By Henry Chu
Los Angeles Times, June 13, 2011

LONDON — Two years ago, Britons were outraged when U.S. politicians like Sarah Palin, in the debate over healthcare reform, turned this country’s National Health Service into a public whipping boy, denouncing it as “evil,” “Orwellian” and generally the enemy of everything good and true.

It’s time for some payback.

Britain is now embroiled in a healthcare argument of its own, prompted by a proposed shake-up of the NHS. And the phrase on everyone’s lips is “American-style,” which may not be as catchy as the “death panels” that Palin attributed to socialized medicine but which, over here, inspires pretty much the same kind of terror.

Ask a Briton to describe “American-style” healthcare, and you’ll hear a catalog of horrors that include grossly expensive and unnecessary medical procedures and a privatized system that favors the rich. For a people accustomed to free healthcare for all, regardless of income, the fact that millions of their cousins across the Atlantic have no insurance and can’t afford decent treatment is a farce as well as a tragedy.

But critics here warn that a similarly bleak future may await Britain if a government plan to put more power in the hands of doctors and introduce more competition into the NHS succeeds — privatization by stealth, they say.

So frightening is the Yankee example that any British politician who values his job has to explicitly disavow it as a possible outcome. Twice.

“We will not be selling off the NHS, we will not be moving towards an insurance scheme, we will not introduce an American-style private system,” Prime Minister David Cameron emphatically told a group of healthcare workers in a nationally televised address last week.

In case they didn’t hear it the first time, Cameron repeated the dreaded “A”-word in a list of five guarantees he offered the British people at the end of his speech.

“If you’re worried that we’re going to sell off the NHS or create some American-style private system, we will not do that,” he said. “In this country we have the most wonderful, precious institution and also precious idea that whenever you’re ill … you can walk into a hospital or a surgery and get treated for free, no questions asked, no cash asked. It is the idea at the heart of the NHS, and it will stay. I will never put that at risk.”

Cameron’s eagerly declared devotion to the NHS illustrates the totemic role it plays in British society, an institution so cherished that some describe it as the closest thing here to a truly national religion. Created in 1948, as the country struggled to rise from the ashes of World War II, the NHS is widely hailed as the welfare state’s biggest triumph.

Since then, it has bloomed into a behemoth that gobbles up nearly $170 billion a year in taxpayer money — an amount set to grow along with Britain’s aging population — and is one of the nation’s largest employers.

Governments of all stripes have taken office pledging to reform the system, to streamline it and make it more efficient, but none has fully succeeded, knowing that they tinker with the NHS at their peril. The current Conservative Party-led coalition, which has embarked on the most radical public spending cuts in a generation, has promised not to take a penny from the health service.

To each other, Britons love to complain about the NHS, retailing gruesome tales of substandard care, of long waiting lists for simple operations like hip replacements, of snotty surgeons and naughty nurses. But when Americans began citing the NHS as the epitome of socialized medicine gone wrong, people here bristled.

Fear that Britain is becoming more like the U.S. extends beyond healthcare. “American-style” is also the epithet of choice to describe the direction of Britain’s higher-education system.

To make up for lost state funding, many public universities, including Oxford and Cambridge, have decided to take advantage of a new law allowing them to charge students a maximum of $14,750 in annual tuition, nearly triple the current price tag. Shelling out huge sums for college may be part of the American way, but Britons don’t like it.

Last week, well-known philosopher A.C. Grayling caused a stir by announcing the creation of a private university, featuring top British and U.S. academics, that will charge nearly $30,000 a year.

There have also been demonstrations over the proposed NHS overhaul. Britons are so uneasy about the changes that a sheepish Cameron was forced to put them on hold and ordered his ministers to go on a two-month listening tour to hear out voters.

“We recognize that many people have had concerns about what we were doing,” Cameron said. “This has been a genuine chance for people … to work together to strengthen the institution we all love and hold dear.”

The results of the review, and the government’s expected concessions, are to be unveiled this week.

The changes will be debated in the public arena and fought over in Parliament. Doctors’ groups will no doubt say one thing, patients’ advocates another. In the end, lawmakers will probably approve a messy healthcare compromise that will anger many and please few.

