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Obama's health exchanges simply explained
Follow the bouncing ball
An Obama campaign ad
Healthcare bill added 2.5 million young adults to coverage
VIA JOHN ALLISON
- SINGLE PAYER FAQ
- GREAT SLIDE SHOW ON SINGLE PAYER
- A HISTORY OF MEDICARE AND EFFORTS TO STOP IT
- WHY SINGLE PAYER IS GOOD FOR BUSINESS
- WORLD HEALTH ORGANIZATION'S RANKING OF INDUSTRIALIZED COUNTRIES' HEALTHCARE SYSTEMS
- CANADIAN HEALTHCARE MYTHS
Sixteen million are expected to be helped due to improvements in Medicaid and CHIP. As the Center on Budget Policy and Prioritis puts it:
"The plan would expand Medicaid up to 133 percent of the poverty line for all children and adults younger than 65 who are lawfully residing in the United States and not eligible for Medicare. This would mean that millions of low-income parents, as well non-disabled low-income adults who do not have dependent children (and who are generally ineligible for Medicaid today except in a small number of states with waivers), would become newly eligible for health coverage through Medicaid. Medicaid is the most cost-effective way to provide comprehensive and affordable coverage to people with very low incomes and thereby ensure that the low-income uninsured gain coverage. "
The individual mandate is unconstitutional. As constitutional attorney David Rivkin has explained, it goes far beyond the standard judicial excuse of regulating interstate commerce: "What's unique is the mandate [is] imposed on individuals merely because they live - not connected with any economic activity, not because they grow something, make something, compose something. Merely because they live. And this is absolutely unprecedented." Even when the government decided to ban drinking during Prohibition, it at least had the decency to pass a constitutional amendment. If this provision is upheld in the courts, nothing would prevent the government from, for example, ordering people above a cetain BMI to buy memberships in private health clubs and to attend them at least three times a week.
THE INDUSTRY SUBSIDY
By requiring new insurance from inefficient private providers instead of through a government program, the administration is subsidizing the insurance cabal by billions of dollars. Further, even though the public option provision fell far short of what it should have been, Obama made a back room deal with the industry to knife it.
A comparison of health care costs has found that 31 cents of every dollar spent on health care in the United States pays administrative costs, nearly double the rate in Canada. Americans spend $752 more per person per year than Canadians in administrative costs, investigators from Harvard and the Canadian Institute for Health Information found. - Reuters
SUBSIDIES FOR CITIZENS
According to the Congressional Budget Office, a family of four earning $54,000 in 2016, when the health legislation is fully in effect, would be eligible for a subsidy of $10,100 to help defray the cost of insurance under the health legislation being debated by the Senate. By then, one of the most popular federal plans, a nationwide Blue Cross and Blue Shield policy, is projected to cost more than $20,000. That could leave the family earning $54,000, slightly more than the current median household income, with monthly premium costs of more than $825.
An amazing number of provisions won't go into effect for four to nine years. One of the problems with this is that if, during this period, the GOP gains control of the Congress, there is nothing to stop them from stalling these programs further. In addition, the Democrats are playing an extraordinarily dangerous political game - taking immediate credit for things that may not happen for years to come. In fact, the first significant benefits to anyone will not occur for four years according to the CBO calculations.
For example, not until 2014 would employers be banned from denying coverage or providing higher premiums for women or older people.
MEDICARE DRUG FUNDING
The reconciliation bill includes additional Medicare drug funding, closing the so-called doughnut hole in coverage.
NEW MEDICARE TAX
Business Week: "A higher Medicare payroll tax will be assessed on individuals who make more than $200,000 a year or families with income of more than $250,000. The reconciliation bill includes an additional 3.8 percent Medicare tax on unearned income such as dividends on these high earners."
Business Week: "If an employer with more than 50 employees doesn't offer coverage and has just one employee who qualifies for a new tax credit, the company must pay a fee for every full-time employee on its roster. The reconciliation bill raises the penalty to $2,000 from $750, though it subtracts the first 30 employees from the calculation.
UNCONSTITUTIONAL BUDGET COMMISSION
The legislation includes a flagrantly anti-constitutional provision, as described by the CBPP:
 The legislation would establish an Independent Payment Advisory Board to develop and submit proposals to slow the growth of Medicare and private health care spending and improve the quality of care. The President would nominate the board's 15 members, who would require Senate confirmation, for staggered six-year terms.
If the projected growth in Medicare costs per beneficiary in 2015 and thereafter exceeded a specified target level which it almost certainly would do in many years the board would be required to produce a proposal to eliminate the difference. The board could not propose increases in Medicare premiums or cost-sharing or cuts in Medicare benefits or eligibility criteria; it would focus on proposals for savings in the payment and delivery of health care services.
The board's recommendations would go into effect automatically unless both houses of Congress passed, and the President signed, legislation to modify or overturn them. If the board recommended changes that the President supported, the President could veto any congressional attempt to block them, and a two-thirds vote of both the House and Senate would be required to override the veto.
This provision is contemptuous of the basic concept of our constitutional government.
CUTTING MEDICARE COSTS
One of the big sleepers in the bill is the plan to "institute efficiencies" in Medicare programs. In fact, Medicare is far more efficient than any private insurance plan in the country.
Consider this snippet from CBPP: "The legislation would reduce annual payment updates to hospitals, skilled nursing facilities, hospices, ambulatory surgical centers, and certain other providers to account for improvements in economy-wide productivity. It would also reduce payments to home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities." And just what will happen to service and its availability?
"[The plan] to cut Medicare to pay for an overhaul of the health system would threaten the profitability of roughly one in five hospitals and nursing homes over the next decade, according to a new analysis by the government official responsible for monitoring the popular health program." - Washington Post
CBPP - Within months, insurers that offer coverage of policyholders' children (including in existing plans) would be required to allow adult dependents younger than 26 to be added to such coverage. In addition, new insurance plans would be barred from excluding children's pre-existing conditions from coverage and would have to cover certain preventive services at no charge to enrollees.
Emily Dalton, Physicians for a National Health Program -Despite all the hopes many of us had for the Affordable Care Act, the current system of medical insurance is a dysfunctional nightmare. I should know, because I am in the unique position of experiencing it from three perspectives simultaneously: that of a patient who uses an insurance plan, that of a small business owner who purchases insurance for a group of employees, and that of a physician who contracts with and gets paid by insurance companies.
As a patient, I am tricked by the expensive insurance plan I bought. Even though the card says HSA 2000, the deductible for my family is actually $4,000. After that the insurance only pays for 70 percent of covered charges when initially we were told 80 percent.
When I call my insurance company to address problems, I must make sure that I have several hours of free time, so that I can stay on hold long enough to get through to the low level representative who has little power to do anything. The disclaimer Description of covered benefits is not a guarantee of payment makes me fearful and insecure. I am at the mercy of large, for-profit corporation that is beholden to shareholders and run by greedy CEOs who do not care about me.
The company has so many devious ways of denying payment that even a sophisticated health care consumer can be taken by surprise. The reason for denial could be the type of treatment (no counseling for you!), or lack of a contract with a specific provider, or that your medication is non generic, or not on formulary.
In the past insurances could kick you off for getting sick or refuse to accept you for having a pre-existing condition, but now they are legally obliged to accept all comers. However, they have found a new way to shed their undesirable patients: balk, deny, hassle and ignore you until you willingly transfer your diseases to another company....
As a small business owner, I have over 25 employees, most of whom rely on me to provide insurance. Over the past decade, we dread the arrival of each new year, because the insurance plans offered previously are cancelled and replaced by more expensive plans with fewer benefits. Typically we see the price of premiums increase by 25-40 percent. The plans are so complicated we cant even understand them, and we have three full time medical billing specialists on staff. The alphabet soup of HMOs, EPOs, PPOs, HSAs is overwhelming, the rules that regulate the deductibles, copays, share of cost, prior authorizations and formularies can be mind-boggling, and even if you understand them, remember: Descriptions of benefits are not a guarantee of payment.
As a physician, I have had no end of problems dealing with the nine different insurance companies with which we have contracts. Our office has three full-time employees whose job it is to make sure the claims we send in get paid correctly, each according to its own set of terms. It seems that any reason is good enough for an insurer to underpay or deny payment. If we dont catch the mistakes, we lose out...
Every time the company refuses to pay for a procedure, consult or a medication, the company gets to keep the money! Every time the company suckers some poor clinic into accepting low rates, the company gets to keep the money! Every time the company forgets to pay a claim, the company gets to keep the money! Each time the company raises premiums, the company gets to keep the money! The worse they behave, the more money they get.
The Affordable Care Act, despite the best of intentions, has fortified a monster. By mandating that everyone purchase insurance, the industry is stronger and feels emboldened to take even more advantage of patients and health care providers. Exponentially larger and more powerful than the agencies assigned to oversee it, the industry finds ways to circumvent and resist restrictions.
This leech has gotten firmly latched on to the lifeblood of American medicine, and is sucking money and energy out of medical care from all angles. Like a cancer, is has created harmful malfunctioning growths that waste our precious health care dollars. How long are we going to stand for this?
I wish Obamacare was what the conservatives imagine it to be and hate -- a comprehensive, Medicare-like, government-run system -- and I wish I could sign up for it.
NY Post - nsurance firms participating in New Yorks ObamaCare health exchange are seeking double-digit hikes for patient medical premiums in 2015, new figures reviewed by The Post reveal.
The average hike sought by insurers for individual plans is 12 percentbut a number of firms serving large numbers of patients want to boost individual premiums by nearly 20 percent.
Leading the charge is Excellus Health Plan, which is seeking to sock more than 24,000 customers with a 19.7 percent hike.
NY Times - The Obama administration is contacting hundreds of thousands of people with subsidized health insurance to resolve questions about their eligibility, as consumer advocates express concern that many will be required to repay some or all of the subsidies.
