Pathways to Universal Coverage: Payment Reform Strategies for Containing Costs - Kaisernetwork.org
Sphere: Related ContentMonday, March 30, 2009
Candian Medical Association Looks to Europe to Improve Health System
Letter to members kicks off CMA debate:
The Canadian Medical Association is looking at European health systems for ways to improve.
The link the the letter is at their website, and a few choice comments are there, and here:The CMA won't launch its online consultation about transforming Canada's health care system until April 6, but if the initial response to President Robert Ouellet's March 6 letter announcing the endeavour is any indication, the consultation website should be a busy place.
Within five days of emailing the letter to members and posting it on cma.ca, the CMA had received 149 emails, many containing lengthy comments.
In his letter, entitled Status quo, or transformation?, Ouellet suggested that if Canada wants 'a sustainable, universal health care system, we have to transform the one we have.' It was first emailed to 45,000 members and posted on cma.ca, and then sent by regular mail to a further 25,000 members.
- "I kindly disagree with you. The problems in our system will not be solved by privatizing the most lucrative parts of it. Canadian doctors want to practise medicine, not run businesses."
- "I was delighted with your comments. The constant arguments that any changes in our system will make us like the US have been misleading and frustrating."
- "It is about time care and money be patient based. Bring on the new system you suggest - it cannot come soon enough for me."
- "I'm baffled how we are like sheep and accept the wait times in our country when other countries far surpass our achievements."
It's funny, isn't it? Canada has the sense to look past the end of its collective nose for solutions, while we continue to try to tweak our system as it continues on its glide-path into the mountain. Sphere: Related Content
Insurers shun those taking certain meds - Costs of Care - MiamiHerald.com
Insurers shun those taking certain meds - Costs of Care - MiamiHerald.com:
"Trying to buy health insurance on your own and have gallstones? You'll automatically be denied coverage. Rheumatoid arthritis? Automatic denial. Severe acne? Probably denied. Do you take metformin, a popular drug for diabetes? Denied. Use the anti-clotting drug Plavix or Seroquel, prescribed for anti-psychotic or sleep problems? Forget about it.
"This confidential information on some insurers' practices is available on the Web -- if you know where to look.
"What's more, you can discover that if you lie to an insurer about your medical history and drug use, you will be rejected because data-mining companies sell information to insurers about your health, including detailed usage of prescription drugs.
"These issues are moving to the forefront as the Obama administration and Congress gear up for discussions about how to reform the healthcare system so that Americans won't be rejected for insurance."
No surprises here, just documenting.
But it does make an interesting contrast to a letter written to the New York times on their piece on a public insurance option by a rather alarmist (and ill informed) physician:
"The unfair competition from a public plan would destroy the private health insurance industry. The inevitable result would be the rationing and other horrors of a Canadian-style single-payer system, which most Americans neither wish nor deserve."
Rationing, in America! God forbid.
Saturday, March 28, 2009
Support Growing for Major Changes to Health-Care System
Support Growing for Major Changes to Health-Care System:
Most notably, the group, known as the Health Reform Dialogue, calls for creating an 'individual mandate' that would require every American to have some type of health coverage. Anyone who cannot afford insurance would be eligible for subsidies or expanded government programs such as Medicaid.
'We should seek to ensure coverage for all,' the group concluded after six months of private, professionally facilitated negotiations.
The results are noteworthy because it is the first time that such a varied mix of special interests -- 'strange bedfellows,' in the words of one participant -- have coalesced around significant changes to the U.S. health system. The signers include the American Medical Association, the National Federation of Independent Business, two hospital groups, AARP and the liberal
consumer advocacy group Families USA.
'We're narrowing the range of disagreement,' said Karen Davis, president of the Commonwealth Fund, a nonprofit private health-care foundation that was not involved in the effort. It is striking, she observed, that the Health Reform Dialogue and influential lawmakers have all but ruled out the prospect of a European-style single-payer system, opting instead to build on the existing employer-based insurance arrangements.Equally striking, however, were the fundamental questions left unaddressed by the group of health-care heavyweights.
'A day late and a dollar short,' said one participant who spoke on the condition of anonymity so as not to jeopardize continuing participation.
