nearly $4.2 billion by the end of 2009.
 
But spokesmen for veterans groups said the VA fills prescriptions for service-related illnesses and injuries at no charge. Its $7 co-pay applies only for medications given to outpatients for ailments unrelated to their service. And even those prescriptions are free when the veteran receiving them has an annual income of less than $9,690 if single and $12,692 if married.
 
*****
To buy or block cheap drugs — Race to the Canadian border
By Froma Harrop  The Providence Journal  12/31/03

WE ARE NOW WITNESSING an extraordinary game of chicken between the states and the Bush administration. About a dozen states are gunning it toward the Canadian border in pursuit of cheaper prescription drugs. The federal government, meanwhile, is racing to block the way. If the states succeed in defying Congress’s ban on drug imports, everything will change: U.S. drug companies will no longer be able to charge Americans up to twice
what foreigners pay for the same pills.
 
The hottest head on the freeway belongs to New Hampshire’s Republican governor, Craig Benson. He has demanded a federal waiver that would let his state import U.S.-made drugs. And he’s setting up an official Web site to help private citizens buy their prescriptions in Canada.

“We will work within the law wherever possible,” says Benson’s spokesman, implying a right to also ignore the law.

Two days after Benson’s announcement, representatives from 10 states met in Atlanta with Canadian pharmacies to discuss doing business together.  The potential savings are huge. One participant, Illinois, puts the savings from buying drugs in Canada at $94 million. Also attending were Ohio, Oklahoma, North Carolina, Massachusetts, Alabama, Vermont, West Virginia, Delaware and Louisiana.

Drugs are cheaper in Canada because Ottawa negotiates the prices pharmaceutical makers may charge there. Most other countries do likewise. The United States, by contrast, keeps its people captive to whatever price the drug companies can get away with. Need we add that the industry is a very generous contributor to political campaigns?

Such policies are not very popular with the electorate, so the powers in Washington have developed complicated rules designed to hide what they’re up to. For example, the new Medicare law cleverly allows Americans to bring drugs back from Canada — but only if the U.S. Food and Drug Administration deems them safe, which it won’t do.

To calm the natives, the administration has left open a safety valve: It looks the other way when individuals bring back medicines from Canada or Mexico for their own use. Slapping cuffs on Grandma as she steps off the bus from Algodones is not good P.R.

But states and cities are another matter. They are enormous purchasers of drugs for workers, retirees, Medicaid patients and prisoners. Once they start going to Canada for drugs also, the ban becomes meaningless.

The battle is not without its comical moments. Three of New Hampshire’s four congressional delegates voted with the Republican leadership against legalizing drug imports. One of them, Rep. Jeb Bradley, now praises Governor Benson for defying a law he helped pass. The two senators, John Sununu and Judd Gregg, had the good sense not to comment.

Is there a states’-rights issue here? “From a constitutional perspective, it’s a fairly clear-cut case,” says Timothy Conlan, a professor of government at George Mason University. “Congress has the power to regulate interstate and foreign commerce.”

However, the Bush administration is under no obligation to block the road to Canada. “It’s likely that the administration has enough discretion that if it wanted to allow states to do this, it probably could have allowed it,” Conlan adds. And giving the states the green light would have fit in with the president’s stated pro-federalism agenda.

(Although conservatives in Washington speak of promoting states’ rights, they often bar state action when it conflicts with the interests of the private sector. “That pattern is pretty consistent,” Conlan says.)

In discussing this issue, it would help to recognize that the pharmaceutical industry is not like most businesses. The public considers its products a social good and helps pay for them with large taxpayer subsidies. Further, a new medication enjoys many years of patent protection — during which its maker has the exclusive right to sell it.

So there’s no point pretending that Coumadin is like a camera battery — a product whose price can be sensibly set by market forces. The federal government must sit down with the pharmaceutical industry and work out a new arrangement for pricing drugs.

Until then, we will be treated to the weird sight of Americans begging foreign governments for relief on the price of American-made drugs. The states’ mad dash to the Canadian border shows more than a dissatisfaction with Washington policy. It demonstrates a growing contempt for it.

Froma Harrop is a Journal editorial writer and syndicated columnist. She may be reached by e-mail at: fharrop@projo.com.