PNHP

Obama, Berwick, Krugman and others on IPAB

Obama, Berwick, Krugman and others on IPAB

The Independent Payment Advisory Board: A New Approach to Controlling Medicare Spending

By Jack Ebeler, Tricia Neuman and Juliette Cubanski
Kaiser Family Foundation
April 2011

Targets on Medicare Spending Growth Rate

The statute sets target growth rates for Medicare spending. The target is not a “hard cap” on Medicare spending growth, but if spending exceeds these targets, IPAB is required to submit recommendations to reduce Medicare spending by a specified percentage. For 2015 through 2019, the target for Medicare spending per capita is the average of general and medical inflation: specifically, the average of the projected percentage increase in the consumer price index for all Urban Consumers (CPI-U) and the medical care expenditure category of the CPI-U. For 2020 and later years, the target for Medicare spending per capita is the increase in the gross domestic product (GDP) plus one percentage point, which historically has increased at a higher rate than the CPI-based measures.

If projected growth for the implementation year exceeds the target, and the medical care component of the CPI-U exceeds the CPI-U, then IPAB is required to develop and submit a proposal to bring Medicare per capita growth within the target in the implementation year, subject to the applicable limits (maximum savings).

Provisions Affecting Beneficiaries

More broadly, to the extent changes in payments to providers affect beneficiaries’ access to care, such policies have an impact on beneficiaries. This issue is raised by the current physician payment limits and in evidence in Medicaid, where the state provider payment constraints are often severe, and is a potential consequence of any enforced target for Medicare growth, whether through IPAB or other means. If IPAB recommends policies that squeeze Medicare payment rates without equal pressure being placed on private payment rates, there is some concern that Medicare beneficiaries would be at greater risk of having access problems, as providers become more inclined to serve other patients.

http://www.kff.org/medicare/upload/8150.pdf

And…

Fact Sheet: The President’s Framework for Shared Prosperity and Shared Fiscal Responsibility

The White House
April 13, 2011

The President’s framework will strengthen IPAB to act as a backstop to the other Medicare reforms by ensuring that Medicare spending growth does not outpace our ability to pay for it over the long run, while improving the program and keeping Medicare beneficiaries’ premium growth under control. Specifically, it would:

Set a new target of Medicare growth per beneficiary growing with GDP per capita plus 0.5 percent. This is consistent both with the reductions in projected Medicare spending since the Affordable Care Act was passed and the additional reforms the President is proposing.

http://www.whitehouse.gov/the-press-office/2011/04/13/fact-sheet-presidents-framework-shared-prosperity-and-shared-fiscal-resp

And…

Berwick Says Obama’s Plan To Trigger Medicare Cuts Won’t Be Necessary

By Susan Jaffe
Kaiser Health News
April 15, 2011

A day after President Barack Obama proposed strengthening an independent commission to control Medicare’s costs, the program’s administrator said such oversight won’t be necessary because new efforts to reduce waste should slow down spending and even improve the quality of care.

“We don’t have to get to that point,” Medicare chief Donald Berwick told Kaiser Health News Thursday.

http://www.kaiserhealthnews.org/Stories/2011/April/15/Berwick-on-IPAB.aspx

And…

Patients Are Not Consumers

By Paul Krugman
The New York Times
April 21, 2011

About that advisory board (IPAB): We have to do something about health care costs, which means that we have to find a way to start saying no. In particular, given continuing medical innovation, we can’t maintain a system in which Medicare essentially pays for anything a doctor recommends. And that’s especially true when that blank-check approach is combined with a system that gives doctors and hospitals — who aren’t saints — a strong financial incentive to engage in excessive care.

And the point is that choices must be made; one way or another, government spending on health care must be limited.

http://www.nytimes.com/2011/04/22/opinion/22krugman.html

And…

The Other Medicare Cutters

The Wall Street Journal
April 20, 2011

Starting in 2014, the board (IPAB) is charged with holding Medicare spending to certain limits, which at first is a measure of inflation. After 2018, the threshold is the nominal per capita growth of the economy plus one percentage point. Last week Mr. Obama said he wants to lower that to GDP plus half a percentage point.

Post-ObamaCare, Medicare’s administered fee schedule is set eventually to dip below Medicaid payments in many states, which are themselves already far lower than the rates of private insurers that reflect the true costs of health care.

As a practical matter, the more likely outcome is the political rationing of care for the elderly, as now occurs in Britain, or else the board will drive prices so low that many doctors and hospitals drop out of Medicare. Either alternative would create the kind of two-tier system dividing the poor and affluent that Democrats claim is Mr. Ryan’s mortal sin.

http://online.wsj.com/article/SB10001424052748704613504576269582048771132.html

And…

Obama Panel to Curb Medicare Finds Foes in Both Parties

By Robert Pear
The New York Times
April 19, 2011

“But, in its effort to limit the growth of Medicare spending, the board is likely to set inadequate payment rates for health care providers, which could endanger patient care,” (said Representative Pete Stark of California, the senior Democrat on the Ways and Means Subcommittee on Health.)

http://www.nytimes.com/2011/04/20/us/politics/20health.html

And…

Health Reform Assumes its Role as a Punching Bag

By Merrill Goozner
The Fiscal Times
April 20, 2011

The IPAB “can’t order the system transformations that we need like care coordination and a focus on chronic conditions,” said Kenneth Thorpe, a professor of public health at Emory University. “So the only thing they can really do is cut payment rates.”

