PNHP

Washington Post Discussion on America's New Health Care Law

Washington Post Discussion on America's New Health Care Law

Washington Post Discussion on America’s New Health Care Law

Kaiser Foundation
May 10, 1010
Jackie Judd, vice president and senior advisor for communications, Kaiser Family Foundation:
“You wrote the… opening, overview chapter (of “Landmark” – a new book by the reporting staff of the Washington Post on the new health care law), and in there you said that while the law is complex, it’s also moderate and incremental, and it’s that very moderation that makes it complicated. What do you mean?”
Alec MacGillis, reporter for the Washington Post:
“Well, it’s something I tried to say often during this whole debate. When people complained about the length of the bill – a two thousand page monstrosity, so complicated – and I wrote a piece back in the Fall that tried to address that argument and pointed out that, you know, if you really wanted a simple bill, then you could just blow this whole thing up.
“And, you know, single payer is very simple. You just, you know – government-run health insurance – get rid of all the health insurance companies, and there are a lot fewer rules to write. That’s simpler, but, obviously, we were not going to do that.
“We were going to take a much more moderate, market-based approach to this. And that means preserving the foundations of our existing system. And that means ending up with something with a law that’s much more complex, because you’re sort of tweaking here and there. You’re not just – it’s not tabula rasa – you’re not starting over.
“But in its main elements it really is a quite moderate and incremental approach. We are preserving the private health insurance system. It’s modeled – no matter what Mitt Romney tells you now – this is modeled on the plan that he passed in 2006 as a Republican governor of Massachusetts; it’s modeled on the Republican alternative to the Clinton plan in the early nineties; it’s modeled on Richard Nixon’s plan in the seventies; it’s modeled on the idea put forward by the Heritage Foundation early last decade, although they’re trying to distance themselves right now from that; but it really is an attempt to build on what we have now, and because you’re doing it that way, you end up with this messy thing. But it’s really not that… but the main elements are not that complicated.
“What we basically have – the best way to think of it is kind of a three legged stool. We are expanding coverage by requiring that everyone get coverage. We’re also telling the insurance companies that they have to provide everyone coverage who comes and asks for it. So they have to take you; you have to get it. That way you get the healthy people into the pool so that they can afford to take the sick people as well. And then to help people afford to get the coverage that they’re required to get, you provide subsidies. But that’s it, and you need all three legs of that stool. That’s why you need have a mandate.”
http://www.c-span.org/Watch/Media/2010/05/10/HP/A/32795/Washington+Post+Discussion+on+Americas+New+Health+Care+Law.aspx

So by pursuing a moderate, market-based, Republican-based approach, the health care law was made much more complicated. But the greater tragedy is that it wasn’t only made more complicated, it failed in our goals of covering everyone with a financing system that we could afford. The complicated reform proposal that is now law is the most expensive model of reform ever devised, not to mention being one of the least effective.
As Alec MacGillis states, “… single payer is very simple. You just, you know – government-run health insurance – get rid of all the health insurance companies, and there are a lot fewer rules to write.”
We still can “blow this whole thing up,” and enact single payer. Not only would there be fewer rules, everyone would have the health care that they need, and we would be able to pay for it. That will never happen under the new law.

Washington Post Discussion on America’s New Health Care Law

Washington Post Discussion on America’s New Health Care Law

Kaiser Foundation
May 10, 1010

Jackie Judd, vice president and senior advisor for communications, Kaiser Family Foundation:

“You wrote the… opening, overview chapter (of “Landmark” – a new book by the reporting staff of the Washington Post on the new health care law), and in there you said that while the law is complex, it’s also moderate and incremental, and it’s that very moderation that makes it complicated. What do you mean?”

Alec MacGillis, reporter for the Washington Post:

“Well, it’s something I tried to say often during this whole debate. When people complained about the length of the bill – a two thousand page monstrosity, so complicated – and I wrote a piece back in the Fall that tried to address that argument and pointed out that, you know, if you really wanted a simple bill, then you could just blow this whole thing up.

“And, you know, single payer is very simple. You just, you know – government-run health insurance – get rid of all the health insurance companies, and there are a lot fewer rules to write. That’s simpler, but, obviously, we were not going to do that.

“We were going to take a much more moderate, market-based approach to this. And that means preserving the foundations of our existing system. And that means ending up with something with a law that’s much more complex, because you’re sort of tweaking here and there. You’re not just – it’s not tabula rasa – you’re not starting over.

“But in its main elements it really is a quite moderate and incremental approach. We are preserving the private health insurance system. It’s modeled – no matter what Mitt Romney tells you now – this is modeled on the plan that he passed in 2006 as a Republican governor of Massachusetts; it’s modeled on the Republican alternative to the Clinton plan in the early nineties; it’s modeled on Richard Nixon’s plan in the seventies; it’s modeled on the idea put forward by the Heritage Foundation early last decade, although they’re trying to distance themselves right now from that; but it really is an attempt to build on what we have now, and because you’re doing it that way, you end up with this messy thing. But it’s really not that… but the main elements are not that complicated.

“What we basically have – the best way to think of it is kind of a three legged stool. We are expanding coverage by requiring that everyone get coverage. We’re also telling the insurance companies that they have to provide everyone coverage who comes and asks for it. So they have to take you; you have to get it. That way you get the healthy people into the pool so that they can afford to take the sick people as well. And then to help people afford to get the coverage that they’re required to get, you provide subsidies. But that’s it, and you need all three legs of that stool. That’s why you need have a mandate.”

http://www.c-span.org/Watch/Media/2010/05/10/HP/A/32795/Washington+Post+Discussion+on+Americas+New+Health+Care+Law.aspx

So by pursuing a moderate, market-based, Republican-based approach, the health care law was made much more complicated. But the greater tragedy is that it wasn’t only made more complicated, it failed in our goals of covering everyone with a financing system that we could afford. The complicated reform proposal that is now law is the most expensive model of reform ever devised, not to mention being one of the least effective.

As Alec MacGillis states, “… single payer is very simple. You just, you know – government-run health insurance – get rid of all the health insurance companies, and there are a lot fewer rules to write.”

We still can “blow this whole thing up,” and enact single payer. Not only would there be fewer rules, everyone would have the health care that they need, and we would be able to pay for it. That will never happen under the new law.

Testimony on ERISA before the Vermont legislature

By Ethan Parke
January 12, 2010

My name is Ethan Parke. I live in Montpelier, and I support universal health care in Vermont as outlined in S.88 and H.100. I thank the Senate President Pro Tem and the Chair of the Senate Health Care Committee for their commitment to giving serious consideration to S.88 in the Senate this year.

