PNHP

End Insurance’s Bad Incentives

End Insurance’s Bad Incentives

By Steffie Woolhandler and David Himmelstein
The New York Times
Room for Debate
June 18, 2009

There are a variety of bad ways of paying doctors, but no particularly good ones. Fee-for-service health care rewards the overprovision of care; capitation (a set monthly fee per patient) rewards underprovision; and salaries reward just showing up. The minority of physicians (and hospital administrators) who are motivated mostly by money will find a way to game an incentive system rather than do the hard work of providing excellent care.

Even paying doctors based on quality measures (using data from medical records that the doctors themselves create) can be fudged. For example, if you pay doctors more for care of patients with diabetes with extra incentives for controlling blood sugar, some doctors will neglect to properly instruct patients to fast before their morning blood tests, falsely diagnosing them as ill. These false diabetics will appear to have superb outcomes since they weren’t sick to begin with.

At the same time, most of the myriad details of care and small kindnesses that make for good doctoring would inevitably go unrewarded, making their neglect essential to a doctor’s financial success.

The Medicare payment system illustrates the false hope of financial savings or improved quality through manipulating financial incentives. The system, which pays health care providers based on “diagnosis-related group,” altered hospitals’ incentives, rewarding short hospital stays instead of long ones. But hospitals quickly adapted, and while Medicare patients’ length of stay plummeted, costs continued to skyrocket.

Financial incentives are not necessary for cost control, and are expensive to administer. A single payer system like Canada’s — in which individuals choose their doctors and other health care providers, but the providers bill one agency for their services — limits entrepreneurial rewards and penalties, covers everyone, and saves much on bureaucracy and profits.

Many American doctors now support a single payer approach because it would improve health and remove the crushing paperwork burden that private insurers impose. Paperwork consumes 31 percent of U.S. health spending, nearly double that of Canada. Our nation wastes $400 billion annually on insurance overhead and useless bureaucracy, money that single-payer reform could shift to patient care. That’s enough to cover all of the uninsured, and to eliminate copayments and deductibles for everyone else. A single payer system would allow doctors to return to the patient-centered care that motivated us to go to medical school in the first place.

In contrast, the Senate Democrats’ proposal to require the purchase of coverage would leave private insurers in charge, and hence sharply increase costs while leaving millions uninsured, or covered by skimpy policies. In 2007, illness and medical bills contributed to 62 percent of personal bankruptcies; most of the medically bankrupt were middle-class families with private insurance. Copayments, deductibles, and loopholes that let insurers deny claims leave millions of Americans in financial ruin. The individual mandate now popular in Congress would merely force the uninsured to buy defective policies – boosting revenues for insurers but not protecting patients.

Unfortunately, adding a public plan option would not correct these flaws. The bureaucratic savings would be minuscule. Moreover, a public plan would be forced to either emulate the bad behavior of its private insurance competitors, or fail in the marketplace — swamped by private insurers that dumped sick, expensive patients onto the public. This kind of tinkering around the edges of our insurance company-dominated system won’t fix it.

Steffie Woolhandler and David Himmelstein are associate professors of medicine at Harvard Medical School, primary care doctors in Cambridge, Mass., and co-founders of Physicians for a National Health Program.

http://roomfordebate.blogs.nytimes.com/2009/06/18/better-medical-care-for-less/

More ‘Skin in the Game’ May Give Perverse Result

Letters
Wall Street Journal
June 17, 2009

You completely discount any administrative savings from a single-payer system.You also ignore the rising number of bankruptcies related to medical care. Every other country covers its citizens, the way it should be here.

Physicians for a National Health Program estimates savings of over $300 billion yearly in a single-payer plan. Why not debate its proposal on its merits and costs, not the derisive dismissal now taking place in Congress?

Thomas Clairmont, M.D.
Portsmouth, N.H.

Canadians contrast their health care to U.S.’s

Cheaper rates cause debate

By Barry Brown
Washington Times
Thursday, June 11, 2009

TORONTO | For a Canadian facing emergency surgery in the United States, a ride on a privately chartered Lear jet back to Canada is a whole lot cheaper than having the operation in a U.S. hospital.

Canada’s universal health care system will pay for urgent medical care outside the country, but at Canadian rates of about $360 a day for a hospital stay.

That compares with daily rates of up to $5,000 to $6,000 a day in Florida, where tens of thousands of well-to-do Canadian retirees spend each winter.

Before stepping across the border, “the first thing a Canadian thinks about is supplemental health insurance,” said Michael MacKenzie, a spokesman for the Canadian Snowbird Association, which represents about 80,000 migratory citizens from the land of ice and snow.

No wonder President Obama’s plan to expand American health coverage to the uninsured has become such a hot topic north of the border.

If Mr. Obama succeeds, the U.S. could draw even more Canadian doctors and nurses to the U.S., exacerbating a shortage of medical professionals, said Dr. Brian Day, a Canadian health care critic and former head of the Canadian Medical Association.

