28 February 2007

Choosing ideology over our children

Next time someone suggests that single-payer healthcare, like they have in Canada, isn't as good as U.S. healthcare, consider the Wilkes family.

Nathan Wilkes' son Thomas, now 3, was born with severe hemophilia. If the Wilkes lived in Canada, Great Britain, Sweden, or any other civilized and wealthy country, they would still have all the stress of caring for a seriously ill child.

Unfortunately the Wilkes live in the United States, a nation that cares so little about its citizens that it allows the Wilkes to be tortured by the ongoing immanent loss of health coverage for Thomas.

Nathan Wilkes spoke outside the Colorado Capitol Building on Monday's Healthcare Day of Action.

He told the crowd that he and his wife learned soon after Thomas' birth that their baby had severe hemophilia. Thomas' treatment cost almost half a million dollars before his first birthday. "When my employer went to renew our insurance at the end of 2004, they found out that premiums were going to go up 36% due to prior claims." Other insurance companies declined to bid for the 150-employee company's business.

Thomas' illness affected every employee at the company, which was forced to switch from a comprehensive PPO plan to a plan with high deductibles. For everyone.

The next year, Thomas' healthcare cost $750,000. Again UnitedHealth boosted premiums. In order to keep the increase down to only 19 percent, employees were were forced to sacrifice even more benefits. Their annual out-of-pocket maximum doubled to $8,000 and copays went up. "And most disturbing of all for my family, we were forced to accept a $1 million lifetime cap," Wilkes said.

Another 12 months, another $750,000 for Thomas' care, and more double-digit rate hikes from UnitedHealth. The Wilkes' out-of-pocket costs are now at about $20,000 a year and Wilkes himself is now virtually unemployable because of his family's healthcare history.

Worst of all, Thomas is nearing the million dollar cap.

What then? The family will probably turn to CoverColorado, which also has a million dollar cap and also has extremely high costs for the family.

"I’m not asking you to pity Thomas or my family," Wilkes said. "We’ve managed to make it this far and we’ll find some way to make it through this crisis. Instead, I need you to consider why we are even in this situation in the first place. I need you to think about what would happen to you and your family if you lost your job, your insurance, or both. What would happen if someone in your family became critically ill and you couldn’t afford to treat them? Or what if you were covered but the cost of this care meant that you couldn’t afford insurance next year?"

How can Americans be duped into thinking that this is acceptable? How can Jews, Christians or Muslims claim to be a people of God and let this happen? The question isn't what's wrong with Kansas. It's rather what the hell is wrong with America?

I can find no mention of similar caps on caring for a child with hemophilia, by the way, in Great Britain or Canada. And you can bet they'd be on the internet, because people are far quicker to complain about public systems than private.

Later in the day, Wilkes spoke to the Health and Human Services Committee of the Colorado House It was early afternoon, and a pale Thomas, looking small and fragile, was curled up asleep in a chair next to his mother and sisters.

Wilkes asked the representatives why, when everyone understood that single-payer is the solution to our healthcare crisis, why were we unable to just admit that and get on with it? Rep. Jim Kerr, whose district, 28, is a conservative southwest suburb of Denver, said that single-payer, or "socialized" medicine, wouldn't work. He first pointed to Canada as proof — because so many Canadians come here for care. The crowd got ugly at that point, and needed to be reined in. Rep. Kerr then cited Norway as proof we couldn't afford universal healthcare. The Norwegians use their oil money from North Sea fields to fund their healthcare. What would we use? Poor us! Fat, wealthy Norway!

The fact that the Norwegian government pays less per person than does the U.S. government has so far eluded Rep. Kerr. Paying less per person, the Norwegians cover everyone. Paying more per person, we leave up to a third of our population out in the cold. And I'm counting people like the Wilkes as being out in the cold, even with their "gold-plated" insurance. Wouldn't you?

The U.S. government already pays about two-thirds of the healthcare bill in this country. It already covers most of the sickest people. We could so easily cover everyone that thinking through why we don't is literally sickening.

Little Thomas is not the norm. Most 3-year-olds cost very little in terms of healthcare. So little, in fact, that decent societies don't worry too much about paying for the Thomases. There just aren't enough of them to break the bank — unless, of course, you put profit and ideology before a child's life.

24 February 2007

Denver's Healthcare Day of Action

If you're anywhere near Denver on Monday, Feb. 26, join us for the Health Care Day of Action at the State Capitol.

Here's the agenda from The Bell Policy Center:

Together we will:
• Call attention to Colorado's health care crisis
• Mobilize a movement for health care reform to ensure real voices of Coloradans are taken into account
• Urge our lawmakers to pass legislation that will improve quality, expand access and increase affordability of health care

Where: The Colorado State Capitol Building
When: Monday, February 26, 8:30 a.m. to noon
Details: 8:30 to 8:45 a.m. - Meet at Central Presbyterian Church, 1660 Sherman. Sign in, breakfast & poster-making
8:45 to 9:15 a.m. - Welcome, review the day's agenda & comments: Dede de Percin, Colorado Consumer Health Initiative; Marty Jacobsen, Pastor, Central Presbyterian Church; Mark Wallace, Vice-Chair, Blue Ribbon Commission on Healthcare Reform
9:15 a.m. - March to the Capitol Building from Central Presbyterian
9:30 to 10:00 a.m. - Optional training session: How to be a good constituent, do's and don'ts on talking with your legislators, with Melanie Herrera Bortz, Colorado Consumer Health Initiative, Capitol building 3rd floor, Old Supreme Court Chambers
9:30 to 11:00 a.m. - Meet with your legislators about health care issues, Capitol building 2nd floor
11 to 11:30 a.m. - Health Care Rally and Press Conference with Rep. Ann McGihon, D-Denver, Rep. Ellen Roberts, R-Durango, health care consumer Nathan Wilkes, and Kersten Hostetter, Colorado Alliance for Microenterprise Initiatives, West Steps of the Capitol building
Noon - Legislature breaks for lunch, Health Care Day of Action concludes. (Lunch is not provided.)
Extra optional events:
9:30 a.m. to noon - Informal open house with members of the Blue Ribbon Commission on Health Care Reform, including Elisabeth Arenales, Mark Simon, Mark Wallace and Christy Blakely, at a table outside the Old Supreme Court Chambers, 2nd floor of the Capitol building
Noon to 1 p.m. - Question and answer discussion with members of the House and Senate health & human services committees, with Rep. Anne McGihon, chair, House Health & Human Services Committee, Capitol basement hearing rooms, No. 107

Be prepared:
Wear blue to identify yourself as part of the Health Care Day of Action
Find out who your legislator is from VoteSmart.org
Come with your health care stories

For more information, contact Nora Bashir: (303) 477-6111, ext. 21, or nbashir@fresc.org

9to5 National Association of Working Women
American Cancer Society
American Diabetes Association
ARC of Arapahoe and Douglas
ARC of Denver
Autism Society of Boulder County
Autism Society of Colorado
The Bell Policy Center
Central Presbyterian Church
The Citizens Project
Colorado Academy of Family Physicians
Colorado ACORN
Colorado AIDS Project
The Colorado Alliance for Microenterprise Initiatives
Colorado Budget Crisis
Colorado Center on Law and Policy
Colorado Children's Campaign
Colorado Children's Health Care Access Program
Colorado Citizens for Accountability
Colorado Coalition for the Homeless
Colorado Coalition for the Medically Underserved
Colorado Consumer Health Initiative
Colorado Cross Disability Coalition
Colorado Developmental Disabilities Council
Colorado for Health Care
Colorado Hospital Association
Colorado Nurses Association
Colorado Organization for Latina Opportunity and Reproductive Rights (COLOR)
Colorado Progressive Coalition
Colorado Society of Clinical Specialists in Psychiatric Nursing
Community Health Charities
Denver Area Labor Federation
Denver Healthy People 2010
Family Voices, Empower Colorado, Parent to Parent
Front Range Economic Strategy Center
GLBT Community Center of Colorado
Health Care for All Colorado
Latina Initiative
Look Forward
Lupus Foundation of Colorado
Lutheran Advocacy Ministries
Mental Health Association of Colorado
Metro CareRing
Metro Organizations for People
National Association of Social Workers
Progress Now
RAIN Colorado/CORA
Rocky Mountain Farmer's Union
Rocky Mountain Stroke Association
Rocky Mountain Synod
Save our Section 8
Sense of Security
Service Employees International Union Local 105
Sisters of Color United for Education
Smart Start: Colorado's Parent and Family Engagement Task Force
Mental Health Association of Colorado
Metro Organizations for People
WE CAN! of Colorado
Women's Lobby

Sen. Sheila Kuehl: patron saint of California healthcare

California State Sen. Sheila Kuehl reintroduced Senate Bill 840 yesterday — that's the same bill with the same number that Gov. Schwarzenegger vetoed last year. This time around it's got 38 authors. There's a rally planned for the steps of the California statehouse on Tuesday. One Care Now, the California organization advocating for the bill, has a page on Tuesday's events.

