PNHP

A Push For A National Health Service?

A Push For A National Health Service?

A Push For A National Health Service?

by Sue Wilson
October, 2003

Since this health column last reported on the plight of the millions of uninsured and under-insured people in New York and across America, the situation has, unfortunately, gotten worse.

Health care costs are soaring once again; insurance premiums are rising at double-digit rates; the economy, despite all the current administration’s talk of a recovery, seemingly remains stalled in the doldrums; states are in fiscal crisis; and continuing layoffs have yanked from millions more Americans the employer-provided health insurance they once took for granted. A September 30 report from the U.S. Census Bureau revealed that, between 2001 and 2002, the number of uninsured Americans rose sharply (by 2.4 million) for the third year in a row. That means 43.6 million Americans, or more than 15 percent of the population, now lack even basic health coverage. Millions more are underinsured. In New York State, the percentage of uninsured is higher than the national average and the total well over three million people, most of them in New York City. According to the Institute of Medicine, already 18,000 Americans die every year because of inadequate insurance; as more lose their coverage, the numbers will rise.

But advocates of a universal national health system – at least, the optimists among them — see promise amidst the general catastrophe. They are allowing themselves to hope that the erosion of health coverage among Americans who until recently considered themselves comfortably middle-class – and thought the lack of health insurance the problem mostly of a limited subclass of the impoverished, the disadvantaged, and the marginal — will have real political repercussions in the forthcoming presidential elections and in the halls of Congress.

Voices ranging from liberal politicians to middle-class consumer groups to physicians can now be heard saying the same thing: that after decades of misfires – most famously Bill Clinton’s messy failure ten years ago to achieve his campaign promise of universal health care – America, the last holdout, may finally join all the other countries of the industrialized world in adopting some form of national health insurance.

An NBC News/Wall Street Journal poll done in July did indeed find that health care costs ranked as Americans’ top economic concern, cited by 24 percent of respondents. By contrast, only 16 percent cited high taxes as their main concern. The incumbent and the other would-be candidates in the next presidential election clearly feel pressure to respond. President George W. Bush and most of the major Democratic presidential contenders have each proposed health care reforms, ranging from Bush’s plan for tax credits to help the uninsured buy insurance to the Democrats’ various proposals to expand health coverage by rolling back Bush’s tax cuts.

But all of these plans retain the basic forms of our current health insurance system — for-profit hospitals and HMOs; private insurance companies that reap high profits and also spend considerable amounts (subsidized by the premiums of the insured) for marketing, overhead, executive salaries, and profit-sharing with investors; and great influence wielded by the hugely powerful and profitable pharmaceutical industry.

But a group of doctors has come up with a far more sweeping and radical plan, one which calls for a true one-payer, nationalized health service that would cover everybody, and that would (theoretically at least) redirect our vast health care expenditures from corporate coffers and back into health care services.

According to one of the proposal’s authors, Chicago physician Dr. Quentin Young, American doctors have traditionally been conservatives when it comes to health care reforms, and they almost reflexively tend to oppose anything that smacks of government-administered health insurance. “But now even doctors are realizing that there’s something worse than the government, and that’s corporations,” Dr. Young said. “Even people who have insurance, so-called ‘good’ insurance, are now finding their charges and coverage being questioned, because the insurance companies have discovered that simply not paying out claims is the best way to maximize their profits. Doctors can’t provide their patients with the care they know is needed, and they’re being harassed to death to justify what they do provide.”

The plan was developed by Physicians for a National Health Service (PNHP), an organization of 11,000 doctors, many of them prominent. Two former Surgeons General and a former editor of the New England Journal of Medicine lead the group, which went public with its so-called “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance” at a press conference in New York in August. The next day, the proposal appeared in the Journal of the American Medical Association (JAMA 8/13/03), which some in the group see as a victory in and of itself, although a spokesman for the (generally conservative) American Medical Association said that the AMA itself still opposes a single-payer health care system. (The AMA has a long history of battling government-administered health insurance; for example, it opposed the creation of Medicaid in 1965.)

The plan, which has now been endorsed by more than 10,000 physicians, calls for a government-financed national health insurance system that would cover every American for all necessary medical care from infancy to death. (In essence, it would be like an improved, expanded version of Medicare, but available to all, not just the elderly and disabled.) Prescription drugs, mental health care, and long-term care would be covered. The government would administer the plan, but most doctors and hospitals would remain private, and patients would be free to choose any physician or hospital they wished. Health professionals would decide what services should be covered, based on the latest medical evidence. Private insurance companies would still exist, but could only provide insurance for services such as elective surgeries that would not be covered by the government plan.

The full text of the proposal, which contains further details and cost-savings analyses, can be read online here (In PDF format).

The proposal criticizes the incremental, piecemeal health reform plans offered by Bush and the main Democratic presidential hopefuls.

“Proposals that call for tax credits or that push seniors into private HMOs all retain the role of private insurers. They are doomed to failure, because they perpetuate administrative waste, and make universal coverage unaffordable,” said Dr. Oliver Fein, chairman of the New York Metro Chapter of PNHP, who presented the proposal at the New York press conference.

The plan’s authors claim that single-payer national health insurance, far from increasing health care costs, would save at least $200 billion each year by eliminating the high overhead, marketing, profits, and administrative costs that private, for-profit insurers divert money to (rather than spending it on actual health care services).

