Today, 3000 New Yorkers joined together at Times Square to support healthcare reform. Among them were quite a few National Physicians Alliance members, and Dr Jonathan Arend spoke at the event. These and quite a few other photos below are from casperr’s diary at dailykos.

Above: Dr Jonathan Arend, of the NYC National Physicians Alliance group, speaking to the crowd.

Above: Some of the physicians who were present at the rally.

Above: braving the rain, 3000+ people show up for the event.

Many words have been spent in the media discussing how the Obama administration is “losing” the healthcare debate.  The reality is, however, that it is the media–mainstream, viral, blogged and all—who will actually be responsible if no real health reform is accomplished.  Howard Dean’s Huffington Post blog of 8/10/09 should serve as an opening salvo in getting the media to wake up to its responsiblities.

http://www.huffingtonpost.com/howard-dean/the-medias-treatment-of-p_b_255878.html

There was a day not so very long ago when news reporters felt that a large part of their job was to educate the public.  Clearly this kind of professional ethic has been on the decline, but the last few weeks have shown it to be on terminal life support.   Many, many citizens are confused about what health care reform will bring.  My parents, both educated people in their 80′s who read 3 newspapers a day and are quite liberal, just feel completely at sea on this issue.  Many of their friends feel the same.

What has the media done to educate folks like my parents?  Nothing.  Instead they spend endless hours talking about Sarah Palin’s outrageous statements about “death squads,” repeating right-wing propaganda as if they were anything but the most egregious, unethical, debased lies, and providing public forums for birthers, deathers and every other crazy, fact denying lunatic.

If the media spent even 10% of the time it has spent giving legitimacy to these folks on educating the American public we would be in a very different place in this debate.

Clearly there is that segment of the population out there who is completely immune to facts—-no matter how many times President Obama says, “if you’re happy with your current health plan you can keep it,” they are going to insist that the government is taking over.  There is no rational debate with such people and we need not even try.   Their objections are really about racism, Republican angst and fear of a pluralistic society.  But the overwhelming numbers are Americans who are confused and need to be educated.  We must demand with letters and posts and phone calls that  people in the media return to  a place where they choose responsible reporting over ratings.

In an editorial titled, “Prognosis: Debt” Fred Hiatt of the Washington Post expresses concern over the (misleading) 1.6 trillion dollar price tag placed on health care reform, but in a way makes a compelling argument for including a public health insurance option in health reform.

He writes that President Obama (and others) have defined the major problem with our health care system as being unsustainable growth in costs, while congressional Democrats have primarily focused on expanding coverage to the uninsured:

congressional Democrats and the most involved interest groups behind them are far more passionate about universal coverage than about controlling costs. Thus Obama’s political calculation: Push for health-care reform that delivers universal coverage — and insist on as many levers to control costs going forward as possible.

He explains that this disconnect between the problem and proposed solution comes from the fact that it’s easy to expand coverage but hard to control costs. He states that proposed cost saving measures, such as focusing on prevention, shifting from specialist care to primary care, and changing provider payments from fee for service, all are unproven, and he implies that expanding coverage to include all Americans would inevitably lead to more debt. He gives several suggestions to the President on how to ensure that whatever “new burden” we take on with health care reform “is really paid for”.

As a physician, I do think universal coverage and equitability in our health care system is a “moral imperative” – I see patients without health insurance or with inadequate health insurance who have put off necessary care due to costs and suffered the consequences – but for the sake of argument, let us just talk about costs.

If we expand health insurance coverage without controlling costs, as outlined by Mr. Hiatt, we would have the equivalent of the Massachusetts plan. Their health exchange (“Commonwealth Connector Authority”) and individual mandate to purchase insurance (with subsidies for lower income individuals and families), along with Medicaid expansion and other measures, has achieved more than 97% health insurance coverage. This initially improved access to care (more individuals had a usual source of care besides the ER and a preventive care visit in the preceding 12 months), and decreased the financial burden of health care costs on some families (with fewer people spending more than 10% of their income on out of pocket costs). However, without a mechanism to control costs, there have been challenges in limiting increases in premiums and some of the gains in affordability have been lost.

This is where the public health insurance option comes in. Massachusetts does not have a true public health insurance option. The Congressional Budget Office’s $1.6 trillion estimate on the 10 year costs of the Senate Health, Education, Labor, and Pension committee’s health reform bill did not include evaluation of the public health insurance option. A proposal by the Commonwealth Fund for comprehensive health system reform including a public health insurance option, provider payment reform, and investment in public health infrastructure was estimated to have a net impact over ten years of $3 trillion in savings. While the upfront costs in expanding insurance coverage may appear daunting, as long as it is coupled with a mechanism to control costs, it will be a wise investment that improves access, quality, and slows growth in health expenditures.

And the cost savings are not just wishful thinking – lower administrative costs and the ability to negotiate lower rates from providers and pharmaceutical companies would allow a public plan to offer premiums at least 20% less than those of comparable plans in private individual or group markets. This expansion of coverage would not reduce overall health care costs, but these savings are not included in the 1.6 trillion dollar price tag for the HELP committee’s proposal. If employers or individuals previously with commercial insurance chose to buy into the public plan and its less expensive premiums, there could be significant savings overall.

A public health insurance plan would also likely reduce the costs of premiums of private health insurance through competition. 94% of health insurance markets are “highly concentrated” by FTC standards and most metro areas only have one or two options for consumers. This near monopoly is not good for costs or quality.

The effects of payment reform may be more difficult for the CBO to estimate, but a public plan would have a clear advantage over private insurers in shifting incentives toward prevention, care coordination, and evidence based medicine. Managed care was supposed achieve these goals in the private sector, but it has failed to control costs or improve quality. Medicare has begun to align payment with outcomes through pay for performance and nonpayment of care for preventable complications instead of simply reimbursing for the volume of care provided. A public plan would have the national scope to influence practice patterns across the country; a public plan would offer transparency and could be held accountable if cost or quality measures were not being reached; and a public plan would have the mission of disseminating effective payment innovations to other payers as a public good.

There are many other reasons why we need fundamental health care reform – most pressingly because it is unconscionable to deny sick patients necessary care because of inability to afford health care costs – but the realities of increasing health care expenditures do require a discussion of costs. While it is unfortunate that a misleading CBO estimate on the costs of one version of the health care bill have decreased momentum for reform, drawing on the lessons from Massachusetts, we can still use this information to promote meaningful change. Relying on the private health insurance industry to control costs would be a mistake. However, adding a public health insurance option is extremely popular, with 72% of Americans supporting a public plan in the most recent poll, and would provide several mechanisms to control costs. The American people are correct on this one, and our elected representatives better be listening.

Aaron Fox, MD
National Physicians Alliance
New York City – Local Action Network

Last night, CNBC featured a segment on “Is Health care a right or a privilege?” and invited two speakers to debate the question. One of the speakers was Dr Mai Pham, senior policy advisor at the National Physicians Alliance (NPA). The NPA fimly believes that health care is a human right and our campaigns and mission speak directly to that. The other speaker was Michael Cannon, director of health policy at the CATO Institute, a free-market, libertarian organization.

We applaud Dr. Pham’s cool and collected manner and her ease at articulating her points under fire. We could learn some tips on how to stay on point and how to debate an issue, from her appearance on the debate.

In any case, it was a pleasant surprise to see this issue covered by CNBC, and a great thanks to them for asking us on the show; perhaps the station will cover such issues in the future!