One Care has a three-minute version of their video explaining single-payer and Sen. Kuehl's bill up on YouTube:

Elsewhere in California, Anthony Wright, executive director of Health Access California, has written a great synopsis of a panel discussion with the Little Hoover Commission — a California state-sponsored group looking at how to make California government more efficient, beginning with healthcare.

Some of the other panelists (Wright himself was one):
• Peter Harbage, senior program associate for the Health Policy Program for the New America Foundation.
• Gerald F. Kominski, Associate Director of the UCLA Center for Health Policy Research
• Glenn Melnick, Professor and Blue Cross of California Chair in Health Care Finance; School of Policy Planning and Development at the University of Southern California

Kominski quoted the Lewin report on what California could expect if the Kuehl bill passed. Initial costs would go up by $25 billion for medical services, but efficiencies (including the use of price controls, reduced fraud, bulk purchasing and $20 billion less spent on private insurance company administration and profit) would save the state $33 billion.
[Commissioner Mitch] Mitchell asked what the minimum basic benefit package should be – and what did panelists think of the $5,000 deductible minimum plan the governor proposed, for those who would not qualify for subsidized coverage.

Kominski laid it out. Such a plan would cost a family about $200 a month -- $5,000 a year.[?] On top of that, the families would still have to pay $5,000 deductible. That’s $10,000 before they even see a dime of coverage. “If these policies were so desirable, why don’t we all have them?’’ he asked.

I said such policies caused families to have to “pay to be uninsured," paying premiums but still facing worse health outcomes and the possibility of medical debt and financial ruin. The other danger of high-deductible plans, he said, is cost-conscious consumers would have to decide which procedures were “necessary’’ and which were not. Half the time, they guessed wrong and forgo preventive treatments that end up making them sicker and costing more money to treat. Some may not also have the cash necessary to pay up front for doctor’s visits.

Mitchell asked why it would not be sufficient to have a high-deductible plan that also covered preventive services. While some high-deductible plans do allow for preventive services, they’re limited, I said. And if a consumer has a chronic disease, such as diabetes, asthma, heart disease, which require regular doctors visits and medications, such a plan would not work for them. Chronic diseases are also the largest cost drivers in health care, and to exclude such coverage would just make matters worse, experts said.
I read this and also Wright's group's blog on the commission, and they sure sound similar to the 208 commission in Colorado.

They're a bunch of bright people doing their best to get around the fact that the solution to the healthcare crisis is blindingly obvious yet somehow off limits.

Actually, maybe the California commissioners aren't all that bright. Commissioner Daniel Hancock suggested that Medi-Cal patients be “timed out" of their entitlement benefits — as welfare recipients were put on a five-year lifetime limit during the 1996 welfare reform.

Now there's a plan. Just because millions of Medi-Cal enrollees are seniors or people with disabilities – on respirators, wheelchairs — doesn't mean they can't get work. Let them join the rest of the working poor. Wheelchair-bound or not, they could all pay $11,000 plus annually for health insurance if they stopped squandering their money. The back of a Buick is a fine place to raise a family — or come home to in those golden years after a hard day's work at Burger King.

23 February 2007

Neoliberal Republic promises change

Kevin Drum links to Politico, which reports that a Canadian company has bought The New Republic, and promises improvement. The new boss says they’ve already become more liberal, having used the first issue under new management to endorse universal healthcare and “retract” a piece from 1994 that attacked the Clinton health plan.

They’ve evidently come around to believing that all Americans should have healthcare. A good thing, although I have a sneaking suspicion that their kind of universal healthcare involves mandates, tax breaks, and expanded current programs. Just a guess, since this particular magazine (their name escapes me, now that I’ve put 50 words in between reading it for the last time) puts almost all its articles behind a firewall, and I don’t like them nearly enough to subscribe.

But since they’re remaking the magazine anyway, I have a suggestion. Change the name. I cannot come up with a mnemonic good enough to keep The New Republic separated in my mind from the National Review. I’m not the only person troubled by this, unless a lot of people have patronized me about it over the years.

National Review: conservative, founded by William F. Buckley; can access most of their articles online

New Republic: so aligned with the Israel lobby that they were in favor of the Iraq war, but otherwise middle-of-the-road, slightly conservative; yet often mistakenly batched with liberal publications; can’t access most of their articles online

But they’re both NR, see? If you’re going to have a political magazine with a two-word name, it should be something strikingly different. Like the Weekly Standard (WS), or the American Prospect (AP). No confusion there whatsoever. Or even better, go for the gold, and have a one-word name: the Nation.

If they insist on an NR name, maybe The Neoliberal Republic. (Since Weekly Standard already has "neoconservative" locked up.) That might even be a way for me to remember who they are.

1993 redux

There was Tom Tomorrow's This Modern World's take on the fearsome specter of healthcare reform:
And then there was this:

What does this cartoon say?

Is the point that Americans don't know what to be scared of? Is it that the Clinton health plan was truly scary?

22 February 2007

$4 trillion for the status quo

Most papers ran a version of the story on healthcare costs doubling by 2016 — according to the Centers for Medicare & Medicaid Services’s deputy director John Poisal, who wrote it up for Health Affairs.

Poisal predicts healthcare costs to go up 6.9 percent a year — not bad, he says.

Karen Davis of the Commonwealth Fund begs to differ, saying that the spending is unsustainable.
Health care is expected to account for $1 of every $5 spent in the United States in another decade.

That means a rise in out-of-pocket expenses, such as the copays for medicine, from about $850 this year to about $1,400 in 2016, a 5.3 percent annual increase.

The cost of health insurance is projected to rise even more quickly during that same time - 6.4 percent annually.

Over the coming decade, spending on health care will continue to outpace the overall economy. By the year 2016, it will total nearly $4 trillion, economists at the Centers for Medicare and Medicaid Services said in a report being released Wednesday.

Today, the number is closer to $1 out of every $6, or $2 trillion.

Consumers are spending more on the latest treatments, despite their rising costs. For example, federal officials cite a significant increase in the use of imaging to detect blockages or other diseases.
Dr. Mark McClellan, who used to oversee Medicare and Medicaid, defended the increase by saying that it has bought a lot of people longer lives.

The story nowhere notes that citizens of other industrial countries live even longer than we do, and that they pay far less for it.

Remember that these numbers are without any reform — still leaving 15 to 30 percent of Americans uninsured or underinsured.

Or more — Poisal notes that employers will be asking workers to pay a greater percentage of the costs.

In fact, more employers will drop coverage all together with those kinds of price hikes, and more individuals and families will also drop their coverage.

I didn’t have health insurance for years when my son was little. I did what millions of single moms do — hoped for the best. We were healthy and I figured that if something awful happened that I’d pay for it. Or go on welfare, and the government would pay for it.

That’s the mindset of tens of thousands of families who are scraping by. Our big dinner out, maybe once a week, was to McDonalds, where I bought Josh a kids meal, I ate some of the fries, and we played in those plastic balls. I remember knowing that the only way I could have afforded healthcare would have been to get fired and go on welfare.

SCHIP programs have expanded since then, so that more kids can get coverage. Although like with everything else in America, it’s still survival of the fittest. Until they go through with reforms that automatically cover kids who are, for instance, eligible for reduced cost or free lunches, there will be a lot of kids whose mothers cannot think clearly enough to get their kids covered.

These are the moms schools call every year to let them know that their kids cannot come to school tomorrow because they still don’t have their shots.

That’s because mom can barely juggle work, daycare, and home — much less think through getting her kids covered.

It’s a bit crazy that Medicare, which up to the prescription benefit Part D launch in 2006, paid only 2 percent of prescription drug spending. Now that number is 22 percent. Part D is a poster child of how not to do healthcare reform. There’s just no way it’s sustainable. And shame on those folks who insist that there should be no formulary, that it should cover every medication at any price.

