Resource – Page 1175

Theodore Marmor comments on Malaysia and Canada

Don, We have a lot to learn from Malaysian doctors. I hope this gets into a letter to the editor of The NY Times or The Post or somewhere.

Also, I might add that the discussion of health finance and the principles of distribution would be advanced if more American policy makers read through the Kirby and Romanow Reports on Canada’s Medicare. Both review what Medicare is meant to do, where strain has arisen, and why neither wanted to change the fundamental structure. They were meant to disagree some, but in the end the similarities are striking. And the premises are worth bringing into the US discussion directly.

Ted Marmor

Comment: Professor Marmor is right. Start writing those letters and opinion
articles now, and contact your legislative representatives ASAP.

Romanow Report:
http://www.healthcarecommission.ca/

Kirby Report:
http://www.parl.gc.ca/37/2/parlbus/commbus/senate/com-e/soci-e/rep-e/repoct02vol6-e.htm

Malaysian Medical Association support of universal government insurance:
http://www.emedia.com.my/Current_News/NST/Monday/National/20021223073302/Article/

Single payer proposed for Malaysia

New Straits Times
December 22, 2002
MMA seeks health cover for all
By Pritam Singh

Kuantan, Dec 22: The Malaysian Medical Association (MMA) has proposed to the Government the setting up of a national health financing scheme that will provide coverage for all citizens.

MMA president Datuk Dr N. Athimulam said under the proposal, already presented to Prime Minister Datuk Seri Dr Mahathir Mohamad, the young would subsidise the old, and the rich would subsidise the poor.

“The MMA feels any insurance scheme should be owned and run by the Government, and operated as a non-profit entity,” said Dr Athimulam at the 20th annual installation dinner of the MMA’s Pahang branch here last night.

Dr. Athimulam said insurance schemes run by private companies were profit-oriented and were only willing to insure the healthy.

“The private sector should not compete with the scheme, but complement it, and the Government should be the single payer of medical expenses.”

http://www.emedia.com.my/Current_News/NST/Monday/National/20021223073302/Article/

Comment: If only the leadership in the United States would abandon their third world” approaches to health care and follow Malaysia’s lead in advocating for a civilized health care system.

California HCOP – more than just another study

The Modesto Bee
December 22, 2002
Bridging insured-uninsured gap becomes fiery health care battle
By Jim Sanders

(California State Senators Sheila Kuehl and Jackie Speier) each are preparing legislation for universal health care, but their approaches differ significantly in style, financing and scope.

Kuehl is pushing for a complete overhaul – a “single payer” system – in which the state would replace insurance companies in collecting monies, contracting for medical services, and paying doctors and hospitals for services rendered.

Kuehl contends that the program would not cost more than is now spent statewide for health care. Conceptually, the program would rely on various taxes, not insurance premiums. Expansion could be supported partly from savings in administrative costs and through bulk purchasing, she said.

Doctors would have wide latitude to determine appropriate care under Kuehl’s proposal. The managed-care system would be replaced by one that relies on medical experts, under the auspices of an elected state health commissioner.

By contrast, Speier wants to build on the existing system, leaving private insurance in place but filling the gaps.

Speier proposes a “play-or-pay” system, Senate Bill 2, that would require employers to provide medical benefits or pay taxes toward creation of a publicly subsidized plan, Healthy California, to provide basic benefits to those lacking insurance.

The California Labor Federation also is developing a “play-or-pay” proposal that would reduce the ranks of the medically uninsured while retaining health care as a central element of collective bargaining.

Sen. Sheila Kuehl:

“Where we used to talk about whether we should attempt universal health care, the argument seems to have shifted to how we can accomplish it.”

http://www.modbee.com/local/story/5679831p-6653530c.html

Comment: Fortunately, the California Health Care Options Project was not just one more study of reform to be filed away, having no more impact than a footnote in future treatises on failed efforts at reform. The findings of the study are now being translated into legislation that actually offers real hope of reform.

Most of the major hurdles are still ahead, but at least we’ve broken from the starting gate. Let’s begin with the assumption that we will have universal health care, and let’s direct our efforts to identifying and adopting policies that are in the best interests of patients. That way, we’ll all be winners.

California Health Care Options Project:
http://www.healthcareoptions.ca.gov/

Dan Hodges dissents from Morone's proposal

I’m glad to see James A. Morone’s proposal has put single payer back in the national debate.

As you say, a value added tax and an employer option for supplementary insurance, could be considered “details” that might divert attention of “some single payer advocates.” However, I believe that every single payer advocate should find the provision of “automatic coverage for all legal residents of every age” a deal breaker.

