PNHP

“The Modern Medical Team” by Dan Wasserman

HHS Secretary-elect Daschle's plan for reform

Daschle Nominated to Human Services Cabinet Post

By Helene Cooper
The New York Times
November 19, 2008
President-elect Barack Obama has offered the nomination of Secretary of Health and Human Services to Tom Daschle of South Dakota, the former Democratic Senate leader who was an early supporter of Mr. Obama’s run for the presidency.
Democratic officials said that Mr. Daschle has accepted the nomination.
Mr. Obama’s transition team announced on Wednesday that Mr. Daschle will also oversee Mr. Obama’s health policy working group to develop a health care plan, which could take care of what his friends say was one of Mr. Daschle’s conditions for considering the HHS post. He was concerned that he not just be the head of a huge bureaucracy but a chief player on the subject he has literally written a book on.
Mr. Daschle’s book about health policy “Critical: What We Can Do About the Health-Care Crisis” came out in February. In it he proposes creating a Federal Health Board, similar to the Federal Reserve System, and the merging of employers’ plans, Medicaid and Medicare with an expanded federal employee health benefits program that would provide universal coverage.
http://thecaucus.blogs.nytimes.com/2008/11/19/daschle-takes-human-services-cabinet-post/?hp

And…

Critical: What We Can Do About the Health-Care Crisis

By Senator Tom Daschle with Scott S. Greenberger and Jeanne M. Lambrew
Macmillan
Daschle’s solution lies in the Federal Reserve Board, which has overseen the equally complicated financial system with great success. A Fed-like health board would offer a public framework within which a private health-care system can operate more effectively and efficiently — insulated from political pressure yet accountable to elected officials and the American people. Daschle argues that this independent board would create a single standard of care and exert tremendous influence on every other provider and payer, even those in the private sector.
http://us.macmillan.com/critical

Today’s quote leads to a question: Can Sen. Daschle’s Federal Health Board do for the crisis in health care what the Federal Reserve Board has done for nation’s financial crisis?
Stay tuned.

HHS Secretary-elect Daschle's plan for reform

Daschle Nominated to Human Services Cabinet Post

By Helene Cooper
The New York Times
November 19, 2008

President-elect Barack Obama has offered the nomination of Secretary of Health and Human Services to Tom Daschle of South Dakota, the former Democratic Senate leader who was an early supporter of Mr. Obama’s run for the presidency.

Democratic officials said that Mr. Daschle has accepted the nomination.

Mr. Obama’s transition team announced on Wednesday that Mr. Daschle will also oversee Mr. Obama’s health policy working group to develop a health care plan, which could take care of what his friends say was one of Mr. Daschle’s conditions for considering the HHS post. He was concerned that he not just be the head of a huge bureaucracy but a chief player on the subject he has literally written a book on.

Mr. Daschle’s book about health policy “Critical: What We Can Do About the Health-Care Crisis” came out in February. In it he proposes creating a Federal Health Board, similar to the Federal Reserve System, and the merging of employers’ plans, Medicaid and Medicare with an expanded federal employee health benefits program that would provide universal coverage.

http://thecaucus.blogs.nytimes.com/2008/11/19/daschle-takes-human-services-cabinet-post/?hp

And…

Critical: What We Can Do About the Health-Care Crisis

By Senator Tom Daschle with Scott S. Greenberger and Jeanne M. Lambrew
Macmillan

Daschle’s solution lies in the Federal Reserve Board, which has overseen the equally complicated financial system with great success. A Fed-like health board would offer a public framework within which a private health-care system can operate more effectively and efficiently — insulated from political pressure yet accountable to elected officials and the American people. Daschle argues that this independent board would create a single standard of care and exert tremendous influence on every other provider and payer, even those in the private sector.

http://us.macmillan.com/critical

Comment:

By Don McCanne, MD

Today’s quote leads to a question: Can Sen. Daschle’s Federal Health Board do for the crisis in health care what the Federal Reserve Board has done for nation’s financial crisis?

