Friday, September 28, 2007

The Scary 'S' Word

A great read....

"The Socialists Are Coming! The Socialists Are Coming!"


New York Times Editorial Observer
September 28, 2007

Our political discourse is so debased that the “s-word” is typically applied where it is least appropriate and never applied where it most fits.

Entrepreneurs and Revolutionists

This morning, I opened my Feed Reader and found an interesting article at Repairing the Healthcare System, "What is an Entrepreneur?"

After discovering Dr. Feld's blog, I have cheered and I have cringed.

Here's a cheer inducer--

"Keep Your Head In There!" - Repairing the Healthcare System
The lesson to be learned is never put you head in front of a fast ball. The healthcare system lesson to be learned from this story is even though they (the healthcare insurance industry) are bigger, more powerful and stronger you need to stick in there and do the right thing. Remember there would be no healthcare system without the primary stakeholders, the patient and the physician.

This one induced a cheer, followed by a cringe--

"This Is What I Mean By Innovative Thinking, Part 1" - Repairing the Healthcare System
The people who control the healthcare system have to start thinking of concepts that will benefit all the stakeholders and not simply the stakeholders in power. I am certain the stakeholders in power are threatened by the potential for change just as the controllers of the educational system are. We now live in a knowledge based economy. The legacy thinking in healthcare has to change. It is presently proprietary and opaque. It is dominated and controlled by the insurance industry. It has to be transparent and beneficial to all.

I agree that the dominant stakeholders in our current healthcare system are threatened by the potential for change. Those in the insurance industry, and the agents who represent and broker insurance products, would have us (patients, individuals, consumers) believe that an individual's struggles or complaints are the direct result of personal irresponsibility in making poor choices in life. Although there may be individuals who make poor choices, such as choosing to eat a dozen donuts each week and not exercising, I strongly disagree with the notion that individuals find themselves seriously underinsured because maybe they didn't research all insurance options available and failed to choose the 'full coverage' package, or that they chose a less expensive package when a 'full' package would have been available, or if only they had used an agent...bullshit!

The insurance industry, including the 'non-profit' providers, are truly in the business of business, not facilitating health. I vaguely remember when health insurance was called medical insurance. This is one reason I never expected pro-health services or activities, such as yoga or nutrition counseling, to be covered by my medical insurance. But I did expect that my medical insurance would cover medical services and products, such as doctor's visits, hospitalization, surgery, testing, vaccines, physical therapy, and most importantly prescription medication.

And this induced a cringe -

"This Is What I Mean By Innovative Thinking, Part 1 (con't)" - Repairing the Healthcare System
Only the consumer will change the healthcare system. It will start with the demand to change the insurance paradigm to the ideal medical saving account. We have seen the failures of the government as a single party payer in the VA Healthcare System. I suspect we are only seeing the tip of the iceberg. I cannot understand why politicians think it will be any better when a single party payer system is applied to the entire population.

I know the consumer does not want that system.

Wait a minute! How do you know what the consumer wants?

If you want to know, ask the consumer, ask the patient.

If you take the time to listen, you will hear consumers strongly supporting a move toward a single-payer system or at least a system which requires the stakeholders to play by the same rulebook. So far I'm only hearing business leaders, investors, policy makers, entrepreneurs, and other big stakeholders say that we need to educate and convince the individual consumer to take control of their healthcare dollars and to negotiate or bargain-shop for healthcare services.

"Optimism Is The Operative Word. We Can Do It!" - Repairing the Healthcare System
The patients must be responsible for their care and their healthcare dollar. Access to care must not be restricted. Patients are capable of being responsible consumers of healthcare given the appropriate incentives.

We will need strong leadership. We need a leader who really understands the problems in the dysfunctional healthcare system. A leader who is not afraid to act contrary to the pressure of facilitator stakeholder vested interests There does not seem to be one around. We will need groups of citizens who are angry enough at the present system who will be willing to demand a consumer driven healthcare system. People power can demand that leadership. First they have to understand the problem and solutions.

Okay. Dr. Feld had me again until he used that phrase, 'consumer driven healthcare.' Here's an interesting website I just discovered yesterday. Republicans for Single-Payer Universal Health Care with Informed Choice. I was intrigued and looked further into the site to see what they had to say which led me to Balanced Choice in Health Care for All. In the description of Balanced Choice, it becomes apparent that the program is designed to limit the dollar amount which the 'insurance' pays and leave the remainder, called the 'gap', for the patient to pay. This would make the consumer more cost-conscious and thus more responsible in spending their healthcare dollars.

This is the fundamental philosophy behind a consumer-driven healthcare system. And many proponents in favor of a consumer-driven system are the same ones in favor of a market-based system. [A free-market healthcare system is a whole other discussion for another time.]

"What Healthcare System Could Work? A Universal Healthcare System Will Not Work!" - Repairing the Healthcare System
The solution should be pretty clear to all following my blog. I advocate the American way! I believe a consumer market driven system with government making rules for the benefit of all members of the society. When one stakeholder takes advantage of another stakeholder to the harm of the other stakeholder the government has to intercede.

Maybe Dr. Feld has my attention again. I support the idea of uniform rules and creating a level and fair playing field.

Then yesterday, Dr. Feld writes about entrepreneurs and discusses the rise of convenience clinics in large chain stores. One proponent of these retail clinics is Steve Case who founded Revolution Health.

"Revolution Health Group is a leading consumer-centric health company founded to transform how people approach their overall health and wellness. By putting individuals at the center of their own healthcare, Revolution Health allows them to make informed choices and offers more convenience and control over their individual healthcare decisions."

"Revolution Health is part of the Revolution LLC family of companies created by Steve Case to be a disruptive force in industries in need of a "better way."" - (from

From Dr. Feld's articles, I don't think that he likes the idea of Redi-Clinic or other convenience clinics due to the effect they may, or may not, have on the stability of physicians in family practice.

"Look What Happens What You Are Not Looking, Part 1" - Repairing the Healthcare System
I believe in-store clinics are a bad idea and they will fail. If successful these clinics can potentially put family practitioners out of business. If they are marginal, they will put a reasonable dent in the primary care physician’s ability to make a living. It is presently difficult for family practitioners to make a decent living. The development of in-store clinics is the result of the difficulties patients are having with affordable access to medical care. If patients have to go to the emergency room of a hospital, wait three hours to be seen, and incur a large bill for a simple illness the healthcare system is not being responsive to the patients’ needs. Convenient Care Clinics’ attraction to patients is they help them avoid these barriers to care.

The growth of these in-store clinics is the result of the primary care physicians’ (PCPs’) inability to set up their medical practices to match the needs and schedules of the hectic life of patients in America today. The blame should not only fall on the PCP. The blame should also fall on organized medicine’s inability to recognize and respond to the needs of the PCPs’ and the practicing physicians’ patients. Organized medicine should be developing programs to teach PCPs how to respond to the changing needs of patients’. If medical practices do not respond to the needs of their patients, someone will.

