December 3, 2005
Where were we? Oh, yes. I was saying last week that it's about time we joined the rest of the civilized and industrialized world in providing publicly financed, universal health care for the American people and their families. But I didn't say why or how.
After all, the United States has some of the finest, most modern medical facilities in the world. I ought to know; Baltimore's Johns Hopkins Medical Center saved my life.
Nearby, the National Cancer Institute and the National Institutes of Health, outside Washington, D.C., set the standards for American research. And patients come from abroad seeking help from many U.S. hospitals.
If you don't have a life-threatening illness, you won't have to wait weeks, as you might in Canada or Britain, for elective surgery on those cataracts or to repair a hernia - if you have the right insurance.
Ah, there's the rub for nearly 46 million Americans (including 9 million children) who have no insurance. For a hacking cough bordering on pneumonia, they wait in crowded clinics or go without care. Caring for a child burning up with fever can be frightening enough, with insurance; being uninsured can end up killing that child.
A Florida study found that children who enter a hospital without insurance are more than twice as likely to die as children with insurance. Another study reported that 18,000 Americans die each year because they are uninsured.
Millions more Americans are underinsured or find that their insurance doesn't cover what they thought. In the United States, administrative costs amount to 25 percent of health care spending, or $300 billion a year, says economics columnist Paul Krugman, partly because the huge bureaucracy is engaged in denying care to those who most need it. The rest of those costs are profits.
According to The New York Times, many of the non-Medicare insured go broke trying to keep up with co-pays for chronic illness or the bills from hospitals, for the room, surgeons, labs, anesthetists, drugs and any other white coat that drops in. A third of American patients spend more than $1,000 a year out of pocket, and 68 percent of those who declared bankruptcy because of medical bills had insurance.
The Washington Post reported weeks ago that the Blue Shield HMO in California, to save money for the company and patients, is sending members from the San Diego area to Mexico for nonemergency care because services are less expensive than in the United States.
A doctor, who performs laser eye surgery on both sides of the border, told the Post he charges in Mexico a third of what he charges in San Diego. A hysterectomy that averages $2,025 in the United States costs $810 in Mexico. Blue Shield said the services on both sides of the border are comparable. And in Mexico the doctors' parking lots are filled with California cars.
The United States spends more than any nation on health: $5,600 for every American, or 14.6 percent of national income, compared with Germany, 10.9 percent; Canada, 9.6 percent; New Zealand, 8.5 percent; and Britain, 7.7 percent. Yet a recent study for the private, nonpartisan Commonwealth Fund, which surveyed 7,000 of the sickest patients in Australia, Canada, Germany, New Zealand, Britain and the United States, found that American medicine has the highest error rates, the most fragmented and disorganized care and highest costs.
Are we getting our money's worth?
Infant mortality - the number of deaths of children under one year, probably the best measure of the level of health of any country - actually increased from 6.6 to 7 per thousand live U.S. births. That's higher than 41 nations, including Italy (6.07), Canada (4.82), Germany (4.2) and Japan, which has the lowest rate in the world at 3.28. The percentage of live births classified as low birth weight, an indication of the mother's health and prenatal care, is 7.8 percent for the United States, behind Canada (5.6), the Netherlands (4.7), Australia (6.2) and all of Europe.
The United States boasts a life expectancy for men of 77.3 years, but we're behind 34 other nations, including New Zealand (79), Germany (79), Britain (79), Canada (80), Australia (81) and Japan (82). Need I add that all these countries provide universal health care - the ability to walk into a doctor's office without worrying about cost? What are we waiting for?
Polls indicate most Americans (75 percent) would support universal health care. And leading newspapers, commentators, economists, lawmakers, 13,000 doctors, former surgeons general, businessmen and a few conservatives have come to the same, obvious conclusion: If we were to pay in taxes just a fraction of what health care now costs us, we could afford it.
But universal health care is much easier said than done. How to deal with the entrenched insurance-medical-hospital complex? How to make the transition relatively painless for medical professionals and patients?
The answer is also obvious: Medicare for every American, or what I proposed years ago, "Medicare for All." A distinguished panel of health care experts, Democrats, Republicans, financiers, insurance executives and academics concluded in an open letter to the journal Health Affairs, that Medicare must be empowered as the vehicle "to make pay-for-performance a national strategy for better quality." Lawmakers, medical journals, a couple of former surgeons general and 13,000 doctors have proposed phasing in "Medicare for All."
And if this administration doesn't trash the rest of Medicare before it leaves the scene, it remains the most obvious, affordable and doable way to providing universal coverage.
WRITE TO Saul Friedman, Newsday,235 Pinelawn Rd., Melville, NY 11747-4250
(from Des Moines Register -- published on December 6, 2005)
Here’s news for anyone who opposes a taxpayer-financed system of health care in the United States: The country already has one. More than one. Public dollars subsidize health care at every turn.
