PNHP

Can we learn from Rawanda?

Can we learn from Rawanda?

In Rwanda, Health Care Coverage That Eludes the U.S.

By Tina Rosenberg
The New York Times, July 3, 2012

Last week’s Supreme Court decision upholding of the constitutionality of President Obama’s health care law moves the United States closer to the goal of health coverage for all. All other developed countries have it. But so do some developing nations — Brazil, Thailand, Chile. These countries are mostly middle income. But one country on the list is among the poorest of the poor: Rwanda.

The point is not that Americans should envy Rwanda’s health system — far from it. But Rwanda’s experience illustrates the value of universal health insurance.  “Its health gains in the last decade are among the most dramatic the world has seen in the last 50 years,” said Peter Drobac, the director in Rwanda for the Boston-based Partners in Health, which works extensively with the Rwandan health system.

It couldn’t have happened without health insurance.

Rwanda is known, of course, for the 1994 genocide that killed 800,000 Tutsi and moderate Hutu. Since 1994, the country has been ruled by Paul Kagame, at first as de facto leader and, since 2000, as president.  Kagame runs a repressive regime that equates criticism with treason; opposition journalists or politicians in Rwanda have disappeared or died mysteriously.

But Kagame is also widely admired as the most effective leader in Africa. A country in ashes 18 years ago is now safe and clean. It is one of the least corrupt countries in Africa. Per capita income has tripled — although the fact that it is now only $550 a year tells you how destitute Rwanda was.

Its most impressive gains, however, have been in health. AIDS has been cutting life expectancies in Africa and is widespread in Rwanda. Yet life expectancy at birth in Rwanda has increased from 48 to 58 — in the last 10 years. Deaths of children under 5 have dropped by half in five years; malaria deaths have dropped by roughly two-thirds. “Of all countries in Africa Rwanda is probably getting the closest to having health for all, health access for all,” said Josh Ruxin, a longtime resident of Rwanda who is the founder of the Access Project, a Rwandan-run health program.

One key reason that Rwandans are so much healthier today is the spread of health insurance.  In 1999, Rwanda’s health facilities sat unused, as the vast majority of people couldn’t afford them.   In response, the Health Ministry began a pilot project of health insurance in three districts.   In 2004, the program began to spread across the nation.   Now health insurance — called Mutuelle de Santé — is nearly universal. Andrew Makaka, who manages the health financing unit at the Ministry of Health, said that only 4 percent of Rwandans are uninsured. 

In most poor countries — and in the United States — health disasters are a leading cause of a family’s decline into poverty, but not for Rwandans. “It gives relief to people knowing that if you get sick, you don’t need to have a lot of money,” said Dr. Agnes Binagwaho, Rwanda’s health minister. “It gives you psychological stability so you can concentrate on something else. The money can be used for other things — this is very important in trying to stimulate economic development.”

“You can bring on all the diagnostic services, new technologies and specialties,” said Drobac. “But if those things can’t reach people in need, what’s the point?”

We could ask the same thing in the United States.  Rwanda, starting from nothing, decided to build a health system that includes everyone.  And it found economic value, alongside human value, in doing so.  Now we can get started.

http://opinionator.blogs.nytimes.com/2012/07/03/rwandas-health-care-miracle/

Comment:  

By Don McCanne, MD

Rawanda, one of the poorest nations in the world, has seen a dramatic improvement in the health of their people since the establishment of their near-universal health insurance program, Mutuelle de Santé, covering all but 4 percent of their population.

After the Affordable Care Act is fully implemented in the United States, over 8 percent of our population will still be uninsured – over twice the percentage of Rawanda’s uninsured. Shouldn’t we be ashamed? We know how to do better than that; we just have to do it.

Can we learn from Rawanda?

In Rwanda, Health Care Coverage That Eludes the U.S.