If Mr. Obama fails, perhaps Canada could open its system to “medical tourism” from the U.S., Dr. Day said.

About 500,000 Americans annually travel to other counties such as India, Thailand and the Philippines for high-quality but much cheaper medical care, he said. Few of them go to Canada, where the notion of funding public hospitals with money from U.S. patients has been politically unacceptable.

The Canadian system insures everyone, and all Canadians have access to basic and critical health care without ever seeing a doctor or hospital bill.

Nevertheless, the demands on the system have led to waiting lists for treatments such as MRI scans, cataract and artery bypass surgeries and hip replacements.

That’s one reason why 70 percent of Canadians have some form of supplemental health insurance, whether or not they plan to visit the United States.

The Canadian system needs fixing, said Dr. Robert Ouellet, president of the Canadian Medical Association.

“We have improved waiting times from years to months in most areas, but people still wait too long even in emergency rooms,” he said.

Dr. Ouellet suggests that the U.S. look elsewhere for models of universal health care.

Both the U.S. and Canadian governments, he said, would do well to examine systems such as one in the Netherlands, which provides universal and broader-based health care through a small number of regulated, private health insurers and government funding at a slightly lower cost than in Canada.

Dr. Catherine Kurozu, a Canadian doctor who has been practicing obstetrics and gynecology in the U.S. and Guam for 13 years, said, “In Canada, there’s an egalitarian attitude I admire. Medical treatment in America depends almost entirely on what insurance company you have and what state you live in.

“In Massachusetts, you get four days in hospital after a C-section birth; in California it’s one day and out the door,” she said.

For Canadian Raymond McEwan, American hospitals are among the best in the world but are focused on making as much money as they can per patient, while in Canada the goal is good medical care for everyone.

In December, he was wintering in Port Richie, Fla., when he checked into a hospital with stomach cramps and pain.

“I’d worked in an auto repair shop for years so I knew all about insurance,” said Mr. McEwan, 68, who had a supplemental policy from a private company.

Over the next several hours, Mr. McEwan said, doctors and nurses came and went, he was given blood tests and an ultrasound and was moved from room to room. He said he was “terrified” that the hospital hadn’t contacted his insurance company: Would he be stuck with an American hospital bill?

Once diagnosed with an infected gallbladder, the hospital was all set to operate and possibly add some repairs to Mr. McEwan’s colon. Before that happened, the hospital apparently got around to notifying his private Canadian insurance company, which put an end to everything.

“A few hours later, I was strapped in a stretcher and my wife and I were on a Lear jet being flown back to Canada,” he said. There, the doctors confirmed the gallbladder infection, deadened the pain and successfully performed Mr. McEwan’s surgery four weeks later.

To save money, Mr. McEwan’s insurance company paid $20,000 for the private flight home and his brief stay in an American hospital.

Mr. MacKenzie of the Snowbird Association said it is not uncommon for U.S. hospital bills to top $100,000, especially when surgery is involved.

Once Mr. McEwan was back in Canada, his insurance company was relieved of responsibility because there are no hospital bills.

“In Canada, the first thing I was asked coming off the plane was, ‘Are you in pain?’ ” he said. In the American hospital, he said, he waited an hour in the emergency room and then five hours more in various rooms without ever being asked whether he needed pain relief.

“It seemed like everyone in the American hospital was working on commission and trying to get me to sign for this and that treatment,” he said. “In Canada, it’s not about making money.”

http://washingtontimes.com/news/2009/jun/11/canadas-health-plan-contrasted-with-us/

Scrushy and the medical-industrial complex: a lesson for reformers

Judge orders Scrushy to pay $2.8B to shareholders

By The Associated Press
The Washington Post
June 18, 2009
(An Alabama) state judge on Thursday ordered former HealthSouth CEO Richard Scrushy to pay about $2.8 billion to shareholders who sued over accounting fraud at the rehabilitation chain.
Circuit Judge Allwin E. Horn, who heard the case without a jury, ruled in favor of HealthSouth shareholders who filed a civil suit claiming Scrushy was involved in a massive fraud that nearly sent the company into bankruptcy.
The Alabama suit accused Scrushy of unethical dealings with the company while it was going broke and complicity in $2.6 billion in fraudulent earnings and asset reports it filed with regulators from 1996 to 2002. The amount shareholders sought included money they claimed he pocketed through sweetheart deals.
Five former HealthSouth finance chiefs gave testimony implicating Scrushy in a scheme to fraudulently inflate earnings. Scrushy, who hired all five when he ran the company, blamed them and described them as having personal weaknesses.
Scrushy wore a dark business suit in court, but his leg shackles jingled as he arrived for his first day of testimony.
During the lawsuit trial, an attorney for shareholders, John W. Haley, repeatedly confronted Scrushy over what Haley described as obvious conflicts of interest. Among them was HealthSouth’s purchase of 19 acres of land next to Scrushy’s suburban Birmingham estate for $1.9 million, then giving him the land three years later. Scrushy said he got the land instead of a bonus one year.
Haley, sounding incredulous, recounted how Scrushy took an $82 investment in a company that purchased property at a discount from HealthSouth and turned it into a personal profit of some $12 million in four years by leasing the property back to the corporation.
“That’s the way it works in America,” Scrushy said.
http://www.washingtonpost.com/wp-dyn/content/article/2009/06/18/AR2009061801985.html
“A Second Opinion,” by Arnold Relman, M.D.:
http://www.publicaffairsbooks.com/publicaffairsbooks-cgi-bin/display?book=9781586484811

