PNHP

Most doctors support national health insurance, new study shows

Most doctors support national health insurance, new study shows

EMBARGOED UNTIL:
March 31, 2008
5:00 PM EST

CONTACTS:
Aaron E. Carroll, MD
Ronald T. Ackermann, MD
Todd Main, PNHP, (312) 782-6006

Support for National Health Insurance Among U.S. Physicians: 5 Years Later

Reflecting a shift in thinking over the past five years among U.S. physicians, a new study shows a solid majority of doctors — 59 percent — now supports national health insurance.

Such plans typically involve a single, federally administered social insurance fund that that guarantees health care coverage for everyone, much like Medicare currently does for seniors. The plans typically eliminate or substantially reduce the role of private insurance companies in the health care financing system, but still allow patients to go the doctors of their choice.

A study published in today’s Annals of Internal Medicine, a leading medical journal, reports that a survey conducted last year of 2,193 physicians across the United States showed 59 percent of them “support government legislation to establish national health insurance,” while 32 percent oppose it and 9 percent are neutral.

The findings reflect a leap of 10 percentage points in physician support for national health insurance (NHI) since 2002, when a similar survey was conducted. At that time, 49 percent of all physician respondents said they supported NHI and 40 percent opposed it.

Support among doctors for NHI has increased across almost all medical specialties, said Dr. Ronald T. Ackermann, associate director of the Center for Health Policy and Professionalism Research at Indiana University’s School of Medicine and co-author of the study.

“Across the board, more physicians feel that our fragmented and for-profit insurance system is obstructing good patient care, and a majority now support national insurance as the remedy,” he said.

Support for NHI is particularly strong among psychiatrists (83 percent), pediatric sub-specialists (71 percent), emergency medicine physicians (69 percent), general pediatricians (65 percent), general internists (64 percent) and family physicians (60 percent). Fifty-five percent of general surgeons support NHI, roughly doubling their level of support since 2002.

Doctors have often expressed concern about lack of patient access to care due to rising costs and patients’ insufficient levels of insurance. An estimated 47 million Americans currently lack health insurance coverage and another 50 million are believed to be underinsured. At the same time, health care costs in the United States are rising at the rate of about 7 percent a year, twice the rate of inflation.

The health care issue continues to rank high among voter concerns in the 2008 elections, placing third in a recent poll after the economy and Iraq.

The current study by the Indiana University researchers is the largest survey ever conducted among doctors on the issue of health care financing reform. It is based on a random sampling of names obtained from the American Medical Association’s master list of physicians throughout the country.

In addition to measuring attitudes toward NHI, the survey also asked doctors about their views about “more incremental reform,” often interpreted as state- or federal-based programs requiring or “mandating” that consumers buy health insurance from private insurance companies, legislative measures providing tax incentives to businesses to provide coverage for their employees, or similar steps.

Fewer physicians (55%) were in support of “incremental” reform. Moreover, virtually all those opposed to national health insurance also opposed incremental reform to improve access to care. In fact, only 14% of physicians overall oppose national health insurance but support more incremental reforms. Ironically, many medical organizations and most politicians have endorsed only incremental changes.

Dr. Aaron E. Carroll, director of Indiana University’s Center for Health Policy and Professionalism Research and lead author of the study, commented: “Many claim to speak for physicians and reflect their views. We asked doctors directly and found that, contrary to conventional wisdom, most doctors support the government creating national health insurance.”

Other signs indicate that attitudes among doctors are changing. The nation’s largest medical specialty group, the 124,000-member American College of Physicians, endorsed a single-payer national health insurance program for the first time in December.

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“Support for National Health Insurance among American Physicians: Five Years Later,”
Aaron E. Carroll and Ronald T. Ackermann, Annals of Internal Medicine, April 2008.

Physicians for a National Health Program, a membership organization of over 15,000 physicians, supports a single-payer national health insurance program. PNHP is headquartered in Chicago and has chapters across the United States. To contact a physician-spokesperson in your area, contact info@pnhp.org or call (312) 782-6006.

Hillary Clinton on single payer

From a transcript of Senator Hillary Rodham Clinton's interview with Kevin Sack of The New York Times about health care.

The New York Times
March 27, 2008

Q: Let’s talk for a minute about the formulation of your plan. I’m interested in how seriously you considered proposing a single payer system and at what point in that discussion did you decide to propose an individual mandate?

