PNHP

No on Prop. 101: It’s a false pitch that blocks reform

No on Prop. 101: It’s a false pitch that blocks reform

By Phil Lopes and George Pauk
Tucson Citizen
Guest Opinion: Health Care Choice
Published: 09.15.2008

When Arizona voters cast their ballots this November, one of the questions they face is whether to vote yes or no on Proposition 101, the misnamed Freedom of Choice in Health Care Act. They should definitely vote no.

Prop. 101 is a constitutional amendment that would forbid restrictions on “a person’s freedom of choice of private health care systems or private plans of any type.”

Sounds like more freedom, doesn’t it? In fact, Prop. 101 protects the private health insurance industry.

Its passage would give the industry a privileged place in our state’s basic law. The result would be less freedom for average Arizonans, not more.

Remember, this is the industry that diverts about 31 cents of every health care dollar toward administrative costs, including big payouts for shareholder profits, marketing expenses and outlandish executive salaries.

Prop. 101 would limit Arizonans’ choices to plans offered by these private insurers, and it would block any steps toward badly needed health care reform.
Let’s step back for a moment and ask: What kind of choices do people want in health care?

They want access to comprehensive, affordable, high-quality care. They want to choose their health practitioner. They want to choose their hospital or other service delivery site.

Under our current health insurance system, Arizonans have none of these choices.

The U.S. Census Bureau reported last month that 45.7 million Americans – including 1.2 million Arizonans – lacked health insurance in 2007.

Employer-sponsored coverage continues to shrink, as do employee health benefits. Access to care, and availability of care, especially in rural areas, is diminishing.

The Commonwealth Fund, a research group, estimates that another 25 million people were “underinsured” last year – i.e., they had insurance but still wouldn’t be able to afford care in the event of a serious illness or injury.

Health insurers are further restricting what they cover – what they’ll pay for and what they won’t – and they increasingly impose big deductibles and co-pays.

They are also constantly changing their lists of “in-network” doctors and hospitals.

Choice of doctor or hospital? What a quaint idea! Just see what happens when you go “out of network.”

Thus, in the name of “freedom” and “choice,” Prop. 101 would give us neither. It would further push Arizonans into the iron grip of an industry that is failing us – an industry in which many put profits above the delivery of sorely needed health care.

There are many potential unintended consequences of Prop. 101.

For instance, if the Arizona Department of Insurance determines that a particular health insurance carrier does not meet set criteria for fiscal solvency and wants to bar it from offering unsound policies, the department would be prohibited from doing so if only one person in the state wanted to purchase this policy.

Wouldn’t it be better if every resident were guaranteed comprehensive, high-quality health care – at least as good as what is offered to our state employees?

If each person could choose his own health practitioner, hospital or clinic (working within our private delivery system), allowing continuity of care, better follow-ups and fewer medical errors?

Wouldn’t it be better if our state’s residents didn’t have to worry about crushing medical bills because they knew a social insurance fund would cover the costs? If every Arizonan were in one big pool, spreading the risk more equitably?

If health care costs were controlled by, for example, bulk purchasing of drugs and medical supplies?

Such a plan exists: the Arizona Health Security Act. Its enactment by our Legislature would go a long way toward curing our state’s health care ills.

It’s practical, fair and eminently realistic.

But take note: The passage of Prop. 101 would prevent Arizonans from choosing that better path, among others. And it’s being bankrolled by at least $434,000 – mainly from business interests, much of it from out-of-state.

In a recent newspaper interview, Dr. Eric Novack, a Phoenix-based orthopedic surgeon and leading proponent of the measure, conceded that Prop. 101 would constitutionally preclude “certain options.”

So the real aim is to preclude certain choices, Dr. Novack?

Arizona voters should not be deceived. They should vote “no” on Prop. 101.

State Rep. Phil Lopes represents Legislative District 27 (central, west and southwest Tucson), is leader of the House Democrats and is the sponsor of the Arizona Health Security Act. George Pauk is an internal medicine physician in Phoenix and a member of Physicians for a National Health Program (www.pnhp.org).

10 Excellent Reasons for National Health Care

10 Excellent Reasons for National Health Care

Edited by Mary O’Brien and Martha Livingston
From the Foreward by Representative John Conyers Jr.:
This insightful book will provide you with the information you need to be an informed participant in the public debate about how to achieve health care for all. This information is especially important now, during this election year.
Within the chapters of this book and in the resource guide in the back, you will find cutting-edge information to help you work toward the only sensible solution to our health care crisis: a single-payer national health insurance program. Contributors to this book include doctors, nurses, patients, and an international union leader. They discuss the benefits of a single-payer plan: that it is cost-effective; will provide choice, quality, and better health for Americans; will help to reduce health care disparities; will make doctors and nurses better able to do their jobs; and will benefit both workers and businesses. They also explain why single-payer universal health care is the only approach that can guarantee Americans the health care that they need when they need it, and explain how, by working together, we can achieve the goal of health care for all.
The New Press: 10 Excellent Reasons for National Health Care
http://www.thenewpress.com/index.php?option=com_title&task=view_title&metaproductid=1711

This compact, easy to read book should be circulated widely so that all Americans can understand that there is an effective and equitable solution to our health care crisis. Read it. Then recommend it to the various organizations and grassroots coalitions with which you are now associated, and initiate efforts to expand activism to yet more individuals and organizations.
The threshold required for reform will be met once the public understands that there really is a solution.

