Los Angeles Times
June 8, 2001
by Ellen Braunstein

In “Talking to Americans,” Rick Mercer, a Canadian comedian and satirist, travels in the United States “asking people ridiculous questions to exploit their ignorance about their northern neighbor.”

Julie Longo, a Canadian citizen that teaches Canadian history at Wayne State University in Detroit:

“I think the show illustrates well our perceptions of Americans — that Americans know nothing beyond their own borders and have no problem with their ignorance.”

http://www.latimes.com/archives/ (and enter name “Rick Mercer” and click “Begin Search)

Comment: It is not surprising that Canadians are quite well informed about the United States considering that the comparatively small population of Canada is concentrated along our border and significantly influenced by our dominance. On the other hand, for most of us in the United States, our understanding of Canada is limited to the exposure that we have had to deliberate information campaigns within our country. An example is the perceptions that we have as a direct result of marketing efforts on behalf of Canadian tourism, a beautiful but shallow impression of Canada.

Unfortunately, there has been a very concerted effort to spread disinformation about the Canadian health care system, a process that has been dominated by libertarian elements that wish to keep the government out of health care in the United States. Because knowledge about Canada by most of us is very limited, and because the supporters of universal health care coverage have not been adequately effective in carrying the message of the benefits of the Canadian Medicare program, the average individual in our country believes that the Canadian health care system is inferior. This misperception is not altogether the fault of health care reform activists. The message of a just, comprehensive health care system is a very complex message to deliver and exceeds the patience and desires of most Americans to study and absorb a subject that for most of them is very boring. On the other hand, the opposition can keep their message very simple by limiting the facts presented to very isolated problems within the Canadian system, while concentrating on simple rhetoric that lumps health care in with features of government that the public believes to be undesirable.

The media readily report the isolated stories of problems within health care. The horror stories of managed care in this country abound, just as the stories of the deficiencies of the government program in Canada make good copy, or at least news filler. The conclusions that our citizens draw from these reports are that (1) a patient bill of rights will correct the defects of managed care, and (2) we do not want a government system like Canada’s. The members of the media reflect the same simplistic viewpoints, and most seem to lack the depth of understanding of the Canadian system that might otherwise influence their reporting stance. This is not laziness on their part but rather reflects the fact that they must make decisions on how to allocate their time effectively. The “government” health care system of Canada is simply not a priority for them.

Our efforts should be directed to informing the media of the realities of the Canadian health care system. We can never tell them what stories to cover, but we can encourage them to base their coverage on a background of comprehensive knowledge of the Canadian system. An excellent beginning source for them is a 251 page report by the Canadian government on the status of their health care system, released February 2, 2001. It can be downloaded at: http://www.hc-sc.gc.ca/medicare/home.htm

For those in the United States that wish further information about our Canadian neighbors, a wealth of such information is available at the website of the Canadian government: http://www.canada.gc.ca/

The Washington Post
June 9, 2001
Editorial

“Health care costs appear to be rising rapidly again after a period in which they were relatively well behaved. Most analysts think that higher rates of increase will persist — that they represent the norm and the respite was the anomaly.”

“Higher health care costs are like a tax increase or an increase in energy costs… They squeeze people out of the health care system; the higher the cost of care, the greater the likelihood that more Americans will be uninsured.”

“The resurgent cost of health care is arguable one of the most serious problems the country faces. But in our view neither political party is facing it.”

http://www.washingtonpost.com/wp-dyn/articles/A43137-2001Jun8.html

Comment: Ignoring the issue of containing costs in health care is no longer an option; we simply cannot afford to continue to parasitize other sectors of our economy for the benefit of the health care industry. Denying access and coverage to tens of millions of Americans remains morally repugnant and can no longer be tolerated by a just society. It is now imperative that our political leaders take a fresh look at all options for reform, including the only proposal that will contain costs, reduce administrative waste, and improve allocation of our abundant health care resources: a publicly administered, universal health insurance program.

The New York Times
June 5, 2001
by Robert Pear

“A top federal official said today that the Bush administration would try to double the enrollment of Medicare beneficiaries in health maintenance organizations within four years.”

