Out of September 11, A Stronger Sense of Community 

Milton A. Braun,    Dallas Texas

Sept. 11 has suddenly changed the way Americans look at the federal government. A poll taken two weeks after the disaster revealed that close to two-thirds of Americans trusted the government "all" or "most" of the time. Suddenly, the trend of the past few decades that "Government is Bad" has been reversed.

And the tragedy has not only changed the way we look at the rest of the world, but also how we Americans relate to each other. Suddenly, there was an overwhelming sense of community, a unifying feeling, as every American felt the disbelief, sorrow, anger and then patriotism and a call for justice and/or revenge. Yes, the strong sense of individualism yielded to a sense that we all shared the pain and cared about each other.

Meanwhile, our economic downswing, already in progress, has accelerated, and the large budget surpluses have evaporated as multi-billions have been appropriated to bail our the airline industry, assist the families of the victims, clean up the debris left by the collapse of the World Trade Center, rebuild the World Trade Center and fight terrorism here and abroad. Many thousands more Americans -- many of them middle class -- lost their health insurance due to having lost thier jobs, pain on top of pain.

Out of the tragedy (and ensuring anthrax scare) perhaps there will come a more permanent sense of community as related to hunger, poverty, homelessness and, perhaps most unjustly of all, the lack of adequte access to qualtiy health care for millions of Americans. Hopefully, America's politicians will finally see the folly of tying health care to employment, and the absurdity and yes, gross unfairness, of merely tinkering about the edges in regard to health care reform with such elitest gimmicks as Medical Savings Accounts. In this writers's opinion the best and the least expensive way to provide all Americans with qulaity health insurance would be to simply place everybody under Medicare, a time-test plan that all Americans undestand and like and that has an extremely low overhead of only about two percent.

While Sept. 11 will always be remembered as a day of unspeakable tragedy and "a day that will live in infamy," the other tragedy that should be addressed now is the tragedy that 43 million Americans do not have any health insurance, 11 million of whom are children, millions are dangerously underinsured and millions are living in fear of losing the health insurance they now have.

Yes, Sept. 11 has clearly demonstrated that Americans have the compassion and inner strength to make change happen and happen very quickly. Thus, we should now use this same compassion, inner strength and deep sense of community to see to it that every American has access to qualtiy and affordable health care. Worrying about terrorism is bad enough, and sadly this worry will be with us from now on. However, the worry about not having health insurance can be allayed NOW by this 107th congess enacting a universal health insurance system.

Threat of the Uninsured to North Carolina Hospital's Financial Solvency 

John E. Hammond (April 2001)

Approximately, 15% or over 1 million citizens of North Carolina lack health insurance. Most of these citizens are the working poor who are in jobs that do not provide health insurance benefits. The lack of health insurance leads to delay in care. In some cases this delay in care leads to a death that could have been prevented if routine basic care had been available earlier. Hospital ER's provide the bulk of indigent care or uncompensated care in North Carolina. Up until the last ten years or so Hospitals covered the cost of indigent care by inflating the charges for all of their paying patients. This method of funding indigent or uncompensated care is called cost shifting. 

Cost shifting let both public and their elected officials off the hook for providing an organized means to fund the indigent care. This allowed the myth that all people had access to care but no one had to pay for it. You might call this indigent health care insurance funded by the tooth fairy. Up until the early 1980's insurance companies, politicians and the federal Medicare Insurance system played the cost shifting game. In the 80's faced with high rates of inflation in health care costs in the Medicare program the Federal Government withdrew from the cost shifting game. 

Fearing that the private insurance companies would get stuck with the cost of uncompensated care, private companies rapidly converted to HMO's. They negotiated heavily discounted contracts with hospitals for their patients that shielded them from cost shift of indigent care. 

In 1997, the third blow in the form of the Balanced Budget Act cut from Medicare approximately $227 billion in reimbursement to hospitals for indigent care. Teaching hospitals have provided almost 50% of the indigent care in the US and have been especially hard hit. Many teaching hospitals including Duke and UNC are now running in the red. The public still gives Hospitals the moral responsibility of providing indigent care but they have no way to recover the costs. The accounting firm of Deloitte and Touche found that by the year 2002, 31% hospitals in North Carolina will in the red. Once hospital reserves are exhausted hospitals must cut services and/or close. The fourth and most recent blow to North Carolina hospital solvency is the proposed cut of $160M in reimbursement to hospitals through the state health plan. Ladies and gentleman if this fourth cut in reimbursement happens the result we be that a even greater number of North Carolina Hospitals will be in the red, more cuts in services and/or more closings will occur. If hospitals close access to healthcare for will be reduced for all. 

