The New York Times
October 22, 2003
Workers Feel Pinch of Rising Health Costs
By Milt Freudenheim

The figures for big companies reflect a broader shift in the American economy away from mechanisms that for decades have spread the burden of health care costs onto more shoulders.

Largely because of the booming cost of prescription drugs, for example, Medicare covers less of its beneficiaries’ health care expenses than at any time since the program was established in 1965, according to Robert M.Hayes, president of the Medicare Rights Center, a patient advocacy group.

As a result, the elderly paid 22 percent of their average median income, or $3,757, for health care last year – a larger proportion than the 20 percent of income they spent before the advent of Medicare.

Comment: So now seniors are worse off than they were before Medicare was
enacted. Half of their care is paid out-of-pocket, and that one-half is now a greater percentage of their income than what they were paying in 1965 without Medicare. Insane.

We need one risk pool for everyone. The $1.66 trillion that we are spending
would provide a rich benefit package for everyone, if allocated appropriately. And Americans now, by a 2:1 ratio, would favor a universal, government-run and taxpayer-financed system.

What are we waiting for?

The Washington Post
October 19, 2003
Poll: Public Supports Health Care for All
By Will Lester

The public’s growing unease with the current health care system has built
support for a new approach that would mean care for all Americans…

By almost a 2-1 margin in this poll, 62 percent to 32 percent, Americans said they preferred a universal system that would provide coverage to everyone under a government program, as opposed to the current employer-based system.

That support drops significantly, however, if universal coverage would mean
a limited choice of doctors or longer waits for nonemergency treatment.When people were asked the question slightly differently in a poll a year ago, they were less enthusiastic. Asked if they wanted a taxpayer-funded, health care system run by the government, fewer than half said yes.

Robert Blendon, a specialist on health care public opinion at Harvard University, said the public’s worries about health care have increased this year.

“Health care is really rising as a political issue,” Blendon said. “When the economy gets bad and health care costs continue to rise, this becomes an economic issue.”

http://www.washingtonpost.com/wp-dyn/articles/A48983-2003Oct19.html

Washington Post-ABC News Poll: Health Care
October 20, 2003

3. And are you generally satisfied or dissatisfied with the total cost of health care in this country? Would you say you are very (satisfied/dissatisfied) or somewhat (satisfied/dissatisfied)?

21% – Satisfied (7% very, 14% somewhat)
78% – Dissatisfied (24% somewhat, 54% very)

37. Which of these do you think is more important: (providing health care
coverage for all Americans, even if it means raising taxes) or (holding down taxes, even if it means some Americans do not have health care coverage)?

80% – Providing health care for all Americans
17% – Holding down taxes
3% – No opinion
38. Which would you prefer – (the current health insurance system in the
United States, in which most people get their health insurance from private
employers, but some people have no insurance); or (a universal health
insurance program, in which everyone is covered under a program like Medicare that’s run by the government and financed by taxpayers?)

32% – Current
62% – Universal
2% – No opinion

39. (IF UNIVERSAL, Q38) Would you support or oppose a universal health insurance program if it limited your own choice of doctors?

56% – Support
42% – Oppose
2% – No opinion

40. (IF UNIVERSAL, Q38) Would you support or oppose a universal health
insurance program if it meant there were waiting lists for some non-emergency treatments?

63% – Support
34% – Oppose
3% – No opinion

http://www.washingtonpost.com/wp-srv/politics/polls/vault/stories/data102003.html

Comment: Although generally satisfied with our healthcare system,Americans
are dissatisfied with the costs, and believe that it is important to provide
health care for all Americans. And by a two to one margin, they would prefer “a universal health insurance program, in which everyone is covered under a program like Medicare that’s run by the government and financed by taxpayers.” This is a true shift in the opinions of Americans, and can be fairly described as nothing less than a groundswell of support for a public, universal health insurance program.

Even the questions that seem to somewhat diminish support for a government-run, taxpayer-financed system would probably not do so if phrased differently. If respondents were told that a single-payer system would provide free choice of physicians as compared to limited choice in PPOs and HMOs, the support not only would not diminish, it would probably be greater.

If they were told that the United States already spends enough on health care to ensure full capacity in our system, thereby limiting excessive waiting periods for elective services, including the infinite “wait” for the uninsured, support would not diminish.

A universal program of social insurance would provide affordable,comprehensive care for everyone. This is what Americans now want.

Let’s go! We’ve got work to do!

