excerpts from an informative study..click the link in the title to access the full study...rw
There are both indicators of health (outcome measures) and determinants of health. Mortality data - life expectancy, standardized mortality, infant mortality, maternal mortality and years of potential life lost - have been the main measures of the health status of a population. As life expectancy and the prevalence of chronic disease has been increasing, there has been a need for other indicators that measure the quality of life; indicators that measure self-perceived health, physical disability, mental functioning, etc.47
The decision of how to rank country performance is based on the paradigm of what should constitute a health-care system's principles when trying to achieve better health status for a population: high quality care, broad access to care and low costs.
Quality of care is measured using the categories of health status, mortality rates, preventable illnesses, appropriateness of services and patient satisfaction. Access to care takes into account the amount of insurance coverage in a population, equity in health outcomes, how health spending is distributed between acute and other health services, the availability of medical expertise and technology. Cost comprises efficiency, total health spending and sustainability.
...Singapore has the "best" health-care system of the eight countries, with a score of 62.1. In terms of the overall health-system score, the United Kingdom ranks second (60.5), Switzerland third (59.2), followed by Germany (59.0), Australia (56.8), Canada (56.7), the United States (53.6) and South Africa (45.4).
Quality of care
The health of a population is due, in part, to the quality of a country's health-care system. The safe birth of a child, the public's awareness of what constitutes healthy eating and living, and the incidence of treatable diseases all relate to how well a health system is performing.
Canada ranks first in health status. This category includes life expectancy, healthy life expectancy (years lived free-of-disability), the percent of population not expected to survive to age 40, self-reported health status, and the prevalence of smoking, alcohol consumption and obesity in the population. (My note: the US rates Fifth of eight, behind Switzerland, Canada, Singapore, and Germany in health status indicators. Tell me again how the US has the best healthcare system in the world? read on, we cant even claim the highest rating for Technology or satisfaction with all our options...)
Switzerland has the highest patient satisfaction, due to short waiting times for non-emergency treatment and to a high system-responsiveness ranking ...
Access to care
In Switzerland, health insurance is mandatory and, in Canada, the United Kingdom and Australia, every citizen is eligible for health insurance provided by the public sector. These countries, therefore, rank highly in terms of health coverage.
With respect to the availability of health-care resources, Germany ranks first, scoring 76.6 for service availability. Germany has more hospital beds per capita, and more physicians, specialists and dentists per 1,000 population than any of the other countries. While Switzerland does not have the most computed tomography (CT) scans per million people or the most magnetic resonance imagers (MRIs) per million population - it comes second to Australia in CT scans and second to the United States with respect to MRIs - it manages to attain the top ranking in the technology category with a score of 88.3.
Cost Of Care
While there is some debate as to whether high health-care spending is positive or negative, the traditional perspective is that health costs must be contained. Therefore, this study assumes that more spending on health is worse than less. Thus, both Singapore (94.7) and South Africa (87.4) rank highly while the United States scores the lowest on every indicator and receives a score of zero for this category. Germany, another big spender on health, scores a 34.6.
The sustainability of a health-care system is dependent on whether a country can afford to maintain it. The aging population is going to put a stress on every health-care system, thus the projected percent of the population over 65 years old and the amount spent on them relative to the rest of the population are included in this category. Sustainability also includes the number of medical students per million population, total expenditure on research and development (R&D), and the number of R&D scientists and technicians per 1,000 population.
Switzerland, with a score of 54.9, is in the most favorable position regarding the future of its health-care system; the United States and Australia, both at 35.7, the worst.
WHO's report ... that there is evidence that health systems do little to improve health: studies have shown life expectancy to be correlated with income per capita but not to the numbers of doctors, hospital beds or health expenditure.
As well, in the United States alone, medical errors kill some 44,000 people in hospitals annually.50 And, WHO notes that, while "rich" people tend to benefit more from the use of hospital and primary care services, "the distribution of primary care is almost always more beneficial to the poor than hospital care…."51
As with most studies of this nature, the main conclusion is that more data and a higher quality of data are needed. Areas for which data are lacking include the numbers and types of hospital procedures being performed; who is being treated, for what and how promptly;
The list is almost endless.
A well-defined set of performance indicators would help policymakers, funders and health managers in the management of health-care systems and policy development. It would help patients better monitor the quality of the system into which their tax dollars are going and from which they must receive their health care.
Tuesday, December 20, 2005
Health Care for All, Just a (Big) Step Away
December 18, 2005
Economic View
By EDUARDO PORTER
"I don't think anybody would dispute the economics," Mr. Gruber said. "I think the dispute would be over the politics."
YOU may find it shameful that some 45 million Americans lack health insurance. Well, by reallocating money already devoted to health insurance, the government could go along way toward solving the problem. But you may not like the solution.Next year, the federal government expects to provide about $130 billion for Americans to buy health insurance. The amount is substantial: it is equivalent to about 11 percent of all federal income tax revenue and more than a fifth of federal spending on Medicare and Medicaid. And it is growing fast: the bill is expected to surpass $180 billion in 2010.
Although subsidizing health insurance may seem a worthy effort, a positive contribution to the goal of universal coverage, it is among the most inefficient spending in the nation's fiscal arsenal."If you had $150 billion to play with, you could come very close to universal coverage," said David Cutler, an economics professor at Harvard. One reason that we are 45 million people short of that goal is that the money isn't being spent on them.According to President Bush's advisory panel on tax reform, about half of the tax break for health insurance accrues to families making more than $75,000 a year. More than a quarter goes to families making over $100,000.
Still, the fiscal incentive isn't helping many of the people who need it most. A report by the Kaiser Family Foundation says two-thirds of the 45.5 million Americans who lacked health insurance in 2004 earned less than twice what the federal government defines as poverty. (For a family of four, the poverty line is about $19,300.) In four of every five cases, the uninsured made less than three times the poverty level.In addition to going to the wrong people, the subsidy as designed promotes wasteful medical spending, encouraging the wealthy to buy more insurance and to use more health services than they need, according to the president's tax panel. And it may bolster premiums across the board.
As part of a series of proposals to rejigger the tax code, the president's tax panel issued a report earlier this year that suggested capping the total that can be paid in pretax dollars at an amount equal to the average health insurance premium in the country: some $11,500 for a family.But if the objective is to expand health care coverage, a bolder option is available: focusing the bulk of the money on the bottom end of the income distribution.Added to what is already spent on Medicaid, this financing would be roughly enough to make health insurance free for people earning up to three times the poverty level, and perhaps somewhat more, said Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology who has studied the efficiency of alternative methods for financing health insurance.
The government could give tightly focused tax credits so that lower-income people could buy health insurance on the market. And it could organize pools by, say, requiring insurers to charge the same for similar policies sold to people of the same age group who live in the same area.Regina E. Herzlinger, a professor of business administration at Harvard Business School, notes that the Swiss have such a system: privately provided health insurance priced by age and residence and subsidized at low incomes. This, she said, gives the Swiss top-notch health services, universal health insurance and a medical bill that tops out at 10 percent of the nation's output, compared with 15 percent in the United States.
SOME of these ideas are beginning to gain traction in America, too. Massachusetts is considering a law that would make health insurance mandatory. It would expand Medicaid to cover families in the state that make less than twice the poverty level and offer tax credits on a sliding scale up to four times the poverty line. It would also provide for creation of insurance pools for people who don't get coverage through employers.This health care revolution, however, is unlikely to catch on nationally anytime soon. For starters, losing the tax break on employer-provided health insurance would be tremendously disruptive for the millions of Americans who get their insurance through their jobs. Perhaps most important, it would force higher-income families to buy health care without the tax break; that idea is probably as politically suicidal as abolishing the mortgage tax deduction."I don't think anybody would dispute the economics," Mr. Gruber said. "I think the dispute would be over the politics."
Economic View
By EDUARDO PORTER
"I don't think anybody would dispute the economics," Mr. Gruber said. "I think the dispute would be over the politics."
YOU may find it shameful that some 45 million Americans lack health insurance. Well, by reallocating money already devoted to health insurance, the government could go along way toward solving the problem. But you may not like the solution.Next year, the federal government expects to provide about $130 billion for Americans to buy health insurance. The amount is substantial: it is equivalent to about 11 percent of all federal income tax revenue and more than a fifth of federal spending on Medicare and Medicaid. And it is growing fast: the bill is expected to surpass $180 billion in 2010.
Although subsidizing health insurance may seem a worthy effort, a positive contribution to the goal of universal coverage, it is among the most inefficient spending in the nation's fiscal arsenal."If you had $150 billion to play with, you could come very close to universal coverage," said David Cutler, an economics professor at Harvard. One reason that we are 45 million people short of that goal is that the money isn't being spent on them.According to President Bush's advisory panel on tax reform, about half of the tax break for health insurance accrues to families making more than $75,000 a year. More than a quarter goes to families making over $100,000.
Still, the fiscal incentive isn't helping many of the people who need it most. A report by the Kaiser Family Foundation says two-thirds of the 45.5 million Americans who lacked health insurance in 2004 earned less than twice what the federal government defines as poverty. (For a family of four, the poverty line is about $19,300.) In four of every five cases, the uninsured made less than three times the poverty level.In addition to going to the wrong people, the subsidy as designed promotes wasteful medical spending, encouraging the wealthy to buy more insurance and to use more health services than they need, according to the president's tax panel. And it may bolster premiums across the board.