I want to address a reason that is frequently given for state legislators’ reluctance to consider public health care financing, and that issue is ERISA, the Employee Retirement Income Security Act. ERISA is a federal law that preempts states from enacting legislation “relating to” employee benefit plans.

In the course of deliberations on federal health care reform, it was reported that Senator Sanders asked for a legal opinion on the question of whether ERISA would preempt a state law establishing a state single payer system. The conclusion was that, although there is very limited case law on this matter, state legislators should not use ERISA as a reason to be defeatist in their attitude toward establishing publicly-funded health care. The following are reasons why this is so:

• Legislation creating a system that raises taxes to achieve a public good is different from a law that requires employers to provide a specific level of private benefits to their employees. Single payer is not an “employee benefit plan” as defined by ERISA.

• An ERISA challenge would target the financing mechanism in the state health care law. If (in a non-single payer system) employers are separately taxed and then required to provide a certain level of employee benefits, ERISA might be likely to preempt the state law. On the other hand, if an employer assessment is only one revenue source along with many others that are combined and deposited into a public fund that is used to provide uniform health care benefits to a population regardless of employment status, then ERISA is thought not to have the force of preemption.

• Although the first state to enact publicly-funded universal health care is likely to face a court challenge based on ERISA, a state with a properly structured single payer plan would have a strong case in its defense. Other state reform models, such as hybrid public/private programs in which employers are mandated to provide private insurance or pay a tax, would have much more difficulty surviving an ERISA challenge.

• ERISA was enacted to protect employees’ and retirees’ interests relating to pensions and health benefits. A single payer health system would strengthen those protections. In fact, looking solely at the health care aspects of ERISA, one could say that a single payer plan would fulfill all of the reasons for which ERISA exists. Therefore an ERISA preemption of a state single payer law would make no sense.

I hope these comments are helpful to you as you mark up S.88 and H. 100. Thank you.

"Behavioral economics" and "choice architecture"

For good behavior

By Rebecca Vesely
ModernHealthcare.com
May 10, 2010

The biggest test of how well behavioral economics can be applied to healthcare is the new federal health reform law, which contains in its more than 1,000 pages many opportunities to nudge people toward better health choices.

“There’s definitely a general fascination about this area,” said Alan Garber, an internal medicine physician and professor of medicine and economics at Stanford University. “In healthcare, for years and years and years there’s been an interest in changing provider and consumer behavior.”

But some worry that behavioral economics could exacerbate health disparities, or inadvertently punish the elderly or people who suffer from chronic diseases.

Meanwhile, some employers are moving full-force to apply behavioral economics to benefit-package design in order to cut healthcare costs.

The most obvious example of behavioral economics in the new healthcare law—and one that drew fire from chronic-disease groups—is a change in employer wellness program incentives. Starting in 2014, employers can offer workers rewards worth up to 30% to 50% of their cost of health coverage for participating in a wellness program and meeting health benchmarks. The law also sets up a 10-state pilot program for similar wellness initiatives on the individual insurance market.

The idea is to create more incentives for workers than is allowed by law today to improve their health, and thus lower medical costs for everyone. The large incentives were pioneered by the grocery chain Safeway.

But the American Diabetes Association, the AARP and other groups have criticized the enhanced incentives, saying that they could penalize those with chronic diseases by forcing them to pay more for healthcare.

“Our position hasn’t changed,” said Colleen Fogarty, spokeswoman for the American Diabetes Association, in an e-mail. “We remain opposed to the language, but it is now the law and we have to work to ensure that these provisions do not have a harmful or unfair impact on people with chronic diseases.”

Proponents of the provision say it is a good example of a component of behavioral economics called “choice architecture.” Essentially, choice architecture is organizing choices in such a way that influences people’s decisions. In theory, enhanced wellness program incentives allow employers to encourage workers to make the healthiest choices.

Choice architecture is sure to be hugely influential in how the government structures new health insurance exchanges, set to go online in 2014, Garber said. While the government won’t be able to pick favorites among insurers participating in the state-run exchanges, it will be able give customers information about the plans, using transparency measures. This has already been done through the Medicare Part D prescription drug program, which lets insurers compete on the Medicare website for business.

“Behavioral incentives can be powerful, but they are unlikely to overcome a powerful financial incentive,” Garber said. So, for some people, an expensive healthcare plan they have to pay for in monthly premiums could be less appealing than a once-a-year financial penalty.

The dangers of financial penalties in healthcare have been shown time and time again when examining prescription drug use. If copayments go up too high, then some people stop filling their prescriptions and wind up sicker.

On the other hand, financial incentives don’t always work to change behavior, as evidenced by the disappointing results in physician pay-for-performance programs.

“We’ll be seeing some interesting experiments unfolding over the next few years,” Garber said. “This will, in the end, play out in the market.”

Express Scripts, a St. Louis-based pharmacy benefit manager, in 2008 launched the Center for Cost-Effective Consumerism and hired experts in behavioral economics—including Garber at Stanford University—to its advisory board.

Lowe’s, the home-improvement retail chain, saved $5.2 million in 2009 by getting employees who take maintenance prescription medications to switch to home pharmacy delivery. It did it using behavioral economics. Bob Ihrie, senior vice president of employee rewards and services at Lowe’s Cos., describes the method as “carrot, carrot, stick, big stick.”

Lowe’s started by educating its 225,000 employees nationwide about home drug delivery, and the cost savings involved. After the third month, if workers hadn’t switched, they are notified at the pharmacy when picking up their prescription and told that if they don’t switch to home delivery, they would start paying the full price of the prescription. The next month, if they hadn’t signed on for home delivery, they paid full price at the in-store pharmacy.

Another carrot followed. Last September, about 22,000 employees who were not signed on for home delivery received a postcard from Lowe’s informing them that if they select home delivery, their prescription drug would be free the first month. About 10% responded to this incentive, Ihrie said.

At the end of 2009, nearly 38,000 workers had switched to home delivery, up about 160% from 14,500 in 2008. Then came the big stick. Starting in January, employees eligible for home delivery but not yet enrolled pay twice the retail price for the drug in store. “We are still waiting to see the outcome of this,” Ihrie said.

The program has worked by breaking the cycle of procrastination, Ihrie said. “We give them choices upfront and then gradually move them along a path that is more mandatory,” he said. Conducted in partnership with Express Scripts, the program cuts waste out of the system without affecting clinical outcomes, Ihrie said.