“We spend $1.6 trillion on health care each year, which is one-seventh of our Gross National Product. That would be a very high cost for an excellent health care system; and what we have is a rather poor one,” Dr. Young said. “Compared to countries that spend far less than we do, America scores very poorly on the standard, accepted indices of public health.”

But is America, the sole holdout among industrialized countries in terms of adopting a national health plan, ready for such sweeping change?

“Well, I’m old enough to remember the civil rights movement, and anybody who predicted that before it happened would have been laughed at as some utopian dreamer,” said Young. “I would say that the conditions for mass social change are ripening. There’s a vast discontent out there with the current system, whose weaknesses are being starkly exposed right now. It will take a monumental effort, and a change of administration, for this to happen, but I think in the end it will.”

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.

Nobel laureates and public funding of research versus marketplace innovation

The Scientist
October 6, 2003
MRI scientists win Nobel Prize

For the third time since 1951, scientists working in the field of nuclear magnetic resonance technology have been recognized by the Nobel Academy, with a British physicist and an American chemist this year taking home the prize for physiology or medicine.

The assembly, at Stockholm’s Karolinska Institutet, named Paul C.Lauterbur
and Peter Mansfield as the 2003 laureates for work in the early 1970s, which provided the basis for the development of magnetic resonance imaging (MRI), a technique that has found a central role in modern medicine.

Lauterbur, born 1929, is a professor of Chemistry, Biophysics and Computational Biology, and Bioengineering at the University of Illinois at Urbana-Champaign. During the early 1960s, he used nuclear magnetic resonance devices to develop carbon-13 spectroscopy and in the early 1970s, discovered the possibility of creating a two-dimensional image by introducing gradients in the magnetic field. In 1984, he was awarded the Lasker Award for Clinical Medical Research for this work.

Mansfield, born 1933, is Emeritus Professor of Physics at the University of
Nottingham. The Nobel committee recognized him for further developing the
use of gradients in the magnetic field and showing how the signals could be
mathematically analyzed, which made it possible to develop a usefulimaging
technique. He also showed how extremely fast imaging could be achieved,
a theory that became technically possible within medicine a decade later.
He was knighted in 1993.

Professor Colin Blakemore, chief executive of the Medical Research Council,
said Mansfield’s work was an example of how high-risk research can pay
off.

“When the MRC first funded Sir Peter in the 1970s, we really didn’t know if
the huge investment in this area would bear fruit,” he said in a statement.
“In fact, it surpassed all hopes. I’m delighted to congratulate him on
his achievement today. His work is correctly credited with changing the
face of modern medicine.”

http://www.biomedcentral.com/news/20031006/06/

About the Medical Research Council (United Kingdom):

The UK Medical Research Council (MRC) is a national organisation funded by
the UK taxpayer. We promote research into all areas of medical and related
science with the aims of improving the health and quality of life of the UK
public and contributing to the wealth of the nation.

http://www.mrc.ac.uk/index/about.htm

The National Institutes of Health (United States):
NIH is the steward of medical and behavioral research for the Nation.
Its mission is science in pursuit of fundamental knowledge about the nature
and behavior of living systems and the application of that knowledge to
extend healthy life and reduce the burdens of illness and disability. The
goals of the agency are as follows: 1) foster fundamental creative discoveries, innovative research strategies, and their applications as a basis to advance significantly the Nation’s capacity to protect and improve health; 2)develop, maintain, and renew scientific human and physical resources that will assure the Nation’s capability to prevent disease; 3) expand the knowledge base in medical and associated sciences in order to enhance the Nation’s economic well-being and ensure a continued high return on the public investment in research; and 4) exemplify and promote the highest level of scientific integrity, public accountability, and social responsibility in the conduct of science.

http://www.nih.gov/about/almanac/index.html

NIH News
October 6, 2003

Dr. Lauterbur is a long-time NIH grantee with the majority of his funding
from the NIH’s National Center for Research Resources (NCRR). Additional NIH
support was provided by the National Cancer Institute (NCI); the National
Heart, Lung, and Blood Institute (NHLBI); the National Institute of General
Medical Sciences (NIGMS); and the National Institute of Mental Health (NIMH).

Of the 81 American Nobel laureates in physiology or medicine since 1945, 62
either worked at or were funded by the NIH before winning the prize.
http://www.nih.gov/news/pr/oct2003/od-06.htm

Comment: The accomplishments of these two gifted researchers are certainly
worthy of the Nobel Prize. The fact that I’m digressing into the relatively
mundane topic of funding of research should in no way detract from this
important recognition of their great genius.

One of the most common criticisms of publicly funded universal health care
programs is that, due to lack of adequate funds, technological innovation is
stifled. But much of the technology for CT and MRI scanning was developed in
Great Britain. Yet the British devote only 7% of their GDP to health care
compared to 15% in the United States.

Much of the important research in Great Britain is publicly funded through
the Medical Research Council. Likewise, in the United States, the National
Institutes of Health also funds much of our important research in health.
Everyone agrees that we have received great value for this public expenditure.

What value are we receiving for technological innovation in the marketplace?
A fundamental market principle is that research must result in enhanced
shareholder value. As an example, the pharmaceutical industry devotes much of its research budget to development of copycat drugs that are designed merely to extend patent exclusivity and high prices. And higher tech medical
care, rampant in Florida, has failed to demonstrate improved medical outcomes in spite of a 30% increase in costs.

