The Health Care Morass

Dose of Reality: Teamsters Tango with Alaska Regional Hospital

2010-08-20T11:02:00.000-07:00

In the latest in his investigation of Wells Fargo, the State of Alaska, and the sudden status of a for-profit hospital as preferred provider, Davis delves in to Alaska Regional Hospital's history.

…the present hospital was actually built and owned by Teamsters Union Local 959 in 1976. It is easily understandable why the hospital’s website does not dwell on this chapter of its history that took place during pipeline construction days.

The era of construction of the Trans-Alaska Pipeline, 1973 to 1977, was a wild time in Alaska, and during that period the Alaska portion of the Teamsters Union, Local 959 with its 23,000 members, was making money hand over fist, taking into its pension trust funds $1 million each week. Head of Local 959 was the notorious Jesse L. Carr who in the late 1960s was charged with extortion, embezzlement, and making false claims to secure a government loan.…Under Jesse Carr’s leadership, the Teamsters Union chose to build an empire by investing in real estate and construction.

Double Dose: Wells Fargo and Alaska Regional Hospital

2010-07-12T13:39:00.000-07:00

Neil Davis has been on the trail of some interesting, and rather peculiar, wrinkles in the State of Alaska's new AlaskaCare health plan administration. Wells Fargo Insurance Services is the current administrator of AlaskaCare for the state, and something is fishy in their new choice of preferred provider. In an early release of the June Dose of Reality, Davis describes the document that tweaked his curiosity about the recent change from a nonprofit, Providence Hospital, to a for-profit, Alaska Regional Hospital:

The reason for the change in preferred provider, the Wells Fargo document implies, is to save money. In support of that idea the document contains a table showing dramatically different costs for medical procedures undertaken at Alaska Regional Hospital and Providence Hospital, both in Anchorage. This is the fishy part: the cost figures given are so different for the two hospitals that something has to be wrong and probably purposely misleading.…Having previously looked a bit at the pricing structure and markups over cost of these two hospitals, I could not accept the idea that to be treated at Providence, on average, costs AlaskaCare members 3.4 times as much as at Alaska Regional.

Following up on this for the July Dose of Reality, Davis discovered that Wells Fargo and Alaska Regional's parent company have a long history together. And that history reveals some shady dealings:

Among the allegations that led to Columbia/HCA’s guilty plea and payment of fines were that Wells Fargo CEO Carl E. Reichardt and four other directors of Columbia/HCA were fully aware that senior management had “devised schemes to improperly increase revenue and profits, and perpetuate a management philosophy that provided strong incentives for employees to commit fraud.” Reichardt and the other four also were charged with knowing about HCA’s improper acquisition practices, which involved offering personal benefits and perquisites to hospital executives during HCA’s negotiations for the purchase of their hospitals.

Dose of Reality: Discount Health Cards

2010-07-12T12:28:00.000-07:00

Neil Davis' May Dose of Reality offering features an analysis of discount health care cards (a bad deal). Davis' attention to this middleman scam in the health care business was drawn by a full-page ad in the Ruralite, GVEA's member magazine. The ad, Davis decided, is deceptive and close to fraudulent. The skinny on discount cards boils down to this:

If you look into the matter you will find that the best approach is to forget the discount cards altogether. A discount card is not likely to get you a discount greater than 10 percent, and if you are not insured you can probably do better by paying cash right away every time you go to the doctor or hospital.

Dose of Reality: Obamacare

2010-05-29T12:24:00.000-07:00

April's Dose of Reality is a discussion of the 900-page Patient Protection and Affordable Care Act, which may, says Davis, actually do some good.

Anyone aware of the control that the health insurance and pharmaceutical industries exert over Congress should not be surprised that the new law does good things for these industries, and very little that may harm their profitability right away. The surprise (for me at least) is that the new law actually does do some good for the public—and in ways that might and should eventually lead to the demise of the for-profit health insurance industry and the continuing obscene profits of the pharmaceutical industry.

The act allows for self-insuring, although it does not include a public option, unfortunately. Health care cooperatives already exist, and this bill may strengthen them by providing an option that costs less. (Obamacare doesn't do much to reduce health care costs, alas--some, but not much.) Neil uses the example of the Seattle-based Group Health Cooperative. The more people who join health care cooperatives, the stronger they will become. And cooperatives, unlike insurance companies, exist to benefit their members. (Insurance companies, you recall, exist to make a profit for their investors.)

Dose of Reality: ACHIA's a bad deal unless you're desperate

2010-05-28T19:10:00.000-07:00

In the March 2010 Dose of Reality, Davis takes on ACHIA and the sudden spate of cheery ads and announcements publicizing Alaska's Comprehensive Health Insurance Association:

These ads stress the idea that every Alaskan already has the ability to buy health insurance. Why do you suppose that is? Could it be that the ads are a propaganda ploy trying to promote the idea that we don’t really need health care reform just because it promises that everyone will be able to get insurance despite pre-existing conditions? Also, we might ask, why are so few Alaskans enrolled in the ACHIA program?

Davis tackled the ACHIA program in an earlier article, too, in February 2009, describing how the program works.

Dose of Reality: We Haven't Hit Bottom Yet

2010-05-28T19:04:00.000-07:00

In the February Dose of Reality, Neil Davis writes:

Back in the 1950s before Alaska achieved statehood, my father was assistant director of the Fairbanks federal prison and then director of the Nome federal prison. In those capacities he saw many people with problems that they sometimes surmounted but often did not. That experience led him to believe that a person headed downward had to hit a floor before bouncing back upward to put his life back in order. I recall him saying of one of his prisoners, “That guy has not hit bottom yet; his life will get worse until he gets there, then maybe he can rebound up to where he can live a decent life.”

It seems to me that this is where the American public now is on health care reform: things are bad but they are going to have to get a lot worse before the public finally rebels against the insane for-profit health care system that it has allowed to come into existence.

Davis provides a few grim statistics to show just how bad health care in this country really is—and worse, how bad the trends in heath care have become, relating to bankruptcies, child mortality, poverty, and CEO salaries.

Dose of Reality: Looking at 2009

2010-02-24T13:53:00.000-08:00

In Davis' January Dose of Reality, he observes that "for the first time, health care reform bills have actually gotten to the House and Senate floors—and been passed." This is a significant achievement, despite the problems associated with them. A comparison of the two bills (PDF) was provided by the Kaiser Family Foundation, but, Davis writes,

Reading through the Kaiser report the main impression I got was that neither the House nor Senate bills do much if anything to reduce the incredible complexity and cost of the American health care payment system. This complexity adds much to the system’s dysfunctional nature and allows uncontrolled escalation of costs.

In other words, both bills miss tackling the main problems with our system.

Imagine: Travel care like health care

2010-01-09T18:03:00.000-08:00

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Dose of Reality: My Rogue Big Toe Two

2009-12-31T11:51:00.000-08:00

Neil Davis' December Dose of Reality continues with the (expensive) lessons learned from his ingrown toenail:

Since last reporting I have again managed to inveigle my way back into Fairbanks Memorial Hospital for a few more days to explore the staff’s expertise in the use of modern diagnostic capabilities designed to unravel the secrets of how my rogue big toe could cause so much havoc. Adding that into the mix of my three other hospital stays plus several days experience with Home Care personnel, I can now say that during the past month or so I have had an unusually comprehensive exposure to the ways of modern medicine. I’ve learned all about emergency rooms, medivac flights, intensive care units, cardiac units, surgeries, cardiac rehab and physical therapy centers, MRIs and various other scanning technologies, plus the supporting function capabilities typical of hospitals and clinics. Considering all this, perhaps it is not amiss to claim that this past month or so my interaction with modern medicine was of such an involved nature that few having such an intensive and comprehensive experience have lived to tell the tale. (Tee, hee; that’s a joke. Did you get it?)

Dose of Reality: My Rogue Big Toe

2009-11-23T14:58:00.000-08:00

Neil Davis' latest Dose of Reality confronts a cost-saving measure often touted by those who don't follow their thought through to its consequences:

One oft-repeated conservative mantra we hear nowadays is the one telling us that the road to health care reform requires each of us to take on more personal responsibility for our own health care. You have to read between the lines to get the intended message here: each of us needs to take care of our own—and nobody else’s—health care needs. In there also is the idea that we should not help raise overall health care costs by running off to the doctor with every little sniffle and ache.

Davis experienced the hidden ingrown toenail in this viewpoint: quite literally.

I suddenly found myself unable to walk and with severe pain that improved only slowly as I spent the next two days in the Intensive Care Unit of Fairbanks Memorial Hospital, and then, after being Medivaced to Anchorage, another nine days in the ICU of Providence Hospital.

Sometimes, it's best to let the experts deal with small things, before they turn into big expensive painful things. And since your average person doesn't have the training to recognize when a small thing can become dangerous, how can one distinguish between "taking responsibility" and "risking life and limb"?

Baucus bill written by Wellpoint

2009-11-11T12:29:00.000-08:00

An interview today on Democracy Now! with Dr. Steffie Woolhandler makes it clear that the health care reform bill is skewed. Woolhandler explains:

The reform process in Washington has been hijacked by the private health insurance industry. If you look at the Baucus framework, which was the basis of the Senate bill—it’s on the Senate Finance Committee website. Just right-click on that document, and it turns out the author of the document was Elizabeth Fowler, who’s a former vice president of Wellpoint, the nation’s largest private insurance company, covering 35 million people. So the private insurance industry has hijacked the process. What’s come out of the House, what’s likely to come out of the Senate, is a completely inadequate bill that takes about $500 billion in taxpayer money and hands it over to the private health insurance industry.

… the Massachusetts plan is considered the model for the national legislation. There’s a mandate that makes it illegal to refuse to purchase private health insurance. The fine is up to $1,068. The good thing with the Massachusetts plan was there was a big Medicaid expansion, but you didn’t need to do the mandates in order to do the Medicaid expansion.

Much of the Massachusetts plan has been wildly expensive. According to the state’s report to its bondholders, it’s cost $1.3 billion this year. The state has opted to pay for that by stealing money from safety net clinics and hospitals, so that safety net providers that care for immigrants, the mentally ill, people with substance abuse, that provide primary care, they’ve seen their funds shrunken, so that money could be handed over to purchase insurance policies. Massachusetts now has the highest healthcare costs in the history of the world.

Democracy Now! has been closely following the health care reform issue. For further background on this bill, see also this recent interview with Rep. Dennis Kucinich and Jane Hamsher.

Franken on medical bankruptcies

2009-10-22T12:48:00.000-07:00

Health care discussion panel

2009-10-20T11:19:00.000-07:00

The University of Alaska Fairbanks Student Pre-Medical Society will host a free public panel discussion on health care reform and how it could affect Alaskans Sunday, Oct. 25, from 4-6 p.m. at the Davis Concert Hall on the UAF campus.

"The UAF pre-med society's goal is to offer the public useful information and discussion on health care reform in understandable language," said Nick Bajada, public relations officer for the society and an undergraduate in UAF's biomedical program.

Panelists include Richard Seifert, a UAF professor and member of the Fairbanks Memorial Hospital Foundation Board; state Sen. Joe Paskvan, vice chairman of the Senate Health, Education and Social Services Committee; Melanie Arthur, UAF assistant professor of sociology; Mike Powers, Fairbanks Memorial Hospital CEO and fellow of the American College of Healthcare Executives; state Rep. John Coghill, member of the Health, Education and Social Services Committee and the HESS finance subcommittee; Lloyd Hilling, Tanana Valley Campus economics instructor; and Dr. Mark Simon, medical director of Golden Heart Emergency Physicians.

The event is free and the public is encouraged to attend. Seating is limited.

CONTACT: Nick Bajada, UAF Pre-Medical Society public relations officer, nickbajada@gmail.com. Marie Gilbert, Institute of Arctic Biology information officer, at 907-474-7412 or megilbert@alaska.edu

Health care reform is real

2009-09-28T17:37:00.000-07:00

This month's Dose of Reality concerns the way the American public pays for health care:

[I]t is important to remember that the public always pays, and in fact, it is the only payer of the cost of health care. Many decades ago, the members of the public mostly paid for health care in only one way: by direct payment to health care providers using cash if they could, or chickens and pigs if they could not.

Then during World War II especially, the public begin to pay more of its medical bills by funneling money through insurance companies…But now that is changing as the system is being reforming in an underhanded, backdoor fashion. Leading the reform is the for-profit health insurance industry, and by doing so the industry is slowly putting itself out of business. The steps the industry is now taking to retain profitability are forcing the American public to funnel an increasing proportion of its health care expenditure through other, more efficient pipelines, namely direct payments to medical providers and payments to them through government channels.

In other words, the insurance companies are making it so onerous to pay premiums and co-pays and deductibles that their customers are simply dropping insurance altogether—which means the companies get nothing from them.

Two Town Meetings on Health Care

2009-09-28T11:50:00.000-07:00

Alaska’s two senators have now held town meetings on Health Care in Fairbanks, Senator Murkowski on August 13, and Senator Begich on September 26. The contrast between the two hosts and their events was striking.

Based on their comments, questions, and levels of applause to statements, I concluded that the 500-member crowd attending the Murkowski town meeting was largely right-leaning Republican, with the majority having an anti-Obama, anti-government attitude that biased them against increased government involvement in health care. This group also showed a substantial presence at Senator Begich’s town meeting hosting about 300, but probably were outnumbered by persons of less conservative bent who were in favor of greater government involvement in the form of establishing a public health insurance option and greater regulation of the health care insurance and pharmaceutical industries.

