PNHP

Donald W. Light, Ph.D., responds on the increased funding for the British National Health Service:

Donald W. Light, Ph.D., responds on the increased funding for the British National Health Service:

The NHS reforms under Tony Blair go much farther than to make up for years of underfunding, which previous Prime Ministers denied was the case. Mr. Blair and Mr. Milburn have open acknowledged central flaws in the NHS that resulted from compromises that Bevan had to make to the medical profession in 1948, and they are rectifying them all.

Severe shortages in nearly every subspecialty are coming to an end. The lack of quality standards is being addressed more systematically than here. The coordination of training of all clinical staff is starting up (like the vision out of PEW in the 1990s here but unlikely to be realized). The hospital-centric system is being systematically transformed into the obverse, with community-based primary care as the center of the system and with GPs and community nurse teams holding the budgets for nearly all health care. These will be population-based and risk-adjusted, roughly what David Kindig envisions in Population-Based Purchasing (Wisconsin 1996). The waiting lists are being transformed. They will be taken away from consultants and coordinated through referral centers. Patients will be given appointments as much as possible. The conflicts of interest in the consultants’ contract are being replaced with productivity-based terms. This is a reform I have been working to bring about for several years, and the Blair Government has accepted most of the recommended changes.

There are serious problems in implementing all this, but the design and vision are worth serious attention by anyone interested in a population-based, community-centered model of health care like that envisioned in the Dawson Report of 1920. I have written several short pieces on aspects of all this as I have worked on the reforms every quarter since 1990.

Don Light

Prof. Donald W. Light
Fax: 1-609-924-1830
Tel: 1-609-924-9220

AMA President Richard Corlin’s insensitive remark on the uninsured provoked more responses than any prior “Quote of the Day” message. Barbara Rylko-Bauer eloquently expresses the innate emotional response that most of us felt on reading his words. My comments follow hers.

Barbara M. Rylko-Bauer:

Dear Don:

According to your “quote of the day,” Dr. Richard Corlin, president of the AMA, during a trip to Cedar Rapids last week, was supposed to have said the following with regards to the uninsured:

“We need a pragmatic, not an ideological solution. Reduce the number from 39 million to its irreducible minimum, probably about 15 million, and consider that a victory and not a terrible tragedy.”

If Dr. Corlin truly did say these very words, then I think that all responsible physicians should call for his resignation…for he has served medicine and the physicians he represents, as AMA president, very poorly, to say the least.

By responsible physicians I mean those :

* who consider that their role is not just to treat a disease that walks in the door, but also to be concerned about larger health care issues facing communities and populations,

* who are compassionate,

* who are concerned with what is happening in health care delivery in this country… NOT just in relation to how it affects medicine’s autonomy, not just in relation to how it is affecting doctor-patient relations, not just in relation to how it affects their pocket book…(ALL valid things to be concerned about.)… but also in terms of how it is affecting the patients they are privileged to treat,

* and who are concerned about all the other people who ARE NOT patients because they have no real access to care…..in other words, those pesky uninsured folks that Dr. Corlin so readily dismisses.

Dr. Corlin should also do a little reading about the state of affairs of health care in the United States. He might discover that it’s not just those 40 million that are the “problem.” There are also another 40 million or so who are unstably insured (with gaps during the year) or underinsured. What, oh what, are we going to do with them?

Of course, the bigger question is why, in the wealthiest country in the world, which in the year 2000 spent $1.3 trillion on health care — that averages to $4,637 per person….(but of course, not distributed evenly) — we even have to be discussing problems like:

* the large and growing number of people who are uninsured,

* the fact that despite all our advanced biotechnology, we are plagued with serious safety and quality problems in health care delivery,

* the large racial and ethnic disparities in health care delivery,

* and the fact that our headlong race to embrace a market-oriented health care system (of which managed care is just one part) has undermined the “health care safety net” which so many of the poor and vulnerable populations rely on?