Several high-ranking officials in the Obama administration are strong proponents of behavioral economics. Cass Sunstein, co-author of Nudge, is now the administrator of the White House Office of Information and Regulatory Affairs. Peter Orszag, director of the White House Office of Management and Budget, has spoken about the promise of behavioral economics to control costs.

http://www.modernhealthcare.com/article/20100510/INFO/100509942#

Comment: 

By Don McCanne, MD

“Behavioral economics” and “choice architecture” are being used to shift health care spending from the healthy to the sick by directly or indirectly assessing financial penalties against those who are unfortunate enough to have greater health care needs. This is strictly another scheme by pro-market enthusiasts who support the flawed concept of consumer-directed health care.

As an example of the flaws, a scheme that requires patients to pay twice the usual retail price for a drug is a perverse scheme indeed. Another example is Safeway’s fraudulent claims of savings from their wellness programs when their savings were really only from shifting to high-deductible health plans.

Instead of jerking patients around with perverse market tools, we need to switch to a public system that simply helps patients get the care that they need – an improved Medicare for everyone.

“Behavioral economics” and “choice architecture”

For good behavior

By Rebecca Vesely
ModernHealthcare.com
May 10, 2010

The biggest test of how well behavioral economics can be applied to healthcare is the new federal health reform law, which contains in its more than 1,000 pages many opportunities to nudge people toward better health choices.

“There’s definitely a general fascination about this area,” said Alan Garber, an internal medicine physician and professor of medicine and economics at Stanford University. “In healthcare, for years and years and years there’s been an interest in changing provider and consumer behavior.”

But some worry that behavioral economics could exacerbate health disparities, or inadvertently punish the elderly or people who suffer from chronic diseases.

Meanwhile, some employers are moving full-force to apply behavioral economics to benefit-package design in order to cut healthcare costs.

The most obvious example of behavioral economics in the new healthcare law—and one that drew fire from chronic-disease groups—is a change in employer wellness program incentives. Starting in 2014, employers can offer workers rewards worth up to 30% to 50% of their cost of health coverage for participating in a wellness program and meeting health benchmarks. The law also sets up a 10-state pilot program for similar wellness initiatives on the individual insurance market.

The idea is to create more incentives for workers than is allowed by law today to improve their health, and thus lower medical costs for everyone. The large incentives were pioneered by the grocery chain Safeway.

But the American Diabetes Association, the AARP and other groups have criticized the enhanced incentives, saying that they could penalize those with chronic diseases by forcing them to pay more for healthcare.

“Our position hasn’t changed,” said Colleen Fogarty, spokeswoman for the American Diabetes Association, in an e-mail. “We remain opposed to the language, but it is now the law and we have to work to ensure that these provisions do not have a harmful or unfair impact on people with chronic diseases.”

Proponents of the provision say it is a good example of a component of behavioral economics called “choice architecture.” Essentially, choice architecture is organizing choices in such a way that influences people’s decisions. In theory, enhanced wellness program incentives allow employers to encourage workers to make the healthiest choices.

Choice architecture is sure to be hugely influential in how the government structures new health insurance exchanges, set to go online in 2014, Garber said. While the government won’t be able to pick favorites among insurers participating in the state-run exchanges, it will be able give customers information about the plans, using transparency measures. This has already been done through the Medicare Part D prescription drug program, which lets insurers compete on the Medicare website for business.

“Behavioral incentives can be powerful, but they are unlikely to overcome a powerful financial incentive,” Garber said. So, for some people, an expensive healthcare plan they have to pay for in monthly premiums could be less appealing than a once-a-year financial penalty.

The dangers of financial penalties in healthcare have been shown time and time again when examining prescription drug use. If copayments go up too high, then some people stop filling their prescriptions and wind up sicker.

On the other hand, financial incentives don’t always work to change behavior, as evidenced by the disappointing results in physician pay-for-performance programs.

“We’ll be seeing some interesting experiments unfolding over the next few years,” Garber said. “This will, in the end, play out in the market.”

Express Scripts, a St. Louis-based pharmacy benefit manager, in 2008 launched the Center for Cost-Effective Consumerism and hired experts in behavioral economics—including Garber at Stanford University—to its advisory board.

Lowe’s, the home-improvement retail chain, saved $5.2 million in 2009 by getting employees who take maintenance prescription medications to switch to home pharmacy delivery. It did it using behavioral economics. Bob Ihrie, senior vice president of employee rewards and services at Lowe’s Cos., describes the method as “carrot, carrot, stick, big stick.”

Lowe’s started by educating its 225,000 employees nationwide about home drug delivery, and the cost savings involved. After the third month, if workers hadn’t switched, they are notified at the pharmacy when picking up their prescription and told that if they don’t switch to home delivery, they would start paying the full price of the prescription. The next month, if they hadn’t signed on for home delivery, they paid full price at the in-store pharmacy.

Another carrot followed. Last September, about 22,000 employees who were not signed on for home delivery received a postcard from Lowe’s informing them that if they select home delivery, their prescription drug would be free the first month. About 10% responded to this incentive, Ihrie said.

At the end of 2009, nearly 38,000 workers had switched to home delivery, up about 160% from 14,500 in 2008. Then came the big stick. Starting in January, employees eligible for home delivery but not yet enrolled pay twice the retail price for the drug in store. “We are still waiting to see the outcome of this,” Ihrie said.

The program has worked by breaking the cycle of procrastination, Ihrie said. “We give them choices upfront and then gradually move them along a path that is more mandatory,” he said. Conducted in partnership with Express Scripts, the program cuts waste out of the system without affecting clinical outcomes, Ihrie said.

Several high-ranking officials in the Obama administration are strong proponents of behavioral economics. Cass Sunstein, co-author of Nudge, is now the administrator of the White House Office of Information and Regulatory Affairs. Peter Orszag, director of the White House Office of Management and Budget, has spoken about the promise of behavioral economics to control costs.

http://www.modernhealthcare.com/article/20100510/INFO/100509942#

Comment: 

By Don McCanne, MD

“Behavioral economics” and “choice architecture” are being used to shift health care spending from the healthy to the sick by directly or indirectly assessing financial penalties against those who are unfortunate enough to have greater health care needs. This is strictly another scheme by pro-market enthusiasts who support the flawed concept of consumer-directed health care.

As an example of the flaws, a scheme that requires patients to pay twice the usual retail price for a drug is a perverse scheme indeed. Another example is Safeway’s fraudulent claims of savings from their wellness programs when their savings were really only from shifting to high-deductible health plans.

Instead of jerking patients around with perverse market tools, we need to switch to a public system that simply helps patients get the care that they need – an improved Medicare for everyone.