Private technological innovation must place profit before the public good.
Publicly funded research will always place the public good first, and value
is an essential feature of publicly funded innovation.

The United States and Great Britain have demonstrated that the level of funding is not nearly as important as the implicit missions of publicly and privately funded research. Paul Lauterbur and Peter Mansfield clearly understood their personal missions, and we are all better for it.

Massachusetts Rallies for Single Payer Health Insurance

Caregivers, seniors, patients, labor leaders and citizens to promote universal health care plan at statehouse hearing on October 8, 2003.

Boston – From all across the state and from all walks of life, proponents of health care reform will descend on the statehouse Wednesday for a hearing in Gardner Auditorium to promote a comprehensive solution to the burgeoning crisis in both cost and delivery that is affecting everyone.  

“A successful health care reform plan has to guarantee coverage to everyone, maintain high quality, and keep costs under control,” said Peggy O’Malley a nurse who chairs MASS-CARE.  “Our plan to set up a statewide health care trust is the best approach to do that.  It would provide secure coverage for everyone while saving money by consolidating payments and eliminating most insurance company paperwork and bureaucratic red tape.”

The hearing is on Senate Bill No. 686 – the Massachusetts Health Care Trust – that would create a state insurance fund to replace the current patchwork of public and private insurance plans.

Buses are bringing people to attend the hearing from New Bedford, Fall River, Dartmouth, Bridgewater, Brockton, Northampton, Springfield, Lynn and Cambridge.

Leaders of nursing, senior, labor, medical and patient advocacy organizations are expected to testify.  They will be joined by many elected officials and a number of nationally recognized experts including Dr. Marcia Angell, former editor of the New England Journal of Medicine.

With costs soaring and coverage dropping, no one is immune from becoming uninsured.  Last week, the US Census Bureau reported that 2.4 million people lost their health insurance, the largest single jump in the number of uninsured in the past decade.  In Massachusetts, an average of 9.1 percent of residents lacked health insurance, with many more uninsured for part of the year.  

A survey by the Kaiser Family Foundation showed that health insurance premiums for employees rose by an average of 13.9 percent this year, the third straight double-digit increase.   
 
Separately, the US Bureau of Labor Statistics reported that the number of Americans who receive health insurance through their employers has dropped to less than one-half of all workers from about two-thirds a decade ago.

The Massachusetts Campaign For Single Payer Health Care (MASS- CARE), is a coalition of over 80 organizations working for a universal, single payer health care plan in Massachusetts.

Contact: Rand Wilson: (617) 989-8039

FROM THE OREGONIAN, by Marc Shapiro

Common rhetoric in presidential campaigns asks “Are you better or worse off than you were four years ago.” As we close in on the anniversary of the Measure 23 initiative campaign, to enact universal single payer health care in Oregon, a similar question comes to mind.  The answer falls out pretty easily from data recently released by the Kaiser Family foundation, and from the US census Bureau.

Looking at the surface information, health insurance premiums have gone up an average of 14%, the worst in five years and more than double the ’99 increase of 5.3%.  This at a time when the FED expresses concern about DEFLATION of the rest of the economy.   This high level of premium inflation, is expected to continue into the foreseeable future, doubling every 5 years. The predictable result is, according to  The Census Bureau, that in the last year the number Americans without health insurance jumped by 2.4 million to a total of 43.6 million people. This is the largest increase in more than a decade.

As a primary speaker for the Measure 23 campaign for several years, I made presentations, responded to questions and concerns from citizens, and debated the opposition, representing insurance companies, insurance agents, and employer groups. Through this activity I became aware of most of the relative questions.  I believe it will be informative to look at the irony of the aftermath of this campaign by sighting where all the opposing forces find themselves ten months later.

*  The employee with employer provided family coverage is paying 12.9% more for premiums with less coverage.
* The Employer is paying 14% more in premiums.
* Members of the Oregon Health Plan, who wouldn’t support the measure because they believed they were secure with health care provided to them without cost.  Now many of them have no coverage, many more have coverage which no longer meets their needs.
*  The employees whose jobs and benefits disappeared in the economic downturn now finds that because of the high cost of providing benefits employers are not rehiring.
* Employers who would not support the plan because they were afraid they could not afford its costs find they are paying far more or having to reduce or terminate their coverage.
* Insurance companies and agents who believed they could remain fat and happy skimming the cream off the top of the insurance premiums are now seeing that fewer and fewer people can afford insurance, so their customer base is actually shrinking (of course this does not compare to being eliminated by a single payer plan so they remain happy if not quite as fat).
* Doctors find that more and more of their patients are without insurance.  8,000 of them have signed onto a proposal for a universal single payer plan put forth by Physicians for National Health Care.
* The AFL-CIO leadership adamantly opposed our campaign and now finds, as we predicted, that an increasing number of union workers are without both jobs and benefits.
* Those on Medicare find that prescription drug coverage,promised them in the last presidential campaign remains elusive with its need serving as a means for the current administration to privatize Medicare so that its resources will provide profits for the insurance industry instead of health care for Seniors.
* Finally, as predicted, hospitals, which universally opposed the plan, find the very viability of their emergency rooms threatened by an inundation of uninsured patients.   The cost of this expensive care is then passed on to those who do pay for care.  This is a major factor in the increased cost of medical care and insurance for those who do pay.