According to the Centers for Medicare and Medicaid, the government picks up nearly 44 percent of the cost of health care in the United States. Medicare, for seniors and the disabled; Medicaid, for the poor; and health insurance for veterans are all government systems of care. All are funded with taxpayer dollars.
Plus, public employees’ health insurance is at least partially subsidized with tax dollars. In the Des Moines schools, for example, tax dollars paid $36.2 million for workers' health care last fiscal year, the equivalent of salaries alone for about 840 teachers.
Residents of Des Moines pay more than $1,000 a month to provide family health care for each of their part-time City Council members. The state of Iowa will spend $245 million in 2006 on medical care for state workers. That doesn't even include state troopers or faculty and professional staff at the three state universities. At Iowa State University, for example, the projected medical and dental cost in 2006 is $43 million.
Everyone from the city engineer to members of Congress gets a little help from the taxpayer.
Taxpayers also pay, in a sense, to help employers pay for health insurance. Employer contributions for medical care and medical-insurance premiums are excluded from taxes. That was a loss of revenue for the federal government that totaled more than $120 billion in fiscal year 2005 — more than 20 times Iowa's $4.9 billion state budget.
So people may say they oppose a tax-financed system of health care for everyone, but the country already pays part of the bill for nearly everyone, at least indirectly.
That's one reason why no one should resent people who receive direct taxpayer-funded care, from the federal-state Medicaid program or Iowa's HAWK-I, the state program for kids in low- to moderate-income families.
The current system isn’t fair, though. Uninsured workers pay taxes to fund others’ care, but have none for themselves.
Non-veterans can’t visit the veterans hospital their tax dollars pay for, even if it's right down the street and provides the best care. Working Americans fund the Medicare system, which pays for an elderly person’s knee surgery. That same taxpayer may not be able to afford his own knee surgery.
The system is inefficient, too. Thousands of private insurance plans add up to a tangle of red tape and administrative waste — dollars not spent directly on care. A Harvard study found bureaucracy accounted for more than 30 percent of total health-care spending in 1999.
Since the government is already involved with nearly everyone's health care, why not allow everyone to buy into a uniform government program such as Medicare? Then public dollars would be spent more wisely. Fewer people would be employed to push papers. If Medicare were reformed to be more comprehensive and add a government drug benefit, the coverage could be top notch.
HR 676, a bill introduced in Congress by U.S. Representative John Conyers Jr., would institute a single payer health care system in the U.S. by expanding a greatly improved Medicare system to cover every resident.
It would cover every person in the U.S. for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, chiropractic and long term care. HR 676 ends deductibles and co-payments. HR 676 would save billions annually by eliminating high overhead and profits of the private health insurance industry and HMOs.
68 House members have now signed on as co-sponsors, and more than 100 labor organizations have officially endorsed it.
More information on the movement for single payer national health care can be found at the website of Healthcare NOW!
SPAN Ohio Walk for Health Care Justice
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Part of the Media Blackout series on underreported labor stories
By David Swanson, ILCA Media Coordinator
Single-payer health care is, according to numerous surveys, supported by a majority of Americans.i Few public policies are inspiring more activism and advocacy in the United States right now than single-payer health care at the national and state levels.ii Organizations are holding marches across major city bridges. Think tanks and foundations and labor unions are generating studies. Doctors, patients, and labor and community organizations are rallying for the cause. Bills have been introduced in Congress and various state legislatures. Polls by the media consistently rank health care as one of the public's biggest concerns when considering political candidates.iii
Labor unions on strike and negotiating contracts usually cite health care as a primary point of contention. Numerous Congressional and state candidates advocate single-payer health care, as did a third of the presidential candidates during much of the run-up to the Democratic primaries. And the media gives extensive, though rarely substantive, coverage to health care. Yet, the media marginalizes single-payer health care, omitting it from discussion, failing to cover mass movements in support of it, misrepresenting what it means, falsely reporting that it is unpopular, and labeling it with scary names intended to make it inadmissible for consideration.
Single-payer health care means private health care publicly paid for. Under such a system, patients would choose their own doctors but be insured by the government rather than being covered by an HMO or private insurance company or not being covered at all.iv The United States would join nearly every other industrialized nation in covering all of its citizens fully, from cradle to grave, with no individual bills, co-payments, or deductibles. Vast amounts of waste in the private insurance industry would be eliminated, so that, according to countless analyses, the nation would spend less to cover everyone than we now spend to leave 45 million uncovered and tens of millions more insufficiently covered.v In effect, Medicare would be enhanced and expanded to cover all patients and to cover all necessary and preventive medicine. But doctors would remain in private practice and would not become government employees.