10 Excellent Reasons for National Health Care

10 Excellent Reasons for National Health Care

Edited by Mary O’Brien and Martha Livingston

From the Foreward by Representative John Conyers Jr.:

This insightful book will provide you with the information you need to be an informed participant in the public debate about how to achieve health care for all. This information is especially important now, during this election year.

Within the chapters of this book and in the resource guide in the back, you will find cutting-edge information to help you work toward the only sensible solution to our health care crisis: a single-payer national health insurance program. Contributors to this book include doctors, nurses, patients, and an international union leader. They discuss the benefits of a single-payer plan: that it is cost-effective; will provide choice, quality, and better health for Americans; will help to reduce health care disparities; will make doctors and nurses better able to do their jobs; and will benefit both workers and businesses. They also explain why single-payer universal health care is the only approach that can guarantee Americans the health care that they need when they need it, and explain how, by working together, we can achieve the goal of health care for all.

The New Press: 10 Excellent Reasons for National Health Care
http://www.thenewpress.com/index.php?option=com_title&task=view_title&metaproductid=1711

Comment:

By Don McCanne, MD

This compact, easy to read book should be circulated widely so that all Americans can understand that there is an effective and equitable solution to our health care crisis. Read it. Then recommend it to the various organizations and grassroots coalitions with which you are now associated, and initiate efforts to expand activism to yet more individuals and organizations.

The threshold required for reform will be met once the public understands that there really is a solution.

Senator Kuehl's Open Letter to the Governor on SB 840

Re: Senate Bill 840 (Kuehl) — Request for Signature

September 10th, 2008

The Honorable Arnold Schwarzenegger
Governor, State of California
State Capitol, 1st Floor
Sacramento, CA 95814

Dear Governor Schwarzenegger:

Rather than write you a pro forma letter regarding SB 840, I am writing a longer than usual request in an effort to at least make certain you have all the facts in front of you as you consider this bill. I am writing to respectfully urge your signature on SB 840 because this legislation will bring a modern universal health care system to California, make health care predictably more affordable for California employers and families, and provide every Californian with a complete choice of their individual doctors and hospitals.

Although you vetoed similar legislation two years ago, I urge your careful reconsideration of this legislation and ask for an opportunity to answer any concerns or questions that you continue to have, in person. I have worked hard to return this legislation to your desk because I see that California’s health care system is falling behind other industrial nations in making the systematic investments that are necessary to build a state of the art health care system as well as to contain long term health cost inflation which is bankrupting our state.

California desperately needs real healthcare reform that strikes directly at the heart of insurance costs that are growing 2-3 times faster than workers wages every year. A system where each of California’s 36 million residents are segregated into dozens of different insurance plans according to whether they are young or old, sick or healthy, rich or poor, and where they live or work requires an unconscionable level of administrative complexity and constant actuarial risk analysis. It conservatively costs 30% of every dollar we spend on healthcare just to keep track of all the different populations and benefit groupings to which each person belongs.

Even more importantly, such a fragmented financing system is clearly unable to respond and adapt to the changing needs of a modern, state of the art, health care system. We have failed to make significant progress in the development of electronic infrastructure, data collection and monitoring, and we have not made necessary investments in preventive health, among many others. While I applaud your leadership on each of these issues, I ask you to ask yourself why the health insurance industry, which controls our health care funds today, has failed to invest in such proven and effective methods for improving quality and containing cost, on their own.

The answer, in part, is that, under a fragmented health care financing system, such as we now have, no “payer” has any incentive to make systematic improvements, regardless of how beneficial they may be to the larger system. It is no accident that physician adoption rates for electronic medical records in the Netherlands are at 98%, while in the United States they linger at around 28%. As other nations make innovative advancements in quality and infrastructure, dramatically reducing preventable deaths and medical errors, and saving lives at the same time they contain costs, here in California, we are falling further and further behind as any semblance of a first world health care system slips through our fingers.

Our slow adoption of cost effective quality improvement technologies is a fatal system failure. Incremental steps may sometimes help in the short term, but each small step requires enormous political effort and yet, inevitably falls far short of producing the health care system of which California is capable, and, frankly, for which it is already paying. We must have the foresight to address the deeper systemic causes underlying the health care crisis.

Importantly, SB 840 does not envision a radical remodeling of our health care delivery system. It is barely a remodeling of the delivery system, at all. It simply calls for privately delivered health care funded by a single comprehensive health insurance plan that covers all residents of the state, allowing them to choose their own doctors and hospitals.

This simple policy change – bringing all residents into one “risk pool”, instead of partitioning residents by medical risk – addresses the deepest systemic reason for our failing health care system. Multiple risk pools mean that competition between insurers is based on having a primarily healthy risk pool relative to the premiums received. This means that sicker individuals will always be undesirable “customers” and our health care resources and capitol investments will not be devoted to effectively treating or serving those patients, but instead will be devoted to attracting and keeping healthy individuals who use less health care than they pay in premiums. For example, hospital infrastructure investments will always be inadequate in low income communities with high health care needs. All the incremental market reforms in the world can never hope to reverse this basic perverse incentive; market forces will inevitably drive insurers to find new and innovative ways to circumvent them. As a result, our political will and financial resources will continue to be worn out through countless futile exercises in partial reform.

As you know, the Lewin Group, an independent analysis group that focuses on healthcare costs, predicts that the universal health care system in SB 840 would save Californians $20 billion in administrative overhead, high-cost emergency room visits and pharmaceutical costs, allowing the savings to be redirected into purchasing health care. California’s own Legislative Analyst found that Lewin’s assessments were reasonable and confirmed the billions of dollars in savings that are estimated under this reform, once it is in place.

