Study Shows Universal Health Benefits

BMC Health Services Research

August 4, 2010

The impact of universal National Health Insurance on population health: the experience of Taiwan

By Yue-Chune Lee, Yu-Tung Huang, Yi-Wen Tsai, Shiuh-Ming Huang, Ken N Kuo, Martin McKee and Ellen Nolte

Background

Taiwan established a system of universal National Health Insurance (NHI) in March, 1995. Today, the NHI covers more than 98% of Taiwan's population and enrollees enjoy almost free access to healthcare with small co-payment by most clinics and hospitals. Yet while this expansion of coverage will almost inevitably have improved access to health care, however, it cannot be assumed that it will necessarily have improved the health of the population. The aim of this study was to determine whether the introduction of National Health Insurance (NHI) in Taiwan in 1995 was associated with a change in deaths from causes amenable to health care.

Methods

Identification of discontinuities in trends in mortality considered amenable to health care and all other conditions (non-amenable mortality) using joinpoint regression analysis from 1981 to 2005.

Results

Deaths from amenable causes declined between 1981 and 1993 but slowed between 1993 and 1996. Once NHI was implemented, the decline accelerated significantly, falling at 5.83% per year between 1996 and 1999. In contrast, there was little change in non-amenable causes (0.64 percent per year between 1981 and 1999). The effect of NHI was highest among the young and old, and lowest among those of working age, consistent with changes in the pattern of coverage. (This result is consistent with our expectations as 77% of the working age population were already covered by the pre-existing social insurance; thus they were inevitably going to be affected less by the introduction of NHI.) NHI was associated with substantial reductions in deaths from circulatory disorders and, for men, infections, whilst an earlier upward trend in female cancer deaths was reversed.

Conclusions

NHI was associated in a reduction in deaths considered amenable to health care; particularly among those age groups least likely to have been insured previously.

Policy Implications

These findings have implications for other countries that do not have universal health insurance coverage. The implementation of NHI in Taiwan was associated with a sustained reduction in deaths from causes amenable to health care, which surpassed the underlying decline in other causes. It is reasonable to expect that the introduction of universal coverage elsewhere might also have beneficial effects.

Looking ahead, while the Taiwanese NHI has succeeded in terms of cost (3.4% of GDP), satisfaction (77.5% satisfied in 2007), low administrative cost (1.49%), and equitable financial burden, the system is not without problems. For example, as a publicly-managed program, it is difficult to insulate it from political interference, a factor that has contributed to a continuing financial deficit. Thus, the existing budget may be inadequate to sustain the current level of performance.

http://www.biomedcentral.com/1472-6963/10/225/abstract

Full article (provisional):

http://www.biomedcentral.com/content/pdf/1472-6963-10-225.pdf

United States has worst rate of amenable mortality:

http://www.pnhp.org/news/2008/january/united_states_has_wo.php

Comment:  Taiwan's 1995 introduction of a single payer system of universal National Health Insurance provides us with a natural experiment on the impact of single payer reform on health outcomes. The results are dramatic. The rate in reductions of deaths due to disorders that are amenable to health care were nine times the reductions in deaths from non-amenable causes. Nine times!

The United States should be especially interested in these results since, in a study of nineteen industrialized nations, we have the worst rate of amenable mortality (link above). We have over 100,000 excess deaths per year due to disorders amenable to health care.

Will the Patient Protection and Affordable Care Act (PPACA) erase this blemish on our health care system? Most of our dysfunctional financing system will remain in place. Some will receive care under an expansion of Medicaid, but as a chronically underfunded program with insufficient numbers of willing providers, access problems are inevitable. Others will receive care under the private plans in the insurance exchanges, but financial barriers to access will remain because of the low actuarial values of the plans and inadequate subsidies. There is little reason to believe that the tweaks of PPACA will have much impact on amenable mortality.

After enacting a single payer system, Taiwan not only greatly reduced amenable mortality, but it was done at a fraction of our spending, with great patient satisfaction, with extremely low administrative costs, and with a financing system that is equitable. Maybe Taiwan needs to spend more, but just think of what we could have with the amount that we are already spending. Besides, saving 100,000 lives a year seems to be a worthy policy goal.

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Opeyemi Column Issues Manifesto Re Health Care

Image via Wikipedia

Opeyemi’s manifesto by Opeyemi Parham.

It’s time to walk away from the beat grinder, folks. I am speaking --truth to power, in relation to our health. The WHOLE of our health. Holistic health. Mind, body, and spirit.