October 3rd to 10th was "Health Care Action Week" and witnessed numerous public forums and protests. As part of this largely unsuccessful effort to get the media's attention, Jobs With Justice released a report funded by six labor unions and developed by the Center for Economic and Policy Research. The report covered new ground with national data and, for the first time, provided state level data on the funds that could be saved by cutting out waste in the health insurance and pharmaceutical industries. The report, titled "Waste Not, Want Not," showed that approximately $245 billion is wasted on private insurance red tape, patent protection sheltering drug companies from competition, and subsidies to private insurance companies in George W. Bush's recently enacted Medicare bill. That's more than enough money to insure all Americans who lacked coverage all or part of last year.
Jobs With Justice and other organizations promoted this report ahead of its release date in many states. Often reporters enjoy nothing better than the ease of covering a report that provides them with new information on a major story and includes both national and state angles. Not this time. New York Times reporters either didn't return calls or said they were too busy, according to Jobs With Justice National Organizer Rand Wilson. A Boston Globe reporter told him the study was "biased." Various labor and progressive web-based publications covered the report, including the Union Advocate, Press Associates Inc., TomPaine.com, and BlackCommentator.com. But the corporate media was less interested. Marketplace Morning Report on public radio was the only national outlet to report on the study.
Six local newspapers covered it, the largest being the Boston Herald, which devoted about 100 words to the report and another 100 to the opinion of a "pro-business" institute that called the report "naïve." To its credit, the Herald printed a 160-word letter from Rand Wilson responding to the article. While no national newspapers, magazines, or broadcast news outlets covered this story as news, USA Today did cover it as opinion, printing a column by the report's primary author, Dean Baker.
The media's handling of this report is in many ways typical of its handling of single-payer health care. An unusually high percentage of the items found when searching in the Nexis database for "single-payer" are letters to the editor, almost all of them in support of single-payer and written in response to articles or columns that opposed it. Other than letters, many of the items found in Nexis are articles listing positions that a political candidate supports or opposes. "Single-payer health care" is listed in these articles but not explained.
Of 205 items containing "single-payer" in the past two months in Nexis, I was able to find only two articles that gave any substantive explanation of what it was. Equally rare are articles explaining that national health care is a solution already arrived at by almost every other wealthy and some much less wealthy countries in the world. Much more common are articles giving the impression that this is a uniquely Canadian idea.
Even opinion pieces explaining single-payer are rare: a total of seven in the past two months in Nexis, one of them by United Auto Workers President Ron Gettelfinger. Only one of the seven was by a staff columnist, Paul Krugman of the New York Times, who "supports" single-payer but says it's not politically feasible right now. In contrast to his usual care, Krugman offered no evidence for this assessment but said he was deferring to the wisdom of others.
Many, if not most, discussions of single-payer in the U.S. media falsely, and without making claim to any evidence, dismiss it as unpopular. During the past two months, false claims that single-payer is unpopular could be read in many "mainstream" newspapers.vi Often the same articles or commentaries argue that this alleged unpopularity will prevent passage of single-payer through Congress.vii Mainstream outlets are towing the very same line on health care as outlets commonly labeled right-wing.viii As documented in a recent study by FAIR, the media almost never mentions insurance industry contributions to Congressional campaigns. This gap makes it easier for a false unpopularity to fill in as an explanation for Congress's failure to pass single-payer.ix
The fact that the media's own polls find popular support for a position that the media keeps telling us is unpopular suggests that there are limits to the media's ability to create reality. When people see their loved ones dying for lack of health coverage, apathetic is the last word in the dictionary that could be applied to their behavior. People in these situations try everything and find information anywhere they can. Many people have obviously found their way around the media to useful information about single-payer.
But the media knows how to play rough and is nowhere near finished supporting the private insurance industry. The right-wing Investor's Business Daily in a September editorial claimed that Canada's health care system is "a disaster." Ted Koppel tried this same lie in 1993, when he told Bill Clinton that Canadians were saying to America "Whatever you do, don't exchange what you've got for what we've got." It would have been hard for Koppel to find an actual Canadian to say that, since only 2 percent of Canadians believed that the U.S. health care system was better than their own, according to a Gallup poll taken only a few days earlier.x
A more creative lie is the one that holds that people simply CHOOSE not to have health coverage. An example of this one was found in the Journal News of Westchester County, N.Y., on September 20th in an interview with Michael Stocker, President and CEO of WellChoice Inc. and Empire Blue Cross Blue Shield, who said: "I believe that we need a universal coverage solution but that such a solution should not be a single-payer, government-run system. People are uninsured for many reasons, some by choice and some by circumstances, and we need to ensure universal coverage through a variety of targeted programs in which both the private and the public sectors participate."
