News & Opinion

Medicine's Sticker Shock

October 2, 2005
New York Times

In the aftermath of Hurricane Katrina, we have an opportunity to construct something far more important than higher levees - a national health care system that looks less like a tightrope and more like a safety net.
A dozen years after Bill Clinton's health reform efforts were destroyed by the insurance industry's duplicity, it's worth trying again. The health care system is steadily becoming more gummed up in ways that are impossible to hide.

 

One of the bumper stickers attacking the Clinton plan read: "If You Like the Post Office, You'll Love National Health Insurance." That wouldn't work today: the Postal Service runs a system that is manifestly more rational and efficient than our health care system. For starters, imagine a postal system that refused to deliver letters to or from 45 million Americans - except on rare occasions, by ambulance.

 

"This is one of those fleeting opportunities where a catastrophe creates an opportunity to rebuild something better than before," says Dr. Irwin Redlener, president of the Children's Health Fund and associate dean of the Mailman School of Public Health at Columbia University.

 

In a sign of the growing disenchantment with our health system, 13,000 doctors have joined Physicians for a National Health Program, which lobbies for a single-payer government-financed health program.

 

There are four main problems with the existing system. First, it leaves out 45 million uninsured Americans, and their number is rising. Second, it is by far the most expensive in the world, costing 15 percent of our national income, yet our outcomes are awful - U.S. life expectancy is worse than Costa Rica's. Third, our business competitiveness is undermined when, for example, medical expenses add $1,500 to the sticker of each General Motors car. Fourth, our system is catastrophically inefficient: according to a study in The New England Journal of Medicine, health administrative costs are $1,059 per capita in the U.S., and just $307 in Canada.

 

A single-payer system would be most efficient but probably is not politically feasible at the moment. The smart new book "The Health Care Mess" suggests a variety of more gradual approaches that would face less opposition.

 

Whatever the mechanism, all children should be covered. It's a disgrace that we use public funds to save the lives of nonagenarians but not those of 9-year-olds. And kids are a bargain: per capita medical spending is $1,525 for children less than 5, and $9,000 per person aged 65 to 74.

 

A second principle is that we should put less emphasis on curative medicine and more on public health and prevention - everything from preparing for avian flu to encouraging exercise. Sure, we can buy more "left ventricular assist devices," which cost $210,000 per patient installed, or buy Erbitux for colon cancer, at $17,000 per month of treatment. But as a wise new book, "Prescription for a Healthy Nation," argues, you get more bang for the buck when you promote healthier lifestyles - fighting obesity, cigarette smoking and the like.

 

Raising cigarette taxes saved far more American lives, for example, than an army of neurologists ever could. In the same spirit, I'd like to see a French-fry tax. And imagine the health gains if we banned potato chips and soda from schools.

 

Reforming the health system won't be easy. In the real world, poor kids don't see doctors not only because they're uninsured, but also because Mom doesn't have a car, can't easily get time off from work, or doesn't speak English. Those are hard nuts to crack - but one reason to think that we can do better is that much of the world does better.

 

I've been thinking of health care partly because of something that happened when I was on vacation in August. My kids and I were stacking firewood for my parents on the Yamhill, Ore., farm where I grew up, when suddenly the seven-foot stack collapsed - on top of my youngest. She was knocked down and pinned, her face bleeding, under a pile of logs.

 

I had insurance, and a car to get to the emergency room - and in the end the logs (stained with blood) turned out to be in worse shape than my daughter. She's just fine. But that instant was heart-stopping in its terror - and the system routinely does fail such children in need. Isn't it worth fighting one more time for reforms, so that we Americans can get health care every bit as good as Canada's?



Health insurance imploding

David Lazarus

San Francisco Chronicle
Wednesday, October 19, 2005

And so the demolition derby that is the U.S. health care system shifts into high gear.
Mighty General Motors, the world's largest automaker and biggest private-sector purchaser of health insurance, said this week that it'll slash its $5.6 billion annual health care spending for workers, retirees and their families by about $1 billion a year.