In other words, the problem isn’t that IPAB has too much power. It’s that it doesn’t have enough.

http://www.thefiscaltimes.com/Blogs/Gooz-News/2011/04/20/Gooz-News-Health-Reform-Assumes-Its-Role-as-a-Punching-Bag.aspx

Today’s quotes provide tastes of the broad spectrum of political flavors inspired by the establishment of the Independent Payment Advisory Board (IPAB). The fervor of the debate risks obscuring an important point that we have made before and must make again: Applying a cap on Medicare payments alone at GDP plus one-half or one percent, without placing the same caps on the rest of health care spending, risks devolving Medicare into an underfunded, lower tier welfare program, with impaired access for Medicare beneficiaries because of a lack of willing providers.

As other nations have demonstrated, global budgeting works as long as it is applied to the entire health care delivery system. Instead of merely taking a cleaver to payment rates, as IPAB would, attention in a single payer system is directed to improving productivity, expanding efficiencies, and reducing administrative and clinical waste, all within the constraints of a universal global budget. For those who would dismiss this because it is rationing, keep in mind that this form of rationing actually improves value in our health care purchasing. Maybe “beneficial rationing” should become a byword for reform.

If you wish to learn more about IPAB, the 24 page Kaiser Family Foundation report (first link above) is an excellent resource. The following quote from this report reemphasizes the primary lesson of today’s message: “If IPAB recommends policies that squeeze Medicare payment rates without equal pressure being placed on private payment rates, there is some concern that Medicare beneficiaries would be at greater risk of having access problems, as providers become more inclined to serve other patients.”

S&P's David Blitzer on single payer

Check-Up on U.S. Healthcare

Squawk on the Street, CNBC
April 21, 2011

Mark Haines: S&P’s latest health care costs report from February 2010 through February of this year shows health care costs rose 6.2%. That’s good in a sense that it’s down slightly from 6.3% in the previous 12-month period, but obviously way above the rate of inflation for everything else. Here first on CNBC, David Blitzer, chairman of the S&P 500 index committee. David, good morning. Thanks for being with us.

David Blitzer: Good morning, Mark. How are you?

Haines: Pretty good. What do you have for us?

Blitzer: Health care costs continue to rise, however the rate of increase continues to creep down a little bit. So the news isn’t good, but it’s not getting worse. It’s getting maybe a touch better.

Haines: Why are these costs escalating at – I don’t know – three or four times the rate of overall inflation? What’s going on here?

Blitzer: Health care – despite all the excitement about technology and drugs – health care is a very labor intensive activity, and people – labor – costs a lot of money, which seems to be the key factor driving it up.

Haines: So, if I may, logically then you would find the worst or the most inflation occurring in hospitals.

Blitzer: You would, and, indeed, on the commercial side you do. On the Medicare side, you don’t, and I think that brings up a different aspect. Over the last few years we have heard a lot of arguments about single payer plans versus other kinds of plans. Single payer means Uncle Sam pays for all the health care. We pay him.

Haines: Right.

Blitzer: Medicare for people over 65 is a single payer plan, and, indeed, we consistently see smaller rates of increase in Medicare items than we do in commercial insurance, the kind of insurance that employers provide for their employees.

Haines: Okay. I’m going to leave that lying there because some of our viewers right now are going apoplectic thinking you have just endorsed single payer health care.

Blitzer: I haven’t. I’ve only reported the numbers. I’m not endorsing anything.

Haines: Believe me, I understand. You’re quoting the facts. Some people think facts are partisan. I don’t know how they get there, but they do. David, thank you very much. Appreciate your input.

Blitzer: Thank you. Have a good day.

Video:
http://video.cnbc.com/gallery/?video=3000017902

Comment: 

By Don McCanne, MD

Facts are not partisan. Standard and Poor’s David Blitzer reports only the facts on single payer – and Wall Street needs to hear them.

S&P’s David Blitzer on single payer

Check-Up on U.S. Healthcare

Squawk on the Street, CNBC
April 21, 2011

Mark Haines: S&P’s latest health care costs report from February 2010 through February of this year shows health care costs rose 6.2%. That’s good in a sense that it’s down slightly from 6.3% in the previous 12-month period, but obviously way above the rate of inflation for everything else. Here first on CNBC, David Blitzer, chairman of the S&P 500 index committee. David, good morning. Thanks for being with us.

David Blitzer: Good morning, Mark. How are you?

Haines: Pretty good. What do you have for us?

Blitzer: Health care costs continue to rise, however the rate of increase continues to creep down a little bit. So the news isn’t good, but it’s not getting worse. It’s getting maybe a touch better.

Haines: Why are these costs escalating at – I don’t know – three or four times the rate of overall inflation? What’s going on here?

Blitzer: Health care – despite all the excitement about technology and drugs – health care is a very labor intensive activity, and people – labor – costs a lot of money, which seems to be the key factor driving it up.

Haines: So, if I may, logically then you would find the worst or the most inflation occurring in hospitals.

Blitzer: You would, and, indeed, on the commercial side you do. On the Medicare side, you don’t, and I think that brings up a different aspect. Over the last few years we have heard a lot of arguments about single payer plans versus other kinds of plans. Single payer means Uncle Sam pays for all the health care. We pay him.

Haines: Right.

Blitzer: Medicare for people over 65 is a single payer plan, and, indeed, we consistently see smaller rates of increase in Medicare items than we do in commercial insurance, the kind of insurance that employers provide for their employees.

Haines: Okay. I’m going to leave that lying there because some of our viewers right now are going apoplectic thinking you have just endorsed single payer health care.

Blitzer: I haven’t. I’ve only reported the numbers. I’m not endorsing anything.

