PNHP

The FDA Huffs, but Canadian Drugs are OK

The FDA Huffs, but Canadian Drugs are OK

The Food and Drug Administration would have consumers believe they’re taking a huge risk when they send their prescriptions to pharmacies north of the border, where the same drugs cost far less than they do here.

Hogwash. The fact is, drugs purchased through the Canadian health care system are every bit as safe as those available in the United States.

The FDA’s warning is a smokescreen thrown up to conceal the agency’s – and Congress’ – unseemly coziness with the drug industry.

The FDA warns that Canadian drugs may be outdated, subpotent, contaminated or counterfeit. The agency says that Canadian pharmacists might dispense the wrong or a contraindicated product, an incorrect dose, or a medication that isn’t accompanied by adequate directions for use.

But the agency has no justification for its cautions. To the contrary, a recent report by the Congressional Research Service supports the safety of drugs from Canada. It found that medications manufactured and distributed there meet or surpass quality-control guidelines set by the FDA.

According to this report, prepared at the request of Rep. Bernard Sanders (I-Vt.), the two countries regulate prescription drugs in virtually identical ways – from manufacturing and importation to labeling, distribution and sales. The report found that Canada’s pharmaceutical controls mimic those in the United States, with Canada tracking drugs through each distribution step.

The proof is in the pudding. Are people really being hurt by taking prescriptions filled in Canada? When asked to give examples of people who have been harmed, Tom McGinnis, the FDA’s director of pharmacy affairs, said late last year, “We don’t have that. I can’t think of one thing off the top of my head where somebody died or somebody got put in the hospital because of these medications. I just don’t know if there’s anything like that.”

Meanwhile, it’s clear that there are major problems in the drug regulatory arena right here in the United States. People were shocked to learn recently that counterfeit versions of the cholesterol-lowering drug Lipitor were surfacing in large U.S. pharmacies. Other instances of counterfeit drugs entering U.S. commerce have led to further questions about the safety of the drug supply.

The real issue, of course, is not whether the drugs from Canada are safe, but rather, why are they so much cheaper? Canadian pharmacies offer savings that average 35 percent over prices available in the United States, mostly because the Canadian government imposes price controls.

In a free-market society, people’s blood boils at the thought of imposing price controls. But is the health care industry part of a true free-market economy? When purchase decisions are ultimately made by the prescriber without much input from the patient, as is the case here, the drug industry is not a free-market economy.

The FDA’s froth about Canadian drugs are indicators of a much larger problem: the inability of the current administration to lower the outrageous cost of prescription drugs. Viewed through that lens, the FDA’s recent rantings are intended to deflect criticism from Congress’ inability to come up with a meaningful program to reduce the costs of drugs and to conceal its toasty warm relationship with the industry.

Cash-strapped health programs from cities and states around our nation are beginning to embrace the idea of taking their business north. Surely, responsible government officials from around the nation would not thumb their collective noses at the FDA if they felt it would put citizens at risk.

Make no mistake about it: Buying drugs from licensed brick-and-mortar pharmacies in Canada is an altogether different proposition from buying drugs from so-called rogue Web sites. Anytime consumers are offered the opportunity to buy prescription drugs without a prescription, they should be suspicious. It is illegal to do so, and more importantly, it’s a risky proposition. But it’s not the same as getting a properly written prescription filled by a licensed and regulated pharmacy through the mail.

The sound of FDA’s sabers rattling is reverberating from Vermont to Florida and from California to Washington.

I am not sure what the answer is, but it is time we shifted our focus from Canada to Washington – where the real problem lies.

Copyright (C) 2004, Newsday, Inc.
Posted under the requirements of “Fair Use.”

Gail Shearer's JEC testimony on "consumer-driven" health care

United States Congress
Joint Economic Committee
February 25, 2004

Impact of “Consumer-Driven” Health Care on Consumers Testimony of Gail Shearer, Director, Health Policy Analysis Washington Office of Consumers Union

Excerpts:

One way to reduce the employer premiums for health insurance, and to make
payments more predictable, is to switch to a “defined contribution” approach
to health insurance… In the employer health insurance market, a key dstinguishing feature of its effort to move toward a defined contribution model is high-deductible coverage. As indicated by the title of the Joint Economic Committee hearing, the term that insurers and employers have coined to name this new trend in the marketplace is “consumer-driven health care.” Consumers Union… is troubled by this trend in the marketplace. In our testimony, we plan to explain why we believe this type of coverage is misnamed, misguided from a policy perspective, and a dangerous distraction from the health insurance crisis that faces 43.6 million uninsured consumers and tens of millions of underinsured consumers.

The focus of the President’s Economic Report chapter on health insurance is
more on the alleged problems of over-insurance rather than the problems associated with the lack of insurance and underinsurance. The chapter could
be a primer for a Health Economics 101 course on the virtues of an unfettered free market for health insurance: the reader learns about different consumption choices that consumers make when they have insurance. It posits that patients might over-consume services if they face too little cost-sharing.