Thomas A. Scully, newly appointed administrator of the Health Care Financing Administration:

“The government is better in the long run when it’s a buyer of insurance, rather than an insurer.”

Comment: Unfortunately, this is not a mere rhetorical statement. It is a blatant lie, and Mr. Scully knows that. Although not without its problems, the HCFA has been much more efficient than the HMOs in the administration of health care coverage. GAO studies have confirmed this. What the HCFA needs now is leadership that will work with Congress to obtain legislative relief and adequate funding to further improve the efficiencies of the HCFA. The task of making the HCFA more user friendly for patients and health care providers alike would not be that great under a dedicated administrative-legislative partnership. Instead, Mr. Scully is intending to use our Medicare dollars to support his friends in the managed care industry, patients and providers be damned.

The New York Times
June 5, 2001
by Robert Pear

“A top federal official said today that the Bush administration would try to double the enrollment of Medicare beneficiaries in health maintenance organizations within four years.”

Thomas A. Scully, newly appointed administrator of the Health Care Financing Administration:

“The government is better in the long run when it’s a buyer of insurance, rather than an insurer.”

Comment: Unfortunately, this is not a mere rhetorical statement. It is a blatant lie, and Mr. Scully knows that. Although not without its problems, the HCFA has been much more efficient than the HMOs in the administration of health care coverage. GAO studies have confirmed this. What the HCFA needs now is leadership that will work with Congress to obtain legislative relief and adequate funding to further improve the efficiencies of the HCFA. The task of making the HCFA more user friendly for patients and health care providers alike would not be that great under a dedicated administrative-legislative partnership. Instead, Mr. Scully is intending to use our Medicare dollars to support his friends in the managed care industry, patients and providers be damned.

amednews.com
(A publication of the American Medical Association)
June 11, 2001
Opinion

By Eric Anderson, M.D., AMNews contributor

Eric Anderson, M.D.:

“Originally a British-trained physician bitterly opposed to socialized medicine, I have actually come to the opinion that America now needs a single-payer system for health care.”

http://www.ama-assn.org/sci-pubs/amnews/amn_01/edca0611.htm

The Washington Post
June 1, 2001

By Ceci Connolly

Steven A. Schroeder, M.D., President and CEO of The Robert Wood Johnson Foundation:

“What we discovered was that six out of ten parents whose children qualified for CHIP or Medicaid didn’t think they were eligible.”

“He then hired ad makers at GMMB for a $48 million promotional campaign that used the power of television and the creativity of grass-roots groups to reel in new participants.”

Comment: It is ironic that a large advertising budget is deemed to be required to sell a program of public insurance. Yet, it will be impossible to enroll every eligible child because of other obstacles, including access to the enrollment process for the eligible, the stigma of a program that smacks of welfare (income eligibility standards), difficulties in re-accessing the process for continued enrollment, premiums that are perceived to be unaffordable for those with no disposable income, changing eligibility because of changing family income levels, and isolated incidences of bureaucratic sloth, amongst other problems. At best, all efforts to increase enrollment can only raise the threshold of the steady state of enrollment, that is, raising the level at which those exiting the program equate to new enrollees. The only way to be sure that all children are enrolled, not to mention their parents, is to make insurance truly universal and truly permanent for life. We lack only the political will to adopt the moral imperative: publicly-administered, universal health insurance with everybody in, nobody out. Let’s work on creating that will.

The New York Times
May 25, 2001

By Milt Freudenheim

“As costs rise, some economists said, the growing unhappiness could stoke popular demand for political solutions, and even revive interest in a national single-payer health system like Canada’s.

“‘In 1991 and 1992, the last time a business slowdown coincided with double-digit inflation in health costs, people started to talk about universal health coverage,’ recalled Uwe Reinhardt, a Princeton university economist. Instead, employers placed their faith in managed care.”

http://www.nytimes.com/2001/05/25/business/25COST.html

Comment: Managed care is losing its clout, and the plans are resembling the indemnity coverage of years past. This quasi-indemnity model is returning us to double digit inflation in health care. The current movement toward “enabling empowered consumers” will compound the problems of of impaired access due to the inevitability of inadequate, flawed coverage. All other paths create so many problems that we are left solely with the logic of a universal health program to solve our problems in health care. We’ve been in denial long enough. Let’s now move forward with rational reform.