MRS. CLINTON: You know, I have thought about this, as you might guess, for 15 years and I never seriously considered a single payer system. Obviously, I listened to arguments about its advantages and disadvantages, and many people who I have a great deal of respect for certainly think that it is the only way to go. But I said, as you quoted me, that we had to do what would appeal to and actually coincide with what the body politic will and political coalition building was. So I think if you look at most public opinion surveys, even from groups of people who you would think would be pretty positive towards single payer, Americans have a very skeptical attitude. They don’t really know that Medicare is a single payer system. They don’t really think about that. They think about these foreign countries that they hear all these stories about, whether they’re true or not, which they’re often not. And so talking about single payer really is a conversation ender for most Americans, because then they become very nervous about socialized medicine and all the rest of this. So I never really seriously considered it.

Q: Last question. You talked earlier in the interview about how your plan maintains the private insurance system. But in October, at the forum of the Kaiser Family Foundation, you were asked whether your plan to make government insurance, a Medicare-type plan, available to all was a backdoor route to a single payer system, and you said, “What are we afraid of? Let’s see where the competition leads us.” So is it okay with you if the market ultimately dictates that the U.S. system sort of morphs into a single-payer system? And if so, doesn’t that arm the Republicans with exactly what you were talking about, this claim that it’s socialized medicine?

MRS. CLINTON: No, because I think what we would be offering would be a Medicare-like system, which is something people are familiar with, and you know whether we would call it Medicare 2.0 or whatever we would call it. And we’d see whether people want that or not. And where it morphs to, I think this whole system will morph. I mean, look at where Medicare started and where it is today. In large measure, some of the problems we have are because of the way it evolved. But I think from my perspective, having this Medicare-like alternative really does answer the desires of people. And there’s a significant minority who want quote a single-payer system. It at least gives them the feeling it’s not for profit, they’re not paying somebody a billion dollars for raising their premiums 200 percent and all the rest of the problems that we face with the for-profit system. You get the costs of overhead and administration down as much as possible. I believe in choice. Let Americans choose and what better way to determine that than letting the market have some competition and you know see where it does lead to.

Q: And if the choice is a single-payer system, that’s fine by you?

MRS. CLINTON: You know, I think that would be highly unlikely. I think that, you know, there’s too many bells and whistles that Americans want that would not be available in kind of a bare-bones Medicare-like system but I think it’s important to have that competition.

http://www.nytimes.com/2008/03/27/us/politics/27text-health.html

Comment:

By Don McCanne, MD

Competition between a bare-bones Medicare-like plan versus private bells-and-whistles insurance? What kind of framing is that!?

In her proposal, is she really advocating for a public Medicare-like option that provides only bare-bones coverage? That’s certainly not the model that single payer advocates propose.

Is she suggesting that the private insurance industry will be able to provide us with an insurance product that includes all of the bells and whistles at a premium that is affordable? If such a plan were to be offered it would have a very small market limited to only the wealthiest of us. Insurers typically shun small markets.

It’s not like she doesn’t understand the numbers. Let’s look at what else she said in this interview:

****

MRS. CLINTON: The average family policy cost in America today is $12,000. That is, you know, considerably, you know, that’s like 25 percent of the median income in the country, right? So people are paying a lot of money. Now, employers defray a lot of that cost but it comes out of wages so you’ve got this unfortunate situation where we’ve had flat wages, declining incomes, rising health care costs, so even though your share of that $12,000 family policy might be say 50 percent, or whatever it would be, you’re doubly paying for it because you’re also paying for it in lost wages.

Q: You’ve also said you would cap premiums. But you haven’t said where you would cap them.

MRS. CLINTON: You know, I think we could do it somewhere between five and 10 percent of income.

****

Or maybe she doesn’t understand the numbers. If she does, she has implied that most of the premium will have to be paid through the tax system.

If we’re going to use the tax system anyway, then why waste resources on our fragmented, multi-payer system that falls far short on most of our goals for reform? That would be a terrible misuse of public funds.

What health care financing system would be a better use of public funds? A single payer national health program is specifically designed to provide comprehensive health care for absolutely everyone at a cost that is affordable for each individual, and with an efficiency that would be much more appropriate for a publicly-funded program. That’s where we need to go.

Hospitals requesting payments upfront

Some hospitals seeking fees before surgery

By Michael O’Connor
Omaha World-Herald
March 26, 2008

The Nebraska Medical Center has joined an increasing number of hospitals nationally that request that patients pay out-of-pocket costs before a scheduled surgery.

The trend is driven in part by the popularity of high-deductible insurance plans, which can mean bigger out-of-pocket costs for patients, said Rick Wade, spokesman for the American Hospital Association.

Bigger out-of-pocket costs can be more of a burden on patients, so hospitals want to make sure patients are aware as early as possible what their financial obligation will be, he said.

