PNHP

On Ethics and Medicine

On Ethics and Medicine

The University of California at San Diego Healthwise
May 2001

Lawrence Schneiderman, MD, Professor, Family and Preventive Medicine, UCSD:

“Every responsible ethicist agrees that we are violating our moral obligations to our citizens by not providing a decent minimum of universal health care…. We are proud to be a free enterprise, capitalist society that has produced many remarkable achievements, but we are trying to use that concept in health care. We are trying to build health care on the profit-based market model and it’s failing miserably…. A fundamental duty of a just society is to all of the citizens. They all are owed a decent minimum standard of health care, and only the government can take that responsibility…. (E)very responsible ethicist I know who has thought about this issue has a similar opinion.”

(Thanks to Jeoff Gordon for today’s quote.)

Court Rules in Favor of Maine Rx Price Controls

As reported May 17 in the Kaiser Daily Health Policy Report, the 1st U.S. Circuit Court of Appeals in Boston on Wednesday struck down a challenge to a Maine law that would “impose price controls on prescription drugs if pharmaceutical companies refuse to provide a discount for thousands of uninsured residents.” Enacted nearly one year ago, Maine’s law allows the state to “leverage its buying clout — $210 million in Medicaid drug purchases — to negotiate discounted prices” for the 325,000 Maine residents not covered by private insurance or Medicaid. If drugmakers refuse to give the state discounts, the law allows Maine to impose price caps by 2003. The Pharmaceutical Research and Manufacturers of America initially brought a lawsuit against the state, saying that the law is unconstitutional because it violates laws regulating interstate commerce by interrupting relationships between drug manufacturers and distributors (Connolly, Washington Post, 5/18). Last October, a federal District Court judge agreed with the pharmaceutical industry and blocked the program’s implementation ( Kaiser Daily Health Policy Report, 10/16/00). In overturning that ruling, the three-judge panel of the circuit court on Wednesday “praised Maine for tackling a vexing problem in a creative way,” the Post reports. In a 75-page opinion, the court said, “It is one of the happy incidents of the federal system that a single courageous state may, if its citizens choose, serve as a laboratory; and try novel social and economic experiments without risk to the rest of the country” (Washington Post, 5/18).

Chellie Pingree, the Maine legislator who “spearheaded” Maine’s law, said, “This is a big win. It makes clear that states should be creative and that Maine, specifically, acted appropriately on behalf of citizens who need this benefit.” PhRMA spokesperson Jeff Trewhitt said that the organization would file an appeal, adding, “The last thing we need is a patchwork of different state laws. We agree that improved access is important. But this is the wrong way to go. The problem requires a national solution.”

More State Action to Come? Twenty-six states are moving forward with plans to create programs similar to Maine’s and have watched the Maine case “closely” (Silverman, Newark Star-Ledger, 5/18). Bernie Horn, policy director of the Center for Policy Alternatives, said, “Now that the appeals court has wiped away the stigma of unconstitutionality, we expect the Maine approach to move like wildfire across the country” (Center for Policy Alternatives release, 5/17). Peter Shumlin (D), president pro tem of Vermont’s Senate, added, “A number of [states] were waiting for a court decision to see what the future would be for fair-pricing legislation. I’m incredibly happy about the court decision. It gives many of us the green light to move forward.”

Alan Sager, a public health professor at Boston University, added that while the pharmaceutical industry has succeeded in “defusing the issue this year by moving it from the legislative arena to the courts,” the “pressure is building up.” Meanwhile, in Maine, the state is prepared to give cheaper drugs to uninsured state residents beginning next month (Ornstein, Dallas Morning News, 5/18).

Keeping Quality on the Policy Agenda

Health Affairs
May/June 2001

“How many more people have to die before we accept that quality is everyone’s problem?” by Elizabeth A. McGlynn and Robert H. Brook

“The science that the nation spent so much public and private money developing could produce its promised results.”

“We spend more money on health care than any country in the world; one of every seven dollars spent in this country goes to medical care. We have sophisticated physicians and social scientists. But we lack the will to reengineer our own health system.”

“Leadership for this reengineering will have to come from both government and the private sector. The government role is particularly critical, something that has been recognized in all other Western nations except the United States.”

“We must find a way to keep quality care at the top of the health policy agenda. After providing insurance to all Americans, there is no issue of equal importance.”

http://www.healthaffairs.org/archives_library.htm

Organizations Find Big Changes in Bush's A-List

The Washington Post
May 17, 2001
“Professional Groups Lose International Delegation Spots” by Karen DeYoung

“The American Public Health Association assumed it would be invited to join the official U.S. delegation to this week’s World Health Assembly in Geneva. As the nation’s oldest and largest organization of public health professionals, the APHA has been a U.S. delegate to the annual meeting of the world’s health ministers for many years…”

Instead, “… ‘five private-sector advisors’ are on the official team,” along with Tommy Thompson and other government officials, that will discuss issues such as global strategies for infant and child feeding, the AIDS pandemic, strengthening health systems, and the health effects of depleted uranium.