These are all topics that the prestigious Institute of Medicine of the National Academy of Science has been exploring. Within the last few years there have been in-depth reports published on all these topics. We are not talking here about some tangential problems, but rather things that are AT THE CORE of health care delivery in the United States. I would be happy to order copies of these for Dr. Corlin… to help him get “up to speed” about the state of affairs for health care in the United States.

I am not a physician. I have, however, studied U.S. health care for many years, as a social scientist. I am frankly astounded that in this day and age, a physician could so glibly erase 15 million people, could stand up and publicly say that if we got the numbers down to 15 million, we could pat ourselves on the back and say, “job well done.” And then to have the insensitivity (and amorality) to consider that having ONLY 15 million uninsured would be a victory, not a tragedy…it boggles the mind. I am also, as a scholar-of-sorts, curious as to how he came to this magical number of 15 million as the “irreducible” denominator. Not from studying health care delivery in other industrialized countries; from where, then?

Dr. Corlin should do even more reading and find out WHO these uninsured folks are….

* he would find out that most of them are employed, hard-working citizens who are in lower paying jobs or with small firms that can’t afford health insurance;

* he would find out that 5.9 million of them are mothers;

* he would find out that about 1/4 of them are children;

* he would find out that many of them are members of minority groups.

I would be willing to bet that herein lies one of Dr. Corlin’s problems. I am looking at a picture of Dr. Corlin as I write…and I can tell you that he:

* is not one of the hard-working poor, not even one of the hard-working middle income Americans who simply can’t afford health insurance,

* is not one of those 5.9 million mothers with small children,

* is not, obviously, a child,

* and is most likely not a member of a minority group.

Dr. Corlin can’t relate to these folks. What I can’t tell from the picture, but can tell from his remarks of last week, is that Dr. Corlin is not a true physician. And he has shamed his profession and his professional position with the irresponsible remarks he made in Cedar Rapids last week. He owes all the uninsured people of this country an apology….and he also owes one to the physicians he is supposed to be representing, as president of one of the major medical associations.

With Dr. Corlin at its head, organized medicine is beginning to look a bit like a ship adrift, these days. Doctors dropping Medicare, opting out of Medicaid, setting up boutique practices, complaining loudly about the abuses of managed care (and there certainly is plenty to complain about, that I agree with) but going along with the for-profit program for the most part, and largely remaining silent about the ways in which big business is shaping health care delivery for its own interests. Its time for more courageous, visionary leadership….and some better ideas for how to solve the problems of health care delivery in this country.

Sincerely,

Barbara Rylko-Bauer

Comment: Dr. Corlin’s apparent insensitivity mandated responses such as Barbara’s. But Dr. Corlin is not the evil person implied by his isolated comment. He is a very fine person, representing the best of the Hippocratic traditions in medicine. So how could he have made such an awful statement?

Health policies that the members of the AMA leadership support include tax credits, MSAs, shifting costs (risk) to individual patients, multiple health plan products (multi-tiered benefits), and eliminating the employment link for health insurance. Dr. Corlin is aware that these policies can never provide true universal coverage. His comment was based on his belief that the AMA policies are in the nation’s interest, and that we have to accept the consequences of these “great” policies. We accept that employment rates will never be 100%, and, likewise, we should accept that health insurance coverage will never be 100%. From his perspective, his comment was a very benign remark on the realities of health care reform.

But what a remark! The AMA leaders are so sold on the righteousness of their approach that they cannot see the cruelty and inhumanity that would be inflicted on those for whom they should be leading the charge: the patients that are most in need of health care! The outrage expressed in response to Dr. Corlin’s comment should bring the AMA Board of Trustees out from their board room to find out what the ruckus is about.

Actually, Dr. Corlin and other members of the AMA leadership, in their tours of the communities, are hearing more and more from many members of the medical profession that we should be taking a very serious look at single payer reform. It is time for the AMA and state and county medical associations to set aside their conservative political ideology and rhetoric, and place on the table all options for reform. It is essential that all policy implications be clearly understood and discussed objectively. The single payer model would provide equitable, comprehensive coverage for absolutely everyone while providing free choice of providers of care and controlling costs. The policies currently supported by the AMA would accomplish none of those goals. But they are goals truly worthy of pursuit.