It is hard to find many who can say that their position with respect to health care is better than it was a year ago. Certainly, looking at the overall society the picture is pretty bleak.   If the deteriorating situation causes you to ask, “what can we do now (beside kick ourselves)?”, the answer is certainly not simple.  For all practical purposes, we will unlikely be able to deal with this crisis through the initiative process.  

The two major reasons are:  a) The same organizations who poured unlimited funds into the campaign to defeat measure 23 would do it again, and b) the AFL-CIO sponsored initiative to prohibit paying signature gatherers by the signature will effectively prevent grass roots movements from being able afford to put initiatives on the ballot.  That leaves only the possibility of a political solution. Unfortunately, the insurance industry directs so much money toward the legislature, that we may expect it will only respond to thecomplete and total collapse of the system (perhaps not far away).  

On the national front, while Dennis Kucinich has consistently supported universal single payer health care, those who control the media have decided to ignore his presidential campaign.  However, he stands as our best chance for reform on a federal level.

In the wake of the demise of measure 23 the basic parameters remain the same.  Virtually all studies show that only a universal single payer health plan has any hope of reversing the disintegration of the American health care delivery system.  It is time for the US to catch up with the rest of the western industrialized world.  If you believe in representative democracy, then it is time you to let your respective representatives know that the health care crisis requires their attention and that a UNIVERSAL SINGLE PAYER SYSTEM appears to be only one viable solution.

Marc Shapiro was the Lane County Chair for the campaign to enact Measure 23

NYT Letters to Editor on Uninsured, 2003

To the Editor:

The Census Bureau data showing 43.6 million uninsured for 2002 (front page, Sept. 30) illustrate an ugly side of the United States that most Americans and politicians would rather ignore.

At people’s time of most need, when physical or mental illness is eroding all other aspects of their life, our society does not guarantee help.

People must choose between caring for themselves or their children and paying for schooling, housing and food. As the Institute of Medicine documented last year, this is estimated to lead to 18,000 premature deaths every year.

It is no wonder that other countries question our ability to build a civil society in Iraq; we have not even built one in the United States.

JEREMIAH SCHUUR, M.D.
Providence, R.I., Sept. 30, 2003

To the Editor:

The big increase in the uninsured (front page, Sept. 30) is only part of the problem with our health care system. The nominally insured whose policies exclude pre-existing conditions also face substantial medical and financial risk.

These problems are inherent in a perverse health care system in which a profit-driven health insurance industry sustains itself by denying the very services the system is intended to provide.

RICHARD PLEVIN
Chiang Mai, Thailand

Sept. 30, 2003

To the Editor:

Your Sept. 30 front-page article about the increase in number of people without health insurance comes one day after I received notice that my own policy, which I pay for entirely, will increase by 17.5 percent this month.

It is no wonder that the middle class, which I consider myself a part of, is being forced out of the health care market. What other item in the marketplace increases in price at this rate in today’s down economy?

MARK SIEGEL
New York, Sept. 30, 2003

To the Editor:
“Big Increase Seen in People Lacking Health Insurance” (front page, Sept. 30) is only the tip of the iceberg. An accompanying news analysis mentions increases in
co-payments and deductibles.

Many people have inadequate or insufficient insurance. A tax credit will not help the millions who pay sales and payroll taxes but no income tax.

Health care and prescription drug costs continue to rise sharply. Our politicians – our leaders – refuse to recognize that other developed countries have universal
health care and much lower prescription drug prices.

If Americans are not bright enough or motivated enough to develop a more efficient and more economical health care system, why not just copy and improve an existing system that works better?

MORT GOODMAN
Longboat Key, Fla., Sept. 30, 2003

click to view

43.6 million without health insurance in 2002

U.S. Census Bureau
September 30, 2003
Health Insurance Coverage: 2002

* An estimated 15.2 percent of the population or 43.6 million people were without health insurance coverage during the entire year in 2002, up from
14.6 percent in 2001, an increase of 2.4 million people.

* The number and percentage of people covered by employment-based health
insurance dropped in 2002, from 62.6 percent to 61.3 percent, driving the overall decrease in health insurance coverage.

* The number and percentage of people covered by government health insurance programs rose in 2002,from 25.3 percent to 25.7 percent,largely
from an increase in the number and percentage of people covered by Medicaid (from 11.2 percent to 11.6 percent).

* The proportion of children who were uninsured did not change, remaining
at 11.6 percent of all children, or 8.5 million, in 2002.

* Although Medicaid insured 14.0 million people in poverty, 10.5 million other people in poverty had no health insurance in 2002; the latter group represented 30.4 percent of the poverty population, unchanged from 2001.

* Hispanics (67.6 percent) were less likely to be covered by health insurance than non-Hispanic Whites who reported a single race (89.3 percent), Blacks who reported a single race (79.8 percent), and Asians who reported a single race (81.6 percent).

* Among the entire population 18 to 64 years old, workers were more likely
to have health insurance (82.0 percent) than nonworkers (74.3 percent).
Among those in poverty, workers were less likely to be covered (52.6 percent) than nonworkers (61.9 percent).

* Compared with 2001, the proportion who had employment-based policies
in their own name decreased from 56.3 percent to 55.2 percent in 2002.

