We deserve U.S. health care

We deserve U.S. health care
Most citizens back national insurance. A bill in Congress would provide this.
By Adam Gilden Tsai

Imagine if Congress passed a bill requiring national public discussions regarding the state of health care in America. Then imagine that these discussions actually happened across our country, and that across the country there was actually a consensus that we need national health insurance to ensure that everyone has access to care. Finally, imagine that when the final report, to be presented to the President and Congress, is drafted, the report makes no mention of this consensus.

There is no need to imagine these things because they have actually happened. The same act that created the Medicare prescription-drug plan mandated the Citizens' Health Care Working Group (www.citizenshealthcare.gov). The group, which included people from medical and public-health backgrounds, held meetings in cities across the country this year. The questions asked (and voted on) at each meeting were the same, and fell into several categories: what health-care services are important; how health care should be delivered; how best to pay for care; and what trade-offs Americans are willing to make to ensure access to quality affordable health care.

I attended the Philadelphia meeting in April, and there was a range of opinions on some of the topics discussed. Some people voiced a need for better coverage of services such as eye and dental care; others wanted more comprehensive end-of-life care; and still others felt we needed a more rigorous system of health education. There also were differences of opinion on financing issues. For example, some people believe that only the most basic level of benefits should be covered and that everything else should be paid for out-of-pocket, while others felt that anything deemed effective by providers and patients should be covered.

One thing, however, on which there was strong consensus at the Philadelphia meeting, and across the country, was that we need a national health-care system to ensure that everyone has access to care. In fact, when given a choice of 10 reform options, participants in most cities clearly favored a national health program by a ratio of at least 3-1. At meetings where participants were asked to rank the 10 options, national health insurance was ranked first 16 of 19 times (Billings, Mont.; Denver; Des Moines, Iowa; Detroit; Eugene, Ore.; Indianapolis; Jackson, Miss.; Kansas City, Mo.; Memphis, Tenn.; Miami; New York; Philadelphia; Phoenix; Providence, R.I.; Sacramento, Calif.; and Seattle). At two meetings, participants were not polled and options were not ranked.

Despite the clear public mandate, the Citizens' Health Care Working Group's report makes no mention of the vast support for a national health program. Instead, the group's official recommendations include only generic suggestions such as promoting "efforts to improve quality of care and efficiency" and finding a way to protect "against very high health costs."

From my experience, most supporters of a national health program favor a single-payer system, which retains the private delivery of health care by physicians and hospitals, but organizes payment under a single public agency. A 2003 study in the New England Journal of Medicine found that a single-payer national health-insurance program would save enough on administrative costs - more than $300 billion per year - to cover all of the uninsured and provide full benefits for everyone else.

Public opinion polls show that Americans favor a system of tax-financed health insurance by a 2-1 ratio, as opposed to our current system linking coverage to employment. A May 2006 Keystone poll found that 66 percent of Pennsylvanians favor the U.S. government guaranteeing health insurance to its citizens even if it means raising taxes. The main obstacle to universal health care is the health-insurance industry, which has made a mint covering healthy people who don't use very much care while avoiding the sick patients who need coverage the most.

If our politicians are listening, they'll realize we don't need Wall Street-controlled health-insurance plans to provide us with health care. We need a streamlined system that can provide quality affordable health care for all. U.S. Rep. John Conyers of Michigan has introduced such a bill, the U.S. National Health Insurance Act, also known as House Resolution 676. We should all be pressuring our senators and representatives to support it.
Adam Gilden Tsai, MD, of Philadelphia, is a member of Physicians for a National Health Program (www.pnhp.org), a not-for-profit group that advocates for a tax-funded, privately delivered system of national health insurance.

Cover All Kids passes, but only a band aid

Press release: Gov. Rendell pleased his Cover All Kids program gets
overwhelming vote in both Chambers.

HARRISBURG -- Governor Edward G. Rendell cheered the House of
Representatives' overwhelming passage of House Bill 2699, his Cover All
Kids initiative, which will enable Pennsylvania's hard working families
to purchase affordable health insurance for their children. The
Pennsylvania Senate also unanimously supported the bill early Tuesday
morning. Currently, 133,000 of Pennsylvania's children are uninsured.

"Under my Cover All Kids program, parents will be able to afford to
insure their children families because the monthly cost will be based on
how much they can afford to pay," said Governor Rendell.

Currently, CHIP is free for children from families with incomes under
$40,000 (family of four - 200 percent of the federal poverty level) and
available at a reduced cost for children with family incomes of $47,000
(family of four - 200 percent - 235 percent of FPL).