 

For its part, the United Auto Workers, one of the nation's most powerful unions, is apparently prepared to swallow this hit to organized labor's most sacrosanct benefit to forestall additional job cuts.

 

We have reached a critical turning point in the decline of health care in the United States, one almost certain to expand the already appalling figure of 45 million people lacking health coverage nationwide.

 

"It's not just a breaching of the social contract that's existed between companies and workers," said David Autor, an associate professor of economics at the Massachusetts Institute of Technology. "It's a reflection of how health care costs are out of control.

 

"Hopefully this will be an opportunity for government and companies to rethink how health care is provided," he added. "The old system is clearly breaking down."

 

Since World War II, the old system has been predicated on the notion that employers will bear the primary cost of insuring U.S. workers and their families.

 

That system, as the GM announcement plainly illustrates, is no longer viable in the face of double-digit annual increases in health care costs. Businesses have responded by insisting that workers -- and especially retirees -- shoulder more of the burden of their health coverage.

 

To be sure, GM has been rewarding its more than 750,000 union members, retirees and their dependents with an uncommonly generous benefits package. The company also faces numerous other issues that affect its profitability (or lack thereof; GM reported a staggering $1.6 billion loss for the latest quarter).

 

But health care is undeniably one of the automaker's biggest headaches. GM estimates that health care adds about $1,500 to the cost of every vehicle it sells in North America.

 

The company's chief exec, Rick Wagoner, told employees on Monday that health care is an issue "of great importance for the future of overall U.S. competitiveness."

 

He also all but pleaded with political leaders to do something about the situation.

 

"We would welcome a more proactive role from elected officials at the national and state levels in broad-based strategies to address the U.S. health care crisis," Wagoner said.

 

Helen Darling, president of the National Business Group on Health, a nonprofit organization composed of some of the country's largest employers, told me that more and more companies will follow GM's example and significantly scale back health coverage for workers.

 

For example, Ford and DaimlerChrysler are already negotiating similar concessions from the UAW.

 

"There's no one in the business world who doesn't share the position that the U.S. health care system has a crisis," Darling said. "The issue here isn't General Motors. The issue is the unaffordability of health care."

 

So what do we do about it?

 

I've written repeatedly about how a single-payer health care system could provide universal coverage for all Americans at a long-term cost to taxpayers well below what's now paid annually by employers and workers.

 

Single-payer systems are the norm in virtually all other developed democracies. While far from perfect -- long waits for treatment are a frequent complaint -- such systems ensure that any citizen can receive care from any doctor at any hospital.

 

There are no co-pays or deductibles, no private-sector premiums soaring year after year.

 

"The basic system is quite good," said Steffie Woolhandler, an associate professor of medicine at Harvard University. "We just need to fund it adequately."

 

As it stands, she said about a third of all health care spending in this country is now squandered on bureaucratic overhead. Under a single-payer system, savings from streamlined paperwork alone would be sufficient to provide coverage for all Americans.

 

"The meaning of GM's announcement is that even people working for a powerful company can have their health care cut," Woolhandler said. "Anyone who gets health insurance from an employer or former employer should be worried."

 

The right message: Speaking of the auto industry, senior execs at Delphi, the largest automobile supplier, have said they'll take voluntary pay cuts until the company emerges from bankruptcy.

 

The company's CEO, Robert Miller, will reduce his base salary from $1.5 million to just $1 annually and won't receive any bonuses. Delphi's president, Rodney O'Neal, will take a 20 percent pay cut, and other execs will forgo 10 percent of their salaries.

 

Declared Miller: "Delphi's transformation message must be unambiguous and marked indelibly by the commitment of Delphi's leadership."

 

Compare that with the top brass at PG&E, who last year handed themselves $83 million in bonuses while the San Francisco utility was still mired in Chapter 11 proceedings.