The positive impact that SB 840 will have on California’s economy is inspiring. SB 840 provides immediate relief to California businesses most of which would save money in the first year of its implementation. Today, half of our small businesses no longer provide health benefits because costs have risen so fast, and their competitors have already eliminated employee benefits. California needs health reform that will immediately reduce health insurance premiums for those businesses that have stuck it out. Such a policy will inevitably bring new business to the state, since health care costs in California would be significantly lower than in other states and more competitive with other industrial nations.

SB 840 will save money for public employers, including the state of California, who purchase health care benefits for current employees and retirees; for this reason, many school districts, city councils, and county boards of supervisors support this legislation. Additionally, state and local governments will see significant savings in the costs of their direct care programs according to the Lewin report as well as other sources.

The savings in health care costs for working families will also help stimulate the economy, by reducing that portion of a family’s income that must be devoted to health care premiums. Additionally, electronic infrastructure investments, called for in the legislation, could easily spur a new era of economic growth in California’s high-tech industry. Instead of investing our health care resources in dead-end administrative paper-pushing, our health care dollars could be used to create new and better paying high-tech jobs that drive economic growth throughout the state.

Overall, SB 840 will make our health care system more reliable and secure by stabilizing the growth in health spending and linking spending increases to state GDP and population growth, employment rates and other relevant demographic indicators. SB 840 will combine needed cost controls with medical practice standards that make use of the best available medical science, and place an emph
asis on preventative and primary care to improve California’s overall health in a way that also saves billions of dollars.

Sheila James Kuehl
Senator, 23rd District

Senator Kuehl’s Open Letter to the Governor on SB 840

Re: Senate Bill 840 (Kuehl) — Request for Signature

September 10th, 2008

The Honorable Arnold Schwarzenegger
Governor, State of California
State Capitol, 1st Floor
Sacramento, CA 95814

Dear Governor Schwarzenegger:

Rather than write you a pro forma letter regarding SB 840, I am writing a longer than usual request in an effort to at least make certain you have all the facts in front of you as you consider this bill. I am writing to respectfully urge your signature on SB 840 because this legislation will bring a modern universal health care system to California, make health care predictably more affordable for California employers and families, and provide every Californian with a complete choice of their individual doctors and hospitals.

Although you vetoed similar legislation two years ago, I urge your careful reconsideration of this legislation and ask for an opportunity to answer any concerns or questions that you continue to have, in person. I have worked hard to return this legislation to your desk because I see that California’s health care system is falling behind other industrial nations in making the systematic investments that are necessary to build a state of the art health care system as well as to contain long term health cost inflation which is bankrupting our state.

California desperately needs real healthcare reform that strikes directly at the heart of insurance costs that are growing 2-3 times faster than workers wages every year. A system where each of California’s 36 million residents are segregated into dozens of different insurance plans according to whether they are young or old, sick or healthy, rich or poor, and where they live or work requires an unconscionable level of administrative complexity and constant actuarial risk analysis. It conservatively costs 30% of every dollar we spend on healthcare just to keep track of all the different populations and benefit groupings to which each person belongs.

Even more importantly, such a fragmented financing system is clearly unable to respond and adapt to the changing needs of a modern, state of the art, health care system. We have failed to make significant progress in the development of electronic infrastructure, data collection and monitoring, and we have not made necessary investments in preventive health, among many others. While I applaud your leadership on each of these issues, I ask you to ask yourself why the health insurance industry, which controls our health care funds today, has failed to invest in such proven and effective methods for improving quality and containing cost, on their own.

The answer, in part, is that, under a fragmented health care financing system, such as we now have, no “payer” has any incentive to make systematic improvements, regardless of how beneficial they may be to the larger system. It is no accident that physician adoption rates for electronic medical records in the Netherlands are at 98%, while in the United States they linger at around 28%. As other nations make innovative advancements in quality and infrastructure, dramatically reducing preventable deaths and medical errors, and saving lives at the same time they contain costs, here in California, we are falling further and further behind as any semblance of a first world health care system slips through our fingers.

Our slow adoption of cost effective quality improvement technologies is a fatal system failure. Incremental steps may sometimes help in the short term, but each small step requires enormous political effort and yet, inevitably falls far short of producing the health care system of which California is capable, and, frankly, for which it is already paying. We must have the foresight to address the deeper systemic causes underlying the health care crisis.

Importantly, SB 840 does not envision a radical remodeling of our health care delivery system. It is barely a remodeling of the delivery system, at all. It simply calls for privately delivered health care funded by a single comprehensive health insurance plan that covers all residents of the state, allowing them to choose their own doctors and hospitals.

This simple policy change – bringing all residents into one “risk pool”, instead of partitioning residents by medical risk – addresses the deepest systemic reason for our failing health care system. Multiple risk pools mean that competition between insurers is based on having a primarily healthy risk pool relative to the premiums received. This means that sicker individuals will always be undesirable “customers” and our health care resources and capitol investments will not be devoted to effectively treating or serving those patients, but instead will be devoted to attracting and keeping healthy individuals who use less health care than they pay in premiums. For example, hospital infrastructure investments will always be inadequate in low income communities with high health care needs. All the incremental market reforms in the world can never hope to reverse this basic perverse incentive; market forces will inevitably drive insurers to find new and innovative ways to circumvent them. As a result, our political will and financial resources will continue to be worn out through countless futile exercises in partial reform.