Don McCanne

Cedar Rapids Gazette

April 19, 2002
By David DeWitte

American Medical Association President Dr. Richard Corlin drop-kicked the notion that national health insurance will ever solve the health insurance crisis during a visit to Cedar Rapids on Thursday.

Finding a system that will cover all Americans is both costly and politically hamstrung, Corlin said.

Richard Corlin, M.D., AMA president:

“We need a pragmatic, not an ideological solution. Reduce the number from 39 million to its irreducible minimum, probably about 15 million, and consider that a victory and not a terrible tragedy.”

http://www.gazetteonline.com

Comment: Dr. Corlin leaves virtually no doubt as to why Physicians for a National Health Program should supersede the American Medical Association as the legitimate physician organization representing the cause of health care justice.

From Karen Palmer, who is currently on a sabbatical at the World Health Organization in Switzerland, commenting on the findings of The Lewin Group in the California Health Care Options Project:

I was skimming through a textbook written by two of my colleagues here at WHO, and I came across this quote, which so supports the findings of the Lewin group. Maybe folks are starting to get the picture, which is so well-known in the rest of the world that it is part of a standard college level text book on public health:

“The United States of America epitomises the problems wealthy countries experience when public health is neglected. The major dilemma facing public health in the United States continues to be its relationship with the organisation and delivery of medical care services. Until a national and equitable system of medical care is achieved, public health will be neglected and receive an inadequate share of the vast resources devoted to “health” in the United States. The tremendous amount spent on medical care limits the availability of funds for a whole range of public services, not just public health.”

Citation: “Public Health at the Crossroads: achievements and prospects” by Robert Beaglehole and Ruth Bonita, Cambridge University Press 1997.

Billions for the NHS

BBC News
April 17, 2002

Spending on the NHS in England will top £100 billion in five years time, Chancellor Gordon Brown has announced.

Mr. Brown has accepted the recommendations of the Wanless Report into the future needs of the health service.

Earlier, a report by former NatWest chief executive Derek Wanless had called for NHS spending to more than double by 2022.

Mr. Wanless said spending on the NHS should rise to £184 billion a year from £68 billion a year now.

His report said the health service had been underfunded by £200 billion over the last 30 years. He called for an initial five year period of high growth to catch up, followed by a lower level of sustained investment.

In his Budget speech, the Chancellor said spending would increase by an average of 7.4% in real terms for each of the next five years – in part funded by a 1% increase in national insurance contributions.

The projections in the report show the UK spending between 10.6% and 12.5% of GDP on health care by 2022. This compares with 7.7% today.

Mr. Brown dismissed calls for alternative funding methods for the health service. General taxation was the equitable option, he said.

Chancellor Gordon Brown:

“We now have the best chance in a generation to secure our national health service, not just for a year or two, but for the long term. The NHS is a British ideal, free at the point of need for everyone in every part of Britain.”

http://news.bbc.co.uk/hi/english/health/newsid_1935000/1935730.stm

Comment: It looks like the opponents of universal health care in the United States won’t have the British NHS to kick around anymore.

Health Care Costs C-SPAN Washington Journal

April 22, 2002

Steve Scully interviewing Dr. Henry Simmons, President, National Coalition on Health Care:

Steve Scully: An e-mail form Don McCanne, who is a medical doctor and president of an organization called Physicians for a National Health Program: “Isn’t it time to include the single payer model in the debates on reform?”