Of the eight million people who signed up for private health plans through insurance exchanges under the new health care law, two million reported personal information that differed from data in government records, according to federal officials and Serco, the company hired to resolve such inconsistencies.
The government is asking consumers for additional documents to verify their income, citizenship, immigration status and Social Security numbers, as well as any health coverage that they may have from employers. People who do not provide the information risk losing their subsidized coverage and may have to repay subsidies next April.
Washington Free Beacon - The [Congressinal Budget Office] estimated that four million people would pay the individual mandate penalty for not having health insurance by 2016 as a result of the presidents health care law, according to a report:
All told, CBO and [the Joint Committee on Taxation] estimate that about four million people will pay a penalty because they are uninsured in 2016 (a figure that includes uninsured dependents who have the penalty paid on their behalf), the report said. An estimated $4 billion will be collected from those who are uninsured in 2016, and, on average, an estimated $5 billion will be collected per year over the 20172024 period.
A chart accompanying the report revealed that 200,000 of those paying the penalty earn less than 100 percent of the poverty line. An additional 800,000 are considered low-income, earning between 100 and 199 percent of the poverty level.
President Barack Obama was once critical of an individual mandate precisely because of its effect on low-income Americans. During a primary debate against Hillary Clinton, then-candidate Obama criticized the idea of a mandate for imposing fines on people who could not afford health insurance.
You can have a situation, which we are seeing right now in the state of Massachusetts, where people are being fined for not having purchased health care, but choose to accept the fine because they still cant afford it even with the subsidies, he said. They are then worse off, they then have no health care and are paying a fine above and beyond tha
LA Times - The Obama administration has quietly adjusted key provisions of its signature healthcare law to potentially make billions of additional taxpayer dollars available to the insurance industry if companies providing coverage through the Affordable Care Act lose money.
The move was buried in hundreds of pages of new regulations issued late last week. It comes as part of an intensive administration effort to hold down premium increases for next year, a top priority for the White House as the rates will be announced ahead of this fall's congressional elections.
Administration officials for months have denied charges by opponents that they plan a "bailout" for insurance companies providing coverage under the healthcare law.
They continue to argue that most insurers shouldn't need to substantially increase premiums because safeguards in the healthcare law will protect them over the next several years.
But the change in regulations essentially provides insurers with another backup: If they keep rate increases modest over the next couple of years but lose money, the administration will tap federal funds as needed to cover shortfalls.
Health coverage not getting better GALLUP
Gallup reports that the percentage of adult Americans without health insurance was higher than in any year the firms started tracking it in 2008. The percentage rose from 14.8% to 17.1%
- Nearly one in ten big employers plan to end health insurance
- 30% of employers ready to drop health insurance when Obamacare goes into effect
- Employer based health insurance premiums jacked 41% in six years 2010
Now, all the countries with AAA ratings have socialized medicine
Real Christian Republicans support single payer: Jesus went throughout Galilee. . .healing every disease and sickness among the people. - Matthew 4:23
SO MUCH FOR AMERICA'S GREAT HEALTH CARE OECD MARYLAND'S IGNORED HEALTHCARE SOLUTION GALLERY: THE HIGH COSTS OF AMERICAN HEALTHCARE REPUBLICANS OPPOSING UNIVERSAL HEALTHCARE
2800 TIMES MORE DANGEROUS THAN TERRORISTS
THE PRICE OF AVOIDING SOCIALISM
ELIZABETH EDWARDS, THINK PROGRESS Senator John McCain's health plan is based on the idea that everyone should be on their own to buy their health insurance on the individual market. And it's an approach fundamentally at odds with the point of health insurance: that we share risks. People with preexisting conditions, like McCain and myself, would pay much more for health insurance under his health plan, if we could get coverage at all.
Insurance companies have all sorts of characteristics they look at in order to increase premiums, such as preexisting conditions, occupation, age, and residence. But I hadn't realized that the McCain plan would enable insurers to "rate-up" my insurance bill for not only my status as a breast cancer patient, but also my gender.
The ability to become pregnant has long been understood as an excuse to charge women more for health insurance (because, of course, men have nothing to do with that particular health condition). But [a David] Lazarus column . . . tells us that insurers are charging women higher premiums even if pregnancy benefits are excluded. Blue Shield of California (Blue Shield) is now charging woman more in the individual market because:
"Our egghead actuaries crunched the numbers based on all the data we have about healthcare," explained Tom Epstein, a Blue Shield spokesman. "This is what they found."
That women get sicker than men?
"It's all about the statistics," Epstein said. . .
Whatever their reasoning, one thing is clear - they don't want to enroll too many women:
"We don't want to get a disproportionate share of high-risk people," added Epstein.
WASHINGTON BUSINESS JOURNAL Current retirees will need tens or even hundreds of thousands of dollars in savings to ensure that they can afford health care after leaving the workplace. That is according to new data from nonpartisan research firm EBRI. . .
For example, a married couple of two 65-year-olds retiring this year would need current savings of $235,000 to have a 90 percent chance of having enough cash to afford their health costs in retirement. That's assuming the couple supplements Medicare with subsidized insurance premiums from a former employer.
Couples who have unsubsidized insurance from an old employer, on the other hand, would need $376,000 in current savings for a 90 percent chance of covering their costs. And a couple with individually purchased insurance to supplement Medicare would need $635,000.
ROSE ANN DEMORO, HUFFINGTON POST - Behind the escalating debate on the health care between Senators Hillary Clinton and Barack Obama on individual mandate -- she's for it, he's against it -- is a critical policy battle that not only cuts across health care reform but also the neo-liberal privatization dreams, the home mortgage crisis, and the recession that is no longer looming, it's here. . .
Banks are already into health care in a big way, serving as a repository for health savings accounts and other tax credit schemes so beloved by the Bush administration and the Republican presidential candidates. But the financiers would like more.
Enter the neo-liberal think tanks and policy wonks and plans they hawk to expand the reach of the market, especially the financial market, in health care. Central to that approach is shotgun insurance, forcing everyone not currently covered to buy health insurance policies.
Compelling people to buy insurance, however, is not the easiest sell. Big insurers and HMOs have a well deserved bad reputation for heartless denials of care - that's how they make money. And, it's pricey. Premiums the past decade have gone up 87 percent, not to mention the ever climbing bills for deductibles, co-pays, and a host of other transaction fees.
The finance industry is over the moon with this scheme.
For insurers, it means millions of new customers marched into their offices with the force of law. With no controls on costs, many consumers will just add on more debt. That's a boon for the credit card companies and other financial institutions, but a heavy new burden on many of the same people now losing their homes or struggling with other financial hardship. . .
To shroud the colossal problems and the real story of who actually makes out like bandits under this scheme, the proponents, including some liberal policy experts, have dressed it up with poll-tested rhetoric that mandatory insurance is "universal health care."
But "having" insurance is not the same as being able to use it. You're only being mandated to purchase the premiums; they're not mandating the insurance companies to make sure you get the care you need. Nor does "having" insurance protect you from financial ruin.
It accelerates the dismantling of group insurance plans with individuals forced to go it alone in the individual market, and institutionalizes risk and cost shifting on to the backs of individuals and families.
[DeMoro is executive director of the California Nurses Association/National Nurses Organizing Committee]
REUTERS - France, Japan and Australia rated best and the United States worst in new rankings focusing on preventable deaths due to treatable conditions in 19 leading industrialized nations. If the U.S. health care system performed as well as those of those top three countries, there would be 101,000 fewer deaths in the United States per year, according to researchers writing in the journal Health Affairs.
Researchers Ellen Nolte and Martin McKee of the London School of Hygiene and Tropical Medicine tracked deaths that they deemed could have been prevented by access to timely and effective health care, and ranked nations on how they did. . .
MARK DUNLEA, COMMON DREAMS - "Bold, new experiments in moving our state to universal health care" have invariably withered away over time, often in only a few years.
For instance, the media coverage over the new "universal" health care system in Massachusetts generally failed to mention similar pronouncements from Governor Dukasis two decades previously that fell apart in a few years. Because Massachusetts expanded its subsidies for insurance premiums for low-income people, over 160,000 of those eligible signed up this year. But only 7% of the nearly 250,000 who must buy unsubsidized insurance -- or face a fine of $2,000 in 2008 -- purchased private health insurance this year. Thus the plan will end its first year at least $147 million over budget, with Massachusetts preparing to cut payments to doctors and hospitals and ramp up out-of-pocket costs for patients. And nearly 500,000 in Massachusetts remain uninsured. Yet the leading Democratic Presidential contenders now embrace Massachusetts' mandate for individual purchase of health insurance.
Maine's patchwork approach to universal health care - the Dirigo plan - is not working. Nor have the plans in Vermont, Minnesota, Washington and Oregon. Tennessee's noteworthy TennCare program to help the poor and uninsured is in the process of being dismantled. NY has added targeted programs such as Child Health Plus and Family Health Plus yet more than 5 million New Yorkers annually lack health insurance.
This fall Vermont launched "Catamount Health," a plan to cover all Vermonters by subsidizing private health insurance from MVP and Blue Cross Blue Shield with a combination of tobacco tax money, Medicaid money and new taxes on employers who don't offer health insurance. But as the plan takes its first steps, the inadequate insurance for those who have it, with soaring co-pays, huge deductibles and unaffordable prescription drugs has put the crisis in health care back into the legislative agenda for 2008, front and center. . .
Incremental approaches evade the fundamental problems that are causing the ongoing crisis in our health care system. Real change requires addressing the entire structure of financing -- in which employer-based private health insurance dominates. Without facing this, the problem of costs cannot be solved. Most of the money spent on health care in New York comes from government (federal and state) spending, yet private health insurance dominates the system. As Governor Spitzer has pointed out, NY's system of health care financing is often not directly tied to the services being provided, its complexity and irrationality a result of the backroom deal making at the State Capitol.