These moms would still have a tough time in Britain or France — because life is hard for single moms. But it doesn’t have to be so hard for the kids, with what we used to call a safety net and what British conservatives sneeringly call a nanny state.

To which Polly Toynbee, one of my favorite Guardian columnists, asks what’s wrong with that?

Me too, Polly. I always wanted a nanny to help. Let those politicians who deride the concept try single parenting for a while, especially moneyless. They’ll be wanting a nanny too.

21 February 2007

One way to pay for single-payer

The McKinsey Report suggests that savings would be greater than this pie chart shows.

In Ohio, they're proposing a payroll tax increase — but only by eliminating the $90,000 cap. They'd collect it on all payroll income, plus a 5 percent surcharge on income earned beyond $200,000.

They would also have an employer tax of up to 3 percent and an income tax increase of up to 3 percent — depending on what costs actually were. Because despite all the modeling, we don't know how much we'd save by eliminating the gross inefficiencies of our current system. It might be just 1 percent in both catagories.

I've seen another model recently that showed that if a person made more than $200,000 a year they'd pay more for healthcare under that single-payer system. Everyone else would pay less.

Which would you prefer: People who earn $250,000 a year paying perhaps $4,000 more annually for healthcare, or people dying because they can't afford it at all?

Hillary: burned once

Jeff Cohen asks, Will Healthcare Timidity Trip Up Hillary Clinton?

Cohen begins by quoting the Washington Post on Hillary in Iowa:
In keeping with her expressed desire to hold a “conversation with Iowans,” Clinton asked at one point for a show of hands from the audience, asking them to declare whether they preferred an employer-based system of insurance, a system that mandates all individuals to purchase insurance, with help from the government if necessary, or one modeled on the Medicare system. Overwhelmingly the audience favored moving toward a Medicare-like system for all Americans.
Cohen then goes on to write about how the people are way out ahead of Hillary, that healthcare may become a dividing line between Democratic candidates, how Hillary never championed single-payer, but stood resolutely against it in the 1993 debacle.

It was Sen. Paul Wellstone, Conyers and Rep. Jim McDermott who were behind single-payer. Hillarycare would have created a convoluted system to keep insurance companies at the heart of the U.S. medical system while appearing to reform it. Cohen warns us not to expect the mainstream media to get anything right this time either.

He ends on this upbeat note, however:
Last November’s election has already changed the terms of the national debate on Iraq. If progressives mobilize, we can also use this moment (and the upcoming presidential primaries) to transform the healthcare debate.

And one day soon we may get what other advanced countries already have: a healthcare system that works, with nonprofit insurance for all.

208 Commission news

Colorado's 208 Commission met today at the Colorado Association of Commerce & Industry.

The meeting was the usual mix of boring and curious. It began with the commission's final drafts of their solicitation for proposals to comprehensively reform healthcare in Colorado and their RFP -- that's the request going out in the high-priced business world of economic healthcare systems modeling. A company called Lewin does most of this, but Price Waterhouse Coopers and other companies bid and sometimes get the job as well.

Commissioners went back and forth over the definition of “comprehensive” — as in comprehensive reform — as they’ve done from their first meeting. Commissioner Dr. David Downs, president of the Colorado Medical Society, sensibly said that comprehensive means that a proposal will markedly improve costs, quality and access.

A question came up about what proposals would do to safety net providers, which led to a vote on the definition of safety net.

Pam Nicholson, vice president in charge of advocacy and community partnerships at 
Centura Health, noted with some asperity during this discussion that hospitals have to provide care to everyone who shows up at their doors, whether it’s part of their mission or not. You'd hate to see what Centura's vice president of finance would add to that comment about Centura's mission.

A commissioner from rural Alamosa argued that the safety net is only in place because the system isn’t working. “We’re not here to protect the safety net, we’re here to reform the system.”

Bill Lindsay, president of the Benefits Group, Lockton Companies of Colorado, Inc. and chair of the commission, noted that the question about the safety-net doesn’t mean that the commission would preclude proposals that affect the safety net, but they want to know how it will affect it. “If the changes mean that there will be no need for a safety net after the reform is implemented, that’s fine,” he said.

The report from the evaluation committee was deadly stuff, mostly concerned with items such as whether state procurement rules apply to the commission. Final answer: No.

The evaluation firms will model not only the three to five best proposals, but also what would happen if we do nothing.

Commissioner Linda Gorman, director of health policy at the libertarian Independence Institute, wanted potential effects on innovation, capital formation and consumer choice included in points the evaluation firm would model. Now this is an economist, arguing that you can model health reform's effect on innovation.

Gorman, who is easily the most entertaining commissioner just by virtue of her outrageous statements, also argued over what access meant. She said that if she has a policy that doesn’t give her access to a specialist, then she doesn’t have access. On the other hand, she added that the OECD keeps complaining how uninsured Americans don’t have access to health care, when in fact they do.

She has many times argued that being uninsured doesn't mean that a person doesn't have access to healthcare in America. They go to emergency rooms! Having a policy that doesn't give her access to a specialist, on the other hand, is clearly an issue.

Gorman successfully proposed removing the requirement that firms bidding to evaluate Colorado's proposals have experience doing evaluation in other states. Gorman argued they simply have experience with states OR equally-sized entities, which Lisa Esgar, director of operations and finance, Department of Health Care 
Policy and Financing, State of Colorado, offered could be commercial establishments.

Gorman also successfully removed the requirement that firms applying to be the evaluator submit three letters of recommendation. They now only have to submit three names and phone numbers for references. The commission's staff member was told she didn’t need to call them.

Esgar showed up and had a couple good points to offer — although not the one about commercial establishments — in the midst of what must have been a rough week. She was one of a couple dozen state political appointees to whom the outgoing Republican governor had promised tenure. No way, Colorado's newly elected Gov. Bill Ritter made public this week. Esgar was making $126,000 a year. Ouch.

For those of us hoping to bring true reform to Colorado, the commission's timeline feels like a race to educate — mostly our neighbors, but also the commissioners and legislators.

The commissioners may actually be the toughest students. Most of them are already expert in one or more field of healthcare, which leads them all to think that they're experts in every field. To varying degrees that see the whole through the narrow window of their own experience — and the more extensive that experience, the harder time they have turning to look at the whole.

It's like listening to theologians decrying the anathema of relative morality, completely unable to see what the average person sees perfectly well: That sometimes a rational fourth person would jump off a raft in the middle of the ocean that could only carry three.

The pity is that we've got a healthcare raft that could easily care for everyone if we stopped the for-profits and insurance companies from poking it full of holes. But these particular theologians either can't imagine a different reality, or they're convinced that the hole-pokers can't be stopped, or they're one of the pokers, or they absolutely believe that people should have the freedom to poke holes in whatever they please.

19 February 2007

Single-payer bill heard in MD

The Maryland House of Delegate’s Committee on Health and Government Operations held a hearing Friday on a single-payer healthcare bill.

HB 400 and its companion bill SB 474 are sponsored by 25 General Assembly members, all Democrats. The committee will hear from citizens "who claim to have sub-standard insurance," according to the Baltimore Chronicle.

Maryland Universal Health Care Action Network has more on their website.

Minnesota docs prefer single-payer

Impressively, 63.4 percent of Minnesota physicians said a single-payer healthcare system would offer the best healthcare to the greatest number of people. That's quite a few more than the 25 percent of physicians who thought health savings account systems were best, or the 11.8 percent who were in favor of managed care.

It's not the best study in the world — the University of Minnesota mailed out a thousand questionnaires to randomly chosen Minnesota physicians, got 39 percent back and called it good — but you can't really say that pro-single-payer doctors would be more likely to mail it back than other docs. They'd be more likely to mail it back than doctors who didn't know or didn't care, but it's probably actually the anti-single-payer physicians who would be most anxious to get the survey in.

The tide's not moving in their direction, after all.

Challenging the Dems

That was then, this is now, but Steven Colbert continues to fiercely, relentlessly support a still-unappreciative Bush.

I missed Colbert's television explanation of Bush's health plan, but it translates well to print: "It’s so simple. Most people who can’t afford health insurance also are too poor to owe taxes. But if you give them a deduction from the taxes they don’t owe, they can use the money they’re not getting back from what they haven’t given to buy the health care they can’t afford."

