Everyones Health Counts

2008-07-10T15:15:00.000-07:00

Welcome to Everyone's Health Counts!

Reforming our broken health care system is foremost in the minds of many of us. We have been asking ourselves how we, as ordinary citizens, can approach such a complex problem.

This six-session Study Guide provides a gateway to explore the issues. Here you will find resources that any group of people can use to deepen its understanding of the health care crisis in this country and to become an effective voice for health care reform.

Start your own "study circle" with friends or with members of your church, neighborhood or civic group. We recommend six two-hour sessions. Here you will find all the tools you need to:

Get Educated on the Issues
•
Hold Informed Discussions
•
Share Your Stories and Learn From Others
•
Take Action
•
Bring About Health Care Reform

This site is designed to enable your group's members to (1) browse the materials on line, (2) Print the Study Guide and/or (3) Buy a CD of the Study Guide.

We do not know how many people this project will touch or how far it will travel—the classic “message in a bottle.” We do know, however, that the time for health care reform is long overdue and urge you to join with us in this important civic and social movement.

We believe…with Margaret Mead that…”A small group of thoughtful people could change the world. Indeed, it’s the only thing that ever has.”

Print the Study Guide

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Using this Study Guide you can start your own Study Circle with friends, neighbors and colleagues . . . because . . . Everyone's Health Counts!

Below you will find links to printer-friendly pages for constructing your own project binders. We found it useful to organize these pages in a three-ring binder and in the order in which they appear below.

To print pages now: Click on a link below to open a page, then pull down your FILE menu and select "Print."

To download a file to your hard drive: Pull down your FILE menu and select "Save as . . . "

Introductory Section

Project Binder Cover

Inside Binder Cover

Introduction - The History and Promise of This Work

Table of Contents

What Are Study Circles?

Guidelines For The Facilitator

Guidelines For Study Circle Participants

Form for Your Group's Schedule

A Note to Users

Article: Series Takes On Healthcare

Study Circle One

Discussion Guide: Caring about Health Care - An Overview

Preparatory Materials - Study Circle One

The Moral Challenge of Our Time: Reforming the Health Care System

Why Not The Best?

Current Problems with Health Care in the United States

Survey - Our Health Care System

Study Circle Two

Discussion Guide: Lifting the Statistical Veil • Seeing the Faces of Real People

Preparatory Materials - Study Circle Two

Form: Top Five Problems of the U.S. Health Care System

Stakeholder Advocate Assignment Sheet

Stakeholder Scenarios Summary

Study Circle Three

Discussion Guide: Current Systems • Current Proposals

Preparatory Materials - Study Circle Three

Health Care Options at a Glance - YES! Magazine

Hillary Clinton’s Plan

John McCain’s Plan

Barack Obama's Plan

Proposals for Comprehensive Health Care Reform at the Federal Level

Physicians For A National Health Program Plan

Common Arguments In Favor Of Establishing Universal Health Care

Common Arguments Against Establishing Universal Health Care

Digging In the Right Place

Study Circle Four

Discussion Guide: What Do We Want? How Can We Get There?

Preparatory Materials - Study Circle Four

Allocate The Federal Budget

The Dot Game Exercise

Health Care Systems - The Four Basic Models

Form: Our Five Top Priorities for the U.S. Health Care System

Study Circle Five

Discussion Guide: Barriers to Reform • Reasons for Hope

Preparatory Materials - Study Circle Five

Allocate The Federal Budget

Paying More But Getting Less, by Tom Daschle

The Logic of the Health Care Debate

How We Talk about Health Care

What Do Voters Want?

What Do Doctors Want?

Study Circle Six

Discussion Guide: Understanding Change • Making It Happen

Preparatory Materials - Study Circle Six

Form: Top FIVE Goals and Solutions for the U.S. Health Care System

An Introduction to the Overton Window of Political Possibilities

The Overton Window - Graphic

Health Care Perspectives In Brief

Starting Positive Conversations

The Six Principles of a Healthy Democracy

Making a Difference

Contact And Interest Form

Resources

Health Care Glossary

Survey - Our Health Care System

Videos On Health Care to Watch Online

Sample Readings to Open a Session

Links

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Please note: when you click on the links below you will be leaving this site.

Physicians for a National Health Program
Physicians for a National Health Program is a non-profit research and education organization of 15,000 physicians, medical students and health professionals who support single-payer national health insurance.
http://www.pnhp.org/

Health Care for All - Washington
Washington State advocates for secure, affordable, and comprehensive health care coverage for all Washington residents, implemented through a unified financing system.
http://www.healthcareforallwa.org/home/

StoryBoard Productions
Web design and administration for the small business, including this blog.
http://www.storyboardproductions.com

Getting Started

2008-07-09T11:01:00.000-07:00

This site is designed to accomplish two things:

give you the ability to BROWSE the contents of this Study Circle Guide
give you the ability to PRINT the contents of the Study Circle Guide (and create a binder) for these six two-hour sessions

Getting Started. Please read and/or print the following printer-friendly pages prior to participating in your first Study Circle. This material provides an overview of the study circle process and will provide guidance as members of your group prepare for each session.

To print pages now: Click a link below, then use the "Print" button in your browser window.

To download: Right-click (PC users) or press-and-hold (Mac users) on each link and select "Save file as ..." to save the file to your computer for printing and constructing your own project binders.

Project Binder Cover

Inside Binder Cover

Table of Contents

The History and Promise of this Work

What Are Study Circles?

Guidelines for the Facilitator

Guidelines for Study Circle Participants

Form for Your Group's Schedule

A Note to Users

Article: Series Takes on Healthcare

HEALTH CARE REFORM IS EVERYONE'S BUSINESS
because
EVERYONE'S HEALTH COUNTS!

Calendar: September '08 Study Circles

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The Adult Programs Committee of Cedars UU presents:

A STUDY CIRCLE SERIES
on
HEALTH CARE REFORM

JOIN a Health Care Study Circle.

SIGN UP for six weekly group explorations.

CHOOSE from among three circles, all are from 7:00 – 9:00 PM:

Tues. Sept. 23 – Oct. 28
Thurs. Sept. 25 – Oct. 30
Sun. Sept. 28 – Nov. 2

Downstairs, in the Sterling Building .

HEALTH CARE REFORM IS EVERYONE’S BUSINESS
because
EVERYONE’S HEALTH COUNTS!

To sign up or for more information contact:
Karen Scarvie - 206-780-0720 - kalena@znet.com
Barbara Clarke - 206-780-0686 - barbara.l.clarke@gmail.com

News & Announcements

2008-07-08T17:11:00.000-07:00

December 7, 2008
When a Job Disappears,
So Does the Health Care
by Robert Pear (Ashland, Ohio)
Excerpted from The New York Times

“As jobless numbers reach levels not seen in 25 years, another crisis is unfolding for millions of people who lost their health insurance along with their jobs, joining the ranks of the uninsured.”

About 10.3 million Americans were unemployed in November, according to the Bureau of Labor Statistics.

The number of unemployed has increased by 2.8 million, or 36 percent, since January of this year, and by 4.3 million, or 71 percent, since January 2001.

Most people are covered through the workplace, so when they lose their jobs, they lose their health benefits.

On average, for each jobless worker who has lost insurance, at least one child or spouse covered under the same policy has also lost protection, public health experts said.

M. Harvey Brenner, a professor of public health at the University of North Texas and Johns Hopkins University, said that three decades of research had shown a correlation between the condition of the economy and human health, including life expectancy.“ In recessions, with declines in national income and increases in unemployment,” Mr. Brenner said, “you often see increases in mortality from heart disease, cancer, psychiatric illnesses and other conditions.”

Read the entire NY Times article

________________________________

A Washington State Legislative Advocacy Network Promotes Our Project

Olympia, WA
September 8, 2008

Washington Unitarian Universalist Voices for Justice, a State legislative advocacy network based in Olympia, Washington, describes with enthusiasm the history, goals and methodology of our Study Circle project in a recently published story on its web site.

Entitled The Moral Imperative of Health Care Reform, this information-packed article states that underscoring our project "is the understanding that equal access to health care is a justice issue, a moral necessity. Just as awareness of moral need stirred other great movements – the end of slavery, protection of child and adult workers, environmentalism – awareness of the moral need for health care reform can bring people together to begin the work for another social transformation."

To read their article about our project visit their web site at http://www.uuvoiceswa.org/

Cedars Adult Program Committee Launches Fall Study Circle Series

Bainbridge Island, WA

September 1, 2008

The health care system in our country is broken. This indisputable fact is readily acknowledged by just about everyone. Can we, in all good conscience, sit back and let millions of Americans go without health care? Are we willing to continue to accept the most inefficient, inequitable and expensive health care system in the developed world? If not, what are we, as caring and responsible citizens, going to do about it?

The members of the Cedars Adult Programs Committee asked just those questions in the summer of 2007 and decided to take on the issue of health care reform. We rolled up our sleeves and created a 143-page Study Circle Guide to help us and others explore this complex territory.

Early this year a group of us embarked on six two-hour study circle sessions to test this newly developed Guide. Based on our experience, we made revisions and have since published the Guide on CD and are making it available on the internet. We are hoping that other churches and community groups will use the Guide to inform themselves and to mobilize to help bring about a health care system that works for everyone.

You can view the results of this project on line by visiting Everyone’s Health Counts at http://everyoneshealthcounts.blogspot.com/.

Meanwhile, Cedars Adult Program Committee is sponsoring a series of study circles for this fall. We urge our members to join one of the three circles that will be meeting one evening a week over a six-week period. You can choose between Tuesday, Thursday and Sunday evenings. Each two-hour circle will convene at 7:00 PM at the Sterling Building.

For information or to sign up please contact:

Barbara Clarke, 206-780-0686 (evenings)
Karen Scarvie, 206-780-0720 (days)

HEALTH CARE REFORM IS EVERYONE'S BUSINESS
because
EVERYONE'S HEALTH COUNTS!

Making Headway on Health Care

from Everyday Democracy, Ideas and Tools for Community Change
January 29, 2008

The economy is on everyone's minds these days. The faltering housing market has the spotlight, but the soaring cost of health care is another burden that American families and small businesses can barely shoulder. Members of the Cedars Unitarian Universalist Church on Bainbridge Island (near Seattle) met earlier this month to launch a round of study circles on “The Moral Imperative of Health Care."

Organizer Barbara Clarke, who formerly worked in managed care, told the Bainbridge Island Review that the debate has started moving beyond whether health care is a right or a privilege. “When you see that women with breast cancer and no insurance have a 40 percent less chance of surviving, that’s moral," she said. "When you see a mother who can’t take her children to the doctor, that’s moral.”

Meanwhile, syndicated columnist David Sirota writes about how the state legislatures in Washington and Wisconsin are considering legislation to extend health care to every citizen in those states. "The plan is simple," he says. "Employers and employees pay a modest payroll tax in exchange for full medical benefits, with no premiums. Patients never lose coverage and pick the doctors they prefer. And for the spendthrifts, here's the best part: According to an analysis of the Wisconsin proposal by the nonpartisan Lewin Group, the plan would save middle-class families an annual average of $750 on their existing health care bills. In all, the state would save almost $14 billion over the next decade."

Series takes on healthcare

Bainbridge Review
by Lindsay Latimore
Jan 19 2008

The modern-day healthcare system leaves too many people at a loss – confused by their options and uncertain how to act. That was the reasoning driving a group of reform-minded members of Cedars Unitarian Universalist Church to develop a new learning and discussion series, “The Moral Imperative of Health Care.”

“This is targeted at informing people...and also engaging them as citizens to go forward,” organizer Barbara Clarke said. Clarke, who worked in managed care for many years, recalled numerous debates with colleagues over the question of whether healthcare was a “right
or a privilege.”

“And I think it’s really moved beyond that,” she said. “When you see that women with breast cancer and no insurance have a 40 percent less chance of surviving, that’s moral. When you see a mother who can’t take her children to the doctor, that’s moral.”

The six-session workshop, which begins tomorrow and runs weekly through Feb. 17, will combine the reading of background articles with facilitated discussions, scenario-based role-playing and the sharing of stories, all with an aim to illuminate the state of healthcare on personal, political and institutional fronts.

A significant component, Clarke said, will be to train future facilitators to organize subsequent workshops Ultimately, the group hopes to to organize a large-scale public forum to be held in August at which community members and public officials work together to create healthcare reform.

“When informed citizens come together, they can create policy and affect change,” she said. Though the upcoming workshop is full, organizers are taking reservations for the next “Moral Imperative of Health Care” series.

Contact Karen Scarvie at 780-0720 or Clarke at 780-0686.

HEALTH CARE REFORM IS EVERYONE'S BUSINESS
because
EVERYONE'S HEALTH COUNTS!

Buy a CD of the complete Study Guide

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Coming soon via Pay Pal.

For immediate shipment of your Study Guide CD (includes shipping and handling) please send your check in the amount of $5.00 to:

Cedars Unitarian Universalist Church

P.O. Box 10175

Bainbridge Island, WA 98110

HEALTH CARE REFORM IS EVERYONE'S BUSINESS
because
EVERYONE'S HEALTH COUNTS!

Resources for Learning

2008-06-30T10:43:00.000-07:00

Links

HEALTH CARE REFORM IS EVERYONE'S BUSINESS
because
EVERYONE'S HEALTH COUNTS!

Sample Readings

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Here are some sample ideas for opening a Study Circle. These are intended to be very brief and not take time away from the curriculum. These readings give your participants a chance to shift gears and settle in.

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever does.”
-- Margaret Mead

______________

“The rise and fall of a nation rests with every one of its citizens.”
-- Chinese proverb

______________

“Healthy citizens are the greatest asset that any country can have.”
-- Winston Churchill

______________

“The Constitution does not provide for first and second-class citizens.”
-- Wendell Willkie

______________

"The moral test of a government is how that government treats those who are at the dawn of life -- the children; the twilight of life -- the elderly; the shadows of life -- the sick, the needy, the handicapped."
-- Vice President Hubert H. Humphrey, 1977

______________

Commitment

"People say, what is the sense of our small effort. They cannot see that we must lay one brick at a time, take one step at a time. A pebble cast into a pond causes ripples that spread in all directions. Each one of our thoughts, words, and deeds is like that. No one has a right to sit down and feel hopeless. There is too much work to do."
-- Dorothy Day

______________

Drop a Pebble

Drop a pebble in the water: just a splash, and it is gone;
But there's half-a-hundred ripples circling on and on and on.
Spreading, spreading from the center, flowing on out to the sea.
And there is no way of telling where the end is going to be.

Drop a pebble in the water: in a minute you forget,
But there's little waves a-flowing, and there's ripples circling yet,
And those little waves a-flowing to a great big wave have grown;
You've disturbed a mighty river just by dropping in a stone.

From Drop a Pebble by James W. Foley, found at www.poofcat.com

2008-06-29T14:11:00.000-07:00

Printer Friendly Version

Introduction

· What Are Study Circles?
· Series Takes on Health Care
· Guidelines for Facilitators and Groups
· Particulars for Your Group––Dates, Time, Location(s) and Contact Person(s)

Study Circle One
Caring About Health Care: An Overview

· Why study health care issues?
· Survey (Optional)
· Introductions. Who are we? What brings us here?
· The Moral Challenge of Our Time: Reforming Health Care

Study Circle Two
Lifting The Statistical Veil • Seeing The Faces Of Real People

* Who are the stakeholders?
* What are their stories, experiences, feelings, fears, etc?

Study Circle Three
Current Systems • Current Proposals

* How do other countries address healthcare?
* What are the proposals of political candidates and some organizations?
* Pending Congressional Bills
* Arguments for and against universal healthcare

Study Circle Four
What Do We Want? How Can We Get There?

* Four basic models in capitalistic, democratic countries
* What would your healthy health care system look like?
* Group brainstorming

Study Circle Five
Barriers To Reform • Reasons For Hope

* Looking at the Federal Budget
* What prevents us from getting what we really need?
* Looking at our cultural mythology/the American psyche
* Examining the power structure.

Study Circle Six
Understanding Change • Making It Happen

* The American political spectrum: Is change possible?
* The Change Agents – Who are they? How do they create conditions for change?
* Mobilizing – What will we do now? How will we do it?

Other Resources

* Health Care Glossary
* Health Care Videos to watch on line
* Sample readings for session openers

Study Circle One: Series Takes On Healthcare

2008-06-24T14:51:00.000-07:00

Bainbridge Island Review
Jan 19, 2008

The modern-day health care system leaves too many people at a loss – confused by their options and uncertain how to act.

That was the reasoning driving a group of reform-minded members of Cedars Unitarian Universalist Church to develop a new learning and discussion series, “The Moral Imperative of Health Care.” See the curriculum at http://everyoneshealthcounts.blogspot.com.

“This is targeted at informing people...and also engaging them as citizens to go forward,” organizer Barbara Clarke said.

Clarke, who worked in managed care for many years, recalled numerous debates with colleagues over the question of whether healthcare was a “right or a privilege.”

“And I think it’s really moved beyond that,” she said. “When you see that women with breast cancer and no insurance have a 40 percent less chance of surviving, that’s moral. When you see a mother who can’t take her children to the doctor, that’s moral.”

The six-session workshop, which begins tomorrow and runs weekly through Feb. 17, will combine the reading of background articles with facilitated discussions, scenario-based role-playing and the sharing of stories, all with an aim to illuminate the state of healthcare on personal, political and institutional fronts.

A significant component, Clarke said, will be to train future facilitators to organize subsequent workshops Ultimately, the group hopes to to organize a large-scale public forum to be held in August at which community members and public officials work together to create healthcare reform.

“When informed citizens come together, they can create policy and affect change,” she said. Though the upcoming workshop is full, organizers are taking reservations for the next “Moral Imperative of Health Care” series. Contact Karen Scarvie at (206) 780-0720 or Clarke at (206) 780-0686.

Back to Study Circle One Preparatory Materials

Guidelines For Study Circle Participants

2008-06-24T14:36:00.000-07:00

Study Circles are highly participatory; they do not look to experts for the final word on an issue, but use expert opinion as only one way to inform ideas and choices.

All viewpoints are taken seriously and each member has an equal opportunity to participate so that the group can capitalize on the unique wisdom and experience of all of its members. The process—democratic discussion among equals—is as important as the content. Study Circles provide comfortable, open settings for everyone to explore public issues without the need to defend their position. People are invited to share their ideas, listen to one another, and learn together thus creating dialog and not a debate.

The Golden Rules for a Successful Study Circle Experience

Make a good faith effort to attend all meetings and arrive on time.
Review the reading materials before each session.
Listen attentively to one another. Listen with respect.
Be curious. Maintain an open mind. Suspend judgment as best you can.
Go for honesty and depth, but don’t go on and on.
One person talks at a time. Please don’t interrupt.
Stick to the issues.
Question assumptions; look for new insights.
When your views differ from those of others, disagree without being disagreeable.
Sharing what we learn about issues outside the circle is encouraged. Personal stories should be kept confidential.
Help the facilitator and timekeeper stay on track.
If the scribe makes a mistake or misses an important point, speak up.

Back to SC One Preparatory Materials

Guidelines For The Facilitator

2008-06-24T14:32:00.000-07:00

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Each session needs a facilitator from the group who “opens” the session and guides the discussion. Different members of the group share this responsibility. Some groups have found it helpful to have a time-keeper and scribe as needed.

TO OPEN THE SESSION:

1. Your role is to bring a short opening for one session (not more than five minutes). It might be a short personal story, an object or photograph that has special meaning, a poem, visualization, etc. Since this is a time for creativity, there is no prescribed format or expectation.
2. The purpose of the opening is twofold. First, it provides a transition from other activities of the day into the group discussion. Second, since the opening is personal, it allows the group to get better acquainted with you. This aspect of the course is often very rewarding.

TO FACILITATE THE SESSION:

1. As facilitator for one session, your principal role is to stimulate and moderate the discussion by asking questions (your own or those from the list of possible discussion questions) identifying key points, and managing the group process. You do not need to be an expert of even the most knowledgeable person about the topic for the week.
2. Begin and end the session on time.
3. Keep discussion focused on the session’s topic. A delicate balance is best–don’t force the group to stick to the topic or the questions in the course book, but don’t allow the discussion to drift too far.
4. A primary goal is for everyone to participate in each session. As facilitator, draw out quiet participants by creating an opportunity for each person to contribute.
5. On the other hand, an important role of the facilitator is to restrain a domineering participant. Don’t let one or two people take over the conversation. Thank them for their opinions and ask another person for his or her opinion.
6. The goal of the course is for participants to learn from themselves and from others in a comfortable setting. Any opinion or question is okay.
7. The focus should be on personal reactions to the readings and on personal values, opinions, feelings, and experiences. The course is not for problem-solving, and consensus is not a goal.
8. Be an active listener. You need to hear and understand what people say if you are to guide the discussion effectively. Listening carefully also sets a good example.
9. Complete the form at the end of your circle. Note the name of your group, the location, and comments about the experience.

Borrowed and adapted by permission from Northwest Earth Institute,
Discussion Course on Exploring Deep Ecology

Back to Study Circle One Preparatory Materials

About You

2008-06-20T11:02:00.000-07:00

What You Stand to Gain

from the Six Study Circles

Like the vast majority of us, you are someone who is aware that our current health care system does not work very well, and you are concerned . . . maybe downright worried. You are also at a loss as to what you can do to change things. You are not an expert. You are just an ordinary citizen who cares. By organizing or joining a local study circle using this self-facilitating Guide you have an opportunity to:

Become an informed citizen on a complex, grave problem facing our nation

Work with others to build a grassroots movement for health justice

Provide a community forum where dialog, rather than debate, can take place

Engage policy makers and elected official by speaking with them, not at them

Turn the political wind . . . !

". . . I think that our current presidential candidates understand that ideally single-payer would be best, but they don't have the political will to move that forward. Their job is to feel which way the wind is blowing. Our job is to turn that wind."

– Quote from Dr. Rocky White, who describes himself as a "rock-ribbed conservative evangelical Christian." He revised and updated Dr. Robert LeBow's classic book, Health Care Meltdown: Confronting the Myths and Fixing Our Failing System. This book advocates for single-payer health care.

HEALTH CARE REFORM IS EVERYONE'S BUSINESS
because
EVERYONE'S HEALTH COUNTS!

Reading: Drop A Pebble by James W. Foley

2008-06-19T22:45:00.000-07:00

Example of a brief reading that might be used to open a session. Such a poem might be followed by some thoughtful commentary.

Drop a pebble in the water: just a splash, and it is gone;
But there's half-a-hundred ripples circling on and on and on.
Spreading, spreading from the center, flowing on out to the sea.
And there is no way of telling where the end is going to be.

Drop a pebble in the water: in a minute you forget,
But there's little waves a-flowing, and there's ripples circling yet,
And those little waves a-flowing to a great big wave have grown;
You've disturbed a mighty river just by dropping in a stone.

From Drop a Pebble by James W. Foley, found at www.poofcat.com

Readings: Hubert Humphrey and Matthew 25

2008-06-19T22:44:00.001-07:00

"The moral test of a government is how that government treats those who are at the dawn of life -- the children; the twilight of life -- the elderly; the shadows of life -- the sick, the needy, the handicapped."
-- Vice President Hubert H. Humphrey, 1977

Might the quote above simply be a paraphrasing of a portion of Matthew 25?

“Then shall the righteous answer him, saying, Lord, when saw we thee hungry, and fed thee? or thirsty, and gave thee drink? When saw we thee a stranger, and took thee in? or naked, and clothed thee? Or when saw we thee sick, or in prison, and came unto thee? And the King shall answer and say unto them, Verily I say unto you, Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me."

Health Care Glossary

2008-06-19T22:38:00.000-07:00

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Access to Health Care: An individual’s ability to obtain needed health care services when they need it.

Benefit Package: A defined set of services or benefits that an insurer provides to subscriber groups or individuals.

Capitation: Refers to the practice by managed care organizations to set a specific amount to be paid per member per month. Health care providers therefore know in advance how much money they can collect from their ‘capitated’ population, regardless of what services are actually performed.

Consumer-Driven Plans: Health plans that provide employees with funds that the employee, rather than the employer, uses to purchase health care services or insurance. The idea is to allow employees to make their own cost-benefit decisions, selecting those providers, services, and insurers that provide the most value to them as consumers.

Co-payments: Health care related costs that a consumer pays out-of- pocket. These are in addition to what is paid by other parties. Co- payments are very common with prescription drugs, and in many plans also apply to office visits and other services.

Cost-sharing: A health insurance policy provision that requires the insured party to pay a portion of the costs of covered services. Deductibles, co- insurance, and co-payments are all examples of cost-sharing.

Cost-shifting: The process of passing the costs of health care from one group to another, most commonly seen in 1) employers expecting employees to pay a greater share of their employer-provided health care expenses; and 2) insurance premiums being raised to cover the cost of caring for the uninsured.

Deductibles: Similar to car insurance, deductibles are health care related costs (either annually, over a lifetime, or case-specific) that an individual must pay out-of-pocket before any additional costs will be picked up by the insurance company. For example, you might be required to pay any hospitalization costs up to $1,000. Usually, higher deductibles result in lower annual premiums.

Defensive Medicine: Describes physicians’ practice of providing more diagnostic and therapeutic services as a means of reducing their risk of liability for negligence in medical injury malpractice suits.

Defined Contribution: A pre-set dollar amount representing the maximum employer contribution to health care benefits for a given period of time.

Employer contribution: The money that an employer pays for its employees’ health plan. Employer contributions vary widely and can be based on percentage of cost, length of employment, family circumstances, or a flat fee.

Employer Mandate: A plan which requires that employers pay all or part of their employees’ health insurance premiums, or pay into a fund that provides the required insurance.

Health Maintenance Organization (HMO): A managed care business that organizes health care services for its members, either on a for-profit or a not-for-profit basis. They are responsible for the financing and delivery of a comprehensive set of benefits for their enrolled members.

Individual Mandate: A plan that requires that individuals purchase their own health insurance, just as they do car insurance.

Managed Care: Managed care is a term that describes systems where the health plan attempts to control or coordinate services delivered and used by its members. The purpose of these arrangements can be to save costs, improve quality, or both.

Medicaid: a federal and state health insurance program for qualifying persons with low income. It also provides coverage for acute and long term care.

Medicaid (Federal) Waivers: The Department of Health and Human Services (DHHS) can waive certain requirements of federal law and regulation in order to encourage innovation and provide states with greater flexibility in their Medicaid and State Children’s Health Insurance Programs (SCHIP). These waivers can enable states to better tailor their programs to meet local needs, and they allow states to experiment with new approaches of providing health care services to Medicaid and SCHIP recipients.

Medical Savings Accounts: Savings accounts through which individuals assume their own risk for minor and major medical needs.

Medicare: A national universal health insurance program for people aged 65 and older and for people with disabilities. It is funded by payroll taxes and modest premiums paid by beneficiaries.

Means Test: The criteria by which an individual’s or family’s income and assets are evaluated for eligibility in a public program, such as Medicaid.

Pay or Play: A system that would guarantee health insurance for everyone by requiring employers to either play by providing insurance to employees or pay into a fund to cover the costs of the uninsured and unemployed people.

Preferred Provider Organization (PPO): A managed care plan that contracts with networks or panels of providers to provide services and to be paid on a negotiated fee schedule. Enrollees are offered a financial incentive to use providers on a preferred list, but may use non-network providers as well.

