PNHP

Healthcare System Is Due for Transformation

Healthcare System Is Due for Transformation

By Margaret Heldring, PhD
President and CEO, America’s HealthTogether

At the top of the healthcare agenda for the 108th Congress could be the transformation of our present healthcare system. According to a recent issue of Health Affairs, nearly 60 percent of the national healthcare dollar is now financed through taxes-for such programs as Medicare, Medicaid, SCHIP, the Veterans Administration, tax-subsidies for workers, and public employee benefit plans. The new Congress will be working hard to reduce that percentage-by squeezing program revenues, cutting benefits, and forcing individuals to pay for more of their own healthcare expenses.

At America’s HealthTogether/Coalition Health First, we believe that there’s a better way. All Americans deserve quality, affordable healthcare. Healthcare should be an essential service, such as public education and national security that we all can count on. There is one insurance program that includes everyone, regardless of income, race, ethnicity, gender, and health status. One program that is administered efficiently and is simple to understand and use. One program that guarantees choice of provider, and is rated highly by a large proportion of its members. That program is called Medicare for Americans aged 65 and older and millions of the disabled.

As more Americans are forced to drop their health insurance coverage because of higher premium costs or to pay more out-of-pocket for their current coverage, we predict that a new and improved Medicare program for all Americans may start sounding like a winning solution in 2004.

Dr. Margaret Heldring served as the Director of Health Policy for former Sentor Bill Bradley’s 2000 presidential campaign. She is a clinical psychologist with more than 30 years experience in health care.

America’s HealthTogether is a public policy organization devoted to assuring affordable health care for all, unencumbered access to essential health care services, and a belief that mental health is fundamental to good health.

Gore favors 'single-payer' health plan

CNN/AP
Former vice president talks about 2000 race

WASHINGTON (AP) — Noting that 40 million Americans now have no health insurance, Al Gore says he now favors “single-payer” national health coverage, a proposal that would require a massive change in the health insurance system.

With single-payer coverage, money to pay for health care — such as insurance premiums and tax dollars — would be collected by a single agency, which would then pay for comprehensive coverage for all citizens.

Gore, the 2000 Democratic presidential nominee and a potential candidate in 2004, offered his views in response to a question at a synagogue in New York during a tour promoting his book “Joined at the Heart,” written with his wife, Tipper.

“I was planning to wait and make a major speech on this and I probably should, but I’ll just answer your question candidly,” Gore told the moderator.

Gore’s comments Wednesday night were first reported by ABC News’ Internet political report “The Note” and were confirmed by Gore spokesman Jano Cabrera, who said any details would come in a future speech on health care.

“I think we’ve reached a point where the entire health care system is in impending crisis,” Gore said. “I have reluctantly come to the conclusion that we should begin drafting a single-payer national health insurance plan.”

Depending on the details, calling for a single-payer plan could be a very dramatic step for Gore. During the 2000 primary campaign, Gore attacked Democratic rival Bill Bradley’s central proposal — universal health care — calling it too expensive and not expansive enough to help poor people afford full coverage.

Another potential Democratic candidate for president, Vermont Gov. Howard Dean, pushed for health care for all Americans in a speech Thursday night to an education group in Washington. He wants to expand coverage under Medicare and Medicaid to cover people who don’t have insurance.

Chastising Democrats for promoting limited goals, Dean said: “On health care, we argue about the patients’ bill of rights when we should be pushing for health care for all Americans. On economic development, we talk about tax reform, but then Democrats support tax cuts which do little to help middle-class families afford college tuition and decent health care, when we should be moving away from subsidizing corporate America, and completely revamping American economic development policy to help small businesses grow.”

Citing the Republicans’ strong election gains, Dean said: “Last week the American people sent the Democratic party a powerful message: It is no longer enough for us as Democrats to blur the distinctions between our party and the Republicans. We need to offer a clear choice, an agenda that is our own. It’s time for our party to once again stand for ideas that touch every American.”

Gore, meanwhile, spoke about his failed presidential race in an interview with Barbara Walters that will air Friday night. He talked about his decision not to call on former President Clinton to campaign for him in the 2000 campaign. Some advisers felt Clinton’s past sex scandals were a liability for Gore, while others in the party wanted Gore to take advantage of Clinton’s political skills and popularity with the party’s base voters.

“I felt that I had to sell myself,” Gore said. Asked whether he would call on Clinton in a future campaign, Gore said, “I might very well … because I think it would be a different situation.”

-=-=-=
Followup Letter to the Editor:
“Gore’s health plan idea”

Letter to the Editor, USA TODAY, 11/22/02

While sitting down for a bite of lunch recently, I read a newspaper report about Al Gore that was intriguing (“Gore wants feds to run health care for all,” News, Nov. 15).

While certainly not a Gore fan, I’m impressed with his idea to have all Americans covered for health insurance under a single-payer, government-sponsored plan.