Incremental approaches have done little to nothing to control costs, while adding more people to the system, thus causing more financial strain on both the government and private sectors, especially in bad economic times
[From a group of Massachusetts physicians]
MASSACHUSETTS PHYSICIANS - In 2006, our state enacted a law designed to extend health coverage to virtually all state residents. Political leaders in other states as well as several Democratic presidential candidates have embraced this model.
Massachusetts' law mandates that uninsured individuals must purchase private insurance or pay a fine. The law established a new state agency to ensure that affordable plans were available; offered low income residents subsidies to help them buy coverage; and expanded Medicaid coverage for the very poor. (Immigrants are mostly excluded from these subsidized programs.) Moneys that previously funded free care for the uninsured were shifted to the new insurance program, along with revenues from new fines on employers who fail to offer health benefits to their workers. In addition, the federal government provided extra funds for the program's first two years.
Starting January 1, 2008 Massachusetts residents face fines if they cannot offer proof of insurance. Yet as of December 1, 2007 only 37% of the 657,000 uninsured had gained coverage under the new program. These individuals often feel well served by the reform in that they now have health insurance. However, 79% of these newly insured individuals are very poor people enrolled in Medicaid or similar free plans. Virtually all of them were previously eligible for completely free care funded by the state, but face co-payments under the new plan. In effect, public funds for care of the poor that previously flowed directly to hospitals and clinics now flow through insurers with their higher administrative costs.
Among the near poor uninsured (who are eligible for partial premium subsidies) only 16% had enrolled in the new coverage. And barely 7% of the uninsured individuals with incomes too high to qualify for subsidies had enrolled according to the official state figures. Few can afford premiums for even the skimpiest coverage; the lowest cost plan offered for a couple in their fifties costs $8,200 annually, and carries a $2,000 per person deductible.
Moreover, the state's cost for subsidies is running $147 million over the $472 million budgeted for fiscal year 2007. Meanwhile, collections from fines on employers who fail to provide coverage are 80% below the original projections. The funding gap will widen in future years as health care costs escalate and insurers raise premiums. Already, state officials speak of making up the shortfall by forcing patients to pay sharply higher co-pays and deductibles, and by slashing funds promised to safety net hospitals.
While patients, the state and safety net providers struggle, private insurers have prospered under the new law, and the costs of bureaucracy have risen. Blue Cross, the state's largest insurer, is reaping a surplus of more than $1 million each day, and awarded its chairman a $16.4 million retirement bonus even as he continues to draw a $3 million salary. All of the major insurers in our state continue to charge overhead costs five times higher than Medicare and eleven-fold higher than Canada's single payer system. Moreover, the new state agency that brokers private coverage adds its own surcharge of 4.5% to each policy it sells.
A single payer program could save Massachusetts more than $9 billion annually on health care bureaucracy, making universal coverage affordable. But because the 2006 law deepened our dependence on private insurance, it can only add coverage by adding costs. Though politically feasible, this approach is already proving fiscally unsustainable. The next economic downturn will push up the number of uninsured just as the tax revenues needed to fund subsidies fall.
The lesson from Massachusetts is that we still need real health care reform: single payer, non- profit national health insurance.
WHY PRIVATE INSURANCE BASED HEALTH CARE WON'T WORK
STEFFIE WOOLHANDLER AND DAVID U. HIMMELSTEIN - In 1966 - just before Medicare and Medicaid were launched - 47 million Americans were uninsured. By 1975, the United States had reached an all time low of 21 million without coverage. Now, according to the Census Bureau's latest figures, we're back where we started, with 47 million uninsured in 2006 - up 2.2 million since 2005. But this time, most of the uninsured are neither poor nor elderly.
The middle class is being priced out of healthcare. Virtually all of this year's increase was among families with incomes above $50,000; in fact, two-thirds of the newly uncovered were in the above-$75,000 group. And full-time workers accounted for 56 percent of the increase, with their children making up much of the rest.
The new Census numbers are particularly disheartening for anyone hoping for a Massachusetts miracle. In the Commonwealth, 651,000 residents are uninsured, 65 percent more than the figure used by state leaders in planning for health reform. Their numbers came from a telephone survey done in English and Spanish. But that misses people who lack a land-line phone - 43.9 percent of phoneless adults are uninsured, according to other studies.
It also skips over the 523,000 non-English speakers in Massachusetts whose native language isn't Spanish (e.g. Portuguese, Chinese, or Haitian-Creole), another group with a high uninsurance rate. . .
Why has progress been so meager? Because most of the promised new coverage is of the "buy it yourself" variety, with scant help offered to the struggling middle class. According to the Census Bureau, only 28 percent of Massachusetts uninsured have incomes low enough to qualify for free coverage. Thirty-four percent more can get partial subsidies - but the premiums and co-payments remain a barrier for many in this near-poor group.
And 244,000 of Massachusetts uninsured get zero assistance - just a stiff fine if they don't buy coverage. A couple in their late 50s faces a minimum premium of $8,638 annually, for a policy with no drug coverage at all and a $2,000 deductible per person before insurance even kicks in. Such skimpy yet costly coverage is, in many cases, worse than no coverage at all. Illness will still bring crippling medical bills - but the $8,638 annual premium will empty their bank accounts even before the bills start arriving. Little wonder that barely 2 percent of those required to buy such coverage have thus far signed up. . .
Health reform built on private insurance isn't working and can't work; it costs too much and delivers too little. At present, bureaucracy consumes 31 percent of each healthcare dollar. The Connector - the new state agency created to broker coverage under the reform law - is adding another 4.5 percent to the already sky-high overhead charged by private insurers. Administrative costs at Blue Cross are nearly five times higher than Medicare's and 11 times those in Canada's single payer system. Single payer reform could save $7.7 billion annually on paperwork and insurance profits in Massachusetts, enough to cover all of the uninsured and to upgrade coverage for the rest of us.
Of course, single payer reform is anathema to the health insurance industry. But breaking their stranglehold on our health system and our politicians is the only way for health reform to get beyond square one.
[Dr. Steffie Woolhandler and Dr. David Himmelstein co-founded Physicians for a National Health Program]
INSURANCE INDUSTRY (THAT ALL MAJOR DEMOCRATIC & GOP CANDIDATES FAVOR) FOUND TO BE ALREADY RIPPING OFF MEDICARE DRUG PATIENTS
MORE THAN ONE THIRD OF AMERICANS UNDER 65 LACKED HEALTH INSURANCE IN LAST TWO YEARS
REUTERS - More than one-third of the U.S. population under the age of 65 went without health insurance for all or part of the last two years. . . The nonprofit Families USA group used data from last month's U.S. Census Bureau report that found 47 million Americans went without health insurance for all of 2006. Families USA broke down that figure and calculated that 89.6 million people under age 65 -- 34.7 percent -- went without health insurance at some point during 2006-2007. It used a projection for the remaining months of this year.
PRIVATIZED MEDICAL INSURANCE SYSTEM RESULTS IN UP TO 18,000 DEATHS A YEAR
PROJECT CENSORED - The Sonoma State University Institute of Medicine estimates that as many as eighteen thousand Americans die prematurely each year because they do not have health insurance. This figure does not include those who die prematurely each year because their insurers delay, diminish, or deny payment for promised benefits. Reports about people who die unnecessarily from services denied or delayed by insurance companies seldom receive broad coverage in the corporate media. Lack of media coverage has led to a nation of people uninformed about how national health and disability policies are controlled by the private insurance industry and how government regulators are powerless to do anything about it.
HOW THE NY TIMES RIGS THE HEALTHCARE DEBATE
DEAN BAKER, PROSPECT - The NYT had a piece on the health care plans being put forward by the presidential candidates that seemed determined to frame the issues in a set of caricatures, where Democrats push for big government while Republicans like the market. It makes this assertion at several points, at one point even telling readers mockingly that "Democrats are competing furiously among themselves over who has the bigger, better plan to control costs and to approach universal coverage."
But is this government/market distinction accurate? Do the Republicans favor ending the subsidies for the private insurers operating within the Medicare program that the Medicare Payments Advisory Commission estimates at 12 percent per beneficiary? Isn't a government subsidy a form of government intervention?
Do the Republicans favor eliminating government granted patent monopolies that raise the price of prescription drugs and medical supplies to levels that are many times the free market price? Aren't government imposed monopolies a form of government intervention?
In short, the NYT piece is written entirely from the Republican perspective in which the interventions they support, which have the effect of redistributing income upward and making health care more expensive, are disguised as being simply the natural workings of the market. On the other hand, the efforts of the Democrats to restructure the market to make it more workable (e.g. mandating coverage to eliminate the problem of adverse section) are mocked as "big government."
HOW DEMOCRATS, SEIU CON VOTERS ON SINGLE PAYER HEALTH CARE
CORPORATE CRIME REPORTER - On Capitol Hill today, SEIU held a rally for a couple of hundred health care workers. The group was addressed by six Senators. . . We asked Dawn Lee, a spokesperson for SEIU, whether SEIU supported HR 676 -- the single payer bill in the House. She said SEIU takes no position on that bill.
SEIU does not support single payer. At the SEIU rally, all spoke in favor of "universal health care." That is code for keep the insurance companies in the game. Single payer would take them out.
Martese Chism was at a similar rally in Chicago last month. Chism is a registered nurse at Cook County Hospital in Chicago. She also sits on the board of the California Nurses Association. . . Chism was attending an SEIU rally in Chicago in support of Illinois Governor Rod Blagojevich's "universal health care" bill that would keep the insurance companies in the game.
Chism says that the SEIU members who gathered for the rally were being actively misled by SEIU. "SEIU members are being led to believe that universal health care means free health care for all -- single payer. . .
CNA president Rose Ann DeMoro is a touch less subtle. "Rather than being on the side of the workers, SEIU continues to be on the side of the bosses," DeMoro told Corporate Crime Reporter. "And it's a disgrace."