Perhaps most striking was the difference in approach and performance of the two hosts. Senator Murkowski stated at the outset that she was against more government involvement in health care. That statement not only made the majority of the audience happy, it set the tone of the entire meeting: generally negative toward any substantial health care reform. Senator Murkowski responded to questions and comments in ways that built on the fears of those in the audience and promoted what I took to be her own personal views. Although she proclaimed that she wanted input from all quarters, it was quite obvious to me that she was not receptive of any new information.

Thinking back on that town meeting after attending Senator Begich’s later one, I was struck by Senator Murkowski’s comparative lack of knowledge about health care issues and apparent willingness to ignore factual information on the topic. To me, this was best illustrated when someone asked if Senator Murkowski knew of even a single country where universal health care was successful. Ignoring the well-known fact that universal health care is successfully operating in every modern country except for the United States, the good senator walked slowly across the stage, shoulders hunched, head shaking and eyes downcast as though seeking inspiration from the floorboards as she replied, “No, I can’t.” Oh come on, Senator, I thought to myself, you are not that ignorant, you know better than that and are just being disingenuous.

By contrast, Senator Begich displayed an impressive breadth of knowledge about and understanding of health care issues. He too had made an opening statement. Unlike Murkowski’s negative opening, Begich’s contained positive assertions regarding desirable goals of health care reform. Some of them were little more than motherhood statements, but at least they were positive in nature. I did not agree with some of Begich’s views—for example, he stated that he was against having a government-operated single-payer health system—but he did at least display an attitude of guarded openness toward the proposal of a public option insurance program.

He used a question on that issue to suggest that perhaps a better option might be to allow everyone to buy into the Federal Employees Health Benefits Insurance program enjoyed by members of Congress and all other federal employees and retirees.

I hope Senator Begich was aware that he was making quite a radical proposal because in this program the government (using funds supplied by the taxpayers) picks up 75 percent of the premium cost. Now that is serious government involvement in health care! At least financially, it is about three-fourths the way to a single-payer health care system. To complete the process the next logical step will be to eliminate the useless middleman: the health insurance industry.

Desperate measures for desperate times

2009-09-16T17:20:00.000-07:00

We're Number 37

2009-09-16T17:07:00.000-07:00

Obama's speech on health care reform

2009-09-10T10:53:00.000-07:00

Here's a transcript of Obama's speech to Congress on health care reform, along with some videos, from Huffington Post.

Public meeing on health care with Senator Begich

2009-09-09T10:25:00.000-07:00

Senator Begich will be holding a forum in Fairbanks, from 11:30 a.m. to 1 p.m. Sept. 26, at Friends Community Church, 1485 30th Avenue. Begich has held open discussions/question-and-answer town hall meetings in Anchorage and Juneau; according to the Anchorage Daily News, they've been beyond "lively" and have gone into outright rudeness.

Begich said he's interested in what people have to say about health care reform, but is growing tired of the lies, myths and fear tactics.

"Now the media are talking about the 'swift-boating' of health reform over the recess," Begich told the Anchorage Chamber of Commerce in a lunchtime speech. He said he's seeing evidence of a political smear campaign in television ads.

Health reform protesters have been hijacking town hall meetings around the country. There's controversy over whether the dissent is real and grassroots, or a sophisticated attack intended to bring down President Obama and the health reforms he seeks.

The point of having a forum like this is to allow the public an opportunity to a) express their opinions, and b) ask questions of—and receive answers from—their representatives in government. That means that when a person is asking their question, everyone else in the audience should let them, and let them hear the answer. It's pretty basic courtesy, but some people just don't want anybody else to have their say.

Let's hope that Fairbanksans will behave like grownups, willing to let every questioner speak, and let Senator Begich answer.

Alaska's Congressional delegation and health care reform

2009-08-17T14:43:00.000-07:00

The July Dose of Reality tackles the stance of our US senators and representative on health care reform. Davis sums up their approach: "According to its own statements, Alaska’s Congressional delegation hopes to kill meaningful health care reform this year." First, the Republicans:

We have not heard much from Representative Don Young on this issue, but Senator Lisa Murkowski has clearly stated her opposition to the public insurance option in an article appearing June 24, 2009, in the Fairbanks Daily News-Miner. First, she presents a tirade against Medicare and Medicaid, playing very loose with factual information both about these programs and the changes to them being proposed by the Democrats in Congress. Then she closes with the false charges that the establishment of a public insurance option would deny the public with choice of doctors, “and leave crucial health care decisions in the hands of government bureaucrats.” Actually, a public insurance option would increase the choice of doctors over what we have now.

And then our lone Democrat, a Blue Dog:

Senator Begich clearly stated his opposition to establishing universal health care in an opinion piece published by the Fairbanks Daily News-Miner on June 12, 2009. His telling statement: “If Congress gets it right, Americans happy with their health insurance and medical care will keep what they have, while everyone will have access to affordable, quality care.” In his article, Senator Begich pointedly ignored the major issue of the moment, that of instigating a program of public health insurance.

Sarah Palin on Health Care

2009-08-13T10:22:00.000-07:00

Sarah Palin’s recent Facebook statement (Associated Press, Aug. 8, 2009) in which she called President Obama’s health plan “downright evil” suggests that she did Alaska a big favor by abdicating the governorship last month. Anyone capable of intentionally publishing such a ridiculous and obviously untrue claim lacks the ethics and moral fiber to hold any public office from dogcatcher on up, never mind one as important as the governorship of Alaska.

When Palin broke her contract (sworn to on the Bible) with the Alaska voters who put her in office, I figured that she had in mind reverting back to a public communications career as in the years of yore. As an ex-governor, she now could aspire to the role of a respected journalist and commentator on world and national affairs whose clever insights, penetrating analyses and profound judgments would earn her respect far and wide. Admittedly, this aspiration could be a little bold for a logically challenged person who sometimes found it difficult to assemble words into a meaningful sentence and who even sometimes was unable to determine when the end of that sentence had come. So was this a hopeless idea? Not in America, absolutely not!

Let’s face it, Palin knew she could easily do it. Despite various psychological weaknesses, she knew she had some nice counterbalancing physiological assets, including a pretty face, a seductively crooked smile and a hell of a wink. The key to success here was merely to pick the right audience to speak to, one to which her physical assets would hold strong appeal and to which her cerebral weaknesses would not matter squat. In other words, Palin needed an audience that liked things simple—not just simple, flat out either black or white—an audience that would suck up to the kind of emotional appeals Palin enjoyed presenting. She did not need to be speaking to that portion of the public that preferred factual information over emotional arguments. Unfortunately for her, there were a lot of people in America like that, maybe even half the population. So forget them; this would not be the audience ex-governor Palin should try to cater to, but this group’s very nature gave a hint as to the direction she go. Best to plant a sharp right heel and do a quick one-eighty away from them. Of course! Now right there in front of her was a ready-made audience already shepherded together by that great Republican leader Rush Limbaugh. This was the audience to go for. Heck yes, Sarah would be a perfect Rush Limbaugh in Lipstick.

Sarah knew that her appeal to this ultraconservative audience was already proven by her recent campaign effort with John McCain to help elect Barack Obama president of the United States. She had come out of it with maybe three-quarter million supporters (more than the entire population of Alaska) and a lucrative book contract. Pondering the issue, Sarah Palin could see that although Rush Limbaugh was the acknowledged spokesman for that group he might not continue to be. “He’s OK on talk radio but he’s an ugly ole cuss, and I betcha I can do better than him on TV, and God would want me to,” Sarah must have thought as she reached her decision to shoot for the position of hostess of the Sarah Palin TV Show or whatever the network might want to call it.

Oh it was going to be so easy, ‘cause it didn’t matter what you would say as hostess of this production. All she would have to do was do as Rush does: pick a topic, any topic involving President Obama, put on a crooked knowing smile and a sneer in the voice and make fun of Obama’s action.

Rush was good. Like just the other day on his program Sarah had heard him say that Obama was going to use several million dollars of the stimulus funds to hire people to clean up and improve the toilets in the national parks. Snickering and scoffing at this huge and pernicious waste of taxpayer funds, Ole Rush made the concept resonate across the airways as another vicious government attempt to takeover our guaranteed 2nd Amendment rights to choose or own methods and manners of bodily waste disposal in the national parks. About the time Limbaugh finished his tirade, a female caller came on air to gush, “Oh thank you, Rush, for telling it to us like it is.” Now that was Sarah Palin’s kind of woman.

Shoot, even if none of the networks wanted to shell out big bucks for her to host a TV talk show, there were plenty of other ways to rally the clueless masses. Twittering was good; 140 characters was just about right to detail any idea that she could think up. They might call her tweets “Quitter’s-Twitters,” and those missives could strike to the hearts of millions who would applaud her abandonment of the Alaska governorship. And then there was Facebook and plenty of Obamamania fumbles to attack on it. Hey, just the stupid idea of reforming health care should get plenty of mileage. “It’s evil, evil, evil,” she could say repeatedly. “We’ve got to stop Obama from trying to take our doctors and guns away. You betcha, folks, now is the time to get our country back. Evil, evil, evil.”

It really would not matter how it all worked out. Sarah was now rich and famous and also free of those nasty ethical constraints some people thought should be imposed on those serving in public office. She now could say anything she wanted, and hundreds of thousands of Americans already thought anything she said was virtually the word of God. If it really went well, those thousands would turn into millions, and if so she might consider letting Rush Limbaugh serve as her running mate in the next election.

So what about the "death panels" we've got now, Sarah?

2009-08-12T14:16:00.000-07:00

Mike Madden of Salon asks this question with his recent article, "The 'Death Panels' Are Already Here":

Opponents of reform often seem to skip right past any problems with the current system -- but it's rife with them. A study by the American Medical Association found the biggest insurance companies in the country denied between 2 and 5 percent of claims put in by doctors last year (though the AMA noted that not all the denials were improper). There is no national database of insurance claim denials, though, because private insurance companies aren't required to disclose such stats. Meanwhile, a House Energy and Commerce Committee report in June found that just three insurance companies kicked at least 20,000 people off their rolls between 2003 and 2007 for such reasons as typos on their application paperwork, a preexisting condition or a family member's medical history. People who buy insurance under individual policies, about 6 percent of adults, may be especially vulnerable, but the 63 percent of adults covered by employer-provided insurance aren't immune to difficulty.

Consider that, and then this news release: "New Poll Shows Canadians Overwhelmingly Support Public Health Care: Group says advocates of private system are out of touch with most Canadians".

Kucinich amendment passes committee

2009-07-22T11:44:00.000-07:00

As pointed out in The Beat, single-payer health care came to Canada province by province. Dennis Kucinich(D-Ohio) has successfully introduced an important amendment to America's Affordable Health Choices Act, H.R. 3200:

By a 25-19 vote, the House Committee on Education and Labor on Friday approved an amendment to the House's health-care reform bill allowing states to create single-payer health care systems if they so choose.

Democracy Now! has a extensive interview with Kucinich about this amendment and health care reform.

Comedy team in health care reform

2009-06-30T10:32:00.000-07:00

Neil's newest Dose of Reality treats the recent hearings on health care reform in the Senate:

As we watch the Senate Committee on Finance grapple with the task of how to reduce the cost of health care in the United States it is easy to get the impression that we are watching a remake of the old movie, Abbott and Costello Meet the Invisible Man, a comedy horror film from 1951. The plot in the new version is thin; centering on the old-timey burlesque gag in which the players have a problem that they stumble around trying solve, not realizing that the solution—which as the watching audience is well aware—is obvious. That solution is virtually staring the Abbott and Costello company in the face, but of course these comics cannot see it, and they take humorously extreme measures to avoid looking in the right direction.

Replacing Abbott and Costello as lead comics in this modern-day version of that film are Senate Finance Committee chairman Max Baucus (D-Montana) and his straight man Chuck Grassley (R-Iowa). The part of The Invisible Man is played by the proposal for single-payer health care, best embodied at the moment by HR 676, introduced into Congress last year and gaining increasing public support. The remainder of the cast is comprised of the other twenty-one members of the Senate committee and their staffs. Experts all, the cast excellently parodies how we in the public think our elected officials should represent our interests.

As well illustrated in an interview with reporter Mike Dennison on Democracy Now!, Baucus and Grassley are heavily funded by the health and health insurance industries, and have not been interested in a full discussion of health care reform options.

Single-payer health care teach-in at UAF

2009-06-16T21:07:00.000-07:00

Addendum 6/30/09: this teach in was postponed and will be rescheduled.

Neil Davis is a guest speaker at a teach-in on single-payer health care systems to be held at the University of Alaska Fairbanks campus, Saturday, June 27, from 1 to 5 pm at the Boyd Berry Auditorium in the Reichardt Building (the Natural Sciences Facility).

In the midst of the health care reform debate, single-payer health care, although a system successfully used in many industrialized countries, including Australia, Canada, and Taiwan, is not even being considered by Congress. Why? Is it a viable option? How does this system work? What advantages does it have over our own? What disadvantages? How does it compare to our own system, or that of countries like Belgium, France, Germany, Great Britain, Japan, New Zealand, or the Netherlands? Explore these questions and others at this event.

Talk of Alaska

2009-06-08T15:00:00.000-07:00

I will be on Steve Heimel's APRN "Talk of Alaska" program airing at 10:00 am tomorow, Tuesday, June 9. We will be talking about the progress of health care reform.