The coalition's report is silent on whether employers have a responsibility to contribute to the cost of care, and it does not address the idea of creating a government-sponsored insurance program that would be available for anyone having difficulty buying coverage."....
"A government-controlled plan available to every American will push 160 million Americans now in private plans into a one-size-fits-all bureaucratic plan," said Nick Simpson, spokesman for Rep. Roy Blunt (R-Mo.).
I love that last bit by Rep. Blunt. If by push, he means that by being cheaper, more efficient and consumer friendly, public plans would be able to out compete the very inefficient private insurers, then yeah, they'll be "pushed." Sphere: Related Content
RAND | (Technical) Reports | Possibility or Utopia?: Consumer Choice in Health Care: A Literature Review
RAND (Technical) Reports Possibility or Utopia?: Consumer Choice in Health Care: A Literature Review:
This literature review examines consumer choice in health insurance plans against the background of the German health system in order to inform the questions: What are models of consumer choice and their effects?, and: If consumers want lower cost health care, what instruments can insurers use to provide it and what are the likely effects of those instruments? The review looked at experiences in other industrialized countries, especially the United States, for consumer choice options such as co-payments, reimbursement/bonuses, and deductibles, as well as organizational designs such as gatekeeper systems and selective contracting. In addition to cost-containment measures, the review also examined what was known about effects on health status, satisfaction, fairness and the macro-economic situation. The review describes the health economics theory of consumer choice, the methodology for the literature review, the German health system, and studies on consumer choice of insurers and providers, and reflects on their relevance on the German system. This literature review examines consumer choice in health insurance plans against the background of the German health system in order to inform the questions: What are models of consumer choice and their effects?, and: If consumers want lower cost health care, what instruments can insurers use to provide it and what are the likely effects of those instruments? The review looked at experiences in other industrialized countries, especially the United States, for consumer choice options such as co-payments, reimbursement/bonuses, and deductibles, as well as organizational designs such as gatekeeper systems and selective contracting.
The full document is here. Sphere: Related Content
The Public Option Favored by the Public
Robert Creamer at Huffington Post has a piece about a poll conducted by the Lake Research "found that a whopping 73% of voters want everyone to have a choice of private health insurance or a public health insurance plan while only 15% want everyone to have private insurance. "
Follow the link to read the rest. (I cannot find a link to the actual polling, sorry.)
This post also gives me a chance to link to
THE CASE FOR PUBLIC PLAN CHOICE IN NATIONAL HEALTH REFORM
KEY TO COST CONTROL AND QUALITY COVERAGE
By Jacob S. Hacker, Ph.D.*
From the executive summary:
This policy brief sets out the argument for public plan choice. The core argument is that public insurance has distinct strengths and thus, offered as a choice on a level playing field with private plans, can serve as an important benchmark for private insurance within a reformed health care framework. This is not an argument for a universal Medicare program, but instead for a "hybrid" approach that builds on the best elements of the present system—large group plans in the public and private sectors—while putting in place a new means by which those without access to secure workplace insurance can choose among health plans that provide strong guarantees of quality, affordable coverage. The case made in this brief is that this menu of health plans must include a good public plan modeled after Medicare if the broad goals of reform—universal insurance and improved value—are to be achieved.Sphere: Related Content
A Healthy Blog » Payment Reform Commission Looks At Payment Systems
A Healthy Blog » Payment Reform Commission Looks At Payment Systems:
"The Payment Reform Commission held its fourth meeting on Tuesday, February 24th. The Commission discussed episode-based payment models and evidence-based purchasing at length. Meeting materials are available here. Our full report is below the fold.
"Consultant Michael Bailit began the meeting by updating the Commission on feedback received from stakeholder input sessions. Bailit, Commissioner Iselin and Administration and Finance staff are conducting three rounds of meetings with stakeholders to gather feedback on the payment reform process."
This is a nice introduction to payment reform, including a section at the end discussing the potential uses of Comparative Effectiveness Research, and also of possible backlash against such work.
Thursday, March 26, 2009
Wednesday, March 25, 2009
Medical Professional Organizations' Views on Legislative, Regulatory, and Other Issues: Health System Reform
ACS Views on Legislative, Regulatory, and Other Issues: Health System Reform:
Since November 1, 2004, representatives (one elected leader and one staff person) from 11 physician organizations have held three health reform summits, with the goal of developing consensus on approaches that might lead to health care coverage for all, control of exploding health care costs, and sensible adjustments to America’s medical justice system.