Which just goes to show that maybe Britain and America aren’t so different after all.

henry.chu@latimes.com

http://www.latimes.com/health/la-fg-britain-health-care-20110613,0,1237142.story

By Jessica Marcy and Shefali S. Kulkarni
Kaiser Health News, June 10, 2011

Nurses converged on Washington in their fight against Wall Street this week.

Hundreds of nurses from across the country rallied to support broader access to health care and to call for higher taxes on corporations and the wealthy.

They gathered Tuesday near the White House and then picketed the U.S. Chamber of Commerce with large red banners that read: “RNs say Heal America, Tax Wall Street.” National Nurses United, the nation’s largest nurses union, sponsored the event to promote its “Main Street Contract for the American People,” a campaign that broadly calls for improved living conditions, including guaranteed health care, better wages and quality education.

They plan to rally on Wall Street later this month.

In response to the Washington rally, Blair Latoff, director of communications for the U.S. Chamber of Commerce, released the following statement: “The Chamber welcomes all voices to the debate, but the debate has to remain focused on creating American jobs and keeping our economy growing. Right now U.S. businesses are saddled with one of the highest corporate tax rates in the world, which is undercutting our global competitiveness.”

Some nurses spoke about the need for improved working conditions by increasing pay and enforcing adequate nurse-patient ratios. Many held signs that read: “I am a patient advocate” and “Medicare for all.” Participants finished the rally by gathering at a park near the Capitol, where Sen. Barbara Boxer, D-Calif., spoke about the need to protect Medicare and Sen. Bernie Sanders, I-Vt., told the crowd of red-shirted nurses that the nation needs a single payer system like that recently promoted in his own state.

Rose Ann DeMoro, executive director of National Nurses United, suggested that nurses offer a unique perspective on the struggles that patients and their families face because of the direct care they provide. “Everywhere the fallout of this system is felt, and it’s felt and experienced by the registered nurse,” she said.

Sue Gray, 51, who has been a nurse for more than 30 years and cares for cardiac surgery patients at Minneapolis Children’s Hospital, says that her own experience as a cancer patient has given her insight into the financial and emotional pressures that patients and their families experience. Diagnosed with breast cancer 12 years ago, Gray continues to work two days a week despite her cancer, which returned five years ago and has spread to her liver and bones. She does so to provide financial support and health insurance to her self-employed husband and three children.

“We really need to get some type of universal health care so that people going through my situation or families that I see at work that are struggling don’t have to worry about not getting health care,” Gray said.

Web version includes slideshow and audio of nurses’ demonstration in Washington: http://www.kaiserhealthnews.org/Slide-Shows/2011/National-Nurses-United-Washington.aspx

By Don Soeken
MichaelMoore.com, June 10, 2011

Ever wondered who the biggest culprits are, when it comes to defrauding the taxpayers of the United States?

The answer to that question may surprise you.

According to some shocking new statistics from the nonprofit Taxpayers Against Fraud (TAF) public interest group, the ranks of the admitted federal cheaters are occupied almost entirely by health insurers and the healthcare pharmaceutical industry.

That’s the clear and thoroughly disturbing conclusion to be found in a revealing TAF study of the “Top 20” fraud lawsuits (ranked by dollar amounts) to have been decided by court judgments or agreed-upon settlements in recent years. Amazingly, the list of penalty awards – as adjudicated under legal procedures mandated by the U.S. False Claims Act – contains no fewer than 19 healthcare or health insurance entities . . . and only a single financial entity who isn’t engaged in the business of health insurance or medical care.

Astonishing? You bet it is. Even a quick look at the list of recent fraud convictions and fraud case settlements involving the U.S. healthcare industry (to review them for yourself: www.taf.org) should be enough to make any alert taxpayer ask: Why haven’t all of these obvious fiscal abuses by healthinsurers and the pharmaceutical industry been reported in the news media . . . even as the entire nation continues to debate the future of healthcare reform?

As the Taxpayers Against Fraud website makes chillingly clear, some of America’s most best known and most trusted healthcare industry corporations are heading up the list of despicable cheaters whose conscienceless manipulation of federal health dollars has resulted in convictions or financial settlements with Uncle Sam.