Exactly. Cornell professor Robert Frank used the Colbert explanation as his lede in the NYT, following it up with a great challenge for the Democratic candidates to stop being sissies and come out for single-payer healthcare:
As health economists have long known, market incentives induce private insurers to spend vast sums to avoid people who may actually require health care. This problem is mitigated (though not eliminated) by employer-provided group policies. Because Mr. Bush’s proposal would steer people toward individual policies, it would actually strengthen the incentive to shun unhealthy people. Such people can now keep their insurance by not changing jobs. But no private company would want them as individual policyholders at a price anyone could afford.

That Mr. Bush’s proposal will not shrink the ranks of the uninsured is not its most serious problem. Far more troubling is its embrace of a system under which we spend more than twice as much on health care, on average, as the 21 countries in which life expectancy exceeds ours. American costs are so high in part because the reliance on private insurance multiplies administrative expenses, currently about 31 percent of total outlays...

If the single-payer system embraced by virtually all other developed countries is clearly the best solution, why doesn’t the United States adopt it? Some analysts concede its merits, but characterize it as either unaffordable or politically unrealistic. But why should a policy that promises better results for less money be considered a nonstarter?

There are two obstacles, which could both be overcome by intelligent political leadership. One is that the single-payer system would require additional tax revenue. In the current climate, that’s a tough political hurdle, to be sure. Yet how complicated would it be to explain to voters that because the single-payer plan would reduce costs substantially, every additional tax dollar would be offset by an even larger reduction in private insurance spending? Given that such a system is so much cheaper over all, calling it unaffordable makes no sense.

The second obstacle is opposition from private insurers, who would be understandably reluctant to abandon multibillion-dollar annual profit streams. Those who stand to lose from policy changes always battle harder than those who stand to gain — an asymmetry that is exaggerated when losses would be concentrated and gains diffuse. So, yes, the insurance industry would bitterly resist...

[F]orceful advocacy of the single-payer approach offers a golden opportunity for any serious presidential candidate. Voters are fed up with rising insurance costs and dwindling coverage...

Critics of the single-payer plan have long railed against the specter of socialized medicine, suggesting that it means being treated by government functionaries. Yet people who have experienced single-payer coverage firsthand seem unconcerned. When one of my sons needed surgery for a broken arm during a sabbatical in Paris, for example, the medical system we encountered was just as professional as the American one and far less bureaucratic. And in France, which spends half as much on health care as the United States and has more doctors and hospital beds per capita, everyone is covered.

We live in challenging times. Does a candidate who couldn’t persuade voters to embrace the single-payer approach deserve to be president?
Bravo. Are you listening, Hillary?

Obama? You there?

18 February 2007

Why U.S. healthcare costs so much

Both Paul Krugman and Steven Pearlstein wrote this week about a January report from the McKinsey Global Institute on accounting for the cost of U.S. healthcare.

Pearlstein, in the Washington Post, writes,
Even after adjusting for wealth, population mix and higher levels of some diseases, McKinsey calculated that we spend $477 billion a year more on health care than would be expected if the United States fit the spending pattern of 13 other advanced countries. That staggering waste of money works out to 3.6 percent of the nation's entire economic output, or $1,645 per person, every year.

In laying out with remarkable clarity how and where we overpay, the McKinsey report punctures myths, exposes common misconceptions and highlights realities long ignored in the health-care debate.

Let's start with one the American Medical Association hopes no one will notice, which is that American doctors make a lot more money than doctors elsewhere -- roughly twice as much. The average incomes of $274,000 for specialists and $173,000 for general practitioners are, respectively, 6.6 and 4.2 times those of the average patient. The rate in the other countries is 4 and 3.2.
Pearlstein outlines why the doctors' arguments fall flat against the evidence in regard to why they deserve so much.

He also reports on other sectors of waste, like the pharmaceuticals' outrageous profits in the United States. He ends up with insurance companies' overhead:
Proponents of a government-run "single-payer" system will certainly home in on the $84 billion a year that McKinsey found that Americans spend to administer the private sector portion of its health system -- a cost that national health plans largely avoid. But as long as Americans continue to reject a government-run health system, a private system will require something close to the $30 billion a year in after-tax profits earned by health insurance companies. What may not be necessary, McKinsey suggests, is the $32 billion that the industry spends each year on marketing and figuring out the premium for each individual or group customer in each state. Insurance-market reform could eliminate much of that expense.

Of course, any effort to reduce these excess costs faces determined opposition from well-financed lobbies, which is why many reformers prefer to focus on the goal of extending coverage to the 47 million Americans who don't have health insurance. But doing the one without the other, the McKinsey researchers warn, would be economic folly. Offering universal coverage without reining in costs would add another $77 billion each year in unnecessary and unproductive health spending.
The problem with this analysis is that Pearlstein is saying Americans reject something that a majority of us have said we would prefer.

Will the McKinsey Report sway Colorado's 208 commission, or any of the other state entities considering reform? Will it help progressives at healthcare institutes and foundations move forward? The good people at the Colorado Consumers Health Initiative have reportedly decided to submit a proposal that is based on expanding assistance without reform to the Colorado commission. This is evidently the default liberal position, and it's part of why people have lost faith in the Democratic Party.

You can read Krugman at Welcome to Pottersville, and also the great comments from readers.

Krugman not only cites the McKinsey Report, he ledes with this:
Is the health insurance business a racket? Yes, literally — or so say two New York hospitals, which have filed a racketeering lawsuit against UnitedHealth Group and several of its affiliates.

I don’t know how the case will turn out. But whatever happens in court, the lawsuit illustrates perfectly the dysfunctional nature of our health insurance system, a system in which resources that could have been used to pay for medical care are instead wasted in a zero-sum struggle over who ends up with the bill.

The two hospitals accuse UnitedHealth of operating a “rogue business plan” designed to avoid paying clients’ medical bills.
Can you believe it? That a company led by a CEO who went into forced retirement last year with $1.6 billion in illegal back-dated stock options, is afloat in a culture of corruption?

Could this be the true meaning of "trickle down"?

How can AARP continue to justify using UnitedHealth as their insurer?

For those of feeling jilted by Krugman's embrace of John Edwards' incremental reform plan, his finale to this piece may be more of the same.
McKinsey estimates the cost of providing full medical care to all of America’s uninsured at $77 billion a year. Either eliminating the excess administrative costs of private health insurers, or paying what the rest of the world pays for drugs and medical devices, would by itself more or less pay the cost of covering all the uninsured. And that doesn’t count the many other costs imposed by the fragmentation of our health care system.
How can we possibly get rid of "excess" administrative costs without getting rid of the insurance companies themselves?

Unruly mobsters

SadButTrue and the rest of the unruly mobsters at Les Enragés have an entertaining layout right now, including this. Those Canadians...

This poster reminds me that in early 2001 Bush said that he saw himself as a president in the mold of Harrison Ford, in Air Force One. And you could see that in the early years, couldn't you? He was like a little boy, strutting around, pretending to be Harrison Ford pretending to be a macho president.

17 February 2007

Looking at limitations

The Catholics teach that it's a moral good to embrace a philosophy of abundance. Meaning that God will provide, and that there are no limitations in faith. That fits right in with the American ideal of the frontier and the "American dream" — where there are also no limitations. There's always more land to develop and each one of us has the personal potential to become a millionaire, if only via the lottery. We don't think about the world's absolute finiteness, and we certainly don't want to hear about restrictions.

This paradigm's tragic results have been an ongoing theme for Colorado's former Gov. Richard Lamm. He served three terms, despite his proclivity to consider public policy in philosophical terms, a decidedly European quality for an American politician. Lamm talked about hard choices in healthcare long before most people were willing to admit that Americans already ration it by income. "Public policy must find a way to prioritize what benefits are covered instead of which citizen is covered," he writes.

Lamm is now a professor at the University of Denver's Institute of Public Policy Studies, where he's also co-director. He's also executive director of the Center for Public Policy & Contemporary Issues. There's still philosophy in the mix, perhaps a la Peter Singer, who also infuriates people by the fact that what he says is so easily taken out of context and seen as dangerous relativism.

And in fact, the common good can be perversely used to foster injustice. The film Damaged Care was the true story of how Humana and other HMOs got it wrong by rationalizing not providing expensive care supposedly so that they could provide more care to other patients. Laura Dern plays a physician who denies coverage to a man on his way to a heart transplant that would have cost $500,000. As she leaves Humana's headquarters, she passes by an extravagant new fountain. Its pricetag: $450,000.