Wade said the national trend of requesting advance payments is partly in response to problems collecting bills.

Jana Danielson, director of patient financial services for the medical center, said the main goal is to help patients know their hospital expenses and eliminate surprises when the bill arrives.

Paying upfront will be an option, and patients who choose not to will still get their surgery, Danielson said. Patients who choose not to pay in advance can get help from medical center financial counselors in setting up a payment plan or obtaining financial assistance.

http://www.omaha.com/index.php?u_page=1219&u_sid=10293524

Comment:

By Don McCanne, MD

The hospitals are not the villains here. By introducing high-deductible plans, the private insurers have relieved themselves of the responsibility of paying for the initial costs of the medical and surgical procedures and services. In so doing, they have placed the burden of obtaining payment of the upfront charges onto the hospitals and health care professionals. Since large medical bills are more difficult to collect after the services have been provided, it is only natural that the hospitals would request payment in advance.

High-deductible plans are a solution that serves the interests of the insurers. Not only are they relieved from paying bills below the deductible, they are also able to sell these plans at premiums that many employers can still afford.

In contrast, high-deductible plans do not serve the interests of most patients. Innumerable studies have now demonstrated that financial barriers impair access to appropriate health care which, in turn, impairs health outcomes. Placing the hospital in the role of the toll-keeper will undoubtedly cause many patients to walk away from the care they should have (if they can walk).

Wouldn’t it be nice if we had a system in which the Admissions Office of the hospital existed solely for the purpose of assisting the patient who is being admitted? Other countries do that. But not us.

We continue to accept the toll-keeper role because it enables the private insurers to thrive. But isn’t it time for us to adopt policies that are designed instead to make patients thrive?

AFL-CIO/Peter Hart health care survey

2008 Health Care for America Survey

Tabulation and analysis by Peter D. Hart Research Associates
AFL-CIO

Over a period of just seven weeks, from Jan. 14-March 3, a total of 26,419 people took the online 2008 Health Care for America Survey sponsored by the AFL-CIO and Working America. Most are insured and employed. Most are college graduates. More than half are union members.

These are the people, it would seem, most likely to have positive experiences with America’s health care system. Instead, their responses tell a sobering story about the breadth of the problems with health care in America. They say our system has fundamental problems that must be fixed.

* The demand for change in today’s health care system is based primarily on deep concerns about costs.

* The failures of America’s health care system, the survey reveals, are a significant factor in broader economic problems facing working families today.

* Having insurance coverage is not insulating families from problems, concerns and dissatisfaction with today’s health care system.

* But people who lack insurance–and those who have children younger than 18 who are not covered–report particularly troubling problems getting the care they need because of cost.

* More than half of survey takers say their health insurance does not cover all the care they need at a price they can afford.

* Medicare is not a shield against unaffordable prescription drug prices.

* Concerns about today’s health care system span all ages, races, education levels and affect the insured as well as the uninsured.

http://www.aflcio.org/issues/healthcare/upload/healthcaresurvey_report.pdf

Comment:

By Don McCanne, MD

This twenty-eight page reports provides statistical data in tables and graphs that demonstrate the level of dissatisfaction with our health care system. Two of the more revealing numbers are that “ninety-five percent say they are somewhat or very concerned about being able to afford health insurance in the coming years,” and “ninety-five percent of respondents say America’s health care system needs fundamental change or to be completely rebuilt.”

If the politicians can’t hear this call for action, they must be deaf.

Federal outsourcing increases uninsured

How Government Adds To Ranks of Uninsured

By Jane Zhang
The Wall Street Journal
March 25, 2008

Covering the uninsured is a central issue in this year’s political campaign. Yet while politicians debate how best to cover the growing ranks of the uninsured, the federal government — by outsourcing service jobs — quietly is adding to those numbers. “As federal employees, we get great insurance,” says (Dr. William Rogers, a medical officer at the Department of Health and Human Services). “People who work as contractors often don’t enjoy those benefits.”

Federal contract employees, including cafeteria workers, security guards and cleaning crews, work on Capitol Hill and in federal agencies across the country. Under a 1965 law, called the McNamara-O’Hara Service Contract Act, most contractors with service contracts of more than $2,500 are required to pay locally prevailing wages, plus fringe benefits or the cash equivalent — $3.16 an hour this year, under a government formula.

Yet some contract employees don’t get either the health insurance or the extra cash. Under the law, employers in industries where health insurance typically isn’t offered are exempt. Other employers don’t comply with the law because they don’t understand it or assume they won’t get caught, say lawyers and consultants who work in the field.