Dr. Henry Simmons: Oh, I think it’s time to discuss a fair number of propositions. In fact, in Roll Call today, Morton Kondracke, the editor, made exactly that point. There are not a whole lot of different options available to this country to deal with this problem. There are some, and we’ve got to examine them all and see which one makes sense for us given the circumstance we find ourselves in now.

http://www.c-span.org/journal/

Roll Call April 22, 2002 Partial Fixes Won’t Solve Crisis In Health Care Costs By Morton M. Kondracke

Surging health costs and insurance premiums – and increases in the number of uninsured Americans sure to follow – cry out for Washington politicians to begin thinking comprehensively about America’s impending health care crisis.

One of these days, they will – ideally, as part of the 2004 election campaign. But for now, they are taking only piecemeal whacks at the problem.

Sometimes incrementalism in Washington produces good results, such as creation of the State Children’s Health Insurance Program that widened Medicaid benefits for lower-income families.

But often it simply results in efforts by one group in the health care industry – say, doctors or hospitals – to get the upper hand over another, such as pharmaceutical or insurance companies.

(Kondracke discusses competing interests and then the CalPERS premium increases.)

Even CalPERS, which theoretically has huge bargaining power with health insurers and providers, has been unable to hold down costs. Most employers lack that power.

So CalPERS has joined the National Coalition on Health Care in urging a new comprehensive look at the health crisis – the first since the ill-fated 1993 Clinton health care plan. The group comprises business, labor, consumer and religious groups, and large-state pension plans.

President Henry Simmons says the group has no plan of its own, but that debate should start over three basic models. One is “play or pay,” in which employers continue to provide most insurance coverage and would receive government help if they can’t do so.

A second, favored by liberals during the 1993 debate, is a single-payer system in which all citizens would get their health insurance from Medicare or another government program.

The third, proposed by some Republicans, would impose an individual requirement on all citizens to have health insurance and offer government subsidies to those who can’t afford it.

Democratic presidential contenders need to be heard on this issue soon, and they should pressure President Bush to be heard, too.

http://www.rollcall.com/pages/columns/kondracke/

National Coalition on Health Care: http://www.nchc.org/ (If you have not yet read Joel Miller’s “A Perfect Storm,” you must. It is available on the NCHC website.)

Blame Me if Health Plans Fail, Blair Says

The New York Times
April 21, 2002

By Reuters

Britain’s Prime Minister Tony Blair said Sunday his government’s mission to overhaul public health care was a huge challenge and he would take the blame if it failed.

Opinion polls published Sunday suggested most Britons were ready to pay more for better health treatment.

But they also revealed a widespread belief that Blair had broken an election pledge not to raise income tax…

…Chancellor Gordon Brown hiked taxes last week to pump billions of extra pounds into the ailing National Health Service (NHS).

Wednesday, Brown outlined plans to pour an extra 40 billion pounds ($58 billion) into public health care over the next five years. Most of the money will come from taxes, with a one percentage rise in National Insurance — a payroll tax — right up the salary scale being the biggest revenue earner.

Blair has refused to rule out further tax rises but said the changes to the health services were covered by Brown’s steps on Wednesday. He dismissed as “nonsense” accusations that his Labor government was returning to a “tax and spend” policy.

http://www.nytimes.com/reuters/world/international-britain-blair.html

Comment: Innumerable models have demonstrated that public funding and public administration can deliver more health services to more people for less money. But public funding has been a major weakness of the existing programs.

In the United States, our system of combining both public and private funding has resulted in the most generous health care funding of all nations, estimated to be 14.7% of our GDP for 2002 (Office of the Actuary of CMS). But we have seen that other nations that have relied on public funding have failed to provide enough resources to assure capacity that would prevent excessive queues for services. The British system has been frozen at 7% of their GDP, primarily because of political resistance to taxes. Apparently the administration of Prime Minister Blair has finally decided to confront the real issue. The National Health Service simply needs more tax revenue.

The lesson for the United States is that we must counter political efforts to isolate the concepts of “taxes” and “government” as if they were topics unrelated to our social needs and desires. Leaving half of our health care system under private funding in the private sector has resulted in the worst inequities in health care of all industrialized nations.