In a landmark 1980 New England Journal of Medicine editorial, former Editor-in-Chief Arnold Relman warned us of the new “Medical-Industrial Complex,” referring to “a medical care system that had begun to attract investors, and in which business interests had started to reshape the behavior of doctors and health care facilities.”
Three decades later, he updated these views in his book, “A Second Opinion.” He writes, “market forces, investors, for-profit corporations, and entrepreneurs are now at the center of the U.S. system, and generation of income is a dominant consideration for most private providers of health care – including those that are not investor owned.” (Not-for-profits must adopt the same perverse behaviors of the for-profits to remain competitive with them.)
With the two great problems to address – 1) the uninsured and underinsured, and 2) skyrocketing health care costs, why should we concern ourselves now with the medical-industrial complex?
First, the medical-industrial complex seeks money, serving those with more money, and shunning those with less money. Theoretically, the private insurance industry would correct this problem by providing the medical-industrial complex with money that many individuals with health care needs simply don’t have. But we’ve all seen how this works. The private insurance industry takes the money from the largest, healthiest sector of our population, and then spends a significant amount of it on administrative services designed to ensure that they can keep as much of that money as possible. The medical-industrial complex has no motivation to try to defeat its money-seeking and money-retaining behavior by increasing the outflow of money to those with health care needs. Thus the problem of the uninsured and underinsured grows worse every year.
Second, the medical-industrial complex, in its drive to fulfill its money-seeking role, does everything that it possibly can to add booster rockets to our skyrocketing health care spending. The culture of the medical-industrial complex provides an economic environment in which the industry thrives, and patients and payers suffer.
Several members of the PNHP leadership have provided decades of well documented, peer review studies confirming that the medical-industrial complex has caused great damage to our health care system, resulting in financial hardship, physical suffering and even death. Although much of our recent advocacy has been around reforming our health care financing system, we have always supported a change from the medical-industrial culture to a culture of a caring health care delivery system that places patients first.
Listening to the national dialogue on reform, you would think that this problem is being ignored. It isn’t. Congressman John Conyers’ HR 676, “United States National Health Care Act or the Expanded and Improved Medicare for All Act,” includes the following language:
“No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor owned… For-profit providers of care opting to participate shall be required to convert to not-for-profit status.”
Richard Scrushy, an animal of the medical-industrial complex, now facing a $2.8 billion judgement against him, reminds us of the slogan of the medical industrial complex: “That’s the way it works in America.”
Let’s do all we can to see that it doesn’t work that way anymore.

Scrushy and the medical-industrial complex: a lesson for reformers

Judge orders Scrushy to pay $2.8B to shareholders

By The Associated Press
The Washington Post
June 18, 2009

(An Alabama) state judge on Thursday ordered former HealthSouth CEO Richard Scrushy to pay about $2.8 billion to shareholders who sued over accounting fraud at the rehabilitation chain.

Circuit Judge Allwin E. Horn, who heard the case without a jury, ruled in favor of HealthSouth shareholders who filed a civil suit claiming Scrushy was involved in a massive fraud that nearly sent the company into bankruptcy.

The Alabama suit accused Scrushy of unethical dealings with the company while it was going broke and complicity in $2.6 billion in fraudulent earnings and asset reports it filed with regulators from 1996 to 2002. The amount shareholders sought included money they claimed he pocketed through sweetheart deals.

Five former HealthSouth finance chiefs gave testimony implicating Scrushy in a scheme to fraudulently inflate earnings. Scrushy, who hired all five when he ran the company, blamed them and described them as having personal weaknesses.

Scrushy wore a dark business suit in court, but his leg shackles jingled as he arrived for his first day of testimony.

During the lawsuit trial, an attorney for shareholders, John W. Haley, repeatedly confronted Scrushy over what Haley described as obvious conflicts of interest. Among them was HealthSouth’s purchase of 19 acres of land next to Scrushy’s suburban Birmingham estate for $1.9 million, then giving him the land three years later. Scrushy said he got the land instead of a bonus one year.

Haley, sounding incredulous, recounted how Scrushy took an $82 investment in a company that purchased property at a discount from HealthSouth and turned it into a personal profit of some $12 million in four years by leasing the property back to the corporation.