Haines: Believe me, I understand. You’re quoting the facts. Some people think facts are partisan. I don’t know how they get there, but they do. David, thank you very much. Appreciate your input.

Blitzer: Thank you. Have a good day.

Video:
http://video.cnbc.com/gallery/?video=3000017902

Facts are not partisan. Standard and Poor’s David Blitzer reports only the facts on single payer – and Wall Street needs to hear them.

Medical bankruptcies will remain high under Obama health plan

By Glen Ford
Black Agenda Radio, March 21, 2011

The Obama administration’s health care legislation will not prevent Americans from going bankrupt in large numbers due to illness, says Dr. David Himmelstein, an author of a study of the “almost identical” Massachusetts health care program implemented in 2005. “People got insurance but, basically, they got such lousy insurance that they ended up bankrupt if they got sick,” said Himmelstein. “For states like Texas, Louisiana and California,” which have far worse health coverage than Massachusetts, “we’re not going to see much improvement” under the Obama plan. A transcript of the interview follows.

A new study shows that people in Massachusetts are still going bankrupt in huge numbers because of medical expenses, five years after implementation of a health care plan that is remarkably similar to President Obama’s health package. Like Obama’s bill, the Massachusetts plan compels residents to buy private health insurance. Dr. David Himmelstein is one of the authors of this study.

David Himmelstein: What we found is that medical bankruptcies haven’t really decreased in Massachusetts, even with our state’s reform. Basically, people got insurance, but they got such lousy insurance that they ended up bankrupt if they got sick – again, even though they had insurance. They were left with giant co-payments and deductibles and things that weren’t covered and the insurance turned out to be like an umbrella that leaks in the rain: it’s not there when you need it.

Glen Ford: So who is it that is helping if there has been little change? And, in fact, in raw numbers there was an increase in bankruptcies.

Himmelstein: That’s right. Probably it’s helping some doctors and some hospitals that are getting paid a little bit more, but it doesn’t look like most patients are actually getting very much help. Maybe some are getting a little bit around the edges if you’re not seriously ill and not getting huge bills that would drive you into bankruptcy, maybe there’s a little bit of help there. But we couldn’t find very much help for patients at all.

Ford: How much does the Massachusetts plan, in these kinds of effects, resemble President Obama’s plan?

Himmelstein: It’s almost identical. I mean, the coverage that people got in Massachusetts is, if anything, a little better than what the national reform says that people have to have. So, just to give you an example, coverage that is most commonly bought through these insurance exchanges here, for someone my age, would cost about $5,600 a year — for the coverage you have to buy. It doesn’t cover any of the first $2,000-worth of bills, so that all comes out of your pocket. And, even after that, you pay another $4,000 in co-payments. So, the coverage is really pretty poor, and it’s pretty much what Washington has coming to the rest of the country.

Ford: And yet, a big part of Obama’s campaign was that it was intolerable that people would go bankrupt on top of the personal catastrophe of illness.

Himmelstein: Well, it made good sound bites, only the legislation they actually passed didn’t actually address the problem. What we really need is full coverage for every American. Every Canadian has first-dollar, full coverage and their health care system cost less than ours and they don’t have much medical bankruptcy — that’s been looked at and they have like 10 percent as much medical bankruptcy as we do. Once in a while someone has something where they are basically out of work, and because of that, an illness drives them into bankruptcy, but the medical bills are not a problem under real national health insurance. We didn’t get real national health insurance.

Ford: And polls show that that’s what people were actually expecting, what they were led to believe was going to be in the hopper. Was this kind of bait and switch?

Himmelstein: I think it was and frankly, it’s what the Republicans are saying we got and we shouldn’t have. In a way, we have the worst of both worlds — we didn’t get really good coverage, and yet the Republicans are claiming that it’s socialized medicine.

Ford: And that, I remember, was one of the great fears. Not only would this bill, this national bill be inadequate to the problem, but that it might create a problem itself forestalling real Medicare for all type coverage.

Himmelstein: That’s what we worry about frankly because there was momentum building for real change, for a Medicare-for-all kind of program, and at this point, some of the steam has been taken out of it. But, frankly we think that the American people are going to discover soon that what they got is not real coverage.

Ford: And now we see that the president is going to let some states opt out of his plan entirely.

Himmelstein: Well, they are already letting states weaken the first parts of the bill. They’re saying, the bill said that insurance companies can’t sell really bare-bones policies, I mean worse than we have in Massachusetts, and get away with it, and the administration has waived that requirement wherever they’ve been asked. So, at McDonald’s and those kinds of places they offer their workers coverage that’s like $3,000. That’s how much might be covered out of a $100,000 illness. And the Obama administration has said, “That’s OK,”’ even though the law says it’s not. So, they’re already waiving some of the better provisions in the law. And, we’re worried they are going to waive more. On the other side, we’d like to see flexibility for states to do better and folks in Vermont are talking about doing a Medicare-for-all kind of plan in Vermont.

Ford: And let’s make it clear, Massachusetts has never been at the bottom of the list or anywhere near it in terms of health care.

Himmelstein: Oh, far from it. Even before our health reform, Massachusetts was one of the better places in the country to be sick. We had relatively few uninsured and we actually had a little bit lower medical bankruptcy rate than the rest of the country, to begin with. We just didn’t improve it with this reform.

Ford: So what does this mean for states that have historically provided poorer health care?

Himmelstein: Well, I think it’s a warning sign that we haven’t really done much for people in those states. If you look at places like Texas, Louisiana and California, which have huge numbers of uninsured and tremendous numbers of medical bankruptcies, we’re not going to see much improvement there.

