The first People’s Health Movement USA National Meeting will be held July 28-29, 2011, at Loyola Marymount University, Los Angeles CA, in conjunction with the annual assembly of Doctors for Global Health. We invite those who endorse the People’s Charter for Health to participate in identifying our medium-term goals and developing a plan to reach them. This is an opportunity for you to get more involved with the international movement that has set the people’s agenda for global health for the last 12 years.

The People’s Health Movement is a global network of people’s organizations, civil society organizations, NGOs, social activists, health professionals, academics and researchers who believe we can provide health for all by tackling the social and economic underpinnings of health status, and providing community based comprehensive primary health care. PHM in the United States has been working in solidarity with health activists around the world, and promoting solutions emerging internationally as a result of local research and action for health.

We have many challenges both domestically and internationally. At this first national meeting we need your input to make decisions about where to focus our energy and how to take advantage of upcoming opportunities. One of those is the 3rd People’s Health Assembly in Cape Town, South Africa next July. If you have thought about attending the PHA3, you should participate in this meeting.

Soon we will send out a pre-meeting survey to hear from as many people as possible as we develop the agenda.

To register for the meeting, go to
http://www.dghonline.org/2011-ga-registration-application

For more information, email phm@hesperian.org.

If you would like to participate but are unable to travel to LA, we will be setting up some kind of virtual participation connection for part of the meeting. Please email phm@hesperian.org if you would like to participate virtually.

Discussion, learning, and action across organizations, disciplines, race and class is needed to build the movement to demand for health for all in the US and globally. We will lay a foundation July 28-29 in Los Angeles.

In Solidarity,

People’s Health Movement–USA National Meeting Organizing Committee

Sri Shamasunder
Sarah Shannon
Laura Turiano
Jyoti Puvvula
Linda Sharp
Lily Walkover
Evan Lyon

Posted by Matt Anderson

http://www.pnhp.org/news/2011/march/the-health-law-at-one-year-should-we-celebrate

On March 23, a year after President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), “the most expansive social legislation enacted in decades,” according to the New York Times, it’s worth taking a look at Massachusetts.

After all, PPACA was inspired in the Massachusetts health plan, which sought universal coverage through Medicaid expansions for individuals living under 150 percent of the federal poverty level (FPL), partial subsidies for those between 151 and 300 percent of the FPL, a state-based exchange to act as a one-stop-shopping place of private insurance plans, and a mandate to purchase one of those plans under penalty of a fine.

And yet, four years after implementation, health reform Massachusetts-style has failed a critical test. As a recent study in the American Journal of Medicine showed, the percentage of personal bankruptcies linked to medical bills and illness, at 52.9 percent, has not decreased significantly, and the absolute number of medical bankruptcies has increased, from 7,504 in 2007 to 10,093 in 2009. How so?

Well, it’s not hard to understand why. Health insurance is a means to an end. The end is health care. And skimpy policies with significant, and increasing, out-of-pocket costs are useless when people need care.

And in Massachusetts, skimpy policies are not even cheap. For example, as study authors pointed out, the least expensive individual coverage available to a 56-year-old Bostonian carries a premium of $5,616 and a deductible of $2,000, and covers only 80 percent of the next $15,000 in costs of covered services (uncovered services fall 100 percent on you).

This is not small change if your annual income is around $32,000, or 300 percent of the FPL, so you’re not entitled to subsidies (which, mind you, come from taxpayers’ pockets).

But what about at least slowing the increase in health care costs? Fail again. Double-digit increases in premiums have become routine in Massachusetts, and insurers have warned this will continue next year, even as “consumer-driven” policies that shift more costs to individuals multiply.

But won’t PPACA, a federal program, control costs in U.S. health care? No, at least if you go by its effect on California, where, maybe to celebrate PPACA’s first year anniversary, Blue Shield recently announced its third premium hike since October 2010. An outside consultant found, unsurprisingly, that the planned hike was “reasonable.” (PPACA does not forbid insurers to raise their prices; it only demands that they show that increases are deemed “reasonable” by authorities that have little power to enforce their standards of reasonableness anyway.)

And what about the promise that kids with “pre-existing conditions” would not be charged more than other kids? Good luck with that one. This past October HHS Secretary Kathleen Sebelius already backed down on that promise, allowing insurers to charge more to cover sick kids to, according to the New York Times, “persuade companies to offer child-only policies.”