* Young adults (18 to 24 years old) were less likely than other age groups
to have health insurance coverage — 70.4 percent in 2002, compared with
82.3 percent of those 25 to 64 and, reflecting widespread Medicare coverage,
99.2 percent of those 65 and over.

* Spells without health insurance, measured on a monthly basis, tend to be
short in duration — about three-quarters (74.7 percent) were over within
one year. (But 43.6 million people were without health insurance coverage
during the entire year.)

http://www.census.gov/hhes/hlthins/hlthin02/hlth02asc.html

The New York Times
September 30, 2003
Big Increase Seen in People Lacking Health Insurance
By Robert Pear

Among people living in poverty, 49 percent of those who worked full-time were uninsured.

But middle-income households accounted for most of the increase in the number of uninsured. In households with annual incomes of $25,000 to $74,999, the number of uninsured people rose last year by 1.4 million, to 21.5 million, and the increase was most noticeable among households with incomes of $25,000 to $49,999.

At companies with fewer than 25 employees, only 30.8 percent of the workers
had employer-sponsored insurance in their own names last year, down from
31.3 percent in 2001. The proportion of workers with insurance also declined
at companies with 25 to 99 employees (by 2.4 percentage points, to 54.4 percent) and even at businesses with more than 1,000 employees (by nine-tenths of a percentage point, to 68.7 percent).

Ronald F. Pollack, executive director of Families USA, a liberal-leaning consumer group, said: “It’s hard to grasp the magnitude of the number of uninsured. It exceeds the aggregate population of 24 states.”


Comment: This is what our $1.66 trillion is buying? Puck had it right:
“Lord, what fools these mortals be!”

Doctors Describe Human Toll As System Fails

Press Release: Doctors Describe Human Toll As System Fails
September 30, 2003

Physicians Group Decries 2.4 Million Rise in Number of Americans Lacking Health Insurance

Doctors Describe Human Toll, Especially for Children and Minorities As Employers Drop Coverage and Incremental Reforms Fail

SEPTEMBER 30, 2003, CHICAGO, IL

The number of Americans without health insurance jumped sharply for the third year in a row, up 2.4 million to 43.6 million, 15.2% of the population, according to a report released by the U.S. Census Bureau today. Members of Physicians for a National Health Program offered graphic descriptions of the human toll behind these numbers.

In cities across the country the rising number of uninsured is straining the nations safety net health care providers and taking a toll on state government budgets. The resulting gaps in access to care can be fatal. This month, in Dyersburg, Tennessee, a 26 year old patient was turned down for coverage by the states TennCare program after losing his job and workplace-based insurance. Denied access to mental health care, his psychiatric condition worsened and he took a room full of college students hostage, severely injuring two classmates before being killed by police.

In a small town, everyone is affected by a tragedy like this, said retired Tennessee pediatrician Dr. Jim Hudson. This is criminal, that in the wealthiest country in the world, we dont assure access to basic life-saving care.

Minorities have been particularly hard hit. One-in-three Latinos are uninsured (32.4%, including 25% of Latinos who were born in the US), as are one-in-five blacks (20.2%). Latinos suffer staggering health consequences from being uninsured, said Dr. Olveen Carrasquillo, a leading academic researcher on the uninsured at Columbia University in New York. Diabetes is 2-3 times more common in Latinos, which can cause blindness, kidney failure, and leg amputation if untreated. Asthma is 3-5 times more common in Latino kids.

The proportion of all children who are uninsured held steady at 11.6%. 8.5 million children remain uninsured, a graphic illustration of the failure of incremental reforms, such as the Childrens Health Insurance Program which is supposed to sharply reduce the number of uninsured children.

Texas residents are the worst insured in the nation, with one in four (24.1%) lacking any health coverage. Over 50% of my young patients are uninsured, said Houston pediatrician Dr. Ana Malinow, who easily recalls a half-dozen patients with terrible complications from being uninsured, including a two year old with a chronic ear infection and perforated eardrum whose family cant afford the $1,000 deposit required for surgery. In Texas, a simple ear infection in a child may not be properly treated for years, causing preventable hearing loss, speech deficits, and lifelong learning problems. The leave no child behind state is frighteningly callous when it comes to childrens health, and its no better for the adults I see in my volunteer work at a local shelter. The health care system in Texas is failing everybody.

Physicians' Group Decries 2.4 Million Rise in Number of Americans Lacking Health Insurance

Doctors Describe Human Toll, Especially for Children and Minorities As Employers Drop Coverage and Incremental Reforms Fail

SEPTEMBER 30, 2003, CHICAGO, IL�The number of Americans without health insurance jumped sharply for the second year in a row, up 2.4 million to 43.6 million,15.2% of the population, according to a report released by the U.S. Census Bureau today. Members of Physicians for a National Health Program offered graphic descriptions of the human toll behind these numbers.

This month in Dyersburg, Tennessee, a 26 year old patient was turned down for coverage by the state�s TennCare program after losing his job and workplace-based insurance. Denied access to mental health care, his psychiatric condition worsened and he took a room full of college students hostage, severely injuring two classmates before being killed by police.