"Look What Happens When You Are Not Looking, Part 3" - Repairing the Healthcare System
Who is not looking? The consumer, patients, doctors and hospitals are not looking. Some day they will all wake up. It is important to see right now what is happening in front of everyone’s eyes. The devaluation of medical care as a way of lowering the price of medical care is happening right now.

The real problem to solve with medical care costs is the cost of the treatment if complications of chronic disease. The complications of chronic disease cost the healthcare system 90% of the healthcare dollar. Effective treatment can lower the cost by at least 50%.

Unholy alliances are formed by the smell of money. The healthcare insurance companies would love the in store clinics because they serve to devalue the physician driven medical care services even further. Innovative cutting edge ideas for medical care should be developed by physicians. After all, who are the experts in the delivery of medical care? However, many physician groups are dysfunctional because of the pressures of overhead, reduction in reimbursement and malpractice concerns. They are fighting for their lives as reimbursement continually decreases. Physician practices must become more innovative, more efficient and more effective. If not I believe the delivery of quality medical care in a dysfunctional healthcare system with decrease even further.

The smell of money. Mmmm. (I wish.)

This past Tuesday, Steve Case through Revolution LLC launched a subsidiary Revolution Money, a payment system company. "Revolution Money's first two major offerings are Revolution MoneyExchange, a service for social and instant messaging networks that enables consumers to safely transfer funds via the Internet for free; and RevolutionCard, a credit card protected with a personal identification number," says Washington Business Journal.

On August 3, 2007, Revolution LLC launched Revolution Places, "an original approach to sustainable destination resort communities." Costa Rican President Óscar Arias Sánchez and Revolution Chairman Steve Case announced the first development, "Cacique, Costa Rica, a first-of-its-kind 650-acre luxury resort community scheduled to open in 2010."

"Revolution Places will bring together premiere hospitality partners and innovative lifestyle brands to develop a new authentic vacation experience that retains the local environment and culture. With a full complement of sustainability principles and community involvement, Revolution Places will create high-end developments that provide consumers with treasured and limited for-sale vacation real estate. These developments will also feature personalized service and unique amenities for home owners."

On July 25, 2005, Revolution Living introduced Lime - Healthy Living With A Twist. "Lime is part of a larger plan by AOL cofounder Steve Case and his company, Revolution Living, which bought the media group [Wisdom Media Group] in April as part of its investments focused on a more natural, healthy lifestyle. Lime will provide a fresh perspective on health and wellness, including content related to healthy foods, mindful exercise, alternative healing, and eco-friendly living. Lime will help consumers better themselves physically, intellectually, and spiritually, and help them live in balance, marrying "what's good for you" with "what feels good." "

Beyond Redi-Clinic, Revolution Health is affiliated with CarePages which is a social networking site, ConnectYourCare which offers assistance to employers and consumers transitioning to consumer-directed healthcare, Extend Health which offers alternative health insurance solutions, and which offers online shopping. Also, Steve Case is finding businesses which cater to the health living lifestyle and is making deals and purchasing large interests in such companies as Gaiam which produces DVDs and equipment related to yoga and pilates. In April 2007, Revolution Health even formed a partnership with the American Academy of Family Physicians "with the shared mission to help consumers find a “medical home,” help technology work seamlessly for consumers and promote a more patient-centered model of care."

As interest grows, I predict that Revolution Health and all of the subsidiaries of Revolution LLC will prove to be a powerful force, very Google-like, in shaping how we think of healthy living. Even PC Magazine, reviewed Revolution Health as a 'Site of the Week' in January 2007.

Finally, let's return to yesterday's blog post by Dr. Feld.

"What is an Entrepreneur?" - Repairing the Healthcare System
How can the healthcare system promote innovation and entrepreneurship to reform the healthcare system for the consumer’s benefit while maintaining freedom of choice for patients and intellectual freedom for physicians. Both freedom of choice for patients and intellectual freedom for pysicians have been severely hampered in the last 35 years. The impingement on these freedoms by restrictions imposed by rules, regulations, and system advantage to secondary stakeholders have led to the mess we are currently encountering.

I believe the mess is a result of the influence various stakeholders’ vested interests have on the political system. I also believe the time has come for the consumer as the most important stakeholder in the healthcare system to demand that the politicians hear them. The politicians need to stop listening to and acting on the vested interests of secondary stakeholders who control the system presently.

This is going to take the will of the people to be informed and express their vested interest. I believe we are getting there and being heard. We still have a couple of problems. It is going to take a Google-like entrepreneur to help the consumer solve the existing problems in the healthcare system.

Sounds to me that Revolution Health just may reveal Steve Case to be a 'Google-like entrepreneur' indeed.

Now please don't ask me if I think the Revolution Health movement is THE ANSWER to our problems....because I don't.

Monday, September 24, 2007

Biogen and Johns Hopkins enter collaboration

Biogen is known to Neurologists and Multiple Sclerosis patients as the manufacturer of Avonex and Tysabri, two of the five primary MS disease-modifying drugs. Biogen also manufacturers Rituxan for the treatment of Rheumatoid Arthrtis and is studying the benefit of Rituxan for MS patients. I'll be interested to see how this works out since I suffer from both.

Today Biogen Idec announced a research collaboration with the Brain Science Institue at Johns Hopkins University.

Cambridge, MA - September 24, 2007 - Biogen Idec (NASDAQ: BIIB) today announced a research collaboration with the newly formed Brain Science Institute at Johns Hopkins University to discover and develop therapies for neurodegenerative diseases such as multiple sclerosis, Alzheimer's and Parkinson's. The collaboration, the first of its kind between Biogen Idec and the University, will be focused on discovering and advancing clinical candidates from the lab into the clinic, with an emphasis on discovering new therapeutics for these diseases.

"Johns Hopkins is home to over 600 staff members and scientists who are focused on the neurosciences, offering world-class expertise in the frontiers of neurology and translational medicine, which complements our strength in neurological drug development," said Al Sandrock, M.D., Ph.D., senior vice president, neurology research and development, Biogen Idec. "This collaboration is part of Biogen Idec's long-term commitment to discovering treatments for neurological diseases with a high unmet medical need, as well as our efforts to develop new therapeutics based on innovative science."

John Griffin, M.D. director of the Brain Science Institute, will serve as the academic lead of the collaboration. He is a Professor and former Director of the Department of Neurology at Johns Hopkins University School of Medicine, Professor of Neuroscience and Pathology, and Neurologist-in-Chief at Johns Hopkins. Dr. Griffin is also a long standing participant in Biogen Idec's neurology scientific advisory board.

The collaboration will be guided by a joint committee composed of representatives from Biogen Idec and Johns Hopkins. The collaboration will begin with a focus on two programs, with an expected expansion to additional programs over time.

