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First, Testimony of Kevin Grumbach, MD, Professor and Chair of the Department of Family and Community Medicine at the UCSF, then "PRIMARY CARE PROFESSIONALS: Recent Supply Trends, Projections, and Valuation of Services", Testimony of A. Bruce Steinwald, Director, Health Care, then February 12, 2008 United States Government Accountability Office (GAO)
There are three main points I would like to emphasize: 1. Primary care is the essential foundation of a well-performing health system 2. The primary care infrastructure in the United States is crumbling, and patient access to primary care is suffering throughout the nation. 3. The federal government can address the crisis in primary care through several reforms.
Health professional workforce projections that are mostly silent on the future supply of and demand for primary care services are symptomatic of an ongoing decline in the nation's financial support for primary care medicine. Ample research in recent years concludes that the nation's over reliance on specialty care services at the expense of primary care leads to a health care system that is less efficient. At the same time, research shows that preventive care, care coordination for the chronically ill, and continuity of care - all hallmarks of primary care medicine - can achieve improved outcomes and costs savings. Conventional payment systems tend to undervalue primary care services relative to specialty services. Some physician organizations are proposing payment system refinements that place a new emphasis on primary care services.
For the Grumbach testimony CLICK HERE
For the Steinwald testimony CLICK HERE
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Center for American Progress, May 6, 2008, The Progressive Generation, By David Madland, Amanda Logan
Young adults the early 2000's often known as the "Millennial Generation" have decidedly progressive views on economic issues, possibly more so than any previous generation. Our analysis also shows that Millennials mostly reject the conservative viewpoint that government is the problem, and that free markets always produce the best results for society. Indeed, Millennials' views are more progressive than those of other age groups today, and are more progressive than previous generations when they were younger.
* Millennials are more likely to support universal health coverage than any age group in the 30 previous years the question has been asked, with 57 percent of 18- to 29-year-olds saying that health insurance should come from a government insurance plan.
* Eighty-seven percent of Millennials think the government should spend more money on health care even if a tax increase is required to pay for it, the highest level of support in the question's 20-year history.
For this Center for American Progress Survey CLICK HERE
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SURVEY OF SMALL AND MID-SIZED BUSINESSES, March 27 - April 1, 2007
The number of companies offering no health benefits at all has increased from 2000 - 2007 by 25%. In 2000, 24% of companies surveyed offered no employee benefits. In 2007, 30% of companies surveyed offer no benefits at all.
for this National Small Business Association National Survey CLICK HERE
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HOW DOES HEALTH CARE SPENDING IN THE USA COMPARE TO OTHER DEVELOPED COUNTRIES?
Health spending per capita in the US is 24% higher than in the next highest spending countries, and over 90% higher than in many other countries that would be considered to be global economic competitors. And, with over 15% of gross domestic product (GDP) devoted to health, the US is committing a substantially greater share of the economy to the health sector. The mean per capita expenditure in 2003 for 18 other OECD nations (for which data could be collected) was $2958 as opposed to the $6711 per capita in the USA. While the US spent 15.2% of GDP on health care (which millions of citizens cannot access) the average as percent GDP for the other 18 OECD nations was just 9.3% (with a standard deviation of just 1.2% - there is SOMETHING SPECIAL WITH RESPECT TO COSTS AND THE US SYSTEM.
The growth in health spending in the US is among the highest for developed countries also. After adjusting for inflation, health spending per capita grew at an average annual rate of 4.4% between 1980 and 2003. Over the same period, health care spending as a share of GDP in the US increased by 6.4 percentage points, a larger gain than seen in other countries that were analyzed. Despite these levels of spending, the US does not provide greater health resources to its citizens or achieve substantially better health benchmarks compared to other developed countries [EINO: in fact much worse according to WHO benchmarks]. The growing gap between health spending levels in the US and other higher-income countries all of which provide universal health coverage may encourage policymakers to look more closely at how our health care dollars are being spent and the value we are getting for those dollars.
For the OECD Health Data published for 2006 CLICK HERE
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WHY HAVE SO MANY US PLANTS MOVED A FEW MILES OVER THE BORDER TO CANADA?
GM, Kraft and others have clearly seen that you can’t compete with the 93% savings on medical care which comes from hiring in Canada. How about being the first US state to establish an efficient stable system for universal health care, why wouldn’t business come flocking to that state? Small business leaders will be freed from being coerced into spending half of their time acting as health care brokers -when its other business they are motivated about and in which they have expertise.
From KPMG get their document CLICK HERE
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IN US HOSPITALS, EMERGENCY CARE IN CRITICAL CONDITION
By Don Snyder
Data from the American College of Emergency Physicians, which represents 23,000 ER doctors, paints a chilling picture of a system in decline. The capacity of the nation's emergency systems has decreased by 14% since 1993, as more than one thousand hospitals have closed their emergency departments nationwide. Meanwhile, demand continues to increase, with 114 million ER visits reported in 2003, the highest number the CDC has ever recorded.
