Health Leaders Seek Consensus Over Uninsured
By Robert Pear
The New York Times
May 29, 2005

At a time when Congress has been torn by partisan battles, 24 ideologically disparate leaders representing the health care industry, corporations and unions, and conservative and liberal groups have been meeting secretly for months to seek a consensus on proposals to provide coverage for the growing number of people with no health insurance.

The participants, ranging from the liberal Families USA to the conservative Heritage Foundation and the United States Chamber of Commerce, said they had made progress in trying to overcome the ideological impasse that has stymied action on the problem for eight years.

The group’s overarching goal is to agree, by the end of this year, on proposals that expand coverage to as many people as possible as quickly as possible. By meeting in secret, the group has tried to shield itself from political pressures.

“This effort holds as much promise as any I’ve participated in over the last decade, probably more,” said Kate Sullivan Hare, the executive director of health care policy at the United States Chamber of Commerce.

“People are uninsured for different reasons,” said Dr. Mary E. Frank, the president of the American Academy of Family Physicians and a participant in the talks. “No one solution will work for everyone. We need different solutions for different groups of the uninsured.”

E. Neil Trautwein, assistant vice president of the National Association of Manufacturers, said the consensus group was “not biased in favor of big government solutions,” and assumed that health care would continue to be provided through a mix of private insurers and public programs.

The group is applying lessons learned in the battle over the Clinton health plan. Members said they were listening carefully to one another, trying to build the trust. They are not trying to remake the health care system or guarantee insurance for every American through one big program, they said.

http://www.nytimes.com/2005/05/29/national/29insure.html?ei=5094&en=4ee7fc0aa141bf73&hp=&ex=1117339200& partner=homepage&pagewanted=print

Comment: And the options that they are considering? (My comments in
parentheses)

* Individual mandate for children (criminalizing parents who cannot afford
coverage?)

* Voluntary payroll contributions made by employees not covered by employer-sponsored plans (causing employers to drop coverage now that it is the employees’ responsibility, even if unaffordable to them)

* Tax credits sent to insurers to help pay for a portion of coverage for low-income individuals and small businesses (a direct subsidy for the flawed private plans, but which would be inadequate for these sectors surviving on very limited budgets)

* Voluntary action on the part of states to expand Medicaid to adults under the poverty level ($9600) (with the budget crises the states are facing, they would be looking for a voluntary way to go deeper in debt?)

* Small federal grants to states to establish insurance purchasing pools (funding a portion of administrative costs only, but not funding health
care)

Everyone recognizes the political ineptitude of the Clinton attempt at reform. Their process could never have ended in a consensus.

Now we are presented with a process that allegedly is firmly based on consensus. But what are they proposing? They have gone to the bottom of the health policy barrel and scraped off the stinky, slimy scum and presented that to us as politically feasible, incremental reform. These policies will increase the numbers of uninsured, reduce the effectiveness of coverage already in place, and fail to control costs. Millions of Americans will suffer and tens of thousands will die as a result of these policies.

Why does Kate Sullivan Hare of the U.S. Chamber of Commerce say that “this effort holds as much promise as any I’ve participated in over the last decade”? It’s because these policies will reduce employers’ responsibilities for requiring coverage; they will enhance business opportunities and profits for insurers; they will maximize the flow of tax dollars towards private interests while ensuring that public programs will remain profoundly underfunded; and they will shift more of the responsibility and burden of paying for care to the individual, regardless of affordability.

But this process has accomplished their unstated primary goal. They were successful in keeping single payer supporters out of this secret process.
And their greatest fear is that Americans might actually demand a program that would provide affordable, comprehensive care for everyone, if Americans only understood that we could have it merely by enacting a single payer system.

By redefining incrementalism as a process that gradually reduces comprehensive coverage, affordability and access, this group has lost all credibility as advocates of reform that would be for the benefit of patients. That’s tragic, because several of these individuals know better and should have been a part of a legitimate process. But their ******* egos got in the way!

And, oh yes, some were there to make sure that the enablement of greed was a defining element in their model of reform. Those individuals need to be banned from the bargaining table forever. But those who know better and really do care should be welcomed back into the process once they have had their personal epiphanies.

Health Leaders Seek Consensus Over Uninsured
By Robert Pear
The New York Times
May 29, 2005

At a time when Congress has been torn by partisan battles, 24 ideologically disparate leaders representing the health care industry, corporations and unions, and conservative and liberal groups have been meeting secretly for months to seek a consensus on proposals to provide coverage for the growing number of people with no health insurance.

