New York State Health Care System Study

Our chapter has begun to look in earnest for funding, somewhere in the $30-50,000 range, to hire an experienced consulting firm like the Lewin Group to undertake a comprehensive study of the NYS health care system. Lewin has done these studies for other states, like Georgia and California and Vermont. The objective data demonstrates that Single Payer is the most efficient and least costly approach to providing health care for every citizen - on a statewide basis. As the the health care crisis emerges front and center, we need this kind of tool in hand to ramp up the discussion, particularly with the business community and political leaders, about Single Payer in New York State. If anyone visiting this site has ANY suggestions about a source of funding for this study, please email or call us and we will follow up promptly!

(from Paul W.)

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Letter to the editor of the Times Union

French health system covers everyone
First published: Saturday, January 28, 2006

I was surprised to read in Michael Luca's commentary (Jan. 2) that Americans may become so dissatisfied with their own health care system that "France's health care system won't look so bad anymore."

Mr. Luca seems to be unaware that the U.S. already has a system that works exactly like the French health care system (recently ranked first in the world by the World Health Organization) and, as far as I know, Americans like it. It is called Medicare. The only major difference is that it covers everyone in France, not just people older than 65.

JEAN-FRANCOIS BRIERE
Albany

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Letter to the editor of the Times Union

Health care equality merits sensible debate
First published (in the Albany Times Union): Sunday, January 15, 2006

A letter (Dec. 30) seeks to ridicule Dr. Alan Miller yet merely patronizes him in a foolish way. In his short essay (op-ed, Dec. 22), Dr. Miller noted that both patients and physicians see grave problems in American health care.

Dr. Miller suggested that health care should be equally available to all members of our society, that individual medical decisions should be made solely between doctors and patients and that physicians, as well as patients, have a stake in seeing that public, not private, interests guide health policy. He concluded that a public insurance system, like Medicare, should cover everyone's medical bills.

The response condescendingly claims to be "for Dr. Miller's edification." But simply invoking the buzzwords "unfunded liability" and touting astronomical deficits (based upon ideological assumptions) sheds no light on these vital issues.

Scrutiny of proposed health care reforms by academics, journalists and others repeatedly demonstrates that Dr. Miller's solution is the only plan that can achieve significant cost savings for the entire health care system.

When the Des Moines Register completed an extensive series of articles in late 2005, "U.S. Health Care: Condition Critical," the newspaper's editorial board came to the same conclusion as Dr. Miller.

So did the award-winning investigative journalists Donald L. Bartlett and James B. Steele in their 2004 book on American medicine, "Critical Condition."

Dr. Miller's ideas are not outlandish, but eminently sensible -- and practical -- and they merit serious discussion.

ANDREW D. COATES, M.D.

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Letter to the editor of the New York Times

[published in the New York Times on Sunday, January 15, 2006.]

To the Editor:

"States Intervene After Drug Plan Hits Early Snags" (front page, Jan. 8) reports that Medicare recipients are being denied promised prescription help. I would add that this has already increased hospitalizations.

I was outraged last week when one of my patients required hospital admission after stopping her medications because she couldn't afford the new $45.57 co-payment demanded by her assigned private pharmaceutical benefit management company. Medicaid had previously covered her prescriptions.

The administration has designed a drug benefit to protect the pharmaceutical industry and discredit Medicare, our one single-payer health insurance program. Today's mess could have been avoided if Congress had included the pharmacy benefit in Medicare and allowed Medicare to negotiate prices.

Congress should make changes in the drug benefit, instead of letting it serve as an opening wedge to privatizing and thus undermining original Medicare. Then it should extend Medicare coverage to everyone.

Oliver Fein, M.D.
New York, Jan. 9, 2006

The writer is chairman of the Metro New York chapter of Physicians for a National Health Program.

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We Will Educate Our Colleagues, the Policy Community, the Media, and Our Patients

First published at MRzine on January 5, 2006

Physicians for a National Health Program held its annual meeting on December 10, 2005.Originally planned for New Orleans, it was relocated to Philadelphia after Hurricane Katrina. Founded in 1987, the organization has over 14,000 members nationally. PNHP advocates and educates for a single national health insurance plan: in the words of PNHP National Coordinator Quentin Young, MD, "everybody in, nobody out." With about 250 in attendance, the meeting consisted of a series of panel discussions.

The PNHP "Proposal of the Physicians' Working Group for Single-Payer National Health Insurance" has been published in the New England Journal of Medicine (in 1989) and the Journal of the American Medical Association (in 2003). Over 12,000 physicians endorsed the plan in 2003-2004. The proposed plan would cover all necessary medical care, including mental health and dental care, long-term care, hospitalization, and all prescription medications.

The Physicians' Proposal articulates four principles:

Access to comprehensive health care is a human right. It is the responsibility of society, through its governement, to assure this right. Private insurance firms' past record disqualifies them from a central role in managing health care.

The right to choose and change one's physician is fundamental to patient autonomy. Patients should be free to seek care from any licensed health care professional.

