Public Opinion Strategies
March 13, 2003
Survey of Small, Medium and Large Businesses

When asked about the most important goal for reforming our health care
system, business leaders focus on “making health care more affordable” and
“providing basic health insurance coverage to all Americans.” Of the five
health care goals tested, the most important for business leaders is “making
health care more affordable” (51%), followed by “providing basic health
insurance coverage to all Americans” (28%). The remaining three goals are
well below the top two: “maintaining the high quality of American health
care” (11%), “making sure people can select the doctor or hospital of their
choice” (6%), and “making sure the system allows the development and
adoption of new medical technologies” (2%).

http://covertheuninsuredweek.org/media/BusinessSurveyReport.pdf

Comment: Previous polls have confirmed that 98% of the general public is
concerned about making health care more affordable. This survey confirms
that affordability is also the most important concern for businesses of all
sizes.

Perhaps the most frequent argument advanced against establishing a mechanism
that contains costs is that innovation and development of new technologies
would be suppressed. This survey confirms that this is the least concern of
businesses.

If business interests had a better understanding of the single payer model,
support would increase. Of all options under consideration, the single payer
model is the only one than can effectively contain costs, and it does so by
its specific design – using a global budget. It would also meet the other
major goal supported by businesses – providing coverage for all Americans.
It would improve quality by improving access and by adoption of an
integrated information technology system. It would ensure free choice of
providers. And it would actually improve innovation and technology by
freeing up funds currently wasted on administrative excesses which would
then increase funding of the health care delivery system which utilizes the
newer technologies.

Isn’t it time for business to take a much closer look at the single payer
model?

American Medical News
March 24/31, 2003
California emergency departments close after hemorrhaging money
By Markian Hawryluk

According to a new study by the California Medical Assn., California emergency departments provided $540 million in uncompensated care in fiscal year 2001, up 24% from the previous year.

… since 1990, 60 emergency departments — nearly 15% of California’s EDs — have shut their doors.

The closures have left entire communities without emergency departments and have led to increased patient volume. Waits of more than four hours are common as physicians and nurses struggle to treat high volumes of patients, the study found.

John Whitelaw, MD, California Medical Association president:

“What we are seeing here is an astonishing growth in losses, and it shows no sign of abating. People depend on their emergency rooms to be there for them, but these losses point to a crisis of extreme proportions and underline the threat to emergency care around the state.”

http://www.ama-assn.org/sci-pubs/amnews/pick_03/gvsd0324.htm

Comment: No amount of personal wealth can protect you from the threat of the deteriorating infrastructure of our emergency system. Rich people will die, along with the poor, because of the failure of our system.

Providing comprehensive coverage for everyone, funded at our current level of spending (15.2% of our GDP), with a level of efficiency available only through public administration, would ensure that our emergency system would be well funded, always there for all of us.

The Washington Post
March 14, 2003
Editorial

Medicine for Medicare

DO NOT BE MISLED by the loud noises coming from congressional Democrats and health care activists. The Medicare modernization plan the president has finally presented to Congress, after much hemming and hawing, is not radical. It does not force anyone to leave the current system. It does not make anyone switch doctors. It adds $400 billion over the next 10 years to pay for extra drug benefits, a number far higher than some have mentioned. Unlike leaked versions of the administration’s proposal, this one does not even provide full details of what the reform would look like, instead leaving Congress to fill in many of the blanks. As a result, it’s difficult to say whether the proposal would produce much change.

In essence, it adds options, instead of removing them. For those who want it, traditional “fee-for-service” Medicare would be preserved more or less intact, with the addition of a prescription drug discount card as well as some catastrophic insurance. No extra payments would be required, it seems. At the same time, Medicare recipients would also be able to opt into a new program — “enhanced Medicare” — that would look a lot like the current federal employee health insurance plan. Those who chose this option would pay a part of the cost themselves. In return, they would get a private plan and better benefits.

Both the administration and its supporters in Congress seem to hope that over time more people (and particularly younger people, by now accustomed to a plethora of health care choices) would select this second option. If this happened, the costs of Medicare to the federal government might not come down dramatically — private insurance isn’t necessarily cheaper, particularly for the elderly — but at least Medicare recipients would have some incentive to choose plans more suited to their specific health needs. Because they pay for more than just emergency visits to the doctor, integrated plans could also care more sensibly for the chronically ill. As a recent report by the Progressive Policy Institute points out, Medicare currently will pay if you’ve been hospitalized for a stroke but will not pay for the anti-hypertension drugs to prevent it. This is the kind of absurdity that a plan designed specifically to meet the needs of older people could avoid.

