Latinos for National Health Insurance -- A Coalition for Equality in Healthcare

2008-02-27T19:42:00.000-08:00

Is 'Cookbook Medicine' Crippling the U.S. Health System?
By Christopher Moraff, AlterNet

Posted on February 25, 2008,
http://www.alternet.org/story/77763/

By now, the case of Nataline Sarkisyan has garnered so much media attention that there's likely few people who haven't heard the story of the 17 year-old California girl who died five days before Christmas after her insurance company refused to approve her liver transplant.

Sarkisyan, who was diagnosed with Leukemia when she was 14, was undergoing treatment at UCLA Medical Center when Philadelphia-based Cigna HealthCare ruled her much-needed transplant "experimental, investigational and unproven."

Sarkisyan spent three weeks in a vegetative state before Cigna bowed to pressure from the girl's doctors and offered to pay for the transplant itself. But by then it was too late.

Whether a transplant would have ultimately saved Sarkisyan's life we will never know. But that's not really the point. After all somebody has to say no; the problem, says David Senoff -- a Pennsylvania attorney who represents patients who have been denied care by their insurance company -- is that the people saying no are the very same people who profit from the answer.

"Health insurance by definition covers some things, and not other things it's the same as any other policy: there are some things that are in and some things that are out and somebody has to be the one who's outside of coverage; but you don't want those people who decide to be the ones who are in the company making additional money by denying care," Senoff said.

"The last person on earth that should be making a determination [on coverage] is the person that's going to be making money off of the decision," echoes Steffie Woolhandler, an associate professor of medicine at Harvard University. "No one that's involved in that decision should stand to gain or lose based on the decision."

Woolhandler, a vocal proponent of a single-payer, universal health care system, recently co-authored a study on the U.S. health care system for the British Medical Journal that exposed the failings of America's managed care system.

"The U.S. health care system is failing because we have adopted a for-profit, market-driven model," Woolhandler said. "Americans die younger and pay more for their care than people in nations with non-profit national health insurance."

For Senoff, profit motive aside, the very nature of managed care is like putting the "fox in charge of the hen house."

"I'm not a person who's against companies making profits, the problem for me is the management portion of the insurance," he said. "When I was a kid this idea of managed care with the insurance company being the manager was unthinkable."

Judging by industry data, the fox has had a very good run of it. Since the Health Maintenance Organization Act of 1973 created the managed care system, the industry has become a virtual profit machine. According to Fortune magazine, the top-ten managed care companies -- ranked by revenue -- made roughly $12 billion in profits in 2007. The ten highest paid HMO chief executives collectively made nearly $170 million last year.

Meanwhile, the industry spent more than $150 million lobbying the government over the past five years, according to the Center for Responsive Politics, and has managed to secure an entrenched position that makes challenging insurance companies difficult if not impossible.
Senoff attributes this to two primary characteristics: a shift in the way claims are classified and processed, and a decades-old federal law that gives HMOs virtual immunity from liability for negligence.

The Best Evidence?

There are two primary rationales managed care organizations use when refusing to cover a specific treatment: one is to say the treatment is in itself experimental or investigational; the other -- as happened in the Sarkisyan case -- is to say it's experimental or investigational for a particular patient's diagnosis.

This second rationale, which is becoming more common, is reliant on a concept called "evidence-based medicine" (EBM) -- a trend that is finding an eager proponent in managed care companies.

Under EBM, medical treatment decisions are made primarily using guidelines from existing literature rather than a doctor's own expert opinion. Advocates of the practice say such guidelines limit variation in physician practice thereby improving quality of care.

But critics dismiss a reliance on such standardized treatment protocols as "cookbook medicine" and argue that EBM not only takes the individuality out of case management, but stifles innovation by removing insurance companies' obligation to pay for treatments they may deem "experimental."

Health insurers began developing guidelines in the 1990s to identify inappropriate medical care and reduce unnecessary utilization of services, according to a 2005 report on evidence-based medicine published by the Minnesota-based patient advocacy group Citizens Council on Health Care (CCHC).

"Insurance companies needed a name and a process that they could call scientific; they dressed it up to look like something different but the whole point still is just to ration health care but to do it from what would be perceived as science," said Twila Brase, a former ER nurse who now heads the CCHC. "It's a fallacy...there's no doctor out there today practicing medicine without evidence."

"What they say is we're going to scour all the journals to find out if this is appropriate with that kind of condition," explained Senoff. "The problem is that the science is always ahead of the literature -- it takes time to get this stuff published. So they might be relying on journal articles that are a year to three years old, which in [today's medical environment] is ancient."

On the federal side, since 1997 the Agency for Healthcare Research & Quality has run a pilot program on evidence-based practice for application to Medicaid and Medicare. In Oct. 2007 the agency announced the third award of five-year contracts to 14 evidence-based practice centers around the country. Commercial HMOs started implementing EBM around the same time and rely heavily on two guideline developers: Seattle-based Milliman USA and the Institute for Clinical Systems Improvement (ICSI), based in Minnesota. Underscoring the synergy between insurance companies and EBM centers, ICSI lists its top-three financial sponsors as Blue Cross/Blue Shield, HealthPartners and Medica -- all managed care firms.

A former Cigna claims manager, who asked that he not be identified because he still works in the medical field, said during his ten years with company, Cigna used guidelines produced by Milliman USA.

"I had cases where they would alter the guidelines a little bit, often with younger patients to give them the benefit of the doubt," he said, "but generally speaking the guidelines were pretty rigid and people had to meet them."

According to Milliman's own assessment, one in three Americans is managed using the company's care guidelines and nine of the eleven largest managed care organizations in the nation are Milliman clients. In 2006, Dr. James M. Schibanoff, editor-in-chief of the Milliman Care Guidelines, was named one of the "50 Most Powerful Physician Executives" in the nation by Modern Physician and Modern Healthcare magazines.

Milliman has had its share of controversy over the years; in the 1990s, for example, the company issued guidelines recommending that mastectomies be performed on an outpatient basis, and drew considerable criticism when it suggested that elderly patients be limited to cataract surgery in just one eye -- presumably because two-eyed sight was unnecessary.

Dr. Craig Umscheid, who helps run the Center for Evidence-Based Practice at the University of Pennsylvania, said EBM often gets a bad rap, primarily because it's either misunderstood or misapplied.

"It's a mistake to say EBM equals a standardized approach; if it were that then you wouldn't even need physicians to practice medicine; experience is important -- but somebody's got to make the decision what to cover and what not to cover -- there's a lot of very expensive snake oil out there."

Dr. Umscheid says his group does not take any funding from health care companies, and can understand why there would be concerns about conflicts of interest with guideline developers that do. But he says when it comes down to it, he believes EBM can be a valuable tool in the health care arsenal if properly utilized.

"Nothing is black and white -- like most things if EBM is practiced appropriately I feel that it's the best way to practice," he said. "I think EBM is a foundation but it's not the end in itself; it's a means to an end. When you have evidence suggesting one treatment may be better than another it's prudent to do what the evidence says is true."

Harvard's Woolhandler says she agrees with that concept in theory, but adds that the very nature of America's health care system often calls the motivation behind EBM into question.

"It's important to figure out what's effective and what's not but the caveat I would add is that there's a problem in that you are very dependent on somebody funding the research to prove the remedy," she said. "In the United States you have a system where often the funding is driven by commercial priorities."

Virtual Immunity

Beyond controversial management practices, in most cases, existing federal law serves as a barrier to holding managed care companies accountable for their actions -- even when they result in death.

A year after the HMO Act, Congress passed the Employee Retirement Income Security Act (ERISA) in response to rampant pension fraud and mismanagement. The statute was designed to protect employees from having their benefits plundered by setting out requirements for the management of all employee benefits, including health care, and placing all legal matters involving benefits under federal jurisdiction.

In practice, when applied to HMOs, ERISA preempts state jurisdiction over tort claims against insurance companies and severely limits an enrollee's legal recourse. Most notably, although enrollees can sue their HMO for denying a claim, under ERISA they can only recoup the costs of the initial test or treatment; the law prohibits additional compensation, such as lost wages, medical expenses to treat an injury, punitive damages for pain and suffering, or wrongful death.

ERISA applies to all self-insured employer-sponsored benefit plans, which comprise roughly 70 percent of the insured public. Only government workers and employees of religious organizations are exempt.

"The ERISA standard so favors the insurance company, I don't even take ERISA cases anymore," said Senoff. "If you win the case, you can petition the court to pay your attorneys fees, but even that's not automatic and the cases take a long time."

Some states, including Pennsylvania and Texas, have attempted, unsuccessfully, to litigate around ERISA. In 1998, the PA Supreme Court concluded that Congress never intended ERISA to bar negligence claims against HMOs just because they are subject to federal employee benefits law. But a federal court subsequently overturned that ruling, and in 2004 the U.S. Supreme Court settled the issue by barring all states from letting patients sue managed care companies whose refusal to pay for treatment resulted in death or injury.

Since then, a legislative effort led by the late congressman Charlie Norwood (R-GA) has continued to push for reforms to the legislation. Norwood first took up the cause in 1997 with the Patient Access to Responsible Care Act, and has reintroduced a similar measure in nearly every Congress since.

Norwood died on Feb. 13, 2007; the day after the most recent version of his bill -- The Bipartisan Consensus Managed Care Improvement Act of 2007 -- was reintroduced by its co-sponsor, John Dingell (D-MI). Last summer, the Norwood/Dingell bill was referred to the House Subcommittee on Health, Employment, Labor, and Pensions, where it sits today.

If the insurance industry gets it's way, that's where it will stay. In November, managed care went on the attack, and together with more the 50 of the nation's largest corporations formed the innocuous sounding National Coalition on Benefits to aggressively lobby against any ERISA changes.

The article originally appeared in The Philadelphia Tribune.

Christopher Moraff is a writer, journalist and photographer and a frequent contributor to In These Times and The American Prospect Online. He also works as a correspondent for The Philadelphia Tribune and is senior editor of the monthly online political journal Common Sense Magazine. He lives and works in Philadelphia.

2008-02-27T19:36:00.000-08:00

From The American Cancer Society

Report Links Health Insurance Status With Cancer Care

Uninsured Americans are less likely to get screened for cancer, more likely to be diagnosed with an advanced stage of the disease, and less likely to survive that diagnosis than their privately insured counterparts, according to a new American Cancer Society report examining the impact of health insurance status on cancer treatment and survival.

American Cancer Society researchers analyzed 598,635 cases using the most recent data from the National Cancer Data Base (NCDB), a hospital-based registry held by ACS and the Commission on Cancer of the American College of Surgeons. The NCDB tracks approximately 70% of the cancer cases in the United States and collects data from about 1,500 hospitals. The patients included had either private insurance, Medicaid, or no insurance. The researchers also examined data from the 2005 and 2006 National Health Interview Survey (NHIS), a nationwide in-person survey of approximately 40,000 U.S. households conducted by the National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (CDC).

For all cancers combined, the ACS researchers found that uninsured patients were 1.6 times as likely to die within 5 years compared to individuals with private insurance.

People with lower incomes were less likely to have insurance, the report found. And those without insurance were less likely to use certain health services. About 54% of uninsured patients aged 18 to 64 did not have a usual source of health care. About 26% delayed care due to cost, while nearly 23% did not get care because of cost. An estimated 23% did not get prescription drugs because of the expense.

Individuals with health insurance were about twice as likely as those without to have had a recent mammogram or colorectal cancer screening. People with insurance were also more likely to be diagnosed with early stage disease and less likely to be diagnosed with advanced stage disease than the uninsured.

The researchers saw a survival difference in breast and colorectal cancer, too. About 89% of privately insured white women with breast cancer survived at least 5 years, compared to 76% of white women with Medicaid or no insurance. Among African-American women, 81% of breast cancer patients with private insurance survived 5 years, compared to 65% of those on Medicaid and 63% of those without insurance. A similar pattern emerged in colorectal cancer. Among white patients with private insurance, 66% survived 5 years, compared to 50% of those with no insurance and 46% of those on Medicaid. Among African Americans, 60% with private insurance survived 5 years compared to 41% of the uninsured and Medicaid patients.

The risk of being uninsured or underinsured varies.

Almost anyone can be underinsured in the event of a major illness. The underinsured, commonly defined as people who spend more than 10% of their after-tax household income on out-of-pocket expenses in the event of a serious illness, often don't realize the gravity of their situation until faced with high premiums and deductibles, limits on terms for covered services, and caps on monthly, lifetime, or disease- specific coverage.

According to a 2003 study sponsored by the Agency for Health Care Research and Quality, the prevalence of being underinsured increased from 6.7% to 8.5% among nonelderly adults between 1996 and 2003. These numbers shot up when the costs of health insurance premiums were factored in. Among people with cancer, 29% had out-of-pocket expenses that exceeded 10% of their family's income and about 11% exceeded it by 20%.

http://www.cancer.org/docroot/NWS/content/ NWS_1_1x_Report_Links_Health_Insurance_Status_With_Cancer_Care.asp
"Association of Insurance with Cancer Care Utilization and Outcomes" January/February 2008 issue of CA: A Cancer Journal for Clinicians, published by the American Cancer
Society:
http://caonline.amcancersoc.org/

2008-01-30T18:20:00.000-08:00

A Health Law with Holes

Massachusetts' experience with health-care reform illustrates the problem of an individual mandate absent comprehensive reform: It makes a social failure the problem of the individual.

Robert Kuttner January 30, 2008

Jon Kingsdale is a good man playing a bad hand dealt him by the Massachusetts Legislature and the Bush administration.

Kingsdale heads the Commonwealth Connector, created in 2006 by then-Governor Mitt Romney and the Legislature, as part of an effort to cover most of the state's uninsured. Kingsdale takes justifiable pride in having brought health insurance to more than 300,000 Massachusetts residents.

However, as the Globe recently disclosed, the program's costs are outstripping its projections by $245 million this year, and $400 million next year. This is not Kingsdale's fault. The program's designers underestimated the uninsured by some 200,000 people (costs of service are also rising). By doing his job - reaching those without coverage - Kingsdale adds to the program's costs.

The Massachusetts program, by going beyond standard Medicaid (which is 50 percent federally funded), needed a waiver of federal rules. The waiver must be renegotiated this year. President Bush has mandated cuts in state aid - during an economic downturn no less - using a characteristically backdoor directive that limits states' ability to extend health coverage beyond the poor. Going forward, Massachusetts will bear more of the program's cost.

The deeper problem is the program's piecemeal design, and the Legislature's failure to levy more than a token annual tax of $295 per worker on businesses that take a free ride by failing to cover employees. If the law had charged delinquent employers the actual cost of decent insurance - more like $5,000 a year - the state would have adequate funds for the uninsured.
By addressing only the poor, near poor, and those without "access" to employer coverage, but not the whole system, the 2006 law produces perverse results.

For the poor, decent insurance is heavily subsidized under an expanded version of Medicaid. For lower-middle-class people without employer-provided insurance, the Connector has worked with private insurers to offer affordable plans partly subsidized by the state ("Commonwealth Care"). Most of this insurance, Kingsdale noted in an interview, is a lot better than what people had before.

Yet another layer of the cake, "Commonwealth Choice," offers unsubsidized plans for moderate income people without access to insurance. But approved plans with affordable premiums have high deductibles and copays - while plans with affordable out-of-pocket charges have high premiums. A family that can only afford lower-premium plans can incur as much as $10,000 in annual costs, plus premium costs, if a member becomes seriously ill.

But people whose employers offer insurance coverage (the vast majority) get scant benefit from the new law, and the program largely fails to address escalating deficiencies in employer-provided plans. Rather, the law legislated an "individual mandate" requiring everyone to get insured one way or another.

Bottom line: the reform helps a great many uninsured but compounds a crisis that Dr. Marcia Angell, former executive editor of the New England Journal of Medicine, calls "coverage without care." As employers and insurers contain their costs by shifting them to individuals, more people find that their insurance fails to pay many expenses when they are sick.

So as a middle-class Massachusetts resident not eligible for the 2006 program, here's what you get: If your employer offers lousy coverage, or sticks you with most of the premiums, you must still buy the plan, or some other plan, or the state penalizes you. The Connector's website helpfully trumpets in large type, "New Penalties for 2008."

This idea of an individual mandate absent comprehensive reform - how to say this politely? - is nuts. It makes a social failure the problem of the individual. As Angell points out, "It gives the idea of government-sponsored universal coverage a bad name."

When Lyndon Johnson devised Medicare in 1965, he didn't order senior citizens to go out and buy private insurance, adequate and affordable or not, or be fined. Medicare covered everyone, bypassing the notoriously inefficient private insurance industry.

Barack Obama has been criticized by some for not including an individual mandate in his health plan. But Obama is correct. The individual should not be punished for government's failure to do reform right. Universal social insurance signals government help. A mandate signals government coercion.

Kingsdale says he is betting that the holes in the current reform will logically lead to more fundamental reforms. I sure hope he's right. But I'm with Marcia Angell. The Legislature, by building half a bridge, has set up one more perceived government failure.

2008-01-30T18:14:00.000-08:00

An Open Letter to the Nation from Massachusetts Physicians:
Early Outcomes from Massachusetts’ Health Care Reform

We write to alert colleagues and the nation to the disturbing early outcomes of Massachusetts’ widely-heralded approach to health care reform. Although we wish that the current reform could secure health insurance for all, its failings reinforce our conviction that only a single payer program can assure patients the care they need.

In 2006, our state enacted a law designed to extend health coverage to virtually all state residents. Political leaders in other states as well as several Democratic presidential candidates have embraced this model.

Massachusetts’ law mandates that uninsured individuals must purchase private insurance or pay a fine. The law established a new state agency to ensure that affordable plans were available; offered low income residents subsidies to help them buy coverage; and expanded Medicaid coverage for the very poor. (Immigrants are mostly excluded from these subsidized programs.) Moneys that previously funded free care for the uninsured were shifted to the new insurance program, along with revenues from new fines on employers who fail to offer health benefits to their workers. In addition, the federal government provided extra funds for the program’s first two years.