"Behavioral economics" and "choice architecture"

For good behavior

By Rebecca Vesely
ModernHealthcare.com
May 10, 2010
The biggest test of how well behavioral economics can be applied to healthcare is the new federal health reform law, which contains in its more than 1,000 pages many opportunities to nudge people toward better health choices.
“There’s definitely a general fascination about this area,” said Alan Garber, an internal medicine physician and professor of medicine and economics at Stanford University. “In healthcare, for years and years and years there’s been an interest in changing provider and consumer behavior.”
But some worry that behavioral economics could exacerbate health disparities, or inadvertently punish the elderly or people who suffer from chronic diseases.
Meanwhile, some employers are moving full-force to apply behavioral economics to benefit-package design in order to cut healthcare costs.
The most obvious example of behavioral economics in the new healthcare law—and one that drew fire from chronic-disease groups—is a change in employer wellness program incentives. Starting in 2014, employers can offer workers rewards worth up to 30% to 50% of their cost of health coverage for participating in a wellness program and meeting health benchmarks. The law also sets up a 10-state pilot program for similar wellness initiatives on the individual insurance market.
The idea is to create more incentives for workers than is allowed by law today to improve their health, and thus lower medical costs for everyone. The large incentives were pioneered by the grocery chain Safeway.
But the American Diabetes Association, the AARP and other groups have criticized the enhanced incentives, saying that they could penalize those with chronic diseases by forcing them to pay more for healthcare.
“Our position hasn’t changed,” said Colleen Fogarty, spokeswoman for the American Diabetes Association, in an e-mail. “We remain opposed to the language, but it is now the law and we have to work to ensure that these provisions do not have a harmful or unfair impact on people with chronic diseases.”
Proponents of the provision say it is a good example of a component of behavioral economics called “choice architecture.” Essentially, choice architecture is organizing choices in such a way that influences people’s decisions. In theory, enhanced wellness program incentives allow employers to encourage workers to make the healthiest choices.
Choice architecture is sure to be hugely influential in how the government structures new health insurance exchanges, set to go online in 2014, Garber said. While the government won’t be able to pick favorites among insurers participating in the state-run exchanges, it will be able give customers information about the plans, using transparency measures. This has already been done through the Medicare Part D prescription drug program, which lets insurers compete on the Medicare website for business.
“Behavioral incentives can be powerful, but they are unlikely to overcome a powerful financial incentive,” Garber said. So, for some people, an expensive healthcare plan they have to pay for in monthly premiums could be less appealing than a once-a-year financial penalty.
The dangers of financial penalties in healthcare have been shown time and time again when examining prescription drug use. If copayments go up too high, then some people stop filling their prescriptions and wind up sicker.
On the other hand, financial incentives don’t always work to change behavior, as evidenced by the disappointing results in physician pay-for-performance programs.
“We’ll be seeing some interesting experiments unfolding over the next few years,” Garber said. “This will, in the end, play out in the market.”
Express Scripts, a St. Louis-based pharmacy benefit manager, in 2008 launched the Center for Cost-Effective Consumerism and hired experts in behavioral economics—including Garber at Stanford University—to its advisory board.
Lowe’s, the home-improvement retail chain, saved $5.2 million in 2009 by getting employees who take maintenance prescription medications to switch to home pharmacy delivery. It did it using behavioral economics. Bob Ihrie, senior vice president of employee rewards and services at Lowe’s Cos., describes the method as “carrot, carrot, stick, big stick.”
Lowe’s started by educating its 225,000 employees nationwide about home drug delivery, and the cost savings involved. After the third month, if workers hadn’t switched, they are notified at the pharmacy when picking up their prescription and told that if they don’t switch to home delivery, they would start paying the full price of the prescription. The next month, if they hadn’t signed on for home delivery, they paid full price at the in-store pharmacy.
Another carrot followed. Last September, about 22,000 employees who were not signed on for home delivery received a postcard from Lowe’s informing them that if they select home delivery, their prescription drug would be free the first month. About 10% responded to this incentive, Ihrie said.
At the end of 2009, nearly 38,000 workers had switched to home delivery, up about 160% from 14,500 in 2008. Then came the big stick. Starting in January, employees eligible for home delivery but not yet enrolled pay twice the retail price for the drug in store. “We are still waiting to see the outcome of this,” Ihrie said.
The program has worked by breaking the cycle of procrastination, Ihrie said. “We give them choices upfront and then gradually move them along a path that is more mandatory,” he said. Conducted in partnership with Express Scripts, the program cuts waste out of the system without affecting clinical outcomes, Ihrie said.
Several high-ranking officials in the Obama administration are strong proponents of behavioral economics. Cass Sunstein, co-author of Nudge, is now the administrator of the White House Office of Information and Regulatory Affairs. Peter Orszag, director of the White House Office of Management and Budget, has spoken about the promise of behavioral economics to control costs.
http://www.modernhealthcare.com/article/20100510/INFO/100509942#

“Behavioral economics” and “choice architecture” are being used to shift health care spending from the healthy to the sick by directly or indirectly assessing financial penalties against those who are unfortunate enough to have greater health care needs. This is strictly another scheme by pro-market enthusiasts who support the flawed concept of consumer-directed health care.
As an example of the flaws, a scheme that requires patients to pay twice the usual retail price for a drug is a perverse scheme indeed. Another example is Safeway’s fraudulent claims of savings from their wellness programs when their savings were really only from shifting to high-deductible health plans.
Instead of jerking patients around with perverse market tools, we need to switch to a public system that simply helps patients get the care that they need – an improved Medicare for everyone.

“Behavioral economics” and “choice architecture”

For good behavior

By Rebecca Vesely
ModernHealthcare.com
May 10, 2010

The biggest test of how well behavioral economics can be applied to healthcare is the new federal health reform law, which contains in its more than 1,000 pages many opportunities to nudge people toward better health choices.

“There’s definitely a general fascination about this area,” said Alan Garber, an internal medicine physician and professor of medicine and economics at Stanford University. “In healthcare, for years and years and years there’s been an interest in changing provider and consumer behavior.”

But some worry that behavioral economics could exacerbate health disparities, or inadvertently punish the elderly or people who suffer from chronic diseases.

Meanwhile, some employers are moving full-force to apply behavioral economics to benefit-package design in order to cut healthcare costs.

The most obvious example of behavioral economics in the new healthcare law—and one that drew fire from chronic-disease groups—is a change in employer wellness program incentives. Starting in 2014, employers can offer workers rewards worth up to 30% to 50% of their cost of health coverage for participating in a wellness program and meeting health benchmarks. The law also sets up a 10-state pilot program for similar wellness initiatives on the individual insurance market.

The idea is to create more incentives for workers than is allowed by law today to improve their health, and thus lower medical costs for everyone. The large incentives were pioneered by the grocery chain Safeway.

But the American Diabetes Association, the AARP and other groups have criticized the enhanced incentives, saying that they could penalize those with chronic diseases by forcing them to pay more for healthcare.

