| Decision 2009: Healthcare Reform Question: What needs to be reformed in healthcare and what should be the key features of a reformed healthcare system? |
Dr. Frank Byrne,
President, St. Mary's
Hospital
President, St. Mary's
Hospital
Meanwhile, the numbers of uninsured increase. Those without insurance tend to seek care later and have worse outcomes. They have more complications
from their diabetes, or their breast cancer is more advanced due to delay in seeking care.
A recent nationwide poll shows that eight of ten Americans believe our health system needs either fundamental change or complete rebuilding. To quote
President Obama in his inauguration speech, “Health care reform cannot wait, it must not wait, and it will not wait another year.”
We must move our country toward a high performance health system that helps everyone, to the extent possible, lead longer, healthier, and more productive
lives. To achieve meaningful health care form, we need to accomplish five goals:
Goal #1: Provide accessible care for everyone. Everyone needs to be covered by health insurance which covers preventive care and catastrophic
coverage. All Americans need a primary care “home,” a medical provider who knows them and coordinates all their care. In Dane County, our United Way led a
successful collaboration of area hospitals, clinics and insurers in its Healthcare Access Pilot program. At the state level, Wisconsin has shown leadership in
expanding Medicaid services to more residents.
As we expand coverage, we also need to eliminate disparities. National research has shown that minorities overall are much less likely to get preventative
care or proper treatment when needed.
Goal #2: Better manage chronic diseases. Health care costs for six chronic conditions account for 75 percent of all health care expenses. Yet the benefits
from chronic disease management don’t align with financial incentives for insurers. For example, insurers, with a one-year contracting cycle, have little
incentive to pay for a comprehensive diabetes management program, which might take up to ten years to yield positive financial results. Compare that to what
happens weekly at our Dean & St. Mary’s Neighborhood Asthma Clinic. With proper education and treatment, asthma patients can feel better, miss less work and
school and reduce their health care costs beginning the same day! Likewise, mental health care needs improvement. In Dane County, the uninsured can
sometimes wait up to nine months for mental health care.
Goal #3: Provide proven preventative care. More—but not nearly enough—businesses are offering incentives for employees to have health screenings,
participate in exercise programs, and lose weight. A U.S. Chamber of Commerce report has shown the return on investment for these programs is $3.50 for each
dollar spent.
Goal #4: Improve patient safety and efficiency. While Wisconsin ranks high among all states in quality of health care, the disparities from state to state are
astounding. All providers need to continue efforts to improve patient safety, such as utilizing the electronic medical record recently implemented at St. Mary’s.
Goal #5: Ensure quality and cost transparency. All providers should be accountable for their costs and their outcomes, and consumers should have access
to this information. Wisconsin is nationally recognized as a leader in this area. One recent hospital trade publication article noted, “In Wisconsin the issue isn’t
about whether to report quality and cost information, it’s about how quickly the information can be made public.” Want more information? Go to www.
WisconsinHealthReports.org, where you can find comparative information. It’s not perfect, but we’re getting there.
There’s no question that health care reform is complicated, and there is no easy solution. However, the wheels of change are finally moving. It will take all
of us working together: employers, consumers, providers, government and insurers.
We here in Wisconsin are well-positioned to play a key role in leading this change. Let’s get to work!
from their diabetes, or their breast cancer is more advanced due to delay in seeking care.
A recent nationwide poll shows that eight of ten Americans believe our health system needs either fundamental change or complete rebuilding. To quote
President Obama in his inauguration speech, “Health care reform cannot wait, it must not wait, and it will not wait another year.”
We must move our country toward a high performance health system that helps everyone, to the extent possible, lead longer, healthier, and more productive
lives. To achieve meaningful health care form, we need to accomplish five goals:
Goal #1: Provide accessible care for everyone. Everyone needs to be covered by health insurance which covers preventive care and catastrophic
coverage. All Americans need a primary care “home,” a medical provider who knows them and coordinates all their care. In Dane County, our United Way led a
successful collaboration of area hospitals, clinics and insurers in its Healthcare Access Pilot program. At the state level, Wisconsin has shown leadership in
expanding Medicaid services to more residents.
As we expand coverage, we also need to eliminate disparities. National research has shown that minorities overall are much less likely to get preventative
care or proper treatment when needed.
Goal #2: Better manage chronic diseases. Health care costs for six chronic conditions account for 75 percent of all health care expenses. Yet the benefits
from chronic disease management don’t align with financial incentives for insurers. For example, insurers, with a one-year contracting cycle, have little
incentive to pay for a comprehensive diabetes management program, which might take up to ten years to yield positive financial results. Compare that to what
happens weekly at our Dean & St. Mary’s Neighborhood Asthma Clinic. With proper education and treatment, asthma patients can feel better, miss less work and
school and reduce their health care costs beginning the same day! Likewise, mental health care needs improvement. In Dane County, the uninsured can
sometimes wait up to nine months for mental health care.
Goal #3: Provide proven preventative care. More—but not nearly enough—businesses are offering incentives for employees to have health screenings,
participate in exercise programs, and lose weight. A U.S. Chamber of Commerce report has shown the return on investment for these programs is $3.50 for each
dollar spent.
Goal #4: Improve patient safety and efficiency. While Wisconsin ranks high among all states in quality of health care, the disparities from state to state are
astounding. All providers need to continue efforts to improve patient safety, such as utilizing the electronic medical record recently implemented at St. Mary’s.
Goal #5: Ensure quality and cost transparency. All providers should be accountable for their costs and their outcomes, and consumers should have access
to this information. Wisconsin is nationally recognized as a leader in this area. One recent hospital trade publication article noted, “In Wisconsin the issue isn’t
about whether to report quality and cost information, it’s about how quickly the information can be made public.” Want more information? Go to www.