"And the problem is that SEIU is giving cover to these Senators -- it makes them look like they are accomplishing something when in fact they are accomplishing
PUBLIC RANKS HEALTHCARE AS SECOND MOST IMPORTANT ISSUE
KAISER FOUNDATION - Health care remains the top domestic issue that the public wants presidential candidates to address, trailing only Iraq on the public's overall priority list, according to the latest Kaiser Family Foundation Health tracking poll. The June poll finds that 43% of adults cite Iraq as one of the most important issues for presidential candidates to talk about, followed by health care (21%). Iraq ranks first among Democrats, Republicans and independents alike.
Health care ranks second among Democrats and independents, while Republicans rank immigration slightly ahead of health (20% vs. 18%). Immigration rose sharply as an issue since March and ranks third overall with 18% in the new poll, which was taken as media attention focused on the Senate debate about immigration reform legislation. The economy (13%) and gas prices (12%) follow.
The poll also measures the public's perceptions of the presidential candidates on health issues. To date, most people don't know or can't name the candidate who they feel is placing the biggest emphasis on health or the candidate who most matches their own views. Across party identification, Sen. Hillary Clinton remains the candidate that people are most likely to name as placing the biggest emphasis on health care (23%) and as agreeing with their views (17%). Sen. Barack Obama is in second place (9% on each question).
Looking only at Democrats, one in three name Sen. Clinton (33%, compared to 27% in March) as the candidate who comes closest to their personal views on health care, compared to 15% who name Sen. Obama (up from 8% in March) and 4% who name former Sen. John Edwards (no change since March).
Few people name any of the Republican candidates as placing the biggest emphasis on health care, with 2% overall naming former New York Mayor Rudy Giuliani.
When asked what concerns them about rising health care costs, the poll found people are twice as likely to cite having to pay higher premiums and increased out-of-pocket costs (38%) as they are to say increases in spending on government health insurance programs like Medicare and Medicaid (18%) or increases in what the nation as a whole spends on health (18%). A smaller share (13%) cite increases in the health insurance premiums that employers pay to cover their workers. These views vary little based on party identification.
LACK OF NATIONAL HEALTH INSURANCE MAY EXPLAIN WHY EUROPEANS ARE TALLER THAN AMERICANS
SPIEGEL, GERMANY - For years, researchers have been wondering why Americans stopped growing. US citizens were among the tallest in the world up until World War II. But since then, heights have stagnated while Europeans have been getting taller and taller, with the average American now between two and six centimeters shorter. The correlation between wealth and height has long been understood, the most recent example coming as Eastern Europeans shot up following the collapse of communism. But why, in the richest country in the world, should growth rates be stagnating?
A new study published in the current issue of the Social Science Quarterly by researchers from Princeton University in the US and the University of Munich in Germany indicates that the difference may have to do more with politics than biology. Specifically, the study, which involved the statistical analysis of demographic and health data collected between 1959 and 2002, concludes that the spotty US health-care system and weak welfare net could explain why Americans have stopped growing.
STUDY FINDS CANADA'S HEALTH SERVICE BETTER THAN AMERICA'S
CANWEST NEWS SERVICE - Canada's health-care system is as good or better than that of the United States and is delivered at half the cost, new research suggests. A review in the inaugural issue of online medical journal Open Medicine, . . . found that while the United States spent an average of $7,129 US per person on health care in 2006, compared with $2,956 US per person in Canada, more studies favored the latter country in terms of morbidity and mortality.
They covered a wide range of diseases and conditions including cancer, coronary artery disease. . .
GREEN PARTY HITS DEMOCRATS FOR RUNNING FROM SINGLE PAYER HEALTHCARE
GREEN PARTY - Green Party leaders have called on Congress to reject health care reform plans that maintained corporate-based insurance and HMO coverage, and urged passage of a single-player national health insurance program. Greens were especially critical of Sen. Hillary Clinton's (D-N.Y.) continuing role in obstructing needed health care reforms. "Hillary Clinton should be banished from the room when health coverage is discussed," said Rebecca Rotzler, co-chair of the Green Party of the United States and Deputy Mayor of New Paltz, New York. "Ms. Clinton's favoritism towards major insurance companies undermined real health care reform when her husband's administration crafted its managed-care monstrosity in 1993. She and other Democrats remain at the top of the list of recipients of contributions from insurance and pharmaceutical lobbies.
"Hillary Clinton, Barack Obama, John Edwards, and other prominent Democrats are the greatest obstacle to universal health coverage. Except for a few mavericks like Rep. John Conyers [D-Mich.], who has regularly introduced single-payer bills, Democrats have joined Republicans in favoring HMO and insurance corporations over guaranteed publicly-financed quality health care for every American. It's a safe bet that the 2008 Democratic nominee will -- like Bill Clinton, Al Gore, and John Kerry before them -- follow the same pattern," said Kat Swift, spokesperson for the National Women's Caucus of the Green Party.
WHY THE DEMOCRATS ARE SO COWARDLY ABOUT HEALTHCARE
CORPORATE CRIME REPORTER - The majority of the American people want a single-payer health care system - Medicare for all. The majority of doctors want it. A good chunk of hospital CEOs want it. But what they want doesn't appear to matter. Why?
Because a single-payer health care plan would mean the death of the private health insurance industry and reduced profits for the pharmaceutical industry.
Presidential candidates John Edwards, Barack Obama, Hillary Clinton, and Mitt Romney and California Governor Arnold Schwarzenegger talk a lot about universal health care. But not one of them advocates for single-payer - because single-payer too directly confronts the big corporate interests profiting off the miserable health care system we are currently saddled with.
"Currently, we are spending almost a third of every health care dollar on administration and paperwork generated by the private health insurance industry," said Dr. Stephanie Woolhandler, an Associate Professor of Medicine at Harvard Medical School and co-founder of Physicians for a National Health Program. "Countries like Canada spend about half that much on the billing and paperwork side of medicine. If we go to a single-payer system and are able to cut the billing and paperwork costs of health care, that frees up about $300 billion per year. That's the money we need to cover the uninsured and then improve the coverage for those who have private insurance but are under-insured."
"The idea behind single-payer is you don't have to increase total health care spending," Woolhandler said in an interview with Corporate Crime Reporter. "You take the money we are now spending but cut the administrative fat and use that money to cover people."
None of the declared Presidential candidates - with the exception of Congressman Dennis Kucinich (D-Ohio) - is supporting single-payer. Last year, Kucinich and Congressman John Conyers (D-Michigan), introduced a single-payer bill, HR 676, which garnered support of more than 75 members of the House. Woolhandler expects that number to grow substantially this year.
And Woolhandler says grassroots activists have been mobilizing at the state level. "State single-payer organizations have been very active," she said. "Early in the process, you can get a lot of politicians interested - they want to show up at your rallies to show support for national health insurance. But as you get closer and closer to actual passage of a law, it is harder to keep the politicians on board.". . .
Woolhandler called the universal health care law passed in Massachusetts by Governor Mitt Romney "a hoax."
"The core idea is the individual mandate - forcing uninsured people to go out and buy insurance," Woolhandler said. "And if they don't buy insurance, we are going to fine them. The first year it is an $80 fine. The second year, it's half the value of the lowest priced policy - we're talking about a $2,000 fine. So, they are saying anyone who earns more than three times poverty has to bear the entire price of a private insurance policy."
"Romney's bill was written by Blue Cross," Woolhandler said. "Romney was saying he was going to offer health insurance starting at $200 a month. And of course, that was a hoax. No insurance policy in Massachusetts comes in at $200 a month. When Blue Cross was asked to produce the policy, it turned out the policy was going to cost $380 a month for a policy that had a $2000 deductible. So, you are going to tell this poor bloke who is earning $29,400 a year that he has to go out and spend $4,000 a year on an insurance policy. And if he gets sick, he doesn't even have any coverage until he has spent $2,000. And that's not family coverage. That's individual coverage."
Former Senator John Edwards would have a Medicare-like system compete with private insurance. "Edwards plan is not going to work," Woolhandler says flatly. "We know there is not going to be fair competition between Medicare and the private plans. You have to take on the private health insurance industry and tell them - you are out of here. This is an entitlement program like traditional Medicare or Social Security. We are going to get the administrative efficiencies you get from running it as a single program and use that to expand coverage. That's what you have to do."
Senator Hillary Clinton (D-New York) doesn't want to get specific. "She is nowhere on this issue," Woolhandler says. Ditto Senator Barack Obama (D-Illinois).
A SHORT HISTORY OF HEALTHCARE MISSTEPS
PHIL MATTERA, CORPORATE RESEARCH PROJECT - In the late 19th Century European countries began adopting government-funded social insurance plans, but the U.S. failed to follow suit. When progressives made a push in the 1910s there was opposition not only from corporate interests but also from organized labor. AFL President Samuel Gompers denounced national health insurance as a paternalistic reform, fearing that its adoption would weaken the role of unions in improving the living conditions of workers.
Consequently, Americans both rich and poor continued to pay the vast majority of medical costs out of pocket. That began to change in the 1930s. While the Roosevelt Administration focused on retirement benefits and unemployment insurance at the expense of health coverage, physicians and hospitals struggling to survive the Depression set up private group insurance plans to bolster demand for their services. . .
In 1945 President Harry Truman proposed a national program establishing a right to medical care and protection from the "economic fears" of illness. But once again, opposition to government involvement in healthcare emerged, this time reinforced by a Cold War hysteria about "socialized medicine" stoked by groups such as the American Medical Association.
As Truman's plan went down to defeat, what grew in its place was a system of employer-provided coverage, stimulated by aggressive bargaining on the part of unions that had come to regard improving employee benefits as a mission as important as increasing wages. . .
THE CASE FOR REAL UNIVERAL HEALTH CARE. . . .BY A RETIRED BUSINESS OWNER
JACK E. LOHMAN, WIS POLITICS - With the vast majority of the public -- and even the "non-healthcare" business leaders -- supporting universal health care, why are our politicians not on board?
It makes every bit of financial sense for businesses to get out of providing health care and to turn it over to the most successful ever public-private venture: Medicare. As a Medicare patient I have the same coverage and physician choice I had before retiring. It's just managed by a single payer: WPS in Madison.