Addendum 6/9/09: a link to the broadcast is available at the Talk of Alaska website. Senator Hollis French (D-Anchorage) was Steve Heimel's other guest.

Community Perspective by Richard Seifert on universal health care

2009-06-06T20:32:00.000-07:00

Rich Seifert's piece in the Fairbanks Daily News-Miner today has provoked quite a lot of comment on the merits (or perceived lack therof) of a single-payer universal health care system. He writes this:

Davis ultimately compares our system to those of other industrialized nations, making a compelling case for a publicly financed system of single-payer national health insurance.

All the members of the Fairbanks Memorial Hospital Foundation have a copy of this book, and I hope they have all read it. It is hard to do so and not come to the conclusion that the U.S. desperately needs a universal, publicly financed health care system. What’s more though, is that we as a nation also need to totally eliminate the insurance industry’s hold on our payer system.

The comments are very interesting, ranging from the irate to the very thoughtful and informative with supporting links and references. "Stakeholder" has found some very intriguing testimony by Dr. Linda Peeno to the US House subcommittee on Health and Environment.

Davis to participate in the 3rd Alaska Book Festival

2009-06-03T10:26:00.000-07:00

The 2009 Alaska Book Festival will be held in Fairbanks on June 11, 12, and 13, with the theme "Historically Alaska." Neil Davis will be available during the general author book signings on Friday the 12th and Saturday the 13th (4 to 6 pm each day at the Exhibit Hall at Pioneer Park) . He will also be on a panel discussion from 10 to 11:30 am on Saturday, "Writing, Publishing, and Marketing Your Book," in the theatre at Pioneer Park.

A cartoonist's view of the health care reform hoo-hah

2009-05-20T15:15:00.000-07:00

Peter Dunlap-Shohl, former editorial cartoonist for the Anchorage Daily News, has a new blog on health care issues and reform: Gurney to the Dark Side. Check it out: he takes a grim subject and puts a bit of much-needed levity into it while skewering the absurdities of our current health care system with that pen of his.

An example that Alaska should not follow

2009-05-18T17:55:00.000-07:00

In the May Dose of Reality, Neil Davis examines the results of the Massachusetts Health Reform Law of 2006. In short, the reform has failed.

There is of course a reason for the failure. The framers of the Massachusetts legislation refused to address head-on the major problem with American health care: the control exerted upon it by the private for-profit health insurance industry. They did not just ignore the problem, they exacerbated it by giving the industry even more power than it had before to dictate to many more Massachusetts residents who gets health care and how much.

Davis warns that this may be relevant to Alaskans' health care future because

Despite the failure of the Massachusetts health insurance reform, Alaska may find itself led down the same garden path to higher health care costs and decreasing access to health care. An attempt to push the state in that unfortunate direction was made in the 2008 legislative session by the introduction of SB 160. The sponsors emphasized that the bill was patterned after the Massachusetts legislation enacted earlier. Senate Bill 160 failed to pass the senate, but Senators Hollis French and Johnny Ellis, both Democrats, resurrected it as SB 61 (short-titled Mandatory Universal Health Insurance) during the just-concluded 2009 session. Although SB 61 went through several hearings, it was in committee when the session ended and is still alive for consideration during the next legislative session.

A comparison of single-payer and multi-payer systems

2009-05-15T17:42:00.000-07:00

The United States uses a multi-payer, for-profit health care system, with some elements that are not for profit, such as Medicare. Our system is administered privately, and operates from a market-based view, i.e., that health care is a commodity. Canada, on the other hand, uses a single-payer system that, while still for-profit, is administered publicly, and operates from the assumption that health care is a right. Our system is financially out of control, and incredibly wasteful and complex. Canada's is fairly simple, and far less expensive. Not only that, Canada's system is rated as better by the World Health Organization than is ours.

The recent hearings in Congress on possible reform measures, headed by Senator Max Baucus, have one striking feature: proponents of instituting a single-payer system in the US have not been invited to participate. Thus, protestors, representing organizations such as the California Nurses Association and Physicians for a National Health Care Program, have taken to interrupting the proceedings to make their point.

Below are two graphic representations of just why our system is so expensive and Canada's is so much cheaper, and yet still outperforms ours. These are taken from Neil Davis' book.

Pharmaceutical industry perturbed by the Drug Savings and Choice Act

2009-04-19T14:51:00.001-07:00

In the April Dose of Reality, Neil Davis shows how the pharmaceutical industry, which is not happy about the provisions in the Medicare Prescription Drug Savings and Choice Act of 2009, is, in effect, a giant marketing machine, but not really an industry devoted to finding new drugs to cure illness. (You read that right.)

It is the most profitable of all industries in the United States, with profits equaling 25 percent of sales. Big Oil isn’t even close.…

In 2000, drug company expenditures for marketing and administration amounted to 36 percent of sales income, but only 14 percent of income went to research and development. Thus, the expenditure for marketing and administration was two and a half times that for drug research and development.

Also, of seventy-eight drugs approved by the Food and Drug Administration (FDA) in 2002, only seventeen contained new active ingredients, and only seven were classified by FDA as improvements over older drugs. Not one of these improved products came from a major drug company.

So, going by the numbers, the truth is that big pharmaceutical companies are primarily marketing machines. Their high profits and large marketing costs are the true reasons that the public has to pay such high prices for pharmaceuticals. It is not due to the need to cover the cost of developing new drugs.

The health care reform war starts

2009-04-18T18:38:00.000-07:00

And the first sally, according to Neil Davis, is the Medicare Prescription Drug Savings and Choice Act of 2009 (HR 684 and S 330).

I am hoping that President Obama and the Democrat-controlled Congress will get behind the serious reform proposed by HR 676… this bill calls for a total overhaul of the system by taking health care out of the marketplace.…But the early signs are that the Democrats in Congress and President Obama are not willing to make a frontal attack on health care reform.

Instead, Davis says, they are hoping to set up a government operated program that would deal with only one small part of the health care picture: negotiating drug prices for Medicare. A step in the right direction, but only one smal step--still, one that would save perhaps $40 billion annually!

More in the March Dose of Reality.

April author events in Fairbanks

2009-04-02T20:22:00.000-07:00

April 4: talk at the meeting of the UAF Society of Pre-med Students, 6 pm

April 28: IDEA Curriculum Fair, Westmark Hotel & Convention Center, 11 to 1

Neil Davis on Sleep in Saturdays with Matt Want

2009-03-05T21:51:00.000-08:00

Matt Want hosts a local talk show on 660-KFAR on Saturday mornings from 10 to 11 am, choosing a different topic each week. This Saturday's topic is the US health care system and Neil Davis has been invited to be on the show. You can call in with questions or ask for advice; the phone number is 907.458.8255 (458-TALK).

(Cross-posted on The Ester Republic blog)

Insuring the Uninsurable

2009-03-05T21:50:00.000-08:00

In February's Dose of Reality, Davis looks at the some 60,000 Alaskans who are refused health insurance by the for-profit industry and the alternative they are provided by the state: health insurance so expensive that almost no one has purchased it:

The cheapest ACHIA policy is a PPO plan with a deductible of $15,000 and maximum out-of-pocket expense of $25,000. A person twenty-five years old can buy this policy for $1,848 per year, but it costs a sixty-year-old person $6,384. Each of those persons is at risk for another $25,000, the out-of-pocket maximum, and each will have to pay the $15,000 deductible before receiving any benefit whatsoever from the policy. Thus the twenty-five-year-old will pay out only $1,848 for health care if he needs no health care during the year (all money goes to policy premiums) but at worst he might have to pay out another $25,000 for the health care he needs before the policy covers all costs thereafter. Thus, his worst-case expenses are $26,848 per year.

How many 25-year-olds can afford $15,000 in deductibles?

The Health Care Reform War Opens

2009-02-19T12:48:00.000-08:00

Democrats fired the opening shot of the Health Care Reform War in January with the introduction of a bill to allow Medicare to negotiate prescription drug prices with the pharmaceutical industry. Introduced in both the House and Senate, the Medicare Prescription Drug Savings and Choice Act of 2009 (H. R. 684) negates provisions of the Bush administration’s Medicare Prescription Drug Improvement and Modernization Act of 2003 that prevented such negotiations.

If the bill becomes law, Medicare will have the same power to negotiate as the Veterans Administration. That organization is able to buy pharmaceuticals for little over half what the Medicare D insurers pay. Consequently it is expected that major savings will accrue to both taxpayers and Medicare beneficiaries, perhaps as much as $40 billion annually.

Very likely, as with the stimulus package legislation just enacted, the passage of this legislation will shape up as a partisan battle. Our Senator Begich surely will vote for it, but the Republicans in Congress probably will stand almost unanimously against passage in order to protect pharmaceutical and insurance industry profits. Alaskans should watch how Senator Murkowski and Representative Young vote on this issue. It is an opportunity for them to display their true colors; are they on the side of the taxpaying public, or are they on the side of the for-profit insurance and pharmaceutical industries? There is no in-between on this one.

A pseudo-solution

2009-01-30T21:28:00.000-08:00

In the latest Dose of Reality, Davis discusses the results of a recent study by Families USA:

Overall, it’s not a very pretty picture. Health insurance premiums for Alaskans increased 73.6 percent from 2000 to 2007. That increase is 5.7 times higher than the rise in median salaries, and to make matters even worse, out-of-pocket costs for health care not covered by health insurance also substantially increased.

Alaska Dispatch has a recent article on this same problem.

However, says Davis,

The public is starting to understand that the situation cannot continue in this direction, but only a portion of the public comprehends that the trend can be reversed by instituting a single-payer health care system. The health insurance industry is ahead of the public on this issue, and is very worried that increasing health insurance costs might actually drive the country into establishing a single-payer system that would put the industry out of business.…

Hoping to fight any reform disadvantageous to itself, the health insurance industry is going on the offensive. Its trade organization, America’s Health Insurance Plans…announced a self-seeking health care reform proposal designed to maintain the industry in the profitable lifestyle to which it has become accustomed.

The gist of the proposal is that the industry will agree to insure everybody—even those with pre-existing health conditions, but that the American taxpayer will pick up a big portion of the bill. In short, it is a bail-out akin to that now being given to the financial and auto industries. However, this one will not be a one-time grant, but rather a subsidy that will last forever.

Medicare for all: 2.6 million new jobs

2009-01-30T20:44:00.000-08:00

According to the California Nurses Association, in a press release dated January 14, a single-payer health care system would:

• Create 2,613,495 million new permanent good-paying jobs (slightly exceeding the number of jobs lost in 2008)
• Boost the economy with $317 billion in increased business and public revenues
• Add $100 billion in employee compensation
• Infuse public budgets with $44 billion in new tax revenues

This is according to a study (be forewarned, it's a 39-page PDF) conducted by the Institute for Health and Socio-Economic Policy (a research arm of the CNA).

If the English can do it, why can't we?

2009-01-13T13:07:00.000-08:00

December's Dose of Reality describes how the United Kingdom, which truly does have socialized medicine, continues to improve their system. In the United States, we have a serious shortage of primary care physicians. Yet, primary health care is vital to the wellbeing of a nation's population, and to keeping the costs of that health care down: nip a disease in the bud, or prevent its occurence in the first place, and it's a lot less expensive for everybody concerned. So the UK is taking a sensible approach:

The new emphasis on primary care in the United Kingdom follows two paths. One tactic is to use modern technology to maintain each patient’s lifelong health record; it details each visit to a primary doctor or specialist, lab results, and any treatment and medication received. That allows both the primary doctors and the specialists to easily download the information when needed, and thereby serve the patients better. The second approach is to make more use of interdisciplinary teams for taking care of patients in ways that maximize care and best utilize medical talents.

One consequence is that nurses are taking on an increasing proportion of the work. They may be the first to see patients with minor illnesses, and they are assuming more responsibility for routine management of chronic diseases. Another is that the role of the primary doctor is being emphasized to the extent that primary care doctors are making more money. Paid by a combination of risk-adjusted capitation and a 25 percent additional amount for performance, primary care doctors in the United Kingdom now have average annual earnings of $220,000. The average annual income of a primary care doctor in the United States is far less, about $150,000.

So the question is, if the UK can not only afford to improve health care but also increase doctors' salaries while at the same time reducing overall costs, why can't we? (Hint: they have universal health care and we don't.)