Those of us who are single payer advocates in California will remember the very bad repercussions in 1994 (and into the following years) because Prop. 186 didn’t provide coverage to the undocumented.

We know from studies that the savings single payer achieves can fund high quality health care for all. Drawing on the findings for the single payer proposals in the state’s Health Care Options Project, for example, Senator Sheila Kuehl is committed to a single payer bill that will provide coverage to all California residents.

I hope in the future you can use the message of the day to raise a discussion about real universal coverage with single payer versus the kind proposed by Mornoe.

Dan Hodges

Dan Hodges dissents from Morone’s proposal

I’m glad to see James A. Morone’s proposal has put single payer back in the national debate.

I hope in the future you can use the message of the day to raise a discussion about real universal coverage with single payer versus the kind proposed by Mornoe.

Dan Hodges

Erosion of the social contract

Health Affairs
November/December 2002
How And Why The Health Insurance System Will Collapse
By Humphrey Taylor, Chairman of the Harris Poll

Abstract

The advocates of defined-contribution health plans extol the virtues of consumer-driven health care, consumer choice, and empowered consumers as solutions to the problems–particularly the rapidly growing costs–of employer-sponsored health benefits. This paper argues that the widespread use of defined contribution plans, with more consumer choice and more knowledgeable consumers, will lead to the erosion of the social contract on which health insurance must be based, with healthier employees subsidizing the care of older and sicker ones, and a death spiral of adverse selection. If unchecked by government intervention, these trends will lead to the collapse of employer-sponsored health insurance.

http://www.healthaffairs.org/1130_abstract_c.php?ID=http://www.healthaffairs.org/Library/v21n6/s28.pdf

Sen. Bill Frist and Medicare

Comment on Sen. Bill Frist and Medicare:

In the recent election, Sen. Frist counseled the Republican candidates to support prescription coverage for senior citizens but without providing any of the specifics of their proposal. The Republicans will now have to deliver on that promise even if their proposal will be inadequately funded, and will primarily benefit pharmacy benefit managers, private insurers and pharmaceutical firms, while providing little benefit for patients.

Most agree that give-back legislation will be important to prevent the exodus of providers from the Medicare program. But the Republican insistence on budget-neutral adjustments does not bode well for maintaining the fiscal integrity of the Medicare program. This is more bad news for Medicare patients.

Sen. Frist strongly supports Medicare privatization through the Breaux-Thomas-Frist premium support proposal. Regardless of their “marketplace competition” rhetoric, the real purpose of shifting from the public program to private plans is to reduce public costs by allowing “more affordable” private plans that shift more costs to patients, while simultaneously supporting the private, middleman health plan industry.

Republicans will continue to block prescription coverage through the traditional Medicare program, authorizing only a separate benefit by private insurers. By doing so, Medicare beneficiaries will be incentivized to exit the public program and enroll in private plans.

If these issues are addressed individually, the Democrats can muster enough support by exposing the nefarious policies behind each issue. It is much more likely that Sen. Frist will orchestrate a plan to present an omnibus bill that “provides prescription coverage, controls Medicare costs by modernizing the program, and assures the viability of providers by reducing some of the scheduled cuts in funding.” Superficially, the package may have broad appeal and gain the support of conservative Democrats that barely survived the last election. These Senators would have little to lose and some to gain by supporting a package that may look good to voters and that really doesn’t cost much at a time when more tax cuts are on the agenda.

Sen. Frist, by “saving Medicare,” will further his personal ambition to assume the number two spot on the 2004 ticket as a step toward the number one spot in 2008.

Although enacting comprehensive reform will be impossible in the next two
years, it will be imperative that we make every effort to:

(1) Protect Medicare as a program of social insurance by opposing privatization efforts,
(2) Fight for a prescription benefit that is incorporated into Medicare’s program of social insurance, and
(3) Assure that adequate give-back provisions are passed that do not parasitize some sectors of Medicare providers for the benefit of others.

Please accept my apologies for this blatantly partisan commentary. But only the Republicans have it in their power to save Medicare through a bipartisan effort that supports the Democratic positions on these issues.