Some appalling examples from the TAF “Top 20” list:

No. 1 Fraud Offender: Pfizer — $1 billion under the False Claims Act. Pfizer paid a total of $2.3 billion, of which $1.3 billion was a criminal fine for kickbacks and off-label marketing and $1 billion was paid under the False Claims Act.

No. 2 Fraud Offender: Tenet Heathcare — $900,000,000 under the False Claims Act. In July 2006, Tenet Healthcare agreed to pay the Federal Government $900 million for billing violations that included manipulation of outlier payments to Medicare, as well as kickbacks, upcoding, and bill padding.

No. 3 Fraud Offender: HCA — $731,400,000 under the False Claims Act.?In December 2000, HCA The Healthcare Company (formerly known as Columbia HCA), the largest for-profit hospital chain in the United States, pled guilty to criminal conduct and agreed to pay more than $840 million in criminal fines, civil penalties and damages for unlawful billing practices.

No. 4 Fraud Offender: Merck – $650,000 under the False Claims Act.?In January of 2008, Merck settled the very first nominal pricing fraud case in which the company was accused of taking kickbacks and violating Medicaid best price regulations for Vioxx (an arthritis drug), Zocor (a cholesterol drug), Pepcid (an acid-reflux drug), Cozaar (a hypertensive medication), Fosamax (a bone loss drug) Maxalt (a migraine medication) and Singulair (an asthma medication).

****

As you read through the “Top 20” list of fiscal malefactors who were either found guilty or agreed to settle in fraud cases against Uncle Sam, one fact stands out with startling clarity: 95 percent of these massively unprincipled cheaters were healthcare players . . . including some of the most venerated names in the pharmaceutical, hospital and health insurance industries.

Unfortunately, however, the taxpayers who are so frequently being bilked by these unscrupulous players haven’t been told that the record already shows how willing the U.S. healthcare industry is to stretch the rules and cheat the public in its ceaseless quest for grotesquely swollen profits.

As a Ph.D. social worker who has spent much of the past 30 years counseling and defending whistleblowers who dare to speak out against fraud against the U.S. government, I learned a long time ago that the U.S. healthcare industry can’t be trusted to provide adequate medical care for the citizenry, or even to obey the laws and regulations that protect the taxpayers from being defrauded.

Make no mistake: That disturbing list of “Top 20” awards against healthcare insurers and the Pharmaceutical industry shows clearly that we cannot leave healthcare to the “profit-oriented” insurance companies and the hospital chains whose greed and willingness to short-change consumers on care is now common knowledge everywhere.

The record shows clearly that allowing the insurers to dictate healthcare policy and healthcare costs can only produce disastrous results. A massive Harvard University study of treatment patterns among patients who were treated in hospital emergency rooms showed that “uninsured” patients were much more likely to die while in the hospital than those who were able to pay the sky-high premiums for adequate healthcare coverage. (To learn more about the study, click on: http://news.yahoo.com/s/hsn/uninsuredtraumapatientsmorelikelytodiestudy).

The first step on the road to getting healthcare reform right is to understand that we are not on a “level playing field,” and that the health industry will stop at nothing to protect its immense profits, regardless of the needless death and the needless suffering their behavior may cause the rest of us.

Donald R. Soeken,is a social worker with 40 years of professional experience; he is also founder of the nonprofit Whistleblower Support Fund – a public service organization that supports whistleblowers.

http://www.michaelmoore.com/words/mike-friends-blog/disturbing-new-statistics

By Paul Krugman
The New York Times, June 13, 2011

Every once in a while a politician comes up with an idea that’s so bad, so wrongheaded, that you’re almost grateful. For really bad ideas can help illustrate the extent to which policy discourse has gone off the rails.

And so it was with Senator Joseph Lieberman’s proposal, released last week, to raise the age for Medicare eligibility from 65 to 67.

Like Republicans who want to end Medicare as we know it and replace it with (grossly inadequate) insurance vouchers, Mr. Lieberman describes his proposal as a way to save Medicare. It wouldn’t actually do that. But more to the point, our goal shouldn’t be to “save Medicare,” whatever that means. It should be to ensure that Americans get the health care they need, at a cost the nation can afford.

