PNHP

Affordable, functional health care

Affordable, functional health care

By Phil Caper and Joe Lendvai
Bangor Daily News
4/15/09

The health care reform bandwagon is rolling in Washington. Committees in both houses of Congress are at work on health care reform, and many politicians are saying “now is the time.” But meaningful reform is about a lot more than getting a few more people “covered.” It must also be about reining in the out-of-control cost, making sure health care is affordable and accessible to everyone and assuring that the right number and types of health professionals are there to care for the millions who are doing without decent health care.

Some in Congress want to require every American to buy private health insurance as a way to reach the goal of universal coverage. But private for-profit insurance is the wrong way to finance a universal system of health care. Contrary to their branding efforts, health insurance companies are not really in the health care business. They are financial services companies. Their business model resembles those of banks more than those of health care companies.

As if they were trying to prove this, when Maine enacted legislation some years ago requiring insurers to accept anybody who applied (guaranteed issue) and charge all policyholders in the same class the same premiums (community rating), most health insurers withdrew from the state. Anthem, Maine’s only remaining for-profit insurer offering policies to individual policyholders, is now asking for permission to raise premiums between 17 and 34 percent above their already high levels.

Health insurers lack the capacity to control underlying medical costs. They also lack the will to do so, as their profitability is closely linked to their cash flow — the more money they process, the higher their opportunities for profits.

They maximize profits by “managing risk,” that is, by avoiding insuring sick people and by denying the claims for payment of people they do insure. That is not an aberration but a core part of their business model. That business model is fundamentally incompatible with the goals of a humane health care system.

America needs a system that does not rely on the insurance industry to provide basic health care. We need a system more like Canada’s. Even though there is some minor grumbling by a few Canadians about waiting times for some discretionary services, their system is enormously popular. No Canadian faces crushing health care bills or bankruptcy due to unexpected medical costs. Canadians proudly view their health care system as being “the highest expression of caring for each other.”

We already spend almost twice as much per person as the Canadians. That should be enough to provide high-quality health care to all Americans. Sixty percent of the total costs of the dysfunctional U.S. health care system is already publicly financed. This figure includes huge tax subsidies that now amount to more than $250 billion a year for the purchase of private insurance, but only if it is a fringe benefit of employment.

Only a simple tax-based system administered by an independent national health care trust fund is capable of controlling overall health care costs. The fund would negotiate standard, reasonable and timely payments with all health care providers. No exclusions, no denials, no hassles. Everyone would have access to guaranteed health care. Instead of wasting time arguing with insurance companies about payments, doctors and nurses could focus on providing services to patients. A publicly financed, privately delivered system would also make the real costs of our system more visible and make true accountability possible.

It is time for the American health care system to return to its roots — driven by mission rather than money. There are proposals in the Congress that would begin to move us toward that goal and rescue our failing health care system. They are the Conyers bill, HR 676 in the House, and the Sanders bill, S 703 in the Senate. Rep. Chellie Pingree is already a co-sponsor of HR 676. We urge you to contact Rep. Mike Michaud and ask him to join her as a cosponsor of HR 676, and Sens. Olympia Snowe and Susan Collins to urge them to cosponsor S 703.

In that way, we can join every other industrial country in the world in making access to affordable health care a right.

Phil Caper is a retired physician and former health care policy adviser to Sen. Edward Kennedy, D-Mass. Joe Lendvai is a retired audiovisual producer and small-business owner. Both live in Brooklin.

LION AND THE LAMB: How good is your health insurance?

By R.C. Braun, M.D.
Crossville Chronicle
April 14, 2009

For the past 60 years access to health care through private insurance plans has been a mainstay of our society. Especially during the past 20 years the health care industry has expanded tremendously. There are many factors for this burgeoning, most notably the great advances in the science and technology of health care.

With new possibilities of care, costs have increased exponentially, and the health insurance industry has been a major player. Originally health insurance policies were almost entirely underwritten by not-for-profit organizations. Today the vast majority of health insurance plans are with for-profit companies, which means that the primary obligation is not to their enrollees, but to the investors who want to make a profit.

Today there are thousands of private insurance plans available and advertised as giving “choice” to the buyers. I am not infrequently asked for advice in purchasing a plan. But even with my medical background I cannot make sense out of the mishmash of plans. I cannot help but think that the confusion is intentional.

Today health insurance companies refer to their “loss ratio,” referring to the amount of money they lose providing health care. And the figures are astonishing — some health insurance firms use as little as 50% of their income in actually providing health care. The rest goes into high salaries for executives, advertising, and reams of paper work trying to figure out how to avoid paying for health care. Letters of “denial” are increasingly common.

Requiring health care recipients to pay large “deductibles” and “co-pays” was considered a means of limiting frivolous and nonessential care. The result has been quite the opposite — encouraging sick persons to neglect needed medical attention in the hope that the problem would go away, ultimately being both more expensive and less assured of a good outcome.