WisconsinHealthReports.org, where you can find comparative information. It’s not perfect, but we’re getting there.
There’s no question that health care reform is complicated, and there is no easy solution. However, the wheels of change are finally moving. It will take all
of us working together: employers, consumers, providers, government and insurers.
We here in Wisconsin are well-positioned to play a key role in leading this change. Let’s get to work!
The Time for Health Care Reform Is Now
$2,304,800,000,000. That’s how much was spent in the U.S. for health care in 2008. What did we get for that cost? Of all
industrialized nations in the world, we have the highest health care cost per capita, yet we are the only country failing to provide
health coverage for all citizens. We rank last in deaths preventable with timely and effective health care.
In 2008, the Commonwealth Fund (Commonwealthfund.org) gave the American health care system a score of 65 of 100. In almost
every area measured, our system fares worse than two years ago.
So who pays for this health care system that is headed in the wrong direction, or, put another way, “Where did my pay increase
go?” Over seven years, while salary increases rose 16 percent, health insurance premiums rose 74 percent.
Not only do you pay for your own care, but you pay for the care of those unable to pay. In America we use the “Robin Hood Method
of Health Care Financing.” Those with insurance pay more to cover the health care costs of those covered by underfunded
government programs or those with no insurance.
Meanwhile, costs continue to escalate. Increasing shortages in many health care professions has pushed up salaries. New
technology improves our care, but is expensive. Our population is aging, and requiring more health care services. The number of
overweight Americans has skyrocketed—in Wisconsin from 11 percent in 1990 to 27 percent in 2007— increasing risk for obesity-
related health conditions.
$2,304,800,000,000. That’s how much was spent in the U.S. for health care in 2008. What did we get for that cost? Of all
industrialized nations in the world, we have the highest health care cost per capita, yet we are the only country failing to provide
health coverage for all citizens. We rank last in deaths preventable with timely and effective health care.
In 2008, the Commonwealth Fund (Commonwealthfund.org) gave the American health care system a score of 65 of 100. In almost
every area measured, our system fares worse than two years ago.
So who pays for this health care system that is headed in the wrong direction, or, put another way, “Where did my pay increase
go?” Over seven years, while salary increases rose 16 percent, health insurance premiums rose 74 percent.
Not only do you pay for your own care, but you pay for the care of those unable to pay. In America we use the “Robin Hood Method
of Health Care Financing.” Those with insurance pay more to cover the health care costs of those covered by underfunded
government programs or those with no insurance.
Meanwhile, costs continue to escalate. Increasing shortages in many health care professions has pushed up salaries. New
technology improves our care, but is expensive. Our population is aging, and requiring more health care services. The number of
overweight Americans has skyrocketed—in Wisconsin from 11 percent in 1990 to 27 percent in 2007— increasing risk for obesity-
related health conditions.
Dr. Michelle DeBose,
Wisconsin Minority Health
Officer
Wisconsin Minority Health
Officer
Wellness and prevention should be a priority, rather than the billons of dollars we see in chronic disease management. Increased quality of care would
result in lower costs so that employers could afford to continue to offer health coverage, especially small business owners. Public health programs that target
wellness and prevention should be linked to health care coverage and the coverage should be portable, so that consumers do not need the added burden of
having job based coverage in order to retain health care coverage.
Most Americans obtain health insurance coverage through their employers. With the cost of health insurance outpacing inflation and wage increases, more
employers are forced to opt out of the market. Family incomes have not kept pace with health care inflation making non-group coverage unaffordable for most
low-income families. In addition, moving from one job to the next should not cause consumers or their families to lose health insurance. The waiting period to
reestablish heath coverage can vary between three, six or nine months to regain coverage.
Access to health care is not as simple as one might think. According to the 2007 Wisconsin Family Healh Survey, it was estimated 93% of Wisconsin household
residents were insured at that point in time, leaving only 6% uninsured.
Hispanics and African Americans also have differential access to a regular doctor or source of care, with Hispanics particularly at risk. As many as 43
percent of Hispanics and 21 percent of African Americans report they have no regular doctor or source of care, compared with 15 percent of whites and 16
percent of Asian Americans. Access to health care is a problem for American Indians and Alaska Natives, who are second only to Hispanics in lacking health
insurance and a significant number of Korean Americans have never heard of the Pap test, a decades-old standard for cervical cancer screening.1
Improve the quality of health care by increasing the value of a more diverse workforce. We must invest in minority students to encourage an interest in the health
care profession. We need to triple our efforts and reach out to students as early as middle school. We need health care professionals to be representative of our
communities, as we more forward to a more diverse nation; we need to follow suit with its workforce in health care.
Bringing more diversity into the health care work force as key features of heath care reform accomplishes several things: patients and providers with the
same background work well together and cultural competency impacts quality of care. This includes behavior as simple as familiarity with the values and
customs of patients, as well as language proficiency to make it possible for provider and patient to communicate freely.
To increase the size of the minority work force, we should encourage minority students to get into the health field beginning in middle school and
continuing through college. Working with Historical Black Colleges and Universities, as well as, major institutions and by exploring the creation of community -
academic-private partnerships are methods in which we can achieve this goal and help reduce disparities.
Healthcare reform is a problem for all of us, not just the poor, the uninsured or minority populations. Everybody needs to be aware of this problem. It affects
everyone. We need everybody involved.
result in lower costs so that employers could afford to continue to offer health coverage, especially small business owners. Public health programs that target
wellness and prevention should be linked to health care coverage and the coverage should be portable, so that consumers do not need the added burden of
having job based coverage in order to retain health care coverage.