Stay tuned.

A Senator's Health Plan

By Rose Ann DeMoro
New York Times
November 18, 2008

To the Editor:

Re “Senator Takes Initiative on Health Care” (news article, Nov. 12):

The proposal by Senator Max Baucus, Democrat of Montana, is a partial step in the right direction, most notably with his common-sense suggestion to expand Medicaid and Medicare, two publicly financed, mostly privately delivered programs.

Medicare has just a fraction of the bloated administrative costs of private insurance, which slices 30 percent off the top for profits and paperwork, much of it spent on denying needed care.

Unfortunately, the Baucus plan has several poison pills: it would force everyone not presently covered to buy private insurance, and revives the discredited McCain plan of taxing health benefits for many employees, which would push some workers from employer-sponsored coverage into the shark-infested private market.

Both steps would buttress and further enrich the health insurance industry, which hardly needs the help, and fail to solve the health care crisis.

Millions of Americans have found out the hard way that access to coverage is not the same as access to care. A better, more cost-effective approach would be to simply expand Medicare to cover everyone, the only real way to assure guaranteed health care for all.

Rose Ann DeMoro
Executive Director,
National Nurses Organizing Committee/California Nurses Association
Oakland, Calif., Nov. 14, 2008

PNHP letter to Sen. Baucus, Senate Finance Committee

November 18, 2008

The Honorable Max Baucus
Chairman, Finance Committee
U.S. Senate
Hart Senate Office Building
Washington, DC 20510

Dear Chairman Baucus,

Physicians for a National Health Program respectfully requests an opportunity for one or more of our members to testify about the merits of single-payer national health insurance (as embodied in the U.S. National Health Insurance Act, H.R. 676, which currently has the support of over 90 member of Congress) at the Senate Finance Committee’s hearings titled “Healthcare Reform: An Economic Perspective.”

Single-payer health reform, sometimes characterized as an improved “Medicare for All,” is the only reform model that offers $400 billion in annual savings in administrative costs. It is the only approach that contains effective cost-containment provisions, such as bulk purchasing and global budgeting. Such economies would allow for expanding health coverage to everyone — with no co-pays or deductibles — with no overall increase in health care spending.

The single-payer model is the only fiscally prudent proposal available, an especially important consideration at a time of economic distress. By basing itself (and improving upon) Medicare, it presents itself as a uniquely American way of guaranteeing care to all who need it. Such an approach has proven its effectiveness.

With a single-payer national health insurance program we can assure lifelong, high quality, comprehensive and affordable coverage for everyone. Such a program will lift the heavy burden of crushing medical expenses off the shoulders of our population, expenses that often lead to personal bankruptcy. And we can save lives: the Institute of Medicine estimates that more than 18,000 Americans die each year from lack of health insurance.

From the standpoint of what benefits our patients, single payer is the health policy model that best reflects their needs and values.

Support for single payer is extensive. In a peer-reviewed statistical study in the Annals of Internal Medicine, 59 percent of U.S. physicians said they would support government action to establish national health insurance. In a recent Associated Press poll, 65 percent of the respondents said, “The United State should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxes.”

In addition, over 480 labor organizations, including 39 state federations of the AFL-CIO, have endorsed single payer legislation, as have numerous professional associations, city and state governments, and religious denominations.

We therefore expect that single-payer proponents will be invited to testify before the Committee and we look forward to your affirmative response. You can telephone me at (312) 782-6006 or reach me via e-mail at info@pnhp.org.

Sincerely,

Quentin Young, MD, MACP
National Coordinator
Physicians for a National Health Program

cc: Senate Finance Committee members

HHS Secretary-elect Daschle’s plan for reform

Daschle Nominated to Human Services Cabinet Post

By Helene Cooper
The New York Times
November 19, 2008

President-elect Barack Obama has offered the nomination of Secretary of Health and Human Services to Tom Daschle of South Dakota, the former Democratic Senate leader who was an early supporter of Mr. Obama’s run for the presidency.

