America’s Health Together (www.healthtogether.org)
April 30, 2002
Washington, DC

Rima Cohen,Vice President at the Greater New York Hospital Foundation and Director of the Insurance Options for the Uninsured Project, whose mission is to devise and implement strategies for expanding health insurance coverage in New York:

… we know for sure that the market has not taken care of the problem. Indeed, about a million people every single year since the census began collecting these statistics, have been added to the ranks of the uninsured. So, that’s a difficult thing for me to grapple with looking back on so many years working on health insurance coverage.

So, I jumped at the chance to move into the state health policy arena, thinking that this is where the action is going to be in the coming years, and to a certain extent, I was right. And I was very fortunate when I moved to New York to be involved with an effort that started off with a coalition of organizations where we developed a health insurance plan that was meant to build on our Child Health Plus Program. It was for parents and childless adults, and within a couple of years of my arrival in New York, that legislation passed into law. And, it was the single biggest expansion in New York’s history since–or I should say, since the creation of Medicare and Medicaid in 1965.

So, having been through that experience, you would think that I might be a big advocate of states as the laboratories of democracy, states experimenting with health insurance coverage initiatives, maximum state flexibility to develop locally tailored solutions to the health insurance crisis, but actually, I came away with exactly the opposite sense.

… health insurance coverage is really something that should not be thrown onto the states. And indeed, New York, with all the fanfare of this huge health insurance expansion, we really have not seen a drop in the uninsured. I think all we’ve done is managed to keep people–more people from losing their coverage.

So, let me just tie this all together with a couple of pearls of wisdom that I think can be used to think about strategies going forward. And the most important one is the one that I call, “Bigger is better when it comes to health insurance coverage.” And what I mean by that is, the lens through which I look at every health reform solution is always, “Does it pool the greatest number of people in the largest pool and the greatest number and the most diverse in terms of their ages and illnesses and so forth?” Because that’s the only way that health insurance works.

Health insurance does not work when people can segment themselves into tiny groups and divide themselves based on their illnesses or even geography or their age. And the system now really divides people, and what we really should be doing is pooling people. That’s the principle of health insurance and that’s why–one of the reasons why I think a resolution like this is so important. It’s saying, “Everybody needs health insurance coverage. Let’s pool the largest number of people together,” and a corollary of that is, “Don’t be fooled by calls for more choice.” I think all Americans want choice of their health care providers. I don’t see individuals clamoring as much for their choice of health plans, their–lots of other kinds of choices that you hear set up. Choices of benefit packages. That only allows people to segment themselves again. We need to be thinking about large solutions, comprehensive solutions. That’s the only way we’re really going to–to see a real program for all Americans.

And that’s why I think a Resolution like this is so important (H Con Res 99). Because it doesn’t say that this is exactly the way the health–the health care solution has to be built, but it says, regardless of the method, it has to be done. And the appropriate place to start is in the U.S. Congress passing this resolution, saying that by a date certain, the feds will come up, hopefully in partnership with the states and with lots of organizations that care about this issue, will come up with a solution but it cannot be done by states alone.

For the transcript: http://www.kaisernetwork.org/health_cast/uploaded_files/Transcript_HealthTogether.pdf (cut and paste to rest of link)

For House Concurrent Resolution 99: http://www.house.gov/conyers/hr99.PDF

The resolution calls for legislation by October 2004 that would guarantee that every person has access to health care that meets fourteen specific criteria that we all support. Read it, and then contact your Congressional representative to enlist his or her endorsement.

The New York Times
May 3, 2002

As a private psychiatrist with about 45 percent of my patients on Medicaid or Medicare, I agree with Marc Siegel (Op-Ed, May 1) that Medicare should be expanded. But let’s not stop with prescription drugs. The program should cover all Americans. We could change its name to National Health Insurance. Were this to happen, I’d gladly accept a pay cut.

J. WESLEY BOYD, M.D. Northampton, Mass. The writer is a lecturer in religion at Smith College and in psychiatry at Harvard Medical School.

http://www.nytimes.com/2002/05/03/opinion/L03DOCS.html

The original Op-Ed by Marc Siegel (“… choosing not to take Medicare patients should not be seen as simply a neutral business decision.”): http://www.nytimes.com/2002/05/01/opinion/01SIEG.html

Comment: “National Health Insurance” or “NHI” is a neutral term that can be used for broad audiences. Now that health reform is back in the news and on many agendas, it is helpful to have a term that represents comprehensive reform but without invoking concepts for which organized opposition already exists. “Medicare for All” provokes negative responses from those that are unhappy with the affects of neglect and political damage done to our Medicare program. “Single payer” provokes responses from those that have been saturated with misinformation about the Canadian system. These terms are certainly acceptable for selected, targeted audiences, but might not be the best terms for large, broad audiences.

“National Health Insurance” suggests the option of comprehensive reform, a concept that is now being accepted as an alternative to our current incremental approaches, now that the public is showing concern about the failures of incrementalism (skyrocketing premiums, excessive cost-sharing, and more uninsured). Once the forum is opened up to National Health Insurance, we can use this opportunity to explain to the public the beneficial features such as equity in funding, comprehensiveness, improved access, and elimination of financial barriers while containing costs.

