SCHIP Will Continue To Be A Remedy For Uninsured Children


In his March 15 commentary in the Asbury Park Press, John O’Shea of the Center for Policy Research of New Jersey wrote that the State Children’s Health Insurance Program (SCHIP) is the wrong remedy for improving kids’ health. To borrow from the late Sen. Daniel Patrick Moynihan, my response to O’Shea is, “you are entitled to your opinion. But you are not entitled to your own facts.”

As the principle author of the bill that was recently signed into law renewing SCHIP, I am familiar with how this program works. Here are the real facts. Since it was enacted, SCHIP has been a resounding success. Between 1997 and 2007, 7 million children were covered by SCHIP and millions more gained coverage through Medicaid. As a result, the uninsured rate among children, especially low-income children, dropped from 23 percent in 1997 to 15 percent in 2006. That’s progress.
In spite of these achievements, SCHIP needed to be strengthened. Numerous states, including New Jersey, were running out of the money they needed to keep their programs running. This wasn’t because states were reckless spenders. The program never had enough money to begin with. Even if you didn’t enroll a single additional child, the cost of simply maintaining the program would continue to increase because of increases in health care costs.

But the goal of SCHIP is not to discourage states from enrolling uninsured children. We want to provide health coverage to as many uninsured children as possible. O’Shea rightly pointed out in his column is that far too many children who are eligible for SCHIP and Medicaid are not enrolled. In order to address these problems, the bill President Barack Obama signed into law last month will provide states with the stable funding levels they need to maintain and expand their programs.

In addition, the new law will give states new tools needed to help them find, enroll and retain eligible children. Experts predict 11 million American children will now have access to health coverage. And despite O’Shea’s claims that children enrolled in Medicaid and SCHIP have to go to the emergency room for primary care, state and national studies have consistently shown children enrolled in these programs have access to primary care at levels similar to children enrolled in private insurance, and well above the levels for uninsured children.
SCHIP has been, and will continue to be, a remedy for our nation’s uninsured children. One thing that doesn’t work is throwing these kids to the mercy of the private insurance market. Programs like this already exist and have largely been a failure.

Premium assistance programs, as they are known, provide financial assistance for people to purchase insurance policies within the private market. More often than not, it has been proven that it is more cost-effective to simply provide coverage through SCHIP or Medicaid than through private insurance policies. Medicaid and SCHIP serve a vulnerable population that suffers from unique health needs, which private insurance policies often fail to provide coverage for.

As Congress begins its deliberations on reforming our health care system, SCHIP can largely serve as a model for how to move forward. But ideologues who cling to worn out mantras that government programs don’t work will persist. Fortunately, the facts tell us otherwise.

Frank Pallone Jr. is a member of United States House of Representatives, where he represents New Jersey’s 6th district.


Canada’s Government-Run Madicare: Low Expections Cloaked in Lofty Rhetoric


On the campaign trail, presidential candidate Barack Obama promised health insurance for all Americans. Now, newly minted President Obama, along with Congressional Democrats, appears eager to deliver on that pledge by giving government a greater role in health-care insurance. Were Mr. Obama to consider Canadians’ struggles with government-run universal health insurance, however, he might have second thoughts.

Those who favor adopting a Canadian-style government-run universal health insurance program need to have a careful look at reality. Canada’s health care system is more an example of how not to organize health care policy. Some Canadians have even resorted to the courts in hope of better access to health care.

Let’s start with the facts about Canada’s Medicare program.

First, it is not cheap. While less expensive than the US health care system, Canada maintains, on an age-adjusted basis, the second most expensive universal access health insurance system in the developed world (of 28 such systems).

Yet Canadians endure service that ranges from mediocre to terrible. Medical technologies like MRI machines, CT scanners, and lithotriptors are in short supply. Canada is also slow to invest in medical technology, while much medical and diagnostic equipment is outdated.

Queues for health care in Canada also rank among the longest in the developed world. A recent study published in Health Affairs found that Canadians, as compared to patients in Australia, New Zealand, Germany, the Netherlands, the UK, and the US, were most likely to wait more than one month for elective surgery, six days or longer to see a doctor when ill, and 2 hours or more for access to the ER. Consider also that in 2008 the median wait time for orthopaedic surgery, from mandatory GP referral to treatment, was nearly 37 weeks. It was nearly 32 weeks for neurosurgery. While wait times for cancer treatment were shorter at 4.6 to 5.8 weeks, they were hardly what you might consider prompt treatment.