Democratic officials said that Mr. Daschle has accepted the nomination.

Mr. Obama’s transition team announced on Wednesday that Mr. Daschle will also oversee Mr. Obama’s health policy working group to develop a health care plan, which could take care of what his friends say was one of Mr. Daschle’s conditions for considering the HHS post. He was concerned that he not just be the head of a huge bureaucracy but a chief player on the subject he has literally written a book on.

Mr. Daschle’s book about health policy “Critical: What We Can Do About the Health-Care Crisis” came out in February. In it he proposes creating a Federal Health Board, similar to the Federal Reserve System, and the merging of employers’ plans, Medicaid and Medicare with an expanded federal employee health benefits program that would provide universal coverage.

http://thecaucus.blogs.nytimes.com/2008/11/19/daschle-takes-human-services-cabinet-post/?hp

And…

Critical: What We Can Do About the Health-Care Crisis

By Senator Tom Daschle with Scott S. Greenberger and Jeanne M. Lambrew
Macmillan

Daschle’s solution lies in the Federal Reserve Board, which has overseen the equally complicated financial system with great success. A Fed-like health board would offer a public framework within which a private health-care system can operate more effectively and efficiently — insulated from political pressure yet accountable to elected officials and the American people. Daschle argues that this independent board would create a single standard of care and exert tremendous influence on every other provider and payer, even those in the private sector.

http://us.macmillan.com/critical

Comment:

By Don McCanne, MD

Today’s quote leads to a question: Can Sen. Daschle’s Federal Health Board do for the crisis in health care what the Federal Reserve Board has done for nation’s financial crisis?

Stay tuned.

A Senator’s Health Plan

By Rose Ann DeMoro
New York Times
November 18, 2008

To the Editor:

Re “Senator Takes Initiative on Health Care” (news article, Nov. 12):

The proposal by Senator Max Baucus, Democrat of Montana, is a partial step in the right direction, most notably with his common-sense suggestion to expand Medicaid and Medicare, two publicly financed, mostly privately delivered programs.

Medicare has just a fraction of the bloated administrative costs of private insurance, which slices 30 percent off the top for profits and paperwork, much of it spent on denying needed care.

Unfortunately, the Baucus plan has several poison pills: it would force everyone not presently covered to buy private insurance, and revives the discredited McCain plan of taxing health benefits for many employees, which would push some workers from employer-sponsored coverage into the shark-infested private market.

Both steps would buttress and further enrich the health insurance industry, which hardly needs the help, and fail to solve the health care crisis.

Millions of Americans have found out the hard way that access to coverage is not the same as access to care. A better, more cost-effective approach would be to simply expand Medicare to cover everyone, the only real way to assure guaranteed health care for all.

Rose Ann DeMoro
Executive Director,
National Nurses Organizing Committee/California Nurses Association
Oakland, Calif., Nov. 14, 2008

The uninsured give but rarely receive transplants

Insurance Status of U.S. Organ Donors and Transplant Recipients: The Uninsured Give, but Rarely Receive