In my opinion you can no longer assume that the local ER will be there when you have your heart attack and need it. Failure to address problem of uninsured puts at risk the hospital system in the State of North Carolina. Cost shifting is dead and so is tooth fairy funded healthcare insurance. I urge you to support passage of House bill 1332. Lets face the problem of the uninsured and deal with it for the good of all the people of North Carolina. Thank you very much for your time.  

John Hammond is a retired Professor of Pathology from the University of North Carolina at Chapel Hill and is active with the North Carolina Committee to Defend Health Care.  

The U.S. Health Care Blues 

Frederick C. Sage ( April 2001)

It's no secret that our health care system is in trouble: hospitals running in the red, doctors getting fed up and retiring early, nursing school applications down 25 percent from 10 years ago, 44 million people without health insurance, the uninsured clogging emergency rooms, financial disaster hanging over all but the rich; medical bills are now the second leading cause of personal bankruptcy.

To discuss the matter, some historical background is necessary. One hundred years ago the leading causes of death were infection, accident and childbirth. Quick and cheap. Now the leading causes of death are heart trouble, cancer and stroke. Slow and expensive. Sixty years ago, when you were old, you were either healthy or dead. An illness or injury that is now expensively disabling was usually fatal. This was the case back to the beginnings of humanity. We now have a new ballgaine with major implications that have not been well recognized.

The non-profit Blue Cross (hospitals) and Blue Shield (doctors) were the first wide-spread health insurance plans, beginning in the late 1920s. They were the only game in town, generally, until the 1950s. They paid out 94 percent of the premiums in benefits compared to the for-profit companies today who get upset if they pay out 80 percent Incidentally, the hospitals' administrative overhead has gone from 8-10 percent of Cost to 20-plus percent, largely due to the problems with the myriad insurance plans. Interestingly, the American Medical Association opposed health insurance until after World War II. The for-profit companies had experience with the war plants covering a young, healthy population while the Blues covered nearly anyone. Time has come for single-payer universal coverage The for-profits saw that they could, by careful selection - cream-skimming if you will - undercut the Blues, even adding to the group plans very profitable life and disability insurance to cover below-cost health insurance. They soon grew into the big chain operations, buying up struggling hospitals, signing up physicians who were afraid of "government medicine' and going after the big bucks.

OK, so what about universal coverage? First of all, by eliminating the big administrative overhead, the uninsured can be covered for no additional money. These peop!e usually do get care eventually for major problems; many of the problems become major because of lack of early attention. It would relieve businesses of the big expense and hassle of insuring employees. There is no logic in tying health care to employment. In addition, physicians could practice medicine rather than wrestle with the swarm of insurance companies.

All other industrialized countries have same form of universal coverage. Our neighbor Canada's system began soon after WWII in Saskatchewan. Our countries are different but we can learn a lot from their experience. The 10 Canadian provinces run their own programs with some federal money. They operate under five principles: the program must be universal, comprehensive, portable, accessible and publicly administered. People have free choice of provider. A province has a lot of bargaining power with drug companies and others. In the three territories the plans are all federal. Canada spends 9 to 10 percent of its gross domestic product on health care while we spend 14 to 15 percent A major problem Canada is having now is underpayment by the provincial and federal governments. The same thing is happening here on the part of Medicare, Medicaid and private plans in the U.S. Waits for non-urgent problems tend to be longer in Canada than here, where, if you have the money, you can get service in a reasonable time and if you don't have the money, you're out of luck.

There are heavy propaganda campaigns in both our countries against universal health insurance. One public relations and lobbying company was paid $80 million to fight Hillary Clinton's scheme which, admittedly, was far too complex but., ironically, tried to include the private companies. Dont believe everything you hear. Canada has had 50 years of experience and the public is sold on it., - especially when they become familiar with our system.

This is not intended to suggest any details of universal insurance system, but only to recommend action toward that goal.

For fuirther information on Canada, there is an excellent article by Daniel Krater in the New Rules Journal at www.newrules.org/journal/ nrwin0lhealth.html. Another good summary of the Canadian system can be found at., www.hc-sc.gc.ca/datapcb/ datahesa/E..sys.htm or just root around in Canada/health on the web.

We may have the best health care in the world - IF you have the money, live in the right place, are medically sophisticated and have a profiitable illness. However, we are ranked 37th in the quality of our overall system by a World Health Organization study.

Frederick C. Sage has lived in Boulder for 26 years. He has a master's degree in hospital administration from the Columbia University School of Public Health and is now retired after a 40-year career in health administration.