By Tina Rosenberg
The New York Times, July 3, 2012
Last week’s Supreme Court decision upholding of the constitutionality of President Obama’s health care law moves the United States closer to the goal of health coverage for all. All other developed countries have it. But so do some developing nations — Brazil, Thailand, Chile. These countries are mostly middle income. But one country on the list is among the poorest of the poor: Rwanda.
The point is not that Americans should envy Rwanda’s health system — far from it. But Rwanda’s experience illustrates the value of universal health insurance.  “Its health gains in the last decade are among the most dramatic the world has seen in the last 50 years,” said Peter Drobac, the director in Rwanda for the Boston-based Partners in Health, which works extensively with the Rwandan health system.
It couldn’t have happened without health insurance.
Rwanda is known, of course, for the 1994 genocide that killed 800,000 Tutsi and moderate Hutu. Since 1994, the country has been ruled by Paul Kagame, at first as de facto leader and, since 2000, as president.  Kagame runs a repressive regime that equates criticism with treason; opposition journalists or politicians in Rwanda have disappeared or died mysteriously.
But Kagame is also widely admired as the most effective leader in Africa. A country in ashes 18 years ago is now safe and clean. It is one of the least corrupt countries in Africa. Per capita income has tripled — although the fact that it is now only $550 a year tells you how destitute Rwanda was.
Its most impressive gains, however, have been in health. AIDS has been cutting life expectancies in Africa and is widespread in Rwanda. Yet life expectancy at birth in Rwanda has increased from 48 to 58 — in the last 10 years. Deaths of children under 5 have dropped by half in five years; malaria deaths have dropped by roughly two-thirds. “Of all countries in Africa Rwanda is probably getting the closest to having health for all, health access for all,” said Josh Ruxin, a longtime resident of Rwanda who is the founder of the Access Project, a Rwandan-run health program.
One key reason that Rwandans are so much healthier today is the spread of health insurance.  In 1999, Rwanda’s health facilities sat unused, as the vast majority of people couldn’t afford them.   In response, the Health Ministry began a pilot project of health insurance in three districts.   In 2004, the program began to spread across the nation.   Now health insurance — called Mutuelle de Santé — is nearly universal. Andrew Makaka, who manages the health financing unit at the Ministry of Health, said that only 4 percent of Rwandans are uninsured.
In most poor countries — and in the United States — health disasters are a leading cause of a family’s decline into poverty, but not for Rwandans. “It gives relief to people knowing that if you get sick, you don’t need to have a lot of money,” said Dr. Agnes Binagwaho, Rwanda’s health minister. “It gives you psychological stability so you can concentrate on something else. The money can be used for other things — this is very important in trying to stimulate economic development.”
“You can bring on all the diagnostic services, new technologies and specialties,” said Drobac. “But if those things can’t reach people in need, what’s the point?”
We could ask the same thing in the United States.  Rwanda, starting from nothing, decided to build a health system that includes everyone.  And it found economic value, alongside human value, in doing so.  Now we can get started.
http://opinionator.blogs.nytimes.com/2012/07/03/rwandas-health-care-miracle/

Rawanda, one of the poorest nations in the world, has seen a dramatic improvement in the health of their people since the establishment of their near-universal health insurance program, Mutuelle de Santé, covering all but 4 percent of their population.
After the Affordable Care Act is fully implemented in the United States, over 8 percent of our population will still be uninsured – over twice the percentage of Rawanda’s uninsured. Shouldn’t we be ashamed? We know how to do better than that; we just have to do it.

Canada's medicare at 50 years: It's part of us

By Roy Romanow
Globe and Mail, July 2, 2012

July 1, the birthdate of our great nation, is also the birthdate of Canada’s emblematic health-care system. And this weekend we celebrated the 50th anniversary of the introduction of medicare in Saskatchewan. Now often referred to as unsustainable, this milestone provides an opportunity to reflect on the hard fought accomplishments of the past, to re-evaluate today’s system and to consider the growing debate about its future.

Until 50 years ago, Canada’s health-care system was based on the private, for-profit model. Patients individually paid for the services of medical professionals and hospitals. Often, those who could not afford health care did not receive it, and even some who could did so by deferring treatment, hoping to save their family budget. Since then we have built a national system, lauded around the world, that allows us all access to high-quality care.

The achievement of universal health care took a long, acrimonious and protracted road. It is no surprise to me that Saskatchewan was at the forefront of this journey. The province’s citizens learned many hard lessons during the desperation of the Great Depression and the sacrifices of the Second World War. They learned about generosity, about hardship and fairness, about boom and bust. They learned about the imperative for co-operative action. They came to understand that the notion of shared destiny was key to our existence.

And so it is with other regions in Canada, where geography and demographics may vary, where many waves of immigration began with an initial sense of isolation, but where we all learned to see survival and progress as a test of our ongoing ability to come together and to remain united around shared values.

Canada’s history offers a strong and rich legacy of success that has forged our country. It is this legacy of a shared destiny that is key to understanding our young but dynamic history. Today, as we find ourselves living in complicated times, I believe it is this same legacy that remains the road map to our future, at home and abroad.

Before we give in to despair around the present-day mantra that our system is unsustainable, there are a few things we must consider. First, a universal, single-payer, public insurance model is both less costly and produces better population health outcomes than multipayer systems like the one that exists in the United States. This has been proven time and time again by study after study. Questions of sustainability can never be successfully addressed by moving incrementally backward to a private, for-profit model, at least not the sustainability of a system that remains accessible to all of us.

Second, if our political leaders are genuine in their desire to rein in health costs while maintaining a system for all of us, our task is clear, if not without difficulties. We must lay the groundwork for including catastrophic drug costs and bringing aspects of home care, long-term care and access to advanced diagnostic services into our not-for-profit system. Otherwise, costs will continue to escalate – without restraint and with relentless abandonment of those in need.