We don't hear about problems with limitations on care in other industrialized nations, which all guarantee healthcare to all their citizens. There were stories for a while from Great Britain, but that was under Maggie Thatcher, who was trying to drown their national health system in a bathtub (a tub now owned by Grover Norquist).

The question of understanding how to use rapidly advancing technology ethically will remain with us as long as we continue to advance technologically. But I'd posit that abuses are more likely to arise when the profit motive becomes involved.

Healthcare, and the conundrums that arise in relation to it because of our American philosophy of abundance, are the subjects of two books by Lamm. He wrote The Brave New World of Health Care in 2003, and a new book is due out this June, Condition Critical: A New Moral Vision for Health Care.

Lamm wrote an article with a similar title for the World Future Society, in which he made several good points, including:
Public policy should concern itself more with extending the health care floor than raising the research ceiling. Public policy makers must care about the health of the total society as passionately as health providers care about an individual's health.
That has largely been missing in the United States — something that public health folks write about over at the American Journal of Public Health.

The healthcare mess is not unlike our crazy system of development — which is also something that Gov. Lamm has thought a lot about. He's the guy, remember, who said "If we don't build it, they won't come" — and said no to a Winter Olympics coming to Colorado.

Denver sprawled anyway, but I remember that at the time, I was pretty enthusiastic about our iconoclastic governor just saying no.

The point is that our philosophy of abundance — that no one should ever say no to advances in heroic medicine, for instance; or that no one should ever say no to another sprawling development — exists without regard to the fact that we live in a finite world.

It leaves us with gross misallocations of healthcare, with the wealthy getting MRIs just because they're insured and their doctor will make an easy $500 if he orders it, and the poor and middle class going without basic primary care.

It also leaves us with eye-watering sprawl that most people don't even seem to see. Its meanness no doubt affects everyone who drives through: Do we really all have to read Jane Jacobs or James Howard Kunstler to actually see?

We're wrong to think that acknowledging limitations will make us less. It's like editing. One of the reasons blogs can go on and on is because there's no editor involved. Really. Someone saying that's too many words — or eating up too much land or resources — can actually make a system better, not worse.

JFK all the way

I took a quiz and now know that JFK is my presidential soulmate.

Thank god someone has the time and energy to do stuff like this so that when the rest of us choose to use our time in this way we can learn with relief that it wasn't a Shrub.

Like when I took a "What's your perfect dog?" quiz and was bemused to learn it was a poodle.

A poodle?

16 February 2007

Giordano Bruno & poetry

It's almost impossible to get a good photo of the statue of Giordano Bruno that stands amidst the riotous flower stalls in the Campo di Fiori.

He's just too shadowed.

The same can be said about the man himself. His biographers say we don't understand him. It's hard to argue the basics, though. Bruno disagreed with the Church about whether the earth was at the center of the universe, with the sun and planets wheeling around us. They burned him for it in 1600. Many of his inquisitors no doubt knew he was right. That only made him more dangerous.

Here's part of Heather McHugh's poem, "What He Thought."

...Giordano Bruno, brought
to be burned in the public square
because of his offence against authority, which was to say
the Church. His crime was his belief
the universe does not revolve around
the human being: God is no
fixed point or central government
but rather is poured in waves, through
all things: all things

Sometimes it takes a poem to understand.

Employed but losing ground...

The Democrats have been in office for less than two months, and already the New York Times is sugar-coating the worsening economic realities of America's working class.

The Times looks at the latest round of factory closings and sees a glass half full (or, as our Dear Leader would say, "a half-glass-full"). Things are actually not so bad. We're not deindustrializing. The Progressive Policy Institute reports that foreign firms invest billions more in the U.S. than U.S. manufacturers invest abroad. That creates hundreds of thousands of American jobs.

This is pap. The United States doesn't have to "deindustrialize" in order to be in a negative spiral that takes us toward Bangladesh and away from Belgium. Our idolatry of celebrity, aristocracy, and wealth; the growing chasm between rich and poor; the hysteria over "illegals"; the growing acceptance of inequality — we're becoming a smaller and meaner America, even if we do still manufacture a fifth of the world's stuff.

The Times calls for retraining workers as the longterm solution. Pro-free-trade politicians risk a protectionist backlash if they don't heed people's pain.
Just to start, pro-trade politicians have to make sure that a lost factory job does not mean a drastic and lasting decline in living standards, with no access to health insurance and no hope for a college education for that worker’s children. As the tide rises, this country cannot allow millions to drown.
The reality for many Americans is worse than that, both in terms of healthcare and higher education. Those costs have risen far faster than average wages. You don't have to lose your job to see little hope of affording real healthcare coverage or something other than community college for your kids.

Healthcare cost comparisons

Healthcare eats up more than 16 percent of U.S. GNP. The average for other industrialized nations, all of which guarantee their citizens healthcare, is 11 percent. Here's what it looks like in a bar graph. Note how low Britain's spending is — it's too bad they don't push it up a point or two, so that they could eliminate the waits.

On the other hand, with all that the U.S. spends, why on earth don't we all have gold-plated coverage?

Now take a look at the dollars spent, per person. These numbers are a couple years old — we now spend more than $7,000 per person. That's including the 17 percent of us who have no healthcare coverage, and for the 17 percent or more of us who are underinsured. We already spend the money. Let's redirect it into healthcare and away from insurance administration and profits.

15 February 2007

Single-payers in the lions' den

The Colorado Health Underwriters Association is hosting the national association in Denver this June. It’s tradition to wow guests with a tourist delight, and the Colorado group decided to take conventioneers on a train that travels up into the Rockies. So they were disappointed to learn that their convention meets a week before the train begins running.

They went to management in hopes the outfit would open up a week early.

No go — although for $35,000 the train company would run the train for that day.

Now where would a little state insurance group come up with that kind of money?

Wait! These guys are part of the second fattest industry in the United States — and before Iraq nudged the oil industry up into number one, they were tops. $35,000 is chump change to this crowd — and sure enough, Humana and Assurant came through with the cash. What a sweetheart deal, wouldn’t you say?

The association’s state president brought that happy news to the Southern Colorado chapter at an “education fair” in Colorado Springs last week.

The Springs has been called the evangelical Vatican for all the right-wing religious groups based there, beginning with Focus on the Family. It’s also home to the Air Force Academy and Fort Carson Army Post — home to the 3rd BCT, 43rd ASG, 3rd ACR, 5th Armored Brigade, 13th Air Support Operations Squadron, and the 10th Special Forces Group. Lots of these guys fall in love with the landscape, the tawny plains running up against the abrupt wall of the Rockies, and have raised their families here.

All in all, it’s become a misplaced piece of Virginia or South Carolina.

And yet Southern Colorado’s underwriters are strangely captivated by the idea of single-payer. Dr. Cory Carroll, another single-payer proponent, spoke to them last year with a fairly hair-raising reception. Evidently he softened them up — either that or their innately Southern manners took over this year in the presence of Health Care for All Colorado’s president and grande dame, Dr. Elinor Christiansen. Audience members may not have believed some of what she told them, but they were mostly polite.

I tagged along to see what kind of questions this crowd would have — and because I had some trepidation about Dr. Christiansen entering this kind of lions’ den. That was even though Eldon VanDerWege, an HCAC member armed with an MBA and a good powerpoint presentation, was already accompanying her.

I shouldn’t have worried.

Dr. Christiansen was born in Beijing, China, the second child of an engineer father and physician mother. She has a ready and gracious smile, but it comes with the sense that she’s also tough and smart.

She reminds me of another amazing woman physician of great courage and stamina: Dr. Cecilia Wood, who runs a clinic for disabled children on the island of Mindanao in the Philippines, a place that the State Department advises Americans stay away from because of terrorism.

Dr. Christiansen also has a remarkable life story: She remembers the Japanese occupation of Beijing, including the day when a Japanese officer casually leaned out from his rickshaw, traveling next to that of the Christiansen children on their way to school. The Japanese soldier lopped off the head of a Chinese man as he passed by.

She worked in inner-city Denver with mothers and children before taking over the University of Denver’s healthcare plan for students — a kind of mini-single-payer plan. Dr. Christiansen is only nominally retired. She works long hours as Health Care for All Colorado’s president.

The underwriters began with business. Their local president spoke unabashedly about the need to give money to Colorado legislators to “financially influence” them.

Working with a local television station’s health fairs would bring “a lot of positive political capital...”