Once the home of one of the developed world’s highest physician-to-population ratios, Canada now ranks (on an age-adjusted basis) a miserable 26th among 28 developed nations who maintain universal approaches to health insurance. And the decline is firmly set to continue. Largely due to government restrictions on physician training, Canada’s physician-to-population ratio will fall in coming years without a significant intake of foreign-trained physicians.

Worse still, Canadian governments have proven impotent in the face of the problem: Recent government attempts to save the public system have shown little initiative and therefore little result.

For example, governments across Canada have attacked the waiting time problem by announcing long wait time benchmarks and selective wait time guarantees along with large increases in funding. Neither the benchmarks nor the guarantees are what you might call ambitious: 4 to 8 weeks for radiation therapy, to as long as 26 weeks for hip and knee replacement, cataract surgery, and lower urgency cardiac bypass surgery.

Government inaction and poor service have brought some Canadians to the realization that the courts may provide the only hope of recourse. In a landmark ruling on Quebec health insurance in 2005, the Supreme Court of Canada found that Canadians suffer physically and psychologically while waiting for treatment in the public health care system, and that the government monopoly on essential health services imposed a risk of death and irreparable harm to health. Ultimately, the Supreme Court determined that the government of Quebec’s prohibition on private health insurance violated citizens’ right to life, personal security, inviolability, and freedom as guaranteed by Quebec’s Charter of Human Rights and Freedoms.

Constitutional challenges before the courts elsewhere in Canada are seeking to expand that finding to other provinces.

In Ontario, the case involves two patients who went abroad for more detailed diagnoses of their brain tumors because of untenable delays in the public health care system. Even armed with clear evidence of dangerous tumors, they could not convince the government health care system to provide treatment quickly and so went to the US to buy treatment. They are challenging Ontario’s government-run monopoly health-insurance system, claiming it violates the right to life and security of the person guaranteed by the Canadian Charter of Rights and Freedoms

In Alberta, a man who was denied a Birmingham hip replacement at age 57 because he was “too old” to enjoy the benefits of returning to an active lifestyle, and then who was denied the opportunity to even pay for it himself in Alberta, is taking the government to court claiming a violation of Charter rights as well.

These legal challenges, along with a Constitutional challenge launched in British Columbia in January, share a common goal: give Canadians the freedom to spend their own money to protect themselves from the all-too-likely (and perhaps inevitable) failure of the government insurance system to provide care in a timely fashion.

The realities of what Canadians endure on a daily basis are far from the paradise many believe to exist. To the contrary, Canada’s health care system is one of low expectations cloaked in lofty rhetoric. It fails Canadians on a regular basis.

It is obviously up to Americans to decide what kind of health care system they want. But this much we know: Canada’s government-run system comes at the cost of pain and suffering for patients who find themselves stuck on waiting lists with nowhere to go. Americans would be well advised to look elsewhere (away from government control and intervention) for their solutions. They should hope that President Obama heeds the lessons that can be learned from Canadians’ hardships and does the same.

Nadeem Esmail is the Director of Health System Performance Studies at the Fraser Institute based in Canada.

A Hospital Germ on the War Path: You Can Take Simple Steps to Avoid Infection


Grace Voros was 85 and enjoying life, watching her family grow and taking romantic walks with the man she fell in love with 61 years ago, when she took a minor fall. She went to the hospital for an x-ray, where tests confirmed she had no broken bones. But while there, she contracted an infection no one in the family had ever heard about, “C. diff,” and died.

C. diff, short for Clostridium difficile, is raging through hospitals, infecting hundreds of thousands of patients a year. The bacteria contaminate every surface, including bed rails, bed tables, nurses’ uniforms, privacy curtains, faucets and call buttons. When patients touch these surfaces and then pick up food without washing their hands, they ingest the germ. Any patient taking antibiotics who ingests C. diff is in danger of developing severe diarrhea, leading to dehydration, inflammation of the colon and even death.

Routine cleaning isn’t enough to protect you from C. diff. Researchers at Case Western Reserve and the Cleveland VA Medical Center found that after routine cleaning at a hospital, 78 percent of surfaces were still contaminated. To kill the germ, you need to use bleach.