Purchasing Pool: Grouping together many small business employers, their employees, and dependents into a larger pool to offer choice of benefits and stability of rates similar to large employers.

Risk Pooling/Sharing: The idea that the greater the number of people who are insured, the more you accurately can predict claims against the pool. That is, larger groups of people allow insurers to use anticipated savings from healthier persons to balance the risks of losses in covering unhealthier persons.

Safety Net: Services and programs, government-sponsored and private, that provide health care regardless of insurance status or ability to pay. This generally includes Medicaid, community health centers, public hospitals, and hospital emergency rooms.

Single Payer Systems/Programs: A financing mechanism for health care delivery in which payers (individuals, employees) contribute to a single fund that reimburses providers of health services. The VA and Medicare are often referred to as examples of single payer within the U.S.: many consumers, many providers, and a single entity (the federal government) paying for all covered services.

Universal Coverage: Basic health insurance coverage for an entire population which is financed through taxes – either from individuals, employers, or both.

Universal Health Care: A health system designed to guarantee that everyone has access to quality health care that is comprehensive and affordable.
______________________

The Archimedes Movement | www.WeCanDoBetter.org
1 SW Columbia, Suite 860 | Portland, Oregon 97258 | 503-709-8574

The Archimedes Movement was established at The Foundation for Medical Excellence in January 2006 under the leadership and direction of former Oregon Governor John Kitzhaber, MD.

Contact and Interest Form

2008-06-19T22:36:00.000-07:00

The Moral Imperative of Health Care Reform Contact and Interest Form

Name ________________________________

Email Address __________________________

Address ______________________________

Phone Number _________________________

Organization (if any) ____________________________________

Do you know someone who might be interested in being contacted about this project?

______________________________________________________________________________

If you are interested in furthering in the work of the health care reform project please indicate the ways in which you may be able to help.

_____ I would like to participate in an email news group dedicated to exchanging information, announcements, articles and opinions on the subject of health care reform.

_____ I would like to participate in another study circle.

_____ I am interested in organizing or leading a new study circle and need materials.

_____ I would like to attend a community forum on health care reform.

_____ I would like to help in planning and organizing a community forum on health care.

We are collecting names of people who would be interested in offering their time, knowledge or expertise in the following areas:

_____ Graphic design

_____ Web development

_____ Public relations, promotions

_____ Production coordination

_____ Organizational development

_____ Writing, i.e. letters to editor, legislators

_____ Fund-raising, grant writing

_____ Public speaking

_____ Networking with other organizations

Study Circle Six: Making a Difference

2008-06-19T22:32:00.001-07:00

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From Access through Action Dialogues, Human Services Coalition of Dade County, Inc.

Approach #1: Become an Informed Consumer.
Investigate the health care options available to you and other members of your community. Research the health care provider or facility you currently use. They may provide services that you need but are not aware of.

Approach #2: Focus on local government.
The local government is responsible for making sure enough funding goes into community health care facilities, programs and initiatives. Stay informed of local health care policies, and monitor how your local government is spending your tax dollars to enhance the quality health care in your community.

Approach #3: Join forces with local organizations.
Get involved with organizations raising awareness around local health care issues. Attend community events, participate in campaigns or become a member.

Approach #4: Establish relationships with key, influential people.
Identify the leaders making or influencing critical decisions on health care in your community. This may be an elected official or the head of leading organization. Express your interest in their work; praise them for the positive impact they have made in the community; request meetings with them to discuss your thoughts on health care issues and inquire how you can assist them in their efforts.

Approach #5: Become part of a broader advocacy movement.
Access barriers to health care are not unique solely to your community; people are struggling with similar problems across the country. Educate yourself on national health care issues. Compare what is going in your local community to what is going on in other people's communities, and research what other concerned people are doing to impact change nationally. Some actions people may be taking to influence national health care issues are making phone calls and writing letters to Congress, signing petitions, meeting face-to-face with members of Congress or protesting.

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Study Circle Six: The Six Principles of a Healthy Democracy

2008-06-19T22:28:00.000-07:00

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Developed by America Speaks*

• Democracy occurs in communities.
While the citizen is the fundamental unit of a democracy and the family is the core of our society, democracy exists and thrives only within the interactions among citizens. While individual expression is essential, democracy is not really about solitary processes such a voting. Citizens in dialogue, articulating the values they share and understanding their differences, reaching conclusions which are acted upon––that is the core democratic image we must nurture.

• Shared responsibilities.
Each community member must recognize the part he or she plays in the health of the community’s democratic condition. Rather than becoming involved to fight a “not in my backyard” issue, participation can be motivated by an understanding that we sink or swim together. This awareness that our society is the sum of each of our actions moves the community beyond factional interest politics.

• Public trust.
The only way a healthy democracy can be sustained is through public trust. Trust depends upon inclusive processes overseen by leaders acting as stewards, who articulate and deliberate citizen concerns and brings all views to the table. It is such processes––managed by leaders serving as stewards, not as career politicians––that evoke the public’s trust and are the foundation of the true authority of leaders in a democratic polity.

• Healthy struggle.
We believe that creative tensions are embedded in society’s most contentious issues. These tensions are the heart of democratic struggle and are the wellspring of a vibrant, vigorous society; they must be worked out in public, in direct processes that engage citizens and leaders in open dialogs.

• “Both––And” Relationships.
The capacity to find common ground amongst, and incorporation of, diverse solution must be restored sanctioned and preserved. The processes that yield to accommodation and integration must be strengthened and pushed to meet the healthy challenges of diversity in America.

• Thoughtful deliberation.
Supporting the five foregoing principles is the capacity for thoughtful deliberation. The necessary skills include listening, inclusion, mediation, dialog, reflection and closure, each of which is recognized as a fundamental tool for strong and effective governance.

Conclusion

Citizens feel less connected to their leaders and institutions than ever before. Across the nation and at all levels of society, the public is losing interest in American governance. Citizens lack and authoritative voice in too many communities, have a deepening sense of insecurity in the face of the monumental changes afoot, and have disengaged from the political process at all levels.

*America Speaks outline for democratic renewal is premised upon partnership. We intend to help create networks of shared responsibility and collaborative decision-making among elected official, business interests, non-profit leaders and citizens to strengthen the civic infrastructure of communities across America. We encourage leaders in government to begin the search for new processes and enduring structure that engage citizens in the healthy, rewarding exercise of self-governance.

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Study Circle Six: Creating Positive Conversations

2008-06-19T22:26:00.000-07:00

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Prepared by the Herdon Alliance

The Conversational Challenges:

1. People understand issues through the narratives and stories they understand.
2. If a concept comes to them that does not fit the narratives they have, they do not listen to or believe it. When beliefs and facts conflict, people disregard the facts.
3. How do we cast policies in narratives that connect to the majority of Washington citizens? And support the reform that we have stated?

Affordable Health Care is a Value:

1. Voters agree with the central principle that there should be access to quality affordable health care.
2. Health care has become a core value, not just a commodity. It is linked to the American dream, our families’ and country’s well being.
3. It is a moral obligation when focused on deserving recipients such as children and seniors.

America’s Future:

1. Voters are feeling that the needs of Americans are being neglected.
2. They are eager for a uniquely American solution, and believe American ingenuity would produce the best solution to the health care problem.
3. Voters want concrete solutions to problems and doable steps to move us forward.

Consumers and Government:

1. The role of government is not alternative to consumer frame. Rather it is a way of ensuring that individual choices are available, responsible behavior rewarded, and greed punished.
2. Government should work as a watchdog and enforcer of rules – not as the mass provider of health care.

Avoid Triggering Fears:

1. Our proposals are in trouble if they make people worry that they will lose what they currently have.
2. When people are fearful, they tend to become less open and less generous.
3. When fearful, they blame others: freeloaders, illegal immigrants, bad parents, welfare cheats, etc.

Prepared using data provided by the Herndon Alliance. The Herndon Alliance is a coalition of 120 state, national, faith, labor and provider groups that agree on changing the conversation so that we can connect with the majority of Americans and achieve affordable health care for all Americans.

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Study Circle Six: Health Care Perspectives in Brief

2008-06-19T22:20:00.000-07:00

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Perspective 1
Competition Makes the System More Efficient

The main problem with the health care system is that costs keep going up. All the other problems in the health care system stem from this and won't be solved until we give everyone real choices and the ability to take responsibility for what they spend on care. That means reducing regulation and using free market competition to allow insurers to offer a wider range of plans. We should also embrace managed care, which watches expenses carefully and has already slowed down the increase in health care costs. By moving further in the direction of managed care, and adopting medical savings accounts, which encourage individuals to save and shop around for health care, we’ll be able to bring down costs and cover more people.

Perspective 2
Expand the Current System to Cover More People

We don’t need to rip up the existing health care system and start over. We already have the best high-tech medical centers in the world and insurance programs in place that cover 85 percent of Americans. We can just extend those proven programs, public and private, to cover more people. We can also give employers financial incentives to cover more of their employees. The federal government already has effective health programs for the elderly (Medicare), the poor (Medicaid), low-income children (CHIP) and its own employees. If we expand the eligibility for those plans, we’ll be able to cover more uninsured people with the least disruption to those who already have insurance. Gradually expanding the current system is the most practical way to cover more people without breaking the budget.

Perspective 3
Create a National Health Care System

Decent health care ought to be a basic right, not something that depends on the job you hold. Our patchwork health care system of private insurance and government programs simply isn’t working. It’s time to try what Canada and most European countries already have: a national, government- run health care system. The system would work much like Medicare, except that everyone would be entitled to coverage, regardless of age, income or job status. Like Medicare, you’d still pick your own doctor, but the government would get the bill. We’ve debated what to do about health care for years, but nothing else has solved the problem. This is the only way to solve the problem of the uninsured, once and for all.

Source: Public Agenda, New York, NY

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Study Circle Six: (Graphic) The Overton Window

2008-06-19T22:16:00.000-07:00

Understanding Social and Political Change

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The image below is a graphic representation of a political spectrum. There is, or there should be, a constant tug-of-war on the edges of the Overton Window on any issue. However . . .

- Relative to the rest of the developed world, the Overton Window in our country has been moving to the Right for several decades.

- What used to be considered “moderate” or “mainstream” in our country several decades ago is now viewed as Left Wing.

- By what mechanism(s) did the Overton Window move toward the Right?

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Study Circle Six: The Overton Window of Political Possibilities

2008-06-19T22:10:00.000-07:00

-- By Nathan J. Russell

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(Note: The late, esteemed Joseph P. Overton exerted enormous influence from 1992 to 2003 as a researcher, author and the Mackinac Center for Public Policy’s senior vice president. Key his name into this Web site’s search engine and you’ll see nearly endless references to his work. He was killed in a plane crash on June 30, 2003 but continues to be a source of inspiration to the many around the world who knew him. He would be 46 years of age today — Jan. 4, 2006. On this day we are pleased to publish this essay by Nathan Russell as a further tribute to Joe and his legacy. — Lawrence W. Reed, President)

What does a think tank do? Does it educate? Advocate policy? Should a think tank focus on short-term or long-term goals?

Among Joe Overton’s many contributions, he was instrumental in defining the role of the Mackinac Center in particular and think tanks in general. He understood that, regardless of how persuasive the think tank, lawmakers are constrained by the political climate. Therefore, Overton concluded, to be truly successful, the Mackinac Center should not focus on direct policy advocacy, but instead should focus on educating lawmakers and the public in an attempt to change the political climate.

To answer the inevitable questions about the role of a think tank, Overton developed an explanation that others have since dubbed the "Overton Window of Political Possibilities." Though his theory has roots in complex public choice economics, it boils down quite easily.[1]

Imagine, if you will, a yardstick standing on end. On either end are the extreme policy actions for any political issue. Between the ends lie all gradations of policy from one extreme to the other. The yardstick represents the full political spectrum for a particular issue. The essence of the Overton window is that only a portion of this policy spectrum is within the realm of the politically possible at any time. Regardless of how vigorously a think tank or other group may campaign, only policy initiatives within this window of the politically possible will meet with success. Why is this?

Politicians are constrained by ideas, even if they have no interest in them personally. What they can accomplish, the legislation they can sponsor and support while still achieving political success (i.e. winning reelection or leaving the party strong for their successor), is framed by the set of ideas held by their constituents — the way people think. Politicians have the flexibility to make up their own minds, but negative consequences await the elected officeholder who strays too far. A politician’s success or failure stems from how well they understand and amplify the ideas and ideals held by those who elected them.

In addition to being dependent on the ideas that form the boundaries of the political climate, politicians are also known to be self-interested and desirous of obtaining the best political result for themselves.[2] Therefore, they will almost always constrain themselves to taking actions within the "window" of ideas approved of by the electorate.

Actions outside of this window, while theoretically possible, and maybe more optimal in terms of sound policy, are politically unsuccessful. Even if a few legislators were willing to stick out their necks for an action outside the window, most would not risk the disfavor of their constituents. They may seek the good of those who elected them, and even the good of the state or nation as a whole, but in pursuing the course they think is best, most will certainly take into account their political future. This is the heart of the Overton window theory.

So, if a think tank’s research and the principles of sound policy suggest a particular idea that lies outside the Overton window, what is to be done? Shift the window. Since commonly held ideas, attitudes and presumptions frame what is politically possible and create the "window," a change in the opinions held by politicians and the people in general will shift it. Move the window of what is politically possible and those policies previously impractical can become the next great popular and legislative rage.

Likewise, policies that were once acceptable become politically infeasible as the window shifts away from them. Think tanks can shape public opinion and shift the Overton window by educating legislators and the public about sound policy, by creating a vision for how things could be done, by conducting research and presenting facts, and by involving people in the exchange of ideas.

The example Joe Overton often used to illustrate his window theory was the Michigan school choice issue during the 1980s and ‘90s. The political spectrum for education ranges from full parental choice on the high end to a complete government monopoly without private schools, home schooling, charter schools or any other school choice on the low end. On this spectrum the politically possible range of options was very limited during the 1980s. Politicians could advocate minor, incremental changes for home schooling, and private schools were part of the status quo, but charter schools were definitely out of bounds for a politician to seriously contemplate.

As citizens became aware of education options and their success in other places, the political climate became more favorable and the window of political possibilities in Michigan began to expand to where politicians could advocate home schooling, school choice and even charter schools without losing at the polls. Not only was the upper limit of the window expanded, but the lower boundary has also moved upwards as well — making it politically unwise to push for restrictions on the education freedoms that have been gained.

Home schooling is here to stay, charter schools are well established, and school choice continues to gain ground. In fact, in some parts of Michigan it is now even possible to run for office on a platform that includes the Universal Tuition Tax Credit — another Overton innovation — a situation that was unthinkable just 10 years ago.

Perhaps the Overton window theory is best summed up by a quote from Milton Friedman in his preface to the 1982 edition of Capitalism and Freedom: "That, I believe, is our basic function: to develop alternatives to existing policies, to keep them alive and available until the politically impossible becomes politically inevitable."

A long-term focus on shifting the Overton window allows a think tank to follow its ideals and perform a genuinely positive public service, instead of being constrained to merely advocating those policies that are currently possible. When the window of political possibilities is moved along the political spectrum, the impossible becomes desirable and the simply desirable becomes imperative. This is the true influence of a think tank — shaping the political climate of future legislative and legal debates by researching, educating, involving and inspiring.

#####

Nathan J. Russell, a 2004 graduate of Hillsdale College, is a graduate student in the Ph.D. program in Economics at George Mason University in Fairfax, Virginia. In 2004 and 2005, Russell served as a summer intern at the Mackinac Center for Public Policy, a research and educational institute headquartered in Midland, Mich. Permission to reprint in whole or in part is hereby granted, provided that the author and the Center are properly cited.

[1] For a more thorough economic or historical treatment, please see Gordon Tullock’s Politics of Persuasion (1967).

[2] Basic public choice theory, developed by James Buchanan and Gordon Tullock in their 1962 book, The Calculus of Consent, explores the consequences of realizing that politicians are just like us — and therefore are subject to the same motives, weaknesses, desires, and self-interests.

Copyright © 2006 Mackinac Center for Public Policy

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Study Circle Six: Preparatory Materials

2008-06-19T22:07:00.000-07:00

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Reading Materials:

An Introduction to the Overton Window of Political Possibilities

Graphic: The Overton Window

Perspectives in Brief

Creating Positive Conversations

The Six Principles of a Healthy Democracy

Making a Difference

Form: Top FIVE Goals and Solutions for the U.S. Health Care System
Download as emailable text file

Thought Questions:

Are there inherent contradictions between our democracy, economic interests, and moral values? Or, can they be mutually supportive or enhancing?
Is our nation's political "window" large enough to contain a health care design that is affordable, accessible and just?
Every poll of voters indicates a strong desire for reform. How does the current power structure block reform?
Who are the players? Legislators, lobbyists, think tanks, research institutes, media corporations, etc.
Who are the change agents in our society? What roles do they play?
Who defines the issues?
As "citizen think tanks" how can we become change agents?
What role can I play?

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Study Circle Six: Top FIVE Goals and Solutions for the U.S. Health Care System

2008-06-19T22:00:00.001-07:00

This form is designed to support several goals of our health care study circle project:

(1) collect the thoughts of our group about the top five goals and solutions that we have identified for our current health care system;
(2) provide a mechanism to combine the result of the efforts of many health care study circles; and,
(3) communicate our priorities to legislators and the policy makers who are involved in efforts to reform our system.

1. ________________________ 1. ________________________
2. ________________________ 2. ________________________
3. ________________________ 3. ________________________
4. ________________________ 4. ________________________
5. ________________________ 5. ________________________

We are planning a community-wide Health Care Forum with our legislators and others to share the results of our various “Citizen Think Tanks.”

Using one form per study circle complete this form at the end of Study Circle Six and mail it with the three forms listed below to:

Health Care Study Circle Results
Attn: Karen Scarvie
8120 Grand Ave. NE
Bainbridge Island, WA 98110

• Top FIVE Problems (from Study Circle Two)
• Top FIVE Priorities (identified in Study Circle Four)
• Top FIVE Goals and Solutions (addressed in Study Circle Six)
• Contact & Interest Form for your group members for future collaboration and announcements (to be filled out at the close of Study Circle Six)

NOTE: Should your group have difficulty reaching consensus, a Minority Report may be added to the back of these two forms.

Study Circle Six Main Page

2008-06-19T21:50:00.000-07:00

I. Welcome

Coming together and settling in with a brief reading or contemplative activity.

Understanding Change

•

Making It Happen

II. Overview

Social and political change occurs only within the “window” of ideas and attitudes that are acceptable to most people in a given population.

Pressure to change our health care system is growing. How might we, as citizens, influence the shape of this change?

III. Group Discussion on Readings

After reading about the Overton Window can you think of any examples of this phenomenon?
How does this “window” relate to the health care debate in this country?
Who are the change agents in our society? What roles do they play?
Who defines the issues?
Where and how do morality, democracy and economics intersect”?
As “citizen think tanks” how can we become change agents?
Is our nation’s political “window” large enough to contain a health care design that is affordable, accessible and just?

IV. Group Exercise – Goals and Solutions

Review the results of the forms from Study Circles Two and Four. Use poster papers to list them for everyone to see.

Are there any changes you want to make at this time? If so, make them.
Now, as a group, try to reach consensus on your Top FIVE Goals and Solutions Form.
1. Use a third sheet of poster paper to collect the group’s suggestions.
2. As a group, select the top five from this larger list and list them on the fourth sheet. (The facilitator provides a method to tally the responses. Show of hands? Secret ballot? Dots?)

The group organizer should fill out this final form and send it with the forms from Study Circles Two and Four to the indicated address.

V. Being an Engaged Advocate for a Reformed Health Care System

I Count
•
I Care
•
I Can

How can you help to empower other to become more engaged?
What role do you see yourself playing in the health care reform movement?
What skills, talents, and interests can you lend to growing our study circle project?

Please complete the Contact Form provided and turn it in to the group’s organizer for mailing.

VI. Closing Activities

Reflections on our group experience. Go around the circle and briefly describe your experiences as a participant. On a scale of 1-10 how has the experience change the way you look at health care in this country?
Thank yourselves and one another for making time in your lives to involve yourselves in active citizenship.

Study Circle One: The History and Promise of This Work

2008-06-19T21:39:00.000-07:00

This project began when a small group of citizens and members of Cedars Unitarian Universalist Church on Bainbridge Island, Washington, came together to talk about health care in the U.S. After our initial meeting we wanted to know and do more than just talk, so we developed this learning and discussion series.

Our six-session Study Circle Program combines:

Reading articles in order to educate ourselves on the issues and to facilitate discussions
Sharing our stories and hearing about others—illuminating the state of healthcare today
Individual and group activities to make real the problems as well as the solutions.

We include a variety of perspectives with the aim of not only informing and empowering participants, but to create what we call a “citizen think tank” in order to influence healthcare policy at the local, state, and federal levels.

We do not know how many people this project will touch or how far it will travel—the classic “message in a bottle.” We do know, however, that the time for health care reform is long overdue and urge you to join with us in this important civic, social, and yes, morally imperative movement.
Becoming an informed citizen is not the only goal.

We urge you to commit to creating—with us—an ever-widening circle of citizens to bring about change. Every member of your “think tank” can start another Circle, write a letter to the editor, or create an event in your own community.

Here on Bainbridge Island, our goal is to hold a community forum, open to the public, but also to create a way for Study Circle “graduates” to come together, share their experiences, and keep the movement for reform going forward. We will invite legislators, policy makers, and representatives from all walks of life to hear directly from informed, committed citizens.

Along the way, you will meet many people who doubt that ordinary people can bring about change. Yet, many of the rights and programs that we take for granted today came about through the initiative of citizens just like us. We sincerely hope that this project—to break through confusion and create engaged citizenship—will be as meaningful for you as it has been for us.

Wishing you well in your effort making “Everyone’s Health Count”

-- Barbara Clarke, Karen Scarvie, and Joanna Garritano, MD - Curriculum Committee

Study Circle One: What Are Study Circles?

2008-06-19T21:36:00.000-07:00

A Brief Description

Study Circles are groups of 6-12 people who self-organize and generally meet regularly over a defined period to explore an important social issue. Each meeting commonly lasts two hours and is facilitated by a group member whose role is to ensure a focused and productive dialog. Groups may choose to have different members serve as facilitators for each session. Because Study Circles are small, democratic and comprised of non-experts they can employed by different organizations (civic organizations, church groups, etc.) or ad hoc groups and can be adapted to many different uses.

Prior to each session members prepare by reading resource materials that provide a background for the issue being studied. Generally speaking, the materials have been compiled and organized by the sponsor of the particular study circle. They are chosen to encourage dialog as members explore the issue. Some groups choose to create their own materials.

Study Circles provide valuable opportunities for members to develop and express their own ideas within a supportive context. Members experience a growing sense of empowerment as they accumulate new information and explore new ideas about complex issues. The experiences in Study Circles and the knowledge and understandings gained by members often lead them to become more involved in civic action.

A Brief History

The idea of Study Circles originated in the US in the late 19th century and peaked in the early 20th century when over 700,000 citizens participated in thousands of Study Circles throughout the country.

In time the Study Circle concept was adopted by Sweden as a way of promoting a strong and informed citizen base for their democracy. The Swedish government helps to fund, but not control, these Study Circles. At any given time during the year 30% of the adult population is engaged in over 300,000 Study Circles. Swedish towns promote Study Circles for their citizens to study pressing civic and economic issues.

Study Circles in Our Country

For information about Study Circles in this country visit the web site of Everyday Democracy: http://www.everyday-democracy.org//en/Article.678.aspx where you will be able to find many ideas and tools to help you create your own Study Circles, or where you can find up-to-date Study Circle Guides on many of the social, economic and political issues that we face today.

- Karen Scarvie, Adult Programs Committee, Cedars Unitarian Universalist Church

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Study Circle Five: Most Docs Favor National Health Insurance

2008-06-19T20:58:00.000-07:00

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A recent survey shows 59% of U.S. physicians support
national universal health insurance,
up from 49% just five years ago.

By Catherine Arnst

Most U.S. doctors now support the idea of national health insurance, a shift from a half-decade ago, when less than half favored a national system, a new survey has found. According to a study published in the Mar. 31 issue of the Annals of Internal Medicine, 59% of the nation's physicians support federal legislation to establish national health insurance, often referred to as a single-payer system.

These plans usually involve a single, federally administered fund that guarantees health-care coverage for everyone, much like Medicare currently does for seniors, and eliminates or substantially lessens the role of private insurers. In a similar survey five years ago, only 49% favored it. Thirty-two percent of doctors oppose universal coverage, down eight points from the previous survey, while 9% are neutral.

As the 2008 election draws near, the country's health-care system is once again top of mind for voters. The leading candidates have drawn up plans for addressing what they consider flaws in a system that has left 47 million people uninsured—although none is calling for a single-payer system (BusinessWeek.com, 9/17/07). Senator Hillary Clinton (D-N.Y.) proposes a mandate requiring everyone to purchase health insurance, with subsidies and affordable federal insurance available, while Senator Barack Obama (D-Ill.) stops short of mandates but does support affordable federal insurance. Obama leads Clinton in winning delegates who have pledged to back his bid for the Democratic nomination. The presumptive Republican nominee, Arizona Senator John McCain, backs tax credits for the purchase of health insurance, similar to what the American Medical Assn. (AMA) proposes.

The findings signal a sea change in the attitude of the medical establishment toward universal care. Throughout the 20th century, U.S. doctors have been among the fiercest and most influential opponents of national insurance, citing concerns of a meddlesome bureaucracy, a loss of independence, and lower reimbursements. Lobbying by the AMA and other professional groups scuttled efforts to introduce universal coverage by several Presidents, starting with Calvin Coolidge and continuing through Franklin Roosevelt, Harry Truman, Jimmy Carter, and Bill Clinton. Back in 1948, after Truman was elected in part on a platform of compulsory health insurance, the AMA urged its members to "resist the enslavement of the medical profession." That attitude held constant for decades.

CURRENT SYSTEM HAMPERS GOOD CARE

But with so many Americans uninsured, doctors are finding that the lack of universal coverage is making it more and more difficult for them to do their jobs. "Across the board, physicians feel that our fragmented and for-profit insurance system is obstructing good patient care, and a majority now support national insurance as the remedy," says Dr. Ronald Ackerman, associate director for the Center for Health Policy-Professionalism Research at Indiana University School of Medicine and a co-author of the study.

Ackerman and his team surveyed 2,193 doctors across the country in 2007 as part of the largest survey yet of physicians on the issue of health-care financing. The researchers found that support for national health insurance exceeded 50% for every medical specialty, except surgical subspecialties, anesthesiologists, and radiologists. Even in those groups, support levels increased from 2002. The researchers also asked doctors if they would support incremental reform, such as tax incentives to buy insurance, or state mandates that all employers offer insurance coverage. They reported that 55% would support incremental reform failing a national solution, but only 14% favored incremental reform instead of national health insurance.

Professional medical associations are also beginning to change their stance on national health insurance. In December, the American College of Physicians, with 124,000 members, endorsed a single-payer national insurance program for the first time. The AMA, with 250,000 members, has not gone that far, instead calling for tax credits and financial assistance so that individuals can purchase health insurance. The group does say, however, that coverage for the uninsured is one of its top priorities. And now, the new survey suggests AMA constituents view national health care as a way to address the insurance shortfall.

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Study Circle Five: What Do Voters Want?