Pursuit of corporate profit and personal fortune have no place in caregiving and they create enormous waste. The U.S. already spends enough to provide comprehensive health care to all Americans with no increase in total costs. However, the vast health care resources now squandered on bureaucracy (mostly due to efforts to divert costs to other payers or onto patients themselves), profits, marketing, and useless or even harmful medical interventions must be shifted to needed care.

In a democracy, the public should set overall heatlh policies. Personal medical decisions must be made by patients with their caregivers, not by corporate or government bureaucrats.

PNHP President John Geyman, MD, welcomed participants to the meeting with brief remarks. Former editor of The Journal of Family Practice and author of many works including the Textbook of Rural Medicine, Dr. Geyman has written several books on the crisis in American health care.

Dr. Geyman's soon-to-be-released book Shredding the Social Contract: The Privatization of Medicare (Common Courage Press, 2006) was available at the meeting. He writes in its first chapter that "the great debate of the 21st century will be about how the new rules for a global market can be rewritten in the public interest. The current model of 'corporate managed trade' serves corporate self-interest at the expense of entire populations."

Steffie Woolhandler, MD, PNHP co-founder and associate professor of medicine at Harvard Medical School, started the day at 78 rpm with a brisk update of the PHNP slideshow, an activists' speaking tool that digests evidence from the medical literature of the injustice, inequality, and inefficiency of health care in the United States.

Dr. Woolhandler explained, for example, that it is a myth that those who have trouble paying for care are uninsured but young and healthy. In a study Dr. Woolhandler published this year with PNHP co-founder David Himmelstein, MD, Elizabeth Warren, and Deborah Thorne, "Illness and Injury as Contributors to Bankruptcy," over half of those declaring bankruptcy were driven into debt by medical costs. Of these, three quarters of debtors had insurance at the onset of illness and three fifths had private insurance at the onset of illness!

As part of a panel discussion on market-driven health care, Adewale Troutman, MD, spoke. An author, with former U.S. surgeon general David Satcher, MD, of "What If We Were Equal? A Comparison of the Black-White Mortality Gap in 1960 and 2000," Dr. Troutman illustrated, with the case of a 56-year-old African American woman, how the failures of the American health care system lead to avoidable death and suffering. He advocated using the terms "injustice" and "inequality" instead of "disparities." He suggested Episode III of Race: The Power of an Illusion, which looks at the question of housing, as a useful video analogy to portray the systemic racism in U.S. health care.

A panel devoted to Canada proved so popular that an extra session had to be organized for continued discussion. Steven Barrett, an attorney who was counsel for the Canadian Labor Congress before the Supreme Court of Canada in the Chaoulli v. Quebec case, gave an overview of medical malpractice in Canada, which is scarcely comparable to the United States. (Among many differences, with a single-payer system like the Canada's Medicare, future health care costs need not be considered in lawsuits.) Joel Lexchin, MD, emergency physician at the University Health Network in Toronto and author of over 60 peer-reviewed articles, spoke on the questions of pharmaceutical regulation and drug costs, comparing the U.S. and Canada.

Public health official and family physician Rosana Pellizzari, MD, discussed the Chaoulli decision and the struggle to resist privatization of health care in Canada. Along the way, Dr. Pellizzari addressed the problem of waitlists in Canada's health system. She included a slide of the lawn sign of the Canadian Health Coalition: "Protect Medicare: Don't privatize it!" Dr. Himmelstein suggested that it was a yard sign that might do just as well south of the Canadian border.

Rocky White, MD, an internist from Alamosa, Colorado, a self-described "hard-core, dyed-in-the-wool, capitalistic, fee-for-service Republican" gave an animated speech. Dr. White became convinced of the need for a single-payer solution after his Nebraska multi-specialty group was forced into a buy-out by the local hospital in 2004 due to the increasing number of uninsured and underinsured. He called upon health care reform activists to work to unite diverse communities around the demand for single-payer health reform, no matter how deep disagreements on other issues might be. He quoted from the Bible to show how he has called upon his own conservative Christian community to stand up for the uninsured. Dr. White also spoke about Martin Luther King, Jr., the 1965 Selma march across the Edmund Pettis Bridge, and passage of the Voting Rights Act as a hopeful example of the tempo that large movements for social change may develop.

Founder of Vermont Health Care for All, Deb Richter, MD, a Vermont family physician and past PNHP president, spoke on the panel together with Dr. White. She showed slides from a talk she has given hundreds of times to make the case that health care reform is in the interest of business. She reported that business people respond favorably to the argument that much of health care costs are fixed infrastructure costs (perhaps more than 70%) that should be borne by the whole society. To illustrate, she tells business people that, when someone goes to the emergency room, we are not paying for the sick person but for the nurse who will be there at the ready.