Starting January 1, 2008 Massachusetts residents face fines if they cannot offer proof of insurance. Yet as of December 1, 2007 only 37% of the 657,000 uninsured had gained coverage under the new program. These individuals often feel well served by the reform in that they now have health insurance. However, 79% of these newly insured individuals are very poor people enrolled in Medicaid or similar free plans. Virtually all of them were previously eligible for completely free care funded by the state, but face co-payments under the new plan. In effect, public funds for care of the poor that previously flowed directly to hospitals and clinics now flow through insurers with their higher administrative costs.

Among the near poor uninsured (who are eligible for partial premium subsidies) only 16% had enrolled in the new coverage. And barely 7% of the uninsured individuals with incomes too high to qualify for subsidies had enrolled according to the official state figures. Few can afford premiums for even the skimpiest coverage; the lowest cost plan offered for a couple in their fifties costs $8,200 annually, and carries a $2,000 per person deductible.

Moreover, the state’s cost for subsidies is running $147 million over the $472 million budgeted for fiscal year 2007. Meanwhile, collections from fines on employers who fail to provide coverage are 80% below the original projections. The funding gap will widen in future years as health care costs escalate and insurers raise premiums. Already, state officials speak of making up the shortfall by forcing patients to pay sharply higher co-pays and deductibles, and by slashing funds promised to safety net hospitals.

While patients, the state and safety net providers struggle, private insurers have prospered under the new law, and the costs of bureaucracy have risen. Blue Cross, the state’s largest insurer, is reaping a surplus of more than $1 million each day, and awarded its chairman a $16.4 million retirement bonus even as he continues to draw a $3 million salary. All of the major insurers in our state continue to charge overhead costs five times higher than Medicare and eleven-fold higher than Canada’s single payer system. Moreover, the new state agency that brokers private coverage adds its own surcharge of 4.5% to each policy it sells.

A single payer program could save Massachusetts more than $9 billion annually on health care bureaucracy, making universal coverage affordable. But because the 2006 law deepened our dependence on private insurance, it can only add coverage by adding costs. Though politically feasible, this approach is already proving fiscally unsustainable. The next economic downturn will push up the number of uninsured just as the tax revenues needed to fund subsidies fall.
The lesson from Massachusetts is that we still need real health care reform: single payer, non-profit national health insurance.

2008-01-14T19:25:00.000-08:00

¡Despierta Hispano, Despierta!
por Dr. Juan José Rivera

Soy un fiel creyente de que nuestra verdadera realidad representa mucho más que las cosas que nos afectan directamente como individuo. Mucho más que ser ciudadanos de los Estados Unidos, Méjico, Argentina, la Unión Europea, Chile o la República Dominicana, entre otros, somos ciudadanos de una comunidad hispana global; ciudadanos del mundo. Es por esta razón que sin importar el lugar del mundo en el cual te encuentras en este momento, si te consideras hispano, el asunto que voy a abordar te compete.

Existen 47 millones de personas en los Estados Unidos los cuales no tienen seguro médico; la gran mayoría no pueden pagarlo. Un porcentaje significativo de éstos, millones, son compañeros de esa gran comunidad hispana a la que pertenecemos. Puertorriqueños, Dominicanos, Mejicanos, en fin, hermanos.

Uno de los propósitos de mi blog, Corazón Hispano, es brindarle a nuestra comunidad la información necesaria sobre salud preventiva cardiovascular para intentar evitar eventos y enfermedades que requieran de un cuidado avanzado, y por ende, costoso. Intentar disminuir la cantidad de amigos que tengan que decidir entre comer o pagar por cuidado médico; entre comprar sus medicamentos o pagar su renta. El que piense que esto es una exageración probablemente o le sobran los recursos económicos, o nunca, gracias a Dios, ha sufrido de una condición seria o crónica y ha tenido que pagar de su bolsillo para proteger su salud o la de los suyos.

Mi práctica clínica es sumamente interesante y frustrante al mismo tiempo. En un día he visto a un paciente que llega a verme en su avión privado, y a un paciente, en ocasiones hispano, que no se toma los medicamentos recetados porque no puede pagarlos. Peor aún, el segundo paciente no tiene seguro médico por lo cual se hace casi imposible hacerle las pruebas necesarias para seguir de cerca su enfermedad coronaria. No estamos hablando de tratamientos electivos o de cirugía plástica, estamos hablando de medicamentos y terapias básicas establecidas como necesarias por las asociaciones de Cardiología del país. Tanto el paciente que llega en su avión privado como el que se le hace difícil llegar a la clínica merece, debe tener el derecho, de recibir ese tratamiento básico.

Este asunto es uno de índole moral. ¿Cree usted que todo ser humano debe tener acceso a un servicio básico de salud; rico o pobre, negro, hispano o blanco, adulto o niño? Algunos te dirán que en los Estados Unidos todas las personas tienen acceso a servicios de salud ya que individuos sin recursos son atendidos en las salas de emergencia del país y reciben el tratamiento adecuado. Tienen toda la razón…son atendidos cuando sufren un ataque al corazón masivo, cuando están casi muriéndose de fallo renal por no tener un centro de diálisis accesible, cuando sus vesículas no aguantan más y están a punto de explotar, cuando sus niveles de azúcar están sumamente elevados porque no tienen acceso a cuidado preventivo, cuando sufren un derrame cerebral por no poder pagar los medicamentos de la presión, en fin, cuando el no hacerlo representaría una clara violación moral y legal.

En los Estados Unidos tenemos doctores buenísimos que hacen bien su trabajo en las salas de emergencia, pero su responsabilidad es el cuidado agudo de una persona y no el cuidado primario o preventivo. El paciente que sufre un derrame cerebral debido a que no puede pagar los medicamentos de la presión, una vez sale de la sala de emergencia o del hospital, vuelve al círculo vicioso que define su realidad. Vuelve a no poder pagar sus medicamentos, la presión arterial le sube a niveles sumamente peligrosos y sufre otro derrame cerebral o un ataque al corazón. A diferencia de otros círculos viciosos, éste lamentablemente en algún momento llega a su fin. Basta con añadir que el fin, en la mayoría de los casos, no representa el control o la cura de la enfermedad.

El otro asunto importante es el económico. ¿Existen fondos para proveer a todas las personas un seguro médico básico? Les contesto con otra pregunta. ¿Existe en los Estados Unidos los recursos económicos para hacerle la guerra al mundo entero? Aparentemente sí. Entonces no es un asunto que tiene que ver con la existencia de recursos sino con la asignación de éstos a los diferentes asuntos, o tal vez sectores poblacionales del país. Un cambio de prioridades nacional no vendría nada mal. Soldados hispanos junto a norteamericanos luchan en Irak con el propósito de brindarle a ese país un clon de la democracia estadounidense cuando en nuestro propio patio millones carecen de lo que debe ser un derecho natural; el derecho a un servicio de salud digno.

Despierta hispano, despierta…porque en este país, cuando se trata de minorías y sectores desaventajados, el lenguaje que se escucha es el de las masas; aquel que tiene impulso y voluntad política para destronar a aquellos que aun dependiendo de la mayoría para subsistir, trabaja para que prevalezcan los intereses del grupo minoritario.
_______________________________________________________________

Dr. Juan J. Rivera pertenece al departamento de Cardiología de la Universidad de Johns Hopkins en Baltimore, Maryland. Además de sus obligaciones clínicas, se dedica a realizar investigación en el área de prevención cardiovascular. También escribe una columna mensual para el periódico médico nacional estadounidense Today in Cardiology.

juanchi07@gmail.com

2007-12-15T15:40:00.000-08:00

NEW YORK TIMES
December 15, 2007

Op-Ed Contributors

I Am Not a Health Reform
By DAVID U. HIMMELSTEIN and STEFFIE WOOLHANDLER

Cambridge, Mass.

IN 1971, President Nixon sought to forestall single-payer national health insurance by proposing an alternative. He wanted to combine a mandate, which would require that employers cover their workers, with a Medicaid-like program for poor families, which all Americans would be able to join by paying sliding-scale premiums based on their income.

Nixon’s plan, though never passed, refuses to stay dead. Now Hillary Clinton, John Edwards and Barack Obama all propose Nixon-like reforms. Their plans resemble measures that were passed and then failed in several states over the past two decades.

In 1988, Massachusetts became the first state to pass a version of Nixon’s employer mandate — and it added an individual mandate for students and the self-employed, much as Mrs. Clinton and Mr. Edwards (but not Mr. Obama) would do today. Michael Dukakis, then the state’s governor, announced that “Massachusetts will be the first state in the country to enact universal health insurance.” But the mandate was never fully put into effect. In 1988, 494,000 people were uninsured in Massachusetts. The number had increased to 657,000 by 2006.

Oregon, in 1989, combined an employer mandate with an expansion of Medicaid and the rationing of expensive care. When the federal government granted the waivers needed to carry out the program, Gov. Barbara Roberts said, “Today our dreams of providing effective and affordable health care to all Oregonians have come true.” The number of uninsured Oregonians did not budge.

In 1992 and ’93, similar bills passed in Minnesota, Tennessee and Vermont. Minnesota’s plan called for universal coverage by July 1, 1997. Instead, by then the number of uninsured people in the state had increased by 88,000.

Tennessee’s Democratic governor, Ned McWherter, declared that “Tennessee will cover at least 95 percent of its citizens.” Yet the number of uninsured Tennesseans dipped for only two years before rising higher than ever.

Vermont’s plan, passed under Gov. Howard Dean, called for universal health care by 1995. But the number of uninsured people in the state has grown modestly since then.
The State of Washington’s 1993 law included the major planks of recent Nixon-like plans: an employer mandate, an individual mandate for the self-employed and expanded public coverage for the poor. Over the next six years, the number of uninsured people in the state rose about 35 percent, from 661,000 to 898,000.

As governor, Mitt Romney tweaked the Nixon formula in 2006 when he helped devise a second round of Massachusetts health care reform: employers in the state that do not offer health coverage face only paltry fines, but fines on uninsured individuals will escalate to about $2,000 in 2008. On signing the bill, Mr. Romney declared, “Every uninsured citizen in Massachusetts will soon have affordable health insurance.” Yet even under threat of fines, only 7 percent of the 244,000 uninsured people in the state who are required to buy unsubsidized coverage had signed up by Dec. 1. Few can afford the sky-high premiums.

Each of these reform efforts promised cost savings, but none included real cost controls. As the cost of health care soared, legislators backed off from enforcing the mandates or from financing new coverage for the poor. Just last month, Massachusetts projected that its costs for subsidized coverage may run $147 million over budget.

The “mandate model” for reform rests on impeccable political logic: avoid challenging insurance firms’ stranglehold on health care. But it is economic nonsense. The reliance on private insurers makes universal coverage unaffordable.

With the exception of Dennis Kucinich, the Democratic presidential hopefuls sidestep an inconvenient truth: only a single-payer system of national health care can save what we estimate is the $350 billion wasted annually on medical bureaucracy and redirect those funds to expanded coverage. Mrs. Clinton, Mr. Edwards and Mr. Obama tout cost savings through computerization and improved care management, but Congressional Budget Office studies have found no evidence for these claims.

In 1971, New Brunswick became the last Canadian province to institute that nation’s single-payer plan. Back then, the relative merits of single-payer versus Nixon’s mandate were debatable. Almost four decades later, the debate should be over. How sad that the leading Democrats are still kicking around Nixon’s discredited ideas for health reform.

David U. Himmelstein and Steffie Woolhandler are professors of medicine at Harvard and the co-founders of Physicians for a National Health Program

2007-11-03T09:59:00.000-07:00

Public Testimony- New York State Partnership for Health Coverage:
Moving Toward Universal Healthcare Coverage:

October 30, 2007

On behalf of Latinos for National Health Insurance, LNHI, I wish to thank Governor Spitzer and Commissioner Daines for their commitment to moving towards universal health coverage in New York. We are extremely thankful to be given this opportunity to provide input on the development of proposals for achieving health system reform. Latinos for National Health Care is a national coalition for equity in health care based in New York. We are composed of leading Latino leaders in health care, labor, government and other sectors. LNHI’s mission is to serve as a Latino focused advocacy group to establish a comprehensive, universal, accessible, equitable, permanent and affordable program of health insurance covering every person living in the United States.

Through presentations, publications, and other outreach and advocacy efforts we seek to inform groups and organizations including elected officials of the insurance crisis in the Latino community and the need for comprehensive approach to health insurance coverage based on national health insurance. Our analysis of the latest data from the Census Bureau in NY portrays a very stark picture for Latinos in New York State. Our data shows that in 2006, 23% of all Latinos in NY lacked health coverage versus only 10% of Non-Hispanics Whites. Further of the states 2.7 million uninsured, 764,000 were Latinos. In other words, although Latinos make up only 17% of the population of New York State, they account for nearly 30% of the states uninsured. In contrast NHWs make up 60% of the states’ population but only 42% of the uninsured. By ethnic subgroup we find that 15% of Puerto Ricans in NY lack coverage. Most vulnerable are Dominicans and Mexicans with 31% and 45%, respectively, lacking coverage. Further, our analysis of Census data finds that the disparity is most pronounced among Latinos who are non citizens with 46% lacking coverage. Yet even among Latinos who were born in the US, 15% lacked coverage, a rate that is one and a half times greater than NHWs. Nevertheless, the fact that 46% of all uninsured Latinos in NY State are non citizens (390,000 people) suggests that any meaningful attempt at health insurance reform must include addressing the plight of non-citizens. We must also note that disparities are also present for other racial minorities with 20% of Asians and 16% of Non-Hispanic blacks also lacking coverage.

While health insurance is the most important determinant of access to health care, we are well aware that other barriers to care exist such as language barriers, cultural competency, and lack of a diverse workforce to name but a few. Nevertheless, before one addresses all these other barriers, you have to eliminate the primary barrier that is preventing nearly a quarter of all Latinos from accessing the system because they are uninsured. This is similar to the recommendation by the landmark 2002 Institute of Medicine report on health disparities, which noted that addressing the plight of the uninsured is needs to be the initial and most important step we can take towards eliminating health disparities. Thus we are extremely pleased that the governor and commissioner have made tackling this extremely difficult health disparity issue a priority.

From a disparities framework and in thinking of health insurance reform we believe that the elimination of segregation and unequal access in our health care system should take utmost priority. Today you may hear from a few presenters advocating for market based reforms or so called medical consumerism. The central tenet of such reform proposals is that consumers should be made more sensitive to the price of health care. These policy formulations seek to reduce health expenditures by rationing health care based on ability to pay. Such policies would move us in the opposite direction of our nation’s and our state’s commitment towards the elimination of health disparities. We hope such approaches would not be central to any health insurance reform approach in NY.

Using the disparities framework we are equally troubled by many of the incremental approaches you will hear about today. As you are well aware, in NY State we essentially have a three tier system. The lowest tier are the uninsured. The highest tier are those having private insurance or national health insurance for elders, known as Medicare. These insurance programs are widely accepted by physicians and hospitals and these groups enjoy the best levels access to health care. In NY 85% of non-Hispanic whites have this highest tier of health care. In contrast, only 50% of Latinos, 66% of blacks and 68% of Asians have such health coverage.

The second tier of our segregated health care system are those covered through the various insurance programs that currently exist serving the poor. These programs including Medicaid and CHIP are critical components of the health care safety net. However, the many hurdles the poor and near poor have to overcome to be able to be insured under these programs and maintain coverage makes these programs a far cry from the stable comprehensive health coverage persons in first tier, such as Medicare beneficiaries, enjoy. Another major flaw in these programs is that they are considered as poverty programs by state and federal legislators and like other such programs, are chronically under-funded. As an example, in NY a private physician providing a comprehensive visit to a new Medicare patient is paid six times as much as when he provides the same service to a Medicaid patient. This forces Medicaid patients in many NY localities, to receive care through the same network of safety net clinics that care for the uninsured. Further, access to sub-specialty care in these settings is often as problematic as it is with the uninsured. As an example, in what is considered by many as one of the best hospitals in New York State, the wait for a Medicaid patient to see a gastroenterologist for a screening colonoscopy is 8 months. In contrast, patients with Medicare could be seen within two weeks in the private offices that are part of the same Medical Center but which do not accept Medicaid patients.

The federal government also reinforces this segregated system of care by providing additional subsidies through grants or Disproportionate Share Payments for these safety reform in NY Sate would proceed using a building-block incremental approach, the Governor has chosen to build on the segregationist and racist system of health insurance that currently exists in our state. Based on testimony he is receiving in these hearings, we would urge the governor and Commissioner to reconsider the merits of a comprehensive approach of single payer coverage that would ensure equitable access to affordable, high quality medical care for every single New Yorker.

LNHI further urges the governor and commissioner to reject health reform proposals that seek to ration health care based on ability to pay as well as those that would place more low income minorities into segregated systems of care. We are keenly aware of political realities. We know that equitable coverage for all residents will be fiercely and vigorously opposed by powerful groups having a vested financial interest in maintaining our discriminatory system of health care. We also know how hard it will for our political leaders to stand up to those forces and take a bold step to eliminate racism and segregation in health coverage in NY. However we believe that at this critical juncture and with capable leadership we do have a unique window.

Martin Luther King once said “of all the forms of inequality, discrimination in health care is the most shocking and inhumane”. Dr. King gave his life in his pursuit of ending racism and discrimination. It is our sincere hope that our new political leaders in this great state of New York will find the courage and stamina to take up this fight, and not accept medical apartheid in NY as an acceptable compromise to placate powerful financed interests.

Thank you,

Olveen Carrasquillo, MD, MPH
Associate Professor of Medicine and Health Policy,
Director, Columbia Center for the Health of Urban Minorities,
Columbia University Medical Center

Speaking in his capacity as
Vice-President,
Latinos for National Health Insurance

2007-10-17T19:46:00.000-07:00

Two Year Anniversary Reception of

Latinos for National Health Insurance!

Roof Garden Reception

125 Maiden Street, NYC

2007-10-17T19:23:00.000-07:00

2007-10-07T10:13:00.000-07:00

Excerpts of Congressman Jose Serrano Remarks
Presented at the

Latinos for National Health Insurance Forum

The Bronx, NY – September 15, 2007 – The following are excerpts of Congressman José E. Serrano’s remarks on health care as prepared for delivery.

“I truly appreciate Latinos for National Health Insurance’s fight to ensure that every man, woman and child in America receives quality healthcare. Your unyielding dedication to achieving this necessary goal is commendable and I hope you will continue your important work on behalf of those in need.