And here’s what you need to know: Medicare actually saves money — a lot of money — compared with relying on private insurance companies. And this in turn means that pushing people out of Medicare, in addition to depriving many Americans of needed care, would almost surely end up increasing total health care costs.

The idea of Medicare as a money-saving program may seem hard to grasp. After all, hasn’t Medicare spending risen dramatically over time? Yes, it has: adjusting for overall inflation, Medicare spending per beneficiary rose more than 400 percent from 1969 to 2009.

But inflation-adjusted premiums on private health insurance rose more than 700 percent over the same period. So while it’s true that Medicare has done an inadequate job of controlling costs, the private sector has done much worse. And if we deny Medicare to 65- and 66-year-olds, we’ll be forcing them to get private insurance — if they can — that will cost much more than it would have cost to provide the same coverage through Medicare.

By the way, we have direct evidence about the higher costs of private insurance via the Medicare Advantage program, which allows Medicare beneficiaries to get their coverage through the private sector. This was supposed to save money; in fact, the program costs taxpayers substantially more per beneficiary than traditional Medicare.

And then there’s the international evidence. The United States has the most privatized health care system in the advanced world; it also has, by far, the most expensive care, without gaining any clear advantage in quality for all that spending. Health is one area in which the public sector consistently does a better job than the private sector at controlling costs.

Indeed, as the economist (and former Reagan adviser) Bruce Bartlett points out, high U.S. private spending on health care, compared with spending in other advanced countries, just about wipes out any benefit we might receive from our relatively low tax burden. So where’s the gain from pushing seniors out of an admittedly expensive system, Medicare, into even more expensive private health insurance?

Wait, it gets worse. Not every 65- or 66-year-old denied Medicare would be able to get private coverage — in fact, many would find themselves uninsured. So what would these seniors do?

Well, as the health economists Austin Frakt and Aaron Carroll document, right now Americans in their early 60s without health insurance routinely delay needed care, only to become very expensive Medicare recipients once they reach 65. This pattern would be even stronger and more destructive if Medicare eligibility were delayed. As a result, Mr. Frakt and Mr. Carroll suggest, Medicare spending might actually go up, not down, under Mr. Lieberman’s proposal.

O.K., the obvious question: If Medicare is so much better than private insurance, why didn’t the Affordable Care Act simply extend Medicare to cover everyone? The answer, of course, was interest-group politics: realistically, given the insurance industry’s power, Medicare for all wasn’t going to pass, so advocates of universal coverage, myself included, were willing to settle for half a loaf. But the fact that it seemed politically necessary to accept a second-best solution for younger Americans is no reason to start dismantling the superior system we already have for those 65 and over.

Now, none of what I have said should be taken as a reason to be complacent about rising health care costs. Both Medicare and private insurance will be unsustainable unless there are major cost-control efforts — the kinds of efforts that are actually in the Affordable Care Act, and which Republicans demagogued with cries of “death panels.”

The point, however, is that privatizing health insurance for seniors, which is what Mr. Lieberman is in effect proposing — and which is the essence of the G.O.P. plan — hurts rather than helps the cause of cost control. If we really want to hold down costs, we should be seeking to offer Medicare-type programs to as many Americans as possible.

By Mary von Euler
The Washington Post, June 14, 2011

Letters

Sen. Joseph I. Lieberman has it backward. While most people would agree with the senator that the wealthy should pay more for health care — applying progressive principles to Medicare funding — he also wants to achieve Medicare solvency by raising the eligibility age to 67, in other words, by serving fewer people and shutting the door to many who would be unable to secure affordable health insurance in the private market.

But, as most experts agree, our problem is the soaring cost of medical care, as a whole, not Medicare, which is the most frugal part of our non-system. And the only way to control medical costs is via a single-payer system that covers everyone, so the government has leverage to tamp down excessive costs and eliminate waste, including the wasteful costs devoted to private-insurance overhead.

Providing Medicare coverage for everyone, regardless of age, is the only way to provide quality health care to all Americans without bankrupting our country.

Mary von Euler resides in Bethesda, Md., and is secretary of Americans for Democratic Action.

http://www.washingtonpost.com/opinions/what-joe-lieberman-got-wrong-on-medicare/2011/06/13/AGbup9UH_story.html