PNHP

Philadelphia City Council Votes to Support Single-Payer Healthcare

Philadelphia City Council Votes to Support Single-Payer Healthcare

Various Groups Present, Applaud Council for Vote that Makes Philadelphia 28th City to Favor HR 676, the National Health Insurance Act

For Immediate Release
January 29, 2009

For more information:
Kathleen Casey, PASNAP: 610-246-1369
Jeff Muckenstrum, Healthcare-NOW!: 267-515-2400

Today, groups representing doctors, nurses, healthcare advocates and labor unions are applauding the Philadelphia City Council for voting in favor of single-payer healthcare. The resolution, sponsored by Councilman Greenlee and Councilwoman Tasco, makes Philadelphia the 28th city and 46th local government to pass a resolution in favor of HR 676, the National Health Insurance Act, sponsored by John Conyers (D-Ill). The resolution also calls for the enactment of the two single-payer state bills, SB 300 and HB 1660.

Nearly 40 people watched the city council pass the resolution. One audience member, Walter Tsou, MD, MPH, former Health Commissioner of Philadelphia, said of the resolution, “Single payer is a win win for Philadelphia. It not only would give 160,000 uninsured Philadelphians health insurance, but it would redirect hundreds of millions of city dollars toward other important priorities, like libraries and fire stations.”

Jed Dodd, a Teamster Union official who represents railroad construction workers in the Northeast stated, “Single payer health plans ensure all people living in the United

States access to quality health at a fair cost. Ninety-seven percent of the resources allocated to support these plans are spent on health care. All other plans waste 30% of these resources on insurance companies who provide no health care to anyone and ironically make more by limiting access to health care instead of making people well. We are heartened that the Philadelphia City Council has endorsed a health care plan for the people of America.”

A fact sheet circulated to Council members demonstrates that if HR 676 were enacted, the city would save $539 million a year, enough to cover its budget shortfall of $2 billion over 5 years. In addition, the bills would guarantee access to comprehensive healthcare at less cost than what average families currently pay for care. Sabrina Nixon, a medical technologist at Temple University Hospital, and a member of PASNAP, said, “As a healthcare professional of 20 years and a parent, I see that HR 676 would not only fix the current healthcare crisis, but eliminate every parent’s worry that their child will not have access to quality healthcare once they turn 18 or as they move between jobs. If HR 676 were passed, the dream of universal healthcare will become reality.”

Groups that have signed on to a letter asking the Council to sign the resolution, many of which were present at the vote, include: Healthcare-NOW; Healthcare for All — Philadelphia; Pennsylvania Association of Staff Nurses and Allied Professionals; United Steelworkers Local 10-1; International Federation of Professional and Technical Employees Local 3; Faculty and Staff Federation of Community College of Philadelphia, AFT 2026; Pennsylvania Federation of the Brotherhood of Maintenance and Way Employees — IBT; American Medical Students Association; Physicians for a National Health Program; Progressive Democrats of America; Philadelphia Chapter Women’s International League for Peace and Freedom; Citizen Access; and Leadership of Neighborhood Networks.

PASNAP represent 5000 nurses and healthcare professionals throughout Pennsylvania, including most nurses in the Temple System. For more information, visit www.pennanurses.org

Jessica Yarbrough
Secretary
California Nurses Association
National Nurses Organizing Committee
888 16th St NW
Suite 640
Washington, DC 20006
(202)974-8300

Support Single-Payer Universal Healthcare
http://www.SinglePayer.com

New health care alliance pushes 'Medicare for All' reform

Leadership Conference for Guaranteed Health Care says high-quality health care is a right of all people

FOR IMMEDIATE RELEASE
Jan. 28, 2009

Contact:
Mark Almberg, (312) 782-6006, cell: (312) 622-0996, mark@pnhp.org

WASHINGTON — Nurses, doctors, students, large community-based membership groups, labor unions, religious organizations and activists launched a new health care alliance today called The Leadership Conference for Guaranteed Health Care/The National Single Payer Alliance (www.guaranteedhealthcare4all.org). The combined organizations have a membership base of more than 20 million people.

“National Nurses Organizing Committee’s 85,000 members lend their continued commitment to our fellow member groups fighting to reform the health care system through a Medicare-for-All system that would be publicly funded and privately provided,” said Geri Jenkins, registered nurse and co-president of NNOC/California Nurses Association. “Our nation’s nurses know that real patient advocacy is only possible in a health care system in which patient care is more critical than insurance company profits.”

Spokespersons for the new coalition said they believe high-quality health care is a right of all people and should be provided equitably as a public service. A single-payer national health program would eliminate the wasteful role played by private health insurance companies and, as a result, is the most cost-effective and efficient way to achieve health care for all in the United States, they said.

“It has become clear, especially now that we are in a recession, that single payer is not merely the best solution, but the only solution,” said Dr. Walter Tsou, Physicians for a National Health Program (PNHP) board adviser and former health commissioner of Philadelphia.

Dr. Robert Zarr, a pediatrician who co-chairs PNHP’s Washington chapter, elaborated on this theme, saying, “The economy is in shambles, and more and more Americans have lost their jobs and their health insurance. One in three Americans does not have timely access to health care. We cannot rely on private health insurance any longer because of its waste and greed.

“This is not a time for small incremental change,” Zarr continued. “This is a time for bold change. With a clear majority of Americans and American physicians demanding national health insurance, now is the time to expand and improve Medicare for all.”

Progressive Democrats of America Executive Director Tim Carpenter added, “The most important step the new administration and Congress can take to provide a stimulus to employers and financial relief to families across all income levels would be to incorporate single-payer health care reform within an economic recovery package.”

The coalition supports H.R. 676, a bill that calls for an expanded and improved Medicare system that would cover all U.S. residents. Rep. John Conyers Jr. (D-Mich.) has reintroduced the legislation in the 111th Congress.

The new coalition’s name — The Leadership Conference for Guaranteed Health Care — is intended to evoke the memory of pioneering civil rights coalitions that successfully united advocates for racial equality with labor unions and religious, women’s and civil liberties groups. Their combined efforts eventually contributed to the passage of landmark legislation like the Civil Rights Act and the Voting Rights Act.

Physicians for a National Health Program, a membership organization of over 15,000 physicians, supports a single-payer national health insurance program. PNHP physicians are available for interview and can speak about options for reform at both the state and national levels. To contact a physician-spokesperson in your state, visit www.pnhp.org/stateactions/ or call (312) 782-6006.

House Democratic Leader Declares National Health Care Legislation “Off The Table” This Year

Bruce Dixon, Managing Editor
Black Agenda Report
Wednesday, 28 January 2009

What does it mean when leading House Democrats, and apparently the White House repudiate their own campaign promises to enact a universal-coverage national health care plan only days into the new Congress and new administration, even though they have a popular president and the biggest Congressional majority in two generations? What does it mean when this doesn’t even make the evening news? It means the awesome power of corporate media decides the topic of our political conversation. It’s not about health care, or campaign promises, or hypocrisy. It’s about Blago. Or Britney. Or whatever they tell us it is.

In the bubble of false reality that passes for corporate journalism, the week’s biggest story was, and still is of this writing, the antics of governor Rod Blagojevich, who showed on Larry King, the View and other places comparing himself to Mandela, Gandhi and Jesus while the Illinois legislature debates his impeachment in absentia.

If, on the other hand, the purpose of journalism were to inform rather than entertain the public, the news cycle would be dominated by quite another, and a vastly more important story. In a C-SPAN interview broadcast Sunday, House Democratic Whip James Clyburn of South Carolina declared that even with the biggest majority in a generation, Democrats will not even try to put a universal health care bill on the president’s desk this year, or maybe the next either.

As recounted by Bob Cusack Monday in The Hill,

During an interview on C-SPAN’s “Newsmakers” program that aired on Sunday, Clyburn said he doesn’t anticipate that comprehensive healthcare legislation will be approved in 2009.

While noting he does not know exactly when President Obama want to move forward with a universal healthcare measure, Clyburn said, “If you take what we’ve done with [the State Children’s Health Insurance Program bill] and then you follow with [more spending] on community health centers, you would have gone a long way to building a foundation upon which to build a universal access healthcare program.

“I would much rather see it done that way, incrementally, than to go out and just bite something you can’t chew. We’ve been down that road. I still remember 1994.”

This troubling statement by the number three Democrat in the House of Representatives is unquestionably more consequential than the clownish Illinois governor and his traveling circus, and profoundly troubling on multiple levels.

To begin with, Democrats in Congress, and the Democrat in the White House clearly ran promising the American people a national health care plan. A public repudiation of that promise by a key member of the president’s team in the House less than three weeks into the new Congress and two weeks into the new administration should be big news. But for some reason it’s not.

