Friday, September 10, 2004 (SF Chronicle)
Health care’s reality
by David Lazarus

The original article can be found on SFGate.com here:
http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2004/09/10/BUGU58MFDG1.DTL

denial noun: a psychological defense mechanism in which confrontation with a personal problem or with reality is avoided by denying the existence of the problem or reality..

Is the U.S. health care system working? Here are the facts:

— The number of Americans lacking health insurance rose last year to a record 45 million from 43.6 million in 2002, according to the latest census figures.

— About 5 million fewer jobs now provide health insurance than just three years ago, according to a newly released Kaiser Family Foundation survey.

— For jobs that do provide coverage, insurance premiums climbed 11.2 percent this year, or five times faster than both inflation and average U.S. workers’ salaries.

— Since 2001, premiums for family coverage have soared by almost 60 percent, compared with a 9.7 percent increase in consumer prices and a 12.3 percent gain in wages.

— More than half of companies with at least 200 workers say it’s very likely they will raise employee contributions to health coverage in the near future.

Yet despite such clear evidence of a health care system in crisis, neither President Bush nor Democratic challenger John Kerry has called for meaningful change in how Americans receive medical treatment.

Instead, both candidates favor keeping the current system intact while using taxpayer funds to expand the reach of the insurance industry.

“To expand a system that’s not working is absolute insanity,” said Don McCanne, a Southern California doctor and former president of Physicians for a National Health Program, a 12,000-strong organization advocating medical coverage for all Americans.

The real solution, McCanne and other health care activists believe, is creation of a so-called single-payer system in the United States.

Under such a system, similar to Canada’s state-backed insurance network, any American would be able to receive treatment from any doctor at any hospital nationwide.

It’s not so far-fetched. Federal and state taxes, along with tax subsidies for businesses, already account for about 60 percent of the nearly $1.8 trillion expected to be spent this year on health care in the United States, primarily through Medicare and Medicaid.

For the remaining 40 percent of health care spending, Physicians for a National Health Program advocates replacing private-sector insurance plans with a government-run program that would allocate funds to medical facilities.

A payroll tax of about 7 percent would replace all other employer expenses for medical costs, and an income tax of about 2 percent would replace employees’ current insurance premiums, co-pays, deductibles and other out-of- pocket expenses.

Such a system not only would work — as has been demonstrated in countries that already have single-payer plans — it would be far cheaper to administer than the existing health care system.

Harvard Medical School researchers determined earlier this year that about a quarter of all health care spending in the United States is now squandered on bureaucratic overhead, such as clerical staff at doctors’ offices to process a vast array of insurance forms.

Under a standardized single-payer system, the researchers estimated, annual administrative costs would be slashed by more than $280 billion. This represents enough money to insure all Americans now lacking coverage and to allow millions of underinsured people to improve their quality of care.

Refinements would be necessary to ensure cost controls and quality. A 2001 study, for example, found that Canadians requiring elective surgery wait an average 16 weeks before reaching an operating table. That would have to be improved upon.

But we’ll never know unless we try.

“It won’t be easy,” observed Kevin Grumbach, chairman of UCSF Medical School’s Department of Family and Community Medicine and a longtime backer of universal health care.

“You’re up against formidable special interests,” he said. “The insurance industry, the pharmaceutical industry — everybody making outrageous profits at the expense of delivering rational care to people.”

It should be noted that Canada didn’t rush into a single-payer plan. It experimented with the system on a province-by-province basis, beginning with Saskatchewan in 1946, before implementing it nationwide 25 years later.

State Sen. Sheila Kuehl, D-Santa Monica, believes California is the ideal proving ground to demonstrate that a single-payer system can work in this country as well.

She’s introduced legislation, SB921, which would insure every Californian under a single-payer plan and save the state about $14 billion in annual administrative costs. The bill was approved by the Assembly Health Committee in June by a vote of 12-5.

However, even if signed into law — which no one expects any time soon — SB921 still would require passage of federal legislation allowing state health authorities to serve as a conduit for Medicare funds.

“That’s going to be difficult under this president and this Congress,” Kuehl acknowledged. “The interests of business take precedence at the moment.”

She thinks this will change. First, though, political leaders will have to stop being in denial about the dysfunctional state of the current health care system.

“We’re often in denial about things we don’t know how to solve,” Kuehl said. “But I’m hopeful. Single-payer is so much more efficient and so much more effective. People will see that.”

When they finally accept reality, that is.

David Lazarus’ column appears Wednesdays, Fridays and Sundays. He also can be seen regularly on KTVU’s “Mornings on 2.” Send tips or feedback to
dlazarus@sfchronicle.com.