They drew a line in the sand. In their reality, I stepped over it.

In Massachusetts, we are penalized each April if we have not purchased the mandatory health insurance legislated by our state. This is NOT universal health care, nor is it health care for all. It is a coercive attempt to monopolize “health” by forcing us into the jaws of Big Pharma and corporate medicine.

Feel like I may be overstating my case? Check out the stock market’s response, as the “public option” section of Obama’s version of comprehensive health coverage gets mangled and co-opted in Washington. The insurance companies stocks are rocketing up.

This year I said “no” to the entire mess, and I mean it.

In Massachusetts, I can say “no” to mandatory health insurance if I have a sincere religious belief that conflicts with purchasing insurance. Well, I do. I believe the system that would be forcing this upon me is EVIL I believe that this system not only has no interest in my health; it actually has an interest in making me, and keeping me, chronically ill.

In order to claim my religious exemption, I must show that I use no medical care. No doctors. No emergency rooms. No hospitals. I am sure that this caveat in the law was influenced by Massachusetts being the birthplace of Mary Baker Eddy’s Christian Science movement. And, I am also sure that the arrogance of the state that birthed Harvard medical school assumes that no one in their right mind would claim such an exemption.

I am not a Christian Scientist, but my spiritual views on health are closer to the fringe than to the mainstream, these days. I had a religious experience back in 2005, that led me to question my entire world view and belief system. Up to now, I held that experience sacred/secret because it is not wise for a conventionally trained M.D. to use the “s” word when speaking about health and healing.

Not the “s” word sex,; the “s” word SPIRIT.

My spiritual experience left me on the wrong side of that line in the sand, drawn by the Bigheads on Beacon Hill. When push comes to shove, if you ask me to use conventional meds as prescribed by my state’s legislature, or be banned from using them at all, I will choose the side of the ban.

THEY drew the line in the sand. In their reality, I am stepping over it.

In my reality, I am dancing into spiritual evolution:

I’m stepping into clarity…
I’m walkin’ in my Power
I’m dancin magic in my life
Every day and every hour
I’m choosin’ to be usin’ the things I got
To make this world so fine
‘Cuz I am one unique expression,
of the great divine…

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Minnesota Health Plan Touted

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Published on Tuesday, February 2, 2010 by CommonDreams.org
Single Payer Solution for Obama

by MN Senator John Marty

"If anyone...has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know."
-- President Obama, State of the Union
January 27, 2010

An open letter in response to President Obama's State of the Union request for a better approach to health care reform:

Dear President Obama,

During your State of the Union address, you explained why you are fighting for health care reform, expressed frustration at the lack of success, and invited others to suggest a better approach.

I'm taking you up on that invitation and offer a bold suggestion:

Take a look at our Minnesota Health Plan -- a proposal that covers everyone, saves money, and creates a logical health care system to replace the dysfunctional non-system which currently exists. It is a proposal that would provide health care to everyone, not merely health insurance for many. Our MN Health Plan (mnhealthplan.org) could be readily adapted as a nation-wide plan. It would meet each of the five requirements you mentioned in your State of the Union request:

Bring Down Premiums. Most Americans would see a big reduction in premiums because the plan would be significantly cheaper than our current health care non-system. Because the premiums for the MHP would be based on ability to pay, everyone's premiums would be affordable. Some would pay more, but overall, costs would go down. Most people would save money, while getting the care they need and deserve. The total costs for the plan would be less than we now are paying for premiums, co-pays, deductibles, and taxes for medical programs.

Bring Down the Deficit. By keeping people healthier and by delivering quality health care efficiently, it would save hundreds of billions of dollars for the federal government, and even more for states. For example, by covering chemical dependency treatment and providing comprehensive mental health services, it would cut crime and human service costs (such as out-of-home placement of children), some of the biggest and fastest growing expenses facing state and local governments.

Cover the Uninsured. It would cover the uninsured and the under-insured. In fact it would cover everyone -- 100% of the public.

Strengthen Medicare for Seniors (and everyone else). It would cover prescription drugs -- with no "doughnut hole." It would cover long term care, in-home care, dental, eye care, physical therapy, and medical supplies -- it would cover all medical needs. And, they would have their choice of doctor, hospital, clinic, dentist -- complete freedom to choose their medical providers.