Nowhere in this chapter is there recognition of the reality that faces millions of Americans every year: For the most part, people are not uninsured out of choice, but because they can not afford to pay health insurance premiums. Every day, uninsured and underinsured Americans are dying because of the lack of insurance.

When the marketplace shifts to one characterized by pricing to risk, as suggested by the President’s Economic Report, this leads to escalating premiums for the very people who can least afford them – people who face serious health challenges.

The Administration’s proposals, which boost “consumer-driven” health care,
by design, shift more costs to those who are sick. The result will ultimately be a health care system that distributes costs of health care even less fairly than it does today.

Based on survey data from the Medical Expenditure Panel Survey (MEPS) and
adjusted to 2000 levels (by the Lewin microsimulation model), the average
health care costs of those with employer based coverage was $2,628 in 2000.
However, the average masks a large degree of variation: those in the lowest
fifth of spending incurred on average $30 of health care expenditures, while
those in the top tenth of spending incurred costs of $16,710. This variation
of risk goes to the heart of the need to find a way to spread costs broadly
in order to keep costs affordable to those at the highest risk level. Yet the Economic Report of the President suggests that instead of spreading risks broadly so that health coverage will be affordable to those with existing conditions, “pricing to risk” is a primary goal of the health insurance marketplace. This approach sacrifices any notion of community and sharing of our neighbor’s burden, in favor of marketplace efficiency.

Expansion of medical savings accounts (MSAs) under the new name of Health
Savings Accounts (HSAs) adds a new wrinkle to “consumer-driven health care”
plans by making the contributions to the health reimbursement account tax
deductible. This new tax policy, combined with high deductible health coverage, is likely to appeal disproportionately to the healthy and wealthy.

Because of the variation of risks, and different selections made by people of different health status, high deductible plans can not exist in the long-term in a marketplace that offers low-deductible plans as well. Ultimately, low-deductible plans will be driven out of the market, with “premium spirals” driving out comprehensive coverage.

“Fundamentally, those who would likely win from shifting to MSA/catastrophic
arrangements are the healthy who will ‘take back’ some of their ‘excess’ contributions that effectively help to subsidize others.”

“The great savings will be for the employees who have little or no health care expenditures. The greatest losses will be for employees with substantial health care expenditures.”

A recent study of “consumer-directed health benefits” concluded that the young and healthy are potential winners, and that older people are less likely to choose high deductible plans.

In sum, high deductible coverage, combined with the new tax shelter, drive up premiums for those wanting low deductible coverage, are likely to lead to elimination of low-deductible coverage, strain the federal treasury, and will lead to shifting of costs to those who are sick while benefiting the healthy and those in high tax brackets.

As the President’s Economic Report clearly points out, high-deductible (and “consumer-driven”) health care plans are designed to increase out-of-pocket
costs for those who have health care expenditures.

Focusing on transforming our health care marketplace into a high-deductible marketplace is a dangerous distraction from the urgent national goal of extending affordable, quality health coverage to all.

For the full testimony:
http://www.consumersunion.org/pub/0225JECTestimonyNoSummary.pdf

Comment: High-deductible coverage, health savings accounts, defined contributions, and plans with Spartan benefits and greater cost sharing are all methods of “empowering the consumer” in the health care marketplace. In health care, an “empowered consumer” means that he or she feels the pain of health care costs. Current trends are intensifying this pain by “pricing to risk.” Those with greater health care risks are being required to pay higher prices if they “choose” to have access to health care. Those who cannot afford the higher prices will “choose” to have impaired health care outcomes (though no other real option is being offered).

Gail Shearer’s testimony should be downloaded and distributed widely. The
nation needs to understand why we should reject current policies that provide the healthy and wealthy with the option of not participating in the risk pools that help to fund care for the sick and poor.

Gail Shearer’s JEC testimony on “consumer-driven” health care

United States Congress
Joint Economic Committee
February 25, 2004

Impact of “Consumer-Driven” Health Care on Consumers Testimony of Gail Shearer, Director, Health Policy Analysis Washington Office of Consumers Union

Excerpts:

One way to reduce the employer premiums for health insurance, and to make
payments more predictable, is to switch to a “defined contribution” approach
to health insurance… In the employer health insurance market, a key dstinguishing feature of its effort to move toward a defined contribution model is high-deductible coverage. As indicated by the title of the Joint Economic Committee hearing, the term that insurers and employers have coined to name this new trend in the marketplace is “consumer-driven health care.” Consumers Union… is troubled by this trend in the marketplace. In our testimony, we plan to explain why we believe this type of coverage is misnamed, misguided from a policy perspective, and a dangerous distraction from the health insurance crisis that faces 43.6 million uninsured consumers and tens of millions of underinsured consumers.

The focus of the President’s Economic Report chapter on health insurance is
more on the alleged problems of over-insurance rather than the problems associated with the lack of insurance and underinsurance. The chapter could
be a primer for a Health Economics 101 course on the virtues of an unfettered free market for health insurance: the reader learns about different consumption choices that consumers make when they have insurance. It posits that patients might over-consume services if they face too little cost-sharing.