“Our position hasn’t changed,” said Colleen Fogarty, spokeswoman for the American Diabetes Association, in an e-mail. “We remain opposed to the language, but it is now the law and we have to work to ensure that these provisions do not have a harmful or unfair impact on people with chronic diseases.”

Proponents of the provision say it is a good example of a component of behavioral economics called “choice architecture.” Essentially, choice architecture is organizing choices in such a way that influences people’s decisions. In theory, enhanced wellness program incentives allow employers to encourage workers to make the healthiest choices.

Choice architecture is sure to be hugely influential in how the government structures new health insurance exchanges, set to go online in 2014, Garber said. While the government won’t be able to pick favorites among insurers participating in the state-run exchanges, it will be able give customers information about the plans, using transparency measures. This has already been done through the Medicare Part D prescription drug program, which lets insurers compete on the Medicare website for business.

“Behavioral incentives can be powerful, but they are unlikely to overcome a powerful financial incentive,” Garber said. So, for some people, an expensive healthcare plan they have to pay for in monthly premiums could be less appealing than a once-a-year financial penalty.

The dangers of financial penalties in healthcare have been shown time and time again when examining prescription drug use. If copayments go up too high, then some people stop filling their prescriptions and wind up sicker.

On the other hand, financial incentives don’t always work to change behavior, as evidenced by the disappointing results in physician pay-for-performance programs.

“We’ll be seeing some interesting experiments unfolding over the next few years,” Garber said. “This will, in the end, play out in the market.”

Express Scripts, a St. Louis-based pharmacy benefit manager, in 2008 launched the Center for Cost-Effective Consumerism and hired experts in behavioral economics—including Garber at Stanford University—to its advisory board.

Lowe’s, the home-improvement retail chain, saved $5.2 million in 2009 by getting employees who take maintenance prescription medications to switch to home pharmacy delivery. It did it using behavioral economics. Bob Ihrie, senior vice president of employee rewards and services at Lowe’s Cos., describes the method as “carrot, carrot, stick, big stick.”

Lowe’s started by educating its 225,000 employees nationwide about home drug delivery, and the cost savings involved. After the third month, if workers hadn’t switched, they are notified at the pharmacy when picking up their prescription and told that if they don’t switch to home delivery, they would start paying the full price of the prescription. The next month, if they hadn’t signed on for home delivery, they paid full price at the in-store pharmacy.

Another carrot followed. Last September, about 22,000 employees who were not signed on for home delivery received a postcard from Lowe’s informing them that if they select home delivery, their prescription drug would be free the first month. About 10% responded to this incentive, Ihrie said.

At the end of 2009, nearly 38,000 workers had switched to home delivery, up about 160% from 14,500 in 2008. Then came the big stick. Starting in January, employees eligible for home delivery but not yet enrolled pay twice the retail price for the drug in store. “We are still waiting to see the outcome of this,” Ihrie said.

The program has worked by breaking the cycle of procrastination, Ihrie said. “We give them choices upfront and then gradually move them along a path that is more mandatory,” he said. Conducted in partnership with Express Scripts, the program cuts waste out of the system without affecting clinical outcomes, Ihrie said.

Several high-ranking officials in the Obama administration are strong proponents of behavioral economics. Cass Sunstein, co-author of Nudge, is now the administrator of the White House Office of Information and Regulatory Affairs. Peter Orszag, director of the White House Office of Management and Budget, has spoken about the promise of behavioral economics to control costs.

http://www.modernhealthcare.com/article/20100510/INFO/100509942#

“Behavioral economics” and “choice architecture” are being used to shift health care spending from the healthy to the sick by directly or indirectly assessing financial penalties against those who are unfortunate enough to have greater health care needs. This is strictly another scheme by pro-market enthusiasts who support the flawed concept of consumer-directed health care.

As an example of the flaws, a scheme that requires patients to pay twice the usual retail price for a drug is a perverse scheme indeed. Another example is Safeway’s fraudulent claims of savings from their wellness programs when their savings were really only from shifting to high-deductible health plans.

Instead of jerking patients around with perverse market tools, we need to switch to a public system that simply helps patients get the care that they need – an improved Medicare for everyone.

Did a split over health care divide the British?

Socialized healthcare: The 'untouchable' of UK politics

By Paul Armstrong
CNN
May 5, 2010

After weeks of feverish election campaigning, Britain’s political parties have fought over every issue, from the economy to the country’s nuclear deterrent, with one exception: the National Health Service.

To many Republican politicians in the United States, a publicly-funded national health system like the NHS is the embodiment of austere, Soviet-era style medical care, but in the UK it is viewed as sacrosanct.

Centrally-funded through taxation, pressure to respond to growing demand has seen record levels of investment in the past decade.

Ruth Thorlby, a research fellow at the King’s Fund, told CNN that all the major parties appreciate the NHS strikes an emotive chord with the public and that it is a price worth paying. She said: “We have this extraordinary political consensus now that the funding structure of the NHS is sound.”

Conservative leader David Cameron seems as committed to the NHS as Labour, despite his party’s ideological disposition to the private sector.

He recently acknowledged its value on his party’s Web site. “Millions of people are grateful for the care they have received from the NHS — including my own family,” he said.

“One of the wonderful things about living in this country is that the moment you’re injured or fall ill — no matter who you are, where you are from, or how much money you’ve got — you know that the NHS will look after you.”

Cameron’s words were reinforced by the party’s election manifesto, in which it calls itself “the party of the NHS” and pledges “never to change at the idea at its heart that healthcare in this country is free at the point of use and available to everyone based on need and not ability to pay.”

http://edition.cnn.com/2010/WORLD/europe/04/23/britain.nhs/?hpt=C2

Comment: 

By Don McCanne, MD

The United Kingdom has the ultimate system of socialized medicine: a government-owned and government-administered National Health Service (NHS). Though their system is much less expensive than ours in the United States, it is viewed as sacrosanct by the British citizens.

The system was launched in 1948 by a left-wing Labour government, but its appeal has become so universal that the right-wing Conservative party now claims to be “the party of the NHS.”

In the United States we have chosen a right-wing solution over which we remain politically divided because of its serious flaws. Since we spend far more on health care than any other nation, we should be able to use those funds to craft a system with such intense universal support that we would consider ours sacrosanct as well.

Of course we can. Try to convince senior Tea Baggers to relinquish their Medicare, even though it is a government program. Medicare is a right that they have earned merely by being American taxpayers. Just imagine improving Medicare and providing it to everyone. After people experienced the benefits of an improved Medicare for all, can you imagine a major political party campaigning against the program? In fact, it’s the Republicans who are now expressing outrage over the fact that PPACA includes some reductions in Medicare funding.