93 cosponsors for HR 676

2008-11-30T16:34:00.001-08:00

The number of cosponsors for this legislation has crept up in the last Congress, to 93. The list below, in alphabetical order by co-sponsor, shows the date at which the representative signed on to this important legislation:

Rep Abercrombie, Neil [HI-1] - 1/24/2007
Rep Baca, Joe [CA-43] - 9/17/2007
Rep Baldwin, Tammy [WI-2] - 1/24/2007
Rep Becerra, Xavier [CA-31] - 6/13/2007
Rep Berman, Howard L. [CA-28] - 6/15/2007
Rep Bishop, Sanford D., Jr. [GA-2] - 12/11/2007
Rep Brady, Robert A. [PA-1] - 2/27/2007
Rep Brown, Corrine [FL-3] - 4/17/2007
Rep Capuano, Michael E. [MA-8] - 11/9/2007
Rep Carson, Andre [IN-7] - 7/10/2008
Rep Carson, Julia [IN-7] - 1/24/2007
Rep Christensen, Donna M. [VI] - 1/24/2007
Rep Clarke, Yvette D. [NY-11] - 2/16/2007
Rep Clay, Wm. Lacy [MO-1] - 1/24/2007
Rep Cleaver, Emanuel [MO-5] - 4/22/2008
Rep Clyburn, James E. [SC-6] - 4/24/2008
Rep Cohen, Steve [TN-9] - 2/7/2007
Rep Cummings, Elijah E. [MD-7] - 1/24/2007
Rep Davis, Danny K. [IL-7] - 1/24/2007
Rep Delahunt, William D. [MA-10] - 2/12/2007
Rep Doyle, Michael F. [PA-14] - 3/21/2007
Rep Edwards, Donna F. [MD-4] - 9/29/2008
Rep Ellison, Keith [MN-5] - 1/24/2007
Rep Engel, Eliot L. [NY-17] - 1/24/2007
Rep Farr, Sam [CA-17] - 1/24/2007
Rep Fattah, Chaka [PA-2] - 1/24/2007
Rep Filner, Bob [CA-51] - 1/24/2007
Rep Frank, Barney [MA-4] - 3/7/2007
Rep Green, Al [TX-9] - 1/24/2007
Rep Grijalva, Raul M. [AZ-7] - 1/24/2007
Rep Gutierrez, Luis V. [IL-4] - 1/24/2007
Rep Hare, Phil [IL-17] - 4/30/2007
Rep Hastings, Alcee L. [FL-23] - 1/29/2007
Rep Hinchey, Maurice D. [NY-22] - 1/24/2007
Rep Hirono, Mazie K. [HI-2] - 7/23/2007
Rep Holt, Rush D. [NJ-12] - 9/18/2008
Rep Honda, Michael M. [CA-15] - 1/24/2007
Rep Jackson, Jesse L., Jr. [IL-2] - 1/24/2007
Rep Jackson-Lee, Sheila [TX-18] - 1/24/2007
Rep Jefferson, William J. [LA-2] - 6/26/2007
Rep Johnson, Eddie Bernice [TX-30] - 1/24/2007
Rep Johnson, Henry C. "Hank," Jr. [GA-4] - 2/13/2007
Rep Jones, Stephanie Tubbs [OH-11] - 5/23/2007
Rep Kaptur, Marcy [OH-9] - 2/12/2007
Rep Kennedy, Patrick J. [RI-1] - 9/24/2007
Rep Kildee, Dale E. [MI-5] - 4/17/2007
Rep Kilpatrick, Carolyn C. [MI-13] - 1/24/2007
Rep Kucinich, Dennis J. [OH-10] - 1/24/2007
Rep Lantos, Tom [CA-12] - 10/1/2007
Rep Lee, Barbara [CA-9] - 1/24/2007
Rep Lewis, John [GA-5] - 1/24/2007
Rep Loebsack, David [IA-2] - 1/24/2007
Rep Lynch, Stephen F. [MA-9] - 10/9/2007
Rep Maloney, Carolyn B. [NY-14] - 1/29/2007
Rep McDermott, Jim [WA-7] - 1/24/2007
Rep McGovern, James P. [MA-3] - 1/24/2007
Rep McNulty, Michael R. [NY-21] - 1/24/2007
Rep Meehan, Martin T. [MA-5] - 1/24/2007
Rep Meeks, Gregory W. [NY-6] - 9/20/2007
Rep Miller, George [CA-7] - 1/24/2007
Rep Moore, Gwen [WI-4] - 1/24/2007
Rep Moran, James P. [VA-8] - 1/22/2008
Rep Nadler, Jerrold [NY-8] - 1/29/2007
Rep Napolitano, Grace F. [CA-38] - 2/27/2007
Rep Norton, Eleanor Holmes [DC] - 3/21/2007
Rep Olver, John W. [MA-1] - 2/16/2007
Rep Pastor, Ed [AZ-4] - 1/24/2007
Rep Payne, Donald M. [NJ-10] - 1/24/2007
Rep Rangel, Charles B. [NY-15] - 1/24/2007
Rep Richardson, Laura [CA-37] - 9/20/2007
Rep Roybal-Allard, Lucille [CA-34] - 1/24/2007
Rep Rush, Bobby L. [IL-1] - 2/6/2007
Rep Ryan, Tim [OH-17] - 5/8/2007
Rep Sanchez, Linda T. [CA-39] - 4/23/2007
Rep Sanchez, Loretta [CA-47] - 9/20/2007
Rep Schakowsky, Janice D. [IL-9] - 4/17/2007
Rep Scott, David [GA-13] - 9/20/2007
Rep Scott, Robert C. "Bobby" [VA-3] - 1/24/2007
Rep Serrano, Jose E. [NY-16] - 2/7/2007
Rep Solis, Hilda L. [CA-32] - 2/12/2007
Rep Sutton, Betty [OH-13] - 3/27/2007
Rep Thompson, Bennie G. [MS-2] - 6/12/2007
Rep Tierney, John F. [MA-6] - 9/6/2007
Rep Towns, Edolphus [NY-10] - 1/24/2007
Rep Udall, Tom [NM-3] - 2/27/2007
Rep Waters, Maxine [CA-35] - 1/29/2007
Rep Watson, Diane E. [CA-33] - 1/24/2007
Rep Weiner, Anthony D. [NY-9] - 1/24/2007
Rep Welch, Peter [VT] - 5/3/2007
Rep Wexler, Robert [FL-19] - 1/24/2007
Rep Woolsey, Lynn C. [CA-6] - 1/24/2007
Rep Wynn, Albert Russell [MD-4] - 1/24/2007
Rep Yarmuth, John A. [KY-3] - 2/27/2007

Those adding their names in 2008 were James Moran (VA), Emanuel Cleaver (MO), James Clyburn (SC), Andre Carson (IN), Rush Holt (NJ), and Donna Edwards (MD). Sponsor John Conyers has a frequently-updated list of endorsements and co-sponsors on his website.

Call to Action Health Care Reform 2009

2008-11-18T16:15:00.000-08:00

Another mostly misguided proposal for reforming our health care system has surfaced this month. It, “Call to Action Health Care Reform 2009,” comes from Montana Democrat Max Baucus, chairman of the Senate Finance Committee. See it at http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf

Eighty-seven pages long, the Call to Action plan claims to be a “comprehensive but not exhaustive exploration of every health care issue that can or should be considered.” The document does present intelligent discussion of the many problems with our health care system and offers workable solutions to some of them, but the claim that it explores every health care issue that can and should be considered is totally false.

In fact, the one most important issue of all is totally ignored, the proper role of the for-profit private insurance industry in administering health care expenditures. By contrast, H.R. 676, a bill in the House sponsored by Representative John Conyers and 90 other congressmen, emphasizes the problems created by the private insurance industry and rightly seeks to get that industry out of the health care financing business altogether. That needs to be done because the private health insurance industry is merely a funds-sucking tapeworm in the gut of the American health care financing system, one that funnels off a huge portion of the funds that should be used to pay for health care.

Rather than to address this serious problem, Senator Baucas’s proposal calls for more investment in for-profit private health insurance. He wants to require that everyone be forced to buy health insurance, and that taxpayers subsidize the industry by supplementing the funds it receives from those who cannot afford to pay its high premiums. Senator Baucus is being disingenuous in ignoring the real problem here, but at least he is honest enough to admit that his plan will increase rather than decrease the cost of health care in the United States. That, we do not need.

(The text of H.R. 676 is at www.thomas.gov/cgi-bin/query/z?c110:H.R.676:)

Dose of Reality: Health Insurance Costs in Retirement

2008-11-14T08:55:00.000-08:00

The November issue of The Ester Republic features Neil Davis' discussion of just how pricey health care will be once you retire. The picture is not pretty.

With the trend away from defined-benefit retirement programs, increasing numbers of Americans are in defined-contribution programs. Many of these people will not have enough saved up for their health care and other costs.

This installment of Dose of Reality compares the effects of having these two types of retirement programs and how they interact with Medicare part A and part B, and with Social Security. As Davis says, "the results horrify me, as they should you."

Dose of Reality: Do Not Resuscitate

2008-10-25T12:22:00.000-07:00

In the October issue of The Ester Republic, Neil Davis discusses the issues brought out in Dr. John Geyman's book, Do Not Resuscitate: Why the Health Insurance Industry is Dying, And How We Must Replace It. The problem, as Geyman observes and Davis concurs, is that

[T]he industry has abandoned the basic goal of insurance, which is to spread risk over the population it serves. Instead of spreading risk, the industry has focused on the avoidance of risk for itself, coupled with a transfer of that risk to the public. In the process, it is destroying its own reason for being.

The consequences of this transfer of risk are that administrative costs go up, employers and other policyholders are charged more, and fewer people are able to afford decent coverage--and as a consequence, good health care. Yet the problem is getting worse, not better, and this is due to a fundamental problem in how we approach health care in the United States.

The Economics of Health Care

2008-10-22T12:26:00.000-07:00

At the Democratic National Convention, Senator Ted Kennedy stated that health care is a human right, and in one of the presidential debates, Senator Barack Obama said the same thing. What this means, of course, is that this country needs to put in place a single-payer universal health care system.

“This is a completely understandable view and one that, I think, is utterly wrong,” wrote columnist Robert J. Samuelson in NEWSWEEK on September 15, 2008. Then he went on to say that the problem was not to improve insurance coverage, it was to contain health care costs. He said, “We need more realism on health care. The trouble with casting medical-care as a “right” is that this ignores how open-ended the “right” should be and how fulfilling it might compromise other “rights” and needs.” What he means by this is beyond me: how does saying fulfilling one right affect fulfilling other rights, whatever they may be?

Samuelson does not seem to understand that treating health care as a right—which implies instituting a program of universal health care—is the direct route to containing health care costs. Doing so has the potential to cut health care costs by 30 percent, while at the same time improving health care for Americans. Another columnist, Bernadine Healy writing in the October 13/October 20, 2008, issue of U.S. NEWS & WORLD REPORT, describes various ills of our dysfunctional multi-payer health care system and then says, “Changing our 50-50 blend of private and public spending into a single-payer system clearly is not feasible.” Why not?

Both she and Robert J. Samuelson seem to have preconceived ideas about health care, and they would do well to open their minds far enough to read and accept what another well-known economist and columnist, Paul Krugman, has to say about the economics of health are. In his January 1, 2007, column in The New York Times he said, “The truth is we can afford to cover the uninsured. What we can’t afford is to keep going without a universal health care system.

“If it were up to me, we’d have a Medicare-like system for everyone, paid for by a dedicated tax that for most people would be less than they or their employers currently pay in insurance premiums. This would, at a stroke, cover the uninsured, greatly reduce administrative costs and make it much easier to work on preventive care.”

Paul Krugman just won the Nobel prize in economics, for good reason it would seem. He is a thoughtful man who pays attention to and carefully analyzes factual information. Too bad Robert J. Samuelson and Bernadine don't do the same.

Pundits on Health Care

2008-10-10T16:28:00.000-07:00

Right now, the crash of the financial markets is taking center stage, but the nation’s health care problems are still the subject of various press pundits’ commentaries. In the October 13, 2008 issue of NEWSWEEK, one of better known commentators, Jane Bryant Quinn, discusses John McCain’s health plan, and alludes to Barack Obama’s. These, of course, are not health care plans as such, but rather are health insurance plans, a fact that the pundits like her seem to be ignoring, or would rather not talk about. It is an easy way out, and a poor substitute for taking on the health care problem directly and discussing solutions.

Quinn notes that the McCain and Obama health insurance plans over the next decade are likely to cost the taxpayers an additional $1.3 billion and $1.6 billion, respectively. She clearly favors Obama’s plan over McCain’s, but she seems to be trapped in the philosophical box that does not allow thinking or discussion about anything but health insurance per se. She is not a dumb person, and I don’t understand why she doesn’t go outside the box and state what she surely knows is the way to reduce health care costs rather than increase them. Maybe her editors would not let her do that. If they would allow it, Quinn could have gone on to say that both the McCain and Obama plans were off the mark, and that the establishment of a single-payer health care system in this country has the only potential to reduce health care costs—not just a little bit, a lot. Instead of spending 16 percent of our gross national product on health care, we could be spending only 10 percent, while giving all Americans health care just as good as the citizens of all other modern countries get from their much cheaper and more effective universal health care systems.

Yes, Quinn and some of her fellow pundits could serve us better by talking more about health care, and less about health insurance. But at least in her column she does say that McCain’s belief in the magic of the marketplace is misplaced. She says, “Friends, there’s zero evidence that that works.”

Davis honored for bringing science to the public

2008-09-20T16:27:00.000-07:00

Neil Davis was one of six people recognized for their contributions to science research, education, and outreach recently by the American Association for the Advancement of Science Arctic Division and the Alaska Chapter of Sigma Xi, the Scientific Research Society. Davis was honored for his support of arctic science and excellence in bringing science to the public.

Dose of Reality: McCain's health care plan

2008-09-19T21:56:00.000-07:00

In the September issue of the Ester Republic, Davis examines John McCain's health care plan and the deregulation he proposes in more detail than in previous issues. From the article:

The immediate consequence is obvious: Insurance companies would immediately relocate to states such as Alaska which have minimal if any regulations. They would no longer be required to insure persons in those states that currently require them to accept individuals with pre-existing conditions, and that means even more Americans would be unable to buy insurance.

The estimates on how many more people would be unable to afford insurance or get good quality coverage as a result vary, but it could be in the many millions.