As a middle-class, self-employed professional with a wife newly diagnosed with a lifelong disease, I face numerous challenges in the years to come.  The irony here is that shortly after lunch, I opened my mail to discover that my current health-insurance carrier is planning to increase premiums nearly 50% next year, along with doubling the co-pay and quadrupling the prescription co-pay.

You can imagine what happened to my lunch.

Bruce G. Levitta
Phoenix

Gore favors ‘single-payer’ health plan

CNN/AP
Former vice president talks about 2000 race

WASHINGTON (AP) — Noting that 40 million Americans now have no health insurance, Al Gore says he now favors “single-payer” national health coverage, a proposal that would require a massive change in the health insurance system.

With single-payer coverage, money to pay for health care — such as insurance premiums and tax dollars — would be collected by a single agency, which would then pay for comprehensive coverage for all citizens.

Gore, the 2000 Democratic presidential nominee and a potential candidate in 2004, offered his views in response to a question at a synagogue in New York during a tour promoting his book “Joined at the Heart,” written with his wife, Tipper.

“I was planning to wait and make a major speech on this and I probably should, but I’ll just answer your question candidly,” Gore told the moderator.

Gore’s comments Wednesday night were first reported by ABC News’ Internet political report “The Note” and were confirmed by Gore spokesman Jano Cabrera, who said any details would come in a future speech on health care.

“I think we’ve reached a point where the entire health care system is in impending crisis,” Gore said. “I have reluctantly come to the conclusion that we should begin drafting a single-payer national health insurance plan.”

Depending on the details, calling for a single-payer plan could be a very dramatic step for Gore. During the 2000 primary campaign, Gore attacked Democratic rival Bill Bradley’s central proposal — universal health care — calling it too expensive and not expansive enough to help poor people afford full coverage.

Another potential Democratic candidate for president, Vermont Gov. Howard Dean, pushed for health care for all Americans in a speech Thursday night to an education group in Washington. He wants to expand coverage under Medicare and Medicaid to cover people who don’t have insurance.

Chastising Democrats for promoting limited goals, Dean said: “On health care, we argue about the patients’ bill of rights when we should be pushing for health care for all Americans. On economic development, we talk about tax reform, but then Democrats support tax cuts which do little to help middle-class families afford college tuition and decent health care, when we should be moving away from subsidizing corporate America, and completely revamping American economic development policy to help small businesses grow.”

Citing the Republicans’ strong election gains, Dean said: “Last week the American people sent the Democratic party a powerful message: It is no longer enough for us as Democrats to blur the distinctions between our party and the Republicans. We need to offer a clear choice, an agenda that is our own. It’s time for our party to once again stand for ideas that touch every American.”

Gore, meanwhile, spoke about his failed presidential race in an interview with Barbara Walters that will air Friday night. He talked about his decision not to call on former President Clinton to campaign for him in the 2000 campaign. Some advisers felt Clinton’s past sex scandals were a liability for Gore, while others in the party wanted Gore to take advantage of Clinton’s political skills and popularity with the party’s base voters.

“I felt that I had to sell myself,” Gore said. Asked whether he would call on Clinton in a future campaign, Gore said, “I might very well … because I think it would be a different situation.”

-=-=-=
Followup Letter to the Editor:
“Gore’s health plan idea”

Letter to the Editor, USA TODAY, 11/22/02

While sitting down for a bite of lunch recently, I read a newspaper report about Al Gore that was intriguing (“Gore wants feds to run health care for all,” News, Nov. 15).

While certainly not a Gore fan, I’m impressed with his idea to have all Americans covered for health insurance under a single-payer, government-sponsored plan.

As a middle-class, self-employed professional with a wife newly diagnosed with a lifelong disease, I face numerous challenges in the years to come.  The irony here is that shortly after lunch, I opened my mail to discover that my current health-insurance carrier is planning to increase premiums nearly 50% next year, along with doubling the co-pay and quadrupling the prescription co-pay.

You can imagine what happened to my lunch.

Bruce G. Levitta
Phoenix

Romanow on "private" solutions

The Canadian Club of Winnipeg
November 20, 2002
Speech: Creating a National Health Care System for Canadians
Roy Romanow, Commissioner
Commission on the Future of Health Care in Canada

Friends, early in my mandate, I challenged those advocating radical
“private” solutions for reforming health care– user-fees, medical savings
accounts, de-listing services, greater privatisation, a parallel private
system — to come forward with evidence that these approaches would improve
and strengthen our health care system.

The evidence has not been forthcoming.

I have also carefully explored the experiences of other jurisdictions with
co-payment models and with public-private partnerships, and have found these
lacking.

There is no evidence these solutions will deliver better or cheaper care, or
improve access (except, perhaps, for those who can afford to pay for care
out of their own pockets). More to the point, the principles on which these
solutions rest cannot be reconciled with the values at the heart of medicare
or with the tenets of the Canada Health Act that Canadians overwhelmingly
support.