Now that the Republican party seems to be presenting itself as “the party of Medicare,” wouldn’t you think that the Democrats would want to trump them by becoming “the party of an improved Medicare for all”?

Will businesses drop their health benefit programs?

Documents reveal AT&T, Verizon, others, thought about dropping employer-sponsored benefits

By Shawn Tully

Fortune
May 6, 2010

The great mystery surrounding the historic health care bill is how the corporations that provide coverage for most Americans — coverage they know and prize — will react to the new law’s radically different regime of subsidies, penalties, and taxes. Now, we’re getting a remarkable inside look at the options AT&T, Deere, and other big companies are weighing to deal with the new legislation.

Internal documents recently reviewed by Fortune, originally requested by Congress, show what the bill’s critics predicted, and what its champions dreaded: many large companies are examining a course that was heretofore unthinkable, dumping the health care coverage they provide to their workers in exchange for paying penalty fees to the government.

That would dismantle the employer-based system that has reigned since World War II. It would also seem to contradict President Obama’s statements that Americans who like their current plans could keep them.

AT&T produced a PowerPoint slide entitled “Medical Cost Versus No Coverage Penalty.”

A document prepared for Verizon by consulting firm Hewitt Resources stated, “Even though the proposed assessments [on companies that do not provide health care] are material, they are modest when compared to the average cost of health care,” and that to avoid costs and regulations, “employers may consider exiting the health care market and send employees to the Exchanges.”

Kenneth Huhn, vice president of labor relations at Deere, said in an internal email that his company should look at the alternatives to providing health benefits, which “would amount to denying coverage and just paying the penalty,” and that he felt he already had the ability to make this change under his company’s labor agreement.

Caterpillar felt it would have to give “serious consideration” to the penalty option.

AT&T revealed that it spends $2.4 billion a year on coverage for its almost 300,000 active employees, a number that would fall to $600 million if AT&T stopped providing health care coverage and paid the penalty option instead.

(Caterpillar) could reduce its bill by over 70%, by Fortune’s estimate.

It’s these analyses — which show it’s a lot cheaper to “pay” than to “play” — that threaten to overthrow the traditional architecture of health care.

The full article contains links to documents supporting some of these assertions:
http://money.cnn.com/2010/05/05/news/companies/dropping_benefits.fortune/index.htm

Comment

By Don McCanne, M.D.

Yesterday’s qotd message described measures in the Patient Protection and Affordable Care Act (PPACA) that would motivate employers to downgrade their health benefit programs to an actuarial value of 60 percent (the employees would pay an average of 40 percent of actual health care costs, in addition to their share of the insurance premium). Today’s message reveals that major employers are considering the option of dumping their health benefit programs altogether.

The government subsidies for plans purchased in the state exchanges are large enough to shift a major portion of the costs of the health benefit programs from the employers/employees to the taxpayers. Further, the subsidized Silver-tier plans in the exchanges provide an actuarial value of 70 percent, resulting in greater benefits than the downgraded plans would have, at a net lower cost for the employers.

Unfortunately, neither is a great deal for the employees and their families. Employer-sponsored plans currently have a typical actuarial value of 80 percent, and sometimes as high as 90 or 95 percent. PPACA exchange plans will shift more costs to those who need health care by reducing the effective actuarial value to 70 percent for those with incomes over 250% FPL (federal poverty level), and those with incomes over 400% FPL would have no out-of-pocket limits to protect them.

Regardless, the complex structure of PPACA will result in worse coverage for employees than many of them currently have. This was the result of Congress and the Obama administration insisting that reform be built on our existing employer-based system, while facing the complex logistical problems of balancing the flow of money between individuals, employers, the government, the insurers, and the providers of health care.

It would have been far simpler, less expensive, and much more effective to establish a single financing pool, equitably-funded through the tax system, while providing significantly greater value in health care purchasing for all of us through a publicly-owned, publicly-administered, beneficent monopsony – an improved Medicare for all. We can still do it.

Did a split over health care divide the British?

Socialized healthcare: The ‘untouchable’ of UK politics

By Paul Armstrong
CNN
May 5, 2010
After weeks of feverish election campaigning, Britain’s political parties have fought over every issue, from the economy to the country’s nuclear deterrent, with one exception: the National Health Service.
To many Republican politicians in the United States, a publicly-funded national health system like the NHS is the embodiment of austere, Soviet-era style medical care, but in the UK it is viewed as sacrosanct.
Centrally-funded through taxation, pressure to respond to growing demand has seen record levels of investment in the past decade.
Ruth Thorlby, a research fellow at the King’s Fund, told CNN that all the major parties appreciate the NHS strikes an emotive chord with the public and that it is a price worth paying. She said: “We have this extraordinary political consensus now that the funding structure of the NHS is sound.”
Conservative leader David Cameron seems as committed to the NHS as Labour, despite his party’s ideological disposition to the private sector.
He recently acknowledged its value on his party’s Web site. “Millions of people are grateful for the care they have received from the NHS — including my own family,” he said.
“One of the wonderful things about living in this country is that the moment you’re injured or fall ill — no matter who you are, where you are from, or how much money you’ve got — you know that the NHS will look after you.”
Cameron’s words were reinforced by the party’s election manifesto, in which it calls itself “the party of the NHS” and pledges “never to change at the idea at its heart that healthcare in this country is free at the point of use and available to everyone based on need and not ability to pay.”
http://edition.cnn.com/2010/WORLD/europe/04/23/britain.nhs/?hpt=C2

The United Kingdom has the ultimate system of socialized medicine: a government-owned and government-administered National Health Service (NHS). Though their system is much less expensive than ours in the United States, it is viewed as sacrosanct by the British citizens.
The system was launched in 1948 by a left-wing Labour government, but its appeal has become so universal that the right-wing Conservative party now claims to be “the party of the NHS.”
In the United States we have chosen a right-wing solution over which we remain politically divided because of its serious flaws. Since we spend far more on health care than any other nation, we should be able to use those funds to craft a system with such intense universal support that we would consider ours sacrosanct as well.
Of course we can. Try to convince senior Tea Baggers to relinquish their Medicare, even though it is a government program. Medicare is a right that they have earned merely by being American taxpayers. Just imagine improving Medicare and providing it to everyone. After people experienced the benefits of an improved Medicare for all, can you imagine a major political party campaigning against the program? In fact, it’s the Republicans who are now expressing outrage over the fact that PPACA includes some reductions in Medicare funding.
Now that the Republican party seems to be presenting itself as “the party of Medicare,” wouldn’t you think that the Democrats would want to trump them by becoming “the party of an improved Medicare for all”?