The participants, ranging from the liberal Families USA to the conservative Heritage Foundation and the United States Chamber of Commerce, said they had made progress in trying to overcome the ideological impasse that has stymied action on the problem for eight years.

The group’s overarching goal is to agree, by the end of this year, on proposals that expand coverage to as many people as possible as quickly as possible. By meeting in secret, the group has tried to shield itself from political pressures.

“This effort holds as much promise as any I’ve participated in over the last decade, probably more,” said Kate Sullivan Hare, the executive director of health care policy at the United States Chamber of Commerce.

“People are uninsured for different reasons,” said Dr. Mary E. Frank, the president of the American Academy of Family Physicians and a participant in the talks. “No one solution will work for everyone. We need different solutions for different groups of the uninsured.”

E. Neil Trautwein, assistant vice president of the National Association of Manufacturers, said the consensus group was “not biased in favor of big government solutions,” and assumed that health care would continue to be provided through a mix of private insurers and public programs.

The group is applying lessons learned in the battle over the Clinton health plan. Members said they were listening carefully to one another, trying to build the trust. They are not trying to remake the health care system or guarantee insurance for every American through one big program, they said.

http://www.nytimes.com/2005/05/29/national/29insure.html?ei=5094&en=4ee7fc0aa141bf73&hp=&ex=1117339200& partner=homepage&pagewanted=print

Comment: And the options that they are considering? (My comments in
parentheses)

* Individual mandate for children (criminalizing parents who cannot afford
coverage?)

* Voluntary payroll contributions made by employees not covered by employer-sponsored plans (causing employers to drop coverage now that it is the employees’ responsibility, even if unaffordable to them)

* Tax credits sent to insurers to help pay for a portion of coverage for low-income individuals and small businesses (a direct subsidy for the flawed private plans, but which would be inadequate for these sectors surviving on very limited budgets)

* Voluntary action on the part of states to expand Medicaid to adults under the poverty level ($9600) (with the budget crises the states are facing, they would be looking for a voluntary way to go deeper in debt?)

* Small federal grants to states to establish insurance purchasing pools (funding a portion of administrative costs only, but not funding health
care)

Everyone recognizes the political ineptitude of the Clinton attempt at reform. Their process could never have ended in a consensus.

Now we are presented with a process that allegedly is firmly based on consensus. But what are they proposing? They have gone to the bottom of the health policy barrel and scraped off the stinky, slimy scum and presented that to us as politically feasible, incremental reform. These policies will increase the numbers of uninsured, reduce the effectiveness of coverage already in place, and fail to control costs. Millions of Americans will suffer and tens of thousands will die as a result of these policies.

Why does Kate Sullivan Hare of the U.S. Chamber of Commerce say that “this effort holds as much promise as any I’ve participated in over the last decade”? It’s because these policies will reduce employers’ responsibilities for requiring coverage; they will enhance business opportunities and profits for insurers; they will maximize the flow of tax dollars towards private interests while ensuring that public programs will remain profoundly underfunded; and they will shift more of the responsibility and burden of paying for care to the individual, regardless of affordability.

But this process has accomplished their unstated primary goal. They were successful in keeping single payer supporters out of this secret process.
And their greatest fear is that Americans might actually demand a program that would provide affordable, comprehensive care for everyone, if Americans only understood that we could have it merely by enacting a single payer system.

By redefining incrementalism as a process that gradually reduces comprehensive coverage, affordability and access, this group has lost all credibility as advocates of reform that would be for the benefit of patients. That’s tragic, because several of these individuals know better and should have been a part of a legitimate process. But their ******* egos got in the way!

And, oh yes, some were there to make sure that the enablement of greed was a defining element in their model of reform. Those individuals need to be banned from the bargaining table forever. But those who know better and really do care should be welcomed back into the process once they have had their personal epiphanies.

Ebbing and Flowing: Some Gains, Some Losses as SCHIP Responds to Third Year of Budget Pressure
By Ian Hill, Brigette Courtot, and Jennifer Sullivan
The Urban Institute
May 2005

Heading into 2004, SCHIP recorded its first-ever decline in enrollment. While it represented just 1 percent of total enrollment, the drop was still a significant turning point, reflecting the cumulative impact of three years of state policy responses to the ongoing economic downturn.