By Andrew A. Herring, Steffie Woolhandler, and David U. Himmelstein
International Journal of Health Services
Volume 38, Number 4
In September of 2005, one of us (Herring), then a third-year medical student, cared for a previously healthy 25-year-old uninsured day laborer who arrived at the emergency department with rapidly advancing idiopathic dilated cardiomyopathy. The patient was ultimately deemed unsuitable for cardiac transplantation. The decision on transplantation was driven, in part, by realistic concern about the patient’s inability to pay for long-term immunosuppressive therapy and to support himself during recovery. Absent such resources, the likelihood of a successful outcome is compromised. The clinicians caring for him faced a wrenching dilemma: deny the patient a transplant, or use a scarce organ for a patient with a reduced chance of success. He died of heart failure two weeks after his initial presentation. This tragedy inspired us to examine data on the participation of the uninsured in organ transplantation, both as recipients and as donors.
Abstract
Organ transplantation is an expensive, life-saving technology. Previous studies have found that few transplant recipients in the United States lack health insurance (in part because patients may become eligible for special coverage because of their disability and transplant teams vigorously advocate for their patients). Few data are available on the insurance status of U.S. organ donors. The authors analyzed the 2003 National Inpatient Sample (NIS), a nationally representative 20 percent sample of U.S. hospital stays, and identified incident organ donors and recipients using ICD-9-CM diagnosis and procedure codes. The NIS sample included 1,447 organ donors and 4,962 transplant recipients, equivalent after weighting to 6,517 donors and 23,656 recipients nationwide; 16.9 percent of organ donors but only 0.8 percent of transplant recipients were uninsured. In multivariate analysis, compared with other inpatients organ donors were much more likely to be uninsured (OR 3.41, 95% CI 2.81-4.15), whereas transplant recipients were less likely to lack coverage (OR 0.08, 95% CI 0.06-0.12). Many uninsured Americans donate organs, but they rarely receive them.
https://pnhp.org/organ_donors/Transplants.pdf

Because of the mismatch between the numbers of individuals who are candidates to receive organ transplants and the numbers of donors available, sometimes difficult decisions have to be made as to who will receive the transplants. As complex as these decisions are, it is a sad commentary that, in the United States, we add one additional complicating factor: Does the potential recipient have insurance?
It is reassuring to note that the dedicated transplant teams can sometimes break through this barrier through vigorous advocacy on behalf of their patients. But it is wrong that they should have to do that. And it is especially wrong that uninsured candidates may be unsuccessful in negotiating this barrier.
These life and death decisions are not based on a lack of money; we are already spending more than enough. Rather people are dying merely because of the way we allocate that money. A single payer national health program would remove money as a consideration and allow us to concentrate on the other moral and ethical factors that should determine who lives and who dies.
What a terrible decision to have to make. But let’s not make it based on ability to pay.

The uninsured give but rarely receive transplants

Insurance Status of U.S. Organ Donors and Transplant Recipients: The Uninsured Give, but Rarely Receive

By Andrew A. Herring, Steffie Woolhandler, and David U. Himmelstein
International Journal of Health Services
Volume 38, Number 4

In September of 2005, one of us (Herring), then a third-year medical student, cared for a previously healthy 25-year-old uninsured day laborer who arrived at the emergency department with rapidly advancing idiopathic dilated cardiomyopathy. The patient was ultimately deemed unsuitable for cardiac transplantation. The decision on transplantation was driven, in part, by realistic concern about the patient’s inability to pay for long-term immunosuppressive therapy and to support himself during recovery. Absent such resources, the likelihood of a successful outcome is compromised. The clinicians caring for him faced a wrenching dilemma: deny the patient a transplant, or use a scarce organ for a patient with a reduced chance of success. He died of heart failure two weeks after his initial presentation. This tragedy inspired us to examine data on the participation of the uninsured in organ transplantation, both as recipients and as donors.

Abstract

Organ transplantation is an expensive, life-saving technology. Previous studies have found that few transplant recipients in the United States lack health insurance (in part because patients may become eligible for special coverage because of their disability and transplant teams vigorously advocate for their patients). Few data are available on the insurance status of U.S. organ donors. The authors analyzed the 2003 National Inpatient Sample (NIS), a nationally representative 20 percent sample of U.S. hospital stays, and identified incident organ donors and recipients using ICD-9-CM diagnosis and procedure codes. The NIS sample included 1,447 organ donors and 4,962 transplant recipients, equivalent after weighting to 6,517 donors and 23,656 recipients nationwide; 16.9 percent of organ donors but only 0.8 percent of transplant recipients were uninsured. In multivariate analysis, compared with other inpatients organ donors were much more likely to be uninsured (OR 3.41, 95% CI 2.81-4.15), whereas transplant recipients were less likely to lack coverage (OR 0.08, 95% CI 0.06-0.12). Many uninsured Americans donate organs, but they rarely receive them.

https://pnhp.org/organ_donors/Transplants.pdf

Comment:

By Don McCanne, MD

Because of the mismatch between the numbers of individuals who are candidates to receive organ transplants and the numbers of donors available, sometimes difficult decisions have to be made as to who will receive the transplants. As complex as these decisions are, it is a sad commentary that, in the United States, we add one additional complicating factor: Does the potential recipient have insurance?