Saving Money on Medical Bills

2008-09-11T16:23:00.000-07:00

Microsoft News Money recently carried a good article on how to save money on medical bills, an article from Kiplinger’s Personal Finance Magazine titled, “Save thousands on medical bills.” See http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/save-thousands-on-medical-bills.aspx?page=1. The article contains several hints on how to save on medical bills that I have previously given in my column Dose of Reality: http://esterrepublic.com/Archives/neildavis.html —and one I had not thought of to include.

That sound suggestion is to not pay any questionable hospital bills by credit card. The reason is simple: once you do that, you lose any ability to bargain. You have, in a sense, already agreed to the debt. Also, do not agree with a hospital’s suggestion to accept a line of credit with an outside lender, because now your debt is off the hospital’s books. The debt is to the lender, not the hospital, so you have no bargaining power at all.

Two other good suggestions contained in the MSN Money article are:

1—Check medical bills for double charging and wrong diagnoses that affect insurance payments or those you make directly.

2—Don’t hesitate to bargain, because hospitals typically charge about three times what they expect to get paid (It varies with the hospital, but that is the average.)

The article concludes with a suggestion that would sound ridiculous to a citizen of any other country with universal health care: hire a “claims assistance professional” to help you negotiate with your medical providers. Yes, because the system is dysfunctional, they will cut your bills, and collect 25 percent of the proceeds while doing it. Only in America are we willing to put up with this nonsense.

UAF: lecture by Devra Davis on cancer prevention and public health policy

2008-09-03T21:23:00.000-07:00

Condensed from the public announcement:

UAF is hosting a talk by Devra Lee Davis, a University of Pittsburg epidemiology professor and author, on Thursday, Sept. 4, at 7 p.m. in Schaible Auditorium. Davis’ lecture, “The Secret History of the War on Cancer,” is free and open to the public, and will be webcast at the website of the Center for Alaska Native Health Research.

Devra Davis advocates for changing the way public health looks at cancer prevention by including toxin awareness.

“I believe if we had acted on what has long been known about the industrial and environmental causes of cancer when this war first began, at least a million and half lives could have been spared…” she writes in the preface to her book, The Secret History of the War on Cancer. Published in 2007, the book is used at major schools of public health, including Harvard, Emory, and Tulane universities.

Davis is the director of the University of Pittsburg Center for Environmental Oncology, the world’s first research institute dedicated to studying cancers caused by environmental pollution. She is also an epidemiology professor at the University of Pittsburgh’s Graduate School of Public Health.

The Center for Alaska Native Health Research at the UAF Institute for Arctic Biology, University Advancement, Alaska INBRE, the College of Natural Sciences and Mathematics; Alaska EPSCoR, and Tanana Chiefs Conference are sponsoring her trip.

Davis will also give public lectures in Nome and in Anchorage at the University of Alaska Anchorage. The Alaska Community Action on Toxics is the host for this part of her Alaska journey.

Dose of Reality: HR 676 and the presidential candidates' proposals

2008-08-29T06:29:00.000-07:00

In the August Dose of Reality column, "HR 676: The Route to Affordable Health Care," Davis discusses why the proposal is "a dream bill...that does all the right things to create an affordable single-payer health care system."

In the July Dose of Reality, Davis looks at the health care plans of John McCain and Barack Obama:

I get the feeling that both the presidential candidates are happy to see the health care issue fade a bit, because neither of them has logically defensible positions on health care, nor do their proposals have any hope of reducing health care costs.

The primary problem in both candidates' proposals is the failure to address actual health care; instead they focus on health insurance. This failure or inability to distinguish between the two is one of the central problems in the national discussions about health care reform.

However, concludes Davis, "Obama's plan is far better than McCain's....Obama at least proposes moving in the right direction." Still, both senators would do well to take a leaf or two more from John Conyers' excellent House bill.

A Good Investment

2008-08-28T13:05:00.000-07:00

This year the Alaska legislature took a small but positive step toward helping to improve health care in the state by appropriating $3.85 million in support of the 26 federally funded Community Health Centers in the state. By taking this action Alaska has, for the first time, joined 37 other states which contribute funds to the CHC programs.

The Community Health Centers play an important role in providing comprehensive, affordable primary care and preventive services to those most in need. The centers accept Medicare, Medicaid, private insurance and also offer a sliding fee scale to those without insurance coverage. They now serve over 88,000 Alaskans, more than half of them with incomes below the Federal Poverty Level. Operating at 124 sites in Alaska, the centers provide the only source of medical care in many of the remote rural villages of the state. The centers are open to all Alaskans, and the care received there is far cheaper than from other sources.

The legislature’s action was in response to a funding request of $13 million from the Alaska Primary Care Association, the umbrella group for the CHCs which are all locally governed. Considering the effectiveness and low cost of the centers, the $3.85 million is a paltry sum. It amounts to only $40 per person for the 88,000 served, and to less than $6 per Alaskan. Compare that to the $1200 per person outlay for energy relief this year and think about the relative value of the two appropriations. The tiny one is an investment in the future, and the big one is a shotgun blast that has no lasting benefit. A significant portion of the money will go to the federal government in income taxes and to Alaskans who do not really need the money. How sad.

Nevertheless, the legislature took an important first step by appropriating funds to the Community Health Centers. The action might be the start of a new era of social responsibility, and we can hope that future legislatures will be far more generous in their appropriations for health care.

Harry and Louise Return

2008-08-24T14:28:00.000-07:00

Today, August 24, 2008, marks the return of the old Harry and Louise ads credited with defeating the Clinton universal health care plan of fifteen years ago. They are being put on the air on the eve of the presidential conventions for the same purpose as the last time: to try to convince Americans that single-payer universal health care is not in their best interest.

The persons portraying the fictional couple Harry and Louise are the same as before, now obviously fifteen years older, but the message is a little different this time. Aware that health care reform might be coming soon, the ads’ sponsors are trying to use the ads to warp that reform in a direction that favors the health insurance industry and its allies, but which is to the detriment of the users of health care, namely the American public.

The sponsors of the new Harry and Louise ads are promoting not only less regulation of the health insurance industry, they want the government to subsidize it by paying the premiums for the high-risk persons that the industry would otherwise either not insure or charge unbearable rates. They are trying desperately to maintain their throttlehold on health care financing. As one ad sponsor, the National Federation of Independent Business, states, “To the greatest extent possible, Americans should receive their health insurance and healthcare through the private sector. Care must be taken to minimize the extent to which government safety nets crowd out private insurance and care.”

Overall, the primary purpose of the new Harry and Louise ads we are going to see a lot of from now on is to maintain the profitability of the private health insurance industry. A proven propaganda ploy; it will be interesting to see how well it works this time.

Also jumping on the bandwagon is the American Medical Association with its own Louise ad (not the same Louise as in the other ads, but obviously borrowing on the Harry and Louise concept) touting the association’s reform proposal. This is not a health care reform proposal at all; rather it deals only with health insurance, and it basically also calls for less regulation of the insurance industry plus government subsidies to the industry to help pay the premiums for high-risk persons. Not the powerhouse it once was, the AMA’s membership has declined, and it now represents less than one-third of all U.S. physicians. Increasingly, physicians are going against AMA and are coming out in favor of establishing a single-payer universal health care system.

Another co-sponsor for HR 676

2008-08-12T14:43:00.000-07:00

The ninety-first co-sponsor of HR 676 is André Carson (D-IL). The list of endorsements of this legislation is growing, including the US Conference of Mayors and numerous unions, including the Alaska AFL-CIO.

The Foraker-Rasmuson Health Insurance Plan

2008-07-28T12:54:00.000-07:00

The July 27, 2008 issue of the Fairbanks Daily New-Miner carries an article based on an earlier one in the Anchorage Daily News describing what it calls a “bold insurance plan” being put forth by the Foraker Group and the Rasmuson Foundation aimed at lowering the number of uninsured persons in Alaska. The idea is to make it easier for the 6,000 employees of nonprofit organizations to buy health insurance for employees, thereby getting the employees off the rolls of the uninsured.

While laudable in its intent to help some Alaskans with their health care expenses, the Foraker-Rasmuson plan, like many other proposals, focuses on the wrong problem. The real problem is affordable health care, not the affordable health insurance the plan proposes. If health insurance actually paid for the full cost of health care, then having affordable health insurance would be a great idea. Unfortunately, that is not the case. Most commercial health insurance pays only a part of the bill, and the proportion it pays declines with greater need for health care. It is generally true that the more affordable a health insurance policy is, the lesser portion of the health care cost it pays. The majority of Alaskans need comparatively little health care each year, so whether or not they have health insurance, their health care costs are limited, perhaps only to what they pay in health insurance premiums if insured. If they have no health insurance, their cost is even less. Insured or not, these are the lucky Alaskans.

But woe is the Alaskan, insured or not, who needs a lot of health care. At no fault of his own perhaps, he has a serious car accident that puts him in the hospital, she has a complicated birth, or he contracts cancer or Alzheimer’s that requires extensive or long-term care. By the time this person pays for any premiums, deductibles, co-pays and all other out-of-pocket expenses associated with his or her health problem the person may face a bleak financial future that might well include bankruptcy.

The Foraker-Rasmuson plan fits right in with the current trend of shifting risk from employers and insurance companies over to individuals by means of high-deductible insurance policies and health savings accounts. While lowering the cost of health insurance, the plan places more of the cost of health care onto the individual, often at a time when the health problem also curtails family income because of inability to work.

One fault that I see with the plan is that it can lull people into thinking that, by having high-deductible insurance and health savings accounts, they are protected from high health care costs. They think they are safe right up to the time when a health crisis occurs, and then they find out just how bad it can get. The statistics are compatible with that pertaining to playing Russian Roulette with a 10-chamber revolver. If the person is commercially insured, only one chamber of the gun contains a bullet, but if he is not insured, two chambers contain bullets. Obviously it is somewhat safer to have insurance, but complete safety is an illusion. Real safety comes only with having a system of universal health care, in which case there are no bullets in the gun.

Latest review, from Alaska Health Policy Review

2008-07-20T06:04:00.000-07:00

Lawrence D. Weiss, Anchorage Daily News blogger of Health4all and editor of the online journal Alaska Health Policy Review, has come out with a detailed and positive review of Mired in the Health Care Morass. The review appeared in the July 16 issue and the excerpt below is reproduced by permission of Alaska Health Policy Review, akhealthpolicy.org. Weiss has extensive experience in public health (PDF of his CV) and designed the Master of Public Health program at the University of Alaska Anchorage.

I found this book to be interesting, challenging in some of the more technical areas, extremely informative in those same areas, and especially interesting because of the Alaska focus. I recommend this book to anyone faced with large medical bills. I recommend this book to anyone who has a serious interest in the structure of health care financing in Alaska or nationally. I recommend this book to all health care and public health professionals, and I think this would be an excellent book for classroom use at the university. I commend the author for his ability and desire to turn personal tragedy into a public resource that will educate and help others.

One aspect of Weiss' review that is unique is his attention to the images of Patricia Davis' artwork that were used as chapter ornaments. Most of the figurines depicted were created during her ordeal of chemotherapy, and had significance for her that related to her health issues. The images were selected with this in mind.

Weiss describes the book chapter by chapter, commenting that the author's "writing style is straightforward and factual" and that "[t]he book includes an excellent glossary and, unlike many books in recent years, a detailed and useful index."

Addendum: this review also appeared on Health4all in two parts (see links at right).

Doctor Shortages?

2008-07-09T12:15:00.000-07:00

How many doctors does it take to adequately serve 1000 people? The number varies with country, it seems. In 1997, two countries with highly rated health care systems, France (WHO rating 1st) and Germany (WHO rating 25th), had about 3.3 doctors per 1000 population, but Japan, also highly rated by WHO at 10th, had only 2.0 doctors per 1000 population. Similarly, the United Kingdom (WHO rating 18th) and Canada (WHO rating 30th) had 2.1 doctors per thousand. The less-highly rated United States (at 37th place) had an intermediate number of 2.7 doctors per 1000.

More recent data indicate that the number of doctors in the United States has declined to about 2.38 per 1000, but, curiously enough, a report from the Organization of Economic Cooperation and Development states that the number of doctors in Canada has been stable at 2.1 per 1000 for at least 20 years. The number in Alaska is about the same, 2.05 doctors per 1000 population.

Obviously, the quality of medical care in a country does not critically depend on the number of doctors the country has. However a recent report from the Alaska Physician Supply Task Force notes that because of Alaska's size, rural nature, and extremes of weather, the state really needs more doctors than it has. It should have about 10 percent more doctors per 1000 than the United States as a whole, the report recommends. Presumably the same is true for Canada because of its similar geography.

References:
http://www.upi.com/Health_News/2008/07/08/Canadian_doctor_shortage_disputed/UPI-89811215532839/

http://www.hss.state.ak.us/Commissioner/Healthplanning/publications/assets/PSTF-06.pdf

The Reality of Health Care: A Huge Disparity in Need

2008-06-24T13:48:00.000-07:00

HEALTH CARE: MYTH AND REALITY

A MAJOR MYTH, One promoted by the current administration, employers and insurance companies: the American health care problem could be solved if we could convince Americans to take more personal responsibility for maintaining healthier lifestyles and giving them a greater freedom of choice in purchasing health insurance.