The Seattle Times
October 14, 2003
Health care for the economy
By Kathleen O’Connor

Administrative expenses devour a 150-percent larger share of America’s health-care spending than our competitors in the Economic Group of Eight.

If we reduced this to only 25 percent more on non-care expenses than the worst of our competitors, the American economy would save $300 billion every year. That’s twice the annual tax savings claimed for the Bush tax cuts.

Much of our political establishment and many deep-pocket special interests have huge stakes in the status quo. These savings are not an abstraction. All our economic peers and competitors can do this.

But what happens when we try to discuss this? The knee-jerk “socialized medicine!” mantra. That universal coverage means “socialized medicine” is hogwash.

How long will we accept name-calling to protect the status quo? Are you better off with your health care than you were 10 years ago? Are you better off economically than you were five years ago? It’s time we changed the terms of the game.

http://seattletimes.nwsource.com/html/opinion/2001765078_kathleen14.html

Comment: It’s clearly time set ideology aside and include all models of reform in the debate. Let’s end the debate about “socialized medicine” and the “power of the marketplace,” and let’s look instead at specific policy issues and the impact that they would have on our health care system.

Kathleen O’Connor is contributing to this dialogue by sponsoring the “Build
an American Health Care System” contest (www.codebluenow.org). 109 models of reform have been submitted. Although they vary in their sophistication, they
certainly do provide a variety of approaches.

Reviewing the executive summaries of the finalists suggests that not much new territory was plowed in the field of health policy science. But such efforts do further reinforce the wisdom of the single-payer model of social insurance. Single payer does seems to be solidifying its position as the golden standard against which all other models should be compared.

Advertiser-Tribune.com
October 14, 2003
Uninsured at times is choice of consumer

Only a very small percentage of the uninsured truly have no access to health insurance and go without insurance for long periods of time. It appears that most of the uninsured simply choose not to buy insurance.

The National Center for Policy Analysis dug a bit deeper into the Census Bureau’s report. It turns out that almost half of the increase in the number of insured has occurred among households earning more than $75,000 a year, and about three-quarters of the rise is among households earning $50,000 a year.

… one thing is certain from the Census Bureau data: There is not really a “crisis” of insured…

http://www.advertiser-tribune.com/edit/story/1014202003_edtedit1014.asp

And…

National Center for Policy Analysis
Brief Analysis
October 7, 2003
Uninsured by Choice: Update

From 1993 to 2002 the number of uninsured people in households with annual
incomes above $75,000 increased by 114 percent. The number of uninsured in households with annual incomes from $50,000 to $75,000 increased by 57 percent.

By contrast, the number of uninsured people in households with incomes
under $25,000 fell by 17 percent.

http://www.ncpa.org/pub/ba/ba460/

Comment: The numbers of uninsured have continued to increase. With the decline in employer-sponsored and individual coverage, the problem would be much worse if it were not for an increase in enrollment in public programs for low-income individuals, especially Medicaid and S-CHIP. By carefully selecting data from the Census Bureau report, NCPA has used correct figures in changes of the rate of coverage to deceive readers into believing that most of the problem lies within high income households. The spurious conclusion is that most of the uninsured are individuals with high incomes who are uninsured by choice. The absolute numbers totally refute this conclusion.

NCPA is a favorite source for conservative journalists. But they are dishonest. They use technically accurate but highly-selected numbers, and present them in a manner that appears to have drawn conclusions that are not warranted by a more comprehensive analysis of the complete data. Reading their brief on the uninsured would lead you to believe that the problem of uninsurance is primarily one of personal choice, but they didn’t quite state that. But as you read articles based on NCPA’s brief, it seems that the authors believe that these conclusions were clearly stated in their
report.

As we reform health care, it is essential that we understand the true nature of the problems. Presenting data that deliberately create false conclusions is really no different than lying. The methods of NCPA should disqualify them as a credible source of health care information.

American Medical News
Oct. 20, 2003
Plans offer prizes to push patients to healthy living
By Robert Kazel

Some health plans are offering rewards ranging from CD-ROMs and exercise
equipment to movie tickets and hotel discounts in exchange for their members’ willingness to shape up, slim down or engage in other health-conscious activities.

PacifiCare Health Systems, the Cypress, Calif.-based managed care plan with
more than 3 million members, this month is rolling out a points-based rewards program intended to boost enrollment in such activities as smoking acessation or weight-loss programs. The rewards program is free and open to all HMO, PPO and POS members.