About Biogen Idec
Biogen Idec creates new standards of care in therapeutic areas with high unmet medical needs. Founded in 1978, Biogen Idec is a global leader in the discovery, development, manufacturing, and commercialization of innovative therapies. Patients in more than 90 countries benefit from Biogen Idec's significant products that address diseases such as lymphoma, multiple sclerosis, and rheumatoid arthritis. For product labeling, press releases and additional information about the company, please visit

About Johns Hopkins University's Brain Science Institute
The Johns Hopkins Brain Science Institute (BSI) was launched in March 2007, with a gift from an anonymous donor family. The Johns Hopkins BSI brings together neuroscientists from across the Hopkins schools and campuses to solve fundamental questions about brain development and function and to use these insights to understand the mechanisms of brain diseases, to develop effective treatments, and to take these therapies to patients. An important component of its mission is to foster translation of basic discovery into treatment. Hopkins neuroscientists have a long history of discovery, with over 1,000 patent applications. This agreement will be one important model of bridging the much-publicized "translational gap" between discovery and patient treatment.

The Johns Hopkins BSI is directed by John Griffin, M.D., and codirected by Rick Huganir. Dr. Griffin is the former Director of the Johns Hopkins Department of Neurology, former President of the American Neurological Association, Editor of Nature Neurology, and a member of the Institute of Medicine. Dr. Huganir is Director of the Solomon Snyder Department of Neuroscience at Johns Hopkins, and a member of the National Academy of Sciences.

Safe Harbor/Forward-Looking Statements
This press release contains forward-looking statements regarding the discovery and development of therapies for neurodegenerative diseases. These statements are based on Biogen Idec's current beliefs and expectations. Drug development and commercialization involves a high degree of uncertainty and risk.

For more detailed information on the risks and uncertainties associated with Biogen Idec's drug development and other activities, see Item 1A "Risk Factors" in Biogen Idec's most recent Form 10-Q filing with the Securities and Exchange Commission. These forward looking statements speak only as of the date of this press release, and we assume no obligation to update any forward-looking statements, whether as a result of new information, future events or otherwise.

For more information contact:

Media Contacts:
Biogen Idec
Shannon Altimari
Ph: 617 914 6524

Johns Hopkins University
Christen Brownlee
Ph: 410 955 7832

Investor Contacts:
Biogen Idec
Eric Hoffman
Ph: 617 679 2812

Sunday, September 23, 2007

Families USA says 89.6 million lacked health insurance in 2006-2007

89.6 million lacked health insurance in 2006-7

Those under 65 had no coverage for at least part of the time, group says

Updated: 7:46 p.m. ET Sept 20, 2007

WASHINGTON - More than one-third of the U.S. population under the age of 65 went without health insurance for all or part of the last two years, a consumer group said on Thursday.

The nonprofit Families USA group used data from last month's U.S. Census Bureau report that found 47 million Americans went without health insurance for all of 2006.

Families USA broke down that figure and calculated that 89.6 million people under age 65 — 34.7 percent — went without health insurance at some point during 2006-2007. It used a projection for the remaining months of this year.

After age 65, Americans become eligible for Medicare, the state-federal health insurance plan for the elderly.

"The huge number of people without health coverage over the past two years helps to explain why health care has become the top domestic issue in the 2008 presidential campaign," Ron Pollack, executive director of Families USA, said in a statement.

"The expansion of health coverage in America is no longer simply a matter of altruism about other people but a matter of intense self-interest."


In the United states, an employer generally supplies health insurance. But rising costs mean fewer employers are offering this benefit.

Budget crunches mean states have tightened eligibility for programs such as Medicaid, the public insurance plan for the poor and disabled, and for programs covering children.

Surveys also suggest that many of those going without insurance are middle-class and employed.

The Families USA report found that nearly two-thirds of people who lacked coverage at some point went uninsured for six months or more, and half went uninsured for nine months or more.

Texas had the most people without insurance — 45.7 percent of the non-elderly population.

The report found that more than 79 percent of those without insurance were in families in which at least one person had a job, 70.6 percent were themselves employed full-time, and 8.7 percent were employed part-time.

"The number of uninsured has reached crisis proportions that must be addressed by the President and Congress to ensure that health coverage is available and affordable for all," Pollack said.

Health insurance is a major topic of the 2008 presidential election campaign, with virtually every candidate offering a plan. Various nonprofits, big employers, unions and other groups are also proposing plans to cover more people.

(c) Reuters 2007. All rights reserved.

Here are some my views on Health Care in America:

Part 1: When staying alive means bankruptcy

Wednesday, September 19, 2007

Senate Passes "Mental Health Parity Act of 2007"

Today, the Senate passed "Mental Health Parity Act of 2007."

But are the requirements too lax?

According to Mental Health America (press release below), only persons covered by an employer-sponsored health insurance policy will be ensured coverage of mental health care at the same level of general health issues. Typically, employer-sponsored health insurance plans are group policies which must meet minimum requirements set at the federal level. Self-insured plans, which are established by many large employers, are not required to meet the same federal standards. Individual policies, being non-group, are subject to state regulations rather than federal regulations. The result becomes inferior health insurance policies offered to those persons not eligible for employer-sponsored coverage or adequate policies being truly unaffordable for the average person.

Emily DeVoto, PhD., at Health Counterspin decided to pass on a mental health rider after learning it would add $570 to the monthly premium. -- "The reform is long overdue. From my own perspective, I recently picked up temporary health coverage with a modest premium of about $230 per month, and noticed when I got the paperwork that it didn't include a mental health rider. When I inquired about the cost with the mental health coverage, I was told my monthly premium would be on the order of $800 per month. So I skipped it, and prayed for mental fortitude, though as far as I know, prayer is not an evidence-based preventive intervention against mental illness."

ALEXANDRIA, Va. (Sept 19, 2007) - Mental Health America commends the United States Senate for passing critical legislation today to end mental health insurance discrimination, and its sponsors, Senators Pete Domenici (R-N.M.), Michael B. Enzi (R-Wyo.) and Edward Kennedy (D-Mass.) for their leadership. The bill - S. 558, the Mental Health Parity Act of 2007 - will ensure that Americans with employer-sponsored health insurance and their families receive mental health care coverage at the same level as coverage for general health problems.

"The support of this legislation is overwhelming as it should be," said David Shern, president and CEO of Mental Health America. "The science is clear. Tomes of research demonstrate the interconnectivity of mental and general health. Public policy is finally catching up with science through passage of this important legislation." S. 558 has a wide range of supporters that, for the first time, includes business and insurance leaders, as well as mental health advocates. For details on the legislation and more information, go to

"With passage earlier this summer of legislation that would provide parity in mental health coverage under both Medicare and the State Children's Mental Health Program, Congress has a historic opportunity this year to end discrimination against people with mental health disorders in both private plans and federal health programs," said Shern. "As we celebrate this first step, we urge House and Senate leaders to make history." Mental Health America and its national network of affiliates now looks to members of the House to pass S. 558 and make history.

Mental Health America is the country's leading nonprofit dedicated to helping all people live mentally healthier lives. With our more than 320 affiliates nationwide, we represent a growing movement of Americans who promote mental wellness for the health and well-being of the nation - everyday and in
times of crisis.

Sunday, September 16, 2007

Dear ABC, 20/20, and John Stossel... please...PLEASE!!!... "Give ME a Break!"