Third, we must also recognize that the well-being of our citizenry goes beyond health care; it is dependent on preventing illness and tackling the more fundamental barriers to good health, including social, economic and environmental factors. How we treat the environment has a direct impact on our health and the longevity of a sustainable economy. The growing gap between the rich and poor directly affects our health and the fiscal demands on our health-care system.

Every day, Canada faces new challenges that prompt key questions about what kind of people we are and what kind of future we wish to shape.

As we celebrate the birth of our nation and of medicare, we must ask ourselves: What kind of Canada do we want? Because, as I see it, the choice Canadians make about health care is fundamentally intertwined with our values and future.

Roy J. Romanow is co-chair of the Canadian Index of Wellbeing advisory board and a former commissioner of the Royal Commission on the Future of Health Care in Canada.

http://www.theglobeandmail.com/commentary/medicare-is-part-of-us/article4380858/

Canada’s medicare at 50 years: It’s part of us

By Roy Romanow
Globe and Mail, July 2, 2012

July 1, the birthdate of our great nation, is also the birthdate of Canada’s emblematic health-care system. And this weekend we celebrated the 50th anniversary of the introduction of medicare in Saskatchewan. Now often referred to as unsustainable, this milestone provides an opportunity to reflect on the hard fought accomplishments of the past, to re-evaluate today’s system and to consider the growing debate about its future.

Until 50 years ago, Canada’s health-care system was based on the private, for-profit model. Patients individually paid for the services of medical professionals and hospitals. Often, those who could not afford health care did not receive it, and even some who could did so by deferring treatment, hoping to save their family budget. Since then we have built a national system, lauded around the world, that allows us all access to high-quality care.

The achievement of universal health care took a long, acrimonious and protracted road. It is no surprise to me that Saskatchewan was at the forefront of this journey. The province’s citizens learned many hard lessons during the desperation of the Great Depression and the sacrifices of the Second World War. They learned about generosity, about hardship and fairness, about boom and bust. They learned about the imperative for co-operative action. They came to understand that the notion of shared destiny was key to our existence.

And so it is with other regions in Canada, where geography and demographics may vary, where many waves of immigration began with an initial sense of isolation, but where we all learned to see survival and progress as a test of our ongoing ability to come together and to remain united around shared values.

Canada’s history offers a strong and rich legacy of success that has forged our country. It is this legacy of a shared destiny that is key to understanding our young but dynamic history. Today, as we find ourselves living in complicated times, I believe it is this same legacy that remains the road map to our future, at home and abroad.

Before we give in to despair around the present-day mantra that our system is unsustainable, there are a few things we must consider. First, a universal, single-payer, public insurance model is both less costly and produces better population health outcomes than multipayer systems like the one that exists in the United States. This has been proven time and time again by study after study. Questions of sustainability can never be successfully addressed by moving incrementally backward to a private, for-profit model, at least not the sustainability of a system that remains accessible to all of us.

Second, if our political leaders are genuine in their desire to rein in health costs while maintaining a system for all of us, our task is clear, if not without difficulties. We must lay the groundwork for including catastrophic drug costs and bringing aspects of home care, long-term care and access to advanced diagnostic services into our not-for-profit system. Otherwise, costs will continue to escalate – without restraint and with relentless abandonment of those in need.

Third, we must also recognize that the well-being of our citizenry goes beyond health care; it is dependent on preventing illness and tackling the more fundamental barriers to good health, including social, economic and environmental factors. How we treat the environment has a direct impact on our health and the longevity of a sustainable economy. The growing gap between the rich and poor directly affects our health and the fiscal demands on our health-care system.

Every day, Canada faces new challenges that prompt key questions about what kind of people we are and what kind of future we wish to shape.

As we celebrate the birth of our nation and of medicare, we must ask ourselves: What kind of Canada do we want? Because, as I see it, the choice Canadians make about health care is fundamentally intertwined with our values and future.

Roy J. Romanow is co-chair of the Canadian Index of Wellbeing advisory board and a former commissioner of the Royal Commission on the Future of Health Care in Canada.

http://www.theglobeandmail.com/commentary/medicare-is-part-of-us/article4380858/

Translating the insurance industry's feel-good rhetoric

By Wendell Potter
iWatch News, July 2, 2012

Health insurers avoided their worst case scenario last week — the prospect of the Supreme Court striking down the individual mandate but letting the rest of the health care law, especially profit-threatening consumer protections, go forward. Now the industry can focus on a goal it has had all along: getting rid of those pesky consumer protections.