“Like you, I believe that the crisis of our uninsured is a national problem, requiring a national solution. Healthcare should not be viewed as a luxury but a basic human right.
“In New York City, more than 1 million of our neighbors are without medical coverage—18 percent of whom live right here in the Bronx.

“That solution, I believe, is a health insurance system – publicly financed, privately delivered – available to everyone in this country.

“Census data reveals that one third of all Latinos in the U.S. are without medical coverage, and twenty percent of blacks and Asians are in the same situation.

“The proportion of uninsured minorities in this country has increased from forty-two percent to fifty three percent in the past twenty years. It is also estimated that almost 80 percent of all undocumented immigrants are without health insurance.

“Sadly, these are the groups that have the greatest need for care, as they disproportionately suffer from chronic diseases such as diabetes, hypertension, heart disease, and asthma.

“And we are not only talking about the uninsured, the middle class in America is also feeling the pain. Higher premiums, deductibles and co-payments are encouraging people to delay seeking health care; so that when they finally do see a doctor are often so ill that the costs associated with their treatment can be astronomical.

“I am a co-sponsor of HR 676, the “U.S. National Health Insurance Act.” This legislation would improve upon the existing Medicare program, extending coverage to all U.S. residents, including those residing in U.S. territories.

“HR 676 would cover every person in the U.S. for all necessary medical care, including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, podiatric, chiropractic and long term care.

“In addition, the legislation would end deductibles and co-payments which take so much out of workers’ pay checks. It requires every employer to contribute only their fair share, based on their payroll, toward the cost of the system.

“Finally, the measure would help curb skyrocketing health care costs, while simultaneously giving every man, woman and child without medical coverage a new lease on life.

“Recent polls show that a majority of Americans want a national, federally guaranteed health care system for everybody. Despite this fact, policy makers on the other side of the issue refuse to explore ways to expand coverage.

“In fact, last week, the Bush Administration rejected New York’s application to allow more middle income families to participate in the State Children’s Health Insurance Program, opting instead to adhere to guidelines that will limit this important program’s scope; a move that will only result in more uninsured children.

“A majority of Americans are uncomfortable with the idea that children are suffering from preventable illness. A majority of Americans are uncomfortable with the idea that the security of so many families is under threat because a person’s health often lies beyond her or his financial grasp.

“We are on the right side of this issue, on the majority side, and so we must remain vigilant in our push for a better way to care for this nation.

“People need to be given hope that a long life is not only possible – it is what our country wants for its people.
###

Congressman José E. Serrano has represented the Bronx in Congress since 1990.

2007-10-07T10:05:00.000-07:00

Community Forum

Universal Health Insurance -- The Solution to the Healthcare Crisis!

Sponsored by
Latinos for National Health Insurance

It is up to you to change our broken and expensive Health Care System.

Your involvement and action will make it possible.

Join us on September 15 and learn how we can have

an Expanded and Improved Medicare for EVERY PERSON !

Featured Speaker:
Congressman José E. Serrano

Saturday, September 15, 2007
Time: 10:00am-1:00pm
Lincoln Hospital Auditorium
234 East 149th St. Bronx, NY

2007-07-02T11:49:00.000-07:00

The RX From "SiCKO:" More Choice
By Dean Baker
t r u t h o u t Columnist
Monday 02 July 2007

The pundits are working overtime trying to defuse the message from "SiCKO," Michael Moore's new film. They are trying to convince the public that the United States could not possibly do what every other rich country (and even some not so rich countries) have managed to do: guarantee their people decent health care.

The centerpiece of the pundits' whine is that universal health care could not work here. They claim the systems which work in other countries require a larger roll for government in health care than Americans want. While this claim is contradicted by poll after poll on the topic, we don't have to argue with the pundits, rather pointless task in any case.

We can just give people a choice and let them vote with their feet. Suppose the government were to establish a Medicare-type program and open it up to all individuals and employers in the country. Those who already have insurance can switch to the government-run plan.

Similarly, employers can switch to it as well. Individuals who do not already have insurance would have the option of buying in to the expanded Medicare plan as would employers who do not currently provide insurance for their workers. We can also have a system of expanded subsidies for health care for low and moderate income households, which will make health care insurance more affordable for those families.

This is more or less what both John Edwards and Barack Obama have proposed in their presidential campaigns. To get to universal coverage, there are important issues like mandating that individuals have health care insurance, and also questions about the revenue source for subsidies, but the key point is to establish a national Medicare-type insurance system that can get costs under control and eliminate the enormous waste in the private insurance system.

Medicare's administrative expenses are a small fraction of the administrative expenses of private insurers. Medicare uses just 2 percent of the money that flows through the system to cover administrative costs. By contrast, private insurers spend between 10 to 20 percent of their premiums to cover administrative costs. They use this money for marketing, high CEO salaries and dividends to shareholders; all expenses that Medicare does not have.

This is the reason Medicare always wipes the floor when it competes against private insurers on a level playing field. That is exactly what happened in the late 90s when the "Medicare Plus Choice" program was restructured to remove most of the subsidy for the private insurers that participated in the program. The vast majority of the HMO's that had entered the Medicare system went running for shelter, whining that they could not make a profit if they were only compensated as much per patient as the traditional Medicare program.

This is why when the Republican Congress wanted to expand the role of private insurers in Medicare with the 2003 Medicare Modernization Act: They put in a system of subsidies that the Medicare Payment Advisory Board estimates at 12 percent per beneficiary. The insurers again claim they could not possibly make a profit if they got the same per patient fees as the traditional Medicare program.

This experience is important. We cannot afford universal health care if we don't bring the costs of the US system more in line with the rest of the world. We currently pay more than twice as much per person, with no obvious benefit in terms of outcome. The key to creating a more efficient system is to have a government-run system comparable to the traditional Medicare system.

But, we don't have to pontificate about American values and the role of government - leave the silly pseudo-philosophical debates out of it. This is a straight dollars-and-cents question that can be determined by the market. Give people a choice and let them decide whether they want to be insured through the government-run system or want to stick with private health care providers.

The pundits have managed to flip reality on its head. It is the health insurance industry and their partners-in-crime, the pharmaceutical industry, that are scared of the market and competition.

If we just allow a government-run plan to compete on a level playing field with private insurers, we can soon get a system of universal health care. The question for the insurance-industry-loving pundits is: "What's wrong with giving people a choice?"

Dean Baker is the co-director of the Center for Economic and Policy Research (CEPR). He is the author of The Conservative Nanny State: How the Wealthy Use the Government to Stay Rich and Get Richer (http://www.conservativenannystate.org/). He also has a blog, "Beat the Press," where he discusses the media's coverage of economic issues. You can find it at the American Prospect's web site.

2007-07-02T11:33:00.000-07:00

from the New York Times
July 1, 2007

http://www.nytimes.com/2007/07/01/health/policy/01insure.html?_r=1&th&emc=th&oref=slogin

Massachusetts Universal Care Plan Faces Hurdles
By PAM BELLUCK

BOSTON, June 30 — With the mandate that everyone in Massachusetts have health insurance taking effect on Sunday, more than 130,000 people — about a third of those who were uninsured a year ago — now have coverage, officials say.
But most of those who have signed up are poor enough to qualify for free or state-subsidized insurance.

People who must pay the full cost themselves, who are crucial to the success of the nation’s most ambitious effort to achieve near-universal coverage, may now be a majority of the state’s uninsured and not all are rushing to get coverage. Many of them are healthy young people in their 20’s and 30’s, state officials say.

“A lot of the population we’re trying to reach right now are young folks who don’t have insurance for a lot of reasons, not the least of which is they don’t think they’re ever going to be sick,” Gov. Deval Patrick said.

Other hurdles include the fact that some businesses, especially small ones, are struggling with the requirement that employers with more than 10 workers offer insurance.

“For a long time we thought in Massachusetts that we had only two choices — between a perfect solution and no solution at all,” Mr. Patrick said in an interview. “We’ve decided to try something and do it just as we go and be very candid about what does work and very frank about what doesn’t work.”

Despite the July 1 rollout, these are early days for the 160,000 to 200,000 people not entitled to state subsidies. Although they have been able to buy insurance privately, moderately priced state plans were not available to them until May 1. Free and subsidized plans have been available considerably longer. People have until Dec. 31 to obtain coverage. After that they will face a state penalty.

Observers of the state’s progress since the health care law was passed in April 2006 say they are impressed that the varied constituencies — including health insurers, businesses, advocates, medical providers and taxpayers — largely continue to support the law and have worked to resolve differences. They say, and officials acknowledge, however, that there is still a long way to go.

“I would give it a B plus,” said John McDonough, executive director of Health Care for All, an advocacy group. “There’s an incredible amount of progress that’s been made. There are some things going in ways that leave us concerned, and there are some important issues that confront us in the future.”

Health care experts view the Massachusetts effort more favorably than one begun in 2005 in Maine, a state with about 130,000 uninsured. Unlike Massachusetts’s program, Maine’s is voluntary, relies on a controversial financing formula and features more expensive premiums. Fewer than 20,000 people enrolled in the program, many of whom already had insurance.
Still, Massachusetts’s model may not work everywhere. When the law passed, the state’s 370,000 to 500,000 uninsured represented less than 10 percent of its population, a smaller proportion than many states. And it does not have a scarcity of large employers, like Maine, or a huge number of immigrants, like California.

Massachusetts is deliberately taking things slowly. In 2008, the penalty for those not insured will be a loss of state tax exemption, worth about $219; later the penalty will be up to half of a monthly insurance premium for each month a person is uninsured. Also, while any insurance is acceptable at first, by January 2009, everyone must have drug coverage.

Officials estimate that 60,000 people will be exempt from getting insurance altogether because they will be ineligible for subsidies but unable to afford other options.

“There was a calculation made about how to phase this in in ways that didn’t frighten people off,” Mr. Patrick said. “Ultimately we are going to have to explain to people that this is an obligation, that it is not optional.”

A $3 million advertising campaign includes postcards to millions of residents, announcements in pharmacies and supermarkets, and television advertisements shown on the Red Sox cable network to reach younger people. The Commonwealth Health Insurance Connector Authority, which oversees the law,has a Web site where people can compare and buy 42 plans offered by six insurers.

Jon Kingsdale, executive director of the authority, said about 50,000 inquiries were received last week, double the number before advertising began in late May. Mr. Kingsdale said he expects enrollment to be gradual, saying “nothing sort of magical is going to happen on July 1.”

Some people buying unsubsidized plans already had insurance but found the authority’s policies to be a better deal. Kathleen Knox, 63, of Arlington, switched from $650-a-month plan that did not cover drugs to a $450 policy with some prescription coverage. Sam and Barbara McGee, both 58, of Brewster, chose a $915 policy, more expensive but with better benefits than the $750 plan they had.

Martin Avila of Plymouth is the kind of enrollee officials really want — 31, relatively healthy, uninsured. Sobered by his fiancée’s recent heart attack, Mr. Avila just bought a $218 insurance plan. “Obviously getting everyone insured is a positive,” Mr. Avila said. “I’m just not sure if the people who aren’t insured right now are helped all that much by my adding $200 a month. I don’t know if it’s a long-term solution.”

Joan Meister, 25, an uninsured film production assistant from Brighton, may not buy in, saying she may choose the penalty if insurance proves too costly. “It would really for me be whatever would be the cheapest and easiest,” Ms. Meister said.

Linda Impemba, 58, a marketing company employee in Wakefield, said she would remain uninsured, pay penalties, and, as soon as her ailing mother dies, will leave Massachusetts. “There’s no way in heaven I can possibly survive in this state,” Ms. Impemba said. “Now not only is my cost going to go up, everything’s going to be raised so I can pay for the other people” to be insured.

A poll released Wednesday by the Harvard School of Public Health, the Kaiser Family Foundation, and the Blue Cross Blue Shield of Massachusetts Foundation found that about two-thirds of Massachusetts residents surveyed supported the law, although two-thirds also think it will ultimately mean higher taxes.

About half of those polled thought small businesses would be hurt. While some will offer insurance to compete for employees, others are daunted by the requirement to include part-time employees working 35 hours or more a week.

“This is going to bring me to my knees,” said Deb Maguire, who runs Liam Maguire’s Irish Pub and Restaurant in Falmouth.

Ms. Maguire said she had offered health insurance, costing employees $42 a week and her $45, but only about 10 of 30 employees purchased it. Now the others will enroll, she said, an expense significant for them and “just astronomical for me.”

Sandy Reynolds, executive vice president of Associated Industries of Massachusetts, representing 7,500 employers, said some businesses were considering limiting part-time employees’ hours to below 35. She said others believe offering insurance might actually hurt low-wage employees because people with employer-offered plans cannot qualify for cheaper state-subsidized plans.

Other concerns about the health overhaul include medical costs that are spiraling upwards and fears that “the influx of new patients who will need to get access to primary care” will strain what is already a shortage of primary care physicians, said Dr. David Torchiana, chief executive of the Massachusetts General Physicians Organization. A $10 million loan forgiveness program to lure primary care doctors was created recently. For now, the focus is on getting people insured.

“We’re attempting to implement a sizeable significant cultural change,” said Mr. McDonough of Health Care for All. “This may blow up in our face, but it’s not going to be for lack of effort.”

2007-07-02T11:29:00.000-07:00

from ALTER NET
http://www.alternet.org/story/54898/

Moore and SiCKO Are a Hit at Congress
By Brian Beutler, Media ConsortiumPosted on June 22, 2007

It's ironic, but outside of hospitals and day care centers, perhaps the best place to acquire some kind of illness on Wednesday in Washington, D.C., was at Michael Moore's press conference on Capitol Hill. The long lines and the sweaty, claustrophobic committee room were emblematic of the enthusiasm that Moore's appearance and SiCKO, his new film on the decrepit state of U.S. health care, have generated both in Washington and around the country.

Behind the podium from which Moore and influential House Democrats spoke and answered questions, an array of sign-wielding activists stood along the back wall. Facing them from the other side of the room, women from the group Code Pink lofted a large, painted sign reading, "Healthcare now, for all." At one point, a security officer approached them about lowering the banner. His face, though, showed a reluctance to scold a group of people who were exercised about a worthy cause. He gave them a thumbs up.

Such was the atmosphere in the committee room, a vibrancy that offset the doleful stories -- about patients dying and insurance companies fleecing -- that were fired off in rapid succession by members of Congress at the podium. It's no surprise that SiCKO features many similar stories -- matched, of course, with the faces of patients themselves, many of whom died for lacking health insurance, and others who died despite it.

The film, characterized by Moore's usual mix of wry humor contrasted sharply with deeply somber personal narratives, traces the health care crisis back to the early 1970s when Richard Nixon, under pressure from Edgar Kaiser, helped launch the Health Maintenance Organization (HMO) system. That system, one of the largest in the world of for-profit medicine, is the prime cause, according to Moore and many others, of phenomena like uninsurance, underinsurance, and adverse selection that have caused our health care standards to topple well below similarly wealthy nations, including France, Germany, and Japan, all of which have government-paid universal health care systems. Today, as Moore noted both on Capitol Hill and in his film, there are four health care lobbyists in Washington for every member of Congress.

Perhaps the greatest, and most awkward, part of yesterday's hearing -- the part that most resembled something from a Michael Moore movie -- occurred when Rep. John Conyers (D-Mich.), chair of the House Judiciary Committee, spotted Rep. Darryl Issa (R-Calif.) standing quietly in the back of the room. Conyers thanked Issa "for making this a bipartisan issue," and invited him to stand in front of the crowd. Issa gestured in protest, waving his hand back and forth like a cutthroat in front of his neck. It was a losing battle. He was ultimately cowed into standing with Moore and the Democrats anyhow.

When Issa finally spoke, he did so extemporaneously, joking that his scheduler must have somehow forgotten to inform him of this engagement and dodging attempts by Conyers and others to bring him to the D.C. premiere of SiCKO. Though he received a lukewarm welcome, Issa sought the common ground, calling health care a "bipartisan issue," approvingly citing Gov. Arnold Schwarzenegger's health care plan for California, and suggesting that, while the parties "may differ on the specifics," Congress and the president "must take steps toward universal access."

On those specifics, Issa differs wildly from either Schwarzenegger or most Democrats. Schwarzenegger, one of a small handful of governors to bring his state's health rolls anywhere near universality, recently enacted an individual mandate to buy insurance that will cover almost everybody in California. His policy, however, exists on the long line that connects Conyers' single-payer plan to provide Medicare for all and Issa's 2005 plan, which works much more incrementally. It would provide credits to business owners in states where the minimum wage exceeds the federal minimum to secure health insurance for their employees.

Aside from Moore, the loudest applause of the afternoon went to Rep. Maxine Waters (D-Calif.), who beseeched universal health care activists not to "get in bed with the right wing who means us no good." More poignantly, Conyers compared his efforts on his bill -- H.R. 676 -- to his efforts years ago to make Martin Luther King, Jr.'s birthday a national holiday. Back then, as today, he told the crowd, many of his colleagues said to him "you have a great idea, but you know you can't win."

Neither Conyers nor Moore sees things that way. And Moore, surpassed perhaps only by Al Gore as the most recognizable activist in America, is advancing his cause in a decidedly un-Gore-like way. Yesterday afternoon, he rented out a theater in Washington's Union Station to hold yet another free screening -- food and drink provided -- for anybody in the city who has a career lobbying on behalf of private health care companies. No word yet on how many people attended.

Brian Beutler is Washington Correspondent for the Media Consortium.

2007-05-04T07:25:00.000-07:00

Latinos for National Health Insurance
Working Together for Equality in Healthcare
_____________________________________________________

268 East Broadway, Suite A1304
New York, NY 10002
917-304-6886
LatinoHealth@msn.com

Estimados amigos,

We are very glad to tell you than on May 4 the New York University School of Medicine and the NYU Center of Latino Health will honor Latinos for National Health Insurance with their Dr. Helen Rodriguez-Trias Service Award. This will be part of the Fifth Annual Latino Health Conference.

The reason the committee chose us is to support our coalition--so many of you--who feel passionately that what our country needs is a single payer national health insurance program where every person is covered from they time they are born, regardless of immigration status. This award will move us forward in our efforts very much.