That was Dr. David Himmelstein. [Dr. Himmelstein is professor of public health at the City University of New York and co-founder of Physicians for a National Health Program.]

Black Agenda Radio is heard on the Progressive Radio Network, with Glen Ford, editor of Black Agenda Report, and Nellie Bailey.

http://blackagendareport.com/content/black-agenda-radio-progressive-radio-network-glen-ford-and-nellie-bailey-%E2%80%93-week-march-21-201

St. Paul City Council supports single-payer health care in state

By Joe Kimball
MinnPost.com, April 21, 2011

The St. Paul City Council passed a resolution Wednesday supporting the Minnesota Health Plan, a proposal that’s floating around the Legislature (but not yet close to passing) for single-payer, universal health care in the state.

The Minneapolis and Duluth city councils previously have voted to support the plan, too.

The St. Paul council will now urge its local legislators to support the plan, which purports to make “health care guaranteed and affordable for every Minnesotan.”

The “Whereas” clauses in the council resolution note:

    * At some point in 2009 approximately 14 percent of St. Paul residents were without health insurance
    * Approximately 71 percent of those without health insurance statewide are employed
    * The Minnesota Health Plan would lower the cost of health care through a single-payer system for all Minnesota residents
    * Lower premiums as a result of the Minnesota Health Plan would have a positive effect on the city’s budget
    * The Minnesota Health Plan would reduce the need for unnecessary emergency room visits, thus reducing the related costs and relieving area hospitals of a burden that threatens solvency.

The Minnesota Universal Health Care Coalition, applauded the vote, noting: “It is time to break the link of health insurance to employment. It no longer works in a society and time where people change jobs frequently and work one or more part-time jobs. When health insurance is linked to employment, people often lose health insurance for themselves (and their families) when they need it most — when they are ill and unable to work.”

http://www.minnpost.com/politicalagenda/2011/04/21/27685/st_paul_city_council_supports_single-payer_health_care_in_state

A call to lead in reducing inequalities

By Jeffrey B. Ritterman, M.D.
Editorial, American Journal of Medicine, April 2011
 
Imagine a microbe that lowers life expectancy. Suppose this microbe also causes increases in obesity, drug use, teen pregnancy, incarceration rates, and homicide rates, and a breakdown of social cohesion.
 
We would expect pharmaceutical companies and the Centers for Disease Control to engage in a no-holds-barred campaign to develop an antibiotic or a vaccine to do away with the threat and protect public health.
 
The threat is here. It is real and it is causing untold harm. But the threat is not a microbe. It is us, or more accurately, how we organize our social environment.
 
The United States is now the most unequal of the rich developed countries in terms of income and wealth. There are now hundreds of papers and an excellent book, “The Spirit Level: Why Greater Equality Makes Societies Stronger,” by Richard Wilkinson and Kate Pickett (1), which document the health and social costs of rising income inequality. Yet mainstream medicine seems to have hardly taken notice.
 
Wilkinson and Pickett document a long list of health concerns and social ills that correlate with increases in income inequality. We don’t live as long as our peers in more equal countries, nor do our infants. We’re fatter, more of our teens get pregnant, we incarcerate more of our citizens, our children score worse on math and science tests, we kill one another more often, and we trust one another less. We even recycle less often.
 
Correlation, however, does not prove causality. Wilkinson and Pickett address this question at some length. They analyze the data on civic trust and conclude that the overwhelming balance of the evidence supports causality. It appears to be the case that the increasing income disparity causes us to trust one another less. The breakdown in trust causes the social fabric to unravel and we begin to experience life as a Hobbesian struggle of all against all. This results in disease in the individual and dysfunction in our society.
 
Why is this so important? Recently, Professor Emmanuel Saez has looked at income tax data dating back to World War I. (2) What he found is amazing and startling: we are more unequal now than at any time in our history, and significantly so. The last time we were this unequal, the stock market crashed and ushered in The Great Depression.
 
What has this to do with medicine and health? A generation ago, Sir Michael Marmot and colleagues (3) showed convincingly that social class was a far more important determinant of health outcome than cholesterol level, blood pressure, diet, and smoking behavior combined. The message was clear. The social environment is the major determinant of health outcome.
 
In the office, we can help one patient at a time. This is worthwhile and important. I have spent my life doing so. But now it is clear that social policies that promote a more equal sharing of the social product greatly improve population health and the social environment. Physicians can help lead society to a more equitable and healthier future by advocating and working toward a fairer distribution of wealth and income.
 
In Virchow’s day, the great physician advocated for social reforms as the best way to fight a typhus epidemic. Virchow, the founder of Social Medicine, claimed that “physicians are the natural attorneys of the poor, and the social problems should largely be solved by them.”(4) Similarly, in our day, Sir Michael Marmot has called on physicians to lead “the charge for action across a broad front to reduce inequalities in health.”(5) Will you join me in this noble cause?
 
Jeffrey B. Ritterman, M.D., retired from the Department of Cardiology, Kaiser Permanente in Richmond, Calif., in November 2010.
 