When the media finishes lying about single-payer, it likes to call it names, including "extreme." Often, the current system is depicted as a moderate middle road between single-payer and some unspecified other "extreme."xi One of the media's favorite names for single-payer is "socialized medicine." In searching Nexis, I found, in the past two months, 141 items mentioning "socialized medicine," the vast majority of them using the phrase pejoratively, and virtually none of them offering any explanation of what it meant or why it was so undesirable. "Socialized medicine" is also a common reason for opposing John Kerry's candidacy for president, despite the fact that Kerry opposes single-payer, and despite the fact that not a single American politician that I'm aware of supports making doctors and nurses state employees.xii
State-level candidates also come under attack. The Worcester (Mass.) Telegram & Gazette reported on a local candidate's view that safe staffing levels for nurses is "socialized medicine": "Ms. Blute labeled one of the ideas -- to recruit and retain nurses -- as a step toward 'socialized medicine,' because it is apparently based on legislation backed by the state nurses union to mandate 'safe' nurse staffing levels." The Florida Times-Union reported that a local candidate's proposal "offers a modern, free-market solution as an alternative to the tired, old remedy of socialized medicine being proposed by others." How something never implemented can already be a tired and old remedy was not explained.
The St. Louis Post-Dispatch this month ran an article attempting to chronicle the fate of national health care proposals since Truman, which included this analysis: "Princeton University professor Uwe Reinhardt, an expert on the politics and economics of health care, said at a forum on universal health care in April that 'Americans fear American government even more than weapons of mass destruction.' With each failure, the task gets harder. The private insurance system becomes more deeply rooted, the political interests more powerful, the public more resistant to dramatic change."
The same article blamed labor unions' resistance to compromise for Congress's failure to pass national health care under Nixon, even while quoting an analyst who blamed Nixon's impeachment proceedings. Next, the Post-Dispatch blamed Hillary Clinton for resistance to compromise, even though her proposal was so corporate and compromised from the outset that many called it oxymoronic: "managed competition." The Post-Dispatch article cited criticism of the Clinton plan as "socialism," "big government," and "stupid." But the Post-Dispatch, to its credit, quoted an analyst to the effect that simple single-payer health care would have been an easier sell.xiii
The Post-Dispatch's chronicling of national health care closed with this false description and baseless crystal ball reading:
"Some advocates of universal care now say the best hope is at the state level; others still want a federal plan. The politics of it won't change anytime soon. 'It's a deeply divisive matter,' Marmor said. 'It divides the country into broad blocs concerning basic values and basic understandings of what government ought to do.'"
How does this fit with all the polls showing that, despite every effort of the media, a strong majority of Americans favor universal health insurance?xiv
The forecast that "the politics of it" won't change anytime soon should be taken with the same grain of salt as the pronouncement by the New York Times in an October 10, 1992, editorial that "the debate over health care reform is over. Managed competition has won," an outcome that the Times found "delicious" and "wondrous."xv
The argument, which I've heard more than once, that the media doesn't cover single-payer health care as a viable option because our elected representatives don't treat it as one is undone by the media's own cursory reporting on Congressional candidates favoring single-payer. In the early 1990s, when 100 members of Congress co-sponsored a single-payer proposal, it received little coverage, even at a time when health care reform was one of the media's top issues. ABC World News Tonight, for example, mentioned the bill only once in all of 1993.xvi The case that the media opposes single-payer for its own reasons was made quite starkly during the 2003-2004 Democratic presidential primaries. Substantive coverage of issues was sparse, but where it existed, it covered the positions of those candidates who did not step outside the range of debate that the media preferred.xvii
In Warren Beatty's 1998 political comedy, "Bulworth," a straight-talking candidate who bad-mouths the insurance industry and makes fun of people who fear the word "socialism" is embraced by CNN's Larry King and skyrockets to electoral victory, after which the insurance industry assassinates him. Back here in reality, Larry King tries to shut down any movement toward single-payer health care by dismissing it as socialism. This is from the transcript of the February 26, 2004, debate that included Kerry, Edwards, Sharpton, and Kucinich:
"KUCINICH: I agree with my friend John Edwards about we need to do something about poverty. And that's why I'd like you to join me in this proposal to have a universal single-payer, not-for-profit health care system, because that would lift tens of millions of Americans out of poverty. And, Larry...
"KING: By the way, Harry Truman proposed that in 1948.
"KUCINICH: Well, and you know what? John Conyers and I introduced the bill in this Congress. And that would provide all coverage for everyone, all medically necessary procedures, plus vision care, dental care, mental health care...
"KING: In other words, socialism?"
End of discussion.
But I prefer to give the last word to Jared Bernstein, senior economist at the Economic Policy Institute, who wrote this letter, published by the New York Times, in response to Krugman's column:
"To the Editor:
"Paul Krugman (''America's Failing Health,'' column, Aug. 27) argues convincingly for a single-payer health care system, but then cites health economists who claim such a goal is politically unrealistic.
"With all due respect to those, like me, in that profession, economists don't always have the best political antennas. Especially where health care is concerned, many economists still believe that markets can save the day, despite the lesson from international comparisons that the best way to provide health care is to take it out of the market.
