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?

Beth Capell, Ph.D. responds on the AAHP/HIAA merger and the importance
of lobbying:

The budgets listed (in yesterday’s message on the AAHP/HIAA merger) probably do NOT include campaign contributions as your comment implies.Instead, these budgets are devoted to lobbying, providing information and “research” that supports lobbying, and activating grassroots presence (though perhaps not that either: it would depend on how these associations structure what they do: the overhead on grassroots could be modest and most of the cost of that effort could be buried within the budgets of individual companies).

Woody Allen says that 90% of life is just showing up. The same is true for moving an idea through the political process. Showing up counts. A lot. The insurers are ubiquitous on health issues–not just universal coverage, but Medicare prescription drugs and probably a dozen other key issues. And they are omnipresent: that’s what $30-$40 million in lobbying presence means: it means that every member of Congress who thinks a thought about health care knows who the insurance lobbyists are and probably what they will think about an issue.

PNHP has a plan for affordable health care for all—but members of Congress won’t know about it or take it seriously without an effective lobbying presence and without grassroots capacity to back that up. An occasional appearance on public television or an article in a medical journal (not widely read on Capitol Hill) are good but not sufficient. It is not a matter of matching the insurance industry dollar for dollar: after all, we beat them on HMO reform in California with far less capacity than that–but we (you, me, lots of other people and a number of key organizations) were there day after day for five years to win that fight. A fight at the national level requires commensurately greater capacity.

Good ideas are important but not sufficient. Just showing up counts for a lot in advocacy. Creating that presence, that showing up is what organizing is about.

Beth Capell, Ph.D., political science, lobbyist for California Physicians Alliance, Health Access California and others.

The Hill
September 23, 2003
Insurance trade groups OK merger
AAHP and HIAA consolidates Hill lobbying efforts
By Michael S. Gerber

Washington, D.C.’s two largest health insurance trade groups (The American
Association of Health Plans (AAHP) and Health Insurance Association of America (HIAA)) announced Monday that their boards of directors had approved a merger…

Leading the new association in its efforts on Capitol Hill to promote
private insurers will be Karen Ignagni, who currently serves as president
and CEO of AAHP.

The two associations’ similar agendas in Washington make it easy to merge
the policy shops. Both have been pressing for a larger role for private insurers in the Medicare prescription drug package as well as increased
payments to HMOs.

AAHP and HIAA spent a combined $9.3 million on lobbying last year,according
to records filed with the Senate.Each group’s budget is around $20 million, according to the Government Affairs Yellow Book published by Leadership Directories.

AAHP currently employs a staff of 120 and HIAA 80, Ignagni said.(AAHP Chairman William) McCallum said the new organization’s budget would be about 40 percent greater than AAHP’s.

http://www.hillnews.com/business/092303_merger.aspx

Comment: So what? Well, AAHP/HIAA and its membership owns a controlling
interest in Congress. That’s what.

When our goal is to try to provide everyone with health insurance, why should we be concerned that this industry has a favored position with Congress? It’s because our current fragmented system of funding care through private and public programs has resulted in unacceptable waste, deficiencies and inequities in our system. Congress continues to perpetuate policies that protect and enhance private health plans at the cost of health care equity for all of us.

AAHP/HIAA’s $40 million budget can secure its position quite solidly in the
hallways and lobby rooms of Congress. In contrast, we have no significant
sources of funds. All we can offer is a plan to provide affordable, comprehensive health care for everyone. Unfortunately, policy position papers don’t have the color and smell of fresh U.S. Treasury ink that serves as an effective attractant to too many of the creatures of Congress.

The Providence Journal
September 21, 2003
There’s no shelter from this storm
By John Kostrzewa

Employees used to contribute about 15 percent of the cost of health care. Now, the contribution has risen to 25 percent to 35 percent. And health-care consultants forecast it will grow to 50 percent at some companies.

Some workers are cutting back on health care and elective Surgeries, deciding to live with the bad knee rather than get a replacement. Or they are deciding to postpone the eye exam to avoid the copay. Or they are going without health insurance.
No relief is on the horizon.

http://www.projo.com/business/content/projo_20030921_jk21x.777bd.html

Comment: Current health care reform efforts continue down this path of shifting costs to patients. But is this really reform? Reform is defined as a change for the better. Reducing affordable access to beneficial health care services is a change for the worse.

Let’s dump this movement to shift costs to patients and get on with the process of real reform!