Members who participate in the program, called HealthCredits, can choose
among 16 programs to earn varying degrees of points that can be redeemed for
prizes or discounts on wellness-related merchandise or services. Additionally, random drawings award other prizes such as treadmills and mountain bikes.

“For so long we’ve been successful at developing educational programs and
incentives for physicians to practice evidence-based medicine, and now we
have what I like to call a reciprocal program for consumers,” said Sam Ho,
MD, PacifiCare’s chief medical officer.

John La Puma, MD, an internist and weight loss specialist in Santa Barbara,
Calif., said tapping patients’ desires to get merchandise and participate in
contests as a way to make wellness programs attractive makes sense.

“It may seem too much like Publishers Clearing House, but those people do
have a terrific track record of attracting participants,” he said. “I think
it’s a strategy whose time has come and will produce benefits for both [the
plan and members]. Americans love games, they love the idea of winning
prizes and they love competing. Thinking outside the box, even if it reminds
one of a game show, is necessary because traditional thinking has failed for
so long.”

http://www.ama-assn.org/sci-pubs/amnews/pick_03/bisc1020.htm
Comment: Does anyone really believe that prizes are adequate motivation
to change fundamental lifestyles?

More importantly, does anyone want their health premium dollar to be paying
for gifts of exercise equipment and mountain bikes? PacifiCare is a provider
of federally funded plans such as Secure Horizons, a Medicare + Choice
option, and options under the Federal Employees Health Benefits Plans. That
means that tax funds will be used to help pay for these prizes.

We would never accept this nonsense in a publicly-administered program of
social insurance such as our traditional Medicare program. So why do we turn
our health care dollars over to the private sector and allow them to make
these ridiculous decisions?

Let’s dump the “game shows” and the other wasteful practices of the
private health plans. We’ll receive far better health care value with our own
publicly-funded and publicly-administered program of social insurance.

American Medical News
Oct. 20, 2003
Plans offer prizes to push patients to healthy living
By Robert Kazel

Some health plans are offering rewards ranging from CD-ROMs and exercise
equipment to movie tickets and hotel discounts in exchange for their members’ willingness to shape up, slim down or engage in other health-conscious activities.

PacifiCare Health Systems, the Cypress, Calif.-based managed care plan with
more than 3 million members, this month is rolling out a points-based rewards program intended to boost enrollment in such activities as smoking acessation or weight-loss programs. The rewards program is free and open to all HMO, PPO and POS members.

Members who participate in the program, called HealthCredits, can choose
among 16 programs to earn varying degrees of points that can be redeemed for
prizes or discounts on wellness-related merchandise or services. Additionally, random drawings award other prizes such as treadmills and mountain bikes.

“For so long we’ve been successful at developing educational programs and
incentives for physicians to practice evidence-based medicine, and now we
have what I like to call a reciprocal program for consumers,” said Sam Ho,
MD, PacifiCare’s chief medical officer.

John La Puma, MD, an internist and weight loss specialist in Santa Barbara,
Calif., said tapping patients’ desires to get merchandise and participate in
contests as a way to make wellness programs attractive makes sense.

“It may seem too much like Publishers Clearing House, but those people do
have a terrific track record of attracting participants,” he said. “I think
it’s a strategy whose time has come and will produce benefits for both [the
plan and members]. Americans love games, they love the idea of winning
prizes and they love competing. Thinking outside the box, even if it reminds
one of a game show, is necessary because traditional thinking has failed for
so long.”

http://www.ama-assn.org/sci-pubs/amnews/pick_03/bisc1020.htm
Comment: Does anyone really believe that prizes are adequate motivation
to change fundamental lifestyles?

More importantly, does anyone want their health premium dollar to be paying
for gifts of exercise equipment and mountain bikes? PacifiCare is a provider
of federally funded plans such as Secure Horizons, a Medicare + Choice
option, and options under the Federal Employees Health Benefits Plans. That
means that tax funds will be used to help pay for these prizes.

We would never accept this nonsense in a publicly-administered program of
social insurance such as our traditional Medicare program. So why do we turn
our health care dollars over to the private sector and allow them to make
these ridiculous decisions?

Let’s dump the “game shows” and the other wasteful practices of the
private health plans. We’ll receive far better health care value with our own
publicly-funded and publicly-administered program of social insurance.