I noted my squeamishness at this bald acknowledgement of the how-to of manipulation — as I expect their lobbyist did as well.

Sure enough, he put the matter back into accepted terms. Money buys access, that’s all.

There was an urgency here in this Marriot banquet room — these women and men (they’re mostly women) need that access. After all, the lobbyist said, there has already been a Republican legislator beating Democrats to the punch in talking up the idea of an insurance “connector.”

“We need to sit down with them and explain why that’s not the best way to go,” he said.

A “connector” does sound ominous, doesn’t it? Kind of Schwarzeneggerian “I’ll be back.” For the underwriters, the word is threatening because it refers to the Commonwealth Connector in Massachusetts, which helps people buy “affordable health coverage” if they don’t have it — in order to conform to that state’s new mandate that everyone have insurance. The Connector offers subsidized insurance to people up to 300 percent of the Federal Poverty Level, and it “connects” small businesses and other individuals to insurance products.

One would think that insurance underwriters would be in favor of a mandate to buy health insurance, but in fact “the Connector” is a government program taking over these people’s jobs — helping people find affordable health insurance.

Which must be an increasingly frustrating job for the percentage of underwriters living in the reality-based community. Has most of the reality-based contingent already left?

As the crowd sitting at round tables on the floor of the small banquet room listened, representatives from Humana, Kaiser, Assurant, Blue Cross and a dozen other HMOs and insurance providers waited on a circular walkway around the room for the breaks that would allow them to explain their “products” to the underwriters. Think about that. There are hundreds of insurance products. Underwriters, to do their job well, have to learn all the arcane loopholes and fine print of as many as possible, in order to give their clients a true choice. It’s a goal that must have actually become impossible years ago, especially for anyone selling to the middle class. But good luck, eh?

The lobbyist also told the group that 5,000 to 6,000 people make their living selling insurance in Colorado, but only 500 belong to the association.

That number came up again when a senior analyst from Colorado’s Department of Insurance talked to the group about consumer complaints against their industry.

Michael Gilles said that his department had recovered $726,000 for consumers in just the past month, and that the figure would be $7 million to $10 million by year’s end.

“We’d like to think that the private sector model fixes problems, but it does not work that way,” he lectured, reminding the group about the Golden Rule.

He said that “cost-effective” products often result in reduced benefits that consumers don’t understand.

“We get the call from someone who says, ‘my agent said that this policy would do everything my current policy does but costs less,’” said Gilles.

“We look at it, and it’s actually dramatically different — not just a little different.”

Gilles said his office doesn’t have problems with association members. The guilty parties were found amidst the other 5,000 agents.

Then it was Eldon’s turn to present his powerpoint slides, which emphasize the lack of cost-effectiveness in our system.

A woman at our table with a “New York Casualty and Life” nametag so audibly and positively responded to his presentation that I worried for her standing with her fellow agents.

Afterwards, one of the questions — accusations, actually — was about waiting for surgery in Great Britain. It’s interesting how waits in Canada and Great Britain symbolize those system’s shortcomings. And it’s interesting that we supporters of single-payer healthcare find ourselves feeling so defensive about those systems — which we all know aren’t perfect. Can humans create a perfect system?

The charge was that Tony Blair was exhorting Britain to improve from its current average of a six-month wait for hip replacements to the European Union standard of three months.

Eldon responded that his sister had to wait a year for a replacement hip — in the United States. Oh.

Eldon also made the point that if his investment broker took 33 percent of his investments — as administration eats up 33 percent of our healthcare dollars — we wouldn’t invest.

Even this audience agreed to that.

Coming up: Dr. Christiansen, Linda Gorman of the Independence Institute, and Rob Rush of Memorial Hospital debate single-payer.

13 February 2007

Time to be counted

There's a lot of guesswork going on about which Democrats are willing to go further than the Rs towards a sustainable healthcare system. That means single-payer — at least in the reality-based world that is based on evidence and past performance.

The three major Democratic candidates are all for covering children and expanding coverage, but neither Barack Obama nor Hillary Clinton will speak in terms of single-payer. John Edwards goes a bit further. His plan includes a public program that would compete with private insurance. Paul Krugman thinks this is a workable avenue to single-payer. A number of other smart observers, on the other hand, think that it would not affect cost-shifting and could not contain costs.

Progressives long ago lost anything but a pragmatic kind of tolerance for Hillary Clinton — much of it based on nostalgia for Bill. That's despite his neo-liberal policies, and rightly so. Anyone still saying that Ds and Rs are the same has not been paying attention for the past six years. We were happier then.

But Obama. Have you heard the man speak? He'll make your heart sense hope and goodness. Obama's not just a competent speaker. He is eloquent in a way that makes you believe it really is morning in America again — an honest, eyes-open sunny day rather than that old Reaganesque "no sacrifices needed, greed is good!" miasma that passed for a sunrise back in the '80s.

On healthcare policy, however, Obama's coming up short.

David Sirota interviewed him last summer, and wrote this:
Obama is all about the art of the possible within the system. “This is a classic conflict within the left: Are you a revolutionary or are you a reformist?” Obama said. “I am less concerned with the labels that are placed on me in terms of what kind of leader I am, and I am more interested in results…. I think within the institutional structures we have, we can significantly improve the life chances of ordinary Americans.” I asked him to give me some specific examples of what he meant. Is a proposal to convert America’s healthcare system to one in which the government is the single payer for all services revolutionary or reformist? “Anything that Canada does can’t be entirely revolutionary–it’s Canada,” Obama joked. “When I drive through Toronto, it doesn’t look like a bunch of Maoists.” Even so, Obama said that although he “would not shy away from a debate about single-payer,” right now he is “not convinced that it is the best way to achieve universal healthcare.”
The Black Agenda Report:
By June 2003, when Obama was a candidate for his current job in the Illinois Democrat primary, we were impolite enough to ask him a direct question about whether he'd support single payer legislation if elected to the U.S. Senate. We asked him: "Do you favor the adoption of a single payer system of universal health care to extend the availability of quality health care to all persons in this country? Will you in the Senate introduce or sponsor legislation toward that end?" Obama's answer was:

"I favor universal health care for all Americans, and intend to introduce or sponsor legislation toward that end in the U.S. Senate, just as I have at the state level."

Already Obama's position on health care had markedly deteriorated. By the following year, Obama was newly elected to the U.S. Senate, and in an interview with BAR's Glen Ford he was asked whether he planned to sponsor the kind of single payer legislation he'd been identified with as a state senator.

Glen Ford: "Are you going to introduce single payer legislation?"

Barack Obama: "No, I am not. Which isn't to say that I'm not interested in the conversation about moving in a direction that expands affordability and accessibility. But my point is that, along that spectrum there are many points that people may arrive at, all of whom affirm the notion that we have a health care crisis that hits our communities much harder than anybody's, but it's everybody's crisis, and we've got to have an agenda in terms of both general health care issues as well as issues like AIDS that are ravaging the African American community."
Obama is at least as distant from single-payer as is Clinton or Edwards.

John Dean and Wesley Clark, on the other hand, have explicitly come out in favor of single-payer. As did Gore in 2002.

12 February 2007

We love California nurses

Wish they were in charge.

Wal-Mart & the SEIU hold hands

Now Wal-Mart and the SEIU have joined together in a coalition for universal healthcare.

Somehow I trust this odd couple more than Families USA and Heritage Foundation. That’s even though I'm proud to still be able to say I’ve never shopped at Wal-Mart.

Nina Owrcharenko of the Heritage Foundation and Kathleen Stoll of Families USA spoke to Colorado’s Blue Ribbon Commission for Health Care Reform a couple weeks ago, explaining “how can strongly held ideological differences be bridged in order to produce consensus on a comprehensive reform plan.”

The answer? It's actually pretty obvious. You just give everyone more of the same. Expand current programs (until the next round of budget cuts) and expand tax credits.

Now there’s a sustainable solution.

Next question: What industry has even more hard-to-remember acronyms than the military? Right. Healthcare policy. So even though the Families USA plan is actually the Health Coverage Coalition for the Uninsured’s plan, and is signed on to by 16 major groups — including Blue Cross/Blue Shield, Kaiser Permanente, Pfizer and the U.S. Chamber of Commerce — let’s just call it the Families USA plan. Or the Give Everyone More Plan.