 

"It's become standard to reward executives for sticking around during bankruptcy," said Kirk Hanson, executive director of the Markkula Center for Applied Ethics at Santa Clara University.

 

"Cutting your pay sends a strong message to employees that management understands they're suffering," he said.

 

David Lazarus' column appears Wednesdays, Fridays and Sundays. Send tips or feedback to dlazarus@sfchronicle.com.

 

Dead Woman Working: American Dream Died Long Ago

Published on Friday, August 17, 2012 by Common Dreams

by Donna Smith

It was a slow and torturous death, my American dream. And for millions of others, I am guessing it is the same. Nothing this current round of politicos is planning to do can restore it. Just like there is nothing to being a little bit pregnant, there is nothing anyone can do to breathe life back into what once seemed possible. Now I just hang on waiting to die.

This piece is not about who will or will not be our president or vice president, as after voting in every election since the 1970s, I am pretty sure what I need and want isn’t coming from any of them.

Read more: Dead Woman Working: American Dream Died Long Ago

Diagnosis For America

Jonathan Tasini
October 25, 2005

Jonathan Tasini is president of the Economic Future Group and writes his "Working In America" columns for TomPaine.com on an occasional basis. His blog Working Life chronicles the labor movement and other issues affecting American workers.  

It is a measure of our lowered expectations, fueled by media spin, that people shrugged and seemed to think that it was inevitable that workers for General Motors were destined to have their health care coverage slashed. After all, some seemed to think, at a time when their company is teetering on the edge of oblivion, these “privileged” auto workers had “gold-plated” coverage that almost no other workers in America have.

 

But let’s be clear: The loss of benefits for GM workers was not inevitable. It happened as a result of many years of bipartisan political and economic decisions and the bipartisan lack of political courage to take on dumb ideology and corporate power.


In the minds of the elites, socking workers with a larger share of the costs of health care is just a natural part of the new economic order. As the Wall Street Journal editorial board said about the health care cost-cutting deal between GM and the United Auto Workers, “We hope it’s the beginning of wisdom about the global economy for the American labor movement.” Speaking about UAW president Ron Gettelfinger, Delphi CEO Steve Miller—who took his company into bankruptcy—said,  “He’s going to have to help half a million of workers get used to the idea that globalization has taken away the ability to have someone who mows the lawn or sweeps the floor get $65 an hour.”

At least one thing is refreshing: It exposes as a fraud the liberal and conservative mantra about the wonders of the global economy. Democrats and Republicans alike—from Bill Clinton to George Bush, with a supporting cast of media and academic geniuses—have repeatedly told workers that the global economy will bring great benefits to America, after a period of “adjustment.” To their credit, Steve Miller and the Journal are more honest: The global economy is a tool to drive down living standards, starting with health care. Get with it, folks: Living large is so “old economy.”

So, the first obvious point to make is that employer-provided health care coverage has failed. Workers should never face the choice between sickness and financial ruin simply because the company they work for is going under, poorly managed or because they change jobs. More important, this has become, as I pointed out some months ago, a matter of economic competitiveness for corporations based in the United States: The health care system is dragging down profits.

The second point, then, is that health insurance can never be left to those whose sole motivation is profit. The last time health care was debated, the Clinton administration lost its nerve—or, perhaps, never had any other intention to pursue a system other than one that was destined to perpetuate the existing ideological flaws.  “Hillarycare” was a disaster for the public not because the mismanaged process produced an overly complex system. Rather, the Clintons made a conscious decision to leave health care in the hands of the private insurers — which allowed the HMO industry to grow, if you’ll pardon the expression, like a malignant tumor.

If we had a different philosophy, GM workers’ health care would never change. As Ida Hellander, executive director of Physicians for a National Health Program (PNHP), puts it, “Political will is infinitely harder to muster, especially when Congress is owned by the drug and insurance companies.” PNHP has a very straightforward set of four principles guiding its universal health care proposal, which I think, if properly understood by the public, would send millions of people to the streets demanding immediate change:

·                   Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to assure this right. Coverage should not be tied to employment. Private insurance firms’ past record disqualifies them from a central role in managing health care.

