Massachusetts Health Reform Bill: A False Promise of Universal Coverage

Statement by Steffie Woolhandler, M.D., M.P.H. and David U. Himmelstein, M.D.

It's a stirring scene.  The Governor, legislative leaders and leaders of Health Care For All standing in the State House Rotunda declaring victory in the fight for universal health coverage.  Unfortunately, this week's tableau merely repeats one from 20 years ago when Governor Dukakis was celebrating passage of his universal healthcare bill.  That plan imploded within two years, and today about 250,000 more people are uninsured in Massachusetts than the day it was signed.  Unfortunately, Massachusetts' new health reform legislation looks set to repeat that disaster.  

The New York Times
September 18, 2005
Five Pioneers Are Awarded Lasker Medical Prizes By Lawrence K. Altman

The 2005 Lasker Awards for medical research are going to scientists who discovered stem cells, invented genetic fingerprinting and developed a powerful technology that played a crucial role in mapping the human genome.

http://www.dissidentvoice.org/Sept05/Skala0916.htm

An August 2 report showing that a full third of America's 8.4 million uninsured children go without any medical care for at least a year is the latest reminder of the inhuman consequences of our broken health system. Unfortunately, it is becoming increasingly clear that the Bush administration's preferred reforms will actually exacerbate existing problems while victimizing the neediest.

Hillary Clinton and Newt Gingrich's bipartisan plan for avoiding talking about real reform of the health system by saying new medical computers will solve all our problems was dealt a fatal blow this morning with a publication in the journal Health Affairs by two Harvard Researchers who debunk the corporate-funded study the proposal was based on.

Projected Savings from Electronic Medical Records Called Illusory

Harvard critics reject Rand Corporation claims that underlie Gingrich and Clinton policies

September 14, 2005                                                  
Contacts: Steffie Woolhandler, M.D.
David U. Himmelstein, M.D.
Nick Skala

Electronic medical records (EMR) are unlikely to save much money according to a commentary by Harvard Medical School health policy experts Drs. David Himmelstein and Steffie Woolhandler that appears in the September/October issue of the journal Health Affairs.  The commentary debunks a Rand Corporation report appearing in the same issue that forecasts massive savings from EMR.

FOR IMMEDIATE RELEASE
Sept 1,2005

Contacts:
David Himmelstein, M.D. (617) 497-1268
Nicholas Skala            (312) 782-6006

Physician Group Decries 859,000 Rise in Uninsured

Medicaid Ranks Swell by 1.9 Million as Poverty Rises and Private Coverage Drops

Middle-Class Losing Coverage at Fastest Rate

13,000 Doctors: "National Health Insurance is the Only Solution"

CHICAGO - Responding to newly-released data from the U.S. Census Bureau showing that the number of uninsured Americans increased by 859,000 in 2004, members of Physicians for a National Health Program condemned the sharp increase in the number of uninsured and called for a national health insurance program to provide comprehensive coverage to all Americans.

This facinating study, the first ever major survey of immigrant health expenditures, turns the conventional thinking on its head: instead of placing a disproportionate burden on the U.S. health system, immigrants have 55 percent lower health expenditures than nonimmigrant Americans.

What's more, because of the Medicare taxes / insurance premiums they pay in vs. their low expenditures, immigrants are actually helping to SUBSIDIZE care for the nonimmigrant population.

Rep. Luis Gutierrez has also issued a statement on this, I think it will be on his website.

you can read the materials at:
www.pnhp.org/immigrants

the password is: "Carrasquillo" (case-sensitive)

Nicholas Skala

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PRESS RELEASE
EMBARGOED UNTIL 4:00 P.M. EDT
July 25, 2005

Contacts:

Sarita A. Mohanty, M.D. (323) 226-5579 (office)
Steffie Woolhandler, M.D. (617) 312-0970 (cell)
Olveen Carrasquillo, M.D. (917) 899-5403 (pager)
Nicholas Skala (312) 782-6006 (office)
(Additional contact info below)

Immigrants' Health Care Costs are Low

Use Half as Much Care as Non-Immigrant Americans

Immigrants in the U.S. receive surprisingly little health care - 55% less than native-born Americans -according to a Harvard/Columbia University study that appears in the current issue of the American Journal of Public Health. Immigrant children received particularly low levels of care, 74% less overall than other children.