As you know, the Lewin Group, an independent analysis group that focuses on healthcare costs, predicts that the universal health care system in SB 840 would save Californians $20 billion in administrative overhead, high-cost emergency room visits and pharmaceutical costs, allowing the savings to be redirected into purchasing health care. California’s own Legislative Analyst found that Lewin’s assessments were reasonable and confirmed the billions of dollars in savings that are estimated under this reform, once it is in place.

The positive impact that SB 840 will have on California’s economy is inspiring. SB 840 provides immediate relief to California businesses most of which would save money in the first year of its implementation. Today, half of our small businesses no longer provide health benefits because costs have risen so fast, and their competitors have already eliminated employee benefits. California needs health reform that will immediately reduce health insurance premiums for those businesses that have stuck it out. Such a policy will inevitably bring new business to the state, since health care costs in California would be significantly lower than in other states and more competitive with other industrial nations.

SB 840 will save money for public employers, including the state of California, who purchase health care benefits for current employees and retirees; for this reason, many school districts, city councils, and county boards of supervisors support this legislation. Additionally, state and local governments will see significant savings in the costs of their direct care programs according to the Lewin report as well as other sources.

The savings in health care costs for working families will also help stimulate the economy, by reducing that portion of a family’s income that must be devoted to health care premiums. Additionally, electronic infrastructure investments, called for in the legislation, could easily spur a new era of economic growth in California’s high-tech industry. Instead of investing our health care resources in dead-end administrative paper-pushing, our health care dollars could be used to create new and better paying high-tech jobs that drive economic growth throughout the state.

Overall, SB 840 will make our health care system more reliable and secure by stabilizing the growth in health spending and linking spending increases to state GDP and population growth, employment rates and other relevant demographic indicators. SB 840 will combine needed cost controls with medical practice standards that make use of the best available medical science, and place an emphasis on preventative and primary care to improve California’s overall health in a way that also saves billions of dollars.

Sheila James Kuehl
Senator, 23rd District

Health policy expertise and presidential politics

Speaking Truth to Power — The Need for, and Perils of, Health Policy Expertise in the White House

By Jacob S. Hacker, Ph.D.
The New England Journal of Medicine
September 11, 2008
The adviser is the president’s ally — in the lingo of organizational economics, an “agent” serving the interests of a “principal.” Yet as a bearer of specialized knowledge, the adviser is also responsible to a larger profession, to its values and commitments, and ultimately to the ideal of expertise itself.
The adviser, in short, must both “speak truth to power” and aid in the exercise of power, both offering unbiased intelligence and acting as a very biased assistant. It is fashionable to pretend these two roles are the same, but they are not. An expert adviser has special knowledge, training, and skills — all of which are needed more than ever in the White House. The question is whether these talents can really be used, or be useful, in the bare-knuckles world of American politics — and, more important, whether the values they embody can be upheld when science, advocacy, and democracy collide.
Politics is about power more than truth, about winning more than being right. But expertise is about truth more than power, and being right is the whole point.
Health policy experts can do more sophisticated analyses than ever, and there are more of them than ever, too — in policy schools, departments of economics, schools of public health, think tanks, private foundations, and government. But the progress in quality of expertise has not been matched by progress in thinking about the role of the expert or about how policy advice can and should be adapted to the political realities that those receiving advice inevitably confront. Policy experts are brilliant when it comes to designing proposals but often horrible at thinking through the ways in which their proposals will be refracted through the political prism. Subtle visions of policy are wedded to crude caricatures of politics, and, not surprisingly, those visions all too often either fail to become reality or fail to work.
Worse, the expert’s claim to authority can undercut the more important wellspring of democratic leadership: the demands and wishes of the people. Experts are habitually disdainful of what ordinary citizens believe. People have opinions; experts have facts. When a well-regarded economist complains that democratic policy choice should be restricted because “irrational” voters endorse all sorts of harmful nostrums — whether trade protection or farm price supports (he might have added health insurance with low deductibles, drug price controls, and free choice of doctors) — he may be out on a limb. But the tree is one that many policy experts climb.
We badly need health care experts in the White House who offer advice based on evidence and analysis, not prejudice. But even the best experts need to know when to defer to the political process, to see the purpose of their craft as facilitating democratic debate rather than providing final answers once Americans have decided on the questions.
Winston Churchill once said that “scientists should be on tap, not on top.” That is a good starting point. But sometimes presidential policy experts should also have the good sense to get out of the way.
http://content.nejm.org/cgi/content/full/359/11/1085

“… expertise is about truth more than power, and being right is the whole point.”
In deciding whether policy is right or wrong, it is essential first to decide what goals are to be achieved by the policy decisions. In reforming health care financing, most of us would agree that the goal is to provide everyone with access to all necessary health care without having to be exposed to financial hardship.
We have available a wide range of expertise within the policy community. When you look at the various policy recommendations, some of them, if enacted, would achieve this specific stated goal, but most of them would not. Those that would not are policies that are designed to achieve other less beneficial or even detrimental goals (ownership society: own your own debts). Stated in other terms, those supporting the few policies that would work are right, and those supporting policies that fall short are wrong.
In policy, being right is the whole point.
“Politics is about power more than truth, about winning more than being right.”
Politics is represented by the great legislative battles that we are witnessing wherein one side advocates for policies that are wrong, largely because they’re inadequate, and the other side advocates for policies that are completely wrong because they make matters worse.
Without the continual involvement of members of the policy community who emphatically support that which is right, we’ll continue to witness politics that results in wrong, wronger and wrongest policies.

