From: Joanne Landy <jlandy at igc.org> Date: August 9, 2006 8:39:28 PM EDT To: lbo-talk at lbo-talk.org Subject: Re: [lbo-talk] Fwd: Change to Win: Stand up for universal health care
Many members of Physicians for a National Health Program participated in the Citizens Health Care Working group sessions held around the country. Below are comments from the NY Metro Chapter of PNHP. --Joanne Landy, Executive Director,PNHP-NY Metro
THE CITIZENS HEALTH CARE WORKING GROUP LISTENED TO THE AMERICAN PUBLIC WITH ONE EAR By Len Rodberg, Ph.D. Physicians for a National Health Program, NY Metro Chapter
The Citizens Health Care Working Group was created by the Medicare Modernization Act of 2003 to provide opportunities for the American public to "engage in an informed national debate to make choices about the services they want covered, what health coverage they want and how they are willing to pay for coverage."After a long and involved process, which included the holding of community meetings in some 40 communities across the country as well as receipt of thousands of online and written individual responses, the CHCWG has issued a set of Interim Recommendations (at www.citizenshealthcare.org) and invited comments on them on a form provided at that site.The deadline for comments is August 31,2006. A month later, the Group will issue final recommendations for consideration by the President and Congress.
The legislation creating the Working Group directed it to submit "an interim set of recommendations on health care coverage and ways to improve and strengthen the health care system based on the information and preferences expressed at the community meetings"(Emphasis ours). (Sec. 1014(h)(4)(D)) The principal recommendation of the Working Group is "It should be public policy that all Americans have affordable health care." This followed from the central message that it heard in these meetings, which it described as follows: "Across every venue we explored, we heard a common message: Americans should have a health care system where everyone participates, regardless of their financial resources or health status, with benefits that are sufficiently comprehensive to provide access to appropriate, high-quality care without endangering individual or family financial security" (Emphasis in original). Accordingly, the Group went on to make the historic pronouncements that (1) "It should be public policy, established in law, that all Americans have affordable health care coverage" and (2) "Assuring health care is a shared social responsibility." (Emphasis ours) However, in their subsequent elaboration, the Working Group seems to ignore, in very important respects, the clearly expressed views of those attending the community meetings. Some key examples: 1. The recommendations assert that "no specific health care financing mechanism is optimal." This conflicts with the views of large majorities of respondents who supported a publicly-funded national program. Twenty-five of 29 community meetings supported "Create a National Health Program" as the most heavily favored answer to the question "If you believe it is important to ensure access to affordable, high quality health care coverage and services for all Americans, is most important to you/which of these proposals would you suggest for doing this?"(Appendix B, p.7). On-line, 72.2% of respondents -- far more than chose any other option -- agreed with the option "Create a national health plan, financed by taxpayers, in which all Americans would get their health insurance."(Appendix C, p. 6) And the CHCWG reported, in "Dialogue with the American People," that "when asked to evaluate different proposals for ensuring access to affordable high quality health coverage and services for all Americans, individuals at all but four meetings ranked …[this option] highest." (p. 41)
2. The CHCWG recommends that a "core" benefit package be defined for all Americans. This seems to have been an assumption of the Working Group rather than a response to the views expressed in community meetings or by individual respondents, who were never asked whether they supported the idea of limited coverage to basic or "core" services. In fact, the Working Group reports in "Dialogue with the American People" that "many participants…were also concerned about arbitrary limits on coverage and were not comfortable with bare-bones benefit packages."(p.2) Moreover, "individuals voiced support for a fairly comprehensive basic benefit design" (p. 10) And these comprehensive services should be affordable; the Working Group reported that "a commonly expressed view was that a simpler system [such as the national program favored by the large majority of respondents] would result in lower administrative costs." (p.3)
The concept of limiting benefits to "core" services grew out of Congress's charge to the Working Group to determine "what trade-offs are the American public willing to make in either benefits or financing to ensure access to affordable, high quality health care coverage and services". However, the clear answer from the public, as expressed in the community meetings and individual responses, was that simplification of the system and cost savings through information technology, quality improvement, and regulation of prices would make such trade-offs unnecessary ("Dialogue" p. 30; online poll items 8e and 12c). As the CHCWG reported in "Dialogue with the American People." "Although worded in a variety of ways, the single most common response to the question about trade-offs can be summarized as 'No trade-offs'."(p. 34)
3. Beyond its proposed limitation to core services, the CHCWG's discussion of Recommendation 1 suggests that even for core services they are thinking of means-tested co-payments. Community meetings and individual respondents rejected this approach. The Working Group says, "Financial assistance will be available to those who need it." Three paragraphs later they comment that certain financial protections "such as those against catastrophic [and impoverishing] health care expenditures" may need to wait until some efficiency gains are realized. And, in discussing Recommendation 5, they call for providing consumer information on cost sharing in federally funded health programs.