2008-06-19T17:38:00.001-07:00

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Findings from the Herndon Alliance
http://www.herndonalliance.org

1) 96% of voters in the 2006 election had health insurance. These voters will first examine any changes to the health care system through their own prism of effects on their cost, control, choice and quality of health care.

2) Voters have significant barriers (fears) to embracing change that must be addressed:

a. Fear of loss – fear of change and potential for loss of current health coverage
b. Taxes – concerns over equity and whether all are paying a fair share
c. Immigration – concerns about providing and paying for health coverage for the “undeserving”
d. Role of Government – erosion of confidence in government programs

3) American Solution – Voters want a uniquely American Solution – they have a strong belief in America and American ingenuity.

4) Control and Choice – Voters want control and choice in their health care system.

5) Government as guarantor, enforcer and watchdog – Voters are comfortable with these roles for government in guaranteeing and regulating their health care system. They are apprehensive about “big government” administering their health care.

6) Fairness and Progressivity - Voters are very concerned about “fairness” in any health care system and want to know that everyone is paying their fair share. They will support a progressive system to finance health care. For example 69% of voters believe corporations are paying too little in overall taxes today and 63 % believe upper income people are paying too little.

7) Personal Responsibility – Voters want to hear a central role for ‘personal responsibility’ in the health care system. One measure of this is that everyone pays their fair share. Another example of this is everyone having access to preventative care and responsibly using it.

The Herndon Alliance is a coalition of 60 national and state groups advocating guaranteed affordable health care for all Americans. Herndon has focused on research and analysis of voter values and beliefs to define the framework of a new health care system Americans could embrace and support.

http://www.herndonalliance.org

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Study Circle Five: How We Talk about Health Care

2008-06-19T17:35:00.000-07:00

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From the Herndon Alliance
http://www.herndonalliance.org

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Study Circle Five:The Logic of the Health Care Debate

2008-06-19T17:27:00.000-07:00

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From: Rockridge Institute, October 2007
http://www.rockridgeinstitute.org

Introduction

Most health care reports advocate a policy, describe it, and argue for it. We take a different approach. In this paper, we describe the logic of the overall debate over the U.S. health care system —the assumptions, the arguments, who makes them, and why. We do come out of this process with recommendations, but not of the usual sort.

This analysis presents something new and important: a distinction among three modes of thought — progressive, conservative, and neoliberal.

A Bit of History

There is a historical reason why health care in the U.S. has not been considered a matter of protection, like military and police protection. When America was founded, the implicit social contract was to surrender some freedoms so that government could protect people from other people, not from ill-health, disability and disease. Because medicine was not all that advanced until the 1920s, inequities of health were primarily a matter of inequities of wealth. Wealthy people lived longer because of better nutrition, less stressful lives, better sanitation, and so on. But before there were antibiotics or dialysis machines, there was no issue as to who would get or use them. As of the 1920s, expensive advances in medical technology began to give ever greater advantages to those who could afford to take advantage of them.1

The creation of the health insurance industry between 1929 and the late 1940s, it was hoped, would close this gap. The idea was to spread the risk, and with it, the costs of expensive care. What did happen, however, is that a new gap developed. And not accidentally or inadvertently.

A Basic Fact

Our health insurance system only works so long as insurance companies profit. And they have. In 2006, according to Consumer Reports, the six largest health insurers collectively posted almost $11 billion in profits.1 Similarly, when insurance companies won't make money, they don't offer insurance policies. No insurance policies, no health insurance system.

American insurance companies make money by providing as little treatment to as few individuals as possible and by offering coverage to as few sick people as possible, while collecting premiums from as many healthy people as possible. That's why people with pre-existing conditions have so much trouble finding insurance — it costs too much to care for them. That's why the insurance companies require pre-approval of treatments and why they may authorize less expensive, rather than more effective, means of medical care. That's also why insurance companies benefit from high co-pay policies: they push patients toward avoiding costly visits to the doctor.2 This is how our health system works to guarantee profits to insurance companies.

The basic fact is this: the sicker you are, the more you cost and the less the company makes by covering you. This is the opposite of the way markets normally work; namely, the more product a company delivers, the greater its profits. But in the health care industry, it is the opposite: the less care an insurance company authorizes, the greater the profit. As long as insurance companies are responsible for authorizing health care, this will be true.

With the present profit imperative of our health care system, we have created a national Sophie's Choice: millions of people must be denied care so that healthier or wealthier people can get it.3

Your Interests? Or Theirs?

Health insurance is not the same as health care. The amount of care you receive is related to how much you can pay. Some expensive insurance plans offer extensive care. Other, less expensive plans, do not.

Currently, 70 million Americans are under-insured — they have health insurance that, as Consumer Reports says, "barely covers their medical needs and leaves them unprepared to pay for major medical expenses."1 Increasing the number of Americans who have health insurance of some kind does not necessarily increase the number of Americans who have sufficient care to keep them healthy.

In a number of respects, this disparity between health insurance and health care comes from the fact that everyone gets sick, will age, and die. At some point in their life, every insured person will cost an insurance company money. Insurance companies can't make much profit on human health care, unless they exclude or limit people from coverage and benefits. Otherwise, premiums aren't profit centers, they are just pre-payments for health care we know we'll need in the future.

To increase profits, insurance policies with benefit limits are commonplace, and no benefits are paid if those limits are exceeded, regardless of needs. You get a debilitating illness, such as cancer, and you receive a maximum payment from the insurance company that is a fraction of the total medical costs. It's as if you were a car and had reached your Blue Book value; you're declared totaled. From there, you pay the full cost of continued treatment, which can be hundreds of thousands of dollars.2 For people with health insurance, this is one of the main causes of bankruptcy: people have to use up their savings and sell their homes in order to pay uncovered medical costs.3

The Conservative Mode of Thought

In the conservative mode of thought, securing health insurance is a matter of individual responsibility. In this view, health care is a commodity that should be bought and sold through insurance policies in the market. If someone wants a commodity, they should work hard to afford it. In a free market economy — given that America is a land of opportunity — they will be able to do so. Anyone without health insurance for himself or his family just isn't working hard enough and doesn't deserve it. It's just like plasma TVs; if you want one, work hard to afford one. Otherwise, you won't get it, because you haven't worked hard enough, and you don't deserve it.1

From the principle of individual responsibility, it follows that employers should never be forced to provide health insurance for their employees. They might choose freely to do so in order to attract talent, but that should be their free choice.

Within the conservative mode of thought, the market is both natural and moral. Natural in that people instinctively seek their own profit and moral in that those who are most disciplined will be most likely to prosper. Market outcomes are therefore always moral and most practical, since the market optimizes the fair and efficient distribution of goods and services. Government interference compromises both the efficiency and morality of market processes.

In conservative thought, health insurance should be a money-making business; it will be most fair and efficient that way. Conservative thought also supports private medical accounts on two similar grounds. First, they are moral because they make the individual responsible. Second, they are practical in that the money can be invested in the market, thereby creating more profits for more people.

What about the denial of care or coverage? In conservative thought this is inevitable and necessary. Your lack of coverage is your own fault. You have not been self-disciplined. You have failed in your individual responsibility to earn it. It's not the fault of the market or insurance companies. Insurance companies provide a service at a profit, and when they cannot provide that service at a profit, they should not do so. Moreover, those who are uncovered have an incentive to work harder and earn coverage. People do not have the moral right to have someone else pay for their health care coverage; indeed it would be immoral to do so, since that promotes dependency.

Promoting dependency — whether by patients, doctors, or plan administrators — is the root of the conservative fear of health care for all Americans. Conservatives label this as "socialized medicine" or "government health care,"2 and they argue that health care for all Americans will undermine our self-discipline and make us weak. This is, above all, a moral issue for conservatives, which is why economic efficiency arguments alone will not carry the day with them.

For example, we already know that U.S. Medicare and Canada's single-payer health care system are more efficiently managed than U.S. private, profit-maximizing insurance companies.3 There is also compelling evidence that savings on the profit and administrative costs of the current private insurance companies could pay for health care for all Americans, if it were run as a single payer system.4 From the conservative perspective, these plans are still viewed from top to bottom as unearned entitlements — automatic care for patients, guaranteed income for doctors, and lifetime jobs for government administrators — and so promote dependency and are immoral.

Finally, once health care is understood as a commodity, then the logic of the market sets the value of human life and limb. Therefore, there should be a limit — a cap — on the value that can be claimed in a lawsuit when medical error causes disability or death.

The Progressive Mode of Thought

The progressive mode of thought begins with progressive morality — the morality of empathy and responsibility, for oneself and others. Others, because life is interdependent; "no man is an island." Translated into policy, that moral view defines two roles for government: protection and empowerment. Protection includes not only military, police, and fire protection, but also disaster assistance, public health, food safety, social security, and so on. The empowerment function of government makes business possible. It also makes it possible for individuals to pursue fulfilling lives. Government empowerment includes the development and maintenance of public roads and bridges, the internet and satellite communications, public education, the banking system, the stock market, and the courts. No business can thrive without government contributions in these areas.1

Progressive views on health care flow from this understanding of the moral mission of government. Empathy requires taking the viewpoint of the person cared for, the health care recipient as well as their family and community. From a policy perspective, health care is a matter primarily of protection, but also of empowerment. Putting these together, we get progressive requirements for a health care system:

Everyone should have access to comprehensive, quality health care (follows from empathy)
No one should be denied care for the sake of private profit (follows from empathy and protection).
You can choose your own doctor (follows from empathy).
Promotion of health and well-being, focusing on preventive care (follows from individual responsibility).
Costs should be progressive, that is, readily affordable to everyone, with higher costs borne by those better able to pay (follows from empathy).
Access should be extremely easy, with no specific roadblocks (follows from responsibility).
Administration should be simple and cheap (follows from empathy and responsibility)
Interactions should be minimally bureaucratic and maximally human (follows from empathy and responsibility).
Payments should be adequate for doctors, nurses, and other health care workers. Conditions of their employment should be reasonable (follows from empathy)

When people are harmed by either the unsafe practices or negligence of health care providers, the redress should be left to the courts — with no arbitrary caps on compensatory payments (follows from protection).2

The Neoliberal Mode of Thought

The health care system of the next decades may be determined by a mode of thought that is neither purely progressive nor conservative, but neoliberal. What we term "neoliberal" thought shares progressive values and the ethic of care. At the same time, it has an Enlightenment-based faith in universal rationality as logical, unemotional, and serving human interests. To argue on the basis of care would be emotional and hence irrational and weak. To argue on the basis of interests is seen as rational and strong. The neoliberal strategy is to serve the ethics of care by serving the economic and other material interests of demographic groups.

In neoliberal thought there is the belief that markets can be effectively regulated to serve those interests, which leads to recommendations for technocratic changes to existing markets as one means to achieve progressive ends. Under the domestic version of neoliberal economics, many progressive moral goals can be achieved through private enterprise as an efficient means to moral ends. Though conservatism sees the market itself as defining moral ends, neoliberalism shares with conservatism the idea that the market can be efficient and serve moral ends. This is why neoliberal thought has no problem with health care solutions that involve profit-maximizing private insurance companies.

The neoliberal emphasis on "systems" often causes a loss of focus upon the progressive morality that lies beneath their political and policy solutions. Specific references to progressive values disappear from their messages. So do references to the government functions of protection and empowerment. Neoliberals may begin with the morality of empathy and responsibility for oneself and others, but their faith and focus soon shifts to the abstract, to complicated systems and intricate public/private solutions. Empathy, the moral force that holds together our democracy and the engine of community, is reduced to sentimentality and shunted aside.

Neoliberal thinking can lead to a dangerous trap. We call it the Surrender-in-Advance Trap. With an exaggerated emphasis on system-based solutions, neoliberal thought may lead one to surrender in advance the moral view that drives an initiative in the first place. Those who pragmatically focus on appeasing what they assume will be unavoidable political opposition to their proposals also run the risk of moral surrender.

For instance, assuming strong, possibly insurmountable, conservative resistance to government-based health care solutions, they will embrace profit-maximizing insurance solutions because they believe that 1) political opposition can be muted; and 2) the "free" market, properly regulated, can serve moral purposes, such as providing health care for all Americans. Proponents of these neoliberal solutions often overlook the fact that the very source of the health care crisis is the structure of insurance: the less care they authorize the more profit they make, and profits come first and are maximized.

But people using a neoliberal mode of thought do not view a market-driven, profit-maximizing approach as a surrender of any kind. They deeply believe that progressive moral principles can be served through neoliberal methods and forms of argument. We want to stress, however, that the consequence is dire whatever the motivation. The failure to articulate a clear progressive morality in favor of more technocratic solutions to profit-maximizing markets puts the progressive cause at a disadvantage on health care and other policy issues as well. It doesn't matter whether one is simply trying to avoid conservative and insurance company opposition or whether one truly believes in one's heart that the market will cure us.

The progressive moral basis for providing health care for all — empathy and responsibility, protection and empowerment — is not stated. As a result, Americans don't get to hear the progressive moral basis for extending health care to all Americans, and they don't get to decide whether they agree with that moral premise. Americans only hear the conservative moral view. That moves them in a conservative direction, not only on this issue, but on all issues.

There is an additional danger. As a strategy, surrender-in-advance puts advocates in the weak position of starting negotiations by going half way or more toward what the other sides want. No one would think of taking that approach when bargaining in the marketplace.

Analysis Of The Arguments

The conservative argument is straightforward, and it is based on the same ideas conservatives have been pounding into the public mind for three to four decades. Government is unreliable, inefficient, and raises your taxes. It can't solve the problem and it costs too much when it tries. It is also immoral because government handouts make people dependent and take away their incentive to work.

Private enterprise is both effective and moral, and strengthening markets generates wealth for the country as a whole. Therefore, there should be private health accounts with private insurance plans and no constraints on the authorization or provision of health care or prescription drugs. Further, there should be caps on lawsuits that might threaten the income of profit-maximizing health care authorizers.

The progressive argument is straightforward and based on progressive views of morality and government: the values of empathy and responsibility, and the view that health care is a matter of fundamental protection — like the army or the police. Therefore, everyone deserves health care, and it is the moral responsibility of our government to ensure that it is available to all of us, its citizens. Profit should never interfere with the delivery of health care. And since health insurance profits are based on the denial of care, health care should not be a matter of profit-maximizing insurance. This progressive worldview tilts progressives toward single-payer or medicare-for-all plans. The problem for progressives is they have not been getting their moral perspective or their view of health care as government protection out in public effectively — even though polls suggest that a majority of the public seems to already agree with their position. 1

The sticky part of the health care debate occurs when neoliberals accept certain modified versions of profit-maximizing insurance programs with technocratic fixes of the sort described above, and then fail to announce (and repeat) the progressive moral basis of their goals, even though they implicitly agree with them. In so doing, they avoid addressing the fundamental tension between the progressive view that government has a moral mission to provide for the security, including the health security, of all its people and our current profit-maximizing health care system which works only by denying care to over 100 million Americans. Instead, neoliberals focus on rational arguments: how their plans maximize material interests of the lower and middle classes. In the end, neoliberals and conservatives are roughly in the same framing ballpark — maximizing material interests of some group — with progressives left in the bleachers.

As a result, the American people will not be given any real choice between the progressive and conservative moral positions. We will never know if those polls were right, if Americans indeed prefer a progressive alternative. The surrender in advance by the neoliberals means that any "compromise" will start with a capitulation to fundamental conservative values, and will be tilted even more strongly in a conservative direction as negotiations proceed.

What We Can Do

The most important lesson for progressives is to keep their fundamental moral view front and center in their politics, in their policy deliberations, and in their hearts. Progressive morality is the morality of empathy and responsibility for oneself and others. These moral premises assign to government two roles: protection and empowerment. In the case at hand, we find that our moral foundations require us to recognize our responsibility to our own health and the health of others. Empathy allows us to recognize this responsibility to work together to protect our health and to act upon it. Democratic government is nothing more than an institution of our own making. It is under our control, an institution we charge with the mission of protection and empowerment. Health care security, from the progressive moral stance, becomes a key function of government.

The best way to proceed is to keep what we care the most about at the center of the discussion of health care security. What we care the most about is the actual health and well-being of flesh-and-blood people. Keeping this care in our hearts does not mean that temporary compromises will not be necessary. It means only that we don't begin with compromise.

Every part of our health care system should serve this purpose — health care security for all Americans — first. It comes before private corporate profits. It comes before the political fates of particular candidates or officeholders. Every plan we might concoct or discuss should be measured against this simple standard: does this improve the health care security of all our fellow citizens in concrete ways? Perhaps the most important word in that sentence is "all." System tinkering — eliminating pre-existing condition exclusions, adding mandatory coverage for this or that ailment, subsidizing (substandard) health care for the poor — will make a difference for many, but not for all. It will leave many more people with the kind of dissatisfaction that those with present health insurance have rightly been complaining about. Tinkering like that is more concerned with saving a system that has already failed than it is with the health of a society, indeed, with saving lives.

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Study Circle Five: Allocate The Federal Budget

2008-06-19T17:19:00.000-07:00

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Compliments of Ben and Jerry’s

Here’s your chance to allocate the discretionary budget. What are your priorities? How would the pie look if you could choose how to slice it?

Discretionary Spending refers to the portion (about one-third) of the federal budget managed through an annual appropriations process, where Congress not only gets to set spending levels for a wide variety of government programs and services, but gets to choose to increase or decrease funding for those programs at any time, too.

Priority Pie: Go to http://www.benjerry.com/americanpie/and follow the directions to create your own budget.

Study Circle Five: Preparatory Materials

2008-06-19T17:15:00.000-07:00

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Reading Materials:

• Priority Pie: Allocate the Federal Budget

• Paying More but Getting Less: Myths and the Global Case for US Health Care Reform, by Tom Daschle (Adobe PDF file)

• What Do Voters Want?

• The Logic of the Health Care Debate

• How We Talk about Health Care

• Most Docs Favor National Health Insurance

Preparation for Next Meeting -- Barriers to Reform

Preparatory Activity (Bring your results to the session):

1. On your computer go to http://www.benjerry.com/americanpie/allocate.cfm

2. Prepare and print out your own Federal Budget to share with the group. How does your budget compare with the real one?

3. If a computer is unavailable make your notes on the Budget Page of this section of the Guide.

Questions to Consider:

MYTHS and MESSAGES • FICTION and FACTS

• What in our cultural mythology limits our ability to find viable health care solutions? Has it changed over the years? If so, in what ways and to what effect?

• What characteristics of the American Character detract from or engage our problem-solving abilities in matters of health care?

• What role does language and framing play in maintaining our dysfunctional system? How might language and re-framing help steer us into a system that works?

• What new “frames” and language are developing around the health care reform movement that will help us as a people design a system that works for all?

Study Circle Five Main Page

Study Circle Five Main Page

2008-06-19T17:11:00.000-07:00

I. Welcome
Coming together and settling in with a brief reading or contemplative activity

Barriers to Reform

•

Reasons for Hope

II. Overview
The American health care system is a patchwork of competing needs, interests and perspectives. What barriers to reform exist? How did these barriers come to be? Why is there reason to believe that they can and will be removed?

III. Group Discussion on Readings

A. Briefly share your experiences in "Allocating the Federal Budget."

How did your budget compare with the real one?
What surprised you?
What questions did this exercise raise in your mind?
What did you learn?

B. Based on your readings what do you believe are the major barriers to health care reform?

In the article Paying More but Getting Less, the author disputes five commonly held beliefs about the American health care system. He refers to them as myths. Did his arguments convince you? Why or why not?
In The Logic of the Health Care Debate, the Rockridge Institute presents several distinctly different modes of thought among our population with regard to health care systems. Discuss the key differences between them? Can you see any way that these differences can be bridged?
Comment on the framing continuum identified by the Herndon Alliance in its How We Talk about Health Care chart.
The article What Do Voters Want identifies a number of concerns and values must be acknowledged and honored for any reform bills to pass. To what extent are they barriers to reform?

C. When you look around, what do you see as reasons to hope that change is possible? What groups besides doctors are viewing the problem differently than before? Speak also from your personal experience.

Next Week: Choose next week's facilitator, scribe and timekeeper.

Study Circle Four: Health Care Systems - The Four Basic Models

2008-06-19T16:48:00.000-07:00

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The following is an excerpt from correspondent T।R. Reid's upcoming book on international health care, titled We're Number 37!, referring to the U.S.'s ranking in the World Health Organization 2000 World Health Report. The book is scheduled to be published by Penguin Press in early 2009.

There are about 200 countries on our planet, and each country devises its own set of arrangements for meeting the three basic goals of a health care system: keeping people healthy, treating the sick, and protecting families against financial ruin from medical bills. But we don't have to study 200 different systems to get a picture of how other countries manage health care. For all the local variations, health care systems tend to follow general patterns. There are four basic systems:

THE BEVERIDGE MODEL

Named after William Beveridge, the daring social reformer who designed Britain's National Health Service. In this system, health care is provided and financed by the government through tax payments, just like the police force or the public library.

Many, but not all, hospitals and clinics are owned by the government; some doctors are government employees, but there are also private doctors who collect their fees from the government. In Britain, you never get a doctor bill. These systems tend to have low costs per capita, because the government, as the sole payer, controls what doctors can do and what they can charge.

Countries using the Beveridge plan or variations on it include its birthplace Great Britain, Spain, most of Scandinavia and New Zealand. Hong Kong still has its own Beveridge-style health care, because the populace simply refused to give it up when the Chinese took over that former British colony in 1997. Cuba represents the extreme application of the Beveridge approach; it is probably the world's purest example of total government control.

THE BISMARCK MODEL

Named for the Prussian Chancellor Otto von Bismarck, who invented the welfare state as part of the unification of Germany in the 19th century. Despite its European heritage, this system of providing health care would look fairly familiar to Americans. It uses an insurance system -- the insurers are called "sickness funds" -- usually financed jointly by employers and employees through payroll deduction.

Unlike the U.S. insurance industry, though, Bismarck-type health insurance plans have to cover everybody, and they don't make a profit. Doctors and hospitals tend to be private in Bismarck countries; Japan has more private hospitals than the U.S. Although this is a multi-payer model -- Germany has about 240 different funds -- tight regulation gives government much of the cost-control clout that the single-payer Beveridge Model provides.

The Bismarck model is found in Germany, of course, and France, Belgium, the Netherlands, Japan, Switzerland, and, to a degree, in Latin America.

THE NATIONAL HEALTH INSURANCE MODEL

This system has elements of both Beveridge and Bismarck. It uses private-sector providers, but payment comes from a government-run insurance program that every citizen pays into. Since there's no need for marketing, no financial motive to deny claims and no profit, these universal insurance programs tend to be cheaper and much simpler administratively than American-style for-profit insurance.

The single payer tends to have considerable market power to negotiate for lower prices; Canada's system, for example, has negotiated such low prices from pharmaceutical companies that Americans have spurned their own drug stores to buy pills north of the border. National Health Insurance plans also control costs by limiting the medical services they will pay for, or by making patients wait to be treated.

The classic NHI system is found in Canada, but some newly industrialized countries -- Taiwan and South Korea, for example -- have also adopted the NHI model.

THE OUT-OF-POCKET MODEL

Only the developed, industrialized countries -- perhaps 40 of the world's 200 countries -- have established health care systems. Most of the nations on the planet are too poor and too disorganized to provide any kind of mass medical care. The basic rule in such countries is that the rich get medical care; the poor stay sick or die.

In rural regions of Africa, India, China and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may have access, though, to a village healer using home-brewed remedies that may or not be effective against disease.

In the poor world, patients can sometimes scratch together enough money to pay a doctor bill; otherwise, they pay in potatoes or goat's milk or child care or whatever else they may have to give. If they have nothing, they don't get medical care.

These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we're Britain or Cuba. For Americans over the age of 65 on Medicare, we're Canada. For working Americans who get insurance on the job, we're Germany.

For the 15 percent of the population who have no health insurance, the United States is Cambodia or Burkina Faso or rural India, with access to a doctor available if you can pay the bill out-of-pocket at the time of treatment or if you're sick enough to be admitted to the emergency ward at the public hospital.

The United States is unlike every other country because it maintains so many separate systems for separate classes of people. All the other countries have settled on one model for everybody. This is much simpler than the U.S. system; it's fairer and cheaper, too.

~ ~ ~

SOURCE: Frontline, a production of PBS
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/models.html

To watch Frontline’s documentary, Sick around the World, that describes the health care systems in Japan, Germany, Switzerland, Taiwan and the UK go to http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Back to Study Circle Four Preparatory Materials

Study Circle Four: FIVE Top Priorities for the U.S. Health Care System

2008-06-19T16:42:00.000-07:00

This form is designed to support several goals of our health care study circle project:

(1) collect our group’s top priorities for reforming our current system.
(2) provide a mechanism to combine the result of the efforts of many health care study circles; and,
(3) communicate our priorities to legislators and the policy makers who are involved in efforts to reform our system.

We are planning a community-wide Health Care Forum with our legislators and others to share the results of our various “Citizen Think Tanks.”

Our FIVE Top Priorities for the U.S. Health Care System

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

4. ________________________________________________________________

5. ________________________________________________________________

Using one form per study circle, complete this form at the end of Study Circle #4. Identify one person in your group who will hold this form until the end of Study Circle #6. Your group will have an opportunity at that time to make any changes.

At the conclusion of Study Circle #6 please mail the three forms listed below to:

Health Care Study Circle Results
Attn: Karen Scarvie
8120 Grand Ave. NE
Bainbridge Island, WA 98110

• Top FIVE Problems (generated in Study Circle #2)
• Top FIVE Priorities (to be identified in Study Circle Four)
• Top FIVE Goals and Solutions (to be addressed in Study Circle #6)
• Contact & Interest Form for your group members for future collaboration and announcements (to be filled out at the close of Study Circle #6)

NOTE: Should your group have difficulty reaching consensus, a Minority Report may be added to the back of these two forms.

Study Circle Four: The Dot Game Exercise

2008-06-19T16:36:00.000-07:00

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Materials and Assignments

1. Poster Paper.
You’ll need 5-8 sheets of Poster Paper (a.k.a. flipchart paper) to post around your meeting room. For this session, you will want to capture and share everyone’s ideas. The poster paper facilitates this process. Hint: The Post-It brand poster paper is self-sticking (no push pins or tape required). You can attach the sheets to any wall and they will not disturb painted surfaces, etc.

2. Marking Pens.
You’ll need one or more large marking pens.

3. Colored Dots.
You will need colored adhesive dots (or one marker pen per person ) to use for voting.

4. Assignments.
Assign people in your group to acquire and bring in the colored adhesive dots, at least 30 per person. Hint: Any color or combination of colors will work for this purpose.

How to Prepare

1. The facilitator reviews with the group the objectives and procedures of this exercise.

2. For this session, you will definitely need a “scribe.”

3. Post 5-8 sheets of paper around the room so that your scribe is prepared to list the ideas that will be generated by the members of the group.

4. Review the list of optional “categories” shown in your Study Circle Guide for this session. If you believe that they will be helpful in listing and organizing ideas you may want use them as labels at the tops of the poster paper.

Developing the Profile of Your Ideal Health Care System

Group members now have the opportunity to identify and describe the elements (values and features) they would like to see in their health care systems.

1. Members take turns sharing the ideas they have developed since the last session or which occur to them as the exercise proceeds.
2. The goal of this exercise is to elicit many ideas. Do not use this time to evaluate the ideas.
3. The scribe lists those ideas on the appropriate sheets of paper. Some ideas may fit in more than one category.
4. There may be conflicting ideas. List them all. This is not the time to choose between them.
5. Don’t get bogged down in details.