(2004) saw virtually no improvement in outreach, thus dimming SCHIP’s prospects for further reducing the rate of uninsurance among children in the coming year. Further, states like Texas did nothing to reverse the raft of changes made in 2003 that cut eligibility and benefits, raised cost sharing, and made enrollment more challenging. Wisconsin maintained its highest-in-the-nation premium, even in the face of declining enrollment. And Florida, despite lifting its enrollment cap, restricted future growth by closing enrollment except during two 30- day “open” periods each year, while requiring families to play a more active role in eligibility renewal.

In the case of outreach there is no ambiguity – SCHIP outreach has for all intents and purposes ceased to exist. Evidently, states have decided that programs cannot sustain the growth rates of SCHIP’s first four years during an economic downturn. Outreach has been scaled back or eliminated in an effort to curtail growth.

Looking ahead, the future course for SCHIP is uncertain. In 2004, 36 states spent more than 100 percent of their annual allotments. Yet that same year, for the first time, unspent federal funds in the amount of $1.3 billion reverted to the treasury. Federal funds available for redistribution are expected to fall in the coming years while the number of states needing redistributions is expected to rise. The only current prospect for enhanced federal funding for SCHIP has been proposed in the Bush administration’s “Covering the Kids” outreach initiative. However, when we asked SCHIP directors what they thought of this proposal, they expressed appreciation tempered by strong trepidation. That is, federal support for outreach would be welcomed by the states, but only if allotments were increased as well to cover the services new enrollees would need. SCHIP already faces excess demand for coverage. Providing new funding for outreach, without supporting states’ ability to supply additional coverage, would only exacerbate the program’s financing challenge.

http://www.urban.org/UploadedPDF/311166_A-68.pdf

Comment: SCHIP, the children’s health insurance program, is the one bright light on the path of incremental reform. Almost 4 million children are covered by this program. Although overall health care costs and coverage continue to deteriorate, the rate of deterioration would have been significantly greater without this very important program.

But how bright is the SCHIP light? The Bush administration is offering administrative funds to sign up new enrollees, but is not providing adequate funds for the care that would be required by new enrollees. And as a program that serves lower-income individuals, it is vulnerable to the wrath of anti-tax, anti-government politicians (“…strangle the beast…”), enabled by the passivity of their milquetoast colleagues (“…I am not a tax-and-spend liberal…”). Thus the response of the states has been to enact changes that control program costs.

It is ironic that our one successful incremental program, SCHIP, is now contributing to our chronic problems of an increasing number of uninsured and of making care less affordable by shifting more costs to the individual. Incrementalism is not working. All parameters are growing progressively worse.

We need comprehensive reform. But we won’t have that until we replace our milquetoast politicians who are too timid to take on the would-be anarchists who are currently in charge.

Milliman Medical Index 2005
Milliman Inc.

Milliman Inc. has completed its first annual study of the total annual medical costs for a “Typical American Family of Four.” The Milliman Medical Index (MMI) measures the average spending by such a family if covered by an employer-sponsored PPO program.

Based on a typical PPO plan design, Milliman estimates that out of the $12,214 total medical costs for 2005, a family would pay $2,035 out of their own pocket through member cost-sharing.

Future trends, including consumer-driven health plans:

As total medical costs continue to rise, employers will continue to look for ways to reduce costs, both for themselves and their employees. Employers are looking at ways to try to improve healthcare quality and reduce costs by sharing information aimed at educating their employees about the costs and efficacy of various medical services. Employers and health plans also continue to try to negotiate favorable rates with healthcare providers.

If these efforts are insufficient to keep employer cost trends at affordable levels, employers will continue to adjust employee contributions (both cost-sharing and premium sharing). While this has happened gradually in the recent past, some employers have concluded that this can only be done with a significant change in the traditional benefit plans being provided. This has led to increased interest in consumer-driven health plans (CDHPs), where members are given a spending account to pay for their own routine care, plus a high deductible plan to pay costs in catastrophic cases. Going from a traditional PPO plan to a high deductible plan can have a substantial impact on the portion of annual costs paid by the member through cost sharing,

A key question regarding CDHPs is whether they will result only in a shift of costs from the employer to the employee, or whether they will affect the total annual cost of healthcare.

http://www.milliman.com/mmi/Milliman_Medical_Index_Final.pdf

Comment: From the Milliman website: “One of the largest consulting and actuarial firms in the United States, we are recognized leaders who have helped shape significant changes in the markets we serve.”

When Milliman speaks, we listen. That doesn’t mean that we like what we hear.