Don't think for a moment that single-payer is just another liberal giveaway; it is the most fiscally conservative way possible of financing health care for Wisconsin citizens. . .
Medicare-for-all would do wonders for businesses by reducing labor costs by 15 percent; reducing worker compensation costs by 50 percent; and cutting their and everybody else's auto insurance rates in half. With these reduced costs they could add jobs in Wisconsin rather than sending them to other countries. Health care would no longer be a labor union negotiation and job changes would not involve gaps in insurance, preexisting disease exclusions or delays, or COBRA costs.
New jobs would mean new tax revenues, increased property values, and less unemployment, welfare and associated costs. New businesses will move to Wisconsin and old businesses will keep their doors open. And when businesses no longer have to add their health costs to the price of their product, we will see lower prices at the cash register and greater competitiveness against foreign products that aren't burdened with health care costs.
Who wouldn't like these single-payer benefits?
For one, the insurance companies that are currently reaping 20-30 percent of health care dollars won't like it a bit, and neither will the politicians who receive campaign contributions from health care interests. Nor will the board members that sit on both health care and non-health care corporate boards, though business associations that serve both factions owe it to the latter to sit this issue out. The conflicts of interest that stand in the way of good public policy abound.
If corporations are not willing to provide employee health care at least equivalent to Medicare, they should get out of the way and let the government do it. We don't want their inadequately funded solutions or a mish-mash of prohibitively expensive half-way measures. Or health savings accounts that are time bombs waiting to explode in credit card debt and bankruptcies.
Nor do we want an incremental approach that will not cover all citizens and is sure to fail. The public wants it done right and wants it done now.
Think about it. For the same amount of money we are paying to cover 85 percent of the public now, we could cover 100 percent under a single-payer plan like Canada's -- but without the wait times. Over 80 percent of Canadians prefer their system to ours. Their life expectancy is two years longer and infant mortality 35 percent less than ours -- mostly because everybody is insured under a single-payer plan.
Canada spends 10 percent of its gross domestic product on health care while we spend 15 percent of GDP and get less for it. They cover 100 percent of their people and we cover 85 percent and that is shrinking. Their administrative costs are 10 percent compared to our 20-30 percent. They have no wait times for urgent procedures, and those for elective care could be eliminated with a simple increase in funding by 10 percent -- to 11 percent of GDP. While their problem is funding, ours is systemic.
THROW THE RASCALS OUT
ROMNEY STYLE UNIVERSAL HEALTHCARE: YOU BUY IT OR WE FINE YOU
ALICE DEMBNER, BOSTON GLOBE - More than 200,000 people with health insurance would have to buy additional coverage to meet proposed minimum standards under the state's new health insurance law, according to a count completed by insurers yesterday. Most of the individuals do not have coverage for prescription drugs or have drug coverage that is more restrictive than the minimum proposed by the state board implementing the law. . . Individuals would face a fine of about $200 next year and more in future years, if they do not have insurance that meets the standards.
"It's very troubling," said Richard Lord, president of Associated Industries of Massachusetts and a member of the Connector board. "The new law was about expanding access for people without any health insurance. I don't think we should be forcing people who do have some coverage to spend more."
SEIU, DEMOCRATS JOINING IN HEALTHCARE CON
[It's bad enough that centrist Democrats are falling for this, but now the leading labor union SEIU has joined in support of phony healthcare reform, backing a plan whose major attribute is that it will continue to permit insurance companies to make huge profits. Instead of a logical approach, such as expanding Medicare, a disturbing consensus is developing around a convoluted, inadequate, corporate-friendly mishmash and calling it - in one of the great spin lies of our times - "universal healthcare." Steven Pearlsein, a corporate columnist of the Washington Post, naturally thinks it's swell]
STEVEN PEARLSTEIN, WASHINGTON POST - There, at the National Press Club, stood the president of the Business Roundtable, representing the country's largest corporations; the president of the Service Employees International Union, the country's most vibrant union and one of its fastest-growing; and the president of AARP, the formidable seniors lobby. They put aside their usual differences to deliver a clear, simple message to President Bush and congressional leaders of both parties: We stand ready to give you the political cover you need for a centrist, bipartisan fix for a broken health-care system. Or, if you refuse, we stand ready to embarrass you and run you out of office.
"Washington is behind where the rest of the country is," said Andy Stern, a labor leader. "Democratic leaders in Congress say this is not the time. The White House has said now is not the time. And we are saying, 'Now is the time.' "
Stern and his new friends are right about one thing: Something's going on.
SCHWARZENEGGER'S HEALTHCARE CON
SHEILA JAMES KUEHL, CHAIR CALIFORNIA SENATE HEALTH COMMITTEE, LA TIMES - Schwarzenegger's plan. . . mandates that every individual have insurance (not just every worker), yet it doesn't ensure that coverage will be comprehensive and affordable. Schwarzenegger also calls for increasing reimbursements paid to providers under public programs by billions of dollars. . .
How does he pay for it? Individuals and employers will contribute, but employers are required to spend only 4% of payroll to insure their employees, or contribute the same amount to a state fund. This is not sufficient to purchase insurance for the working uninsured, who will be required to have it. This means that the governor's plan can at best provide high-cost, low-benefit plans for many Californians; it limits what employers pay but not what individuals must pay or what insurance companies can charge.
A portion of the funding for the plan would also come from federal money that is at this point only "hoped for." There also would be a tax on providers, such as doctors and hospitals, and the governor would redirect public money now spent on poor people in hospitals to insurance companies. This would create an immediate problem for hospitals, which are already closing because of inadequate reimbursement from private insurance companies.
Finally, the governor would adopt President Bush's plan for individual health savings accounts by requiring employers to "allow" employees to put away money, pretax, to pay for unreimbursed medical expenses. These accounts effectively shift the costs and liability of healthcare away from insurance companies and onto consumers. Such a plan would not benefit people who are already too strapped to meet current expenses, and it does nothing to expand coverage or affordability.
GOP GOVERNORS PROPOSING FAKE UNIVERSAL HEALTH COVERAGE
WITH THE uncritical blessing of the media, GOP governors of Massachusetts and now California have gotten away with calling required purchase of private health insurance "universal health coverage." Both the NY Times and the Washington Post gave this badly misleading impression of what appears a conservative plan to derail growing support for real universal coverage. Much as the right and the media have used grossly distorted phrases like "Social Security reform," the Schwarzenegger and Romney plan create their universality not by providing coverage but by forcing citizens to buy it from private insurers. This falls somewhere between being a con and being unconstitutional, not unlike being told you have to buy telephone service from a private vendor because it's good for you.
CHERRY PICKING HEALTH INSURANCE COMPANIES REFUSE TO INSURE CERTAIN JOBS
LISA GIRION, LA TIMES - Health insurers in California refuse to sell individual coverage to people simply because of their occupations or use of certain medicines, according to documents obtained by The Times. Entire categories of workers - including roofers, pro athletes, dockworkers, migrant workers and firefighters - are turned down for insurance even if they are in good health and can afford coverage, according to the confidential underwriting guidelines of four health plans. . .
Such restrictions are legal in California, and state regulators have no authority to stop them. Health plans defend their restrictions as necessary to keep premiums down. . .
At issue is individual insurance, the type of coverage purchased by people who do not have job-based group health benefits. Unlike group coverage, individual insurance is granted case by case, meaning in effect that health plans are free to choose whom to cover and what to charge them.
MYTHS ABOUT SINGLE-PAYER HEALTHCARE
[From the Hunger Action Network of New York]
Myth: The government would dictate how physicians practice medicine.
In countries with a national health insurance system, physicians are rarely questioned about their medical practices (and usually only in cases of expected fraud). Compare it to today's system, where doctors routinely have to ask an insurance company permission to perform procedures, prescribe certain medications, or run certain tests to help their patients.
Myth: Waits for services would be extremely long.
In countries with NHI, urgent care is always provided immediately. Other countries do experience some waits for elective procedures (like cataract removal), but maintaining the US's same level of health expenditures (twice as much as the next-highest country), waits would be much shorter or even non-existent. Compared to most other countries with universal health care, it is the US with the long waiting times - especially for the tens of millions without health insurance. There would be no lines under a universal health care system in the United States because we have about a 30% oversupply of medical equipment and surgeons, whereas demand would increase about 15%
Myth: People will over-use the system.
Most estimates do indicate that there would be some increased use of the system (mostly from the 42 million people that are currently uninsured and therefore not receiving adequate health care), however the staggering savings from a single-payer system would easily compensate for this.
Myth: Universal Health Care Would Be Too Expensive
The United States spends at least 40% more per capita on health care than any other industrialized country with universal health care. Federal studies by the Congressional Budget Office and the General Accounting office show that single payer universal health care would save 100 to 200 billion dollars per year despite covering all the uninsured and increasing health care benefits. The United States spends 50 to 100% more on administration than single payer systems. By lowering these administrative costs the United States would have the ability to provide universal health care, without managed care, increase benefits and still save money.
Myth: A single payer system Would Result In Government Control And Intrusion Into Health Care Resulting In Loss Of Freedom Of Choice
There would be free choice of health care providers under a single payer universal health care system, unlike our current managed care system in which people are forced to see providers on the insurer's panel to obtain medical benefits. There would be no management of care under a single payer system unlike the current managed care system which mandates insurer pre-approval for services thus undercutting patient confidentiality and taking health care decisions away from the health care provider and consumer
Myth: Universal Health Care Is Socialized Medicine And Would Be Unacceptable To The Public
Single payer universal health care is not socialized medicine. It is health care payment system, not a health care delivery system. Health care providers would be in fee for service practice, and would not be employees of the government, which would be socialized medicine. Repeated national and state polls have shown that between 60 and 75% of Americans would like a publicly financed, universal health care system
PHYSICIANS FOR A NATIONAL HEALTH PROGRAM FAQ http://www.pnhp.org/facts/singlepayer_faq.php#socialized
MORE THAN HALF OF AMERICANS DISSATISFIED WITH HEALTH COSTS
RICARDO ALONSO-ZALDIVAR, LA TIMES - The annual Health Confidence Survey, released by the nonpartisan Employee Benefit Research Institute, found that more than half of those surveyed 52% were dissatisfied with health insurance costs, a sharp increase from 33% last year. . .