Copyright 2004 SF Chronicle

Jewish Journal of Greater Los Angeles, September 2004

Israel Has Rx for U.S. Health Careby

Mordechai Shani

Israel and the United States each have successes and failures in their respective health care systems, but the younger of the modern nations, rooted in its tradition of helping the needy, has much to teach its American ally. When it comes to some of the most important issues facing the American health care system today – universal health care, administrative costs and establishing a national health basket of services – America can look to Israel.

Until 1995, health insurance in Israel was voluntary, although 99 percent of the Jewish population and 97 percent of the Arab population were covered by four HMOs, the first of which was established at the end of 1911. This was a system wherein the insured members paid the HMO, and the employer made a compulsory payment to the National Insurance Institute.

Today in Israel, everyone is covered by health insurance. In 1994, the Israeli parliament passed a groundbreaking health insurance bill that made every Israeli resident automatically insured, no matter their age, financial status or religion. In the United States today, more than 43 million people, including 12 million children, are uninsured.

Israel’s universal health care is characterized by its “national health care basket,” which defines the range of services to which every resident is equally entitled. Residents can petition a labor court if they believe an HMO has ignored their rights to a medical service.

Universal access to Israel’s national health care basket means that there is no underinsurance in Israel, which happens when there are gaps in coverage. In the United States, more than 100 million citizens are underinsured, including 40 million with Medicare, 50 million with Medicaid and at least 10 million who are employed in large companies that have self-insurance.

The main health care delivery system for all Israelis is through primary and secondary clinics. These clinics, which are present throughout the country, provide easy and efficient access to care.

The clinics that belong to the HMOs enable quick access to primary medical care and also easy referral to specialists without waiting lists. There is continuity of care, while there is now a tremendous effort to computerize all the medical data.

Ninety-five percent of general care hospitals in Israel are public. There is no wait for diagnostic examinations such as MRI and CT or for procedures such as open-heart surgery. Payment for hospitalization is the responsibility of the HMO, and there is no deductible or co-insurance payment required of the patient.

There is a $3 co-payment for each prescription on the approved drug list covering acute and chronic diseases.

High unemployment and the Israeli economic recession make it difficult for about 10 percent of the population to pay even this, even though there is a $50 biannual co-payment cap.

Caring for the elderly is a core social policy and an integral part of health care in Israel. While in the United States geriatric care is handled by Medicare, in Israel it is part of the health basket and is the responsibility of the HMOs.

Only hospitalization in nursing homes is the responsibility of the Ministry of Health for those who cannot afford to pay for private insurance or from their own means. Geriatric care, being an integral part of health care in Israel, is of high quality.

I do hope that one of the Israeli government’s priorities in an improved economic situation will be to reflect the nation’s social values by exempting the poorest 5-10 percent of the population from drug co-payments.

Israel’s health indicators for longevity and infant mortality are better than those of the United States. This aspect is not unique to Israel, but many Western countries are better in the various indicators of health than the United States. Yet while Israel spends 8.8 percent of its Gross National Product on caring for the elderly, the United States spends 15 percent of its GNP.

In international comparisons of health care systems, Israel ranks among the top 20 in the world. But, even with its favorable standing, Israel faces many challenges, such as the financial limitations of introducing new technologies and prescription drugs to the health basket and the high taxes Israelis pay. Also of concern are high out-of-pocket expenses for cost sharing and for health care services that are covered only by complementary insurance.

Israel’s health care system, while based on the core value of access for all, is still evolving. The establishment of a “health parliament,” a private initiative endorsed by the government, enabled input from ordinary Israelis to help set priorities for the future, including the challenges of limited resources and the growing gap between rich and poor.

Obviously, Israel and the United States differ vastly in size, making full comparisons limited. But with the exception of four large states, Israel is similar in size to most U.S. states. The American health system can be improved only if states take responsibility for health care, or, in the case of the four largest states, if there is regional responsibility within the state.

In 2003, the United States spent at least 30 percent of its national health expenditures on administration, while Israel spent less than 10 percent. The United States could have saved at least $280 billion of the $400 billion spent in administrative expenditures in 2003 to cover the uninsured and to close the gap of the underinsured, strengthening the democratic principles it holds dear.

Professor Mordechai Shani is the director general of Sheba Medical Center at Tel Hashomer, Israel’s largest hospital. He served twice as director general of the Ministry of Health, including 1994, when the Insurance Bill and the Patients Bill of Rights were passed by the Knesset.

