
The National Health Program Book A Source Guide for Advocates
Himmelstein, David, & Woolhandler, Steffie Publisher: Common Courage Press, Monroe ME 04951, USA Year Published: 1994 Pages: 288 Price: $11.95 ISBN: 1-56751-018-3 Book Type: Handbooks/Manuals
Resource Type: Book
Facts, statistics, and myth-debunking about the Canadian health insurance system and about competing proposals for reform of the U.S. health care system. Part I covers the Economic Context of the Health Care Crisis: Rising Costs, Declining Coverage and Incomes; Part II covers the Impact of the Crisis: Care Denied and Delayed; Part III covers the Social Cost of the American System: Poor Health care Leads to Poor Health. Part IV covers Rationing in the Midst of Plenty. Part V focuses on Exploring the Alternative: Canada's National Health Program. Part VI looks at Why Our System Costs More and Delivers Less: Administrative Waste in U.S. Health Care. Part VII deals with a National Health Program for the U.S.. Part VIII covers Paying for a National Health Program. Part IX looks at President Clinton's Plan: Making Insurance Companies the Feudal Lords of American Medicine. Part X is A Force for Change: Public Opinion on Health Care Reform. Part XI is A National Health Program for the United States: A Physicians' Proposal.
Abstract: Facts, statistics, and myth-debunking about the Canadian health insurance system and about competing proposals for reform of the U.S. health care system. Part I covers the Economic Context of the Health Care Crisis: Rising Costs, Declining Coverage and Incomes; Part II covers the Impact of the Crisis: Care Denied and Delayed; Part III covers the Social Cost of the American System: Poor Health care Leads to Poor Health. Part IV covers Rationing in the Midst of Plenty. Part V focuses on Exploring the Alternative: Canada's National Health Program. Part VI looks at Why Our System Costs More and Delivers Less: Administrative Waste in U.S. Health Care. Part VII deals with a National Health Program for the U.S.. Part VIII covers Paying for a National Health Program. Part IX looks at President Clinton's Plan: Making Insurance Companies the Feudal Lords of American Medicine. Part X is A Force for Change: Public Opinion on Health Care Reform. Part XI is A National Health Program for the United States: A Physicians' Proposal.
Table of Contents
Introduction: Ten Myths about Health Care
Part I The Economic Context of the Health Care Crisis: Rising Costs, Declining Coverage and Incomes Health Costs Rise 10% in One Year! Wages Devoted to Meeting Health Costs on the Rise A Country at Risk The Number of Uninsured Rose by Over 50% in 15 Years 25% Uninsured at Some Point During a 28 Month Period Most Uninsured Adults Have Jobs Those Lacking Insurance Come From All Walks of Life Hispanics are Twice as Likely to Lack Health Insurance as Non-Hispanic Whites 1 out of 5 African-Americans Is Uninsured More Money Insures Fewer People Health Insurance: Only the Healthy Need Apply 50 Million with Insurance Risk Banruptcy in the Event of Major Illness Insured Americans Often Can't Afford Care Seniors Spend 50% More on Health Costs than in 1977 Avoidance of Care Due to Cost Is on the Rise More and More People Can't Afford to Pay for Care Employers Cut Their Contribution to Health Costs The Need for Insurance Restricts People's Choices in the Job Maket American Cars Contain More Health Care than Steel Corporate Health Spending Skyrockets U.S. Real Wages Decline in Decade of Rapid Economic Growth Poverty Is on the Rise More of Our Children Are Living in Poverty U.S. a Leader -in Poverty Percentage of Working Poor Is on the Rise The Rich Get Richer… While the Poor Get Poorer The U.S. Leads the World in CEO/Worker Pay Ratio In a Society with a Gold-Plated (but Sorely Lacking) Health System, Other Priorities are Underfunded
Part II The Impact of the Crisis: Care Denied and Delayed Lacking Insurance, 300,000 Refused Emergency Care Annually Loss of Coverage Results in Poor Health -and Death Delayed Care Increases Death Rates The Uninsured See Doctors Less Insured People Get More Hospital Care Poverty and Lack of Insurance Both Decrease Access to Care The Uninsured Get Less Preventative Care
Part III The Social Cost of the American System: Poor Health Care Leads to Poor Health Fewer Women Get Early Prenatal Care Progress on Black Infant and Child Health Comes to a Standstill Black Infant Mortality Is Twice that of Whites Many Other Countries Have Lower Infant Mortality Rates that Are not Influenced by Race Deaths During Pregnancy and Childbirth are Rising Among African Americans Death Rate for African-American Women Stops Declining African-American Male Death Rate is Increasing Men in Harlem Have a Shorter Life Expectancy than Men in Bangladesh White Women Live Nearly Six Years Longer than Black Women White Men Live Nearly Eight Years Longer than Black Men Life Expectancy Could be Increased by Better Medical Care Poverty and Racism Cause African-Americans' Poor Health Wealth Improves Health Poverty Correlates with Ill Health American Men Live Shorter Lives Women Die Younger
Part IV Rationing in the Midst of Plenty One-Third of Hospital Beds Are Empty While Millions Are Denied Care Many High-tech Specialities Are Overcrowded While Millions Got without, Many Get Unnecessary Surgery More Technology Isn't Always Better Lives Lost Because of Inappropriate Allocation of Resources Too Many Machines, Too Much Money, Too Little Care Long Waiting Lines for Emergency Care Denying Care in the Land of Surplus More Administrators Keep More Beds Empty