Mohammad Akhter, executive director of the American Public Health Association:

“I think this is setting a bad precedent. This is not at all what America is about. It doesn’t matter who the president is, we represent the people. That’s what has put us above all the other countries in the world…. Now, we’re the same as third world countries where they bring in their friends and make a mess of things.”

http://www.washingtonpost.com/wp-dyn/articles/A36643-2001May16.html

Comment: Is the APHA is being punished for supporting health care for everyone?

Organizations Find Big Changes in Bush’s A-List

The Washington Post
May 17, 2001
“Professional Groups Lose International Delegation Spots” by Karen DeYoung

“The American Public Health Association assumed it would be invited to join the official U.S. delegation to this week’s World Health Assembly in Geneva. As the nation’s oldest and largest organization of public health professionals, the APHA has been a U.S. delegate to the annual meeting of the world’s health ministers for many years…”

Instead, “… ‘five private-sector advisors’ are on the official team,” along with Tommy Thompson and other government officials, that will discuss issues such as global strategies for infant and child feeding, the AIDS pandemic, strengthening health systems, and the health effects of depleted uranium.

Mohammad Akhter, executive director of the American Public Health Association:

“I think this is setting a bad precedent. This is not at all what America is about. It doesn’t matter who the president is, we represent the people. That’s what has put us above all the other countries in the world…. Now, we’re the same as third world countries where they bring in their friends and make a mess of things.”

http://www.washingtonpost.com/wp-dyn/articles/A36643-2001May16.html

Comment: Is the APHA is being punished for supporting health care for everyone?

Health plans' costs set to jump: CalPERS is ready to increase premiums by about 17 percent in its two self-insured care plans.

The Sacramento Bee
May 16, 2001
by Lisa Rapaport

Bert Clark, a retired enrollee: “A lot of people will gripe and say these rates are hard to take. What gets me is I pay Medicare, then I pay CalPERS, and then I pay for drugs.”

David Thompson, a public agency representative: “We get a wonderful benefit structure that’s all you could want — it’s just expensive. It’s fair as long as we have a choice.”

Comment: A choice? Making health care unaffordable gives many retired folks the choice of not eating or paying rent as the price of health care. Some choice!

Health plans’ costs set to jump: CalPERS is ready to increase premiums by about 17 percent in its two self-insured care plans.

The Sacramento Bee
May 16, 2001
by Lisa Rapaport

Bert Clark, a retired enrollee: “A lot of people will gripe and say these rates are hard to take. What gets me is I pay Medicare, then I pay CalPERS, and then I pay for drugs.”

David Thompson, a public agency representative: “We get a wonderful benefit structure that’s all you could want — it’s just expensive. It’s fair as long as we have a choice.”

Comment: A choice? Making health care unaffordable gives many retired folks the choice of not eating or paying rent as the price of health care. Some choice!

American Medical Association Policy and Advocacy

H-165.960 Health Access America Refinements

Excerpts:

(11) The AMA should achieve the right to negotiate for physicians program payment and the other conditions in government health entitlement programs, where legislative and/or administrative restrictions are unilaterally applied to physicians’ freedom to set their own fees. Any such fee restrictions should be limited to those patients who cannot reasonably afford to pay the difference between the physician fees and government reimbursement levels. In the private sector, where insurance arrangements for thousands of patients are increasingly controlled by single third party payers, physicians should have the ability to negotiate collectively on behalf of their patients and themselves.

(12) Single-payer systems are not in the best interests of the public, physicians or the health care of this nation and should be strenuously resisted.

http://www.ama-assn.org/apps/pf_online/pf_online (Check “House of Delegates” and enter “H-165.960”)

Comment: It is unfortunate that the leadership of the American Medical Association continues to endorse official AMA policies that protect physicians’ income while essentially neglecting the great, unmet, health care needs of the nation. As long as they continue to support grossly deficient policies such as tax credits and medical savings accounts, the AMA will have very limited legitimacy in the process of reforming health care in America.

Should the AMA ever take a strong advocacy role on behalf of physicians? The answer may be, “Yes.” I’ll explain.

Most of us engaged in compassionate reform activities firmly believe that our abundant health care resources can be allocated much more effectively, resulting in comprehensive, high quality care for everyone. But under our current sick structure, efforts to remove cost restraints for the purpose of embellishing physician wealth can only place additional stresses on our deficient mechanisms of delivering resources for care of the medically underserved. Physicians must advocate for structural reform that will improve resource allocation before they can legitimately advocate for their own financial interests.