Under Cover All Kids 100 percent of the parents who currently cannot
afford to ensure their children will get assistance from the state to
ensure that the cost of health insurance for their children is
reasonable.

Under House Bill 2699 the monthly cost for parents is based on a sliding
scale:

* $36 a month per child for a family earning 200 percent - 250 percent
of FPL (under $50,000 for a family of four)

* $50 a month per child for a family earning 250 percent -275 percent of
FPL ($50,000- $55,000 for a family of four)

* $57 a month per child for a family earning 275 percent - 300 percent
of FPL ($55,000-$60,000 for a family of four)

Families that cannot find or afford private health insurance for their
children who are earning above 300 percent of the FPL ($60,000 a month
for a family of four) can purchase the coverage at the state cost based
on certain eligibility requirements. These families must show that
coverage was denied due to a pre-existing condition, or the cost of
private coverage totals more than 10 percent of the family's annual
income, or cost of private insurance one and a half times (150 percent)
more than the state monthly per child cost for Cover All Kids.

If parents can purchase coverage for their children through their
employer but are unable to afford the full premium, the state will
provide assistance to the family to pay the premiums for private
insurance, rather than enrolling the child in CHIP - if the cost of the
private premium is less than the monthly cost to the state of the Cover
All Kids premium.

To discourage parents from dropping private coverage to take advantage
of the state subsidy, Cover All Kids a "go bare period" that requires
families show that their child has not had coverage for the last six
months, unless the child is two years of age or less. The "go bare
period" is not required for infants, or for children who have lost
coverage because a parent lost their job or they are moving from another
public insurance program.

The 2006-07 state budget includes $4.5 million for Cover All Kids, which
will be used to draw down additional federal funds This bill allows the
state to step up our outreach for existing programs for children, such
as CHIP and Medicaid (MA) to ensure every kid who qualifies is signed up
and covered.

Contact: Kate Philips, 717-783-1116

Langfitt Memorial Lecture Debate on Universal Health Care

12th Annual Thomas Langfitt Jr. Memorial Symposium

Innovative Approaches to Universal Health Coverage:

Massachusetts and Beyond



Wednesday, November 8th
6:00 PM
BRB II/III Auditorium (421 Curie Blvd.)
(Reception with wine and hors d'oeuvres to follow)

~~ RSVP by November 3rd~~

Stuart H. Altman, PhD, Dean of the Heller School for Social Policy and Management at Brandeis University and central architect of the new Massachusetts universal coverage legislation. One of the nation's leading experts on health care policy and economics, Professor Altman is a member of The Institute of Medicine of the National Academy of Sciences, Chair of The Robert Wood Johnson Foundation sponsored Council on the Economic Impact of Health System Change, and was a senior member of the Clinton-Gore Health Policy Transition Team. In August 2003 Modern Healthcare named him among the 100 Most Powerful People in Healthcare.

Steffie Woolhandler, MD, Associate Professor of Medicine at Harvard Medical School and co-director of the Harvard General Internal Medicine Fellowship Program. Dr. Woolhandler has been one of the most passionate advocates for single-payer universal coverage since co-founding Physicians for a National Health Program (PNHP) in 1987. She has also been one of the most outspoken critics of the new Massachusetts universal coverage legislation.

Patricia Danzon, PhD, Professor and Chair of the Health Care Systems Department at Wharton. Professor Danzon is a renowned health care economist whose major research interests include the international pharmaceutical industry, health care economics and policy, managed care, and medical liability systems. She is also an associate editor of the Journal of Health Economics and an adjunct scholar at the American Enterprise Institute.

Moderated by Sandford Schwartz, MD, Professor of Medicine, Health Care Management, and Economics, and Nicholas Stine, 2nd-year Penn medical student.

The Langfitt Memorial Symposium is named for the son of the late Dr. Thomas W. Langfitt, a longtime and cherished chairman of neurosurgery at Penn and former president ofthe Pew Charitable Trusts. Sponsored by The Langfitt Family, the University of Pennsylvania School of Medicine, and the Leonard Davis Institute of Health Economics

Citizens Working Group Final Recommendations fails

The federally mandated Citizens Working Group released its final recommendationsin August 2006. Their recommendations do not support the overwhelming sentiment given at the Philadelphia Town Meeting for single payer, national health insurance. We have written our objections and if you want to read our letter to the CWG, you can go to this web address.

http://www.citizenshealthcare.gov/recommendations/orgs/pacdhc.pdf