Ana Malinow, MD, pediatrician at the Harris County Hospital District Ben Taub General Hospital Pediatric Emergency Center and co-founder of Health Care for All Texas, spoke on lessons from Hurricane Katrina. An organizer of the Houston Astrodome medical clinic -- where over 15,000 patient visits took place over a span of two weeks, including 2,000 visits in one day, and at one point, 100 visits per hour -- Dr. Malinow said that practicing medicine had never been so rewarding for the physicians involved: the emergency conditions forced bureaucracy and billing paperwork to vanish, leaving the doctor-patient relationship unfettered. She underscored the strain that Hurricane Katrina placed upon the already stressed Texas health system -- following Hurricane Katrina, some 373,000 people re-located to Texas. (Of these, 59,680 had been covered by Medicaid.) The annual increased cost to the state of Texas could be about $1.6 billion -- provided the health system can absorb the increased demand for services.

From Louisville, Kentucky, Garrett Adams, MD reported on the vigorous work the PNHP chapter there, particularly with successful interventions at a broad range of meetings, "including those to which we were invited as well as those at which we were not invited to speak." Also in attendance from Louisville was Kay Tillow, Director of the Nurses Professional Organization, who has spearheaded an effort to gain union support for HR 676, "The United States Health Insurance Act." At dinner, the Executive Director of the California Nurses Association, Rose Ann DeMoro spoke to the PNHP members. The California Nurses Association recently merged with the AFL-CIO with the specific goal of leading a union campaign for a single-payer health care system.

Dr. Himmelstein, as a panel respondant, offered remarks on the importance of unconventional thought and a diversity of approaches to building a movement for a single-payer health system -- just as the diversity of patients demands a diversity of doctors. He told a story of a patient, a smoker, who had suffered a heart attack. After the episode subsided, the patient went to see a cardiologist. The cardiologist asked if the patient had quit smoking. The patient replied that he had smoked for decades and had no intention of quitting just because he had had a heart attack. The cardiologist, an intense and excitable man, began jumping up and down, swearing at the patient and yelling words to the effect that he would "not take care of a goddamned smoker." This so frightened the man that he quit smoking -- "which is either brilliant medicine or utter malpractice," Dr. Himmelstein concluded.

Don McCanne, MD was welcomed by warm applause as he participated in afternoon panel discussions from the stage. He is the author of the listserv Quote of the Day, which PNHP activists rely upon. He concluded his remarks on the strategy for health reform by saying: "We have a mission to educate. We will educate our colleagues, the policy community, the media, and our patients."

Andrew D. Coates, MD, is a member of Physicians for a National Health Program.

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Medicare for All

Remarks at People’s State of the State Rally
January 3, 2006
Paul Sorum, PhD, MD

As you all well know, as Governor Pataki and our legislators well know, New Yorkers face a growing crisis in health care:

• Health insurance premiums are inexorably rising.
• Businesses, small and large, are struggling under—and are increasingly shedding—the burden of providing health insurance for present and past employees.
• County property tax payers in New York are footing the bill for the ever-rising costs of Medicaid, not because Medicaid patients use more health care—they don’t—but because their care is singled out and its costs passed on to the counties.
• Health providers and patients are drowning in the flood of red tape and regulations issued by the multiplicity of insurers.
• Physicians are plagued by often frivolous malpractice charges and rising malpractice insurance costs.
• And an increasing number of New Yorkers have no or inadequate health insurance.

It is time for Governor Pataki and the legislature to listen to the pleas for help coming from all sides.

It is time for them to make high quality and affordable health care services available to all New York residents.

What in particular should they do?

• First, they should establish a Legislative Commission--as proposed by Assemblyman Richard Gottfried, the chair of the Assembly Health Committee--to study in depth the financial and social implications of the various ways to achieve universal access to health care.
• Second, they should realize that the only way to provide universal coverage in a simple, efficient, and cost-effective manner is to institute in New York State an expanded and comprehensive system of Medicare for All (such as the plan introduced in the Assembly by Assemblyman Gottfried).

Medicare for All would change the financing of medical care (via a single administrative board), not the delivery of it:

• All residents would have access to comprehensive care.
• Providing & receiving care would be simple. All patients would have the same card: Governor Pataki, the legislators, you and me, a homeless person—the same card. It would be accepted by all providers. There would be only 1 set of rules, 1 drug formulary, 1 set of quality improvement measures. Simple and fair.
• You could go to the physician and hospital of your choice. Competition among providers would occur on the basis of quality, not on the basis of price or special deals with insurers.
• Care would be less expensive financially and emotionally. Physicians could take care of patients, not the insurance companies. The armies of people working in the offices of health care providers and of insurers could be put to better uses. And the central board could negotiate lower prices with pharmaceutical companies.
• The Medicaid problem would be gone: again, everyone would have the same card.
• The malpractice threat would be alleviated. The system could set up a no-fault mechanism for compensating patients who have adverse outcomes; and they would have no need to sue to provide for future health care costs.
• Large and small businesses would be out of business of health care.

So, if we had an expanded Medicare for All, patients and physicians, employers and employees, big and small businesses, county administrators and country property tax payers, rich and poor—all would rejoice.

We appeal, therefore, to Governor Pataki and our state legislators to make fundamental health reform a priority in 2006 and to institute an expanded Medicare for All for the citizens of New York.

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