Doctors interviewed for this article unanimously decried the deterioration of emergency care and see a single-payer universal health plan as the answer. They point out that government programs could meet important health needs and operate with less overhead than private plans designed to make profits and satisfy stockholders.
Dr. Peter Viccellio, the head of the emergency department at Stony Brook University Hospital, says Medicare operates with a 3% overhead compared to private insurers who spend 30% on overhead. Stony Brook University Hospital spends $15 MIL dollars a year on billing because the private plans are so different and criteria for payment so complex. A single payer system would eliminate the need for each hospital to operate its own billing department. "I could vaccinate a lot of kids with the $15 million our hospital would save," said Dr. Viccellio.
This article is from FOX NEWS of May 1, 2006 and may still be available at
CLICK HERE
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A GROWING HOLE IN THE SAFETY NET: PHYSICIAN CHARITY CARE DECLINES AGAIN
By Peter J. Cunningham and Jessica H. May
Continuing a decade-long trend, the proportion of U.S. physicians providing charity care dropped to 68% in 2004-05 from 1996-97, or by more than 10%, according to a national study from the Center for Studying Health System Change (HSC). The ongoing decline in physician charity care is alarming given the increase in the number of uninsured people, particularly during the first half of the decade. Declines in charity care were observed across most major specialties, practice types, practice income levels and geographic regions. Increasing financial pressures and changes in practice arrangements may account in part for the continuing decrease in physician charity care.
This article is from Center for Studying Health System Change of March 2006 and may still be available at
CLICK HERE
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MEDICAL TOURISM CAUSES COMPLICATIONS
Approximately 750,000 Americans traveled overseas for medical treatment in 2007, and the number of so-called medical tourists could increase to more than 15 million in 2017. Overall the effects of medical tourism are mixed. On the one hand, the industry can boost a developing country's gross domestic product and investment in health facilities. Upgrades in a country's hospitals also tend to decrease external brain drain, as top physicians find local jobs instead of leaving for employment in developed nations. [EINO: Of course, rather than being a reform of any sort for the US health care system, this is just a way that some (upper middle class) might be able to avoid some limitations and severe financial consequences.]
Neither is this tourism necessarily good for the developing country. Medical tourism may threaten to exacerbate unequal access to quality health care in developing countries. Although relatively cheap by most Western standards, the private hospitals that treat foreigners are out of reach for the majority of people, and the revenue they bring in rarely makes its way to the public sector. External brain drain is often replaced by internal brain drain, as doctors leave public health care centers to work in private hospitals.
Aside from the negative effects on public health overseas... medical tourism is not predicted to reduce US health spending by more than 1 to 2%. By introducing global competition to an industry that's long been considered immune to outsourcing, medical tourism may up the ante on reforming coverage, cost, and quality at home.
MEDICAL TOURISM CAUSES COMPLICATIONS Carnegie Council Policy Innovations October 27, 2008 By Christina L. Madden
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RELATIONSHIP BETWEEN EMPLOYER-SPONSORED HEALTH BENEFITS AND EMPLOYEE COMPENSATION AND EARNINGS
Employer-sponsored health insurance is the primary source of health coverage in the USA, and health benefits are a key element of the total compensation that an employee receives. Conventional wisdom views the ability of employers to provide health benefits through the lens of large firms and small firms. Taken together, these two studies suggest that a better lens than firm size may be high-wage and low-wage firms. The studies underscore the difficulties low-wage firms and low-wage workers face affording health insurance coverage.
Workers with access to health benefits on average receive more than double the compensation of workers without access to health benefits ($30.01 versus $12.43). This gap has been widening over time, and holds even for firms of different sizes and ranges of occupations. For example, a clerical/administrative employee in 2005 who had access to health benefits had average hourly payroll compensation of $17.13 versus an average hourly compensation of $11.95 for an employee in the same occupation without access to health benefits.
Across all establishment sizes, businesses with higher-wage workers are more likely to offer health benefits than establishments with lower-wage employees. In general, even small establishments, for instance those with less than 50 workers, are likely to offer health benefits if there is a comparably large share of high-wage workers.
RELATIONSHIP BETWEEN EMPLOYER-SPONSORED HEALTH BENEFITS AND EMPLOYEE COMPENSATION AND EARNINGS October 2, 2008Original Article
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1 The first 5 of these six attempts are described
in detail in John Geyman's book (see
pages 310 - 316. The sixth attempt is the post-Clinton attempt, both state
work and the Conyers Resolution "Health Care Access Resolution".
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