It would be irresponsible of me to jeopardize what has been, and can remain,
a world-class health care system and a proud national symbol, by accepting
anecdote as fact, or on the dubious basis of “making a leap of faith”.

Tossing overboard the principles and values that govern our health care
system would be betraying a public trust. Canadians will not accept this,
and without their consent, these so-called “new” solutions are doomed to
fail. Canadians want their health care system renovated; they don’t want it
demolished.

Some have described it as a perversion of Canadian values that they cannot
use their money to purchase faster treatment from a private provider for
their loved ones. I believe it is a far greater perversion of Canadian
values to accept a system where money rather than need, determines who gets
access to care.

My final report will address this issue in very direct terms, and in a way
that is consistent with what Canadians want and expect from their health
care system.

http://www.healthcarecommission.ca/default.asp?DN=cn=1380,cn=17,cn=3,cn=2,ou=Stories,ou=Suite247,o=HCC

Study urges single-payer health system

The Providence Journal
http://www.projo.com/health/content/projo_20021121_ccjstudy.5bf90.html

Administrative costs alone could be cut in half from their current $1.47 billion by establishing one source of financing, says the report by the Health Reform Program at the Boston University School of Public Health.

11/21/2002

BY FELICE J. FREYER
Journal Medical Writer

PROVIDENCE — Rhode Island’s expensive health-care system has enough money to provide for everyone’s needs — from the elderly who cannot afford medications to the low-paid worker who can’t afford dental care — according to a study released yesterday.

But redistributing the system’s $7.2 billion to care for everyone will require a radical overhaul of financing, eliminating insurance companies and having all money flow to and from a central authority.

Such a “single payer” system, resembling those used in most Western countries, has been talked about for decades as a solution to U.S. health-care ills, but the political will for such vast changes in a long-entrenched system has never been mustered. This month, voters in Oregon overwhelmingly rejected a proposal to establish a taxpayer-financed single-payer system in that state.

The $10,000 study, by the Health Reform Program at the Boston University School of Public Health, was financed with a grant from the General Assembly and commissioned by the Coalition for Consumer Justice.

By coincidence, the study comes two days after Blue Cross & Blue Shield of Rhode Island released a $3-million report showing that Rhode Islanders are heavy users of health care and that the demand for nursing homes, hospitals and nurses will exceed supply by 2006.

And it comes a day after the National Academy of Sciences declared that the U.S. health-care system is in crisis and urged the Bush administration to allow a handful of states to test solutions, including universal coverage.

The Boston University study says that health-care spending in Rhode Island is the fourth highest in the nation, 21.5 percent above the U.S. average. Each year, more than $7,000 per person is spent on health care in this state.

“Isn’t that a staggering sum?” said the report’s chief author, Alan Sager, professor of health services at the Boston University School of Public Health. “It’s four times what we spend on defense.”

Despite all that spending, many people can’t get the care they need, the report asserts, including insured people who can’t afford dental care and elderly people who can’t find adequate home care.

Meanwhile, as much as 20 percent of the health-care dollar is spent on clerical tasks. Sager talked of a hospital administrator in Massachusetts who said he had to fire a nurse to hire two clerks to chase down overdue reimbursements from the various insurers and government agencies.

“We have three choices in health care,” Sager said. “We can suffer and die for lack of needed care. Or we can pay more year after year if we can somehow find the money. Or we can change the way we do things.”

The study estimates that it would cost an additional $1 billion to cover all the people who have no insurance or whose insurance doesn’t pay for all their needed care. But those additional costs can be more than offset by savings in a newly structured system.

Administrative costs could be cut in half from their current $1.47 billion by establishing one source of financing. That source could be the government, which would raise the money through taxes. Or it could be a separate central authority or trust fund. Everyone who now pays for health care — employers, individuals, the government — would funnel that money to this single entity, which would disburse payments to providers.

If there was one source of financing and all people were covered, providers would no longer need to hire staff to determine which patients are eligible for which services and to seek reimbursements from an array of private and governmental payers.

Additionally, the report says, cost savings could be realized if the state negotiated discounts on drugs for all its citizens and if doctors were charged with managing care responsibly. Sager proposes that doctors, as a group, be guaranteed 20 percent of health-care costs, with the understanding that they will direct the appropriate use of the remaining 80 percent, within a prescribed budget.

“These are not numbers we made up,” Sager said of the projected administrative savings. “This is the experience of countries where simplified financing exists and where doctors aren’t on the phone negotiating with managed care. If you speak with any doctor who’s not on salary, who runs a practice — the fury; you watch their blood pressure rise when they talk about this.”

Dr. Jeremiah Schuur, a resident physician in emergency medicine, said that doctors would be amenable to “health-care reform that puts the patient first.”