And Medicaid expansions, which would enroll at least 16 million individuals? Not a chance, especially after governors throughout the nation begin to implement the creative ideas offered by Sebelius explaining how, as state budgets collapse and nobody bails them out, Medicaid costs can be reduced “by cutting benefits,” as noted in California Healthlines.

Wait a minute, you might say. Whatever problems it may have, the law offers (near) universal coverage, no? Out of luck again. The law will leave around 23 million uninsured close to 10 years out from its implementation (and over 50 million annually over the next three years). Many of these will be undocumented immigrants, whom the law forbids to buy coverage from the insurance exchanges, even with their own money.

On the bright side, as the failure of the attempt to further strengthen the worst of the U.S. health care system — for-profit insurance for medically necessary care, and trading uninsurance for underinsurance — becomes increasingly apparent, a space will open up for Americans to demand real health care reform: a publicly financed, privately delivered health care system that provides comprehensive and equitable health care to everybody in the United States: an expanded and improved Medicare for All.

Claudia Chaufan, M.D., Ph.D., is assistant professor at the Institute for Health and Aging at the University of California, San Francisco. She teaches sociology of health and medicine, sociology of power, public health, comparative health care comparative health care systems and sociological theory. Dr. Chaufan is also vice president of Physicians for a National Health Program-California (http://pnhpcalifornia.org/).

But it does not. It makes no more sense to let people’s house burn down because they cannot pay their fire-department fees — maybe they chose the wrong “plan”? or a plan with a deductible they cannot afford? – than to let them die because they cannot afford their health care.

Now, why the new federal law, the Patient Protection and Affordable Care Act P-PACA), will fail to keep its two key promises (protecting patients and making health care affordable), is not the topic of this posting, because I and many others have commented on it extensively elsewhere.

Rather, it is to point out that if we continue turning health care more and and more into a “consumer good” that those who have the ear (and pockets) of Congress and the White House can make a profit off of (and P-PACA reinforces the trend ), we are up to extremely unpleasant experiences.

Such as, for instance, looking at our homes burn down while the Fire Department watches. And unfortunately, this nightmare is already with us. It happened just a few days ago, in Tennessee.

Here is a video clip produced by Newsy.com, illustrating the story and the debate it ignited in cyberspace:

“No pay, no spray”.

Interestingly, one reporter critiques the city implementing the fee because it likens a public service, fire protection, to auto insurance (note: remember the comparison made by President Obama  between health insurance and auto insurance, once even the token gesture, the ‘public option’, towards his progressive base had been cast aside to give full way to the Well Point-crafted federal legislation?)

And here is how the episode is described in Amy Goodman’s show, Democracy Now:

Tenn. Fire Department Allows Home to Burn Down over Unpaid $75 Fee

In Tennessee, a local fire department refused to put out a house fire last week because the homeowner had forgotten to pay $75 for fire protection from a nearby town. The firefighters showed up to the scene of the fire and then watched as the home of Gene Cranick burned to the ground. Cranick’s neighbors had paid the $75 fee, so when the fire spread across the property line firefighters took action, but only to save the neighbor’s property.

The local mayor defended the actions of the firefighters. South Fulton Mayor David Crocker said, “Anybody that’s not in the city of South Fulton, it’s a service we offer. Either they accept it or they don’t.” On Monday, Gene Cranick appeared on Countdown with Keith Olbermann.

Gene Cranick: “Everything that we possessed was lost in the fire. Even three dogs and a cat that belonged to my grandchildren was lost in it. And they could have been saved if they had been—they had put water on it. But they didn’t do it, so that’s just a loss.”

Keith Olbermann: “When you all called 911, as I understand it, you told the operator you’d pay whatever was necessary to have the firefighters come put out and prevent the fire from spreading to your house. What was their response?”

Cranick: “That we wasn’t on their list.”

Are we going to watch in disbelief while our homes burn down?

As Dr. Bill Skeen, executive direction of Physicians for a National Health Program-California, wrote:

Sadly, those of us who believe healthcare is a right know that this country has never assumed the mantle of providing healthcare to all its residents. Currently we leave 50 million of our brothers and sisters uninsured; 45,000 of them die each year because of it. It is time for us to stand up and demand that our nation return to the real American values of empathy and compassion and caring about our neighbors’ wellbeing.