The problems of our health care have been receiving a lot of attention in the new administration and Congress. Some consider it priority No. 1. A major effort is going into promoting a dual system, giving individuals a choice between a public system, patterned after Medicare, and the private health insurance market.

It is unclear from proponents whether it is considered that such a system could solve the problems of access and cost, or whether the political strength of the health insurance industry is too strong to fight and must be accommodated. I would envision that in such a system the sickest people with the most medical expenses would gravitate to the public system, leaving the private insurance industry free to reap the harvest by insuring the more healthy.

An outcry of “socialized medicine” is often heard, ignoring the fact that already more than 50% of health care expenses in our country come through government at some level. I know of no one who advocates for our country a system such as England, where medical personnel are government employees and health care institutions are government owned.

The proposed “single-payer” health care system for our country would merely unify payment systems, and would in effect make the government the insurance carrier for all Americans. Already a majority of physicians support such a program, as well as a sizable majority of the general public. Can Congress be far behind? Let your voice be heard.

This column is sponsored by Cumberland Countians for Peace and Justice, an organization composed of representatives from various churches in the area, and dedicated by the local writers to the theme that the lion and the lamb can and must learn to live together and grow in their relationship toward one another to ensure a better world. Opinions expressed in “Lion and the Lamb” columns are not necessarily those of the Crossville Chronicle publisher, editor or staff. For more information, contact Emerson Abts, editor, at 277-5101.

Dr. Steffie Woolhandler on Radio Times

Radio Times with Marty Moss-Coane
WYCC
Wednesday 4/15/2009

When Barak Obama outlined his proposal for reforming the health care system, the concept of a single-payer system was once again left out of the equation. But there still is a strong and vocal voice for the concept. What is a single payer system and why is it, or isnā€™t, the solution to our health care crisis? Our guests are ROBERT MOFFIT of the Heritage Foundation and STEFFIE WOOLHANDLER of Physicians for a National Health Program

Click here to listen (mp3)

Crisis = Opportunity for Single-Payer

Fiscal crises may force Obama to save costs via a single-payer plan.

By Roger Bybee
Dollars & Sense
Issue 281 – March/April 2009

President Obama seems ready to proceed full-throttle toward a health care reform plan, but one that will keep private insurers at the center of the system. The plan, termed “guaranteed affordable choice,” would allow workers to “keep the insurance they like,” find a rival private insurer, or opt into a Medicare-style public plan.

To date, Obama has sensibly insisted that quick action on health care is imperative. “It’s not something that we can put off because of the [financial] emergency,” Obama declared in December. “This is part of the emergency.” Questioned about the wisdom of launching a $100 billion health care program at a time of mounting government deficits, “I ask a different question,” Obama countered. “How can we afford not to?”

He’s right: economic meltdown is making health care reform more urgent by the day. Hospitals are hurting; while “the number of paying patients and profitable elective procedures is down . . . ,” the LA Times reported recently, “the number of uninsured patients whom hospitals treat is rising.” At the same time, escalating health care costs are squeezing private employers and governments alike. “The new Congressional Budget Office report shows that rising health care costs are the largest driver of the nation’s long-term budget problems,” budget watchdog Robert Greenstein of the Center on Budget and Policy Priorities told Congress last fall.

But Obama’s hybrid, public-private plan is likely to hit a fiscal wall as federal spending balloons, and along with it the deficit. In the end, both popular sentiment and fiscal barriers may force him to follow a different course.

The administration’s plan subsidizes lower-income Americans to enable them to buy private health insurance. Contrary to Obama’s statements during the campaign, his plan will “need to require” all individuals to have health insurance, concludes the respected Commonwealth Fund. Such a mandate would be crucial to securing industry concessions necessary to move toward universal coverage, particularly a ban on excluding people with pre-existing conditions from coverage.

If so, the plan would eventually deliver tens of millions of new enrollees –the number of uninsured is about 47 million–to the insurance companies. Some 31% of their premiums, in many cases government-subsidized, will go into overhead and insurance company profits–an estimated $400 billion annual burden weighing down the health care system.

But this plan is on a collision course with the fiscal realities. On top of the budget wreckage left by the Bush years, the federal government’s fiscal demands are exploding. Health care reform faces daunting competition from a $787 billion stimulus package; the president’s $72 billion decision to delay repealing the Bush tax cuts for high earners; a Wall Street, bank, and insurance company bailout at $700 billion to date and likely to grow; and the ongoing Iraq and Afghanistan wars, together costing $170 billion in “extra” defense spending in FY2009.

Still, a leading advocate of the Obama plan, political scientist Jacob Hacker, argues that it can be billed as an important economic stimulus and thus escape the fierce budgetary competition. In December, Hacker cheerfully declared in The New Republic that the Obama plan offers nothing less than a “magic bullet” that will yield “short-term spending and long-term saving”–a perfect combination as the economy moves deeper into recession.