Friday night ABC aired a special 20/20 news report "American Health Care in Critical Condition" presented by John Stossel and Andrew Sullivan. However, an earlier preview of the show was billed as "Healthy in Cuba, Sick in America?" Even last Wednesday, Stossel published "Cuba has Better Health Care than U.S.?" So you would think that the show would focus on the 'universal' healthcare debate and proposals of presidential candidates, but it didn't. The change in focus did not go unnoticed as reported Trisha Torrey at Every Patients' Advocate, "Stossel, 20/20, Bait & Switch, Naivete."

In my opinion, Stossel's report was propaganda in favor of the health insurance industry proposing 'market-based' solutions. Stossel uses information provided by Karen Ignagni, president and CEO of America's Health Insurance Plans (AHIP), who represents the interests of the health insurance industry. Of course, representatives of the health insurance industry would be opposed to any solution which takes power away from for-profit companies. In fact, recently, Ms. Ignagni has been lobbying furiously against portions of the SCHIP bill which diminish government subsidies for insurance companies offering Medicare Advantage plans. In June 2006, the Commonwealth Fund issued a report, "Medicare Part D: A Successful Public-Private Partnership" by Ignagni.

Back to the crisis of healthcare. If you've seen or heard anything about Michael Moore's film "SiCKO" you know that he, his film crew, and eight American patients travel to Cuba and receive medical attention at a Cuban hospital. Some viewers may say to themselves that Moore staged this 'stunt' in Cuba just for the controversial publicity it stirred up for the film and the oodles of money Moore might garnish from the proceeds.

If so, you might begin to wonder about those 'patients'...

  • Come on now...were they real people, or actors?
  • Couldn't they just see a doctor or go to Wal-Mart for $4 meds?
  • Hey, just go to the ER....that's where the poor and uninsured go.

Solution...get insurance...see doctor...take problem. See?

But wait a minute...

Didn't Stossel claim that too many Americans irresponsibly use their insurance coverage and thus are to blame for the escalating costs of health care in America which indirectly causes the tens of millions of those without insurance to be unable to afford coverage?

He did indicate that too many patients are unaware, or don't care, what the actual costs are for the care they seek. He assumes this is because the majority of insured Americans receive their health benefits through employer-sponsored, group package deals struck with the insurance company. Often (though at a declining rate recently), the employer pays a portion of the premiums as doing so is a tax write-off for the employer.

I do agree with a portion of his theory. Who does know the exact cost to see the doctor or the real price of a prescription refill? In health care, the concept of 'suggested retail price' doesn't exist. And even in retail, the 'suggested retail price' doesn't represent the actual cost for obtaining the item or service. That number doesn't really mean much, now does it?

Who sets the price....the doctor....the pharmacy....the drug company....the hospital....the lab....the manufacturer....the insurance company....the benefits manager....the government....the customer....the patient? I think we can agree that the patient is the one with the least amount of power over the rising cost of health care services. It's not like shopping at the grocery store and choosing the brand of spaghetti sauce which happens to be on sale that week to save a little money in the family budget.

When the insurance companies are involved, relevant questions become--
  • What is the allowed or negotiated rate?
  • Is this service excluded from my coverage?
  • When does insurance stop paying for my care?

When one has health insurance, he expects that the insurance company has negotiated fair allowable rates with those health providers 'in network.' Personally, I like the 'in network' concept... as long as my preferred doctors, the local hospital, and convenient pharmacies are 'in network.' Each time I receive a Explanation of Benefits statement from my insurance company, I note the rate billed by the doctor (or other provider), the rate which was 'non-allowed' by the insurance company, the amount which insurance paid, and the amount for which I am responsible. If I owe more than the copay rendered at the time of service, I know a bill will be arriving soon.

Example of charges/payments for doctor's visits I had this year:

  • $78 billed - $22.04 non-allowed - $25 copay = $30.96 ins.paid
  • $142 billed - $54.49 non-allowed - $25 copay = $62.51 ins.paid
  • $164 billed - $76.49 non-allowed - $25 copay = $62.51 ins.paid

Example of lab charges/payments also this year:

  • $120.42 billed - $102.17 non-allowed - $1.82 co-ins. = $16.43 ins.paid
  • $135.30 billed - $115.30 non-allowed - $2.00 co-ins. = $18.00 ins.paid
  • $181.10 billed - $156.65 non-allowed - $2.44 co-ins. = $22.01 ins.paid

Although I may not know the true costs involved in seeing the doctor, I do know the dollar amounts which have exchanged hands as a result of my having seen the doctor. Just I do not know the true costs involved in getting that on-sale jar of spaghetti sauce to the local grocer's shelf, but I do know how much I paid for it. Mr. Stossel please do not insult us in claiming that consumers of health care do not know that there are costs involved in receiving that care, regardless of how the dollars are exchanged between the interested parties.

Stossel's recommendation of Health Savings Accounts (HSA) as a means to fix the problems with our country's health care crisis reveals his libertarian preference for market-based solutions and limited government regulation. A prime feature of 'consumer-driven' health insurance products is the HSA which is typically paired with a high-deductible plan. The theory behind the HSA is that patients will more carefully choose how their healthcare dollars are spent when they are taken out of a personal tax-preferred account which, if left alone, could continue to grow through retirement. And by being more aware of each dollar spent, consumer-patients will research and negotiate lower prices, ultimately leading to more competition for healthcare dollars and thus lower healthcare costs.


Let me share a story. My individual private health insurance policy covers prescriptions... but with an annual cap of $1500. To receive the negotiated rates, I must fill prescriptions at an 'in network' pharmacy and use generics if available. To save on maintenance medications, I use the preferred mail-order pharmacy, Walgreens, which is the only mail-order pharmacy which must honor my insurance's negotiated rates. My insurance company employs an outside pharmacy benefit manager, Argus Health, to negotiate and manage pharmacy benefits. However, Argus does not require that Walgreens obtain stock from the least expensive manufacturer or wholesaler. In the case Gabapentin, a generic version of Neurontin which is manufactured by several generic drug companies, there are nine different NDC (National Drug Code) codes and prices, but only one which Walgreens stocks.

Knowing in June that I was approaching the $1500 limit, I called Argus to inquire as to what the negotiated rates were for each of my medications. I simply wanted to be able to budget appropriate for the increased cost as I had already spent $500 year-to-date and was looking at spending another $2000 minimum to the end of the year. A very patient woman worked with me in determining the negotiated rates for ten different medications, both in brand and generic forms. When I attempted to refill the gabapentin prescription through Walgreens, I was unpleasantly shocked to find that the 'negotiated rate' was twice what Argus customer service had quoted. After several phone calls, to Walgreens, Argus, Walgreens, Argus, Walgreens, and Argus again, it was revealed that of the nine sources of gabapentin, Walgreens only stocked one choice and that not being the least expensive.

I was not happy and wanted to know the exact amounts my insurance had paid toward each prescription filled and I politely asked for this detailed information. It was becoming clear just how my insurance company had 'blown through' my $1500 pharmacy benefit so quickly.