As part of our Strategic Plan we hope to continue educating the Latino community, organizations and elected officials as to what is a national health insurance, why it makes sense economically, and why it is the solution to the uninsured crisis in our country. We know that Latino businesses are suffering with the increased cost of healthcare for their employees.

We are also very glad that the opening panel of the conference was organized by LNHI, with the title: "Towards Universal Healthcare! -Which plans will benefit the Latino community?" where panelists will discuss several of the national proposals.

We hope you can attend the conference.

Trabajando juntos por nuestra gente,

Dr. Jaime R. Torres, Founder and National Coordinator
Dr. Olveen Carrasquillo, Co-Founder and Policy Director
David Galarza, for the Board of Directors

2007-05-04T07:24:00.000-07:00

"Myths and Facts About Universal Health Care With
A Single-Payer Financing System"

Tuesday, April 24, 2007
2:00 pm - 4:30 pm
Rayburn House Office Building
Room 2237
Washington, D.C. 20515

INTRODUCTION: Congressman John Conyers, Jr. (D-MI), Chairman, U. S. House Judiciary Committee

REMARKS: Members of Congress

MODERATOR: Dr. Quentin Young, National Coordinator, Physicians for National Health Program

PRESENTATION
Walter Tsou, M.D., MPH., Former President, American Public Health Association, Member, Physicians for a National Health Program (PNHP)

PANELIST

David Himmelstein, M.D., co-founder of Physicians for a National Health Program (PNHP); Associate Professor of Medicine at Harvard Medical School.

Marcia Angell, M.D., Former Editor-in-Chief of the New England Journal of Medicine; Senior Lecturer in the Department of Social Medicine at Harvard Medical School.

Claudia Fegan, M.D., Past President of Physicians for a National Health Program (PNHP)

Arnold S. Relman, M.D., Former Editor, New England Journal of Medicine; Professor Emeritus of Medicine & Social Medicine, Harvard Medical School

Jaime Torres, D.P.M, M.S, Founder & National Coordinator of Latinos for National Health Insurance; Member, Advisory Board, National Hispanic Medical Association

Dean Baker, Ph.D., Co-Director, Center for Economic and Policy Research; Former Senior Economist, Economic Policy Institute

John Sheils, M.S., Senior Vice President, The Lewin Group, Former Congressional Budget Office Analyst.

2007-05-04T07:14:00.000-07:00

Un seguro médico, para todos, de por vida

OPINIÓN - 04/24/2007Jaime Torres

En toda la nación el tema de la crisis en nuestro sistema de salud está candente y la gente está demandando a los políticos que la resuelvan. Hay 47 millones de personas sin cobertura médica -14 millones son hispanos- y más de 50 millones con seguros inadecuados. El Instituto de Medicina reportó que cada año 18,000 personas mueren por falta de cobertura médica.

En salud, los EE.UU. gastan por persona más que cualquier otro país avanzado (casi el doble de Canadá y Francia). Aun así, tenemos la más alta mortalidad infantil y casi la más baja expectativa de vida del mundo desarrollado. Es muy claro que hay mucho sufrimiento y que las propuestas para "mejorarlo" en recientes años han tenido poco resultado.

En mis años como doctor he visto a un hombre perder una pierna porque no pudo pagar por antibióticos para curar una úlcera en un pie; he peleado con aseguradoras por denegar procedimientos necesarios, y he visto niños recibir cuidado deficiente porque tenían Medicaid-un seguro que muchos ven de segunda clase. Es increíble que en el país más rico del mundo haya tanta injusticia y dolor.

Pero los demás países desarrollados brindan atención de salud a todos. La única razón que no tenemos cobertura universal es la espectacular ineficiencia de nuestro sistema. Aunque los EE.UU. gastan $2 trillones en gastos de salud, $600 billones nunca llegan a la gente, pero se usan en gastos administrativos, y para pagar a accionistas y ejecutivos millonarios que nunca han cambiado un vendaje en sus vidas.

Es muy claro que el sistema necesita una cirugía radical. Eli Siegel, el gran filósofo y fundador de la educación Realismo Estético, demostró su falla central cuando explicó que un sistema de salud basado en lucro es inmoral porque está "basado en desprecio por la gente". El explicó que tan pronto uno está en busca de lucrarse, uno no puede estar muy interesado en lo que otras personas se merecen, lo que sienten, ya que eso restringiría nuestra habilidad de ganar dinero de ellos.

Nuestro sistema no debe depender en que algunos se lucren de las desdichas de otros seres humanos. Cuando aseguradoras, hospitales o médicos ven a pacientes en término de cuánto dinero se puede hacer de ellos es puro desprecio, y es completamente opuesto a desear que se fortalezcan y que sean más saludables.

Lo cierto es que podemos dar cobertura a todos en los EE.UU. si expandimos el plan federal Medicare a todas las personas que residan en el país, sin importar su estado migratorio, o su estado de salud. El Medicare es la aseguradora federal sin fines de lucro que ha cubierto eficientemente, y con cuidado de calidad, a nuestras personas mayores.

Esto se lograría pagado con un impuesto que representaría menos de lo que la mayoría de los empleados o de sus empleadores pagan hoy en seguros. Así, en un solo paso, se daría cobertura a los no asegurados, se bajarían significativamente los costos administrativos y se avanzaría en la prevención.

Es por eso que debemos educarnos y demandar a todos los que desean la presidencia de este país a que expandan el Medicare como el seguro médico nacional, donde todos estemos cubiertos, y cuyo único propósito sea mejorar nuestra salud y no obtener ganancias.

El Dr. Jaime R. Torres es fundador de Latinos por un Seguro Médico Nacional y un Asociado en la Fundación Realismo Estético en NY.

2007-02-26T18:39:00.000-08:00

LEFT FORUM 2007:

Forging a Radical Political Future

March 9-11

The Cooper Union, New York City

7 East 7th Street (at 3rd Avenue) New York, NY 10003

Sunday March 11, 10 am

Agitating for a National Health Plan

Marilyn Clement, National Coordinator, Healthcare-NOW (Chair)

Dr. Mary O’Brien, NY Metro Chapter, Physicians for a National Health Program

Dr. Jaime Torres, Latinos for National Health Insurance

Ajamu Sankofa, National Organizer, Healthcare-NOW

2007-02-26T18:32:00.000-08:00

NEW YORK TIMES
February 15, 2007
Economic Scene

A Health Care Plan So Simple, Even Stephen Colbert Couldn’t Simplify It
By ROBERT H. FRANK

In his State of the Union address, President Bush proposed tax cuts to make health insurance more affordable for the uninsured. The next day, Stephen Colbert had this to say on his show on Comedy Central: “It’s so simple. Most people who can’t afford health insurance also are too poor to owe taxes. But if you give them a deduction from the taxes they don’t owe, they can use the money they’re not getting back from what they haven’t given to buy the health care they can’t afford.”

Just so. As health economists have long known, market incentives induce private insurers to spend vast sums to avoid people who may actually require health care. This problem is mitigated (though not eliminated) by employer-provided group policies. Because Mr. Bush’s proposal would steer people toward individual policies, it would actually strengthen the incentive to shun unhealthy people. Such people can now keep their insurance by not changing jobs. But no private company would want them as individual policyholders at a price anyone could afford.

That Mr. Bush’s proposal will not shrink the ranks of the uninsured is not its most serious problem. Far more troubling is its embrace of a system under which we spend more than twice as much on health care, on average, as the 21 countries in which life expectancy exceeds ours. American costs are so high in part because the reliance on private insurance multiplies administrative expenses, currently about 31 percent of total outlays.

Most health economists agree that government-financed reimbursement is the only practical way to control these expenses, many of them stemming from insurers’ efforts to identify and avoid unhealthy people. Canada’s single-payer health system, which covers everyone, spends less than 17 percent on administrative expenses.

Annual health spending in the United States currently exceeds $2 trillion. A single-payer system that did nothing more than reduce administrative expenses to the levels of other countries would save roughly $300 billion annually.

Some critics worry that expensive but ineffective medical interventions may proliferate if health care becomes a federal responsibility. But Victor Fuchs, a respected health economist at Stanford University, and Dr. Ezekiel Emanuel, chairman of the department of clinical bioethics at the National Institutes of Health, have outlined a single-payer plan that would limit such interventions far more effectively than the current system. (A copy of their plan is on the links page of my Web site, www.robert-h-frank.com.)

If the single-payer system embraced by virtually all other developed countries is clearly the best solution, why doesn’t the United States adopt it? Some analysts concede its merits, but characterize it as either unaffordable or politically unrealistic. But why should a policy that promises better results for less money be considered a nonstarter?

There are two obstacles, which could both be overcome by intelligent political leadership. One is that the single-payer system would require additional tax revenue. In the current climate, that’s a tough political hurdle, to be sure. Yet how complicated would it be to explain to voters that because the single-payer plan would reduce costs substantially, every additional tax dollar would be offset by an even larger reduction in private insurance spending? Given that such a system is so much cheaper over all, calling it unaffordable makes no sense.

The second obstacle is opposition from private insurers, who would be understandably reluctant to abandon multibillion-dollar annual profit streams. Those who stand to lose from policy changes always battle harder than those who stand to gain — an asymmetry that is exaggerated when losses would be concentrated and gains diffuse. So, yes, the insurance industry would bitterly resist.

But intelligent leadership could overcome that resistance. Whenever a pie gets bigger, everyone can get a larger slice than before. Because moving to a single-payer system would make the economic pie bigger, it should be possible for everyone, including the insurance industry, to come out ahead.

The first step is to acknowledge that insurance companies are not evil, that they invested in good faith under tax laws that favored employer-provided private health insurance. To put them out of business with an overnight switch would be unjust.

Even so, they are not entitled to a permanent license to operate a system that has become economically unsustainable. The move to a single-payer plan would save far more than enough to compensate insurance companies for lost profits. Compensation for losses could start at 100 percent, then be gradually phased out as companies shifted investments elsewhere.
Selling this argument in an era of 15-second sound bites would be challenging, but hardly impossible. Indeed, forceful advocacy of the single-payer approach offers a golden opportunity for any serious presidential candidate. Voters are fed up with rising insurance costs and dwindling coverage. On the merits, single-payer coverage is an unassailable solution to both problems. Its rationale is simple enough to articulate clearly during a long campaign. And if the proposal were devised so that everyone stood to win, corporate interests would have little reason to attack it.

Critics of the single-payer plan have long railed against the specter of socialized medicine, suggesting that it means being treated by government functionaries. Yet people who have experienced single-payer coverage firsthand seem unconcerned. When one of my sons needed surgery for a broken arm during a sabbatical in Paris, for example, the medical system we encountered was just as professional as the American one and far less bureaucratic. And in France, which spends half as much on health care as the United States and has more doctors and hospital beds per capita, everyone is covered.

We live in challenging times. Does a candidate who couldn’t persuade voters to embrace the single-payer approach deserve to be president?

Robert H. Frank, an economist at the Johnson School of Cornell University, is the author of “The Economic Naturalist,” which will be published this spring. Contact: www.robert-h-frank.com

2007-02-26T18:25:00.000-08:00

from ALTER NET

Private Health Insurance Is Not the Answer
By Phil Mattera, Corporate Research Project
Posted on February 23, 2007,
http://www.alternet.org/story/48371/
Healthcare reform is in the air.

Ideas for dealing with the 46 million Americans without medical insurance seem to be popping up faster than new cases of the winter flu. President Bush proposes to use tax deductions to help people buy individual plans. California Governor Arnold Schwarzenegger wants to make it mandatory for everyone in his state to obtain insurance and would force employers who don't provide coverage to pay into a fund.

Democratic Presidential candidate John Edwards would raise taxes on the affluent to pay for subsidies to help those with low incomes obtain policies. Some members of Congress are promoting insurance purchasing pools for small businesses. An odd bedfellows coalition including the Business Roundtable, AARP, the Service Employees International Union and Wal-Mart is pushing for some kind of expansion of coverage but is not saying what form it should take.

What these varied plans have in common is the assumption that, at least for the foreseeable future, most of the working population (and their dependents) will continue to receive coverage through private insurance carriers. Public officials across the political spectrum are, in effect, seeking to expand the customer base for a highly profitable industry.

Surely, it is a good thing to provide coverage to the uninsured, but it is remarkable that almost everyone assumes that coverage has to come from for-profit (or, in some cases, private non-profit) providers. Despite the overwhelming evidence from other industrial countries -- and even domestic programs such as Medicare -- that government-run health plans are much more efficient, the U.S. political class seems to be on a mission to save private insurance.

A Paternalistic Reform?

To understand the current debate, it is helpful to recall some of the tortured history of health insurance in the United States. In the late 19th Century European countries began adopting government-funded social insurance plans, but the U.S. failed to follow suit. When progressives made a push in the 1910s there was opposition not only from corporate interests but also from organized labor. AFL President Samuel Gompers denounced national health insurance as a paternalistic reform, fearing that its adoption would weaken the role of unions in improving the living conditions of workers.

Consequently, Americans both rich and poor continued to pay the vast majority of medical costs out of pocket. That began to change in the 1930s. While the Roosevelt Administration focused on retirement benefits and unemployment insurance at the expense of health coverage, physicians and hospitals struggling to survive the Depression set up private group insurance plans to bolster demand for their services. The most successful of these were the non-profit multi-hospital plans that grew under the rubric of Blue Cross. These were later followed by Blue Shield plans, which covered outpatient physician services. Once the Blues paved the way, commercial insurers also entered the field, though their coverage tended to be more restricted.

After the end of World War II, there was great momentum toward expanding the portion of the population with some form of sickness insurance. In 1945 President Harry Truman proposed a national program establishing a right to medical care and protection from the "economic fears" of illness. But once again, opposition to government involvement in healthcare emerged, this time reinforced by a Cold War hysteria about "socialized medicine" stoked by groups such as the American Medical Association.

As Truman's plan went down to defeat, what grew in its place was a system of employer-provided coverage, stimulated by aggressive bargaining on the part of unions that had come to regard improving employee benefits as a mission as important as increasing wages. This put pressure on non-union employers to follow suit, and by the mid-1950s, about two-thirds of the country was getting coverage through either their own jobs or those of spouses or parents. The Blues, which held the largest share of this booming market in the early postwar period, began to fall behind the commercial carriers by the late 1950s.

Around that same time, there was growing concern about the large number of retired workers who were left out of this workplace-oriented system. This eventually led to the 1965 creation of the federal Medicare program for seniors, along with the federal-state Medicaid program for the poor, but most of those with insurance continued to get it from the private sector.

In the wake of these significant expansions of coverage, liberals renewed calls for comprehensive national health insurance. These efforts, however, were drowned out by a rising chorus of concern about escalating health costs -- a problem that was greatly exacerbated by the growth of for-profit hospital chains. During the 1980s, Congress created a cost-control system for Medicare, while growing numbers of employers transferred their workers from traditional plans into health maintenance organizations (HMOs) -- both non-profit and for-profit. The Clinton Administration tried to reach the goal of universal coverage through a complex system that preserved the role of HMOs and other private insurers, but it was crushed by business interests and the medical establishment.

Awash In cash

The failure once again to create a system of universal care left the American people at the mercy of the market. The ranks of the uninsured swelled as many employers solved their health finance problems by eliminating coverage or by shifting premium and co-payment costs to workers to such an extent that they opted out. Many of those who tried to obtain individual coverage found themselves priced out of the market or rejected because of a pre-existing condition. Those workers who retained workplace coverage increasingly had to confront HMOs and other purveyors of "managed care," whose business plan depended on restricting the use of medical services. A 1994 Wall Street Journal article stated: "Health maintenance organizations are all about penny pinching, yet they are so awash in cash that they don't know what to do with it all."

At the forefront of these service (non)providers was U.S. Healthcare, which grew out of the first for-profit HMOs in the 1970s. By the early 1990s, it was the largest publicly traded HMO, with annual revenues of more than $1 billion. The company -- a notorious proponent of gag clauses in physician contracts that prevented doctors from giving patients a thorough description of their treatment options -- took on the mission of revolutionizing the insurance industry. In a 1992 interview with Business Week , U.S. Healthcare founder and chairman Leonard Abramson expressed scorn for traditional carriers, calling them "dinosaurs" and saying they operated in "a dying world."

Four years later, U.S. Healthcare agreed to be acquired by one of those dinosaurs, Aetna Inc., for $9 billion. It was clear from the start that Aetna was going to be adopting the style of U.S. Healthcare and not vice versa. "Strong forms of managed care, gated managed care, is really coming into its own," said Aetna chief executive Ronald Compton, who also announced that Abramson would join the board of the parent company.

Aetna's marriage with U.S. Healthcare was part of a larger consolidation of the industry and a shrinkage of the non-profit portion. Aetna itself went on to acquire healthcare operations from New York Life and Prudential Insurance, while rivals such as United Healthcare (later UnitedHealth Group) also bought various competitors to rise rapidly in the field. For-profit hospital chains such as Columbia-HCA gobbled up insurers. Even the Blues were abandoning all pretenses that their main mission was to serve the community. Some set up their own HMO subsidiaries, and by the late 1990s a bunch were preparing to take the next step: abandoning their non-profit status and becoming for-profit enterprises. A few such as Anthem Inc., formerly Blue Cross and Blue Shield of Indiana, went yet further, becoming publicly traded companies.

Meanwhile, there was a growing effort to tame HMOs through the courts. In 1999 several of the country's leading trial lawyers announced plans to bring a wave of racketeering lawsuits to pressure companies to provide better coverage. Some physician groups also sued managed-care firms over restrictions on their members. The legal assault was counting on the fact that HMOs had become the most reviled industry in the United States, but the judiciary was a harder sell.
In 2002 a federal judge in Miami hearing the consolidated cases granted class-action status to claims that managed-care plans systematically denied and delayed payments to more than 600,000 doctors, but he rejected that status on behalf of some 145 million members of the plans. Five companies ended up paying nearly $650 million in settlements with the doctors and their lawyers, while two others (including UnitedHealth) went to court and had the charges against them dismissed.

