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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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