Retirement plans took a big hit, with 36% of those who reported higher costs over the last year saying they had reduced their contributions to 401(k) plans. Of that group, 28% said that because of health-related costs, they had trouble paying for such basic necessities as housing, heat and food. . . The institute's poll found that workers regard their employer-sponsored coverage as an ever more valuable benefit, even as many new jobs come with no coverage and employers cut back or drop existing plans.
QUARTER OF AMERICANS SAY THEY OR FAMILY PUT OFF MEDICAL TREATMENT BECAUSE OF COST
KAISER FOUNDATION - One in four Americans say that they or a family member in their household had problems paying medical bills during the past 12 months, according to a new poll conducted jointly by ABC News, the Kaiser Family Foundation and USA Today. That's the highest share of Americans reporting a problem paying medical bills in a series of Kaiser surveys taken since 1997. Among those reporting a problem this year, nearly seven in 10 have health insurance.
- About one in four (28%) Americans say that in the past year they or a family member have put off medical treatment because of its cost. Of those who delayed treatment, seven in 10 (70%) say that the care was for a serious medical condition.
- Among those with health insurance, most (60%) are worried about not being able to afford coverage over the next few years, with 27% saying they are very worried.
- More than half (54%) of those without health coverage say the main reason is because they can't afford it, while another 15% say they can't get it due to poor health, illness or age. In comparison, just 4% say the main reason they lack health insurance is because they think they don't need it.
- Eight in 10 Americans (80%) say they are dissatisfied with the overall cost of health care to the nation. When asked about their own concerns about the health care system, cost comes out far ahead of quality. Four in 10 say that they are dissatisfied with their personal health care costs, compared with one in 10 who say they are dissatisfied with the quality of their health care.
JULIE APPLEBY, USA TODAY - Fifty-six percent say they would prefer universal coverage to the current system. . . In the survey, 68% said providing coverage for everyone is more important than keeping taxes down. . .
When survey respondents were asked about possible trade-offs that might come with a universal program, positive responses plummeted. The poll found:
76% would oppose universal coverage if it meant some medical treatments currently covered by insurance would no longer be covered.
68% would be against it if it led to limits on the choice of doctors.
DEAN BAKER, PROSPECT - USA Today had an article this morning on rising U.S. health care costs. It never mentions the fact that the United States pays more than twice as much per person as the average among other wealthy countries, yet has shorter life expectancies.
LACK OF HEALTH ISURANCE KILLS SIX TIMES AS MANY AMERICANS EACH YEAR AS 9/11 DID
SARAH RUTH VAN GELDER AND DOUG PIBEL, YES MAGAZINE - An estimated 50 million Americans lack medical insurance, and a similar and rapidly growing number are underinsured. The uninsured are excluded from services, charged more for services, and die when medical care could save them -- an estimated 18,000 die each year because they lack medical coverage. But it's not only the uninsured who suffer. Of the more than 1.5 million bankruptcies filed in the U.S. each year, about half are a result of medical bills; of those, three-quarters of filers had health insurance.
Businesses are suffering too. Insurance premiums increased 73 percent between 2000 and 2005, and per capita costs are expected to keep rising. . .
Employers who want to offer employee health care benefits can't compete with low-road employers who offer none. Nor can they compete with companies located in countries that offer national health insurance. . .
Among politicians and pundits, a universal, publicly funded system is off the table. . . The United States leaves the health of its citizens at the mercy of an expensive, patchwork system where some get great care while others get none at all. The overwhelming majority -- 75 percent, according to an October 2005 Harris Poll -- want what people in other wealthy countries have: the peace of mind of universal health insurance.
PORTLAND PRESS HERALD - Patricia LaMarche, the Green Independent candidate in Maine's five-way race for governor, proposed a state-run universal health-care plan Thursday that would tax employers to pay for the program. . . [The] program would have no co-pays, no deductibles and no out-of-pocket expenses for essential care. Elective procedures would not be covered. . . Her plan, which has been described as the cornerstone of her campaign, would impose a payroll tax of 5 percent to 12 percent on employers, depending on the size of their work force. Employers with no more than five workers would pay atax equivalent to 5 percent of their payroll. The rate would rise gradually as the number of employees increased, hitting a maximum of 12 percent, for employers with more than 1,000 workers. State, county and municipal governments also would be taxed, and their employees would be covered by the plan. Providers would bill a state-appointed Maine Healthcare Authority, which would pay the bills. . . . LaMarche said her plan would seek a federal waiver to let state government roll Medicaid funds into the new program, but it would not alter the Medicare program for the elderly.
PAT LAMARCHE HEALTHCARE PLAN
HEALTH INSURANCE COST RISE TWICE INFLATION RATE
JULIE APPLEBY, USA TODAY - Workers and employers won't find much comfort in the smallest increase in health insurance costs since 1999. The 7.7% increase this year is still more than twice the rate of inflation. And those rising costs have so far failed to boost the percentage of employers offering what are touted by some, including President Bush, as an answer to health care inflation: high-deductible insurance policies coupled with savings accounts. Despite being the biggest buzz among benefit consultants, the Kaiser Family Foundation says only 7% of employers offered such policies this year, unchanged from 2005. The results come from the non-profit foundation's annual employer survey, released Tuesday. . . The total premium increase is up 87% since 2000.
89% INDIVIDUAL HEALTH INSURANCE APPLICANTS EITHER REJECTED OR FIND IT TOO EXPENSIVE
MEDICAL NEWS TODAY - Of working-age U.S. residents who sought individual health coverage in the last three years, 89% were rejected for medical reasons or felt that the available plans were unaffordable, according to a study released Thursday by the Commonwealth Fund, the Los Angeles Times reports. . . According to the survey, 58% of respondents who applied for individual coverage found the health plans unaffordable. Twenty-one percent of those who sought individual coverage were rejected, charged a higher premium or were offered a policy that excluded coverage for a specific health condition they had. The study also finds: Two in five people with individual coverage spend at least 5% of their incomes on premiums, compared with one in seven who have employer-sponsored coverage. More than half of people with individual coverage pay at least $3,000 annually in premiums, and about one-third paid at least $6,000 annually. One-third of people with individual coverage have to pay $1,000 out-of-pocket each year before coverage takes effect;
MORE ADULT CHILDREN RELYING ON PARENTS' HEALTH INSURANCE
JENNIFER 8. LEE, NY TIMES - With 18- to 34-year-olds the fastest growing group of uninsured, states are extending the time that children can be a dependent for insurance purposes. In New Jersey, which this year enacted the highest age limit, children can "piggyback" until they turn 30, as long as they live in the state and don't have their own children. The trend stems from a concern that a healthy - and profitable - segment of the population is dropping out of the insurance pool. About half of all states have studied such proposals, and at least nine have passed laws, eight of them since 2003 and three just this year, according to the National Conference of State Legislatures.
KIM DIXON, REUTERS - Most U.S. employers are planning to further scale back health benefits offered to retirees, as companies struggle with the upward march in the cost of medical care and weigh increased contributions from government's Medicare program, a survey found. Ninety-five percent of the mostly Fortune 500 companies polled expect to further restrict their retiree health plans over the next five years, and 14 percent plan to stop providing coverage entirely, the survey of 163 companies by benefits consultants Watson Wyatt found. Employers have been exiting the retiree health business for a decade-and-a-half. . .
About a third of U.S. employers offered current workers retiree coverage in 2005, down from about two-thirds in 1988, according to a recent study by the nonprofit Kaiser Family Foundation.
A DOCTOR COMES TO LIKE SINGLE PAYER
BENJAMIN BREWER, MD - It took me a while to conclude that a single-payer health system was the best approach. My fear had been that government would screw up medicine to the detriment of my patients and my practice. If done poorly, the result might be worse than what I'm dealing with now.
But increasingly I've come to believe that if done right, health care in America could be dramatically better with true single-payer coverage; not just another layer -- a part D on top of a part B on top of a part A, but a simplified, single payer that would cover all Americans, including those who could afford the best right now. Representatives and senators in Washington should have to use the same system my patients and I do were they to vote it in.
Doctors in private practice fear a loss of autonomy with a single-payer system. After being in the private practice of family medicine for 8 1/2 years, I see that autonomy is largely an illusion. Through Medicare and Medicaid, the government is already writing its own rules for 45% of the patients I see.
The rest are privately insured under 301 different insurance products (my staff and I counted). The companies set the fees and the contracts are largely non-negotiable by individual doctors.
The amount of time, staff costs and IT overhead associated with keeping track of all those plans eats up most of the money we make above Medicare rates. As it is now, I see patients and wait between 30 and 90 days to get paid. My practice requires two full-time staff members for billing. My two secretaries spend about half their time collecting insurance information. Plus, there's $9,000 in computer expenses yearly to handle the insurance information and billing follow up. I suspect I could go from four people in the paper chase to one with a single-payer system.
It would be simpler and better for the patient, and for me, if the patient could choose a doctor, bring their ID card with them, swipe it in a card reader at the time of service and have the doctor get paid on the spot with electronic funds transfer.
Instead, patients have to negotiate a maze of deductibles, provider networks, out-of-network costs, exclusions, policy riders, ER surcharges, etc. Wouldn't a card swipe be simpler? No preexisting conditions to worry about. No indecipherable hospital bills. One formulary to deal with and one set of administrative rules to learn instead of 300.
With a single-payer system, there are concerns about waiting times for procedures and not getting access to the "best doctors." These are real issues, but not unsolvable ones. We have these disparities now. Fact is, they are mostly a matter of geography, insurance status and personal wealth.