Secondarily, in the powerful position of House Democratic Whip, Clyburn is a key member of President Obama’s team, and consults with the White House on legislation and legislative priorities multiple times a day. Clyburn undoubtedly has the cell numbers of Rahm Emanuel and other White House officials on his speed dial. The notion that Clyburn is not privy to the Obama administration’s decision of whether or not to push a universal health care plan this year is something you have to be dumber than a fifth grader to believe. There’s only one president at a time, and one leader of the Democratic party at a time. When Clyburn’s lips move, the Obama administration is talking.

You haven’t heard the White House press spokespeople disown Clyburn’s backtracking on Democratic campaign promises to enact universal health care, and you won’t. It’s hard to avoid the conclusion that the rollback of Democratic promises to enact a national health care plan is just a Democratic congressional leadership thing. It’s clearly the decision of the Obama White House too.

Third, Clyburn is a longtime member of the Congressional Black Caucus, and back in April of last year signed on as a co-sponsor of HR 676, the Medicare-For-All single payer health care proposal advanced by Rep. John Conyers (D- MI) and endorsed by Physicians For A National Health Care Plan. Is Clyburn being forced to toe the White House line and violate Democratic campaign promises and his personal commitments? Or are he and the House leadership taking initiative on their own to violate those promises and commitments? Again, the silence from the White House makes the former the most likely. How many other co-sponsors of HR 676 just signed it because it made a good press release, but have no intention of seeing it ever brought to a vote?

Finally, Democrats at this moment have a popular and newly elected president, along with the biggest majority in the House and Senate they have enjoyed in a generation. If Democratic leaders are reluctant even to try to put a national health care plan on the president’s desk under these favorable circumstances, when will they ever try? Mid-term elections almost invariably shrink Congressional majorities as large as these.

It is estimated that 18,000 premature deaths occur in the US each year because of lack of medical coverage. Fifty or sixty million Americans have no health coverage at all, and another hundred fifty million are grossly underinsured. Democrats were able to pass SCHIP with a smaller majority under the Bush administration. They did not run on promises of “incremental reform”. They ran promising to deliver national, comprehensive, universal health care. Clyburn himself is a co-sponsor of the single payer bill. So why are the expectations of House Democrats and the White House, with a popular wind at their backs, so unconscionably low now?

Despite the Obama administration’s open phone lines and email boxes at www.change.gov, and its hypocritical encouragement of supporters to hold health care house meetings to voice their opinions, the Obama White House, and House Democrats Ć¢ā‚¬ā€œ just like their Republican counterparts — are hip deep in campaign contributions private health insurance companies. These private insurers, according to Physicians For a National Health Care Plan, rake off thirty cents of every health care dollar under the present broken health care system, so they have an enormous financial stake in preventing universal health care, especially single payer health care. Their dollars apparently speak louder than our votes.

The deep and multilayered hypocrisy around the issue of whether Democrats, with huge majorities in the House and Senate, will even try to produce national health care legislation is only exceeded by that of the corporate news establishment, who won’t tell the story, and instead dangle the clownish Illinois governor before us. One supposes that in a week when Britney Spears has remained sober and Paris Hilton has avoided a public breakdown, this is the best and most important news they can find.

For Black Agenda Report, I wish to recognize CD at www.correntewire.com for drawing our attention to this story.

Bruce Dixon is managing editor at Black Agenda Report, and based in Atlanta. He can be reached at bruce.dixon(at)blackagendareport.com

How the U.S. measures up to Canada’s health care system

World Focus
January 28, 2009

The Worldfocus signature story Canada’s hospitals cut the paperwork, emphasize care explores Canada’s health care system.

In this extended interview, Uwe Reinhardt, a leading adviser on health care economics and professor of political economy at Princeton University, compares the Canadian and American health care systems. Reinhardt criticizes the U.S. health care culture and expresses his optimism about the Obama administration.

As part of Worldfocus’ Health of Nations signature series, correspondent Edie Magnus conducted this half-hour interview with Uwe Reinhardt on January 20, 2008, the day of President Barack Obama’s inauguration.

Reinhardt blogs at The New York Times’ “Economix” blog. A transcript of the interview is below the video.

Edie Magnus: What do you think of Canada’s national health care system?

Uwe Reinhardt: I think it’s a high performer in the following sense: Canadians spend half as much per capita on health care as we do in the U.S., and yet if you go up there, sure you have to wait for some MRI image or for some heart procedures, but overall the system produces very good health outcomes. People are more satisfied there with their care than Americans are with theirs. So if you diagnosed it like a physician, you’d give that system an A and you’d have a hard time giving more than a B to ours.

Edie Magnus: Why do you think it is that most Americans don’t see it that way?

Uwe Reinhardt: Most Americans, first of all, are bombarded with propaganda. You don’t know how many think tanks are paid by certain industry — insurance, drug, organized medicine — to feed out negative stories about the Canadian health system. They do of course have mishaps, as do we, but there is a whole industry collecting them and beaming them out here. That is one.

Secondly, people are always more comfortable culturally with whatever they have than with some other system.

Third, people imagine having the worst illness, and if you are really very sick in the U.S., you generally do have more hope than in any other country if you are very sick, particularly if you are well insured. But if you sort of live the average life of Americans and have a Canadian system, they have better primary care, easier access to it. They would never go bankrupt over health care, because they don’t do that up there. They would realize what they are missing here.

Edie Magnus: We were in a hospital that was affiliated with McGill University, and it was a regional system that had six hospitals that were affiliated with one another, and they annually have some 39,000 inpatients, and they do about 34,000 surgeries and they deliver about 3,000 babies. And managing all of this is a staff of 12 people doing the billing, the administration. What would an equivalent hospital in the U.S. take to run administratively?

Uwe Reinhardt: You’d be talking 800, 900 people, just for the billing, with that many hospitals and being an academic health center. We were recently at a conference at Duke University and the president of Duke University, Bill Brody, said they are dealing with 700 distinct managed care contracts. Now think about this. When you deal with that many insurers you have to negotiate rates with each of them. In Baltimore, they are lucky. They have rate regulations, so they don’t have to do it. But take Duke University, for example, has more than 500,000 and I believe it’s 900 billing clerks for their system.

Edie Magnus: What are 800, 900 people doing?

Uwe Reinhardt: Well first of all there’s a contract. With each different managed care contract you have different rates. You have different things that need pre-authorization, not depending on the contract. You haggle over every bill. You submit the bill, the insurer rejects it, you haggle, and it may take 90 days to settle one bill. They don’t have that in Canada. You see, we spend in this country an enormous amount of money just administering claims. It’s a huge wrestling match over the payment.

Edie Magnus: When we pay a medical bill, how much of that bill goes to these kinds of administrative costs?

Uwe Reinhardt: Well, in general what you’ll find in our official statistics, we’re spending 7 percent on administration, but that only accounts for the insurers’ administrative costs and that includes Medicaid, which burns only two percent of its money throughput on administration. On the other hand, Medicare and Medicaid both cost the hospitals administrative costs that are booked as medical care, but it’s really administrative costs.

Steffie Woolhandler and David Himmelstein of Harvard did a study comparing Canada and the U.S. looking at what it costs employers, providers, doctors and hospitals and the insurance mechanism and compared Canada and the US, and they found that we in 1999, spent $300 billion on administration for all these three functions, and that was about 24 percent of national health spending there, but they say it was actually 31 percent because of the fraction of spending that they could actually identify and link to administrative costs. So they came to 31. So it’s somewhere between 25 and 30 percent that goes for administration and it doesn’t even include the patients’ time of billing. Anyone who has had anyone really sick in their family knows how much time you spend haggling over the bills and they have none of that in these systems.

Edie Magnus: I know that there’s some dispute about all those numbers, about what percentage of our spending the administrative costs represent, but you have said that with what America could be saving in administrative costs, that it could completely fund universal health care for all Americans.

Uwe Reinhardt: Oh yes, I’m totally convinced of that.

Edie Magnus: How is that possible?

Uwe Reinhardt: Well for one, many insurance companies have a nomenclature that when they issue a bill, when the hospital issues a bill, the insurance company can’t understand it. So there are entities, enterprises that translate that from the insurance companies’ nomenclature into the hospitals’ nomenclature and vice versa.

Edie Magnus: Alright, but tell us, I’m not sure my mother would understand this explanation…

Well I mean, just imagine a hospital sees a horse and it says I code that as H-O-R-S-E, and the insurance company uses French for that, C-H-E-V-A-L, and now the computers, they can’t mesh this unless there is a translator in between who says “Oh, horse for that insurance company means cheval.”