The primary purpose of health care reform is to ensure that financial barriers do not keep anyone from receiving necessary care. But because the CHCWG has largely failed to focus on any cost control strategy other than limiting covered services to a "core" set, their recommendations are potentially harmful to people's health. Shared social responsibility at the level of system financing means that people contribute according to their ability. But the CHCWG's recommendations abuse this principle when they extend it to mean cost sharing at the point that someone needs health care. The threat of facing out-of-pocket costs would deter many from getting needed care. Justifying cost sharing at the point of service delivery is a socially irresponsible way to apply the principle of shared social responsibility.
Comments on the Interim Recommendations
Recommendation 1: It should be public policy that all Americans have affordable health care.
We applaud this recommendation. It is encouraging to see an entity created by the U.S. Government supporting the concept of universal health care, the principle that everyone in this country should have access to the health care they need without facing financial barriers that would discourage them from seeking care. We believe it is long past time for the United States to move toward this goal, which every other advanced country has already achieved.
We do not, however, accept the idea, which the CHCWG supports, that Americans should have access to only a "core" set of services, with the wealthy able to buy their way into more services. Other, less wealthy countries have shown that comprehensive services can be made available to everyone without creating such a two-class system. An American system should also provide access to a comprehensive set of services, without bias or exclusion.
Further, the concept of making "financial assistance available to those who need it" suggests that this will be a means-tested system. We believe that everyone should have access to health care without having to face such demeaning examinations of their finances.
We believe there should be a universal, government-financed system of national health insurance that will make health care available to everyone. This country has the financial means to do this; in fact, many studies show that we can do this without spending any more than now.
Recommendation 2: Define a "core" benefit package for all Americans.
As we have stated above, we do not accept the concept of this recommendation. Experience with Medicare in this country, and with the health systems of many other countries, has shown that comprehensive benefits can be provided without excessive spending and without creating a two-class system, one for those who can afford only "core" services and another for those who can afford to buy more. We need to avoid such a two-tiered system; this country should move as quickly as possible to a single system for all.
Recommendation 3: Guarantee financial protection against very high health care costs.
A comprehensive, publicly-financed system could provide access to a full range of services without need for any special "catastrophic" coverage such as this recommendation suggests. Further, since such a system will facilitate access to low-cost primary care, this will reduce the need for the high-cost services that this recommendation addresses.
Recommendation 4: Support integrated community health networks.
We support this recommendation. Such networks are an efficient, community-friendly way of providing services.
Recommendation 5: Promote efforts to improve quality of care and efficiency.
We strongly support this recommendation. We believe that creating a universal, publicly-financed system will provide the best means of achieving this, since this will enable the quality of care to be measured and the current wasteful administrative costs of private insurance to be eliminated.
Recommendation 6: Fundamentally restructure the way palliative care, hospice care and other end-of-life services are financed and provided.
We strongly support this recommendation as well. We are a humane society, and we should show treat our people humanely throughout their lives, including at the end of life.
> At 05:37 PM 8/9/2006 -0400, you wrote:
>
> --- Change to Win <takeaction at changetowin.org> wrote:
>
> Date: Wed, 09 Aug 2006 21:04:07 GMT
> From: "Change to Win" <takeaction at changetowin.org>
> Subject: Stand up for universal health care
>
> We believe that the time has come for universal health care --
> and you can help make it a reality.
>
> The Citizens' Health Care Working Group was set up by Congress
> to find out how to fix our broken health care system. It is
> currently talking to average Americans around the country to
> find out how we feel about the state of health care today.
>
> This important group has developed a set of proposed solutions
> for the health care crisis, and they are seeking comments from
> the public on their recommendations. The comment period ends on
> August 31 -- and with it, our opportunity to ensure that the
> needs of working people are addressed when the recommendations
> are presented to Congress.
>
> You can help by submitting comments on the Working Group's
> recommendations. Follow this link to go to a Web page where you
> can read and comment on each recommendation:
>
> * http://www.citizenshealthcare.gov/speak_out/ircomment1.php
>
> There are six different recommendations on the online form that
> you can comment on. We believe the last two recommendations on
> this form are the most important ones to comment on. While they
> are not numbered online, they are Recommendation 5 (which has
> two parts) and Recommendation 6.
>
> We've prepared talking points for you to look over as you
> provide your comments on these two recommendations. You can
> download them (in Adobe PDF format) by following this link:
>
> * http://www.changetowin.org/pdf/CHCWGTalkingPoints.pdf
>
> If you would like more information, including an analysis and
> critique of the Working Group's recommendations, you can go
> here:
>
> * http://www.uhcan.org/campaign/files/resources/analysis.doc
>
> Working people's voices need to be heard in this debate. The
> health of our families depends on it. Help us make a better
> future by standing up for universal health care today!
>
> Thanks for all your support,
>
> Anna Burger
> Chair, Change to Win
>
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