“That’s the way it works in America,” Scrushy said.

http://www.washingtonpost.com/wp-dyn/content/article/2009/06/18/AR2009061801985.html

“A Second Opinion,” by Arnold Relman, M.D.:
http://www.publicaffairsbooks.com/publicaffairsbooks-cgi-bin/display?book=9781586484811

Comment:

By Don McCanne, MD

In a landmark 1980 New England Journal of Medicine editorial, former Editor-in-Chief Arnold Relman warned us of the new “Medical-Industrial Complex,” referring to “a medical care system that had begun to attract investors, and in which business interests had started to reshape the behavior of doctors and health care facilities.”

Three decades later, he updated these views in his book, “A Second Opinion.” He writes, “market forces, investors, for-profit corporations, and entrepreneurs are now at the center of the U.S. system, and generation of income is a dominant consideration for most private providers of health care – including those that are not investor owned.” (Not-for-profits must adopt the same perverse behaviors of the for-profits to remain competitive with them.)

With the two great problems to address – 1) the uninsured and underinsured, and 2) skyrocketing health care costs, why should we concern ourselves now with the medical-industrial complex?

First, the medical-industrial complex seeks money, serving those with more money, and shunning those with less money. Theoretically, the private insurance industry would correct this problem by providing the medical-industrial complex with money that many individuals with health care needs simply don’t have. But we’ve all seen how this works. The private insurance industry takes the money from the largest, healthiest sector of our population, and then spends a significant amount of it on administrative services designed to ensure that they can keep as much of that money as possible. The medical-industrial complex has no motivation to try to defeat its money-seeking and money-retaining behavior by increasing the outflow of money to those with health care needs. Thus the problem of the uninsured and underinsured grows worse every year.

Second, the medical-industrial complex, in its drive to fulfill its money-seeking role, does everything that it possibly can to add booster rockets to our skyrocketing health care spending. The culture of the medical-industrial complex provides an economic environment in which the industry thrives, and patients and payers suffer.

Several members of the PNHP leadership have provided decades of well documented, peer review studies confirming that the medical-industrial complex has caused great damage to our health care system, resulting in financial hardship, physical suffering and even death. Although much of our recent advocacy has been around reforming our health care financing system, we have always supported a change from the medical-industrial culture to a culture of a caring health care delivery system that places patients first.

Listening to the national dialogue on reform, you would think that this problem is being ignored. It isn’t. Congressman John Conyers’ HR 676, “United States National Health Care Act or the Expanded and Improved Medicare for All Act,” includes the following language:

“No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor owned… For-profit providers of care opting to participate shall be required to convert to not-for-profit status.”

Richard Scrushy, an animal of the medical-industrial complex, now facing a $2.8 billion judgement against him, reminds us of the slogan of the medical industrial complex: “That’s the way it works in America.”

Let’s do all we can to see that it doesn’t work that way anymore.

Gutting the Health Care Plan: The Scorpion and the Congress

By Paul Loeb
Huffington Post
June 8, 2009

Will serious health reform meet the fate of the scorpion and the turtle? In that fable, the scorpion pleads with the turtle to carry him across a river. The turtle resists, fearing the scorpion’s sting, but the scorpion reassures him that he’d do nothing so foolish, since both would drown if he did. Finally the turtle agrees. Halfway across, the scorpion betrays his promise with a lethal sting. As the turtle begins to drown, he asks why he took both their lives. “It’s just who I am,” the scorpion replies.

I fear we’re about to get stung again. When people look back at the failure of the Clinton-era health care initiative, they point, accurately, to an opaque process that produced a baroque Rube Goldberg mess that satisfied no one. That happened even before the insurance industry went on the attack with their Harry and Louise ads. But another element parallels our current challenge–appeasement of the insurance companies as the plan’s centerpiece, and the inevitability that these same interests will betray us again.

The Clintons assumed the insurance companies were too powerful to confront, so the plan had to go along with them. But once they assumed any bill had to get the companies’ approval, no plan could work, because it had to build in ways for the companies to maintain their profit margins and the immensely wasteful overhead they spend on advertising, processing claims, and turning down as many sick people as they can. Their approach also creates corollary wastes, like the third of the expenses of the average medical office that go toward dealing with insurance company paperwork.

Our health care crisis is so dire that the simple single-payer approach, as in Canada, should be at least seriously debated. Compared with us, most Canadians are satisfied with their system, in contrast with a recent US poll where 49 percent said our health system needed fundamental changes and 38 percent said it should be completely rebuilt. Canadians get a full choice of doctors (unlike in the US, where households have to switch doctors when employers change their insurance or insurance companies change their preferred provider lists). Tommy Douglas, the Canadian New Democratic Party leader who pushed through national health care in the mid-60s (replacing a system like ours), was recently voted Greatest Canadian in a recent contest, beating hockey star Wayne Gretzky and Prime Minister Pierre Trudeau.