Some contract workers who get the $3.16 in extra cash use it for rent, food or other things rather than health insurance. Federal contract workers — even if they wanted to pay for it — aren’t eligible for coverage offered to regular federal employees.

Outsourcing of federal-government jobs reflects the same cost-cutting imperatives that drive private businesses to outsource. The U.S. government keeps tabs on how much it pays contractors, but no government agency keeps a tally of the workers who are employed or how many have health insurance. Paul Light, a political scientist at New York University’s Wagner School of Public Service and a specialist on government employees, estimates that in 2005, there were 5.4 million federal service-contract workers, double the number in 1990.

About 80% of those, he says, are lower-wage workers, the ones less likely to be offered or to obtain health insurance. “A substantial number of lower-level white-collar and blue-collar contract workers do not have health insurance,” Mr. Light says. “Either they don’t purchase it or aren’t provided it through their employer,” he says.

http://online.wsj.com/article/SB120640675912461079.html

Comment:

By Don McCanne, MD

We won’t get it right until we’re ready to automatically enroll absolutely everyone in a single national health program. Until then, even the government will game the system.

More on wages and health care costs

Rising Health Costs Cut Into Wages

By Michael A. Fletcher
The Washington Post
March 24, 2008

Recent history has not been kind to working-class Americans, who were down on the economy long before the word recession was uttered.

The main reason: spiraling health-care costs have been whacking away at their wages. Even though workers are producing more, inflation-adjusted median family income has dipped 2.6 percent — or nearly $1,000 annually since 2000.

Employees and employers are getting squeezed by the price of health care. The struggle to control health costs is viewed as crucial to improving wages and living standards for working Americans. Employers are paying more for health care and other benefits, leaving less money for pay increases. Benefits now devour 30.2 percent of employers’ compensation costs, with the remaining money going to wages, the Labor Department reported this month. That is up from 27.4 percent in 2000.

“It is clear that benefits have been the biggest issue on collective bargaining tables and in company compensation calculations,” said Thomas A. Kochan, an economist at the Massachusetts Institute of Technology. “They eat up scarce dollars, and that limits the amount of money firms feel they can put on the table for wage increases.”

http://www.washingtonpost.com/wp-dyn/content/article/2008/03/23/AR2008032301770.html

Comment:

By Don McCanne, MD

This report is further confirmation that increases in health care costs are not being absorbed by employers but are being passed on to employees in the form of forgone wage or salary increases. Since the percentage of compensation in the form of health insurance is inversely related to the income of the employees, this is a regressive method financing health care. Furthermore, higher-income individuals also receive a greater tax subsidy for employer-sponsored coverage than do lower-income individuals. Thus employer-sponsored health care financing is doubly regressive. Lower-income individuals pay a much higher percentage of income for their health care benefits than do higher-income individuals.

The employer role in most current proposals for reform ranges from a mandate for employers to provide private coverage for their employees, to removing the employer from any role while shifting the responsibility for obtaining coverage to the individual. These proposals are flawed for many reasons, but one of the most important is that the premium for private plans is determined by the benefits provided and not by the income of the beneficiaries. Whether paid directly by the employee or nominally by the employer, health care financing remains regressive.

Some proposals would attempt to correct this by providing refundable tax credits on a sliding scale based on income. But this would produce an administrative nightmare. The tax credit eligibility for each individual and family would be in a constant state of flux because of changes in employment status, income, family size, plan availability, eligibility for public programs such as Medicare, and numerous other potential factors that might be considered to improve equity. Adding more administrative complexity to a system already overburdened with profound administrative excesses doesn’t make sense from a policy perspective.

Rather than assigning a fee (insurance premium) to an individual or family based on an insurance product, it would be much simpler and much more equitable to assign a tax or combination of taxes, based on ability to pay, that is contributed to a universal risk pool that covers everyone. Plus the administrative savings would go a long way toward financing care for those currently left out of our system. And isn’t it really our goal to provide affordable care for everyone?

Why Not Health Care?

by Jeff Crosby
AFL-CIO Weblog
Feb 22, 2008

Andy, an IUE-CWA Local 201 member, looked at his pension check from General Electric as he sat in my office at the union hall. The local vice president and the president of the retirees association usually respond to benefit questions like this. But they were both on vacation, and I was struggling to catch up and be of some help.

“I got the $40 raise you told us about in December” he told me. “Then in January, I lost it again, plus another $6. What good was it? What happened?”