BUT THE MOST IMPORTANT REALITY OF HEALTH CARE is depicted by the associated diagram. The second panel states a startling fact: it takes only 5 cents of the health care dollar to pay for the health care of the lowest-cost 50 percent of the population, and notice that the highest-cost 1 percent requires 22 cents of the health care dollar. For that 1 percent, the per-person cost now exceeds $39,000 per year.

This diagram tells us that there is no way the heaviest users of health care can pay for that health care. Therefore, in a responsible society the payment for health care must be a societal, not an individual, responsibility. The only way we can exercise that responsibility is to establish a system of single-payer universal health care. We must get the for-profit health insurance industry out of the loop, as is called for by H.R. 676, the "United States National Insurance Act."

Mayors Back Universal Health Care

2008-06-24T11:31:00.000-07:00

Yesterday, the U.S. Conference of Mayors unaninously adopted a resolution in support of the "United States National Health Insurance Act," H.R. 676. Known also as the "Improved and Expanded Medicare for All Act," H. R. 676 is sponsored by Rep. John Conyers of Michigan and 90 members of Congress.

This is an excellent bill that, unlike the proposals of Senators Obama and McCain, actually addresses health care and guarantees everyone in the country affordable health care by forcing the highly profitable private health insurance industry out of the loop. That is a necessary action if the country is to have an effective health care system like that of all other modern countries.

The backing of HR 676 by the nation's mayors is highly significant because the mayors, far more so than most elected officials, are closer to the people and more free of pressure from the pressures of health insurance industry and pharmaceutical industry lobbying efforts that hope to maintain the staus quo. The fact that the mayors are backing HR 676 indicates that the public is increasingly in favor of universal health care. We may be closer to an effective universal health care system than many have thought possible.

New reviews of Mired

2008-05-12T18:28:00.000-07:00

From Midwest Book Review's California Bookwatch Health and Medicine Shelf:

A shocking note Americans don't know about medical bills: They don't reflect the costs of the medicine itself. "Mired in the Health Care Morass: An Alaskan Takes On America's Dysfunctional Medical System for his Uninsured Daughter" is the tale of accomplished author and geophysicist Neil Davis's fight against the American Health care system and how it is extorting Americans when they are at their most vulnerable - when they are ill themselves or deathly concerned for the well being of their loved ones. With advice to fight these corrupt practices and get the more correct and proper hospital bill, [this book] is highly recommended for anyone who has been scorned by the American health care system and for community library social issues shelves everywhere.

And from Humane Medicine, a Canadian publication, comes this:

Davis’s book is an important contribution to the literature on the American Health Care System since it is written by a consumer rather than a professional provider of medical services. Davis structured the book around the experiences that his family endured when his adult daughter, Patricia, was diagnosed with lung cancer....

Given all of Davis’ discoveries, he concluded that there are four criteria for an effective health care system. First, an effective health care system provides comprehensive health coverage for all citizens. If not, the poorest individuals will get inadequate health care. Second, a health care system ensures that health care is distributed to citizens according to their ability to pay. Otherwise, the poorest members of that society are penalized by paying a higher proportion of their financial resources for health care. Third, each health care system should provide uniform payment for necessary health care services. Fourth, prescription drug prices must be regulated, either by fixing drug prices or regulating pharmaceutical industry profits. For this to occur, the government must assume the primary role in operating the health care system.

Thus, in conclusion, this book will be especially relevant to consumers of heath care and is an eye opener for those who may be seriously ill in the United States and are trying to understand why receiving health care creates serious financial difficulties for them.

Another four-star review from LibraryThing

2008-05-01T06:52:00.000-07:00

A review from April 25 on LibraryThing:

The many charts and statistics he uses to illustrate his findings can be hard to understand at times, but believe it or not they accurately illustrate his point that the complexity of the American system creates expense. He skewers some fondly held myths about the U.S. Health care system and shines light on the health care systems in other nations. He also gives his prescription for how the U.S. Health care system can be changed.

Neil Davis has experiences in being a consumer of health care that most of us never hope to have, but which will become increasingly commonplace as the health care becomes increasingly broken. His answers to the health care crises (universal, uniform payments, distributed to patients regardless of ability to pay, regulation of drug companies) are well thought out and do not come from a place of a particular political ideology but instead from his own experiences and research. His book is well researched and a convincing call to radically overhaul the American health care system from someone who has experienced the worst that the American health care system has to offer.

John Conyers reprints a list of four myths about universal health care by Dr. Marcia Angell. Davis sums up an answer to her myth #4, "Claims the government can't do anything right," in his index (look up "Mistrust in government").

HR 676 Universal Health Care

2008-04-28T15:19:00.000-07:00

I have been looking closely at health care reform and related matters for the past two years, and it seems like I learn something new every day. It embarrasses me to admit that just this week I became aware of HR 676 (The United States National Insurance Act) introduced into the House of Representatives by Rep. John Coyers (D-MI) in January 2007. This bill contains all the right provisions for setting up a first-rate universal health care system in this country. Unlike the proposals of the leading presidential candidates that continue the role of private insurance companies, HR 676 basically calls for eliminating them altogether, and turning the health care system into one having the delivery of health care as the first priority. In essence, the proposal calls for a complete conversion to a non-profit health care system.

The proposal has several key features. One is that it provides complete coverage for all medically necessary services including long-term care, prescription drugs, dental care and eye care. Another is that it provides for all United States residents and visitors. The act totally eliminates co-pays and deductibles, and it prohibits for-profit insurers from selling insurance covering services duplicating those provided by the universal health care system. Under this act, patients would have complete freedom of choice in providers, hospitals, clinics, and practices. In recognition that all this cannot happen in one day, the bill calls for a conversion to a not-for-profit health care system to take place over a period of fifteen years.

Financing for the program would be provided by an employer payroll tax of 4.75%, and employee payroll tax of 4.75%, a 5% health tax imposed on the top 5% of income earners and a small tax on stock transactions. The end effect would be a small reduction in overall health care spending.

I don’t see anything wrong with any provision of the bill; in fact it looks to be well thought out. One pleasing thing is that the bill is gaining support in Congress and elsewhere. When first introduced, the bill had 25 co-sponsors, and by April 2008 it had 90. Eighty-nine of these are Democrats, one is an Independent, but none are Republicans. No commentary needed here.

You can read the full text of the bill at:

http://www.thomas.gov/cgi-bin/query/z?c110:H.R.676:

Another positive review

2008-04-22T11:23:00.000-07:00

The fifth review from LibraryThing, giving it four stars:

Less of a personal journey than an exploration into the true costs of medical treatment in the United States today, and where the money goes. For anyone concerned with injustice, inequalities, or lack of checks within the system; or anyone who is concerned that they cannot afford the medical care they or their loved ones need, this clear and non-judgmental book written by a layman with no preconceptions or industry biases is highly recommended.

More reviews from LibraryThing

2008-04-02T10:02:00.000-07:00

Two more LibraryThing reviewers have written about Mired. The first one gave a mixed review, but had this to say:

Most patients have no idea how health care billing works until they are faced with a financial crisis. A book like Mr. [sic] Davis' would be very helpful in leading them through the process, especially if they live in Alaska.

The second reviewer said this:

A myriad of books have been written on this topic; however, Mr. Davis' strength lies in the fact that he writes it from the perspective of a consumer. It could be argued that he is not qualified to write a book about the health care industry as merely a consumer. Certainly, economists may be more capable of addressing the macro issues of national healthcare, and pundits the political ramifications; however, that really isn't the purpose of Mr. Davis' book. Rather, it reads like a good summary (with a clearly liberal bent) on the state of the health care industry.

And, unlike economic and political pundits, Mr. [sic] Davis doesn't shy away from actually providing a solution. As he says, "What is needed is single-payer universal healthcare ... the most economical form is a fully socialistic system like the United Kingdom's (and the VA system as well) in which the government owns and operates the hospitals and hires healthcare providers."

(Davis recommends a single-payer arrangement like France's system or Canada's, rather than socialized medicine.)

Prognosis for the Future of "Mired in the Health Care Morass"

2008-03-19T21:37:00.000-07:00

After last evening's superb event at the Blue Loon, I predict that Neil has no idea how important this book could become. It has every important element crucial to the major review and total overhaul of our horrific health insurance debacle in the USA. Because it is so personal and detailed, it is a natural ally to Michael Moore's film "SICKO". This is why the interviews with Marcia Angell and Elizabeth Warren were so fitting for the opening of the signing party. The first thing we need to do is send Moore a copy with a free pass to read this blog. Some clever legislator may seize it too, but right now that's unlikely as they are submerged in the middle of the session.

Neil has done us all a huge service. Now please everyone, READ THE BOOK!! You won't be sorry!

Your local Solarhero

Another review from LibraryThing

2008-03-19T12:08:00.000-07:00

A second LibraryThing reviewer has posted comments about Mired in the Health Care Morass:

An excellent book that focuses on the state of health care costs for the uninsured. The under-insured and the insured have much to gain from the exhaustive statistical details in this book.… The book is not a sentimental one but a refreshing look at a father's attempt to understand how the health care system in the US charges for each procedure, medication, in and outpatient visit and makes a compelling argument and a very strong case for reform in the health insurance "industry" along with an accurate look at how we as consumers can and should take charge of our health care. Otherwise, we may end up paying for mistakes (documented in the book) of the various personnel in making coding errors or charging according to outdated schedules. Anyone facing a chronic disease--anyone who uses their health insurance at all, this book is an easy read with documentation.

This reviewer found the book's citations of websites to be a drawback, expressing a preference for more peer-reviewed print sources, but wrote, "however, these may be difficult to obtain considering the subject matter."

Public discussion of health care March 18

2008-03-12T15:27:00.000-07:00

With Fairbanks Community Hospital Foundation trustee Richard Seifert acting as master of ceremonies, author Neil Davis and Mike Powers, CEO of the Fairbanks Memorial Hospital, will give a short presentation on the healthcare situation in America and Alaska today, followed by an informal Q&A and discussion. This will also be a book release party in the convivial atmosphere of the Blue Loon theatre, club, and bar, where the attendees can eat dinner while they participate and celebrate the publication of a much-needed guide through the byzantine billing methods of our current healthcare system.

Where: the Blue Loon, 2999 Parks Highway

When: 5:30 to 7:30 pm, March 18, Tuesday evening

Please come and bring your perspective and experiences to the discussion!

Clinton and Obama on Health Care

2008-02-29T08:55:00.000-08:00

Listening to the debate of February 27, 2008, between Democratic presidential contenders Hillary Clinton and Barack Obama, I was pleased that they both paid much attention to the issue of health care. Up to this point, the Republican candidates have not said much about the health care issue, obviously wishing to ignore it. The Democrats, on the other hand, have made it clear that they want to push forward toward changing our dysfunctional health care system into something more sensible.

However, it was distressing to see both Clinton and Obama start by saying how important it was for everyone to have affordable health care and then switch the discussion over to health insurance. Perhaps intentionally, they were both failing to distinguish the difference between health care and health insurance. They each seemed to be trying to claim that having affordable health insurance was equivalent to having affordable health care.

If all health insurance was like Medicaid insurance—which pays the full costs of health care for its beneficiaries—then affordable health insurance would be equivalent to affordable health care. But we all know that most insurance policies pay only a portion of health care costs, and in extreme cases, not even a major part. It is getting worse by the day, too. Private insurers and the employers that buy insurance from them are increasingly trying to dump more of the cost of paying for health care off onto individuals. Furthermore, the insurance companies are doing their best to refuse insurance coverage to those persons needing the most health care. These are the persons who are getting hit the hardest by our current system.

It would be nice if our presidential candidates felt they could be forthright in admitting that the only way to bring affordable health care to all Americans is to establish a government-operated program of universal health care and to get the private insurance industry out of the picture altogether.

So we can only hope that once he or she gets elected, the winner of the presidential race will get down to business and push for real progress by establishing a universal health care program rather than continuing to promote a program of universal health insurance in which the insurance industry plays the major role. This industry’s high administrative costs and shareholder profits absorb a substantial share of the health care dollar. This is money that should be going to pay for health care directly, and if that money did go there, the overall cost of health care would go down.

It won’t be easy of course, because even if Clinton and Obama do, a large segment of the American public does not recognize the difference between health insurance and health care, and many are leery of increasing the government’s role in health care or any other arena. Many Americans have a hard time realizing that the best tool we have available for fixing the health care system is our federal government.

Second review of the book, from LibraryThing

2008-02-26T11:44:00.000-08:00

From Kevin Bondelli, political activist and participant on LibraryThing, comes another praise-filled review of Mired in the Health Care Morass:

Davis' research is extensive, and his ability to dissect the unreasonably complex health care process is unrivaled. Due to the complexity of the process his book has a great number of charts and diagrams that do wonders to help the reader make sense of it all.

Book news: upcoming events, first review

2008-02-24T18:37:00.000-08:00

Two book signing events are scheduled in Fairbanks within the next week:

February 28, 6 to 8 pm at Gulliver's Books, College Road

Alaska Library Association Conference
Saturday, March 1, 2:30 to 4, Princess Hotel

Dermot Cole of the Fairbanks Daily News-Miner writes, "I look forward to reading the latest book from Fairbanks scientist and writer Neil Davis, a thoughtful researcher who has spent more time than anyone I know studying the health care system."

And David A. James, also of the Fairbanks Daily News-Miner, has written the first published review of Mired in the Health Care Morass, titled "Mired offers eloquent indictment of America's health care system", calling Davis' writing "eloquent," "persuasive," "commendable," and "illuminating."