The Washington Post
September 17, 2003
Health Plan Costs Up 10.6%
By Christopher Lee

Health insurance premiums for federal employees and retirees (under the Federal Employees Health Benefits Program) will rise an average of 10.6 percent next year, the fourth consecutive year of double-digit increases, the Bush administration said yesterday.

Kay Cole James, director of the Office of Personnel Management:”This is great news for the federal employees, and we’re excited today on their behalf.”

Alwyn Cassil, spokeswoman for the Center for Studying Health System Change:Although federal workers’ premium increases have been comparatively
smaller,10.6 percent “is still a very high rate of growth. It’s growing much faster than increases in wages, increases in growth of the economy and increases in inflation. That means that more and more money will be coming out of people’s pockets to pay for health care.”

The administration also announced that, for the first time in five years,the government will expand the number of health plan choices under the Federal Employees Health Benefits Program. The program will offer 205 plans nationwide next year, up from 188 in this year.

http://www.washingtonpost.com/wp-dyn/articles/A21909-2003Sep16.html Comment: The largest purchaser of health care coverage, the Federal Employees Health Benefits Program, has not been able to slow the rise in health care costs to anywhere near the rate of inflation. That is not good news.

The fact that more plans wish to participate in the program indicates that our national policies are designed to enhance the business model of private health plans at the cost of higher health care expenses for the employees and their families.

Should we continue with national policies that are designed to protect the health plans of the members of Congress, or should we change to policies that are designed to ensure access to affordable care for everyone?

The Washington Post
September 16, 2003
Proposals for Expanding Health Care Coverage
By Julie Ishida

While the uninsured are left to deal with the consequences of being uninsured, policymakers have designed a variety of proposals to expand access to health insurance. The majority of Americans polled in a 2003 survey by the Kaiser Family Foundation and the Harvard School of Public Health support increasing the number of people in the United States covered by health insurance, but there is no consensus on how to accomplish this.

Karen Davis, president of the Commonwealth Fund:

“The proposals that are now being talked about are more pragmatic and less ideological and more focused on building [on] what works currently. How can we find out what’s working now and add more people?”

Paul Ginsburg, president of the Center for Studying Health System Change:”The reason why individuals are uninsured differs so much that it is unlikely that a single provision is going to cover them all. We need different approaches for different segments of the population.”

Here’s a summary of the major approaches under discussion.

Universal Coverage Proposals:

* Single payer

* Employer mandate

* Individual mandate

Incremental Proposal:

* Expansion of Medicaid and Children’s Health Insurance Program (CHIP)
eligibility

* Subsidization of private insurance

* Creation of a system similar to the Federal Employees Health Benefits
(FEHB) Program

http://www.washingtonpost.com/wp-dyn/articles/A15812-2003Sep15_2.html

Comment: The messages of individuals such as Karen Davis and Paul Ginsburg have dominated the national dialogue on health care reform. They imply that only piecemeal measures are feasible.

But the failure to control increasing costs, combined with a failure to reduce the numbers of uninsured have created an awareness that we need a more aggressive approach toward reform.

The recent publicity surrounding the physicians’ proposal for national health insurance published in JAMA, and the administrative efficiency achievable by a single payer system published in NEJM, have regenerated an interest in looking again at truly universal models of health care coverage.

Washington Post reporter Julie Ishida exemplifies the changing dialogue as she now includes universal models in her list of proposals. Members of the media understand the need to broaden the debate. But we need to convince the leaders of those organizations which support comprehensive health care coverage that it is once again okay to discuss universal systems of reform.Davis and Ginsburg need to hear that message.

One more message that we need to deliver is that there are very fundamental differences between the single payer model of social insurance and other so-called universal proposals. As an example, SB 2, California’s employer mandate which passed last week (but not yet signed by Gov. Davis) will still fail to provide coverage for over four-fifths of those currently uninsured.

It will significantly increase costs because it fails to eliminate the administrative excesses and fails to provide any significant cost-containment features. It also represents flawed tax policy since it is regressively funded, providing tax advantages for the wealthy and a lower net cost of their coverage, a benefit not available to low income individuals. It falls so far short of single payer goals that it is inappropriate to consider it in the same general category of reform.

Let’s convince our policymakers that it is time to put everything on the table. But let’s also convince them that single payer needs to be in a special place on the table wherein the policies of all other models are challenged to meet the golden standard of a universal, single payer system of social insurance.