Follow the Dots

There are three steps in this part of the process. Together they will give you an idea of the kind of health care system individuals and the group would like to see. Each person has been provided with a set of colored dots (or a colored marker).

1. Individual Voting. Each person should review the lists of ideas or elements that have been generated by the above group work. Next, each person should take their 15 dots and place them on their highest priorities on any of the sheets. As examples, some people will spread their dots evenly among the sheets; others will place them in only two or three.

2. Reviewing the Collective Vote. Now everyone is able to see at a glance how the group as a whole ranks the ideas or elements that have been generated.

3. Compiling the Results. Someone should take the sheets home and fill in the FORM with the results. This form will be reviewed in Study Circle #6.
Now the group is ready to discuss the results of this exercise.

Study Circle Four: Preparatory Materials

2008-06-19T13:40:00.000-07:00

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Reading Material

• The Dot Game Exercise Instructions
• Health Care Systems, The Four Basic Models

Form:
Our FIVE Top Priorities for the U.S. Health Care System
Download as emailable text file

Taking Stock

Study Circles #1-3. In our three previous sessions we focused on:
1. Our own perspectives and experiences;
2. The perspectives and experiences of others;
3. The health care systems of some other countries; pending legislation
and the proposals of various political candidates and organizations.

Study Circles #4-6. In this and upcoming sessions we will:
4. Create a vision of a health care system that reflects our values (SC Four);
5. Identify the contradictions between our vision and the unsustainable
status quo of our current system (SC Five);
6. Identify ways in which we can become involved in the process needed to
bring about reform (SC Six).

Preparing for this Study Circle
Thought Questions • Dream BIG

To stimulate your thinking do a brief review the platforms, proposals and health care systems presented in SC Three.

You are in charge of designing a health care system that’s perfect for you, your family and your country. Here is an opportunity to begin to clarify your values. Start with the end in mind. What would your fully functioning system look like? What would be its basic elements? How would it work? What kinds of health care experiences would you have in such a system?
Observe your own process. In doing this exercise to what extent were you able to let go of any limited thinking you encountered in yourself?
Pretend you are running for President. What is your healthcare platform?

NOTE: Group members should thoroughly understand the procedures in The Dot Game Exercise prior to this Study Circle.

Study Circle Four Main Page

Study Circle Four Main Page

2008-06-19T13:34:00.000-07:00

Discussion Guide to Study Circle Four - Printer Friendly Version

Study Circle Four Preparatory Materials

I. Welcome

Coming together and settling in with a brief reading or contemplative activity.

What Do We Want?
•
How Can We Get There?

II. Overview

Here is an opportunity for you to re-imagine a health care system that reflects your values and yearnings. As you "design" your ideal health care system–by listing its elements–be true to those values by thinking beyond the limitations imposed by the status quo.

III. The Dot Game Exercise – Part One

The faciltator of this circle should have thoroughly read the instruction page and be well prepared. As a group list, but don’t discuss, the key elements of your ideal health care system. The goal of this exercise is to elicit many, many ideas, in any order (even if they are contradictory), and jot them down. Here are some optional categories and questions to stimulate your thinking and assist you in compiling your group wish list. (up to 30 minutes)

A. Core Values
We all hold core values about what is good and right. When we don’t see these values reflected in the institutions and systems in which we live we feel the conflict. Identify and list your core values and the qualities in a health care system that would reflect them (i.e. fairness, compassion, honesty, etc).

B. Core Principles
Reformers do not all agree on how to reform our system as they address the following issues:

Universality
Should health care by extended to all residents?

Basic Coverage
What types and minimum kinds of care can eligible parties expect to receive?

Portability
How transferable is one's coverage when they move or change jobs?

Accessibility
How accessible are health services? What conditions must be met to receive care?

Affordability
Are our country’s resources adequate to support health care for all? Is the cost of medical care within reach of the average American household?

C. Economics and Financing

Resources
Do we, as a country, have the resources to deliver basic care to everyone?

Equity
If not, how do we distribute care as fairly as possible?

Financing
How would we finance it? Who should pay for it? What should be the role of profit-making?

Administration
What should be the roles, if any, of government, employers and insurance companies? What would be the responsibilities of individuals?

D. Delivery of Services

Choice
Does your system include choice in professional services? If so, what kinds?

Prevention
Does your system include prevention?

E. Education and Training: How does your system prepare and support providers and patients? Does your system:

Include medical personnel training and education? If so, how they are financed?
Include health education for all citizens?
Address the roles and responsibilities of individuals? If so, in what ways?

IV. The Dot Game Exercise – Part Two

Review the instruction page for the Dot Game Exercise. This is your opportunity to prioritize the ideas on your lists. The “voting with dots” portion of the game should take approximately 10 minutes.
Which elements or ideas received the most dot votes? What were the top FIVE priorities? Record this data on the sheet provided.

V. Discussion: Reflection on your individual and group experiences

What did you learn from having done this exercise? Did this exercise help you to clarify your values? Any surprises? What plans or proposals reviewed in Study Circle #3 most closely matches yours or your group’s priorities? To what extent are our needs and desires grounded in moral principles?

VI. Next Week
Choose next week's facilitator, scribe and time-keeper.

Study Circle Three: Proposals for Comprehensive Health Care Reform at the Federal Level

2008-06-19T13:00:00.000-07:00

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The following bills have been introduced by the Congress in recent years:

The Medicare for All Act (S. 2229 and H.R. 4683) would guarantee coverage of every citizen, phased in over a 10 year period. At this time it is estimated that the financing would require a 7% payroll tax on businesses and a 1.7% tax on workers. By comparison, businesses today spend an estimated 13% of payroll on their health plans. Unions could continue to bargain for supplemental benefits. This bill was introduced by Senator Edward Kennedy (D-Mass) and Rep. John Dingell (D-Michigan)

The United States National Health Insurance Act (H.R. 676) would create a publicly-financed, privately-delivered health care program based on Medicare. All U.S. residents would be covered. Funding would come from maintaining the current Medicare payroll taxes and Medicaid funding, plus an additional 3.3% payroll tax on employers and a 5% tax on the top five percent of income earners. Other funding would come from eliminating the Bush tax cut, closing corporate tax loopholes, and new taxes on stock and bond transfers.

This bill was introduced by Rep. John Conyers (D-Michigan)

The American Health Security Act (H.R. 1200) would create a new health care system which would replace all currently existing public programs. Private health insurance plans would be permitted only to supplement the new public plan which would cover virtually all U.S. residents. The program would be administered by the states. This bill was introduced by Rep. Jim McDermott, MD, (D-Washington)

For more detailed information on these pending bills please refer to internet resources.

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Study Circle Three: Digging In the Right Place, by David Sirota

2008-06-19T12:57:00.001-07:00

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A Washington State Legislative Proposal by State Senator Karen Keiser

There's a memorable moment in "Raiders of the Lost Ark" when Indiana Jones sees a rival's archaeological excavation and realizes the buried treasure is somewhere else. "They're digging in the wrong place!" he exclaims.

The line could explain why our national elections leave us feeling empty. By expecting so much so fast from Washington D.C., we are digging for "change" in the wrong place.

Think about it: The White House can only be won by raising truckloads of cash from moneyed interests looking to preserve the status quo. Likewise, the U.S. Senate's filibuster rules allow 41 lawmakers, representing just 11 percent of the population, to stop anything. These are institutions designed to prevent change, not embrace it.

Thankfully, the same cannot be said for the so-called "laboratories of democracy" — state legislatures. Amid pundits' breathless analyses of Hillary Clinton's tear ducts, these arenas quietly opened throughout America this month. And from beneath the rubble of celebrity-obsessed campaign journalism and the ruins of national political gridlock, change is being exhumed in two bellwether states.

In a move making health care lobbyists quiver, Washington state Sen. Karen Keiser (D), chairwoman of her legislature's powerful health committee, this week introduced the nation's most far-reaching universal health care proposal. Her legislation is the American West's version of a parallel Wisconsin initiative, and the replication suggests this model may begin building the universal health care system our country wants.

The plan is simple: Employers and employees pay a modest payroll tax in exchange for full medical benefits, with no premiums. Patients never lose coverage and pick the doctors they prefer. And for the spendthrifts, here's the best part: According to an analysis of the Wisconsin proposal by the nonpartisan Lewin Group, the plan would save middle-class families an annual average of $750 on their existing health care bills. In all, the state would save almost $14 billion over the next decade.

Seem too good to be true? That's because you're used to being bilked by an insurance industry that drives up premiums, drives down benefits and gives executives like former UnitedHealth CEO William McGuire $1.6 billion worth of stock options in one year.

Eliminating that greed is precisely how the Washington state and Wisconsin proposals simultaneously save money and cover everyone.

Unlike the much-touted Massachusetts law forcing citizens to buy insurance from the private profiteers, the Washington and Wisconsin models pool all existing health care expenditures and then replace the middlemen with one publicly controlled, not-for-profit system. That structure attacks problems beyond the immorality of allowing 18,000 Americans to die each year because they lack health coverage.

For businesses faced with crushing health care costs, the Lewin Group predicts the plan will save private-insuring employers almost $700 million a year. For politicians looking to provide economic stimulus in the face of a recession, the nonpartisan Families USA estimates the proposal's investments will create 13,000 new jobs. Even tax reformers have something to like, as Wisconsin's version directs much of the system's savings into property tax relief.

The Royalist Right is distraught about the plan. When an initial draft passed the Wisconsin Senate last year, the Wall Street Journal's editorial board attacked it on the grounds that it "reduces out-of-pocket copayments" and "increases the number of mandated medical services covered" for patients. Wow. Sounds just awful.

The paper then criticized it as a tax increase and labeled it "government-run" — as if patients are better served by paying even bigger premium increases to corporate CEOs whose paychecks grow with each coverage denial.

The screed showed how little conservative elites care, not just for the uninsured, but for the working-class wing of the Republican Party — the roughly 40 percent of GOP voters who, according to the Pew Research Center, tell pollsters they "favor universal health coverage, even if it means higher taxes." These voters are part of a new transpartisan consensus — one that believes the words of the hero we remember this week. "Of all the forms of inequality," Dr. Martin Luther King Jr. said, "injustice in health care is the most shocking and inhumane."

Those desiring "real change" should applaud these Washington and Wisconsin leaders confronting that injustice. Unlike the nearsighted nabobs of national politics and the adversaries of Indiana Jones, these state legislators are digging in the right place.

David Sirota is a bestselling author whose newest book, "The Uprising," will be released in June of 2008. He is a fellow at the Campaign for America's Future and a board member of the Progressive States Network — both nonpartisan organizations. His blog is at www.credoaction.com/sirota.

http://www.creators.com/opinion/david-sirota/digging-in-the-right-place.html

COPYRIGHT 2008 CREATORS SYNDICATE, INC.

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Study Circle Three: Against Universal Health Care

2008-06-19T11:23:00.000-07:00

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Common Arguments Against Establishing Universal Health Care

Health care is not a right. As such, it is not the responsibility of government to provide health care.
Increased wait times. Universal heath care would result in increased wait times, which could result in unnecessary deaths.
Universal Health Care has not proven successful. Unequal access and health disparities still exist in universal health care systems.
Universal health care would reduce efficiency because of more bureaucratic oversight and more paperwork, which could lead to fewer doctor-patient visits. Advocates of this argument claim that the performance of administrative duties by doctors results from medical centralization and over-regulation, and may reduce charitable provision of medical services by doctors.
A Safety Net already exists. The Federal Emergency Medical Treatment and Active Labor Act requires hospitals and ambulance services to provide emergency care to anyone regardless of citizenship, legal status or ability to pay. The health care safety net, which includes free medical clinics, charity care, nonprofits and government-run community hospitals, provides necessary care to the uninsured.
The Market is a superior regulator of cost. Empirical evidence on the Medicare single payer-insurance program demonstrates that the cost exceeds the expectations of advocates. As an open-ended entitlement, Medicare does not weigh the benefits of technologies against their costs. Paying physicians on a fee-for-service basis also leads to spending increases. As a result, it is difficult to predict or control Medicare's spending. Large market-based public program such as the Federal Employees Health Benefits Program and CalPERS can provide better coverage than Medicare while still controlling costs as well.
Universal healthcare is unfair to healthy tax payers because it gives people who smoke, drink, do drugs, and eat unhealthily unfair benefits.

SOURCE: http://en.wikipedia.org/wiki/Universal_health_care

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Study Circle Three: For Universal Health Care

2008-06-19T11:19:00.000-07:00

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Common Arguments In Favor of Establishing Universal Health Care:

Everybody in, nobody out. Universal means access to health care for everyone, period.
Portability. Even if you are unemployed, or lose or change your job, your health coverage goes with you.
Uniform benefits. No Cadillac plans for the wealthy and Pinto plans for everyone else with high deductibles, limited services, caps on payments for care, and no protection in the event of a catastrophe. One level of comprehensive care no matter what size your wallet.
Prevention. By removing financial roadblocks, a single payer system encourages preventive care that lowers an individual's ultimate cost and pain and suffering when problems are neglected, and societal cost in the over utilization of emergency rooms or the spread of communicable diseases.
Choice of physician. Most private plans restrict what doctors, other caregivers, or hospital you can use. Under a single payer system, patients have a choice, and the provider is assured a fair reimbursement.
Ending insurance industry interference with care. Caregivers and patients regain the autonomy to make decisions on what's best for a patient's health, not what's dictated by the billing department or the bean counters. No denial of coverage due to pre-existing conditions or cancellation of policies for "unreported" minor health problems.
Reducing administrative waste. One third of every health care dollar goes for paperwork, such as denying care, and profits, compared to about 3% under Medicare a single-payer, universal system.
Cost savings. A single payer system would produce the savings needed to cover everyone largely by using existing resources without the waste. Taiwan, shifting from a U.S. healthcare model, adopted a single-payer system in 1995, boosting health coverage from 57% to 97% with little if any increase in overall healthcare spending.
Common sense budgeting. The public system sets fair reimbursements applied equally to all providers while assuring all comprehensive and appropriate health care is delivered and uses its clout to negotiate volume discounts for prescription drugs and medical equipment.
Public oversight. The public sets the policies and administers the system, not high priced CEOs meeting in secret and making decisions based on what inflates their compensation packages or stock wealth or company profits.

SOURCE:
http://www.guaranteedhealthcare.org/fact/top-10-reasons-enacting-single-payer-healthcare-system

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Study Circle Three: Physicians for a National Health Plan

2008-06-19T11:16:00.001-07:00

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Key Features of the Plan Proposed by Physicians For a National Health Program

Universal, Comprehensive Coverage. Only such coverage ensures access, avoids a two-class system, and minimizes expense
No out-of-pocket payments. Co-payments and deductibles are barriers to access, administratively unwieldy, and unnecessary for cost containment
A single insurance plan in each region, administered by a public or quasi-public agency. A fragmentary payment system that entrusts private firms with administration ensures the waste of billions of dollars on useless paper pushing and profits. Private insurance duplicating public coverage fosters two-class care and drives up costs; such duplication should be prohibited
Global operating budgets for hospitals, nursing homes, allowed group and staff model HMOs and other providers with separate allocation of capital funds. Billing on a per-patient basis creates unnecessary administrative complexity and expense. A budget separate from operating expenses will be allowed for capital improvements
Free Choice of Providers. Patients should be free to seek care from any licensed health care provider, without financial incentives or penalties
Public Accountability, Not Corporate Dictates. The public has an absolute right to democratically set overall health policies and priorities, but medical decisions must be made by patients and providers rather than dictated from afar. Market mechanisms principally empower employers and insurance bureaucrats pursuing narrow financial interests
Ban on For-Profit Health Care Providers. Profit seeking inevitably distorts care and diverts resources from patients to investors
Protection of the rights of health care and insurance workers. A single-payer national health program would eliminate the jobs of hundreds of thousands of people who currently perform billing, advertising, eligibility determination, and other superfluous tasks. These workers must be guaranteed retraining and placement in meaningful jobs.

From the American Journal of Public Health January 2003, Vol 93, No.1

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Study Circle Three: Barack Obama's Plan

2008-06-19T11:10:00.000-07:00

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Quality, Affordable and Portable Coverage for All

Obama's Plan to Cover Uninsured Americans:
Obama will make available a new national health plan to all Americans, including the self-employed and small businesses, to buy affordable health coverage that is similar to the plan available to members of Congress.

The Obama plan will have the following features:

Guaranteed eligibility. No American will be turned away from any insurance plan because of illness or pre-existing conditions.
Comprehensive benefits. The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care.
Affordable premiums, co-pays and deductibles.
Subsidies. Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.
Simplified paperwork and reined in health costs.
Easy enrollment. The new public plan will be simple to enroll in and provide ready access to coverage.
Portability and choice. Participants in the new public plan and the National Health Insurance Exchange (see below) will be able to move from job to job without changing or jeopardizing their health care coverage.
Quality and efficiency. Participating insurance companies in the new public program will be required to report data to ensure that standards for quality, health information technology and administration are being met.

National Health Insurance Exchange:
The Obama plan will create a National Health Insurance Exchange to help individuals who wish to purchase a private insurance plan. The Exchange will act as a watchdog group and help reform the private insurance market by creating rules and standards for participating insurance plans to ensure fairness and to make individual coverage more affordable and accessible.

Insurers would have to issue every applicant a policy, and charge fair and stable premiums that will not depend upon health status. The Exchange will require that all the plans offered are at least as generous as the new public plan and have the same standards for quality and efficiency. The Exchange would evaluate plans and make the differences among the plans, including cost of services, public.

Employer Contribution:
Employers that do not offer or make a meaningful contribution to the cost of quality health coverage for their employees will be required to contribute a percentage of payroll toward the costs of the national plan. Small employers that meet certain revenue thresholds will be exempt.

Mandatory Coverage of Children:
Obama will require that all children have health care coverage. Obama will expand the number of options for young adults to get coverage, including allowing young people up to age 25 to continue coverage through their parents' plans.

Expansion Of Medicaid and SCHIP:
Obama will expand eligibility for the Medicaid and SCHIP programs and ensure that these programs continue to serve their critical safety net function.

Flexibility for State Plans:
Due to federal inaction, some states have taken the lead in health care reform. The Obama plan builds on these efforts and does not replace what states are doing. States can continue to experiment, provided they meet the minimum standards of the national plan.

Lower Costs by Modernizing The U.S. Health Care System:
Reducing Costs of Catastrophic Illnesses for Employers and Their Employees: Catastrophic health expenditures account for a high percentage of medical expenses for private insurers. The Obama plan would reimburse employer health plans for a portion of the catastrophic costs they incur above a threshold if they guarantee such savings are used to reduce the cost of workers' premiums.

Helping Patients:

Support disease management programs. Seventy five percent of total health care dollars are spent on patients with one or more chronic conditions, such as diabetes, heart disease and high blood pressure. Obama will require that providers that participate in the new public plan, Medicare or the Federal Employee Health Benefits Program (FEHBP) utilize proven disease management programs. This will improve quality of care, give doctors better information and lower costs.
Coordinate and integrate care. Over 133 million Americans have at least one chronic disease and these chronic conditions cost a staggering $1.7 trillion yearly. Obama will support implementation of programs and encourage team care that will improve coordination and integration of care of those with chronic conditions.
Require full transparency about quality and costs. Obama will require hospitals and providers to collect and publicly report measures of health care costs and quality, including data on preventable medical errors, nurse staffing ratios, hospital-acquired infections, and disparities in care. Health plans will also be required to disclose the percentage of premiums that go to patient care as opposed to administrative costs.

Ensuring Providers Deliver Quality Care:

Promote patient safety. Obama will require providers to report preventable medical errors and support hospital and physician practice improvement to prevent future occurrences.
Align incentives for excellence. Both public and private insurers tend to pay providers based on the volume of services provided, rather than the quality or effectiveness of care. Providers who see patients enrolled in the new public plan, the National Health Insurance Exchange, Medicare and FEHBP will be rewarded for achieving performance thresholds on outcome measures.
Comparative effectiveness research. Obama will establish an independent institute to guide reviews and research on comparative effectiveness, so that Americans and their doctors will have the accurate and objective information they need to make the best decisions for their health and well-being.
Tackle disparities in health care. Obama will tackle the root causes of health disparities by addressing differences in access to health coverage and promoting prevention and public health, both of which play a major role in addressing disparities. He will also challenge the medical system to eliminate inequities in health care through quality measurement and reporting, implementation of effective interventions such as patient navigation programs, and diversification of the health workforce.

Insurance reform:
Obama will strengthen antitrust laws to prevent insurers from overcharging physicians for their malpractice insurance and will promote new models for addressing errors that improve patient safety, strengthen the doctor-patient relationship and reduce the need for malpractice suits.

Lowering Costs Through Investment in Electronic Health Information Technology Systems:
Most medical records are still stored on paper, which makes it hard to coordinate care, measure quality or reduce medical errors and which costs twice as much as electronic claims. Obama will invest $10 billion a year over the next five years to move the U.S. health care system to broad adoption of standards-based electronic health information systems, including electronic health records, and will phase in requirements for full implementation of health IT. Obama will ensure that patients' privacy is protected.

Lowering Costs by Increasing Competition in the Insurance and Drug Markets:
The insurance business today is dominated by a small group of large companies that has been gobbling up their rivals. There have been over 400 health care mergers in the last 10 years, and just two companies dominate a full third of the national market. These changes were supposed to make the industry more efficient, but instead premiums have skyrocketed by over 87 percent.

Barack Obama will prevent companies from abusing their monopoly power through unjustified price increases. His plan will force insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profits and administration. His new National Health Exchange will help increase competition by insurers.
Lower prescription drug costs. The second-fastest growing type of health expense is prescription drugs. Pharmaceutical companies are selling the exact same drugs in Europe and Canada but charging Americans more than double the price. Obama will allow Americans to buy their medicines from other developed countries if the drugs are safe and prices are lower outside the U.S. He will repeal the ban that prevents the government from negotiating with drug companies, with savings as high as $30 billion. Finally, Obama will work to increase the use of generic drugs in Medicare, Medicaid, and FEHBP and prohibit big name drug companies from keeping generics out of markets.

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Study Circle Three: John McCain’s Plan

2008-06-19T11:05:00.000-07:00

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John McCain is willing to address the fundamental problem: The rapidly rising cost of U.S. health care.

Bringing costs under control is the only way to stop the erosion of affordable health insurance, save Medicare and Medicaid, protect private health benefits for retirees, and allow our companies to effectively compete around the world.
Families should be in charge of their health care dollars and have more control over their care. We can improve health and spend less, while promoting competition on the cost and quality of care, taking better care of our citizens with chronic illness, and promoting prevention that will keep millions of others from ever developing deadly and debilitating disease.
While we reform the system and maintain quality, we can and must provide access to health care for all our citizens - whether temporarily or chronically uninsured, whether living in rural areas with limited services, or whether residing in inner cities where access to physicians is often limited.
America's veterans have fought for our freedom. We should give them freedom to choose to carry their VA dollars to a provider that gives them the timely care at high quality and in the best location.
Controlling health care costs will take fundamental change - nothing short of a complete reform of the culture of our health system and the way we pay for it will suffice. Reforms to federal policy and programs should focus on enhancing quality while controlling costs:
Promote competition throughout the health care system - between providers and among alternative treatments.
Make patients the center of care and give them a larger role in both prevention and care, putting more decisions and responsibility in their hands.
Make public more information on treatment options and require transparency by providers regarding medical outcomes, quality of care, costs, and prices.
Facilitate the development of national standards for measuring and recording treatments and outcomes.
Reform the payment systems in Medicare to compensate providers for diagnosis, prevention, and care coordination. Medicare should not pay for preventable medical errors or mismanagement.
Dedicate federal research on the basis of sound science resulting in greater focus on care and cure of chronic disease
Give states the flexibility to, and encourage them to experiment with: alternative forms of access; risk-adjusted payments per episode covered under Medicaid; use of private insurance in Medicaid; alternative insurance policies and insurance providers; and, different licensing schemes for medical providers.
Build genuine national markets by permitting providers to practice nationwide.
Promote rapid deployment of 21st century information systems.
Support innovative delivery systems, such as clinics in retail outlets and other ways that provide greater market flexibility in permitting appropriate roles for nurse practitioners, nurses, and doctors.
Where cost-effective, employ telemedicine, and community and mental health clinics in areas where services and providers are limited.
Foster the development of routes for safe, cheaper generic versions of drugs and biologic pharmaceuticals. Develop safety protocols that permit re-importation to keep competition vigorous.
Pass tort reform to eliminate frivolous lawsuits and excessive damage awards. Provide a safe harbor for doctors that follow clinical guidelines and adhere to patient safety protocols.
Protect the health care consumer through vigorous enforcement of federal protections against collusion, unfair business actions, and deceptive consumer practices.
John McCain believes that insurance reforms should increase the variety and affordability of insurance coverage available to American families by fostering competition and innovation.
Reform the tax code to eliminate the bias toward employer-sponsored health insurance, and provide all individuals with a $2,500 tax credit ($5,000 for families) to increase incentives for insurance coverage. Individuals owning innovative multi-year policies that cost less than the full credit can deposit remainder in expanded health savings accounts.
Families should be able to purchase health insurance nationwide, across state lines, to maximize their choices, and heighten competition for their business that will eliminate excess overhead, administrative, and excessive compensation costs from the system.
Insurance should be innovative, moving from job to home, job to job, and providing multi-year coverage.
Require any state receiving Medicaid to develop a financial "risk adjustment" bonus to high-cost and low-income families to supplement tax credits and Medicaid funds.
Allow individuals to get insurance through any organization or association that they choose: employers, individual purchases, churches, professional association, and so forth. These policies will be available to small businesses and the self-employed, will be portable across all jobs, and will automatically bridge the time between retirement and Medicare eligibility. These plans would have to meet rigorous standards and certification.

John McCain Believes in Personal Responsibility:

We must do more to take care of ourselves to prevent chronic diseases when possible, and do more to adhere to treatment after we are diagnosed with an illness.
Childhood obesity, diabetes and high blood pressure are all on the rise. We must again teach our children about health, nutrition and exercise - vital life information.
Public health initiatives must be undertaken with all our citizens to stem the growing epidemic of obesity and diabetes, and to deter smoking.
John McCain on Combating Autism in America
As President, John McCain will work to advance federal research into autism, promote early screening, and identify better treatment options, while providing support for children with autism so that they may reach their full potential.

http://johnmccain.com/Informing/Issues/19ba2f1c-c03f-4ac2-8cd5-5cf2edb527cf.htm

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Study Circle Three: Preparatory Materials

2008-06-19T11:03:00.000-07:00

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Reading Materials:

• Health Care Options at a Glance (Adobe PDF file)

• Hillary Clinton’s Plan

• John McCain’s Plan

• Barack Obama’s Plan

• Proposals for Comprehensive Health Care Reform at the Federal Level

• Physicians for a National Health Program

• Arguments FOR Universal Health Care

• Arguments AGAINST Universal Health Care

• Digging in the Right Place, by David Sirota

Questions about Current Systems and Reform Proposals:

Read and consider the materials provided. Be prepared to discuss their key differences and similarities and what you like or don’t like about the proposals. What do critics say?

What, Who, How, When, Where, Why?