A single-payer system would increase access to care for the uninsured and the underinsured, including the working poor. It would lower total health costs, in part by replacing 50 different state Medicaid programs and umpteen insurers with one system. This approach has the potential to improve quality and lower costs by improving care for chronic illnesses such as diabetes, high blood pressure and heart disease. . .
I used to think a single-payer system would keep my income down and inject bureaucracy into my medical decision-making. But with the efficiency it could bring, it would at worst be an economic wash; more likely, the trimmed costs would more than make up for any foregone revenue. As for autonomy, I'm already struggling to maintain it amid the interference of insurers.
[Benjamin Brewer is a doctor with a family practice in the rural village of Forrest, Il]
BUSH HAS MORE THAN DOUBLED COST OF MEDICARE IN COVERT ATTACK ON PLAN
BLOOMBERG - The U.S. Medicare plan will ask elderly people to pay 11 percent more in health-insurance premiums for doctors' visits next year, the program's trustees said in a report released yesterday. Medicare intends to charge a monthly premium of $98.20 in 2007, up from $88.50 this year, the trustees said. The premium has more than doubled from the $45.50 charged in 2000. The Senate Democrats yesterday said they want to peg the premium increases to the Consumer Price Index, a measure used to track economic growth, to slow rate hikes.
MIDDLE CLASS WITHOUT HEALTH INSURANCE SOARING
NICK TIMIRAOS, LA TIMES - The number of uninsured adults who earn between $20,000 and $40,000 annually is rising, according to a study released today - suggesting that fewer employers are providing healthcare coverage. That study, along with one that says the uninsured are likely to seek treatment only when they become seriously ill, coincides with a national campaign, Cover the Uninsured, to make healthcare coverage a top legislative priority.
Research by the Commonwealth Fund, a nonpartisan New York-based foundation that examines healthcare issues, found that the percentage of moderate-income Americans who were without insurance for at least part of the year had jumped sharply over four years - from 28% in 2001 to 41% in 2005.
ROMNEY HEALTHCARE PLAN IS A CON
STEFFIE WOOLHANDLER AND DAVID HIMMELSTEIN, PHYSICIANS FOR A NATIONAL HEALTH PROGRAM - The politicians assumed that only about 500,000 people in Massachusetts are uninsured. The Census Bureau says that 748,000 are uninsured. Why the difference? The 500,000 figure comes from a phone survey conducted in English and Spanish. Anyone without a phone or who speaks another language is counted as insured. The 748,000 figure comes from a door-to-door survey carried out in many languages (including Portuguese and Haitian Creole, common languages in Massachusetts). In sum, the reform plan wishes away 248,000 uninsured people who don't have phones or don't speak English or Spanish. It provides no funding or means to get them coverage.
Second, the linchpin of the plan is the false assumption that uninsured people will be able to find affordable health plans. A typical group policy in Massachusetts costs about $4500 annually for an individual and more than $11,000 for family coverage. A wealthy uninsured person could afford that &SHY; but few of the uninsured are wealthy. A 25 year old fitness instructor can find a cheaper plan. But few of the uninsured are young and healthy. According to Census Bureau figures, only 12.4% of the 748,000 uninsured in Massachusetts are both young enough to qualify for low-premium plans (under age 35) and affluent enough (incomes greater than 499% of poverty) to readily afford them. Yet even this 12.4% figure may be too high if insurers are allowed to charge higher premiums for persons with health problems; only half of uninsured persons in those age and income categories report that they are in "excellent health".
The legislation promises that the uninsured will be offered comprehensive, affordable private health plans. But that's like promising chocolate chip cookies with no fat, sugar or calories. The only way to get cheaper plans is to strip down the coverage &SHY; boost co-payments, deductibles, uncovered services etc.
Hence, the requirement that most of the uninsured purchase coverage will either require them to pay money they don't have, or buy nearly worthless stripped down policies that represent coverage in name only.
Third, the legislation will do nothing to contain the skyrocketing costs of care in Massachusetts &SHY; already the highest in the world. Indeed, it gives new infusions of cash to hospitals and private insurers. Predictably, rising costs will force more and more employers to drop coverage, while state coffers will be drained by the continuing cost increases in Medicaid. Moreover, when the next recession hits, tax revenues will fall just as a flood of newly unemployed people join the Medicaid program or apply for the insurance subsidies promised in the reform legislation. The program is simply not sustainable over the long &SHY; or even medium &SHY; term.
What Are the Alternatives?
A single payer universal coverage plan could cut costs by streamlining health care paperwork, making health care affordable. Massachusetts Blue Cross spends only 86% of premiums paying for care. It spends the rest - more than $700 million last year - on billing, marketing and other administrative costs. Harvard Pilgrim and Tufts Health Plan &SHY; our other big insurers - are little better; each took in about $300 million more than it paid out. That's ten times as much overhead per enrollee as Canada's national health insurance program. And our hospitals and doctors spent billions more fighting with insurers over payments.
Overall, Massachusetts residents will spend $13.3 billion on health care bureaucracy this year &SHY; nearly one third of our total health bill. If we cut bureaucracy to Canada's levels we could save $9.4 billion annually, enough to cover all of the 748,000 uninsured in Massachusetts and to improve coverage for the rest of us.
Study after study &SHY; by the Congressional Budget Office, the General Accounting Office and even the Massachusetts Medical Society - have confirmed that single payer is the only route to affordable universal coverage.
And single payer is popular. The Massachusetts Nurses Association supports it along with dozens of other labor, seniors and consumer groups; so do 62% of Massachusetts physicians according to a recent survey. National polls find that almost two-thirds of Americans favor a tax-funded plan like Medicare that would cover all Americans.
But single payer national health insurance threatens the multi-million dollar paychecks of insurance executives, and the outrageous profits of drug companies and medical entrepreneurs.
FIVE MYTHS ABOUT NATIONAL HEALTHCARE
[Tyler Zimmer, Campus Progress]
Myth #1: It would be too expensive
UHC would actually reduce the cost of health care. The Congressional Budget Office estimated that UHC could save up to $14 billion annually by spreading the risk evenly over the entire population, eliminating deductibles and co-pays and making preventive medicine available to the poor and uninsured. The federal government already subsidizes private health insurance in the form of tax deductions.
Private insurance companies also spend billions on administration and overhead, advertising, and determining and inspecting patient eligibility, all while trying to make a profit. UHC would not be burdened with some of those costs, like advertising, and unlike private business, it could run at a loss and still be viable. . .
Myth #2: It would require a huge, inefficient bureaucracy
The current system is already a huge, inefficient bureaucracy! As previously mentioned, much of the unnecessary overhead and micromanaging in the system now could be eliminated if UHC were implemented. For example, the bureaucracy and paperwork involved in determining patient eligibility would be completely unnecessary if everyone were eligible and covered. Insurance companies spend an estimated 25 cents of every dollar on administration. Canada, which already has a comprehensive UHC in place and still manages to pay 70 percent less per citizen on health care, spends about the equivalent of about 12 cents of every dollar on administration.
Myth #3: It would restrict patient choice
UHC wouldn't directly dictate what doctor you have to see in order to get treatment and would thus enable more choice in selecting a physician than the current system would for many, if not most, Americans.
Myth #4: It would be a socialist seizure of the medical industry
It would be nothing of the sort. Socialized medicine would entail hospitals and doctors becoming employees of the state. UHC only provides funding for people's health care, but doesn't provide the health care itself. . . UHC would be no more socialist than Medicare and arguably less so than public education.
Myth #5: UHC would impede economic growth
An added benefit of UHC would be that private business would no longer have to worry about health-care benefits, and employees wouldn't have to remain in unpleasant jobs just to keep their benefits. Benefits wouldn't interfere with wage increases, and employers would have more financial mobility. . .
MEDICARE DRUG PLAN IS BIGGEST GOVERNMENT LEGISLATIVE FRAUD SINCE THE S&L BAILOUT
PROGRESSIVE REVIEW - The new Medicare drug plan is probably the biggest government fraud since the S&L bailout. And as with the savings and loan scandal, the media is simply going along with it, reporting what is massive giveaway to the drug corporations as just another government program. It isn't: the measure was specifically designed the give the drug industry the biggest profits possible with Medicare recipients the ultimate victims. It was deliberately written to confuse, obscure and complicate use of the benefits. Name one other such widely used federal program where you have to go to a two hour workshop just to find out what the hell is going on. Name one other with a permanent continuing penalty attached to those who fail to sign up by a certain time. Name one other with such a bewildering set of choices for no good purpose other than to let the big corporations make more money.
Here for example, are just two paragraphs from an attempt in the Texasrkanan Gazette to explain the program to its readers:
"For example, your prescriptions costs now run about $100 per month. You could choose a plan with a '0' monthly premium and a $250 yearly deductible. You would have met your deductible in less than three months. The rest of the year, you would have no expense other than the amount your plan charges for your prescription. Spending no more than $100 per month or less on prescriptions, you will never reach the $3,600 out of pocket expenses and the catastrophic coverage.
"On the other hand, your prescription costs run $1,500 per month. You choose a plan with a $250 deductible and a '0' or low monthly premium. You will have reached your $250 deductible the first month and $3,600 "out of pocket expense" by the third month. Your prescriptions would then cost no more than $2 for generics and $5 for brand names."
This measure joins the S&l bailout and a few others as legislation which by its very nature borders on criminal intent, a deliberate effort to defraud the those who were meant to benefit from it.
THE ISSUE THE MEDIA REFUSES TO ADDRESS
ROBERT KUTTNER, BOSTON GLOBE - Health insurance is the most vivid case of what political scientist Walter Dean Burnham calls a ''politics of excluded alternatives." Polls consistently show that over two-thirds of Americans want universal tax-supported health insurance. Gallup found that 79 percent of Americans want coverage for all, and 67 percent don't mind if taxes are raised to pay for it. Fully 78 percent are dissatisfied with the present system. Medicare, the one part of the system that is true national health insurance (for seniors) is overwhelmingly popular.