A conference call or two later, and we both knew three things had happened. In December, his pension went up $40. In January, his health care went up $46. So when the dust settled, his pension check dropped by $6. And keep in mind that he is one of the lucky ones: The share of employees offering any group health insurance at all to their retired workers dropped from 66 percent in 1988 to 33 percent in 2007.

We fight and fight, but health care costs are killing us. And you can’t bargain your way out of this mess. Understandably, getting the labor movement on the same page on a specific plan to fix health care is no easy task. I can’t even get all the local unions in my labor council to support the same person for school committee!

Still, we hope for another chance for health care reform in January 2009 if we do well in the elections this fall. The buzzwords are flying for health care reform: “Secure,” “Affordable,” “Universal” and “Quality.”

The “universal” part will peel off a Republican or two. They just think that people make bad health care choices; it’s their fault if have lousy health care. As some mainstream economists would have it, bad choices in the health care market by uneducated consumers are the root of the problem. (Check out a “solution” that targets consumers and providers–and not coincidentally leaves the drug companies and insurers off the hook–as offered by the former head of GE’s medical center in Lynn, Mass., and Newt Gingrich.)

There are winners and losers, right? Someone explain that to Andy the next time he drops by the union hall.

The problem is this: Practically everyone uses the same words when they talk about reforming health care. What elected official is against “secure, affordable, quality” health care? If you use buzzwords that are that broad, or a list of good principles 70 words long, you leave a lot of wiggle room for the next president and Congress to provide lousy answers under the same umbrella. Principles and buzzwords can mean a lot of things to a lot of people.

We have to be very sharp to make an impact.

First, we have to identify what we are for–specifically. The best laws, like Kennedy-Dingle that would expand Medicare to those between ages 55-65 and children under 20, and the Conyers single payer bill (H.R. 676) that would overhaul health insurance completely, are included in our AFL-CIO campaign. Even the proposal to expand Medicare has problems, since in its current, increasingly privatized form, Medicare costs themselves are increasing rapidly. The single-payer approach should be upfront–anything short of that we can deal with later, if necessary, as a compromise.

Second, we have to take head-on the issue of “government” control of health care. We can expect the right wing and health care profiteers to fund a zillion ads suggesting that some government apparatchik will be snuffling through our medicine cabinet and yanking IV’s from our aunt Ethel–even if we say we are talking about government in a “watchdog” role and not “in control”.

The right wing is not moved by fine distinctions, and being on the defensive won’t help us. It’s either the government or the insurance companies and drug companies that make the rules and run health care. And the latter have to get out.

I know, people are wary of big government. The problem of rebuilding support for the public sector in general as a campaign for the public good is more than I can go into here, but it’s arguably the key task of the labor movement today. Sure, building trades folks have problems with the city inspectors when they do side jobs. A buddy of mine got screwed by the zoning board when he tried to remodel his garage. It has taken my brother months to figure out the “Aid and Attendance” benefit from the VA for my dad. Nobody wants to pay taxes, and everybody thinks the governor and the mayor (apparently all of the mayors, everywhere) and his buddies are ripping us off. On the other hand, we know that 82 percent of union members want government to do more on health care. So we think conflicting things, side by side. It’s called confusion. The answer to confusion is clarity, even if it takes a while to get there. It is suggested that if we are asked if we support something like the Canadian health care system, we denounce the question as “scare tactics.” Yet even an article by Stanley Greenberg in the American Prospect last June, which is sometimes circulated as a cautionary note on why we have to soft-pedal government’s role in health care reform, says: “A majority goes so far as to say it’s time to establish a Canadian-style health care system.” If a majority of the American people already support it, why should those of us fighting for health care reform not defend it?

According to our own research, three times as many people think health care in Sweden is better than ours, as compared to those who think we have a better system than Sweden. Sounds like a rejection of the market-driven health care flop in favor of those Volvo-driving socialists.

Give me a chance to argue the guv’mint against the insurance companies and drug companies, and I’ll deliver you the majority every time.

In a catastrophic illness, the insurance companies are appreciated. But I fought my insurance company for five months to get them to pay for treatment of my son’s broken collarbone when he fell snow-boarding at Sunday River in Vermont–the last two months because they would not pay for $5 worth of ibuprofen. I fought my insurance company again when they wanted me to pay for my wife’s mammogram out of my own pocket. The hospital gave the insurance company the wrong Social Security number for my wife (even though she used to work there!), and by the time they corrected it, the insurance company said the bill was submitted too late. So the hospital put collection agencies on me. These were high-level negotiations. As in, “Hey, have you ever broken your collarbone? Well, IT HURTS!”