This study reports that a typical family of four, enrolled in an employer-sponsored PPO pays $2,035 for out-of-pocket cost sharing of $12,214 in covered expenses. It is important to realize that the $2,035 does not include the employee’s contribution to the insurance premium, nor payments for non-covered products and services. When those are included, it is quite clear that average-income individuals would have difficulty affording the total out-of-pocket health care costs even though insured through the employer-sponsored PPO plan. Since PPO plans in the individual market are even less comprehensive, out-of-pocket expenses would be even more burdensome, not to mention the fact that the individual usually pays the full premium.

Also, since the study was limited to employer-sponsored PPO plans, the patient population is composed of relatively healthy, gainfully-employed individuals and their relatively healthy families. Just imagine the greater potential financial burden faced by those with more significant health care needs.

Thus the question posed by Milliman regarding the impact of the trend toward consumer driven health plans does not bode well for ensuring future affordable access to health care. In shifting more costs to the employees, either individuals will have the formidable task of reducing spending in other sectors of their already tight budgets, or, more likely, they will have to do without beneficial health care services.

Then, of course, in theory this could reduce total health care costs by motivating patients to reject unnecessary health care services. But first would someone show me all of those patients who are out seeking so much unnecessary care? I certainly don’t know who they are, or if they even really exist. When was the last time that you went to a doctor to try to obtain all of the unnecessary care that you could get?

New Projections From Nation’s Largest Health Care Coalition Show Health Care Reform Would Produce Huge Savings
National Coalition on Health Care
Press Release
May 23, 2005

System-wide health care reform would save much more money than it would cost, according to economic projections released today by the National Coalition on Health Care.

In four scenarios for reform analyzed by Professor Kenneth Thorpe of Emory University, the investment needed to achieve universal health coverage would be more than offset by savings. In each case, the cost of a reformed system would be much less than the cost of continuing with the current system.

Announcing these new findings, the Coalition’s president, Dr. Henry E. Simmons, said, “What this economic modeling shows unambiguously is that done right, health care reform will save America a great deal of money – while at the same time assuring health coverage for all Americans and dramatically improving health care.”

From Professor Thorpe’s PowerPoint presentation:

Total change in spending for years 2006 through 2015 under four scenarios (in comparison with the status quo):

$320 billion reduction – Employer mandate supplemented by individual mandate

$320 billion reduction – Expand existing programs to expand coverage

$370 billion reduction – Develop new program modeled after the FEHB (federal employees’ program)

$1136 billion ($1.136 trillion) reduction – Universal publicly financed program (“single payer”)

National Coalition on Health Care:
http://www.nchc.org/

Press Release:
http://www.nchc.org/news/press_releases/2003/2005_05_23.pdf

KFF video HealthCast of the press conference:
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?create=high_windows&linkid=1&display=detail&hc=1439

Kenneth Thorpe’s PowerPoint:
http://www.nchc.org/materials/nchcpressclub-final%20copy.pdf

Comment: The Honorary Co-Chairs of the National Coalition on Health Care are former presidents George Bush, Jimmy Carter and Gerald Ford. The member organizations of the Coalition represent about 150 million Americans and include business, labor, consumer, religious, provider, and health and pension fund interests. Every effort has been made to remove any partisan agenda from the process. Our former presidents can attest to that.

A highly objective process was used to evaluate the models of reform which would provide comprehensive coverage and higher quality care for everyone.
Which model would you choose?

New Projections From Nation’s Largest Health Care Coalition Show Health Care Reform Would Produce Huge Savings
National Coalition on Health Care
Press Release
May 23, 2005

System-wide health care reform would save much more money than it would cost, according to economic projections released today by the National Coalition on Health Care.

In four scenarios for reform analyzed by Professor Kenneth Thorpe of Emory University, the investment needed to achieve universal health coverage would be more than offset by savings. In each case, the cost of a reformed system would be much less than the cost of continuing with the current system.

Announcing these new findings, the Coalition’s president, Dr. Henry E. Simmons, said, “What this economic modeling shows unambiguously is that done right, health care reform will save America a great deal of money – while at the same time assuring health coverage for all Americans and dramatically improving health care.”

