Author: cmh

Senate Finance Committee Hearing on Expanding Health Care Coverage

“Roundtable Discussion on “Expanding Health Care Coverage”
May 5 , 2009, at 10:00 a.m., in 106 Dirksen Senate Office Building

Over at the PNHP Blog, Don McCanne points out that the voices for single payer are being stifled and excluded because of the view of most in the Congress that it is a politically unviable proposition, though he “respects” their views.

Even more problematic was an exchange later in the hearings between Sen. Pat Roberts and Scott Serota, CEO of the Blue Cross and Blue Shield Association.

Sen. Roberts told the tale of how a group of surgeons and anesthesiologists surrounded him after his knee surgery and told him and said they’d all quit if we went to a national health plan or even, I believe, to a public option and their reimbursements were to be decreased.

I don’t have the transcript, but he went on to say something along the lines of how there was no way to control costs in a national health system and then asked Serota what he thought.

Of course, Serota explained in that patrician way of so many how there was no way in the world to produce high quality and lower costs than we have in the US now with private insurance.

Now, if Sen. Baucus doesn’t want single payer advocates around because he doesn’t think it is politically viable, that is one thing. But what he doesn’t seem to realize is that having a knowledgeable single payer advocate and someone knowledgeable about international comparative health care in the room would have resulted in the particular line of BS that Roberts and Serota were peddling to be swatted down without breaking a sweat.

That is why it is so critical to have a broader range of views at the table. There was no one there willing to point out the obvious: Reducing future surgeons’ income from $500 K to $400 K, for example, will not bring the world to a halt. Essentially every country in the world controls costs and maintains quality at massive savings compared to the disastrously inefficient US private insurance industry.

But there was no one at the table willing to tell them that.

Schumer Offers Middle Ground on Health Care – NYTimes.com

Schumer Offers Middle Ground on Health Care – NYTimes.com:

“Scorched by Republican opposition to the idea of a new public program like Medicare, Senate Democrats are looking for a middle ground that would address the concerns of political moderates. One way they propose to do that is by requiring the public plan to resemble private insurance as much as possible.

“The public plan,” Mr. Schumer said Monday, “must be subject to the same regulations and requirements as all other plans” in the insurance market. Democrats in Congress hope to shift the debate from the question of whether to create a public health insurance plan to the question of how it would work. In so doing, they look for the support of influential moderates. But in the last few days, three moderate senators — Ben Nelson, Democrat of Nebraska; Olympia J. Snowe, Republican of Maine; and Arlen Specter of Pennsylvania, who switched parties to become a Democrat — have expressed reservations about a public plan.

Insurers also remain skeptical. Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, said, “We are very, very grateful that members of ongress have been thoughtfully looking at our concerns.” But she said she still saw no need for a public plan “if you have much more aggressive regulation of insurance,” which the industry has agreed to support.

Linda Douglass, a White House spokeswoman, said that Mr. Obama was for a public plan but that he realized it could be defined in different ways. Mr. Schumer said his goal was “a level playing field for competition” between public and private insurers.

But Ms. Ignagni said, “It’s almost impossible to accomplish that objective.””

…with high corporate salaries, really nice corner offices, expensive buildings, luxury sports boxes and all those other bare necessitites of modern corporate life!

Firedoglake also has a good post on this as a capitulation.

And Rachel Maddow reported tonight about White House talked about offering some concessions in the HC reform debate and that, in return, the Republicans offered (wait for it!) nothing!

OECD Waiting Times Study Executive Summary

I realized that while I have a link to this study elsewhere, it is rather a pain to get to the information because the document is in pdf.

Now, this is from 2003, and so the UK/NHS data is now happily out of date. And leaders in Canada have seen the results in the UK and are pushing to end the bloc financing of hospitals that helped so much in the UK. But anyway, here is the summary:

  • Waiting times for elective surgery are a significant health policy concern in approximately half of all OECD countries.
  • This report is devoted to [analyzing waiting times]. An interesting feature of OECD countries is that while some countries report significant waiting, others do not.
  • Waiting times are a serious health policy issue in the 12 countries involved in this project (Australia, Canada, Denmark, Finland, Ireland, Italy, Netherlands, New Zealand, Norway, Spain, Sweden, and the United Kingdom).
  • Waiting times are not recorded administratively in a second group of countries (Austria, Belgium, France, Germany, Japan, Luxembourg, Switzerland, and the United States) but are anecdotally (informally) reported to be low.
  • This paper contains a comparative analysis of these two groups of countries and addresses what factors may explain the absence of waiting times in the second group. It suggests that there is a clear negative association between waiting times and capacity, either measured in terms of number of beds or number of practising physicians. Analogously, a higher level of health spending is also systematically associated with lower waiting times, all other things equal.
  • Among the group of countries with waiting times, it is the availability of doctors that has the most significant negative association with waiting times. Econometric estimates suggest that a marginal increase of 0.1 practising physicians and specialists (per 1 000 population) is associated respectively with a marginal reduction of mean waiting times of 8.3 and 6.4 days (at the sample mean) and a marginal reduction of median waiting times of 7.6 and 8.9 days, across all procedures included in the study.
  • Analogously, an increase in total health expenditure per capita of $100 is associated with a reduction of mean waiting times of 6.6 days and of median waiting times of 6.1 days.
  • In the comparison between countries with and without waiting times, low availability of acute care beds is significantly associated with the presence of waiting times. Also, evidence from this and other studies suggests that fee-for-service remuneration for specialists, as opposed to salaried remuneration, is negatively associated with the presence of waiting times. Fee-for-service systems may induce specialists to increase productivity and may also discourage the formation of visible queues because of competitive pressures. In addition, evidence from this and other studies suggests that activity-based funding for hospitals may also help reduce waiting times.

Exclusive: NHS hospital waiting times are the lowest since records began – mirror.co.uk

Exclusive: NHS hospital waiting times are the lowest since records began – mirror.co.uk:

“Hospital waiting times are the lowest since records began, Health Secretary Alan Johnson will say today as he rounds on critics of the NHS.

“Mr Johnson aims to hit back at the doom and gloom-mongers by showing how the nation’s health service has been transformed for the better in the 12 years since 1997.

“He will highlight figures showing delays for treatment have fallen in many areas.”

Some of the numbers are quite impressive. I don’t think these numbers are significantly different than US (and by that, I mean these are not intolerable waits by most standards). And remember, they hae health care for their entire population, not just those who can afford it.

Kaiser Family Foundation Health Policy Tutorials and Compendia

Tutorials:

KaiserEDU’s tutorials are multimedia presentations on health policy issues, research methodology or the workings of government.

Here are a few to get started (I haven’t yet, but put them here for reference and eventual use!)

Health policy experts provide overviews of current topics in health policy. Watch and download slides from these and other tutorials:
The Public and Health Care Reform
A Primer on Tax Subsides for Health Care
Expanding Health Coverage to the Uninsured

They also have Compendiums:

These modules include background summaries along with links to academic literature, policy research and data sets on current health policy issues, such as:
U.S. Health Care Costs
Health Information Technology
Addressing the Nursing Shortage
The Uninsured
International Health Systems

Groups strategize for single-payer plan – Politico.com Print View

Groups strategize for single-payer plan – Politico.com Print View:

“President Barack Obama and Senate Finance Committee Chairman Max Baucus (D-Mont.) rarely pass up a chance to snub single-payer health care — a term that means a government-run system. So opponents on the left who want their voices heard in the debate over health care reform are planning to yell a little bit louder as Congress considers creating a public insurance plan to compete with private insurers.

“Their strategy is simple: By pushing hard for single-payer health care, a robust public insurance option ends up looking like a compromise Democrats could accept.

““The best way to get half the pie is ask for the whole pie,” said Katie Robbins, assistant national coordinator of Healthcare-Now, which will not endorse the public plan but acknowledges the strategy. “It is like horse trading.””
…

“And here is a hint about why proponents and opponents of the public plan talk so frequently about “choice”: It polls really, really well. Support for the public plan jumped to 78 percent when people were told it would give consumers more options. “

EzraKlein Archive | The American Prospect

EzraKlein Archive The American Prospect

This is just too fun. Fraser Institute puts on prominent Canadian physician to dis Canadian health care, which he does, mildly IMHO, but then proceeds to dis the American system even more!

And Dr. Day (former CMA President) makes some great points:

1. Waiting times are a function of the way Canada funds hospitals, by bloc grants to hospitals rather than having money follow the patients as in the rest of the world.

2. Waiting times cost more, particualarly in terms of patients illness progression and economic costs of lost work, wages, productivity, etc.