When surfaces are not properly disinfected, the results can be deadly. At Thomas Jefferson Medical Center in Philadelphia, three consecutive patients occupying the same room came down with C. diff. One died.

Staffs at many U.S. hospitals are woefully uninformed about what to do. One study reported that 39 percent of medical personnel didn’t know that C. diff could be spread on stethoscopes, blood pressure cuffs and other equipment. About two-thirds of medical staff were unaware they should clean their hands with soap and water, because alcohol sanitizers don’t kill this superbug.

What can you do to protect yourself? Insist that everyone treating you clean their hands before touching you.

Clean your own hands thoroughly before eating. Do not touch your hands to your lips. Do not place your food or utensils on any surface except your plate. Ask family to bring wipes containing bleach to clean the items around your bed.

When you leave the hospital, assume any belongings you bring home are contaminated. Do not mix clothes from the hospital with the family wash; wash with bleach. Regular laundry detergents do not kill C. diff.

If you are visiting someone in the hospital, be careful about eating in the cafeteria or a restaurant where the staff go in their scrubs or uniforms. These uniforms could be covered in invisible superbugs. More than 20 percent of nurses’ uniforms had C. diff on them at the end of a workday, according to one study. Imagine sliding into a restaurant booth after a nurse has left the germ on the table or the seat. You could easily pick it up on your hands and then ingest it with your sandwich.

Poor hospital hygiene and lax practices such as wearing scrubs in public are putting all of us at risk. That’s why I founded RID, the Committee to Reduce Infection Deaths, so that other families won’t have to go through what Grace Voros’ family suffered.

Betsy McCaughey is a former lieutenant governor of New York.

New Jersey: A Viable Future or an Economic Wasteland?

By: Salvatore Pizzuro

On Tuesday, February 26, 2008, New Jersey Governor Jon Corzine will deliver a budget address that will call for cuts in the State budget that will include downsizing in vital services. This is the result of desperation in the effort to cure the State’s fiscal woes. It is apparent that the Governor has realized that his “Toll Hike Plan” will not fly, politically. In addition, realistic alternative plans have not been forthcoming. Without true teamwork in solving this dilemma, New Jersey will continue to struggle under the maze of uncontrollable debt.

In the past, I have suggested that Governor Corzine must serve a second term in order to make any fiscal plan truly effective. Nevertheless, the possibility exists that if an effective plan is not agreed upon by the State Legislature, the Governor will opt to not seek reelection. The result will be that the debt burden will be inherited by the next administration and future State Legislators. The portion of the annual budget that is reserved for debt service will continue to grow every year. Eventually, New Jersey will take on increased sales and income taxes, and local communities will see continued property tax hikes.

The impact that this scenario will have on New Jersey will be unprecedented. We already have the highest property taxes in the nation. The middle class exodus to other states will make it all but impossible for some communities to survive, as the tax base will become smaller and smaller. New Jersey, even with excellent resources at its disposal, will become the economic wasteland sandwiched between New York City and Philadelphia.

The Governor and the Legislature do not have ample time to seek a solution. Decisions must be made now. Some economists insist that we must raise State income and sales taxes now. Others claim that such a move will destroy an already shaky State economy. Increased gasoline taxes seem to be given more credence by lawmakers. However, there is the suggestion that additional gasoline taxes will be devastating for the tourist industry.

The latest economic forecasts suggest that a recession is inevitable. Should this happen, will the Xanadu project, scheduled to open within the next year, be economically viable, or an albatross that will falter after costing taxpayers millions of dollars? With an increased number of hospitals closing in New Jersey, will emergency medical services decline to a level where it would be more expedient to seek medical care in another state? Will further cuts in higher education make it so expensive to seek a higher education in New Jersey that one portion of our young people will forgo college and another portion will opt to be educated in other states?

New Jersey has reached a point where we cannot offer young adults the concept that staying in school and working hard will necessarily serve as a road to a better life. More importantly, time is passing all too quickly, and the opportunity to fix this problem may not continue to be within our grasp.

The time for a solution is now. State lawmakers must place their egos and political careers aside and do the right thing, now. We cannot sit back and wait, since there is no more time.