Health policy expertise and presidential politics

Speaking Truth to Power -- The Need for, and Perils of, Health Policy Expertise in the White House

By Jacob S. Hacker, Ph.D.
The New England Journal of Medicine
September 11, 2008

The adviser is the president’s ally — in the lingo of organizational economics, an “agent” serving the interests of a “principal.” Yet as a bearer of specialized knowledge, the adviser is also responsible to a larger profession, to its values and commitments, and ultimately to the ideal of expertise itself.

The adviser, in short, must both “speak truth to power” and aid in the exercise of power, both offering unbiased intelligence and acting as a very biased assistant. It is fashionable to pretend these two roles are the same, but they are not. An expert adviser has special knowledge, training, and skills — all of which are needed more than ever in the White House. The question is whether these talents can really be used, or be useful, in the bare-knuckles world of American politics — and, more important, whether the values they embody can be upheld when science, advocacy, and democracy collide.

Politics is about power more than truth, about winning more than being right. But expertise is about truth more than power, and being right is the whole point.

Health policy experts can do more sophisticated analyses than ever, and there are more of them than ever, too — in policy schools, departments of economics, schools of public health, think tanks, private foundations, and government. But the progress in quality of expertise has not been matched by progress in thinking about the role of the expert or about how policy advice can and should be adapted to the political realities that those receiving advice inevitably confront. Policy experts are brilliant when it comes to designing proposals but often horrible at thinking through the ways in which their proposals will be refracted through the political prism. Subtle visions of policy are wedded to crude caricatures of politics, and, not surprisingly, those visions all too often either fail to become reality or fail to work.

Worse, the expert’s claim to authority can undercut the more important wellspring of democratic leadership: the demands and wishes of the people. Experts are habitually disdainful of what ordinary citizens believe. People have opinions; experts have facts. When a well-regarded economist complains that democratic policy choice should be restricted because “irrational” voters endorse all sorts of harmful nostrums — whether trade protection or farm price supports (he might have added health insurance with low deductibles, drug price controls, and free choice of doctors) — he may be out on a limb. But the tree is one that many policy experts climb.

We badly need health care experts in the White House who offer advice based on evidence and analysis, not prejudice. But even the best experts need to know when to defer to the political process, to see the purpose of their craft as facilitating democratic debate rather than providing final answers once Americans have decided on the questions.

Winston Churchill once said that “scientists should be on tap, not on top.” That is a good starting point. But sometimes presidential policy experts should also have the good sense to get out of the way.

http://content.nejm.org/cgi/content/full/359/11/1085

Comment:

By Don McCanne, MD

“… expertise is about truth more than power, and being right is the whole point.”

In deciding whether policy is right or wrong, it is essential first to decide what goals are to be achieved by the policy decisions. In reforming health care financing, most of us would agree that the goal is to provide everyone with access to all necessary health care without having to be exposed to financial hardship.

We have available a wide range of expertise within the policy community. When you look at the various policy recommendations, some of them, if enacted, would achieve this specific stated goal, but most of them would not. Those that would not are policies that are designed to achieve other less beneficial or even detrimental goals (ownership society: own your own debts). Stated in other terms, those supporting the few policies that would work are right, and those supporting policies that fall short are wrong.

In policy, being right is the whole point.

“Politics is about power more than truth, about winning more than being right.”

Politics is represented by the great legislative battles that we are witnessing wherein one side advocates for policies that are wrong, largely because they’re inadequate, and the other side advocates for policies that are completely wrong because they make matters worse.

Without the continual involvement of members of the policy community who emphatically support that which is right, we’ll continue to witness politics that results in wrong, wronger and wrongest policies.

Is the window for reform really open?

Drop in Uninsured Unlikely to Influence Health Care Overhaul, Experts Say

By Neda Semnani
CQ HealthBeat
September 5, 2008
While new government figures show that a greater enrollment in public health programs has helped reduce the number of Americans without health insurance, experts said the data are unlikely to help make the case for expanding those programs as part of broader health care legislation next year.
David S. Johnson, the Census Bureau’s chief of Housing and Household Economics Statistics, which published the new figures, credits public programs like Medicaid and SCHIP for the increase in the insured, a trend experts believe may continue as employer-based coverage falls.
Analysts said the drop in the uninsured rate will have little influence in the broader discussion of health care legislation expected next year when a new president and Congress take office. The economic downturn and other budget priorities make it difficult for health care overhaul–a costly endeavor–to take center stage, they said.
“How much flexibility does the federal government have, given the declining economy and vast array of other problem areas? We have a lot of policy priorities. Health is an important one, but it’s not the only one,” said Joseph Antos, a health care scholar with the American Enterprise Institute, a conservative think tank. “Some kind of reform needs to happen . . . eventually. Gigantic reforms cost money. So ‘eventually’ may not happen in the first year or even in the first ten years of a new administration.”
Mark McClellan, director of the Engelberg Center for Health Care Reform with the non-partisan Brookings Institution, said, “With the fiscal outlook so tight, the challenge will be finding new ways to get costs down and coverage up, while filling gaps in quality.”
Judith Solomon, a senior fellow at the left-leaning Center on Budget and Policy Priorities, said the report examines the period just before the economic downturn and “doesn’t change what is the case for reform, it doesn’t change the case for reauthorizing strong public programs,” said Solomon, who specializes in Medicaid and the State Children’s Health Insurance Program (SCHIP).
The trend of greater enrollment in public health programs may continue in the current economic slowdown, said Karen Davenport, director of health policy with the liberal Center for American Progress. “On the one hand, we’re likely to see a greater insecurity in health coverage; on the other, a further up-tick in public coverage … The report points out just how effective these programs are in catching people when they fall. It shows that the individual market alone doesn’t work.”
http://www.commonwealthfund.org/healthpolicyweek/healthpolicyweek_show.htm?doc_id=704405