People like Andy get a little cranky when William Van Faasen, CEO of Blue Cross Blue Shield of Massachusetts, walks off with $16.4 million in retirement benefits–and then, oops, doesn’t quite retire after all and continues to pull down $3 million a year in salary and bonuses as chairman. And we call BC/BS a “nonprofit”.

Quality health care? The American Academy of Dermatology reported you can get an appointment for Botox to get rid of those pesky wrinkles on your face in eight days–but it takes more than three times as long to find someone to evaluate a potentially cancerous mold on the third wrinkle from the left. Free-market health care follows the money. And the insurance companies only want to offer health care to people who don’t need it. Is this some kind of a revelation?

The next time your prescription drug “co-pay” creeps up, remember that the drug companies are making three times the profit rate of the average corporation. Still want your co-pay to foot the bill for the 80,000 full-time salesmen who knock on doctors’ doors to offer “incentives” to push the latest pill?

Medical “free-market efficiency” has one hand in my pocket and the other on my throat. I don’t need another focus group; I need a Louisville slugger.

We’re trying to break out of the “neo-liberal box” of privatization, deregulation and free trade that has been choking us for the last several decades. There is no ducking the argument of government control vs. market-based health care. There’s no shortcut. Health care is not just another commodity.

This is a street fight. We can win, even if it’s not in January. And sooner or later, we have to win this one.

Jeff Crosby is president of IUE-CWA Local 201 in Lynn, Mass., where he also heads up the AFL-CIO’s North Shore Labor Council.

Universal Insurance Could Lift New Mexico

By Winthrop Quigley
Journal Staff Writer
Albuquerque Journal
Friday, June 22, 2007

SANTA FE — Any of three universal health coverage proposals would improve the state’s economy, raise taxes and cause a modest improvement in health, policy analysts said Thursday.

Testifying before the Health Coverage for New Mexicans Committee, a team of consultants said a state-funded single-payer system would be the least expensive way to cover all of the state’s 400,000 uninsured residents. However, a system of state-subsidized vouchers allowing people to buy insurance plans screened by the government would do the most to improve the economy.

The single-payer and voucher systems would require new payroll taxes of between 4 percent and 8 percent, but the taxes would be less than employers pay now because, as publicly funded programs began, their private health insurance premiums would decline or disappear entirely, said University of New Mexico Bureau of Business and Economic Research director Lee A. Reynis.

Deborah Chollet, an economist with Mathematica Policy Research Inc., said total spending on health care is about $6.24 billion in New Mexico today. All proposals offered would increase medical spending as more people received coverage.

Using computer simulations and assumptions provided by supporters of different approaches, Chollet estimated:

Spending would decline to as little as $6.03 billion under a single-payer plan because nonmedical costs would be reduced even while medical spending increased.

Spending would increase to as much as $6.7 billion under a voucher system because administrative overhead would increase along with medical spending.

Expanding eligibility for existing public programs would cost $6.43 billion.

Reynis estimated that any of the three approaches would add as few as 2,500 jobs and as many as 11,400 jobs and increase residents’ total annual income by anywhere between $84 million and $408 million, depending on the approach the state adopted.

More demand for health care would allow the health care industry to increase staffing, generating more wages and economic activity, she said.

Any universal coverage plan, including expansion of existing programs, will depend on increased federal funding, Reynis said.

Bill Wiese of the UNM Institute for Public Health cautioned the panel not to expect too much from finance changes. “The bottom line is universal coverage will probably help (improve people’s health) but the improvement will be modest,” Wiese said.

The health care system will remain stretched even if funding improves, and interventions that make a big difference in people’s health, like improved lifestyles, “are beyond the scope of universal coverage,” Wiese said.

State tax analysts estimated a single-payer or voucher system would raise taxes for some households.

The committee, appointed by the governor and legislative leaders, will discuss the findings today at the State Capitol.

Debate: Is Health Care a Right?

Justice Talking
National Public Radio
3/17/2008

Original Link: http://www.justicetalking.org/viewprogram.asp?progID=653#Segment2

Host Margot Adler speaks with professors Russell Roberts and Dr. Quentin Young about whether or not Americans have a right to health care.

Russell Roberts is a professor of economics at George Mason University, the J. Fish and Lillian F. Smith Distinguished Scholar at the Mercatus Center, and a research fellow at Stanford University’s Hoover Institution. Professor Roberts’ latest book is “The Price of Everything: A Parable of Possibility and Prosperity,” and he also runs the podcast EconTalk.

Dr. Quentin Young is a practicing internist and clinical professor of preventive medicine and community health at the University of Illinois Medical Center. He is the founder and chairman of Health & Medicine Policy Research Group, and co-founder of Physicians for a National Health Program.