However, it is likely that Hacker seriously overstates the long-term savings while underestimating the clash of government priorities that lies just ahead. First, Obama-style individual mandate plans have run aground in at least six states that have tried them. With no mechanism to control the premiums charged by private insurers, the ever-higher cost of subsidizing low-income residents’ premiums soon exhausts available funds. Nor will sufficient savings be derived from Obama’s plan for electronic recordkeeping and more treatment of chronic illness, recent studies by the Congressional Budget Office and others suggest.

To many, a single-payer plan is the obvious way to ensure universal health coverage while containing costs. In addition to the dramatic reduction in administrative costs, single-payer plans offer other opportunities for controlling costs. For instance, they allow government–the “single payer” –to negotiate for lower costs with providers like doctors, hospitals, and pharmaceutical companies.

Unfortunately, Obama’s statements and key appointments suggest he has already disqualified single-payer as a serious option.

Tom Daschle, tapped for Health and Human Services secretary and “point man” on the health care reform effort until tax problems forced him to withdraw his name in February, appeared unwilling to let the private insurance industry go. His basic policy direction emerged in an interview last May. In a remark that seems staggering in hindsight, Daschle said, “And I would ask the question, if you think our banking system today is reasonably regulated, why not try the same model for our health-care system?”

Obama’s initial pick for surgeon general was TV health expert Dr. Sanjay Gupta. Gupta was trounced by Michael Moore in a televised debate over Moore’s documentary “Sicko,” and was then forced to retract some of the factually inaccurate criticisms of single-payer he had offered.

Another key player is Senate Finance Chair Max Baucus, author of a plan similar to Obama’s. Baucus recently dismissed the single-payer option on this basis: “We are Americans; we’re different from Canada, we’re different from the United Kingdom.” Baucus was probably not referring to the United States’ poorer health outcomes at vastly higher costs when he spoke of the American “difference.”

Promoted by this kind of team, Obama’s health-care plan could prove to be the most vulnerable component of his domestic program. The Republicans feel confident about their ability to brand Obama’s plan as overly complex and a threat to consumer choice in medical care, as they did so successfully with the Clinton plan in the 1990s.

The Obama plan’s “pay or play” component, giving employers a choice between insuring their employees or paying a tax to help finance the government plan, will no doubt open it up to conservative criticism as a coercive, big-government program. This line may also strike a chord among moderate-income citizens who earn too much to qualify for a subsidy and consequently lose enthusiasm for reform once they start to pay mandatory health premiums.

The single-payer approach, on the other hand, would disarm many of the most explosive Republican arguments. It is far less costly to both employers and individuals–nearly 50% lower per person in Canada than the United States, for instance–and there is no billing of patients or other complexity. Every citizen enjoys the right to health care and a free choice of doctors and hospitals. Start-up costs would be minimal, especially if Medicare were simply expanded to cover the entire public.

Back in 2003, Barack Obama told the Illinois AFL-CIO: “I happen to be a proponent of a single-payer universal health care program. I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14% of its Gross National Product on health care, cannot provide basic health insurance to everybody . . . a single-payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

Now that Obama himself occupies the White House and health care costs consume nearly 17% of GNP, the new president may rediscover that single-payer is the truly pragmatic course on health care reform. Hemmed in on all sides by the enormous costs facing the federal government, Obama may find–despite his misgivings–that pursuing a single-payer reform plan is the sole means of creating a low-cost and appealing alternative to the health-care status quo.

Roger Bybee is the former editor of the union weekly Racine Labor and is now a consultant and freelance writer whose work has appeared in Z Magazine, The Progressive, Extra!, The Progressive Populist, In These Times, commondreams.org, and other national publications and websites. Visit his webpage at www.zmag.org/zspace/rogerdbybee.

SOURCES: Jacob S. Hacker, “A Healthy Economy,” The New Republic, Dec. 31, 2008; S. Woolhandler, T. Campbell, and D. Himmelstein, “Costs of Health Care Administration in the United States and Canada,” New England Journal of Medicine, Aug. 21, 2003; Physicians for a National Health Program, “Barack Obama on single payer in 2003,” posted June 4, 2008; Maggie Mahar, “On Healthcare Reform Stimulating the Economy: the Massachusetts Example,” Health Beat blog (Century Foundation, Dec. 12, 2008); Sara Collins et al., “An Analysis of Leading Congressional Health Care Bills, 2007-2008: Part I, Insurance Coverage,” Commonwealth Fund, Jan. 9, 2009; Kevin Freking, “Health secretary pick seeks health care overhaul,” Associated Press, Jan. 10, 2009.

Politico lets Gingrich attack public health insurance plan without disclosing financial ties to insurance companies

Summary: Politico quoted Newt Gingrich’s criticisms of including a public health insurance plan option in a health care reform proposal without noting his financial ties to several major health insurance companies.

