Medical Economics
June 18, 2001
Letters to the Editors

I read with interest the April 23 “Memo From the Editor” regarding the roundtable discussion on the state of our nation’s health care. While I respect the members of that select panel, I don’t think it should have dismissed a universal national health plan as passé.

I, along with nearly 10,000 other disgruntled physicians, belong to Physicians for a National Health Program (www.pnhp.org). We readily acknowledge that the US health care system is seriously flawed. Despite the fact that this country spends far more on health care than any other industrialized nation, over 42 million Americans have no health care coverage.

I agree that Hillary Clinton’s plan was flawed, but we’ve got to do something other than apply more Band-Aids to remedy our current mess. While Congress has already passed a gigantic tax cut, and is considering a multitrillion-dollar defense shield, we still have not acted to ensure that every citizen has adequate access to health care.

Howie Wolf, MD
Lafayette, CO
Lobo985@home.com

Editor’s Note: For the roundtable discussion itself, see “What it will take to fix the system.”

Part I of the roundtable discussion is now available at: http://me.pdr.net/me/public.htm?path=content/journals/m/data/2001/0618/round1.html

The New York Times
June 26, 2001

To the Editor:

Re “A Wrong Turn on Patients’ Rights,” by Marcia Angell (Op-Ed, June 23):

Dr. Angell is right when she says “a single-payer system that covers everyone” offers the only solution to this country’s deepening health care crisis. As long as we permit corporate medicine to squander precious resources on marketing, excessive administrative costs and profits, patients will be left in the lurch.

We should do what every other industrialized country in the world does: guarantee health care to all. Although we support patients’ rights legislation like the Kennedy-McCain bill, it won’t provide insurance for the 43 million uninsured or prevent employers and H.M.O.’s from continuing to cut back benefits.

OLIVER FEIN, M.D. JOANNE LANDY New York, June 23, 2001

The writers are, respectively, chairman and executive director, Physicians for a National Health Program, New York chapter.

The concluding remarks from the original Op-Ed by Marcia Angell, M.D, former editor of the New England Journal of Medicine.:

“The answer is a single-payer system that covers everyone and more efficiently uses the resources we allocate to health care. That is tantamount to extending Medicare to all Americans. Medicare is not perfect, but it provides a uniform set of benefits to nearly everyone who qualifies, and it does so far more efficiently than the private employment-based system. Extending and improving Medicare would be simpler and more realistic than trying to shore up a fundamentally irrational system by measures like patients’ rights bills.”

The entire article is available at: http://www.nytimes.com/2001/06/23/opinion/23ANGE.html

The New York Times
June 26, 2001

To the Editor:

Re “A Wrong Turn on Patients’ Rights,” by Marcia Angell (Op-Ed, June 23):

Dr. Angell is right when she says “a single-payer system that covers everyone” offers the only solution to this country’s deepening health care crisis. As long as we permit corporate medicine to squander precious resources on marketing, excessive administrative costs and profits, patients will be left in the lurch.

We should do what every other industrialized country in the world does: guarantee health care to all. Although we support patients’ rights legislation like the Kennedy-McCain bill, it won’t provide insurance for the 43 million uninsured or prevent employers and H.M.O.’s from continuing to cut back benefits.

OLIVER FEIN, M.D. JOANNE LANDY New York, June 23, 2001

The writers are, respectively, chairman and executive director, Physicians for a National Health Program, New York chapter.

The concluding remarks from the original Op-Ed by Marcia Angell, M.D, former editor of the New England Journal of Medicine.:

“The answer is a single-payer system that covers everyone and more efficiently uses the resources we allocate to health care. That is tantamount to extending Medicare to all Americans. Medicare is not perfect, but it provides a uniform set of benefits to nearly everyone who qualifies, and it does so far more efficiently than the private employment-based system. Extending and improving Medicare would be simpler and more realistic than trying to shore up a fundamentally irrational system by measures like patients’ rights bills.”

The entire article is available at: http://www.nytimes.com/2001/06/23/opinion/23ANGE.html

Mark Hannay, Director, Metro New York Health Care for All Campaign:

“The author of the latest Kaiser Family Foundation study re: the private individual health insurance market (Karen Pollitz) did a briefing for legislative staff here in NY (Albany) last week, and showed that while you are right, a universal public program is ultimately the only long-term solution, in the shorter-term, there are steps states can take to stabilize and make their individual markets work successfully to some degree. These include: community rating, guaranteed issue, standardized comprehensive products, re-insurance & risk-sharing/adjustment mechanisms, public subsidies to insurers who end up with a disproportionate share of high-cost people, and not allowing opt-outs for special categories of individuals (e.g., sole proprietors into the small group market) but rather keeping the market whole as much as possible.