Senate Bill 160

2008-02-18T07:33:00.000-08:00

The current draft of Senate Bill 160 contains improvements over the original draft proposed by the sponsors, but it still fails to address the real problem of high costs of health care for the heaviest users of health care in Alaska: the total cost of health care of which insurance premiums are just a part. The bill seeks only to provide affordable health insurance, not affordable health care. For those Alaskans needing the most health care, the cost of insurance premiums is often only a fraction of the total cost of health care. They also have to pay for insurance deductibles, co-payments, and additional out-of-pocket expenses.

By mandating the purchase of insurance from private industry, the bill can only drive up overall health care costs for Alaskans. Private insurance companies have much higher administrative costs than government insurance programs such as Medicare and Medicaid, and they rake off additional money for shareholder profit. Roughly 20 to 30 percent of the health care dollars funneled through private insurers are lost in administrative costs and shareholder profits. This is money that should be spent directly for health care.

Because the effect of the bill will be to increase total health care costs, its passage by the legislature will be a backward step toward more affordable health care. The legislature would do better to expand Alaska’s highly efficient Medicaid program, making it available to more low-income Alaskans.

Legislative public hearing on SB 160

2008-02-17T23:11:00.000-08:00

As pointed out on Health4all, there is a public hearing on SB 160 on Monday. SB 160 is the mandatory health insurance bill introduced by Hollis French, about which Neil Davis wrote in his December 2007 Dose of Reality column.

The hearing is at 1:30 pm. Testimony is described as by invitation only.

Legislative public hearing on the CON

2008-02-08T17:48:00.000-08:00

The legislature is holding public hearings on the issue of revoking the Certificate of Need requirement. The first one is:

Saturday, February 9, 9 am
at the Legislative Affairs Office in the Alaska USA building
at 1292 Sadler Way, Suite 308, Fairbanks.

Below is a list of observations on the value of the Certificate of Need requirement, forwarded to me and in direct counterpoint to many of the points raised in the insert in last Sunday's News-Miner (be forewarned, it's long):

1. The absence of market competition does not cause increasing healthcare costs. Rising costs are caused by a combination of many other factors. Three major drivers of rising health care costs are:

a. Medical advances and improved technologies account for one-half to two-thirds of the increase in health care spending in excess of general inflation.(1)

b. Neither the patient who uses healthcare nor the physician who orders it are the direct payer for most healthcare costs. Insurance lowers the effective price of healthcare, which increases demand and leads to overuse. Few people realize that the magnetic resonance image (MRI) for which they paid a $10 co-payment could actually cost $250 or more.

c. Aging and lifestyle choices, such as smoking and inactivity, contribute to a wide variety of health problems. The average age of Fairbanks is rising, one in four Alaskans smoke, and 63% are overweight.(2)

2. Adding providers often raises costs
Since “for much of U.S. health care, supply drives demand. In other words, higher-than-average utilization of a particular procedure may occur in an area where the technology or specialists performing the procedure are in abundance.”(3)

3. Other states that have abolished CON have had a variety of unintended consequences.
The Virginia General Assembly removed all medical equipment CON requirements in 1989. The result was rapid proliferation of for-profit providers. Average volumes fell and prices rose. So, in 1992, the Virginia legislature reinstated CON regulation of medical equipment. Alaska shouldn’t repeat Virginia’s mistake.

4. CON review doesn’t prevent any needed projects from going forward. It does help to ensure that they are based on a sound business plan and respond to a genuine community need.

5. Experience in the auto industry shows that medical costs are lower in states that have CON legislation.
Studies undertaken by General Motors, Ford and DaimlerChrysler demonstrate that health care expenditures per employee are significantly lower in states with CON legislation, such as Michigan and New York, than in states without it, such as Indiana, Ohio and Wisconsin.”(4) In fact, their MRI costs per covered person were up to 20% higher in states without CON.(5)

6. “Competition” doesn’t lower prices.
In Fairbanks, when AOIC opened, they charged more per scan than FMHDC. There is no evidence of lower costs or charges in states where physician-owned ambulatory surgery centers and freestanding diagnostic imaging centers are widespread.

7. Healthcare is an unusual business.
It’s possible to keep prices high even when there are alternatives because of a host of inherent structural quirks of the healthcare marketplace. Much of healthcare is supply-sensitive, where the use rate is driven primarily by the available supply of resources.(6) That is why Alaska requires a demonstration of community need before permitting additional services. Now some are seeking to repeal CON rather than play by the rules required of all service providers.

8. The state plays a necessary role in realms that markets cannot value properly.
Regulation is required to solve problems that the market cannot fix, such as education, health, public infrastructure, and clean air and water.

9. CON makes sure that good planning has been done that meets a real community need.
In Alaska, and in other states with CON programs, health care facilities are required to “play by the rules” and meet specified planning requirements. That’s it, that’s what it does.

10. Repeal of CON will NOT lead to competition, and competition will not lower costs.
As Yale professor Ted Marmor said recently, “choice and competition have no proven record of cost control in medical care either in the United States or elsewhere.”(7)

11. The notion of competition is a Trojan horse.
It may look great on the outside, but a complex set of conditions and devices lurk inside. Conditions that increase overall healthcare costs, decrease the ability of the local hospital to invest in new services and support those that can’t pay for themselves, and favor the wealthy and well-insured at the expense of the poor and the sick. Don’t be fooled by the skin-deep attraction of the competition argument.

12. Research shows “competition” has negative consequences in health care.
The Center for Studying Health System Change 2005 survey is the fifth conducted by the Center. Recent survey results reinforce and amplify earlier observations. Key findings include:

• Socially nonproductive competition between and among hospitals, freestanding service centers, and physicians appears to be having significant system distorting effects.

• It contributes to:
-- decreased average service volumes,
-- reduced system efficiency,
-- increased withdrawal of operating returns as profit,
-- promotes undesirable joint ventures, and
-- provides economic incentives for the provision of unnecessary services and of care of little benefit to patients.

• With the possibility of shifting their practices, or selected patients, to outpatient services in which they may have a financial interest, larger numbers of physicians are shunning hospital and related professional community service.
-- Many hospitals are being forced to hire physicians to provide on-call emergency, trauma and specialty care. Concern about access to specialty care – inpatient psychiatric services for example – for some patients is growing.

• With the shift of profitable services to physician owned facilities, and the increased focus on profitable services at some hospitals, “safety net” community hospitals are under increasing pressure to provide needed, but unprofitable, services. The revenue stream needed to support these services is drying up.

• This wouldn’t be good news, but if CON is repealed, we’ll be seeing it here.

13. Financial incentives can distort clinical decisions made by physician-owners.
Specialty facilities erode cross-subsidization by “cherry picking” relatively well-insured and healthy patients (where profit margins are higher) and by limiting or denying care outright to underinsured, indigent, and less healthy patients.(8)

Because physicians may refer patients to specialty facilities in which they have an ownership interest, financial self-interest may overwhelm clinical judgment and lead to unnecessary referrals, threatening both cost and quality.(9)

“Medical profiteering steers care away from what's best for the patient in favor of what's best for the doctor. That greed undermines the entire process: It compromises quality, increases cost, and erodes the patient-physician relationship.” (10)

Saying that physician self-referral arrangements are “creating incentives for overutilization and corrupting medical decision-making,” CMS’s proposed Physician Fee Schedule (PFS) rule for calendar year 2008 signals the agency’s intent to clamp down on the practice and has led some providers to temporarily put such deals on hold. (11)

According to a recent study by McKinsey, “physicians have been making profits estimated at $8 billion annually through the practice for self-referral.”(12)

“Like all of us, physicians are susceptible to the financial conflicts that are inevitable in an entrepreneurial society. Clearly, professional self-regulation isn't working. Nor is the system yet transparent enough to discourage these behaviors and protect patients. So additional safeguards are required.”(13)

Barring a legislative prohibition on physician investment in health care facilities, CON is the best safeguard Alaskans have against the problem of financially conflicted care.

14. State support for Certificate of Need (CON) is not ideological.
CON laws require that entities proposing to build new facilities demonstrate that they are meeting an unmet health care need.(14) The American Health Planning Association recently summarized the breadth of state regulation, and the pattern of distribution is not clearly related to the overall political leaning of the state. Thirty-six states today retain some sort of CON oversight.

15. Specialty providers avoid patients who are uninsured or underinsured.
Specialty facilities focus exclusively on profitable procedures. Since no financial incentive exists for the care of Medicaid patients, it is not surprising that specialty hospitals treat proportionately fewer Medicaid inpatients.(15)

16. Specialty providers are not more efficient.
The recently published MedPAC report found that physician-owned specialty hospitals do not have lower costs for Medicare patients than community hospitals, despite shorter lengths-of-stay. (16)

17. Specialty providers are not higher quality.
A recently published study by Peter Cram and colleagues found no difference in Medicare mortality rates between specialized hospitals and community hospitals, but did find that specialized facilities are more likely to treat healthier patients.(17)

There is an extensive literature demonstrating that institutions that perform a high volume of a given procedure provide higher-quality care.(18) Eliminating CON from Alaska’s largest communities, as HB287 sought to do, would only serve to dilute an already small number of procedures across a greater base of providers—with a strong potential for compromising the quality of care we can provide in-state.

18. Specialty providers treat less complex, more profitable cases.
The treatment of patients of lower acuity (“cherry picking”) by ASCs and specialty facilities appears to be taking place.(19) In strong support for this hypothesis, Ariel Winter found that Medicare patients treated in ASCs had lower risk scores (a reflection of a patient’s expected costliness based on age, sex, and diagnoses) than patients treated in hospital outpatient departments for all ten procedure categories that accounted for the highest share of Medicare payments to ASCs in 1999. (20)

Similarly, a recent GAO report found that specialty hospitals treated a lower proportion of severely ill patients in the same diagnostic categories treated at general hospitals.(21) The recent MedPAC and CMS reports also confirm these results.(22) Since no financial incentive exists for the care of Medicaid patients, it is not surprising that specialty hospitals treat proportionately fewer Medicaid inpatients.(23)

Cross-subsidies have always been a key part of the health care financing system, with hospitals using profitable services and patients covered by profitable payers to offset their losses from less profitable services and patients.(24) The strong financial incentives to select more-profitable cases and patients, combined with niche providers’ greater inclination and ability to act on those incentives, makes community hospitals financially vulnerable.

19. Specialty providers raise overall healthcare costs.
On the state level, experience in the auto industry shows that medical costs are lower in states that have Certificate of Need programs because these programs reduce redundant capacity and limit the proliferation of specialty providers and unnecessary capital expansion projects. Studies undertaken by General Motors, Ford and DaimlerChrysler demonstrate that health care expenditures per employee are significantly lower in states with CON legislation, such as Michigan and New York, than in states without it, such as Indiana, Ohio and Wisconsin.(25)

The peer-reviewed literature on self-referral suggests that physician ownership of facilities leads to higher use rates. Self-referring physicians were 4 to 4.5 times more likely than radiologist-referring physicians to obtain radiological investigations, and they charged much more for tests of the same complexity.(26) Similar results have been observed for physician ownership of physical therapy and rehabilitation facilities and radiation therapy clinics.(27)

One standard hypothesis in favor of ASCs is that their main effect on hospitals is a competitive reduction in price, but on balance not a large loss of hospital outpatient surgery volume.(28) Contrary to that hypothesis, research shows a substantial loss of hospital volume.(29)

Another recent study indicates that prices do not necessarily come down, either.(30) In fact, as the economics in an imperfect market would predict, overall costs increase instead. “While purchasers are predisposed to favoring increased competition to help keep prices low, what we heard generally from health plans and employers is that specialty hospitals are contributing to higher costs without any clear quality benefits," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.

“Some purchasers believe that referring physicians, especially those with a financial interest in the specialty hospital, increase volume by inducing patient demand for elective procedures. The higher volume raises costs more than the savings achieved from lower prices from competition, leading to increased aggregate costs.”(31)

Lynk and Longley found evidence that this belief is well-founded: adding an ASC to the markets they studied caused the total volume of outpatient surgeries to rise 9% over the trend.(32) Furthermore, this volume increase is largely confined to those physician investors with a financial interest in the ASC.

There is strong evidence that ASCs—which, in Alaska, currently exist only in Anchorage—increase both overall demand and per unit costs as well, consistent with research we have cited above. The surgical use rate in Anchorage is over 50% higher than that in Fairbanks. Obviously, this leads to much higher total healthcare costs to the community as a whole—while simultaneously undercutting a community hospital’s ability to care for the most vulnerable members of the community.

20. Alaska’s CON Program
Consistent with the state’s unique geography and demography, the program has taken on a distinctive Alaskan character.
Most states that set expenditure review thresholds usually distinguish between new services, medical equipment, and health facility renovation, expansion and development. Alaska does not. Some states review all projects that establish a category service (e.g., a service for which review standards exist) regardless of their capital or annual operating costs. Others limit this to certain categories (e.g., CT scanners, MRI scanners, PET scanners, cardiac catheterization laboratories, ambulatory surgery centers, linear accelerators).

21. Eliminating or weakening CON is not a good solution to Alaska’s healthcare marketplace.
Weakening CON would make it likely that the communities in Alaska will see spiraling healthcare costs, and higher utilization—without increasing access, cost, price or quality.

Weakening CON will not result in better healthcare for rural communities or larger communities. It will only raise the overall cost of healthcare by enriching a few investors at public expense.