Participating organizations included:
- American Academy of Family Physicians
- American Academy of Orthopaedic Surgeons
- American Academy of Pediatrics
- American College of Cardiology
- American College of Emergency Physicians
- American College of Obstetricians and Gynecologists
- American College of Osteopathic Family Physicians
- American College of Physicians
- American College of Surgeons
- American Medical Associatio
- American Osteopathic Association
The Board of Directors of 10 of the 11 participating organizations approved the final set of “Principles for Reform of the U.S. Health Care System”; the AAP did not sign on.
The goal when signing on to the principles was for each organization to be able to say: “These principles are consistent with our organization’s policy, and therefore we support them.”Now is the time for the organizations to begin discussions about how we might wish to introduce these important principles to various external audiences — key decision makers, policy makers, the media — and to consider any other "next steps" that we might consider regarding this important issue.
................
1.Health care coverage for all is needed to ensure quality of care and to improve the health status of Americans.
2.The health care system in the U.S. must provide appropriate health care to all people within the U.S. borders, without unreasonable financial barriers to care.
3.Individuals and families must have catastrophic health coverage to provide protection from financial ruin..............
6. Access to and financing for appropriate health services must be a shared public/private cooperative effort, and a system which will allow individuals/employers to purchase additional services or insurance.
...
11.Comprehensive medical liability reform is essential to ensure access to quality health care.
This was news to me, and it is something to build on... Sphere: Related Content
Tuesday, March 24, 2009
National Journal Online -- Health Care Experts -- The Public Plan: Time Bomb?
National Journal Online -- Health Care Experts -- The Public Plan: Time Bomb?:
"Can Congress fashion a public health plan option so that it does not blow up health care reform this year?"
I didn't get invited to leave a response, so here's mine:
Interesting discussion.
Dr. Nichols wonders if we have examples of regulated private insurers brhaving properly. At the risk of venturing beyond our shores, don't we have examples in Switzerland, Germany and other Social Health Insurance Model countries? His examples of public plans already alive and well in the US seem like good models to consider.
Ms. Turner and Mr. Goodman seem to be arguing opposite sides of magical market place coin: One laments that privte insurers will never be able to compete with the public option, and the other that the private insurers will eat the public plans' lunch. It is possible for them to co-exist, again, if one is willing to suspend the idea of American Exceptionalism and benefit from the experiences of other nations. I will venture to say that if Mr. Goodman is correct and the private insurers provide efficiency, quality and win-out, then "Hallelujah!", and all of us skeptics of the efficiency and value of private insurers will have been proved wrong, will eat crow, and happily allow the private insurers to be our vehicles for value.
I don't think this will happen, and it seems that Mr. Goodman may be conflating the role of private insurers in their function as Medicare Carriers and ther role as profit making (even when ostensibly "not for profit") insurers, dominating their regional markets, and squeezing their policy holders and providers alike.
Dr. Reinhardt, of course, always nails things and does again here. I think he may have overlooked another latent demand among physicians and other providers. Depending upon where you practice medicine, Medicare may be your most reliable, hassle free and even, in some markets, your best payer. Private insurers, while paying significantly more in some regions, may cost providers more in time, hassle, staffing costs and the like that their reimbursement warrants.
Ms. Davis also frames the debate well by focusing in on the acknowledged truth that we must pay smarter, not just more and more and more.
Cheers,
Monday, March 16, 2009
Sources of Waste in the US healthcare system
AMNews: March 16, 2009. White House summit takes 1st step in health system reform discussion ... American Medical News
AMNews: March 16, 2009. White House summit takes 1st step in health system reform discussion ... American Medical News:
AMNews had a more complete list of physicians in attendance than I did in an earlier post about the Summit:
"President Obama invited more than 100 people to a White House summit on health system reform on March 5, including the following physicians.