All we need to achieve comprehensive health care reform is to elect a new Congress and a new administration, and use the momentum of the first 100 days to push through Congress the voters’ mandate for reform. Right? Hmmm.
If we are going to have new legislation ready by January or February, the specifics of the proposals need to be precisely defined now so that they are ready to be converted into legislative language ASAP.
Is the McCain proposal ready? It would not be too difficult to write legislation that would diminish employer contributions to health plans by eliminating the tax advantages. It also would be fairly easy to allow sale of plans across state borders thereby creating a competitive market of the lowest common denominator of underinsurance plans. Tearing down programs that aren’t working very well and replacing them with programs that are much less effective is certainly not the reform we need.
What about creating a universal market of private plans like the members of Congress have: an FEHBP-like program? To be effective, these plans would have to cover essentially all necessary health care, and include individuals with greater health care needs. Those plans would be very expensive, certainly more than the $12,000 average premium charged for employer-sponsored plans covering healthy employees and their healthy families. Our current business-based private plans would require massive transformation to convert them into private social insurance plans characteristic of some of the European nations. Can you imagine the complexity of the legislation that would be required? Has anyone seen any serious specifics of such an approach that could be converted into legislative language within the first 100 days?
What about allowing the purchase of a Medicare-like option to complement the private insurance market? It wouldn’t be simply a provision to allow a buy-in to the current Medicare program simply because the Medicare risk pool is composed of very high-cost populations (elderly, chronically disabled, and chronic renal disease), and the premiums could never be affordable. Then what would a separate Medicare-like option look like? Good question. How comprehensive would the benefits be? How could cost-sharing be kept at a reasonable level? How much of the premium would the individual be responsible for? Would the balance be paid by the government? Would the private insurers who benefit from favorable selection be required to transfer funds to the public program? Has anyone seen any serious specifics that could be converted into legislative language in the first 100 days?
We do have legislative language for a proposal that actually would work, and it is already in a bill before Congress, with about 90 cosponsors in the House of Representatives: John Conyers’ HR 676. Oh, wait a minute; that’s not feasible, they tell us.
So what do the Democrats have in mind for the first 100 days, should they have control? Easy. They are going to expand the children’s health insurance program – SCHIP – certainly a good thing. They are going to look at the damage done to Medicare by the privatizers, but significant repairs will be too complex to enact right away; they’ll get to that later. Comprehensive reform? Not now; there are too many other important issues. Next year? Well, that’s an election year, so we can’t do it then. But we should be able to get to it possibly before the end of the president’s first term, and certainly by the end of the second.
Window slammed shut!
But don’t anyone start working on these issues now. We have more important decisions to make. Do we support the moral high ground of lipstick on a pit bull, or the moral low ground of lipstick on a pig?
In the face of all of our shameful societal problems, surely someone will come up with this answer to this most pressing problem of the day: the lipstick needs to go on the figurehead of the Swift Boat.

Is the window for reform really open?

Drop in Uninsured Unlikely to Influence Health Care Overhaul, Experts Say

By Neda Semnani
CQ HealthBeat
September 5, 2008

While new government figures show that a greater enrollment in public health programs has helped reduce the number of Americans without health insurance, experts said the data are unlikely to help make the case for expanding those programs as part of broader health care legislation next year.

David S. Johnson, the Census Bureau’s chief of Housing and Household Economics Statistics, which published the new figures, credits public programs like Medicaid and SCHIP for the increase in the insured, a trend experts believe may continue as employer-based coverage falls.

Analysts said the drop in the uninsured rate will have little influence in the broader discussion of health care legislation expected next year when a new president and Congress take office. The economic downturn and other budget priorities make it difficult for health care overhaul–a costly endeavor–to take center stage, they said.

“How much flexibility does the federal government have, given the declining economy and vast array of other problem areas? We have a lot of policy priorities. Health is an important one, but it’s not the only one,” said Joseph Antos, a health care scholar with the American Enterprise Institute, a conservative think tank. “Some kind of reform needs to happen . . . eventually. Gigantic reforms cost money. So ‘eventually’ may not happen in the first year or even in the first ten years of a new administration.”

Mark McClellan, director of the Engelberg Center for Health Care Reform with the non-partisan Brookings Institution, said, “With the fiscal outlook so tight, the challenge will be finding new ways to get costs down and coverage up, while filling gaps in quality.”

Judith Solomon, a senior fellow at the left-leaning Center on Budget and Policy Priorities, said the report examines the period just before the economic downturn and “doesn’t change what is the case for reform, it doesn’t change the case for reauthorizing strong public programs,” said Solomon, who specializes in Medicaid and the State Children’s Health Insurance Program (SCHIP).

The trend of greater enrollment in public health programs may continue in the current economic slowdown, said Karen Davenport, director of health policy with the liberal Center for American Progress. “On the one hand, we’re likely to see a greater insecurity in health coverage; on the other, a further up-tick in public coverage … The report points out just how effective these programs are in catching people when they fall. It shows that the individual market alone doesn’t work.”

http://www.commonwealthfund.org/healthpolicyweek/healthpolicyweek_show.htm?doc_id=704405

Comment:

By Don McCanne, MD

All we need to achieve comprehensive health care reform is to elect a new Congress and a new administration, and use the momentum of the first 100 days to push through Congress the voters’ mandate for reform. Right? Hmmm.