According to the study, immigrants accounted for 10.4% of the U.S. population, but only 7.9% of total health spending, and only 8% of government health spending. Per capita health expenditures averaged $1,139 per immigrant vs. $2,564 for non-immigrants. 30% of immigrants used no healthcare at all in the course of a year.

Most immigrants had health insurance coverage. Though uninsured immigrants used the least health care of any group - 61% less than US-born persons who were uninsured - even immigrants with coverage used 52% less health care than insured non-immigrants.

Immigrant children received far less care in doctors' offices (71% less than non-immigrant children) and received 72% less prescription medications. Immigrant children had a significantly lower average number of emergency room visits than non-immigrant children. However, their emergency room costs - $45 per child - were nearly three times greater - suggesting that immigrant children forewent care until becoming very ill.

The study is the first nationwide analysis of immigrants' health care expenditures. The researchers analyzed data on 21,241 people in the Agency for Healthcare Research and Quality's 1998 Medical Expenditure Panel Survey, which collects detailed health spending data on a representative cross-section of Americans. They used statistical techniques to adjust comparisons between immigrants and non-immigrants for differences between the two groups in age, race/ ethnicity income, health status, and insurance status.

Dr. Sarita Mohanty, who led the study while she was at Harvard and is currently an Assistant Professor of Medicine at the University of Southern California, commented: "Our study lays to rest the myth that expensive care for immigrants is responsible for our nation's high health costs. The truth is, immigrants get far less care than other Americans. Further restricting their eligibility for care would save little money and place many immigrants - particularly children - at grave risk. Already, many immigrant children fail to get regular checkups, and as a result more end up needing emergency care, or get no care at all."

"Our data indicates that many immigrants are actually helping to subsidize care for the rest of us. Immigrant families are paying taxes - including Medicare payroll taxes - and most pay health insurance premiums, but they're getting only half as much care as other families." said Dr. Steffie Woolhandler, a study co-author and co-founder of Physicians for a National Health Program.

According to study co-author Dr. Olveen Carrasquillo of Columbia University's College of Physicians and Surgeons: "Latino immigrants had the lowest health expenditures - $962 per person - half those of US-born Latinos ($1,870) and less than one third those of US-born whites ($3,117). The future economic success of the United States depends on a healthy immigrant workforce. Our findings suggest an urgent need for partnerships between health organizations and community groups to improve access to care, particularly for minority immigrants. This study shows that a national health program that includes all immigrants would cost much less than is widely assumed."

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Physicians for a National Health Program is an organization of 13,000 physicians advocating for non-profit national health insurance. PNHP has chapters and spokespersons across the country. For contacts, call (312) 782-6006

Johns Hopkins University
Center for Civil Society Studies
Institute for Policy Studies
October, 2004

The Health Benefits Squeeze:
Implications for Nonprofit Organizations and Those They Serve By Lester M. Salamon and Richard O'Sullivan

Conclusion: The Silent Tax

Escalating health insurance premiums have emerged as a silent tax on the American workforce, offsetting by a substantial margin whatever advantage workers received as a consequence of recent federal tax cuts and contributing to the reluctance of employers to add new workers to their rolls.

For the most part, attention to the impact of these rising healthcare costs has focused on the business sector. But as the research reported here makes clear, nonprofit organizations have not been immune to these pressures. To the contrary, there is evidence that they have been particularly hard hit, perhaps because they are generally smaller in scale or lack access to the benefit management specialists that seem so important in keeping healthcare costs in check in an increasingly complex healthcare market.

To date, nonprofit managers have succeeded in shielding those they serve from the impact of escalating healthcare costs except for a growing need to introduce or increase service fees. To do so, however, nonprofit managers have had to shift the costs on to their employees - through increased premiums, co-pays, and cost-sharing or through reduced raises or other benefits. In the process, however, they may be undermining one of the few concrete advantages of nonprofit employment - the generally benign human resource policies that nonprofits tend to provide.