As part of a series of proposals to rejigger the tax code, the president's tax panel issued a report earlier this year that suggested capping the total that can be paid in pretax dollars at an amount equal to the average health insurance premium in the country: some $11,500 for a family.But if the objective is to expand health care coverage, a bolder option is available: focusing the bulk of the money on the bottom end of the income distribution.Added to what is already spent on Medicaid, this financing would be roughly enough to make health insurance free for people earning up to three times the poverty level, and perhaps somewhat more, said Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology who has studied the efficiency of alternative methods for financing health insurance.
The government could give tightly focused tax credits so that lower-income people could buy health insurance on the market. And it could organize pools by, say, requiring insurers to charge the same for similar policies sold to people of the same age group who live in the same area.Regina E. Herzlinger, a professor of business administration at Harvard Business School, notes that the Swiss have such a system: privately provided health insurance priced by age and residence and subsidized at low incomes. This, she said, gives the Swiss top-notch health services, universal health insurance and a medical bill that tops out at 10 percent of the nation's output, compared with 15 percent in the United States.
SOME of these ideas are beginning to gain traction in America, too. Massachusetts is considering a law that would make health insurance mandatory. It would expand Medicaid to cover families in the state that make less than twice the poverty level and offer tax credits on a sliding scale up to four times the poverty line. It would also provide for creation of insurance pools for people who don't get coverage through employers.This health care revolution, however, is unlikely to catch on nationally anytime soon. For starters, losing the tax break on employer-provided health insurance would be tremendously disruptive for the millions of Americans who get their insurance through their jobs. Perhaps most important, it would force higher-income families to buy health care without the tax break; that idea is probably as politically suicidal as abolishing the mortgage tax deduction."I don't think anybody would dispute the economics," Mr. Gruber said. "I think the dispute would be over the politics."
Wednesday, December 14, 2005
EBRI Report of SurveyFindings
Employee Benefit Research Institute
December 2005
Early Experience With High-Deductible and Consumer-Driven Health Plans:
Findings From the EBRI/ Commonwealth Fund Consumerism in Health Care Survey
By Paul Fronstin, EBRI, and Sara R. Collins, The Commonwealth Fund ...
The sample was randomly drawn from Harris Poll Online...The final sample of adults participating in the survey is skewed toward higher-income, more highly educated individuals and also under represents minorities. Despite its limitations, this is the first national survey of individuals with high-deductible health plans who also have savings accounts (HSAs or HRAs), or so-called consumer-driven health plans (CDHPs), and people with high-deductible health plans who are eligible to contribute to a health savings account but who currently do not have an account (HDHP).
...When combined with premiums, outlays on health care as a share of income rose substantially among those with HDHPs and CDHPs, particularly among those with low incomes or health problems. More than two-fifths (42 percent) of people with HDHPs and 31 percent of those in CDHPs spent 5 percent or more of their income on out-of-pocket costs and premiums, compared with 12 percent of people in comprehensive plans. Nearly everyone (92 percent) with HDHPs with incomes under $50,000 spent 5 percent or more of their income on out-of-pocket costs and premiums, and one-third spent 10 percent or more. This compares with 34 percent of people in that income group in comprehensive plans...
While people reported using health services at similar rates across health plans, adults with CDHPs and HDHPs were significantly more likely to report that they had avoided, skipped, or delayed health care because of costs than were those with comprehensive insurance...
About one-third of people in CDHPs (35 percent) and HDHPs (31 percent) reported delaying or avoiding care, twice the rate of those in comprehensive health plans (17 percent)...
....the survey...demonstrates that cost-related reductions in demand are highest among individuals with the most to lose-those who are sick and those who have low incomes. To the extent that the health care cost problem is a problem owned by all of us, early evidence from the consumerism movement suggests that solving it through blunt, demand-side instruments like high deductibles gives disproportionate responsibility for the problem to the most vulnerable among us.
For the Full report @ http://www.ebri.org/pdf/briefspdf/EBRI_IB_12-2005.pdf
or click the Title of this post for the link.
Comment:
Although the negative impact of CDHPs and HDHPs were fully predicted and then confirmed by this survey, one finding is shocking in the intensity of the negative impact: "Nearly everyone (92 percent) with HDHPs with incomes under $50,000 spent 5 percent or more of their income on out-of-pocket costs and premiums, and one-third spent 10 percent or more." The introduction of financial disincentives to care resulted in widespread financial hardship. A fundamental principle of health care research is that when preliminary results demonstrate significant harm that cannot be offset by any potential benefit, it is an ethical imperative that the study be terminated immediately. The experiment with CDHP and HDHP has already crossed that threshold. Further experimentation can only define more precisely the enormity of financial hardships created. Health policy researchers have the same ethical obligation as biomedical researchers; they should call for an immediate end to this disastrous experiment. What feature of this model is causing the harm? The HSA plays an insignificant role in that it is merely a restricted savings account. The patient must still meet the out-of-pocket expenses whether they come from other income or savings or from this account distinguished primarily by an inequitable, regressive tax benefit. The real harm is caused by the high-deductible requirement of both the CDHPs and the HDHPs. Extensive data already exist that confirm the harm done by high deductibles in impairing access and health outcomes and in creating a financial burden for those in need. This study indicates that the financial hardship appears to be far more extensive than previously thought. What can we do? Existing HSAs can be converted into IRAs, and future HSAs should be prohibited as bad tax policy, bad pension policy and bad health policy. HDHPs should be prohibited. Financial hardship created by the need to access the health-care system can be eliminated by covering all beneficial services through a single risk pool. Since insurers will never attempt to corner the market on those who need care, this can be accomplished only by public policies requiring a universal pool. It's time for single payer.
Quote-of-the-day mailing list
Quote-of-the-day@mccanne.org
http://two.pairlist.net/mailman/listinfo/quote-of-the-day
December 2005
Early Experience With High-Deductible and Consumer-Driven Health Plans:
Findings From the EBRI/ Commonwealth Fund Consumerism in Health Care Survey
By Paul Fronstin, EBRI, and Sara R. Collins, The Commonwealth Fund ...
The sample was randomly drawn from Harris Poll Online...The final sample of adults participating in the survey is skewed toward higher-income, more highly educated individuals and also under represents minorities. Despite its limitations, this is the first national survey of individuals with high-deductible health plans who also have savings accounts (HSAs or HRAs), or so-called consumer-driven health plans (CDHPs), and people with high-deductible health plans who are eligible to contribute to a health savings account but who currently do not have an account (HDHP).
...When combined with premiums, outlays on health care as a share of income rose substantially among those with HDHPs and CDHPs, particularly among those with low incomes or health problems. More than two-fifths (42 percent) of people with HDHPs and 31 percent of those in CDHPs spent 5 percent or more of their income on out-of-pocket costs and premiums, compared with 12 percent of people in comprehensive plans. Nearly everyone (92 percent) with HDHPs with incomes under $50,000 spent 5 percent or more of their income on out-of-pocket costs and premiums, and one-third spent 10 percent or more. This compares with 34 percent of people in that income group in comprehensive plans...
While people reported using health services at similar rates across health plans, adults with CDHPs and HDHPs were significantly more likely to report that they had avoided, skipped, or delayed health care because of costs than were those with comprehensive insurance...
About one-third of people in CDHPs (35 percent) and HDHPs (31 percent) reported delaying or avoiding care, twice the rate of those in comprehensive health plans (17 percent)...
....the survey...demonstrates that cost-related reductions in demand are highest among individuals with the most to lose-those who are sick and those who have low incomes. To the extent that the health care cost problem is a problem owned by all of us, early evidence from the consumerism movement suggests that solving it through blunt, demand-side instruments like high deductibles gives disproportionate responsibility for the problem to the most vulnerable among us.
For the Full report @ http://www.ebri.org/pdf/briefspdf/EBRI_IB_12-2005.pdf
or click the Title of this post for the link.
Comment:
Although the negative impact of CDHPs and HDHPs were fully predicted and then confirmed by this survey, one finding is shocking in the intensity of the negative impact: "Nearly everyone (92 percent) with HDHPs with incomes under $50,000 spent 5 percent or more of their income on out-of-pocket costs and premiums, and one-third spent 10 percent or more." The introduction of financial disincentives to care resulted in widespread financial hardship. A fundamental principle of health care research is that when preliminary results demonstrate significant harm that cannot be offset by any potential benefit, it is an ethical imperative that the study be terminated immediately. The experiment with CDHP and HDHP has already crossed that threshold. Further experimentation can only define more precisely the enormity of financial hardships created. Health policy researchers have the same ethical obligation as biomedical researchers; they should call for an immediate end to this disastrous experiment. What feature of this model is causing the harm? The HSA plays an insignificant role in that it is merely a restricted savings account. The patient must still meet the out-of-pocket expenses whether they come from other income or savings or from this account distinguished primarily by an inequitable, regressive tax benefit. The real harm is caused by the high-deductible requirement of both the CDHPs and the HDHPs. Extensive data already exist that confirm the harm done by high deductibles in impairing access and health outcomes and in creating a financial burden for those in need. This study indicates that the financial hardship appears to be far more extensive than previously thought. What can we do? Existing HSAs can be converted into IRAs, and future HSAs should be prohibited as bad tax policy, bad pension policy and bad health policy. HDHPs should be prohibited. Financial hardship created by the need to access the health-care system can be eliminated by covering all beneficial services through a single risk pool. Since insurers will never attempt to corner the market on those who need care, this can be accomplished only by public policies requiring a universal pool. It's time for single payer.