If we are going to have new legislation ready by January or February, the specifics of the proposals need to be precisely defined now so that they are ready to be converted into legislative language ASAP.

Is the McCain proposal ready? It would not be too difficult to write legislation that would diminish employer contributions to health plans by eliminating the tax advantages. It also would be fairly easy to allow sale of plans across state borders thereby creating a competitive market of the lowest common denominator of underinsurance plans. Tearing down programs that aren’t working very well and replacing them with programs that are much less effective is certainly not the reform we need.

What about creating a universal market of private plans like the members of Congress have: an FEHBP-like program? To be effective, these plans would have to cover essentially all necessary health care, and include individuals with greater health care needs. Those plans would be very expensive, certainly more than the $12,000 average premium charged for employer-sponsored plans covering healthy employees and their healthy families. Our current business-based private plans would require massive transformation to convert them into private social insurance plans characteristic of some of the European nations. Can you imagine the complexity of the legislation that would be required? Has anyone seen any serious specifics of such an approach that could be converted into legislative language within the first 100 days?

What about allowing the purchase of a Medicare-like option to complement the private insurance market? It wouldn’t be simply a provision to allow a buy-in to the current Medicare program simply because the Medicare risk pool is composed of very high-cost populations (elderly, chronically disabled, and chronic renal disease), and the premiums could never be affordable. Then what would a separate Medicare-like option look like? Good question. How comprehensive would the benefits be? How could cost-sharing be kept at a reasonable level? How much of the premium would the individual be responsible for? Would the balance be paid by the government? Would the private insurers who benefit from favorable selection be required to transfer funds to the public program? Has anyone seen any serious specifics that could be converted into legislative language in the first 100 days?

We do have legislative language for a proposal that actually would work, and it is already in a bill before Congress, with about 90 cosponsors in the House of Representatives: John Conyers’ HR 676. Oh, wait a minute; that’s not feasible, they tell us.

So what do the Democrats have in mind for the first 100 days, should they have control? Easy. They are going to expand the children’s health insurance program – SCHIP – certainly a good thing. They are going to look at the damage done to Medicare by the privatizers, but significant repairs will be too complex to enact right away; they’ll get to that later. Comprehensive reform? Not now; there are too many other important issues. Next year? Well, that’s an election year, so we can’t do it then. But we should be able to get to it possibly before the end of the president’s first term, and certainly by the end of the second.

Window slammed shut!

But don’t anyone start working on these issues now. We have more important decisions to make. Do we support the moral high ground of lipstick on a pit bull, or the moral low ground of lipstick on a pig?

In the face of all of our shameful societal problems, surely someone will come up with this answer to this most pressing problem of the day: the lipstick needs to go on the figurehead of the Swift Boat.

A Market for Compassion: Single-Payer Health Insurance

To view the video, please visit http://www.medscape.com/viewarticle/579369 (free registration required)

by Prajwal Ciryam
From The Medscape Journal of Medicine
Webcast Video Commentaries
Posted 09/05/2008

When the ethics and the economics of major public policy agree, we ought to pay attention. House Resolution 676 promises to create a single-payer health insurance system to provide expanded and improved Medicare for all Americans.[1] It will insure everyone, and unlike many competing proposals, it could actually work.

In a single-payer system, the government will fund health insurance, but private providers will continue to deliver care. Economies of scale will save the money to make this possible. Many Americans, including Democratic presidential nominee Barack Obama, concede that single-payer insurance is probably our most efficient option.[2] But they worry that it lacks the spirit of the American market. Nothing could be further from the truth.

A single-payer system will harness the market’s strengths while addressing its limitations. The private health insurance market is inefficient, bloated by advertising, duplicated bureaucracies, dividends, and executive compensation. What’s worse, insurance policies are so complex and individuals’ future needs so unpredictable that consumers cannot make the informed selections that induce competition between insurers.

However, consumers can create competition among healthcare providers. This is paramount because patients need the best healthcare, not the best middlemen to pay for it. Currently, providers are insulated from competition because private insurers often restrict coverage to select physicians. In addition, the 47 million uninsured Americans[3] have little impact on the market. A single-payer system will give all consumers the power of choice and open all healthcare providers to the effects of consumer decisions.

Single-payer works because of the efficiency of specialization. The government will manage the paperwork and private entities will provide the care. Adam Smith would be proud.

So if you believe in the market, ask your congressman to support HR 676. Together, we can restore common sense and common decency to American healthcare.

That’s my opinion, I’m Prajwal Ciryam, a second-year MD/PhD student in the Medical Scientist Training Program at Northwestern University and a Co-Founding Member of Health Care for All Illinois.

References:

1. House Resolution 676: To provide for comprehensive health insurance coverage for all United States residents, and for other purposes. Available at: http://thomas.loc.gov/cgi-bin/bdquery/z?d109:h.r.00676 Accessed August 20, 2008.

2. Macfarquhar L. The conciliator. New Yorker. May 7, 2007. Available at: http://www.newyorker.com/reporting/2007/05/07/070507fa_fact_macfarquhar?currentPage=1 Accessed August 20, 2008.

3. US Census Bureau. Income climbs, poverty stabilizes, uninsured rate increases. US Census Bureau News. August 29, 2006. Available at: http://www.census.gov/Press-Release/www/releases/archives/income_wealth/007419.html Accessed August 20, 2008.