Stop Insurance Company Abuses. There would be no "pre-existing conditions" to worry about, no underwriting, no denials of coverage, no "out of network" problems. I like to use the analogy of police and fire protection. When you return home to find a burglary in process and call 911, the police dispatcher does not ask if you qualify. They do not ask if you have police insurance. They do not ask whether your policy covers home burglary. They don't ask if you have pre-existing conditions that would disqualify you. They don't waste time and money having you fill out forms so your insurance company can be billed. The police response does not depend on your insurance status. Everyone is treated equally. It's the American way. It is time to treat health care the same way.

As a 23 year member of the Minnesota Senate, let me comment briefly on the politics of this proposal:

The MHP is a single payer proposal. You have acknowledged that single payer is the only way to cover everyone. Seven years ago you said that single payer health care is "what I'd like to see. But... we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House." Now that we have taken back the White House and the Congress, it is time to act.

I recognize, as you do, that you do not have the votes to pass truly universal health care at this time. The insurance and pharmaceutical industries contribute so much to members of Congress -- they control the debate -- so health care for everyone isn't even on the table.

This, however, is your opportunity for leadership. If you propose and fight for health care for all, as FDR did with Social Security in 1935, the voters would respond. If you don't win this year, ask the American people to elect candidates who will stand with you. Make it the issue of the campaign: Health Care for All vs. Health Insurance for Some. Instead of losing Democratic members of Congress this year -- as Massachusetts illustrates -- you would gain votes and could actually pass the bill next year.

Dr. Martin Luther King stated, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane."

Almost a half century later, we still have not addressed the injustice in health care that Dr. King described as the most inhumane. Ignoring this injustice is immoral and it is economically unsustainable. People are hurting, some are literally dying, businesses are folding, and it is crushing our national economy.

Please, restore the Hope that you raised in all of us, bring back the inspiration that made the American people so excited by your inauguration. I urge you to step back, reconsider, introduce a health care plan that is truly universal, and fight for it.

Justice requires no less.

Respectfully,

John Marty
John Marty is a state Senator from Minnesota, who is currently a Democratic candidate for governor. John currently chairs the Minnesota Senate Health, Housing and Family Security Committee. He is author of the Minnesota Health Plan, a bold single-payer health plan that would cover all Minnesotans for all their medical needs, including mental health and chemical dependency. He has been successful in gaining the support of one-third of the state's legislature as co-authors.