In an April 14 article, Politico’s Carrie Budoff Brown reported that Newt Gingrich — identified as “the former Republican House Speaker from Georgia and founder of the Center for Health Transformation” — “argues that government intervention in the financial and auto industries will sour voters on a deep reach into health care.” Budoff Brown went on to quote Gingrich’s criticisms of the inclusion of a public insurance plan option in a health care reform proposal, including his remark: “There is always interest in it in general — until you start describing it, then it collapses.” But Budoff Brown did not note that the Center for Health Transformation is a for-profit entity that receives annual membership fees from several major health insurance companies, which have a direct interest in whether a public insurance plan is part of health care reform. Moreover, Gingrich himself reportedly profits from his involvement in the Center for Health Transformation. Indeed, the group’s website notes that “[t]he Center for Health Transformation and The Gingrich Group are corporate for-profit organizations not affiliated with any other corporation or organization” [emphasis added].

According to the Center for Health Transformation’s website, members pay tiered annual membership fees, providing varying degrees of “[a]ccess to Newt Gingrich on your company’s strategy,” among other benefits. Insurance groups UnitedHealth Group, the parent of UnitedHealthcare, and WellPoint Inc. are listed as “Charter” members, BlueCross BlueShield Association is listed as a “Platinum” member, and AHIP is listed as a “Premier” member.

Additionally, Gingrich has reportedly profited from his work with the Center. In a January 16, 2005, article, The New York Times described Gingrich as “a well-paid broker of ideas and influence in the field of health care policy” and reported that “[b]ase camp for Mr. Gingrich’s health policy work is his Center for Health Transformation, a for-profit organization that occupies new office space overlooking K Street, the main street for Washington lobbyists.” The Times also reported that the center’s members “pay yearly fees of up to $200,000.” Further, The Washington Post reported in a July 13, 2004, article (accessed via Nexis) that according to Gingrich aide Rick Tyler, the center’s for-profit status — as opposed to being a registered as a nonprofit lobbying group — enabled Gingrich to operate ” ‘under the radar.’ ” The article further quoted “former adviser Rich Galen” saying of Gingrich: “He’s making more money than he ever thought possible and doesn’t have to tell everybody where it’s coming from.”

From the Post article (accessed via Nexis):

Gingrich’s center is a “brilliantly packaged way of offering his services as former speaker and a man who can open doors to push along what he calls health transformation,” said Joseph Antos, a health policy expert at the American Enterprise Institute. “In other words, lobbying.”

Gingrich is not a registered lobbyist. The think tank is for-profit, he said, because “you get more drive and energy” from employees when money is at stake and “I believe in entrepreneurship.”

Aide Rick Tyler, however, acknowledged there were political reasons for diverging from the standard nonprofit lobby group model.

Having been formally reprimanded by the House in 1997 for violations associated with the political use of tax-exempt organizations — which were structured similarly to the new center — Gingrich decided that a nonprofit would have invited enormous scrutiny. Organizing as a for-profit company, however, permits him to operate “under the radar,” Tyler said.

“He’s making more money than he ever thought possible and doesn’t have to tell everybody where it’s coming from,” marveled former adviser Rich Galen. “He has the amount of influence he chooses to have. I suspect there is virtually no one in this town of either party who will not take a call from Newt Gingrich, if only to hear what he has to say.”

— M.W.

Hacker says that public option/private exchange would EXPAND private insurance market

Extended discussion of Lewin Group

By Jacob Hacker
Institute for America’s Future
April 11, 2009
Put simply, Health Care for America is a pure, undiluted proposal for public plan choice. So it’s notable that under my proposal, according to the Lewin Group’s analysis of a couple years ago, the public plan ends up with much lower enrollment in the public plan than projected in the Lewin Group’s new analysis (90 million versus over 131 million). (For aficionados, the national insurance exchange in my proposal would have larger enrollment, but around 38 million people in the exchange would choose private plans instead of the public plan.)
In short, the Lewin Group’s hypothetical proposal has three features that guarantee the public plan will be big. Whatever “131 million enrollees in the public plan” represents, it does not represent an accurate picture of Obama’s campaign pronouncements, or Max Baucus’s “White Paper,” or my plan, or any other proposal under serious consideration today.
To get an estimate of how many people will end up in the public plan, therefore, we need to go back to the Lewin Group’s analyses of proposals more or less like what Obama proposed during the campaign–namely, play-or-pay plans with an exchange that features a competing public plan, and without extensive new rules on employment-based insurance. Those analyses (of my proposal or the Commonwealth Fund proposal) show that enrollment in the public plan is likely to be much, much smaller than the Lewin Group’s analysis estimates. Indeed, if you look at the Lewin Group’s analysis of my proposal (again, the maximalist public plan choice approach), more Americans have private insurance after reform than do before–either through their employer or through the new national insurance exchange.
http://institute.ourfuture.org/healthcare/hacker/lewin-group-analysis%20