Maybe answers are over rainbow

By Dr. Kathlene S. Waller
Fort Collins Coloradoan, May 6, 2010

Dear Auntie Em,

As I was just telling Toto a few days ago we’re sure not in Kansas anymore. We’ve noticed that things are very strange when it comes to health-care reform here in the land of Oz.

First of all, there is the Tin Man. He’s a Republican, and he sure could use a heart. President Obama extended his hand in a gesture of bipartisanship, but the Tin Man took his little ax and chopped the president’s hand right off!

He didn’t offer any good ideas himself, just tried to weaken any potential legislation and then voted against it anyway. He also said that he wants the president to fail. Can you imagine? He didn’t care about people suffering and dying because they can’t afford health care; he just wanted to obstruct everything for the sake of politics. I hope he is able to find a heart soon.

Then there’s the Cowardly Lion. He’s a Democrat, and he could definitely use some courage. He was so afraid to stand up to the health-care industry that he didn’t even consider the best solution to the whole health-care mess: a single-payer financing system.

It doesn’t take ruby slippers to understand that a single-payer system is the best way to assure that every person in this country has access to quality health care, while managing costs and saving billions of dollars. But even while controlling Congress and the White House, he was so cowardly that he took single payer “off the table” at the beginning, starting the discussion with a much weaker public option that was later compromised away.

Most remarkable of all is the Scarecrow, who doesn’t have a brain. He is the loud, ill-informed segment of the American public that is opposed to any government involvement, while ignoring the fact that Medicare is a government-run financing system which has provided health care to the oldest and sickest members of our society for more than 45 years.

He can’t seem to understand that having health insurance is not the same as having access to affordable health care, and that for-profit health insurance companies must do everything they can to deny care to sick people in order to maximize profits for shareholders.

Medicare is a single-payer system that could be improved and extended to all Americans from cradle to grave, but unfortunately, any mention of graves makes the poor Scarecrow worry about death panels since those flying monkeys in the right-wing media spread so many lies about health-care reform. It would sure be helpful if the Scarecrow could find a brain.

I was told to follow the yellow brick road to the Emerald City, and I finally figured out that they were solid-gold bricks, leading to a city the color of greenbacks.

I should have known, since I found the Wizard of Oz behind a curtain of campaign contributions. And guess what? The wizard was the health insurance and pharmaceutical companies who wrote the health-care bill and stand to profit greatly from its implementation.

After our long and turbulent journey, the final legislation turned out to be mostly just smoke and mirrors!

Well, we’ve been through quite a storm. Unfortunately, I guess real reform still lies somewhere over the rainbow …

Love, Dorothy

http://www.coloradoan.com/article/20100506/OPINION04/5060338/1014/OPINION/Maybe+answers+are+over+rainbow

After the Reform: Aiming High for Health Justice

By Margaret Flowers, M.D.
Tikkun Magazine, May/June 2010

As we sit here on the other side of the recent health reform process, we have an opportunity for reflection. There were many times during the past year and a half when passage of a health bill seemed unlikely. However, in the end, the White House and Democratic leadership joined forces and converted the last holdouts with scare tactics of electoral turnovers and even a trip on Air Force One in order to muscle a bill over the final hurdles. The mere fact that any bill was passed at all was hailed as the great accomplishment, because no honest proponent of health reform could call the final product a solution to our nation’s serious health care crisis.

This entire health reform process occurred under the shadow of the previous attempt to pass significant health legislation. President Obama made this his signature issue, and so for his administration failure was not an option. He surrounded himself with many of those who were traumatized by their participation in the last go-round. Thus, the resulting strategy was based more on fear of the opposition than on sound health policy. An opportunity for an honest debate about the needs of our people was squandered for backroom deals with industry giants and the photo ops so reminiscent of the previous administration. And for the most part, the resulting legislation benefits the very industries that profit most from our current situation more than it benefits the people of America.

Pros and Cons of the Legislation

There are some provisions within the bill that are positive steps: comparative effectiveness research; funding for demonstration projects to improve care; a new emphasis on prevention, wellness, and public health; increased funding for community health centers; and incentives for primary care providers. These are all necessary provisions, but they do not offset the harm done by other provisions in the bill, such as the individual mandate to purchase private insurance with penalties for noncompliance and the $447 billion in public dollars being used to subsidize such purchases. The bill will omit at least 23 million people from having any coverage. And the requirement to accept people with pre-existing conditions will most certainly increase premiums such that they become unaffordable, or people will purchase policies with skimpier coverage. This will likely result in a larger population of underinsured people—those who risk bankruptcy from medical debt should they develop health problems.

And none of the positive steps turn us in the direction of creating a national health system such as there is in every other advanced nation. Rather, on the whole, this legislation, which was written with heavy input from private health insurance and pharmaceutical lobbyists, further privatizes the financing of our health care and further enriches and empowers the very industries that are the problem. We know from experience both in the United States and abroad that market-based financing of health care is both the most expensive model and the most unjust, providing only as much health care as the patient can afford.

The Public Option Was Ruled Out at the Start

From the beginning of this process, it was clear that the administration and leadership had developed a strategy based on an outcome they believed they could achieve. The path was predetermined. All of the steps along the way, from the house parties that started during the winter of 2008 to the hearings, to the media spin, were planned so that the resulting “debate” was a drawn out performance of political theater. In order to disarm the corporate interests, the health industries that had opposed previous reforms were included on the inside. In order to disarm the Right, bipartisanship was at the forefront. In order to disarm the supporters of a single-payer plan, who are the majority, a campaign was developed around a promised “compromise,” the public option, and given tens of millions of dollars for organizing and advertising. The public option succeeded in splitting the single payer movement and confusing and distracting it with endless discussion about what type of public option would be effective.

Despite all of the attention, the public option was never meant to be part of the final legislation. As early as March 2009, Senator Baucus admitted that the public option existed as a bargaining chip to convince private insurers to accept increased regulation. And a year later, Glenn Greenwald and others confirmed that the public option had been privately negotiated away, although members of Congress continued the charade and “fought” for it.

Toward the final vote, supporters of the public option were hearing the same excuses that single-payer advocates have heard for decades. We are always told that single-payer is not politically feasible. However, we know that political feasibility can change. We are told to be pragmatic, yet we know that the reform being passed was not practical, in that it failed to guarantee health care to everyone and to be financially sustainable. We are told we are asking for too much and should accept incremental change. However, we know that the smallest effective step we can take in health reform is the creation of a publicly funded health system. Beyond that, there is much more to do in order to create a health system that raises us into the top ten in the world.

