Health Reform

Passing the Buck

Paul Krugman, New York Times, April 22, 2005

The United States spends far more on health care than other advanced countries. Yet we don't appear to receive more medical services. And we have lower life-expectancy and higher infant-mortality rates than countries that spend less than half as much per person. How do we do it?

An important part of the answer is that much of our health care spending is devoted to passing the buck: trying to get someone else to pay the bills.

According to the World Health Organization, in the United States administrative expenses eat up about 15 percent of the money paid in premiums to private health insurance companies, but only 4 percent of the budgets of public insurance programs, which consist mainly of Medicare and Medicaid. The numbers for both public and private insurance are similar in other countries - but because we rely much more heavily than anyone else on private insurance, our total administrative costs are much higher.

State must lead on single-payer

Jean W. Dillard, RN, Lenox, Berkshire Eagle, April 15, 2005

Health care is on the minds of lots of people these days. The bad news is that insurance premiums are rising yet again.

Many people are losing coverage altogether. Hospitals are losing money and patients are getting wrong medications; nurses are leaving their jobs because of over-work and being unable to give patients the time and care they used to give. Pharmaceutical companies are hiding information that some of their new medications are not as safe as the older cheaper ones; they charge higher and higher prices for new medications that are not very different from the old ones, but the statute of limitations has run out on the old ones that are now generic and cheaper.

The state has lost three Fortune 500 companies within the last year and there are maybe more to come. A single-payer health care system would save them millions of dollars. A recent article reported that health insurance today costs about $1,500 per year.

Healthcare reform tango

Scot Lehigh, Boston Globe, April 8, 2005

It's a daze of dueling policy prescriptions.

On Wednesday, Senate President Robert Travaglini addressed the Greater Boston Chamber of Commerce, offering a broad outline of the Senate's approach to expanding healthcare coverage.

Just hours later, Governor Romney unveiled, after at least three previews, his own legislation to clear the way for lower-cost private health insurance.

Each camp is eyeing the other's timing suspiciously.

Romney's folks insist the governor had had his press conference and several related events on tap for days and, what's more, had told Travaglini on Monday that he would file his bill this week. And, further, that they had no idea the Senate president had similar plans.

Travaglini seeks to raise rates of insured residents

Kat Dowling, The Daily Free Press, April 8, 2005

Senate President Robert Travaglini proposed making long-term investments in health care to reduce the amount of Massachusetts residents without health insurance at a meeting with the Boston Chamber of Commerce Wednesday.

"We have an obligation to fix the existing health care system so that it continues to take care of the sick, the poor and the uninsured," he said.

Travaglini (D-Boston) said his plan would cut the number of uninsured residents in half within the next two years and boost the economy. It will also improve the quality of health care, he said, without raising taxes or fees and without imposing mandates on insurers and businesses.

Travaglini plan would tap reserves for healthcare

Scott S. Greenberger, Boston Globe, April 8, 2005

Senate President Robert E. Travaglini has proposed tapping state reserves for $168 million as part of a far-reaching plan to trim medical costs and boost the number of Massachusetts residents with health insurance.

Like Governor Mitt Romney, who submitted his own healthcare bill on Wednesday, Travaglini is seeking to reduce the ranks of the roughly 500,000 uninsured in Massachusetts by allowing insurance companies to offer lower-cost policies with scaled-back benefits. But his 63-page proposal goes further than the plan put forth by the governor, who has promised to propose more changes later this year.

Healthcare reform efforts win praise

Hospitals, insurers see proposals as 'great beginning'
Scott S. Greenberger, Boston Globe, April 7, 2005

Hospitals, insurers, and business groups are rallying behind Beacon Hill leaders' efforts to expand healthcare coverage, praising Governor Mitt Romney and Senate President Robert E. Travaglini for unveiling plans yesterday that would achieve that goal in large part by allowing insurance companies to offer less expensive policies with scaled-back benefits.