Offering a public plan option within a market of private health plans has been one of the more controversial proposals during the current national dialogue on health care reform.
The opponents of the public option, especially the private insurance industry and the Republican members of Congress, insist that a government-sponsored plan would be an unfair competitor and drive the private insurance industry out of business. Theoretically, the government would do this by extracting unfair concessions from the health care providers, pricing the public option at a lower level than the private insurance sector could ever meet. (This ignores the more important evidence such as the demonstrated greater efficiencies of our public Medicare program when contrasted with the private Medicare Advantage plans.)
The supporters of a public option, especially the progressive community, contend that the public option would be a superior product made more affordable by reducing administrative inefficiencies. They contend that competition would motivate a massive shift to the public option, bringing us much closer to the single payer model that many in the progressive community prefer. (Much has been said about why this approach actually sacrifices most of the single payer advantages and would likely never lead to a single payer system.)
Professor Jacob Hacker of the University of California at Berkeley (and formerly at Yale) has been a leading proponent of reform based on a national insurance exchange of private plans with the addition of a public plan option. And what does he have to say about the impact that a public plan option would have on market share for the private health plans? He says that under his proposal, “more Americans have private insurance after reform than do before — either through their employer or through the new national insurance exchange.”
Get That? Even with a Medicare-like public plan option, the market for the private insurers will expand! That is the real tragedy of this debate over a public plan option. It has led us away from the debate we should be having instead: an affordable single payer national health program for everyone, versus expansion of our over-priced, inequitable, and inefficient system of financing health care through private plans and public programs
Forget about the public plan option! Let’s get rid of the private health plans, and go with single payer!

Hacker says that public option/private exchange would EXPAND private insurance market

Extended discussion of Lewin Group

By Jacob Hacker
Institute for America’s Future
April 11, 2009

Put simply, Health Care for America is a pure, undiluted proposal for public plan choice. So it’s notable that under my proposal, according to the Lewin Group’s analysis of a couple years ago, the public plan ends up with much lower enrollment in the public plan than projected in the Lewin Group’s new analysis (90 million versus over 131 million). (For aficionados, the national insurance exchange in my proposal would have larger enrollment, but around 38 million people in the exchange would choose private plans instead of the public plan.)

In short, the Lewin Group’s hypothetical proposal has three features that guarantee the public plan will be big. Whatever “131 million enrollees in the public plan” represents, it does not represent an accurate picture of Obama’s campaign pronouncements, or Max Baucus’s “White Paper,” or my plan, or any other proposal under serious consideration today.

To get an estimate of how many people will end up in the public plan, therefore, we need to go back to the Lewin Group’s analyses of proposals more or less like what Obama proposed during the campaign–namely, play-or-pay plans with an exchange that features a competing public plan, and without extensive new rules on employment-based insurance. Those analyses (of my proposal or the Commonwealth Fund proposal) show that enrollment in the public plan is likely to be much, much smaller than the Lewin Group’s analysis estimates. Indeed, if you look at the Lewin Group’s analysis of my proposal (again, the maximalist public plan choice approach), more Americans have private insurance after reform than do before–either through their employer or through the new national insurance exchange.

http://institute.ourfuture.org/healthcare/hacker/lewin-group-analysis%20

Comment:

By Don McCanne, MD

Offering a public plan option within a market of private health plans has been one of the more controversial proposals during the current national dialogue on health care reform.

The opponents of the public option, especially the private insurance industry and the Republican members of Congress, insist that a government-sponsored plan would be an unfair competitor and drive the private insurance industry out of business. Theoretically, the government would do this by extracting unfair concessions from the health care providers, pricing the public option at a lower level than the private insurance sector could ever meet. (This ignores the more important evidence such as the demonstrated greater efficiencies of our public Medicare program when contrasted with the private Medicare Advantage plans.)

The supporters of a public option, especially the progressive community, contend that the public option would be a superior product made more affordable by reducing administrative inefficiencies. They contend that competition would motivate a massive shift to the public option, bringing us much closer to the single payer model that many in the progressive community prefer. (Much has been said about why this approach actually sacrifices most of the single payer advantages and would likely never lead to a single payer system.)

Professor Jacob Hacker of the University of California at Berkeley (and formerly at Yale) has been a leading proponent of reform based on a national insurance exchange of private plans with the addition of a public plan option. And what does he have to say about the impact that a public plan option would have on market share for the private health plans? He says that under his proposal, “more Americans have private insurance after reform than do before — either through their employer or through the new national insurance exchange.”

Get That? Even with a Medicare-like public plan option, the market for the private insurers will expand! That is the real tragedy of this debate over a public plan option. It has led us away from the debate we should be having instead: an affordable single payer national health program for everyone, versus expansion of our over-priced, inequitable, and inefficient system of financing health care through private plans and public programs

Forget about the public plan option! Let’s get rid of the private health plans, and go with single payer!