Quote-of-the-day mailing list
Quote-of-the-day@mccanne.org
http://two.pairlist.net/mailman/listinfo/quote-of-the-day
Thursday, December 01, 2005
Lehrer News Hour/Plight of the Uninsured
This information comes thru Peggy @ FamiliesUSA
Click on the post title if you would like to access the segment from the mentioned FamiliesUSA website, or check them out thru my links on the right-rw
On Monday, November 28th, the NewsHour with Jim Lehrer carried a special segment on the plight of the uninsured. This very good segment will be of interest to all who missed it. One of the people interviewed was Anthony Wright of Health Access California...
So, if you missed the NewsHour segment, you can get the transcript and/or watch the video clip by going to the NewsHour site. We have also included a link to this on our Web site, in the Across the States page under "What's New in the States?"
Click on the post title if you would like to access the segment from the mentioned FamiliesUSA website, or check them out thru my links on the right-rw
On Monday, November 28th, the NewsHour with Jim Lehrer carried a special segment on the plight of the uninsured. This very good segment will be of interest to all who missed it. One of the people interviewed was Anthony Wright of Health Access California...
So, if you missed the NewsHour segment, you can get the transcript and/or watch the video clip by going to the NewsHour site. We have also included a link to this on our Web site, in the Across the States page under "What's New in the States?"
Tuesday, November 29, 2005
qotd: Single payer as an issue for "Unpartisans"
posting from another Blog, forwarded with comments by McCanne @ Quote of the Day...i enjoyed it because i consider myself and independent or "unpartisan" as the author puts it...enjoy and follow the link to the full article, by clicking the title here...rw
The State.com Nov. 27, 2005
It's my party, and I'll vie if I want to
By Brad Warthen, Editorial Page Editor
Why is it so hard for partisans and ideologues to understand that we might hold our own values and positions even more passionately than they hold theirs, for the simple fact that they are ours. We didn't do what they did, which was to buy an entire set of attitudes off the rack, preselected and packaged by someone else, and chosen based on nothing deeper than brand name. ("moderates") ...are the people who take the independent risks that make things happen, from campaign finance reform to banning torture. Without them as pivots, giving ideas credibility by virtue of their own independence, we'd be forever in a state of stalemate, unable to settle any difficult issue. And those of us who support their like are the ones who decide elections - not the partisans, who can be taken for granted.
The best thing is to have no parties. But it's still fun to imagine what kind of party we who despise them would create if we were so inclined. ...for now, let's just call it the "Unparty." Every Unpartisan would have his or her own set of positions on issues, having worked them out independently. But to banish the thought that Unpartisans don't take strong stands, here would be some positions I would bring to the party table (and remember, this is just me, not the editorial board of The State):
* A single-payer national health care system - for the sake of business and the workers. If liberals and conservatives could stop driving a wedge between labor and capital for about five minutes, we could make this a reality. (His other positions are omitted from this message.) Such ideas are not left, right or wishy-washy. Admittedly, in my zeal to debunk the myth that we "moderates" (an inadequate word, really, for independents) don't take strong stands, I've deliberately chosen some ideas that are attractive to me but are too out there for my own editorial board.
The State.com Nov. 27, 2005
It's my party, and I'll vie if I want to
By Brad Warthen, Editorial Page Editor
Why is it so hard for partisans and ideologues to understand that we might hold our own values and positions even more passionately than they hold theirs, for the simple fact that they are ours. We didn't do what they did, which was to buy an entire set of attitudes off the rack, preselected and packaged by someone else, and chosen based on nothing deeper than brand name. ("moderates") ...are the people who take the independent risks that make things happen, from campaign finance reform to banning torture. Without them as pivots, giving ideas credibility by virtue of their own independence, we'd be forever in a state of stalemate, unable to settle any difficult issue. And those of us who support their like are the ones who decide elections - not the partisans, who can be taken for granted.
The best thing is to have no parties. But it's still fun to imagine what kind of party we who despise them would create if we were so inclined. ...for now, let's just call it the "Unparty." Every Unpartisan would have his or her own set of positions on issues, having worked them out independently. But to banish the thought that Unpartisans don't take strong stands, here would be some positions I would bring to the party table (and remember, this is just me, not the editorial board of The State):
* A single-payer national health care system - for the sake of business and the workers. If liberals and conservatives could stop driving a wedge between labor and capital for about five minutes, we could make this a reality. (His other positions are omitted from this message.) Such ideas are not left, right or wishy-washy. Admittedly, in my zeal to debunk the myth that we "moderates" (an inadequate word, really, for independents) don't take strong stands, I've deliberately chosen some ideas that are attractive to me but are too out there for my own editorial board.
Comment: Set aside the political divide that has paralyzed health care reform and see which model of reform would appeal to independent thinkers. This "Unpartisan" editorialist claims his right to express his passionate support for his own values and positions. His independent thinking has led him to conclude that single payer is the health care position that he would bring to the Unparty table. Many conservatives now recognize that there are many benefits to the single payer model.
Reduction of administrative waste is a good thing, even if it is the waste of private insurance bureaucracies and the burden they place on the health care system. Conservatives recognize that laissez faire market forces have not been able to harness run-away, detrimental high-tech excesses that are a major contributor high-cost, low-value health care. Many conservatives reject the inhumane notion that we must now turn to the market principle that costs should be controlled by making care unaffordable precisely for those who have health care needs.
Most conservatives do believe in the fundamental insurance principle of pooling risk, and they are chagrined by the insurance industry's success in dumping risk on others while avoiding their obligation to provide financial security for those with needs. Liberals support the fundamental concept that health care should be affordable and accessible for everyone, but many of them reject the most effective model - single payer - on the basis that it isn't politically feasible.
Perhaps it is time for the left to relinquish their exclusive claim to the single payer model. They don't have to turn it over to those on the right. They could turn it over to the Unpartisans who might welcome input from recovering Democrats and Republicans. An Unpartisan approach does not imply a process of compromise or "meeting in the middle." The truth in the health policy science behind the single payer model allows it to stand on its own.
Presumably, the Unpartisans would place truth above partisanship. - QOTD
Monday, November 28, 2005
Health Affairs - Nov-Dec 2005
The Cost Of Health Insurance Administration
In California: Estimates For Insurers, Physicians, And Hospitals
By James G. Kahn, Richard Kronick, Mary Kreger and David N. Gans
Estimates of administrative costs in the U.S. health care system have been the subject of considerable controversy during the past decade. Single-payer analysts Steffie Woolhandler, David Himmelstein, and their colleagues have argued that moving to a Canadian-style system would reduce U.S. administrative costs by 10-15 percent of total health spending. The hypothesis suggested by Woolhandler and colleagues, and supported by common sense, is that the complexities of a highly fragmented, multiple-payer system account for the "excess" administration.
To inform discussions of reform-related cost savings, it is valuable to document the portion of administrative costs attributable to the U.S. system of paying providers.
Administrative costs account for 25 percent of health care spending, but little is known about the portion attributable to billing and insurance-related (BIR) functions. We estimated BIR for hospital and physician care in California. Data for physician practices came from a mail survey and interviews; for hospitals, from regulatory reporting; and for private insurers, from a consulting company. Private insurers spend 9.9 percent of revenue on administration and 8 percent on BIR. Physician offices spend 27 percent and 14 percent, and hospitals, 21 percent and 7-11 percent, respectively.
Overall, BIR represents 20-22 percent of privately insured spending in California acute care settings. In comparison to the health care systems of other advanced economies, it is difficult to argue that the United States has an efficient health care system: Its high level of clinical health care spending does not seem to be matched by superior outcomes. To the extent that competition does not foster cost control and quality improvement, and to the extent that a simpler system with fewer insurers would allow a reduction in BIR, then reductions in BIR are an attractive target for reform initiatives.
In California: Estimates For Insurers, Physicians, And Hospitals
By James G. Kahn, Richard Kronick, Mary Kreger and David N. Gans
Estimates of administrative costs in the U.S. health care system have been the subject of considerable controversy during the past decade. Single-payer analysts Steffie Woolhandler, David Himmelstein, and their colleagues have argued that moving to a Canadian-style system would reduce U.S. administrative costs by 10-15 percent of total health spending. The hypothesis suggested by Woolhandler and colleagues, and supported by common sense, is that the complexities of a highly fragmented, multiple-payer system account for the "excess" administration.
To inform discussions of reform-related cost savings, it is valuable to document the portion of administrative costs attributable to the U.S. system of paying providers.
Administrative costs account for 25 percent of health care spending, but little is known about the portion attributable to billing and insurance-related (BIR) functions. We estimated BIR for hospital and physician care in California. Data for physician practices came from a mail survey and interviews; for hospitals, from regulatory reporting; and for private insurers, from a consulting company. Private insurers spend 9.9 percent of revenue on administration and 8 percent on BIR. Physician offices spend 27 percent and 14 percent, and hospitals, 21 percent and 7-11 percent, respectively.