Most Americans obtain health insurance coverage through their employers. With the cost of health insurance outpacing inflation and wage increases, more
employers are forced to opt out of the market. Family incomes have not kept pace with health care inflation making non-group coverage unaffordable for most
low-income families. In addition, moving from one job to the next should not cause consumers or their families to lose health insurance. The waiting period to
reestablish heath coverage can vary between three, six or nine months to regain coverage.
Access to health care is not as simple as one might think. According to the 2007 Wisconsin Family Healh Survey, it was estimated 93% of Wisconsin household
residents were insured at that point in time, leaving only 6% uninsured.
Hispanics and African Americans also have differential access to a regular doctor or source of care, with Hispanics particularly at risk. As many as 43
percent of Hispanics and 21 percent of African Americans report they have no regular doctor or source of care, compared with 15 percent of whites and 16
percent of Asian Americans. Access to health care is a problem for American Indians and Alaska Natives, who are second only to Hispanics in lacking health
insurance and a significant number of Korean Americans have never heard of the Pap test, a decades-old standard for cervical cancer screening.1
Improve the quality of health care by increasing the value of a more diverse workforce. We must invest in minority students to encourage an interest in the health
care profession. We need to triple our efforts and reach out to students as early as middle school. We need health care professionals to be representative of our
communities, as we more forward to a more diverse nation; we need to follow suit with its workforce in health care.
Bringing more diversity into the health care work force as key features of heath care reform accomplishes several things: patients and providers with the
same background work well together and cultural competency impacts quality of care. This includes behavior as simple as familiarity with the values and
customs of patients, as well as language proficiency to make it possible for provider and patient to communicate freely.
To increase the size of the minority work force, we should encourage minority students to get into the health field beginning in middle school and
continuing through college. Working with Historical Black Colleges and Universities, as well as, major institutions and by exploring the creation of community -
academic-private partnerships are methods in which we can achieve this goal and help reduce disparities.
Healthcare reform is a problem for all of us, not just the poor, the uninsured or minority populations. Everybody needs to be aware of this problem. It affects
everyone. We need everybody involved.
The good news is that we are all aware that essential changes are needed in health care delivery in the United States,
Wisconsin is not alone. Ongoing efforts to improve the quality of patient care have been central to reforming our overwrought
health system, in Wisconsin.
Health care costs are linked to income and the economy. Whether you are insured, underinsured, or uninsured, the quality of
care in the American health care system affects you. Far too many consumers utilize emergency rooms for primary care services.
This creates an over-burdened emergency care system nationwide. It also leads to inefficiency in care management, late stage
diagnosis of disease and other numerous inconsistencies in care. In addition many Americans experience unequal health care
outcomes because of race, ethnicity, and income.
There are several key features of what a “truly” reformed health care system might look like. It should have a high-performing
health care system with the greatest access to affordable, quality health care coverage possible, regardless of age, medical
history, race or ethnicity. Health care costs should also reflect your ability to pay. Currently, the cost of care for the uninsured is
largely borne by those with insurance, providers charge higher prices to a patient with private coverage to make up for
uncompensated care and these costs are passed on to consumers and businesses in the form of high premiums. The more we
expand access to health insurance the more we reduce the shift of these costs to those with insurance.
Wisconsin is not alone. Ongoing efforts to improve the quality of patient care have been central to reforming our overwrought
health system, in Wisconsin.
Health care costs are linked to income and the economy. Whether you are insured, underinsured, or uninsured, the quality of
care in the American health care system affects you. Far too many consumers utilize emergency rooms for primary care services.
This creates an over-burdened emergency care system nationwide. It also leads to inefficiency in care management, late stage
diagnosis of disease and other numerous inconsistencies in care. In addition many Americans experience unequal health care
outcomes because of race, ethnicity, and income.
There are several key features of what a “truly” reformed health care system might look like. It should have a high-performing
health care system with the greatest access to affordable, quality health care coverage possible, regardless of age, medical
history, race or ethnicity. Health care costs should also reflect your ability to pay. Currently, the cost of care for the uninsured is
largely borne by those with insurance, providers charge higher prices to a patient with private coverage to make up for
uncompensated care and these costs are passed on to consumers and businesses in the form of high premiums. The more we
expand access to health insurance the more we reduce the shift of these costs to those with insurance.
Gabriela de la Cruz,
Consumer
Consumer
had to undergo important tests because of complicated health problems, his doctor was even trying to compute the cheapest form of lab tests to do! And when
we visit our doctors, why do they have to time our visit to, say, a maximum of 15 minutes each? And, how much, on the average does each of us in the family
pay every month to our health insurance companies, plus co-pays? I am paying more than $800 a month just for myself! And for major health operations or
expensive dental work, I choose to go abroad for treatment. Isn’t that shameful to America?
Rising health insurance costs have forced many small business owners to lay off employees and/or totally close shop. I am a small business owner, too, and
I feel the high cost of health insurance is strangling us.
I appeal to Pres. Barack Obama to please fulfill his promise for a universal health care. All Americans deserve a better health care system fully supported by
our government. Health care must be considered the business of our government, not the private sector’s.
we visit our doctors, why do they have to time our visit to, say, a maximum of 15 minutes each? And, how much, on the average does each of us in the family
pay every month to our health insurance companies, plus co-pays? I am paying more than $800 a month just for myself! And for major health operations or
expensive dental work, I choose to go abroad for treatment. Isn’t that shameful to America?