Most Americans do believe that we need greater equities in both access and coverage. The private sector has proven that these goals cannot be achieved without including taxes and the government in the comprehensive design of the system. Whereas other nations are facing the issue of needing more funding, we have already made the decision to devote the resources needed that would fund comprehensive care for everyone.

Let’s now define the proper role of government and taxes in a system that actually would provide the universal access and coverage for which we are already paying. Even the political opponents admit that a single payer system would do this. Why do you think they are excluding us from the forums on reform? Simply because the logic of our message is so clear that our voice must be stifled. Thus, the deceptive “tax and spend” rhetoric is being used to dismiss us in our absence.

Let’s end these deceptions by adopting more accurate rhetoric such as, “Comprehensive health care for everyone: We’re paying for it! Let’s have it!”

And then let’s carry that message to the nation.

Health Care Options Project Symposium

California State Capitol
Sacramento, CA April 12, 2002

John Sheils, Vice President of The Lewin Group, in his concluding remarks on the micro-simulation of the nine health care reform proposals:

“This next table (Change in Total Health Spending under Coverage Expansion Plans) is kind of interesting. It summarizes the impact of these plans on total health spending in the state. Now this is total health spending for everybody, regardless of who’s writing the check, regardless of who’s paying. This is the total amount spent for health care, including administration. We expect it to be $151.8 billion (for California) in the year 2002, this year.

“Under all of the plans here, there is an increase in costs, reflecting the fact that you’d have more insured people using more health services, and that represents some increase in costs. But, interestingly, under the single payer program, we show that there is a net reduction in spending. We actually spend less, in the aggregate, on health care. The reason for this is that there are very large administrative savings that are realized through using a simple, single program to pay for health care. There are also some bulk purchasing savings which we believe could be quite substantial.

“Now, one of the major claims of the single payer advocates for a long time has been that we could cover more people, for more services, for less money. Our study is showing that, for these very carefully designed plans, that’s true. To the best of our ability to estimate it, that’s true. So I think that’s an important finding.

“I don’t want to sound like I’m favoring one program over another at all, of course, because ‘all of our children are above average.'”

http://www.healthcareoptions.ca.gov/

CalPERS to increase '03 health care rates

San Francisco Chronicle
April 18, 2002

By Victoria Colliver

Marking an unprecedented increase in health care costs, the board of the California Public Employees’ Retirement System said that its HMO premiums for 2003 will have to increase by an average 25.1 percent and that it will dump its PacifiCare and Health Net plans.

CalPERS officials mentioned several strategies to save money in 2003. They included what’s known as “single-risk pool,” a self-funded model that would put all employees in one pool and require everyone to pay the same amount for similar services.

Peter Lee, President and CEO of the Pacific Business Group on Health, a statewide purchasing coalition for major employers, saying that change needs to come from the state and federal government:

“This is a signal health care has to be at the top of legislative policy agenda.”

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2002/04/18/BU16464.DTL

And from David Broder’s column in the April 17 edition of The Washington Post:

Dr. Henry Simmons, President of the National Coalition on Health Care (of which CalPERS is a member):

“The message is that the problem is far more serious than anybody in the political process is acknowledging. The incremental strategy is bankrupt. We need a big debate on how to get a grip on this system.”

http://www.washingtonpost.com/wp-dyn/articles/A63337-2002Apr17.html

Comment: The largest (next to the federal government) and most effective purchaser of health plans is on its knees, paying a 25% percent premium increase!

And now the president of the Pacific Group on Health, representing major employers, states that change needs to come from the state and federal government. And the president of a bipartisan coalition on health care states that the incremental strategy is bankrupt.

And the Los Angeles Times, in an editorial on April 16, states that the California Health Care Options Project “tells us there is a way to expand health coverage,” including three (of nine proposals) “that would provide universal coverage under a single payer system.”

Is there a message here?