Edie Magnus: And this goes on every day between hospitals and insurers?

Uwe Reinhardt: This goes on every day. They don’t understand the way that they “code” things. So I hope Obama will come and say, “You guys had 30 years to figure it out and obviously you couldn’t. I’ll figure it out for you. Here’s a nomenclature. You must use it, and if you don’t, you don’t get paid, period.”

Edie Magnus: Can you talk about that and how it contributes to our administrative headaches?

Uwe Reinhardt: Well, I once did a dumb thing: I asked an insurance executive “What do you pay in New Jersey for a colonoscopy?”

And he just laughed at me and said, “What a silly question. There is no price for a colonoscopy. We have a different price for every hospital. And for the same hospital, we might have six prices depending on the insurance product, is it an HMO, etc.”

So I said, “This is mad. How many could there be?”

He says, “There could be 30, 40 for us, but then with Aetna, they could have another 30, and everyone has a different contract, so a hospital might receive 60, 80,100 different prices for a colonoscopy, depending on which insurance company and what contract it is. So when you say Ć¢ā‚¬ĖœWhat are the private market prices?’ there is no price.”

And I said, “Well how, when you have consumer-directed health care, where people are supposed to shop around, what are you going to tell them?”

And he said, “We can’t, really. What would you tell them?”

There is no real price, and every price has been negotiated and haggled over. So imagine what it costs compared to a system where a government negotiates with a physician association. Here’s the fee schedule, and that’s it, and everyone uses the same fee schedule. You can put that into a computer. You have a little card like an American Express card. The price list is already there. You swipe it through, the doctor keys what he or she did and here’s your bill. Well here you have to look at what contract was it and the coding turns out to be wrong, and the bill isn’t clean.

I know an entrepreneur who is a multi-zillionaire, and I said, “What did you do before to be so rich?”

And he said, “I can write clean bills for doctors.”

And I said, “What is your product?”

He said, “My computer knows every managed care contract in this area, hundreds and hundreds of them, and if the doctor tells me the product, the insurance contract, and I know what the doctor did, my machine can type a bill that the doctor never could get right, and submit it to insurance, and we get paid 30, 40 days faster and more accurately, and we split — the doctor doesn’t pay me — we just split the extra money and make the doctor.

I have another friend in Princeton. He gets all of these bills, his wife was ill and he says, “I don’t do the claiming, there is a company that specializes in claiming for you. You just turn over all your stuff and they submit the bills.” So you now have companies that help doctors bill, and then you have companies that help patients pay these bills.

There was a company, I think it was a subsidiary of United, that wrote software to help hospitals bill better and get every dime they could from insurance companies and sold other software to help insurance companies that helps them defend themselves against the doctors’ billing. It’s laughable. It’s hard to explain it without laughing, but we do.

I tell you, if you gave a keg or two of beer to six Princeton undergraduates and said “Drink till you fall over, and then design something really mischievous,” they couldn’t come up with what we adults have come up with being sober, or seeming to be sober. This is a totally insane system.

Edie Magnus: And if we could save those administrative dollars, is there an amount that you think we would save?

Uwe Reinhardt: I think we should be able to cut it in half, what we spend. That would still be more than most other nations spend, but we should use other nations as a benchmark and say, “They can do it for this, so let’s at least cut ours in half.” We would still be spending more than these other nations, but Obama should simply set a goal. Like Kennedy said we’ll go to the moon in so many years, Obama said in so many years we’re going to save that much on administration and I’m going to put someone in charge of it and we’re going to keep books.

Edie Magnus: And to the person who hears that and thinks, “Yeah, but you know, sometime I’m going to be in a jam, I’m going to want some care, and if we go to this other system it might not be available to me…”

Uwe Reinhardt: Mind you, I’m not advocating the Canadian system. It works well for them. I’m not saying we need to have this, but I’m saying whatever we have, if you have government saying there is going to be one computer system, that doesn’t mean one manufacturer, but whatever they make has to interoperable. Whatever language they use has to be the same. We’re going to speak English, so to speak. One nomenclature. You have to call this operation by one code, no matter who it is. There have to be common billing forms. Not every company has its own incomprehensible explanation of benefits, you know. Every hospital bill is just a living insult, when you actually get one as a patient. There has to be something people understand.

And it turns out that after giving it to the industry for 30 years to straighten out and they didn’t, it will have to be the Obama government that says, “Guys we’re going to rig this for you. You can have all the machines you want, all the software. You can buy it from whomever, but it has to obey these rules.”

Just like electric plugs. No matter who makes the stuff, there has to be one plug. But for some reason, the electric industry has been able to settle on one plug. The Cell phone industry has still not settled on one charger. You have to have chargers that vary by thing. The earplugs for the cell phones are different depending on the model. This is nonsense. You give the industry time and if you can’t figure it out, kids, we’ll figure it out for you.

Edie Magnus: Why do you think it is that Canadians are, in large percentages, so much more satisfied with their health care system?

Uwe Reinhardt: I think, for one, you don’t have this constant fear when you go to bed, if whether tomorrow you have health insurance. You know you will. You almost feel it when you go to the airport and you ask these people. That’s not something they worry about. Here you ask any waitress “Are you insured?” Half the time they’re not even insured. If they have it, they don’t know if they have it tomorrow.

One of the interesting things is 250 finance people have been laid off. That industry is going to be small in the future. They’re not going to have health insurance. I think a lot of those people who hated the Canadian system and socialized medicine and so on will discover it might not be a bad idea to have a safety net for some things — education for your kids, health care when you get sick, justice when you are in the courts — and for some reason to think that rugged individualism can cope with this is nonsense.

Edie Magnus: Would national health care work in the United States?

Uwe Reinhardt: Yes.

Edie Magnus: Would Canada’s plan work in the United States?

Uwe Reinhardt: Well, it works. We have a Canadian health plan in America. It’s called Medicare. It works. Don’t tell me medicare doesn’t work. Tell that to the elderly. One way to test it is to say “Let’s take it away.”

Edie Magnus: But it is running out of money.

Uwe Reinhardt: No, it’s not, no way. It’s not running out of money. I mean we still have a surplus in that account. At some point in the future it will run out of money unless we raise premiums, that is, payroll contributions. We’ll have to do this. But the idea that that it runs out of money and General Motors, which is almost bankrupt, doesn’t, tell me about who is running out of money. GM is living on taxpayers’ blood transfusions. Why? Over health care. They ran out of money, not Medicare. I think this is a myth.

Of course, if you keep payroll tax where it is, it will run out money. But the elderly could contribute more to it and they will. Payroll taxes can be raised a little bit. Higher income recipients probably have to contribute more to it. These are really solvable problems, but Medicare is a Canadian style heath care system.

Edie Magnus: If it seems such long odds that we will ever have a single payer system for all of the United States, what’s the point of comparing us to Canada?

Uwe Reinhardt: You have to have benchmarks. You can’t just say, “We’re unique therefore we can simply spend the whole GDP on health care.” You do have to ask how does Canada do it. How does Germany do it? How does Taiwan do it? How do other nations do it? And if you think you are way out of line, if you’re spending twice as much as the people who are culturally similar to us — their income is somewhat lower but not that much lower than ours, we’re really one North America — you’d really have to ask yourself. Now mind you, you could also look within the US. Utah and Oregon are much, much cheaper than Massachusetts or Miami. So you could look at Canada, but you could also look within the U.S. where you have these variations. But why should you not be able to learn from other countries, particularly when you run a huge single payer system, and Obama is going to put in another single payer system, this public “Medicare light” plan for people under 65? So yeah, we can learn something from Canada. They can learn a lot from us.

Edie Magnus: If you don’t have all the free market forces in health care, would you have as much competition, innovation?

Uwe Reinhardt: Innovation, in the pharmaceutical products and devices, maybe not, because the money wouldn’t be as generous. I mean, we’ve had an unbelievable generous… I mean, if you spend twice as much, you will fund a lot of innovation with it and you’ll fund a lot of waste with it, both. We’ve had both, waste galore and innovation galore. You might have less innovation, but I think a good science policy could contravene that.

In other words, you could fund and support drug companies, not through the price of the drugs, but by giving them grants, government grants. We need a drug for Alzheimer’s, and like the defense contractors — we need a jet that can do these missions — we need a drug that does Alzheimers. And the government is going to lend research contracts to the pharma. industry, and you get your cost reimbursed, but the winner who has the best product — you have a fly by like you do with jets — and the winner gets the contract. So there are other ways of funding devices and of funding drugs and other innovations than just through the price, you know? We have to think of other ways to do this. There is no reason why we couldn’t have a flourishing innovative high tech industry, even if we stepped down on prices, which the private sector will too.