Listen to Audio:
MP3 version

Universal health care or universal nightmare?

by Claudia Chaufan
IndyBay Media
Saturday Mar 15th, 2008 9:21 PM

When compared to health care systems of other wealthy economies, the American one comes out as the most expensive, the most unfair, and the worst in relevant health indices (http://www.who.int/whr/2000/en/index.html). While in other countries most health care costs are financed by individuals contributing to a system that guarantees everybody some amount of medical care, in the United States most individuals purchase a commodity in a market, a liability insurance policy (White 1995). This article explains key differences between the two systems, each based on two types of insurance, and the implications of choosing either type for achieving universal coverage.

As the public outcry over our broken health care system gets louder, individual insurance mandates are being hailed as the solution. Individual mandates legally obligate individuals (as opposed to, say, employers) to purchase health insurance for themselves and their families. They are central to Sen. Hillary Clinton’s health care plan, as they were to the (stillborn) Schwarzenegger/Nunez plan for California. But will mandating health insurance guarantee universal access to medical care?

For starters, the numbers don’t add up. As legislative analyst Elizabeth G. Hill noted, there was reason to believe that Schwarzenegger’s plan would have run out of money by the fifth year of operation. And while Sen. Clinton has claimed that with her plan those who are “satisfied” with their current policies can keep them, this promise presuposes that keeping such policies will be possible. But that is precisely the problem: there is no evidence that they will be — quite the contrary. In fact, as the prices of services and premiums continue to rise, employers are increasingly offering policies that are either more expensive or shift costs to the employee, in the form of higher deductibles, co-pays, or coinsurance, when not dropping benefits altogether (Gould 2007).

The deepest problem is confusing universal health insurance with universal access to comprehensive medical care. Clearly, in both cases universal means “everybody”, but a “universal” social health insurance, such as single payer health care reform, and a “universal” health insurance mandate, based on liability insurance, differ in fundamental ways, and the implications of this difference for health reform are enormous.

In a social insurance system, everybody contributes to a system. Because contributions are compulsory and proportional to income — usually a mix of taxes and payroll deductions — and because many individuals participate (a locality, a state or province, or a nation), the system is financially sustainable. Because risk is spread widely, there is no need to separate people into different “pools”, which saves everybody time and money. And because the system consolidates the purchasing power of many individuals, it has the capacity to negotiate prices with providers of medical care. For these reasons, a social insurance system has the greatest capacity to control costs and to provide a guaranteed amount of medical care to all participants.

In contrast, with individual mandates, everybody is compelled by law to buy liability insurance in the “health insurance market”, with policies priced according to individual or group risk (the latter is currently the case with employer provided insurance). The social problem of meeting a people’s medical needs is transformed into a “problem” of millions of individuals and families, “empowered consumers”, who have no choice but to comparison-shop for policies, while weighing their current and future medical needs against other basic needs, like housing or groceries — a “universal” nightmare.

The assumption underlying the idea of mandates is that as “customers” flood the “marketplace”, competition will bring prices down. Which of course may apply to the price of insurance policies, but not necessarily of medical services. Yet the real “disease” in American health care is rising prices of medical care (which is why the price of policies keeps going up). As economists Gerard Anderson, Uwe Reinhardt and collaborators noted, “It is the price, stupid” (Anderson, Reinhardt et al. 2003).

Spiraling, out-of-control prices are a product of a dysfunctional system built upon perverse incentives, among others, an incentive to “cut costs” not by buying in bulk, or eliminating waste, administrative or otherwise, but by denying payment for care and cherry-picking “good” customers (least likely to need health care). This is because those who are in charge of controlling costs are those whose interest in providing health care is only instrumental to the fundamental goal of making profit by selling a commodity: insurance policies. So whenever underwriting helps private insurers deny payments for care, even as it increases administrative waste and leaves people in the cold with their medical needs, insurers are happy to “invest” in it, so long as it contributes to their profit-maximizing goal.

Another key assumption underlying the idea that the solution lies with individual mandates is that shopping for health insurance policies is functionally equivalent to shopping for designer shoes: faced with an offer, a customer is free to take it or leave it. If the price is too high, customers wait for a sale. But, of course, the demand for medical care cannot be likened to the demand for designer shoes. A critical operation cannot be put off until prices come down.

Now proponents of individual mandates claim that insurers will be legally bound to sell policies to everybody regardless of “pre-existing conditions”, and to not rate policies according to “individual risk” (although they can still do so on the basis of “group risk”). But how are we to know, assuming insurers comply, that they won’t “spread” their “losses”, or rather, their foregone profits, to everybody else, and raise the price of everybody else’s policies? Scandal after scandal give us little reason to believe that private insurers will stop selling policies that meet their profit-maximization goals, and will suddenly begin to deliver what they have failed to do for decades.