CalPERS to increase ’03 health care rates

San Francisco Chronicle
April 18, 2002

By Victoria Colliver

Marking an unprecedented increase in health care costs, the board of the California Public Employees’ Retirement System said that its HMO premiums for 2003 will have to increase by an average 25.1 percent and that it will dump its PacifiCare and Health Net plans.

CalPERS officials mentioned several strategies to save money in 2003. They included what’s known as “single-risk pool,” a self-funded model that would put all employees in one pool and require everyone to pay the same amount for similar services.

Peter Lee, President and CEO of the Pacific Business Group on Health, a statewide purchasing coalition for major employers, saying that change needs to come from the state and federal government:

“This is a signal health care has to be at the top of legislative policy agenda.”

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2002/04/18/BU16464.DTL

And from David Broder’s column in the April 17 edition of The Washington Post:

Dr. Henry Simmons, President of the National Coalition on Health Care (of which CalPERS is a member):

“The message is that the problem is far more serious than anybody in the political process is acknowledging. The incremental strategy is bankrupt. We need a big debate on how to get a grip on this system.”

http://www.washingtonpost.com/wp-dyn/articles/A63337-2002Apr17.html

Comment: The largest (next to the federal government) and most effective purchaser of health plans is on its knees, paying a 25% percent premium increase!

And now the president of the Pacific Group on Health, representing major employers, states that change needs to come from the state and federal government. And the president of a bipartisan coalition on health care states that the incremental strategy is bankrupt.

And the Los Angeles Times, in an editorial on April 16, states that the California Health Care Options Project “tells us there is a way to expand health coverage,” including three (of nine proposals) “that would provide universal coverage under a single payer system.”

Is there a message here?

Consumer Reports

Consumer Reports
May 2002

“Card programs often work like this: The company negotiates discounts and buys provider lists from preferred provider organizations (PPOs); the company generally does not contract with service providers. Some cardholders have reported that doctors, hospitals and pharmacies said they didn’t know about the discount programs and wouldn’t honor the cards.”

Comment: The advertising for these programs is designed to make them appear to be very low cost insurance plans, but of course they are not. The ads are deceptive enough such that many will purchase these cards in the belief that they are a low cost substitute for insurance.

Examples: http://www.aquent.com/financial/medical_savings_card.html
http://www.careentree.com/
http://www.insurancequotes4u.com/discount-medical.html
http://www.addhealth.com/index.html
http://www.firstchoiceinvestors.com/health.html
http://www.ameriplanusa.com/about.asp

And the response of the AOL legal department: http://legal.web.aol.com/decisions/dljunk/national.html

And even Tommy Thompson and Tom Scully are being sued as potential perpetrators of this type of deception: http://www.heartland.org/health/aug01/pharmacy.htm

The Kentucky Department of Insurance has issued an informative consumer alert on health discount plans: http://www.doi.state.ky.us/Kentucky/Documents/consumer/consalertv3.pdf

This worthless industry will be discarded on the same trash heap as the private health plans once we establish a single payer system. What are we waiting for?

Beth Capell, Ph.D., on behalf of Health Access California, responds on health discount cards:

Major legislation is pending in this area in California. Both Consumers Union and Health Access California are involved.

The point you make is the one Health Access California has always made in opposing the creation of such plans: that some employers and workers will be confused and regard these dubious discounts as a substitute for health insurance.

And the discounts are dubious: since no one knows what the price of anything is in health care, how can a “real” discount be determined? No one has found an answer to this conundrum.

However, since seniors rely so heavily on these discount programs as a substitute for Medicare prescription drug coverage, they are unlikely to be banned outright.

Comment: One more reason to enact Medicare prescription drug coverage, or, better yet, a comprehensive, universal single payer system.

Snowshoe Documentary Films

Rudolph Mueller, M.D., author of “As Sick As It Gets”:

“… and, then, the other thing we do in this nation is we blame it on the individual. If someone dies prematurely, it’s their fault. If they have a bad outcome, it’s their fault. If they have a job that doesn’t provide insurance, it’s their fault that they didn’t get a well paying job that had insurance. If they come in and their diabetes is uncontrolled, they didn’t take their medicines, it’s their fault they didn’t take their medicines. No, it’s more… They don’t have insurance. They don’t have prescription coverage. They can’t afford their medicines. Their employer doesn’t provide health insurance because they need to be profitable.”