“Could” and “might” are the operative words here, however. The president’s proposal is not a panacea but rather a set of suggestions that reflect the politics of the moment. Clearly, this president does not want to be accused of “abandoning” Medicare. On the contrary, he wants to be able to say that “Medicare will always be there, just how it’s always been, if you want it that way.” If Congress chooses to stick too closely to this mantra, and to keep benefits the same across the board, there will be little incentive for anyone to opt out of the current system or to contribute to the costs of his or her care. However politically difficult it appears to be, Congress must make it possible for Medicare to change with the times.

http://www.washingtonpost.com/wp-dyn/articles/A23255-2003Mar13.html

Comment: Neither of the “either-or” options behind this editorial can be good news. Either the editorial staff has failed to do its homework in understanding the fundamental principles of social insurance, or the editorial position of The Washington Post is to support a system that ensures comprehensive services for those able to afford them, but relegates lower-income beneficiaries to a program that falls short on basic health care needs. Have the editors demonstrated incompetence by failing to inform themselves adequately on the issues, or, worse, are they suggesting that personal wealth should determine whether Medicare beneficiaries should have access to all essential services?

Adding a drug discount card to the program would cost nothing, which is exactly what it is worth under this “budget-neutral” administration. And the $6000 deductible catastrophic drug coverage would benefit only the affluent. Prohibiting any other improvements in the benefit package of the traditional program would perpetuate the impaired access to care for those who are unable to afford essential services that are not currently a benefit of the program. The most immediate need is for a bona fide prescription benefit.

The Washington Post supports the FEHBP model of “enhanced Medicare,” making available a private plan, with BETTER BENEFITS, by PAYING A PART OF THE COST themselves, while still prohibiting coverage of the “better benefits” in the traditional program. This would end Medicare as an egalitarian program of social insurance.

The Washington Post is supporting the shift to “consumer-directed” Medicare, not only by shifting costs to beneficiaries when offering more plan options, but also by providing “incentive to choose plans more suited to their specific health needs.” But it is impossible to select a plan that will be the best choice for medical events that cannot possibly be predicted. Also, for those with chronic disorders, providing options creates all of the inequities characteristic of risk segmentation. Lower-income beneficiaries with chronic disorders would be locked into the traditional program. The Washington Post states that covering a stroke but not covering the medications that would prevent it is “the kind of absurdity that a plan designed specifically to meet the needs of older people could avoid.” Yet The Washington Post has endorsed precisely this type of absurdity.

Is this editorial incompetence, or is it support for the concept that there is a “lower class” that is not entitled to all essential health care? Perhaps The Washington Post does not want them to have their “cake,” but, rather, “Let them have strokes.”

The Washington Post
March 14, 2003
Editorial

Medicine for Medicare

DO NOT BE MISLED by the loud noises coming from congressional Democrats and health care activists. The Medicare modernization plan the president has finally presented to Congress, after much hemming and hawing, is not radical. It does not force anyone to leave the current system. It does not make anyone switch doctors. It adds $400 billion over the next 10 years to pay for extra drug benefits, a number far higher than some have mentioned. Unlike leaked versions of the administration’s proposal, this one does not even provide full details of what the reform would look like, instead leaving Congress to fill in many of the blanks. As a result, it’s difficult to say whether the proposal would produce much change.

In essence, it adds options, instead of removing them. For those who want it, traditional “fee-for-service” Medicare would be preserved more or less intact, with the addition of a prescription drug discount card as well as some catastrophic insurance. No extra payments would be required, it seems. At the same time, Medicare recipients would also be able to opt into a new program — “enhanced Medicare” — that would look a lot like the current federal employee health insurance plan. Those who chose this option would pay a part of the cost themselves. In return, they would get a private plan and better benefits.