A system heavily reliant on for-profit health insurance is fundamentally flawed: its ultimate goal is profit, not meeting the health care needs of the American people. Only a system based on the principle of social insurance can meet this fundamental human need because that is precisely its goal. Only such a system constitutes meaningful universal health care reform.

And sound legislation towards this system exists: they are single-payer plans, SB840, the California Universal Healthcare Act, recently vetoed by Schwarzenegger, and HR676, the expanded and improved Medicare for All Act, dismissed over and again by the mass media, by health policy “experts”, and by most politicians as “politically unfeasible”.

But they forget that if health care reform is about anything at all, it is about meeting a fundamental need of the American people, who have shown their collective political power at important crossroads in American history, especially when they are fed up. And because people are fed up, there is in our day hope for meaningful health care reform. Nothing can stand in its way, if the American people demand it.

References
Anderson, G. F., U. E. Reinhardt, et al. (2003). “It’s The Price, Stupid: Why The United States Is So Different From Other Countries.” Health Affairs 22(3): 89-105.
Gould, E. (2007). The Erosion of Employment-Based Insurance: More working families left uninsured. Washington, DC, Economic Policy Institute: 1-24.
White, J. (1995). Competing solutions: American health care proposals and international experience. Washington D. C, The Brookings Institution.

Claudia Chaufan teaches sociology of health and medicine, public health, and health policy at the University of California at Santa Cruz. She is the Vice President of California Physicians Alliance, the Californa Chapter of Physicians for a National Health Program, an organization that supports single-payer health care reform.

Doctor to prescribe cure for health care ills

By BENNETT HALL Gazette-Times reporter

After more than 30 years of practicing medicine, Dr. Don McCanne has devoted himself to prescribing a cure for the nation’s ailing health care system: national health insurance.

“I really have one big message, and that is private health plans are an obsolete model of financing health care,” said McCanne, a retired California family practitioner and former president of Physicians for a National Health Program.

He’ll bring that message to Corvallis this week. At 7 p.m. Thursday, McCanne will deliver a free talk titled “Will Health Care Ever Be Affordable Again?” at Oregon State University’s Milam Auditorium, Northwest 26th Street at Campus Way.

McCanne believes the answer to the affordability question is national health insurance. By bringing all Americans under a single government-controlled plan, he argues, administrative costs can be consolidated, trimming much of the waste from the system.

Another cost driver in the private-payer approach is that it pays for procedures, rather than prevention, although early intervention is cheaper and often more effective. Another problem, McCanne said, is that Americans are far too enamored of costly high-tech diagnostic equipment such as MRIs, even when they can provide only limited help.

“Where it’s of benefit, it’s great,” he said. “But there’s a lot of data that show we overuse health care services for those individuals where there’s no benefit.”

McCanne sees little hope for improvement in the reform plans being offered by any of the leading presidential contenders, all of which he says boil down to variations on the current market-based approach of private coverage.

“Market costs are too high. You can’t just tell the public to start shopping better,” he said. “The private insurance industry can no longer provide us with products that are reasonably comprehensive … and have a premium that’s affordable to average-income households.”

Ultimately, McCanne thinks that things will have to get worse — both economically and medically — before Americans demand real health care reform from their government.

“It’s going to take a grass-roots effort.”

McCanne plans to speak to health care professionals at Good Samaritan Regional Medical Center on Friday before traveling to Portland, where he’ll give another talk to medical providers next Monday.

“Action to bring change depends on education, and a lot of the public and physicians as well are simply unaware of the deep crisis we’re in,” said Dr. Mike Huntington of Corvallis, a former radiation oncologist who helped launch the Oregon chapter of Physicians for a National Health Program, which is sponsoring McCanne’s talk.

“This is a chance to educate providers and the public on what can be done and to give our legislators courage — because they’ll need it.” McCanne’s appearance is co-sponsored by the OSU Public Health Club, Mid-Valley Health Care Advocates and the local chapter of the Archimedes Movement.

screen the Video

The Darkside Cinema, 215 S.W. Fourth St., will hold a benefit screening of “Health, Money and Fear” at 7 p.m. today and Tuesday. The video, a critique of the U.S. health care system, was produced by Corvallis emergency room physician Paul Hochfeld. Tickets are $5, with half the proceeds going to the Oregon chapter of Physicians for a National Health Program.