Once we have in place an effective system that will assure comprehensive care for everyone, mechanisms of cost containment will be essential. At that time, physicians will need a strong and effective voice in negotiating rates and practice environment. Otherwise, those in control will divert physician resources into other sectors of the budget. Very soon medicine as an occupation would be appealing only to the Mother Teresas of this nation, and, frankly, there simply are not enough individuals that are so dedicated. So it is in the best interests of patients to be certain that physicians are rewarded at a level that will assure that prime candidates will continue to be attracted to the medical work force.

The AMA’s position that it should “achieve the right to negotiate (collectively) for physicians” is a proper stance, but not within our current sick system. If the AMA actively participates in bringing about the ethical reforms that will cure the ills of our system, than it will have earned its position as negotiator on behalf of the medical profession.

Don McCanne

Physicians Promote Universal Health Care

May 21, 2001

“Several prominent physicians, fed up with ‘market-based medicine’ have banded together to advocate for single-payer national health insurance.” by Amy Snow Landa

Quentin Young, M.D., commenting on a conversation he had with Rep. John Conyers Jr.:

“I represented to him that the leaders of medicine are no longer to be painted with one stripe as conservative, even reactionary obstacles to universal health care, but that leadership is taking quite a different tack, and he accepted my comments and challenged me to produce that group.”

http://www.ama-assn.org/sci-pubs/amnews/pick_01/gvsb0521.htm

Comment: This is yet another article on the pivotal, landmark meeting of several Congressional caucuses and the Physicians’ Working Group for Single-Payer National Health Insurance. The objectivity of this article is to be commended considering that this is a publication of the American Medical Association.

A picture of our Santa Barbara friends:

http://community.webshots.com/photo/14083539/14083762FJqxqmJZsP

Thanks to Robert Bernstein, Chair, Sierra Club – Santa Barbara Group

Reforming Medicare’s Benefit Package: Impact on Beneficiary Expenditures

The Commonwealth Fund
by Stephanie Maxwell, Marilyn Moon, and Matthew Storeygard
The Urban Institute
May 2001

“Expanding Medicare’s benefit package would enhance equity of coverage among beneficiaries, who currently obtain coverage through a patchwork of sources at varying costs. Coordinating coverage under a single source would allow for greater overall efficiency in furnishing health insurance coverage to Medicare beneficiaries and society as a whole. Moreover, administrative costs for public insurance programs are lower than those for private insurance plans: a public program does not need to maintain reserves to protect against adverse risk, nor does it need to pay marketing or sales commissions.”

“Expanded Medicare coverage would clearly result in decreased out-of-pocket costs for many beneficiaries, particularly those with the highest expenses.”

The full report is available at: http://www.cmwf.org/programs/medfutur/maxwell_reforming_medbenefits_461.pdf

Comment: This study demonstrates that improving Medicare benefits can eliminate the need for expensive Medigap coverage, and result in the reduction of out-of-pocket spending. This is the type of Medicare reform that we should be supporting, rather than the severely flawed Breaux-Frist premium support proposal.

Reforming Medicare's Benefit Package: Impact on Beneficiary Expenditures

The Commonwealth Fund
by Stephanie Maxwell, Marilyn Moon, and Matthew Storeygard
The Urban Institute
May 2001

“Expanding Medicare’s benefit package would enhance equity of coverage among beneficiaries, who currently obtain coverage through a patchwork of sources at varying costs. Coordinating coverage under a single source would allow for greater overall efficiency in furnishing health insurance coverage to Medicare beneficiaries and society as a whole. Moreover, administrative costs for public insurance programs are lower than those for private insurance plans: a public program does not need to maintain reserves to protect against adverse risk, nor does it need to pay marketing or sales commissions.”

“Expanded Medicare coverage would clearly result in decreased out-of-pocket costs for many beneficiaries, particularly those with the highest expenses.”

The full report is available at: http://www.cmwf.org/programs/medfutur/maxwell_reforming_medbenefits_461.pdf

Comment: This study demonstrates that improving Medicare benefits can eliminate the need for expensive Medigap coverage, and result in the reduction of out-of-pocket spending. This is the type of Medicare reform that we should be supporting, rather than the severely flawed Breaux-Frist premium support proposal.

Income gap in California gets wider

The Orange County Register
May 10, 2001
by Michelle Quinn

According to a study conducted by the Public Policy Institute of California, inflation adjusted family income at the 10th percentile dropped 14 percent, from $15,810 in 1969 to $13,600 in 1999. (The 90th percentile increased 58 percent – from $86,140 to $135,850.)

Deborah Reed, an economist and co-author of the study:

“When we have families with disparate income, how do we offer equal opportunity to the children? Children of the rich are afforded better schools and health care.”

Comment: Since our economic system supports and encourages the movement of capital from lower and middle income individuals to the wealthy, it becomes even more imperative that we have in place a system that will assure health care access and coverage for all of us, as health care is becoming less and less affordable.