Expand Medicare

Times Record
Letter to the Editor
09/02/2008

To the editor:

Cancer, like most serious illness, strikes unexpectedly. Did you notice that football great Gene Upshaw just died of pancreatic cancer three days after he fell ill?

Who will pay the bills when you are stricken? Which problems will your health insurance policy cover? With what limits?

How high will your out-of-pocket expenses be?

Millions of Americans are underinsured, and if you are unlucky, you may face bankruptcy on top of that sudden illness.

Costs are steadily increasing. But our less adequate coverage, in spite of personal cost increases, shows that competition among insurance companies dramatically fails to control costs.

Attend to these startling and well-understood facts about costs and coverage:

— Giving every citizen a Medicare card would cost less than current total expenses of about $2 trillion. Medicare comes with free choice of doctor, hospital and consultants, low out-of-pocket costs and you have it even if you lose your job.

Medicare for everyone costs less because administration at every level is cheaper. It’s cheaper because insurers don’t profit from your illness and because we would not pay chief executive officers seven-figure incomes. And we could finally get a handle on rising costs by planning and budgeting.

Yes, we might wait a little longer for that hip replacement or a tummy tuck.

Ask your Canadian friends what they prefer! Ask yourself why the citizens of every other developed country support their single-payer universal coverage systems.

Those who profit from the current system are powerful — and using your payments to lobby! It’s time we treated health care like police and schools.

Urge your candidates and representatives to support Medicare for everyone, or our personal expenses and worries will continue to increase.

Speak out!

Dr. William Clark
Woolwich, Maine

In Texas, the health care crisis is only getting worse

Census statistics show state’s children at risk

By DR. ANA MALINOW
Houston Chronicle
Monday, September 8, 2008

TEXANS had little to cheer about in the recent report by the U.S. Census Bureau that the number of Americans without health insurance dipped slightly in 2007.

Instead of the 47 million uninsured in 2006, last year our nation had “only” 45.7 million who lacked health insurance, a drop of a half percentage point from 2006 (from 15.8 percent of the population to 15.3 percent). Most of the dip was due to an expansion of government programs like Medicaid, especially among children.

So instead of running a fever of 107 degrees, the patient’s temperature dropped to 106.8 – better, yes, but only marginally.

In Texas, however, the temperature actually rose. The number of uninsured- went up by 258,000, yielding a total of nearly 6 million residents with no health coverage at all during 2007. That translates into an uninsured rate of 25 percent, the highest in the nation. It also translates into mounting financial stress, deferred medical care, untreated illness and in some cases premature death for millions of Texans from one end of the state to the other.

Keep in mind that these figures don’t reflect this year’s economic downturn, in which employers are shedding workers and benefits, and state governments are cutting health programs. And they don’t reflect the additional tens of millions in our country who are “underinsured,” meaning they would be hard pressed financially if they were to get sick, oven though they have some kind of insurance.

It is clear that last year’s gain in the number of insured people was entirely due to an expansion of government programs like Medicare, Medicaid and the Children’s Health Insurance Program (S-CHIP). While the number of uninsured in the country decreased by 1.3 million, the number of people covered by government health programs increased by 2.7 million. Had these public programs not been there to catch those falling off the rolls of employer-sponsored health insurance, the number of uninsured would have increased.

But in states like Texas, where the average annual growth in Medicaid has been low, the number of uninsured went up, not down. Furthermore, eligibility criteria in Texas for adults make it nearly impossible for working adults, even at minimum wage, to qualify for Medicaid. In Texas, a working parent of two making more than $6,000 per year makes too much to qualify for Medicaid! As fewer and fewer employers offer health insurance, individuals in Texas, where enrollment in public programs is not keeping up, are faced with only one alternative: joining the swelling ranks of the uninsured.

This is happening with children in Texas, whose working parents are losing health insurance. According to the census, the number of uninsured children in Texas soared to 1.5 million. These children will be at higher risk of getting sick from preventable illnesses, will visit the doctor less and will die prematurely. Certainly not good news for the children of Texas.

But enlarging Medicaid is not the answer. Texas ranks 49th in terms of its Medicaid reimbursement rates. In fact, many health providers routinely shun Medicaid patients because they know the government will shortchange them on payment for services rendered. And further cuts in these rates are on the way. This is a prescription for disaster.

As a physician, I am committed to practicing evidence-based medicine. I know you can’t close your eyes to a problem and pretend it doesn’t exist. If someone has a fever, yes, I can prescribe medication to bring the temperature down. But I’m obliged to look for the deeper cause. Otherwise I’m merely prescribing a placebo, not a cure.

The problems of our state and nation’s health care are systemic. They are a result of a defective model of financing health care, a model based on the investor-owned private health insurance industry, which adds no value to health care.

The private health insurers make profits by enrolling the healthy, screening out the sick and denying claims. I see the destructive results of this “non-system” every day. It is simply not sustainable economically nor justifiable morally.

The cure is a single-payer national health insurance program, an improved and expanded Medicare for all. Cut the administrative waste and profits of the insurance companies out of the picture. Let people go to the doctors and hospitals of their choice. Give everyone, without exception, access to the medically necessary care they need. We don’t need to spend a penny more than we spend right now if we take insurance companies out of the equation.

An old Chinese proverb goes: If we keep going in the same direction, we will end up exactly where we are going. What are we waiting for?

Malinow, a pediatrician at Ben Taub General Hospital, is President of Physicians for a National Health program..