That goal was clear to me from the reaction statement issued by America’s Health Insurance Plans. The statement was jam-packed with feel-good phrases like “secure and affordable,” “peace of mind,” and “choice and competition.” Allow me to provide an interpretation of what AHIP, the industry’s biggest PR and lobbying group, was really saying and really planning. After twenty years as an industry PR guy, I’m all too familiar with prose written to obscure intentions.

Sentence by sentence, here’s what AHIP’s communications people crafted as soon as they realized the industry would not have to go nuclear to wipe out ObamaCare — that instead, it could conduct a stealth ground war to get rid of everything in the law that might threaten profits.

“Individuals and families need secure, affordable coverage choices. Maintaining the link between market reforms and universal coverage is essential to avoiding significant cost increases and loss of choice for consumers and employers.”

Translation: “Whew! Thank you, Chief Justice Roberts. We can now shelve the campaign we were poised to launch to convince people why the consumer protections in the law won’t work without the mandate. We won’t have to squander resources on that effort. Now we can devote our war chest to helping elect candidates willing to use our talking points and vote the way we tell them to vote — and to persuading people to believe the consumer protections are not in their best interests after all. The mandate will work best for us when they’re all gone.”

Next sentence: “As the reform law is implemented, health plans will continue to focus on promoting affordability and peace of mind for their beneficiaries.”

Translation: “We are masters at stringing together words that test especially well in focus groups, even if they have little or nothing to do with the way we really conduct business. ‘Affordability and peace of mind’ sound great, don’t they? So trust us. Just don’t look at our track record.”

And so on: “The law expands coverage to millions of Americans, a goal health plans have long supported, but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed.”

Translation: “First off, we want you to suspend disbelief for a moment and forget that if health plans really cared a whit about expanding coverage, they would have ended their routine practices of refusing to sell coverage to people with preexisting conditions and charging exorbitant rates years ago. That’s why 50 million Americans are uninsured. As for that premium tax, even though we stand to gain billions every year because of the individual mandate and the subsidies the government will provide to help low-income families pay their premiums, we don’t want to give up a dime of those billions to help the government pay for the expanded coverage we’ve been in favor of for so long. So we’ll have a campaign designed to mislead people into thinking that their premiums will have to increase and that their coverage might somehow have to be disrupted as a result of the tax. We’d love to be able to say that we are so grateful for the billions in new revenue that we will agree not to pass the tax along to our customers. We’d love to say that, we’d even consider doing it — if only our shareholders would let us.”

Wait, there’s more: “Health plans will continue to work with policymakers on both sides of the aisle to make coverage more affordable, give families and employers peace of mind, and promote choice and competition. Health plans also will continue to lead efforts to reform the payment and delivery system to promote prevention and wellness, help patients and physicians manage chronic disease, and reward quality care.”

Translation: “We have Democrats as well as Republicans in our pocket. And look how we’ve worked in ‘affordable’ and ‘peace of mind’ into our little statement again. Aren’t we good at this? And we know ‘choice’ and ‘competition’ are two words that test especially well. So well, in fact, that we and our allies named one of the front groups we set up a few months ago, the one we’re using to try to control how the state health insurance exchanges operate, the ‘Choice and Competition Coalition.’ And instead of focusing on how we can — and do — get between you and your doctor whenever we want to, please suspend disbelief once again and just think of us as your doctor’s helper. Doctors don’t know best, silly. We do. So trust us.”

Expect to hear all of these buzzwords and phrases coming out of the mouths of the industry’s friends in politics, business and the media in the coming months — over and over and over again. The coming war will be a war of words, a war of messaging.

Next week I’ll provide a more detailed list of the other provisions of the law the insurers have their sights on, along with some of the talking points they’ll be deploying to try to take them out.

Wendell Potter is a former CIGNA executive-turned-whistleblower who writes about the health care industry and the ongoing battle for health reform. He is the author of “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans.”

http://www.iwatchnews.org/2012/07/02/9249/opinion-translating-insurance-industrys-feel-good-rhetoric

Translating the insurance industry’s feel-good rhetoric

By Wendell Potter
iWatch News, July 2, 2012

Health insurers avoided their worst case scenario last week — the prospect of the Supreme Court striking down the individual mandate but letting the rest of the health care law, especially profit-threatening consumer protections, go forward. Now the industry can focus on a goal it has had all along: getting rid of those pesky consumer protections.

That goal was clear to me from the reaction statement issued by America’s Health Insurance Plans. The statement was jam-packed with feel-good phrases like “secure and affordable,” “peace of mind,” and “choice and competition.” Allow me to provide an interpretation of what AHIP, the industry’s biggest PR and lobbying group, was really saying and really planning. After twenty years as an industry PR guy, I’m all too familiar with prose written to obscure intentions.