You look at what the Bush administration has done with drugs, turning the Medicare Part D to private industry, and what did they do? They persuaded millions of the elderly to switch out of brand name drugs into generics, totally devastating the drug industry. This wasn’t done by the government. It was done by private enterprise, by private, competitive enterprise.

Edie Magnus: You’ve sort of alluded to this, but are you optimistic that America, starting today with a new president, can get it right with health care?

Uwe Reinhardt: Well, “get it right…” that’s partly an ideological thing, but get it done in this sense… You could say there are certain requirements we have of our health system. An American family where a member is stricken with cancer shouldn’t go broke. That’s easy to achieve. Do you have to do it the Canadian way? No. We can do it our way, even if it’s a little pricier.

A requirement that when somebody thinks they have major illness they should able to get access and not have to worry about whether they can pay the bill. There are certain things you can write down that health systems should achieve, and you say “We’re going to go there our own way. We’re not going to copy Germany, we’re not going to copy Canada, but we want to end at the same point,” and that is that you can go to bed and not worry about losing your health insurance when you lose your job. And those things are achievable, and the Obama plan, if you look at it, has all that in it. It says we keep the system we have, but we put some new things in, like this government program for the people under 65 such that when you lose your job, you don’t lose your family’s insurance, and we can do this. I’m optimistic.

Now a year ago I would have said we’ll never do it, because we’re a bunch of spoiled children.

Edie Magnus: Now we’ve been slapped upside the head…

Uwe Reinhardt: We’ve been slapped upside the head, and in fact people are talking about it, T-shirts, “Grow up America.” I’ve always told my wife “I never understood Americans till our kids became teenagers, and then I understood this whole culture.” It’s a teenage culture. That’s all I really know about Americans, people who want the best health care, they don’t want to pay high premiums, don’t want to pay taxes — this is juvenile. And I think Obama’s inauguration speech was basically very serious, saying, “You know, we have to grow up. We now have to grow up.” I’m much more hopeful now that children in distress will rediscover the virtue of mothers.

In fact I wrote a piece, “I hate Mom and the Government Too,” and I say that it’s amazing, given how teenagers curse mothers, that mothers somehow, that evolution didn’t do away with them, that the reason evolution kept them there is that when the kids get in trouble they run to Mom. And look at what happens now. GM driving overnight, begging mom, that is, government, to help them. The bankers of New York, you know, who used to sit in their golf carts cursing government regulation, running to Washington, to Mom, “Please help us.” And I think, like teenagers at some point discover the virtue of moms who can give them help, the American people will discover, “You know what, there are good things about government, like there are about moms. When you get in trouble they’re really cool to have around.” And I think we’re at that moment, and that is why I believe health reform has a hope. We could literally get this done this year.

Edie Magnus: And just to be clear, Obama’s plan is not national health care, right? It’s not a single payer system…

Uwe Reinhardt: If you mean a nationalized health care with a single…

Edie Magnus: Yes. Government funded, government run, the taxpayers pay, everyone gets it…

Uwe Reinhardt: No. It’s not that. It says you keep whatever you have as long as they’ll give it to you, but if they don’t give it to you anymore, Mom is here for you. You can go out there. You can ride your bike, but if you get hurt you can come here. If the private sector has not sold you a private health insurance policy, we will.

I can’t see what could be fairer that to say to everyone you can play all these games, but there are certain rules. You have to, in the end, cover people. And if you, the private health insurance agency, are not able to do it, we can do it. The government can do it.

And we’ll discover this more and more. Our banking system, you’d be surprised what that’ll look like. It will be highly regulated, like a utility. It’ll be small. It’ll do what it was supposed to do rather than being a gambling casino, which is what it became. You know, they too behaved like teenagers. In fact, this piece I just wrote, it’s actually only for the student newspaper, “I Hate Mom and the Government Too,” the Financial Times printed it, the German Zeit printed it, because everyone understood that that’s what it really was. We had all become teenagers, irresponsible, naughty, and so on, and I think we will become a much better nation because of this calamity.

http://worldfocus.org/blog/2009/01/28/how-the-us-measures-up-to-canadas-health-care-system/3783/

Uwe Reinhardt on comparing U.S. to Canada

How the U.S. measures up to Canada’s health care system

Worldfocus
January 28, 2009
As part of Worldfocus’ Health of Nations signature series, correspondent Edie Magnus conducted this half-hour interview with Uwe Reinhardt on January 20, 2009, the day of President Barack Obama’s inauguration.
Edie Magnus: What do you think of Canada’s national health care system?
Uwe Reinhardt: I think it’s a high performer in the following sense: Canadians spend half as much per capita on health care as we do in the U.S., and yet if you go up there, sure you have to wait for some MRI image or for some heart procedures, but overall the system produces very good health outcomes. People are more satisfied there with their care than Americans are with theirs. So if you diagnosed it like a physician, you’d give that system an A and you’d have a hard time giving more than a B to ours.
Edie Magnus: Why do you think it is that most Americans don’t see it that way?
Uwe Reinhardt: Most Americans, first of all, are bombarded with propaganda. You don’t know how many think tanks are paid by certain industry — insurance, drug, organized medicine — to feed out negative stories about the Canadian health system. They do of course have mishaps, as do we, but there is a whole industry collecting them and beaming them out here. That is one.
Secondly, people are always more comfortable culturally with whatever they have than with some other system.
Third, people imagine having the worst illness, and if you are really very sick in the U.S., you generally do have more hope than in any other country if you are very sick, particularly if you are well insured. But if you sort of live the average life of Americans and have a Canadian system, they have better primary care, easier access to it. They would never go bankrupt over health care, because they don’t do that up there. They would realize what they are missing here.
Edie Magnus: We were in a hospital that was affiliated with McGill University, and it was a regional system that had six hospitals that were affiliated with one another, and they annually have some 39,000 inpatients, and they do about 34,000 surgeries and they deliver about 3,000 babies. And managing all of this is a staff of 12 people doing the billing, the administration. What would an equivalent hospital in the U.S. take to run administratively?
Uwe Reinhardt: You’d be talking 800, 900 people, just for the billing, with that many hospitals and being an academic health center. We were recently at a conference at Duke University and the president of Duke University, Bill Brody, said they are dealing with 700 distinct managed care contracts. Now think about this. When you deal with that many insurers you have to negotiate rates with each of them. In Baltimore, they are lucky. They have rate regulations, so they don’t have to do it. But take Duke University, for example, has more than 500,000 and I believe it’s 900 billing clerks for their system.
Edie Magnus: What are 800, 900 people doing?
Uwe Reinhardt: Well first of all there’s a contract. With each different managed care contract you have different rates. You have different things that need pre-authorization, not depending on the contract. You haggle over every bill. You submit the bill, the insurer rejects it, you haggle, and it may take 90 days to settle one bill. They don’t have that in Canada. You see, we spend in this country an enormous amount of money just administering claims. It’s a huge wrestling match over the payment.
Edie Magnus: When we pay a medical bill, how much of that bill goes to these kinds of administrative costs?
Uwe Reinhardt: Well, in general what you’ll find in our official statistics, we’re spending 7 percent on administration, but that only accounts for the insurers’ administrative costs and that includes Medicaid, which burns only two percent of its money throughput on administration. On the other hand, Medicare and Medicaid both cost the hospitals administrative costs that are booked as medical care, but it’s really administrative costs.
Steffie Woolhandler and David Himmelstein of Harvard did a study comparing Canada and the U.S. looking at what it costs employers, providers, doctors and hospitals and the insurance mechanism and compared Canada and the US, and they found that we in 1999, spent $300 billion on administration for all these three functions, and that was about 24 percent of national health spending there, but they say it was actually 31 percent because of the fraction of spending that they could actually identify and link to administrative costs. So they came to 31. So it’s somewhere between 25 and 30 percent that goes for administration and it doesn’t even include the patients’ time of billing. Anyone who has had anyone really sick in their family knows how much time you spend haggling over the bills and they have none of that in these systems.
Edie Magnus: I know that there’s some dispute about all those numbers, about what percentage of our spending the administrative costs represent, but you have said that with what America could be saving in administrative costs, that it could completely fund universal health care for all Americans.
Uwe Reinhardt: Oh yes, I’m totally convinced of that.
****
Edie Magnus: Would national health care work in the United States?
Uwe Reinhardt: Yes.
Edie Magnus: Would Canada’s plan work in the United States?
Uwe Reinhardt: Well, it works. We have a Canadian health plan in America. It’s called Medicare. It works. Don’t tell me Medicare doesn’t work. Tell that to the elderly. One way to test it is to say “Let’s take it away.”
Full transcript and video:
http://worldfocus.org/blog/2009/01/28/how-the-us-measures-up-to-canadas-health-care-system/3783/#comments

Save this link until you have 27 minutes to watch the complete video. It will be well worth your time.