How long this process can continue before serious problems of employee turnover and burnout surface is anyone's guess. What is more, the pressures of continued health insurance cost escalation are likely to accelerate the trend toward increased nonprofit fees and charges, undermining the sector's ability to fulfill its mission of service to those in greatest need and its broader advocacy role. The "silent tax" represented by continued rapid increases in health insurance costs thus has particularly profound implications for the nation's nonprofit sector, implications that have been largely overlooked until now. Hopefully, the data reported here will help focus new attention on the health insurance crisis facing nonprofit employers as well.

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Comment: Employees of nonprofit organizations usually accept lower levels of compensation, but do so graciously, acknowledging that the social good advanced has its own rewards. Unfortunately, these organizations are not exempt from the same health care cost pressures faced by for-profit corporations. But most nonprofit entities do not have as much budgetary flexibility. It is particularly disconcerting to see these organizations being forced to use the same methods as businesses in shifting health care costs to their hard-pressed employees.

We are already paying enough to provide comprehensive care for everyone. We could fund our system much more equitably through a national health insurance program. Then nonprofit organizations would not be faced with the current, unacceptable alternatives of either shifting more health care costs to employees, or increasing fees to the needy being served. We can do better.

Read the entire report: http://www.jhu.edu/listeningpost/news/pdf/comm03.pdf

Learn about single-payer NHI: http://www.pnhp.org

From an awful article:

The New York Times
November 18, 2004
Controlling Health Care Costs
By Hal R. Varian

Health care just keeps getting more expensive.

It has been argued, with considerable justification, that a significant part of the increase in health care expense is a result of improved quality.

Economists have two magic potions to control prices and improve quality:
competition and incentives.

What is needed is experimentation with, and competition among, different ways of delivering health care: prepaid group practices, health maintenance organizations, traditional preferred providers, and other ways not yet thought of. The key is to give consumers a choice among different delivery systems, not just minor variations on a single theme.

Current practices offer perverse incentives. Employers often cover some fixed fraction of the cost of each plan. (Stanford economist Alain C.) Enthoven... argues that it would be better to have the employer cover the entire cost of the low-price plan, and let the employees who choose higher-priced plans cover the additional costs themselves.

...it seems clear that more choice, more competition and stronger incentives would be good medicine for the health care industry.

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Comment (by Dr. Don McCanne): Just in case you believe that we have moved the reform debate beyond failed models, we haven't. But Enthoven and colleagues are still beating the drum for an experiment with competition amongst health care middlemen, integrated with delivery systems.

The fact that this article was published in the business section of The New York Times implies that the concept has some credibility. But California has completed an extensive and expensive period of experimentation with this model and it has failed miserably.

Admittedly, Enthoven claims that the experiment wasn't valid because comprehensive, integrated systems were under-represented in the experiment.
But even large urban areas would have difficulty corralling providers into enough truly integrated but completely separate systems to be able to provide multiple, readily accessible, comprehensive systems. He believes that part of the problem lies in the fact that most providers contracted with many loose networks, and they really couldn't effectively compete against themselves. As an example, in his model, a major hospital would be a part of a single integrated system. Since hospitals must be accessible, how many hospitals can compete in one service area when patients are limited to the hospital that is a part of their integrated system? Enthoven's refinement of the failed model of competing plans simply cannot work because of the logistical hurdles.

And if Berkeley professor Varian (the author) believes that the primary reason for the increase in health care costs is quality, he must have isolated himself from the great body of health policy literature. It is no wonder that he supports such a highly flawed model that has already failed experimentation in the marketplace. He missed the whole show.

The business community should be interested in a model that controls costs, improves efficiency, provides better incentives for quality, and eliminates the benefit plan problem for employers. The health policy literature indicates that a single payer plan would accomplish those goals. You would think that the editors of the business section of The New York Times might want to publish such a concept in the interest of promoting an informed discourse on reform, especially reform that serves the interests of business.

Or shall we simply continue on the easier path of living with our political preference for perpetuating a system characterized by waste, inefficiency, mediocrity, and staggering costs in health care?