1. Who gets covered? Who doesn’t? How much gets covered?

2. What gets covered (basic, alternative, pre-existing, preventive, dental, etc.)?

3. How is health care delivered (public/private/mixed)?

4. How is it financed (payroll taxes, income tax, sales tax, VAT, private premiums)?

5. Who administers it, or how are providers paid (insurance companies; federal, state, local governments; trusts)?

6. Whose interests are best/least served by this proposal (patients, taxpayers, insurance companies, providers, investors, etc.)?

7. Does the proposal address the moral aspect of the health care question? In what ways?

8. Other questions/issues?

Study Circle Three Main Page

Study Circle Three: Hillary Clinton’s Plan

2008-06-19T10:54:00.000-07:00

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Providing Affordable & Accessible Health Care

Hillary Clinton unveiled the third part of her plan to ensure that all Americans have affordable, quality health insurance. Building on her proposals to rein in costs and to insist on value and quality, her American Health Choices Plan will secure, simplify and ensure choice in health coverage for all Americans.

This Plan covers every American - finally addressing the needs of the 47 million uninsured and the tens of millions of workers with coverage who fear they could be one pink slip away from losing their health coverage - with no overall increase in health spending or taxes. For those with health insurance, the plan builds on the current system to give businesses and their employees greater choice of health plans - including keeping the one they have - while lowering cost and improving quality.

Specifically, the American Health Choices Plan will:

1. OFFER NEW COVERAGE FOR THE INSURED AND UNINSURED
The American Health Choices Plan gives Americans the choice to preserve their existing coverage, while offering new choices to those with insurance, to the 47 million people in the United States without insurance, and the tens of millions more at risk of losing coverage.

The Same Choice of Health Plan Options that Members of Congress Receive: Americans can keep their existing coverage or access the same menu of quality private insurance options that their Members of Congress receive through a new Health Choices Menu, established without any new bureaucracy as part of the Federal Employee Health Benefit Program (FEHBP). In addition to the broad array of private options that Americans can choose from, they will be offered the choice of a public plan option similar to Medicare.
A Guarantee of Quality Coverage: The new array of choices offered in the Menu will provide benefits at least as good as the typical plan offered to Members of Congress, which includes mental health parity and usually dental coverage.

2. LOWER PREMIUMS AND INCREASE SECURITY
Americans who are satisfied with the coverage they have today can keep it, while benefiting from lower premiums and higher quality.

Reducing Costs: By removing hidden taxes, stressing prevention and a focus on efficiency and modernization, the plan will improve quality and lower costs.
Strengthening Security: The plan ensures that job loss or family illnesses will never lead to a loss of coverage or exorbitant costs.
End to Unfair Health Insurance Discrimination: By creating a level-playing field of insurance rules across states and markets, the plan ensures that no American is denied coverage, refused renewal, unfairly priced out of the market, or forced to pay excessive insurance company premiums.

3. PROMOTE SHARED RESPONSIBILITY
Relying on consumers or the government alone to fix the system has unintended consequences, like scaled-back coverage or limited choices. This plan ensures that all who benefit from the system share in the responsibility to fix its shortcomings.

Insurance and Drug Companies: insurance companies will end discrimination based on pre-existing conditions or expectations of illness and ensure high value for every premium dollar; while drug companies will offer fair prices and accurate information.
Individuals: will be required to get and keep insurance in a system where insurance is affordable and accessible.
Providers: will work collaboratively with patients and businesses to deliver high-quality, affordable care.
Employers: will help financing the system; large employers will be expected to provide health insurance or contribute to the cost of coverage: small businesses will receive a tax credit to continue or begin to offer coverage.
Government: will ensure that health insurance is always affordable and never a crushing burden on any family and will implement reforms to improve quality and lower cost.

4. ENSURE AFFORDABLE HEALTH COVERAGE FOR ALL
Senator Clinton’s plan would:

Provide Tax Relief to Ensure Affordability: Working families will receive a refundable tax credit to help them afford high-quality health coverage. 
Limit Premium Payments to a Percentage of Income: The refundable tax credit will be designed to prevent premiums from exceeding a percentage of family income, while maintaining consumer price consciousness in choosing health plans.
Create a New Small Business Tax Credit: To make it easier-not harder-for small businesses to create new jobs with health coverage, a new health care tax credit for small businesses will provide an incentive for job-based coverage. 
Strengthen Medicaid and CHIP: The Plan will fix the holes in the safety net to ensure that the most vulnerable populations receive affordable, quality care.
Launch a Retiree Health Legacy Initiative: A new tax credit for qualifying private and public retiree health plans will offset a significant portion of catastrophic expenditures, so long as savings are dedicated to workers and competitiveness.

5. A FISCALLY RESPONSIBLE PLAN THAT HONORS OUR PRIORITIES

Most Savings Come Through Lowering Spending Due to Quality and Modernization: Over half the savings come from the public savings generated from Senator Clinton’s broader agenda to modernize the heath systems and reduce wasteful health spending.
A Net Tax Cut for American Taxpayers: The plan offers tens of millions of Americans a new tax credit to make premiums affordable-which more than offsets the increased revenues from the Plan’s provisions to limit the employer tax exclusion for health care and discontinue portions of the Bush tax cuts for those making over $250,000. Thus, the plan provides a net tax cut for American taxpayers.
Making the Employer Tax Exclusion for Health Care Fairer: The plan protects the current exclusion from taxes of employer-provided health premiums, but limits the exclusion for the high-end portion of very generous plans for those making over $250,000.

http://www.hillaryclinton.com/issues/healthcare/summary.aspx

Back to SC Three Preparatory Materials

Study Circle Three Main Page

2008-06-19T10:48:00.000-07:00

I. Welcome

Coming together and settling in with a brief reading or contemplative activity.

Current Systems
•
Current Proposals

II. Overview

All existing or proposed health care systems answer basic questions. Using the questions on the preparatory materials page to help guide us, we will be sharing what we have learned about systems in other countries and States, as well as those proposed by organization and our current Presidential candidates.

III. Activities for this session

What, Who, How, When, Where, Why?
Using the preparatory questions for this session as your guide discuss the following:

A. Countries:
What are the major differences between the health care systems in Britain, France, Canada and the United States?

B. Proposals:
Your Guide provides information about reform proposals currently being debated in this country:

The plans offered by our Presidential candidates McCain, Clinton, Obama
Three reform bills introduced in the Congress, and
The proposal from the Physicians for a National Health Program (PNHP).

In your opinion which proposal best addresses the major problems you identified in Session #2? Which of the proposals offers the best solutions and why? Do any of them satisfactorily address our health care crisis? Why? Why not?

C. Opposing Philosophies

Discuss the differences between the points of view of advocates for establishing a universal health care system and those who oppose it.

D. Reform at the State Level

Share your reactions to David Sirota’s essay that addresses health care reform in the State of Washington.

IV. Group Reflection

A. What surprised you the most from the readings, discussions and activities for this session?
B. What moral issue did the readings, discussions and activities raise for you?

V. Next Week

Choose next week’s facilitator, scribe and timekeeper.

Scenario #5 – Dr. Martha Middleton, Family Physician

2008-06-15T19:22:00.000-07:00

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Dr. Middleton is in her sixth year of private practice, has $160,000 of debt left to pay off from medical training. She works four days a week in a practice with a group of 5 other family physicians. They each earn $80,000/year. She has 1 child, age 3 at home with a nanny. Martha’s husband works in new construction, but since the housing market slump has been going farther away from home to find work.

She and her colleagues are assessing how many Medicare and Medicaid patients they can afford to carry on their books due to the low reimbursement rates for each category. With fewer family physicians willing to take Medicare patients in their community, they are under a great deal of personal and ethical pressure to see more of the elderly. In order to make the financial numbers work, they must see a maximum number of patients with private insurance each day in the shortest amount of time. The brevity of contact is counter to their original reasons for going into family practice—starting out with young families and seeing them into their old age. The number of staff needed to handle the billing and paper work has increased as well.

Dr. Middleton is politically active and wants to see as many uninsured patients as possible, but when she averages out the reimbursement, she often receives reimbursement that is 50% or less of cost. The doctors are also faced with the developing trend of patients wanting referrals to specialists for conditions that they feel they are more than qualified to treat. They believe that this is the result of insurance companies selling “no need for a referral to see a specialist” programs in order to attract members.

Medical System Frustrates Doctors Too
-- From Health Systems Unmasked (Internet site) November 13, 2007
by Jacqueline L. Jones

There was a time when I hated mainstream medical professionals. Wouldn’t YOU get a little surly after repeatedly hearing that you were a hypochondriac in spite of the fact that you had a persistent fever of 104 degrees, your ankles were so swollen you couldn’t walk, and you couldn’t lift your hands over your head or do dishes? How could you avoid feeling a little smug when you fixed much of the problem without them, and most of them didn’t know enough to know anything was wrong?

My attitude is beginning to change thanks to the book How Doctors Think. Dr. Jerome Groopman, the book’s author and a medical researcher, Harvard professor, and journalist, says that though some insensitive physicians make snap decision that harm patients, most started off as caring professionals and have become jaded by dealing with the system.

Insane restrictions from insurers and equally insane control by pharmaceutical companies along with time restrictions dictated by practice managers have created a prescription for disaster. Unfortunately, insensitivity only adds to the problem, but I can’t say I’d have a different attitude under the circumstances. I hate to say it, but I’m beginning to empathize with them.

Disease Care Wastes Money and Lives
-- From Health Systems Unmasked (Internet site) November 13, 2007
by Jacqueline L. Jones

We buried my aunt last Saturday as another group of relatives gathered in a different city to bury her best friend, a cousin, at the same hour. They were two victims of chronic illness, and both had access to medical care. My aunt received treatment at one of the best medical centers in the country. I don’t know the specifics of the cousin’s care.

Chronic illness often affects several parts of the body. My aunt’s case was no exception. As each body system manifested its own crisis, the attending physician of the moment sent her to a hospital specializing in that area. I lost count of how many transfers she endured. Surely travel fatigue hastened her death.

This saga highlights the real health care debate in this country. While we read stories of people who lack access to care, my aunt had access to care that did not serve her needs, but the physicians were willing to serve because the government was willing to pay.

According to The World Health Organization (WHO), the U.S. government, insurance companies, and individuals in this country spent an average of $6,096 on each person who had access to the system in 2004. Canada’s government-run universal system, in which most services are provided by private companies, spent $3,038. Canada ranked 30th in system performance among 191 nations in a 2000 WHO survey; the U.S. ranked 37th.

Though the reason for these disparities is unclear, one fact is certain: prevention and early intervention can save billions of dollars and countless lives. Florida Hospital in Orlando implemented a self-care program with a booklet and flow charts that instructed employees on how to prevent certain illnesses and when to seek professional help. The program reduced clinic and emergency room visits by $60,313 or $75.30 per person in five months.

Most health care plans in this country, even for those who have access, lack extensive coverage for prevention and early intervention. Equal access to a broken system is not the answer.

Barriers to Diabetes Care
-- Townsend Letter for Doctors and Patients, May, 2007 by Jule Klotter

US family physicians, who care for about 90% of the nation's diabetics, face a difficult battle adjusting medications and monitoring patients for kidney disease, peripheral neuropathy, leg ulcers, and diabetic retinopathy during brief office visits. Education about nutrition and self-care help people with diabetes avoid these serious complications.

Unfortunately, the health system in the US is set up to deal with acute rather than chronic disease and does not support preventive measures. Patients without insurance and/or with low incomes face an added challenge. Even if they understand the importance of monitoring blood sugar levels and seeing their physician, low-income diabetics cannot afford it. As one family physician told J.B. Brown and colleagues, "Diabetes is a fairly expensive illness. The testing, the medication, the diet and the frequency of visits."

During the late 1990s, four New York City hospitals set up "boot camps" for diabetics. At these education centers, diabetics learned about the consequences of uncontrolled diabetes, how to check their blood sugar levels accurately, and how to use nutrition to keep those levels more stable; they also began an exercise program. Specialists in endocrinology and ophthalmology monitored patients for disease progression. Within seven years, three of the four centers had closed because they were losing too much money. The fourth one at Columbia University Medical Center relies on generous donors to stay open.

Medicare Reimbursement to Physicians
-- From the American Academy of Family Physicians, February 10, 2005

This statement is submitted on behalf of the 94,000 members of the American Academy of Family Physicians to the House Ways and Means Health Subcommittee as part of its hearing on Medicare reimbursement to physicians.

The AAFP appreciates the work of this subcommittee to examine the issue of how Medicare reimburses physicians services and we share the subcommittee’s concerns that the current system is unproductive. This fee-for-service system as presently constructed rewards increased volume of services whether or not these services enhance quality outcomes for Medicare beneficiaries. Such a system of physician reimbursement by itself and without improvement is unworkable and unsustainable over the long-term.

This is why the AAFP supports the restructuring of Medicare reimbursement to reward quality and care coordination. This restructuring must be built on a fundamental reform of the underlying fee-for-service reimbursement system.

Family physicians have a unique perspective on the effectiveness of the Medicare system. After all, the majority of Medicare beneficiaries who identify a physician as their usual source of care report that they have chosen a family physician. Family physicians take very seriously the obligation to provide the best health care possible to our Medicare patients. But Medicare reimbursement policies are challenging the ability of family physicians to fulfill that obligation.

The American Academy of Family Physicians supports congressional action to replace the formula known as the sustainable growth rate (SGR) used to determine the annual updates in the Medicare Physician Fee Schedule (MPFS) conversion factor. Above all, the reimbursement system should be designed to ensure that Medicare patients can continue to receive the care they depend on and deserve.

Congress must act to protect the stability of the ambulatory care portion of the Medicare program which is essential to meeting the medical needs of our nation’s seniors. Without action to fix the SGR, these insufficient updates will continue to disproportionately affect primary care offices relative to other subspecialties because of higher overhead costs.

Is There a Doctor in the House?
A look at the family doctor shortage in North America
From Medhunters.com – an Internet site April 2007 by Sheng Wang)

In a 2006 report entitled The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation's Health Care, the American College of Physicians (ACP) warned that the there is a severe shortage of primary care physicians (family doctors, pediatricians, and internists) in the United States. The situation is equally dire in Canada. According to a November 2, 2006 article from CBC News, five million Canadians, or 17% of the population, do not have a family doctor. Furthermore, nearly two million of those people have tried, and failed, to find a family physician in the past year.

This shortage of general practitioners has widespread implications for patients, doctors, and for the American and Canadian healthcare systems. Not having timely access to a family doctor leads to the overuse of emergency rooms, later diagnoses, difficulty in getting referrals to specialists, and poor management of chronic health problems. Ultimately, it results in poorer health across the country, as well as higher healthcare spending.

Since the baby boom generation will soon be relying on their GPs to care for them in their old age, the problem is expected to worsen. However, family doctors themselves are an aging population. An American Medical Association report found that one-third of US family physicians were over the age of 55, and most of those practitioners were expected to retire within 10 years. Furthermore, there will be fewer new graduates to replace them. According to a study by the American Academy of Family Physicians (AAFP), the number of medical students choosing family medicine has dropped by half between 1998 to 2003.

Even as the demand for family doctors increases, medical students are eschewing general practice in favor of better paying and more glamorous specialties. According to an AAFP study, in 1999, the average American pediatrician saw 122 patients per week and earned $137,800 per year, while the average gastroenterologist saw 90 patients per week and earned $299,200. Since the average American medical student is graduating with $120,000 in debt, it's not hard to see why family medicine is losing its appeal.

Scenario #6 - Ernie Smith, independent insurance agent

2008-06-15T19:18:00.000-07:00

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Ernie has been an insurance agent, working on his own, for twenty years and wants to retire within the next two years, at age 63. His doctor has told Ernie that he will need at least one hip replacement soon. He will have to hire a temporary worker to help him with the business while he recovers.

He sells all lines of insurance: life, health, property & casualty, long-term care, etc. but is wondering with the elections coming up how his health insurance business will fare. He works with ten insurance companies so that he can offer his clients choice. He specializes in small businesses and acknowledges that it is getting harder to find affordable plans for his clients.

One other change in Ernie’s business is the Internet. Many people now bank, shop, and sign up for all manner of insurance and other programs online. The “e-insurance” business, Ernie fears, might well put his personal, face-to-face livelihood in jeopardy. He worries that much of the advertising he sees on these Web sites is misleading, making the “fine print” even smaller.

While Ernie believes that everyone should have basic health care coverage, if the insurance companies were eliminated, his income of $85,000/year would take a big hit. He is selling the HSA program to some of his clients, but feels compelled to tell them the downside as well as the affordable rates of the program. Experts are concerned that people will be moved to delay getting necessary care in order to keep the most money possible in their savings accounts.

From U.S. Department of Labor – Bureau of Labor Statistics

The median annual earnings of wage and salary insurance sales agents were $43,870 in May 2006. The middle 50 percent earned between $31,640 and $69,180. The lowest 10 percent had earnings of $24,600 or less, while the highest 10 percent earned more than $115,090. Median annual earnings in May 2006 in the two industries employing the largest number of insurance sales agents were $46,210 for insurance carriers, and $42,950 for agencies, brokerages, and other insurance related activities.

Many independent agents are paid by commission only, whereas sales workers who are employees of an agency or an insurance carrier may be paid in one of three ways: salary only, salary plus commission, or salary plus bonus. In general, commissions are the most common form of compensation, especially for experienced agents. The amount of the commission depends on the type and amount of insurance sold and on whether the transaction is a new policy or a renewal. Bonuses usually are awarded when agents meet their sales goals or when an agency meets its profit goals. Some agents involved with financial planning receive a fee for their services, rather than a commission.

Company-paid benefits to insurance sales agents usually include continuing education, training to qualify for licensing, group insurance plans, office space, and clerical support services. Some companies also may pay for automobile and transportation expenses, attendance at conventions and meetings, promotion and marketing expenses, and retirement plans.

Independent agents working for insurance agencies receive fewer benefits, but their commissions may be higher to help them pay for marketing and other expenses.

Small Employer Group Coverage

According to a 2007 study, about 59% of employers at small firms (3-199 workers) in the U.S. provide employee health insurance, compared to 99% of large employers. The percentage of small firms offering coverage has been dropping steadily since 1999. The study notes that cost remains the main reason cited by small firms who do not offer health benefits.

The types of coverage available to small employers are similar to those offered by large firms, but small businesses do not have the same options for financing their benefit plans. In particular, self-insuring the benefits is not a practical option for most small employers.

States regulate small group premium rates, typically by placing limits on the premium variation allowable between groups (rate bands). Insurers price to recover their costs over their entire book of small group business while abiding by state rating rules. Over time, the effect of initial underwriting "wears off" as the cost of a group regresses towards the mean — the average health status of the group eventually moves towards that of an average group. The process used to price small group coverage changes when a state enacts small group reform laws.

Insurance brokers play a significant role in helping small employers find health insurance, particularly in more competitive markets. Average small group commissions range from 2 percent to 8 percent of premiums. Brokers provide services beyond insurance sales, such as assisting with employee enrollment and helping to resolve benefits issues.

For many small employers, years of premium increases have given them few options: Raise the amount workers pay, drop coverage or reduce benefits. "When they hit us with another 25% increase for this year, we had to re-evaluate," says Howard Chanin, president and co-owner of 17-employee Butler Mortgage in Kissimmee, Fla. Chanin asked his workers whether they'd rather have higher deductibles or higher premiums. They wanted the lower premiums. So the annual deductible — the amount workers pay, in addition to premiums, for medical care before their insurance coverage begins — went from $500 a year to $2,500. "We're taking it year by year," Chanin says.

The Underinsured

There are 17 million people with coverage, but that coverage will not pay for the treatments necessary to fight cancer and other very serious diseases.
More than an estimated total of 61 million adults, or 35 percent of individuals, ages 19 to 64, had either no insurance, sporadic coverage, or insurance coverage that exposed them to high health care costs during 2003.

Relative to those with more adequate insurance, the underinsured were significantly more likely to go without care because of costs. In fact, they reported rates of cost-related, forgone care close to those of the uninsured.

Scenario #7 – Joyce Holmes, insurance claims department manager

2008-06-15T19:13:00.000-07:00

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Joyce has been working for a large for-profit insurance company for twenty-five years. She is 52 years old, divorced, and in good health. She has, however, sought relief from the stress of her job and is seeing a mental health counselor. With her son out of the house, this is the first time that she has been able to travel some and finally buy her dream house.

She began as a file clerk and over the years was promoted, most recently, to be the Manager of the claims department of more than fifty employees. She has taken industry courses in claims management, but has no professional medical training. The CEO of her company was fired by the board of directors and given a $1.2 million severance plus lifetime health benefits last year.

Joyce’s best friend is the secretary to the Chief Financial Officer and says that the company is joining several other large insurance companies to lobby against health care reform. They will be running ads in prime time and have doubled the number of lobbyists in Washington.

Joyce went with some people from work to see the movie Sicko! and was shocked to hear her colleagues call Michael Moore a liar. She has had to work with procedures developed by the finance department that set up many barriers and cumbersome appeals for the last ten years. She has been increasingly unhappy at work, feels like she is on the wrong side of what is right, but doesn’t know what else she could do for work that would pay her the kind of money she makes. She found well over 1 million “hits” on Google when she searched with the words: “claims health insurance issues.”

A 2006 survey based on data from nearly 25 million claims, processed by a total of 26 large and small health plans in the United States.

From Center for Policy and Research, America’s Health Insurance Plans:

The percentage of claims received electronically was 75 percent in 2006, up from 44 percent in 2002.
There is often a significant time lag before health insurance plans receive claims from health care providers. In 2006, 29 percent of claims were received from health care providers more than 30 days after the date of patient service, and 15 percent of claims were received from providers more than 60 days after the service was provided.
Health insurance plans processed 98 percent of "clean" claims within 30 days, up from 94 percent in 2002. Processing time is the number of days from when a claim is received until the claim is paid, denied, or "pended" for further information. ("Clean" claims are those for which no additional information is needed.) Fourteen percent of claims in the survey were "pended" or delayed, usually because of incomplete or incorrect information.
Approximately two-thirds (68 percent) of all claims are now adjudicated automatically; that is, processed without manual intervention. Among electronic claims, 71 percent were adjudicated automatically in 2006, up from 49 percent in 2002. Forty-four percent of paper claims were adjudicated automatically in 2006, up from 27 percent in 2002
Electronic claims are less costly to process than paper claims. The average cost of processing a clean electronic claim was 85 cents, nearly half the $1.58 cost of processing a clean paper claim. Pended claims requiring manual or other review cost $2.05 on average per claim to process.

Some of the facts stated in Sicko that bothered Joyce the most:

"A study by Citizen Action, a consumer group, reports that doctors, hospitals, insurance companies and other providers of medical services made campaign contributions of $ 79 million during the 1993-1994 election cycle. The insurance industry passed out $16 million. The American Medical Association, which objects to cost-control measures, contributed $ 3 million." Froma Harrop, "The big lie about health reform," Rocky Mountain News, August 20, 1995.
Aetna: "Aetna Inc. … settled with the plaintiffs, which include the medical associations of California and Texas. Aetna agreed to pay the plaintiffs $120 million." Milt Freudenheim, "Class-Action Status Is Upheld for Doctors Suing Insurers," New York Times, September 2, 2004. See also, Susan Beck, "HMO Postmortem," American Lawyer, October 10, 2003. Settlement Agreement.
Blue Cross/Blue Shield: "Sixty-seven Blue Cross/Blue Shield companies across the nation have paid the United States a total of $117 million to settle government claims that Medicare made primary payments for health care services that should have been paid by the Blue Cross/Blue Shield private insurance companies, the Department of Justice announced today." "Blue Cross/Blue Shield Companies Settle Medicare Claims, Pay United States $117 Million, Agree To Share Information," Department of Justice News Release, October 25, 1995.
Michael B McAllister earned $3.33 million in compensation as CEO of Humana. "Forbes 2006 Executive Pay list," April 20, 2006.
John W Rowe earned $22.2 million in compensation as CEO of Aetna. Rowe has since left Aetna. "Forbes 2004 Executive Pay list," April 21, 2005.Bill McGuire has stock options worth $1.6 billion at the end of 2005, as CEO of UnitedHealth Group. Robert Simison, "SEC Investigates UnitedHealth Over Stock-Options Practices," Bloomberg News, December 27, 2006; Michael Regan, "Business 2006: Who Won, Who Lost," Associated Press,December 26, 2006.
There are four times as many health care lobbyists as there are members of Congress. According to the Center for Responsive Politics, in 2005 there were 2,084 health care lobbyists registered with the federal government. With 535 members of Congress, that's 3.895 lobbyists per member.

Scenario #8 – Josh Holmes, graduate student

2008-06-15T19:06:00.000-07:00

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Josh Holmes is Joyce Holmes’ son, age 22. He is in graduate school in a distant state, no longer eligible to be on her health insurance plan as a dependent, and doesn’t see the need for insurance.
His mother has offered to help pay for a minimal medical policy for him, but he says he’s healthy and doesn’t want her to spend the money. Josh would rather have help with his auto insurance payments since he had several accidents as a teen driver and his car insurance premium is very high. He won’t be eligible for a good driver reduction until age 25.

The Uninsured

Approximately 47 million Americans are without any kind of health insurance.
Their access to care is either to seek care in the emergency room, qualify for community/charitable programs, pay out of pocket for services, or go without.
The number of uninsured children increased from 8 million (10.9 percent) in 2005 to 8.7 million (11.7 percent) in 2006.

Note: More than one-half of the underinsured (54%) and uninsured (59%) went without needed care during the year: they failed to fill a prescription, skipped a test or follow-up, failed to visit a doctor for a medical problem, and/or did not get specialist care.

First, changes in the workplace mean fewer jobs now have full benefits: Only 60 percent of employers offered health insurance to new employees in 2005. Young adults entering the workforce are finding that many jobs out there are now consulting, freelance and contract positions that don't provide benefits.

Second, the cost burden for insurance is shifting from the employer to the employee. New workers who are young, healthy and don't yet have families of their own are deciding they don't want to pay a couple of thousand dollars each year for benefits they feel they don't need.

Health Insurance For Young Adults
NEW YORK, Sept. 28, 2006

(CBS) Despite relatively low unemployment rates the last five years, the number of young adults without health insurance has skyrocketed. More than 15 million people between the ages of 18 and 34 are now living without medical coverage.

On The Early Show Thursday, financial guru Ray Martin offered advice on finding affordable health insurance for people in that age group. "I strongly advise that no one go without health insurance, even for a few months. Why? Because you're exposing yourself to a major financial expense that can take years to recover from or ruin your credit history. In fact, lack of medical insurance is the No. 1 reason cited by people who file for personal bankruptcy."

Martin says some young adults who were covered under their parents' plans get kicked off when they graduate college. They typically have what the health insurance industry calls a "change of insurable status." Even if a young adult is covered as a dependant under his or her parents' employer-provided health insurance, many group health plans only cover dependant children up to age 19, or up to age 23 or 25 as long as they are full-time students. With many plans, as soon as the student graduates high school or college, he or she is no longer a covered dependant and no longer has health insurance.

But, because so many young adults are going without health insurance, more and more states have enacted laws designed to give them more breathing room, allowing children to remain covered as dependants on their parents' health plans well into their 20s. In New Jersey, which enacted the highest age limit this year, children can actually remain covered under their parents' health insurance until they turn 30.

There are also options for young adults who continue their education, but aren't eligible to be covered under their parents' plans.

For full-time students who fall under that category, there's the student health plan, which are offered either by the school or through independent insurance companies, such as eHealthInsurance.com.