Sentence by sentence, here’s what AHIP’s communications people crafted as soon as they realized the industry would not have to go nuclear to wipe out ObamaCare — that instead, it could conduct a stealth ground war to get rid of everything in the law that might threaten profits.

“Individuals and families need secure, affordable coverage choices. Maintaining the link between market reforms and universal coverage is essential to avoiding significant cost increases and loss of choice for consumers and employers.”

Translation: “Whew! Thank you, Chief Justice Roberts. We can now shelve the campaign we were poised to launch to convince people why the consumer protections in the law won’t work without the mandate. We won’t have to squander resources on that effort. Now we can devote our war chest to helping elect candidates willing to use our talking points and vote the way we tell them to vote — and to persuading people to believe the consumer protections are not in their best interests after all. The mandate will work best for us when they’re all gone.”

Next sentence: “As the reform law is implemented, health plans will continue to focus on promoting affordability and peace of mind for their beneficiaries.”

Translation: “We are masters at stringing together words that test especially well in focus groups, even if they have little or nothing to do with the way we really conduct business. ‘Affordability and peace of mind’ sound great, don’t they? So trust us. Just don’t look at our track record.”

And so on: “The law expands coverage to millions of Americans, a goal health plans have long supported, but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed.”

Translation: “First off, we want you to suspend disbelief for a moment and forget that if health plans really cared a whit about expanding coverage, they would have ended their routine practices of refusing to sell coverage to people with preexisting conditions and charging exorbitant rates years ago. That’s why 50 million Americans are uninsured. As for that premium tax, even though we stand to gain billions every year because of the individual mandate and the subsidies the government will provide to help low-income families pay their premiums, we don’t want to give up a dime of those billions to help the government pay for the expanded coverage we’ve been in favor of for so long. So we’ll have a campaign designed to mislead people into thinking that their premiums will have to increase and that their coverage might somehow have to be disrupted as a result of the tax. We’d love to be able to say that we are so grateful for the billions in new revenue that we will agree not to pass the tax along to our customers. We’d love to say that, we’d even consider doing it — if only our shareholders would let us.”

Wait, there’s more: “Health plans will continue to work with policymakers on both sides of the aisle to make coverage more affordable, give families and employers peace of mind, and promote choice and competition. Health plans also will continue to lead efforts to reform the payment and delivery system to promote prevention and wellness, help patients and physicians manage chronic disease, and reward quality care.”

Translation: “We have Democrats as well as Republicans in our pocket. And look how we’ve worked in ‘affordable’ and ‘peace of mind’ into our little statement again. Aren’t we good at this? And we know ‘choice’ and ‘competition’ are two words that test especially well. So well, in fact, that we and our allies named one of the front groups we set up a few months ago, the one we’re using to try to control how the state health insurance exchanges operate, the ‘Choice and Competition Coalition.’ And instead of focusing on how we can — and do — get between you and your doctor whenever we want to, please suspend disbelief once again and just think of us as your doctor’s helper. Doctors don’t know best, silly. We do. So trust us.”

Expect to hear all of these buzzwords and phrases coming out of the mouths of the industry’s friends in politics, business and the media in the coming months — over and over and over again. The coming war will be a war of words, a war of messaging.

Next week I’ll provide a more detailed list of the other provisions of the law the insurers have their sights on, along with some of the talking points they’ll be deploying to try to take them out.

Wendell Potter is a former CIGNA executive-turned-whistleblower who writes about the health care industry and the ongoing battle for health reform. He is the author of “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans.”

http://www.iwatchnews.org/2012/07/02/9249/opinion-translating-insurance-industrys-feel-good-rhetoric

OECD 2012 Economic Survey of the United States

The United States needs to foster education and innovation to keep its cutting edge

OECD Economic Surveys: United States 2012
OECD, June 26, 2012

Particularly worrying is the performance in education, which is essential to provide workers with the skills necessary to become more productive and to adapt to technological change. Attainment in tertiary education stagnated over the past three decades while it grew significantly in almost every other OECD country. Today, 22 out of 30 OECD countries surveyed have more graduates in science and engineering among the 25 to 34 year old workers than the United States.

To prevent long-term unemployment from becoming chronic, the Survey suggests a greater focus on “active” labor market programs that help to facilitate job search and guide individuals towards training and education. These measures have proven to be effective even during periods of high unemployment and should complement existing “passive” benefit programs. The United States spends very little on activation policies relative to other OECD countries.

The Survey also highlights rising income inequality in the United States. The trend owes mainly to rising skill premiums and disproportionate income growth for top earners over the past two decades. High income inequality is also associated with low intergenerational social mobility. Children born to low-income parents in the U.S. find it more difficult to move up the social ladder than in most European OECD countries.