Nowhere in this chapter is there recognition of the reality that faces millions of Americans every year: For the most part, people are not uninsured out of choice, but because they can not afford to pay health insurance premiums. Every day, uninsured and underinsured Americans are dying because of the lack of insurance.

When the marketplace shifts to one characterized by pricing to risk, as suggested by the President’s Economic Report, this leads to escalating premiums for the very people who can least afford them – people who face serious health challenges.

The Administration’s proposals, which boost “consumer-driven” health care,
by design, shift more costs to those who are sick. The result will ultimately be a health care system that distributes costs of health care even less fairly than it does today.

Based on survey data from the Medical Expenditure Panel Survey (MEPS) and
adjusted to 2000 levels (by the Lewin microsimulation model), the average
health care costs of those with employer based coverage was $2,628 in 2000.
However, the average masks a large degree of variation: those in the lowest
fifth of spending incurred on average $30 of health care expenditures, while
those in the top tenth of spending incurred costs of $16,710. This variation
of risk goes to the heart of the need to find a way to spread costs broadly
in order to keep costs affordable to those at the highest risk level. Yet the Economic Report of the President suggests that instead of spreading risks broadly so that health coverage will be affordable to those with existing conditions, “pricing to risk” is a primary goal of the health insurance marketplace. This approach sacrifices any notion of community and sharing of our neighbor’s burden, in favor of marketplace efficiency.

Expansion of medical savings accounts (MSAs) under the new name of Health
Savings Accounts (HSAs) adds a new wrinkle to “consumer-driven health care”
plans by making the contributions to the health reimbursement account tax
deductible. This new tax policy, combined with high deductible health coverage, is likely to appeal disproportionately to the healthy and wealthy.

Because of the variation of risks, and different selections made by people of different health status, high deductible plans can not exist in the long-term in a marketplace that offers low-deductible plans as well. Ultimately, low-deductible plans will be driven out of the market, with “premium spirals” driving out comprehensive coverage.

“Fundamentally, those who would likely win from shifting to MSA/catastrophic
arrangements are the healthy who will ‘take back’ some of their ‘excess’ contributions that effectively help to subsidize others.”

“The great savings will be for the employees who have little or no health care expenditures. The greatest losses will be for employees with substantial health care expenditures.”

A recent study of “consumer-directed health benefits” concluded that the young and healthy are potential winners, and that older people are less likely to choose high deductible plans.

In sum, high deductible coverage, combined with the new tax shelter, drive up premiums for those wanting low deductible coverage, are likely to lead to elimination of low-deductible coverage, strain the federal treasury, and will lead to shifting of costs to those who are sick while benefiting the healthy and those in high tax brackets.

As the President’s Economic Report clearly points out, high-deductible (and “consumer-driven”) health care plans are designed to increase out-of-pocket
costs for those who have health care expenditures.

Focusing on transforming our health care marketplace into a high-deductible marketplace is a dangerous distraction from the urgent national goal of extending affordable, quality health coverage to all.

For the full testimony:
http://www.consumersunion.org/pub/0225JECTestimonyNoSummary.pdf

Comment: High-deductible coverage, health savings accounts, defined contributions, and plans with Spartan benefits and greater cost sharing are all methods of “empowering the consumer” in the health care marketplace. In health care, an “empowered consumer” means that he or she feels the pain of health care costs. Current trends are intensifying this pain by “pricing to risk.” Those with greater health care risks are being required to pay higher prices if they “choose” to have access to health care. Those who cannot afford the higher prices will “choose” to have impaired health care outcomes (though no other real option is being offered).

Gail Shearer’s testimony should be downloaded and distributed widely. The
nation needs to understand why we should reject current policies that provide the healthy and wealthy with the option of not participating in the risk pools that help to fund care for the sick and poor.

18,000 premature deaths: one individual

The Boston Globe
2/24/2004
Vocal critic of abuse by clergy found dead
By Brian MacQuarrie

Patrick McSorley, a victim of defrocked priest John J. Geoghan who became one of the most visible critics of clergy sexual abuse, was discovered dead early yesterday in a North End apartment, his lawyer said yesterday.

A close friend said McSorley, 29, occasionally went to the apartment to take drugs owing to a chronic substance-abuse problem that had plagued him for several years.

“To think he had come this far and just to have it end so abruptly — it’s a tragic ending,” said the friend, Alexa MacPherson, 29,…

“I spent a lot of last summer and fall trying to help him get into a drug- rehabilitation program. He definitely was in need of some serious help,” MacPherson said. “There were days when we would spend 10, 12, 14 hours at . . . hospitals, trying to get him in. He wanted their help so badly, and we basically got turned away because he had no health insurance.”

http://www.boston.com/news/local/massachusetts/articles/2004/02/24/vocal_critic_of_abuse_by_clergy_found_dead/

Comment: “… turned away because he had no health insurance.”
Patrick McSorley may or may not be one of the 18,000 young adults who will
die this year merely because of the lack of health insurance. It is quite possible that his disease of chemical dependency may have been lethal even if he were insured. But now we’ll never know.