References
 
1. Wilkinson R, Pickett K. The Spirit Level: Why Greater Equality Makes Societies Stronger. New York: Bloomsbury Press; 2009.
2. Saez E. Striking it Richer: The Evolution of Top Incomes in the United States (Updated with 2007 estimates) August 5, 2009. Available at: http:// econ.berkeley.edu/~saez/saez-UStopincomes-2007.pdf. Accessed February 11, 2011.
3. Rose G, Marmot M. Social class and coronary heart disease. Br Heart J. 1981;45(1):13-19.
4. Wikipedia. Rudolf Virchow. Available at: http://en.wikipedia.org/wiki/ Rudolf_Virchow. Accessed February 11, 2011.
5. Marmot M. Status syndrome: a challenge to medicine. JAMA. 2006; 295:1304-1307.
 
doi:10.1016/j.amjmed.2010.11.021
 
http://download.journals.elsevierhealth.com/pdfs/journals/0002-9343/PIIS0002934311000039.pdf

Canada’s Health Care: An Alternate Universe

By Elizabeth Rosenthal
CommonDreams.org, April 20, 2011

I recently returned from a visit of several days to an alternate universe: Canadian health care.

As a physician who has practiced in the United States for 44 years, I have experienced many aspects of our health care system, including its terrible inequities.

Although some Americans get very good health care, there are many who get little or none. Then there are others who get too much: tests, procedures and drugs that they don’t need. The whole system is fragmented, chaotic, inefficient and terribly expensive. We are not getting good value for our enormous expenditure on health care.

Some years ago, having come to the conclusion that a single-payer national health program – an improved Medicare for all – is the solution to our problem, I joined Physicians for a National Health Program (PNHP). I wanted to help bring about a system that provides comprehensive coverage to everyone, removes the extremely wasteful and intrusive private insurance companies from the doctor-patient relationship, and gives every patient free choice of doctor and hospital.

Our new federal health law, unfortunately, doesn’t achieve these key goals.

Over the years, in my talks about single payer, I have often cited Canada’s system as an example worthy of study, if not emulation. But it wasn’t until earlier this month that I paid a visit to Toronto with the express purpose of learning more about how the Canadian single-payer system actually works. I traveled there as part of an 8-member delegation of physicians, health care advocates and policy experts from New York state.

All of us wanted to see “up close and personal” what their Medicare (the name for the Canadian system) looks like and find out how they manage to provide high-quality care for all Canadians and yet spend only half of what we spend, per capita, doing so.

The trip was an eye-opener. We met with physicians in many specialties — both academics and community-based physicians in private practice — and got to shadow them as they went about their work in their offices. We met with health care administrators. We talked to patients. We learned a lot.

Although some of us thought we were coming to the “promised land” of single-payer health care, where everyone has access to high-quality care regardless of ability to pay, our Canadian counterparts were much more blasé about their egalitarian, publicly financed system. They took it for granted. They don’t  know anything else and are mainly focused on what is needed to improve it.

One thing that became clear to us is that figuring out what works and what doesn’t work, and how to make a change, is much easier to do in a unified system like Canada’s. We also saw that the single-payer system in practice is not as simple as we thought and that there are still political realities to deal with that control the funding and who gets what part of the pot.

There are still inequities in the system. There is a shortage of physicians and there can be long waits for elective procedures and non-urgent doctor visits. For most Canadians the cost of drugs, dental care and some psychiatric services is not included in the basic package provided by the government. The benefits vary somewhat by province.

But Canada’s medical outcomes are excellent; urgent needs get urgent care; and Canadians live two years longer on average than we do. Problems like medical bankruptcy are virtually unknown. The overwhelming majority of Canadians, when polled, say they’d prefer their system over ours any day.

We learned that doctors in Canada earn a good income not much different from most of those in the United States. Although most have a good quality of life with adequate free time, some are overworked and a few can’t find positions due to lack of facilities in some specialties. But few Canadian physicians emigrate, and in fact each year since 2004 more physicians have returned to Canada than have moved abroad.

Canadians were totally perplexed as to why Americans have put up with our faulty and expensive system for so long. It was hard for me to explain this as I cannot understand it myself. Although polling shows that two-thirds of American are in favor of Medicare for all, their voices are not heard in the media nor in the halls of Congress. On the contrary, our legislators are now debating whether to end Medicare as we know it.

I am more certain than ever of the truth that a single-payer system, like the Canadian one, is the right solution for us. I am energized to continue advocating for such a system here. Hopefully we can soon bring the United States into this alternate universe.

Elizabeth Rosenthal, M.D., is a dermatologist who resides in Larchmont, N.Y. She is a board member of the NY Metro Chapter of PNHP, www.pnhp.org. She has been a dermatologist in private practice in Mamaroneck, N.Y., for 35 years and on the clinical faculty of the Albert Einstein College of Medicine for 37 years.

http://www.commondreams.org/view/2011/04/20-0

Spreading the single-payer gospel: Talking health care reform in Summit County

Activist physician Margaret Flowers talks about a universal, single-payer model

By Kathryn Corazzelli
Summit (Colo.) Daily News, April 16, 2011

FRISCO, Colo. — The reason Dr. Margaret Flowers works full-time to advocate a universal, single-payer health care model, she told a packed room Thursday, is because she wasn’t able to provide the quality of care she wanted to as a pediatrician. Flowers said she was pressured to see more patients in less time, and had to compromise her integrity by not being fully honest to insurance companies about patient problems.
 
Flowers is congressional fellow for Physicians for a National Health Program, a nonprofit research and education organization consisting of health professionals and students who support a single-payer national health insurance model. The former director of the pediatric hospital program and chief of pediatrics at a rural Maryland hospital, she left practice in 2007 to work full-time on health care reform. She is giving her presentation at numerous stops in Colorado, including Thursday’s at the Summit County Community and Senior Center. The event drew a mix of the community — those who agreed, those who didn’t, and some on the fence.
 