From Professor Thorpe’s PowerPoint presentation:

Total change in spending for years 2006 through 2015 under four scenarios (in comparison with the status quo):

$320 billion reduction – Employer mandate supplemented by individual mandate

$320 billion reduction – Expand existing programs to expand coverage

$370 billion reduction – Develop new program modeled after the FEHB (federal employees’ program)

$1136 billion ($1.136 trillion) reduction – Universal publicly financed program (“single payer”)

National Coalition on Health Care:
http://www.nchc.org/

Press Release:
http://www.nchc.org/news/press_releases/2003/2005_05_23.pdf

KFF video HealthCast of the press conference:
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?create=high_windows&linkid=1&display=detail&hc=1439

Kenneth Thorpe’s PowerPoint:
http://www.nchc.org/materials/nchcpressclub-final%20copy.pdf

Comment: The Honorary Co-Chairs of the National Coalition on Health Care are former presidents George Bush, Jimmy Carter and Gerald Ford. The member organizations of the Coalition represent about 150 million Americans and include business, labor, consumer, religious, provider, and health and pension fund interests. Every effort has been made to remove any partisan agenda from the process. Our former presidents can attest to that.

A highly objective process was used to evaluate the models of reform which would provide comprehensive coverage and higher quality care for everyone.
Which model would you choose?

Decoding Health Insurance
By Robin Cook
The New York Times
May 22, 2005

In this dawning era of genomic medicine, the result may be that the concept of private health insurance, which is based on actuarially pooling risk within specified, fragmented groups, will become obsolete since risk cannot be pooled if it can be determined for individual policyholders.

Genetically determined predilection for disease will become the modern equivalent of the “pre-existing condition” that private insurers have stringently avoided.

As a doctor I have always been against health insurance except for catastrophic care and for the very poor. It has been my experience that the doctor-patient relationship is the most personal and rewarding for both the patient and the doctor when a clear, direct fiduciary relationship exists. In such a circumstance, both individuals value the encounter more, which invariably leads to more time, more attention to potentially important details, and a higher level of patient compliance and satisfaction – all of which invariably result in a better outcome.

But with the end of pooling risk within defined groups, there is only one solution to the problem of paying for health care in the United States: to pool risk for the entire nation. (Under the rubric of health care I mean a comprehensive package that includes preventive care, acute care and catastrophic care.) Although I never thought I’d advocate a government-sponsored, obviously non-profit, tax-supported, universal access, single-payer plan, I’ve changed my mind: the sooner we move to such a system, the better off we will be. Only with universal health care will we be able to pool risk for the entire country and share what nature has dealt us; only then will there be no motivation for anyone or any organization to ferret out an individual’s confidential, genetic makeup.

There are plenty of compelling arguments for a national, single-payer, universal access plan – like every developed industrialized country has one. But those arguments have so far seemed insufficient. And none of them is nearly as cogent and persuasive as the growing impact of genomics and bioinformatics. Of course, far too many wealthy stakeholders in the current system (thanks to 15 percent of our gross domestic product being thrown at health care) are eager to lobby members of Congress to keep things as they are. The basic challenge is to blast the public and their elected representatives out of their shared apathy toward what the decipherment of the human genome has brought.

Robin Cook is a medical doctor and the author, most recently, of the novel “Marker.”

http://www.nytimes.com/2005/05/22/opinion/22cook.html?pagewanted=all

Comment: Every time that reason is introduced into the national dialogue on reform, the arguments for a single payer system become ever more compelling.

The Pew Research Center
Survey Report
Beyond Red vs. Blue
May 10, 2005

Health Insurance

Solid majorities of every group, with the sole exception of Enterprisers, favor a government guarantee of health insurance for all Americans, even if it means raising taxes. Across the electorate, support for guaranteed health insurance ranges from 55% among Upbeats and 59% among Social Conservatives to 90% among Liberals. By contrast, Enterprisers strongly oppose guaranteed health insurance for all, if it means higher taxes (76% oppose, 23% favor).

Percent favoring government health insurance for all, even if taxes increase:

65% of the total

23% of enterprisers

59% of social conservatives

63% of pro-government conservatives

55% of upbeats

64% of disaffecteds

73% of conservative Democrats

65% of disadvantaged Democrats

90% of liberals

For profiles of the typology groups:
http://people-press.org/reports/display.php3?PageID=949

For navigating the full report:
http://people-press.org/reports/display.php3?ReportID=242

Comment: Only the enterprisers (“staunch conservatives”) are opposed to tax-supported, government health insurance. The remarkable finding is that 59% of social conservatives (“moderate Republicans”) and 63% of pro-government conservatives (“populist Republicans”) do favor tax-supported government health insurance. Now if we can only get them to communicate that to their legislators.