It is reassuring to note that the dedicated transplant teams can sometimes break through this barrier through vigorous advocacy on behalf of their patients. But it is wrong that they should have to do that. And it is especially wrong that uninsured candidates may be unsuccessful in negotiating this barrier.

These life and death decisions are not based on a lack of money; we are already spending more than enough. Rather people are dying merely because of the way we allocate that money. A single payer national health program would remove money as a consideration and allow us to concentrate on the other moral and ethical factors that should determine who lives and who dies.

What a terrible decision to have to make. But let’s not make it based on ability to pay.

Uninsured Give but Rarely Receive Organs for Transplant

Posted by Vanessa Fuhrmans
Wall Street Journal Blog
November 18, 2008, 8:26 am

Call it the ultimate inequity in health care. A team of Harvard researchers finds that people without health insurance are about 20 times more likely to donate a liver or kidney than to receive one.

The results of the study, which appear in the current issue of International Journal of Health Services, looked at U.S. transplant patients in 2003. It found that 16.9% of organ donors had no health insurance at the time of hospitalization. But only 0.8% of transplant recipients were uninsured.

Why the stark unfairness? The study’s authors say the share of uninsured donors is roughly proportionate to the total uninsured population. But donors also tend to be younger adults, who also happen to go without coverage at higher rates than older people.

The problem is on the recipient side. If someone doesn’t have financial resources or insurance, few medical centers will consider that patient a transplant candidate, the authors say.

The study was triggered after its lead author, Andrew Herring, then a third-year medical student, cared for a 25-year-old uninsured day laborer at Cambridge Hospital in Boston in 2005. Suffering from advanced cardiomyopathy, or a severely inflamed heart, the patient could not get on a transplant list, in part because he wouldn’t have been able to pay for the expensive medications needed to support his recovery. He later died.

“What struck us was he was eligible to give but not receive an organ,” says Steffie Woolhandler, the study’s co-author who was Herring’s supervisor at the time. “Had he been in a car accident six months before, everyone would have been willing to harvest his organs.” She says she doesn’t blame doctors, who must follow explicit criteria to put patients on transplant lists, but an inequitable system.

Senator urges reform to 'hodge-podge' health care system

By DIANE COCHRAN
The Billings Gazette Staff
10/20/2008

The nation’s health care system is broken, and Congress is obligated to repair it, Sen. Max Baucus told an audience in Billings on Monday.

“I think in life we only have two choices on most things – try, or do nothing, and clearly we’ve got to try to crack this nut,” Baucus said at St. Vincent Healthcare during one of 10 health care listening sessions across the state. “Doing nothing is not an option.”

Reforming the country’s health care “hodge-podge” – it’s too fragmented to be called a system, Baucus said – will probably be the biggest problem he tackles in his Congressional career, the senator said.

“Maybe it’s a new definition of the term ‘masochism,’ but I have taken it on myself to address this challenge,” Baucus said.

The United States spends more on health care than does any other industrialized nation, but Americans are not healthier than people in other countries. In fact, we’re significantly less healthy.

And the costs associated with U.S. health care are rapidly rising.

In Montana, health insurance premiums increased at more than five times the rate of wages between 2000 and 2007, according to Baucus’ statistics.

Premiums rose almost 90 percent in that time, he said.

Everything should be on the table as lawmakers consider ways to improve health care, Baucus said.

That includes making health insurance a requirement for all Americans and implementing a single-payer system, although Baucus said he didn’t think the single-payer option was realistic.