Some may want to blame the victim. Others may blame clergy abuse. The issues
are complex, as they are in every instance of preventable premature death. But we can very easily eliminate the factor of being insured and move on with efforts to correct the other individual and societal problems that culminate in these tragedies. Just that first step alone would save 18,000 young adult lives.

Impact of “Consumer-Driven” Health Care on Consumers

Testimony of Gail Shearer
Director, Health Policy Analysis
Washington Office
CONSUMERS UNION
Before the
Joint Economic Committee
On
Impact of “Consumer-Driven” Health Care on Consumers
February 25, 2004

Employers, who provide health insurance for about 60 percent of the U.S.
population, are increasingly under pressure to constrain their spending on health
insurance premiums, which have been growing in recent years at an annual rate of 5 to 8 percent. This pressure is aggravated by the recent weakness in the economy. One way to reduce the employer premiums for health insurance, and to make payments more predictable, is to switch to a “defined contribution” approach to health insurance, similar to the shift in recent decades from defined benefit pensions to defined contribution pensions.


please click here to view the full report

Steelhead fever and health care

San Diego Trout
Accounts of Indians

Interview with Babe Ramos, a Native American of the Juaneno Band of the Acjachemen Nation, who was born in the Aguilar Adobe House (in San Juan Capistrano, CA where the Jack-in-the-Box is presently sited):

We asked Babe to talk about his life and to especially recall his or his brothers’ experiences around the steelhead in both the San Juan Creek and Trabuco Creek.

“In ’39 there was a big flood on the Trabuco, but lots of steelheads -they caught steelhead into the 1950’s. The last one I remember was in ’58.”

“I remember back oh, starting at 7 or 8 years old, with my brothers,Julian Junior, Aurelio, and Rudy, we wore uniforms to the Mission school. We weren’t supposed to – well Mother was strict about our uniforms, but one day after school before coming home we followed the creek, and jumped in – jumped in on a 30″ fish, a steelhead. We just had our pocket knife, and would jump in to them and bring them home. Mom, she saw us all wet and had that look – we were in for it, but when I took that big steelhead out from behind my back she showed a small, a little smile. They were very good to eat.”

“I guess (at age) 13 or 14 – I needed an operation right away, so my Dad took me to the closest hospital. Yes, my appendix. This was up in Anaheim, and we didn’t have money to pay for the doctor or hospital bill. Well that doctor told my Dad don’t worry about the hospital bill. Mom told me my end of the bargain was to take the doctor a steelhead once a week. Mom made sure to remind me to take that steelhead – which I did! That was in ’46.”

http://www.sandiegotrout.org/indians.html

Comment: What on earth is steelhead doing in a health policy message? Well,
first of all, steelhead fever is a life-long disorder that, unlike other diseases, dramatically improves quality of life. Any person reading this who has steelhead fever knows he or she has it and knows that the condition cannot be adequately explained to those people who don’t. It also seems to be a familial disorder since my sons have it as well.

That said, the plight of the steelhead in San Juan Capistrano exemplifies some of the dramatic changes resulting from ecological factors, especially in human ecology.

I arrived in San Juan Capistrano and San Clemente in July, 1966, the same month that Medicare and Medicaid provided coverage to many with health care
needs who could not otherwise afford to pay for it. The decimated steelhead
population could no longer serve as a source of payment for health care services, and other sources of barter were totally inadequate. Medicare
and Medicaid were a great advance forward in ensuring affordable access to
health care.

37 years later, what further advances have we made? Universality? Sustained
comprehensive coverage? Affordability? Accessibility? It seems that the dynamics of human ecology have not been very kind. We do have the resources. We do have the health policy knowledge on how to improve utilization of our resources. But we seem to lack solidarity and egalitarianism. Does it really have to remain that way?

Although a few steelhead have been spotted in Orange County in the past decade, sadly, human ecological factors will prevail. And what fate does human ecology hold for native Americans, for descendents of more recent European arrivals, and for all of the rest of us in the mix of the great American melting pot?

Maybe it’s time to turn to the sociologists to show us how to apply human ecology for the betterment of mankind, at least as it applies to health care. We can certainly continue to try to use what we have also learned from the economists, political scientists and others who have attempted to show us the light. There must be a solution. Steelhead bartering certainly won’t do it anymore.

Does solidarity exist in the United States?

Date: Mon, 23 Feb 2004 09:57:02 -0800
Does solidarity exist in the United States?

Los Angeles Times
February 23, 2004
State Cutbacks Harm Kids’ Health Program

Re “Budget Signals Narrowed Ambitions,” Feb. 18: Gov. Arnold Schwarzenegger’s finance director, Donna Arduin, suggests that expanding California’s Healthy Families insurance program for low-income children was indulging a policy whim. To the contrary, the state-federal Children’s Health Insurance Program is recognized widely as the one genuine health policy success of the last decade. Although the numbers of uninsured have continued to increase, they would be even greater without this program.

The political agenda on both the state and federal levels is to create nearly intolerable debt in place of modest taxation of significant private revenue sources. But the voters surely didn’t intend that more children be excluded from this essential health insurance program. Or did they?