�In a small town, everyone is affected by a tragedy like this,� said retired Tennessee pediatrician Dr. Jim Hudson. �This is criminal, that in the wealthiest country in the world, we don�t assure access to basic life-saving care.�

Minorities have been particularly hard hit. One-in-three Latinos are uninsured (32.4%, including 25% of Latinos who were born in the US), as are one-in-five blacks (20.2%). �Latinos suffer staggering health consequences from being uninsured,� said Dr. Olveen Carrasquillo, a leading academic researcher on the uninsured at Columbia University in New York. �Diabetes is 2-3 times more common in Latinos, which can cause blindness, kidney failure, and leg amputation if untreated. Asthma is 3-5 times more common in Latino kids.�

The proportion of all children who are uninsured held steady at 11.6%. 8.5 million children remain uninsured, a graphic illustration of the failure of incremental reforms, such as the Children�s Health Insurance Program which is supposed to sharply reduce the number of uninsured children.

Texas residents are the worst insured in the nation, with one in four (24.1%) lacking any health coverage. �Over 50% of my young patients are uninsured,� said Houston pediatrician Dr. Ana Malinow, who easily recalls a half-dozen patients with terrible complications from being uninsured, including a two year old with a chronic ear infection and perforated eardrum whose family can�t afford the $1,000 deposit required for surgery. �In Texas, a simple ear infection in a child may not be properly treated for years, causing preventable hearing loss, speech deficits, and lifelong learning problems. The �leave no child behind� state is frighteningly callous when it comes to children�s health, and it�s no better for the adults I see in my volunteer work at a local shelter. The health care system in Texas is failing everybody.�

In Chicago, Dr. Claudia Fegan (who is also incoming president of Physicians for a National Health Program) runs the outpatient clinics for one of the city�s busiest safety-net hospitals. �People who thought they�d never be here find themselves begging for care. Yesterday a woman who had recently suffered a stroke sat crying outside my office in a wheelchair. Another hospital had discharged her and brought her here via ambulance. They told her she had to come here to receive her medications and follow-up care. We took care of her but we do not have any more available appointments for new patients until 2004. Where are people supposed to go?�

In Massachusetts, Dr. Steffie Woolhandler is in charge of quality reviews for the Department of Medicine at Cambridge Hospital. �I review the cases of people who should not have died to find out what went wrong. Too often the problem was that the patient didn�t have insurance and delayed care,� said Dr. Woolhandler. She cited the case of an uninsured health care professional who died of a treatable cancer before her biopsy results had even come back from the laboratory. �She correctly diagnosed herself with a liver problem based on her symptoms. She thought if she quit drinking she�d improve on her own. If she�d come in sooner, we could have treated the lymphoma we found in her liver.�

�The incremental reforms of the past two decades have failed,� said Dr. Carrasquillo. �The economic boom of the 1990�s barely dented the number of uninsured. The last three years of recession has exposed the cracks in our unsound health system. The number of people without insurance is skyrocketing, while benefits for people who still have coverage are shrinking rapidly. This should be a wake-up call to all political and health care leaders, including Latino leaders, that the time for bold solutions is now.�

Physicians for a National Health Program has more than 11,000 members across the country which advocates national health insurance for the U.S. PNHP members take care of the uninsured in every state and medical specialty. To interview a PNHP physician about the problems of lacking health insurance and options for reform, contact Ida Hellander at (312) 782-6006 or
pnhp@aol.com .

Small Towns Struggle to Find Dentists

IN SOME AREAS, PEOPLE MUST WAIT MONTHS FOR APPOINTMENTS OR TRAVEL LONG DISTANCES. SOME MEDICAID FAMILIES CAN’T GET TREATED AT ALL.

By David Crary
Associated Press Writer of LA Times
September 28, 2003

BERLIN, N.H. – Every few days, an agonized child or adult shows up at the emergency room of this mill town’s lone hospital, seeking relief from a pain that should have been treated elsewhere.

They have an abscess or a toothache, long-festering and suddenly unbearable. They turn to ER doctors, who can do little beyond supplying antibiotics, because Berlin – like hundreds of communities nationwide – has too few dentists.

Home to 10,600 people – just two of them dentists – in far-northern New Hampshire, Berlin is one of 1,480 areas in the United States designated by federal authorities as suffering from a dentist shortage. That number has nearly doubled since 1990.

In some areas, even patients with private dental insurance have to wait months for an appointment or travel long distances to a dentist with an open slot. Many low-income families have it worse: Their Medicaid coverage often isn’t enough to gain access to already busy dentists.

Loretta Morrissette, who runs an oral health program in Berlin’s public schools, sees the damage close-up in children whose parents can’t afford dental visits or can’t find a dentist who accepts new patients. She cited one mother who called 22 dental offices in one morning, many of them in distant towns, without getting an appointment for her child.

“If the children had early intervention, they could be helped before they get to the point of pain,” said Morrissette, a dental hygienist with Coos County Family Health Services. “They end up with an abscess two years down the road and a four-surface filling instead of one little one. It’s traumatic.”

Morrissette’s program tries to help children in kindergarten through third grade get dental treatment, although more than 70 students with cavities had to be placed on a slow-moving waiting list this year.

“I get an unbelievable amount of calls from parents wanting services, hoping for something that I can’t offer,” she said. “If they have a child in second grade and one in sixth, it’s very hard to tell them there’s no access for that older one.”

Dr. William Kassler, New Hampshire’s state medical director, said nearly 20% of the state’s 1.2 million residents live in communities with too few dentists. Many of those towns, Berlin among them, have unfluoridated water, causing higher cavity rates among children who then lack ready access to treatment.