Even if single payer isn’t politically achievable yet, there’s no reason to take it off the table from the beginning. Doing so means most Americans never get to hear the contrast in cost savings, in allocation ease, in impact on ordinary citizens and their health outcomes. They never get to hear the story that might allow them to overcome current fears about losing the health care they have, being unable to see their preferred doctor, or being condemned to the Purgatory of endless waiting. Maybe we’ve been so conditioned that we can’t quite get the support for a full-fledged switch. A recent Kaiser Foundation poll still gives single-payer a narrow 49 to 47 percent majority, vs 67 percent for including a fully competitive public option, and maybe that isn’t enough. But at least we need to tell the story, so the probably inevitable compromise works down from full public coverage, as opposed to considering options that gut even the option of serious public coverage entirely.

Instead, because we’ve accepted the premise that the private insurance companies have to be included, we’re now starting to consider including a public option only if it includes poison pills that will doom it to fail, like requiring it be triggered by a set of exceedingly unlikely circumstances deferred to the indefinite future. Or requiring it to play by rules so onerous that it can’t achieve its straightforward cost savings. Or turning it over to the states, so Big Pharma and Big Insurance interests can simply, as Robert Reich warns in one of the best summaries of the game, “buy off legislators and officials as they’ve been doing for years.”

But why assume that the insurance companies are our friends? Why appease them at all? It’s not as if they’ve played a helpful role in our current system. Rather, they’ve gamed it in every possible way, leaving our country with the highest health care costs in the world and worst health outcomes of any advanced industrial country. While they’ve made promises to cut costs, their promises are only that (like the scorpion’s), and they’re already lobbying with everything they have to gut any seriously competitive public option. Add in examples like former HCA/Columbia CEO Rick Scott. after his company paid a $1.7 billion fine (the largest in US history) for defrauding Medicare, Medicaid, and the program that serves our armed forces, he is now organizing attacks on any public program (hiring the PR firm that coordinated the “Swift Boat” attacks on John Kerry). We need to challenge the insurance companies, not appease them. There’s no evidence that suggests they’re constructive players, or are likely to do anything except defend their own parochial interest.

The insurance companies and other major financial interests are talking a good line of late. They have no choice if they don’t want to be cut out of the game. But ultimately, they are who they are, and their behavior reflects this. It makes no sense to embrace a partner who you know will ultimately betray you.

Maybe the public private mix is the best compromise we can get at the moment. But we must raise our voices now to demand a full debate on the other alternatives, like single payer, and then if necessary settle for something that gives a public option a chance, under equitable rules, to see how it plays out in efficiency, service, and cost. Trusting the insurance companies and stacking the deck to guarantee that private options will prevail merely assures we continue our dysfunctional system until its human and financial costs drown us all.

Sebelius: flat out never single payer

Sebelius: Single-Payer Health Care Not In Plans

Morning Edition
NPR
June 16, 2009

Interviewer: What’s been the hardest thing for you to explain?
HHS Secretary Kathleen Sebelius: I think that the whole idea of the public option has been difficult, in part because I think some of the opposition has described it as a potential for a draconian scenario that was never part of the discussion in the first place. So disabusing people of what is not going to happen is often difficult because there is no tangible way to do that.
Interviewer: Can you say flat out it’s just never going to be single-payer health insurance, and we’re going to try to write it, if we can, so that it won’t ever be?
Secretary Sebelius: Oh I think that’s very much the case, and, again, if you want anybody to convince people of that, talk to the single-payer proponents who are furious that the single-payer idea is not part of the discussion.
http://www.npr.org/templates/story/story.php?storyId=105442888

The proposal to provide a government-run Medicare-like program as an option for purchase within an insurance exchange of private health plans is vehemently opposed by the insurance industry, the U.S. Chamber of Commerce, the AMA, all Republicans, a large bloc of conservative Democrats, and many others. No amount of negotiation can resuscitate a Medicare-like option. It’s dead.
To avoid losing the support of the progressives and many of the moderates in Congress, efforts are being made to create a new private program that has distinguishing features, primarily cosmetic, that will allow them to mislabel it as a public option. The fear of opponents is that this pseudo-public option could later be transformed into a government-run program. Thus it is imperative that the design of the option would lock it up as a private sector model with no possibility of transformation. Without that assurance, the pseudo-public option will have to be eliminated during markup in order to salvage other reform policies. The opponents will never ever sign on to single-payer-in-waiting.
Those in the progressive community who abandoned single payer to support a public Medicare-like option, believing that this was the politically feasible strategy for success, simply haven’t been paying attention if they still really believe that a government-run public option can survive. They can keep on wishing, but they would be wise to back up their position by signing Sen. Bernie Sanders’ Petition to Congress:
http://sanders.senate.gov/petitions/index.cfm?uid=7fd59f2e-88e1-477a-8eaf-762a5b050809

Sen. Bernie Sanders' Petition to Congress

Sign the Petition

Senator Bernie Sanders
June 16, 2009

For a quick and painless way to express your support for a single-payer Medicare-for-all program, click on this link to co-sign Senator Bernie Sanders’ petition to Congress, and then share this link with others who care.

http://sanders.senate.gov/petitions/index.cfm?uid=7fd59f2e-88e1-477a-8eaf-762a5b050809

Comment:

By Don McCanne, M.D.