Last night we as a nation let a family’s house burn to the ground while those who could save it watched and did nothing. Everyday we let more than a hundred people die who have no health insurance. Are we willing to standby and do nothing to stop it?

We don’t need to. And we mustn’t.

Let’s pick up the phone and call our U.S. Representatives today, and tell him or her to co-sponsoer HR676 when it is reintroduced next year in Congress. Tell him or her that you are outraged at what happened in Tennessee and that these two issues, fire protection and health care for all, are one and the same at their core. They demonstrate the incontrovertible need for government to protect the common good, and for we Americans to show our humanity to each other.

The Capitol Switchboard at 202-224-3121 / 202-224-3121  can connect you to the office of your Representative.

See below for a list of US Representatives that demonstrated their support this year for single payer by co-sponsoring HR 676. Please thank those legislators for their support, and urge the others to get on board!

Let us demand Medicare for All – everybody in, nobody out!

Name                                  State    District    Date signed
Rep Woolsey, Lynn C.        CA        6             01/26/09
Rep Miller, George             CA        7             03/19/09
Rep Lee, Barbara               CA        9             01/26/09
Rep Honda, Michael M.      CA      15             02/11/09
Rep Lofgren, Zoe                CA     16             05/20/09
Rep Farr, Sam                    CA      17             01/26/09
Rep Berman, Howard L.     CA     28             01/26/09
Rep Becerra, Xavier           CA     31              03/17/09
Rep Chu, Judy                   CA     32              07/31/09
Rep Watson, Diane E.        CA    33              01/26/09
Rep Roybal Allard, Lucille   CA    34             03/30/09
Rep Waters, Maxine           CA    35             03/19/09
Rep Napolitano, Grace F.   CA    38             01/26/09
Rep Baca, Joe                   CA    43              10/07/09
Rep Filner, Bob                  CA    51              02/11/09

As reported by California Healthline, Gov. Arnold Schwarzenegger (R) signed and vetoed several health care-related bills, not to challenge the federal health reform law but rather on the (dubious) grounds that these bills would duplicate its provisions.

So a perfectly reasonable, incremental-approach type bill, AB 2540, by Assembly Member Hector De La Torre (D- South Gate), which would have made it illegal for a health plan to collect a policyholder’s premiums and then rescind coverage after the member becomes ill, was vetoed (so much for the promise of  an end to rescisions).

Similarly, AB 2042, by Assembly member Mike Feuer (D-Los Angeles), which would have prohibited health plans from raising rates more than once each calendar year, was also vetoed (so much for PPACA helping you keep your plan if you like it).

The California governor also vetoed AB 1600, by Assembly member Jim Beall (D-San Jose), which would have required most health insurers to cover the diagnosis and treatment of mental illness, and AB 113, by Assembly member Anthony Portantino (D-La Cañada Flintridge), which would have required most health insurers to cover mammograms (so much for PPACA enhancing preventive health care).

Why would the California governor so blatantly block legislation that would clearly favor ordinary citizens vis-a-vis corporate actors, however important a question, is not the topic of this posting.  Nor is the problem with health care corporations, whose first fiduciary responsibility, like that of any other corporation, is to produce profit for shareholders.

The real question is why leave a basic human need and social right to corporate America in the first place and what is the role of ordinary citizens of democratic nations in deciding upon this and similar issues.

It is high time that these questions be debated in every American household. Their answer will determine what type of country and society we will bestow on our children.

1. Insurers are no longer permitted to rescind coverage for technical mistakes made on patient applications
2. Lifetime monetary limits on insurance coverage will end
3. Adult children will be allowed to remain on their parents’ plan until age 26
4. Insurers will be required to provide certain no-cost preventive services, such as colonoscopies, immunizations and mammograms
5. Consumers will be allowed to appeal claims decisions through an external review process.

These are only a few of the many provisions that take effect as of today, and that as it appears we are supposed to celebrate. But are we?

Not just yet. Let’s look at the “good news” through an alternative, and equally plausible, lens:

Number 1: While insurers may not be permitted to rescind coverage for technical mistakes made on patient applications, they will be able to do so based on other considerations. For instance, based on“intentional misrepresentation”, the number 1 reasons insurers allege to cancel policies.