“The current system is swamping doctors in administrative hassle, preventing them from performing their duty of providing care to the sick,” Schuur said at a news conference held to release the report.

Christine C. Ferguson, the former state director of human services who attended the news conference as a representative of Governor-elect Donald Carcieri, said that the study’s findings about the current situation were correct, but that its proposed solution is unlikely to win a following.

“Are we in the middle of a serious problem? Yes, that is true,” she said. But adopting a single-payer plan? “Not in the foreseeable future,” Ferguson predicted. “People don’t inherently trust the government to do that.”

But Marti Rosenberg, of the Health Care Organizing Project, said that as costs keep rising and alternatives keep failing, people will be ready for fundamental change.

Romanow on “private” solutions

The Canadian Club of Winnipeg
November 20, 2002
Speech: Creating a National Health Care System for Canadians
Roy Romanow, Commissioner
Commission on the Future of Health Care in Canada

Friends, early in my mandate, I challenged those advocating radical
“private” solutions for reforming health care– user-fees, medical savings
accounts, de-listing services, greater privatisation, a parallel private
system — to come forward with evidence that these approaches would improve
and strengthen our health care system.

The evidence has not been forthcoming.

I have also carefully explored the experiences of other jurisdictions with
co-payment models and with public-private partnerships, and have found these
lacking.

There is no evidence these solutions will deliver better or cheaper care, or
improve access (except, perhaps, for those who can afford to pay for care
out of their own pockets). More to the point, the principles on which these
solutions rest cannot be reconciled with the values at the heart of medicare
or with the tenets of the Canada Health Act that Canadians overwhelmingly
support.

It would be irresponsible of me to jeopardize what has been, and can remain,
a world-class health care system and a proud national symbol, by accepting
anecdote as fact, or on the dubious basis of “making a leap of faith”.

Tossing overboard the principles and values that govern our health care
system would be betraying a public trust. Canadians will not accept this,
and without their consent, these so-called “new” solutions are doomed to
fail. Canadians want their health care system renovated; they don’t want it
demolished.

Some have described it as a perversion of Canadian values that they cannot
use their money to purchase faster treatment from a private provider for
their loved ones. I believe it is a far greater perversion of Canadian
values to accept a system where money rather than need, determines who gets
access to care.

My final report will address this issue in very direct terms, and in a way
that is consistent with what Canadians want and expect from their health
care system.

http://www.healthcarecommission.ca/default.asp?DN=cn=1380,cn=17,cn=3,cn=2,ou=Stories,ou=Suite247,o=HCC

Institute of Medicine loses credibility

The National Academies
Institute of Medicine
Fostering Rapid Advances in Health Care: Learning from System Demonstrations

State Health Insurance: Making Affordable Coverage Available to All
Americans

Demonstration projects in this category are intended to result in the availability of affordable insurance coverage to all Americans in a state.

Coverage expansions – Demonstration projects might expand insurance coverage
through either tax credits to be applied to an insurance plan, expanded eligibility for public insurance programs, or a combination of the two. Under the tax credit approach, the federal government would provide support to a demonstration site to be used for premium assistance, and the state would provide state tax credits to uninsured individuals. The state tax credit would likely be based on a sliding scale tied to income, and would need to be adequate to enable the individual to purchase a good insurance package. Under the approach of expanded eligibility for public insurance programs, the federal government would provide federal matching support for a significantly expanded eligibility program under a state Medicaid or SCHIP program.

http://books.nap.edu/books/0309087074/html/R1.html

Comment: Health and Human Services Secretary Tommy Thompson requested the Institute of Medicine to prepare a report on demonstration projects that would find ways to fix our health care delivery system, a system that is unable to meet current and future needs. It is probably no coincidence that the demonstration projects, including expansion of community health centers, and introduction of tax credits to purchase private health plans, reflect the policies already publicly supported by the Bush administration.

Recent reports have demonstrated the deficiencies of relying on community health centers, especially in their inability to provide access to adequate
specialized services, or even access to prescription drugs. And tax credits
primarily support the individual insurance market, noted for its higher costs, fewer benefits, excessive cost sharing, and especially for its underwriting practices that exclude those with the greatest health care needs. If a state were to establish a pilot project, certainly it should have the option of establishing a single insurance program that provides comprehensive services for everyone, made possible by eliminating the administrative excesses of the private insurance market.

By issuing a report that is designed to support the credibility of the Bush administration’s highly inadequate and grossly flawed health policies, The Institute of Medicine has severely tarnished its own credibility.