Let’s let Congress know how many of us there are who really care.

Dr. Farley's Rx — single-payer — is the cure

Editorial
Capital Times (Madison, WI)
6/10/2009

Dr. Linda Farley, the local physician and nationally recognized advocate for health care reform who died this week, had long championed the replacement of the current for-profit health care system with a single-payer plan. Such a plan would guarantee that all Americans have access to quality care while at the same time cutting costs associated with insurance and health care industry profiteering.

We have taken our counsel from Dr. Farley, and her husband, Dr. Gene Farley, on these issues for a number of years.

Our confidence in the experience and wisdom of these veteran physicians, who worked in a variety of public and private settings, has informed this newspaper’s commitment to the view that only a single-payer system will achieve the stated goals of President Barack Obama and congressional leaders. The Obama administration and Democrats and most Republicans in Congress say they want more and better care for all, with real flexibility for patients who want to keep the same doctor and genuine savings.

But we have also been informed over the years by Farley’s reminders that our current broken system does not merely make it harder for ailing Americans to get care and for healthy Americans to maintain their fitness. It also imposes incredible economic hardship on Americans who fall ill.

The extent of that hardship was revealed last week in a study that will be published this summer by the American Journal of Medicine. According to the study, medical problems contributed to almost 62.1 percent of all bankruptcies in 2007.

Worse yet, the data from the study show that, from 2001 to 2007, the proportion of all bankruptcies attributable to medical problems rose by 49.6 percent.

That’s a particularly unsettling notion, as the current economic meltdown is all but sure to have caused an expansion of the crisis. Thus, as many as two-thirds of the 1.5 million Americans who are being forced into bankruptcy annually end up there because they made the “mistake” of getting sick.

And here is where things get downright scary. According to the study:

• Most of those bankrupted by medical problems had health insurance. More than three-quarters (77.9 percent) were insured at the start of the bankrupting illness.

• Most of the medically bankrupt fell into income categories that the authors of the study identify as “solidly middle class before financial disaster hit.” Two-thirds were homeowners, and three-fifths had gone to college.

• In a substantial number of instances, high medical bills coincided with a loss of income as illness forced breadwinners to lose time from work. Often illness led to job loss, and with it the loss of health insurance.

“Our findings are frightening,” says Dr. David Himmelstein, the lead author of the study and an associate professor of medicine at Harvard. “Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy. For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments and deductibles that illness can put you in the poorhouse. And even the best job-based health insurance often vanishes when prolonged illness causes job loss — precisely when families need it most. Private health insurance is a defective product, akin to an umbrella that melts in the rain.”

Elizabeth Warren, the Leo Gottlieb professor of law at Harvard and one of the leading experts on personal bankruptcy, explains: “For many families, bankruptcy is a deeply shameful experience. People arrive at the bankruptcy courts exhausted — financially, physically and emotionally. For most, bankruptcy is a last choice to deal with unmanageable circumstances.”

And more often than not, notes Warren, a co-author of the report, they arrive because they fell ill or suffered from a chronic condition.

Thus bankruptcy is not for the most part a matter of personal responsibility — or the lack thereof. It is a matter of bad health and a broken health care system.

How should we respond at a point when the United States is preparing to enter into another national health care debate?

Not with the gimmicks that members of Congress on both sides of the aisle and the Obama administration have been proposing, which leave most Americans in the grip of insurance companies that don’t provide adequate or humane coverage when people need it the most.

“We need to rethink health reform,” says Dr. Steffie Woolhandler, an associate professor of medicine at Harvard and a primary care physician in Cambridge, Mass., who is another co-author of the study. “Covering the uninsured isn’t enough. Reform also needs to help families who already have insurance by upgrading their coverage and assuring that they never lose it. Only single-payer national health insurance can make universal, comprehensive coverage affordable by saving the hundreds of billions we now waste on insurance overhead and bureaucracy. Unfortunately, Washington politicians seem ready to cave in to insurance firms and keep them and their counterfeit coverage at the core of our system. Reforms that expand phony insurance — stripped-down plans riddled with co-payments, deductibles and exclusions — won’t stem the rising tide of medical bankruptcy.”

Woolhandler is right.

Only the creation of a single-payer national health insurance system will address not just the health care crisis but the bankruptcy crisis.