Options for health care cost control

The Obama Administration’s Options for Health Care Cost Control: Hope Versus Reality

By Theodore Marmor, PhD; Jonathan Oberlander, PhD; and Joseph White, PhD
Annals of Internal Medicine
April 7, 2009
In short, if medical costs are to be controlled, no substitute exists for constraining prices and capping expenditures. Frank talk about these cost-control realities, however, is politically difficult. It immediately elicits alarms from the medical care and insurance industries about “rationing” (ignoring the fact that the United States could realize significant savings from lower prices and administrative costs). Others, particularly the pharmaceutical industry, raise alarms about the effect that cost control would have on the pace of medical innovation. In addition, spending targets constrain medical providers’ income and thereby prompt intense political struggles. The Obama team’s limited treatment of cost-control realities — including the absence of global budgets and spending targets or caps — seems to reflect a desire to avoid such political controversies.
We write this essay, then, as a cautionary tale. Claims of savings from health information technology, prevention, P4P, and comparative effectiveness research are politically attractive. Their political appeal lies largely in the embrace of widely supported goals, including better health and improved quality of medical care. In theory, these reforms — more research, more preventive screenings, and better organized patient data — sound like benign devices to moderate medical spending. For many purposes, such reforms are substantively very desirable. But these reforms are ineffective as cost-control measures. If the United States is to control health care costs, it will have to follow the lead of other industrialized nations and embrace price restraint, spending targets, and insurance regulation. Such credible cost controls are, in the language of politics, a tough sell because they threaten the medical industry’s income. The illusion of painless savings, however, confuses our national debate on health reform and makes the acceptance of cost control’s realities all the more difficult.
http://www.annals.org/cgi/content/full/150/7/485

High health care costs are the primary driving force behind the renewed effort for reform. Everyone agrees that high costs are straining personal, business and government budgets, and something must be done to make health care affordable for all of us.
Some of us are also concerned about health care justice. We want to see that everyone has affordable access to high quality care. It is more than fortuitous that the most effective methods of reducing excess health system spending also achieve the social justice goal of health care for everyone.
Much has been written on what does work and what doesn’t work in controlling spending. This paper provides an excellent, brief summary of the concepts being floated, and is well worth downloading. We should be very concerned that the leading mechanisms proposed, as summarized in this article, would not have a significant impact on slowing spending, and would likely actually increase our costs. Nor would they be effective in achieving health care justice for all.
If we are going to address costs seriously, there is no other option than to fundamentally restructure our health care financing system. As the authors state, “no substitute exists for constraining prices and capping expenditures.” We can never achieve that by relying on our wasteful, fragmented multi-payer system of financing health care. As all other nations have shown us, there is no other option than central, public control.
It is true that some nations do use private insurers. But private insurers in their countries organized into social insurance programs serving the public good have almost nothing in common with private insurers in the United States that shun organization in order to serve their own business interests. Adding a few regulations to our current fragmented system will increase costs but cannot transform a self-serving business model into a public-serving social insurance model.
We really have only two effective choices that would achieve both of our goals. We can dismiss our current private insurers and bring in new private insurers with a mission of serving the public good, but that is the most expensive model of reform, and it compromises equity and efficiency. Our other choice would be to eliminate our fragmented financing system and replace it with a single payer national health program. That would allow us to constrain prices and cap expenditures while achieving our other goal of providing all necessary care for everyone.
We can do it, but the people, through our elected representatives, are going to have to tell the special interests that we’ve had enough.

Options for health care cost control

The Obama Administration's Options for Health Care Cost Control: Hope Versus Reality

By Theodore Marmor, PhD; Jonathan Oberlander, PhD; and Joseph White, PhD
Annals of Internal Medicine
April 7, 2009

In short, if medical costs are to be controlled, no substitute exists for constraining prices and capping expenditures. Frank talk about these cost-control realities, however, is politically difficult. It immediately elicits alarms from the medical care and insurance industries about “rationing” (ignoring the fact that the United States could realize significant savings from lower prices and administrative costs). Others, particularly the pharmaceutical industry, raise alarms about the effect that cost control would have on the pace of medical innovation. In addition, spending targets constrain medical providers’ income and thereby prompt intense political struggles. The Obama team’s limited treatment of cost-control realities — including the absence of global budgets and spending targets or caps — seems to reflect a desire to avoid such political controversies.

We write this essay, then, as a cautionary tale. Claims of savings from health information technology, prevention, P4P, and comparative effectiveness research are politically attractive. Their political appeal lies largely in the embrace of widely supported goals, including better health and improved quality of medical care. In theory, these reforms — more research, more preventive screenings, and better organized patient data — sound like benign devices to moderate medical spending. For many purposes, such reforms are substantively very desirable. But these reforms are ineffective as cost-control measures. If the United States is to control health care costs, it will have to follow the lead of other industrialized nations and embrace price restraint, spending targets, and insurance regulation. Such credible cost controls are, in the language of politics, a tough sell because they threaten the medical industry’s income. The illusion of painless savings, however, confuses our national debate on health reform and makes the acceptance of cost control’s realities all the more difficult.

http://www.annals.org/cgi/content/full/150/7/485

Comment:

By Don McCanne, MD

High health care costs are the primary driving force behind the renewed effort for reform. Everyone agrees that high costs are straining personal, business and government budgets, and something must be done to make health care affordable for all of us.