Don McCanne MD
San Juan Capistrano

http://www.latimes.com/news/opinion/letters/la-le-priests23.2feb23,0,7725486.story?coll=la-news-comment-letters

And…

Los Angeles Times
February 23, 2004
In health, Canada tops U.S.

An impressive array of data shows that Canadians live longer, healthier lives than we do. What’s more, they pay roughly half as much per capita as
we do…

Exactly why Canadians fare better is the subject of considerable academic
debate. Some policy experts say it’s Canada’s single-payer, universal health
coverage system. Some think it’s because our neighbors to the north use
fewer illegal drugs and shoot each other less often with guns…

Still others think Canadians are healthier because their medical system is tilted more toward primary care doctors and less toward specialists. And some believe it’s something more fundamental: a smaller gap between rich and poor.

Perhaps it’s all of the above. But there’s no arguing the basics. “By all measures, Canadians’ health is better,” says Dr. Barbara Starfield, a university distinguished professor at Johns Hopkins Medical Institutions.

Gerald Kominski, associate director of the UCLA Center for Health Policy Research, puts the Canadian comparison this way: “Are they richer? No. Are
they doing a better job at the lower end of the income distribution? For
lower-income individuals, they are doing a better job.”

“The summary of the evidence has to be that national health insurance has
improved the health of Canadians and is responsible for some of the longer
life expectancy,” says Dr. Steffie Woolhandler, an associate professor at
Harvard Medical School and staunch advocate of a single-payer system.

Of course, some causes of death, such as homicide, wouldn’t be much affected
by having a single payer system.

“Other things might be differences in seat belt usage,” adds Robert Blendon,
a professor of health policy and political analysis at the Harvard School of
Public Health. “We are also disproportionate consumers of illegal drugs… ”

The health of Americans would be better with universal healthcare, he says.

The bottom line is that Canada is doing something right, even if “the reasons are not totally understood,” says Kominski of UCLA.

http://www.latimes.com/features/health/la-he-canada23feb23,1,6443349.column?coll=la-headlines-health

Comment: Although there are many differences between the United States and
Canada, there is absolutely no dispute that affordable access to comprehensive health care has improved health care outcomes in Canada. How have they been able to achieve so much more at a significantly lower cost? Based on the well documented, universal support of their medicare system, Canadians have demonstrated the importance of national solidarity.

Does solidarity exist in the United States? Some believe that it is only a matter of educating the public. If people really understood that we could raise the standards for lower-income individuals with relatively modest public support, then we would unite in solidarity.

But many states have had ballot measures that required voters to choose between taxes or the necessity to reduce public programs for the most vulnerable citizens. The results have revealed our dirty secret. Of all ndustrialized nations, the people of the United States are unique in lacking solidarity. Is it possible for us to change that?

Illegal to be sick?

The Progressive
February 2004
Gouging the Poor
By Barbara Ehrenreich

There’s been a lot of whining about health care recently: the shocking cost of insurance, the mounting reluctance of employers to share that cost, the challenge–should you be so lucky as to have insurance–of finding a doctor
your insurance company will deign to reimburse, and so forth. But let’s look
at the glass half full for a change. Despite the growing misfit between health care costs and personal incomes, it is not yet illegal to be sick.

Not quite yet, anyway, though the trend is clear…

… it’s not just the dodgier, second-rate hospitals that are relying on the police as collection agents. Yale-New Haven Hospital, for example, has obtained sixty-five arrest warrants for delinquent debtors in the last three years.

Of course, if you work for Yale-New Haven, it’s not your body that gets “attached.” On a recent visit to Yale hospital workers, I met Tawana Marks, a registrar at the hospital, who had the misfortune to also be admitted as a patient. Unsurprisingly, her hospital-supplied health insurance failed to cover her hospital-incurred bill, so Marks now has her paycheck garnished by her own employer–a condition of debt servitude reminiscent of early twentieth century company towns.

But for those of you who still imagine that illness and pain should elicit kindly responses from one’s fellow humans, I have one last half full observation: Our prisons do offer health care–grossly inadequate care to be sure–but at least it’s free, even for child molesters, ax murderers, and those miscreants who have the gall to be both sick and uninsured.

http://www.progressive.org/feb04/ehr0204.html

And…

The New York Times
February 20, 2004
Hospitals Can Provide Discounts to Uninsured and Needy Patients, Bush
Administration Says
By Robert Pear

The Bush administration encouraged hospitals on Thursday to give discounts
to uninsured patients and to financially needy Medicare beneficiaries. Such discounts are permissible under federal fraud and abuse laws, the government said, in a clarification requested by the hospital industry.

The new guidelines are a bit stricter for Medicare beneficiaries than for uninsured patients.

Consumer groups say the billing practices of some hospitals have been too aggressive. Medicare will pay hospitals for a share of their bad debt if they make “reasonable efforts” at collection, but the Bush administration said hospitals did not have to seize patients’ homes or other assets.

Comment: Routine discounting of fees for the uninsured and routine waiving of deductibles for the insured are usually prohibited by Medicare and by private insurance provider contracts. Third party payers rely on deductibles as disincentives, in order to reduce utilization of health services. Also, contracts are usually granted at rates below the usual fees charged. Routine discounts establish a lower usual fee than the list prices that then would be rarely collected. Thus Medicare and private insurance contracts have prohibited the routine waiving of list prices and deductibles.