Providing equal access to high-quality elementary and secondary education is essential to addressing this challenge. The Survey also notes that the U.S. tax and benefits system is much less effective in reducing relative poverty than that of other OECD countries. This is largely the result of the limited and poorly targeted financial transfers to low-income households.

http://www.oecd.org/document/59/0,3746,en_21571361_44315115_50653435_1_1_1_1,00.html

OECD Economic Surveys: United States 2012 (122 pages)
http://www.keepeek.com/Digital-Asset-Management/oecd/economics/oecd-economic-surveys-united-states-2012_eco_surveys-usa-2012-en

Comment: 

By Don McCanne, MD

So what does an economic survey of the United States have to do with health care? Simply that we cannot expect to have a superior health care system that serves everyone well if we don’t fulfill our citizen obligation to demand greater government oversight and intervention in education, employment, and especially in the intolerable rise in income inequality. Current trends in the United States are not encouraging.

Trying to fix health care alone without addressing our other serious economic deficiencies offers little hope of bringing to all of us a truly high performance  health care system. The Affordable Care Act, by establishing a standard of low actuarial value plans with excessive financial barriers to care will not enable the masses to have the same access to high quality care that the more affluent members of our society experience.

Why are we focusing on austerity when our potential is so great? We should reject political leaders who would foster yet more austerity. We need leaders who understand the importance of education, employment, and more equitable income distribution. That’s not only good for our economy, it’s good for our health as well.

America's health care problems were not fixed by Affordable Care Act

By Ed Weisbart, M.D.
St. Louis Post-Dispatch, July 3, 2012

Many of my patients will benefit from the Affordable Care Act: A 25-year-old with sickle cell disease can keep his insurance. A 32-year-old mother can get contraception. And a 47-year-old hemophiliac doesn’t have to worry about being too sick for health insurance. I’m celebrating these things and others.

But now is not the time to breathe a sigh of relief. We haven’t fixed the crisis in health care. And we won’t, as long as our health care system remains dominated by private insurance companies.

Insurance companies limit our choices of doctors, drive Americans into bankruptcy and shorten our lives. None of this is necessary if we’d just improve Medicare and give it to all Americans. Our broken system is even deadlier if you’re poor. Now that it’s optional, our state House leadership has declared that it is not going to expand the roles of Medicaid, even with the federal government paying for it (“Medicaid expansion? Missouri GOP balking,” July 1).

This means that 300,000 of our friends and family members will not get even the minimal access to health care that Medicaid provides. Aside from being morally repugnant, we all pay for their strokes instead of their blood pressure pills. Those pills are cheap; recovering from a stroke is not. We need to demand our legislators expand Medicaid as provided under the ACA. We can save even more lives and money by fixing Medicare and providing it to all Americans. This isn’t about politics; it’s about our lives.

Dr. Ed Weisbart is a member of Physicians for a National Health Program – St. Louis. He resides in Olivette.

Read more: http://www.stltoday.com/news/opinion/mailbag/letters-to-the-editor-july/article_f0e5d9b8-aea1-5332-a8d3-dcb8edadf69e.html#ixzz1zZBXIQeH

America’s health care problems were not fixed by Affordable Care Act

By Ed Weisbart, M.D.
St. Louis Post-Dispatch, July 3, 2012

Many of my patients will benefit from the Affordable Care Act: A 25-year-old with sickle cell disease can keep his insurance. A 32-year-old mother can get contraception. And a 47-year-old hemophiliac doesn’t have to worry about being too sick for health insurance. I’m celebrating these things and others.

But now is not the time to breathe a sigh of relief. We haven’t fixed the crisis in health care. And we won’t, as long as our health care system remains dominated by private insurance companies.

Insurance companies limit our choices of doctors, drive Americans into bankruptcy and shorten our lives. None of this is necessary if we’d just improve Medicare and give it to all Americans. Our broken system is even deadlier if you’re poor. Now that it’s optional, our state House leadership has declared that it is not going to expand the roles of Medicaid, even with the federal government paying for it (“Medicaid expansion? Missouri GOP balking,” July 1).

This means that 300,000 of our friends and family members will not get even the minimal access to health care that Medicaid provides. Aside from being morally repugnant, we all pay for their strokes instead of their blood pressure pills. Those pills are cheap; recovering from a stroke is not. We need to demand our legislators expand Medicaid as provided under the ACA. We can save even more lives and money by fixing Medicare and providing it to all Americans. This isn’t about politics; it’s about our lives.

Dr. Ed Weisbart is a member of Physicians for a National Health Program – St. Louis. He resides in Olivette.

Read more: http://www.stltoday.com/news/opinion/mailbag/letters-to-the-editor-july/article_f0e5d9b8-aea1-5332-a8d3-dcb8edadf69e.html#ixzz1zZBXIQeH

The Affordable Care Act ruling won't heal our ailing health system

By Margaret Flowers, M.D.
Yubanet.com, July 2, 2012

As a physician, I find it very odd that the debate over the Affordable Care Act has focused on the effect the law will have on the presidential election rather than the impact it will have on patients, health professionals, and health outcomes.