“In fact, NY is one of the few (only?) states to have taken these various steps, and as a consequence, unlike in the states she looked at, ALL the persons profiled in her study would be able to get comprehensive coverage without having to pay more or suffer a loss in benefits in NY. However, they would still have to pay high premiums of $4,000+ annually for individuals (more than double that for families), which is a never-ending battle — this year the average rate increases in NY so far are 20-30%+, with some rates going up as much as 75+%!

“In NY, most of our ‘reforms’ were fought against the initial opposition of the insurance industry, who were neutralized once we assured them that they’d not be put at an undue disadvantage and the state would help them shoulder the burden. After all, this market is disproportionately comprised of high-volume health care users (i.e., the chronically ill and disabled) who buy in this market because they MUST have this coverage to literally survive and often have no other alternatives, and so they scrape the pennies together somehow because it is THE most expensive way to buy insurance.

“All this is by way of saying that there are things which can be done to somewhat alleviate the crisis for people in the individual market, but clearly a long-term systemic solution is called for (i.e., universal health care.) If you want to see what’s coming down the road for the rest of us as the American health care system continues to collapse, take a look at the individual market in most states. The modus operandi? Once you get sick and need coverage which you will actually use, you either can’t get it at all, or can’t get it for what you need it for, and you’ll pay through the nose regardless.

“Makes sense huh? Kick ’em while they’re down!”

For the full KFF report: http://www.kff.org/content/2001/20010620a/indivifull2.PDF

Comment: Mark has pointed out the fact that a tightly regulated insurance market, as in Albany, has the distinct advantage of assuring the theoretical availability of coverage for everyone. The crucial tradeoff is that the very high premiums that result create significant financial barriers to coverage for young and healthy consumers, along with everyone else. Once again this demonstrates the pressing need to eliminate the waste of our private health plan bureaucracies, to pay for health care in a fair and just manner through progressive funding, and to contain costs through mechanisms that improve the allocation of our health care dollars. Mark has shown us that application of rational health policies in our current health care market still fails to address the issue of affordability, and that there is no way to escape the reality that we really do need publicly administered, universal health insurance. We are getting closer to a rational system, and some day we’ll get it right.

Institue for Public Accuracy
June 19, 2001

Quentin Young, M.D., National coordinator of Physicians for a National Health Program:

“The heart of our problem is the takeover of health care by corporate interests. Having the right to sue an HMO is an attempt to seek justice after the HMO has inflicted the harm. But we have to stop the harm. We have an urgent need to establish universal coverage, like Medicare for all.”

http://www.accuracy.org/new.htm

Institue for Public Accuracy
June 19, 2001

Quentin Young, M.D., National coordinator of Physicians for a National Health Program:

“The heart of our problem is the takeover of health care by corporate interests. Having the right to sue an HMO is an attempt to seek justice after the HMO has inflicted the harm. But we have to stop the harm. We have an urgent need to establish universal coverage, like Medicare for all.”

http://www.accuracy.org/new.htm

Edmonde Haddad, former Deputy Assistant Secretary of State for Public Diplomacy:

“Both Drs – Beth Capell and the equally hardworking Don McCanne – are properly enraged by how America treats those who are either sick or poor. There seems to be no real way to combat the massive and crushing power wielded by such entities as the insurance companies, pharmaceutical industry, and the American Medical Association. Don suggests taking to the streets. It is really depressing that the United States ranks so low throughout the world in making available health care to all citizens regardless of ability to pay. There are doctors and other health care professionals who cannot abide the present healthcare delivery system. Perhaps, if they joined together in a common effort, well-financed and organized, they could force the issue. The present system is a disgrace and demeans us as a people. It is equally important that the United States look to the many more advanced democracies around the world where good health long has been considered a basic human right… ”

Milton Braun, retired CPA and health care reform activist from Dallas, responding to the comments about abandonment of women with positive breast cancer screening tests:

“If these women were politicians or wives of politicians they would get treatment.”

“YES, it is time to MARCH, to RALLY!!!!!”

Naomi Shaiken, Chair of Connecticut Call to Action:

“I’ve suggested this, but have been met by raised eyebrows! I believe we SHOULD get a march [a la 1972 against the ‘Nam War] in DC – can’t we get buses, set a date and do this? Why not? ‘If not now, when??'”

Comment: Our nation’s leaders are not listening. They are quibbling over patients’ rights bills that will have virtually no impact on the real problems of our health care system. In fact, passage of any of these bills will be used as an excuse to shift more costs to patients, further impairing coverage and access for tens of millions in the United States. Worse, this legislation will be passed off as adequate health care reform, and Congress will move on to other issues. We urgently need genuine, comprehensive reform, but the current political climate remains an impenetrable barrier. To break through this barrier, our leaders need to hear the resounding voice of the people echoing throughout the land, demanding health care justice.