"Perhaps we need to turn to the political scientists to help us figure out how to build a movement that can alter the political realities that are supposedly blocking the way to universal health care."
The article can be reproduced with or without the endnotes if credit is given to the ILCA and this link to the full text is included: http://ilcaonline.org/modules.php?op=modload&name=News&file=article&sid=801
The International Labor Communications Association, founded in 1955, is the professional organization of labor communicators in North America. The ILCA’s several hundred members produce publications with a total circulation in the tens of millions.
Published in the Cleveland Plain Dealer 12/27/05 under the title: No easy cure for health care maladies
New York Times
Health care seems to be heading back to the top of the political agenda, and not a moment too soon. Employer-based health insurance is unraveling, Medicaid is under severe pressure, and vast Medicare costs loom on the horizon. Something must be done.
But to get health reform right, we'll have to overcome wrongheaded ideas as well as powerful special interests. For decades we've been lectured on the evils of big government and the glories of the private sector. Yet health reform is a job for the public sector, which already pays most of the bills directly or indirectly and sooner or later will have to make key decisions about medical treatment.
That's the conclusion of an important new study from the Brookings Institution, "Can We Say No?" I'll write more about that study another time, but for now let me give my own take on the issue.
Consider what happens when a new drug or other therapy becomes available. Let's assume that the new therapy is more effective in some cases than existing therapies - that is, it isn't just a me-too drug that duplicates what we already have - but that the advantage isn't overwhelming. On the other hand, it's a lot more expensive than current treatments. Who decides whether patients receive the new therapy?
We've traditionally relied on doctors to make such decisions. But the rise of medical technology means that there are far more ways to spend money on health care than there were in the past. This makes so-called "flat of the curve" medicine, in which doctors call for every procedure that might be of medical benefit, increasingly expensive.
Moreover, the high-technology nature of modern medical spending has given rise to a powerful medical-industrial complex that seeks to influence doctors' decisions. Let's hope that extreme cases like the one reported in The Times a few months ago, in which surgeons systematically used the devices of companies that paid them consulting fees, are exceptions. Still, the drug companies in particular spend more marketing their products to doctors than they do developing those products in the first place. They wouldn't do that if doctors were immune to persuasion.
So if costs are to be controlled, someone has to act as a referee on doctors' medical decisions. During the 1990's it seemed, briefly, as if private H.M.O.'s could play that role. But then there was a public backlash. It turns out that even in America, with its faith in the free market, people don't trust for-profit corporations to make decisions about their health.
Despite the failure of the attempt to control costs with H.M.O.'s, conservatives continue to believe that the magic of the private sector will provide the answer. (There must be a pony in there somewhere.) Their latest big idea is health savings accounts, which are supposed to induce "cost sharing" - meaning individuals will rely less on insurance, pay a larger share of their medical costs out of pocket and make their own decisions about care.
In practice, the health savings accounts created by the 2003 Medicare law will serve primarily as tax shelters for the wealthy. But let's put justified cynicism about Bush administration policies aside: is giving individuals responsibility for their own health spending really the answer to rising costs? No.
For one thing, insurance will always cover the really big expenses. We're not going to have a system in which people pay for heart surgery out of their health savings accounts and save money by choosing cheaper procedures. And that's not an unfair example. The Brookings study puts it this way: "Most health costs are incurred by a small proportion of the population whose expenses greatly exceed plausible limits on out-of-pocket spending."
Moreover, it's neither fair nor realistic to expect ordinary citizens to have enough medical expertise to make life-or-death decisions about their own treatment. A well-known experiment with alternative health insurance schemes, carried out by the RAND Corporation, found that when individuals pay a higher share of medical costs out of pocket, they cut back on necessary as well as unnecessary health spending.
So cost-sharing, like H.M.O.'s, is a detour from real health care reform. Eventually, we'll have to accept the fact that there's no magic in the private sector, and that health care - including the decision about what treatment is provided - is a public responsibility.
By FRITZ LOEWENSTEIN. M.D.
January 26, 2006
Assuming health care, like food and shelter, is a necessity of life, the nation's present health care system, if it can be called a system, has failed miserably.
It is inefficient and far too costly. More than 45 million people are without health insurance and receive haphazard medical care if they receive any at all in this wealthiest of countries. Those on Medicaid also receive inferior care and many doctors and almost all dentists deny care to Medicaid recipients.
Many hospitals and health maintenance organizations (HMOs) are profit-making institutions. They operate under constant pressure to limit services in order to reward stockholders. In other respects too, they incorporate some of the worst features of big business — overpaid executives, some of whom have been indicted for fraud; questionable accounting practices; takeovers of plans with sudden changes in costs and benefits; and termination of programs due to bankruptcy.
Approximately 25 percent of every health care dollar spent in the United States goes to administrative costs, which add up to $294 billion annually. Canadian Provincial Plans spent proportionally less than one-third that amount. In the Medicare program, only 6 percent of total expenditures go to administrative costs.