The Wal-Mart/SEIU plan (aka the Businesses Can't Do It All Plan) also includes other heavy hitters: AT&T, the Communication Workers of America, Intel, Kelly Services, the Center for American Progress,

Other unions’ leaders have criticized Service Employees International Union’s president, Andy Stern, for holding hands with Wal-Mart CEO Lee Scott.

They’ve got a good point. Here’s Press Associates take on Walmart: "...the nation's largest private employer--is known for its expensive health care coverage, skimpy wages, labor law-breaking, mistreatment of workers and the fact that it forces 46 percent of its workers and their families into publicly paid health care programs."

(Now you won’t read that in the “mainstream liberal media.” Not a lot of union coverage there. Hmmm...)

Then again, Jeanne Lambrew (of the Center for American Progress) also has a good point, here with Amy Goodman on Democracy Now!: “Lee Scott said himself in the discussions the other day, he is the head of the largest company in the world, yet this problem is bigger than Wal-Mart.”

Goodman quotes Wal-Mart critics: ““If Wal-Mart is truly serious about universal healthcare, we challenge it to provide universal healthcare to all of its uninsured employees and make universal healthcare a litmus test for its political contributions. We await their answer.”

Lambrew replied that “we, in the US, are fairly unique, in that we have this expectation that goes back decades that our employers will do what government has failed to do, which is to provide affordable access to health benefits. The truth is, the unions -- AFL, SEIU before, when it was part of it -- were really instrumental in making that happen. …. So employers should do the best they can for their employees, and it's a necessary part of the system, but it's not sufficient. We need to kind of build on what we have today, but also create new systems for the people who can't access employer-based coverage.”

As incoherent as that was, this plan is easier to like than the Families USA plan. Sure that's at least partly because there aren’t any specifics out on the Wal-Mart/SEIU plan. Just this statement:
America's health care system is broken. The traditional employer-based model of coverage in its current form is endangered without substantial reform to our health care system. It is being crushed by out of control costs, the pressures of the global economy , and the large and growing number of uninsured. Soaring health costs threaten workers' livelihoods and companies' competitiveness, and undermine the security that individuals of a prosperous nation should enjoy. We can only solve these problems – and deliver health care that is high quality, affordable, accessible and secure – if business, government, labor, the health care delivery system and the nonprofit sector work together.
And these four principles:
1. We believe every person in America must have quality, affordable health insurance coverage;

2. We believe individuals have a responsibility to maintain and protect their health;

3. We believe that America must dramatically improve the value it receives for every health care dollar; and,

4. We believe that businesses, governments, and individuals all should contribute to managing and financing a new American health care system.
That’s not bad.

Especially with Stern saying, "We can't keep tinkering, hoping that incremental change will fix our broken health care system. We need fundamental change, and it is going to take new thinking, leadership, new partnerships, some risk taking, and compromising to make it happen. But that is what we all owe our country."

That's actually far better than Lambrew's "We need to kind of build on what we have today, but also create new systems for the people who can't access employer-based coverage."

Send her back to D.C. with Stoll, where Owrcharenko can tutor the two on Ivory Think Tank rationals for allowing the insurance industry to continue to wreak havoc on us all.

Which side are you on, girls? Which side are you on?

10 February 2007

Conservative values

The first universal healthcare system was passed in 1883 by an archconservative, Germany's Otto von Bismarck. He and other European conservatives saw universal healthcare as a way for Germany to have stronger workers and soldiers. Those conservatives wanted people to contribute to their families and society.
When people are ill, in pain, or disabled, they are less able to take care of themselves or others.

Ties that Bind

By Christopher Juniper

In a capitalist society, it is a worthwhile exercise to identify all the forms of capital that we need for our prosperity. The authors of the LASER system for sustainable economic development planning by a community (LASER stands for Local Action for Sustainable Economic Renewal), of which I am one, identified ten forms of capital that a community must plan to build and preserve to support its long-term prosperity. One of them is “human capital.”

Some object to the phrase “human capital” since it implies that all we are good for is usefulness in wealth production. But the people in the public policy arena who have been using this term don’t have that nefarious purpose in mind. It is instead a recognition that each of us wants to be useful to each other, and sometimes we are useful in a way that we are paid for in the marketplace…but if our human capital (i.e. the ability to do work) declines, we are simply less useful to those we care about, both in personal matters and in the marketplace.

Human health is a core component of our human capital. Along with education, family stability and self-esteem it’s key to making us useful in the world.

To succeed in a capitalist system, we each must be good capitalists. To do that, we make investments that build capital – for today and the future. Thus, we must devise a human healthcare system that maximizes the health component of our human capital. Exactly who pays how much for building this essential part of human capital isn’t as important as that we are building it rather than allowing it to decline.

This week in the Colorado Springs Independent, there’s the sad tale of a young anorexic woman who is too weak to work. Without health insurance or savings, she’s become functionally homeless. A Colorado judge has tried to help her — without success. The woman is presently staying with his mother.

Whether you are suspicious of anorexia as a condition that deserves thousands of dollars to treat paid by the rest of us (i.e. why can’t she just start using some discipline and eat?!) as I am, or whether you believe that people are often victims of their own bad judgment in a way that still deserves our compassion for helping them recover (which a significant minority if not majority of us have done to ourselves)

– But the point is that her human capital – the ability to be productive – is zero, and will only recover if somebody invests in her future through a program that helps such folks. Aren’t we all better off if she returns to being a productive member of society?

We have to stay strategic rather than petty in our approach to building the capital we need. Strategic in this case means not only investing in people; it also means understanding the whole-system that is at work either building or destroying our capital….the ties that bind. And there is no doubt that natural capital (otherwise known as environmental health) is closely bound to human capital (or human health).

In short, it is foolish to focus on health care without also focusing on care for the natural capital that also underpins our prosperity. How silly to deplete natural capital – which includes the clean air, clean water, natural beauty, and the pollination services of bees and other pollinators that allow our food to grow (a vast majority of our food is pollinated by wild pollinators – without them we are in big trouble and they are in worldwide decline).

My message is simply this: don’t consider human capital/human health as separate from natural capital/ecological health. They are inextricably bound together. An investment in one enhances the rate of return on investments in the other. And where they come together most dramatically is in the health care system itself – i.e. whether the health care system we choose to fund – however we fund it – is building rather than depleting natural capital. A sustainable health care system includes minimizing drugs that leave our system and toxic wastes that end up polluting waterways; sustainable cleaning systems for health facilities; minimizing energy use in facilities; and maximizing use of the one clear rule for cost-effective human and natural health: prevention is many times cheaper than the cure.

Author Christopher Juniper is vice-president of Natural Capitalism Solutions Inc., a Colorado non-profit that helps nations, communities and organizations throughout the world enhance their prosperity through sustainability practices. He is also co-founding director of the Sustainability Leadership Institute and serves on the board of directors of CORE – Connected Organizations for a Responsible Economy, a partner non-profit of Colorado’s Advance Center for economic development. Full disclosure – he is also happily married to the usual author of Ave Cassandra, Kristen Hannum, who has become a single-payer activist. Both of us believe that a single-payer system is the most efficient way to build human capital in the healthcare arena, and we believe that building natural capital for the future is equally important.

06 February 2007

Ezra covers Edwards

Ezra Klein gives John Edwards' health plan a good grade in this crib sheet at the Prospect.
Here's how it works: On first blush, the plan is much like the Wyden initiative, though it puts the onus of the responsibility for funding health coverage on employers... The employers can satisfy that responsibility by either providing comprehensive care, or helping employees purchase from a menu of insurance options provided by newly formed, state-run "Health Markets."

As of now, the plan doesn't explain how much employers must provide towards health market coverage, but it's a safe bet to assume that it's somewhat less than the total cost of health care, and so the incentive will be for employers to encourage their employees to purchase from the HMs. And that's where things get interesting. The HMs will offer a menu of private options that are totally community rated. The plan "will require insurers to keep plans open to everyone and charge fair premiums, regardless of preexisting conditions, medical history, age, job, and other characteristics." These days, though, community rating is a common enough.

Where the Edwards' plan takes a big step forward is in mandating, along with the private options, that HMs offer "at least one plan [that] would be a public program based upon Medicare." And the intent is explicit: "Health Markets will offer a choice between private insurers and a public insurance plan modeled after Medicare, but separate and apart from it. Families and individuals will choose the plan that works best for them. This American solution will reward the sector that offers the best care at the best price. Over time, the system may evolve toward a single-payer approach if individuals and businesses prefer the public plan."
At his own site, Klein writes that the media coverage of John Edwards' health plan was bad — snarkily compared to Hillary's 1994 plan in the NYT and just given a mushy "it's a tree" description in WaPo: "Reading their coverage, you'd be hard-pressed to distinguish the plan from any other proposal ever offered," opines Klein.