3. Britain has essentially fixed its waiting time issues by dispensing with the bloc system.

4. “I think this is what people tend to forget. They equate alternatives to the Canadian health care system with ‘Americanization,’ which is not what we’re talking about. We’re talking about countries like Belgium, and Switzerland, and France, and Austria.”

5. One should be able to buy private health insurance (in Canada) to supplement the Candian Medicare system.

Congressional Health Care Caucus

Congressional Health Care Caucus

I found this website, apparently the nexus of pushing back on Democratic attempts at halth care reform.

It is fairly lame, in my estimation, largely reminding readers how horrible the rest of the world has it and how the free market and charity care can still fix it all, in spite of a half-century of evidence to the contrary. You know, let private health insurance CEOs and bureaucrats do whatever they choose so that we can be protected from government bureaucrats.

Anyway, one of the things that I always hear from conservatives, and is found in a primer written by Congressman Michael Burgess, MD, is that medical innovation will come to a screeching halt if we get universal health care. He points out that 22 of the past 25 Nobel Laureates in Medicine were Americans.

So, I checked it out on Wikipedia, and I will admit I only checked out the most recent 10 or so, but would you be shocked to learn they all worked at Universities or large, well-funded, non-profit foundations (like the Howard Hughes Insitute)? Me neither.

Paperwork, profits clog health care’s efficiencies

Paperwork, profits clog health care’s efficiencies:
DEAN CALBREATH, San Diego Union Tribune

“Jim G. Kahn, health economist at the Institute for Health Policy Studies at the University of California San Francisco, found a similar pattern during a study of California hospitals, clinics and doctors’ groups. He found the doctors’ groups were spending an average of 14 cents per dollar related to legal, accounting and processing costs involved with health insurance.

““You have to have teams of lawyers and accountants to negotiate contracts and to figure out who pays for what,” Kahn said. “You have to have whole teams in place to figure out what errors there are (in the paperwork) and how to fix them.”

“Kahn said that in a single-payer system like Canada’s, the data are centralized, resulting in less time, money and effort being spent on administrative tasks. “And then you could apply that savings to provide better health coverage,” he said.

“Critics of a single-payer concept worry that a government-run system would end up being too costly and too bureaucratic, without providing the benefits of innovation and cost-cutting that competition is supposed to bring. But if that were true, why does our system cost more than those abroad?

“The entities that seem to benefit most from the current system are the major pharmaceuticals, which are among the nation’s most profitable companies, and the life insurers, which have also done well.

“Donald Cohen, executive director of San Diego’s Center for Policy Initiatives, a liberal think tank, said the top seven for-profit health insurers made a combined $12.6 billion in 2007, an increase of more than 170 percent from 2003. Part of those profits go toward paying high salaries for the top executives. The seven chief executives received an average compensation of $14.3 million in 2007, with pay packages ranging from $3.7 million to $25.8 million.

“Cohen suggested that one way of lowering costs would be to create more competition, by having a government health plan competing with the private insurers. Government-run programs, he said, typically run with low administrative expenses, often with overhead running at 1 percent to 3 percent of their expenses. In contrast, the privately run insurance firms have overhead costs as high as 20 percent, partly because of their high salaries.

“As Cohen noted, conservative think tanks like the Reason Foundation, Heritage Foundation and others have argued that allowing the private sector to compete with the public sector can benefit the taxpayer. Why shouldn’t the reverse be true?

““Public-private competition in health insurance will squeeze overhead and profits from the middlemen in the system so we can put more money into actual health care,” Cohen said. “

Reforming Health Care – washingtonpost.com

Reforming Health Care – washingtonpost.com:

The WaPo decides a public option is a bizarre fixation…

“Of the many possible issues that could snarl health-care reform, one of the biggest is whether the measure should include a government-run health plan to compete with private insurers. The public plan has become an unfortunate litmus test for both sides. The opposition to a public plan option is understandable; conservatives, health insurers, health-care providers and others see it as a slippery step down the slope to a single-payer system because, they contend, the government’s built-in advantages will allow it to unfairly squash competitors.

“For liberals, labor unions and others pushing to make health care available to all Americans, however, the fixation on a public plan is bizarre and counterproductive. Their position elevates the public plan way out of proportion to its importance in fixing health care. It is entirely possible to imagine effective health-care reform — changes that would expand coverage and help control costs — without a public option.”

The comments excoriate them, for the most part.