Rep. Michael Burgess, MD (R, Texas)
Ted Epperly, MD, American Academy of Family Physicians president
Oliver Fein, MD, Physicians for a National Health Plan director
Jeffrey P. Harris, MD, American College of Physicians president
Risa Lavizzo-Mourey, MD, Robert Wood Johnson Foundation president and CEO
Nancy H. Nielsen, MD, PhD, American Medical Association president
Irwin E. Redlener, MD, Columbia University Mailman School of Public Health professor
Elena V. Rios, MD, MSPH, Hispanic Medical Assn. president
Michael Salem, MD, National Jewish Health hospital system president
Henry E. Simmons, MD, MPH, National Coalition on Health Care president
David T. Tayloe Jr., MD, American Academy of Pediatrics president
Ho Luong Tran, MD, MPH, Asian and Pacific Islander American Health Forum president and CEO
W. Douglas Weaver, MD, American College of Cardiology president"
For my own edification, I did some research on membership numbers:
First, total number of ohysicians in US about 800K.
American College of Physicians (Internists and Medical Specialists) 126,000 members
American Academy of Family Physicians 94,000 members
American Academy of Pediatrics 60,000 members
Amercian College of Cardiology 36,000 members
AMA 240,000 including students and residents (free membership) and retired.
--- maybe 140,000 practicing physicians (Approximately 20 % or less of all physicians)
Hispanic Medical Association 36,000 members
Others:
American College of Surgeons 76,000 members
American College of Obstetricians and Gynecologists 52,000 members
American Society of Anesthesiology 43,000 membersAmerican Psychiatric Association 38,000 members
American College of Radiology 32,000 members
American College of Emergency Physicians 27,000 members
American Academy of Dermatology 16,000 members
American Academy of Ophthalmology 7,000 members
American Orthopaedic Association (AOA) 1,500 members
These numbers are from the organizations own websites, except for the AMA data which is from Wikipedia - I actually have the actual data from the membership committee buried in my office somewhere, and if I can find it, I'll post it.
In any case, some of the numbers include medical students, residents and fellows, and international members. But at least a rough guide, suggesting that there really is no single big gorilla, but I know some small groups put their money where their mouths are and have outsized political clout...
Some State Membership numbers, from their web sites:
California Medical Association 35,000
Texas Medical Society 43,000
Medical Society of New York 30,000
Florida Medical Association 19,000
Illinois State Medical Society _____
Pennsylvania Medical Society 20,000
Sphere: Related Content
Massachusetts Faces Costs of Big Health Care Plan - NYTimes.com
Massachusetts Faces Costs of Big Health Care Plan - NYTimes.com:
"“Frankly, it’s very hard for the average consumer, or frankly the average governor, to understand how some of these companies can have the margins they do and the annual increases in premiums that they do,” Mr. Patrick said in an interview. “At some level, you’ve just got to say, ‘Look, that’s just not acceptable, and more to the point, it’s not sustainable.’ ”
"The threat seems to have been heard. Insurers seeking to participate in the state’s subsidized insurance program, Commonwealth Care, recently submitted bids so low that officials announced last week that they would keep premiums flat in the coming year. That may provide cover for the program as the state seeks ways to fill a nearly $4 billion gap in its 2010 budget."
Saturday, March 14, 2009
The Concerns of "Harry and Louise" circa 1994
YouTube Link to videos here.
Because my daughter is working on her undergraduate thesis on comparing the health care reform policy environment in 1994 and now, we were looking at the old Harry and Louise videos.
It is funny, because there are two issues raised in the commercials. In the first, set "Sometime in the Future,"the concern is about having to choose among "insurance plans designed by government bureaucrats" and the lack of choice among doctors, hospitals, etc., should this happen. And the cute little line about, "Remember our old plan? That was a good one."
Well, of course, those ships have all sailed. Our insurers now dictate our provider choices ever more restrictively. If you've ever changed your insurer, you probably have come to terms with looking through the provider book and figuring out which PCP practice to switch to, whether to go "out-of-network" to keep your old specialists, and whether to drive to a new hospital in your network. Unless, of course, you are in a federal plan, designed by bureaucrats, which generally will provide you with substantially more choice than your private plan.
It's also worth saying that in most markets, insurance consolidation has resulted in ever dwindling choice in private insurers. So, the choice thing? Not so much.