Klein thinks Edwards' plan is a big step forward, because it will allow the public and private sectors to compete with each other. If that were to be the case, I'd feel better about this plan, even though it does seem to be a long way around to the right solution. However, why would the powerful medical insurance lobby ever allow the public sector to compete on a level playing field? Medicare would have to be adequately funded for that, and all the private sector would need to do is ensure that the people signed on to the public program were subsidizing people who couldn't afford insurance and voila — the public subscribers be getting a raw deal. There would also be the same stigma as riding the city bus in Denver.

Can't afford a car, eh?

Maggie Mahar, author of Money Driven Medicine (2006), writes, in a response to Klein at The Prospect:
We don't have the best healthcare system in the world — patient satisfaction is lower in the U.S. and hospital errors are higher — as are mortality rates for many diseases. End-of-life care in the U.S. is both extraordinarily expensive and cruel.

Yet we spend far more than any other country on health care ($2 trillion, of which about $600 billion is wasted) and that bill has been rising by 6% to 10% a year--more than twice as fast as wages or GDP.

By accepting runaway healthcare inflation we are caving in to the corporate interests now running our health care system: Big Pharma, device-makers, for-profit hospitals and lobbies created by some of the highest-paid specialists who do the largest number of unnecessary sometimes unproven procedures.

These are powerful interests, but unless we face them down, healthcare reform will simply mean universal access to unnecessary, sometimes unwanted care at a price that we cannot afford.

This is not a one-time waste of money (like Iraq)--it is a continuous, ever-escalating expense. We have to get a handle on cost if we have any hope for healthcare reform.

I would love to see the Edwards plan empower the public insurer (Medicare) to use its enormous clout to negotiate serious discounts on drugs and devices. Medicare also needs to stop paying doctors and hospitals for volume (fee-for-service).

On March 1, the Medicare Payment Advisory Commission (MedPac) will be releasing a report March 1 that talks about waste in the system--and alternatives to paying doctors for volume. It will be interesting reading.

Krugman speaks

Well put. We could give every American healthcare for less than than the 16 percent of GNP that we currently spend to just cover some people. But even if that weren't the case, we should provide care for all. It's a moral issue.
What kind of people are we?

05 February 2007

Canada, U.S. waits

So again, what is it with the Canadians and knee surgery?

Their knee surgery rates are up 20 percent in 2005-2006 from the previous year.

Here in the United States, single-payer activists hear about Canadians’ waits for knee surgery almost on a daily basis. To hear “socialized medicine” critics, there are entire provinces of crippled Canadians who have been on waiting lists for decades.

Don’t get me wrong. I understand that while knee and hip surgeries aren’t life-savers, they are quality-of-life-savers.

My grandmother, who lived alone in the house she’d raised her children in, fell off her back porch on New Years Eve in the late 1980s. She came to with her foot next to her head. Being one tough old lady, she dragged herself up the stairs, back into the house, through her kitchen and to the phone in the livingroom. She was never the same afterwards — something that doctors say is often the case for seniors after breaking a hip.

After the actually-elected President Bush had his hip surgery a while back, CNN quoted a doctor saying, “Some patients can't walk from a chair to a bed, but with surgery we can make them almost normal and take away their pain."

So I’m glad the Canadian prime minister and provincial premiers targeted hip and knee surgery as being two of the country’s five “priority” surgeries — reducing waiting times by increasing surgeries.

But I’m also thankful because those waits gave ammunition to the enemies of equitable healthcare — leaving people like me sputtering that no system can possibly be perfect, considering that humans are in charge, but that Canada is doing a lot better than we are.

CNN noted that the cost of a hip replacement was $25,000 in the U.S. in 2000:
A major study published in the Journal of the American Medical Association in 1996 found the operation was cost effective. It found the average lifetime savings of a hip replacement is $117,000. The difference is largely due to savings in nursing care.
“Unless, of course,” muses the health insurance CEO, “you simply eliminate the nursing care...”

That increase in surgeries in Canada was part of a $41 billion agreement between the provinces and the national government that brought wait times down by 20 percent in Ontario, according to a Globe and Mail story.

Some Canadians are traveling abroad for surgery. Bob McDonnell, a high-school teacher, decided to have his surgery done in “the popular medical tourist destination” of Chennai, India.

He paid $7,000, plus $4,000 travel expenses.

The Ontario government reimbursed McDonnell for his surgery, but not for his transportation and lodging. Seems like he should have been reimbursed for that as well, considering he’d been quoted a two and a half year wait:
However, waiting times vary widely, with the queue at St. Joseph's Health Care, London, being the shortest in the province, with 90 per cent of patients obtaining their hip-replacement surgery in 41 days. Compare that to Lakeridge Health Corporation in Oshawa, where Mr. McDonnell was queued: 90 per cent of patients had their surgery done in 370 days, during the same period.

SadButTrue over at Friendly Neighbour and Les Enragés notes that it would be interesting to compare the out of pocket costs for patients on either side of the border who both had hip replacements.

I can’t find the average cost for a hip surgery for an American citizen, but the biggest medical tourism company, MedRetreat, is U.S.-based. Don’t think those Indian surgeons only operate on Canadians.

MedRetreat sends customers to Brazil, India, South Africa, Thailand, Malaysia, and Agentina. They say:
Incredible Savings Why do people travel abroad to undergo medical procedures? The answer is simple...Affordable healthcare. Not to mention a little peaceful relaxation in complete anonymity.

Christian Science Monitor quotes Alain Enthoven, senior fellow at the Center for Health Policy in Stanford, Calif., saying that "Global healthcare is coming and American healthcare, which is pricing itself out of reach, needs to know there are alternatives…"
For critics, Americans heading overseas for care shows the severity of the country's healthcare crisis - especially as employers' health insurance premiums have risen 73 percent while average employee contributions have risen 143 percent since 2000, according to the NCHC [the National Coalition on Health Care]. Rising costs stem from poor management, inefficiences, waste, fraud, and lack of competition, critics say.

"We're seeing some employers who are seriously beginning to think about doing [global healthcare] and not giving employees an option," says Joel Miller, vice president of operations at the NCHC. "And that has implications for quality of care, and what recourse people have if something goes wrong overseas."

Hospital officials say only a sliver of business will be lost to overseas providers. Yet going overseas for expensive medical services, such as heart bypass surgery, cut into US hospitals profit centers - such as heart units - that are used to underwrite emergency rooms and indigent care.

"[Global healthcare] will limit the amount of money that's available for everybody else to have access to the system and starts to jeopardize access to healthcare for everybody in the community," says Don Dalton, a spokesman for the North Carolina Hospital Association.

The Americans who won't know about this, as always are the politicians, many of whom — ex-presidents and Indiana lawmakers, for instance — enjoy gold-plated coverage for life. Now if it's good enough for public servants, wouldn't it be good enough for us too?

If you had a choice...

This from Mike Konopacki, with his permission. Konopacki and Gary Huck are authors of Bye! American, Mad in USA, Two Headed Space Alien Shrinks Labor Movement, Working Class Hero, and Them.

My editor in Portland has a framed aphorism on his wall: "Organized Labor: the folks who invented the weekend."

Americans turn away from organized labor at our peril. Unions are another way of spelling middle-class and American values. Here's what the Catholics say:
The Principle of Participation.
"We believe people have a right and a duty to participate in society, seeking together the common good and well-being of all, especially the poor and vulnerable..."

Without participation, the benefits available to an individual through any social institution cannot be realized. The human person has a right not to be shut out from participating in those institutions that are necessary for human fulfillment.

This principle applies in a special way to conditions associated with work. "Work is more than a way to make a living; it is a form of continuing participation in God's creation. If the dignity of work is to be protected, then the basic rights of workers must be respected--the right to productive work, to decent and fair wages, to organize and join unions, to private property, and to economic initiative"
That's from Jesuit Father William Byron's article in America, on the "Ten Building Blocks of Catholic Social Teaching." He in turn drew from Sharing Catholic Social Teaching: Challenges and Directions--Reflections of the U.S. Catholic Bishops, p. 5.