Peter Meade, executive vice president of Blue Cross/Blue Shield, described the day as ''a great beginning," and Bill Vernon of the National Federation of Independent Business said, ''Trusting the market to provide flexibility and choice of products is critical to solving the healthcare crisis in our state."

Plan would charge companies that don't provide health insurance

Theo Emery, Associated Press, April 7, 2005

Boston - A new legislative health care proposal would impose a surcharge on large companies that don't offer worker health benefits in an effort to reduce the number of people receiving free health care from the state, Senate President Robert Travaglini said Thursday.

One element of Travaglini's plan is a proposed "Free Rider Surcharge" on employers of 50 or more whose workers use the state's uncompensated care pool for the poor.

Canada Health Act

The five principles of the Canada Health Act are the cornerstone of the Canadian health care system, and have iconic status for Canadians. This legislation, passed unanimously by Parliament in 1984, affirms the federal government's commitment to a universal, accessible, comprehensive, portable and publicly administered health insurance system. The Act aims to ensure that all residents of Canada have access to necessary hospital and physician services on a prepaid basis. The Canada Health Act provides the provinces and territories with criteria and conditions that they must satisfy in order to qualify for their full share of federal transfers under the Canada Health and Social Transfer (CHST).

Resource Page

Legislation:

Massachusetts Health Care Trust bill (S.755)
State universal single-payer healthcare system, comprehensive, portable, accountable

Congressman Conyers' Bill (HR. 676)
US National Health Insurance Act

Studies:

BUSPH Access & Affordability Monitoring Project
Links to many studies, including MMS/Massachusetts Senate Ways & Means Single-Payer Feasibility Study

LECG Report

Incremental approaches to solving the health care crisis won’t work

Pay or play - a useless diversion
Rose Ann DeMoro, Executive Director, California Nurses Association, 2003

At a moment when the public response to the present managed care system of delivering health care services ranges between apprehension and disgust, and support grows for doing something really meaningful to change the situation, along comes something with the catchy title: “pay or play.”

Pay or play is simply a rehash of the notion that we are entitled to all the health care we can afford. As another health insurance scheme its most distinguishing feature is that it is not universal health care. That is, it’s a counter to the principles of a “single payer” health care arrangement. Rather than challenging the dominant role of the insurance companies and health maintenance organizations in determining who receives health care and how it is delivered, it perpetuates it. Even worse, pay or play will most assuredly accelerate a process already underway under the HMOs’ reign - that is, the creation of a multi-tiered health care system guaranteeing that those with the lowest incomes will receive inferior care.

The basic idea here is that all employers would be required to offer health insurance to their employees (“play”) or pay a tax into a government fund that will provide a health plan to uninsured people. As embodied in legislation currently before the California legislature, the government would cover only uninsured people who are employed.

The employer mandate has been praised by the leaders of some unions in California and elsewhere for expanding the existing method of job-based health coverage, the primary source of health benefits in the US. Actually, health care through insurance linked to employment has been the Achilles heel of health care in our country. Five decades or so ago when the labor movements of most of the rest of the industrialized world were campaigning for and winning universal health care, we settled for insurance linked to employment. For many, coverage was secured as part of union contracts. Left out, for the most part, were many of those employed by small employers and the unemployed. The limitations of the system are now being underscored by the existence of 42 million people in the country with no insurance and the rush of employers to shift more of the financial burden onto workers or to pull out of the system altogether.