·                   The right to choose and change one’s physician is fundamental to patient autonomy. Patients should be free to seek care from any licensed health care professional.

·                   Pursuit of corporate profit and personal fortune has no place in caregiving and creates enormous waste. The U.S. already spends enough to provide comprehensive health care to all Americans with no increase in total costs. However, the vast health care resources now squandered on bureaucracy (mostly due to efforts to divert costs to other payers or onto patients themselves), profits, marketing and useless or even harmful medical interventions must be shifted to needed care. 

·                   In a democracy, the public should set overall health policies. Personal medical decisions must be made by patients with their caregivers, not by corporate or government bureaucrats.

The economics of a single-payer, universal health care system are unassailable. It would save $300 billion in administration costs. It would be financed partly by the 60 percent of taxes that already go into the health care system via Medicaid, Medicare and payments for public employee coverage. The rest of the financing, over the long term, would be easily done with modest tax increases (by a 7 percent payroll tax and a 2 percent progressive income tax) — and result in better health care for people for less money than people shell out in ever-rising deductibles. With one bold stroke, a single-payer system would do more to help the bottom line of companies than any tax break or so-called “free trade” agreement.

The troubling reality to the arguments I’ve made is that they are not particularly original: The moral and economic need for a universal health care system has been well-known for a very long time. The only question now is: How many companies will have to go belly up and how many more millions of workers will face bankruptcy and illness because we allow ideology—the deification of the so-called free market—to triumph over common sense?

 

Business Leaders Support Single-Payer

Business leaders lean toward dramatic health-care changes

 

Friday, September 16, 2005
By Rick Haglund
Detroit Bureau
MLive.com

TRAVERSE CITY — Frustrated over seemingly never-ending hikes in health care costs, some 40 percent of Michigan business executives polled in a new survey say they support nationalized health care or a privately run, single-payer system financed by the federal government.

 

The poll of 350 business people, released here Thursday at the Michigan Chamber of Commerce’s annual Future Forum conference, found that 42 percent of those surveyed supported a national health care system. Answering a second question, 40 percent said they supported a single-payer system.

In the wide-ranging survey by pollster Steve Mitchell, business leaders also expressed a deep pessimism about the state’s business climate and Democratic Gov. Jennifer Granholm’s leadership.

Sixty-nine percent said the state’s business climate is on the wrong track, while only 43 percent approved of the job Granholm is doing.

“We have not seen numbers like this since the early 1990s,” Mitchell said.

That was a time when unemployment in the state topped 15 percent. Unemployment currently is at 6.7 percent.

But Mitchell said Granholm’s low approval rating wasn’t too surprising, given the Republican leanings of most business owners surveyed. President Bush got a 70 percent approval rating in the poll.

Also the national economy is doing well, while Michigan’s manufacturing-based economy is struggling, he said.

Granholm’s spokeswoman Liz Boyd said the governor’s 43-percent approval rating by members of a group with close ties to the state Republican Party was “just great.”

Support for universal health care among most Republican business executives was surprisingly high, even in the face of rapidly rising costs.

“This finding that four in every 10 business decision-makers are willing to look at a different way of delivering health care is something you wouldn’t have seen 10 years ago,” said Mitchell, president of Mitchell Research and Communications Inc. in East Lansing.

His poll surveyed Michigan Chamber of Commerce members from Aug. 15-Sept. 1. Of those surveyed, 72 percent represented businesses employing fewer than 50 workers; 16 percent were in manufacturing.

Rich Studley, senior vice president of government affairs at the chamber, said business owners may be looking to the federal government to provide health care because they’re frustrated that their efforts to control costs aren’t working.

And many of the chamber’s small-business members who can’t afford to provide health insurance for their workers, but who would like to, “see that goal just getting farther and farther away,” Studley said.