Some of us are also concerned about health care justice. We want to see that everyone has affordable access to high quality care. It is more than fortuitous that the most effective methods of reducing excess health system spending also achieve the social justice goal of health care for everyone.

Much has been written on what does work and what doesn’t work in controlling spending. This paper provides an excellent, brief summary of the concepts being floated, and is well worth downloading. We should be very concerned that the leading mechanisms proposed, as summarized in this article, would not have a significant impact on slowing spending, and would likely actually increase our costs. Nor would they be effective in achieving health care justice for all.

If we are going to address costs seriously, there is no other option than to fundamentally restructure our health care financing system. As the authors state, “no substitute exists for constraining prices and capping expenditures.” We can never achieve that by relying on our wasteful, fragmented multi-payer system of financing health care. As all other nations have shown us, there is no other option than central, public control.

It is true that some nations do use private insurers. But private insurers in their countries organized into social insurance programs serving the public good have almost nothing in common with private insurers in the United States that shun organization in order to serve their own business interests. Adding a few regulations to our current fragmented system will increase costs but cannot transform a self-serving business model into a public-serving social insurance model.

We really have only two effective choices that would achieve both of our goals. We can dismiss our current private insurers and bring in new private insurers with a mission of serving the public good, but that is the most expensive model of reform, and it compromises equity and efficiency. Our other choice would be to eliminate our fragmented financing system and replace it with a single payer national health program. That would allow us to constrain prices and cap expenditures while achieving our other goal of providing all necessary care for everyone.

We can do it, but the people, through our elected representatives, are going to have to tell the special interests that we’ve had enough.

Indicting the insurance companies and the system that supports them

based on evidence from many sources including the SiCKO film

Denial of Access to Insurance

Count #1: That insurance companies charge such high insurance premiums that millions of Americans cannot afford to purchase any insurance at all, leading to 18,000 deaths every year.

Count #2: That insurance companies deny access to insurance for people who may have one of a long list of diseases, rather than make arrangements to see that they receive the care they need.

Count #3: That insurance companies drop people from coverage while they are sick, when they can no longer work at the job from which they get their insurance or can no longer pay their premiums.

Count #4: That insurance companies retroactively cancel insurance because of presumed undisclosed pre-existing conditions, even after the patient has received care and incurred financial liability for the care.

Denial of Coverage

Count #5: That insurance companies often cover such a small portion of necessary medical costs that millions of Americans with insurance end up bankrupt.

Count #6: That insurance companies require prior approval for large numbers of medically-necessary tests and procedures, adding needless expense, delay, and stress for doctors and hospitals. Prior approval is often required even in emergency situations when it is physically difficult or impossible to obtain such approval.

Count #7: That insurance companies deny access to care on the grounds that drugs or procedures are experimental, even when there is good evidence that the drug or procedure is potentially life-saving.

Count #8: That insurance companies deny coverage for tests or treatments without any review by the responsible Medical Director or other medically-qualified person on their staff.

Count #9: That pharmaceutical companies charge such high prices for drugs, and insurance companies cover such a small portion of their cost, that millions of Americans are denied the medications they need to recover, survive, and live comfortable lives.

Perversion of the Medical Profession

Count #10: That insurance companies pervert the medical profession by providing financial incentives that lead their Medical Directors and other medical personnel on their staff to deny access to care and thereby to harm patients.

Count #11: That insurance companies impose medical decisions without the direct interaction with patients required of treating physicians.

Misuse of Funds

Count #12: That insurance companies file fraudulent claims for payment from government insurance programs (Medicare and Medicaid).

Count #13: That insurance companies use our money to pay their CEOs hundreds of millions of dollars that could be used to provide us with more and better medical care.

Count #14: That insurance companies draft legislation behind the scenes and without public disclosure that include financial giveaways to themselves and their pharmaceutical company allies.

Count #15: That insurance companies use our money to make political contributions in order to avoid government regulation and to resist proposals that would replace them with a public program that would provide better, more comprehensive, life-saving care.

Count #16: That insurance companies use our dollars to support the publication of propaganda that provides false and distorted information on the health care programs of other countries.

Count #17: That insurance companies use our dollars to support the publication of propaganda that seeks to persuade the American people that they do not have a right to health care when they need it and that health care is a consumer commodity that only those with the ability to pay are entitled to receive.

Count #18: That insurance companies mislead the American public by offering choices of plans while denying them their choice of doctor and hospital, often including, in emergencies, denying them access to the nearest hospital.

