Rendell to push health coverage

From today's Philly Inquirer. Sounds like a proposal to support nurse practitioners and not a supporter of single payer.

He plans a major initiative to insure more people and to make care more efficient.
By Amy Worden and Angela Couloumbis
Inquirer Harrisburg Bureau
HARRISBURG - Gov. Rendell next month will unveil a plan to greatly expand health-care coverage for the uninsured while attempting to rein in spiraling health-care costs, a move he said was sure to produce "widespread squawking."

In what is likely to be a key initiative of his second-term agenda, Rendell yesterday offered few details about the two-pronged proposal, except to say it was aimed at providing medical coverage to roughly one million uninsured Pennsylvanians and targeting providers with cost-containment measures.

Speaking at his annual year-end interview with Capitol reporters, the governor said he felt compelled to act because of the increasing number of uninsured residents in Pennsylvania.

"It used to be that health care was a poor people's issue," he said. "... But now, retirees who thought they had health care that was guaranteed for life are seeing that health care vanish and disappear. Workers, each time their contract is up, having to co-pay more and more for their own health care... . So even if I am a worker who has health-care coverage, I'm worried."

It was unclear how much of Rendell's proposal could be completed through the regulatory process or executive order, and what elements would need legislative approval.

Hinting that a possible battle with the General Assembly was looming, Rendell challenged all parties involved to find the "intestinal fortitude to look down the barrel of the special interests" to support the proposal.

"This plan will mete out pain to everybody in the health-care delivery system - everyone," said Rendell. "It will step on everyone's toes. It will make everyone tighten their belts. It will make everyone have to do things more effectively and efficiently."

The governor did tick off several cost-cutting measures he said he would include in next month's proposal, including implementing measures to reduce infections that patients might get while in the hospital; changing regulations to allow nurse-practitioners to handle some duties now performed under the supervision of doctors; and adding new sections within hospital emergency rooms, staffed by nurse-practitioners, to treat minor ailments and injuries.

Referring to the expanded insurance coverage, Rendell made it clear yesterday that his proposal would not follow Massachusetts' universal health-care plan, set to go into effect next spring, which works through government funding and pooled contributions from employers.

Rendell said his insurance proposal would follow the model of how he expanded the Children's Health Insurance Program (CHIP) this year "with pay-ins depending on your income level."

"I'm not proposing a single-payer system," he said. "A single-payer system means that [a private employer] doesn't need to have its own health-care plan because everyone goes into one statewide plan, but then everyone pays significant taxes to fund that plan.

"We think that is less achievable and less workable," he said.

According to the U.S. Census Bureau, 1.3 million Pennsylvania residents - 10.5 percent of the state's population - lacked health insurance in 2005.

Several groups representing hospitals and doctors said yesterday that they did not want to weigh in on the governor's plan until they could review the complete proposal.

In general, however, most agreed that changes needed to be made - the debate would be over what those changes should be.

"Any systemic reform is going to involve a lot of different stakeholders and no doubt there will be robust debate of every piece of it," said Andrew Wigglesworth, president of the Delaware Valley Healthcare Council, an association of hospitals and health systems in Southeastern Pennsylvania, New Jersey and Delaware.

Chuck Moran, director of media relations for the Pennsylvania Medical Society, said some of the group's members had participated in committees Rendell had put together during the last year to study the health-care issue. Those members, he said, "have been sworn to secrecy."

But Moran said the society believes physicians and nurse practitioners must be "partners," and that any concerns about expanding the powers of nurses "usually involve invasive procedures, and what kinds of medication they can prescribe."

Others, such as Roger Baumgarten, spokesman for the Hospital & Healthsystem Association of Pennsylvania, pointed out that there is a shortage of nurse practitioners in Pennsylvania.

"We look forward to seeing how that is addressed as well," he said.

Rendell said studies show that nurse practitioners can handle 70 percent of what doctors do, so there was no reason not to use nurse practitioners more widely.

"I want to free nurse practitioners to virtually do anything that they are capable of doing and unlock all the regulations and restrictions and put them back into the game," he said. "You don't open up brain surgery to nurse practitioners, but those things that academics believe they can do, they can do."

Rendell used himself - and the state's insurance plan - as an example to illustrate how health-care costs can be cut. He said he was recently notified that if he wanted to continue taking the brand-name anti-cholesterol drug Zocor, he would have to pay $160 per prescription, compared with $10 for the generic version.

"I panicked because I've done so well on Zocor and my doctor had me read the generic that they had specified, and in the end, my doctor said don't worry, it's exactly the same," said Rendell. "The point is, we are doing things that businesses should be doing. And we want to make it easier for businesses to do those things."

Contact staff writer Amy Worden at 717-783-2584 or aworden@phillynews.com.

Single payer video from Calif

While about single payer in California, you may find this an interesting video explaining single payer.