Number 2: While lifetime monetary limits on insurance coverage will end, these limits apply only to covered services. Uncovered ones will be on patients, as they always have been. And as insurers are permitted to sell policies that cover as little as 60% of covered services (again, only covered services), patients will be extremely vulnerable to financial ruin if they become seriously ill.

Number 3: Yes, your “adult child” will be able to remain on your plan (assuming you have one and you or your “child” pay for the coverage) until age 26. And if you signed up to receive email alerts from Barak’s cheerleaders, Organizing for America, you may have read illustrative stories about the law’s goodness. For instance, you may have read that Kristin, a recent grad living in Scottsdale, Arizona, laments that health reform was not implemented last year, because it would have allowed her to remain on her mom’s plan, something that young folks now are able to do….until they turn 26, of course. But clearly this is only good news compared to the status quo, yet why should this be our standard? If Kristen lived in Canada, or in the UK, or anywhere else in the industrialized world, including Taiwan (and soon in China) she would not be hoping to remain forever young just to have access to her parents’ coverage – at least not for those reasons – because her health care needs would be covered as a matter of right, and for life.

Number 4: Yes, insurers will be required to provide certain no-cost preventive services, but, who do you think is going to foot the bill? You guessed it! All of us in the form of increased premiums — together with the bill for any other provision that affects insurers’ bottom line, such as the provision that insurers spend no more than 20% in administrative overhead.

Indeed, in a less cheerful mood just yesterday, New York Times reporter Robert Pear wrote that  “state insurance regulators told the White House…that health insurance markets in some states would be disrupted unless President Obama gave insurers a temporary dispensation from one major provision of the new health care law” – remarkably, that which requires that insurers spend no more than 20 or 30 cents of every premium dollar on paper shuffling or profit rather than on health care (For the record, the Robert Wood Johnson Foundation estimated that insurers’ expenses on physicians and clinical services amount to a mere 21.2%, so insurers are complaining about having to spend no more than roughly the same amount for “administering” our money).

Just getting a tad ahead of us (and of the law), as California Healthline noted earlier this week, Blue Shield of California has ended its “one-year rate guarantee”. This means that Blue Shield will be able to increase health plan rates throughout the year, instead of waiting for the annual renewal period. As a company spokesperson reported, Blue Shield opted to end the rate “because of forthcoming changes under the federal health reform law”. All which, according to the same source, has left Democrats and Republicans scratching their heads, seeking reasons behind hikes in premium costs (really???).

Ok. If depression has not prevented readers to read this far, let’s examine “reason for celebrating number 5″. As it appears, as of today “consumers” (we’re all consumers now) will be allowed to appeal claims decisions through an external review process. Now, assuming that it is good news that the bad guy will be still around yet now we are allowed to defend ourselves from him, the downside is that it is unclear who will be in charge of those appeals, or more importantly, who will pay for them. Indeed, just days ago, the same California Healthline announced that “state agencies have limited resources to implement reform law”.

Should we be surprised? Not at all. Indeed, the law was not passed to make ordinary Americans happy, although that was certainly the rhetoric. It was passed to satisfy the real constituency of the folks in Washington, a corporate lobby that has hijacked American democracy. In fact it was drafted by a member of that lobby, a WellPoint executive, himself. And they surely have reason to celebrate, now that they’ve been given at least $447 billion in taxpayer money to subsidize the compulsory purchase of their shoddy products.

Can we do something about it? Yes we can. We can, and must, demand a public single payer system that streamlines administration, stops wasting money in paper pushing or inflated prices, puts back medical decisions where they belong — in the hands of providers and patients — and allows us to make badly needed improvements in the health care delivery system – increasing the number of primary providers, emphasizing primary care, and so forth.

We need a new civil rights type movement. We need to demand health care justice for all.

To the Editors of the New York Times

Re: The Recession’s Awful Impact

You correctly state that “the driving force” for the steep rise in uninsurance rates was “a 6.5 million drop in private healthcare coverage as employers laid off workers or eliminated health benefits”. You also correctly state that “the percentage of people covered by employment-based health insurance dropped to 55.8 % in 2009 from 58.5 % the previous year…the lowest level…since 1987”. Moreover, you note that public programs like Medicaid “picked up some of the slack”.