What ails private insurance

These lawsuits may have shaken the industry somewhat, but they did not put an end to the abuses that characterize managed care. Here are some of the key remaining issues that surround the business:

Consolidation has continued unabated. There are now two superproviders that increasingly dominate the for-profit healthcare field. One is UnitedHealth, which capped a long series of acquisitions with the 2005 purchase of Pacificare for some $8 billion. In 2006 United's health services revenues reached an astounding $64 billion, and its medical enrollment rose to about 28 million individuals.

The other giant is Wellpoint Inc., created through the blockbuster 2004 merger of Anthem Inc. and Wellpoint Health Network, formerly Blue Cross of California. Wellpoint later spent $6.5 billion to acquire WellChoice, the publicly traded parent of New York's Empire Blue Cross Blue Shield. By 2006 Wellpoint controlled the Blues in 14 states, had some 34 million members and took in annual revenues of about $52 billion.

The second tier consists of Aetna (2006 revenues and members, respectively: $25 billion and 15 million), Humana ($21 billion and 11 million), Cigna ($16 billion and 9 million) and Health Net ($13 billion and 7 million). The non-profit wing of the industry also has big players, led by Kaiser Permanente with 8.6 million members.

There is no evidence that the consolidation has enhanced efficiency or improved the quality of coverage. Instead, the big carriers simply accumulate more power over healthcare providers and patients, using it to their own advantage.

While millions remain uninsured or underinsured, the industry's profits swell. Last year, the top six health insurance companies had combined profits of more than $10 billion. What's amazing is that they netted so much after spending prodigious amounts on marketing and administration. In 2006 Wellpoint alone burned up nearly $9 billion in such costs -- nearly one quarter of what it paid out in actual benefits. By contrast, in Canada's government-run single-payer system, administration accounts for only about 3 percent of total costs.

Legal controversies continue to plague the industry. Lawsuits over the denial of care are still being filed against the big insurers. For example, two hospitals in Queens, NY recently sued UnitedHealth, alleging a "pattern of racketeering activity." At the same time, UnitedHealth has been the subject of a federal investigation following reports last year that the company was routinely backdating stock options awarded to executives, especially long-time chief executive William McGuire, who -- on top of annual salary and bonuses totaling $10 million -- had accumulated some 29 million shares through option awards. Thanks to the backdating scheme, McGuire had racked up paper gains of more than $1 billion on those shares. In October McGuire was forced to resign and to give up an undisclosed portion of those gains.

McGuire's excesses are emblematic of the fundamental conflict in the industry -- the clash between maximizing gains for executives and shareholders, and the need of its customers for services that are often a matter of life and death. Public officials should abandon the mission of saving commercial insurance and devote themselves instead to creating a healthcare system that substitutes the public interest for private profit.

Philip Mattera heads the Corporate Research Project, an affiliate of Good Jobs First.

2006-12-31T15:37:00.000-08:00

New York Times (Business section)
Sunday, December 31, 2006

Business section

Economic View

Health Care Problem? Check the American Psyche

By ANNA BERNASEK

WHAT is the most pressing problem facing the economy? A good case can be made for the developing health care crisis. Soaring costs, growing ranks of uninsured and a steady erosion of corporate health benefits add up to a giant drag on the nation’s future prosperity.

While the outlook seems scary, it doesn’t have to be. There is a solution, proven effective for hundreds of millions of people: single-payer health insurance.

Yes, single-payer — that much-maligned idea that calls for everyone to pay into one insurer, typically the government or a public agency. The insurer then pays doctors, pharmacists and hospitals at preset rates. Patients who want unapproved procedures and doctors not willing to accept the standard payment remain free to deal with one another directly, outside the system.

Such a system makes it much easier to deal with the growing costs of medical care, like administrative expenses and prescription drugs. It could also reduce the mountains of paperwork plaguing the current system and provide insurance coverage for the 46 million Americans now doing without it.

What’s more, as demonstrated in France, Britain, Canada, Australia and other countries with functioning single-payer systems, significant savings can come without hurting the overall health of the population.

There’s only one catch. Most Americans just don’t believe it can be done. The health care crisis may turn out to be more of a problem of ideology than economics.

The economic case for a single-payer system is surprisingly strong. Start with what we already know. Countries with single-payer systems have long records of spending less on health care than the United States does. The United States spent an average of $6,102 a person on it in 2004, according to the Organization for Economic Cooperation and Development, while Canada spent $3,165 a person, France $3,159, Australia $3,120 and Britain just $2,508.

At the same time, life expectancy in the United States, a broad measure of health, was slightly lower than it was in those other countries in 2004, the latest year for which complete figures are available. And the United States had a higher rate of infant mortality.

To be sure, a single-payer system has plenty of critics. Unattractive features of some such systems, including waiting lists for particular types of care, are often highlighted by skeptics. But supporters note that the overall health of people fares well in those countries.

“The story never changes,” said Gerard F. Anderson, a professor at the Johns Hopkins Bloomberg School of Public Health. “The United States is twice as expensive with about the same outcome.

“As a consumer, I don’t mind paying more if I’m getting more, but that’s just not the case in the U.S.,” said Professor Anderson, who publishes an annual review comparing the American health care system with those of its peers.

What may be less well known is the level of administrative waste in the United States health care system, versus that of well-designed systems elsewhere. Although Americans tend to equate efficiency with private enterprise, that’s not the case with the current system.

The American system, based on multiple insurers, builds in more unnecessary costs. Duplicate processing of claims, large numbers of insurance products, complicated bill-paying systems and high marketing costs add up to huge administrative expenses.

Then there’s an enormous amount of paperwork required of American doctors and hospitals that simply doesn’t exist in countries like Canada or Britain.

“There’s little disagreement among economists today that a single-payer system would lead to lower administrative costs,” said Len Nichols, a health economist with the New America Foundation, a policy research organization in Washington. But he said that estimates varied widely over how big the savings could be.

One of the first major studies to quantify administrative costs in the United States was published in August 2003 in The New England Journal of Medicine by three Harvard researchers, Steffie Woolhandler, Terry Campbell and David U. Himmelstein. It concluded that such costs accounted for 31 percent of all health care expenditures in the United States.

More recently, in 2005, a study by the Lewin Group, a health care consulting firm commissioned to examine a proposal to provide universal health coverage in California, estimated that administrative costs consumed 20 percent of total health care expenditures nationwide.

Then there’s the test of time. Health care costs tend to rise over time as new technology and procedures are introduced. Yet here, too, government-funded systems appear to help contain long-term costs.

Consider Canada’s system. Professor Anderson points out that in the 1960s, Canada and the United States spent roughly the same per person on health care. Some three decades later, though, Canada spent half as much as America. How did Canada manage this? By controlling the use of medical equipment and hospital resources, which statistics show has helped Canadians keep a lid on costs without measurably compromising the overall health of the population.

Economic studies also show that a government-funded system could reduce costs while providing coverage for everyone. The Lewin report on the proposal to provide universal health coverage in California calculated that if such a system had been operating in 2006, it would have saved $8 billion, or around 4.3 percent of total health spending in the state. From 2006 to 2015, it estimated, savings would total $343 billion. Currently, California spends about $180 billion a year on health care.

Despite everything that is known about the economic benefits of a single-payer system, there’s one big stumbling block: many Americans don’t believe in it. They have heard horror stories from abroad, often spread by partisan advocates, focusing on worst-case examples. Such tales play upon the aversion of many Americans to government involvement in the economy.

Victor R. Fuchs, an economics professor at Stanford and a specialist in health care economics, explained it this way: “The Canadian system is a nonstarter for the U.S. even though it’s a good system for Canadians. You’re dealing with two very different countries. We were founded on life, liberty and the pursuit of happiness. They were founded on peace, order and good government. It’s a difference of values.”

Others in the field echo his skepticism. But that raises questions about how well Americans understand the system they have, and what the alternatives are.

JUDGING from other countries, many features that Americans really like — being able to choose their own doctor, for example — would remain available in a well-designed single-payer system. And a single-payer system need not mean government-provided care: it often means government-provided insurance that encourages competition among providers.

Much of the resistance to a single-payer system appears to stem from a lack of confidence in the nation’s ability to make positive change. With all of its prowess in research and technology, can’t the United States match the efficiency of other developed nations, or do even better?

Changing the minds of so many millions of people isn’t done overnight. But sooner or later, persuading people to do something that’s in their own economic interest ought to succeed.

http://www.nytimes.com/2006/12/31/business/yourmoney/31view.html?pagewanted=all

2006-11-17T15:31:00.000-08:00

Latinos for National Health Insurance &
PHYSICIANS FOR A NATIONAL HEALTH PROGRAM
____________________________________________________

From Bad to Worse: New Study Details Health Insurance Crisis Among Different Latinos Groups

November 14, 2006

For Immediate Release Contacts:

When it comes to health care, most Latinos subgroups continue to be shut out of the health care system. That is the principal finding of a new study being released today by researchers from the Columbia University and Montefiore Medical Center that is being published in the November issue of the journal Health Affairs. The study, the first longitudinal analysis of trends in health insurance coverage among Latinos subgroups finds steady increases in the number of uninsured across most Latino subgroups and among both US born and immigrant Latinos. In contrast, the number of Non-Hispanic whites without coverage was essentially the same in 1993 as in 2004.

For the study, investigators analyzed twelve years of federal data on health insurance among the Mexicans, Puerto Ricans, Cubans and Dominicans. According to lead author, Dr. Sarita Shah a physician at Montefiore Medical Center, “over the study period, we found some striking differences in coverage trends among Latinos sub-groups.” For example, the study found that during the 1990’s welfare reform had a disproportionate impact on Puerto Ricans whose rates of Medicaid coverage dropped from 35% in 1993 to 21% in 1999. In contrast, among Mexicans, many whom are not US citizens and may not qualify for Medicaid, losses were more modest with declines in Medicaid from 19% to 14% during this period.

Senior author Dr. Olveen Carrasquillo who is also Director of the Columbia Center for the Health of Urban Minorities, noted that there were some good news. “For example, there were gains in employment coverage for Latinos in the late 1990’s, particularly for Cubans and Puerto Ricans. However, during the past four years we have seen erosion of these gains. These losses have continued even after the recession ended, particularly among Mexicans.” The study found that in 2004 one third of all Mexicans, and one quarter of all Cubans and Dominicans living in the US lacked insurance.

However, most adversely affected during this twelve year period, were immigrant Latinos who are not yet US citizens. They saw a seven percentage point increase in their uninsured with 57% lacking coverage in 2004. While the number of uninsured non-citizen Latino immigrants increased by 3 million, the investigators also found that the number of US born Latinos who are uninsured also increased by nearly 2 million. Steffie Woolhandler, co-founder of physicians for a National Health Program and an internist at Harvard Medical School added, clearly the incremental reforms that have been enacted over the last 12 years have been a failure for all Latinos, immigrants and US born alike. These findings cry out for comprehensive reform.

In the study, both authors, also critique current approaches to the uninsured and call for National Health Insurance (NHI) to end the ongoing health insurance crisis in the Latino community. Dr. Carrasquillo notes that “current approaches such as medical consumerism would distribute health care by ability to pay. This would be catastrophic for the Latino community.” Dr. Jaime Torres, co-founder of Latinos for National Health Insurance adds “Given these alternatives, the increasing support and momentum for NHI that we are now seeing among Latino leaders comes as no surprise. It is the only health reform that would provide equal access to comprehensive high quality health care for all Latinos.”

Contacts:
Dr. Sarita Shah, (718) 944-3843
Dr. Olveen Carrasquillo, office (212) 305-9782, cell (917) 882-7997

Dr. Steffie Woolhandler, (617) 497-1268

Dr. Jaime Torres, (212)848-6573

The study “Twelve year trends in health insurance coverage among Latinos: Analysis by subgroup and immigration status” is available at http://www.healthaffairs.org/

###

Citation: Shah, N. and Carrasquillo, O. “Twelve Year Trends in Health Insurance Coverage Among Latinos,” Health Affairs 25(6) November / December 2006

Copies are available to the press after the embargo lifts at:
http://www.pnhp.org/latinostudy or call Nicholas Skala at 312-782-6006 or email nick@pnhp.org

2006-08-13T08:08:00.000-07:00

David Sirota is a columnist and the author of the new book “Hostile Takeover.”

Addressing the country’s health care taboo

David Sirota, The ExaminerAug 7, 2006 5:00 AM

WASHINGTON - Here’s an idea rarely discussed in our nation’s capital: Health insurance should not be a for-profit industry.

Think that’s a radical concept? If so, then the majority of Americans are radicals. According to a national Harris poll in 2003, a strong majority of American “would prefer health care services to be provided by non-profits or government.”

The public’s sentiment is understandable, given the facts. Take, for instance, a recent Reuters story on a major university study. “For-profit nursing homes and hospitals on average provide an inferior quality of care compared with their nonprofit peers,” the news service reported, adding that “Nonprofit hospitals are also better at keeping costs down.”

How about Businessweek’s June expose on the Veterans Administration? The magazine found that this nonprofit “nationwide health system that is run and financed by the federal government provides the best medical care in America.” It does so at the same time “VA has held its costs per patient steady over the past 10 years despite double-digit inflation in health care prices.”

Then there is Medicare. Harvard researchers have documented that America’s elderly, who are covered by the program, are 20 percent happier with their health care than other Americans who are in the private, for-profit system. And while roughly 15 cents of every dollar goes to “administrative” costs in the for-profit system, just 4 cents of every dollar goes to the same in Medicare.

So if Americans want the private profit motive removed from health care, and the data shows nonprofit health care delivers better, more cost-efficient care, then why do so few politicians in Washington talk about creating a government-sponsored, nonprofit universal health care system? Especially at a time when health care premiums are skyrocketing, more Americans are going uninsured, and voters consistently rank health care as a top concern, the question is critical.

Some claim the silence comes from voter opposition to the general concept of government health care. That assertion is not supported by facts. A 2003 ABC News poll found roughly two-thirds of Americans support a “universal health insurance program, in which everyone is covered under a program like Medicare that’s run by the government and financed by taxpayers.” Similarly, a 2005 poll by the nonpartisan Pew Research Center found a strong majority support “government guaranteeing health insurance for all citizens, even if it means raising taxes.” That included about half of core GOP voters.

No, as with everything in Washington, the real answer to the question is found by following the money. Politicians don’t talk about creating a not-for-profit health care system because they operate in a pay-to-play culture — one that rewards their silence.

Since 2000, the health industry has donated more than $370 million to the lawmakers of both political parties. The No. 1 recipient of that largesse last year was Republican Sen. Rick Santorum — the third-ranking Republican in the U.S. Senate who has ardently opposed a single-payer health care system. No. 2 was Democratic Sen. Hillary Clinton — who, just 12 years removed from her attempt to reform health care, is now giving speeches apologizing for her previous efforts. Also bathed in health industry cash has been Senate Majority Leader Bill Frist. He has been a key opponent of health care reform — not surprising, considering he is also one of the heirs of HCA, the largest for-profit hospital chain in America.

These campaign contributions and conflicts of interest guarantee that false debates substitute for a discussion of serious health care reform that might end health industry price gouging.
And make no mistake — a casual look at the headlines from research firm Weiss Ratings shows gouging is exactly what’s happening: “HMOs’ Profits Climb 81 Percent to $5.5 Billion in 2002”; “HMOs Earn $10.2 Billion in 2003, Nearly Doubling Profits”; “Nation’s HMO Profits Increase 10.7 Percent in 2004”; “HMO Profits Jump 21 Percent in First Quarter 2005.” You can bet those profits aren’t being plowed into better care — they are being put into the pockets of executives like UnitedHealth’s CEO William Maguire, who over the last few years alone has amassed $1.5 billion in executive compensation.

Thankfully, a diverse coalition including health care professionals and courageous politicians are fighting back. That includes 14,000 doctors who are now members of Physicians for a National Health Care Program. It also includes Sen. Byron Dorgan, D-N.D., who just published a bold new book showing how the current for-profit system is destroying America’s economy. He says it is time “we get [the government] more involved in cleaning up the health care mess.”
These and other leaders are breaking the silence and addressing the taboo subject of making health care off-limits to profiteers. And the louder their voices get, the closer this country will be to getting the not-for-profit health care system its citizens want and deserve.

David Sirota is the author of the new book “Hostile Takeover,” a national best-seller (Crown 2006). He is the co-chair of the Progressive States Network (www.progressivestates.org).

2006-07-15T08:15:00.000-07:00

National Health Insurance Caucus
Capitol Hill, Washington DC
June 7 2006

Speakers:

John Conyers
Jim McDermott
Sheila Jackson Lee
Andy Shallal
Dr. Jaime Torres
Rev. Lennox Yearwood

Tresa Martinez, from HEALTH CARE NOW!, presents Congressman Conyers 30,000 petitions collected around the country asking for single payer national health insurance.

from, NATIONAL JOURNAL
06-17-2006
Issues & Ideas

Single-Payer Comeback?
Marilyn Werber Serafini
© National Journal Group, Inc.

Rep. John Conyers, D-Mich., is plotting the comeback of a liberal idea that's been locked in a closet for more than a decade. Even some opponents acknowledge that the concept of single-payer health care is again drawing attention, and others contend that it may be the first sign of push-back against the conservative, free-market, consumer-driven health care movement that has dominated discussions in Washington for 15 years.Last week, Conyers launched the Congressional National Health Insurance Caucus in the House; Reps. Dennis Kucinich, D-Ohio, Barbara Lee, D-Calif., and Jim McDermott, D-Wash., will co-chair.

The caucus will conduct briefings, unofficial hearings, and seminars on single-payer health care, which is usually defined as a system in which the government reimburses some part, or all, of everyone's medical costs. Already, Conyers has 70 Democratic co-sponsors on a bill to extend Medicare-style health care coverage to all Americans.Since the early 1990s, a few lone Democrats in Congress -- namely Conyers, fellow Michigan Democrat John Dingell, and Sen. Edward Kennedy, D-Mass. -- have introduced bills to keep the idea of government health care for all from disappearing.

But interest was weak. Indeed, sweeping health care reform of any sort hasn't had an audience since President Clinton's effort to enact health coverage for every American failed in 1994. When Republicans won control of Congress that year, even most Democrats began limiting themselves to pushing for small health care fixes.So what makes Conyers think he can revive the idea now? Especially when Republicans, who control Congress and the White House, are pushing market-driven programs that place greater responsibility on individuals?