Part V Exploring the Alternative: Canada's National Health Program Canada's Plan: Everyone is Covered National Health Program Encourages Sick Patients to Visit Doctors Americans are 3 Times More Likely than Canadians to Lack Needed Care Canadians are More Satisfied than Americans Canadians Receive More Physician Care than Americans Insured Americans Get about as Much Hospital Care as Canadians Transplants Are as Available in Canada as in the U.S. Faster Care in Canada for Breast Cancer Patients Americans See Their Doctors Less Often Americans Get Less Health Care as Measured by Hospital Length of Stay Canada's Plan Provides Safer Surgery Surgery in Canada In Not Biased Toward Higher Incomes More High-tech Care in the U.S. Does Not Save Lives Canada's System Doesn't Compromise Innovation U.S. Physician Income Is Higher for Specialists but Not for Primary Care Doctors Nursing Salaries Similar in U.S. and Canada German System Is No Answer: It Saves by Paying Workers Poorly Canada Saves on Administration but Doesn't Skimp on Caregivers Respect for Medical Profession is Higher in Canada than in the U.S. Canadians Are Most Satisfied with Care -Americans Least Satisfied Canada's Health Care System Costs Less than Ours
Part VI Why Our System Costs More and Delivers Less: Administrative Waste in U.S Health Care More Money in Canada Devoted to Care instead of Overhead Americans Pay 6 Times More for Insurance Overhead than Canadians U.S. Insurance Overhead Is Enormous; Canada's Is Negligible Multiple Payers are Less Efficient than a Single Payer Plan Competition Raises Hospital Costs Insurance Overhead: Many Components are Eliminated in the Canadian System Health Maintenance Organizations Don't Cut Out the Waste What the Bureaucracy Is Paid For: Oversee, Push Paper, and Sell, Sell, Sell Profit: a Growing Factor in HMO's We Could Save $50 Billion/Year in Hospital Costs on the Canadian Plan The Billing Bureaucracy Clinical Workforce Grows Little While Marketing Mushrooms U.S. Doctors Spend 2.5 Times More on Billing Expenses than Their Canadian Counterparts The U.S. Spends 3 Times More than Canada on Administration Managers Do Not Productivity Make Drug Advertisements Waste Billions U.S. Drug Prices 50% Higher than in Canada Medical Malpractice Is the Leading Cause of Accidental Death in the U.S. Spending on the Last Year of Life is Not Driving Up Medicare Costs HIV Is Not the Cause of Spiraling Health Costs Illegal Drug Abuse Does Not Account for Rising Health Costs
Part VII A National Health Program for the U.S. Essentials of a National Health Program The NHP would Eliminate Barriers to Access Paying Physicians Under the National Health Program Capital Payment Can Be Planned to Meet Costs Effectively Hospitals Can Be Successfully Operated with the NHP A Health Plan to Cover Everyone Providing Care for the Disabled in the Community Few Have Private Insurance for Long-Term Care Long-term Care Given by Families and Friends Must Be Valued and Supported Goals for Long-Term Care The Meaning of Comprehensive Care The Quality of Long-Term Care Must Be Improved
Part VIII Paying for a National Health Program Getting from Here to There Savings in Efficiency Would Provide Better Coverage for All Average Americans Would Pay No Extra: Taxes Would Replace Out-of-Pocket Costs Expand Long-Term Care to Meet Need Quality Long-Term Care Is Affordable The Clinton Plan: The Poor Would Still Pay the Most Who Would Pay with a Progressive Tax Payment for Canada's NHP Is Progressive The Canadian System Is Possible within Our Current Costs and Taxes
Part IX President Clinton's Plan: Making Insurance Companies The Feudal Lords Of American Medicine The Clinton Health Plan: A Grimm Fairytale Details of the Clinton Plan Many Proposals: All Preserve Insurance and Managed Care Giants Clinton Believes We Are Overinsured(!) Perpetuating the Health Insurance Industry -and Crisis Managed Care: Part of the Problem, Not the Solution HMOs Haven't Contained Costs HMOs Offer No Clear Advantages in Rate of Premium Increase More HMO's Correlate with Greater Cost Increases HMOs Have Higher Insurance Overhead costs HMO Overhead Averages 19% Overheads and Profits Swallow 18% to 25% of Revenues Federal Employees' Plan is No Model for Containing Costs Managed Competition: Health Will Depend on Wealth California Public Employee Plan Isn't a Good Model HMOs Don't Give Better Care Patients Prefer Small Doctors' Offices, But Clinton Proposes Massive HMOs Managed Care Works Worst for Those Who Are Poor and Ill Most Americans Don't Live in an Area Dense Enough to Support Competition Managed Competition: Incentives to Avoid Treating the Sick Big Profits for Big Companies Forcing Doctors Out of Work The Clinton Plan: Free Choice of Doctor Only for the Wealthy Managed Competition Could Cause a Massive Disruption of Care Doctors Outside HMOs Would be Forced to Charge Huge Fees Managed Competition: A Grimm Fairytale Managed Competition: Prudential's Choice A New-Yorker Critique
Part X A Force For Change: Public Opinion on Health Care Reform NHP Supporters and Opponents Insurance Industry Dominates the Boston Skyline Most Americans Prefer the Canadian NHP Fewer than 5% of Canadians Want the U.S. System Contrary to Industry Claims about "Cultural Differences," Americans View Are Similar to Canadians U.S. Support for Canadian System Cuts Across Economic and Ethnic Lines The Public Is Willing to Pay Taxes for Better Long-Term Care Dissatisfaction Is Rising Americans Want Change Higher Out-of-Pocket Expenses Rejected as Means to Control Costs Nearly 3/4 of Americans Want National Health Insurance Most Doctors Side with the Public Canadian Physicians Wouldn't Want the U.S. System Most U.S. Doctors Would Accept a 10% Cut in Pay for Less Hassle Even Health Economists Favor Canada's System
Part XI A National Health Program for the United States: A Physician's Proposal
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