Virtually in the same breath, you praise the Patient Protection and Health Care Act, premised on the same employer-sponsored, for-profit health care, the very same system crumbling in front of our eyes, while completely missing your own point: that taxpayers, once again, are bailing out, and even consolidating the power of, a for-profit system of financing health care that has sorely failed to do its job. Not to mention your complete silence about a valid alternative: a streamlined, improved Medicare for All.

Am I missing something?

Put another way, as the employer-based and private for profit driven health care system crumbles, publicly financed health care comes to the rescue (remember taxpayers’ bailing out the banks? more of the same…).

So how has the Obama Administration reacted to this catastrophe? Well, by implementing a federal health care reform law whose centerpiece is….yes, you guessed it: employer-based and private for profit driven health care!

Let’s think about it: do we really need “more evidence”, or to “wait and see” whether this form of health care financing will finally work? Readers can form their own judgment — there is no paucity of evidence, national or international, in these matters. Below goes some analysis that can help, including a table with a state-by-state analysis.

Number of uninsured skyrockets 4.3 million to record 50.7 million in 2009

Big leap points to urgency of enacting single-payer Medicare for all: national doctors’ group

By Physicians for a National Health Program. September 16, 2010

Contact:
Quentin Young, M.D.
Olveen Carrasquillo, M.D.
Margaret Flowers, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org
Local physicians in almost all 50 states available for comment (See historical table of uninsured by state below).

Official estimates by the Census Bureau showing a dramatic spike of 4.3 million in the number of Americans without health insurance in 2009 – to a record 50.7 million – underscore the urgency of going beyond the Obama administration’s new health law and swiftly implementing a single-payer, improved Medicare-for-all program, according to Physicians for a National Health Program, a 17,000-member physician group.

The Census Bureau reported that 16.7 percent of the population lacked health insurance coverage in 2009, up from 15.4 percent in 2008, when 46.3 million were uninsured.

Lack of health insurance is known to have deadly consequences. Last year researchers at Harvard Medical School showed that 45,000 deaths annually can be linked to lack of coverage.

“Tragically, we know that the new figures of uninsured mean a preventable annual death toll of about 51,000 people – that’s about one death every 11 minutes,” said Dr. Quentin Young, national coordinator of PNHP. Young is a Chicago-based retired physician whose private medical practice once counted President Obama among its patients.

Young said that even if the administration’s new health law works as planned, the Congressional Budget Office has projected about 50 million people will be uninsured for the next three years and about 23 million people will remain uninsured in 2019.

“Today’s report suggests those projections are likely too low,” he said.

The jump of 4.3 million uninsured is the largest one-year increase on record and would have been much higher – over 10 million – had there not been a huge expansion of public coverage, primarily Medicaid, to an additional 5.8 million people.

The rise in the number of uninsured was almost entirely due to a sharp decline in the number of people with employer-based coverage by 6.6 million. In 2009, 55.8 percent of the population had such coverage, having declined for the ninth consecutive year from 64.2 percent in 2000.

The record-breaking number of uninsured – exceeding 50 million for the first time since the Census Bureau started keeping records – includes 7.5 million children.

The biggest jumps in the percentage of uninsured were in Alabama, Oklahoma, Ohio, Missouri, Georgia, Delaware, North Carolina and Florida. In terms of absolute numbers, the biggest increases were in California, Florida, Texas, Ohio, Georgia, North Carolina, Illinois, Alabama, Michigan and Pennsylvania. In Massachusetts, 295,000 people remain uninsured despite that state’s 2006 reform. (See link below for historical tables of the uninsured by state.)

“The only way to solve this problem is to insure everyone,” Young said. “And the only way to insure everyone at a reasonable cost is to enact single-payer national health insurance, an improved Medicare for all. Single payer would streamline bureaucracy, saving $400 billion a year on administrative overhead, enough to pay for all the uninsured and to upgrade everyone else’s coverage.”

Dr. Olveen Carrasquillo, a PNHP board member and chief of general internal medicine at the University of Miami’s Miller School of Medicine, noted that the Census Bureau was once again silent on the pervasive problem of “underinsurance.”