Uwe Reinhardt on comparing U.S. to Canada

How the U.S. measures up to Canada's health care system

Worldfocus
January 28, 2009

As part of Worldfocus’ Health of Nations signature series, correspondent Edie Magnus conducted this half-hour interview with Uwe Reinhardt on January 20, 2009, the day of President Barack Obama’s inauguration.

Edie Magnus: What do you think of Canada’s national health care system?

Uwe Reinhardt: I think it’s a high performer in the following sense: Canadians spend half as much per capita on health care as we do in the U.S., and yet if you go up there, sure you have to wait for some MRI image or for some heart procedures, but overall the system produces very good health outcomes. People are more satisfied there with their care than Americans are with theirs. So if you diagnosed it like a physician, you’d give that system an A and you’d have a hard time giving more than a B to ours.

Edie Magnus: Why do you think it is that most Americans don’t see it that way?

Uwe Reinhardt: Most Americans, first of all, are bombarded with propaganda. You don’t know how many think tanks are paid by certain industry — insurance, drug, organized medicine — to feed out negative stories about the Canadian health system. They do of course have mishaps, as do we, but there is a whole industry collecting them and beaming them out here. That is one.

Secondly, people are always more comfortable culturally with whatever they have than with some other system.

Third, people imagine having the worst illness, and if you are really very sick in the U.S., you generally do have more hope than in any other country if you are very sick, particularly if you are well insured. But if you sort of live the average life of Americans and have a Canadian system, they have better primary care, easier access to it. They would never go bankrupt over health care, because they don’t do that up there. They would realize what they are missing here.

Edie Magnus: We were in a hospital that was affiliated with McGill University, and it was a regional system that had six hospitals that were affiliated with one another, and they annually have some 39,000 inpatients, and they do about 34,000 surgeries and they deliver about 3,000 babies. And managing all of this is a staff of 12 people doing the billing, the administration. What would an equivalent hospital in the U.S. take to run administratively?

Uwe Reinhardt: You’d be talking 800, 900 people, just for the billing, with that many hospitals and being an academic health center. We were recently at a conference at Duke University and the president of Duke University, Bill Brody, said they are dealing with 700 distinct managed care contracts. Now think about this. When you deal with that many insurers you have to negotiate rates with each of them. In Baltimore, they are lucky. They have rate regulations, so they don’t have to do it. But take Duke University, for example, has more than 500,000 and I believe it’s 900 billing clerks for their system.

Edie Magnus: What are 800, 900 people doing?

Uwe Reinhardt: Well first of all there’s a contract. With each different managed care contract you have different rates. You have different things that need pre-authorization, not depending on the contract. You haggle over every bill. You submit the bill, the insurer rejects it, you haggle, and it may take 90 days to settle one bill. They don’t have that in Canada. You see, we spend in this country an enormous amount of money just administering claims. It’s a huge wrestling match over the payment.

Edie Magnus: When we pay a medical bill, how much of that bill goes to these kinds of administrative costs?

Uwe Reinhardt: Well, in general what you’ll find in our official statistics, we’re spending 7 percent on administration, but that only accounts for the insurers’ administrative costs and that includes Medicaid, which burns only two percent of its money throughput on administration. On the other hand, Medicare and Medicaid both cost the hospitals administrative costs that are booked as medical care, but it’s really administrative costs.

Steffie Woolhandler and David Himmelstein of Harvard did a study comparing Canada and the U.S. looking at what it costs employers, providers, doctors and hospitals and the insurance mechanism and compared Canada and the US, and they found that we in 1999, spent $300 billion on administration for all these three functions, and that was about 24 percent of national health spending there, but they say it was actually 31 percent because of the fraction of spending that they could actually identify and link to administrative costs. So they came to 31. So it’s somewhere between 25 and 30 percent that goes for administration and it doesn’t even include the patients’ time of billing. Anyone who has had anyone really sick in their family knows how much time you spend haggling over the bills and they have none of that in these systems.

Edie Magnus: I know that there’s some dispute about all those numbers, about what percentage of our spending the administrative costs represent, but you have said that with what America could be saving in administrative costs, that it could completely fund universal health care for all Americans.

Uwe Reinhardt: Oh yes, I’m totally convinced of that.

****

Edie Magnus: Would national health care work in the United States?

Uwe Reinhardt: Yes.

Edie Magnus: Would Canada’s plan work in the United States?

Uwe Reinhardt: Well, it works. We have a Canadian health plan in America. It’s called Medicare. It works. Don’t tell me Medicare doesn’t work. Tell that to the elderly. One way to test it is to say “Let’s take it away.”

Full transcript and video:
http://worldfocus.org/blog/2009/01/28/how-the-us-measures-up-to-canadas-health-care-system/3783/#comments

Comment:

By Don McCanne, MD

Save this link until you have 27 minutes to watch the complete video. It will be well worth your time.

"Managed consumerism"

Consumer-Driven Health Care: Promise And Performance

by James C. Robinson and Paul B. Ginsburg
Health Affairs
January 27, 2009
This paper analyzes the evolution of consumer-driven health care in terms of its original vision, its subsequent implementation, and the transformations it has endured as it moves into its second decade. The market is generating product designs that combine elements of consumerism with elements of managed care, but the trend is always toward a stronger role for consumer choice and a weaker role for management of those choices by physicians, insurers, employers, and regulators.
Impact of the PPO
The insurance market has merged the ideas of consumer-driven health care with those of managed care instead of replacing the latter by the former. The dominant form of health insurance today, by far, is the PPO. It combines network principles from managed care with some of the cost-sharing principles from consumer-driven health care; in 2008, PPOs accounted for 58 percent of enrollment in employment-based coverage. The PPO began to displace the HMO in the late 1990s as HMOs’ gatekeeping and utilization review created too much consumer and provider animosity.
Despite the verbiage and vitriol on both sides, it appears that consumer-driven health care and managed care are complements more than they are substitutes for one another. The mainstream health insurance industry is reorienting itself to replace administrative controls with incentives and information but in a manner in which the health plan functions as an important intermediary for structuring choices and informing enrollees about provider price and quality.
A dilution of principles
The heart of the consumer-driven health plan is the philosophical belief that each individual should make his or her own health care decisions. Health care decisions should not be “managed” by third parties, and especially not by physicians and nurses employed by insurance companies. The consumer-driven health care movement has been obliged to dilute its principles in light of the overuse of inappropriate services and underuse of appropriate services in the real world. HDHPs now incorporate elements of disease management for enrollees with chronic conditions; case management for enrollees with complex or comorbid conditions; and utilization management for patients using particularly costly drugs, devices, or procedures. Most of these medical management programs are obtained from the same diversified insurers that offer HMO and PPO products.
Conclusions
As it moves further along the consumer pathway, health insurance is likely to strengthen rather than weaken some vestiges of its managed care heritage, especially the development of programs seeking to improve the care of enrollees along the spectrum from full health to dire illness. These include preventive and wellness programs for healthy enrollees, service coordination for patients needing acute care, disease management for enrollees with chronic conditions, and intensive case management for enrollees with severe conditions. These likely will be presented as options rather than mandates, consistent with the consumer-driven ethos, although perhaps with higher cost sharing for those who are eligible but choose not to participate. What is unclear, over the long term, is the extent to which more choice for consumers will prevent health insurers from being able to continue to offer the steep discounts they currently wrest from their provider networks.
The market continues to pioneer hybrid forms that incorporate elements of both managed care and of health care consumerism. We can name the emerging system “managed consumerism” or “facilitated consumerism,” or we can find some more felicitous phrase. The important point is that for choice to be meaningful, it has to be choice among meaningful options, and meaningful options need to be designed, built, and managed.
http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w272v1

Managed care, consumer-driven health care, managed consumerism – these are just labels for a private insurance industry that has evolved from a role of indemnifying individuals and families against loss in the face of medical need, to an industry that has introduced innovative plan designs to enhance the success of its own business model.
Managed care was not designed to benefit patients. Its primary function was to enhance the business success of the insurers through provider contracting, limiting access and choice for the patients.
Consumer-driven health care was not designed to benefit patients. Its primary function was to enhance the business success of the insurers through the erection of financial barriers to health care, primarily through the use of high-deductible health plans.
The hybrid, “managed consumerism,” is not designed to benefit patients. Its primary function will be to continue to limit access and choice through provider contracting, and to continue to reduce access through the use of financial barriers to care.
These measures are designed to reduce spending by the insurers in order to keep their premiums affordable in a competitive market. For the insurers, the importance of consumers is simply that someone with enough money has to be there to purchase their products. Insurance products that take away choice and expose the ill to excessive costs are not the products that people want, but PPO/HDHPs are the predominant product that insurers offer.
Imagine if we had a single payer national health program – an improved Medicare for all. Would “managed care” even be a topic? Not when managed care has come to mean that individuals lose their choice by segregation of physicians and hospitals into plans to create an artificial market. Would “consumer-directed” health care be a topic? Not when consumer-directed care has come to mean that choosing to have the care that you need will cost you money out of your pocket that you may not have.
Tossing around labels and pretending that they represent solutions to our health care problems has got to go. No more con jobs with “managed consumerism.” It’s time to enact our own public system that simply pays our bills when we need health care – health care of our own choosing.