** PLEASE READ THIS ONE ** This is an important quote about the direction in which our health care system is headed.

JAMA May 23/30, 2001

By James C. Robinson, Ph.D., Associate Professor of Health Care Economics, University of California, Berkeley

“The consumer era in health care is emerging due to the rejection of governmental, corporate, and professional dominance rather than due to a judicious evaluation of the alternative.”

“Four problems will plague a consumer-driven health care system. First, despite the widespread dissemination of information, consumers will face significant obstacles in understanding the quality and even the true price of health insurance and health care services. Variations in utilization, cost, and outcomes challenge the analytical capabilities of governmental, corporate, insurer, and physician organizations and are daunting even for the most sophisticated and Internet-enabled consumer. Second, consumers vary enormously in their financial, cognitive, and cultural preparedness to navigate the complex health care system. The new paradigm fits most comfortably the educated, assertive and prosperous and least comfortably the impoverished, meek, and poorly educated. Third, the consumer era will complicate the pooling of insurance risk between consistently healthy citizens and those who are chronically ill. Risk-adjusted subsidies by government and employers can foster risk-spreading, but the requisite actuarial methods are only embryonic. Finally, the emerging era will make transparent and render difficult the redistribution of income from rich to poor that otherwise results from the collective purchasing and administration of health insurance. The proliferation of insurance products and physician networks likely will accentuate the contemporary allocation of care based on ability to pay, partially mitigated through tax exemptions and refundable tax credits.”

Comment: Perhaps the most appropriate comment is that of the author, James Robinson, in a May 23 Reuters release, “If all the good people got together and designed a health care system, they wouldn’t design the health care system that we’re heading towards.”

April 19, 2001
Keynote Address by Professor Regina Herzlinger, Harvard Business School
“A Force for Innovation, Consumers Taking Charge of Their Health Care”

“Harvard University Professor Regina Herzlinger, the author of ‘Consumer-Driven Health Care’ and other books on America’s health care marketplace, predicts consumers exercising personal choice – not employers or managed care companies – will create dramatic change in the health care marketplace of the future.”

Audience Question:

“With a consumer driven model, a lot of people are concerned that folks who are healthy will elect into the lower cost options leaving the cost of care to the folks with the most chronic conditions and sometimes to the people who can afford it the least.”

Professor Regina Herzlinger:

“…. What happens in the individual market in a risk adjusted… the community rating systems end up in a death spiral. It there’s a community rated system there’s a great incentive for anybody whose costs are lower than the community average to get the hell out of that system. So ultimately it becomes a very expensive system because the people who are left in it are only the very sick. Doesn’t it make more sense to price the sick accurately and to price the well accurately right from the start and to provide more subsidies for the sick and fewer subsidies for the well and to get the incentives lined up the right way?”

http://www.bhcag.com/herzlinger_speech.pdf

Comment: The Buyers Health Care Action Group (BHCAG) has become the glamour boy of advocates that support utilizing “empowered consumers” in the marketplace to control costs and improve quality in health care. Although we share their goals of cost containment and quality improvement, their methods can only be disastrous for those with the greatest health care needs. Individuals active in the health care reform movement should be aware of this organization, and be prepared to respond to their defective proposals (www.bhcag.com). (Also, some of their concepts on quality improvement and improving efficiency may have some merit, although they are flawed in assuming that solutions should be limited to control by market forces.)

The extent to which marketplace advocates manipulate policy theory for the purpose of preserving our very sick system of pseudo-free market medicine is astonishing, considering that we could solve most of the problems of access, coverage, quality, and cost containment, by adopting the moral imperative, a publicly-administered risk pool with everybody in and nobody out.

amednews.com
May 28, 2001

Richard Corlin, M.D., President-elect of the American Medical Association:

“First, last and always is dealing with the 43 million uninsured. That is simply a stain on our national fabric, if you will, that we have got to erase.”

http://www.ama-assn.org/sci-pubs/amnews/pick_01/prsa0528.htm

Comment: Now if the AMA can only get the policy right.