Dr. Mueller critiques the U.S. health care system in this 11 minute video that can be downloaded at: http://www.snowshoefilms.com/

Olin Frederick, Inc., the publisher of “As Sick As It Gets”: http://www.olinfrederick.com/

Emanuel Gale, Emeritus Professor of Social Work and Gerontology

Callifornia State University, Sacramento, on the California Health Care Options Project (HCOP):

I attended the final HCOP meeting yesterday.

It is clear from the Lewin analyses that the single payer proposals meet the goals of universality and cost-savings. In fact – the conclusions are that everyone in California can be covered for less than the projected $151b in 2002.

The major challenges are to:

– Consolidate the three single payer proposals into one

– Organize the broadest coalition of organizations and individuals to inform and educate the population to support single payer

– Build the community-based, political structure, to legislate and implement the program

The recent reports of the collapsing “sick illness” system, and the HCOP assessment, provides the opportunity to confront the need for dramatic change.

Can California trigger a national trend for health care reform?

San Francisco Chronicle
April 11, 2002
By Spyros Andreopoulos, Director Emeritus of the Office of Public Affairs at Stanford University Medical Center

(On April 12), California will unveil options calling for a major overhaul on health-care financing. The proposed alternatives include expanding health insurance coverage through modifications in existing programs and three proposals calling for a transition to a single-payer system.

Single payer, which is receiving considerable attention, would replace private insurance and HMOs with a publicly financed, privately delivered system covering 31 million Californians with comprehensive benefits, and would be administered by the state.

Although the three proposals differ in details, generally a single-payer system would offer a health-insurance package modeled on benefits now provided by employers. And it would be financed with new employer payroll taxes and health-care funding from the federal insurance programs of Medicare and MediCal, which would be combined with the new financing system.

Proponents believe single-payer can adequately cover all of the state’s residents, including the 6.8 million uninsured, and provide more care for the money through reductions in administrative costs and other efficiencies.

The proposals culminate a two-year study by the Health Care Options Project (HCOP), created by the passage of SB480, signed into law by Gov. Gray Davis in 1999.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2002/04/11/ED24365.DTL

Comment: The final versions of the nine proposals for the California Health Care Options Project have been posted: http://www.healthcareoptions.ca.gov/

The final report of the analysis by The Lewin Group had not been posted by this morning (April 12), but the results will be presented this afternoon in Sacramento, and posted soon.

The forum will be broadcast on The California Channel from 1:00 to 3:30 PM, Pacific Daylight Time, April 12. Also it can be viewed live on the Internet at: http://www.calchannel.com In a few days it will be available in the archives for viewing at: http://www.calchannel.com/april2002.htm In addition, a videotape can be purchased from the Assembly TV office for $10.00 by calling 916-319-2813.

The Lewin Group analysis will show that the two single payer proposals and the health service model would each fulfill the goals of providing full comprehensive services to absolutely everyone while saving Californians billions of dollars in health care costs. The other six proposals that build on our current system would fall short on equity, universality and comprehensiveness, and would increase health care costs for Californians. One of those six models does come close to universality and comprehensiveness, though it leaves in place many flawed policies of our current system that impair equity. Also, this latter model is the most expensive of the proposals, increasing health care costs for Californians by billions of dollars.

Although this study was done for California, it should have national impact. It establishes forevermore the credibility of the single payer and health service models. Efforts to exclude single payer models from any and all discussions or forums on reform should be exposed as the nefarious, immoral, unethical acts that they are. The credibility and superiority of the single payer model is firmly established. It is now our responsibility to see that we are included in all future activities on reform, even if uninvited. It is time for ubiquitous, aggressive (but genteel) activism.