Salvadoran Social Movement Declares Historic Victory Against Privatization: ASSEMBLY RATIFIES DECREE

New Law Will Outlaw Privatization, Concession of Health Care
Strike continues as unions negotiate rehiring of illegally fired workers
Friday, November 15, 2002

The applause of thousands of doctors, nurses, healthcare workers and their supporters hushed to a respectful silence as Ricardo Monge, Secretary-General of the STISSS healthcare workers’ union, took over the bullhorn and addressed the crowd. “I want to thank each and every one of you for this historic victory,” he proclaimed, holding back tears in his eyes. “We have proven today the truth of our most important rallying cry: the people united will never be defeated. Through struggle, the Salvadoran people have stopped the privatization of health care, and struck a decisive blow against the neoliberal model which strips us of our humanity.” A deafening cheer rose up from the crowd that could hold its silence no longer. One after another, the leaders of the two-month health care strike stood up to voice the same sentiment: the people of El Salvador had won an historic victory in their struggle against privatization, one that would be remembered as the turning point in the war between the neoliberal model of human poverty and environmental destruction, and the alternative model of human equality and sustainable development.

Yesterday afternoon, the opposition parties in the Salvadoran Legislative Assembly united behind an FMLN decree outlawing the privatization of health care. They left ARENA standing alone, and voted unanimously to overturn Flores’s changes to the “State Guarantee of Health and Social Security,” effectively ratifying the original document as written by the STISSS and SIMETRISSS unions. Now, President Francisco Flores is constitutionally obligated to swallow his pride and sign the bill into law. The new law establishes as dominant legal principle the state’s obligation to provide accessible quality health care to every Salvadoran near their home, regardless of ability to pay. It prohibits the privatization, concession, subcontract, licitation, or transfer of any health care or support service to private companies, and calls for all current concessions to be cancelled by the end of the year. According to Monge, “the “State Guarantee” provides the foundation on which we can begin a real reform of the healthcare system in El Salvador, benefiting the interests not of the multinational corporations but of the Salvadoran people, and always guaranteeing that health is a human right and will not be privatized or concessioned.”

As a jubilant crowd left the Legislative Assembly and flooded the streets of San Salvador in a spontaneous celebration, strike leaders recalled that the struggle continues. Flores could take advantage of a number of procedural tricks to delay signing the decree, and unions will continue the strike until it is published in the Official Diary. Only then can real negotiations begin on the rehiring of illegally fired workers, the payment of withheld salaries, and a guarantee of no reprisals against striking workers. In order to ensure this third point, explained Monge, “[ISSS director] Mauricio Ramos will probably have to be removed.” Also, while the new law only covers health care, Flores seeks to privatize many public services, and Monge called for the hundreds of thousands of Salvadorans who participated in the three “White Marches” to join in solidarity with the STSEL union’s strike against the privatization of electricity. Finally, Monge warned the people of El Salvador of a new danger that could undo all of the work that they had done: CAFTA, a free trade agreement between the US and Central America that would supercede the new law and mandate the sell-off of public services like health care to multinational corporations.

That’s the news this morning in El Salvador.

Rhode Island Can Afford Health Care for All

EXECUTIVE SUMMARY
(the full report can be found at http://www.healthreformprogram.org/)

This report finds that complete, comprehensive health care for all Rhode Islanders is already affordable.

Complete care means coverage for people who lack insurance coverage today.

Comprehensive care means thorough insurance for prescription drugs, dental care, and other services that are omitted from many insurance policies today.

Why is complete and comprehensive health care for all Rhode Islanders affordable today? For two main reasons:

The money is already available. Current health care spending in Rhode Island is fourth-highest in the nation, 21.5 percent above the U.S. average. And U.S. average spending per person is itself more double the western European average. Those nations cover all citizens and enjoy better health outcomes than do Americans.

Cutting administrative waste, cutting drug prices, acting to prevent some medical problems, and other efficiencies save enough money to finance full insurance coverage for people who are now uninsured or inadequately insured.

This report finds that the three main alternatives to health care for all are themselves unaffordable. These alternatives are more money for business as usual (without improving coverage), efforts to cover more people with band-aid additions, and efforts to cut health costs by cutting insurance coverage or asking families to pay more.

This report estimates the costs of universal health care in Rhode Island and contrasts those costs with a continuation of the current system. It shows that universal health care for the people of Rhode Island is affordable. It offers alarming new evidence that ever-higher spending for business-as-usual in Rhode Island health care is not sustainable for people who pay for it or for people who use it, and that business-as-usual is cheating the state�s people by wasting huge sums on the private sector�s payment bureaucracy at the expense of the care that all Rhode Islanders need.

Consolidated financing is essential to cutting administrative costs. (And cutting those administrative costs is essential to financing comprehensive health care for all.) Financing can be consolidated in one of two ways.

The first is the simple single payer approach. Here, private insurance simply ends, out-of-pocket payments are virtually eliminated, and taxes are raised to replace the lost revenue. This means big tax increases.

The second is to pool all revenues in one reservoir, which allows the same administrative savings as single payer but requires much smaller tax increases. This has the advantage of capturing dollars now paid through private health insurance by employers and employees. Today�s private insurance payments are frozen in today�s dollars. Checks are written to a new health care trust fund, not to private insurers. Increased health costs in future years are covered by public spending. This means much smaller tax increases.