Don McCanne

Single payer, Medicare for All option added to ESRI proposals

Economic and Social Research Institute
November 2002
Covering America: Real Remedies for the Uninsured
Volume II

Medicare for All

James A. Morone has proposed a single-payer approach to provide universal coverage with the following elements:

* The Medicare program with expanded benefits, including no cost sharing, would provide automatic coverage for all legal residents of every age.
* Funding would come solely from revenues raised by a new federal value-added tax.
* States could opt out (for residents under age 65) by proposing a program that meets federal guidelines and by paying 25 percent of the cost.
* Employers could offer coverage for additional benefits, with the employer-paid premium not subject to income tax.

http://www.esresearch.org/newsletter/booktwo/CovAm2.htm

Comment: Three new proposals for comprehensive health care reform have been added to the ten proposals presented last year by the Economic and Social Research Institute. Of great significance is the fact that this single payer, Medicare for All proposal has helped to place this concept back into the national debate over the various options for reform. This is another crucial breakthrough since the single payer option has often been explicitly excluded from the forums on reform (as it was in the ESRI report last year).

Some single payer advocates might be concerned about a few of the features of Professor Morone’s proposal, such as the value added tax (VAT) and an employer option for supplementary insurance. He ameliorates, to some degree, the regressive nature of the VAT by exempting food, medicine and shelter, and by expanding the earned income credit to families with incomes up to $45,000. Also he limits the employer supplement to extra benefits such as hospital amenities.

But rather than diverting attention to various details of his proposal, we should direct our efforts to being certain that the fundamental single payer message is included in all forums, discussions and deliberations. America can only benefit by making health care reform a fully informed process.

Doctor cites support for changing system

By D.R. Bahlman
Berkshire Eagle Staff
Monday, December 16, 2002

PITTSFIELD — Support for a single-payer health care insurance system appears to be gaining among health care providers in Berkshire County, according to a survey conducted by a Great Barrington physician.

Dr. David Lippman said that, of those who responded to his survey of all practicing physicians in the county, 86 percent stated that they might favor a single-payer system. The survey was sent to members of the Berkshire District Medical Society; he could not provide exact figures about the numbers of surveys sent out or returned. He noted that many of the county’s health care providers were not surveyed because they are not on the rolls of the medical society, which has about 200 members. He also said that a wide range of opinions were expressed.

“Some said they wanted the government out of it entirely,” he said.

Lippman and other members of MassCare, a statewide organization that advocates for a single-payer “universal” health care system, note that Massachusetts residents pay the highest health care costs in the nation — 30 percent above the national average per person, according to a 2000 study by two Boston University researchers — and that a single-payer system would reduce those costs substantially.

“The whole state will pay less for health care under a system that will cover every single person in the state,” said Jean Dillard of Lenox, a nurse who is a member of MassCare. “If such a system had been instituted in 2000, the state would have saved approximately $1.2 billion in that year alone.”

Citing the BU study, Dillard declared that “the biggest things we’re paying for now are administrative costs and the million-dollar salaries of CEOs of insurance companies and pharmaceutical companies.”

Under a single-payer system, said Dillard, “you could forget those costs, forget the costs of advertising that those companies and some hospitals and some doctors do, forget about costs of the bodily injury coverage in auto and homeowners’ insurance policies and the bodily injury portion of Workers’ Compensation.”

Citing statistics indicating that between 400,000 and 600,000 Massachusetts residents are currently without health insurance coverage, Dillard acknowledged that there would be a cost associated with entitling them to such coverage, “but they all won’t be sick at once.”

A “two-tier” system that combines state-funded universal health care with private health care-cost indemnity coverage wouldn’t work, said Dillard.

“The ‘healthy-wealthy’ will have the private coverage and that will leave all the expenses for the sick and poor,” she said. “The state has got to be the insurer.”

Lippman said that the benefits of a single-payer system also include uniformity of fees for service.

“It’s embarrassing that [universal access to government-funded health care] isn’t available in the world’s wealthiest nation. There’s something about medicine and something about money that’s like oil and water: They don’t mix,” he said.

Care of chronic conditions requires systemic reform

Partnership for Solutions
A Project of Johns Hopkins University
and The Robert Wood Johnson Foundation
“Chronic Conditions: Making the Case for Ongoing Care”
December 2002

In the coming years, our health care system will devote increasing amounts of resources-both services and dollars-to care for people with chronic conditions. As a society, we need to ensure that these resources are spent as effectively and wisely as possible to maintain the health and enhance the individual functioning of this large segment of our population.

Care provided in the current system is not cost-effective and often leads to poor outcomes for patients with chronic conditions.

Providers, patients, and the public recognize that adjustments within the health care system are needed to improve chronic care in this country. In order to make these adjustments, health policymakers will need to reexamine how our current health care financing system values and pays for care received by people with chronic conditions, how we train health care providers to treat chronic conditions, and how the needs of people with chronic conditions are met.

http://www.partnershipforsolutions.com/

Comment:

From the Introduction:

This chartbook outlines the challenges the health care system continues to face in using its resources efficiently and effectively to provide access to high-quality, coordinated care and appropriate services that maintain health and functioning for people with chronic conditions.