Overall, BIR represents 20-22 percent of privately insured spending in California acute care settings. In comparison to the health care systems of other advanced economies, it is difficult to argue that the United States has an efficient health care system: Its high level of clinical health care spending does not seem to be matched by superior outcomes. To the extent that competition does not foster cost control and quality improvement, and to the extent that a simpler system with fewer insurers would allow a reduction in BIR, then reductions in BIR are an attractive target for reform initiatives.
Comment: This landmark study supports prior evidence that the United States wastes a tremendous amount of resources on health care administration. What is particularly noteworthy in this study is that it breaks out the administrative costs that are specifically due to billing and insurance related functions for health care covered by private insurance plans in California, a microcosm of health spending in the United states. Let's state that again.
Billing and insurance related functions represent over one-fifth of privately insured spending.
Is that clear?
The billing and insurance administration functions of private insurers combined with the resultant billing and administrative burden placed on physicians and hospitals constitute over one-fifth of privately insured spending. How many times have you heard that, even if the administrative waste is real, the U.S. health care system is so complex that you could never recover those costs with a single payer system? Do not ever again let such a statement go unchallenged.
Under a single payer system, much of the billing and insurance related functions would disappear. This study confirms the enormity of the savings that would ensue.
Wednesday, August 03, 2005
Paying a Premium : The Added Cost of Care for the Uninsured
This study lends empiric support to the idea that the US needs a Standardized National Health Policy. The reality is, we the taxpayers , either by taxes or higher premiums, are already paying for Healthcare for the uninsured and the Underinsured in this country. Insured taxpayers fund 65% of the cost of healthcare for those with who are un- or underinsured. We are paying for this in the least economically feasible manner. Those without healthcare are sicker and have higher health costs when they finally do seek medical attention, than people with health coverage. It makes economic sense for the taxpayer in this country to spend our tax dollar instead on a healthplan that ensures access for the uninsured, thereby lower our costs as taxpayers and insureds. This is not about 'warm and fuzzy' or 'giveaways'. We're are giving this away anyway, let's develop a strategy that makes economic sense for us to do so....Raising minimum wage is another angle, another tool to decreasing the cost of taxpayer funded systems.
Click the link in the Main title for the entire report with the numbers, then research cost and savings of a National health program.
rw
A R E P O R T B Y
Families USA
From the Study...
What we have shown in this study is that we are all affected by the presence of large numbers of Americans without health insurance.
Unless we find realistic ways to help the uninsured get coverage, the problem can be expected to worsen—for the uninsured and the insured alike...
This study quantifies, for the first time, the dollar impact on private health insurance premiums when doctors and hospitals provide health care to uninsured people. In 2005, premium costs for family health insurance coverage provided by private employers will include an extra $922 in premiums due to the cost of care for the uninsured; premiums for individual coverage will
cost an extra $341. ( see Tables 1 & 2, pgs 4-5).
Nearly 48 million Americans will be uninsured for the entire year in 2005.
What happens when some of these 48 million Americans get sick? Research has
shown that the uninsured often put off getting care for health problems—or
forgo care altogether.1 When the symptoms can no longer be ignored, the
uninsured do see doctors and go to hospitals. Without insurance to pay the
tab, the uninsured struggle to pay as much as they can: More than one-third
(35 percent) of the total cost of health care services provided to people without
health insurance is paid out-of-pocket by the uninsured themselves...
Who Are the Uninsured?
Contrary to popular belief, the overwhelming majority of uninsured people
are workers or members of a family in which at least one member works. Researchers
have estimated that four in five individuals without health insurance
are employed or in a family with an employed adult.
There are several reasons why people with jobs lack health insurance. First,
not all jobs offer health insurance benefits. The likelihood that an employer
offers health benefits to its workers varies considerably. Small employers,
employers with low-wage workers, and employers with older workers are all
less likely to be able to afford to offer health coverage to their employees. (small business may have an understandable impediment to offering health coverage , never completely addressed in this study, is the cost we bear because of larger corporations that avoid offering coverage to significant numbers of their employees at all... that is for another post--rw)
Second, some people who are offered coverage by their employer do not sign
up for that coverage because they cannot afford to pay the portion of the
premium that is not paid by their employer. In 2004, full-time workers receiving employer-sponsored health insurance were asked to pay, on average, $564 per year in premiums for individual coverage and $2,664 per year in premiums for family coverage. Paying the employee share of the premium is particularly difficult for low-wage workers. Recent research from California shows that a worker’s share of premiums can account for as much as 46 percent
of full-time wages for minimum-wage workers...
Even after making tremendous personal sacrifices, the contributions made by uninsured people
toward their medical bills cover an estimated 35 percent of the cost of care they receive from doctors and hospitals.
Who Pays for Health Care for the Uninsured?
To develop an estimate of the cost of care that the uninsured receive
and cannot afford to pay (“uncompensated care”), our study adjusts the total
charges to the uninsured to reflect what the privately insured would pay, on
average, in the state for the same health care services. We do this in order
to avoid inappropriately inflating the value of the health care services and to
ensure that our estimate of what providers will need to recoup is a conservative
one. Research has shown that uninsured patients are charged much more than
insurance companies are charged for the same services.
Nationally, we estimate that about $43.1 billion in health care for which
the uninsured cannot afford to pay will be provided by hospitals and doctors in
2005. In 2010, about $60.4 billion in uncompensated care will be provided
(seeTable 3).
(These estimates do not include uncompensated care provided to insured
people, who may be unable to pay because they face high deductibles,
high copayments, uncovered services, and other out-of-pocket costs that
people with insurance are sometimes unable to pay.)
These costs are covered by the following three sources:
1. non-patient, non-government revenue sources, including philanthropy;
2. federal, state, and local programs that partially reimburse providers
for the cost of care to the uninsured; and
3. higher premiums for people with private health insurance.
...data from the Medical Expenditure Panel Survey, philanthropy is estimated to cover only 1 to 2 percent...
The combined contribution of federal, state, and local programs that partially
reimburse providers for the cost of care to the uninsured accounts for approximately
one-third of the uncompensated care provided by both hospitals and
physicians nationally (see Appendix Tables 1 and 2). This comes to 33 percent
in 2005 and 29 percent in 2010....
But that leaves two-thirds of the cost of uncompensated care unpaid—a
gap that is filled by patients with private health insurance. We estimate that
almost $29 billion worth of unpaid care received by the uninsured in 2005
and more than $43 billion in 2010 will be financed by higher premiums for
privately insured patients.
As a result, the cost of private insurance will be, on average in the nation, 8.5 percent higher in 2005 than it would be if everyone in the United States were to have health insurance. This translates into $341 more for the average individual premium and $922 more for the average
family premium (see Table 1 and Appendix Table 1). In 2010, the annual impact will be 8.7 percent...
Given that most health care providers are not driven to bankruptcy and our health care system survives from year to year, we can say with certainty that those with health insurance finance the residual two-thirds of the cost of care for the uninsured provided by a state’s hospitals and doctors. Ironically, this increases the cost of health insurance and results in fewer people who can afford insurance—a vicious circle.
Click the link in the Main title for the entire report with the numbers, then research cost and savings of a National health program.
rw
A R E P O R T B Y
Families USA
From the Study...
What we have shown in this study is that we are all affected by the presence of large numbers of Americans without health insurance.
Unless we find realistic ways to help the uninsured get coverage, the problem can be expected to worsen—for the uninsured and the insured alike...
This study quantifies, for the first time, the dollar impact on private health insurance premiums when doctors and hospitals provide health care to uninsured people. In 2005, premium costs for family health insurance coverage provided by private employers will include an extra $922 in premiums due to the cost of care for the uninsured; premiums for individual coverage will
cost an extra $341. ( see Tables 1 & 2, pgs 4-5).
Nearly 48 million Americans will be uninsured for the entire year in 2005.
What happens when some of these 48 million Americans get sick? Research has
shown that the uninsured often put off getting care for health problems—or
forgo care altogether.1 When the symptoms can no longer be ignored, the
uninsured do see doctors and go to hospitals. Without insurance to pay the
tab, the uninsured struggle to pay as much as they can: More than one-third
(35 percent) of the total cost of health care services provided to people without
health insurance is paid out-of-pocket by the uninsured themselves...
Who Are the Uninsured?
Contrary to popular belief, the overwhelming majority of uninsured people
are workers or members of a family in which at least one member works. Researchers
have estimated that four in five individuals without health insurance
are employed or in a family with an employed adult.
There are several reasons why people with jobs lack health insurance. First,
not all jobs offer health insurance benefits. The likelihood that an employer
offers health benefits to its workers varies considerably. Small employers,
employers with low-wage workers, and employers with older workers are all
less likely to be able to afford to offer health coverage to their employees. (small business may have an understandable impediment to offering health coverage , never completely addressed in this study, is the cost we bear because of larger corporations that avoid offering coverage to significant numbers of their employees at all... that is for another post--rw)
Second, some people who are offered coverage by their employer do not sign
up for that coverage because they cannot afford to pay the portion of the
premium that is not paid by their employer. In 2004, full-time workers receiving employer-sponsored health insurance were asked to pay, on average, $564 per year in premiums for individual coverage and $2,664 per year in premiums for family coverage. Paying the employee share of the premium is particularly difficult for low-wage workers. Recent research from California shows that a worker’s share of premiums can account for as much as 46 percent
of full-time wages for minimum-wage workers...