For starters, there's the appeal of the new Massachusetts law that promises universal health care coverage for residents of the Bay State. And Conyers cites a groundswell of grassroots support for national health care, mostly because carmakers and other large corporations say they just can no longer afford skyrocketing health care costs for their employees.

"Collective bargaining is taking it on the chin" when it comes to health care benefits, Conyers said in an interview.Grace-Marie Turner, president of the Galen Institute, a free-market-oriented research organization that focuses on health and tax policy, has also noticed an "ever more organized and louder call from people who want a larger role for government."

Although Turner supports the free-market approach, she acknowledges that the single-payer message was undeniable at recent hearings conducted by the Citizen's Health Care Working Group, which Congress established in 2003."In meeting after meeting, there was strong support for a national health plan, financed by taxpayers," Turner said. "Granted, many of those who showed up were encouraged to attend by groups that have a vested interest in government-funded programs. There was a strong feeling that, if the profit motive in the health sector just could be eliminated, all of these goals could be achieved without any other trade-offs." The hearings gave "Conyers the impetus to say, 'Let's go for [single-payer] again,' " Turner said.

Polls by the Kaiser Family Foundation consistently show that one-third of Americans embrace a single-payer system, and that 15 percent name it as their top choice, said Drew Altman, Kaiser's president. "There's a growing frustration with the problems of health care, and so it doesn't surprise me that that base of support is revving up again," he said. "It's not that we're being swept up in a new wave of single-payerism. It's a sign of push-back to the consumer-driven approaches."

Single-payer could get a boost if Democrats win control of the House or Senate in November. In the House, Conyers would likely chair the Judiciary Committee, Dingell could chair the Energy and Commerce Committee, and Rep. Charles Rangel, D-N.Y., would probably get the gavel at the Ways and Means Committee.If Democrats win the Senate, Kennedy would probably retake the top spot at the Health, Education, Labor, and Pensions Committee.

Already on the Senate side, Sens. George Voinovich, R-Ohio, and Jeff Bingaman, D-N.M., have introduced the Health Partnership Act of 2006 to allow states to apply for federal grants to experiment with single-payer systems, health savings accounts, and other new approaches.

"There's a general and slow revving up for what will be another national health reform debate after the 2008 election," Altman said. "The direction that it will take will depend heavily on who wins the election."

In the end, Altman said, he doubts that the direction will be purely single-payer or purely market-driven. "But the energy has been with the Right, and now we're seeing some push-back from the Left ."

2006-07-15T06:47:00.000-07:00

676= Healthcare for Everyone-NOW!
June 7, 2006

June 7th, 2006 was a unique and historic day. It happened once, and only once, that 6/7/6corresponds with the identifying numbers of the bill introduced in Congress by Representative John Conyers: HR 676 “The United States National Health Insurance Act” which is the extension of Medicare—that truly American--truly red, white and blue program—plan to every person living in this nation, regardless of immigration status.

So, that day advocates all over the nation demanded, in different ways, the passing of this bill. There were, for example, press conferences in front of City Hall in Atlanta GA, Saint Louis MO,; demonstration in front of an insurance companies in California, Gainesville, Florida, Pittsburg. In Seattle, there were distribution of information at the Mariners' game. In many states highways and bridges were adorned with "676 national healthcare" banners; there were Citizen/ Congressional Hearings in Tyler, TX, Newark, DE, Bangor, ME, Atlanta, GA where people can talked to their members of Congress.

And in Capitol Hill there was the first meeting of the newly formed "National Health Insurance Caucus" chaired by Congressman Conyers; Reps. Dennis Kucinich, D-Ohio, Barbara Lee, D-Calif., and Jim McDermott, D-Wash., will co-chair.

In New york City there was a large celebration with elected officials and union leaders where the new animated film "Don’t Be a Chicken” about healthcare--which explains the issue in an entertaining way--was debuted.

Invited Speakers Includeded: NYC Councilman G. Oliver Koppell. Union officials Lillian Roberts, Barbara Edmonds. Health care advocates Dr. Oliver Fein, Dr. Jaime Torres, Marilyn Clement, and Reverend Yearwood.

We are proud to publish below the important remaks of Dr. Fein, which where one of the highlights of the evening:

Good Evening!

My name is Oliver Fein. I am the Chair of the New York Metro Chapter of Physicians for a National Health Program – P N H P. Physicians for a National Health Program is a national organization with 14,000 physician and medical student members that supports universal access to health care through a single-payer financing system – an improved and expanded “Medicare-for-All” program for the United States.

Many of you are familiar with Physicians for as National Health Program – P N H P. But, for those of you who have not heard about us, I would like to tell you more. Physicians for a National Health Program was founded in 1989. As a national organization, we have been in the forefront of research and analysis of the changing U.S. healthcare system. It is our members that have documented the huge administrative costs of the U.S. healthcare system (close to 25 to 30 % of all national health expenditures) as published in the New England Journal of Medicine.

We did the research that showed that more than 50% of all personal bankruptcies in the U.S. were due to medical care expenditures.

The Physicians’ Proposal published in the August 2003 Journal of the American Medical Association was a fundamental building block for Representative John Conyer’s “Medicare-for All” bill, HR 676.

And, today, press releases just went out to announce the publication of an article in the June issue of American Journal of Public Health, by Drs, Karen Lasser, Steffie Woolhandler and David Himmelstein, which shows that U.S residents are less healthy and have less access to healthcare than Canadians.

Our Metro New York chapter of PNHP, with close to 1,000 members, covers a broad geographic area including the 5-New York City boroughs, northern New Jersey, Westchester and Long Island. We hold monthly educational forums at the Beth Israel Ambulatory Care Center at Union Square on topics ranging from the Malpractice Crisis to Immigrant Healthcare.

We have a speaker’s bureau that provides speakers not only to medical Grand Rounds, but also to labor unions, senior citizens centers and church groups. Over the last few years, we have debated the AMA trustees on healthcare reform over 10 times. We are an activist group, supporting health reform contingents on significant public demonstrations and leafleting movie theaters with our single-payer solution after the film John Q, which illustrated the lack of access in the U.S. healthcare system.

We are actively working actively with medical student groups and residents throughout the metropolitan area. On all 8 of the New York Metropolitan medical school campuses, Metro NY PNHP has a student affiliated chapter or committee. Metro-NY PNHP is a local New York organization. What is the biggest threat to health care reform in New York State? We believe it is the Massachusetts approach to Universal Coverage. If the Democrats win the governorship and control of the NYS Senate, there will be the enormous temptation to adopt a plan resembling the Massachusetts Plan. What are the essential elements of the Massachusetts plan?

An employer mandate to buy private health insurance
An individual mandate to buy private health insurance
Subsidies and tax incentives to buy private health insurance
A modest expansion of Medicaid for the poor

What’s wrong with the Massachusetts Plan?

The employer mandate has no teeth. Small employers will pay the $295 per year in taxes rather than buy health insurance for their employers; because they cannot afford to pay the price of decent private health insurance for their employees.
The individual mandate is cruel and punitive. The analogy to automobile insurance is deeply flawed. You can chose not to own an automobile, if you cannot afford car insurance; but you cannot chose not to live, if you cannot afford to buy health insurance.
The subsidies and tax incentives are too small to induce poor people to buy private health insurance.
The Massachusetts plan will result in “skinny” stripped down health insurance with $1,000 deductibles; high co-pays; and swiss cheese coverage – full of holes: people will have to pay for preventive care – like PAP smears and flu shots; even prenatal and maternity care.

What’s at the root of all these problems?

What’s really wrong with the Massachusetts Plan is the virtual total reliance on private health insurance to reach the goal of universal coverage.

Everyone knows what’s wrong with private health insurance!

The administrative costs of private health insurance are too high. Medicare as a single-payer spends only 2-3% on administrative costs. But, private health insurance spends 16 to 30% of all premium dollars on administrative costs, including payments to the company’s high paid executives, it’s bureaucracy and it’s investors.

Just today, Crain’s Pulse sent a fax reporting that William McGuire, the CEO of United Healthcare, was paid $8 million dollars last year; and other health insurance CEOs were paid between $3 and 5 million dollars.

Private health insurance costs too much: Employers are shifting more and more of the premium costs onto employees. The major reason that labor unions strike is around health benefits. Private insurance is covering less and less – like a hospital gown which leaves the derrière exposed – private insurance doesn’t cover a lot of the important things – preventive care, dental care, mental health care, long term care, prescription drugs.

In order to remain competitive, private insurance companies avoid the sick and recruit the healthy. Even doctors have problems with private health insurance companies, because they delay paying doctors and hospitals, so they can make money by investing the premiums they collect.

Our mantra should be: “Get the insurance companies out of my health care.” How can we stop this steamroller designed to get NYS to ape the Massachusetts Plan?

1. Fight for the NYS Legislative Commission on Healthcare Access.

2. Petition the NYC Council and the County legislatures throughout the State to pass resolutions supporting HR 676, John Conyers bill for “Medicare-for-All”

3. Warn Democrats and other liberals that the false promises and ultimate failure of the Massachusetts Plan will come back to haunt them in the future.

What we need is an improved and expanded “Medicare-for-All.”

2006-07-15T06:39:00.000-07:00

2006-07-14T11:37:00.000-07:00

National Uninsured Latinos Conference

Raul Yzaguirre Policy Institute

McAllen Texas
May 21-22, 2006

Drs. Olveen Carrasquillo and Jaime Torres, from Latinos for National Health Insurance, were invited panelists at this conference. Raul Yzaguirre--past president of the National Council of La Raza--is part of our coalition!

Health experts from across the country and congressional members met to discuss the issue of insurance among the Latino population during the “National Uninsured Latinos Conference” held at The University of Texas-Pan American, in conjunction with the Raul Yzaguirre Policy Institute, May 21-22.

The conference served as the inaugural event of the new Raúl Yzaguirre Policy Institute at UTPA, which will be dedicated to the advancement of Hispanic leadership and scholarship, with the goal of helping bridge the gap between the theory and practice of public policy by drawing together experts from academia, government, business, and non-governmental organizations.

Highlights of the conference included an introductory discussion on the consequences of uninsurance and the health policy challenges of covering uninsured Hispanics, followed by a panel session on the merits and the expected impact of several proposals on how to cover the uninsured.

Day two of the conference opened with a morning session featuring six panelists and Raúl Yzaguirre, a Rio Grande Valley native, as the moderator. Yzaguirre, former president and CEO of The National Council of La Raza, told those in attendance that although the Raúl Yzaguirre Institute is often referred to as a “think tank,” he desired for it to go beyond that, to be a “do tank.” He told the audience that with their help, it can happen.

Henry Cisneros, chairman of CityView and former San Antonio mayor, served as the morning keynote speaker and told attendees the lack of health insurance specifically compromises health because people are less able to get access to care that would promote prevention of certain diseases.

“This conference deals with such a timely subject and it will allow us to get ahead of the discussion and to shape the debate,” Cisneros told the more than 100 conference attendees.
Cisneros recommended five specific courses of action during his speech and said the United States should adopt a universal health care program; promote prevention strategies for diabetes, asthma and heart disease; engage the Latino population in promoting public health as a priority; encourage Hispanic students to pursue health careers; and focus policy advocacy of Latino organizations on quality health care.

“We need to create a system of insurance that recognizes the needs of all Americans and this conference has raised the urgency and priority and has shown us how to work on this issue,” Cisneros said.

Former U.S. Senator and vice presidential candidate John Edwards delivered the luncheon keynote address and talked about health care and poverty in America.

“What are we going to do, not just about health care, but what are we going to do to lift up all of the families in this country and address what I think is the great moral issue of our time. Thirty-seven million Americans wake up every day and worry not just about health care coverage, but worry about feeding their children, clothing their children and having a decent place to live,” said Edwards, who is currently the director of the Center on Poverty, Work, and Opportunity for the University of North Carolina at Chapel Hill. “I think that we – all of us collectively – have a huge moral responsibility to do something about this.”

Edwards said he supports a universal health care plan and that the nation’s current public health facilities need to be expanded.

“I think that universal health care is the solution to this issue,” Edwards said. “First, we have to have a national dialogue and be willing to do something. This is an issue that touches virtually every family in America.”

Other panelists and speakers for the conference included Dr. Kenneth Shine, executive vice chancellor for Health Affairs, The University of Texas System; Robert Mallett, senior vice president for Corporate Affairs, Pfizer Inc; Dr. Mark V. Pauly, Bendheim professor, professor of Health Care Systems, Business and Public Policy, Insurance and Risk Management, and Economics, The Wharton School, University of Pennsylvania; Dr. Elena Rios, president and CEO, National Hispanic Medical Association; Drs. Jaime Torres and Olveen Carrasquillo, from Latinos for National Health Insurance; Roberto Suro, director, Pew Hispanic Center; Al Zapanta, president and CEO, U.S.-Mexico Chamber of Commerce; U.S. Rep. Rubén Hinojosa, TX-15; and U.S. Rep. Silvestre Reyes, TX-16.

2006-06-04T18:24:00.000-07:00

John Edwards pushes universal health care
May 23, 2006 Jennifer C. Smith
The Monitor, McAllen Texas

EDINBURG — The uninsured have many faces: the teenager who steps on a nail and develops tetanus; the elderly person who chooses between paying for a prescription or a utility bill; the middle-aged male family breadwinner who develops diabetes and is buried under an avalanche of medical bills.

These true situations exemplify the current healthcare system’s faults and why universal health coverage is essential for all Americans and especially Hispanics, said former North Carolina senator John Edwards on Monday at the University of Texas-Pan American Field House.
Out of the nearly 46 million Americans without health insurance, 13.7 million are Hispanics.
"I think all of us have the responsibility to do something about this," he said to rousing applause at the National Uninsured Latinos Conference.

The 2004 Democratic vice presidential nominee and 2008 presidential prospect spoke briefly to the 200 audience members on how high uninsured rates among Hispanics are related to their high poverty and disease incidence rates.

"Poverty does have a face in America and it doesn’t always involve a color, but it often does."
Disparities in health care access and service call for immediate solutions, dozens of health care policy panelists said.

Edwards proposed a national language translation service to facilitate provider and patient communication. "We need a call center open 24 hours a day, seven days a week or staff at hospitals," Edwards said.

Other panelists volleyed ideas about increased Medicare and Medicaid funding; offering small businesses tax credits to purchase health care for their employees; automatic enrollment in social service programs and even developing binational U.S.-Mexico health insurance.

"We need to use every possible argument so every stakeholder can get involved," said Jaime Torres, founder of Latinos for National Health Insurance.

Those stakeholders include federal and state government officials, social service and minority advocacy organizations, and small businesses.

U.S. Rep. Rubén Hinojosa, D-Mercedes, said he has co-authored several bills to increase funding to offer coverage to working parents and children and allow those 55 to 64 years of age to purchase Medicare plans.

"The state of health care is an issue that has arguably reached a critical level," he said.
Igniting a healthcare reform movement for Americans — and particularly Hispanics — fueled the two-day conference.

About 350 people, including local and national healthcare policy experts, community health center and hospital representatives, and academic officials had gathered since Sunday to hear ideas how to extend coverage to the uninsured as the immigration debate brews in Congress.
Panelists lauded the concept of universal coverage, but it is a controversial and expensive measure, said Mark V. Pauly, a healthcare economics professor at the University of Pennsylvania.

"To cover the uninsured, it will cost $50 to $150 billion annually, leaning toward the higher number," he said." You have to ask the question, ‘Would I pay $1,000 to $1,500 more in taxes each year to cover the uninsured?’"

But fewer uninsured Hispanics are important as the population swells in the future, said U.S. Rep. Silvestre Reyes, D-El Paso.

"If we don’t make dramatic improvements in our healthcare system, it will be one of the greatest challenges our country has ever faced," he said.

2006-05-12T11:49:00.000-07:00

A Congressional Hearings for Artists on Health Care

Saturday, May 6 2006

Brooklyn Borough Hall

New York City

Presided over by Hon. John Conyers and

Councilman Charles Barron

Sponsored by Art Without Walls and Acts of Art

Some of the panelist joining Cogressman Conyers were:

Mitchell Ryan: President Screen Actors Guild Faundation

Kevin Muhammad: Minister Mosque # 7 in Manhattan

Don Sloan, MD: Health Care Now!

Dr. Jaime R. Torres: Latinos for National Health Insurance

Bill Dennison: VP. Local 802, Associated Musicians of Greater New York

Kevin Keating: Filmaker "Giuliani Time"

Norma Munn: New York City Art Colalition

In this moving hearning, artists, community leaders and family members gave testimony about the unisured crisis in New York City. Theirs stories were heart wrtenching and courageous; they are evidence of the great need for a national health insurance plan. We are proud to post some of them in our site.

TESTIMONY OF EDISA WEEKS

My Name is Edisa Weeks and I am speaking about Homer Avila who was my partner for nine years. In 1993 Homer and I started a dance company together called Avila/Weeks Dance. In 2001 Homer was diagnosed with a rare type of cancer – chondro sarcoma – and because the cancer had severely spread had to have his right leg and hip amputated.

Homer was born and raised in New Orleans and was a first generation American. His mother is from El Salvador and worked as a cleaning lady, his father is from Honduras and was a merchant marine. Homer’s ticket out of New Orleans was gymnastics. He received a gymnastics scholarship at the University of Tennessee, Knoxville, which is where he discovered dance. Homer was passionate about dance. It wasn’t just a profession it was a calling for him. He worked with several luminaries in the dance world including Twyla Tharp, Bill T. Jones/Arnie Zane Dance Company and Mark Morris. Homer and I met working with Bill T. Jones.

In 1998 Homer started to have an occasional discomfort and pain in his right hip. Neither of us had health insurance, we couldn’t afford it, so Homer tried to self diagnose and ease his pain through massage and advil.

In 2000 Homer had a summer job dancing at the Santa Fe Opera, which was a union position and provided health coverage. When the job ended we debated if he should continue the coverage through COBRA, and if he could afford it. I am so grateful that Homer decided to pay for COBRA for without it our lives would have been hell.