The second commercial talks about the dangers of "community rating" to the premiums of the younger and healthier. This is exactly right, and Uwe Reinhardt has been warning about this lately. If not forced to buy insurance, those who are at lower risk of needing health insurance will opt out, driving up the premiums for those buying insurance, particularly small employers who can't spread the risk out. A genuinely fair concern that is still in the mix of issues that need to be dealt with today.
So, how to deal with it? Everyone must be in. We must accept the societal bargain that when we are healthy, we subsidize those who are not. When our kids are healthy, we subsidize our neighbors' kids with diabetes and autism and cancer. When our parents have chronic illnesses, we spread the risk amongst us all.
Wednesday, March 11, 2009
Dr. Oliver Fein reports on the White House health summit - PNHP’s official Blog
Dr. Oliver Fein reports on the White House health summit - PNHP’s official Blog
An excerpt:
Sphere: Related ContentWhat was my role in all of this? Despite my best efforts, I was unable to make a public statement at the meeting, although thanks to the PNHP staff in Chicago we were able distribute my prepared remarks to the media while the summit was under way. Our staff member in Washington, Danielle Alexander, also handed out hard copies to summit participants as they left the White House.
I took the opportunity to talk one-on-one with six senators and seven representatives and suggested that if their committees held hearings on health
reform, at least one or two single-payer advocates should be included on the
hearing panel. I also said that single-payer bills like H.R. 676 should be
compared with all other proposals for health care reform by the Congressional
Budget Office. There was considerable receptivity to these ideas among some of
the Congress members. We will pursue these leads.The media took great interest in the successful battle by Rep. Conyers and myself to get into the summit, with stories in the Congressional Quarterly, The Wall Street Journal, and The New York Times, among other places. We have also been able get the single-payer message out on radio, with myself and Drs. Walter Tsou, Steffie
Woolhandler, David Himmelstein and Quentin Young, among others, being invited to
appear on the air, often on programs with national reach. This was a plus.In sum, I came out of the White House Health Care Summit with conviction that
single payer – that is, publicly funded, privately delivered health care, which
removes the wasteful for-profit, private health insurance companies as middlemen, remains the only solution that can guarantee access to comprehensive, quality health care with choice of doctor and hospital, and reduce overall cost. Single-payer, an improved and expanded Medicare-for-All, is the gold standard against which all other proposals for health care reform should be measured.
Rep. Roy Blunt on Healthcare reform - RNC Weekly Address
Republican • National • Committee:
A snippet from Roy Blunt's response to the Obama weekly address, on Health Care Reform:
“Just imagine a health care system that looks like a government run operation most of us are all too familiar with - the local DMV. Lines, paper work, taking a number. Or how about another government agency - the IRS."
Now, Mr. Blunt gets his health care through his job, I imagine, which puts him in the federal program, and most of my patients get their health care courtesy of Medicare, and I don't hear much complaining from them, while I hear LOTS of complaining from those who have private health insurance. All the time. Sphere: Related Content
Eight principles of Health Care Reform - from Obama Budget
• Guarantee Choice. The plan should provide Americans a choice of health plans and physicians. People will be allowed to keep their own doctor and their employer-based health plan.
• Make Health Coverage Affordable. The plan must reduce waste and fraud, high administrative costs, unnecessary tests and services, and other inefficiencies that drive up costs with no added health benefits.
• Protect Families’ Financial Health. The plan must reduce the growing premiums and other costs American citizens and businesses pay for health care. People must be protected from bankruptcy due to catastrophic illness.
• Invest in Prevention and Wellness. The plan must invest in public health measures proven to reduce cost drivers in our system—such as obesity, sedentary lifestyles, and smoking—as well as guarantee access to proven preventive treatments.
• Provide Portability of Coverage. People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of preexisting conditions.
• Aim for Universality. The plan must put the United States on a clear path to cover all Americans.
• Improve Patient Safety and Quality Care. The plan must ensure the implementation of proven patient safety measures and provide incentives for changes in the delivery system to reduce unnecessary variability in patient care. It must support the widespread use of health information technology with rigorous privacy protections and the development of data on the effectiveness of medical interventions to improve the quality of care delivered.