September 10, 2004
Cost of Insuring Workers’ Health Increases 11.2%
By MILT FREUDENHEIM

http://www.nytimes.com/2004/09/10/business/10care.html (story has a good chart that doesn’t show up here)

The cost of providing health care to employees has risen 11.2 percent this year, according to the results of an authoritative national survey reported yesterday.

It was the fourth consecutive year of double-digit increases in health insurance premiums, which has resulted in a steady decline in the number of the nation’s workers and their families receiving employer health care coverage.

The annual survey of 3,000 companies, conducted between January and May by the Kaiser Family Foundation and Health Research and Educational trust, is considered a reliable indicator of health care costs paid by companies and their workers.

Perhaps the only good news in the report was its indication that the rate of increase slowed from the record 13.9 percent in 2003, turning down for the first time since 1996. But this year’s jump was still more than five times the national 2.2 percent increase in wages from the spring of 2003 to spring 2004, as reported by the Bureau of Labor Statistics.

Small businesses are being especially hard hit as the average family coverage in preferred provider networks, the most common type of health plan, has risen to $10,217, with employees paying $2,691 of the total. In response to the soaring costs, many small companies are simply no longer offering coverage of a worker’s spouse and children.

“Small employers just cannot afford to spend the bulk of $10,000 on a family health plan for a $30,000 employee,” said Kate Sullivan Hare, the executive director of health care policy for the United States Chamber of Commerce. That same family coverage “used to cost $4,500 about six years ago,” she noted.

The survey found that the share of companies of all sizes offering health benefits to their workers declined to 61 percent, down from 65 percent in 2001. As a result, an estimated five million fewer workers have access to employer health care coverage than the 127 million reported in 2001, said John Gabel, vice president of Health Research and Educational Trust.

With health care high on the list of voter concerns in election year polls, the Bush and Kerry campaigns quickly jumped into the fray.

Senator John Kerry blamed Bush administration policies. “It’s wrong to allow skyrocketing health care costs to choke off new jobs, eat up family incomes and leave millions uninsured,” Mr. Kerry, the Democratic presidential candidate, said yesterday during a campaign stop in Des Moines.

The Census Bureau said last month that the nation’s total number of uninsured people had risen by 1.4 million in 2003, to a record 45 million.

Reed Dickens, a spokesman for the Bush-Cheney campaign, said: “This administration has helped slow the rate of increase for the first time in seven years. The president’s approach to this is a consumer-driven approach, and John Kerry’s philosophy is to shift the decision-making power to the federal government and shift the financial burden to the taxpayer.”

But Ms. Sullivan Hare at the Chamber of Commerce said that “neither presidential candidate is really talking about government policies to control health care inflation.” She added that most employers feel frustrated by the problems but they do not see “any magic bullets to help bring down costs.”

Health premiums are rising faster than the underlying cost of doctor and hospital care, as consolidation in the insurance industry has given insurers greater clout. The monthly cost of two-person coverage for workers and their spouses increased 23 percent, to $836.78, this year at the John G. Shelley Company, a distributor of industrial products with 26 employees in Wellesley Hills, Mass. Monthly premiums for individuals rose 13 percent, to $418.39.

Full family coverage at Shelley is now $1,255.17, with the company offering to pay nearly half. Kara Connaughton, the financial controller at the Shelley company, said nobody signed up. “They all have their children covered under their spouse’s plan,” she said.

Frank Ciotola, an owner of Da Vinci Ristorante in northwest Columbus, Ohio, is another employer grappling with premium inflation.

“It’s the same story with everybody I talk to,” Mr. Ciotola said. “We got 31 percent increase last month to renew our insurance.” He said he erased the increase by changing to a health savings plan, with a $1,700 annual deductible, for the three owners and four full-time employees in the plan.

The Kaiser report said that a growing number of employers were familiar with the health savings approach, a centerpiece of President Bush’s health care program that combines pretax savings accounts and high deductibles. But the report said that only 3.5 percent of the employers in the survey had adopted the plans. The favorable tax feature took effect last January.

Megan Hauck, deputy policy director of the Bush campaign, said that a survey by Fortis Health, a company that sells the health savings plans, reported that about one-third of the early recruits were “previously uninsured.”

For years, employers have been paying about 84 percent of premium costs, with workers picking up the remaining 16 percent, the survey said. But in dollar terms, that now means the average employee’s share has risen by more than $1,000 since 2000, said Drew Altman, the chief executive of the Henry J. Kaiser Family Foundation.

The rising cost of health insurance is not only affecting the current working population.

The federal Centers for Medicare and Medicaid announced last week that Medicare premiums deducted from Social Security checks of elderly and disabled people would rise 17.4 percent next year to $78.20 a month. Meanwhile, Social Security payments are expected to rise by only 2 to 3 percent, according to the Medicare Rights Center, an advocacy group for Medicare beneficiaries.