Consolidated financing alone is essential to financing comprehensive health care for all Rhode Islanders today. Looking ahead, though, it is not enough�by itself�to ensure affordable medical security for years ahead.

That is because health care costs continue to increase as the population ages and as costly new medical advances are made�things like expensive new drugs, surgical treatments, and transplants.

But what good are these medical advances if Rhode Islanders can�t afford them? Rhode Islanders deserve medical security. This first requires deciding what �medical security� really means. It then requires making sure that we shape health care�delivery and financing�to reach this goal. If we don�t deliberately plan to succeed, we are surely planning to fail. And that would be a tragedy.

Ultimately, no state or nation can ever spend enough to win immortality for its citizens. So immortality is not the goal. Rather, the goal should be something like this:

All Rhode Islanders should be able to get the health care they need�high-quality health care that works�without having to worry about whether they can afford it.

Health care spending in the United States is vast. In the year 2000, health spending in the U.S.A. was more than four times as great as was spending on national defense. And spending in Rhode Island was 21.5 percent above the U.S. average, as noted earlier.

For the long haul, reaching the goal of affordable high-quality health care for all Rhode Islanders requires that we spend our vast but still finite health care dollars as carefully as possible. This requires going far beyond the simple but vital step of consolidating financing.

It requires that doctors, hospitals, and other caregivers be paid in financially neutral ways�in ways that encourage, liberate, and require them to spend money as carefully as possible. This means, certainly, that all needed caregivers be paid enough money to allow them to remain open in Rhode Island�as long as they operate efficiently.

It requires, further, that doctors�who make the key decisions about how the great bulk of health care dollars are spent�are particularly empowered to spend our money carefully. This should begin by recognizing that doctors traditionally get about one-fifth of the health care dollar. They should be assured this money, to be divided up among them in reasonable proportion to competence, kindness, effort, and other factors.

But doctors also should be encouraged, liberated, and required to marshal the bulk of the remaining 80 percent of the money (excepting only dollars needed by dentists, public health agencies, researchers, and other independent actors) to provide the care that all Rhode Islanders need. Doctors would have to spend all of that money on their patients, and could not spend more. They could not personally benefit by economizing on care. This approach encourages patients and payers to trust doctors� decisions.

This has been called �professionalism within a budget.� It is one sensible way to balance the books in health care. If any patient is denied a service because it would be of small benefit to them, the aim would not be to enrich a physician or a for-profit HMO. Rather, the only reason for denying a service would be to make that service available to another patient who needed it more.

This is nothing more than spending money carefully�of getting as much health care as possible to the people who need it. This is nothing more than recognizing that all Rhode Islanders need health care but that dollars are always going to be limited. This is nothing more than a way to build trust in Rhode Island health care that offers medical security�durably affordable medical security�to all residents.

We offer this report in the hope that it will help the public and policy-makers to grapple with the complexity of our health care system, and to identify the benefits of universal access to comprehensive care with simplified administration.

-=-=-=

The American Medical Student Association (AMSA) is pleased to cite a report to the Rhode Island General Assembly proving that a single-payer universal health care system would save the state $270 million in health care costs. AMSA, the nation�s largest independent organization of physicians-in-training, believes that equal access to comprehensive health care is a basic human right. AMSA has supported single-payer national health insurance as a solution to the nation�s crumbling health care system since 1989. The AMSA Foundation�s 2002 American Health Care System Survey found that an overwhelming majority of first and fourth year medicals students believe that health care is a right.

�Healthcare is an issue that touches every American, regardless of age, race, or gender. Quality health care for all people through a single-payer system would help end the dramatic disparities that continue as long as we consider health care a privilege for those who can afford it,� says AMSA National President Eric J. Hodgson, M.D.

The results of the Rhode Island study conducted by Alan Sager, Ph.D., of Boston University School of Public Health�s Health Reform Program found that the state could provide, with a savings of 3.6%, complete care to its 75,000 uninsured residents and comprehensive care for residents currently with insurance but lacking coverage for prescription drugs, dental care, and other services.

The Rhode Island study is the latest to confirm that single-payer reform is not only a feasible solution, but also one that is more favorable than other, incremental approaches. The study comes a week after former Vice President Al Gore announced that he favors single-payer national health insurance as a solution to the health care crisis. AMSA supports Mr. Gore�s statement as a way to re-ignite the debate on needed health reform.

On November 18, four former Secretaries of Health & Human Services and former Surgeon General David Satcher described the nation�s health system as �too costly, inefficient, [and] unfair,� and in need of an �overhaul.� (Toner, Atlanta Journal-Constitution, 11/19) The Rhode Island study shows that such an overhaul is possible with a single-payer system, providing health insurance to the uninsured and to those with insufficient coverage. The study coincides with a report from the Institute of Medicine calling for 3-5 states to begin demonstration projects providing universal health care.