William Rustem, president of Public Sector Consultants Inc. in Lansing, said the apparently increasing support by business for universal health care could lead to radical reforms. Many business leaders have been reluctant to push for universal health care because the Bush administration and the Republican-controlled Congress are opposed.

“I think this is an amazing result,” Rustem said about the chamber poll. “This may be a recognition by the business community of a public will to do something about health care.”

On Wednesday, the annual Kaiser Family Foundation survey found it now costs U.S. employers an average $10,800 a year to provide health insurance for a family. That’s up 9.2 percent from 2004.

The chamber survey also found the top two problems limiting the hiring of workers in coming years are a lack of skilled applicants and the high cost of health care.

Among various state taxes, 56 percent of business decision-makers said the Single Business Tax was the most onerous.

Studley credited Granholm with proposing sweeping changes in the SBT earlier this year, even though the chamber has vehemently opposed Granholm’s plan to raise taxes on insurance companies in order to give manufacturing and research companies a break.

He criticized the Legislature for not yet passing SBT reform.

“Every day our members are making decisions about whether to stay in Michigan or leave,” Studley said. “The message we want to send to the Legislature is: For goodness sake, take action.”

For Americans, Getting Sick Has Its Price

Survey Says U.S. Patients Pay More, Get Less Than Those in Other Western Nations

By Rob Stein
Washington Post Staff Writer
Friday, November 4, 2005

Americans pay more when they get sick than people in other Western nations and get more confused, error-prone treatment, according to the largest survey to compare U.S. health care with other nations.
The survey of nearly 7,000 sick adults in the United States, Australia, Canada, New Zealand, Britain and Germany found Americans were the most likely to pay at least $1,000 in out-of-pocket expenses. More than half went without needed care because of cost and more than one-third endured mistakes and disorganized care when they did get treated.

Although patients in every nation sometimes run into obstacles to getting care and deficiencies when they do get treated, the United States stood out for having the highest error rates, most disorganized care and highest costs, the survey found.

"What's striking is that we are clearly a world leader in how much we spend on health care," said Cathy Schoen, senior vice president for the Commonwealth Fund, a private, nonpartisan, nonprofit foundation that commissioned the survey. "We should be expecting to be the best.
Clearly, we should be doing better."

Other experts agreed, saying the results offer the most recent evidence that the quality of care in the United States is seriously eroding even as health care costs skyrocket.

"This provides confirming evidence for what more and more health policy thinkers have been saying, which is, 'The American health care system is quietly imploding, and it's about time we did something about it,' " said Lucian L. Leape of the Harvard School of Public Health.

The new survey, the eighth in an annual series of cross-national surveys conducted by Harris Interactive for the fund, is the largest to examine health care quality across several nations during the same period. The survey was aimed at evaluating care across varying types of health care systems, including the market-driven U.S. system and those that have more government controls and subsidies.

The survey, published in the journal Health Affairs, questioned 6,957 adults who had recently been hospitalized, had surgery or reported health problems between March and June of this year.

"These patients are the canary in the coal mine of any health care system," Schoen said.

Nearly a third of U.S. patients reported spending more than $1,000 in out-of-pocket expenses for their care, far outpacing all other nations. Canadians and Australians came next, with 14 percent of patients spending that much. The proportion reporting similarly high costs was far lower in the other countries.

Americans had the easiest access to specialists, but they experienced the most problems getting care after hours, and Americans and Canadians were the most likely to report problems seeing a doctor the same day they sought one.

Americans were also much more likely to report forgoing needed treatment because of cost, with about half saying they had decided not to fill a prescription, to see a doctor when they were sick or opted against getting recommended follow-up tests. About 38 percent of patients in New Zealand reported going without care; the numbers were 34 percent in Australia, 28 percent in Germany, 26 percent in Canada and 13 percent in Britain.

"If that's not a reason for moral outrage, I don't know what is," Leape said.