Even after making tremendous personal sacrifices, the contributions made by uninsured people
toward their medical bills cover an estimated 35 percent of the cost of care they receive from doctors and hospitals.
Who Pays for Health Care for the Uninsured?
To develop an estimate of the cost of care that the uninsured receive
and cannot afford to pay (“uncompensated care”), our study adjusts the total
charges to the uninsured to reflect what the privately insured would pay, on
average, in the state for the same health care services. We do this in order
to avoid inappropriately inflating the value of the health care services and to
ensure that our estimate of what providers will need to recoup is a conservative
one. Research has shown that uninsured patients are charged much more than
insurance companies are charged for the same services.
Nationally, we estimate that about $43.1 billion in health care for which
the uninsured cannot afford to pay will be provided by hospitals and doctors in
2005. In 2010, about $60.4 billion in uncompensated care will be provided
(seeTable 3).
(These estimates do not include uncompensated care provided to insured
people, who may be unable to pay because they face high deductibles,
high copayments, uncovered services, and other out-of-pocket costs that
people with insurance are sometimes unable to pay.)
These costs are covered by the following three sources:
1. non-patient, non-government revenue sources, including philanthropy;
2. federal, state, and local programs that partially reimburse providers
for the cost of care to the uninsured; and
3. higher premiums for people with private health insurance.
...data from the Medical Expenditure Panel Survey, philanthropy is estimated to cover only 1 to 2 percent...
The combined contribution of federal, state, and local programs that partially
reimburse providers for the cost of care to the uninsured accounts for approximately
one-third of the uncompensated care provided by both hospitals and
physicians nationally (see Appendix Tables 1 and 2). This comes to 33 percent
in 2005 and 29 percent in 2010....
But that leaves two-thirds of the cost of uncompensated care unpaid—a
gap that is filled by patients with private health insurance. We estimate that
almost $29 billion worth of unpaid care received by the uninsured in 2005
and more than $43 billion in 2010 will be financed by higher premiums for
privately insured patients.
As a result, the cost of private insurance will be, on average in the nation, 8.5 percent higher in 2005 than it would be if everyone in the United States were to have health insurance. This translates into $341 more for the average individual premium and $922 more for the average
family premium (see Table 1 and Appendix Table 1). In 2010, the annual impact will be 8.7 percent...
Given that most health care providers are not driven to bankruptcy and our health care system survives from year to year, we can say with certainty that those with health insurance finance the residual two-thirds of the cost of care for the uninsured provided by a state’s hospitals and doctors. Ironically, this increases the cost of health insurance and results in fewer people who can afford insurance—a vicious circle.
Tuesday, July 26, 2005
FIELD REPORT from Familes USA
A wealth of ideas are in this report, click the link in the main title to review the report in it's entirety, requires Adobe Reader. i have cut and pasted a few excerpts here...rw
July 2005
The Good, the Bad, and the Ugly: Analysis of the National Governors Association’s Medicaid Reform Proposal
On June 15, the National Governors Association (NGA) released “Medicaid Reform : A Preliminary Report,” a proposal that describes the NGA’s vision for the future of Medicaid, as well as some aspects of the broader health care system. The proposal is the culmination of several months of discussions among a small group of governors that includes both Democrats and Republicans. At NGA’s July 15 meeting, governors voted to adopt this proposal as official NGA policy.
NGA’s adoption of this proposal comes at an inauspicious time. This is because
the congressional budget resolution requires that as much as $10 billion1 be cut
from the Medicaid program by mid-September as part of the so-called “budget
reconciliation” legislation. In making these cuts, Congress has placed the cart
before the horse, requiring that budget cuts be made before policy changes can
be fully examined. The NGA proposal should not be adopted in the context of
Congress’s effort to obtain short-term budget savings. Instead, the changes
proposed by NGA should be postponed until they can be carefully analyzed and
until their impact on Medicaid beneficiaries are fully understood.
In this preliminary analysis, we highlight key concerns about the NGA proposal
and describe some of the promising ideas as well. The analysis also assesses
NGA’s ideas for expanding federal assistance to the uninsured.
Contents:
- Proposals that Hurt People Who Rely on Medicaid
- Medicaid Reform that Makes Sense
- Expanding Federal Help to the Uninsured
Proposals That Hurt People Who Rely on Medicaid
Erecting Barriers to Health Care for the Poor
The NGA proposes giving states broad discretion to dramatically increase cost-sharing—the amount that people pay out of their own pockets in premiums, copayments, and deductibles to receive services through Medicaid. This proposal would remove the current reasonable limits on how much states can charge people who must rely on Medicaid—including low-income children, pregnant women, and people with disabilities, as well asseniors on low fixed incomes...
Arguments for higher out-of-pocket costs suggest that the low-income people served by Medicaid (most live on budgets that are below the federal poverty level—some are well below that level) will thus be less likely to make unneeded visits to the doctor or to seek out unnecessary treatment. There is absolutely no evidence to support the assertion that low-income people are over-utilizing the health care system.
However, there is ample evidence that increased cost-sharing discourages people from seeking necessary care:
Increasing the copayments charged to the poor has been shown to reduce their access to critical needed services, leading them to seek more costly care later. Further, a significant body of research has shown that charging premiums to low-income people deters them from enrolling in coverage and thereby increases the ranks of the uninsured.
Picking and Choosing Who Gets What Health Care
The NGA proposes eliminating federal assurances that people who rely on Medicaid have access to critical health care services. In place of the current federal requirements that spell out the minimum set of benefits that must be provided to Medicaid enrollees, the NGA proposes that states be given very broad discretion to determine the services provided and to “tailor” services to meet the needs of broad categories of people.
Under current law, individuals in Medicaid only get the health care services that are medically necessary for them. Thus, it is unclear how much savings could be generated from “tailoring” the Medicaid benefit package for individuals or groups—unless the “tailoring” consists of eliminating coverage of health care services...To contain costs, we should pursue the use of disease management, home- and community-based care, and other methods that promise to deliver
quality health care services more efficiently, ather than arbitrarily strip away vital services from those who need them.
Medicaid Reform that Makes Sense
Prescription Drug Cost Savings
The NGA proposes reducing Medicaid costs by cutting spending on prescription drugs. Prescription drugs have consistently been among the fastest growing Medicaid costs in the past several years, and there is widespread agreement that Medicaid is paying too much for drugs. This is one area where savings can be found without reducing services essential to those with Medicaid and where improvements are long overdue.
Specifically, the NGA has identified the following positive reforms that will save significant federal and state Medicaid dollars:
- increase the minimum rebates that states collect on brand-name and generic drugs;
- require that authorized generics be included in “best price” calculations for purposes of determining rebates;
- force discounts on the front end of drug purchasing;
- enact sanctions for companies and individuals that fail to accurately report the average sales price;
- allow states to join purchasing pools; and allow managed care organizations to obtain rebates directly for the Medicaid populations they serve.
In addition to these proposals, policy changes that encourage states to restructure pharmacists’ reimbursements could also result in very significant savings. In particular, moving away from payments based on Average Wholesale Price (AWP) to another pricing calculation, such as one based on average sales price (ASP—the weighted average of all non-federal sales prices to all purchasers, excluding sales exempt from the best price calculations,net of rebates, discounts, and other price concessions), would save money for both states and the federal government without hurting the people who must rely on Medicaid.
With this change, pharmacy dispensing fees should be set at a flat rate that adequately covers reasonable costs and that does not create incentives for pharmacists to dispense higher-priced drugs. The administration of the current drug rebate program also needs to be strengthened.
read more in the report by clicking the main title in this post or @ http://tinyurl.com/cu5e5
Monday, July 18, 2005
American Healthcare Crisis: A Perfect Storm
The growing proportions of this crisis put all Americans at risk. Fewer and fewer employers can even afford to offer insurance. Insurance that is offered is often inadequate, and in many cases unaffordable at todays wages which have failed to keep up with the growing cost of even the barest neccessities. Follow the link to one writer's perception of the problem and what extremes may need to be reached for the American voter to make this a priority. Please post any comments, articles or personal experiences you would like to offer.
rw
Patrick Lannigan - Winter 2004
A perfect storm is in the forecast. 43 million Americans have no healthcare, a tsunami of baby boomers will retire in the next 15 years, and health costs are soaring. Yet - Americans sleep soundly at night. On occasion, there is a wakeup call but the groundhog sees no shadow, hits the snooze button, and goes back to sleep. Is this sustainable? Will Americans continue spending their hard-earned tax dollars on vote-getting missions to Mars or Iraq - versus that of life itself? Are Americans that cruel?
I say no. The America I lived in, (Massachusetts), rallied to the misfortune of a neighbour, or a crisis, with as much passion as a Canadian would. So why, then, do Americans not rally around the healthcare cause?
Healthcare as a Taboo Subject.
I discovered that when you break bread with Americans, and bring up the subject of national healthcare, the debate loses all life support when those in opposition paint images of wait-times and higher taxes. In some cases the feedback I received would make the late Senator McCarthy proud. "Socialism", they say. "Big Government", they protest. I quickly got the message. National Healthcare was a Do-Not-Discuss item at the lunch or dinner table.