Rising health insurance costs have forced many small business owners to lay off employees and/or totally close shop. I am a small business owner, too, and
I feel the high cost of health insurance is strangling us.
I appeal to Pres. Barack Obama to please fulfill his promise for a universal health care. All Americans deserve a better health care system fully supported by
our government. Health care must be considered the business of our government, not the private sector’s.
The United States is the only wealthy and industrialized nation on earth — according to the Institute of Medicine of the National
Academy of Sciences — that doesn’t ensure that all its citizens have health coverage. I am saddened that 45.7 million Americans —
15.3 percent of the U.S population — have NO insurance coverage, which means these millions have NO access to health care! I am
saddened by the fact that we, American consumers, have been relegated to the back seat as far as decisions for our health care is
concerned. For decades now since the ‘70s, we have allowed our politicians to “take care” of our health through the institution of a
private health insurance system which has been draining the personal resources of consumers like me. This system has been siphoning
off whatever is left of my bone marrow, especially during these hard times.
The ongoing debate on health care reform in the United States centers around these questions: right and access to health care,
equality of treatment, quality of medical attention, and cost. As a consumer and as a taxpayer in this wealthiest democratic nation on
earth, I think my government should make sure that I, as well as all Americans like me, should equally have the right and access to high
quality health care at minimal cost, at all times.
Why should private business (the insurance industry) be allowed to decide on our health? When my mother was in the hospital
nearing death, a representative of her health insurance “visited” us in the hospital every day to convince us to take her home! The
insurance company couldn’t wait for my mother to die because its “bills” were soaring! How cold could that be? When my brother
Academy of Sciences — that doesn’t ensure that all its citizens have health coverage. I am saddened that 45.7 million Americans —
15.3 percent of the U.S population — have NO insurance coverage, which means these millions have NO access to health care! I am
saddened by the fact that we, American consumers, have been relegated to the back seat as far as decisions for our health care is
concerned. For decades now since the ‘70s, we have allowed our politicians to “take care” of our health through the institution of a
private health insurance system which has been draining the personal resources of consumers like me. This system has been siphoning
off whatever is left of my bone marrow, especially during these hard times.
The ongoing debate on health care reform in the United States centers around these questions: right and access to health care,
equality of treatment, quality of medical attention, and cost. As a consumer and as a taxpayer in this wealthiest democratic nation on
earth, I think my government should make sure that I, as well as all Americans like me, should equally have the right and access to high
quality health care at minimal cost, at all times.
Why should private business (the insurance industry) be allowed to decide on our health? When my mother was in the hospital
nearing death, a representative of her health insurance “visited” us in the hospital every day to convince us to take her home! The
insurance company couldn’t wait for my mother to die because its “bills” were soaring! How cold could that be? When my brother
We Need to Fix the Health Care System
The U.S. health care system is in a state of crisis. Costs continue to rise astronomically, the public health workforce will soon be
unable to keep up with growing demands, more than 50 million Americans lack health insurance, and another 25 million are
underinsured.
Health care must be seen as a human right, not a luxury. I support the American Nurses Association position that Americans are
entitled to ready access to quality and affordable health care services offered by an adequately sized and well-educated workforce.
Quality health care is safe, effective, and timely care that meets patients’ needs. It is equitable, acknowledging but not discriminating
on the basis of factors such as culture, gender, and socioeconomic status. It is patient-centered, respectful of patients and their
families, and actively involves consumers in managing their own health. Access means that care is affordable and available, and that
services are delivered in ways reflecting the realities of today, not outmoded patterns from the past.
The cost of health care is a complex issue. But it’s time for a shift in thinking. Let’s redirect the system away from overusing
expensive, acute-care, hospital-based services and toward more community-based, preventive care. In addition, recruiting, educating,
and retaining the workforce is key to system reform. Current estimates predict a shortage of up to a million nurses by 2020. This
shortage will affect every aspect of patient care.
While we must do all we can to mitigate the effects of this shortage, let’s be clear about how we got here. The U.S. government
spends fifty times ($8 billion yearly vs. $156 million) more on medical than on nursing education. We cannot prepare nurses for
tomorrow if we don’t have the financial support for teachers and adequate teaching facilities today.
Bold action is called for. The time to reform the system is now.
The U.S. health care system is in a state of crisis. Costs continue to rise astronomically, the public health workforce will soon be
unable to keep up with growing demands, more than 50 million Americans lack health insurance, and another 25 million are
underinsured.
Health care must be seen as a human right, not a luxury. I support the American Nurses Association position that Americans are
entitled to ready access to quality and affordable health care services offered by an adequately sized and well-educated workforce.
Quality health care is safe, effective, and timely care that meets patients’ needs. It is equitable, acknowledging but not discriminating
on the basis of factors such as culture, gender, and socioeconomic status. It is patient-centered, respectful of patients and their
families, and actively involves consumers in managing their own health. Access means that care is affordable and available, and that
services are delivered in ways reflecting the realities of today, not outmoded patterns from the past.
The cost of health care is a complex issue. But it’s time for a shift in thinking. Let’s redirect the system away from overusing
expensive, acute-care, hospital-based services and toward more community-based, preventive care. In addition, recruiting, educating,
and retaining the workforce is key to system reform. Current estimates predict a shortage of up to a million nurses by 2020. This
shortage will affect every aspect of patient care.
While we must do all we can to mitigate the effects of this shortage, let’s be clear about how we got here. The U.S. government
spends fifty times ($8 billion yearly vs. $156 million) more on medical than on nursing education. We cannot prepare nurses for
tomorrow if we don’t have the financial support for teachers and adequate teaching facilities today.