The Supreme Court case reinvigorated debate over the Obama administration’s 2010 health care reform law. But we’re still getting partisan talking points instead of an honest review of the changes that are in store. This will likely worsen as we get closer to Election Day.

The new law is based on concepts developed by the Heritage Foundation, a conservative think tank. Republican presidential candidate Mitt Romney passed a very similar law for his state when he was the governor of Massachusetts. So while most Democrats are celebrating the Supreme Court decision to uphold the Affordable Care Act and Romney is saying he’d repeal it, consider this: Had a Republican passed this federal law, we would have the opposite situation.

Let’s put politics aside and look at the law from a policy standpoint. The big winners of the Supreme Court decision are the corporations who are profiting from the current health system — private health insurers, pharmaceutical companies, and corporate-owned hospitals and medical practices.

The Court has deemed it constitutional for the government to require people to spend up to 9 percent of their income to purchase private insurance despite it being a defective product. People with insurance continue to face financial barriers to care. They delay and avoid necessary care because of the cost of co-pays and deductibles.

When patients have a serious medical condition, they risk financial ruin. Illness and soaring medical costs are the greatest causes of bankruptcy in the United States, even though four out of five people experiencing medical bankruptcy have health insurance. Purchasing private insurance is going to be subsidized with taxpayer dollars. It will cost Uncle Sam an estimated half a trillion dollars between 2014 and 2019 to pay that tab, according to the Congressional Budget Office. The insurance mandate and these subsidies will create corporate welfare on steroids.

What will the insurance companies do with all that money? They’ll hold onto as much as they can by denying and restricting payment for care. And they’ll use those dollars to weaken regulations meant to protect patients.

When national health care reform is fully implemented in 2019, 26 million people will still lack coverage. And health costs will continue to rise because the law lacks proven cost controls.

While the law does include a few positive provisions, it won’t stop the deterioration of our health care system. We’ll continue to see unnecessary suffering and preventable death. This is unacceptable when we are already spending nearly twice as much per person on care each year as other industrialized nations with universal health systems and much better health outcomes.

The truth is that we can solve our health care crisis. The fastest way to accomplish this is to drop just two words from the Medicare Act — “over 65” — and immediately expand Medicare to every person. That would create a system that’s about health care, not corporate profits. A universal Medicare system would control costs and improve the quality of patient care.

Let’s demand Medicare for all now. The longer we wait, the more people will suffer and die needlessly.

Dr. Margaret Flowers is a pediatrician from Baltimore and co-director of ItsOurEconomy.US. Distributed via OtherWords (OtherWords.org).

http://yubanet.com/opinions/Margaret-Flowers-The-Affordable-Care-Act-ruling-won-t-heal-our-ailing-health-system.php#.T_IGv5GBq1c

The Affordable Care Act ruling won’t heal our ailing health system

By Margaret Flowers, M.D.
Yubanet.com, July 2, 2012

As a physician, I find it very odd that the debate over the Affordable Care Act has focused on the effect the law will have on the presidential election rather than the impact it will have on patients, health professionals, and health outcomes.

The Supreme Court case reinvigorated debate over the Obama administration’s 2010 health care reform law. But we’re still getting partisan talking points instead of an honest review of the changes that are in store. This will likely worsen as we get closer to Election Day.

The new law is based on concepts developed by the Heritage Foundation, a conservative think tank. Republican presidential candidate Mitt Romney passed a very similar law for his state when he was the governor of Massachusetts. So while most Democrats are celebrating the Supreme Court decision to uphold the Affordable Care Act and Romney is saying he’d repeal it, consider this: Had a Republican passed this federal law, we would have the opposite situation.

Let’s put politics aside and look at the law from a policy standpoint. The big winners of the Supreme Court decision are the corporations who are profiting from the current health system — private health insurers, pharmaceutical companies, and corporate-owned hospitals and medical practices.

The Court has deemed it constitutional for the government to require people to spend up to 9 percent of their income to purchase private insurance despite it being a defective product. People with insurance continue to face financial barriers to care. They delay and avoid necessary care because of the cost of co-pays and deductibles.

When patients have a serious medical condition, they risk financial ruin. Illness and soaring medical costs are the greatest causes of bankruptcy in the United States, even though four out of five people experiencing medical bankruptcy have health insurance. Purchasing private insurance is going to be subsidized with taxpayer dollars. It will cost Uncle Sam an estimated half a trillion dollars between 2014 and 2019 to pay that tab, according to the Congressional Budget Office. The insurance mandate and these subsidies will create corporate welfare on steroids.