Americans face a terrible dilemma. On one hand they're a great nation that has faced and survived many a crisis. Yet, they have a disdain for anything that smacks of Big Government and Government Control of their lives.
Healthcare Bill: Do Not Resuscitate
Is there a solution in politics? Is there some visionary politician that could mobilize support for a healthcare system that wouldn't turn suffering people away? Unfortunately, the last real attempt at material change (Bill and Hillary's health bill) died on the operating table. Furthermore, opposing politicians spray-painted DO NOT RESUSCITATE graffiti all over capitol hill.
The telegram for most politicians?
DO NOT TALK ABOUT FIXING HEALTHCARE. STOP.
TALK BAND-AID FIXES ONLY. STOP.
NEVER IMPLY RAISED TAXES. STOP. OVER.
Will change ever occur? I believe it will, but the crisis will have to worsen. If the number of uninsured Americans were to pass the 100 million mark, then we're talking real vote power. Politicians will have no choice. As much as I love Arthur C. Clarke, the proposed social-science-moon-base-project may have to wait.
A certain segment of Americans I spoke to, had a me-vote-Republican
'cause-me-want-low-taxes approach to their political views. Lower taxes was all that mattered to them. Death and suffering could change that. There's nothing like the death of a father, mother, uncle, or brother, who just happens to be uninsured, to help change somebody's outlook.
rw
Patrick Lannigan - Winter 2004
A perfect storm is in the forecast. 43 million Americans have no healthcare, a tsunami of baby boomers will retire in the next 15 years, and health costs are soaring. Yet - Americans sleep soundly at night. On occasion, there is a wakeup call but the groundhog sees no shadow, hits the snooze button, and goes back to sleep. Is this sustainable? Will Americans continue spending their hard-earned tax dollars on vote-getting missions to Mars or Iraq - versus that of life itself? Are Americans that cruel?
I say no. The America I lived in, (Massachusetts), rallied to the misfortune of a neighbour, or a crisis, with as much passion as a Canadian would. So why, then, do Americans not rally around the healthcare cause?
Healthcare as a Taboo Subject.
I discovered that when you break bread with Americans, and bring up the subject of national healthcare, the debate loses all life support when those in opposition paint images of wait-times and higher taxes. In some cases the feedback I received would make the late Senator McCarthy proud. "Socialism", they say. "Big Government", they protest. I quickly got the message. National Healthcare was a Do-Not-Discuss item at the lunch or dinner table.
Americans face a terrible dilemma. On one hand they're a great nation that has faced and survived many a crisis. Yet, they have a disdain for anything that smacks of Big Government and Government Control of their lives.
Healthcare Bill: Do Not Resuscitate
Is there a solution in politics? Is there some visionary politician that could mobilize support for a healthcare system that wouldn't turn suffering people away? Unfortunately, the last real attempt at material change (Bill and Hillary's health bill) died on the operating table. Furthermore, opposing politicians spray-painted DO NOT RESUSCITATE graffiti all over capitol hill.
The telegram for most politicians?
DO NOT TALK ABOUT FIXING HEALTHCARE. STOP.
TALK BAND-AID FIXES ONLY. STOP.
NEVER IMPLY RAISED TAXES. STOP. OVER.
Will change ever occur? I believe it will, but the crisis will have to worsen. If the number of uninsured Americans were to pass the 100 million mark, then we're talking real vote power. Politicians will have no choice. As much as I love Arthur C. Clarke, the proposed social-science-moon-base-project may have to wait.
A certain segment of Americans I spoke to, had a me-vote-Republican
'cause-me-want-low-taxes approach to their political views. Lower taxes was all that mattered to them. Death and suffering could change that. There's nothing like the death of a father, mother, uncle, or brother, who just happens to be uninsured, to help change somebody's outlook.
Friday, July 15, 2005
One Nation, Uninsured
An excellent assessment and evaluation of solutions to the worsening healthcare crisis in this country from the well known and respected economist Paul Krugman. Sharing the risk among a large single payer is an option that will bring down the skyrocketing costs of healthcare, which has already led to reduced access for many hard working americans and their families...
rw
The New York TimesJune 13, 2005
One Nation, Uninsured
By Paul Krugman
Harry Truman tried to create a national health insurance system. Public opinion was initially on his side: Jill Quadagno's book "One Nation, Uninsured" www.booksense.com
tells us that in 1945, 75 percent of Americans favored national health insurance.
If Truman had succeeded, universal coverage for everyone, not just the elderly, would today be an accepted part of the social contract. But Truman failed. Special interests, especially the American Medical Association and Southern politicians who feared that national insurance would lead to racially integrated hospitals, triumphed.
Sixty years later, the patchwork system that evolved in the absence of national health insurance is unraveling. The cost of health care is exploding, the number of uninsured is growing, and corporations that still provide employee coverage are groaning under the strain. So the time will soon be ripe for another try at universal coverage. Public opinion is already favorable: a 2003 Pew poll found that 72 percent of Americans favored government-guaranteed health insurance for all. But special interests will, once again, stand in the way. And the big debate among would-be reformers is how to deal with those interests, especially the insurance companies.
These companies played a secondary role in Truman's failure but have since become a seemingly invincible lobby. Let's ignore those who believe that private medical accounts - basically tax shelters for the healthy and wealthy - can solve our health care problems through the magic of the marketplace. The intellectually serious debate is between those who believe that the government should simply provide basic health insurance for everyone and those proposing a more complex, indirect approach that preserves a central role for private health insurance companies. A system in which the government provides universal health insurance is often referred to as "single payer," but I like Ted Kennedy's slogan "Medicare for all." It reminds voters that America already has a highly successful, popular single-payer program, albeit only for the elderly. It shows that we're talking about government insurance, not government-provided health care. And it makes it clear that like Medicare (but unlike Canada's system), a U.S. national health insurance system would allow individuals with the means and inclination to buy their own medical care.
The great advantage of universal, government-provided health insurance is lower costs. Canada's government-run insurance system has much less bureaucracy and much lower administrative costs than our largely private system. Medicare has much lower administrative costs than private insurance. The reason is that single-payer systems don't devote large resources to screening out high-risk clients or charging them higher fees. The savings from a single-payer system would probably exceed $200 billion a year, far more than the cost of covering all of those now uninsured. Nonetheless, most reform proposals out there - even proposals from liberal groups like the Century Foundation and the Center for American Progress - reject a simple single-payer approach. Instead, they call for some combination of mandates and subsidies to help everyone buy insurance from private insurers.
Some people, not all of them right-wingers, fear that a single-payer system would hurt innovation. But the main reason these proposals give private insurers a big role is the belief that the insurers must be appeased. That belief is rooted in recent history. Bill Clinton's health care plan failed in large part because of a dishonest but devastating lobbying and advertising campaign financed by the health insurance industry - remember Harry and Louise? And the lesson many people took from that defeat is that any future health care proposal must buy off the insurance lobby.
But I think that's the wrong lesson. The Clinton plan actually preserved a big role for private insurers; the industry attacked it all the same. And the plan's complexity, which was largely a result of attempts to placate interest groups, made it hard to sell to the public. So I would argue that good economics is also good politics: reformers will do best with a straightforward single-payer plan, which offers maximum savings and, unlike the Clinton plan, can easily be explained. We need to do this one right. If reform fails again, we'll be on the way to a radically unequal society, in which all but the most affluent Americans face the constant risk of financial ruin and even premature death because they can't pay their medical bills.
rw
The New York TimesJune 13, 2005
One Nation, Uninsured
By Paul Krugman
Harry Truman tried to create a national health insurance system. Public opinion was initially on his side: Jill Quadagno's book "One Nation, Uninsured" www.booksense.com
tells us that in 1945, 75 percent of Americans favored national health insurance.
If Truman had succeeded, universal coverage for everyone, not just the elderly, would today be an accepted part of the social contract. But Truman failed. Special interests, especially the American Medical Association and Southern politicians who feared that national insurance would lead to racially integrated hospitals, triumphed.
Sixty years later, the patchwork system that evolved in the absence of national health insurance is unraveling. The cost of health care is exploding, the number of uninsured is growing, and corporations that still provide employee coverage are groaning under the strain. So the time will soon be ripe for another try at universal coverage. Public opinion is already favorable: a 2003 Pew poll found that 72 percent of Americans favored government-guaranteed health insurance for all. But special interests will, once again, stand in the way. And the big debate among would-be reformers is how to deal with those interests, especially the insurance companies.
These companies played a secondary role in Truman's failure but have since become a seemingly invincible lobby. Let's ignore those who believe that private medical accounts - basically tax shelters for the healthy and wealthy - can solve our health care problems through the magic of the marketplace. The intellectually serious debate is between those who believe that the government should simply provide basic health insurance for everyone and those proposing a more complex, indirect approach that preserves a central role for private health insurance companies. A system in which the government provides universal health insurance is often referred to as "single payer," but I like Ted Kennedy's slogan "Medicare for all." It reminds voters that America already has a highly successful, popular single-payer program, albeit only for the elderly. It shows that we're talking about government insurance, not government-provided health care. And it makes it clear that like Medicare (but unlike Canada's system), a U.S. national health insurance system would allow individuals with the means and inclination to buy their own medical care.