40% of Large Firms Will Offer Consumer-Driven Plans in 2004

American Medical News
Dec. 23/30, 2002
More big firms want Web-based health plans
By Tyler Chin

Based on a survey of 25 large companies with more than 1,000 employees each, 16% of large employers will offer Web-based health plans to employees in 2003. This is up from 4% in 2002, according to estimates by the Cambridge, Mass.-based consulting firm. That number will rise to 40% in 2004, the firm said.

Large employers are interested in offering Web-based plans because they are looking for ways to lower health care costs, said Bradford J. Holmes, the firm’s research director.

Web-based plans let patients contribute a certain amount toward their health care costs and control how they spend money in their personal health care spending accounts

http://www.ama-assn.org/sci-pubs/amnews/pick_02/bisb1223.htm

Comment: Consumer-driven health care is here. Are we ready to accept the consequences of shifting costs to those with the greatest health care needs?

Health care is big profit business

By MARTIN DYCKMAN, Times Associate Editor

TALLAHASSEE — One of the perils of being a public official is to mingle with and take favors from people he will have reason to wish he had never met. (Remember the Keating Five?). Most recently, it happened to Gov. Jeb Bush.

He took a pasting in the press over private jet trips and campaign contributions provided by a company called National Century Financial Enterprises and its founder, Lance K. Poulsen. National Century was hit last month with a $3.5-billion fraud suit, filed for bankruptcy, and involuntarily welcomed swarms of FBI agents and accountants to its Ohio headquarters.

But the real story, universally overlooked, was bigger than the efforts of yet another questionable entepreneur to ingratiate himself with one of the Bushes. It had to do with the nature of the perfectly legal business that National Century was in.

That business was to finance doctors, hospitals, nursing homes and other health care providers while they waited — and waited, and waited — for money owed them by health insurance companies, HMOs, and Medicare and Medicaid.

Every dollar in profits was a charge against the nation’s overall health care bill. Not a penny of it made any sick person well.

There would be no place in an efficient or humanistic health care system for a practice like that.

It must be an awfully lucrative business, however, because there are other companies in the field.

They do it by buying accounts receivable at a discount and pocketing the difference when they finally collect the unpaid bills. It comes as no news that health insurance companies stall on paying out for as long as they think they can get away with it.

The business of buying accounts receivable is known as factoring. It is common in other lines of commerce.

But health care is not, or ought not to be, just another line of commerce. It’s a matter of life or death for everyone. It should more resemble a religion than a business.

Instead, health care has become the biggest of businesses. Overall, America will spend an estimated $1.5-trillion on health care this year. That’s more (often more than twice as much) by every measure — total, per capita, percentage of gross domestic product — than any other developed nation. Yet for more than 40-million Americans, those with no health insurance of any kind, the doors of this business are closed except on an emergency basis, when it is most costly and often too late.

A shocking amount of this money — $112-billion this year, according to government data — is written off to what it calls “government administration and net cost of private health insurance.” The private sector accounts for most of that.

Another significant statistic, according to the Organization for Economic Cooperation and Development, is that 27 of 28 other countries spend proportionately more of their total health costs out of public funds than we do. (The exception is South Korea). The OECD average: 74.1 percent. The United States: 46.4.

Many of the others are healthier, though whether it’s for better medical care or for eating less and walking more would be hard to say.

None squanders money the way we do in ways that make people richer but not healthier: on swollen profits for HMOs, hospital chains and the like.

Everywhere else, private health insurance is a small slice of the pie. Here, it’s nearly 35 percent. France, at 12.8 percent, and Germany, at 12.5, come next.

Speaking of France, the total bill for a routine visit to the doctor is $20, and the Securite Sociale refunds the patient most of that.

The United States could afford good health care for everybody with the money we would save by getting rid of the middlemen.

Sam Gibbons, the former congressman, had the right idea: Medicare for everyone.

Medicare has its faults, chiefly in the exclusion of pharmaceuticals and preventive care. It also pays less than the doctors and hospitals say they need. But it is not as slow to pay as the private insurers are. Unlike the private insurance companies, it has no profit motive for making the doctors wait for what they have earned. Its cost of administration is the lowest of all, and it could easily be expanded into a true single-payer health insurance system covering everyone.

This issue is coming to life again despite the calamitous defeat under the Clintons. Even Al Gore, reversing himself in barely two years, has come out for single-payer (“A death-defying act,” according to the Economist.)

But that single-payer has got to be the government, not the private health insurance industry. Otherwise there will always be money to be made not from making patients well, but by stiffing the people who do.

Footer