Alaska should consider establishing different cost thresholds for different types of projects, an approach followed by most other states. This approach recognizes that it is primarily the on-going cost of potentially excess utilization that has the greatest risk of increasing health care costs. It is also because these are the services where damaging “cherry-picking” behavior is most likely.

(1) New England Journal of Medicine, Controlling Heath Care Costs, Oct. 14, 2004.
(2) The Kaiser Family Foundation, statehealthfacts.org, at www.statehealthfacts.org
(3) General Accounting Office. Health Care: Unsustainable Trends Necessitate Comprehensive and Fundamental Reforms to Control Spending and Improve Value. Highlights of the May 2004 Health Care Forum GAO-04-793SP. Page19
(4) United Auto Workers. Health Care.
(5) State of Missouri Department of Health and Senior Services. (PDF)
(6) http://www.gao.gov/new.items/d04793sp.pdf
(7) Marmor TR and Marshaw JL. “Understanding Social Insurance: Fairness, Affordability, and the “Modernization” of Social Security and Medicare.” Health Affairs 25 (2006): w114-w134 (published online 21 March 2006; 10.1377/hlthaff.25.w114). Page w132.
(8) Sujit Choudhry, Niteesh K. Choudhry, and Troyen A. Brennan. Specialty Versus Community Hospitals: What Role For The Law? Health Affairs: Health Tracking: Marketwatch 9 August 2005.
(9) Choudhry, Choudhry, and Brennan.
(10) Brian Klepper, PhD. “When Medical Care Is Financially Conflicted.” Webcast Video Editorials. Medscape General Medicine. 2007;9(2):39. ©2007 Medscape. Posted 05/18/2007.
(11) For the proposed rule, see: http://www.cms.hhs.gov/physicianfeesched/downloads/CMS-1385-P.pdf
(12) Kaiser Daily Health Policy Report. “CMS Officials Taking Steps To Reduce Physician Self-Referrals Under Medicare, Wall Street Journal Reports” Posted Sep 12, 2007.
(13) Brian Klepper, PhD. “When Medical Care Is Financially Conflicted.” Webcast Video Editorials. Medscape General Medicine. 2007;9(2):39. ©2007 Medscape. Posted 05/18/2007.
(14) Institute of Medicine, Health Planning in the United States (Washington: National Academies Press, 1981).
(15) GAO, Specialty Hospitals: Geographic Location.
(16) Medicare Payment Advisory Commission, Report to the Congress: Physician-Owned Specialty Hospitals, March 2005, (PDF)
(17) P. Cram, G.E. Rosenthal, and M.S. Vaughan-Sarrazin, “Cardiac Revascularization in Specialty and General Hospitals,” New England Journal of Medicine 352, no. 14 (2005): 1454–1462.
(18) See, for example, R. A. Dudley et al., “Selective Referral to High-Volume Hospitals: Estimating Potentially Avoidable Deaths,” Journal of the American Medical Association 283, no. 9 (2000): 1159–1166.
(19) Cram et al., “Cardiac Revascularization.”
(20) A. Winter, “Comparing the Mix of Patients in Various Outpatient Surgery Settings,” Health Affairs 22, no. 6 (2003): 68–75.
(21) U.S. Government Accountability Office, Specialty Hospitals: Information on National Market Share, Physician Ownership, and Patients Served, Pub. no. GAO-03-683R (Washington: GAO, 2003).
(22) MedPAC, Report to the Congress: Physician-Owned Specialty Hospitals; and CMS, “CMS Outlines Next Steps.”
(23) GAO, Specialty Hospitals: Geographic Location.
(24) See, for example, S. Guterman, Putting Medicare into Context: How Does the Balanced Budget Act Affect Hospitals? 1 July 2000 (PDF accessed 10 April 2006).
(25) United Auto Workers.
(26) B.J.Hillman et al., “Frequency and Costs of Diagnostic Imaging in Office Practice—a Comparison of Self-Referring and Radiologist-Referring Physicians,” New England Journal of Medicine 323, no. 23 (1990): 1604–1608.
(27) Mitchell and Scott, “Physician Ownership”; and J.M. Mitchell and J.H. Sunshine, “Consequences of Physicians’ Ownership of Health Care Facilities—Joint Ventures in Radiation Therapy,” New England Journal of Medicine 327, no. 21 (1992): 1497–1501.
(28) The argument is that overall volume in the outpatient surgery market rises when price in the market falls and that that increase in total market volume offsets the incremental volume that the ASC takes from the hospital.
(29) Lynk and Longley. What can happen when a hospital’s staff physicians become its business rivals. Health Affairs. 2002 Jul-Aug;21(4):215-21. Specifically, that analysis yields a coefficient estimate for the ASC effect of 0.0932 (with a statistical significance level of p=0_.0238) and an adjusted R-square of 0.8449.
(30) Robert A. Berenson, Gloria J. Bazzoli, Melanie Au. Do Specialty Hospitals Promote Price Competition? Center for Studying Health System Change. Issue Brief No. 103. Jan. 25, 2006. (10 April 2006).
(31) Berenson, Bazzoli, and Au.
(32) Lynk and Longley.

Health Care for Alaskans: An "Informational" Publication

2008-02-06T12:48:00.000-08:00

An insert with the above title (minus the weasel quotes) in the Fairbanks Daily News-Miner's Sunday edition appears, at first glance, to be a special medical issues insert created by News-Miner staff. Article bylines read "Staff Report", with the exception of an article on the last page entitled "Certificate of Need hinders health care innovation," which is written by Michael Morrisey and Michael Ciamarra.* It is on the bottom of this last page, and this page alone, that a small notice reads, "Paid for by the Alliance for Healthcare in Alaska, 1275 Sadler Way, Fairbanks, AK 99701," thus revealing that the 8-page newsy-looking insert is in fact a paid advertisement. The staff "reports" are in fact opinion pieces, and are riddled with false and misleading statements.

Articles in this advertisement include:

• "Nation faces crisis due to physician shortage," which falsely claims that physician shortages "will only be exacerbated with universal health care"; and that "It is well documented that many Canadians wait an inordinate amount of time for their much-needed medical and surgical care," and "end up coming to the United States for their treatment".

• "Alaska's healthcare system locked in textbook 'monopoly'," laughably states, "It is important to understand that the health care system in America is second to none." This is flatly false, unless one is extolling its virtues as a money-making machine for insurance and pharmaceutical companies.

• "Competition necessary for industry to flourish," is a summarization of a presentation by Mark J. Botti of the Antitrust Division of the US Department of Justice in February 2007, "Competition in Healthcare and Certificates of Need." It extolls the virtues of competition in health care and argues against the need for Certificates of Need laws.

• "Breaking down 'Certificate of Need'" (subtitled "Program designed to aid patients in health care community now contains flaws, causes more harm than good"), provides a timeline graph of the number of states with CON laws and takes the form of arguments and rebuttals on the CON issue.

• "Certificate of Need hinders health care innovation,", which describes problems in Alabama, Georgia, and North Carolina's CON laws.

Quite clearly, the sponsors of this multipage advertorial want Alaska's Certificate of Need law overturned, as requested by Governor Palin (although this action was NOT recommended by the Alaska Health Care Strategies Planning Council she created to advise her). Unfortunately, the Alliance for Healthcare in Alaska appears willing to promulgate nonsense in order to do it.

*Ciamarra is vice president of the Alabama Policy Institute, a right-wing conservative think tank, described by the U of Alabama College Republicans as "the largest and most influential Conservative think tank in the state of Alabama."

A Note from the Publisher: Book signing at Gulliver's

2008-01-31T13:23:00.001-08:00

The advance copies of Mired in the Health Care Morass are due from the printer today, and the main shipment should be arriving before the end of February. Please contact the publisher if you are interested in obtaining a review copy for your periodical.

Gulliver's Books, Fairbanks, Alaska's local independent bookstore, will be hosting the first book signing on February 28, Thursday evening, 6-8 pm.

More on CON Legislation

2008-01-28T15:01:00.000-08:00

A year ago, Governor Sarah Palin, with Administrative Order No. 232 established, in the Office of the Governor the Alaska Health Care Strategies Planning Council. The purpose was to “identify short-term and long-term strategies to effectively address the issues to, and cost and quality of health care for Alaskans,” and to report it its findings “to the governor and the Legislature by January 1, 2008.” In May 2007, the governor appointed 14 voting members to the council which would be managed and operated by Karleen Jackson, Commissioner of Health and Social Services. It would also have as ex-officio non-voting members the chairs of the legislature’s Health, Education and Social Services committees, Senator Bettye Davis and Representative Peggy Wilson. The voting appointees consisted of five doctors, two nurses, one health insurance industry representative, five health association or health facilities administrators, and one town mayor. Notice that no health consumers or health consumer advocates were included in the membership.

One issue taken up by the council was the matter of Alaska’s Certificate of Need (CON) legislation, and the council established within itself a Certificate of Need Negotiated Regulations Committee. This committee issued a report stating that the current CON legislation needed changing, but it reported a very strong consensus among members that the CON process “should not be eliminated” and offered several suggestions for strengthening and clarifying the current regulations.

So what happened then? Commissioner Karleen Jackson ignored these recommendations, and concluded that the CON program does not benefit the citizens of Alaska, “given the litigious environment surrounding it.” Then awarding the council members a second kick in the teeth for their efforts, Governor Palin, as part of her Alaska Health Care Transparency Act presented to the legislature, called for the repeal of Alaska’s certificate of need legislation in entirety.

I bet those people who served on the Health Care Strategies Planning Council will think twice before again agreeing to another committee assignment from the governor. But this sort of thing happens a lot in Alaska state government. A governor has preconceived ideas about something so and appoints a committee in hopes that it will reach a conclusion that will justify the governor’s view and subsequent action.

This time it did not go well, so Governor Palin simply rejected the committee’s conclusion that the CON legislation needed to be both retained and improved upon.What will happen now is anybody’s guess, but let’s hope the legislature follows its conscience and stands up to the governor on this issue. Legislators would do well to listen to what the Alaska Health Care Strategies Planning Council had to say about how to improve the CON legislation and then take steps to do it.

Health care an issue in upcoming Alaska elections

2008-01-20T12:41:00.000-08:00

People running for office in Alaska are getting tough questions from their audiences on the campaign trail, apparently. Phil Munger at Progressive Alaska observed this when Ethan Berkowitz addressed the Mat-Su Democrats:

Berkowitz handled an array of questions fairly deftly until the talk turned to reform of our failing medical care structures. He's the least progressive of the three Dems on this, and struggled in his earnest efforts to answer some sweeping questions from the audience, with answers which wouldn't really provide solutions.

Berkowitz is right that medical care reform is a very complex set of problems with no easy answer for one community, let alone for the entire state or for our country. When he talked of waste, inefficiency and greed as being the major systemic flaws, though, his suggestions that we can tweak our way out of this dilemma didn't resonate at all with the audience.

David Sirota writes about alternatives being proposed in Washington state and Wisconsin: publicly controlled not-for-profit health care systems. Proposals like this could be adapted for Alaska, although we'd need to look at what is appropriate here.

Certificate of need law

2008-01-16T15:52:00.000-08:00

In her State of the union address on January 16, 2008 Governor Sarah Palin expressed her desire to eliminate Alaska’s certificate of need law. With this statement the governor is demonstrating that she cares more about the needs of profit-seeking business interests than the Alaska public’s need for affordable health care. As I wrote in my Dose of Reality column published in the Ester Republic in September 2007, the elimination of the certificate of need law is guaranteed to drive Alaska health care costs up. Proliferation of unneeded for-profit health care facilities will force nonprofit hospitals to raise their overall rates to compensate for losses incurred when their existing facilities are underutilized. Not only that, health care consumers must also bear the costs of the for-profit facilities, and part of that cost is the profit raked off by the operators of these facilities. Their primary purpose is to make money, and for them the provision of health care is secondary. Counter to what Governor Palin says, it will be a disservice to the Alaska public to repeal our certificate of need law.

Talk at the Interior Democrats' luncheon

2008-01-10T18:19:00.000-08:00

Neil Davis on health care finance at the Interior Democrats' Luncheon
Westmark Hotel, 12 noon
813 Noble Street, #1
Fairbanks, Alaska

A Note from the Publisher: About the book

2008-01-09T10:57:00.000-08:00

The marketing campaign has begun! The first batch of galleys of Neil Davis' book, Mired in the Health Care Morass, are done and will be mailed tomorrow to prospective reviewers. From the cover:

Mired in the Health Care Morass describes a predicament known to almost 47 million Americans: paying for medical bills without health insurance. Neil Davis navigated this financial black hole and discovered a hidden truth: medical bills don't reflect the costs of medicine. Davis describes the harrowing journey his family took in paying for cancer treatments, and comes to the well-informed conclusion that our health care system is broken, and doesn't have much to do with health.

John P. Geyman, MD, professor emeritus in family medicine at the University of Washington and author of the bestselling book, The Corporate Transformation of Health Care, read the manuscript and provided this explanatory prepublication review of Davis' work:

This is a well written and researched book illuminating the dark interior of health care financing, ranging across billing practices for physician services, drugs, laboratory and hospital services. A penetrating analysis from a consumer's point of view, unique in its detail, which shows how complex, fragmented, unaffordable, and unsustainable our market-based health care "system" has become. Motivated by the tragic illness of a family member, Davis carries his research to a study of our system as it compares with those of other industrialized nations, making a compelling case for a publicly financed system of single-payer national health insurance.