Flowers told the crowd corporate influences from insurance companies — in both the Democratic and Republican parties — have invaded the country, and made it difficult for citizens to get the care they need. She said 51 million Americans have no insurance, and over 10 million became “under-insured” in 2009. She said health administrators have grown faster than physicians in this country, and that currently, we spend one-third of our health care dollars on things that don’t have anything to do with health care.
 
“We’re already spending enough money to provide quality care to everyone,” she said. “We’re spending more per person, per dollar, than any other nation. We’re not getting a very good value for our dollar.”
 
Flowers said the single-payer system would free up more than $400 billion per year, allowing all Americans access to quality coverage, and choice of provider.
 
“There’s no gaps people can fall through,” she said. “We’re told we’re the best. Well, we are the best … if you have the money to pay for it.”
 
Attendees asked Flowers questions regarding the viability of the plan, including: What would happen to malpractice insurance, wouldn’t care be rationed, and could it ever actually be implemented? Flowers said malpractice insurance would be reduced, care is already rationed through insurance companies (who choose what to cover), and the plan’s execution is feasible — as long as citizens request it and work for it. She said it wouldn’t be a perfect system, but it would be more efficient in dollars and coverage than anything else.
 
“There’s a lot of propaganda on your side,” one man said. “People have to understand there’s going to be rationing.”
 
Flowers said needs are met in every similar health care system studied.
 
“If we continue on the same path, we’re headed down the wrong path,” she said.
 
Summit resident Emily Tracy said she attended because she’s had a long-term interest in health care, and has seen faults in the current system. She said her son and his wife don’t have health insurance, which worries her.
 
“I’m just constantly looking for more knowledge and more information,” said attendee Del Bush, who spent 12 years selling group insurance.
 
“I thought it was pretty interesting,” said Jeff Lynn, who is studying to be a physician’s assistant.
 
“We’ve been getting a good turnout,” Flowers said of the Colorado tour. “In Fort Collins, we did a reception with small business owners, and this concept was new to a lot of them. I think the discussions have been really great.”
 
Flowers said a private reception before the presentation — which included community members from both political parties — sparked useful conversation about the status of America’s health care, and what works and what doesn’t.
 
http://www.summitdaily.com/article/20110416/NEWS/110419844/1078&ParentProfile=1055

Single-payer health care system would save lives, money

By Joseph Sparks
Columbia Missourian, April 15, 2011

The 2001 terrorist attacks on the World Trade Center killed 2,751 people. In 2001, it has been estimated that more than 18,300 people died due to lack of health insurance, according to the American Journal of Public Health.

Where was the outraged horror that six times as many people died because they lacked health insurance?

Repealing or preventing health care reform will likely kill many more people than terrorist attacks. From 2001 through 2010, about 3,450 people were killed in terrorist attacks that took place in the U.S. or against American targets. A study from the Department of Medicine at Cambridge Health Alliance, based on data from 2007-08, estimated that 45,000 adults died in the U.S. from a lack of health insurance.

Here is the missing headline to celebrate the recent first anniversary of health care reform: “No insurance: 45,000 deaths in first year.”

Since 2001, the U.S. has spent more than $1.2 trillion on the war on terror. From 2001-08, almost nothing was done to address the lack of access to health care. Late in 2008, the health care debate started that led to the passage of the Patient Protection and Affordable Care Act in March 2010. The good news is the act will save lives. According to a Congressional Budget Office analysis, by 2019, the law will reduce the number of uninsured by 32 million. This will save approximately 32,000 lives. The bad news is the act will leave 23 million people uninsured, resulting in approximately 23,000 deaths. So, while the proponents of the act were busy defending the legislation from false charges, such as death panels, they neglected to consider the amount of lives that would be saved and how many will still die.

The outcry would be deafening if the U.S. instituted an anti-terrorist policy that chose to leave more than 15 percent of the population unprotected.

The Protection and Affordable Care Act will not reduce the percent of GDP spent on health care, and this will continue to drag down the U.S. economy. The act will increase GDP spending on health care from 20.8 percent to 21 percent because it will cover more people. In terms of spending, the act is roughly equal to the current system.

What has been lost in the debate over health care reform is that it would be possible to implement a single-payer system that would cover everybody, prevent those 23,000 unnecessary deaths and reduce health care costs by 40 percent. In 2008, France, which has a single-payer system, spent just over 11 percent of its GDP on health care. In the same year, the U.S. spent 16 percent of its GDP on health care. France is ranked first in health care, while the U.S. is ranked at 37.

The difference in per capita spending is even worse for the U.S. While the U.S. spends $7,538 per capita, France spends $3,696. The U.S. spends more than twice as much on a per capita basis to achieve our dismal rank of 37.

Economic efficiency can be defined as allocating resources in a manner that minimizes waste and inefficiency. While some believe private enterprise will always be more efficient than the government, when it comes to health care, they are wrong. In every developed country that has a national health system, the percentage of GDP spent on health care is substantially less than the percentage spent in the U.S.

The tragic truth is terrorists do not have to resort to violent acts against the homeland when the lack of access to health care is so much more effective at killing Americans.

Joseph Sparks is master’s candidate in journalism at Missouri University.

http://www.columbiamissourian.com/stories/2011/04/15/column-if-only-we-were-outraged-about-health-care-we-about-terrorism/

What Happened to Social Justice in Health Care Reform?

By Arthur Sutherland 
Tikkun magazine, April 15, 2011
 
In the wake of Republican House Speaker Paul Ryan’s proposals last week to systematically dismantle Medicare and gut the Medicaid program, steps that would inexorably lead to greater suffering and penury and many thousands of preventable deaths, one is prompted to ask, “Have you no sense of decency, sir?”
 
