Universal health plan is endorsed

[pickledpepperRN]

http://www.boston.com/news/nation/articles/2003/08/13/universal_health_plan_is_endorsed_boston_globe

Universal health plan is endorsed

Thousands of doctors back proposal in JAMA

By Liz Kowalczyk, Globe Staff, and Amber Mobley, Globe Correspondent, 8/13/2003

Thousands of US physicians have endorsed a broad proposal that would abolish for-profit hospitals and insurers and transfer all Americans into an expanded and improved Medicare program for all ages, reigniting the debate over universal health care a decade after President Clinton's failed plan.

While the four physicians who wrote the plan -- three of whom are affiliated with Harvard Medical School -- are members of a nonprofit organization that has long pushed for universal health coverage, the new proposal is important for two reasons: It was published today in one of the country's most prestigious and its most widely circulated medical journal, the Journal of the American Medical Association, and because of the large number of doctors -- nearly 8,000, including two former surgeons general -- who endorsed it.

JAMA officials said it is unusual for the journal, which has a circulation of about 700,000 worldwide, to publish an article endorsed by such a large number of physicians. JAMA's editor, Dr. Catherine DeAngelis, said that an editorial accompanying the article represents the journal's viewpoint that it is time for the country to grapple more seriously with major problems in the health-care system.

"Look, if you don't agree with this plan, it's not a foolproof plan, there are plenty of problems with it, come up with something better," she said in an interview. "Let the debate resume. It's sort of been on the back burner and it's time we get on the stick with this. We are the only developed country in the world that doesn't have a specific health plan for our people. It's a disgrace. We have too many people not insured, and this is wrong."

In the editorial accompanying the proposal, Rashi Fein of Harvard Medical School said one drawback of such a comprehensive plan is that it may be too radical to pass the US political system, but that the doctors' proposal "should re-energize the debate."

The plan, developed by the Physicians for a National Health Program, based in Chicago, differs from Clinton's 1993 initiative in fundamental ways. Clinton sought to avoid large new taxes, instead seeking to require all companies to offer health insurance with federal subsidies helping small employers, Fein said. The country's basic system -- employers buying health insurance from nonprofit and for-profit insurance companies -- would have remained intact.

The physicians' plan is more radical and more encompassing, including coverage for the 41 million uninsured Americans as well as incorporating ways to control costs by setting a national budget, providing a set amount of money to hospitals for day-to-day operations and major expansions, paying for nursing home and home care for the elderly, and developing a national list of drugs the program would pay for.

The government would pay for health care through an expanded version of traditional Medicare, the federal health insurance program for the elderly. Most hospitals and clinics would remain privately owned and operated, and the national health insurance program would pay them a monthly budget for operating costs. Investor-owned facilities would be converted to nonprofit status. Private insurance companies would be virtually eliminated. The plan is endorsed by former surgeons general Dr. David Satcher, who served under Clinton, and Dr. Julius Richmond, appointed by Jimmy Carter.

One of the doctors' arguments is that for-profit companies and multiple insurers are diverting money from clinical care for the demands of business. The physicians estimate that the country would save $200 billion annually by eliminating profits of investor-owned hospitals and insurance companies and by reducing administrative costs for hospitals and doctors who must bill dozens of different insurance companies. Private health insurers now consume 12 percent of premiums for overhead, while Medicare and the Canadian national health insurance system have overhead costs below 3.2 percent, the doctors reported.

Taxes, the doctors said, would increase. But except for the very wealthy, higher taxes would be offset by the elimination of insurance premiums and out-of-pocket copayments and deductibles, they argued.

Lead coauthor Dr. Marcia Angell, a senior lecturer at Harvard Medical School and former editor of the New England Journal of Medicine, said during a news conference in Washington, D.C., that the doctors want to curtail the entrepreneurial aspects of medicine, where insurers and providers avoid unprofitable patients and try to shift costs back to patients. But she said they also sought ways to control costs amid skyrocketing insurance premiums.

Dr. Steffie Woolhandler and Dr. David Himmelstein, both physicians at Cambridge Hospital and associate professors at Harvard Medical School, were coauthors.

Critics and even advocates of universal health insurance said the doctors' proposal has major shortcomings. Susan Pisano of the American Association of Health Plans said private industry, not the government, has led the way in adopting disease management programs and prescription drug coverage. "Political pressures on Congress make change and innovation very difficult," she said.

Giving hospitals a set monthly budget is similar to a form of managed care called "capitation," in which insurers paid doctors and hospitals a set amount of money to treat patients. If they kept under the budget, providers made a profit; if they exceeded the budget, they lost money.

But capitation is now being called a failure by many providers, because it creates a financial incentive to limit care, and many insurers are moving away from it.

Further, many health-care economists questioned whether the proposal is realistic in the United States, given that even Clinton's more modest plan failed.

Liz Kowalczyk can be reached at [email protected]. Amber Mobley reported from Washing-

ton, Liz Kowalczyk from Boston.