Bold action is called for. The time to reform the system is now.
Kathryn May, Dean, UW
Schol of Nursing
Schol of Nursing
Drs. Linda and Eugene Farley, Healthcare
Reform activitists
Reform activitists
“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”-Martin Luther King Jr.
Reform of health care has been an issue in the U.S. for over 100 years with presidents Teddy Roosevelt,
FDR, Truman, Johnson, Nixon, Clinton, and now President Obama all introducing proposals. Only Lyndon
Johnson succeeded so far. Because the elderly and the poor, more subject to illness, cost too much for the
insurance companies to take on as risks, and because the people demanded help, Johnson was able to push
through reforms known as Medicare, an entitlement federally funded, for the elderly and people with
disabilities, and Medicaid, a state-federal publicly funded program for the very poor. Both of these programs, as
well as health care for Veterans, the Military, and Native Americans, are paid for with tax-payer money and are
popular examples of what is called Single Payer Health Care. Most providers of care remain in the private
sector but the funding is supplied by the people through their Government. A National Health Program, like that
introduced in the House by John Conyers (HR 676), and in the Senate by Bernie Sanders (S 703), would be
Single Payer and would be administered and built on the Medicare model. President Obama said in 2003,
speaking to the AFL-CIO,
“I happen to be a proponent of a single payer universal health care program.” (applause) “I see no reason
why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its
Gross National Product on health care cannot provide basic health insurance to everybody. … everybody in,
Reform of health care has been an issue in the U.S. for over 100 years with presidents Teddy Roosevelt,
FDR, Truman, Johnson, Nixon, Clinton, and now President Obama all introducing proposals. Only Lyndon
Johnson succeeded so far. Because the elderly and the poor, more subject to illness, cost too much for the
insurance companies to take on as risks, and because the people demanded help, Johnson was able to push
through reforms known as Medicare, an entitlement federally funded, for the elderly and people with
disabilities, and Medicaid, a state-federal publicly funded program for the very poor. Both of these programs, as
well as health care for Veterans, the Military, and Native Americans, are paid for with tax-payer money and are
popular examples of what is called Single Payer Health Care. Most providers of care remain in the private
sector but the funding is supplied by the people through their Government. A National Health Program, like that
introduced in the House by John Conyers (HR 676), and in the Senate by Bernie Sanders (S 703), would be
Single Payer and would be administered and built on the Medicare model. President Obama said in 2003,
speaking to the AFL-CIO,
“I happen to be a proponent of a single payer universal health care program.” (applause) “I see no reason
why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its
Gross National Product on health care cannot provide basic health insurance to everybody. … everybody in,
nobody out. A single payer health care plan, a universal health care plan, …”
The time is ripe for the people to push their legislators toward Single Payer as the only really practical solution and thus persuade President Obama that
his analysis is correct and can be politically possible.
As to what needs to be reformed, the following is a partial list:
1.Cost: currently the cost of health care in the US is 2.5 trillion dollars; $8,000 per capita and over $12,000 per family. This is twice the cost of health care
in every other industrialized country in the world but still leaves us with at least 100 million people uninsured or underinsured, and costs more because of
inadequate access to care.
Private, for- profit insurance companies and HMOs market to the healthy, deny care to the sick, and consider as their bottom line, profits for their
shareholders, who contribute nothing to the care of the sick
Fragmentation with over 1500 insurance companies each offering many plans, requiring a huge bureaucracy to manage the paperwork.
Pharmaceutical Companies, always looking for higher profits, control the cost of drugs lobbying for subsidies even for Medicare patients as in Part D.
Overhead in the US amounts to 31% of total costs compared to an average of 16% in other countries. Think what a savings of 16% of 2.5 trillion dollars would do
toward providing health care for everyone including preventive care and education about healthy life styles. No longer would 50% of bankruptcies involve
health care debt.
2. Burden for Business results from our reliance on employers to shop for and buy health insurance for all employees. This favors large business because
small businesses cannot compete and often cannot offer health care. Today even big business cannot compete in the global market and must put more of the
burden on its employees or offer inferior coverage.
3. Chronic Illness such as hypertension, heart disease, cancer, cost us more because our health care system does not offer continuity and because many
people with chronic illness cannot afford health insurance and thus only seek care when illness becomes very severe and costly.
4. Primary Care/Specialist ratio does not meet the needs of good health care for the people. It is about 30 primary care providers/70 specialists and sub
specialists in this country with a desirable ratio of 50/50
5. Disparities in health care such as high infant mortality, and earlier deaths, among minority and/or poor people.
6. Inequality means money determines who gets the benefits of good health care.
As to the key features of a reformed Health Care System, the US would: Save at least 4 hundred billion dollars by passing a Single Payer National Health
Program with only one funding source as in Medicare with 3% overhead; Eliminate all for-profit insurance companies, HMOs, and other for-profit institutions
such as hospitals, nursing homes, home-care companies; Require that these institutions operate on a not-for-profit basis and be subject to regional planning, and
distributed according to population need; Provide only one equitable plan available to all. There would be regulation of pharmaceutical company profits and
bargaining on behalf of the entire population. Employers would no longer be involved in shopping for health care for their employees.
Such a program would provide continuity of care and increase frequency of visits with emphasis on prevention and health maintenance through careful
follow-up. There would be no co-pays or deductibles.