“Not having health insurance, or having poor quality insurance that doesn’t protect you from financial hardship in the face of medical need, is a source of mounting stress and poor medical outcomes for people across our country,” Carrasquillo said.  New research has found that about 14.1 million children and 25 million non-elderly adults were underinsured in 2007, a figure that is likely much higher today.

“The government subsidies under the new health law will not be sufficient to provide quality and affordable coverage to the vast majority of Americans,” he said. “Tens of millions will remain uninsured, underinsured and without access to care. We need more fundamental reform to a single-payer national health insurance program.”

*****
State-by-state data on the uninsured from 2006-2009 can be found here: www.pnhp.org/sites/default/files/docs/2010/Uninsured-by-state-2006-2009.pdf

Physicians for a National Health Program (www.pnhp.org) is an organization of more than 17,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

posted by Matt Anderson, MD

As Medicare celebrated its 45th anniversary July 30, the White House sent its present: a Deficit Commission, composed by some of the very folks who were unable, or unwilling, to see the $8 trillion housing bubble that brought the financial system to a halt. Nope. It’s no joke: these folks are now at the forefront of the campaign to “save” Medicare and the budget.

But, does Medicare need to be saved? Let’s do a little history.

When Medicare was signed into law by President Lyndon Johnson, almost overnight millions of seniors, and later disabled Americans, were able to meet their health care needs, and rates of poverty among them dramatically decreased. Eventually, Medicare added benefits, laid the foundation of studies of health care quality, and provided a model of administrative efficiency still unmatched by for-profit insurers. Today, Medicare meets the health care needs of over 45 million Americans.

To be sure, aging baby boomers will add pressure to Medicare, and the program can be improved: rather than allowing dubious “Advantage” plans, benefits in traditional Medicare could be expanded; gaps, now covered through Medigap policies, a source of profit for insurers yet a financial burden for seniors, could be eliminated; the Kafka-esque Part D could be dumped and Medicare could be allowed to use its huge purchasing power to negotiate prices directly with drug companies, rather than banned from doing so; and doctors’ payments could stop being subject to flawed accounting formulas liable to political manipulation.

So if everything is on the table, how about saving Medicare by expanding it to include everyone living in America? How about replacing the insane patchwork of thousands of plans and paper-pushing designed not to provide access to care, but to undermine it, with a single paying public agent? Over $400 billion could be saved with this move alone, without adding a dime to overall costs. This amount would generously cover all — not “near” all — the uninsured, and improve the coverage of a growing number of Americans who must settle for skimpy policies and unaffordable out-of-pocket costs that drag thousands to bankruptcy annually.

And whatever taxes were needed to finance Medicare-for-All would be generously offset by eliminating increasingly unaffordable out-of-pocket costs and premiums. American families and individuals would see their health care costs precipitously fall and their health care fears vanish. Imagine the change this move would unleash — Americans no longer worried that their dream jobs offer no “health benefits” and businesses finally able to compete internationally with countries guaranteeing public health care.

There is nothing to “wait and see” about the Orwellian Patient Protection and Affordable Care Act signed into law this past March. Close to a century of failed experiments with for-profit insurance for everybody but the most vulnerable among us, who are dumped on taxpayers’ shoulders, should suffice. While millions continue to suffer and die unnecessarily, we already pay for universal health care yet not get it.

Let’s not be misled by propaganda and demand our legislators support a financially sustainable and socially just, publicly funded, privately delivered, universal health care system — a single payer national health program. It’s not too late to do things right. Let’s not take no for an answer so that we can soon sing together “Happy Birthday, Medicare for All!”

Claudia Chaufan received her medical degree in Argentina and her doctorate in sociology at UC Santa Cruz. She is an assistant professor of Sociology and Health Policy at the Institute for Health and Aging at UC San Francisco and vice president of Physicians for a National Health Program — California.

By Claudia Chaufan MD, PhD

In a recent issue in the New England Journal of Medicine, economist Jonathan Gruber praises the Patient Protection and Affordable Health Care Act (PPACA) as a “step in the right direction,” even as he expresses a healthy skepticism about PPACA’s capacity to control escalating health care costs, which he recognizes as “key to the long-term viability of our health care system.” Gruber also argues that there is “shortage of evidence” regarding which approach will meet Americans’ health care needs while controlling costs; therefore there is “no consensus” on what works [1].