Friday, September 10, 2004 (SF Chronicle)
Health care’s reality
by David Lazarus

The original article can be found on SFGate.com here:
http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2004/09/10/BUGU58MFDG1.DTL

denial noun: a psychological defense mechanism in which confrontation with a personal problem or with reality is avoided by denying the existence of the problem or reality..

Is the U.S. health care system working? Here are the facts:

— The number of Americans lacking health insurance rose last year to a record 45 million from 43.6 million in 2002, according to the latest census figures.

— About 5 million fewer jobs now provide health insurance than just three years ago, according to a newly released Kaiser Family Foundation survey.

— For jobs that do provide coverage, insurance premiums climbed 11.2 percent this year, or five times faster than both inflation and average U.S. workers’ salaries.

— Since 2001, premiums for family coverage have soared by almost 60 percent, compared with a 9.7 percent increase in consumer prices and a 12.3 percent gain in wages.

— More than half of companies with at least 200 workers say it’s very likely they will raise employee contributions to health coverage in the near future.

Yet despite such clear evidence of a health care system in crisis, neither President Bush nor Democratic challenger John Kerry has called for meaningful change in how Americans receive medical treatment.

Instead, both candidates favor keeping the current system intact while using taxpayer funds to expand the reach of the insurance industry.

“To expand a system that’s not working is absolute insanity,” said Don McCanne, a Southern California doctor and former president of Physicians for a National Health Program, a 12,000-strong organization advocating medical coverage for all Americans.

The real solution, McCanne and other health care activists believe, is creation of a so-called single-payer system in the United States.

Under such a system, similar to Canada’s state-backed insurance network, any American would be able to receive treatment from any doctor at any hospital nationwide.

It’s not so far-fetched. Federal and state taxes, along with tax subsidies for businesses, already account for about 60 percent of the nearly $1.8 trillion expected to be spent this year on health care in the United States, primarily through Medicare and Medicaid.

For the remaining 40 percent of health care spending, Physicians for a National Health Program advocates replacing private-sector insurance plans with a government-run program that would allocate funds to medical facilities.

A payroll tax of about 7 percent would replace all other employer expenses for medical costs, and an income tax of about 2 percent would replace employees’ current insurance premiums, co-pays, deductibles and other out-of- pocket expenses.

Such a system not only would work — as has been demonstrated in countries that already have single-payer plans — it would be far cheaper to administer than the existing health care system.

Harvard Medical School researchers determined earlier this year that about a quarter of all health care spending in the United States is now squandered on bureaucratic overhead, such as clerical staff at doctors’ offices to process a vast array of insurance forms.

Under a standardized single-payer system, the researchers estimated, annual administrative costs would be slashed by more than $280 billion. This represents enough money to insure all Americans now lacking coverage and to allow millions of underinsured people to improve their quality of care.

Refinements would be necessary to ensure cost controls and quality. A 2001 study, for example, found that Canadians requiring elective surgery wait an average 16 weeks before reaching an operating table. That would have to be improved upon.

But we’ll never know unless we try.

“It won’t be easy,” observed Kevin Grumbach, chairman of UCSF Medical School’s Department of Family and Community Medicine and a longtime backer of universal health care.

“You’re up against formidable special interests,” he said. “The insurance industry, the pharmaceutical industry — everybody making outrageous profits at the expense of delivering rational care to people.”

It should be noted that Canada didn’t rush into a single-payer plan. It experimented with the system on a province-by-province basis, beginning with Saskatchewan in 1946, before implementing it nationwide 25 years later.

State Sen. Sheila Kuehl, D-Santa Monica, believes California is the ideal proving ground to demonstrate that a single-payer system can work in this country as well.

She’s introduced legislation, SB921, which would insure every Californian under a single-payer plan and save the state about $14 billion in annual administrative costs. The bill was approved by the Assembly Health Committee in June by a vote of 12-5.

However, even if signed into law — which no one expects any time soon — SB921 still would require passage of federal legislation allowing state health authorities to serve as a conduit for Medicare funds.

“That’s going to be difficult under this president and this Congress,” Kuehl acknowledged. “The interests of business take precedence at the moment.”

She thinks this will change. First, though, political leaders will have to stop being in denial about the dysfunctional state of the current health care system.

“We’re often in denial about things we don’t know how to solve,” Kuehl said. “But I’m hopeful. Single-payer is so much more efficient and so much more effective. People will see that.”

When they finally accept reality, that is.