The result was fully predictable. Aggressive collection practices have continued in order to demonstrate compliance with these requirements, whether it is for fear of reprisal or as an excuse to improve collection ratios. Personal bankruptcies because of medical bills have become commonplace. And non-payment of medical bills has even been criminalized by legal mechanisms such as “body attachment.”

It is a relief that the Bush administration does recognize the seriousness of the inability of many individuals to pay for essential medical care, even though they are hedging on the Medicare requirements. But rather than merely reducing penalties against providers for failing to aggressively pursue bill collection, wouldn’t it be better to find a way to provide everyone with comprehensive health insurance? Unfortunately, the current official position of the Bush administration is that it can’t be done.

We can show them how.

Health care for low income children is a "policy whim

Los Angeles Times
February 18, 2004
Budget Signals Narrowed Ambitions
By Peter Nicholas and Virginia Ellis

For decades, California distinguished itself by pioneering easy and inexpensive access to college and championing broad medical coverage and a generous financial lifeline for the poorest families.

Now, driven by financial necessity, political leaders are redefining California’s government, positioning it as a follower instead of a leader.

Even as California’s finances were strained by the dot-com collapse, former
Gov. Gray Davis plowed resources into the subsidized health insurance program for poor children, Healthy Families (California’s SCHIP program). Enrollment rose from about 100,000 to 700,000.

Donna Arduin, Schwarzenegger’s finance director, questioned the sincerity of
recent officials who had approved such largess. With no steady source of money for the expansion, the state was not so much preserving a progressive legacy as indulging a policy whim, Arduin suggested.

“If the policymakers that preceded our being here had a long-term plan for those programs, the argument would be much stronger that these were the priorities of the state,” Arduin said in an interview. “I don’t see that long-term funds were planned and made available to keep these expansions going.”

In navigating the financial crisis – preserving essential services while wiping out the state’s deficit – California may yet prove to be a model for the rest of the country, she added.

http://www.latimes.com/news/local/la-me-budget18feb18,1,1991364.story?coll=la-home-headlines

Comment: The only truly significant advance in health care reform in the past decade was the federal enactment of the State Children’s Health Insurance Program (SCHIP). Intensive enrollment efforts within the states were effective in providing health care coverage for low income, uninsured children. Although the total numbers of individuals without insurance continued to increase, the numbers would be even greater without this program.

There was bipartisan consensus that this program was worthy of tax support, and that the long term plan was to continue to fund it through tax revenues. A separate issue in California is that one-third of the members of either the Assembly or the Senate can prevent approval of the state budget. As we are seeing on the federal level as well, this partisan element is forcing us into nearly intolerable debt in order to prevent modest taxation of significant private revenue sources.

Donna Arduin, who slashed Gov. Jeb Bush’s budget, is now swinging the cleaver in California. She, with Gov. Schwarzenegger’s blessing, considers tax supported health insurance for low income children to be “indulging in a policy whim.” Is this really the change that Californians voted for? Excuse me; I’m nauseated.

Don

Prevailing Health Principles

Prevailing Health Principles
by Karen Pollitz
February 18, 2004

Recently the Institute of Medicine challenged our leaders to take a principled approach to achieving universal health insurance coverage in the U.S. by 2010. The president’s new budget fails to meet this challenge, offering instead proposals intended to garner more political points than new health coverage. 

According to the IOM, the plight of more than 43 million uninsured Americans is a dire threat to the public health. Each year 18,000 people in the United States die needlessly as a direct result of being uninsured. It is well documented that the uninsured have to do without needed health care or get it later than they should. In addition to this being bad for their health, it is a drag on our economy. When the uninsured cannot get the health care they need, their lost productivity costs us all between $65 billion and $130 billion annually. In a nation as great as ours, these problems are a red-faced shame. The IOM called for action, outlining five basic principles for reaching universal coverage. The first four of those principles are:

Accessibility Health insurance must be available to everybody. Today, people’s health coverage depends on their job, family status, age, income, or health. Most uninsured people are workers whose employers don’t offer health benefits or low income adults who aren’t eligible for Medicaid. Employer health plans and government safety net programs cover three-fourths of Americans under age 65. These mainstays of coverage, or a decent alternative to them, must be expanded so that everyone has access to health insurance.

Affordability In addition, health coverage has to be affordable for everyone, regardless of income. The vast majority of uninsured have incomes below twice the poverty level. Their health insurance premiums will have to be free, or close to it, if we’re going to expand coverage.

Adequacy The IOM also said coverage must be adequate to assure access to quality, necessary health care. That means “bare bones” plans – for example, plans that don’t cover prescriptions or that have deductibles of $1,000 or more – won’t work for any but the wealthiest and healthiest among us.

Always Finally, coverage must be continuous, unlike today when Americans are constantly churning in and out of coverage. For example, even if we could wave a magic wand to cover all 9 million uninsured kids in the United States today, evidence suggests that by this time next year we’d have 4.5 million uninsured kids again. When we cover the uninsured, we should make coverage stick. Americans need health care that’s always there.