The report states:

  • Total scripts: 9
  • Total price: $307.02
  • Using generics saved you: $0.00
  • Your insurance saved you: $3510.79

*All nine prescription fills were for generics with $307 for
copays. This does not include prescriptions filled at the local
Rite-Aid. But what EXACTLY did my insurance PAY!!!! You better believe it wasn't $3500 when they stop paying at $1500.

I don't appreciate that my insurance company paid too much for my meds, leaving me with higher expenses beyond the $1500. In the 7 years I have had the same policy, the annual limit for medications has never increased while the premiums have increased 88%. Carefirst is able to offer such a policy because it is an individual policy. Individual policies are not subject to the same regulations as group policies. In Virginia, this leaves individuals, like me, not covered for a basic need such as maintenance medication. This results in patients going without needed treatments, drug companies having little incentive to keep prices lower, insurance companies being allowed to sell insufficient (essentially unregulated) policies to persons without employer-sponsored benefits, and ultimately much waste in the financing and spending of healthcare dollars.

Trying to come up with a solution to the fighting over access to those healthcare dollars reminds me of lunchtime in elementary school. I grew up in a poor section of Oklahoma City and attended an elementary school which had a government-subsidized lunch program. Of course at the time, I had no idea that what was available to me on a daily basis was anything out of the ordinary. For many children, lunch was likely the first meal of the day and maybe the best meal. Every child received a well-balanced meal and if you were still hungry, you were allowed to have seconds. Knowing that you would not go hungry eliminated the urge to hoard food or any need to fight over access to the biggest portions. No negotiations over lower prices, no stealing or cheating, no begging for charity care, no being sent away for inability to knew you would be fed and learned not to be wasteful.

I hope for a day in which receiving HEALTH CARE and MEDICAL CARE will be as dependable as that daily school lunch 30+ years ago. So far the best solution I have studied is found in the idea of Medicare for All. For a nice description of how this would work, read "Single Payer- Grassroots & Tactics" by DrSteveB at the Daily Kos.


"Single-Payer Health Coverage: Scary Boogey Man or Super Process-Improvement Force in Health Care Reform?"

Thursday, September 13, 2007

2008 Race to the White House - Is U.S. Health Care a Priority?

The issue of Health Care in America has become one of the hot topics in 2008 presidential campaigns. And early though it is in the race, a number of candidates have proposed their recommended prescription and complementary course of treatment intended to heal our ailing healthcare system.

Unfortunately, our seriously ill patient, being the United States Healthcare System, is unique and sufficient studies showing statistically significant outcomes are lacking. What we do know, without a doubt, is that the current approved treatment is failing our patient and we need to design a new protocol quickly before our patient is beyond rehabilitation.

Several independent organizations are tracking the candidates' positions on healthcare reform and other important issues.
Have fun scouring these resources to find YOUR candidate. - Election News, Analysis, and Events is part of a broad effort by the KAISER FAMILY FOUNDATION to provide a central hub for resources and information about health policy issues in the 2008 election. The site -- operated by Kaiser staff -- provides analysis of policy issues, regular public opinion surveys, daily news updates, video of speeches and debates from the campaign trail, original interviews and resources for journalists covering the election.

2008 Presidential Candidates - Biographies and Positions

This site was established in order to provide voters with information about the primary presidential candidates for 2008.
On The Issues - Every Political Leader on Every Issue

2008 Presidential Election on Yahoo!

BLOG HER - An Open Letter To All Presidential Candidates

AHCJ - Election 2008: Health Care

As the 2008 presidential campaign intensifies, ASSOCIATION OF HEALTH CARE JOURNALISTS will be tracking the candidates' positions on health care issues.
Based on what candidates reveal in debates, speeches and statements, we will update this with information on where they stand on other issues, including stem cell research, abortion and more.
NPR - 2008 Candidates

NATIONAL PUBLIC RADIO - For the first time since 1928, the race for president will not include a sitting president or vice president. Here, a look at the declared - and likely - Democratic and Republican candidates for the White House 2008.
NYT - The Presidential Candidates on Health Care

NEW YORK TIMES - Presidential candidates in both parties are promising to overhaul the nation's health care system and cover more - if not all - of the nation's uninsured. In 2005, 44.8 million people - 15.3 percent of the population - were without health insurance, according to estimates released by the Census Bureau in March. The leading Democrats are competing among themselves over who has the better plan to control costs and approach universal coverage. The Republicans, for the most part, are promising to expand coverage without increasing the role of the federal government, and reduce cost through tax incentives. Most of the candidates have not presented a detailed outline of their health care plans, but here is what they have said so far. - FARHANA HOSSAIN
Working Families Vote 2008 - The Candidates on Health Care

WORKING FAMILIES VOTE 2008 is the online center for union members and all working women and men to get involved in selecting America's next president. This site's goal is to provide a comprehensive voter guide that fosters civic participation among working people and encourages them to register and vote by informing and engaging them on key working family issues and the presidential candidates' records and positions on the issues. The AFL-CIO has not endorsed any candidate, and as a matter of policy, the AFL-CIO will not do so unless and until its affiliated unions reach a sufficient consensus on a particular candidate. Meanwhile, this website provides and links to information about all viable declared and exploratory presidential candidates seeking the nomination of either major political party.
AAFP - 2008 Presidential Candidates' Health Care Positions

The AMERICAN ACADEMY OF FAMILY PHYSICIANS continues to work to put health care and place family medicine issues in front of presidential candidates. The AAFP has launched an initiative to help members become informed about and active in the 2008 Presidential Campaign. Here you will find helpful and timely materials so that you can bring a family medicine perspective to health policy in the campaigns at state and local campaign events.
The Pew Forum - Health Care, Religion and Politics 2008

THE PEW FORUM ON RELIGION & PUBLIC LIFE, launched in 2001, seeks to promote a deeper understanding of issues at the intersection of religion and public affairs. The Forum pursues its mission by delivering timely, impartial information to national opinion leaders, including government officials and journalists. As a nonpartisan, non-advocacy organization, the Forum does not take positions on policy debates.
Divided We Fail - The Candidates 2008

AARP, Business Roundtable and Service Employees Union (SEIU) launched DIVIDED WE FAIL to engage the American people, businesses, non-profit organizations, and elected officials in finding bi-partisan solutions to ensure affordable, quality health care and long-term financial security – for all of us. The need for health and financial security is something we all share, not just for ourselves, but for future generations. It is the promise of America.
2008 Health Care Challenges and Opportunities

U.S. Presidential Candidates' Health Care Plans - A Side-by-Side Comparison by Susan J. Blumenthal, M.D., Jessica B. Rubin, Michelle E. Treseler, Jefferson Lin, and David Mattos
2008 Presidential Candidates - Comments on Women's Health Issues

The following are statements by the 2008 presidential candidates on issues related to reproductive rights and women’s health, compiled by PLANNED PARENTHOOD ACTION FUND. Some statements are excerpts from longer statements.
RH Reality Check - Election 2008