It would encourage medical students to choose primary care pathways by offering greater incentives such as better pay; select students who desire primary
care; cut costs of medical education; expose students to the challenges of primary care;
In summary we need a Single Payer Health Care Program because : 1. It’s good for our health, 2. It costs less and saves money, 3. It will assure high quality
health care for all Americans, rich or poor, 4. It’s the best choice – morally and economically 5. It may be a matter of life or death 6. It will let doctors and
nurses focus on patients, not paperwork 7. It will reduce health care disparities 8.It will eliminate medical debt 9.It will be good for labor and for business and
10.It’s what most Americans want – and we can make it happen!
The time is ripe for the people to push their legislators toward Single Payer as the only really practical solution and thus persuade President Obama that
his analysis is correct and can be politically possible.
As to what needs to be reformed, the following is a partial list:
1.Cost: currently the cost of health care in the US is 2.5 trillion dollars; $8,000 per capita and over $12,000 per family. This is twice the cost of health care
in every other industrialized country in the world but still leaves us with at least 100 million people uninsured or underinsured, and costs more because of
inadequate access to care.
Private, for- profit insurance companies and HMOs market to the healthy, deny care to the sick, and consider as their bottom line, profits for their
shareholders, who contribute nothing to the care of the sick
Fragmentation with over 1500 insurance companies each offering many plans, requiring a huge bureaucracy to manage the paperwork.
Pharmaceutical Companies, always looking for higher profits, control the cost of drugs lobbying for subsidies even for Medicare patients as in Part D.
Overhead in the US amounts to 31% of total costs compared to an average of 16% in other countries. Think what a savings of 16% of 2.5 trillion dollars would do
toward providing health care for everyone including preventive care and education about healthy life styles. No longer would 50% of bankruptcies involve
health care debt.
2. Burden for Business results from our reliance on employers to shop for and buy health insurance for all employees. This favors large business because
small businesses cannot compete and often cannot offer health care. Today even big business cannot compete in the global market and must put more of the
burden on its employees or offer inferior coverage.
3. Chronic Illness such as hypertension, heart disease, cancer, cost us more because our health care system does not offer continuity and because many
people with chronic illness cannot afford health insurance and thus only seek care when illness becomes very severe and costly.
4. Primary Care/Specialist ratio does not meet the needs of good health care for the people. It is about 30 primary care providers/70 specialists and sub
specialists in this country with a desirable ratio of 50/50
5. Disparities in health care such as high infant mortality, and earlier deaths, among minority and/or poor people.
6. Inequality means money determines who gets the benefits of good health care.
As to the key features of a reformed Health Care System, the US would: Save at least 4 hundred billion dollars by passing a Single Payer National Health
Program with only one funding source as in Medicare with 3% overhead; Eliminate all for-profit insurance companies, HMOs, and other for-profit institutions
such as hospitals, nursing homes, home-care companies; Require that these institutions operate on a not-for-profit basis and be subject to regional planning, and
distributed according to population need; Provide only one equitable plan available to all. There would be regulation of pharmaceutical company profits and
bargaining on behalf of the entire population. Employers would no longer be involved in shopping for health care for their employees.
Such a program would provide continuity of care and increase frequency of visits with emphasis on prevention and health maintenance through careful
follow-up. There would be no co-pays or deductibles.
It would encourage medical students to choose primary care pathways by offering greater incentives such as better pay; select students who desire primary
care; cut costs of medical education; expose students to the challenges of primary care;
In summary we need a Single Payer Health Care Program because : 1. It’s good for our health, 2. It costs less and saves money, 3. It will assure high quality
health care for all Americans, rich or poor, 4. It’s the best choice – morally and economically 5. It may be a matter of life or death 6. It will let doctors and
nurses focus on patients, not paperwork 7. It will reduce health care disparities 8.It will eliminate medical debt 9.It will be good for labor and for business and
10.It’s what most Americans want – and we can make it happen!
David Newby,
President, Wisconsin
State AFL-CIO
President, Wisconsin
State AFL-CIO
What needs to be reformed in health care? We need health care for all! It needs to be affordable to all, and it needs to be top-
quality health care for all.
But the argument against universal health care is noisy, persistent, irrational and unceasing. The current Republican proposal to
simply and inadequately subsidize the individual purchase of private health insurance is especially unwelcome and unworkable.
Let’s think about universal health care this way: Early in the life of this country we did not have universal fire protection. There
were no municipal fire departments with services available to all. We had competing private fire companies (thus, the reason our public
fire departments are often referred to as “fire companies” today). If you had the money, you employed a private fire company, and if your
house caught fire, they would come and put it out.
If you couldn’t afford to pay a private fire company, your house burned down.
In the mid-nineteenth century, our society came to realize that fire protection should be a social good, available to all. Fire
protection should be provided by local government, and funded by all the people (along with police protection, water and sewer
services, food safety inspection, and other services in support of the public good) through municipal taxation.
So consider health care: Individuals now employ private health companies, which ration health services to our citizenry based on
their ability to pay — just like individuals used to pay for private fire protection.
But most people now regard health care as a social good, one which should be provided to all and paid for through fees levied on
us all. We now need our political leaders to institute universal health care affordable to all in the interest of everyone.
quality health care for all.
But the argument against universal health care is noisy, persistent, irrational and unceasing. The current Republican proposal to
simply and inadequately subsidize the individual purchase of private health insurance is especially unwelcome and unworkable.
Let’s think about universal health care this way: Early in the life of this country we did not have universal fire protection. There
were no municipal fire departments with services available to all. We had competing private fire companies (thus, the reason our public
fire departments are often referred to as “fire companies” today). If you had the money, you employed a private fire company, and if your
house caught fire, they would come and put it out.
If you couldn’t afford to pay a private fire company, your house burned down.