HMOs, hospitals and drug companies spend huge amounts of money on advertising and promotion, with all the expenses ultimately borne by the consumer. Health insurance premiums, already high, have risen an additional 27 percent for individuals and 16 percent for families during the past year. Small-business owners are no longer buying health insurance for their employees, and increasing numbers of workers cannot afford to pay the premiums.
Many companies now prefer to hire part-time workers in order to avoid paying for health insurance. As a result, more of the working poor are left without coverage and middle-class families are increasingly anxious about possible financial ruin that may result from a serious illness.
Clearly, we need to reform the system. A publicly administered program of universal health insurance, similar to Medicare, would eliminate most of the inequities and inefficiencies. A California study showed that such a plan would cover all that state's residents, including the 6 million uninsured, and save over $7 billion annually in health spending.
Most polls have shown the public favors such a course. Funding would need to come from payroll and income taxes, but premiums and deductibles would be small and the overall cost to business and individuals would be much lower than they are now.
Achieving this will not be easy. Presidents Truman and Clinton tried and failed. The health insurance industry has powerful lobbies in Washington and in state capitals who influence lawmakers to oppose change. Adding insult to injury, the cost of that lobbying, harmful to the consumer, is also borne by the consumer.
However, there are encouraging signs. The Journal of the American Medical Association has taken a strong stance in support of the development of government-supervised universal health insurance. The Institute of Medicine of the National Academy of Sciences also has called for a universal health care plan.
To those who disapprove of government involvement in health care, it should be pointed out that Medicare is both fair and practical, and extension of the program to cover the entire population would be entirely reasonable. The savings in administrative costs alone would amount to many billions of dollars annually.
I know of no patients who ever failed to enroll in Medicare, whereas many patients have complained of lack of coverage, difficulty in obtaining benefits, and high premiums in the private plans.
The recently enacted modification of Medicare by the Bush administration and narrowly passed by Congress takes the program in exactly the wrong direction by introducing private plans. Furthermore, the drug provisions give high rewards to the pharmaceutical industry at the expense of the consumer.
In short, we must adopt a nationwide, single-payer system supervised by the government. But for that to happen, intense pressure needs to be applied to legislators by an informed public.
Loewenstein is a retired physician in Binghamton, NY.
© 2005 Binghamton Press & Sun-Bulletin – Binghamton, NY
The Business Journal (Milwaukee)
From the September 2, 2005 print edition
By Jack Lohman and Dr. Eugene Farley
It is by historical accident that U.S. businesses provide health care to their employees, and it has now placed them at a serious disadvantage when competing globally or against imports whose manufacturers do not have to add this extra 8 percent to 15 percent to the price of their products.
In other countries, health care is a taxpayer burden. It is here too, but we pay through many circuitous routes that have caused jobs to leave the country. We add these costs to our product prices, and it makes us uncompetitive with products that come from countries that already have taxpayer-paid medical systems. Corporations in Canada pay only an $800 annual per-employee tax. The result, as just one example: The Big Three auto companies now make more cars in Ontario than in Detroit, and Toyota just selected Canada over the United States for its new Rav4 manufacturing plant. Jobs are leaving our country because they are doing it right and we are doing it wrong!
The United States must adopt a universal health care system like Canada’s, but long wait times do not have to be a part of our system. We can do better and we will do better. With universal coverage, Canadians have longer life expectancy (by two years), 35 percent lower infant mortality, and 100 percent of the citizens are covered with 40 percent less in total costs. They’ve paid for it with a system that has 8 percent rather than 30 percent administrative costs. More than 90 percent of the patients love it, as do most of the physicians.
But who would pay for our system? The same people who are paying for it today: the taxpayers. We all pay for our health care system, which costs $1.6 trillion each year nationally, and 100 percent of this money comes from we the people, through taxes, premiums, co-pays, deductibles, purchases, employer tax breaks and the other methods we use for collecting money. When we buy product, that company adds its health care costs to the price and we pay at the cash register.
Jobs at stake
But that added price is killing American jobs, and if the feds aren’t willing to fix it the state must. We are only talking about changing how we collect and use the same health care money. Such a system would also replace our Medicaid and BadgerCare costs, assume 40 percent of worker compensation costs, and even replace Medicare if the feds were willing to buy in.
Even if it were zero savings we’d be market winners. And we’d have more than adequate coverage, though it would not cover non-essential lifestyle enhancement surgeries or drugs. Gap insurance would be an option for employers and those wanting to pay for those procedures themselves. That leaves a job for the 400 insurance companies.
Once we eliminate employer-paid medical coverage, which now represents from 8 percent to 15 percent of U.S. employee costs, companies and jobs will stop leaving the state and new companies and jobs (and the tax revenues that result) will start flowing into the state. A properly run universal health care system is the most business-friendly and public-friendly system available.