"Managed consumerism"

Consumer-Driven Health Care: Promise And Performance

by James C. Robinson and Paul B. Ginsburg
Health Affairs
January 27, 2009

This paper analyzes the evolution of consumer-driven health care in terms of its original vision, its subsequent implementation, and the transformations it has endured as it moves into its second decade. The market is generating product designs that combine elements of consumerism with elements of managed care, but the trend is always toward a stronger role for consumer choice and a weaker role for management of those choices by physicians, insurers, employers, and regulators.

Impact of the PPO

The insurance market has merged the ideas of consumer-driven health care with those of managed care instead of replacing the latter by the former. The dominant form of health insurance today, by far, is the PPO. It combines network principles from managed care with some of the cost-sharing principles from consumer-driven health care; in 2008, PPOs accounted for 58 percent of enrollment in employment-based coverage. The PPO began to displace the HMO in the late 1990s as HMOs’ gatekeeping and utilization review created too much consumer and provider animosity.

Despite the verbiage and vitriol on both sides, it appears that consumer-driven health care and managed care are complements more than they are substitutes for one another. The mainstream health insurance industry is reorienting itself to replace administrative controls with incentives and information but in a manner in which the health plan functions as an important intermediary for structuring choices and informing enrollees about provider price and quality.

A dilution of principles

The heart of the consumer-driven health plan is the philosophical belief that each individual should make his or her own health care decisions. Health care decisions should not be “managed” by third parties, and especially not by physicians and nurses employed by insurance companies. The consumer-driven health care movement has been obliged to dilute its principles in light of the overuse of inappropriate services and underuse of appropriate services in the real world. HDHPs now incorporate elements of disease management for enrollees with chronic conditions; case management for enrollees with complex or comorbid conditions; and utilization management for patients using particularly costly drugs, devices, or procedures. Most of these medical management programs are obtained from the same diversified insurers that offer HMO and PPO products.

Conclusions

As it moves further along the consumer pathway, health insurance is likely to strengthen rather than weaken some vestiges of its managed care heritage, especially the development of programs seeking to improve the care of enrollees along the spectrum from full health to dire illness. These include preventive and wellness programs for healthy enrollees, service coordination for patients needing acute care, disease management for enrollees with chronic conditions, and intensive case management for enrollees with severe conditions. These likely will be presented as options rather than mandates, consistent with the consumer-driven ethos, although perhaps with higher cost sharing for those who are eligible but choose not to participate. What is unclear, over the long term, is the extent to which more choice for consumers will prevent health insurers from being able to continue to offer the steep discounts they currently wrest from their provider networks.

The market continues to pioneer hybrid forms that incorporate elements of both managed care and of health care consumerism. We can name the emerging system “managed consumerism” or “facilitated consumerism,” or we can find some more felicitous phrase. The important point is that for choice to be meaningful, it has to be choice among meaningful options, and meaningful options need to be designed, built, and managed.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w272v1

Comment:

By Don McCanne, MD

Managed care, consumer-driven health care, managed consumerism – these are just labels for a private insurance industry that has evolved from a role of indemnifying individuals and families against loss in the face of medical need, to an industry that has introduced innovative plan designs to enhance the success of its own business model.

Managed care was not designed to benefit patients. Its primary function was to enhance the business success of the insurers through provider contracting, limiting access and choice for the patients.

Consumer-driven health care was not designed to benefit patients. Its primary function was to enhance the business success of the insurers through the erection of financial barriers to health care, primarily through the use of high-deductible health plans.

The hybrid, “managed consumerism,” is not designed to benefit patients. Its primary function will be to continue to limit access and choice through provider contracting, and to continue to reduce access through the use of financial barriers to care.

These measures are designed to reduce spending by the insurers in order to keep their premiums affordable in a competitive market. For the insurers, the importance of consumers is simply that someone with enough money has to be there to purchase their products. Insurance products that take away choice and expose the ill to excessive costs are not the products that people want, but PPO/HDHPs are the predominant product that insurers offer.

Imagine if we had a single payer national health program – an improved Medicare for all. Would “managed care” even be a topic? Not when managed care has come to mean that individuals lose their choice by segregation of physicians and hospitals into plans to create an artificial market. Would “consumer-directed” health care be a topic? Not when consumer-directed care has come to mean that choosing to have the care that you need will cost you money out of your pocket that you may not have.

Tossing around labels and pretending that they represent solutions to our health care problems has got to go. No more con jobs with “managed consumerism.” It’s time to enact our own public system that simply pays our bills when we need health care – health care of our own choosing.

BBC Show on U.S. Health Care Unavailable in USA

John Tepper Marlin
Huffington Post
1/26/09

My sister Brigid Marlin lives in the UK and a few days ago was watching a BBC program on health care in the United States. Brigid is not a public affairs junkie so I was interested when she sent me an email reporting that the program was a shocking portrayal of the high cost and low coverage of U.S. medical care. This itself is not news but there are two things about the show that are worth an alert: (1) The BBC’s effectiveness in describing the problems with U.S. health care, and (2) The fact that Americans can’t watch it. My sister says:

They were discussing the problems that Obama faces in meeting his promise to provide health care for poor Americans. The program showed an English medical team that set out to provide medical services to poor people overseas. They ended up spending 60 percent of their time helping poor Americans, as they are the most needy! We were shown people getting up at 4 am and driving for hundreds of miles to be early in a huge queue for a doctor’s help.

The program was produced by BBC’s Panorama, the world’s oldest television documentary program, begun in 1953.

The Panorama team managed to get inside a briefing that a large US insurance company was giving its staff, awarding them huge bonuses for finding loopholes in the clients’ policies, so they didn’t have to pay up! They boasted that one employee had saved the company $7 million by giving them the basis for refusing to pay out because of a tiny flaw in the way they had filled out the form. This story was contrasted with the company’s television ads, where a kindly fatherly figure assures clients that they will be safe and looked after.

The BBC itself describes the program as follows:

Barack Obama takes over as U.S. President with a promise to dramatically change America and make it a fairer place. He is inheriting the worst economic crisis in almost a century, and a country so unequal that 23,000 people die every year because they cannot afford basic healthcare. To close the gap between rich and poor Obama will have to take on the might of the corporate world, which wields enormous influence in Washington. Can he change the world’s most powerful country, and should he?

My sister’s message to me goes on:

The drug companies are just as bad, Panorama shows. They have bumped up their prices so that Americans pay twice as much for their medicines as the same companies charge to other countries. It seems that the drug companies are uncontrollable because they wine and dine the senators so no votes are cast against their policies. The program showed the drug companies supporting senators with money for electioneering and their favourite charities. They are determined not to allow a comprehensive health care system in America!

Well, I attempted to watch the program myself and give you a link to it. It was broadcast on BBC One, 8:30 pm, January 19. It’s a half-hour show produced by Jeremy Vine. My sister is not the only fan of the show. It is posted as a “pick” by blogger “Up Your Ego: Love Your Inner Geek”. The blogger is trying to emulate the “brilliant” Watchification, Telegraph iPlayer Pick of the Day and the Radio Times Downloads index, and says:

My pick is the Panorama special on the USA health care system. I really enjoyed Michael Moore’s Sicko but it was a little (ok a lot) one sided. A great piece of entertainment and a good piece of journalism when preaching to the choir BUT lacking slightly in balance. The BBC tries to look at both sides of the story. Watch it HERE.

Unfortunately, when I tried the link in several places, I got a message each time that the link won’t work in the United States. So the best anyone can do, so far as I know, is to get a U.S.-formatted DVD sent over or persuade a PBS station to air the program in the United States. The program’s e-mail address is: panorama@bbc.co.uk. I have written to them asking to be advised if the health care show has been or will be aired here. No answer to my question yet.