In the mid-nineteenth century, our society came to realize that fire protection should be a social good, available to all. Fire
protection should be provided by local government, and funded by all the people (along with police protection, water and sewer
services, food safety inspection, and other services in support of the public good) through municipal taxation.
So consider health care: Individuals now employ private health companies, which ration health services to our citizenry based on
their ability to pay — just like individuals used to pay for private fire protection.
But most people now regard health care as a social good, one which should be provided to all and paid for through fees levied on
us all. We now need our political leaders to institute universal health care affordable to all in the interest of everyone.
Patient 1: A funny thing happened to me on the way to the doctor’s office. My health insurance premiums went up 6.1%*. Again!
Patient 2: That’s not so funny. It happened to me, too. How can this keep happening to us? It must be those darn insurance companies
trying to gouge us. Again.
Patient 3: Well, once we get single payer universal health care, I hear, we won’t have to pay a thing and those evil insurance
companies will be kaput for good, right?
Patient 4: Well, yes. And, no. You might not have to pay a cent, if you:
-Don’t work
-Don’t have income (or your income is below a specified level) or
-Pay taxes.
Patient 3: So that’s pretty good.
Patient 4: No, that’s fantastic! And it ought to be that way. Regardless of your ability to pay or your status as a citizen you should receive
the best health care, if you need it, no matter what.
Patient 3: But you said yes and no. So universal health care is great, right?
Patient 4: Right. It should be put in the law books tomorrow.
Patient 3: So what’s the hitch?
Patient 4: Single Payer may not be the best answer because you’re still going to have to pay for it and it could:
-Cost you a little less
Patient 2: That’s not so funny. It happened to me, too. How can this keep happening to us? It must be those darn insurance companies
trying to gouge us. Again.
Patient 3: Well, once we get single payer universal health care, I hear, we won’t have to pay a thing and those evil insurance
companies will be kaput for good, right?
Patient 4: Well, yes. And, no. You might not have to pay a cent, if you:
-Don’t work
-Don’t have income (or your income is below a specified level) or
-Pay taxes.
Patient 3: So that’s pretty good.
Patient 4: No, that’s fantastic! And it ought to be that way. Regardless of your ability to pay or your status as a citizen you should receive
the best health care, if you need it, no matter what.
Patient 3: But you said yes and no. So universal health care is great, right?
Patient 4: Right. It should be put in the law books tomorrow.
Patient 3: So what’s the hitch?
Patient 4: Single Payer may not be the best answer because you’re still going to have to pay for it and it could:
-Cost you a little less
Fred Marshall
Owner, Marshall
Financial Group
Owner, Marshall
Financial Group
-About the same
-Or even a lot more.
It’s the TINSTAAFL Theory.
Patient 3: What’s that?
Patient 4: There Is No Such Thing As A Free Lunch.
Patient 3: You mean it’s not free. I thought the government was just going to pay for it, not me. So, how can this happen?
Patient 4: Medical care has a cost that keeps going up due to medical technology, inflation, new cures, medical education, legal actions, etc. Since some
people are not going to be paying for services, someone else is going to have to cover their share of the cost. It depends how they determine to allocate where
the premiums come from. Here’s why:
Health insurance is really a wonderful invention that makes it possible for a 56-year-old male (who smokes, drinks a little bit, is overweight, doesn’t want to
exercise or change his eating habits) pay only $500 per month (for a $1000 deductible plan) to cover the unexpected heart surgery ($150,000) he’s going to
need next week. As you can see, it also helped physicians and health care providers get out of the debt collection business.
Nothing would make health insurance companies happier than to offer their clients a major medical plan where premiums would be guaranteed to never
go up. But here’s the rub. Despite what many claim, it’s not the insurance companies trying to grab more profits, it’s the underlying cost of the health care that
keeps going up.
According to David Saltzman, RHU in Life Insurance Selling, March 2009 and a study “Factors Fueling Rising Healthcare Costs,” by PriceWaterhouse
Coopers*confirms that only 3% of health premiums goes to profits. 87% of premiums paid is actually spent on for claims, 6% is for government payments,
compliance, claims processing and administrative costs, and 4% is used for to consumer service, provider support and marketing.
Except for profits, we believe, the costs of delivering health care, educating consumers and supporting providers (97%, give or take 5%) is more dependent
on the delivery system than on the system insuring the risk (and that holds true even if the government is left as the sole insurance company). In fact, it’s hard to
deny that competition helps keep prices down. So if you remove that, now you’ve got price creep on a second front.
As an example, let’s say you could save 10% by going to a single payer plan. Then a family of four paying $1,000 a month might save $100. But even
those savings might be wiped out entirely by the adverse selection created by increased claims from those formerly not covered, (initially glutting the system due
to the advent of universal coverage.) And there would never be an incentive to compete for business in the market place that automatically strives to keep
pricing as low as possible.
Patient 3. So what you are saying is, the fact remains, someone, somehow has to pay the premiums, whether it’s to Uncle Sam or XYZ Insurance Company. And
those premiums are still going to rise, because it’s based on the underlying cost of health care. Multiple payer choices actually keep prices lower.
Patient 4: That’s right. Keep the multiple payer system. Let the government mandate changes and enter the market place. Just like having the post office,
Fedex, UPS and local delivery companies all trying to pick up whatever business they can. Coverage is customized and competition will keep pricing low. Even
you could go into the insurance business, if you think 3% is a big enough profit margin (before taxes, that is).
Patient 3: So then besides mandating Universal Coverage (which will actually increase costs) and allowing some sort of multiple payer system, what can be
done?
Patient 4: A lot!