School-provided policies may require using the on-campus medical facilities and may be more restrictive than policies obtained elsewhere. These policies cover graduate students and are typically available regardless of age or health. The cost of a typical student health policy is about $70 per month for a plan with a $1,000 deductible and a 20 percent co-payment. Also, many college alumni associations offer health insurance to graduates.

There's also a plan for those who aren't in school but need coverage for short spans. It's called short-term health coverage and it's offered by a select group of insurance companies. It features coverage for periods as short as one month and as long as 12. This can be a good option if you can't remain as a covered dependant on your parents' plan and you aren't yet eligible for coverage that comes from a new job. One drawback, though, is that pre-existing conditions aren't covered.

As an example, the Celtic Insurance Company offers a short-term health plan that can cost about $114 a month with a deductible of $2,500. After that is satisfied, the coverage pays up to 80 percent of the next $5,000 in covered expenses, then 100 percent of covered medical expenses up to $2 million. Other companies offering short-term health insurance include Fotis Health and Golden Rule.

Still another possible choice is health insurance with high deductibles. These policies are primarily designed to offer affordable coverage for major health and medical expenses. The cost is relatively low, because covered people must first satisfy a high deductible, ranging from $1,000 to $15,000, depending on the plan. These policies aren't intended to pay for routine doctor's office visits or trips to the emergency room for minor ailments. These plans come with an option to open a Health Savings Account, or HSA, which allows you to make a tax-deductible contribution to the account in the amount of the deductible, up to $2,650 for single people. That money accumulates interest tax-free and can be withdrawn tax-free to pay for out-of-pocket medical expenses, such as deductibles and co-payments. While this can be affordable coverage for unexpected and large medical costs, you will still need to come up with the first $2,650 in expenses (either from your HSA or out-of-pocket) to satisfy such a deductible if you incur a serious illness or accident.

Scenario #9 – Andrew Vitale, retiree on Medicare

2008-06-15T18:57:00.000-07:00

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Andrew is age 70, lives on a small pension and Social Security. With his basic Medicare Part B deduction, a supplemental plan with AARP ($150.00 each month), and his Part D premium ($78 each month), he is spending nearly all of his income on rent, food, transportation and insurance.

Andrew’s mother is 93 and lives with his sister, but will soon need to be moved to a facility due to advancing Alzheimer’s and a heart condition. His visits to help out his sister and see his mother are getting to be too hard, given the 400 miles that separate them. He would move closer, but his sister lives in the city where rents are high and food is more expensive.

Andrew came to the U.S. as a young boy, worked in the garment industry until his retirement. He has a great deal of difficulty figuring out the bulletins and books that the government sends him, especially about Medicare programs. He would like to get help for himself and his mother, but doesn’t know who to ask that he could trust or that could explain it to him “in plain English.” He has always paid his bills on time and never taken a handout from anyone, even when his company moved the business overseas. He has always saved for a rainy day, but worries that if something happened to him, he would go through all his savings and have to go on “welfare.”

What Medicare Costs Andrew Vitale and Other Retirees

Medicare Part A – Hospital coverage - $0 – If you or your spouse paid Medicare taxes as a working person. Buying Part A today costs $423/month.
Medicare Part B – Physician services. In most cases, if you have Part A, you must also purchase Part B coverage. This is taken directly from your Social Security check (if you are collecting SS) at the current rate of $96.40 in 2008. Your monthly premium will be higher if you are single (file an individual tax return) and your yearly income is more than $82,000, or if you are married (file a joint tax return) and your yearly income is more than $164,000. You also pay a Part B deductible each year before Medicare starts to pay its share. In 2008, the deductible amount is $135.
Medicare Part D – Prescription drug coverage. The plans available depend on the amount of prescription coverage you choose. The better the coverage, the higher the monthly premium. One of the least expensive is Humana @ $26.00/month, but you must first meet a $250 deductible before any coverage occurs. This is not full coverage – there are copays and a complicated listing of what drugs are covered depending on whether they are generic, etc.
The donut hole: about 3 million of the 23 million Americans who receive the Medicare drug benefit are expected to reach the gap in 2006. A few more-expensive plans have no doughnut hole, and low-income beneficiaries can receive extra help from Medicare that eliminates the gap. The approximate gap in $$ in the donut hole runs from: $2,250 - $3,600. This is the amount an individual must pay out-of-pocket until coverage begins again at 95%.
Supplemental health insurance – to cover whatever Medicare doesn’t cover in terms of fees and charges. The supplement will only cover what Medicare covers. The monthly premium depends upon the type of coverage you want and the insurance plan you choose. A typical (and lower end of the cost scale) premium is from AARP (Am. Assoc. of Retired Persons) @ $145.00/month

Study Circle Two: Long-Term Care Insurance Provides Security For A Rainy Day

2008-06-15T18:08:00.000-07:00

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Andrew is age 70, lives on a small pension and Social Security. With his basic Medicare Part B deduction, a supplemental plan with AARP ($150.00 each month), and his Part D premium ($78 each month), he is spending nearly all of his income on rent, food, transportation and insurance.

Andrew’s mother is 93 and lives with his sister, but will soon need to be moved to a facility due to advancing Alzheimer’s and a heart condition. His visits to help out his sister and see his mother are getting to be too hard, given the 400 miles that separate them. He would move closer, but his sister lives in the city where rents are high and food is more expensive.

Andrew came to the U.S. as a young boy, worked in the garment industry until his retirement. He has a great deal of difficulty figuring out the bulletins and books that the government sends him, especially about Medicare programs. He would like to get help for himself and his mother, but doesn’t know who to ask that he could trust or that could explain it to him “in plain English.” He has always paid his bills on time and never taken a handout from anyone, even when his company moved the business overseas. He has always saved for a rainy day, but worries that if something happened to him, he would go through all his savings and have to go on “welfare.”

What Medicare Costs Andrew Vitale & Other Retirees

Medicare Part A – Hospital coverage - $0 – If you or your spouse paid Medicare taxes as a working person. Buying Part A today costs $423/month.
Medicare Part B – Physician services. In most cases, if you have Part A, you must also purchase Part B coverage. This is taken directly from your Social Security check (if you are collecting SS) at the current rate of $96.40 in 2008. Your monthly premium will be higher if you are single (file an individual tax return) and your yearly income is more than $82,000, or if you are married (file a joint tax return) and your yearly income is more than $164,000. You also pay a Part B deductible each year before Medicare starts to pay its share. In 2008, the deductible amount is $135.
Medicare Part D – Prescription drug coverage. The plans available depend on the amount of prescription coverage you choose. The better the coverage, the higher the monthly premium. One of the least expensive is Humana @ $26.00/month, but you must first meet a $250 deductible before any coverage occurs. This is not full coverage – there are copays and a complicated listing of what drugs are covered depending on whether they are generic, etc.
The donut hole: about 3 million of the 23 million Americans who receive the Medicare drug benefit are expected to reach the gap in 2006. A few more-expensive plans have no doughnut hole, and low-income beneficiaries can receive extra help from Medicare that eliminates the gap. The approximate gap in $$ in the donut hole runs from: $2,250 - $3,600. This is the amount an individual must pay out-of-pocket until coverage begins again at 95%.
Supplemental health insurance – to cover whatever Medicare doesn’t cover in terms of fees and charges. The supplement will only cover what Medicare covers. The monthly premium depends upon the type of coverage you want and the insurance plan you choose. A typical (and lower end of the cost scale) premium is from AARP (Am. Assoc. of Retired Persons) @ $145.00/month

The federal government subsidized all of the health plans that chose to participate in Medicare Part D.

It is also worth noting, that once you receive Medicare Parts A & B, you MUST enroll in Medicare Part D or pay an increasing penalty for the life of the program, unless you can prove that you have similar coverage through another source—employer, other insurance, etc.

Forty percent (40%) of Medicare beneficiaries live below 200% of the federal poverty level ($16,988 per individual and $21,430 per couple). Sixty-five percent (65%) have incomes below $25,000. In contrast, the average annual base salary of federal employees was $53,959 in 2001.

Average Daily Cost for Nursing Home Care by State, 2006

While the national average daily cost for private nursing home care is $194, the cost varies widely from state to state, according to the Genworth Financial 2006 Cost of Care Survey. The survey evaluated the daily cost of assistance in a nursing home for a person suffering from debilitating conditions, such as Parkinson's disease. It did not include costs for therapy, rehabilitation or medications. For Washington the rate is: $186 per day; Seattle is $236 per day.

Long-Term Care Insurance Provides Security For a Rainy Day. But Can You Afford It?
-- December 2006, The AARP Bulletin by Barbara Basler

Boomers who have helped a frail or sick parent search for a nursing home or hire a home care aide are learning hard lessons early: Long-term care is expensive—it can cost tens of thousands of dollars a year—and only those who are virtually impoverished qualify for government aid.

Those lessons are pointing a growing number of boomers toward long-term care insurance, an intriguing idea designed for this brave new world where many more Americans will live until they need help just to get up and dressed in the morning.

About 7 million people now have these policies. First sold as nursing home insurance in the 1970s, and purchased mainly by people in their 70s, long-term care policies today can cover a range of services, including extended care at home or in an adult day care center as well as in an assisted living residence or nursing facility. Some even cover home modifications. Benefits are usually triggered when a person cannot perform at least two key daily activities, such as bathing or dressing, or is cognitively impaired by Alzheimer's or another form of dementia.

This insurance can protect assets, help guarantee care and soothe anxieties. And recent surveys show boomers are buying it so they can control how they're cared for later in life, when they are at their most vulnerable.
The policies, however, are not for everyone. Many people simply cannot afford the kind of coverage they need to make a policy worthwhile.

The best long-term care policy has a reasonable deductible, covers a wide range of care options, guarantees a sufficient financial benefit and is buttressed by inflation protection. This kind of security doesn't come cheap: It could cost a 55-year-old $3,000 a year and a 65-year-old more than $5,000.

Long-term care insurance makes sense for those who earn good salaries, have accumulated assets they want to protect and have planned for a comfortable retirement. TheStreet.com Ratings says households with annual income of at least $50,000 to $75,000 and assets of $150,000—not including a car or house—might want to consider a policy. Financial planners typically recommend it for their clients, who tend to earn more.
Many experts say flatly that those who can't afford a good policy shouldn't buy one at all. The worst approach, they say, is to start with a solid, comprehensive policy and whittle it down to something affordable, tossing out expensive but critical provisions such as inflation protection.
Moreover, even those people who can afford a good policy while they're still working may not be able to pay the premiums in the future.

"When you think about these policies, focus on how affordable that premium will be when you're living on a fixed income," advises Robert Friedland of Georgetown University's Center on an Aging Society. "If you don't have a good retirement package, if you haven't been actively saving for retirement, then long-term care insurance is the least of your problems."

Long-term care insurance is complicated. Policies are extremely difficult to compare, so even savvy consumers should seek advice from a financial planner or trained insurance agent.
Recently the profile of who buys long-term care insurance has changed dramatically—from people in their 70s to those in their 50s and early 60s. "Today, two-thirds of all purchasers are still working," says Marc Cohen, president of LifePlans Inc., a Boston consulting and research company that gathers facts and figures for the insurance industry.

The trend could continue. More employers are offering policies, and some politicians are now pushing this kind of private insurance as a way to encourage people to secure their own future.
Congress recently passed legislation allowing states to set up "partnership programs" that permit residents who buy long-term care insurance to protect a portion of their assets if the benefits run out and they eventually qualify for Medicaid.

Twenty years ago, assisted living residences and adult day care centers didn't exist—and more changes are expected in the next 20 years. New technologies and fresh, innovative public policies could offer more options to all Americans.

Study Circle Two: Stakeholder Scenarios

2008-06-15T18:02:00.000-07:00

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Scenario #1 – Bob Martin, United Auto Worker member

Bob is age 29, a member of the United Auto Workers (UAW), and employed at U.S. Motors plant. His wife, Sally, is a homemaker and cares for their family of 5. He and Sally have 3 young children, ages 1, 3 and 6. Their 6 year old has had asthma since he was 2 and sometimes needs emergency room services during an asthma attack. Bob has an AA degree and has always worked in the metal trades. Sally finished high school, married Bob, and worked at Sears until their first child was born.

Bob’s hours have been cut to less than 40/week, with the possibility of his being moved to half-time employment sometime in 2008. At half-time hours, he would fall out of the generous health care benefits offered by U.S. Motors. He is considering whether to look for another job with benefits or count on the possibility that the UAW will successfully bargain for holding on to his current level of benefits that include medical, dental, and vision.

Scenario #2 – Max Anderson, Vietnam Veteran

Max is age 61, divorced, and lives in a rural area of Washington State. He has been a smoker since the age of 16 and has several chronic and increasingly serious medical conditions—heart disease and emphysema. He works part-time at a local “big box” store for minimum wage in order to supplement his income. He had intended to stay in the military until he was fully vested, but developed breathing problems ten years after his return from Vietnam and had to leave the military. He would like to take advantage of the services offered at the VA center in Seattle, but he tires easily and the 4-hour roundtrip ride in the VA van is getting more difficult.

He has filled out several forms to qualify him for programs offered at the VA, but so far he hasn’t heard anything. His friend who rides the van with him to Seattle told him that there is a huge backlog and that it could take up to a year before he can enroll in the specialized program.

Scenario #3 – Sarah Robbins, Chief Financial Officer, Large Coffee Company

Sarah is 48 years old, married with one child, age 9. Her husband works for an Internet company.
Sarah announced at a shareholders’ meeting that their coffee beans now cost less than providing employees with health insurance benefits. The company recently offered their plan to employees at their many locations in order to cut down on a costly high turnover rate, but few could afford the employee share of the monthly premium. The premiums for the three types of benefit plans they offer employees (HMO, PPO, or major medical only) have on average gone up by more than 12% over the past two years. They are faced with increasing health costs as well as meeting the demands of their customers for more expensive to buy coffee beans that are fair-traded, shade-grown, and organic.

Sarah is advocating for shifting more of the costs to employees by: either raising the employee contribution to family coverage; raising copays and putting in a deductible for all plans except the HMO (which has been losing members); and offering a Health Savings Account (HSA). Their consultant says the HSA is a great deal for the healthy, single people, but Sarah is worried that it hasn’t been around long enough to see if it is really an answer to their fiscal problem. And if the young people move into that plan, the premiums for older employees (about 34% of their workforce) may go up significantly (since they generally use more services). She is wondering why employers have to provide health care insurance at all and how to shift the country to another system.

Scenario #4 – Christy Greg, self-employed graphic artist

Christy is 41 years of age and was diagnosed with gestational diabetes during her pregnancy with her infant daughter. Christy worked for an advertising agency for many years, but wanted to be at home with the baby, rather than spend most of her salary on childcare. Christy earns about $29,000 a year and with her diabetes, is unable to find individual coverage that she can afford. She is considering joining an association or the local chamber of commerce that might offer members a way to purchase affordable health insurance. The local Chamber’s program was recently dropped by Aetna.

Currently, Christy is uninsured and paying out of pocket for the baby’s care. She found a community clinic in Seattle that will provide some care for the baby at a reduced price. She was told by a friend to wait before applying for her insurance, since she would have to check diabetes on the required and very detailed health history.

Christy’s same-sex partner is hoping that the small company (40 employees) where she works will offer dependent coverage for Christy and their daughter, but she is still waiting to hear.

Scenario #5 – Dr. Martha Middleton, Family Physician

Dr. Middleton is in her sixth year of private practice, has $160,000 of debt left to pay off from medical training. She works four days a week in a practice with a group of 5 other family physicians. They each earn @ $80,000/year. She has 1 child, age 3 at home with a nanny. Martha’s husband works in new construction, but since the housing market slump has been going farther away from home to find work.

She and her colleagues are assessing how many Medicare and Medicaid patients they can afford to carry on their books due to the low reimbursement rates for each category. With fewer family physicians willing to take Medicare patients in their community, they are under a great deal of personal and ethical pressure to see more of the elderly. In order to make the financial numbers work, they must see a maximum number of patients with private insurance each day in the shortest amount of time. The brevity of contact is counter to their original reasons for going into family practice—starting out with young families and seeing them into their old age. The number of staff needed to handle the billing and paper work has increased as well.

Dr. Middleton is politically active and wants to see as many uninsured patients as possible, but when she averages out the reimbursement, she often receives reimbursement that is 50% or less of cost. The doctors are also faced with the developing trend of patients wanting referrals to specialists for conditions that they feel they are more than qualified to treat. They believe that this is the result of insurance companies selling “no need for a referral to see a specialist” programs in order to attract members.

Scenario #6 - Ernie Smith, independent insurance agent

Ernie has been an insurance agent, working on his own, for twenty years and wants to retire within the next two years, at age 63. His doctor has told Ernie that he will need at least one hip replacement soon. He will have to hire a temporary worker to help him with the business while he recovers.

He sells all lines of insurance: life, health, property & casualty, long-term care, etc. but is wondering with the elections coming up how his health insurance business will fare. He works with ten insurance companies so that he can offer his clients choice. He specializes in small businesses and acknowledges that it is getting harder to find affordable plans for his clients.

One other change in Ernie’s business is the Internet. Many people now bank, shop, and sign up for all manner of insurance and other programs online. The “e-insurance” business, Ernie fears, might well put his personal, face-to-face livelihood in jeopardy. He worries that much of the advertising he sees on these Web sites is misleading, making the “fine print” even smaller.

While Ernie believes that everyone should have basic health care coverage, if the insurance companies were eliminated, his income of $85,000/year would take a significant hit. He is selling the HSA program to some of his clients, but feels compelled to tell them the downside as well as the affordable rates of the program. Experts are concerned that people will be moved to delay getting necessary care in order to keep the most money possible in their savings accounts.

Scenario #7 – Joyce Holmes, insurance claims department manager

Joyce has been working for a large for-profit insurance company for twenty-five years. She is 52 years old, divorced, and in good health. She has, however, sought relief from the stress of her job and is seeing a mental health counselor. With her son out of the house, this is the first time that she has been able to travel some and finally buy her dream house.

She began as a file clerk and over the years was promoted, most recently, to be the Manager of the claims department of more than fifty employees. She has taken industry courses in claims management, but has no professional medical training. The CEO of her company was fired by the board of directors and given a $1.2 million severance plus lifetime health benefits last year.

Joyce’s best friend is the secretary to the Chief Financial Officer and says that the company is joining several other large insurance companies to lobby against health care reform. They will be running ads in prime time and have doubled the number of lobbyists in Washington.

Joyce went with some people from work to see the movie Sicko! and was shocked to hear her colleagues call Michael Moore a liar. She has had to work with procedures developed by the finance department that set up many barriers and cumbersome appeals for the last ten years. She has been increasingly unhappy at work, feels like she is on the wrong side of what is right, but doesn’t know what else she could do for work that would pay her the kind of money she makes. She found well over 1 million “hits” on Google when she searched with the words: “claims health insurance issues.”

Scenario #8 – Josh Holmes, graduate student

Josh Holmes is Joyce Holmes’ son, age 22. He is in graduate school in a distant state, no longer eligible to be on her health insurance plan as a dependent, and doesn’t see the need for insurance.

His mother has offered to help pay for a minimal medical policy for him, but he says he’s healthy and doesn’t want her to spend the money. Josh would rather have help with his auto insurance payments since he had several accidents as a teen driver and his car insurance premium is very high. He won’t be eligible for a good driver reduction until age 25.

Scenario #9 – Andrew Vitale, retiree on Medicare

Andrew is age 70, lives on a small pension and Social Security. With his basic Medicare Part B deduction, a supplemental plan with AARP ($150.00 each month), and his Part D premium ($78 each month), he is spending nearly all of his income on rent, food, transportation and insurance.

Andrew’s mother is 93 and lives with his sister, but will soon need to be moved to a facility due to advancing Alzheimer’s and a heart condition. His visits to help out his sister and see his mother are getting to be too hard, given the 400 miles that separate them. He would move closer, but his sister lives in the city where rents are high and food is more expensive.

Andrew came to the U.S. as a young boy, worked in the garment industry until his retirement. He has a great deal of difficulty figuring out the bulletins and books that the government sends him, especially about Medicare programs. He would like to get help for himself and his mother, but doesn’t know who to ask that he could trust or that could explain it to him “in plain English.” He has always paid his bills on time and never taken a handout from anyone, even when his company moved the business overseas. He has always saved for a rainy day, but worries that if something happened to him, he would go through all his savings and have to go on “welfare.”

Scenario #10 – Representative James Timmons, (R-WA) elected to Congress in 1990

Representative Timmons is a lawyer by profession until he ran for his district’s House seat, defeating a Democratic incumbent who proposed health care reform and changing some tax programs in order to support expanding universal coverage. He has met the “time in” requirement in order to receive full retirement and healthcare benefits as one of the 8 million federal employees.

Rep. Timmons has recently begun to dread going home to his district and hearing the desperate straits of some of his constituents who can’t afford health insurance. He is also aware that the bankruptcy rate in his district has increased by 12% in the last three years due to medical bills. He can’t see a way to expand Medicare to everyone without bankrupting the whole system given the surge of baby boomers coming into the program.

He is fiscally conservative and would like to solve the health care crisis in an American way, rather than adapt some other country’s system like Canada.
Rep. Timmons has more of an insider’s view of the health care crisis than some of his colleagues. His son is an emergency room physician and was furious when he heard President Bush say that anyone can go to the emergency room, thereby giving all Americans access to care.

Scenario #11 – Emily Webb, Single uninsured mother with a child in the SCHIP program

Emily is 29 years old; her son, Billy, is age 7. They live in federally subsidized housing, receive food stamps, and Billy is currently enrolled in the State Child Health Insurance Program (SCHIP). Recent changes to the criteria may put his participation in jeopardy.

Billy is currently receiving services for a learning disability and neurological problems as a result of spiking fevers he had as an infant. He takes several expensive prescription drugs.

Emily is in a welfare-to-work program, studying to be a dental technician. She has only six months to go before has her certificate and can work under supervision in a nearby dental office. She will not qualify for medical benefits until she’s been there six months and is worried that with her success in the work world, she will be giving up supportive programs, like SCHIP, that have made all the difference to her and Billy.

Emily does not currently have insurance and is still making payments to the hospital for Billy’s five-day stay in the Intensive Care Unit shortly after he was born. She has worked with a credit counselor in order to stop the calls from the collection agencies that the hospital and doctors engaged. Until she found SCHIP, she and Billy both used the emergency room as their primary source of medical services. An emergency room doctor referred Emily to a pharmaceutical “mercy” program.

Scenario #10 – Representative James Timmons, (R-WA) elected to Congress in 1990

2008-06-15T17:58:00.000-07:00

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Representative Timmons is a lawyer by profession until he ran for his district’s House seat, defeating a Democratic incumbent who proposed health care reform and changing some tax programs in order to support expanding universal coverage. He has met the “time in” requirement in order to receive full retirement and healthcare benefits as one of the 8 million federal employees.

Rep. Timmons has recently begun to dread going home to his district and hearing the desperate straits of some of his constituents who can’t afford health insurance. He is also aware that the bankruptcy rate in his district has increased by 12% in the last three years due to medical bills. He can’t see a way to expand Medicare to everyone without bankrupting the whole system given the surge of baby boomers coming into the program. He is fiscally conservative and would like to solve the health care crisis in an American way, rather than adapt some other country’s system like Canada.

Rep. Timmons has more of an insider’s view of the health care crisis than some of his colleagues. His son is an emergency room physician and was furious when he heard President Bush say that anyone can go to the emergency room, thereby giving all Americans access to care.

Federal Employees Benefits

Federal Employees & Elected Officials – Senators, Representatives

Federal Employees Health Benefits Program (FEHB)

Provides health insurance benefits to about 8 million Federal enrollees and dependents.
Members of Congress receive retirement and health benefits under the same plans available to other federal employees. They become vested after five years of full participation.
About 70% of FEHBP participants were enrolled in fee-for-service plans in 2002. The three largest plans, all fee-for-service, account for almost two-thirds of FEHBP enrollees. The Blue Cross Blue Shield standard option plan alone accounts for nearly half of all FEHBP enrollment.
Many HMOs have terminated their participation in FEHBP. In 2002, federal workers in 11 states had no choice of an HMO. The number of HMOs participating in FEHBP declined from 276 in 2000 to 170 in 2002.

Federal Employees to See Moderate Rise in Health Insurance Premiums

Health insurance premiums for federal employees and retirees will increase by an average of 2.1 percent next year, the Office of Personnel Management announced this afternoon.

Officials said they held down the rate increase, which is substantially lower than what most other workers will be asked to pay in 2008, by dipping into excess financial reserves of the Federal Employees Health Benefits Program, which provides about $35 billion in health-care benefits annually.

The decision to tap the reserves provides federal employees with their second break in a row on premiums. This year's average premium was only 1.6 percent, on average, the lowest annual increase in the employee program since 1997.

The federal program will offer 283 plans next year and will provide insurance coverage to about 8 million Americans: civil service and postal workers, retirees, and family members. The government picks up about 70 percent of premium costs in its role as employer.

Next year, individuals will pay an average of $1.58 more per two-week pay period, and families will pay $4.11 more biweekly, officials said.

About 60 percent of the federal program's enrollees are in two plans provided by the Blue Cross and Blue Shield Association, and Blue Cross enrollees will see an increase in their share of the premium.

Enrollees in the Blue Cross standard option will pay $62.15 biweekly, $4.85 more than this year. Families covered by the standard option will pay $145.14 biweekly, or $10.84 more.

The Blue Cross basic option, which requires enrollees to stay in the Blue network, will raise premiums after three years of no rate increases. The enrollee cost will be $39.13 for individuals, up $1.14, and $91.66, up $2.67, for families on a biweekly basis.

The use of the cash reserves brought down next year's premium by 3 percentage points, officials said. The use of the program's reserves reduces rate increases next year for national, fee-for-service plans, which are required to set aside money for contingencies. The program's health maintenance organizations do not build up reserves because they operate on fixed-price contracts each year, according to officials.

The use of the financial reserves to lower this year's and next year's rates has worked to the advantage of federal employees. The average cost of private-sector, employer-provided health insurance rose 6.1 percent this year, according to a survey released this week by the Henry J. Kaiser Family Foundation.

Mercer Health & Benefits, a part of the global consulting company, projects that private-sector premiums in 2008 will increase by 6.7 percent, based on a survey of 1,557 employer plans.The California Public Employees' Retirement System, which covers 1.2 million state and local government employees and retirees, has approved a 6.3 percent premium increase for 2008.

-- By Stephen Barr Washington Post Staff Writer
Thursday, September 13, 2007; 4:20 PM

Scenario #11 – Emily Webb, Single uninsured mother with a child in the SCHIP program

2008-06-15T17:51:00.000-07:00

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Emily is 29 years old; her son, Billy, is age 7. They live in federally subsidized housing, receive food stamps, and Billy is currently enrolled in the State Child Health Insurance Program (SCHIP). Recent changes to the criteria may put his participation in jeopardy.

Billy is currently receiving services for a learning disability and neurological problems as a result of spiking fevers he had as an infant. He takes several expensive prescription drugs.

Emily is in a welfare-to-work program, studying to be a dental technician. She has only six months to go before has her certificate and can work under supervision in a nearby dental office. She will not qualify for medical benefits until she’s been there six months and is worried that with her success in the work world, she will be giving up supportive programs, like SCHIP, that have made all the difference to her and Billy.