John Tepper Marlin teaches corporate responsibility and finance to MBA and MPA students as Adjunct Professor at NYU’s Stern School of Business, the University of Geneva, and Pace University.

BBC documentary takes on Obama’s plans for American health care system

Nick Cargo
Raw Story
Sunday, January 25, 2009

A January 19 episode of BBC One’s Panorama, the world’s longest running television documentary show, tackles the dismal state of health care in the United States, the lengths to which its estimated 45 million uninsured citizens will go to in pursuit of care, the pharmaceutical industry’s rigged pricing against the American patient, and the insurance industry’s efforts to deny care whenever possible.

The documentary opens in rural Kentucky, where people have driven within a 200-mile radius to wait in line in the early morning for a spot in line to see a volunteer doctor thanks to the efforts of Remote Access Medical, who originally set out to help people in the Amazon jungle, but now focus 60% of their time on Americans.

“The need is enormous,” said the organization’s founder Stan Brock. “We discovered…there are people here that need help just as much as they do in Guatemala or in the Amazon and all these other places we go to.”

President Obama faces a difficult task to deliver on his promises of change, the segment explains, the country divided between the “super rich” and the “new poor,” and lobbyists putting their power to work to prevent reforms from taking place. Also, 533 members of Congress, out of 535, have received campaign contributions from within the health sector.

“We plan on mounting a national campaign,” warned health insurance industry lobbyist Angela Hunter, “and what we hope to do is to, number one, get some articles in the newspaper explaining what the problems are that we see with the plan. Two: Educate lawmakers, people who are members of our organizations, their clients–to go and lobby members of Congress–call them on the phone, visit them in their offices, and to just do everything that we can possibly do to preserve the freedom of choice for individuals in health care in America.”

“It’s really a system of legalized bribery,” said Richard Kirsch of Healthcare for America Now. “As one congressman says, we’re the only people in the world who are expected to take money from strangers and provide nothing in return.”

Due to licensing restrictions, the episode, “What Now, Mr. President?,” is only officially available to view online from connections within the United Kingdom. However, it has also been uploaded to YouTube, where it appears in three parts below.

Single-payer health bill has healthier prospects than ever

With dozens of coauthors, the Minnesota Health Act has its best chance in 15 years of making it out of committee

By Andy Birkey
The Minnesota Independent
1/23/09

Sen. Linda Berglin chairs the powerful Health and Human Services Budget Division in the Minnesota Senate and has long advocated a managed-care approach to rising health care costs. Although a staunch progressive on health care policy (she helped create and protect MinnesotaCare, the state’s health insurance program for low-income residents), she has typically demonstrated lukewarm interest in a single-payer system.

But this year, Berglin has signed on as a coauthor of the Minnesota Health Act, the bill that would create the Minnesota Health Plan. The Act (HF 135, SF 118) would take health insurance out of the private sector and put it under the control of a state board to cover all Minnesotans.

Citizens would be free to choose their own physicians or practitioners and would not be subject to any preexisting conditions clauses. The premiums that employees and employers currently pay would go into the state-run system, and each user would pay premiums according to his or her ability to pay. Advocates say those premiums will shrink for everyone under the plan.

When asked why Berglin seemed to have changed her mind on the single-payer plan, her office said her position is not quite a break from the past: “She has supported this bill in the past, so her support is not new.”

But this year, as the bill’s co-sponsor, she has brought that advocacy to a new level.

Berglin is not alone, as the bill is seeing more profound backing this year than in the previous 15 years or so that it’s been up for consideration.

While conservatives decry the plan as costly, advocates point to a number of ways a state-run health care plan could stimulate the economy.

“It makes the entire health care system less costly by making it more efficient,” said health policy expert Kip Sullivan, who has been active in Minnesota’s push for a single-payer system.

“The largest single improvement in efficiency under the plan will be the elimination of the excessive administrative costs created by health insurance companies,” he said.

Supporters expect the system to generate a 20 percent savings in health care costs. Those lowered costs would attract businesses to the state, they argue.

“[The plan] is especially beneficial to smaller employers because they are the least likely to be able to afford health insurance under the current system,” said Sullivan.

Indeed, small businesses are struggling to cover their employees and themselves, according to a study of 1,200 small businesses released this month (pdf) by the Main Street Alliance. Only 34 percent of small employers offer health coverage for their employees, and 43 percent of those only offered coverage for the business owner. Almost half, 49 percent, said that “any insurance, even bare bones coverage, is too expensive.”

Among small business owners, 59 percent said they would support a public solution to rising health care costs, compared to just 26 percent who said they’d rather let the private market sort the problem out.

Sullivan says that in addition to helping struggling small businesses, the Minnesota Health Plan could have a positive impact on the foreclosure crisis.

“Another benefit that will materialize in both good and bad economic times is fewer personal bankruptcies and home mortgage foreclosures, both of which are caused to a large extent by medical bills people can’t afford to pay.”

And as the foreclosure crisis continues to unfold in the United States, several studies have shown that just under half of all foreclosures were precipitated by medical crises, and one-quarter were due directly to insurmountable medical costs.

Under the Minnesota Health Plan, advocates say, those medical crises would be muted.

The bill co-sponsored by Berglin has two dozen coauthors in the Senate and three dozen in the House, but even with that support it’s unclear whether the measure will make it out of committee, as more conservative DFLers tend to support a free-market approach. In the past, single-payer bills have not reached the Minnesota House or Senate floors for votes.

And even if it does, passing the Legislature and making it to Gov. Tim Pawlenty’s desk most certainly means a veto.

“Those of us supporting the Minnesota Health Plan expect it will take multiple sessions of the Legislature to get it passed,” said Sullivan.

“What’s different now is that a single-payer bill like the Minnesota Health Act is actually being heard in the Legislature. That is the first step to educating the Legislature, the media and the public about the need for a single-payer solution to the crisis.”

“Managed consumerism”

Consumer-Driven Health Care: Promise And Performance

by James C. Robinson and Paul B. Ginsburg
Health Affairs
January 27, 2009

This paper analyzes the evolution of consumer-driven health care in terms of its original vision, its subsequent implementation, and the transformations it has endured as it moves into its second decade. The market is generating product designs that combine elements of consumerism with elements of managed care, but the trend is always toward a stronger role for consumer choice and a weaker role for management of those choices by physicians, insurers, employers, and regulators.

Impact of the PPO

The insurance market has merged the ideas of consumer-driven health care with those of managed care instead of replacing the latter by the former. The dominant form of health insurance today, by far, is the PPO. It combines network principles from managed care with some of the cost-sharing principles from consumer-driven health care; in 2008, PPOs accounted for 58 percent of enrollment in employment-based coverage. The PPO began to displace the HMO in the late 1990s as HMOs’ gatekeeping and utilization review created too much consumer and provider animosity.

Despite the verbiage and vitriol on both sides, it appears that consumer-driven health care and managed care are complements more than they are substitutes for one another. The mainstream health insurance industry is reorienting itself to replace administrative controls with incentives and information but in a manner in which the health plan functions as an important intermediary for structuring choices and informing enrollees about provider price and quality.

A dilution of principles

The heart of the consumer-driven health plan is the philosophical belief that each individual should make his or her own health care decisions. Health care decisions should not be “managed” by third parties, and especially not by physicians and nurses employed by insurance companies. The consumer-driven health care movement has been obliged to dilute its principles in light of the overuse of inappropriate services and underuse of appropriate services in the real world. HDHPs now incorporate elements of disease management for enrollees with chronic conditions; case management for enrollees with complex or comorbid conditions; and utilization management for patients using particularly costly drugs, devices, or procedures. Most of these medical management programs are obtained from the same diversified insurers that offer HMO and PPO products.

Conclusions

As it moves further along the consumer pathway, health insurance is likely to strengthen rather than weaken some vestiges of its managed care heritage, especially the development of programs seeking to improve the care of enrollees along the spectrum from full health to dire illness. These include preventive and wellness programs for healthy enrollees, service coordination for patients needing acute care, disease management for enrollees with chronic conditions, and intensive case management for enrollees with severe conditions. These likely will be presented as options rather than mandates, consistent with the consumer-driven ethos, although perhaps with higher cost sharing for those who are eligible but choose not to participate. What is unclear, over the long term, is the extent to which more choice for consumers will prevent health insurers from being able to continue to offer the steep discounts they currently wrest from their provider networks.