• Maintain Long-Term Fiscal Sustainability. The plan must pay for itself by reducing the level of cost growth, improving productivity, and dedicating additional sources of revenue.
Nothing over the top in here. The principles, I think, are not very assailable.
The Politico offers their "translation" and I think zeroes in on what may become the critical throw down issue: Will we have a public insurance option to compete with private insurers in a system where all are required to have insurance?
Henry Waxman told AMA members in DC that a public option was in his plans, and Obama and Sen. Baucus have also indicated support for a public option.
Here is a link to the AMA National Advocacy Council news site. I have to say, the list of speakers is impressive. No Cato, Fraser, Heritage to be found (at least on the fist day - Tuesday) speaker list. Mostly progressive speakers.
Tuesday, March 10, 2009
The White House - Press Office - White House Forum on Health Reform Attendees and Breakout Session Participants
The White House - Press Office - White House Forum on Health Reform Attendees and Breakout Session Participants
I was curious who was invited, so click on the link to see the complete list.
The physicians groups that I saw are below.
American College of Physicians, Jeff Harris, President
American Academy of Pediatrics, David Tayloe, President
American College of Cardiology, W. Douglas Weaver, President
American Academy of Family Physicians, Ted Epperly, President
American Medical Association, Nancy Nielsen, President
National Medical Association, Mohammad Akhter, Executive Director
Physicians for a National Health Plan, Dr. Oliver Fein, Director
University of Chicago Medical School, Eric Whitaker, Executive Vice President For Strategic Affiliations
And only one nurses group?
American Nurses Association, Rebecca Patton, President
Monday, March 9, 2009
Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries -- American College of Physicians, -- Annals of Internal Medicine
Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries -- American College of Physicians,:
When we were talking last week about the lack of single payer advocates at last week's summit, I didn't realize that ACP was there. The President of the ACP was there, though I don't know his persoanl feelings about reform, I did go back and look at the recommendations published by ACP last year.
"Paying for Health Care
"Recommendation 1a: Provide universal health insurance coverage to assure that all people within the United States have equitable access to appropriate health care without unreasonable financial barriers. Health insurance coverage and benefits should be continuous and not dependent on place of residence or employment status. The ACP further recommends that the federal and state governments consider adopting one or the other of the following pathways to achieving universal coverage:
"1. Single-payer financing models, in which one government entity is the sole third-party payer of health care costs, can achieve universal access to health care without barriers based on ability to pay. Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per capita health care expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access. They may require a higher tax burden to support and maintain such systems, particularly as demographic changes reduce the number of younger workers paying into the system. Such systems typically rely on global budgets and price negotiation to help restrain health care expenditures, which may result in shortages of services and delays in obtaining elective procedures and limit individuals' freedom to make their own health care choices. [CMHMD Note: I guess it shows how complicated this all is. ACP considers Japan single payer and France a hybrid sytem, but most consider both single payer. In any case, neither have significant problems with waiting times.]
"2. Pluralistic systems, which involve government entities as well as multiple for-profit or not-for-profit private organizations, can assure universal access, while allowing individuals the freedom to purchase private supplemental coverage, but are more likely to result in inequities in coverage and higher administrative costs (Australia and New Zealand). Pluralistic financing models must provide 1) a legal guarantee that all individuals have access to coverage and 2) sufficient government subsidies and funded coverage for those who cannot afford to purchase coverage through the private sector. (See the ACP's proposal for expanding access to health insurance as an example of how a pluralistic system can achieve universal coverage [69].)
"Recommendation 1b: Provide everyone access to affordable coverage—whether provided through a single-payer or pluralistic financing model—that includes coverage for a core package of benefits, including preventive services, primary care services—including but not limited to chronic illness management—and protection from catastrophic health care expenses.
"Recommendation 1c: Until there is political consensus for achieving universal coverage at a federal level, Congress should encourage state innovation by providing dedicated federal funds to support state-based programs with an explicit goal of covering all uninsured persons within the state. (See the ACP position paper, "State Experimentation with Reforms to Expand Access to Health Care" [70].)
