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The Picture of Health Care

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3. GEORGANNE CHAPIN: President and CEO,
Hudson Health Plan in Tarrytown, NY

Hudson Health Plan is a not-for-profit managed care organization that provides free and low-cost insurance to 70,000 members in the lower Hudson Valley of New York. Chapin has a bachelor's degree in anthropology from Barnard College, a master's degree in sociomedical sciences from Columbia University, and a JD from Pace University School of Law in New York City. She founded Hudson Center for Health Equity and Quality, a not-for-profit health advocacy program, in 2005.

UO: What are the health related policies or laws put into effect since 2000 that you believe have had the most effect on our country?

GC: The biggest federal law, without question, is the Medicare Modernization Act. Obviously what’s good is the widespread recognition that a drug benefit has to be part of any basic health care package. Medications are a critical part of health maintenance—you can’t rely on people to go out of pocket for them. The way the law was adopted also tells us is that the government is willing to pay retail when they could certainly negotiate wholesale. And all of this is in the name of privatization. That is a horrible thing and a huge challenge for us over the next few years: How we are going to dig out of these commitments we’ve made to the corporate sector to stoke their furnaces?

Health savings accounts are bound to implode. They will probably work for a few people for a period of time, but they give the illusion of insurance until somebody really gets sick. With the state expansions that have been proposed, HSAs are really dangerous because once again, they are affordable in the sense that for less money you can have what passes as insurance. But, nothing at all is done to address cost. So it will continue to go up, and how are we going to pay for health care?

UO: What has been the impact for physicians and patients?

GC: People can’t shop for health care. You don’t go shopping for price with a neurosurgeon. You don’t go shopping for price with an emergency room. And you don’t go shopping for price when you have a baby. You go where you live, or where your networks of contacts send you. And so I think that health savings accounts are very dubious. There is nothing anywhere to show that they work.

That said, I do think that the ideological lessons that these laws teach us are significant. As a nation, we still lack leadership in figuring out how to solve our health care problems and how to control cost. None of the leading candidates are willing to say they will take on the forces of insurance and health care.

UO: What should the next administration do in the health care arena?

GC: The solution to our problem is far simpler than all the gobbly gook out there. We have been conned into thinking this is so complicated and it’s not. Other countries do a perfectly good job in providing health care to all people in their country. And they do it for a third to half as much as we spend, and they’re not Communist countries. These are capitalist democracies that have made the decisions that they need to make. For one thing, their governments negotiate prices without any shame, and there is a commitment to provide basic health care, and some decisions are made about what’s necessary and what’s not necessary to pay for. We are subsidizing the pharmaceutical industry around the world in what we pay. Did we decide that ideologically? That’s crazy. It’s not complicated if we are willing to confront the fact that our health care system is owned by corporate interest.

I am a single-payer advocate, but I don’t think there is an appetite for a single-payer system. It looks like everybody wants to at least retain privatized health care. I do believe that the next administration must establish, if they want competition, a well-funded public system that can compete with the private sector. Make it affordable, a robust benefit package that pays enough so that doctors and hospitals will not hesitate to participate. I predict that system would be more cost effective than the private insurance system, which is just weighted down by huge administrative cost and profits.

4. DON McCANNE, MD: family practitioner, a senior policy analyst and the former president of Physicians for National Health Care Program (PHNP)

McCanne, of San Juan Capistrano, California, retired from practice 10 years ago and is a full-time volunteer for Physicians for National Health program, a single-issue organization advocating a universal, comprehensive, single-payer national health program. PNHP has more than 14,000 members and chapters across the United States.

UO: What are the health related policies or laws put into effect since 2000 that you believe have had the most effect on our country?

DM: The Medicare Modernization Act (MMA). It’s designed to privatize Medicare to shift from a publicly administered program to a privately administered program. We’ve only seen the first steps, so it hasn’t had too much impact so far. But, we see what’s happening: The Medicare Advantage Plans are being paid a lot more and yet most of the extra is used by the plans themselves rather than providing expanded services and benefits for patients.

This plot to privatize Medicare overwhelmed those of us who work in health care reform.

UO: What has been the impact for physicians and patients?

DM: For physicians, it was a distraction on efforts to reform health care. As people enroll in the Medicare Advantage Plans, support for the traditional Medicare program declines. Right now we are seeing the fight over where physicians will receive a 10 percent cut in their fees, and maybe over the next several years a 40 percent cut, which is exactly what the Republicans wanted when they enacted this MMA. Physicians and hospitals will start dropping out and [that will] basically ruin the program.

It also increases the paperwork because now there are multiple plans and increased complexity in administrative ways.

As for patients, it’s not having that much impact yet. The one that most Medicare beneficiaries talk about is Part D, the prescription benefit, and that actually, at a limited expense, has improved access to drugs. But it’s done in a way that is very flawed, so patients don’t often get the drugs they really want. It depends on the various pharmacy benefit manager formularies. Then the impact of the donut hole has been great. For instance, cancer chemotherapy and very high priced drugs take people into the donut hole, where they have to foot the entire cost. It was unnecessary to structure it that way.

UO: What should the next administration do in the health care arena?

DM: We need a rational system of financing health care for everyone through a single payer national health care program. That is the first step. Once we do that, we would be able to make a lot of the changes that we need to improve the efficiency and equality of our health care.

We totally need to displace the private insurance system. The leading Democrat candidates, [Hillary Clinton, Barack Obama] support offering a public insurance model as an option, with people gradually dropping their private coverage and moving into the public program. But that is unlikely to happen, mainly because the public program would attract the very high-cost patients and would not be able to compete with the private plans that would continue to be successful and selectively market to the healthy people.

You would have to move funds from the private insurance pools that insure healthy people over into the insurance pools that take care of sick people. Well, that’s not a concept you can sell easily, even though we have done it in reverse: We are moving public funds from the traditional Medicare program over to the private Medicare Advantage Plans, and people seem to think that’s OK. Our concept of the market is insane. It’s fine if we take tax money and give it to the people in the marketplace but boy, don’t you dare do it the other way around.

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Kelly Kirch is a freelance writer who writes on health care and business topics for UO.