As Dr. Linda Farley told us for years: “Single-payer is the cure.”

So how do we prescribe it?

The best way is by supporting the efforts of the group with which Farley was long associated: Physicians for a National Health Program, the real reform group that has won the support of more than 16,000 doctors nationwide.

To learn more about Physicians for a National Health Program, visit the group’s website at www.pnhp.org or call 312-782-6006.

http://www.madison.com/tct/opinion/454232

Robert Douglas: Canada is a good model for health care reform

By Robert Douglas
Tallahassee Democrat
My View
June 13, 2009

My first encounter with the U.S. health care system was in 1979. Thirty years later, it still haunts me and fuels my passion for supporting fundamental reform.

During a visit to a small hospital just outside Washington, D.C., I witnessed a scene that was utterly foreign to me as a recent immigrant from Canada. It involved a dispute between an unkempt young man in need of help and an officious clerk doing her best to deny it.

He had come into the hospital on a nonemergency basis to have stitches removed from a hand that had been injured weeks before on a nonunion construction site. The clerk told him that, until he produced proof of insurance or $60, he could not be seen by someone from the medical staff.

With his voice rising in frustration enough to prompt crying from the infant carried by his old-beyond-her-years wife who stood beside him, the man said as he started to leave: “I don’t have any insurance. I don’t have any money. The boss won’t let me back on the job until I get the stitches out. So I guess I’ll have to take them out myself.”

I left as well. But as a native Canadian who had never seen a doctor’s bill or been hassled at a hospital, I was shaken by this brutal show of how Americans treat those with no means but great needs.

With the typically understated smugness Canadians exude when they find something besides hockey where they outshine Americans, I chalked it up as another reason why my native country is a more civilized society than the one I was choosing to adopt.

But now that I’m a U.S. citizen, I’m no longer smug. And while I feel blessed to have adequate insurance myself, I’m angry that the injustice of our health care system persists.

But I’m also hopeful that fundamental reform finally has a chance here. And as the reform debate heats up, I feel obliged to share my perspective as someone who came of age Up North as Canada adopted its version of universal health care.

While progressive groups such as the Physicians for a National Health Program (PNHP) are backing legislation to create a Canadian-style system, in which government is the single payer of most health care costs, the health care establishment is cautioning against any reform that usurps its control and cuts into its profits. And now it seems that President Obama — pragmatist that he is — is listening, because he would rather achieve some incremental reform than no reform at all.

But that doesn’t mean we should take the Canadian model off the table, because it is the standard against which any progress here ultimately will be measured.

To be sure, the Canadian system of care is not perfect. And for every proponent of it you can find a detractor. But there are a few irrefutable facts. For instance:

* Per capita health care costs in Canada are about half of the comparable costs in the U.S., where 45 million remain uninsured — more than the entire 33.5 million population of Canada.

* Research suggests that medical outcomes in Canada are generally superior to those in the U.S.

* Most importantly, the specter that has haunted me for 30 years — of someone in need but without means being denied care — would not be shrugged off as routine in Canada as it too often is here.

Of course, Canadians had their share of struggles on their way to universal coverage — some of which have a familiar ring.

Socialism. Rationing. Long waits for inferior care. No choice. When reform talk here turns to the Canadian model, these are canards often used to strike fear in The Great Unwell. Much as they were in 1962, when the grandfather of actor Keifer Sutherland pioneered universal health care as premier in the sparsely populated prairie province of Saskatchewan.

The doctors in the province actually went on strike to protest changing the status quo. But Premier T.C. Douglas (no relation) would not be deterred. He successfully implemented a universal health care program in his own province and, by 1966, Canada’s federal government had adopted legislation calling for all provinces to create their own versions of a program guaranteeing that none of their citizens be denied care on the basis of their ability to pay for it.

Perhaps the biggest challenge to the Canadian system over the years has been keeping the system adequately funded. Just as Florida legislators are prone to cheat our children by underfunding education, some provincial legislators are prone to cheat the sick by underfunding health care.

But Canadians have always fought back to keep the “wonderful legacy” of universal health care that T.C. Douglas once told his grandson defines what makes Canadians special as much as their ability to endure harsh winters.

The grandson, who ironically has become an iconic American hero with his portrayal of terrorist-fighter Jack Bauer on television’s “24,” spoke passionately as a Canadian in defense of his grandfather’s legacy in 2000 at a rally in Edmonton called to protest another legislative effort to undermine universal health care.

Sutherland told a crowd of 8,000 that the universal health system his grandfather pioneered is “the envy of the rest of the world” because it shows Canadians have a way to “take responsibility for each other” by developing a platform for medical health for both the rich and poor, regardless of color or political bent. In Canada, he said, anyone can get the care he or she needs “because it is humane.”

“This is not a political issue,” he told the Canadians in a message that should resonate with Americans now. “It is an issue of humanity.”