Posing as champions of fiscal responsibility, Ryan and his GOP cohorts are unleashing a cruel assault on the health and well-being of our most vulnerable populations: the elderly, the disabled, and the poor. They do this even as they hand out ever more favorable tax breaks to the largest corporations and the wealthiest 1 percent of U.S. taxpayers.
 
While Ryan’s latest assault is particularly flagrant, it betokens a wider retreat from the goal of a more just and egalitarian society that has been under way for the past three decades. Its effects can be seen in the policies of both major parties.
 
The mythology of “free market economics” and the pursuit of individual gain have undermined the conception that society has a moral obligation to care for its members. We have been told, in many and various ways, to let the devil take the hindmost.
 
The casualties of this ideology go far beyond the poor. The victims represent the vast majority of the population, even those considered relatively well-off. Nowhere is this more evident than in health care.
 
The First Anniversary of Obama’s Healthcare Law
 
Take the Obama administration’s health care law, for example, whose first anniversary was observed just last month. In view of sharply rising health insurance premiums, co-pays, and deductibles, not to mention special government waivers giving big corporations such as McDonalds the go-ahead to evade standard health policy provisions, the promise of universal, quality coverage looks as remote as ever.
 
It begs the question: What happened to social justice in health reform?
 
The short answer is that social justice was not served by the passage of this law. Despite the early rhetoric from President Obama that health reform must cover everyone, control long-term costs, and improve the quality of health care delivery, none of these goals will be met by the Patient Protection and Affordable Care Act (PPACA).
 
I say this with considerable sadness as a physician and as a man of faith. But there is no avoiding coming to terms with the mountain of accumulated evidence and experience, both domestic and worldwide, that achieving social justice in health care is impossible as long as investor-owned health insurance companies dominate the system. And the new law is based on precisely that parasitic and immoral industry.
 
At the beginning of the reform debate, the president said that all ideas would be put on the table for consideration. But this did not happen. The most rational, proven method of financing comprehensive and affordable health care — single-payer national health insurance, or an improved Medicare for all — was deliberately excluded from the debate.
 
It took the dramatic civil disobedience and arrest of Dr. Margaret Flowers and other courageous single-payer advocates in Senator Max Baucus’ Senate Finance Committee chambers for single payer to register a tiny blip on the congressional radar. Even then, the Medicare-for-all proposal — which enjoys the support of two-thirds of the American people, according to a panoply of polls — was relegated to the sidelines by Baucus and his colleagues, most of them beneficiaries of private health industry largess.
 
A Modest Reform that Left the Investor-Owned System in Place
 
As a result, the bill that Congress fashioned and the president signed is not fundamental reform. It leaves our immoral arrangements essentially in place.
 
What we have in PPACA is a set of modest restraints on the for-profit health industry that were largely shaped by its medical-industrial lobby. Notwithstanding some beneficial features in the law, such as more funding for community health centers, the ability of young adults to stay on their parents’ plan till age twenty-six, the expansion of Medicaid, or regulations curtailing some of the most outrageous practices of the private insurers, PPACA basically maintains our present system.
 
The new law does nothing to effectively control rising health care costs, including skyrocketing premiums for individuals and businesses alike.
 
In short, the new law puts corporate interests over patients’ rights.
 
Accommodating the wishes of the private health industry may have been the “politically smart” way to get the bill passed, but it left in place our fragmented, chaotic, and costly health care “non-system” — a non-system that is inherently unjust.
 
I am disappointed that our nation’s religious institutions failed in their prophetic mission to reframe the health reform debate from one of partisan politics to the real moral issue involved here, namely, that “Health care is a human right.”
 
Nowhere is the immorality of our situation more dramatically illustrated than in the number of the uninsured.
 
The 2009 census figures show that we had 50.7 million people uninsured — an increase of 4.3 million, or nearly 10 percent, over the previous year. The Congressional Budget Office estimates we’ll have about 50 million uninsured for the next three years. In 2014, when the new insurance mandates and Medicaid expansion go into effect, the number will drop to about 30 million. But even if PPACA works as planned, we will still have 23 million people without insurance in 2019.
 
45,000 Unnecessary Deaths Each Year
 
Lack of health insurance is deadly, as numerous research studies have pointed out. An estimated 45,000 annual deaths can be linked to not having insurance and therefore not having access to care, according to a 2009 article in the American Journal of Public Health.
 
Under the new law we can also see a trend in the type of insurance coverage that will be offered to the public. That trend will be toward offering high-deductible and co-pay policies like the “medical savings account” products. These types of “under-insurance” policies will put more financial burden on the public, and will leave people with less financial security if they contract any major illnesses.
 
As a consequence, medical bills will continue to be a major contributing factor to personal bankruptcy. Writing in the American Journal of Medicine, researchers in 2009 found that illness and medical bills can be linked to 62 percent of personal bankruptcies in our nation. Significantly, three-quarters of all medically bankrupt persons were insured at the onset of their illnesses. This statistic could become worse.
 
What we need in America is a national health program that covers everyone — especially the most vulnerable such as immigrants and all those made poor and marginalized in our society.
 
Even with PPACA, we will still be rationing health care by wealth and position in society. This is not social justice and our faith communities need to speak and demand that the system be changed.
 
As a member of a church and as a member of Physicians for a National Health Program, I work to share the solid research that shows a single-payer national health insurance program, like an expanded and improved Medicare for all, is a just way to improve our nation’s health and wellness.
 