If our state is the first to do this we will gain jobs from other states. If we are last, they will get our jobs. We must be the leaders, and business leaders must sideline the health care interests to make it happen here.
Jack Lohman of Colgate is the retired CEO of an independent diagnostic lab. Dr. Eugene Farley is a retired physician in Madison.
It is the paradox of America's medical system: While hands can be transplanted and the tiniest babies kept alive, many people cannot afford to see a doctor and live with the threat of financial ruin if they get sick.
Francene Shepard of Louisville had a heart attack in 1999, needed stents to open blocked arteries and ran up about $50,000 in medical bills that went unpaid.
Ian Copeland, a 27-year-old self-employed carpet cleaner who lives in Louisville, goes to the emergency room when he's sick because he cannot afford a private doctor.
"It's a gamble," said his mother, Michelle Copeland. "If something happens, it could be devastating."
Such stories are increasingly common and are leading to growing support among some politicians and medical groups for implementing a national health system offering care for all, including the 45 million Americans and more than half a million Kentuckians without health insurance.
Earlier this month, the Kentucky House Health and Welfare Committee voted to urge Congress to pass a bill, introduced by Democratic Rep. John Conyers Jr. of Michigan, that would expand Medicare to cover all Americans.
The bill would create a "single-payer" health-care system, publicly financed and privately delivered. All Americans would have access regardless of employment, income or health. Each year, the program would set reimbursement rates for health-care providers and negotiate the cost of prescription drugs.
Critics say such a measure would be too costly and unwieldy, but the passion of supporters was evident when the Kentucky House committee vote was called, and Rep. Kathy Stein, D-Lexington, answered: "Hell, yes!"
Conyers' office and the group Physicians for a National Health Program are watching Kentucky and hoping that the General Assembly will back the effort.
"It would be historical to have a Southern state endorse universal health care and medicine for all," said Joel Segal, a legislative assistant for Conyers who handles health-care issues. "This is a life-and-death crisis for many people."
A possible groundswell
A 2002 report by the Institute of Medicine, which advises the federal government on health issues, said 18,000 adults die each year because they lack health insurance. Overall, the United States has a lower life expectancy than several countries, including Canada and the United Kingdom, that have national systems.
"The health-care system is in a deepening crisis," said Dr. Steffie Woolhandler, an associate professor of medicine at Harvard University and co-founder of Physicians for a National Health Program. "The public is quite fed up."
There are signs that the idea of a national system has increasing support here:
A poll last year by the Pew Research Center found that 65 percent of Americans favor national health insurance, even if it means higher taxes.
An Indiana University poll, published in the Annals of Internal Medicine in 2003, said 49 percent of doctors support government legislation to establish national health insurance, while 40 percent oppose it.
Membership in Physicians for a National Health Program, meanwhile, has risen from about 10,000 to 14,000 in recent years.
City councils have passed resolutions in support of the Conyers' bill in Morehead, Ky.; Baltimore; and Erie, Pa.
Locally, Conyers' proposal has gained support from the Kentucky Psychiatric Medical Association, the Louisville-based Falls City Medical Society, and Dr. Adewale Troutman, director of the Louisville Metro Health Department.
A faction of the Kentucky Medical Association also supports the idea of a national health system, said its president, Dr. Daniel Varga. And although Varga and others say they doubt that the United States will be ready, philosophically, to enact a national health plan anytime soon, experts say the debate points to a growing dissatisfaction with the status quo.
That sentiment has been reflected in polls such as one released last week by the Center for American Progress and the Service Employees International Union, which found that nearly nine out of 10 Americans think the current system is broken.
Opposition to proposal
Although opponents agree that the problem of the uninsured must be addressed, they say a national system would drive up taxes, stifle medical innovation and lead to waits for services.
"If you think you can get free health care and you don't have to pay for it in some way, you're being naïve," said Robert Moffit, director of the center for health policy studies at the Heritage Foundation, a Washington-based conservative think tank.
Moffit pointed to a proposal for a state-level universal plan in Oregon that would have required a new personal income tax of as much as 8 percent and a payroll tax for businesses of 3 percent to 11.5 percent.
In addition to tax increases, Moffit said, "once the health-care dollar becomes a part of the federal budget, it competes with education and other priorities."
State Rep. Bob DeWeese, R-Prospect, a retired physician who voted against the Conyers resolution in the Kentucky House committee, also expressed concern about rising taxes.
He said something must be done about the growing number of uninsured Americans, but "we don't have to change the whole system to fix this problem."
Proponents argue that a national health plan would save money. In recent years, increases in insurance premiums have far outpaced inflation. A summary of the Conyers bill says 95 percent of families would pay less for health care under the plan than they do today.
Moffit argued that ultimately, the quality of care would suffer with a national setup, partly because such systems generally don't invest as much in medical technology.