Both the administration and its supporters in Congress seem to hope that over time more people (and particularly younger people, by now accustomed to a plethora of health care choices) would select this second option. If this happened, the costs of Medicare to the federal government might not come down dramatically — private insurance isn’t necessarily cheaper, particularly for the elderly — but at least Medicare recipients would have some incentive to choose plans more suited to their specific health needs. Because they pay for more than just emergency visits to the doctor, integrated plans could also care more sensibly for the chronically ill. As a recent report by the Progressive Policy Institute points out, Medicare currently will pay if you’ve been hospitalized for a stroke but will not pay for the anti-hypertension drugs to prevent it. This is the kind of absurdity that a plan designed specifically to meet the needs of older people could avoid.

“Could” and “might” are the operative words here, however. The president’s proposal is not a panacea but rather a set of suggestions that reflect the politics of the moment. Clearly, this president does not want to be accused of “abandoning” Medicare. On the contrary, he wants to be able to say that “Medicare will always be there, just how it’s always been, if you want it that way.” If Congress chooses to stick too closely to this mantra, and to keep benefits the same across the board, there will be little incentive for anyone to opt out of the current system or to contribute to the costs of his or her care. However politically difficult it appears to be, Congress must make it possible for Medicare to change with the times.

http://www.washingtonpost.com/wp-dyn/articles/A23255-2003Mar13.html

Comment: Neither of the “either-or” options behind this editorial can be good news. Either the editorial staff has failed to do its homework in understanding the fundamental principles of social insurance, or the editorial position of The Washington Post is to support a system that ensures comprehensive services for those able to afford them, but relegates lower-income beneficiaries to a program that falls short on basic health care needs. Have the editors demonstrated incompetence by failing to inform themselves adequately on the issues, or, worse, are they suggesting that personal wealth should determine whether Medicare beneficiaries should have access to all essential services?

Adding a drug discount card to the program would cost nothing, which is exactly what it is worth under this “budget-neutral” administration. And the $6000 deductible catastrophic drug coverage would benefit only the affluent. Prohibiting any other improvements in the benefit package of the traditional program would perpetuate the impaired access to care for those who are unable to afford essential services that are not currently a benefit of the program. The most immediate need is for a bona fide prescription benefit.

The Washington Post supports the FEHBP model of “enhanced Medicare,” making available a private plan, with BETTER BENEFITS, by PAYING A PART OF THE COST themselves, while still prohibiting coverage of the “better benefits” in the traditional program. This would end Medicare as an egalitarian program of social insurance.

The Washington Post is supporting the shift to “consumer-directed” Medicare, not only by shifting costs to beneficiaries when offering more plan options, but also by providing “incentive to choose plans more suited to their specific health needs.” But it is impossible to select a plan that will be the best choice for medical events that cannot possibly be predicted. Also, for those with chronic disorders, providing options creates all of the inequities characteristic of risk segmentation. Lower-income beneficiaries with chronic disorders would be locked into the traditional program. The Washington Post states that covering a stroke but not covering the medications that would prevent it is “the kind of absurdity that a plan designed specifically to meet the needs of older people could avoid.” Yet The Washington Post has endorsed precisely this type of absurdity.

Is this editorial incompetence, or is it support for the concept that there is a “lower class” that is not entitled to all essential health care? Perhaps The Washington Post does not want them to have their “cake,” but, rather, “Let them have strokes.”

Seattle Post-Intelligencer
March 12, 2003
National solution best for health care
By Mary O. McWilliams

Here, in the midst of Cover the Uninsured Week, it is important that this be said: All Americans should be covered by health insurance.

To that end, I offer the following principles to guide the debate. These ideas center on the values of individual responsibility, collective accountability and equality.

* Coverage for all is a national public policy matter.

* We should focus on adding to the coverage that exists today.

* We must acknowledge that solutions will have a cost.

* We need a basic set of health benefits as the floor.

* This is a collective responsibility.

* Government-sponsored programs must be adequately funded.

* We must improve the current system.

* Consumers must have a direct relationship with the cost of care.

It is to be hoped that these concepts will further spark a meaningful debate, which must continue in earnest beyond the focus of this week.

Mary O. McWilliams is president of Regence BlueShield.

http://seattlepi.nwsource.com/opinion/112031_regence12.shtml

Comment: During Cover the Uninsured Week, there is a unified voice stating clearly that everyone should be covered by health insurance. Listening to the various interests, it almost sounds like we finally agree that we must have a universal, egalitarian system. But then there are always the details.