The great advantage of universal, government-provided health insurance is lower costs. Canada's government-run insurance system has much less bureaucracy and much lower administrative costs than our largely private system. Medicare has much lower administrative costs than private insurance. The reason is that single-payer systems don't devote large resources to screening out high-risk clients or charging them higher fees. The savings from a single-payer system would probably exceed $200 billion a year, far more than the cost of covering all of those now uninsured. Nonetheless, most reform proposals out there - even proposals from liberal groups like the Century Foundation and the Center for American Progress - reject a simple single-payer approach. Instead, they call for some combination of mandates and subsidies to help everyone buy insurance from private insurers.
Some people, not all of them right-wingers, fear that a single-payer system would hurt innovation. But the main reason these proposals give private insurers a big role is the belief that the insurers must be appeased. That belief is rooted in recent history. Bill Clinton's health care plan failed in large part because of a dishonest but devastating lobbying and advertising campaign financed by the health insurance industry - remember Harry and Louise? And the lesson many people took from that defeat is that any future health care proposal must buy off the insurance lobby.
But I think that's the wrong lesson. The Clinton plan actually preserved a big role for private insurers; the industry attacked it all the same. And the plan's complexity, which was largely a result of attempts to placate interest groups, made it hard to sell to the public. So I would argue that good economics is also good politics: reformers will do best with a straightforward single-payer plan, which offers maximum savings and, unlike the Clinton plan, can easily be explained. We need to do this one right. If reform fails again, we'll be on the way to a radically unequal society, in which all but the most affluent Americans face the constant risk of financial ruin and even premature death because they can't pay their medical bills.
Wednesday, June 22, 2005
Insight into the Problem of Healthcare in America today
While there is no single cause for the healthcare crisis in america today, this website, it's fact site, illustrates for us, how moving to a form of national health policy, would benefit us as taxpayers, our neighbors and our society. Our taxpayer dollars are already benefitting the big business'. Click the Heading here to find out more about the outrage, and explore the PNHP link in my links section for more information how one option for a national health policy would work.
rw
rw
Friday, June 17, 2005
Declining Job Based Health Coverage for Working Families
Folks, we are only so healthy as are the most vulnerable in our society, the very young, the very old, the indigent, and soon the middle class.
Affordable , accessible healthcare Must be maintained for the backbone of American society, the middle class, otherwise, we are no better than any third world country, pick one.
Taxpayers are paying for the healthcare of those who are falling through the cracks, already, let's put a 'stitch in time' by initiating healthplans that work for employees,employers and the Nation,ie, taxpayer....rw
USAHealth Care Policy
Brief June 2005
FALLING APART - Declining Job-Based Health Coverage for Working Families in California and the United States
By Arindrajit Dube, Ph.D., Ken Jacobs, Sarah Muller, Bob Brownstein and Phaedra Ellis-Lamkins
To put it in context, the average growth in premium prices during the most recent period was 11% nationally and 13% in California.If premium rates (in California) continue to rise 10% annually... Looking at the entire non-elderly population (adults and children) with incomes below 300% of FPL (the median American family income), more will be uninsured than have coverage through an employer by 2010, if current trends continue. Only 29% of individuals with incomes under 300% of FPL will have job-based coverage, 36% will be uninsured and 28% will have coverage through a public program.Policy implications:* Without major policy changes, employer-based coverage will continue to erode. - What used to be a fundamental component of the social contract for American workers across the income spectrum is now becoming a benefit enjoyed primarily by higher-income families.* A continued decline in employer-sponsored insurance will shift additional health care costs from employers to the public sector, and increase the numbers of uninsured. - Unless immediate steps are taken to stem the decline in job-based coverage, significant new revenues will be needed to cover the increased demand for public health programs.* Proposed cutbacks to Medicaid will jeopardize coverage for low-income adults. - Any cuts to public programs will threaten access to coverage for millions of low-income adults.* Private insurance options are mismatched to those losing coverage. - Policies that rely on private insurance, such as individual mandates or health savings accounts, are mismatched to the economic realities of those losing insurance today.
And...Reuters May 29, 2005Toyota to build plant in Canada - NikkeiToyota Motor Corp. plans to build another plant in Canada, its seventh in North America... Toyota had considered building the plant in the United States but selected Canada because of lower labor costs, it said. Meanwhile, Toyota has started investigating suitable sites in the United States or Mexico for its eighth North American plant...
http://www.reuters.com/newsArticle.jhtml?type=businessNews&storyID=8637099
Comment: The opponents of national health insurance (NHI) have this one right. Policies designed to protect and expand our system of employer-sponsored coverage are doomed to failure because they fail to address the issue of affordability for employers, employees and taxpayers. Even if the rate of premium increases dips below 10%, the decline in coverage for Americans below the median income level may not accelerate as rapidly as predicted in this study, but it will still continue. But the opponents of NHI would shift much of the financial risk to individuals, and on this one, they're wrong.So who is supporting the protection and expansion of employer-sponsored coverage? To no surprise, it is the incrementalists who believe that single payer reform is not politically feasible, and who believe that the only possible political path to universal or near-universal coverage is to expand on our current fragmented system of funding care.Employer-sponsored premiums can be made affordable only by allowing employers and insurers to shift the costs of care away from the common risk pools and onto the backs of those individuals who need care, a disaster for both financial and health security. It is time to abandon the search for policies that would reduce premiums for private health plans!Are we ready to start demanding policies that would ensure heath care access for everyone through affordable, comprehensive, universal coverage (i.e., NHI)? Or are we going continue to tremble about the prospect of political feasibility, as we drive around in our Toyotas from Canada and Mexico? DM
Affordable , accessible healthcare Must be maintained for the backbone of American society, the middle class, otherwise, we are no better than any third world country, pick one.
Taxpayers are paying for the healthcare of those who are falling through the cracks, already, let's put a 'stitch in time' by initiating healthplans that work for employees,employers and the Nation,ie, taxpayer....rw
USAHealth Care Policy
Brief June 2005
FALLING APART - Declining Job-Based Health Coverage for Working Families in California and the United States
By Arindrajit Dube, Ph.D., Ken Jacobs, Sarah Muller, Bob Brownstein and Phaedra Ellis-Lamkins
To put it in context, the average growth in premium prices during the most recent period was 11% nationally and 13% in California.If premium rates (in California) continue to rise 10% annually... Looking at the entire non-elderly population (adults and children) with incomes below 300% of FPL (the median American family income), more will be uninsured than have coverage through an employer by 2010, if current trends continue. Only 29% of individuals with incomes under 300% of FPL will have job-based coverage, 36% will be uninsured and 28% will have coverage through a public program.Policy implications:* Without major policy changes, employer-based coverage will continue to erode. - What used to be a fundamental component of the social contract for American workers across the income spectrum is now becoming a benefit enjoyed primarily by higher-income families.* A continued decline in employer-sponsored insurance will shift additional health care costs from employers to the public sector, and increase the numbers of uninsured. - Unless immediate steps are taken to stem the decline in job-based coverage, significant new revenues will be needed to cover the increased demand for public health programs.* Proposed cutbacks to Medicaid will jeopardize coverage for low-income adults. - Any cuts to public programs will threaten access to coverage for millions of low-income adults.* Private insurance options are mismatched to those losing coverage. - Policies that rely on private insurance, such as individual mandates or health savings accounts, are mismatched to the economic realities of those losing insurance today.
And...Reuters May 29, 2005Toyota to build plant in Canada - NikkeiToyota Motor Corp. plans to build another plant in Canada, its seventh in North America... Toyota had considered building the plant in the United States but selected Canada because of lower labor costs, it said. Meanwhile, Toyota has started investigating suitable sites in the United States or Mexico for its eighth North American plant...
http://www.reuters.com/newsArticle.jhtml?type=businessNews&storyID=8637099
Comment: The opponents of national health insurance (NHI) have this one right. Policies designed to protect and expand our system of employer-sponsored coverage are doomed to failure because they fail to address the issue of affordability for employers, employees and taxpayers. Even if the rate of premium increases dips below 10%, the decline in coverage for Americans below the median income level may not accelerate as rapidly as predicted in this study, but it will still continue. But the opponents of NHI would shift much of the financial risk to individuals, and on this one, they're wrong.So who is supporting the protection and expansion of employer-sponsored coverage? To no surprise, it is the incrementalists who believe that single payer reform is not politically feasible, and who believe that the only possible political path to universal or near-universal coverage is to expand on our current fragmented system of funding care.Employer-sponsored premiums can be made affordable only by allowing employers and insurers to shift the costs of care away from the common risk pools and onto the backs of those individuals who need care, a disaster for both financial and health security. It is time to abandon the search for policies that would reduce premiums for private health plans!Are we ready to start demanding policies that would ensure heath care access for everyone through affordable, comprehensive, universal coverage (i.e., NHI)? Or are we going continue to tremble about the prospect of political feasibility, as we drive around in our Toyotas from Canada and Mexico? DM
Tuesday, April 05, 2005
" It's the Premiums Stupid " abstract and commentary
From Don Mcanne @QOTD, one of my favorite sources for research and data. I always enjoy the comments as well....