RH [Reproductive Health] REALITY CHECK is an online community and publication serving individuals and organizations committed to advancing sexual and reproductive health and rights. RH Reality Check is guided by the issues and recommendations identified in the Program of Action agreed on at the International Conference on Population and Development at Cairo in 1994. Protection is our watchword—we are contributing to the global effort to empower people with the information, services and leadership they need to safeguard their sexual and reproductive health and rights and to guard against false attacks and misinformation. RH Reality Check exists as a resource for evidence-based information, provocative commentary, and interactive dialogue. We enjoy the support of the UN Foundation and the editorial independence entrusted to us.
SelectSmart - 2008 Presidential Candidates Selector

This selector features over two dozen names of announced candidates and politicians considered by pundits to be possible White House contenders. You may select a position for every issue, or just select those issues important to you. The candidates' positions are based upon their voting records, special interest group ratings and the candidates' statements in the public record. In cases where a would-be president has no known public record or statement on an issue, they are not given a score, which tends to reward candidates who take stands on more issues. Also candidates for president who take consistent and stronger stands tend to get higher scores. All the candidates and/or their staffs were written to and given an opportunity to clarify or correct their views as characterized here.
Or...simply go directly to the candidate's campaign site:

Sen. Joe Biden (DE)
Sen. Hillary Clinton (NY)
Sen. Christopher Dodd (CT)
Former Sen. John Edwards (NC)
Former Sen. Mike Gravel (AK)
Rep. Dennis Kucinich(OH)
Sen. Barack Obama (IL)
Gov. Bill Richardson (NM)

Kent Mesplay
Kat Swift

Daniel Imperato
Steve Kubby
George Phillies
Wayne Allen Root

Sen. Sam Brownback (KS)
Former Gov. Mike Huckabee (AR)
Former Gov. Jim Gilmore (VA)
Former Mayor Rudolph Giuliani (NY)
Rep. Duncan Hunter (CA)
Sen. John McCain (AZ)
Rep. Ron Paul (TX)
Former Gov. Mitt Romney (MA)
Rep. Tom Tancredo (CO)
Former Sen. Fred Thompson (TN)
Former Gov. Tommy Thompson (WI)
Former Secretary of Health and Human Services who ensured passage of Medicare Modernization Act of 2003

John Cox
Ray McKinney
Jim Mitchell
Richard Michael Smith

Friday, September 7, 2007

Questcor uses the Orphan Drug Act as a strategy tool to boost marketing and development

"Abusing the orphan drug law to rip off customers" by David Williams, Health Business Blog. When I read Williams' article, I became furious, not because I am familiar with Infantile Spasms (IS), but because the families affected by IS will be facing an outrageous financial battle. On August 30, 2007, the Epilepsy Foundation announced "Dramatic Increase Seen in Cost of H.P.Acthar Gel."

Acthar was developed in the 1950's for the treatment of exacerbations in Multiple Sclerosis. In 1997, the FDA recognized the need to continue manufacturing of H.P.Acthar Gel by Centour for use in the treatment of Infantile Spasms. In August 2006, Questcor Pharmaceuticals, Inc. submitted sNDA for FDA approval to include treatment of IS on the label of H.P.Acthar Gel which had been acquired from Aventis in 2001. On May 14, 2007, Questcor announced that the FDA did not approve the sNDA. One week later, Questcor CEO James Fares resigns.

On August 27, 2007, Questcor board announces New Strategy and Business Model for H.P. Acthar Gel.
will initiate a new pricing model, create an expanded safety net for patients using Acthar, and provide a group of Medical Science Liaisons to work with health care providers who are administering Acthar.

"...the goal of Questcor's new strategy is to make manufacturing and distribution of Acthar economically viable on a stand-alone basis, so that Questcor can continue to ensure the availability of Acthar for those patients who need it most and fund projects which can contribute to the growth of the company."

Previously, the FDA granted Orphan Designation to H.P.Acthar Gel for the treatment of IS. As a result of this Orphan Designation, if Questcor is successful in obtaining FDA approval for the IS indication, Questcor will also qualify for a seven year exclusivity period...

The cost for a course of treatment could approach $80,000-$100,000.

The term "orphan drug" refers to a product that treats a rare disease affecting fewer than 200,000 Americans. The Orphan Drug Act was signed into law on January 4, 1983. The intent of the Orphan Drug Act is to stimulate the research, development, and approval of products that treat rare diseases.

Now the issue of "rare diseases" is one which I do have personal knowledge. I have MS and I use an expensive self-injectible drug. The safety net for that drug is administered by National Organization for Rare Disorders (NORD), which is the same safety net Questcor now uses for H.P.Acthar Gel. However, this 'safety net' has big holes and many families will likely fall right through. If you've read my other posts, you are aware that NORD finally awarded full assistance in receiving that $21,000 drug after my earnings sunk below $20,000.

So this is what I suspect happened sometime before 2001 (of course I have no proof):
  • Investor A looks at the drug industry and thinks to himself, "where is there a better opportunity to make some money?"
  • Investor B - "hey, the neurological med field is booming...just look at the success of the self-injectible MS meds. They are industry blockbusters."
  • Investor C - "yeah, those MS drugs are working so well that the old standby exacerbation drugs, like Aventis' H.P.Acthar Gel, aren't doing as well."
  • Investor B - "you're right, but the H.P.Acthar Gel is working wonders for Infantile Spasms."
  • Investor C - "you know, it's the specialty pharms which are raking in the money. We could do that with the Acthar Gel, if we owned it."

In 2001, Questcor acquires H.P.Acthar Gel from Aventis. In 2002, the FDA uses Questcor's Acthar Gel as an example of how they respond to drug shortages which affect seriously ill patients. In Oct 2003, the FDA grants 'orphan drug' status to Acthar Gel for the treatment of Infantile Spasms. In November 2003, Questcor and IDIS enter into an exclusive agreement for distribution outside of the U.S. Between 2001 and 2005, Questcor makes several strategic moves to consolidate Acthar manufacturing and distribution.

In February 2005, Questcor names James L. Fares President and CEO, followed by the announcement in April of a New Business Strategy -- Company to Focus on Neurology Products." Between May 2005 and September 2005, Questcor hires Craig Chambliss as Vice President of Sales & Marketing, Gregg Lapointe to the Board of Directors, and George Stuart as Chief Financial Officer. In October 2005, Questcor sells three of their products for $28.3 Million earning them enough money to pay off much debt and focus on realizing their grand vision. In May 2006, Questcor acquires Doral(R) giving them a Second Product for National Neurology Sales Force. In December 2006, Questcor presents data on H.P.Acthar Gel at American Epilepsy Society annual meeting. In May 2007, FDA rejects sNDA application and James Fares resigns.

So in August 2007, Questcor finally announces their new strategy which will effectively drain as much profit as possible out of A.P.Acthar Gel. Whether from private insurance, Medicare, SCHIP, Medicaid, or the doesn't matter as long as Questcor is able to...