Although no single terminology would be appropriate for all circumstances, National Health Insurance, or NHI, should be in our tool box as we communicate to the nation the advantages of reform that would provide affordable, comprehensive care for everyone.

May 2, 2002

Academics, analysts, lawmakers and the public: from all sides there are complaints that the country’s health care system isn’t working. More than 40 million are uninsured. Costs are soaring and so are premiums, nowhere more than in California, where many will see their rates rise 25% in the next year.

James Kahn, M.D., an epidemiologist and health services researcher at the Institute for Health Policy Studies at the University of California, San Francisco:

“We spend ($15 billion in California) every year to administer the health care system, and what do we get for that? Are people pleased that they have to change health plans? Are they pleased that they have to change doctors, that they have to fight with insurance plans about what’s covered and what isn’t?”

… single payer advocates claim that they can give more people more services for less money, a claim substantiated by an independent review of California’s single payer proposals from the Lewin Group.

In order to overhaul the system there needs to be broad political backing and extensive public education and support, but California advocates of a single payer system point to the increasing premiums, dwindling benefits, and the growing number of uninsured. The time is right for change, they say, and California, with its history of political independence, stands the best chance of making it happen.

This audio report is available through a link at KFF’s Daily Health Policy Report at: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=10945 Those with RealPlayer can hear PRI’s three minute report by clicking “online” at the end of the KFF written report.

James Kahn’s co-authors of the UCSF single payer proposal for the California Health Care Options Project include Thomas Bodenheimer, Kevin Grumbach, Vishu Lingappa, Krista Farey and Don McCanne. All proposals and the analyses of them are now available at: http://www.healthcareoptions.ca.gov/doclib.asp

May 2, 2002

Academics, analysts, lawmakers and the public: from all sides there are complaints that the country’s health care system isn’t working. More than 40 million are uninsured. Costs are soaring and so are premiums, nowhere more than in California, where many will see their rates rise 25% in the next year.

James Kahn, M.D., an epidemiologist and health services researcher at the Institute for Health Policy Studies at the University of California, San Francisco:

“We spend ($15 billion in California) every year to administer the health care system, and what do we get for that? Are people pleased that they have to change health plans? Are they pleased that they have to change doctors, that they have to fight with insurance plans about what’s covered and what isn’t?”

… single payer advocates claim that they can give more people more services for less money, a claim substantiated by an independent review of California’s single payer proposals from the Lewin Group.

In order to overhaul the system there needs to be broad political backing and extensive public education and support, but California advocates of a single payer system point to the increasing premiums, dwindling benefits, and the growing number of uninsured. The time is right for change, they say, and California, with its history of political independence, stands the best chance of making it happen.

This audio report is available through a link at KFF’s Daily Health Policy Report at: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=10945 Those with RealPlayer can hear PRI’s three minute report by clicking “online” at the end of the KFF written report.

James Kahn’s co-authors of the UCSF single payer proposal for the California Health Care Options Project include Thomas Bodenheimer, Kevin Grumbach, Vishu Lingappa, Krista Farey and Don McCanne. All proposals and the analyses of them are now available at: http://www.healthcareoptions.ca.gov/doclib.asp

The New York Times
April 26, 2002
By Milt Freudenheim

Aetna reported a turnaround in its troubled health insurance business yesterday, reflecting sharply higher premiums and the loss of millions of members that it said had been money losers.

Aetna said its premiums would rise 18 percent this year, ahead of medical costs, which are expected to grow 15 to 16 percent.

Dr. John W. Rowe, chief executive of Aetna, said that as premiums rose many employers were passing some costs to employees. Workers, who are paying more in premiums, deductible amounts and copayments, may hesitate before going to a hospital emergency room for, say, a sprained ankle, he said.

http://www.nytimes.com/2002/04/26/business/26CARE.html

Comment: It is reassuring to learn that everyone now knows how to determine whether an ankle injury is a tear of the anterior talo-fibular ligament or a fracture of the distal fibula. If it is a tear, they also know the degree of the tear and the management of each level of severity. Not only that, they also know how to prevent the prolonged disability that results from an enlarging hematoma typical of these injuries. They also understand the rehabilitation measures that will optimize their return to normal function. Or do they? Have we come to the point that any medical problem that is not a life-threatening event is to be considered an abusive use of our health care system by a woose and therefore not worthy of being funded by health insurance?

Dr. Rowe’s insensitive comments confirm that he and others like him should no longer control our health care funds. Let’s throw out this egregiously wasteful middleman industry that is now abandoning its essential role of funding health care.

We know that we can replace this abusive system with a program of national health insurance which would provide truly comprehensive coverage for everyone at a lower cost. What are we waiting for?

“Harry, did you see this article on the California study on single payer?”

“Is that like that terrible Clinton plan?”

“No, honey. This one’s really different. This study was done by reputable health policy researchers, including many from the University of California. It shows that absolutely everyone could have truly comprehensive health care while saving Californians billions in health care costs.”

“Now Louise, that’s impossible.”

“No. Really. By replacing the hodgepodge of health plans with a single insurance program, enough administrative waste would be eliminated to pay for comprehensive health care for everyone. And we wouldn’t be limited to that list of doctors that our current plan requires. We’d have free choice again.”

“Wow. It sounds like the voters should be checking this out.”

“And our legislators too.”

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.

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.

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.)

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.