[oramar]

interesting read

[pickledpepperRN]

Originally posted by spacenurse

http://www.boston.com/news/nation/articles/2003/08/13/universal_health_plan_is_endorsed_boston_globe

Universal health plan is endorsed

Thousands of doctors back proposal in JAMA

One of the doctors' arguments is that for-profit companies and multiple insurers are diverting money from clinical care for the demands of business. The physicians estimate that the country would save $200 billion annually by eliminating profits of investor-owned hospitals and insurance companies and by reducing administrative costs for hospitals and doctors who must bill dozens of different insurance companies. Private health insurers now consume 12 percent of premiums for overhead, while Medicare and the Canadian national health insurance system have overhead costs below 3.2 percent, the doctors reported.

Liz Kowalczyk can be reached at [email protected]. Amber Mobley reported from Washing-

ton, Liz Kowalczyk from Boston.

https://allnurses.com/t41908/s.html

How One Hospital Benefited on Questionable Operations

http://www.nytimes.com/2003/08/12/b...0ebed35066f697b

[eltrip]

Interesting idea. Now, who's going to pay for it?

[donmurray]

I thought this was the answer.

The physicians estimate that the country would save $200 billion annually by eliminating profits of investor-owned hospitals and insurance companies and by reducing administrative costs for hospitals and doctors who must bill dozens of different insurance companies. Private health insurers now consume 12 percent of premiums for overhead, while Medicare and the Canadian national health insurance system have overhead costs below 3.2 percent, the doctors reported.

Taxes, the doctors said, would increase. But except for the very wealthy, higher taxes would be offset by the elimination of insurance premiums and out-of-pocket copayments and deductibles, they argued.

[VivaLasViejas, ASN, RN]

We tried putting a similar idea on the ballot in Oregon a couple of years ago, but it failed miserably. The only way to EVER make universal health care a reality is to totally eliminate the insurance companies and their multimillionaire CEOs who profit at the expense of everyone else. And with the conservative turn this country has taken over the past 25 years or so, I don't think it'll happen in my lifetime. Maybe in my kids', Lord willing, but not soon enough to do my generation or the one right after it any good.

[teeituptom, BSN, RN]

Holy Shades of Ted Kennedy, universal health care. This has to be sposored by the democrats at the very least. No self respecting republican will ever go for it.

Ride Teddy Ride

[donmurray]

You know it makes sense!

[pickledpepperRN]

Originally posted by donmurray

You know it makes sense!

Please, will you share with us about the National Health system you have?

[donmurray]

Big topic!

UK healthcare is free to all citizens at the point of need, and funded by taxation.

There are lots of issues surrounding inadequate funding and waiting times for cold surgery/specialist consultations. The current Govt. has skewed the provision of services further by setting targets such as maximum waiting times, so that the focus is on the target areas, and the rest falls behind.

Prescriptions are charged at £6:20 per item, (just under 10 dollars) but your GP will usually prescribe 3months at a time. Some chronic conditions, such as diabetes get some exemptions from their ongoing costs.

There's a fuss going on at the moment about "Health Tourists" who fly in as visitors, register with a Doctor, and get the free care without meeting the residence condition of one year. Whilst it is a problem in London and the South, it has brought out all the xenophobic tendency.

Beverly Malone's mother was one example, on one visit, she had eye surgery on the NHS, paid for by the British taxpayer. Main cost to her was the airfare.

The system is not, and never can be perfect, but it is a lot more equitable than any alternatives on offer.

[essarge]

I guess my problem with this, although it would be nice to see all people having access to medical help, is the wage issue. If you have universal health insurance, won't that stall wages for healthcare workers.....especially nurses?????

[Brownms46]

]Most hospitals and clinics would remain privately owned and operated, and the national health insurance program would pay them a monthly budget for operating costs. Investor-owned facilities would be converted to nonprofit status. Private insurance companies would be virtually eliminated

Here is the problem I have with this. First why should the govt pay for the operating costs of hospitals and clinics that are privately own??? If the govt..Ie the citizens of this country, is paying your operating expenses, why should they keep the profits??? So the govt. would be paying for the employee costs of a hospital/clinic, and then ??? So what would those who own these facilities be paying, as the cost of doing business??? Would they be exempt for employment taxes??? So in other words, they would be operating like federal facilities, but they owners would be able to reap any of the profits??? How do you remain privately own, if the govt (US) are paying for your costs to do business, thru higher taxes???

Next what makes them think that those who couldn't afford to pay for insurance, can now pay higher taxes, for something they couldn't afford to pay for in the first place????

I totally believe there are doctors who are truly concerned about the amount of pts they treat, who have no ability to buy the medications they need, and for those who can't afford to be seen outside of the ERs. But I also believe that many doctors are suffering financially, because of the burdens placed on them by the requirements of the different insurance companies, and feel that they're hands are tied by them. They don't like being dictated to as what they can and can't do with or for a pt.

They're also plagued by higher and higher malpractice costs, and everyone knows it's a lot harder to sue the govt., than it is to sue a private MD.

I maybe wrong, but I think this stinks of just another way to get away with having to do less to make a profit, than it does to help the pt. Just my opinion though. As they do admit, that the plan has a lot of flaws, and hopefully someone will come up with a better answer to some very distressing problems.