..."fund projects which can contribute to the growth of the company."

Job well done clever investors.

So sorry patients.


Tuesday, September 4, 2007

Single-Payer Health Coverage: Scary Boogey Man or Super Process-Improvement Force in Health Care Reform?

Health care is an essential safeguard of human life and dignity and there is an obligation for society to ensure that every person be able to realize this right. Joseph Cardinal Bernardin, Chicago Archdiocese

So what have you heard about Single-Payer?

A single-payer, national health insurance program equates to socialist, government-controlled, ineffective health care. And Michael Moore's SiCKO exaggerated the negative outcomes of Americans who may, or may not, have health insurance coverage. Finally, it may sound good, but we can't afford it.

But I disagree...

My understanding is that the United States health care system is comprised of both public and private systems; public examples being Medicare, FEHBP; private examples being everybody else in the insurance industry. In the private sector, there exist a plethora of insurance coverage options (group, non-group, self-insured, association plans, guaranteed issue, risk pools, underwritten, employer-sponsored, high deductible, managed care, indemnity, individual, family, etc.), accompanied by equally thick layers of regulations at local, state, and federal levels.

The result of this multiplicity being inequality of access, coverage, and affordability, abundant bureaucracies, excess layers of administration, profit-motivated corporations, and the general third-payer choke-hold of our current US health care system.

Establishing universal health care in this country is not a new idea. The Consumers Union, the parent of Consumer Reports, has lobbied for universal health care for most of its 70-year history. In May 2001, Kaiser Family Foundation published Physicians' Working Group on Single-Payer National Health Insurance, A Proposal for Health Care Reform.

Many of the 2008 presidential candidates are calling for universal health care in their campaign platforms, but most of these proposals are still bound by the choke-hold of the profit-driven, financially-powerful, free-market (so called), private insurance industry and its monopolies.

In February 2003, Dr. Marcia Angell, Harvard Medical School, introduced The United States National Health Insurance Act, H.R.676 which would establish a single-payer system for health care in America. For complete text - read here.

So far, only one presidential candidate publicly endorses H.R.676, Rep. Dennis Kucinich (D-OH) who is one of the originators of the bill.

What IS Single-Payer Health Coverage -- What is it NOT!!!

What is Single-Payer?

The term single-payer describes the method by which some countries provide its citizens with health insurance. The name comes from the fact that doctors, hospitals, pharmacists, and other health care providers, are paid by ONE organization. In a single-payer national health insurance system, as demonstrated by Canada, Denmark, Norway, and Sweden, health insurance is publicly administered and most physicians are in private practice. (OECD)

Single-payer saves lives.

In a single-payer health system, everyone has health insurance. Lacking health insurance in the U.S., 18,000 people die each year -- at the rate of two per hour -- according to the Institute of Medicine. The US has higher infant mortality levels compared to most other democratic countries. Babies would be healthier if all pregnant women could get access to a doctor while they're pregnant. Or think of how much less-crowded emergency rooms would be if people could see a primary care doctor when they were sick, instead of only going to an ER when they become sicker.

To be without health insurance in this country means to be without access to medical care. But health is not a luxury, nor should it be the sole possession of a privileged few. We are all created b’tzelem elohim — in the image of God — and this makes each human life as precious as the next. By ‘pricing out’ a portion of this country’s population from health care coverage, we mock the image of God and destroy the vessels of God’s work. Rabbi Alexander Schindler, Past President, Union of American Hebrew Congregations [1992]

Single-payer saves time.

Imagine if all doctors and hospitals in the US had a uniform claim form to submit for payment; if all patients had the same insurance card; and if patients had health insurance by virtue of being US citizens.

Ever hear the business saying? Time is Money.

Consider the savings in time and money by eliminating wasteful paper-pushing. Doctors would have more time to care for patients; patients would have fewer headaches waiting to talk to their HMO to prove their coverage; nurses would be able to focus on nursing instead of spending 40%-60% of their time dealing with paperwork (AHIC, 03/13/07, meeting notes)

Single-payer saves money.

By streamlining the administration of the health care system, the paper-pushing is greatly decreased in frequency, duplication, and cost. A greater percentage of each health care dollar could be used to care for people's health, instead of going to managers and forms. Even advocates for private health insurance report that 56 cents of every health care dollar goes to the administrative costs of insurance companies, doctors and hospitals.

"The insurance system is a mess," said Greg Scandlen, the founder of Consumers for Health Care Choices, which advocates for private health insurance. "That's why we support health savings accounts," he said. With health savings accounts, insurance companies, doctors and hospitals can save on administrative costs and pass those savings on to consumers, Scandlen explained. These costs take 56 percent of every health care dollar, he said. — Steven Reinberg, HealthDay News, 08/07/07

By eliminating the bulk of paperwork duplication, a single-payer system could potentially save hundreds of BILLIONS (that's 100,000 million) of dollars. As it is right now, American businesses are at an economic disadvantage, because their health costs are so much higher than in other countries. The Canadian branches of Ford, GM, and Daimler-Chrysler all publicly support Canada's health care system, because it saves them an enormous amount of money, compared to their counterparts in the US.

Most single-payer systems save a ton of money by buying prescription drugs for its patients in huge bulk quantities. Consider the money you save by buying in bulk at Costco or Sam's Club? Now imagine applying that concept to buying prescription drugs for America's 290 million people.

Single-payer creates financial security.

A single-payer system would mean fewer personal bankruptcies due to medical bills--and an end to patients actually receiving bills. Medical bankruptcies account for 55% of all bankruptcies filed in the US. In most countries with a single-payer system, patients never see a bill. The billing process doesn't even involve patients. (This saves money, too--think of how much work goes into itemizing each bill, sending it to each patient, following up on the bill if there's been an error... and on, and on.)

"Four out of 10 Americans can't count on having health insurance when they need it," said senior project editor Nancy Metcalf, [Consumer Reports]. "This includes people who don't have health insurance, but also the 3-in-10 people whose health insurance is so bad or so costly to them that [they] are having trouble accessing and paying for medical care."Steven Reinberg, HealthDay News, 08/07/07

Single-payer saves choice.

Americans love choices and being presented with options. With a single-payer system, patients could go to any doctor they preferred. You could see the doctor that's closest to you, the one that all your friends recommend, or even choose one of your same religion, ethnicity, or race. A much different experience than being limited to the preferred providers of your HMO, if you don't want to pay an arm and a leg for it.

With a single-payer system, people would not be shackled to their current job solely for the health insurance it provides. People would be liberated to find jobs they're happier with or even consider starting their own businesses. Employers would be freed from the constraints of providing health benefits and could be more confident their happier-healthier workers were a good fit for their jobs.

"In 2005, we passed a milestone that no country should be proud of, which is that the average cost of a family plan in a workplace-based policy was more than a full-time employee making minimum wage gets in a year," Metcalf said. "Employers, too, are feeling the strain of rising costs. In 2000, the average employer contribution for a family plan was $135 a month; by 2006, the cost was $248," Metcalf said.