Emily does not currently have insurance and is still making payments to the hospital for Billy’s five-day stay in the Intensive Care Unit shortly after he was born. She has worked with a credit counselor in order to stop the calls from the collection agencies that the hospital and doctors engaged. Until she found SCHIP, she and Billy both used the emergency room as their primary source of medical services. An emergency room doctor referred Emily to a pharmaceutical “mercy” program.

Washington State SCHIP Program

Infants through teenagers can receive free or low-cost health insurance. Many families in Washington State qualify and don't know it. The programs are flexible and cover kids in many types of households:

Kids with single parents
Kids with working parents
Kids living with grandparents, other family or friends
Kids with two parents
Young adults (under 19) living on their own
Non-citizen kids
Kids with pre-existing medical conditions

Qualifying income standards Income levels are effective 4/1/07 through 3/31/08. If your monthly family income is close to the amounts on the chart, your kids may qualify for free or low-cost health insurance. Even if your income is above these amounts, we still encourage you to call 1-877-KIDS-NOW.

Don't Think Of A Sick Child

President Bush wants to leave American families to the mercy of profit-run healthcare -- a practical and moral failure. By George Lakoff and Glenn W. Smith (Oct. 20, 2007)

George W. Bush doesn't want you to think of a sick child. He wants you straining your eyes on the fine print of policies, puzzling over the nuances of coverage -- whether you can afford premiums for basic, catastrophic, comprehensive or limited health insurance. Last week on "Real Time With Bill Maher," even Tucker Carlson kind of got it right, saying, "No one child is a metaphor -- he's a kid!" That's the point. They're all kids, each one, one by one. The question is, do you care?

The actuaries don't. And can't. Health insurance companies make their money by denying care. They maximize profit by authorizing as little care as they can get away with. That's what all those administrative costs -- as high as 30 percent -- and all that paperwork are mostly about. It takes a lot of people to justify denying care.

It's the opposite of the way the market is supposed to work: Make more money by delivering more product. The health insurance industry makes more money by delivering less product. It maximizes profits by minimizing care.

Profit-run medicine is not, and cannot be, full care. What is needed is patient- and doctor-run medicine. The State Children's Health Insurance Program (SCHIP) is just that. Our children need care. Our doctors provide it. The government handles the transactions, period. And we pay a lot less and get a lot more, because there are virtually no administrative costs and no profits being taken by outsiders.

Profit-maximizing insurance, as opposed to doctor-provided care, forces the nation to choose among its children: who will get care and who won't, who will suffer and who won't, who will live and who will die.
Bush and his conservative allies don't want us to see sick children, just as they don't want us to see those bodies in bags coming back from Iraq. They're in the habit of sweeping our human casualties under the rug.

But Americans are a compassionate people. We do care about sick children. We do care about our dead and wounded vets and their families. We do care about victims of Hurricane Katrina. Empathy and compassion are what this country is about. America is about caring for one another, about being in the same boat, about being a national family. It is not about profiting from someone else's suffering, especially if that someone else is a child.

Government in America has a sacred moral mission to protect us, its citizens. Protection means more than the military and the police. It means worker protection, consumer protection, environmental protection and Social Security. And it means health security.

President Bush warns us against "government-run" healthcare, which is anything but government run. In SCHIP, the government doesn't deliver care, it enables it. It directs payments. Bush wants to leave the nation's children -- and the rest of us -- to the mercy of profit-run healthcare. The reason we need SCHIP is that profit-run healthcare has failed.

When children in your family fall sick, you don't look away. You make sure they are cared for and get better. That's the way the American family should also work.

-- George Lakoff and Glenn W. Smith are senior fellows at the Rockridge Institute in Berkeley, Calif.

Scenario #1 – Bob Martin, United Auto Worker member

2008-06-15T17:45:00.000-07:00

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Bob is age 29, a member of the United Auto Workers (UAW), and employed at U.S. Motors plant. His wife, Sally, is a homemaker and cares for their family of 5. He and Sally have 3 young children, ages 1, 3 and 6. Their 6 year old has had asthma since he was 2 and sometimes needs emergency room services during an asthma attack. Bob has an AA degree and has always worked in the metal trades. Sally finished high school, married Bob, and worked at Sear’s until their first child was born.

Bob’s hours have been cut to less than 40/week, with the possibility of his being moved to half-time employment sometime in 2008. At half-time hours, he would fall out of the generous health care benefits offered by U.S. Motors. He is considering whether to look for another job with benefits or count on the possibility that the UAW will successfully bargain for holding on to his current level of benefits that include medical, dental, and vision.

U.S. Health Care and the Cost of a Car
Canadian Econometrics report (July 2005)

The auto industry spends more on employee health care than it does on steel—health care adds $1500 US to the cost of a car [as of 2005]. General Motors was once a powerhouse of U.S. industry. Now, while still a major producer and employer, GM's losing money hand over fist and has had its bonds downrated to junk status. USA Today looked into the details of GM's health insurance plan not too long ago. The American auto industry is one of the last bastions of generous benefits that were once part of many employers' largess: fully paid health insurance, retiree medical coverage and pensions.

At a time when the average American company requires workers to pay more than $2,000 a year toward family health insurance premiums, the auto industry is among the 4% of employers that offer free family health coverage. Retirees, who outnumber workers by more than 2-to-1 at General Motors and represent significant percentages at the other major U.S. automakers, get the same deal.

Unionized autoworkers can choose plans for which they pay nothing toward monthly premiums. Nationally, workers pay an average of 16% of the premium toward single coverage and 28% of the premium for family policies, a Kaiser Family Foundation survey of employers shows. That's an average of $558 a year for single employees and $2,661 for families.

Nationally, only 36% of large firms offered retiree health benefits in 2004, down from 66% in 1988, the Kaiser survey shows. Outside the auto industry, retirees who do get insurance coverage pay an average of $187 a month toward it, says Brian Johnson, senior research analyst at Sanford Bernstein. Writing in a June 10 Bernstein Research Call report, he says GM alone could save $1.4 billion in cash annually if it began charging retirees $150 a month toward their health costs.

________________________________________

Not bad coverage, is it? That bit at the end about forcing retirees to pay a premium - normally that kind of suggestion is denounced as an attack on the elderly, but does anyone doubt that GM also has a pretty generous pension plan?

Those retirees account for a pretty hefty chunk of GM's health care costs. According to conservative columnist George Will:

Health care for retirees and their families -- there are 2.6 of them for every active worker -- is 69 percent of GM's health costs. GM says it has $19.8 billion in cash and normal mortality rates will reduce the ratio of retirees to active workers.

Shifting health-care costs doesn't exactly lower them

Today's Topic: Health-care hunt is hard work
The Tennessean.com Monday, 12/17/07

Our View
Most Americans weren't affected by union settlements with U.S. automakers this year, but it behooves the nation to watch how those settlements work out because the situations are perfect examples of how health-care costs are crippling the country.

General Motors, Ford and Chrysler — facing fierce competition from foreign competitors — found themselves crumbling under the expense of providing health-care benefits. The United Auto Workers, put in a corner to keep jobs afloat, took on the enormous responsibility of handling retiree health-care benefits. The deal lifted a heavy weight off the struggling companies, who agreed to contribute billions of dollars to special trust funds for the care, and it probably saved a lot of jobs, but it also plopped that burden smack on the back of the union to handle those funds. No one else has been able to solve the problem of managing health-care costs. It will be interesting to see if the unions' trustees can administer the plans effectively, because their odds don't look good.

The trusts are known formally as Voluntary Employees Beneficiary Associations, or VEBAs, which are provided under the Internal Revenue Service Code section 501(c)(9). They are not new, having existed since 1928, but their application in the current financial climate is a significant development. It is doubtful VEBAs will save the day on health care, so it's a good idea for the country to look for bigger, better alternatives.
The union agreements with automakers are vivid examples of what is probably the most difficult issue for American families today — the ability to afford health insurance. And bear in mind that's just affording insurance, not health care itself, which no one can afford, unless they're Bill Gates. The outrageous cost of health care is bringing huge companies to their knees. The issue should no longer be whether anyone can find solutions to those costs but about how long this country is going to put up with them.

One proposal put forward has been to allow employers and unions to buy into Medicare for early retirees age 55-64. The logic is that the administrative costs in Medicare are far lower than the administrative costs of insurance companies, which only compound the current problem because insurance companies have their own profit motives. This would put those retirees into a single-payer health-care system, which of course would cause volcanic eruptions in some circles because it would be a "step toward socialized medicine."
The single-payer system known as Medicare works. Moreover, people seem to like Medicare. If buying into Medicare before age 65 is a way to help solve the crisis hurting workers and employers, who could complain? It's worth considering.

For now, the country is left to deal with unreasonable costs and to watch valiant efforts like a last gasp from a labor union on how to handle health care. But this much should be certain: If a labor union is able to show everyone the way and manage costs under the current health-care system in this country, that union will go down as one of the biggest heroes in American history.

UAW's Retiree Health Benefits Takeover
Could Change Way Care is Delivered
(Nov 29, 2007 –The Canadian Press)

DETROIT - On Sept. 26, something happened that is likely to wreck Ben Carter's time-honoured health care business model.

That's the day the United Auto Workers and General Motors Corp. settled on a revolutionary new contract that shifts US$46.7 billion worth of retiree health care costs from the company to the union.
As chief operating officer of the Detroit Medical Center, Carter sees the deal as a major change in the way health care is priced and delivered. He and others see it as a catalyst for change in a business that costs employers millions and rises in price by double the rate of inflation almost every year.

"We're viewing it as an opportunity to work with the union leadership and their retired members to design a better mousetrap that keeps them healthier, have a better standard of living and reduces the cost of providing that," Carter said.

The UAW worked similar deals this year with Ford Motor Co. and Chrysler LLC, turning the labour union into one of the largest health care consumers in the United States.

In early 2010, the union will become responsible for the health care bills of 540,000 retirees and their spouses, a population equal to that of Portland, Ore.

The numbers give the UAW bulk buying power and enough clout to bring costs down, according to some experts. Retirees, now on the same team as the entity paying their bills, will have incentives to live healthier and limit their health-care use. Some observers also say the move will lead the union to step up its lobbying efforts for a national health-care system.

If the union is successful in its cost-cutting efforts, those reforms likely would spread to companies and other health-care consumers similar to the way health maintenance organizations led to cost cuts decades ago, said J.B. Silvers, professor of health systems management at Case Western Reserve University in Cleveland.
"If they come up with better models for how to provide health care, that will diffuse across the system probably pretty fast," he said. "In that sense, everybody's going to benefit."

Scenario #2 – Max Anderson, Vietnam Veteran

2008-06-15T17:40:00.000-07:00

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Max is age 61, divorced, and lives in a rural area of Washington State. He has been a smoker since the age of 16 and has several chronic and increasingly serious medical conditions—heart disease and emphysema. He works part-time at a local “big box” store for minimum wage in order to supplement his income.

He had intended to stay in the military until he was fully vested, but developed breathing problems ten years after his return from Vietnam and had to leave the military. He would like to take advantage of the services offered at the VA center in Seattle, but he tires easily and the 4-hour roundtrip ride in the VA van is getting more difficult.

He has filled out several forms to qualify him for programs offered at the VA, but so far he hasn’t heard anything. His friend who rides the van with him to Seattle told him that there is a huge backlog and that it could take up to a year before he can enroll in the specialized program.

Military Benefits

VA provides a Medical Benefits Package, a standard enhanced health benefits plan available to all enrolled veterans. This plan emphasizes preventive and primary care, and offers a full range of outpatient and inpatient services within VA health care system.

VA maintains an annual enrollment system to manage the provision of quality hospital and outpatient medical care and treatment to all enrolled veterans. A priority system ensures that veterans with service-connected disabilities and those below the low-income threshold can be enrolled in VA’s health care system. VA enrollment allows health care benefits to become portable throughout the entire VA system.

All veterans are potentially eligible. Eligibility for most veterans’ health care benefits is based solely on active military service in the Army, Navy, Air Force, Marines, or Coast Guard (or Merchant Marines during WW II), and discharged under other than dishonorable conditions.

Reservists and National Guard members who were called to active duty by a Federal Executive Order may qualify for VA health care benefits. Returning service members, including Reservists and National Guard members who served on active duty in a theater of combat operations have special eligibility for hospital care, medical services, and nursing home care for two years following discharge from active duty.

There is no monthly premium required to use VA care. You may, however, have to agree to pay copays. If you have insurance, it may cover the cost of copays. The military’s Tricare health care system uses a combination of military hospitals, clinics and civilian professionals to treat service members, reservists, retirees and their families.

Active-duty members have priority, which may limit access for military families and retirees and force many to go to civilian hospitals and health providers. Those eligible for Tricare include family members of active-duty personnel; retirees and their families; some former military spouses; certain survivors; and Medal of Honor recipients and their immediate families.

Three basic health care plans are available under Tricare: Tricare Prime, Tricare Standard and Tricare Extra. An individual can pay less by using a restricted network of military and civilian doctors under Prime or Extra, or pay more for a wider choice of providers under Standard.

The three plans are available in the U.S., but not in every U.S. location. All three have a cap on how much a family pays out of pocket each fiscal year, depending on the sponsor’s duty status and the type of Tricare program used.

Through Tricare for Life, Tricare medical benefits extend to military retirees over age 65 who are eligible for Medicare Part A, provided they buy Medicare Part B outpatient insurance.

Service members who leave the military before retirement can enroll in the Continued Health Care Benefit Program to bridge the gap between separation from service and obtaining health insurance through a civilian employer.

Outpatient care at military facilities is free, with minimal charges for inpatient care. Treatment in civilian facilities generally means more out-of-pocket expenses. An exception is for active-duty dependents in Prime; they do not have to pay for civilian care if they get it through the Prime program.
Source and Information Resource: www.armytimes.com

Veterans health care costs around $650 billion
Veterans' health care costs could exceed war costs

SEATTLE - Senator Patty Murray and a group of doctors released a new report Thursday that estimates health care costs for our returning soldiers at $650 billion.

The Physicians for Social Responsibility, an anti-war group, put together the report. One of the researchers is a University of Washington psychiatrist who has worked extensively with injured soldiers.

Murray plans on using the report's data to re-ignite the debate on how much money should be spent to take care of injured vets in Seattle and around the country.
"This report should serve as a wake up for Americans and this administration. While we endlessly debate what we are gaining in Iraq, hundreds of thousands of soldiers and their families are falling victim to death, post-war trauma and lifelong struggles with mental and physical wounds as a legacy of this war. The U.S. needs to bring its troops home now,” said Dr. Evan Kanter, author of the report.

The data from the heavily cited new report written by the group of physicians also says Post Traumatic Stress Disorder among returning soldiers is high, perhaps around 20 percent. Iraq war vets are more likely to suffer from serious mental health problems such as depression or anxiety attacks, and is more likely to have a substance abuse disorder.

Murray claims the data shows the need for increasing veterans' health funding, which is the subject of heavy debate right now on Capitol Hill in Washington, D.C.
The current VA funding bill that is before a Senate subcommittee puts the total budget for next year's VA funding around the $87 billion range.

Troops returning home after serving overseas are also among those most at risk of becoming homeless. According to a new report, veterans make up 25 percent of the entire homeless population. The Veterans Department says at least 1,500 are homeless veterans from the wars in Iraq and Afghanistan.

-- CHRIS DANIELS / KING 5 News and KING5.com
Staff Report, Thursday, November 8, 2007

Scenario #3 – Sarah Robbins, CFO, Large Coffee Company

2008-06-15T17:34:00.000-07:00

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Sarah is 48 years old, married with one child, age 9. Her husband works for an Internet company.

Sarah announced at a shareholders’ meeting that their coffee beans now cost less than providing employees with health insurance benefits. The company recently offered their plan to employees at their many locations in order to cut down on a costly high turnover rate, but few could afford the employee share of the monthly premium.

The premiums for the three types of benefit plans they offer employees (HMO, PPO, or major medical only) have on average gone up by more than 12% over the past two years. They are faced with increasing health costs as well as meeting the demands of their customers for more expensive to buy coffee beans that are fair-traded, shade-grown, and organic.

Sarah is advocating for shifting more of the costs to employees by: either raising the employee contribution to family coverage; raising copays and putting in a deductible for all plans except the HMO (which has been losing members); and offering a Health Savings Account (HSA). Their consultant says the HSA is a great deal for the healthy, single people, but Sarah is worried that it hasn’t been around long enough to see if it is really an answer to their fiscal problem. And if the young people move into that plan, the premiums for older employees (about 34% of their workforce) may go up significantly (since they generally use more services). She is wondering why employers have to provide health care insurance at all and how to shift the country to another system.

Employer Provided Insurance Systems
Most private health coverage in the U.S. is employment based, and the employer typically makes a substantial contribution towards the cost of coverage. According to the Centers for Medicare and Medicaid Services, nearly 100% of large firms offer health insurance to their employees.

Costs for employer-paid health insurance are rising rapidly: since 2001, premiums for family coverage have increased 78%, while wages have risen 19% and inflation has risen 17%, according to a 2007 study by the Kaiser Family Foundation.

However, in a 2007 analysis, the Employee Benefits Research Institute concluded that the availability of employment-based health benefits for active workers in the U.S. is stable. The "take-up rate," or percentage of eligible workers participating in employer-sponsored plans, is falling. The percentage of workers actually covered has fallen somewhat, but not sharply. EBRI interviewed employers for the study, and found that others might follow if a major employer discontinued health benefits. Public policy changes could also result in a reduction in employer support for employment-based health benefits.

Although much more likely to offer retiree health benefits than small firms, the percentage of large firms offering these benefits fell from 66% in 1988 to 34% in 2002.

Employer-provided Insurance Continues to Decline
by Julie Appleby, USA TODAY

The percentage of people with health insurance through their employers — traditionally the way most people get coverage — is continuing to shrink, raising anxiety among workers and invigorating a debate about whether insurance should be tied to jobs.

Many of those who get their coverage through their jobs are becoming less secure that those benefits will always be there.

"It's going to disappear," says Angela Ruggiero of North Port, Fla., who lost her insurance when she and her husband changed jobs. "There's no way employers can continue to pay premiums if they continue increasing."

Her concern is reflected in the ongoing discussions among policymakers, politicians and some business leaders over whether to alter the link between employment and insurance. Several ideas have been floated, including a range of proposals in Congress.

The measures can be lumped into differing philosophies about the direction the USA should move: either toward a health insurance market in which people buy policies on their own while armed with tax credits or deductions, or one in which people are able to buy insurance through group-like "exchanges," with some government oversight. Some of the plans likely would encourage employers to drop coverage because the employers would lose all or part of their ability to write off insurance as a business expense.
Federal legislation is unlikely this year. But the chatter about fundamental changes in health insurance comes as a declining percentage of employers are offering coverage. That's fueling concern among consumers such as Ruggiero who say the system isn't working and is poised to leave rising numbers of people — particularly those with health problems — struggling to get insurance:

•The percentage of all employers offering health insurance in the past eight years peaked in 2000 at 69% and has fallen steadily since, hitting 60% this year, according to an annual survey of employers by the non-partisan Kaiser Family Foundation. Among small firms of three to nine workers, the percentage offering insurance has dropped even more — from 58% in 2001 to 45% this year.

•From 2001 to 2005, the number of uninsured U.S. workers rose by 3.4 million. Almost 19 million workers — 17% of all employees — were uninsured in 2005, according to the Kaiser Commission on Medicaid and the Uninsured.

"I don't think people realize" how easy it is to become uninsured, says Ruggiero, 41, who says she used to think "the only uninsured Americans were the homeless."
Three years ago, she and her husband, John, left jobs with health benefits in New York to move to Florida to strike out on their own: John as a real estate agent and Angela as an office manager for an financial planner. Neither job came with health insurance.

Then they learned how difficult it is to buy health insurance outside of employment, mainly because they both had some minor health conditions. They were hopeful about an "open enrollment" period allowed each year under Florida law. During that time, insurers must offer coverage to sole proprietors and may not exclude those with medical problems.

But for the Ruggieros, the cost of coverage was out of the question: $1,500 a month to cover the couple and their 11-year-old son, Jared. So they remained uninsured until last January. When the real estate market tanked, John took a job as a package handler for a shipping firm, a position he still holds part time because it provides his family with health insurance.

Eventually, John quit real estate sales and took another full-time job in a warehouse. The warehouse job offers health insurance, but his share of the monthly premiums would have been $300, or about 10% of his income, so he declined. Insurance from his part-time job doesn't cost anything out of his paycheck. "It's a lot of juggling," says Angela Ruggiero.

Paying more for coverage
Among people with health insurance, the Census reports that 59.7% got it through their jobs in 2006, down from 60.2% in 2005. And they're paying more for it. The average amount workers pay toward the premium for a typical family policy rose from $129 a month in 1999 (about $160 in today's dollars) to $273 this year, a jump of 70% when adjusted for inflation, the Kaiser survey of employers shows.

The increases come mainly because premiums have soared, rising at several times the rate of inflation in most years. In many cases, cost-cutting employers have increased the share of the premiums that workers pay.

For years, Lyle Kenaga, president of Business Cards Tomorrow in Nashville, paid 100% of the premiums for his 15-employee firm. But two years of 20% rate increases from his insurer forced him to reduce the amount his company pays toward coverage. This year, the firm pays 70% of the premium cost; workers pick up the rest. If huge increases in premiums continue, "We'll have to consider whether or not to continue providing coverage," he says.

Premiums continue to go up, although the rate of increase has slowed in the past couple of years. This year, the average increase faced by employers was 6.1%, according to the Kaiser survey, well below the recent peak increase of 13.9% in 2003.
Such premium increases weigh heaviest on lower-income workers. For example, a household earning $40,000 this year would have to pay 8% of its pretax income to cover the average share paid by workers — $3,281 — for a typical family policy offered by employers, which this year cost $12,106. That doesn't include deductibles and co-payments that those with coverage must pay.

"People should be nervous," says Len Nichols, an economist at the Washington think tank New America Foundation. "People aren't so afraid of losing their jobs as (of) not being able to afford health insurance even with a good job," he says.

Looking for answers
Many large employers are uncomfortable with the growing cost of health insurance, but few want to get out of offering coverage entirely.

"They see it as a way to compete for skilled workers, and they do sense that they have a compact with the employee not to walk away from it," says Robert Laszewski, president of Health Policy and Strategy Associates, a consulting firm that works with insurers and other health care clients.

Many small employers also say they want to continue offering benefits.
"I can't imagine not offering insurance," says Diane Dearing, owner of Display Structures in Troy, Mich.

Because of rising costs, Dearing had to change insurers this year — and put more than half of her 20 employees into an HMO, which has a specific list of doctors and hospitals that it covers, rather than a more expensive preferred-provider organization with a wider choice of doctors. Her workers pay 25% of the premium.
"It's a huge expense," Dearing says. "But even if I had to go to something like a high-deductible major medical plan, if we're in business and making anything at all, we will still provide insurance."

The idea of separating insurance from employment has been raised before. "Even in the height of a strong economy, people were talking about it," says Paul Fronstin of the Employee Benefit Research Institute, which published a book in 1999 called Severing the Link Between Health Insurance and Employment.

"Now it's taking on a new life." Among other things, critics of the current system say it grants tax breaks to corporations that offer coverage, and tax-free benefits to the workers who get coverage.

At the same time, low-wage workers who don't get insurance through their jobs not only don't have coverage, but also don't get the tax break. "The employer-based system is fundamentally unjust," says Guy Clifton, a professor of neurosurgery at the University of Texas Health Science Center in Houston who is in Washington as a Robert Wood Johnson health policy fellow.

Proposals to modify the health insurance system — or sever it from employment — are gaining currency across the political spectrum, from presidential candidates to Congress to business groups.

Some of the proposals now under debate would encourage people — armed with tax credits or deductions — to buy their own insurance on the private market, but would not require anyone to buy it or insurers to sell to all who apply.

Other proposals would require all individuals to have coverage and would create "exchanges" in which groups of residents and employees could buy health insurance, regardless of where or if they work. Insurers would be required to sell policies even to applicants with health problems.

In Congress, a bipartisan bill — unusual for a health-reform effort — has been proposed by Sens. Ron Wyden, D-Ore., and Bob Bennett, R-Utah. It would have employers drop coverage and give workers raises, then create exchanges that would allow everyone to buy insurance.

Even the president of the Service Employees International Union, Andrew Stern, has said that employer-based coverage is dead and an alternative should be found.
"It's a terrible idea to rely on the individual market as it's presently constituted," says Jacob Hacker, professor of political science at Yale, mainly because those with medical conditions find it difficult to get coverage and insurers fear that people wait until they know they need health care to buy it.

Sara Horowitz, founder and director of the Freelancers Union — whose members are independent workers in finance, non-profits, domestic services, publishing, advertising and health care — says something needs to change, because the working world has. "The nature of work is changing: Jobs are much more short-term and flexible," Horowitz says. "That's why we need to think about new kinds of models … and start building a portable benefits network."

Change is not likely soon, however. Efforts to revamp health insurance have begun in a few states — including Massachusetts, Vermont and Maine — but no big changes will occur nationally until well after the November 2008 election. And although it's eroding, employer coverage isn't going to end suddenly.

"Employer coverage won't go away overnight, unless there's a major change to federal legislation that oversees health insurance," says the employee benefit institute's Fronstin. "Employers don't have to offer it, but they see a business case for offering it, and they don't (currently ) see a viable alternative."

Scenario 4 – Christy Greg, self-employed graphic artist

2008-06-15T17:30:00.000-07:00

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Christy is 41 years of age and was diagnosed with gestational diabetes during her pregnancy with her infant daughter. Christy worked for an advertising agency for many years, but wanted to be at home with the baby, rather than spend most of her salary on childcare.

Christy earns about $29,000 a year and with her diabetes, is unable to find individual coverage that she can afford. She is considering joining an association or the local chamber of commerce that might offer members a way to purchase affordable health insurance. The local Chamber’s program was recently dropped by Aetna.

Currently, Christy is uninsured and paying out of pocket for the baby’s care. She found a community clinic in Seattle that will provide some care for the baby at a reduced price. She was told by a friend to wait before applying for her insurance, since she would have to check diabetes on the required and very detailed health history.

Christy’s same-sex partner is hoping that the small company (40 employees) where she works will offer dependent coverage for Christy and their daughter, but she is still waiting to hear.

How To Find The Best Deal On Health Insurance
by Maureen Farrell, 12.07.07 (Forbes.com – Magazine article)

The numbers are enough to scare you sick. Some 60% of companies now offer health benefits, down from 69% in 2000, according to the 2007 annual health benefits survey from the Kaiser Family Foundation. Small businesses are even less generous: Just 45% of companies with three to nine workers offer health benefits. Total number of uninsured Americans: roughly 47 million, or 16% of the U.S. population.

Buying insurance as an "individual" is nothing less than a nightmare. For starters, employees of firms that offer health insurance can use pretax dollars to purchase it; individuals can't (at least not yet). Worse, individual buyers are entitled to fewer protections than employees of large firms. In most states, insurance carriers can deny coverage to individuals with a preexisting condition like cancer or diabetes. And for the fortunate few who can afford to buy insurance on their own, there's a labyrinth of options and loopholes to navigate when choosing a policy.

But make no mistake: Traversing this territory is worth the effort. The consequences of choosing the wrong policy at the wrong price are just too large.

Good data on the individual health-care market are fragmented at best. A 2004 survey by America's Health Insurance Plans, a trade group of health-benefit providers, pegged the average premium cost at $2,268 for a single person, and $4,424 for a family of three.