Profit-Driven Insurers Cannot Prioritize Care

While politicians claim that we have finally achieved comprehensive health reform and that now all Americans will have guaranteed affordable health care, we in the single-payer movement experience a sense of déjà vu. We have seen the same scenario occur at the state level from Oregon to Maine to Tennessee, and most recently in Massachusetts. Every state that has passed a health reform package has made these claims, only to find that within a few years they were unable to cover the number of people they had hoped to cover and that their health care costs exceeded their budget. The reason for this is that every state, and now our federal government, ignored the data showing that we cannot achieve universal and affordable health care as long as we retain private insurers as an integral part of health care financing. This truth has been documented both in practice and in numerous economic studies.

We cannot control health care costs, without severe rationing, as long as we retain multiple private insurers, because this model wastes at least a third of our health care dollars on areas that have nothing to do with direct health care: marketing, high CEO salaries, profits, and administration. We cannot guarantee that patients will be able to afford needed care using private insurers because the private insurance model is profit driven. These corporations profit by avoiding the sick and denying and restricting payment for care. Their bottom line is profit, not improved health. And no amount of industry regulation to date has been successful in changing that bottom line. Likewise, the new federal legislation is full of loopholes that will allow private insurers to continue to skirt the regulations.

The White House and Congress claimed throughout the process that we must retain private insurance because Americans desire choice, and this has been framed as choice of insurance. However, this is a false concept. No person can anticipate what their health care needs will be or which insurance will be best. Health care needs change the day a patient has a serious accident or is diagnosed with a serious illness. We all need the same health insurance: one that covers all medically necessary care when and where we need it. Those of us who travel and listen find that people in America desire choice of health care provider and choice of treatment: the two choices that private health insurers restrict.

So what are t
he White House and Congress really saying when they claim that we must retain a private insurance model? That they are unwilling to take on these powerful industries, and so we, the people, must be willing to compromise and work within their framework. Mohandas Gandhi said:

All compromise is based on give and take, but there can be no give and take on fundamentals. Any compromise on mere fundamentals is a surrender. For it is all give and no take.

When it comes to health reform, compromise on the fundamentals is unacceptable because the human costs are continued preventable deaths, continued suffering as patients fight for needed care, and continued bankruptcy from medical debt as families struggle to pay for deductibles and uncovered services. In a study published in Health Affairs in January 2008 that looked at the top nineteen industrialized nations, the United States ranked the worst—we have the highest number of preventable deaths (101,000 each year) because we lack a health system. All of the other industrialized nations have health systems based on the principles of health care as a human right: universality, equity, and accountability.

Why We Failed

Why have the American people been denied this same right? As I look back at the health reform process, I see three serious errors: a willingness to compromise, a lack of clarity about what we require, and a fear that failure to pass reform will have electoral consequences. These are the areas we must address as a people if we want to see real change in this nation, not just in health care but also in many areas that affect our ability to survive on this planet.

The willingness to compromise has occurred repeatedly at the state level. As a result, fewer people have access to care, and health care costs continue to rise; the fundamental problems are not corrected. This willingness to compromise is based on a real sense of desperation. We see real suffering. We want to do something. We are told that this reform, whatever it is, is the best we can get this time. We accept that and tell ourselves that it is something, it is a step.

As the congressional fellow of Physicians for a National Health Program, I saw this desperate attempt to pass something, anything, rise to the surface in the final weeks of the reform process. Patients and their families were brought into Congress to tell their stories of abuse at the hands of private insurers. Well-meaning legislators looked them in the eye and told them that this reform would change that. When I challenged the truth of that response, I was told, often in heated tones, that they (the legislators) had to do something and that at least this reform would help some people. I could only think of those who would not be helped. What about them?

The lack of clarity was grounded in the belief that if we simply advocated based on principles such as access and affordability, then the legislation would meet those principles. Legislators and pro-reform groups were content to speak based on principles as long as they were not challenged about whether those principles were being met. We must go beneath the surface of simple principles, educate ourselves, and define what is acceptable and what isn’t. If we don’t know exactly what we are asking for, we won’t get it. And we mustn’t be afraid to ask for what we require. As a people, we have become willing to accept crumbs when we require so much more than crumbs.

The final mistake was to pin the results of the upcoming elections to the success or failure of passing reform. Those who were reluctant to support the legislation were forced to support it in the end or risk being blamed for possible electoral consequences. As has often happened in past campaigns, people were forced to vote for the lesser of two evils instead of for what they truly wanted.

We Can Still Create a National Health Program!

So what do we do now that a health bill has been signed? Now that the clamor has quieted, it is time for a civilized discussion of what our health needs are and how best to meet them. This discussion is unlikely to occur in a mainstream media dominated by advertising dollars from health insurance and pharmaceutical corporations. We will need to have this discussion at a more personal level and through independent sources of media. We must educate ourselves and those around us about what is possible to achieve in this nation.

It is possible to create a national health program in which every person living in this country is able to receive the same high standard of medical care whenever and wherever they need it, without fear of financial consequences. We call this health security. Other advanced nations have achieved this goal. The United States has not, and is currently ranked thirty-seventh in the world for health outcomes. We spend more per capita on health care than every advanced nation, yet leave a third of our population either completely on the outside or vulnerable to financial ruin should they have a serious health problem.

Physicians for a National Health Program, founded in 1987, educates and advocates for a health system that will improve our health outcomes and provide health security based on the evidence of what has worked in our nation and what is effective in other advanced nations. We envision a lifelong universal health system—much like traditional Medicare—that is nationwide. We envision a system that allows patients to choose where they receive their care, permits caregivers and patients to determine the best course of treatment with assistance from evidence-based data, controls costs in a rational way through simplified administration and negotiation of fair prices, and is progressively financed. Its publicly funded nature would make it transparent and accountable. Because it would be privately delivered, it would allow caregivers to compete based on quality of care provided. Private health insurers would be relegated to a position of offering supplemental plans and possibly providing administrative support.

The Rev. Dr. Martin Luther King Jr. taught us that to witness an injustice and not work to correct it is in itself an act of violence. As a physician and an advocate for nonviolence, I cannot ignore the injustice of the great health inequality that exists in our nation or ignore those in need who cannot afford medical treatment. We have delayed this struggle for too long. Alice Walker said, “We are the ones we have been waiting for.” So, let’s do it. We have the resources. Now we must create the political will. Together, we can create a health justice movement, educate ourselves, speak with clarity, and organize independently of any political party. Please join us. You can learn more at www.pnhp.org or join the grassroots movement at www.healthcare-now.org.


Dr.Margaret Flowers is a pediatrician who serves as the congressional fellow for Physicians for a National Health Program and is on the board of Healthcare-NOW! She is one of the “Baucus 8.”

http://www.tikkun.org/article.php?story=may2010flowers