Had Gruber looked beyond the U.S. borders, however, he would have found plenty of evidence. For instance, he would have found that U.S. consumption of health care as measured by critical indicators — per capita annual doctor visits, length of stay following heart attacks, or length of stay following normal childbirth – is no greater than the OECD average, and therefore cannot justify the extraordinary level of U.S. spending [2].

He would also have found that U.S. prices for medical care commodities and services are significantly higher than in other nations and constitute a key determinant of U.S. overall spending [3]. And had he looked into why this is the case, Gruber would have found that US high prices are determined by the exceptionally high administrative overhead caused by the system’s fragmented, public-private financing [4] and by the comparatively limited market power of American patients vis-à-vis their counterparts in countries with national health systems where the government negotiates prices with drug and medical device companies [5]. And he might have concluded that PPACA will do predictably little to change all this.

Moreover, the international literature would have shown the author the extraordinary international consensus around nonprofit financing to cover medically necessary services [5].

But what about the dramatic expansion of coverage promised by PPACA? Is this not a step in the right direction? The problem is that insurance coverage, as desirable as it may be, is not health care, but just a means to that end. And the U.S. system is notorious for providing coverage without care. High co-pays and deductibles are significant obstacles to access. Nor does health insurance offer financial security: nearly 78 percent of personal bankruptcies in 2007 that were linked to medical debt involved persons who were insured at the onset of their illness or injury [6]. PPACA, by allowing the sale of premiums for policies that will cover only 60 percent of health expenses [7], will do predictably little to change this state of affairs.

There is, however, an alternative proposal whose financial and policy soundness are based on decades of international experience and evidence. It would improve and expand Medicare to include all residents in the nation or in one state. That alternative may have to wait until PPACA unravels, as it predictably will [8].

President Obama argued that a model of reform as that implemented by PPACA would allow Americans to build on “what works” [9] – a decades-long experience with employer-sponsored for-profit health insurance. Maybe paradoxically, however, PPACA will unravel as employers realize that it is cheaper to pay a fine than pay for increasingly more expensive and inadequate policies, and employees enter the individual health exchanges implemented by the new law and find them so expensive that they “clamor for a nationalized health care system” [10].

References

1. Gruber, J., The Cost Implications of Health Care Reform. N Engl J Med: p. NEJMp1005117.

2. Peterson, C.L. and R. Burton, U.S. Health Care Spending: Comparison with Other OECD Countries. 2007. Order Code RL34175(September 17): p. http://assets.opencrs.com/rpts/RL34175_20070917.pdf (Accessed November 10 2007).

3. Anderson, G.F., et al., It’s The Prices, Stupid: Why The United States Is So Different >From Other Countries. Health Affairs, 2003. 22(3): p. 89-105.

4. Woolhandler, S., T. Campbell, and D.U. Himmelstein, Costs of Health Care Administration in the United States and in Canada. The New England Journal of Medicine, 2003. 349(August 21): p. 768-75.

5. White, J., Competing solutions: American health care proposals and international experience. 1995, Washington D. C: The Brookings Institution.

6. Himmelstein, D., U. , et al., Medical Bankruptcy in the United States, 2007: Results of a National Study. The American Journal of Medicine, 2009. 122(8): p. 741-746.

7. Dorgan, B., The Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act. http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm, 2010. Democratic Policy Committee.

8. Angell, M., Is the House Health Care Bill Better than Nothing? Physicians for a National Health Program, 2010: p. http://www.pnhp.org/news/2009/november/is_the_house_health_.php (May 17, 2010).

9. The New York Times, Obama’s Health Care Speech to Congress. 2009: p. http://www.nytimes.com/2009/09/10/us/politics/10obama.text.html?_r=1&pagewanted=print (Date accessed September 12, 2009).

10. Helderman, R., Gingrich in Va.: A Republican Congress could defund health care law. 2010: The Washington Post. p. http://voices.washingtonpost.com/virginiapolitics/2010/05/former_speaker_of_the_house.html.

Claudia Chaufan, M.D., Ph.D., is assistant professor at the Institute for Health and Aging at the University of California, San Francisco. She teaches sociology of health and medicine, sociology of power, public health, comparative health care systems and sociological theory. Dr. Chaufan is also vice president of Physicians for a National Health Program-California (http://pnhpcalifornia.org/).

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