He also pointed to waits for services. One recent survey by a Canadian economic think tank called the Fraser Institute -- which seeks to bring attention to the issue of market competition -- found that waiting times there between referrals and treatment averaged 17.7 weeks across specialties last year.
Proponents of national health care say that concern is overblown.
But Julia Costich, chairwoman of the department of health services management at the University of Kentucky, said the Conyers bill stands little if any chance of passing, partly because it calls for such sweeping change.
"I applaud their ambition," Costich said of proponents, "but it seems very far-fetched."
Kentucky is not the first state to show support for a government-run health system. Some states have gone so far as to move toward their owns plans. In Oregon, where voters rejected a single-payer proposal in 2002, supporters are pushing for another measure in 2008.
In Ohio, a coalition claims it has collected tens of thousands of signatures in support of such a plan and hopes to put the issue on the ballot next year.
Maine already has a program offering affordable health-care coverage that aims to cover all uninsured residents eventually.
Dr. Garrett Adams, a retired physician who heads up the Kentucky chapter of Physicians for a National Health Program, said universal health care is a matter of fairness and humanity. His group prefers a national system to state efforts.
Adams said the problems faced by the uninsured are particularly acute in Kentucky, which was shown in a recent Courier-Journal investigation to be among the least healthy states in the nation.
"This is so wrong," Adams said. "They're real lives. They're people."
Shepard, a 51-year-old home health aide who spoke before the state House Health and Welfare Committee, said that since her heart attack, she has been diligent about getting care at the Family Health Centers' Portland clinic.
But with a low income, specialized care can be a struggle.
A national program would help her "and others like me who fall through the cracks," she said in an interview.
One patch of common ground for supporters and opponents is the belief that the current U.S. system has serious problems.
A 2003 ABC News/Washington Post poll showed that more than half of Americans are dissatisfied with the quality of health care, the first majority in three polls since 1993.
Sandie Limpert of Louisville, a 53-year-old graduate student who has gone half her adult life without health insurance, said she believes the system is in such disarray that a major overhaul would be better than small reforms.
"It's like we're trying to plug our fingers into the dam," she said. "But it's only a matter of time before the whole thing cracks and explodes."
Reporter Deborah Yetter contributed to this story.
Reporter Laura Ungar can be reached at (502) 582-7190.
Wednesday September 14, 6:33 pm ET
By Matthew Daly, Associated Press Writer
Starbucks to Spend More on Health Care Than Coffee, Company's Chairman Says
WASHINGTON (AP) -- Starbucks Corp. will spend more on health insurance for its employees this year than on raw materials needed to brew its coffee, the company's chairman said Wednesday.
Howard Schultz, whose Seattle-based company provides health care coverage to employees who work at least 20 hours a week, said Starbucks has faced double-digit increases in insurance costs each of the last four years.
"It's completely non-sustainable," he said.
Schultz made the comments Wednesday at a meeting with Sen. Patty Murray, D-Wash., and Rep. Adam Smith, D-Wash. The event was one of several organized by Schultz and other executives to call attention to what they called a growing health care crisis.
"I would hope congressional leaders put this at the front of their agenda," said Schultz, noting that a majority of the estimated 45 million uninsured Americans have jobs.
Later, Schultz and other executives, including Costco CEO Jim Sinegal; Dawn Lepore, president and CEO of Drugstore.com; and Ivan Seidenberg, chairman and CEO of Verizon Communications Inc., attended a health care summit at a Senate office building.
Meanwhile, the Kaiser Family Foundation reported Wednesday that the growth rate of health insurance premiums failed to reach double digits this year, the first time that's happened since 2000.
Still, premiums rose much faster than overall inflation and wage growth, the report said.
The foundation, which specializes in health care research, said premiums increased 9.2 percent between spring 2004 and spring 2005. Such an increase could devour much, if not all, of the 2.7 percent increase the average employee saw in wages.
"There is some good news, I suppose. The rate of growth is slightly lower than last year," said Drew Altman, the foundation's president and CEO. "The bad news is that's the only good news, because premiums are still going up 3 times faster than wages."
Schultz said Starbucks expects to spend about $200 million this year for health care for its 80,000 U.S. employees -- more than the total amount it spends on green coffee from Africa, Indonesia and other countries.
Starbucks has about 100,000 employees worldwide, Schultz said, including about 65 percent who work part-time. Increasingly, the company is hiring older workers, who are attracted in large part by the company's generous benefits, he said.
Schultz said Starbucks' benefits policy is a key reason it has low employee turnover and high productivity.
He declined to endorse any specific legislation, saying his goal was to raise awareness of the problem. But whatever solution is adopted, he said, "Every single American needs to have access to health insurance -- full-stop."
Associated Press writer Kevin Freking contributed to this story.
Kaiser Family Foundation: http://www.kff.org