Count #19: That insurance companies support a system that requires that Americans have the right job to qualify for health care.

Count #20: That insurance companies support a system that sets the price of medical tests and procedures out of reach of millions of Americans, even though little additional cost would be incurred by treating the patient.

Compiled by Len Rodberg, Research Director, New York Metro Chapter of Physicians for a National Health Program

New York Metro Chapter, Physicians for a National Health Program
PO Box 50193, Brooklyn, NY 11205. Tel: 718-222-9266 Fax: 718-222-1140
Email: pnhpnymetro@nyc.rr.com

Focusing on doctor pay misses point

By PAUL DEMARCO
The State, South Carolina
Monday, Mar. 23, 2009

I hate to disagree with my friend John Black, the president-elect of the S.C. Medical Association; he is a good man, a good clinician and a passionate advocate for primary care physicians. But his recent column, “Medicaid: a fair price must be paid,” misses the point.

Doctors complaining about Medicaid rates in the current health-care climate are about as tone-deaf as the crew of a sinking ship complaining to the passengers about their low pay. Yes, Medicaid rates are too low and need to be addressed, but Black approaches the problem from the wrong direction. We must put patients first, not doctors.

The Medical Association must make access to decent health care for all South Carolinians its central focus. When I took the Hippocratic Oath, I took it to mean that I would care for any patient who made it to the threshold of my office, no questions asked, and that my fellow physicians would do the same. The issue of how the patient was going to pay was only a secondary concern.

I don’t deny the business aspect of medicine. Physicians endure rigorous training for years, sometimes incurring tremendous debt. When we finally begin practice, we have a right to make a good living. Most physicians realize the privilege we have in serving our patients and provide free or low-cost care to some. Black rightly points out that there is a limit to physicians’ generosity; however, his comparison of physicians and car dealers is misplaced (“the car dealer is not expected to sell for a loss”). We chose medicine over selling cars for a reason. We wanted to take care of patients, to provide them healing and compassion impossible in the car business. And we knew that would involve taking all comers.

Unfortunately, some physicians look for ways to avoid taking care of the poor and uninsured. It is a discouraging fact that part of the unraveling of the medical safety net has been physicians’ doing. Some physicians drop out of Medicaid and Medicare legitimately, but others do it to preserve a certain high salary expectation. This is an abdication of their duty to the medical profession and to their patients.

Black’s warning that the situation is grave and that physicians “can no longer pay essential bills to keep our offices open” is an overstatement. First, there is no evidence that significant numbers of physician practices are closing because of payment issues.

Second, plenty of high-paying openings are available to physicians looking for jobs in South Carolina. I found more than 100 on MDsearch.com. One listing for a family practitioner in Clinton advertised “excellent income potential in excess of $250,000.”

Third, it is not physicians who are most at risk in the current system; it is patients. Forty-six million have no coverage, and 25 million more are underinsured. According to one report, in 2001, medical expenses helped push an estimated 2 million Americans into bankruptcy.

As physicians, we must roll our sleeves up, but not in the service of padding our own pockets. We must work together to craft a system that covers all the patients that we care so deeply about. As we remake America’s health care system, we’ll ensure that its physicians are adequately compensated, but that must be a byproduct of our effort. The patient always, always, always comes first.

Dr. DeMarco is a spokesman for South Carolinians for Universal Health Care. Reach him at pvdemarco@bellsouth.net.

National call-in day on April 15

Dear Single-Payer Supporter:

On April 15th, the Leadership Conference for Guaranteed Health Care is launching a nationwide call-in day for single-payer national health care. Our message is clear: “Tax payer dollars should go to people, not profits. Support single-payer national health care now.”

Lesser reform proposals will have our taxes subsidizing insurance company profits, not paying for real health care. We must fix our health care system by putting everybody in, and removing for-profit interests that are responsible for the sky-rocketing cost of health care. The only plan that meets these criteria is a single-payer national health care system.

So on April 15th, 2009, we ask that you join with thousands of others to call Congress, to support single-payer legislation in both the House (HR 676) and the Senate (S703).

If you don’t know your Congresspersons, or want a script, all of the information you need is on our National Call-In Day page – http://www.healthcare-now.org/campaigns/call/

If you know your Representative and Senators, the Capitol Switchboard number is 866-338-1015*. Ask to be connected, and then ask him or her to support HR 676 or S703. If they are already a co-sponsor, thank them.

The injustice in our healthcare system must end. If our Congress is serious about health reform, they will support single-payer health care now.

Health and Justice,

Katie Robbins
Assistant National Coordinator, Healthcare-NOW!
Support Staff, Leadership Conference for Guaranteed Health Care
o: 800.453.1305
c: 330.618.6379
f: 212.475.8350
healthcarenow08@gmail.com
www.healthcare-now.org
339 Lafayette St
New York, NY 10012

*If you cannot make phone calls, information for your US Representatives and Senators can be found at www.votesmart.org