This Week:

Quote of the Week

A Week Off For Nygaard Notes

Wellstone's Universal Health Care Bill

Canadian Health Care: Nuts and Bolts

Greetings,

So, Nygaard Notes #101 is the first issue of year 2001. How about that? I still haven't gotten around to any sort of retrospective or look ahead or anything. Does anybody care? If you do, let me know and I'll make time for it. Otherwise I'll just keep cruisin' along (after I take a week "off").

The first meeting of the Context Club will be tomorrow, January 6th, from 1 to 3 pm at the Second Moon coffee shop at 2225 East Franklin Avenue in Minneapolis. Some readers have already "signed on" and received their notice separately, but it's open to all Nygaard Notes readers, very informal. If you want to be on the list (separate meeting notices, inside gossip, etc.) just let me know. We'll be working out regular times, places, and format over the first few weeks/months with whoever is present. As with everything associated with Nygaard Notes, it will constantly evolve in a participatory and dialectical fashion. If you know what I mean.

I am shamelessly cheating this week, since both the articles health care are reworkings of articles that will appear next week in my favorite local paper, ACCESS PRESS. They may sue me, but I thought they were worth a wider distribution. Maybe I'll sue myself.

I am publishing these two articles this week not because I think that either Canadian health care nor the Wellstone legislative initiative is the best approach to meeting the health care needs of the U.S. population; far from it. But my guess is that most readers' knowledge on the two subjects consists largely of misinformation in the first case and, well, nothing in the second. I hope that the learning of a few facts about the two subjects will remind readers of extent of the power of the information/propaganda system in this country. That's worth thinking about.

In the spirit of counter-propaganda,

Nygaard

"Quote" of the Week:

"The delivery of health care cannot be subjected to the same principles as those used, for example, in manufacturing. Producing a gross of widgets, all with identical characteristics, needing the same time for production and taking place in a controlled environment has nothing in common with the delivery of health-care services to very different individuals, at different times in their illness and in widely divergent settings. Rules of efficiency cannot be lifted from the manufacturing sector and pasted on to the health-care sector. The incentives, the outcomes and the conditions of those needing health care differ far too dramatically for such a rigid approach."

- The Registered Nurses Association of Ontario, in a paper presented to The Ontario Medical Association Summit on The Canada Health Act in May 1999.

A Week Off For Nygaard Notes

The end of the year brings added bookkeeping, clerical, and other responsibilities, so I am taking next week off to attend to them. The next Nygaard Notes -- #102 -- will be published on January 19th, 2001.

Wellstone's Universal Health Care Bill

Since the defeat of President Clinton's health care initiative in 1994, the subject of universal health care has virtually disappeared from the national agenda. In the standard acquiescence to the wishes of big business -- in this case the insurance industry and segments of the for–profit medical industry – the health care legislation now offered by our national leaders is quite limited. We hear a lot of noise about prescription drug coverage under Medicare, a patients' bill of rights, and other piecemeal approaches, all of which are symptom relief rather than structural reform. (Kind of like our health care system itself, but that's another story.)

The exception to the rule is the recent introduction in the United States Senate by Minnesota Senator Paul Wellstone of the Health Security for All Americans Act, S. 2888. Fairly timid by world standards, the bill seems wildly radical in the U.S. context. It would mandate "quality, affordable health care for all Americans" by requiring every state to create its own system of universal coverage; the federal government would supply significant funding to those states that fulfill the mandate of 100% coverage. The bill was introduced this past July in the Senate, and companion legislation has been introduced in the House by Washington State Representative Jim McDermott and 21 co-sponsors. Although little-reported here in his home state (or anywhere else), grassroots organizing for the bill is occurring around the country, led largely by the nation's largest health care union, the Service Employees International Union (SEIU). Wellstone believes that his bill is the first step in putting universal health care "back on the front burner where it belongs."

In a speech on the Senate floor when the bill was introduced, Wellstone reminded his colleagues of the 45 million Americans who are uninsured, along with the millions more who are underinsured, and pointed out that "All the doctors and all the nurses and all the other health care providers in America cannot solve this problem nor right this injustice, but we in the Congress can!" He's right; the problem is not the fault of the people who work in health care, but is rather a structural problem that is built into our national health care "system."

Wellstone believes that a single-payer plan, similar to the system in Canada, might actually be the best approach for the United States to take. No one can even bring themselves to mention a fully socialized system, which I think is worth a good look. Like all good "progressives" in positions of leadership in this country, however, Wellstone is a "realist," meaning that he concedes huge hunks of territory to corporate wishes before the game even starts. As a result, the Health Security for All Americans Act is not even a single-payer plan. Instead, Wellstone points out that the 50 U.S. states could reach the goal of universal coverage "in a variety of ways: with an employer mandate, with a combination of public and private initiatives, with single payer, or some other method." Still, as I said earlier, even this seems like a Communist plot to many in today's America.