Ted Cross, a retired small-business owner, told Baucus that health care needs to be simplified.

Cross said he was charged different amounts for two identical medical treatments at the same doctor’s office, and he couldn’t figure out why. When consumers can’t decipher their medical bills, they can’t tell if they’re being overcharged, he said.

“The complexity reminds me of derivatives in the mortgage industry, and we know what’s going on there,” Cross said.

Because it is complicated and disjointed, the health care system can be difficult for senior citizens to access, said Dr. Pat Coon, a gerontologist at Billings Clinic.

“There is a spectrum of services available to them, but the ability to attain them is often fragmented,” Coon said. “Rather than staying at home where they’d prefer to live, they’re forced to move into long-term care facilities.”

There are programs in place to help some people navigate the system, but not everyone qualifies for those programs, she said.

That means some people get better access than others, and physicians sometimes have to decide who gets it, Coon said.

Sue Bailey, program manager for the Yellowstone County Council on Aging Resource Center, urged Baucus to find a way to rein in skyrocketing medical costs.

If price increases continue to outpace inflation, even people who save for long-term care or future medical problems will have trouble paying their bills, Bailey said.

“Almost everyone, if they live long enough, is going to outlive their money,” she said.

Contact Diane Cochran at dcochran@billingsgazette.com or 657-1287.

Senator urges reform to ‘hodge-podge’ health care system

By DIANE COCHRAN
The Billings Gazette Staff
10/20/2008

The nation’s health care system is broken, and Congress is obligated to repair it, Sen. Max Baucus told an audience in Billings on Monday.

“I think in life we only have two choices on most things – try, or do nothing, and clearly we’ve got to try to crack this nut,” Baucus said at St. Vincent Healthcare during one of 10 health care listening sessions across the state. “Doing nothing is not an option.”

Reforming the country’s health care “hodge-podge” – it’s too fragmented to be called a system, Baucus said – will probably be the biggest problem he tackles in his Congressional career, the senator said.

“Maybe it’s a new definition of the term ‘masochism,’ but I have taken it on myself to address this challenge,” Baucus said.

The United States spends more on health care than does any other industrialized nation, but Americans are not healthier than people in other countries. In fact, we’re significantly less healthy.

And the costs associated with U.S. health care are rapidly rising.

In Montana, health insurance premiums increased at more than five times the rate of wages between 2000 and 2007, according to Baucus’ statistics.

Premiums rose almost 90 percent in that time, he said.

Everything should be on the table as lawmakers consider ways to improve health care, Baucus said.

That includes making health insurance a requirement for all Americans and implementing a single-payer system, although Baucus said he didn’t think the single-payer option was realistic.

Ted Cross, a retired small-business owner, told Baucus that health care needs to be simplified.

Cross said he was charged different amounts for two identical medical treatments at the same doctor’s office, and he couldn’t figure out why. When consumers can’t decipher their medical bills, they can’t tell if they’re being overcharged, he said.

“The complexity reminds me of derivatives in the mortgage industry, and we know what’s going on there,” Cross said.

Because it is complicated and disjointed, the health care system can be difficult for senior citizens to access, said Dr. Pat Coon, a gerontologist at Billings Clinic.

“There is a spectrum of services available to them, but the ability to attain them is often fragmented,” Coon said. “Rather than staying at home where they’d prefer to live, they’re forced to move into long-term care facilities.”

There are programs in place to help some people navigate the system, but not everyone qualifies for those programs, she said.

That means some people get better access than others, and physicians sometimes have to decide who gets it, Coon said.

Sue Bailey, program manager for the Yellowstone County Council on Aging Resource Center, urged Baucus to find a way to rein in skyrocketing medical costs.

If price increases continue to outpace inflation, even people who save for long-term care or future medical problems will have trouble paying their bills, Bailey said.

“Almost everyone, if they live long enough, is going to outlive their money,” she said.

Contact Diane Cochran at dcochran@billingsgazette.com or 657-1287.