With its efficiency, transparency, and enormous clout in the marketplace, an improved and expanded Medicare program could control long-term costs, implement national standards, and p
rovide for regional planning to improve the quality of care we receive. Improved Medicare for all would cover everyone in America — all of our neighbors. This would result in health care justice grounded in the equality of all human persons before God, which is exactly what God demands of us in our scriptures and in our professed religious traditions.
 
Why can’t we do this?
 
Arthur J. Sutherland III, M.D., F.A.C.C., of Memphis is coordinator of the Tennessee chapter of Physicians for a National Health Program (www.pnhp.org). He is a retired physician and founder of the Sutherland Cardiology Clinic. He works with The Healthy Memphis Common Table, which is addressing the obesity and diabetes epidemics, health literacy, and efforts to eliminate social and health disparities. Dr. Sutherland is also a member of the Memphis School of Servant Leadership and works with the Memphis Theological Seminary in its urban ministry program.

Stop the bipartisan assault on Medicare, support the People’s Budget

By Claudia Chaufan
OpEdNews, April 15, 2011

So, folks, what is the greatest danger affecting the nation?
 
You might think that it is a completely out-of-control military machinery, which has maimed or murdered millions of innocents throughout the world and made a mockery of our so-called American values. Or maybe it is the 8 million families thrown out of their homes over the last three years while bankers sit on big piles of cash and Wall Street gangsters are paid corporate bonuses at taxpayers’ expense. Yet another good candidate for “greatest danger to the nation” would be the 50 million uninsured, many of them lining up in health fairs throughout the country, such as that at the Oakland Coliseum this past week, to receive free medical care from organizations like Remote Area Medical, which conducts medical “expeditions” in the “Third World.”
 
But then, you would be wrong.
 
As President Obama announced in his Wednesday evening address, our Greatest Danger is the Federal Deficit. And he said this with a straight face, and to frantic applauses from many Very Important People, including many “progressives.”
 
Now, you would imagine that, in order to fight this Greatest Danger, the president has proposed to end wars, raise taxes on millionaires or billionaires, or eliminate the cancer of a health care system that spends at least a third of each health care dollar avoiding the sick. And that he’s proposed instead to replace it with a truly universal, comprehensive and high quality Medicare for All, supported by over half of the population and close to 60 percent of U.S. physicians, and possessing the power to reduce the deficit by half a trillion dollars in the first year alone.
 
But you would be wrong again. Instead, Obama is out to slash domestic spending, increase the military monster until it devours whatever good is left of this nation, and assign an unelected “commission” the power to “overhaul” (“dismantle” in Washington-speak) an American symbol of solidarity: Medicare, or what it’s left of it after years of encroaching privatization.
 
Granted, the Republican alternative is outright brutal: the latest star in Capitol Hill, Rep. Paul Ryan, has proposed to turn Medicare into an all but worthless voucher program that will send impoverished seniors to comparative-shop for the sort of policies that are leading an increasing number of Americans to bankruptcy when they need serious health care. And it launches an open war on the poor, turning Medicaid (health care for the poor) into confetti, and slashing the food stamps program, support for child care, the environment, and the rest of socially useful services other than the military.
 
So it is really not hard to score political points if you spend at least half an hour denouncing the Republicans’ plan, as Obama self-righteously did, because whatever you do will look good by comparison.
 
Yet if you set aside the hype and look at the details of Obama’s plan (or listen carefully to the candid comments offered to Fox News by White House political strategist David Plouffe), parts of the Republican plan for Medicare are already part of “Obamacare.” After all, Obamacare builds upon the Republican idea of a mandate to purchase commercial insurance, and the Medicare “improvements” it envisions will soon become a very real part of the New American Nightmare.
 
Should we be surprised? I don’t think so. After all, the president’s call to, yet again, “make sacrifices” and “learn to live within our means” is in line with last Saturday’s weekly Internet/radio address, in which Obama suggested that the proposed $38 billion slash in the federal budget was an instance of “cooperation” between “the two parties” to “invest in our country’s future while making the largest annual spending cut in our history” — and all in one and the same breath.
 
If you are still desperately trying to find a silver lining in Obama’s by now well-established Orwellian double-speak, get it over with: there is none.
 
So what to do?
 
First, we need to act quickly. Before John Boehner’s House Republicans succeed in ramming through this Friday their right-wing budget for 2012, which would destroy Medicare and Medicaid to pay for tax cuts for millionaires and billionaires, we need to demand that legislators, if they have any decency left, vote for the “People’s Budget,” fought and won by the 80-member Congressional Progressive Caucus (CPC).
 
In a nutshell, the CPC People’s Budget reduces the deficit by 2021 without devastating Medicare, Medicaid and Social Security, and targets the true drivers of the deficit: the Bush tax cuts, the wars overseas, and the causes and effects of the recent recession. It restores the nation’s economic health by building roads and bridges, training more and better teachers, and supporting community colleges. Last, it ensures that the banks that wrecked our economy pay a modest financial responsibility fee, that exotic trading by Wall Street traders is taxed, and that oil companies making record profits from price gouging at the pump no longer receive taxpayer charity. And it taxes U.S. corporate income as it is earned, in much the same way working Americans are taxed.
 
There is no time to lose. Tell your representatives to vote for the CPC People’s Budget.
 
Claudia Chaufan, M.D., Ph.D., is assistant professor at the Institute for Health and Aging at the University of California, San Francisco. She teaches sociology of health and medicine, sociology of power, public health, comparative health care systems and sociological theory. Dr. Chaufan is also vice president of Physicians for a National Health Program-California (http://pnhpcalifornia.org/).
 
http://www.opednews.com/articles/Stop-the-Bipartisan-Assaul-by-Claudia-Chaufan-110415-369.html