OC Weekly
October 10 – 16, 2003
Million-Dollar Munchkins
By Nick Schou

Huntington Beach City Council members aren’t in the job for the money: as part-time Surf City employees, their salaries are set at only $175 per month each. But they may be attracted to the handsome medical benefits that come with their elected posts: council members are the only part-time municipal employees who receive full medical benefits under Huntington Beach’s generous health plan.

Exhibit A: Councilwoman Pam Julien Houchen, who was first elected to the council in 1996 and served as mayor in 2001. Last year, Houchen took a two-month break from council meetings to give birth to triplets-a procedure that may have cost as much as $2 million. Fortunately for Houchen, the tab was entirely covered by the city employees’ health package, which is paid for by city taxpayers.

Houchen’s medical benefits will disappear as soon as a she leaves office. But Houchen’s expensive childbirth took place even as Huntington Beach began eliminating social services and laying off employees to save money. Late last year, the council voted to stop funding the only community center in Oakview, Surf City’s impoverished and long-neglected Latino neighborhood.

And on July 7, the council voted to eliminate 70 positions at City Hall. Twelve employees were laid off, nine retired early, 19 were switched to other departments and another 12 were demoted to lesser-paying jobs.

And more layoffs are on the horizon. According to Clay Martin, director of the city’s administrative-services department, part-time councilmembers are also negotiating to have full-time city employees increase their monthly contributions to the city’s health plan. Council members would also have to pay more, but not the rest of the city’s part-timers, who don’t receive any medical benefits at all.

Houchen’s triplets appear to have caused a major increase in the cost of the city’s employee health plan. The year before she gave birth (fiscal year
2000-2001), the city’s health plan-which covers 985 employees-cost taxpayers
$8,516,092, not including Medicare payments, unemployment insurance or worker’s-compensation costs. The year she became a happy mother of three,
those costs increased more than 40 percent to a whopping $12,027,917.

Meanwhile, budget figures from other cities show that Huntington Beach had
the highest per-employee health-care costs that year: $12,211.But one of the city’s most vocal critics of city-employee benefits, Chuck Scheid, said he doesn’t care about Houchen’s triplets or the fact that council members receive full medical benefits.

“It’s a perk; hell, let’s face it,” he said. “And it can be a very valuable one, I guess. I don’t find anything wrong with it per se, or even that a part-time employee doesn’t get it and a part-time elected person does. They tend to get more than the man in the street.”

http://www.ocweekly.com/ink/04/06/news-schou.php

Comment: So let’s face it. In affluent Orange County, health care is a very generous “perk” for the elite, but not an entitlement for Huntington Beach’s
part-time city employees.

Not only is Huntington Beach’s health coverage highly inequitable, it also demonstrates the impact of major “losses” on a relatively small risk pool.

It’s not as if we don’t understand policies that would make health care accessible and affordable for everyone. We do. What we can’t understand is why we aren’t doing it.

Annals of Family Medicine
September/October 2003
On Being New to an Insurance Plan: Health Care Use Associated With the First Years in a Health Insurance Plan
By Peter Franks, MD, Colin Cameron, PhD and Klea D. Bertakis, MD

Results:

After multivariate adjustment, the first year of insurance was associated with a higher risk of not getting a mammogram, a higher risk of avoidable hospitalization, greater likelihood of visiting a physician, and higher expenditures, especially for testing.

Conclusions:
The findings suggest there might be adverse clinical and financial implications associated with changing insurance.

From the Discussion:
The 20% annual turnover in insurance observed in this study represents a considerable proportion of those insured and is consistent with previous national data.

… this study represents a step toward examining possible costs of changing
insurance status. Depending on the measure examined, we observed adverse
effects (less prevention, higher costs, more avoidable hospitalizations)
that lasted up to 3 years from enrollment in the health plan. These findings are consistent with the observations of Hjortdahl that it took 1 to 5 years for the primary care physician’s sense of medical responsibility for and knowledge about their patients to reach adequate levels also reflected in resource use. Together with studies showing decreased patient
satisfaction with forced health plan switches, the findings suggest that there are likely pervasive adverse consequences of the frequent rebidding of insurance contracts by employers.

http://www.annfammed.org/cgi/content/full/1/3/156

Comment: Changing insurance plans, a very common occurrence in our current
fragmented system of funding care, results in adverse clinical and financial
outcomes. Life long coverage through a single universal insurance system
would eliminate this cause of impaired continuity of care.

(The current issue of Annals of Family Medicine contains several other
articles and editorials on continuity of care which you may find of
interest: http://www.annfammed.org/current.shtml)