In February 2001 Homer and I completed a job guest teaching and performing at Boston University. Homer was in amazing amount of pain, yet persisted in performing. We were in a difficult situation as we make a living with our bodies, and no performance, no income. On returning to NY Homer made an appointment in March to see a doctor who referred him to a specialist. At this point Homer and I thought he had worn away the cartilage in his hip - a common dancer injury – and would need a hip replacement. It was a shock to see the MRI images and see the cancer that had spread from his hip and was pushing his bladder to the other side of his body. The doctor was horrified that Homer had been dancing as the cancer had so corroded his hip that a wrong move could send his femur bone driving through his body. Homer and I had performances and teaching jobs lined up for April and the rest of the year, however the doctor told us that he wanted to operate in the next few weeks and would need to amputate Homer’s hip and leg. We were devastated.

In retrospect I wonder, if Homer had been able to receive healthcare when his hip first started bothering him, could his leg have been spared and would he still be alive today. In 2003 the cancer metastasized to his lungs and in April 2004 Homer passed away.

What is amazing is that Homer kept dancing after his leg was amputated. It was beautifully bizarre and incredibly inspiring to see him leap, turn and dance on one leg. He performed the last evening of his life. He checked himself into the hospital that night and died the next day.

Disability rights and access to health care became important issues for Homer. I wish he could be here today to speak for himself and the courage it takes to continue when you don’t have resources or support, or when a significant part of your life has been radically altered. He would be delighted and proud to know that his story helped inspire the Artists Access Program developed at Brooklyn’s Woodhull Hospital Medical Center. Artists Access provides comprehensive health care coverage at extremely reasonable co-pays levels – based upon a person’s income level.

TESTIMONY OF SUSAN BRENNAN

Thank you Congressman Conyers and panel members for being here today. My name is Susan Brennan. I’m a member of Acts of Art. I am a poet, screenwriter and actress.

At the present moment, I have a day job and insurance. But for many years, I worked part time at coffee shop and paid for all my health care out of pocket. I could not afford the monthly rates that health insurance cost.

At this time, I was performing as an actress in various downtown theatres, including a community street theatre throughout the boroughs, as well as participating in and organizing poetry readings. My small, radio theatre company produced an award winning radio drama which we performed, edited, and distributed. The hours I spent beyond my part time job, in rehearsals, on the phone planning rehearsals, gathering actors, generating material, talking with kids after shows, and just plain writing, exceeded a full time job hourly schedule without the pay or benefits.

I passionately loved and still love every moment I can dedicate to acting or writing. These arts have crafted me into a person who is a caring, thinking, and active member of the community.

One summer I found a lump in my breast. For several months, I tried to pretend it wasn’t there. But a lump doesn’t go away on its own. I was terrified and in denial. I had no insurance and feared the cost of a hospital visit. Not going to the hospital was not for lack of knowledge. I knew that I should go.

Several years previous to this summer, my mother died of breast cancer. I knew a lot about lumps. I watched her for six years as she not only battled the cancer, but battled insurance companies and hospital bills. I didn’t have a lot of faith in health insurance. Basically, health insurance and hospitals seemed both out of my reach and what I was trying desperately to avoid.

Eventually, I couldn’t avoid the reality anymore. I got very lucky. I met a doctor who severely negotiated his price and a rich relative paid for the hospital bill. And most of all, the lump was not cancerous; but if it had been, I would have missed a very important opportunity for preventative treatment. I don’t think we can afford to leave the fate of our health up to luck – the body won’t always thrive against the odds.
A recent study “found that the uninsured were over twice as likely to forego treatment for serious symptoms, even those for which care was thought necessary. While this does not necessarily reflect on the health status of artists as a whole, it does indicate that uninsured workers may face increased health care needs due to lack of coverage and resulting poorer health status.”

The creative imagination is responsible for inventing solutions, for remembering beauty, for communicating and contemplating our very existance. If we want a culture which values the imagination and therefore reaps the benefits of doing so – then we need to value the facilitators of the imagination; we need to invest in those who stand guard over the imagination – the artists, the dreamers, the creators.

I have a vision. Based on three things I believe to be true.
1) The imagination is our most valuable resource.
2) Everyone deserves health care.
3) And every one is an artist.

When we care for the artist, we are caring for an element of ourselves and communities which clarifies the meaning of our lives. Although an act of art can transcend its artist, the artist must still reckon with its personhood. Health care is a form of deeply personal praise for the body and soul. And from that praise, the body responds with gifts of song, dance, and inspiration.

2006-04-23T19:46:00.000-07:00

SPONSORED BY PHYSICIANS FOR A NATIONAL HEALTH PROGRAM, NY METRO CHAPTER CO-SPONSORS: METRO NEW YORK HEALTH CARE FOR ALL CAMPAIGN, LATINOS FOR NATIONAL HEALTH INSURANCE, STUDENT NATIONAL MEDICAL ASSOCIATION-REGION IX, QUEENS COLLEGE URBAN STUDIES DEPARTMENT

SHUT-OUT IMMIGRANTS
IN THE
U.S. HEALTH CARE SYSTEM

A FORUM WITH

Marcia Bayne-Smith, DSW
Associate Professor, Urban Studies, Queens College, CUNY
Past Chair, Caribbean Women’s Health Association

Olveen Carrasquillo, MD
Director, Columbia Center for the Health of Urban Minorities
Co-Founder Latinos for national Health Insurance

Sang Hee Won
Program Associate, Education Fund of Family Planning Advocates of NY State Board Member, National Asian Pacific American Women’s Forum

ON

Tuesday, April 25, 2006
7:30pm
AT
Beth Israel Medical Center-Phillips Ambulatory Care Center
10 Union Square East

New York City
Second Floor · Lecture Hall

· ADMISSION FREE ·

For further information contact

2753 BROADWAY #198, NEW YORK, NY 10025
212 666-4001 FAX: 212 866-5847
EMAIL: pnhpnyc@igc.org WEB: www.pnhpnyc.org

2006-04-23T19:37:00.000-07:00

The Massachusetts Health Reform Bill:
A False Promise of Universal Coverage

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.

What’s in the New Bill?

The new bill includes three key provisions meant to expand coverage. First, it would modestly expand Medicaid eligibility. Second, it would offer subsidies for the purchase of private coverage to low-income individuals and families, though the size of the subsidies has yet to be determined. Finally, those making more than three times the poverty income (about $30,000 for a single person) would have to buy their own coverage or pay a fine.

To help make coverage more affordable, a new state agency will connect people with the private insurance plans that sell the coverage, and allow people to use pre-tax dollars to purchase coverage (a tax break that mostly helps affluent tax payers who are in high tax brackets). This new agency is also supposed to help design affordable plans.

Businesses that employ more than 10 people and fail to provide health insurance will be assessed a fee (not more than $295) to help subsidize care. Additionally, hospitals won a rate hike assuring them better payments from state programs, and several provisions were included that are meant to attract additional Federal funding to help pay for the Medicaid expansion.

What’s Wrong With This Picture?

First, the politicians assumed that only about 500,000 people in Massachusetts are uninsured. The Census Bureau says that 748,000 are uninsured. Why the difference? The 500,000 figure comes from a phone survey conducted in English and Spanish. Anyone without a phone or who speaks another language is counted as insured. The 748,000 figure comes from a door-to-door survey carried out in many languages (including Portuguese and Haitian Creole, common languages in Massachusetts). In sum, the reform plan wishes away 248,000 uninsured people who don’t have phones or don’t speak English or Spanish. It provides no funding or means to get them coverage.

Second, the linchpin of the plan is the false assumption that uninsured people will be able to find affordable health plans. A typical group policy in Massachusetts costs about $4500 annually for an individual and more than $11,000 for family coverage. A wealthy uninsured person could afford that – but few of the uninsured are wealthy. A 25 year old fitness instructor can find a cheaper plan. But few of the uninsured are young and healthy. According to Census Bureau figures, only 12.4% of the 748,000 uninsured in Massachusetts are both young enough to qualify for low-premium plans (under age 35) and affluent enough (incomes greater than 499% of poverty) to readily afford them. Yet even this 12.4% figure may be too high if insurers are allowed to charge higher premiums for persons with health problems; only half of uninsured persons in those age and income categories report that they are in “excellent health”.

The legislation promises that the uninsured will be offered comprehensive, affordable private health plans. But that’s like promising chocolate chip cookies with no fat, sugar or calories. The only way to get cheaper plans is to strip down the coverage – boost copayments, deductibles, uncovered services etc.

Hence, the requirement that most of the uninsured purchase coverage will either require them to pay money they don’t have, or buy nearly worthless stripped down policies that represent coverage in name only.

Third, the legislation will do nothing to contain the skyrocketing costs of care in Massachusetts – already the highest in the world. Indeed, it gives new infusions of cash to hospitals and private insurers. Predictably, rising costs will force more and more employers to drop coverage, while state coffers will be drained by the continuing cost increases in Medicaid. Moreover, when the next recession hits, tax revenues will fall just as a flood of newly unemployed people join the Medicaid program or apply for the insurance subsidies promised in the reform legislation. The program is simply not sustainable over the long – or even medium – term.

What Are the Alternatives?

The legislation offers empty promises and ignores real – and popular - solutions.
A single payer universal coverage plan could cut costs by streamlining health care paperwork, making health care affordable. Massachusetts Blue Cross spends only 86% of premiums paying for care. It spends the rest - more than $700 million last year - on billing, marketing and other administrative costs. Harvard Pilgrim and Tufts Health Plan – our other big insurers - are little better; each took in about $300 million more than it paid out. That’s ten times as much overhead per enrollee as Canada’s national health insurance program. And our hospitals and doctors spent billions more fighting with insurers over payments for each bandaid and aspirin tablet.

Overall, Massachusetts residents will spend $13.3 billion on health care bureaucracy this year – nearly one third of our total health bill. If we cut bureaucracy to Canada’s levels we could save $9.4 billion annually, enough to cover all of the 748,000 uninsured in Massachusetts and to improve coverage for the rest of us.

Study after study – by the Congressional Budget Office, the General Accounting Office and even the Massachusetts Medical Society - have confirmed that single payer is the only route to affordable universal coverage.

And single payer is popular. The Massachusetts Nurses Association supports it along with dozens of other labor, seniors and consumer groups; so do 62% of Massachusetts physicians according to a recent survey. National polls find that almost two-thirds of Americans favor a tax-funded plan like Medicare that would cover all Americans.

But single payer national health insurance threatens the multi-million dollar paychecks of insurance executives, and the outrageous profits of drug companies and medical entrepreneurs.

It’s time for politicians to stand up to the insurance and drug industries and pass health reform that can work.

Steffie Woolhandler and David Himmelstein are primary care physicians at Cambridge Hospital and Associate Professors at Harvard Medical School.

2006-03-20T17:43:00.000-08:00

Estimados amigos,

Join us in WASHINGTON DC to discuss the Real solution to our healthcare crisis.

National Health Insurance: A Step Closer Towards

Eliminating Health Disparities

Join Congressman John Conyers and a panel of experts to discuss lack of national health insurance as a determinant of increasing health disparities in the U.S., the richest nation on the globe. African Americans and Hispanics suffer an unacceptable rate of health disparities due to the lack of access to health insurance. This must change.

Wednesday, March 22, 2006 from 12:00pm to 2:00pm
2237 Rayburn House Office Building, Capitol Hill Washington DC.

AND

National Hispanic Medical Association Conference-- “Somos Unidos!”

Policies for Single Payer Insurance in the US

Dr. Olveen Carrasquillo & Dr. Jaime R. Torres
Latinos for National Health Insurance

Ludmilla Scott and Joel Segal
Legislative Assistants for Congressman John Conyers
The USA Health Insurance Act (HR 676)

SUNDAY, March 26, 2006 from 10:30 am to 11:30 am
Marriot Wardman Park Hotel

This morning session is OPEN TO THE PUBLIC—No registration required

Sponsored by

Latinos for National Health Insurance—A Coalition for Equality In HealthCare

917-304-6886

2006-02-03T13:41:00.000-08:00

"MEDICARE FOR ALL" WILL SAVE BILLIONS AND GIVE ALL AMERICANS THE CARE THEY NEED

January 31, 2006

Washington, DC: Today, as President Bush focuses on health care in his State of the Union address after ignoring it for five years, Senator Kennedy will put forward real health care reform that would give quality affordable health care for all Americans. America’s health care system is the most economically inefficient in the industrial world. Kennedy’s plan would fix our fractured system of care, by extending Medicare to all Americans, from birth to the end of life, while allowing any American who wishes to stay in their current employer-sponsored plan to do so. Under Kennedy’s bill, employers can tailor their health plans to provide additional services to their employees that wrap around Medicare coverage.

Tonight, as he attempted to do last year with his Social Security privatization fiasco, President Bush will try to make the American people believe that the solution to rising health costs is to shift more and more of those costs to ordinary Americans, or to deny care to those in need. Kennedy believes that’s the wrong prescription for health care.

“America’s failure to guarantee the basic right to health care for all its citizens was one of the great public policy failures of the 20th century, and we must not allow that failure to continue in this new century,” Senator Kennedy said. “Like his Social Security privatization fiasco, President Bush’s health savings accounts are a gimmick that will only make a bad situation worse. Our goal should be an America where no citizen of any age fears the cost of health care, and no employer stops creating jobs because of the high cost of providing health insurance.”

The Medicare for All proposal

The “Medicare for All" plan will make health care coverage available to every American by expanding the Medicare program to the under 65 population. To promote competition and choice, enrollees will also have the option of choosing any of the plans offered to members of Congress, the President, and Federal employees.

Costs will be reduced by administrative savings from moving to a Medicare-style financing system, by bringing modern information technology to health care, by improving quality of care, and by rewarding health care providers based on performance, not just on the number of procedures performed. International competitiveness and job creation will be enhanced by reduced costs and by shifting some of the burden of financing from business contributions to general revenues, as well as the healthier and more productive work-force that will result from universal health insurance coverage.

To ease the transition to the new system, coverage will be implemented in phases. In the first, coverage will be extended to individuals 55-65 and to children under 20 years old. In later phases, coverage will be extended to all other Americans not already covered under Medicare.

To see full proposal to:

www.americanchronicle.com/articles/viewArticle.asp?articleID=5319

2006-02-03T13:23:00.000-08:00

It's time for a National Health Plan

Note: The District Council 37 is the largest public employee union in New York City, with over 121,000 members.

By LILLIAN ROBERTS Executive DC 37, AFSCME

February 1, 2006

I cut my teeth as a union activist when I was a young Nurse’s Aide in Chicago. One of my proudest moments was leading the organizing drive in the public hospitals in the 1960s that established DC 37 as the premier municipal union in New York City. So, health care is an issue I am particularly passionate about. And right now, our system is an economic mess and a human crisis.

As an advocate for poor and working families, I see health care as a right, not a business product to produce profits. I believe it is scandalous that we are the only country in the industrialized world that doesn’t offer free health care to its citizens.

Canada spends half as much per person as the United States on health care, but our infant mortality rate is higher and our life expectancy is shorter. Last year, Toyota cited health costs as one reason it is putting a new plant and thousands of jobs in Canada, which has national health care, rather than in Tennessee.

The soaring cost of health care cripples companies in the private sector, busts budgets in the public sector, and undermines collective bargaining for unions — while 45 million Americans are left out in the cold with no health coverage at all.

Prescription drug firms get away with charging far more here than in other countries for the same medications. They make the nation’s highest profits while their outrageous prices put the squeeze on union members’ benefits and leave others to choose between medicine and food.

It’s time we demand that our policymakers give us a simple, national health plan that covers everyone and controls the prices of vital prescription drugs. A national health plan would remove health care from the bargaining table, provide financial relief to cities and free up funds to boost salaries and improve services.

In health care, the profit motive creates waste. The New York Times recently pointed out that many private plans refuse to pay $150 for preventive care of diabetic foot ailments, yet they cover amputations, which cost $30,000. The quest for enormous profits has no place in caregiving. One-third of U.S. health care spending goes to huge insurance companies. Without them, we would be well on our way to a health-care system that works for patients’ needs rather than corporate greed.

Quality health care — and savings, too

The administrative cost of Social Security is only 1 percent. Our Health and Hospitals Corp. institutions — staffed by DC 37 members — have been cited by national accreditation agencies for their top quality care. A well designed government program could deliver superior health care to all Americans for less than the private sector.

The skyrocketing cost of prescription drugs eats away at union benefits and attacks the living standards of seniors. The Bush administration’s new Medicare Part D drug plan is inadequate and mired in confusion. Worse, to please Bush’s friends in the pharmaceutical industry, the Republican legislation actually bans the government from controlling high drug prices.

Without controlling prices, I don’t see how most seniors or our union benefit plan can ever escape the financial vice of the pharmaceutical industry. In World War II, price controls prevented profiteering on gasoline, sugar and meat. Are prescription drugs less essential to our quality of life today?

Unions like ours must take the lead in the struggle for national health insurance and drug price controls. We should work with a coalition of progressive politicians, forward-looking employers, community and faith-based organizations to catapult these issues to the top of our country’s political agenda.

We have to send Washington a message: Our health is too important to leave to the current failing system. If you want to be part of the fight for an equitable, economical, universal health care system, send me the coupon below. I am planning to personally deliver these messages to our state’s delegation in Congress.

www.dc37.net

Es hora de un plan médico nacional
Por Lillian Roberts Directora Ejecutiva de DC 37, AFSCMEDI

MIS PRIMEROS PASOS como activista sindical cuando era enfermera auxiliar en Chicago. Uno de los momentos que más orgullo me da fue cuando encabecé la campaña organizativa en los hospitales públicos en los años 60, la cual estableció al DC 37 como el principal sindicato municipal de la Ciudad de Nueva York. Por ello, la atención médica es un asunto que me apasiona particularmente. Y hoy en día, nuestro sistema es un lío económico y una crisis humana. Como defensora de los pobres y de las familias de los trabajadores, veo la atención médica como un derecho y no como un producto comercial para generar ganancias. Considero escandaloso que seamos la única nación del mundo industrializado que no ofrece atención médica gratuita a sus ciudadanos.Canadá gasta por persona en atención médica la mitad de lo que gasta Estados Unidos, pero nuestro índice de mortalidad infantil es más alto y nuestra expectativa de longevidad es más corta. El año pasado, Toyota citó los costos médicos como una de las razones para instalar una planta y miles de empleos en Canadá — donde hay un sistema nacional de atención médica — en lugar de hacerlo en Tennessee.