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Another Lump of Coal

Image by Public Citizen via Flickr

Published on Saturday, December 26, 2009 by CommonDreams.org

Healthcare Bill a Nightmare Before Christmas

by Billy Wharton

Call it the nightmare before Christmas or Santa's lump of healthcare coal. Either title captures the disastrous qualities of the healthcare reform bill passed by Senate on Thursday. After months of media coverage, a summer of wild town hall meetings and all the high-sounding rhetoric one could swallow, a 2,000 page monster has been birthed. Though President Barack Obama hailed the bill's passage by declaring, "This will be the most important piece of social legislation since Social Security passed in the 1930s," it carries few of the universal qualities or public control of the Social Security legislation. For all the political theater associated with the bill, remarkably little in the bigger picture of healthcare in America has changed - private health insurers still run the system, Washington politicians are still gathering in the campaign contributions and millions will still be left without health insurance.
Bad Gets Worse in the Senate
The Senate bill is even weaker than the already comprised piece of legislation passed by the House of Representatives. The number of uninsured capable of gaining insurance will be somewhere around 24 million. With private plans as the alternative, estimates are that more than $450 billion in tax-payer money will be transferred to private insurers in order to allow the uninsured to gain coverage. However, that coverage will be something akin to the lowest form of car insurance - you get by before the eyes of the state, but get into an accident and you will find yourself facing massive debt. Estimates are that the low-coverage plans would only cover 60% of costs. Even worse news comes for the more than 20 million people who will likely remain uninsured. They will now also have to forfeit 2% of their annual income because of it. A nightmarish scenario indeed - uninsured and penalized!
Smaller parts of the bill also promise negative outcomes. Medicare plans are still being trimmed by $43 billion. Democrats claim it is fat-cutting through the elimination of tax-payer subsidies to private insurers. Seniors fear the long-term impact of the cuts will result in reduced services, especially for quality of life issues such as the ability to participate in exercise programs for free. Reproductive rights also took a hit. While the Senate bill moves off the harsh language on abortion proposed by the Stupak amendment in the House bill, it still represents a serious reversal of reproductive rights on a national scale. If a female subscriber wishes to use her healthcare plan to pay for an abortion, she will have to pay into a separate fund connected to plan. Given the unexpectedness of most unwanted pregnancies, this measure practically eliminates the ability to use insurance to obtain an abortion. The Stupak amendment was defeated in
words, but its content seems certain to return in practice.
Finger-pointing Misses the Big Picture
Who is to blame for such a fiasco? Much progressive ink has been spilt in examining the days leading up the Christmas Eve coup. Joe Lieberman has been a particular target, and even Bernie Sanders has taken some grief for removing his single-payer amendment and, ultimately, voting yes on the bill. Yet this focus on the theatrics of the approval misses the larger structural dimensions of how this bill will become law. Sure, Lieberman converted his leverage as a fence-sitting Conservative into a further watering of bill and Sanders left the field without much of a fight, preferring a go-along-to-get-along approach in order to fight another day. Neither of these statements says much about how this bill came to be.
The real story of this bill is rooted in two moments. One came from the campaign trails of 2008, where massive sums of campaign contributions from health insurers and pharmaceutical companies tipped the balance of national and local elections throughout the country. Democrats drank deeply from this revenue stream and proved to be loyal servants to both the insurance industry and the pharmaceutical lobby. The contributions were targeted - committees that would be formulating the healthcare reform bill, such as the House Committee on Ways and Means, received an inordinate amount of funds. No wonder then, that when candidate Barack Obama declared a goal of "universal healthcare coverage," little rebuttal was heard from the normally vocal insurance lobby. The fix was in and it was insured by some $2 million dollars in donations to his campaign.
Just to insure that things went well for the healthcare lobby, an army of lobbyists was mobilized at a critical juncture in May 2009. The lobby spent a reported $2.3 million a day peddling influence. Such a massive expenditure of political and financial resources insured that the perspectives of private insurers were represented at every committee meeting and in the offices of every elected representative. The lobby was also buffered by the efforts of the right-wing Heritage Foundation, which successfully exported their free-market notion that "insurance exchanges" could cure the ills of rising healthcare costs. Soon everyone - from Barack Obama to Harry Reid and even Howard Dean in his statement opposing the bill - was parroting this line. This, despite the fact that nearly sixty years of private control, through free-market policies, over healthcare has created a national emergency in the cost and access to care. So much for learning from
history.
Single-Payer: Union Hall or Lobby Day?
There was some resistance to this process as single-payer proponents did their best to fight the good fight. Massively outgunned in the realm of financial resources, they turned to a campaign of civil disobedience that bore witness to the sheer hypocrisy of the proceedings. Democracy was not in motion in the House committees that formulated the bills, and doctors, healthcare activists and victims of private insurers rallied to express their dissent. For their trouble, these activists received stinging rebukes from some of the very same politicians they had championed as friends. Not only Sanders, but Representative John Conyers, the author of the single-payer bill HR 676, voted in favor of the watered-down reform proposal. Both yielded to expediency and provided a useful lesson in how power politics work in Washington, where you are only as good as your next campaign contribution or legislative horse-trade.
In the end, the movement in support of single-payer was too thin - not able to mobilize large numbers or exercise any influence on a political process saturated with corporate funds. Single-payer activists will have to return to running broad educational campaigns with an eye toward developing a movement with solid roots in working communities throughout the country. They may pick up some new allies from a labor movement that recoiled from unfettered support of the Democrats once the terms of the Senate bill were released. Now wonder then that the bill was swiftly forced through - popular support was rapidly dwindling. In the end, a painful lesson may have been learned - only the ungovernability of the people in motion can win single-payer. To accomplish this, the church congregation, the dinner table and the union hall are more potent weapons than cultivating "friends" in the Senate or House.
The Healthcare Scrooges
Like Scrooge before his revelation, the health insurance industry and their Democratic and Republican representatives have one-track minds - money, money, and money. Such a singular pursuit blinds one to the reality of the social suffering that the three ghosts introduced old Scrooge to. A day may come, perhaps even sometime soon, when the millions of sufferers wake up from this nightmare in order to assert the only quality that no socio-economic system can strip them of - their humanity. Then we might not be willing to offer our healthcare Scrooges the chance to reform themselves. It will be right to the political grave for the private insurers and their political lackeys in order to insure that healthcare becomes the birth-right of all the people. What a wonderful Christmas present that would be.
Billy Wharton is the editor of The Socialist and the Socialist WebZine. His articles have appeared in the Washington Post, Monthly Review Webzine, The Indypendent, CommonDreams.org and Links International Journal of Socialist Renewal.]