[PERSONAL NOTE: In 2007, an individual (non-group, not employer-based), PPO (managed care), underwritten (pre-existing conditions excluded), private insurance policy for a 39-year old single female living outside Washington, D.C., costs $274 each month, while providing limited $1500 drug coverage. In 2000, the monthly cost was $151 with the same $1500 limited drug coverage.

In 2006, uncovered medical expenses exceeded $31,000, in addition to health insurance premiums, for the treatment of Multiple Sclerosis. Fragmented assistance received for obtaining necessary medication came as: 50% award from pharmaceutical company=$9000; county Coordinated Services grant=$900; local charity=$200; donated medications from doctors' offices=$6000+; 'We Care' donation from D.C. Musicians' Union=$2000. Earnings 2006: $19,421.]

What isn't single-payer?

There's a great deal of incorrect information out there about health care reform. It's time to set the record straight--and if you want more information, you can always dig deeper.

Single-payer isn't socialized medicine... it's socialized insurance.

What's the difference?

Socialized medicine is the system in the Britain where the government owns the hospitals and employs the doctors--truly a government-run health care system.

Socialized insurance is the system in Canada where the government pays the hospitals and pays the doctors. An important difference is that hospitals and doctors remain part of the private sector in the single-payer system.

Single-payer isn't government bureaucracy... it's actually government efficiency.

Admittedly, some parts of the government are inefficient. Some waste your time; but so do HMOs and other corporations that keep you on hold for hours. In fact, the Medicare system is much more efficient than any HMO. About 4 cents of every dollar goes to administration in Medicare, but it's anywhere from 10 to 30 cents of every dollar in HMOs--the average being 11 cents.

Single-payer is health care rationing... but not the type you think.
Currently, health care is rationed by ability to pay. If you have insurance, you get health care; if you don't have insurance, you generally don't get health care. Basically a no pay-no play system which costs us all more.

Single-payer rations care by health care need. There would be no more "pre-existing conditions" limiting insurance availability, no more hassles to see a doctor of your choosing, no more denied applications for prescription assistance, no more demoralizing cling to a disintegrating safety-net system, no more delaying medical attention for inability to pay. Every American can receive necessary health care attention regardless of ability to pay.

Single-payer isn't free care... but it's certainly less expensive.

Money would come from employers and employees. Most of the necessary money is already in the system--currently going to HMOs instead of to a single-payer organization. Studies by the Congressional Budget Office, the General Accounting Office (GAO), the Lewin Group, Boston University, and numerous other reports, have done the math and come to the conclusion that single-payer would save enough money to cover the cost of insuring all the 45 million uninsured in the United States today.

How single-payer would affect all the health care players...


Single-payer national health insurance would provide health insurance coverage for everyone in the United States which currently has about 45 million uninsured. Patients would have access to all medically necessary care, including doctor visits, hospital care, prescriptions, mental health services, nursing home care, rehab, home care, eye care and dental care. (Sorry, "medically-necessary" doesn't cover cosmetic surgery or botox injections.) Patients would have their complete choice of doctors, cheaper prescription drugs, and no bills for health care.


Doctors would have less paperwork and fewer administrative headaches, while given more freedom and choices, too. Because there would be "one form" for doctors to file and less time spent figuring out a patient's insurance status and coverage limitations (and therefore more time to spend helping patients), doctors would be able to return to the reason they entered medicine--to help care for patients.

Most primary care physician doctors' incomes would stay about the same (when Canada passed its health care reform, salaries actually went up). Specialists' incomes would decrease, but doctors' own costs would be decreased, too: they could spend less on office staff and employees that work on insurance claims, as well as the health insurance for those workers.


Nurses' salaries increased greatly in Canada after passage of its health system reform. More nurses would be trained and hired to work in departments where nurses have been cut to save costs (and to work in nursing, where there is already a shortage.) This would decrease stress levels, and give nurses more time to spend caring for each individual patient.

Medical Students

Medical students would graduate with significantly less medical debt, if the single-payer plan mimicked the Canadian system. Many students cite debt (currently averaging around $90,000) as a reason they do not enter the field they truly want to enter.


Researchers would still have their research funded like it currently is--through the National Institutes of Health, the main entity in the United States that provides research grants to professors and scientists working on science-related research.


All hospitals would be converted to non-profit status, after a one-time payment to investors (several of the largest for-profit hospital chains have paid billions of dollars for defrauding Medicare.) Hospital billing would be virtually eliminated. Instead, hospitals would receive an annual lump-sum payment from the single-payer to cover its expenses—a "global budget." A separate budget would cover such expenses as hospital expansion, the purchase of technology, marketing, etc. Hospitals would no longer close because of unpaid bills.


Businesses would see the single-payer system decrease their health costs and remove the burden of administering health insurance for their employees. They would gain the competitive advantage that Canada and other countries have from decreased health costs per worker, and wouldn't need to worry about health care cost increases every year--the single-payer system helps control costs much better than the current system does.

Health Insurance Industry

The health insurance industry would be mostly eliminated--only organizations that actually employed doctors (like Kaiser Permanente in California) would be allowed to continue to operate. One proposed single-payer bill would provide one percent of funding for retraining displaced insurance workers during its first few years of implementation.

What would single-payer look like in the US?

The Single-Payer(s)

Okay. You got me. Multiple single-payer groups. Most blueprints suggest that the US would have regional payers--so, maybe a Western, Mountain, South, Midwest, South, and Northeast payer. Each would be responsible for a certain number of states, and each would still work with the others, so that if you live in California and take a trip to Atlanta, you're still covered. These payers would handle their states' paperwork and payments, and would get their money from the federal government, who would collect all the money to begin with.

The Doctor's Office

You go to see a new doctor. You give them your health card, they scan it, and you're in their system. You fill out the paperwork about your health for your doctor, and see him or her. The doctor either treats you or sends you to a specialist, and you don't see a bill or invoice. The doctor simply bills the regional payer electronically for the treatment or care he or she provided, and within 30 days, the doctor is paid.

When integrated with Health Information Technology, a single-payer system would created a unified, compatible, secure, system for receiving health care services, maintaining transparency, increasing quality, and ensuring confidence in evidence-based medicine.

How would we pay for all this?

"That's all fine and dandy," you say, but you want to know how we're going to pay for it all. A reasonable question. And for it, a reasonable solution.
Luckily there's already plenty of money in the health care system. The US spends double what most other countries spend on health care, and Americans still have shorter lifespans, and 45 million people still go uninsured every year. Many financing schemes exist. Hundreds of billions of dollars could potentially be saved in administrative costs, which would far exceed the amount needed to insure everyone in the United States. Put most simply, the money that businesses currently pay for health care would go to the single-payer; this would make up most of the money needed.

A wealth of other questions answered...

Special thanks to Graham from whom I 'borrowed' a great deal of material and inspiration regarding single-payer health care system.

More information is available at: - Physicians for a National Healthcare Program - RESULTS - Consumer Affairs - Single-payer info by Graham, med-student