"[ACP]Comment: Universal health care insurance is necessary to ensure that everyone within the United States has access to needed health care services of high quality. The federal government should assure that all persons within the borders of the United States also have access to health care services without undue financial barriers and that health care services provided are adequately reimbursed. The ACP recommends 2 alternatives: a system funded solely or principally by government (federal and state), commonly known as a single-payer system, or a pluralistic system that incorporates existing public and private programs with additional guarantees of coverage and with sufficient subsidies and other protections to assure that coverage is available and affordable for all. The ACP has proposed a step-by-step plan that would achieve universal coverage while maintaining a pluralistic system of mixed public and private sector funding."
------------------------------------------
SO, ACP advocates either a single payer model, or a social health insurance model (i.e., a hybrid system) as the path to paying for universal health care. This is where I come down as well. I think it would be very useful if we could get a majority of physicians to accept this either/or approach with the caveat that we vigorously campaign to allow NOTHING LESS than this to be our line in the sand.
Sphere: Related ContentThursday, March 5, 2009
McCain's hero Teddy Roosevelt was more socialist than Obama. - By Timothy Noah - Slate Magazine
McCain's hero Teddy Roosevelt was more socialist than Obama. - By Timothy Noah - Slate Magazine:
All from Tim Noah's Slate.com post from before the election. I got an email from a local restauranteur decrying "villifying the rich" and complaining about complaining about excessive corporaatte entertaining.
T.R., of course, was no socialist. Indeed, his purpose was largely to prevent socialists from coming to power. But the trust buster got called a socialist a lot more often than Obama ever will. He writes in his autobiography:
Because of things I have done on behalf of justice to the workingman, I have often been called a Socialist. Usually I have not taken the trouble even to notice the epithet. … Moreover, I know that many American Socialists are high-minded and honorable citizens, who in reality are merely radical social reformers. They are opposed to the brutalities and industrial injustices which we see everywhere about us.
T.R. then goes on to outline his strong differences 'with the Marxian Socialists' and their belief in class warfare and the inevitable demise of capitalism. Later, he returns to his earlier theme:
Many of the men who call themselves socialists today are in reality merely radical social reformers, with whom on many points good citizens can and ought to work in hearty general agreement, and whom in many practical matters of government good citizens can well afford to follow.
There were, however, limits to T.R.'s tolerance. 'I have always maintained,' he concluded, 'that our worst revolutionaries today are those reactionaries who do not see and will not admit there is any need for change.'" Sphere: Related Content
Wednesday, March 4, 2009
Updated:Action Alert: Call The White House: Let Single Payer In | Physicians for a National Health Program
Action Alert: Call The White House: Let Single Payer In Physicians for a National Health Program:
***Update***
The White House has reversed itself and extended invitations for two single payer supporters to attend Thursday’s Healthcare Summit.
Congressman John Conyers, author of HR 676 single payer legislation in the House, and Dr. Oliver Fine, who currently heads Physicians for a National Health Program (PNHP), received invitations on Wednesday.
"On Thursday, March 5, 2009, the White House will host a summit on how to reform the healthcare system.
"The 120 invited guests include lobbyists for various interest groups including the private-for-profit insurance industry (AHIP), some members of Congress including Senate Finance Chairman Max Baucus who has already ruled single payer “off the table,” and various others concerned with healthcare.
"No single payer advocates have been invited to attend."
A disappointing turn of events. My letter to the White House and Senator Casey (my Senator, who is now on the HELP Committee.)
RE: March 5th Health Care Summit
I am disappointed that Single-Payer Health Care advocates are not going to be represented at the Summitt. If this is because Single-Paye is "off the table," then I suggest you disinvite all those representing the status quo, as I understand that that option is also off the table.
I personally favor transitioning to Universal Health Care via the Swiss or German Societal health Insurance model, but by not having Single Payer advocates at the table, a vast swath of serious intellectual and scientific thought is cut out of the discussion. This is NOT acceptable if we are to have a serious debate about the faith of Health Care in the US.
Thank you, etc.To Senator Casey:
Dear Senator Casey,
I was very pleased to see that you have joined the HELP Committee. It represents a very important opportunity to do "to the least among us," what we would want for ourselves and our children.
I hope you will push for a very strong intellectual debate on health care reform, in particular.
I was very disappointed in a recent decision by President Obama to exclude those who advocate for a Single Payer system in the US from his upcoming Health Care Summit.