What will the insurance companies do with all that money? They’ll hold onto as much as they can by denying and restricting payment for care. And they’ll use those dollars to weaken regulations meant to protect patients.

When national health care reform is fully implemented in 2019, 26 million people will still lack coverage. And health costs will continue to rise because the law lacks proven cost controls.

While the law does include a few positive provisions, it won’t stop the deterioration of our health care system. We’ll continue to see unnecessary suffering and preventable death. This is unacceptable when we are already spending nearly twice as much per person on care each year as other industrialized nations with universal health systems and much better health outcomes.

The truth is that we can solve our health care crisis. The fastest way to accomplish this is to drop just two words from the Medicare Act — “over 65” — and immediately expand Medicare to every person. That would create a system that’s about health care, not corporate profits. A universal Medicare system would control costs and improve the quality of patient care.

Let’s demand Medicare for all now. The longer we wait, the more people will suffer and die needlessly.

Dr. Margaret Flowers is a pediatrician from Baltimore and co-director of ItsOurEconomy.US. Distributed via OtherWords (OtherWords.org).

http://yubanet.com/opinions/Margaret-Flowers-The-Affordable-Care-Act-ruling-won-t-heal-our-ailing-health-system.php#.T_IGv5GBq1c

ObamaCare as Corporatists United

A Huge Bailout for Another Failing Industry

By Clark Newhall, M.D.
Counterpunch, June 29, 2012

In an eagerly anticipated opinion on the Patient Protection and Affordable Care Act, colloquially known as “Obamacare,” an unusual alignment of justices upheld the Act nearly entirely. The crucial part of the decision found the odd-bedfellows combination of Chief Justice Roberts joining the four “liberal” justices to uphold the “individual mandate,” the section of the law requiring all Americans to buy health insurance from private health insurance companies. The alignment is especially strange given the lengths to which Justice Roberts had to go to support his convoluted reasoning.

He accepted the argument that the individual mandate was unconstitutional as an exercise of the Commerce Clause because it required a commercial activity that had never hitherto existed, i.e. the purchase of health insurance by someone who had never purchased it. He accepted the argument that the individual mandate was unconstitutional as an exercise of the “Necessary and Reasonable” clause. And he rejected the argument that the payment of a penalty to the IRS by those who refused to comply with the individual mandate (“refuseniks”) was a “tax” subject to a law that says you first have to pay the tax before you can sue for a refund.

But then he turned about and found that the money that the IRS can take from a refusenik WAS a tax and NOT a penalty.  Under that reasoning, the “individual mandate” requiring everyone to buy health insurance from a private company becomes a “tax law” and therefore constitutional.

With this bizarre twisting of words, the Supreme Court has revealed the nature of 21st-century American political thought. Those who make, interpret and enforce the laws no longer lie on the “left-right” political continuum. Instead, they are in effect at right angles to that continuum.

The ideology that drives the Supreme Court, the political administration and the Congress is not Conservative or Liberal but can best be described as Corporatist. This is the ideology that affirms that “corporations are citizens, my friends.”  It is the ideology that drove the Roberts court to the odious Citizens United decision. It is the ideology behind a bailout for banks that are “too big to fail.” And it is the ideology that allows Congress to pass a law like the ACA that is essentially written by a favored industry.

The Corporatist ideology allows the Supreme Court to uphold the ACA despite the obvious and glaring consequence: forcing someone to buy health insurance is like forcing someone to buy a used Rambler — it’s a shoddy product at an inflated price, but you must pay a tax or swallow your anger and buy it from the smirking dealer down the street.

Why does Corporatism favor Obamacare?  Because Obamacare is nothing more than a huge bailout for another failing industry — the health insurance industry.

No health insurer could continue to raise premiums at the rate of two to three times inflation, as they have done for at least a decade. No health insurer could continue to pay $200 million-plus bonuses to top executives, as they have done repeatedly. No health insurer could continue to restrict Americans’ access to decent health care, in effect creating slow and silent “death panels.” No health insurer could do those things and survive.

But with the Obamacare act now firmly in place, health insurers will see a HUGE multibillion-dollar windfall in the form of 40 million or more new health insurance customers whose premiums are paid largely by government subsidies. That is the explanation for the numerous expansions and mergers you have seen in the health care industry in the past couple of years. You will see more of the same, and if you are a stock bettor, you would do well to buy stock in smaller health insurers, because they will be snapped up in a wave of consolidation that dwarfs anything yet seen in this country.

As I write this, I note that health industry stocks have taken a big jump on Wall Street.

What a surprise!

Clark Newhall, M.D., J.D., is executive director of Health Justice. Please reply to cnewhall@cnewhall.com.

http://www.counterpunch.org/2012/06/29/obamacare-as-corportists-united/