To put those figures in context: The median income in the U.S. that year was $44,389--or around $38,000 after taxes. Assuming that the median income of individual health-insurance buyers was roughly the same as the median income of those covered by employer-based plans, health-insurance premiums for individual-insurance buyers gobbled between 6% and 12% of after-tax household income. Big money.

And that's just the premiums. Health-care costs also include payments to cover deductibles (the amount you pay for treatment before the insurance kicks in) and co-payments to doctors and hospitals--meaning that the overall health bill takes an even bigger bite out of household income. For people buying insurance in the individual market, these additional out-of-pocket costs tend to run higher than for those covered under employer plans, says Kevin Lucia, assistant professor at Georgetown University's Health Policy Institute.
A big reason for the discrepancy between the individual market and the employer-based market: Insurers figure there's adverse selection in the individual market. People are more likely to buy health insurance when they're sick, or think they will get sick, and that makes them a higher risk.

In many cases, individual insurance buyers don't have any options--expensive or otherwise. Under the Health Insurance Portability and Accountability Act of 1996, employer-sponsored health plans can't discriminate against employees with pre-existing conditions; by contrast, the individual health-insurance market follows state laws, which generally offer fewer protections.

In 45 states, individuals can be denied coverage by insurers due to previous health problems. (New York, Maine, Vermont, New Jersey and Massachusetts are the exceptions; a few other states are forced to provide insurance for "unhealthy individuals" but the rates, not surprisingly, are steep.) If insurers do offer a policy, many can choose to "rider out" any medical costs related to the existing disease.

One morsel of good news: More carriers are targeting individual insurance buyers. "The big insurers--Aetna, UnitedHealthcare, Cigna and Humana--have come into this market very aggressively over the last few years," says Bob Hurley, vice president of health-carrier relationships at Mountain View, Calif.-based eHealth, a search engine that compares health plans offered throughout the U.S.

Of course, with more choice comes more complexity: "Individual insurance is very market-specific," says Hurley. "Where you live ultimately determines how many policies are available to you."
While we can't spit out a one-size-fits-all list of the cheapest health-insurance plans, we can offer a step-by-step process for finding the best deal in your market.

Fist step: Understand your state's rules governing individual insurance. The regulations cover a myriad of issues--from "guaranteed" coverage for all applicants (regardless of health condition) to pooling micro-businesses with individuals in order to reduce costs. (One caveat on "guaranteed" coverage: It comes at a price, and with few plan options.) Understanding these rules will help you navigate your policy options later on. One useful resource is healthinsuranceinfo.net, run by Georgetown's University Health Policy Institute; another is your state's Department of Health Insurance.

Next, lay out your options. Here is where the work comes in, but again, it's worth your time. Three key sources of information include Web engines like eHealthinsurance.com; insurance brokers who work with multiple carriers; and the carriers themselves. You can find carrier names on your state's Department of Health Insurance site.

To winnow the options, decide what you can afford and what level of coverage you are willing to pay for. Low monthly premiums tend to come with higher deductibles or co-payments to doctors and hospitals.
Compare two policies--one with a $200 monthly premium and a $5,000 deductible, the other with a $400 premium and a $1,000 deductible. While the first policy will save you $2,400 a year in premiums, you could end up spending an additional $4,000 to cover your deductible. Net loss: $1,600.

But premiums and deductibles are only a small part of the story--and cheaper is not always better. Beware policies with ultra-cheap rates, such as "discount cards" that offer 25% off doctors' visits and prescriptions. Very cheap but limited Association Health Plans (that cover, say, a group of scuba instructors) have their own catches. Then there are the "policies" that cover a specific health issue (say, accidents or specific cancers), but not much else.

You should also consider variables like prescription drug benefits and the number of allowable doctor visits or hospital stays per year.

eHealthinsurance.com allows users to compare up to four plans at a time, across some 25 categories and exceptions. Another bear trap: switching costs. If you enter a plan in good health, but are later diagnosed with an illness, it will most likely be impossible to switch to more comprehensive coverage down the road.
"It's very hard to make calculations on what type of plan to purchase," says Linda Blumberg, a health-policy analyst at the Urban Institute. "The nature of this market is that if you go with more trimmed-down coverage now, you run the risks of limiting your options down the road." In some states, it's possible to purchase cheap, temporary coverage--a so-called "stop gap" plan--for a year, but it can't be renewed.

Finally, be honest and careful with all paperwork. The minute you apply for insurance, carriers have the right to dig through your medical records. Remember: The less insurance carriers pay out, the more money they make--so they're looking for those mistakes. Says Blumberg: "Even if you make an honest mistake or put down something that's a little off, you can get denied coverage."

Study Circle Two Preparatory Materials

2008-06-15T17:26:00.000-07:00

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Stakeholder Stories

There are both summary and full text versions of 11 health care stakeholder stories. Read about and reflect upon the needs, concerns, experiences and perspectives of all the individuals below. What is it like to “stand in their shoes?”

Summary Version
Summary of all stakeholder stories

Full Text Versions
1. a union member
2. a veteran living in a rural area
3. an employer in a large company offering HSA or HMO benefits
4. a self-employed person with a chronic illness
5. a family physician
6. an independent insurance agent
7. a 10-year employee in the claims department of an insurance company
8. a student entering a master’s program
9. a retiree
10. a legislator
11. a parent on Medicaid with a child in the SCHIP program

Thought Questions

1. From the stakeholders’ vantage points what are the issues and challenges they face?
2. Are you optimistic about their futures? Why or why not?
3. Which of the stakeholders is least vulnerable? Most vulnerable?
4. When you “stand in their shoes” are you surprised by anything that you “learn” about their lives? Explain.

NOTE: The use of the Stakeholder Advocate Assignment Sheet in this section is optional. You may want to use it should you choose to assign an individual “advocate” to read the full text version of one or more of the stakeholders stories and represent them in discussion.

Form: Top FIVE Problems
of the U.S. Health Care System

Download as emailable text form

Back to Study Circle Two Main Page

Study Circle Two Main Page

2008-06-15T17:19:00.000-07:00

I. Welcome
Coming together and settling in with a brief reading or contemplative activity.

Lifting the Statistical Veil

•

Seeing the Faces of Real People

II. Overview
The goal in this session is to acquaint ourselves with issues affecting a variety of people whose life situations and available choices may be different from our own.

III. Activities for this session

A. Stepping into the Other's Shoes. In group discussion share the stakeholders' situations and their implications.
1. What are the basic facts of the stakeholders' lives?
2. What kind of health coverage do they have, if any?
3. In what ways and to what extent are they vulnerable?
4. How does the issue of health care spill into other spheres of their lives; such as employment opportunities, financial stability, where they live, etc.
5. Other questions . . . .

B. Whose Shoes Are Most or Least Expendable?
Look around you and look at one another. If we were to apply the logic of our current health care system to ourselves as members of this study circle how would we decide which ones of us would not receive health care? Which ones of us would receive the best health care? What logic would you apply?

C. Stepping out of the Other's Shoes
Extract from these stories the kinds of problems that are driving the movement in this country for health care reform.
1. Using easel paper or available chalk or bulletin board quickly list all of the problems identified in your discussion.
2. As a group select the top FIVE problems from the above list. Transfer them to the form provided and identify a group member to save the form for Session #6.

D. Group Reflection
1. What surprised you the most from the readings, discussions and activities for this session?
2. What moral issues did the readings, discussions and activities raise for you?

IV. Next Week
Choose next week's facilitator, scribe, time-keeper.

Study Circle One: Caring about Health Care; An Overview

2008-06-15T16:44:00.000-07:00

I. Welcome

Settling in with a brief reading (poem, meditation, etc. depending upon the group)

II. Introductory Materials

Overview of Our Work Together
This is our opportunity to clarify the study circle process as described in the introductory materials.
• What can we expect to gain from a group learning experience?
• What commitments will we make to each other and the group?

Opportunity to clarify
• Reviewing of the history of the project
• Growing the work we do: Getting the word out, organizing and/or leading a new Study Circle
• Planning for a Community Forum on Health Care Reform: Organizing, publicizing, volunteering, attending, etc.

ASSESS THE SITUATION
•
DISCOVER BIG QUESTIONS
•
CREATE IMAGES OF POSSIBILITY
•
EVOLVE WORKABLE STRATEGIES

III. Survey

Take a few minutes to complete the Study Circle Survey. This survey is for your information only and will not be collected. Save it. It will be repeated at our final session to help you assess changes in your attitudes, opinions and knowledge.

IV. Activities for Study Circle #1

Going around the circle each member addresses these questions.

• Round One:
Group member introductions: Briefly say why you are here? Why is this subject personal to you? What is your greatest concern about our health care system and why?
• Round Two:
Share one health care story with the group. To what extent does it lead you to consider its moral implications?

Open Discussion on the readings
• Were you surprised by anything you read? If so, what?
• To what extent is our health care system designed to reflect our values?
• Do you agree that health care reform is a moral imperative? Why or why not?

V. Meeting Details for next time

Choose a facilitator, time-keeper and scribe for the next meeting.

Back to Study Circle One Main Page

Study Circle One: Current Problems with Health Care in the United States

2008-06-15T16:22:00.000-07:00

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What is all the fuss about?

Diminishing Access to Health Care

47 million Americans without health insurance (15% of population)
-- 25% of uninsured are children (nearly 12 million children)

Over 18,000 Americans die each year because they lack health insurance.

Discrimination in Health Care Coverage - Percentage without insurance

32.7% Hispanic Americans
19.7% African Americans
16.8% Asian Americans
11.3% Caucasian American

Rising Cost of Health Care

Health care spending is currently over 15% of GDP
The U.S. spends over twice the amount per capita on health care compared with all other industrialized nations.

The U.S. Health Care System Wastes Money

Approximately 1/3 of health care dollars are spent on insurance paperwork, bureaucracy and administration and not directly on patient care.
Private Insurers have much higher overhead costs compared with public programs
HMO CEO Compensation consumes millions of health care dollars annually

Medical Bills Cause Financial Hardship

Medical Bills are the #1 cause of personal bankruptcy and over 70% of bankruptcy filers had some form of health insurance.
25% of people surveyed in 2006 said they had problems paying medical bills.
-- Nearly 40% of the terminally ill report financial hardship and suffering at the end of their life.

Suboptimal Quality of Health Care is Delivered

The health care system of the United States is ranked 37th in the world by the WHO (World Health Organization)
The infant and maternal mortality is higher and the life expectancy is lower in the U.S. as compare with other industrialized countries.
Overcrowding in Emergency and Urgent Care situations

Even Those With Health Insurance Are At Risk

Since health insurance is linked with employment, it only takes one debilitating illness or injury that could lead to the loss of a job and thus loss of insurance.

Health Care Industry is Profitable despite poor health care markers, diminished access to care and financial hardships of general public

Current System is Confusing for Patients

NOTE: Slides and Pictures are from Physicians for a National Health Program’s Educational Power Point Presentation, 2008

Back to Study Circle One Preparatory Materials

Study Circle One: Why Not The Best?

2008-06-15T16:14:00.000-07:00

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National Scorecard Results:
U.S. Health System Performance

Reprinted with permission for distribution – The Commonwealth Fund, 3/2008

Executive Summary

Once upon a time, it was taken as an article of faith among most Americans that the U.S. health care system was simply the best in the world. Yet growing evidence indicates the system falls short given the high level of resources committed to health care. Although national health spending is significantly higher than the average rate of other industrialized countries, the U.S. is the only industrialized country that fails to guarantee universal health insurance and coverage is deteriorating, leaving millions without affordable access to preventive and essential health care. Quality of care is highly variable and delivered by a system that is too often poorly coordinated, driving up costs, and putting patients at risk. With rising costs straining family, business, and public budgets, access deteriorating and variable quality, improving health care performance is a matter of national urgency.

The Commonwealth Fund Commission on a High Performance Health System has developed a National Scorecard on U.S. Health System Performance (see the table below for scores on 37 key indicators). The Scorecard assesses how well the U.S. health system is performing as a whole relative to what is achievable. It provides benchmarks for the nation and a mechanism for monitoring change over time across core health care system goals of health outcomes, quality, access, efficiency, and equity.

Scores come from ratios that compare the U.S. national average performance to benchmarks, which represent top performance. If performance in the U.S. was uniform for each of the health system goals, and if, in those instances in which U.S. performance can be compared with other countries, we were consistently at the top, the average score for the U.S. would be 100. But, the U.S. as a whole scores an average of 66. Several different measures or indicators were examined for each of the goal areas and dimensions of health system performance. There are wide gaps between national average rates and benchmarks in each of the dimensions of the Scorecard, with U. S. average scores ranging from 51 to 71.

By showing the gaps between national performance and benchmarks that have been achieved, the Scorecard offers performance targets for improvement. And it provides a foundation for the development of public and private policy action, and a yardstick against which to measure the success of new policies.

Scorecard Highlights and Leading Indicators

The table summarizes U.S. average rates on 37 indicators, their benchmark comparison rates—typically those achieved by the top 10 percent of countries, states, health plans, hospitals, or other providers—and the U.S. average score, calculated as the ratio between U.S. performance and benchmark rate. In just a few instances the benchmarks represent targets, rather than achieved top performance. The sources of the benchmarks are shown in the table.

Some Major Findings Include:

Long, Healthy, and Productive Lives: Total Average Score 69

The U.S. is one-third worse than the best country on mortality from conditions "amenable to health care"—that is, deaths that could have been prevented with timely and effective care. Its infant mortality rate is 7.0 deaths per 1,000 live births, compared with 2.7 in the top three countries. The U.S. average adult disability rate is one-fourth worse than the best five U.S. states, as is the rate of children missing 11 or more days of school because of illness or injury.

Quality: Total Average Score 71

Despite documented benefits of timely preventive care, barely half of adults (49%) received preventive and screening tests according to guidelines for their age and sex.
The current gap between national average rates of diabetes and blood pressure control and rates achieved by the top 10 percent of health plans translates into an estimated 20,000 to 40,000 preventable deaths and $1 billion to $2 billion in avoidable medical costs.
Only half of patients with congestive heart failure receive written discharge instructions regarding care following their hospitalization.
Nursing home hospital admission and readmission rates in the bottom 10 percent of states are two times higher than in the top 10 percent of states.

Access: Total Average Score 67

In 2003, one-third (35%) of adults under 65 (61 million) were either underinsured or were uninsured at some time during the year.
One-third (34%) of all adults under 65 have problems paying their medical bills or have medical debt they are paying off over time. And premiums are increasingly stretching median household incomes.
Efficiency: Total Average Score 51
National preventable hospital admissions for patients with diabetes, congestive heart failure, and asthma (ambulatory care sensitive conditions) were twice the level achieved by the top states.
Hospital 30-day readmission rates for Medicare patients ranged from 14 percent to 22 percent across regions. Bringing readmission rates down to the levels achieved by the top performing regions would save Medicare $1.9 billion annually.
Annual Medicare costs of care average $32,000 for patients with congestive heart failure, diabetes, and chronic lung disease, with a twofold spread in costs across geographic regions.
As a share of total health expenditures, U.S. insurance administrative costs were more than three times the rates of countries with the most integrated insurance systems.
The U.S. lags well behind other nations in use of electronic medical records: 17 percent of U.S doctors compared with 80 percent in the top three countries.

Equity: Total Average Score: 71

On multiple indicators across quality of care and access to care, there is a wide gap between low-income or uninsured populations and those with higher incomes and insurance. On average, low-income and uninsured rates would need to improve by one-third to close the gap.
On average, it would require a 20 percent decrease in Hispanic risk rates to reach benchmark white rates on key indicators of quality, access, and efficiency. Hispanics are at particularly high risk of being uninsured, lacking a regular source of primary care, and not receiving essential preventive care.
Overall, it would require a 24 percent or greater improvement in African American mortality, quality, access, and efficiency indicators to approach benchmark white rates. Blacks are much more likely to die at birth or from chronic conditions such as heart disease and diabetes. Blacks also have significantly lower rates of cancer survival.

System Capacity to Innovate and Improve: Not Scored

Innovations in the ways care is delivered—from more integrated decision-making and information sharing to better workforce retention and team oriented care—are necessary to make strides in all dimensions of care.
Investment in research to assess effectiveness, develop evidence-based guidelines, or support innovations in care delivery is low. The current federal investment in health services research, estimated at $1.5 billion, amounts to less than $1 out of every $1,000 in national health care spending. Ideally a national Scorecard would include indicators of the system's capacity to innovate and improve, but good indicators in this area are not currently available—itself a problem.

Summary and Implications - The Case for a Systems Approach to Change

The Scorecard results make a compelling case for change. Simply put, we fall far short of what is achievable on all major dimensions of health system performance. The overwhelming picture that emerges is one of missed opportunities—at every level of the system—to make American health care truly the best that money can buy.

And let there be no doubt, these results are not just numbers. Each statistic—each gap in actual versus achievable performance—represents illness that can be avoided, deaths that can be prevented, and money that can be saved or reinvested. In fact, if we closed just those gaps that are described in the Scorecard—we could save at least $50 billion to $100 billion per year in health care spending and prevent 100,000 to 150,000 deaths. Moreover, the nation would gain from improved productivity. The Institute of Medicine, for example, estimates national economic gains of up to $130 billion per year from insuring the uninsured.

The central messages from the Scorecard are clear:

Universal coverage and participation are essential to improve quality and efficiency, as well as access to needed care.
Quality and efficiency can be improved together; we must look for improvements that yield both results. Preventive and primary care quality deficiencies undermine outcomes for patients and contribute to inefficiencies that raise the cost of care.
Failures to coordinate care for patients over the course of treatment put patients at risk and raise the cost of care. Policies that facilitate and promote linking providers and information about care will be essential for productivity, safety, and quality gains.
Financial incentives posed by the fee-for-service system of payment as currently designed undermine efforts to improve preventive and primary care, manage chronic conditions, and coordinate care. We need to devise payment incentives to reward more effective and efficient care, with a focus on value.
Research and investment in data systems are important keys to progress. Investment in, and implementation of, electronic medical records and modern health information technology in physician offices and hospitals is low—leaving physicians and other providers without useful tools to ensure reliable high quality care.
Savings can be generated from more efficient use of expensive resources including more effective care in the community to control chronic disease and assure patients timely access to primary care. The challenge is finding ways to re-channel these savings into investments in improved coverage and system capacity to improve performance in the future.

Setting national goals for improvement based on best achieved rates is likely to be an effective method to motivate change and move the overall distribution to higher levels.

Our health system needs to focus on improving health outcomes for people over the course of their lives, as they move from place to place and from one site of care to another. This requires a degree of organization and coordination that we currently lack. Whether through more integrated health care delivery organizations, more accountable physician groups, or more integrated health information systems (in truth, likely all of these), we need to link patients, care teams, and information together. At the same time, we need to deliver safer and more reliable care.

Furthermore, the extremely high costs of treating patients with multiple chronic diseases, as detailed in this report, serve as a reminder that a minority of very sick patients in the U.S. account for a high proportion of national health care expenditures. Payment policies that support integrated, team-based approaches to managing patients with multiple, complex conditions—along with efforts to engage patients in care self-management—will be of paramount importance as the population continues to age.
By assessing the nation's health care against achievable benchmarks, the Scorecard, in a sense, tracks the vital signs of our health system. With rising costs and deteriorating coverage, leadership to transform the health system is urgently needed to secure a healthy nation.

Citation

The Commonwealth Fund Commission on a High Performance Health System, Why Not the Best? Results from a National Scorecard on U.S. Health System Performance, The Commonwealth Fund, September 2006

Reprinted with permission for distribution – The Commonwealth Fund, 3/2008

Note: The Commonwealth Fund is “a private foundation working toward a high performance health system.”

For more information, go to www.commonwealthfund.org

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Study Circle One: The Moral Challenge of Our Time: Reforming the Health Care System

2008-06-15T16:05:00.000-07:00

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The following has been excerpted from The Center for American Progress, a progressive think-tank dedicated to improving the lives of Americans through ideas and action.

www.americanprogress.org

Different Messages for a Common Goal

Faith denominations express their desire to improve health care in America in diverse ways. Yet everyone seems to agree on a few things:

America’s health care system costs too much and covers too few.
Health care is a basic right, not a privilege.
Reforming health care is of the utmost economic urgency.
We have a moral imperative to fix our system, and anything less than covering all Americans would be unjust.

Different parts of the faith community
express these ideas in their own ways:

"Providing health care is not just an obligation for the patient and the doctor, but for society as well."
-- Union for Reform Judaism

"The need for change seems evident—it is troubling that so many Americans are without health insurance."
-- National Association of Evangelicals

"It is the responsibility of the public—through government—to meet [America’s health care needs] in a just, equitable, and compassionate manner."
-- Unitarian Universalists Association

"The Bible tells us to do unto others as we would have others do unto us. If I were uninsured, I would want others to come to my aid and demand solutions—with this country's economic prosperity, we can and should find ways to provide health care for everyone."
-- Richard Land, President of Southern Baptist Convention's Ethics and Religious Liberty Commission, in Christianity Today

"Health care should be viewed as a right, not a privilege—the basic goal for health care reform should be universal access to comprehensive benefits."
-- American Baptist Churches USA

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Study Circle One: Preparatory Materials

2008-06-15T16:01:00.000-07:00

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Survey:

Please take a few minutes to complete a Study Circle Survey. This survey is for your information only and will not be collected. Save it. It will be repeated at our final session to help you assess changes in your attitudes, opinions and knowledge

Reading Materials:

• The Moral Challenge of Our Time: Reforming Our Health Care System, Center for American Progress

• Why Not the Best? Results from a National Scorecard on U.S. Health System Performance

• Current Problems with Health Care in the United States, Source: PNHP

Thought Questions:

• In your opinion, is health care a moral issue? If so, why? If not, why?

• With respect to the health care system in our country, what is your greatest concern and why? What are you doing about it? If so, why? If not, why?

• Reflect upon any personal health care story. To what extent does this story lead you to consider its moral implications?

Back to Study Circle One Main Page

Study Circle One Main Page

2008-06-15T15:57:00.000-07:00

I. Welcome

Settling in with a brief reading (poem, meditation, etc. depending upon the group)

ASSESS THE SITUATION
•
DISCOVER BIG QUESTIONS
•
CREATE IMAGES OF POSSIBILITY
•
EVOLVE WORKABLE STRATEGIES

II. Introductory Materials

Overview of Our Work Together
This is our opportunity to clarify the study circle process as described in the introductory materials.
• What can we expect to gain from a group learning experience?
• What commitments will we make to each other and the group?

Opportunity to clarify
• Reviewing of the history of the project
• Growing the work we do: Getting the word out, organizing and/or leading a new Study Circle
• Planning for a Community Forum on Health Care Reform: Organizing, publicizing, volunteering, attending, etc.

III. Survey

Take a few minutes to complete the Study Circle Survey. This survey is for your information only and will not be collected. Save it. It will be repeated at our final session to help you assess changes in your attitudes, opinions and knowledge.

IV. Activities for Study Circle #1

Going around the circle each member addresses these questions.

• Round One:
Group member introductions: Briefly say why you are here? Why is this subject personal to you? What is your greatest concern about our health care system and why?
• Round Two:
Share one health care story with the group. To what extent does it lead you to consider its moral implications?

Open Discussion on the Readings
• Were you surprised by anything you read? If so, what?
• To what extent is our health care system designed to reflect our values?
• Do you agree that health care reform is a moral imperative? Why or why not?

V. Meeting Details for Next Time

Choose a facilitator, time-keeper and scribe for the next meeting.

About Us

2008-06-09T16:53:00.000-07:00

This project began when a small group of citizens and members of Cedars Unitarian Universalist Church on Bainbridge Island, Washington, came together to talk about health care in the U.S. After our initial meeting we wanted to do more than just talk.

We searched the Internet and our own resources and could not find a "learning tool" that would do what we had in mind. So, we developed this discussion series, Everyone's Health Counts.

We imagined everyday people joining together in small groups to study this critical issue. We imagined “graduates” of this grassroots effort as informed and empowered proponents of real change – perhaps starting new study circles, creating local events, writing Letters to the Editor and to their State and National representatives, and just generally spreading the word. We believed that citizens can create “think tanks” too. Now we know first hand that they can.

This Study Circle Guide was tested with a group of 14 individuals. Feedback, during and after our six sessions, helped us to make improvements to the Guide. Interest in our project began to grow, and soon we set about creating a web presence for Everyone's Health Counts! This site provides all of the links you will need to Print the Study Guide, complete the six sessions, and to contribute to what we know is a growing grassroots movement.

Wishing you good health and better health care for all,

The Curriculum Committee
Barbara Clarke, Karen Scarvie, and Joanna Garritano, MD

Barbara Clarke has an M.A. in Health Services Administration and worked as an executive for 15 years in managed care. She currently works in fund development for a nationally recognized non-profit agency that brings generations together through adult health and childcare/early learning programs. She is knowledgeable about health care systems, is an experienced health and wellness writer, completing a novel about health care, and one of the co-creators of the Health Care Study Circles project.

Karen Scarvie retired in 2006 after a 35 year career as owner of a successful retail business. As a founder and past president of ASTRA, the American Specialty Toy Retailing Association, she understands the concerns of small business owners. In her leadership role, she witnessed the explosive increase in the cost of health care coverage and its effect on the health of small businesses throughout the country. Karen is a co-creator of the Health Care Study Circles project and holds an MA in Psychology.

Joanna Garritano is a residency trained and board certified Emergency Medical Physician who currently practices at Virginia Mason Medical Center in Seattle. Through her work in the Emergency Department she witnesses the inequities of our current health care system and has become a dedicated health care justice advocate. She is a past president of the Western Washington chapter of Physicians for a National Health Program in 2007 and currently a board member. She also serves on the board of the Washington State chapter of Physicians for Social Responsibility.

Videos About Health Care to Watch Online

2008-06-09T16:26:00.000-07:00

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Bill Moyers Journal

Bill Moyers speaks with advocate Donna Smith about how our broken system is hurting ordinary Americans.
May 22, 2009
http://www.pbs.org/moyers/journal/05222009/watch.html

Frontline: Sick Around America
Investigating the stories of Americans whose lives have become a quest to find and keep health insurance.
March 31, 2009
http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/

Sick Around the World
5 Capitalist Democracies and How They Do It
Frontline PBS TV Documentary, April 15, 2008
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

The Pinky Show Presents: The Health Care Crisis, Part I
Length: 15 Minutes
http://www.youtube.com/watch?v=3XlPU5rUeI0&feature=related

Speech: "The Unfinished Business of the Baby Boom Generation"
By John Kitzhaber, MD, former Governor of Oregon, February 9th 2008.
Length: 24 minutes
http://wcdb.us/unfinished-business-of-the-baby-boom-generation-640.html

Documentary film: Sicko, by Michael Moore, 2007
Investigates the American health care system with a focus on the behavior of large health insurance companies and contrasts the U.S. system with those of other countries with universal health care coverage.
http://www.webcom123.com/movies/sicko_DVD.html

Contact Us

2008-06-08T16:36:00.000-07:00

For more information, to make comments, or to provide feedback don't hesitate to write us. We suggest that you write "Study Circle Guide" on the subject line of your first email so that we can readily identify its purpose. Thank you.

Barbara Clarke - barbara.l.clarke@gmail.com
Karen Scarvie - kalena@znet.com

HEALTH CARE REFORM IS EVERYONE’S BUSINESS
because
EVERYONE’S HEALTH COUNTS!