Millones sin plan

El costo altísimo de la atención médica inmoviliza a las empresas del sector privado, quiebra los presupuestos del sector público, y deteriora la capacidad de negociación colectiva de los sindicatos, en tanto que 45 millones de estadounidenses son abandonados en el frío sin ninguna cobertura médica.Las empresas de recetas médicas se salen con la suya, cobrando muchísimo más aquí que en cualquier otro país por los mismos medicamentos. Son las que tienen mayores ganancias en el país, en tanto que sus precios indignantes exprimen las prestaciones de los miembros sindicales y a otros los dejan teniendo que elegir entre medicinas y comida.Es hora de que exijamos un simple plan de atención médica que cubra a todos y controle los precios de medicinas vitales. Un plan médico nacional quitaría el tema de la atención médica de la mesa de negociaciones; brindaría un alivio financiero a los gobiernos municipales y liberaría fondos para alzar los salarios y mejorar los servicios.En el sector de atención médica, la motivación de la ganancia genera desperdicio. Hace poco, el New York Times señaló que muchos planes privados se niegan a pagar $150 por atención preventiva de dolencias diabéticas del pie, aunque cubren amputaciones que cuestan $30,000. No hay lugar para la búsqueda de ganancias enormes en la atención médica. Una tercera parte del gasto federal de atención médica se destina a las gigantescas compañías de seguro. Sin ellas, nos las arreglaríamos en rumbo a un sistema de atención médica que funcione para las necesidades del paciente en lugar de para la codicia empresarial.

Falta control de precios

El costo administrativo del Seguro Social es sólo el 1%. Nuestras instituciones de Health and Hospitals Corp. — cuyo personal es de nuestros miembros — ha sido citado por agencias de acreditación nacionales por su alta calidad en la atención médica. Un programa gubernamental bien diseñado podría proporcionar una atención médica superior para todos los estadounidenses por menos de lo que gasta el sector privado.El costo disparado de las medicinas recetadas destruye gradualmente las prestaciones sindicales y ataca los niveles de vida de los ancianos. El nuevo plan de medicinas “Parte D” de Medicare elaborado por la administración de Bush es inadecuado y está lleno de en confusión. Lo peor es que, para complacer a los amigos de Bush en la industria farmacéutica, la legislación republicana de hecho le prohíbe al gobierno controlar los altos precios de las medicinas.Sin un control de precios, no sé como la mayoría de los ancianos de nuestro plan sindical de prestaciones podrán jamás escapar del vicio financiero de la industria farmacéutica. En la Segunda Guerra Mundial, los controles de precio impedían lucrar con gasolina, azúcar y carne. ¿Son las medicinas menos esenciales para la calidad de nuestra vida?

Los sindicatos al frente

Los sindicatos como el nuestro deben ir a la cabeza de la lucha por un seguro médico nacional y un control de precios de las medicinas. Debemos trabajar con una coalición de políticos progresistas, empleados con visión al futuro y organizaciones sociales y religiosas para catapultar estos problemas al primer lugar de la agenda política de nuestro país.Tenemos que transmitirle a Washington este mensaje: nuestra salud es demasiado importante como para dejarla en manos del sistema fallido actual.

District Council 37 endorses federal legislation calling for universal healthcare

At the March 28th delegates meeting, the District Council 37 delegates voted unanimously to endorse federal legislation calling for universal healthcare. The bill, The United States National Health Insurance Act (HR676) is also known as the "Expanded & Improved Medicare For All Bill" and is sponsored by Congressman John Conyers.

"We are supporters of this bill because we believe that a new American national health insurance program creating a single payer health care system is crucial," said Executive Director Lillian Roberts. "Health care costs are soaring out of control for my members and for all Americans. The time has come for labor to speak up and join together with those who are trying to change our inefficient and costly fragmented health care system. I'm asking our members to fill out coupons calling for universal healthcare which we'll deliver to Washington. We need a single-payer system and we need it now."

The bill would create a publicly financed, privately delivered health care program that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans, guaranteed by law, will have access to the highest quality and most cost effective health care services regardless of employment, income or health care status. (See text of bill at http://www.pnhp.org/nhibill/nhi_bill_final.pdf)

"We will put all our resources and the institutional power of DC 37 behind this bill to ensure its success. We will encourage other unions and all those interested in doing something about the deplorable state of our healthcare system to join us in this effort," added Ms. Roberts.

District Council 37 represents 121,000 city workers and 50,000 retirees.

2006-02-03T06:42:00.000-08:00

NEW COALITION OF 54 organizations, representing medical, labor, business, activist and faith communities from 22 states, announces campaign to provide NATIONAL HEALTH INSURANCE for all americans by 2009

For more information: please contact Diane Shamis 845-661-3754

On January 15, 2006, a new nationwide coalition of 54 advocacy groups from 22 states gathered in Chicago to launch a national campaign to assure equitable health care for all American citizens. The meeting was convened by Marilyn Clement, national coordinator of Healthcare-NOW, who explains, “Americans must be bold and speak out for much more than just another study commission, or President Bush’s high-deductible low quality healthcare savings accounts. We demand a quality national healthcare system that includes everyone, not the same broken system that excludes 45 million Americans who cannot afford high insurance premiums, co-pays and deductibles. The new coalition wants a national single standard of care for every person in the United States -- an affordable single payer system, which will cost less money and provide more health care for everybody.”

Coalition members include steelworkers from Pittsburgh, Chicago and Nashville; a librarian from Texas; a labor organizer from Kentucky; a gubernatorial candidate from Maine, an activists with Jobs With Justice from Boston; a peace activist from Atlanta; farmers and community organizers from Alabama and Washington; activists from the United Auto Workers retirees divisions in Michigan and Delaware; a representative of Physicians for Social Responsibility from New York, a businesswoman from Illinois; Catholic, Jewish and Protestant leaders from Rochester, Pittsburgh and Chicago, a victim of healthcare cutbacks in Tennessee; leaders of the Missourians for Single Payer and many others. Each of these representatives and more are involved in organizing Citizen/Congressional Hearings in 94 cities.

“Over the past nine months, Healthcare-NOW has organized Citizen/Congressional Hearings in every corner of the nation,” said Clement of Healthcare Now, an all-volunteer agency with headquarters in New York City. “The plan is to continue these hearings calling on Members of Congress to come home to hear what their people have to say about the healthcare crisis.”

Healthcare-NOW is co-chaired by Dr. Quentin Young, National Coordinator of Physicians for a National Health Program; Leo Gerard, President of the Steelworkers, the largest industrial union in North America; and Jim Winkler, head of the United Methodist Board of Church and Society. The group supports H.R. 676, “The United States National Health Insurance Act,” a bill introduced by Congressman John Conyers (D-MI) calling for greatly enhanced and improved Medicare for all Americans. The bill provides the resources needed for universal healthcare because it would eliminate the excess administration, marketing and duplication in the current profit–making industry.

“It is elemental. We must adopt basic business savvy, (1) economy of scale – we want everybody covered in the largest possible pool in order to make healthcare more affordable, and (2) we want to cut out the unnecessary middleman –the insurance companies and HMO’s whenever possible,” said business woman, Rebecca Spoon.

Joel Segal, Senior Legislative Aide to Congressman Conyers, came back to Washington, D.C. from the meeting with this message: “We now have a groundswell in the United States for national health insurance. Because people are sick and tired of being gouged by private health insurance companies. Because people are sick and tired of being uninsured and broke. Because people are sick and tired of being unable to see a doctor when they need to.

Said Dr Quentin Young, national co-chair of the campaign, “We now have 13,000 physicians, 11 national labor unions, 80 local labor unions and their affiliates, and 65 members of Congress who believe the time for universal national health insurance has come. This meeting and strategy session, this past weekend showed that people are united across the country from coast to coast behind HR 676. Congressman Conyers is dead serious about getting this bill passed, but we need a movement, like the civil rights movement, like the anti-war movement in the 1960’s if we are going to have a chance of getting this bill out of Congress.”

Coalition coordinator, Marilyn Clement, started organizing with Dr. Martin Luther King, Jr. in the 1960’s is optimistic. She adds, “We have a feasible target date. By the end of 2009 we expect to have a National Health Security card in the hands of every person in the United States.”

Speakers at the Chicago meeting included: Michael Lighty of the California Nurses Association, which led the successful challenge to Gov. Arnold Schwarzenegger’s attempts to cut back nursing and other public services in California and defeated his recent referendums; Rick Romero, media strategist from Finis Productions in Phoenix; Kay Tillow, a Kentucky labor organizer, who has organized about 80 labor unions in support of the program, and Dr. Fergie Reid, surgeon and former elected official from Maryland. Dr. Reid led the group in planning organizing tactics and preparation for the upcoming election years, which, he states, “will be critical to winning a healthcare system that will serve everybody.” A Strategy Team of the new coalition will work out the details for the four year time-table established at the Chicago meeting.

The enthusiasm, commitment and concrete campaign plan coming out of the coalition’s meeting indicates that such a movement is gaining momentum and an expansive, growing base of support. “By the end of the Chicago meeting the new coalition was so energized that people, joined in singing movement songs in honor of Dr. Martin Luther King – who also advocated universal health care. Finally, we joined with Dr. Quentin Young in the Physicians for a National Health Program’s slogan: “Everybody in, nobody out!” Clement said.

“Of all the forms of inequality, injustice in health

is the most shocking and the most inhumane.”

--Martin Luther King, Jr

2006-02-03T06:06:00.000-08:00

La diabetes y el púgil latino
JOSÉ 'CHEGÜÍ' TORRES

Note: This was submitted by our coalition member Jose Torres, who feels that national health insurance would be a means to ensure that people with diabetes would get the care they need.

Hay formas de evitar el mal que afecta a tantas personas en nuestra sociedad

(ESPNdeportes.com)--Curiosamente, en años recientes yo he mencionado mi condición de diabético con la idea de que más gente se entere de la epidemia de esa enfermedad que está arrasando con las comunidades hispanas en los EE.UU. Y por supuesto, me he encontrado con pugilistas activos de trasfondo latino que están sufriendo de ese peligroso mal. Hay boxeadores boricuas, dominicanos, mexicanos, sur y centroamericanos que están padeciendo de diabetes, y después de platicar con unos cuantos de ellos la curiosidad me ha abrumado.

He descubierto, como en todas nuestras sociedades hispanas en nuestros respectivos países, ha existido una cultura que estimula la posibilidad de esa ingrata enfermedad. Y no ha sido con toda intención, sino por esas manías que ayudan con gran vigor a desarrollar condiciones culturales que facultan nuestro ambiente social con ideas falsas pero convincentes.

Yo recuerdo, durante mi crianza en Puerto Rico, que comentarios sobre personas delgadas eran despectivos, injustos e insolentes, como menos. Mirar a una mujer delgada no importa lo bella que fuese, inspiraba dichos como:

"Tan linda que es, pero, mira como está: 'tísica' y tuberculosa."

O gente joven ignorándose los unos a los otros por estar muy "flacos." Igual que ver a un padre o a una madre obligar a sus hijos de seis, siete, ocho o nueve años de edad, a que coman más de la cuenta para que se mantengan "gordos y saludables," era un hábito cultural que se extendía mucho más lejos de los bordes borincanos. He averiguado que es un problema cultural hispano, que no nació en Puerto Rico. Ser flaco reflejaba al ser inferior y enfermo; el gordo manifestaba buena salud y estabilidad económica.

De hecho, en las décadas de los 1940 y 1950, durante una epidemia de tuberculosis que hubo en Puerto Rico, los niños que todavía estaban de biberón eran forzados a tomar leche extra todos los días para poder todos sentirse orgullosos al escuchar piropos como: "Qué lindo y qué gordito!"

En el Puerto Rico de aquellos años todo bebé tenía que estar más pesados de lo que debía estar, si no quería caer automáticamente en la lista de los "tísicos" y los "tuberculosos."
Los boxeadores aficionados y profesionales en los EE.UU. no se examinan para averiguar si tienen o no diabetes. Yo no creo que la condición le crearía problemas serios a ningún pugilista que se enfrasque a otro consciente de que padece de diabetes.

En los EE.UU. hay docenas de millones de diabéticos, de los cuales más de diez millones no saben que padecen de ese mal. No hay crisis de muertes masivas entre ellos, pero de los boxeadores con ese mal ninguno, que yo sepa, se ha distinguido en el ring y todos se quejan de dolores musculares que le afectan las caderas y los hombros. Y más importante, la vista se le va aflojando con el tiempo.

Desgraciadamente, los males físicos que el enfermo desarrolla como consecuencia de la diabetes no son mejorados con medicina, sino mantenidos en el mismo estado, como el desgaste de la vista y el adormecimiento de las extremidades. Todo eso se puede evitar no con las medicinas que los médicos les puedan recetar, sino con las comidas que el enfermo está obligado a alimentarse. Yo le hablé a un grupo de boxeadores diabéticos y les pedí que no se arriesgaran a comer nada en lo absoluto que contuviera -o que se convirtiera en- azúcar. La dieta, no la medicina, es su salvación.

Si no, el resultado sería horroroso. El hombre se disminuye totalmente en el aspecto sexual; luego se le amputan los dedos de los pies y de las manos, para entonces expandirse hacia el pie, la mano, sin descontar la ceguera de sus ojos y así sucesivamente hasta que uno no puede, ni quiere sobrellevar la enfermedad ni un solo minuto más.

José 'Chegüí' Torres fue ganador de la medalla de plata del peso mediano-ligero por los EE.UU. en los Juegos Olímpicos de 1956, posteriormente fue campeón mundial de los pesos semi completos. A su retiro, se convirtió en autor y periodista del boxeo con una gran experiencia.

2006-01-16T20:06:00.000-08:00

Medicare para todos --La solución a la crisis en salud
Por Dr. Jaime R. Torres

Washington Hispanic

23 de diciembre, 2005

Me enfurece que personas sufran sin necesidad sólo porque nuestro sistema de salud es tan injusto. Tenemos más de 45 millones de personas sin seguros médicos en toda la nación —14 millones son hispanos. La mayoría son personas que trabajan muy duro para empleadores que no ofrecen seguros médicos. Hay ancianos que, debido al exorbitante costo de los medicamentos, están forzados a decidir entre comprar comida o las medicinas necesarias para vivir.

En mis años como doctor he visto a un hombre perder una pierna porque no pudo pagar por antibióticos para una úlcera en un pie; he visto niños recibir cuidado deficiente porque tenían Medicaid.

Recientemente acudí al funeral de una niña de 14 años que murió cuando su HMO se negó a pagar por un simple examen de sangre que hubiese indicado que su sufrimiento provenía de un páncreas perforado y no de un virus, como había dicho la clínica. El dolor de esa familia es REAL y no una “anécdota”, como estas compañías aseguradoras suelen decir.

Nuestro sistema de salud no debe depender en que algunos lucren con las desdichas de otros seres humanos. Es despreciable denegar servicios médicos mientras accionistas y ejecutivos millonarios que nunca han cambiado un vendaje en sus vidas lucran con las enfermedades de la gente.

Es muy claro que este sistema no funciona. Eli Siegel, el gran filósofo y fundador de la educación Realismo Estético, demostró su falla central cuando explicó que un sistema de salud basado en lucro es inmoral porque está “basado en desprecio por la gente”.

Estas palabras hacen muy claro que el ver a los pacientes en término de cuánto dinero se puede hacer de ellos es puro desprecio, y es completamente opuesto a desear que se fortalezcan y que sean más saludables.

Es evidente que el sistema de salud basado en el lucro es un fiasco y las diferentes propuestas para mejorarlo son equivalentes a asegurar que todos los pasajeros tengan salvavidas en el Titanic, lo que no prevendrá el naufragio.

Si en el Congreso quieren reformar el sistema, deben votar por la propuesta del congresista John Conyers, quien quiere expandir el plan de Medicare a todas las personas que viven en los Estados Unidos sin importar su estatus migratorio o su condición de salud. Este plan nacional cubriría a todas las personas y su único propósito es ser útil y no obtener ganancias.

“ Nadie debería jamás tener que pagar por el cuidado de [los males] de su cuerpo”, dijo Eli Siegel en el Reporte de Ética Nacional del 19 de julio del 1968. Y añadió, “la idea de que haya gente preocupada por su salud y de cómo pagar por ella, es barbárica. Es egoísmo corrupto”.

Nuestro próximo sistema de salud debe ser basado en la ética. Y la pregunta más importante, Siegel demostró, es ¿qué se merece una persona por el solo hecho de existir?

La respuesta a esta pregunta traerá verdadera justicia a todos las personas es este país, incluyendo atención médica con compasión.

El Dr. Jaime R. Torres es fundador de Latinos por un Seguro Médico Nacional y un Asociado en la Fundación Realismo Estético en New York. Su correo electrónico es latinohealth@msn.com

2006-01-16T19:45:00.000-08:00

Hispanic Policy Makers Back Universal Coverage to Reduce Health Disparities
By Noel Thomas
Epoch Times Washington D.C. Staff

Dec 21, 2005

WASHINGTON D.C. - The Congressional Hispanic Caucus is making moves to support providing universal health care to all U.S. residents. To support of Representative John Conyers (D- Michigan) bill to that end, the Hispanic Caucus co-hosted a luncheon last week. Conyers is Dean of the Congressional Black Caucus.

Speakers included a panel of Hispanic doctors and policy experts who addressed health care providers and national advocates concerned about disparities in coverage. According to the Kaiser Family Foundation, 35 percent of Hispanics and 20 percent of African Americans are uninsured, compared to 12 percent of whites.

Panelists maintained that a universal health care system would eliminate health care disparities for Hispanics and other racial minorities.

Dr. Olveen Carasquillo, Assistant Professor at Columbia University and an advocate for universal health insurance, claimed that all residents in the nation could receive equal coverage by creating a universal system run in a manner similar to Medicare.

According to Carasquillo, most of the costs for the proposed system could be achieved by replacing major health programs such as Medicaid and the State Children's Health Insurance Program with one universal system.

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"The Latino Health Insurance Crisis:
A Forgotten Community"