The market continues to pioneer hybrid forms that incorporate elements of both managed care and of health care consumerism. We can name the emerging system “managed consumerism” or “facilitated consumerism,” or we can find some more felicitous phrase. The important point is that for choice to be meaningful, it has to be choice among meaningful options, and meaningful options need to be designed, built, and managed.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w272v1

Comment:

By Don McCanne, MD

Managed care, consumer-driven health care, managed consumerism – these are just labels for a private insurance industry that has evolved from a role of indemnifying individuals and families against loss in the face of medical need, to an industry that has introduced innovative plan designs to enhance the success of its own business model.

Managed care was not designed to benefit patients. Its primary function was to enhance the business success of the insurers through provider contracting, limiting access and choice for the patients.

Consumer-driven health care was not designed to benefit patients. Its primary function was to enhance the business success of the insurers through the erection of financial barriers to health care, primarily through the use of high-deductible health plans.

The hybrid, “managed consumerism,” is not designed to benefit patients. Its primary function will be to continue to limit access and choice through provider contracting, and to continue to reduce access through the use of financial barriers to care.

These measures are designed to reduce spending by the insurers in order to keep their premiums affordable in a competitive market. For the insurers, the importance of consumers is simply that someone with enough money has to be there to purchase their products. Insurance products that take away choice and expose the ill to excessive costs are not the products that people want, but PPO/HDHPs are the predominant product that insurers offer.

Imagine if we had a single payer national health program – an improved Medicare for all. Would “managed care” even be a topic? Not when managed care has come to mean that individuals lose their choice by segregation of physicians and hospitals into plans to create an artificial market. Would “consumer-directed” health care be a topic? Not when consumer-directed care has come to mean that choosing to have the care that you need will cost you money out of your pocket that you may not have.

Tossing around labels and pretending that they represent solutions to our health care problems has got to go. No more con jobs with “managed consumerism.” It’s time to enact our own public system that simply pays our bills when we need health care – health care of our own choosing.

Journalism professor on reporting about Canadian health system

Universal Health Care For Elephant, Mouse

By Gene Costain
Tampa Bay Online
January 26, 2009
Ben Jonson was a cantankerous, 17th century British dramatist who despised the early days of journalism because he thought it was overrun with propagandists and charlatans.
I’m no modern-day cynic, but the record of news coverage on universal health care has been rife with ideological cant and tall tales. In my view, journalists have formed a kind of parasitic osmosis with powerful interests that impairs robust debate.
My meager standing for wading in is that in the past 25 years I’ve lived half of that time in Canada and the other half here in the last Western refuge of commoditized medicine.
I have been making mental notes on the accumulated fallacies and misnomers about the Canadian universal system. Your neighbor to the north has always been a great case study, because the country is a near mirror image of America on many levels.
My first memory of family struggle over medical bills was in 1962, when my mother was about to give birth to the last of seven kids. The single-payer system – in which all health care providers bill a single entity – was still a few years away. Just before she went into the hospital to deliver, I overheard an anxious conversation she had with my father about how they were going to pay the anticipated $300 hospital bill. My working-class father supported us on a salary of $55 a week. Within a few years, that financial anxiety vanished, and all they had to deal with was a small plastic card, with the added bonus of virtually no paper trail.
My move to America in 1996 meant facing a small pile of bureaucratic paper before starting my doctorate in Tennessee. During my adult life in Canada, a little card was my official point of contact with the health care bureaucracy. Forget about annoying co-pays, a new concept for me. The relative wonder of it all captured my imagination, and for years I’ve been monitoring debates about the issue in a vain search for balance, especially as it relates to some of the good things you don’t hear about the Canadian system.
Let me frame this in a larger context. The late Canadian Prime Minister Pierre Trudeau said that living next door to America was like a mouse sleeping with an elephant. Canada has one-tenth of the U.S. population, and its citizens are largely resigned to (but secretly admire) the large American pachyderm. Despite the similarities, Americans have missed out on an honest depiction of what Canadians think about their system.
There is one key element in the Canadian story that Americans rarely hear about in their media. Polls show that Canadians would not trade their single-payer system for all the tea in Indonesia. Most Canadians say their health care is their most valued citizenship asset. That is not hyperbole: For years, Gallup polls have chronicled this high regard for the system. It makes you wonder why we don’t often get this view here – after all, there are plenty of Canadians sunning themselves in these parts.
One of the most persistent challenges is that there are long waiting lines for some services in Canada; my experience is that both systems are virtually indistinguishable. An informal consensus of family and friends in Canada, including my aging mother, is that the medial service is good to great. I have honestly not heard of one major medical service horror story.
But who is to blame for Americans not receiving these political, cultural and news representations? One reason is that journalists here are like reporters in other nations, they root around in their backyards for sources and social insight.
As the debate returns this year, we may get a more expansive rendering of the story because everyone agrees the system is broken. But it won’t happen unless more journalists, filmmakers and bloggers chip in with a more balanced rendering of this Byzantine story. It might make the cynical ghost of Ben Jonson happy.
(Gene Costain is a University of Tampa journalism professor.)
http://www2.tbo.com/content/2009/jan/24/co-universal-health-care-for-elephant-mouse/

And…

Health Care in Canada

Canadian Institute for Health Information
2008
Physician migration
Information on health care workers’ migrations into and out of Canada, and into and out of individual professions, is difficult to capture. However, data on physicians show that the number of physicians leaving and returning from abroad declined over the five years to the end of 2006, with those emigrating declining by more than half (56.9%) and those returning dropping by 18.2%. In the three years to the end of 2006, physicians returning to Canada outnumbered those who left.
Wait time
While it is difficult to compare jurisdictions’ progress in reducing wait times, it is possible to compare jurisdictions’ surgery rates in the priority areas. Overall, rates in these areas rose by 8% more than the expected increase from population growth and aging between 2004-2005 and 2006-2007.
Diagnostic imaging
Over the three years ended in 2006-2007, the number of MRI and CT exams in Canada rose by 42.9% (to 31.2 per 1,000 population) and 27.9% (to 103.3 per 1,000 population), respectively. During the same period, the increase in the number of exams was greater than in the number of scanners, for both MRI and CT. In the case of MRI, a 27% growth in the number of scanners led to a 47% growth in the number of exams. In the case of CT, a 12% growth in the number of scanners led to a 32% growth in the number of exams.
http://secure.cihi.ca/cihiweb/products/HCIC_2008_e.pdf

The data base that most of us use for our routine thoughts is that which is stored in our memories. When we have need for other information, we know that there are other resources to which we can turn, but for most of our rote activities, memory is presumed to be adequate and reliable.
Almost every resident of the United States can tell you several things about the Canadian health care system. The problem is that much of it is wrong.
How did it happen that our memories/knowledge of the Canadian system are so distorted? One of the more important reasons is that we have little exposure to the routine functioning of the Canadian health care system. It’s not that the information isn’t available. The Canadian Institute for Health Information is a highly credible resource for such information. You can learn quite a bit just by reading their 2008 report, Health Care in Canada.
So why hasn’t our media reported any of this information? Quite simply, it is boring. There is no mention of problems such as the number of uninsured, bankruptcy due to medical debt, or care denied because of the inability to pay for it, because those problems don’t even exist in Canada. The reports are of a system that is functioning well, but is not perfect, so measures that are being taken to improve their system are also reported. What U.S. journalist would waste their time with that, and which editor would approve it in the first place?
Another reason that our views are so distorted is that, for decades, several conservative and libertarian organizations opposed to public insurance have spoon fed the U.S. media with reports of problems in the Canadian system that happen to make good copy. Although those reports are often embellished, most do have a factual basis even if they don’t represent the mainstream functioning of their system. They are great fodder for our journalists who themselves have misperceptions about Canadian health care because they also are exposed to these highly selected, exceptional stories that do not include the boring stories of the routine.
A couple of examples of distortions were pulled out of the CIHI report. Everyone knows that physicians are fleeing Canada based on innumerable stories here, yet the reality is that more physicians are returning to Canada. Wait times for elective (not emergency) surgery have been an issue, but this report shows that the problem is being addressed with some success. The availability of diagnostic imaging also is improving significantly.
We hear stories of journalistic misbehavior, which are all too frequent, but they are not balanced with stories of the day in and day out routine of journalism. Responsible journalism is the norm in this nation, but we don’t hear much about it, thus our view of journalists may be inappropriately jaded. What journalists here often don’t realize is that, like most of the rest of us, their views of the Canadian health system are highly distorted by the selective reporting of others who are also driven by these same distortions that dwell in our cumulative memories.
Our thinking is based on what we know, but not on what we don’t know, and we won’t even know what it is that we don’t know unless our journalists start doing some more intensive research, even if it is very boring.