Key Features

Since it is the closest thing to a structural approach on the federal government's agenda right now in regard to health care, I think it is worth looking at some of the key features of the Health Security for All Americans Act, of which there are eight:

1. Each state would be required to devise a way to "establish and implement State-administered systems to ensure universal health insurance coverage equal to the benefits provided" to members of Congress and other federal employees. The states would have 5 years to reach the goal of 100% coverage.
2. The federal government would provide the funding necessary for the states to assure that no citizen pays more than a small percentage of their family income for coverage under their plans (ranging from one-half of one percent for the lowest-income families to 7% for upper-income families).
3. The bill anticipates substantial "direct savings in [overall] health care expenditures resulting from the implementation of this Act," with additional funds coming from the federal government and drawn from the projected budget surplus and from taxes raised by closing existing loopholes on wealthy individuals and large corporations.
4. Acknowledging that it would take some time for the states to implement their universal care plans, the bill would immediately enact into law a patients bill of rights (as previously submitted in the U.S. House) and the provisions of another previously-submitted bill that would "prohibit discrimination or retaliation against health care workers who report unsafe conditions and practices which impact on patient care."
5. The bill would establish a "Health Care Quality, Patient Safety, and Workforce Standards Institute" within the federal Department of Human Services. The Institute would improve patient safety and quality of care by addressing the recently-publicized issue of workplace errors, including ongoing study of "how patient safety issues and workplace conditions are linked" to those errors and overall quality of care.
6. The Institute would also "study and report to Congress and the President legislative recommendations for adding a comprehensive, accessible, and affordable prescription drug benefit to Medicare."
7. Title VI of the bill, entitled "Long-term and Home Health Care," would mandate the Secretary of Health of Human Services to "conduct studies and demonstration projects...designed to identify model programs for the provision of long-term and home health care services," and "report any recommendations for legislation to expand or continue such studies and projects."
8. The bill contains a requirement that any American entitled to benefits under either Part A or Part B of the Medicare program "shall be provided full mental health and substance abuse treatment parity under the medicare program."

Wellstone maintains that his bill, by allowing states maximum flexibility while establishing federal responsibility for setting standards and providing funding, gives the United States the best chance at the present time to meet the goals of "universal coverage; comprehensive benefits as good as Congress gets; quality care guaranteed with patient protections; real income protections; and honoring of health care workers." He may be right; it may be the best we can hope for at this point in history.

Despite the fact that this bill was introduced in July by Minnesota's senior Senator, and is the only bill in the Senate the deals in any significant way with the overwhelming desire on the part of Americans for "fundamental changes" in the health care system, the bill has received almost no coverage in the local press. I thought I remembered a brief mention on page 10 of the Star Tribune (Newspaper of the Twin Cities!) back in July, but when I did a database search for it, they hadn't even bothered to archive it. No mention at all in the St. Paul daily paper.

The United States remains the only industrialized nation in the world without a national health care system. In fact, no nation other than the United States allows more than 1% of its residents to live without full health coverage; in the United States, the number is 17%. It should be a national scandal, all over the front pages every day. The fact that it is not says a great deal about the extent of corporate power in this country, and the subservience of our mass media.

Canadian Health Care: Nuts and Bolts

There is much misunderstanding in the United States about the health care system in Canada. This week I'll give a brief overview of the system that serves our neighbors to the north; in a future issue of Nygaard Notes I will attempt to address some of the most prevalent myths propagated by free-marketeers in the United States about Canadian health care.

Universal health care is not a complicated matter. In contrast with the failed Clinton health care plan of 1994, which ran to more than 1,000 pages, the entire Canada Health Act (CHA) is a mere 12 pages in length. Despite the fact that the CHA is extraordinarily popular among Canadians (surveys show that over 90% of Canadians prefer their health care system to the U.S. model) the mid-1990s saw a serious cut in federal funding for health care in Canada, ostensibly due to "budget shortfalls." One of the predictable consequences of such a cut in health care funding is that it "promotes privatization of health care, as the private sector steps in to fill the void left by the public funding cuts," in the words of the Registered Nurses Association of Ontario. This pattern of de-funding of public programs, followed by attacks on those programs for the resulting failures to live up to their mandates, is a familiar feature of U.S. political culture since the Reagan era. Reference the relentless attacks on the U.S. Social Security system, for example.

Despite the cutbacks in funding and resulting stresses on the system, a 1999 survey showed that almost 85% of Canadians said the medical care they and their families received in the last year was good, very good or excellent, following the pattern of earlier surveys. In contrast, a recent CBS News poll showed that a startling 86% of Americans said that the U.S. health care system needs "fundamental changes" or needs to be "completely rebuilt."

How Canadian Health Care Works

In Canada each resident is issued a health insurance card – similar to a Social Security card in the U.S. – which entitles them to go to any doctor, anywhere, anytime and receive any covered service, for which there are no deductibles, co-payments, or dollar limits. Covered services are defined as "all medically necessary services," and include in-patient care at the ward level (unless private or semi-private rooms are medically necessary) and all necessary drugs, supplies and diagnostic tests, as well as a broad range of out-patient services. Most chronic care services are also insured.

Overall, the Canadian health care system, called "Medicare," is a system in which the federal government sets national standards for health care and assists in the financing of the system. The management and delivery of health care services is the responsibility of each individual province, which are equivalent to our states. Canada does NOT have a system of "socialized medicine," with doctors employed by the government. What they have is a national health insurance system -- a "single payer" -- which pays for most services delivered by doctors, most of whom are private practitioners who work in independent or group practices and have a high degree of autonomy. The system is referred to as a "national" health care plan in that all provincial and territorial hospital and medical insurance plans are linked through adherence to national principles set at the federal level.

Fundamental to the ongoing "love affair" that Canadians are said to have with their Medicare system are the Five Principles upon which it has been based since 1984. In Nygaard Notes #102 (remember, that won't be out for TWO weeks) I will explain those principles and, if I have room, dispel a large number of myths about the current state of health care in Canada.