Health AffairsApril 5, 2005
It's The Premiums, Stupid: Projections Of The Uninsured Through 2013By Todd Gilmer and Richard Kronick
Abstract:
Increases in the cost of health care from 1979 to 1999 accounted for the decline in health insurance coverage that occurred during that time period, as our earlier work demonstrated. Here we examine whether the model we presented adequately accounts for the observed changes in health insurance coverage from 1999 through 2002, and we show that the model accurately predicted the increase in uninsured people during that time period. Using the model and projections for national health spending, we project that the number of nonelderly uninsured Americans will grow from forty-five million in 2003 to fifty-six million by 2013.
>From the Discussion:
In 2001 we published a paper titled "The Calm Before the Storm," projecting that the number of uninsured Americans would increase rapidly as a result of health insurance premiums rising more rapidly than personal incomes. It is clear that a full-force storm blew in from 1999 to 2002 and that the actual path of the percentage uninsured... followed the path we expected based on our estimated relationships between affordability and coverage.
We expect the storm to continue during the next decade. However, based on CMS spending projections, its ferocity will lessen. The CMS predicts that health spending for insured people under age sixty-five will grow 2.4 percent per year faster than personal incomes from 2002 to 2013. At this "moderate" rate of spending growth, we expect that the number of uninsured people will increase "only" thirteen million over the next decade from its 2002 level, or eleven million from the estimate of forty-five million uninsured people in 2003. Based on estimates from the Institute of Medicine, this will lead to an increase of 4,500 deaths annually and to an increased annual loss of human capital of $16-$32 billion. If the estimated growth rates for health care prices and income are wrong (as they almost certainly are), it seems much more likely to us that affordability will decline more quickly than expected rather than more slowly, and it seems more likely that the number of uninsured people will increase more quickly than projected rather than more slowly.
It is unlikely that we will be able to solve the problem of the uninsured without some form of universal health insurance coverage requiring contributions from some combination of employers, employees, and taxpayers. It is also unlikely that either our current system of employer-sponsored coverage or an alternative system of universal coverage will be sustainable without more effective efforts at cost containment.
Comment:
Professors Gilmer and Kronick have provided objective evidence of what we instinctively knew. Lack of affordability of insurance premiums has prevented tens of millions from being covered, and, without major change, the problem will only get worse. A few comments are warranted.
The term "affordability" is often avoided by economists because it is not well defined and includes an element of subjectivity based on varying opinions on what is and what is not affordable. Gilmer and Kronick have demonstrated that there is a degree of objectivity in the concept of affordability since the "affordability index" (per capita health spending for nonelderly insured adults divided by the median income of nonelderly adult workers) does correlate quite predictably with the percentage uninsured among nonelderly workers. This article provides us with credibility when we state that health care is becoming less and less affordable.
This article also provides us with a prediction of what would happen if we were able to bring the rate in growth of health spending down to the rate of inflation, assuming no other structural reform of health care financing. They project that an additional 13 million will be without insurance in 2013. Of those, 4.4 million would be due merely to the increase in the population, whereas 8.6 million would be due to a further deterioration in affordability. Though many suggest that all will be well if we merely control health care costs, the numbers of uninsured would still expand by 4.4 million. Obviously structural reform must involve more than merely containing costs.
Another crucial point is that the authors' model implicitly assumes that health insurance premiums will continue to purchase coverage that would provide financial protection against significant medical losses. Unfortunately, current trends could change their model. Competition based on premiums is resulting in a shift of risk to patients. Reports such as the recent Harvard bankruptcy study are demonstrating that we are facing an epidemic of underinsurance. Although this could reduce the upward pressure on premiums and lessen the growth in the uninsured, it could also have the paradoxical affect of causing even more to drop coverage when they recognize that it no longer protects against financial catastrophe. Why invest large sums in insurance premiums when major illness will drain all of your resources anyway?
Gilmer and Kronick are quite right that we need both universal coverage and more effective cost containment. But our current demand side efforts utilizing private plans can only increase the problem of underinsurance and affordability of health care. We need to change to supply side economics if we expect to have affordable, comprehensive care for everyone.
A single payer system, by design, is universal, comprehensive, and utilizes supply side mechanisms to contain costs. In the United States, the $6423 per capita that we are already spending on health care supplies some of us with too much care that is not beneficial, while leaving many with unmet needs. But we won't get our spending right until we decide to adopt supply side funding of a universal system. It won't be perfect (no system is), but it'll be vastly superior to what we have.
Or we can continue to do nothing. The lack of insurance will then cost us 22,500 nonelderly adult lives per year. Is that a price that we are willing to pay for our inaction? Before grumbling about another stupid rhetorical question, think about the consequences of merely walking away and going about your usual business. Tens of thousands of people will continue to die.
Health AffairsApril 5, 2005
It's The Premiums, Stupid: Projections Of The Uninsured Through 2013By Todd Gilmer and Richard Kronick
Abstract:
Increases in the cost of health care from 1979 to 1999 accounted for the decline in health insurance coverage that occurred during that time period, as our earlier work demonstrated. Here we examine whether the model we presented adequately accounts for the observed changes in health insurance coverage from 1999 through 2002, and we show that the model accurately predicted the increase in uninsured people during that time period. Using the model and projections for national health spending, we project that the number of nonelderly uninsured Americans will grow from forty-five million in 2003 to fifty-six million by 2013.
>From the Discussion:
In 2001 we published a paper titled "The Calm Before the Storm," projecting that the number of uninsured Americans would increase rapidly as a result of health insurance premiums rising more rapidly than personal incomes. It is clear that a full-force storm blew in from 1999 to 2002 and that the actual path of the percentage uninsured... followed the path we expected based on our estimated relationships between affordability and coverage.
We expect the storm to continue during the next decade. However, based on CMS spending projections, its ferocity will lessen. The CMS predicts that health spending for insured people under age sixty-five will grow 2.4 percent per year faster than personal incomes from 2002 to 2013. At this "moderate" rate of spending growth, we expect that the number of uninsured people will increase "only" thirteen million over the next decade from its 2002 level, or eleven million from the estimate of forty-five million uninsured people in 2003. Based on estimates from the Institute of Medicine, this will lead to an increase of 4,500 deaths annually and to an increased annual loss of human capital of $16-$32 billion. If the estimated growth rates for health care prices and income are wrong (as they almost certainly are), it seems much more likely to us that affordability will decline more quickly than expected rather than more slowly, and it seems more likely that the number of uninsured people will increase more quickly than projected rather than more slowly.
It is unlikely that we will be able to solve the problem of the uninsured without some form of universal health insurance coverage requiring contributions from some combination of employers, employees, and taxpayers. It is also unlikely that either our current system of employer-sponsored coverage or an alternative system of universal coverage will be sustainable without more effective efforts at cost containment.
Comment:
Professors Gilmer and Kronick have provided objective evidence of what we instinctively knew. Lack of affordability of insurance premiums has prevented tens of millions from being covered, and, without major change, the problem will only get worse. A few comments are warranted.
The term "affordability" is often avoided by economists because it is not well defined and includes an element of subjectivity based on varying opinions on what is and what is not affordable. Gilmer and Kronick have demonstrated that there is a degree of objectivity in the concept of affordability since the "affordability index" (per capita health spending for nonelderly insured adults divided by the median income of nonelderly adult workers) does correlate quite predictably with the percentage uninsured among nonelderly workers. This article provides us with credibility when we state that health care is becoming less and less affordable.
This article also provides us with a prediction of what would happen if we were able to bring the rate in growth of health spending down to the rate of inflation, assuming no other structural reform of health care financing. They project that an additional 13 million will be without insurance in 2013. Of those, 4.4 million would be due merely to the increase in the population, whereas 8.6 million would be due to a further deterioration in affordability. Though many suggest that all will be well if we merely control health care costs, the numbers of uninsured would still expand by 4.4 million. Obviously structural reform must involve more than merely containing costs.
Another crucial point is that the authors' model implicitly assumes that health insurance premiums will continue to purchase coverage that would provide financial protection against significant medical losses. Unfortunately, current trends could change their model. Competition based on premiums is resulting in a shift of risk to patients. Reports such as the recent Harvard bankruptcy study are demonstrating that we are facing an epidemic of underinsurance. Although this could reduce the upward pressure on premiums and lessen the growth in the uninsured, it could also have the paradoxical affect of causing even more to drop coverage when they recognize that it no longer protects against financial catastrophe. Why invest large sums in insurance premiums when major illness will drain all of your resources anyway?
Gilmer and Kronick are quite right that we need both universal coverage and more effective cost containment. But our current demand side efforts utilizing private plans can only increase the problem of underinsurance and affordability of health care. We need to change to supply side economics if we expect to have affordable, comprehensive care for everyone.
A single payer system, by design, is universal, comprehensive, and utilizes supply side mechanisms to contain costs. In the United States, the $6423 per capita that we are already spending on health care supplies some of us with too much care that is not beneficial, while leaving many with unmet needs. But we won't get our spending right until we decide to adopt supply side funding of a universal system. It won't be perfect (no system is), but it'll be vastly superior to what we have.
Or we can continue to do nothing. The lack of insurance will then cost us 22,500 nonelderly adult lives per year. Is that a price that we are willing to pay for our inaction? Before grumbling about another stupid rhetorical question, think about the consequences of merely walking away and going about your usual business. Tens of thousands of people will continue to die.
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