As one of 16 states with no dental school, New Hampshire struggles to recruit newcomers to serve needy towns or replace the many dentists nearing retirement. The dentists who do come – like their peers elsewhere- generally prefer relatively well-to-do communities, not rural areas and poor urban neighborhoods with the most need.

Like many other states, New Hampshire is trying to ease the shortages by offering to repay the student loans of young dentists willing to work in underserved areas. Under another new program, the state will pay the malpractice insurance and license fees of retired dentists willing to donate at least 100 hours a year to treat needy patients.

“All states are struggling with these issues,” said Kassler, whose own family had to wait nine months for dental appointments after moving to New Hampshire five years ago. “It’s something that cries out for national policy intervention.”

Nationwide, there are about 152,000 active dentists, more than one-third of them over age 55, according to the American Dental Assn. Experts estimate that dentists’ ranks will begin to decline in about 10 years as the number of dental school graduates – now about 4,000 annually – falls below the number of dentists leaving the work force due to retirement or other reasons.

To reverse the trend, dental schools would need to graduate more students. But many of the nation’s 56 dental schools are struggling to maintain current operations; there are more than 350 vacant faculty positions because of an exodus of teachers into better-paying private practice.

Even now, there are severe shortages of dentists in certain regions – a huge swath of the Great Plains, southern Texas, much of Nevada, northern Maine and poor, rural counties in many other states. The U.S. Department of Health and Human Services says more than 31 million people live in shortage areas; officials estimate that 4,650 dentists would be needed to provide the proper level of service.

Senate Minority Leader Tom Daschle (D-S.D.) drew attention to the dentist shortage while touring his home state last month. “I’ve heard horror stories from South Dakotans who were forced to travel more than 100 miles for a simple dental procedure,” he said.

A recent South Dakota Dental Assn. survey projected that the number of practicing dentists in the state under age 65 could drop from 308 now to 217 by 2020.

Many of the nation’s problem areas have large minority populations, yet only 3.4% of the nation’s dentists are black and 3.3% are Latino.

Dr. Eugene Kruysman, one of the two practicing dentists in Berlin, has hired a headhunter agency to recruit an associate to help him with his overbooked practice. He is unable to take on new patients and even his regulars sometimes have to wait several months for a routine visit.

Kruysman, 49, has been practicing profitably in Berlin for 22 years; he raves about the appreciative attitude of his patients and the outdoor attractions of the surrounding White Mountains. But he knows that it won’t be easy to lure an associate to an economically struggling town several hours’ drive from the nearest big cities.

“It’s tough to draw someone up here,” he said. “The problem only worsens the more remote the location.”

He serves on a local dental-care task force and pitches in by treating some low-income emergency patients. His regulars include some Medicaid-covered families. But he knows that many children and adults in the area are suffering from lack of dental care.

“I don’t have an answer,” he said. “I see no solution to this shortage anywhere on the horizon.”

Canada's council for health policy and accountability

Toronto Star
Sep. 26, 2003
Ottawa, provinces agree to national health council

The federal government and provinces have reached agreement on the creation
of a 27-member national health council, a key source said today.

The council, which would monitor health policy and accountability, would be comprised of a chairperson, 13 government representatives and 13 people
from outside government.

Roy Romanow recommended the council last year in his royal commission
report on the future of health care.

click here to view the article

Comment: Imagine a national health council in the United States monitoring
health policy and accountability. Just to begin with, what would such a commission have to say about our very high costs in the face of the profound
deficiencies and inequities in our system?

Such a council would be invaluable to help fine tune a comprehensive health
care system such as Canada’s. But, in the United States, we don’t need to
fine tune a system. We need to establish a system. The sooner the better.

Sat, 27 Sep 2003 11:06:15 -0700
Subject: qotd: Federal regulations produce a return on our investment

The White House
Office of Management and Budget
Informing Regulatory Decisions: 2003 Report to Congress on the Costs and Benefits of Federal Regulations and Unfunded Mandates on State, Local, and
Tribal Entities.

OMB reviewed 107 major Federal rulemakings finalized over the previous ten
years (October 1, 1992 to September 30, 2002). The estimated total annual
quantified benefits of these rules range from $146 billion to $230 billion, while the estimated total annual quantified costs range from $36 billion to $42 billion.

Table 2: Estimates of the Total Annual Benefits and Costs of Major Federal Rules, October 1, 1992 to September 30, 2002 (millions of 2001 dollars):

Health & Human Services
Benefits: 9,129 to 11,710
Costs: 3,165 to 3,334

Environmental Protection Agency
Benefits: 120,753 to 193,163
Costs: 23,359 to 26,604

(six other agencies are listed, and each shows a significantly greater benefit than cost.) http://www.whitehouse.gov/omb/inforeg/2003_cost-ben_final_rpt.pdf

Comment: One of the most common objections to the role of government is the cost of regulatory requirements. Although the social benefits of many regulations may be priceless, it is very reassuring to know that President Bush’s OMB has provided a report that demonstrates that the regulations of each agency also produce a significantly greater dollar value in benefits than are the costs of fulfilling the regulations.

Although the greatest return has been through EPA regulations, agencies such as HHS have also produced a positive dollar return on the regulatory requirements.