Unfortunately, in the budget he submitted to Congress on Feb. 2, the president proposed programs that fail to live up to these principles. Leading his agenda are refundable tax credits. He would offer a credit of up to $1,000 per person to buy individual policies, with no other help. That’s problematic in an insurance market that can and does turn people down or charge them more when they’re sick, or that can find ways to raise the cost of coverage for people over time after they become sick. The $1,000 annual subsidy is also problematic considering that annual per capita health spending is more than $5,000 per person. The limited credit is intended to foster competition to sell cheap policies, priced at about the credit amount. But cheap policies are already abundant today; they just don’t cover much. Annual deductibles of $1,000 to $5,000 are common, and key benefits – such as maternity care and prescription drug coverage – are scarce, or cost extra. So the principles of Access, Affordability, Adequacy, and Always are all violated. 

The president also advocates association health plans (AHPs). These new arrangements ostensibly let small businesses join forces to negotiate better health insurance deals, as if they were a big employer. In reality, the AHP proposal would de-regulate health insurance and de-stabilize coverage by promoting “cherry picking.” Instead of joining forces, small businesses with healthy workers would have incentives to churn coverage, constantly seeking to associate with other healthy groups and avoid sick ones. Insurers would have free reign to design policies to encourage this behavior. According to the Congressional Budget Office, AHPs could, indeed, reward the best cherry pickers with slightly lower premiums (at least, as long as people remain healthy) and the number of uninsured would decline by a scant 550,000. At the same time, however, premiums outside the AHPs (where sick groups would predominate) would increase, making coverage harder to keep for most other small businesses. Further, state insurance regulators warn that de-regulated AHPs will be a breeding ground for fraudulent coverage that evaporates when claims are filed. Once again, this proposal fails to meet all four IOM principles. 

The IOM’s fifth principle is that our national strategy for getting to universal health coverage – whatever it is – must be politically sustainable in our society. That means we need leadership to engage this nation in an honest dialog of what it will take to guarantee health security for everybody. Here, the President really misses the mark. By offering false solutions, he’s trying to make the status quo sustainable. Although his proposals won’t help the uninsured, the rhetoric he cloaks them in is seductive – they require no new spending, cut taxes, and make no new government rules – and could even prevail. Hopefully that won’t happen. We can’t keep dodging the problem of the uninsured because it’s politically expedient. The stakes are simply too high.

Fixing our health care system so that it serves everyone will require resources and rules and hard choices. We can do it. Our nation has met even greater challenges before, but it takes leadership. We need leadership to build consensus for doing the right thing – building a system that satisfies the IOM’s principles and guarantees everyone access to health coverage that is affordable and adequate all of the time. 

Karen Pollitz is a health policy researcher and adjunct professor at the Georgetown University Health Policy Institute. Her consumer guides to getting and keeping health insurance are on the web at www.healthinsuranceinfo.net.

 

Push Made In Greensboro For Single-payer Health Plan

BY ROGER LeCOURS
News Correspondent – the Caledonian-Record

A referendum calling on the Vermont Legislature to enact a universal, single-payer program to provide quality health-care coverage to every Vermonter received a unanimous vote of support from 50 area residents. The spirited, two-hour forum was held Tuesday night in Fellowship Hall of the United Church of Christ in Greensboro.

There were no dissenting votes when Dr. Deborah Richter of Cambridge asked how many favor a single-payer health insurance plan. Richter, who is on leave from her physician’s duties, has been traveling all around the state calling for legislative action on the universal health-care proposal. The passionate call for action provides a boost to the referendum article that will be presented to Greensboro voters at their annual meeting March 2.

The referendum asks selectmen, Gov. Jim Douglas and the state Legislature to support and actively work for the creation of a universal and comprehensive health-care system based on a single, statewide plan with administration supervised by a non-partisan commission with every Vermonter covered without regard to age, income, employment or medical condition.

It also stipulates that all appropriate and necessary medical services covered will include prescription drugs and long-term care; that the consumer has a free choice of health-care providers; that the program will be financed primarily through taxes; and that there will be accountability to the public for financial performance and for quality of service.

Participating in the forum along with Richter were Paulette Thabault and Herbert Olsen, deputy commissioner and general counsel, respectively, of the state Banking, Insurance, Securities and Health Care Administration; and three state legislators, Rep. John Rodgers, D-Glover, Rep. David Bolduc, R-Orleans, and Rep. Michael Fisher, D-Lincoln.

Some blunt comments were directed at the legislators and state officials as the forum participants expressed their dissatisfaction with the Republican health-care plan proposed by Gov. Douglas and another plan put forward by some House Democrats.

Thabault briefly reviewed the Douglas proposal which includes a Small Market Access Reinvestment Trust (SMART) Insurance plan which would give immediate insurance premium relief (up to 10 percent) to individuals and small business; and a small-employer health-care incentive plan for small businesses with 25 employees or less by offering a tax credit so that health care to every worker becomes an affordable option.