About one-third of U.S. patients reported problems with the coordination of their care, such as test results not being available when they arrived at a doctor's appointment or doctors ordering duplicate tests. In the other countries, 19 to 26 percent of patients reported similar problems.

Americans also reported the greatest number of medical errors. Thirty-four percent reported getting the wrong medication or dose, incorrect test results, a mistake in their treatment or care, or being notified late about abnormal test results. Only 30 percent of Canadian patients, 27 percent of Australian patients, 25 percent of New Zealanders, 23 percent of Germans and 22 percent of Britons reported errors.

"The findings show that we have a lot to learn from our colleagues" in other countries, said Carolyn Clancy of the federal Agency for Healthcare Research and Quality during a briefing at which the results were released. She said the federal government has launched a number of initiatives to find ways to improve care, particularly for the increasing number of Americans with chronic illness.

"The findings here reinforce how difficult it is coordinating care. . . . That's the next frontier," Clancy said.

© 2005 The Washington Post Company

Patient-driven health care gains attention

Harvard prof touts advantages

By LUKE SHOCKMAN
TOLEDO BLADE STAFF WRITER
Article published Saturday, November 5, 2005

What if picking your doctor or hospital were like buying a car?

Maybe you'd sort through a Consumer Reports-like guide to see which doctor or hospital most reliably saves lives. Next to each hospital or doctor would also be a price.

 

Using this information, you would then make a decision on which doctor or hospital to choose. Evaluating quality and price is how a lot of transactions - from buying cars and DVD players to choosing a new coat or even a cheeseburger - work in America today.

 

It's not like that with health care. But maybe it should be, said Regina Herzlinger, a Harvard University business professor who spoke yesterday at the Medical University of Ohio. Her presentation was part of a discussion at MUO called: "Health Care Access, Delivery and Cost: Is the Status Quo Sustainable?"

 

The short answer to that discussion? No.

 

Dr. Lloyd Jacobs, MUO's president, said the "course we're on is not sustainable."

 

Health-care costs are soaring every year, and the number of Americans without health insurance - now about 45 million, which is more than the number of Americans on Medicare - continues to grow.

 

The situation is "almost at meltdown proportions," Dr. Jacobs said.
Politicians and the American public have ignored this problem for so long that the time for tinkering is over, he said, and it will soon take a massive intervention, likely by the government.

 

"It's too late for incremental steps. My fear is we're going to experience an upheaval. We'll see the bankruptcy of a large corporation like General Motors [partly because of rising health-care costs] … and we'll end up looking more like Canada," which has a single payer system, he said.

 

It doesn't have to be this way, Ms. Herzlinger said. Give patients information and direct control over their health-care dollars, and they'll do a better job at holding down health-care costs, she argued.

 

This theory, which is being embraced by many companies, is known as "consumer-driven" health care. Though businesses are trying to embrace this concept, it's been a struggle because of the lack of reliable information. "I know more about my car, tomato sauce, and panty hose than I do about the doctor or hospital who is about to perform a mastectomy on me," she said.

Ms. Herzlinger said she favors universal health-care coverage, but not a single payer system because it stifles competition. One major criticism of consumer-driven health care being a solution to rising costs is that it's no help to those who can't afford insurance in the first place. Ms. Herzlinger said she supports things like tax credits or other subsidies that would give all Americans access to insurance plans.

 

Some are still skeptical. Dr. Jacobs, for example, worries that while consumer-driven health care is a good idea, it's not a radical enough step given the sorry state of U.S. health care. Kenneth Raske, president of the Greater New York Hospital Association and another speaker at MUO's forum, is also skeptical.

 

He said the "structure of our health-care system is collapsing as we speak," and like it or not, a single payer system is on the way. "It won't happen in 2008 or 2010? Maybe. But it's going to happen."

 

Contact Luke Shockman at:
lshockman@theblade.com
or 419-724-6084.

 

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