Earlier this year, the AMSA Foundation conducted the first-ever study of medical student knowledge and attitudes of issues surrounding universal health care and health disparities. The study found that about 90% of first and fourth year medical students agree that every American is entitled to adequate medical care regardless of ability to pay. A majority of students believe that some form of a universal heath care system would provide the best health care to the most people for the least amount of money.

Gore's gutsy gambit on health care for all American citizens

Published November 20, 2002

WASHINGTON — Like a dateless and desperate guy who is calling up a girlfriend about two years late, Al Gore finally is expressing serious interest in single-payer health care. Better late than never. But before we can examine Gore’s plan, he has to come up with one.

For the moment, though, it is enough that he has even put the issue on the table. Health care, like the economy and the environment, is one of the big issues onwhich polls show most voters look to Democrats for the best answers.

Yet Democrats oddly avoided these issues and just about every other galvanizing theme in their recently disastrous midterm election campaigns.

So while many Democratic activists consider a second Gore presidential campaign to be about as exciting as yesterday’s pizza, a larger percentage of rank-and-file Democrats think the former vice president deserves a second chance, especially if he can arouse Democratic impatience with the Bush administration.

And besides, with less than a year to go before 2004 campaigning starts getting serious, no other likely Democratic contender comes close to Gore in the polls.
So you can’t blame the guy for seizing an opportunity when he sees it.

Basically, single-payer coverage would collect insurance premiums or tax dollars in a single agency, which would pay for comprehensive coverage for all citizens. Canadians have a form of it and it constantly rankles conservatives and the health-insurance industry. They talk a lot about Canadians who come here for health care. They talk very little about Americans who go to Canada for cheaper drugs. Canada’s program has its problems, and while there have been many moves to improve it and even privatize parts of it, there have been few moves to scrap it.

Centrist Democrats, of which Gore has been a leader in the past, along with the Clintons, have been scared of it. Sounds too much like socialism, they say. But so did Social Security, Medicare and Medicaid, which have been some of the government’s most popular programs during much of the past half-century or so.
So, now, as Gore ponders whether to run again, he has broken “reluctantly” with his former centrist position on health care. In front of several hundred people in a Manhattan synagogue on Nov. 14, Gore said that he has decided that single-payer is the best solution to the nation’s health-care crisis.

More details to come, Gore spokesmen said, along with Gore’s announcement of whether he is running for president. In the meantime, he is behaving like a man who plans to run, including doing a stint as host of “Saturday Night Live,” a leading platform for reaching that coveted late-night youth vote.

Health care is no laughing matter for 40 million Americans who don’t have coverage. Nor is it a laugh riot for those who were frightened away from government intervention by the “Harry and Louise” TV ads in the early 1990s that warned of rationed health care.

Instead, growing numbers of covered Americans are receiving a different form of rationed health care in the name of “managed” health care.

So, if Gore, a former newspaper reporter, is as smart as he needs to be to win this time, he will remember the four initials countless editors have passed on to young reporters: “K.I.S.S. –Keep It Simple, Stupid.”

First, he should stop using the clunky term “single payer” to describe his plan. Nobody except for us news junkies and policy wonks knows what that means.

Instead, he should describe it as a simple expansion of Medicare to cover everybody. Medicare is a program most Americans understand comfortably and want to keep. Building on that popularity and comfort level, many experts over the years have advocated expanding Medicare to cover everyone, regardless of age.

Of course, funding and administering a health plan to cover all Americans will be anything but a simple matter. But to start a national dialogue, grand ideas must be expressed in simple terms.

At least Gore is giving voters something serious to think about. I hope he keeps it up. Americans deserve to have a choice, not an echo. That was a slogan of conservative Republicans in the 1960s. They made a comeback. So can the Democrats–if they offer Americans something worthwhile to choose.

Medical Student Education Damaged by Managed Care Says Survey of 500 Medical Professors

(Click to download as an Adobe PDF.)

CONTACT:

Amy Brodkey, MD
215-831-7949
brodkeya@fast.net

Fredrick McCurdy MD. PhD, MBA
402-559-2263
famccurd@unmc.edu

CHICAGO, ILLINOIS, November 14, 2002 _ A study to be published in the journal Academic Medicine on Friday, November 15, 2002 details the findings of a large survey of key medical student educators on the destructive impact of managed care on the education of future physicians. Faculty members from the disciplines of gynecology-obstetrics, internal medicine, neurology, pediatrics, psychiatry, and surgery perceive that the erosion of faculty support for teaching may have placed the foundation of the nation�s future health care in jeopardy.