- Mandate electronic record keeping and transferring. Including an option that each patient can receive portable records chip which they can use to submit
their own medical info.
- A federal insurance agency to replace state regulation for health insurance so all plans are standard and portable to all states.
-Require coverage for pre-existing conditions, even on individual plans (part of the Obama’s proposed White House Plan).**
-Multiple suppliers for insurance products.
-Explore a system similar to Medicare that offers supplements to fill the gaps not covered in the program for those who want better coverage.
-Create a new Small Business Health Tax Credit to help small business provide affordable plans (part of the Obama’s proposed White House Plan).**
-Establish a National Health Insurance Exchange with a range of private options as well as a new public plan. (part of the Obama’s proposed White House Plan)**
-Ensure everyone who needs it will receive a tax credit for their premiums. (part of the Obama’s proposed White House Plan)**
*www.ahip.org/content/default.aspx?docid=25123, “Factors Fueling Rising Healthcare Costs”, by PriceWaterhouse Coopers
**www.whitehouse.gov/agenda/health_care/, From the President Obama’s White House Website
Also of value in our research that every reader is urged to visit:
National Coalition on Health Care, www. Nchc.org, an excellent website that is extremely objective in examining all solutions to the problem.
The American Medical Student Association, www.amsa.com, While we disagree with some of the conclusions, the paper Single Payer 101 is very informative.
-Or even a lot more.
It’s the TINSTAAFL Theory.
Patient 3: What’s that?
Patient 4: There Is No Such Thing As A Free Lunch.
Patient 3: You mean it’s not free. I thought the government was just going to pay for it, not me. So, how can this happen?
Patient 4: Medical care has a cost that keeps going up due to medical technology, inflation, new cures, medical education, legal actions, etc. Since some
people are not going to be paying for services, someone else is going to have to cover their share of the cost. It depends how they determine to allocate where
the premiums come from. Here’s why:
Health insurance is really a wonderful invention that makes it possible for a 56-year-old male (who smokes, drinks a little bit, is overweight, doesn’t want to
exercise or change his eating habits) pay only $500 per month (for a $1000 deductible plan) to cover the unexpected heart surgery ($150,000) he’s going to
need next week. As you can see, it also helped physicians and health care providers get out of the debt collection business.
Nothing would make health insurance companies happier than to offer their clients a major medical plan where premiums would be guaranteed to never
go up. But here’s the rub. Despite what many claim, it’s not the insurance companies trying to grab more profits, it’s the underlying cost of the health care that
keeps going up.
According to David Saltzman, RHU in Life Insurance Selling, March 2009 and a study “Factors Fueling Rising Healthcare Costs,” by PriceWaterhouse
Coopers*confirms that only 3% of health premiums goes to profits. 87% of premiums paid is actually spent on for claims, 6% is for government payments,
compliance, claims processing and administrative costs, and 4% is used for to consumer service, provider support and marketing.
Except for profits, we believe, the costs of delivering health care, educating consumers and supporting providers (97%, give or take 5%) is more dependent
on the delivery system than on the system insuring the risk (and that holds true even if the government is left as the sole insurance company). In fact, it’s hard to
deny that competition helps keep prices down. So if you remove that, now you’ve got price creep on a second front.
As an example, let’s say you could save 10% by going to a single payer plan. Then a family of four paying $1,000 a month might save $100. But even
those savings might be wiped out entirely by the adverse selection created by increased claims from those formerly not covered, (initially glutting the system due
to the advent of universal coverage.) And there would never be an incentive to compete for business in the market place that automatically strives to keep
pricing as low as possible.
Patient 3. So what you are saying is, the fact remains, someone, somehow has to pay the premiums, whether it’s to Uncle Sam or XYZ Insurance Company. And
those premiums are still going to rise, because it’s based on the underlying cost of health care. Multiple payer choices actually keep prices lower.
Patient 4: That’s right. Keep the multiple payer system. Let the government mandate changes and enter the market place. Just like having the post office,
Fedex, UPS and local delivery companies all trying to pick up whatever business they can. Coverage is customized and competition will keep pricing low. Even
you could go into the insurance business, if you think 3% is a big enough profit margin (before taxes, that is).
Patient 3: So then besides mandating Universal Coverage (which will actually increase costs) and allowing some sort of multiple payer system, what can be
done?
Patient 4: A lot!
- Mandate electronic record keeping and transferring. Including an option that each patient can receive portable records chip which they can use to submit
their own medical info.
- A federal insurance agency to replace state regulation for health insurance so all plans are standard and portable to all states.
-Require coverage for pre-existing conditions, even on individual plans (part of the Obama’s proposed White House Plan).**
-Multiple suppliers for insurance products.
-Explore a system similar to Medicare that offers supplements to fill the gaps not covered in the program for those who want better coverage.
-Create a new Small Business Health Tax Credit to help small business provide affordable plans (part of the Obama’s proposed White House Plan).**
-Establish a National Health Insurance Exchange with a range of private options as well as a new public plan. (part of the Obama’s proposed White House Plan)**
-Ensure everyone who needs it will receive a tax credit for their premiums. (part of the Obama’s proposed White House Plan)**
*www.ahip.org/content/default.aspx?docid=25123, “Factors Fueling Rising Healthcare Costs”, by PriceWaterhouse Coopers
**www.whitehouse.gov/agenda/health_care/, From the President Obama’s White House Website
Also of value in our research that every reader is urged to visit:
National Coalition on Health Care, www. Nchc.org, an excellent website that is extremely objective in examining all solutions to the problem.
The American Medical Student Association, www.amsa.com, While we disagree with some of the conclusions, the paper Single Payer 101 is very informative.