The benefits of regulatory oversight are further evidence that our government is not our enemy. And we could benefit even more if we would begin to use a Universal, “government-run,” social insurance program to improve the value of our health care investment.

Canada’s council for health policy and accountability

Toronto Star
Sep. 26, 2003
Ottawa, provinces agree to national health council

The federal government and provinces have reached agreement on the creation
of a 27-member national health council, a key source said today.

The council, which would monitor health policy and accountability, would be comprised of a chairperson, 13 government representatives and 13 people
from outside government.

Roy Romanow recommended the council last year in his royal commission
report on the future of health care.

click here to view the article

Comment: Imagine a national health council in the United States monitoring
health policy and accountability. Just to begin with, what would such a commission have to say about our very high costs in the face of the profound
deficiencies and inequities in our system?

Such a council would be invaluable to help fine tune a comprehensive health
care system such as Canada’s. But, in the United States, we don’t need to
fine tune a system. We need to establish a system. The sooner the better.

Sat, 27 Sep 2003 11:06:15 -0700
Subject: qotd: Federal regulations produce a return on our investment

The White House
Office of Management and Budget
Informing Regulatory Decisions: 2003 Report to Congress on the Costs and Benefits of Federal Regulations and Unfunded Mandates on State, Local, and
Tribal Entities.

OMB reviewed 107 major Federal rulemakings finalized over the previous ten
years (October 1, 1992 to September 30, 2002). The estimated total annual
quantified benefits of these rules range from $146 billion to $230 billion, while the estimated total annual quantified costs range from $36 billion to $42 billion.

Table 2: Estimates of the Total Annual Benefits and Costs of Major Federal Rules, October 1, 1992 to September 30, 2002 (millions of 2001 dollars):

Health & Human Services
Benefits: 9,129 to 11,710
Costs: 3,165 to 3,334

Environmental Protection Agency
Benefits: 120,753 to 193,163
Costs: 23,359 to 26,604

(six other agencies are listed, and each shows a significantly greater benefit than cost.) http://www.whitehouse.gov/omb/inforeg/2003_cost-ben_final_rpt.pdf

Comment: One of the most common objections to the role of government is the cost of regulatory requirements. Although the social benefits of many regulations may be priceless, it is very reassuring to know that President Bush’s OMB has provided a report that demonstrates that the regulations of each agency also produce a significantly greater dollar value in benefits than are the costs of fulfilling the regulations.

Although the greatest return has been through EPA regulations, agencies such as HHS have also produced a positive dollar return on the regulatory requirements.

The benefits of regulatory oversight are further evidence that our government is not our enemy. And we could benefit even more if we would begin to use a Universal, “government-run,” social insurance program to improve the value of our health care investment.

Canada's MRI and CT scanners

Canada Newswire
Sept. 24, 2003
Release from Canadian Institute for Health Information (CIHI)
CIHI report shows dramatic increase in MRI, CT scans and scanners

A new national report on medical imaging by the Canadian Institute for Health Information (CIHI) shows the supply of MRI (Magnetic Resonance Imaging) and CT (Computed Tomography) scanners and the number of scans performed have risen dramatically in the past decade, and that the distribution of major imaging equipment varies across the country.

A recent Statistics Canada survey found that 6.7% of Canadians age 15 and
over – a total of 1.7 million people – had a non-emergency MRI, CT, or angiography in 2001. Provincial data show volumes have risen sharply in
recent years.

Canada had a total of 147 MRI scanners in January 2003 compared to 30 in
1993, an increase of nearly 400%. The number of CT scanners rose by about
50% over the same period, from 216 in 1993 to 326 in January 2003. The country also had 594 nuclear medicine cameras, 165 angiography suites,
94 Catheterization labs, and 14 PET scanners in January 2003. Canada’s MRI and CT machines are, on average, newer than those in Europe.

Waiting for Care: The 2001 Statistics Canada Health Services Access Survey
found that about half of Canadians aged 15 and older who reported receiving
a non-emergency CT, MRI, or angiography waited three weeks or less. Most
(55%) waited less than a month; about 5% waited six months or more. One-quarter of those who were tested felt their wait was unacceptable; about
one in six (16%) said the wait affected their lives. Most (68%) of those who
said the wait affected them said it caused worry, anxiety, or stress.

http://www.newswire.ca/releases/September2003/25/c4564.html

Comment: One of the most common arguments presented against the adoption of a single payer system in the United States is that there are unacceptable
queues or delays for services in any universal, government funded program.
Perhaps the most frequent example given is the unacceptable delays in diagnostic imaging in Canada due to the fact that they do not have enough CT or MRI scanners to meet their needs. This report reveals that, in the past decade, great progress has been made by Canada in addressing this problem.

Emergency imaging is always available without delay. And, by 2001, three-fourths of Canadians who had elective scans do not believe that they were subjected to unacceptable delays. Since the release of the Romanow report, an even greater effort has been made to ensure adequate capacity.

Canada’s access to imaging is not bad and is improving dramatically. Contrast that to imaging in the United States. We have the capacity, but the uninsured and many of the under-insured cannot afford CT or MRI scans. Tens of millions of Americans are not even allowed a place in the queue.

Which system is better: a lower cost system that recognizes a capacity problem and takes measures to resolve that, or a higher cost system that has adequate capacity but nevertheless engages in wholesale rationing based on ability to pay?