Edmonde Haddad suggests that doctors and other health care professionals could join together in a well financed and organized common effort, and force the issue. Physicians for a National Health Program (www.pnhp.org) is such an organization that is dedicated exclusively to this issue. We have 9000 physician members, but we need to recruit tens of thousands more. Each of you can help by contacting your personal physicians and physician colleagues and friends and directing them to PNHP. We could carry our message to the public much more effectively if we had significant additional funding, especially for a media campaign. If any of you know progressive minded individuals that have benefited from the upward shift in income redistribution, you may suggest that donating to PNHP may assuage their penurious guilt. We also need more active involvement on the part of physicians. They need to be heard distinctly as a rebel call standing out within the resounding voice of the people.

And what about taking to the streets with rallies and marches? Emphatically, YES! We need to bring together all of our people in a clear, loud, unified voice that will penetrate the sound barriers surrounding our political leaders. This should probably be done as part of a coordinated, universal effort, including a media campaign.

Now is the time for ideas. Start thinking about how we can create an effective, national movement. We have to do it. If not us, who?

Don McCanne

Beth Capell, PhD, legislative representative for health care reform:

“We live in a society in which a man who loses a leg to diabetes can get the amputation but not the insulin to manage the disease; in which a woman who has cataracts loses her job because she is blind; in which a child goes deaf simply because she had the misfortune to lack clear immigration status; in which a person screaming with pain from metastasized cancer gets pain medications from the ER and nothing more. Every case is obscene.

“Every person who should be able to lead a productive life should be given that chance. This is not charity. This is not obligation. It is a society making the most of its most precious resource: its people.”

Oakland Tribune
June 15, 2001
by Lisa Friedman

“1000 California women each year enter state or federally funded detection programs only to find out they have cancer but cannot afford treatment.”

“Now health advocates fear some or all of the $20 million Gov. Gray Davis pledged last year toward the federal matching funds program may fall victim to far-reaching budget cuts.”

Barbara Brenner, executive director of Breast Cancer Action:

“It’s not a matter of charity. It should be a matter of obligation.”

http://www.oaklandtribune.com/S-ASP-BIN/REF/Index.ASP?PUID=490&Indx=927402

Comment: How can decent Americans tolerate a system in which the government will pay for mammograms to detect breast cancer, but then abandon the women that have positive tests? We already have enough funds to provide comprehensive care for everyone. Decent Americans should be out marching in the streets, demanding health care justice!

And in USA Today:

“The pity is that today’s policymakers lack the courage and foresight to address the problem… ”

http://www.usatoday.com/news/comment/2001-06-14-edtwof2.htm

Let’s start marching! Really!

Don

The Bush administration is currently considering new names for the Health Care Financing Administration (HCFA). American Medical News, a publication of the American Medical Association, is conducting a poll on proposals for a better name. If you check the polling page at the link that follows, you will find that most suggestions are not serious. However, one stands out as representing the goal to which many of us are dedicated: National Health Insurance Administration (NHIA). Voting for this choice would send a message to the AMA that we are serious in our support of national health insurance. If enough of us register our votes, the message may even reach our political leaders.

Cast your vote now, and then forward this message to your friends and colleagues.

Vote for: National Health Insurance Administration (NHIA)

http://www.ama-assn.org/public/journals/amnews/amnqp8.htm

On behalf of the dream of health care justice for all in the United States, thank you.

Don McCanne

The Seattle Times
June 11, 2001
by Carol M. Ostrum

” …’defined contribution’ health plans are being offered in Washington by (Regence BlueShield).”

“Under the plans’ most pure form, employers would hand employees a voucher, give them a push toward a list of insurance plans and wish them luck. Touted as giving employees more choice, the plans trouble some health-care economists who worry that the trend may unleash forces that will widen the gap between health-insurance haves and have-nots.”

“Play it out a couple of years, critics say, and employees could get caught in the middle, as employers’ contributions lose ground to rapidly escalating benefit costs. An early version of this movement found that when health-insurance premiums rose faster than company contributions, employees simply dropped coverage… ”

Regence President Mary McWilliams:

“Health-care inflation is not abating. Employers need ways to fix what their costs are, and a lot of the tools we had in the past to try to manage health-care costs aren’t workable today.”

http://seattletimes.nwsource.com/html/localnews/134305355_contributions11m0.html

Comment: Isn’t our health care system about patients? If we would redirect our reform efforts to creating a system that is designed specifically to provide the best possible care for everyone, within the limits of our resources, then employers, employees, providers, and everyone else would do just fine. Only the middleman profiteers would suffer under patient oriented reform, but then we can no longer afford the luxury of enriching our friends on Wall Street at the cost of losing patient care dollars.