If this is because Single-Payer is "off the table," then I suggest disinviting all those representing the status quo, as I understand that that option is also off the table.
I personally favor transitioning to Universal Health Care via the Swiss or German Societal Health Insurance model, but by not having Single Payer advocates at the table, a vast swath of serious intellectual and scientific thought is cut out of the discussion. This is NOT acceptable if we are to have a serious debate about the faith of Health Care in the US.
Although I do not expect you to be able to change what will happen on March 5th, I hope you will use your position on the HELP Committee to ensure a robust, inclusive debate on health care reform.
Thank you etc.
You can get more details at the PNHP site, including that Rep. Conyers, the sponsor of HR 676 asked to be invited and was not at the PNHP site. And the WH phone numbers. Sphere: Related Content
The Globalist | Global Health -- What Obama Can Learn from European Health Care (Part I)
The Globalist Global Health -- What Obama Can Learn from European Health Care (Part I):
"Imagine a place where doctors still do house calls. When I was visiting my friend Meredith, living in the small rural town of Lautrec about an hour’s drive outside Toulouse, France, one day she was stung badly by a wasp, causing a sizable and painful swelling on her hand.
"She called her doctor, and to my great surprise within 15 minutes he had shown up at her door — the famous French doctor’s house call. I couldn’t get over it. “House calls in the United States went out when Eisenhower was president,” I told her, shaking my head."
Part Two of this article is here.
"The first overriding difference between U.S. and European healthcare systems is one of philosophy. The various European healthcare systems put people and their health before profits — la santé d’abord, “health comes first,” as the French are fond of saying.
"It is the difference between health care run mostly as a non-profit venture with the goal of keeping people healthy and productive — or running it as a for-profit commercial enterprise. "
And this section is well said:
Unlike single-payer Britain or Sweden, other nations like France, Germany, Switzerland and Belgium have figured out a third way, a hybrid with private insurance companies, short waiting lists for treatment and individual choice of doctors (most of whom are in private practice).
This third-way hybrid is based on the principle of “shared responsibility” between workers, employers and the government, all contributing their fair share to guarantee universal coverage.Participation for individuals is mandatory, not optional, just as it is mandatory to have a driver’s license to drive a car.
These healthcare plans are similar to what Massachusetts recently enacted — but with two essential differences. First, in France and Germany, the private insurance companies are non-profits. Doctors, nurses and healthcare professionals are paid well, but you don’t have corporate healthcare CEOs making hundreds of millions of dollars. Generally speaking, the profit motive has been wrung out of the system.
The second key difference is in the area of cost controls. In France and Germany, fees for services are negotiated between representatives of the healthcare professions, the government, patient consumer representatives and the private non-profit insurance companies.
These are a nice pair of articles to send to people who need a basic primer on what "socialized medicine" really is, rather than what the Right wants you to think it is.
Cheers, Sphere: Related Content
Tuesday, March 3, 2009
Poll: Obama Gets Strong Support -Health care nugget.
Poll: Obama Gets Strong Support - WSJ.com:
"On health care, the poll flashed warning signs for the administration.
"Forty-nine percent said they were willing to pay higher taxes so that everyone can have health insurance, compared with 66% who said the same in March 1993, when President Bill Clinton was embarking on his ultimately unsuccessful health-reform effort. That underscores why the administration is focused on cutting costs, not covering the uninsured."
My take is twofold. First, Americans are paying such a large percentage of household income on health care now, 17% according to Len Nichols at New America, that perhaps they can't imagine paying more than 17%. I often wonder how people think about this question: Do they think, "Hmm, would I be willing to pay my 17% AND more in taxes" and answer "No," or do they think, "Hmm, the 17% of my income that goes to health care and my taxes go up some uncertain amount," and answer "Yes?" (Or maybe they answer "no," too.)
Or, perhaps they are picking up on the conversations we are having in the health care reform debate and take us at our word. That is, many of us routinely point out that if we truly reform health care, we should eventually be able to spend less overall. If we are right, perhaps consumers are beginning to catch on and realize we might actually end up spending less in the long run and they shouldn't be expected to pay more of our GDP on health care.
But that would require a lot of average people paying quite a bit of attention...
I can dream, can't I?
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