Ms. McWilliams believes in a national solution, as long as that solution protects her industry, funds it more generously, and allows it to shift the burden of actually funding health care to the individual patients, to “encourage cost- and quality-conscious purchasing.” What will her position be if it is decided to reduce expensive administrative excesses by eliminating middleman health plans and adopting a single public payer?

Cover the Uninsured Week should not only end with a resolve to cover everyone, but it should also end with a resolve to put the interests of patients above all others. Without such a resolve we will flounder and founder.

United States Senate Special Committee on Aging
March 10, 2003
Testimony of Karen Davis, President, The Commonwealth Fund

Time for Change: The Hidden Cost of a Fragmented Health Insurance System

Executive Summary

We have entered the 21st century encumbered by a health system that is not up to the challenge of ensuring a healthy and productive nation. Set in motion over 50 years ago, the system is costly, complex, and confusing. Most important, it is failing to achieve the twin objectives of health insurance: to ensure that people have access to needed medical care and to protect them from the financial burdens of costly medical bills.

There are five types of costs inflicted by our fragmented health insurance system:

* Costs of a growing number of uninsured

# 41 million Americans in 2001 fell through the cracks of the American health care system because they were not lucky enough to be covered by employer-based coverage, Medicare, Medicaid, or the Children’s Health Insurance Plan

* Health and economic consequences of gaps in health insurance coverage

# 18,000 deaths of adults ages 25 to 64 occur each year as a result of the absence of health insurance coverage – making it the sixth-leading cause of death in this age group, ahead of HIV/AIDS or diabetes

* Cost-shifting that occurs in a fragmented financing system, especially as health care costs accelerate

# 70 million American workers are covered by their own employer; 20 million by a family member’s or previous employer; 30 million are not covered by an employer

# Our “pass the buck” system of health insurance perpetually shifts costs from one employer to another, employers to workers, federal government to state governments and back, and to safety-net hospitals serving the uninsured

# Far more energy goes into shifting costs than enhancing efficiency or quality of health care; insurance companies are profitable by attracting favorable risks, not through innovative incentives to improve quality and efficiency

* Costs of churning in health insurance coverage, as people’s economic and personal circumstances change

# Churning results in frequent gaps in insurance. Sixty-two million – one of four – were uninsured during 2000; 75 million were uninsured in 2000 and 2001. These people were at high risk of not getting care when needed and facing unaffordable medical bills when care could not be postponed.

# The U.S. spent $111 billion in 2002 on private insurance and government administrative costs – not including administrative costs incurred by hospitals and other health care providers or by individuals as they enroll, disenroll, and re-enroll and change insurance coverage and plans.

* Costs of complexity from a pluralistic system of health insurance without an integrating framework and consensus on basic principles

# Cost of large numbers of individuals eligible for but not enrolled in public programs

# Cost of lost productivity, health, anxiety, sick days, and valuable time of uninsured patients spent seeking care

# Cost of resources wasted on administration – jobs underwriting, screening, and verifying eligibility; new administrative apparatuses to cover narrow target groups of eligible individuals; costs of enrolling and disenrolling for public and private insurers and for individuals

# Costs of inefficient and low-quality care – high costs in emergency rooms for preventable conditions and hospitalizations; costs of differing standards of care depending on insurance status

# The U.S. spends twice as much per capita on health care as other industrialized OECD nations and is the only one to fail to cover everyone

There has to be a better way:

* Automatic and affordable coverage for all

(Truncated. See “Comment” for the solution suggested.)

http://www.cmwf.org/programs/insurance/davis_senatecommitteetestimony_622.pdf

Comment: Karen Davis has provided the rationale for ending our fragmented health insurance system. The obvious conclusion is that we need a single, publicly-funded and publicly-administered insurance program. But here is the solution that Karen Davis offers:

“We have built an incredibly complex, costly, and confusing health insurance system. We need a single guiding framework for coverage. It can include multiple sources of financing, multiple choices of public and private coverage, and multiple benefit packages, but it needs to be integrated within a single framework. Certainly, we should have a system that preserves innovation, flexibility, and choice, but some standardization will be required to cut through the maze of complexity in our current system. Reaching consensus on the parameters of choice versus standardization is an important part of public debate on this issue.”

It is astounding to see the efforts that are being made to avoid a program of social insurance but instead to build on our current fragmented system. To present compelling arguments on why the fragmented system does not and cannot work, and then to suggest that we build on it, defies all logic.