The study was conducted by the Alliance for Clinical Education (ACE), a group composed of leaders of seven education organizations representing faculty who direct the core clinical clerkships in medical schools across the country. The clerkships are medical students� first and primary exposure to clinical medicine and the foundation of medical education. By virtue of their role in developing and overseeing clerkships, and their close contact with students and the local educational environment, clerkship directors are in a unique position to observe the effects of managed care on clinical education in medical schools.

The 500 clerkship directors from across the nation who responded to the anonymous survey indicated particular concern about difficulty recruiting faculty to teach and to participate in other educational activities, as well as a decline in the quality of clerkship training sites. The survey also documented widespread diminished enthusiasm for teaching. The greatest negative impact on education was perceived in locations with the highest amount of managed care. Over 88% of the respondents stated that managed care has made health care more like a commodity, and 72% stated it had reduced professionalism in medicine.

Managed care has adversely affected academic medical centers financially, reducing the time and resources available for education and research. Tuition pays for only a fraction of the cost of medical students� education. In addition, managed care companies frequently exclude students from patient care and the opportunity to learn physical examination and diagnostic skills. Many educators expressed concern over a possible decline in professionalism due to training in an environment of increasingly commercial values and reduced quality of care.

�The findings are impressive in part because of their strength and uniformity _ every specialty that was surveyed reported the same problems,� said Amy C. Brodkey, MD, the study�s lead investigator. �Many people think that the spread of for-profit managed care has made it more difficult to get good medical care, but most people don�t realize the impact it has had on the ability of academic medical centers to train future doctors. Our study respondents indicated that it is the current economic pressures associated with for-profit managed care, rather than the management of care itself, that is responsible for the damage. Given the further penetration of managed care into academic medical centers since the time of this study, I would predict that this situation will only get worse.�
# # #

Alliance for Clinical Education (ACE) was formed in 1992 to foster collaboration across medical specialties to promote excellence in the clinical education of medical students. Its mission is to foster collaboration across specialties to promote excellence in clinical education of medical students. Its member organizations include: Association of Directors of Medical Student Education in Psychiatry; Association of Professors of Gynecology and Obstetrics; Association for Surgical Education; Clerkship Directors in Internal Medicine; Consortium of Neurology Clerkship Directors; Council on Medical Student Education in Pediatrics; and Society of Teachers of Family Medicine.

Physicians for a National Health Program has been advocating for health care reform for 15 years with more than 10,000 members across the United States.
PNHP is headquartered in Chicago.
www.pnhp.org

Patients more likely to die in private for-profit dialysis centers, major study finds

CONTACT:

Janet Maher (coordinator) cell: 416-770-1311
Dr. P.J. Devereaux pager number 905 521 5030 pager 2530
Dr. P.J. Devereaux office: 905-525-9140 ext. 22160
McMASTER UNIVERSITY, Faculty of Health Sciences, Clinical Epidemiology & Biostatistics

TORONTO, November 19, 2002 _ If Canada switched to for-profit dialysis centers, approximately 150 additional dialysis patients would die each year, according to a major study to be published in the Journal of the American Medical Association (JAMA) tomorrow.

The research builds on finding released by the same research group earlier this year that revealed statistically significant higher death rates in private for-profit hospitals.

“In both hospital and outpatient settings the profit motive drives up death rates,” said Dr. P.J. Devereaux, lead author of the study.

The systematic review and meta-analysis compared death rates in over 500,000 adult patients receiving care in either for-profit or not-for-profit American dialysis facilities. The study found an 8% greater risk of dying in a for-profit facility. The results were extremely consistent across all the studies surveyed. They showed that if American patients received care in private not-for-profit dialysis facilities instead of for-profit facilities, approximately 2,500 lives would be saved each year.

“The reason more patients are dying in for-profit facilities is that administrators must spend 10 to 15 per cent of all expenses satisfying shareholders and paying taxes.” said Dr. Devereaux. “For-profit providers cut corners to ensure shareholders achieve their expected returns on investment.”

The results of this review are directly relevant to over 12,000 Canadians receiving dialysis. First, the studies included patients receiving publicly financed care in private not-for-profit and private for-profit dialysis facilities, a situation identical to what Canadian policy-makers have been considering. Second, the results are consistent over time, despite changes in American health care. Third, if Canada moved to for-profit dialysis facilities, the same large American dialysis chains included in the review would be purchasing Canadian dialysis facilities.

The results come at a time when Senator Kirby is advocating a permissive stance with regards to private for-profit health care facilities and a number of provinces have allowed for-profit MRI facilities and surgical facilities. The study results suggest that the profit motive may be compromising care in all out-patient for-profit clinics and hospital.

“Our results should raise serious concerns about moves to private for-profit care, whether in hospitals, day surgeries, or other outpatient facilities. It is time to base health care policy on evidence, not ideology.”

# # #

Physicians for a National Health Program has been advocating for a single-payer national health program since 1987, with more than 12,000 members across the United States.
PNHP is headquartered in Chicago.

www.pnhp.org