I close my eyes and fantasize Sutherland’s Jack Bauer persona getting in the face of the clerk I saw 30 years ago denying care to the construction worker and, with his hallmark enhanced intensity, appealing to her sense of humanity.

Eyes wide open, I’m rooting for real-life champions of the reform that is in the spirit of Sutherland’s granddad.

The Truth About Healthcare Reform: What You Don't Know Can Kill You

“Single-payer is the health system that works for every other industrialized nation on earth.”

By Sylvia Hampton
East County Magazine, California
6/16/09

Supporters of real health care reform want a national expansion of the popular Medicare single payer program now covering every American over age 65. But they are being told that it is just not “politically feasible.” When one asks “Why?” there is double talk and a run-around. The facts are clear. Oxen will be gored–and the industry and some in Congress are circling the wagons to protect their own self interests. We have some blatant conflicts of interest here that would make an eight-year-old blush: Congress members who have stock holdings in the industry and get large campaign contributions from insurers. Imagine that.

The insurance industry competes by selling large group insurance to businesses employing young healthy people. Ca-ching! They get those contracts by promising low cost to the employer, so the employee “contribution” becomes a pay deduction. Then if an employee gets sick or in an accident, his co-pays can become so large as to cause him to go bankrupt. But hey–no skin off the insurance company’s nose! Ca-ching.

If the sickness or injury is bad enough to lose your job they don’t have to mess with you anymore. They just drop you if you live long enough (after they do everything in their power to deny the claims.) After all, they have stockholders to think about–they must, by law, make a profit. Ca-ching. And because the drug companies don’t want to have to negotiate with the big bad government on prices, they stick with the captains of this industry like two peas in a private money pot. That’s what makes health insurance hooked to employment so darn great–for insurers. The result is that they have so much money they can scare the pants off everyone in government. They will run an ad campaign so slick a good guy will look like Satan when they are done.

Who gets the money for all those campaigns to sell insurance, sell drugs, sell the negative campaign ads? The Media. Ca-ching. So don’t ask them to help you gore that ox. That money talks–big time.

Single-payer is the health system that works for every other industrialized nation on Earth. Single-payer results in health statistics better than ours, costs the people far less than ours, and at the same time covers everyone in their country. But it was not given consideration in Congress and is deemed an evil communist plot by 30% of our population. The other 70% have caught on after hard knocks in our system and now support single payer/Medicare for all. But that is not even what the president is asking for; he just wants a “public option” in addition to the private plans.

But no, the industry says that is not fair. Why? Too many employers and workers will grab it in a heartbeat. Why? Better, cheaper, faster, nicer and more complete–like what all of us over 65 have and love: Medicare. The modern robber barons are throwing so much money and weight around Washington D.C. right now that you ordinary people out here in the real world don’t have a chance.

There is only one way you young ‘uns will get what I have–and that is to take to the streets and demand it. Call your congressman, demonstrate in the street by his office, call the talk shows, and scream bloody murder. Because murder is what is happening to you right now. They are killing you. But as long as insurers, drug companies and legislators make a profit and you don’t pay attention, their life goes on.

Sylvia Hampton is the past director of Health Care for All CA and a current board member of San Diegans for Health Care Coverage.

The views expressed in this editorial reflect the views of the author and do not necessarily reflect the views of East County Magazine. If you wish to submit an editorial for consideration, contact editor@eastcountymagazine.org.

Health-Care Polemic

Letters
The Washington Post
Monday, June 15, 2009

Dana Milbank’s description of the recent congressional hearing on single-payer health care [“It’s Healthy to Vent,” June 11] was polemical.

First, many attendees were congressional staff members, not single-payer advocates.

Second, to describe the testimony of witnesses, which included Rep. John Conyers Jr., chairman of the House Judiciary Committee, as mere “venting” and “an exercise in blowing off steam” was offensive to the millions of Americans whose views they represent.

Third, Rep. Dennis Kucinich’s grilling of the Manhattan Institute’s David Gratzer was justified by Mr. Gratzer’s selective use of statistics to portray a falsely grim picture of the Canadian single-payer system. Certainly, a national system of health insurance that guarantees comprehensive access to needed care and eliminates profit is anathema to someone who cheerleads the intellectually and morally bankrupt “consumer-driven health care” movement.

Finally, to decry a national system of health-care financing that retains the private delivery of health care as socialism simply plays into the propaganda and fear-mongering of the right and the private insurance lobby, which opposes any challenge to its obscene profits.

Make no mistake: Single-payer advocates have much to be upset about, given our near-complete exclusion from the congressional debate on health reform.

But we are the only health-care reform movement with strong and growing grass-roots support, and we will be heard.

JAMES FLOYD
Washington

The writer, a physician and a health researcher for Public Citizen, which supports single-payer national health insurance, attended the hearing in question.

http://www.washingtonpost.com/wp-dyn/content/article/2009/06/14/AR2009061402388.html