Also included is a proposal to stimulate and strengthen health-care information accessibility through Internet-based solutions that will encourage wide usage.
Rep. Fisher explained the Democratic proposal, titled “The Vermont Small Business Health Plan,” which would provide relief to small business and self-employed Vermonters who choose to offer health coverage for their employees.

“I cannot sit on my heels and wait until there is enough pressure to do something,” Fisher said. “I have put the plan on the table to start the idea that the state can offer a good insurance plan. It doesn’t do what the single-payer plan does and it doesn’t bring the cost down enough but it’s a start.” Rodgers said he is a freshman legislator who is still in the difficult stage of becoming acclimated while listening.

Bolduc said the single-payer plan sounds good, but studies show that caution is needed. “I’m not sure that’s the way to go,” he said.

Peter Romans expressed his frustration that there has to be sides on the issue. Why can’t both sides get together and come up with a workable program, he asked. “Why aren’t we intelligent enough to figure this out?” he wondered.
Wayne Young, a member of the school board for Lakeview School, used the metaphor of a freight train to describe the health-care crisis.

“Let’s get going here,” Young said. “If we have a train wreck coming, let’s get going.” Bobbie Nisbet, the nurse at Hardwick Elementary School, spoke of her own heart-rending experiences working with children whose parents cannot afford to pay for health insurance.

“It gives me great pause,” Nisbet said. “Is it possible that children in our district will not have coverage under the Dr. Dynasaur Program because of a rate increase?” Many others at the forum spoke of their personal experiences with illness and their fear that they may not be able to acquire insurance or continue paying for what they now have.
“My family runs Willey’s Store,” said Tom Hurst. “We have 30 employees. About half do not have coverage.”
Addressing the legislators, Hurst said, “I want you guys to get on board now. Why wouldn’t you? Do it quick.”
“We have a small group here tonight,” Rep. Rodgers replied.
“Most seem interested in universal insurance,” Rodgers said. “Remember this is a small group. We hear from some who aren’t interested in single-payer insurance.”
Lisa Sammet asked if there could be a statewide referendum on the single-payer plan.

Rep. Fisher replied: “We don’t have a statewide referendum process in the state but we have town meetings. This tonight is an impressive showing of passionate support for single-payer. There are Republicans who could go in favor of it. We need to help educate them. Push them!”
“You all need to put on pressure,” Richter said. “I’m talking all over the state. They need to hear from you.”

The forum was moderated by Tim Nisbet. When the session ended there was a round of applause for organizer Nancy Potak of Greensboro, who has worked tirelessly on health-care issues for several years. The event was sponsored by Reps. Bolduc and Rodgers along with the Vermont Health Care for All organization, Willey’s Store, Highland Lodge, Greensboro Early Education Center, Greensboro Nursing Home and Greensboro Garage.

Health care for low income children is a “policy whim

Los Angeles Times
February 18, 2004
Budget Signals Narrowed Ambitions
By Peter Nicholas and Virginia Ellis

For decades, California distinguished itself by pioneering easy and inexpensive access to college and championing broad medical coverage and a generous financial lifeline for the poorest families.

Now, driven by financial necessity, political leaders are redefining California’s government, positioning it as a follower instead of a leader.

Even as California’s finances were strained by the dot-com collapse, former
Gov. Gray Davis plowed resources into the subsidized health insurance program for poor children, Healthy Families (California’s SCHIP program). Enrollment rose from about 100,000 to 700,000.

Donna Arduin, Schwarzenegger’s finance director, questioned the sincerity of
recent officials who had approved such largess. With no steady source of money for the expansion, the state was not so much preserving a progressive legacy as indulging a policy whim, Arduin suggested.

“If the policymakers that preceded our being here had a long-term plan for those programs, the argument would be much stronger that these were the priorities of the state,” Arduin said in an interview. “I don’t see that long-term funds were planned and made available to keep these expansions going.”

In navigating the financial crisis – preserving essential services while wiping out the state’s deficit – California may yet prove to be a model for the rest of the country, she added.

http://www.latimes.com/news/local/la-me-budget18feb18,1,1991364.story?coll=la-home-headlines

Comment: The only truly significant advance in health care reform in the past decade was the federal enactment of the State Children’s Health Insurance Program (SCHIP). Intensive enrollment efforts within the states were effective in providing health care coverage for low income, uninsured children. Although the total numbers of individuals without insurance continued to increase, the numbers would be even greater without this program.

There was bipartisan consensus that this program was worthy of tax support, and that the long term plan was to continue to fund it through tax revenues. A separate issue in California is that one-third of the members of either the Assembly or the Senate can prevent approval of the state budget. As we are seeing on the federal level as well, this partisan element is forcing us into nearly intolerable debt in order to prevent modest taxation of significant private revenue sources.

Donna Arduin, who slashed Gov. Jeb Bush’s budget, is now swinging the cleaver in California. She, with Gov. Schwarzenegger’s blessing, considers tax supported health insurance for low income children to be “indulging in a policy whim.” Is this really the change that Californians voted for? Excuse me; I’m nauseated.

Don