David Lazarus’ column appears Wednesdays, Fridays and Sundays. He also can be seen regularly on KTVU’s “Mornings on 2.” Send tips or feedback to
dlazarus@sfchronicle.com.

Copyright 2004 SF Chronicle

NHS plc
THE PRIVATISATION OF OUR HEALTH CARE

ALLYSON M POLLOCK

Whether or not the public has a ‘right to choose’, it seems likely that the basic right to free care that the creation of the NHS sought to enshrine will continue to suffer at the hands of a succession of politicians more interested in media presence than in the realities of public health policy. Now, more than ever, it is vital to understand what has happened to our health service, and to ask whether it is in the public interest for matters to continue in this way.

NHS plc tells the story of how the ideal of universal, comprehensive health care, equally available to all and disconnected from income and the ability to pay, has been progressively eroded, and how the clock is being turned back to pre-NHS days. Now even the shrinking core of free NHS hospital services is being handed over to private providers at the taxpayers’ expense. Allyson Pollock deconstructs slogans like ‘care in the community’, ‘diversity’ and ‘local ownership’, to present a clear and powerful analysis of the transition from a comprehensive and universal service to New Labour’s ‘mixed economy of health care’.

“This is a shocking story, brilliantly told, by one of the leading thinkers in the field of public health policy. Here you will learn how Labour politicians, with their cronies from the private sector, are turning this magnificent institution into one of the greatest pork barrels of all time. No one who cares about the health of the nation should ignore NHS plc.”Prof Raymond Tallis, author of Hippocratic Oaths. Medicine and its Discontents

Allyson M Pollock. NHS plc: the privatisation of our health care. London: Verso 2004
Hardback: £15
ISBN: 1 84467 011 2

To order your copy for £12 (plus postage) please contact direct sales at:

Marston Book Services
Unit 160
Milton Park
Abingdon
Oxon OX14 4SD

Tel +44 (0)1235 465 500
Fax +44(0)1235 465 555
direct.orders@marston.co.uk

Please quote the reference PPPOL in order to receive the discounted price.Payment is accepted by credit card, switch, international money order or cheque drawn on a UK bank account.
Please note payment must be in pounds sterling.

Dirigo Health: Don’t compound the illness
By Kent Price

WALDO COUNTY (Aug 29, 2004): Last week’s Citizen reported that as many as 3,500 of Maine’s hospital jobs may be at risk under cost-cutting ideas being considered by the Commission to Study Maine Hospitals, part of the Dirigo Health plan soon to be under way. Asked to comment on this prospect, Mark Biscone is not at a loss for words: “Devastating, outrageous and horrible,” are just a few.

Biscone, CEO of Waldo County General Hospital, is not crying wolf. The hospital has cut services, reduced positions, and is among the state’s most-efficient facilities. Yet, if the proposed reductions are approved, the hospital may have to trim an additional 40 to 50 positions, directly affecting patient care services.

Are across-the-board cuts appropriate for all Maine hospitals? Does one size fit all? Does community need diminish along with position cuts, or is the opposite more likely? The very fact that such a high degree of controversy exists suggests that, as the movie line has it, we have here a failure to communicate. State health policymakers need to collaborate closely with those most directly affected by their decisions.

Still, few would deny that a health care crisis exists and that Dirigo Health is a bold and positive bid to insure the uninsured, reduce costs for both individuals and small businesses and boost preventative programs. It is a Maine original — unique in the nation — and other states are looking at us closely. Dirigo means “I lead” and we are doing just that.

But if Dirigo is pioneering, it also may be only a step in the right direction. In what might be called consumer-owned medicine, national health insurance would take high-profit insurance companies out of the health-care equation while extending coverage to the tens of millions of Americans who lack it.

A year ago, in August 2003, nearly 8,000 physicians, including two former U.S. Surgeons General and hundreds of medical school deans and professors, proposed a plan for national health insurance. Writing in the Journal of the American Medical Association, they said a national single-payer plan not only is the best way to deal with our mounting health-care crisis, it is the only way.

National health insurance is not pie in the sky. Every other industrialized nation in the world takes care of its people in this way. Only in the U.S., and only because of an accident of history, are employers the primary providers of health insurance. It makes little sense, and the whole system now is breaking down under soaring costs and lack of coverage. Neither our health nor our wallets can afford it anymore.

It may well be years before the U.S. joins the rest of the world in guaranteeing basic health care to all our citizens. In the meantime, let’s be sure not to make a bad problem worse by cutting needed community services. After all, the Hippocratic oath taken by physicians provides that, “First, do no harm.”

Kent Price is a Democratic candidate for Maine House District 41, which includes Searsport, Frankfort, Stockton Springs, Prospect, Verona Island and Orland.