A quick look shows that the “play or pay” employer mandate offers much less than meets the eye - to employees, retirees, the unemployed and even to many employers. For instance:

* Employers are mandated to offer health plans to their employees, but the individual employee may not be able to afford the deductibles or the co-pays for the plan his or her family needs.
* No protection is provided at a time when many employers are reducing benefits, increasing co-pays, or dropping coverage for employees altogether. A Bureau of National Affairs survey in January found that higher deductibles are a bargaining goal for 43 percent of employers with such provisions, and 17 percent without deductibles intend to introduce them.
* The multi-tiered marketplace of insurance plans - the very opposite of a single standard of care - pushes the least advantaged workers into the lowest tier, into underinsurance, into lesser quality care.
* Employees will have to guess and gamble which plan is best for themselves and their families (if it even covers dependents): a plan that pays routine expenses but quickly maxes out on total coverage, or a plan that drains money from the employee's pocket in return for major medical protection in the event of highly expensive treatment.
* Employees who lose their jobs lose their coverage, too. When and if the employee finds a new job, his/her physician or other health care providers may not be available through the new employer's plan.
* For employees in unions, the exact terms of benefits remain an element of collective bargaining. The employer still whipsaws employees between wage gains and health coverage.
* The multiplicity of health plans and the expanded demand for health insurance continue to eat up precious dollars in administrative duplication and competitive marketing.
* If retirees are left out of the mandate, they are left with no coverage beyond Medicare, which has huge gaps, such as prescription drug coverage. (This was written before the 2004 Medicare ‘drug benefit’ was added.)
* Rising unemployment throws more people out of their employer coverage, forcing them to rely on programs such as Medicaid, which is currently facing cutbacks due to state budget deficits.
* Small employers in particular face high cost and administrative hurdles arranging coverage for their employees.

The barebones nature of a program financed by employer taxes cannot provide full coverage to vast numbers of people. A number of them wind up in emergency rooms - the most expensive way of delivering care. Thus, the problem of “uncompensated care” remains, resulting in continued cost shifting by hospitals and other providers and raising the prices charged to more generous employers.

An employer mandate does nothing to control skyrocketing health care costs. According to a survey by Mercer Human Resources Consulting, premiums for job-based health coverage increased by an average of 14.7 percent in 2002, and are expected to go up another 14 percent in 2003.

An employer mandate leaves the failing and corrupt health care industry intact. It does nothing to crack down on corporations like Tenet Health care that have been alleged to exploit and defraud the current reimbursement structure. It does not crack down on HMOs that have dropped millions of seniors from Medicare plans. It does not challenge the pharmaceutical industry, which chooses only to develop medications that produce the most income or government subsidies.

An employer mandate fails to resolve systemic problems of today's health care. It does not rectify abuses by HMOs that have prompted a grassroots rebellion and demands for fundamental change. Play or pay does nothing to improve the deteriorating patient care conditions in hospitals and nursing homes or to protect patients from unsafe staffing and medical errors. It offers no plan for reversing the growing closures of hospitals and emergency rooms. It is another band-aid to be applied to a discredited and dysfunctional system. It is intended to sidetrack the growing public embrace of the idea of universal, comprehensive health care for all.

Copyright ©2003 California Nurses Association www.calnurse.org

For a PDF version of this article, suitable for printing and mass distribution, go to:

Incremental approaches

Bitter medicine: Why health care is a privilege, not a right, in America

Tom Gallagher, San Francisco Bay Guardian, June 25, 2003 (Vol. 37, No. 39)

As VI Lenin, the leader of the Russian Revolution, wrote, "Socialized Medicine is the keystone to the arch of the Socialist State." Actually, Lenin didn't write that, but the American Medical Association figured he might as well have, so it made up the quote for him and used it in its anti-national health insurance literature of the late 1940s. Such were the politics of health care in the 20th-century United States. Since those politics resulted in our nation's ending the century as the world's only wealthy democracy without a national health insurance system, much of Colin Gordon's Dead on Arrival: The Politics of Health Care in Twentieth-Century America is the story of how the opponents kept it that way.

Healthcare Reform Resources

All the groups listed in the Web Directory to the left fight for a just healthcare system and are valuable resources for nurses engaged as patient advocates. The Labor Party specifically hosts a page dedicated to its campaign for

Just Health Care

. For several years now, Page 2 of The Massachusetts Nurse, the organ of the

Massachusetts Nurses Association

, has been dedicated to providing information nurses need to carry on the struggle for single-payer universal health care. This

Single Payer Page

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