There is no hotter political issue, nor one that strikes closer to home. So, if Americans overwhelmingly want national health insurance, why don't we get it? Three huge reasons: political, fiscal, and jurisdictional.
Politically, the immensely powerful private insurance industry would be displaced by national health insurance. Nearly all corporations would rather suffer with the devil that they know (escalating premiums) than the devil they hate (an expanded role for government). Ideologically, something supported by overwhelming majorities is seen as radical. (So was Social Security until it was enacted).
MEDICARE DRUG PLAN CUTS OFF AID TO THE NEEDY
THOMAS GINSBERG, KNIGHT RIDDER - Under federal rules effective Jan. 1, low-income and elderly patients who enroll in the program, known as Medicare Part D, will lose the ability to get free medications through the drugmakers' tax- deductible charities, known as patient- assistance programs. Some companies, going further, said this week that they would drop patients who were merely eligible for Part D, whether or not they actually enrolled in it, as allowed under longstanding rules. As a result, in about six weeks, up to half of the roughly 3 million to 4 million charity patients nationwide may lose free access to more than 1,200 brand-name drugs, according to estimates of three companies. Other recipients should be unaffected. . . News of the cutoff followed a ruling last week by the Inspector General of the Department of Health and Human Services barring companies from giving free drugs to Part D enrollees, hoping to prevent fraud. While suggesting an alternative charity system, the ruling threw a confusing twist into the already-baffling Medicare prescription-drug program. ''The last thing we need is one more variable in a hopelessly complex situation," said Robert M. Hayes, president of the Medicare Rights Center, an advocacy group based in New York. On Tuesday, Americans could begin to sign up for the new voluntary Medicare prescription-drug coverage. About 42 million Medicare recipients are eligible for the program.
LEAVE NO SENIOR UNSTYMIED ACT CONT'D
USA TODAY - Using the Medicare drug-benefit search tool requires patience. With a high-speed Internet link, allow at least 20 minutes to do a simple search:
1. Go to www.medicare.gov. Select the "Compare Medicare Prescription Drug Plans" link.
2. Enter a Medicare member's number or select the general search button and type in a ZIP code to find all the plans serving a region. You may get a long list.
3. Narrow the selection by entering the names of the prescription drugs taken by the Medicare member. You can enter exact dosages or click a button that will enter commonly prescribed dosages for you. Keep in mind that the list that results includes plans that may not cover all the drugs you've chosen.
4. Compare plans on cost, deductible, premium and other factors by selecting up to three plans at a time and clicking on the compare button. Choose several options that look appealing and print out the list of your selections for later reference.
5. Go back to the main home page. Select the link to "Formulary Finder."
6. Enter your state and re-enter all the drug names. You'll get two lists of plans. The list at the top of the page shows plans that cover all your selected drugs. The second list at the bottom shows plans that cover only some of the drugs.
7. Refer to the printout of choices you're considering in your ZIP code. By clicking on the plan names, you can learn more about the drugs covered by each plan and what restrictions, if any, are placed on them.
[This, mind you, only gives a list of drug merchants who may offer some but not all of the drugs a senior may need]
SENIORS JOIN CHILDREN IN BEING LEFT BEHIND BY BUSH REGIME
ROBERT PEAR, NY TIMES Enrollment in the new Medicare drug benefit begins in three days, but even with President Bush hailing the plan as "the greatest advance in health care for seniors" in 40 years, large numbers of older Americans appear to be overwhelmed and confused by the choices they will have to make. At a senior center in Urbana, Lynn Heskett of the Ohio Senior Health Insurance Information Program described the drug plan to a full house. "I have a Ph.D., and it's too complicated to suit me," said William Q. Beard, 73, a retired chemist in Wichita, Kan., who takes eight prescription drugs, including several heart medicines. "I wonder how the vast majority of beneficiaries will handle this. . .
"The whole thing is hopelessly complicated," said Pauline H. Olney, 74, a retired nurse who attended a seminar at a hotel in Santa Rosa, north of San Francisco. . .
In most states, beneficiaries have a choice of more than three dozen prescription drug plans. Premiums, deductibles, co-payments and covered drugs vary widely. Many retirees also have other options: getting drug coverage through former employers or through Medicare-managed care plans. In Kansas, Medicare beneficiaries have a choice of 40 prescription drug plans charging premiums from $9.48 a month to $67.88 a month. . .
PAUL KRUGMAN, NY TIMES - At first, the benefit will look like a normal insurance plan, with a deductible and co-payments. But if your cumulative drug expenses reach $2,250, a very strange thing will happen: you'll suddenly be on your own. The Medicare benefit won't kick in again unless your costs reach $5,100. This gap in coverage has come to be known as the "doughnut hole." . . .
One way to see the bizarre effect of this hole is to notice that if you are a retiree and spend $2,000 on drugs next year, Medicare will cover 66 percent of your expenses. But if you spend $5,000 - which means that you're much more likely to need help paying those expenses - Medicare will cover only 30 percent of your bills. A study in the July/August issue of Health Affairs points out that this will place many retirees on a financial "roller coaster."
AMERICANS PAY MORE, GET LESS HEALTH CARE
MARGUERITE HIGGINS, WASHINGTON TIMES - Out-of-pocket medical expenses and medical errors were higher for patients in the United States than for those in countries that have state-funded health care systems, according to a new report. The study, which was released yesterday by the Commonwealth Fund, surveyed nearly 7,000 patients from March to June in the United States, Britain, Canada, Australia, Germany and New Zealand. Roughly 34 percent of U.S. patients encountered a medical mistake in the past two years, followed by 30 percent of Canadian patients, said the New York health research organization, which promotes universal health care coverage through government and corporate initiatives. . .
Additionally, 34 percent of U.S. patients paid more than $1,000 in out-of-pocket medical expenses in the past year while only 14 percent of Canadian and Australian patients paid that much in the same period, the report said.
ROB STEIN WASHINGTON POST - "What's striking is that we are clearly a world leader in how much we spend on health care," said Cathy Schoen, senior vice president for the Commonwealth Fund, a private, nonpartisan, nonprofit foundation that commissioned the survey. "We should be expecting to be the best. Clearly, we should be doing better." Other experts agreed, saying the results offer the most recent evidence that the quality of care in the United States is seriously eroding even as health care costs skyrocket. "This provides confirming evidence for what more and more health policy thinkers have been saying, which is, 'The American health care system is quietly imploding, and it's about time we did something about it,' " said Lucian L. Leape of the Harvard School of Public Health.
OCTOBER 2005. . .
THE FAILURES OF HEALTH INSURANCE
JOHN LELAND, NY TIMES - After decades in which private and government insurance covered a progressively larger share of medical expenses, insurance companies are now shifting more costs to consumers, in the form of much higher deductibles, co-payments or premiums. At the same time, Americans are saving less and carrying higher levels of household debt, and even insured families are exposed to medical expenses that did not exist a decade ago. . . Lawyers and accountants say that for the more than 1.5 million American families who filed for bankruptcy protection last year, the most common causes were job loss and medical expenses. New bankruptcy legislation, which went into effect Oct. 17, requires middle-income debtors to repay a greater share of their debt.
SEPTEMBER 2005. . .
NUMBER WITHOUT HEALTH INSURANE RISING
BOSTON GLOBE - With the exception of 1999 and 2000, the number of Americans without health insurance has risen steadily from just over 30 million in 1987. It is a bipartisan failure. After President Clinton dropped his botched attempt for a more universal form of healthcare in his first term, the numbers of the uninsured soared from 35 million to nearly 45 million. Aided by a booming economy, the numbers fell in Clinton's last two years to 40 million. Under Bush, the number cracked the 45 million barrier for the first time -- 45.8 million, to be exact.
WHY SMALL BUSINESSES SHOULD BE LOOKING AT NATIONAL HEALTHCARE
SMALL BUSINESS TIMES - Health care costs are rising at 10-15% per year and employers are struggling for ways to pay these costs, which typically represent 15% of their labor costs. Many are shifting the costs to their employees by demanding high deductibles and co-pays, and in some cases contracting with HMOs who make their money more by denying care than providing it.
But what else can companies do? They are competing with manufacturers in countries that have taxpayer-paid universal health care systems, and these competitors need not add health care to the cost of their products. Of course our manufacturers can send their work abroad, but then American jobs are lost.
Rising health care costs are the result of only one thing, a medical community that has switched from being humanitarian medical centers to for-profit corporations. The industry has run amok. They are inefficiently operated and they love it, because inefficiency is where they make much of their profits. Medicare and private insurers are incurring 20% to 30% of their costs from unnecessary and inappropriate medical testing, and another 30% in exorbitant administrative waste. Compare that 30% to Canada's 8% and Medicare's 3.5%. Wisconsinites are supporting 400 for-profit insurance companies compared to the ONE non-profit contractor in each Canadian province.
The 30% waste is not exclusive to government systems; it also exists within the private sector. It is the profit motive that is driving up health care costs, and this motivation exists on all fronts: hospitals, physicians and insurers, including for-profit HMOs. For-profit entities are obligated by law to seek the highest profits possible for their shareholders, and cutting care helps achieve this goal.
The United States and South Africa are the only two industrialized countries that do not have universal health care for their citizens. Over 45 million Americans, 15% of our population, are totally without health care and just show up at the emergency room for treatment, which is the most expensive form of rationing possible. The E.R. charges sometimes force them into bankruptcy, where the losses are shifted to those who are insured or to the taxpayers. Over 18,000 Americans die prematurely every year because they lack coverage - which is six times more than died on 9/11. Another 50 million Americans are underinsured and are a mishap away from bankruptcy and the societal costs that result.
Why do we allow this? Because our politicians are paid to allow it: it's called "$100 million per year in political contributions given by our health care and pharmaceutical industries." Political money got us into this mess and eliminating political money will be the only way of getting us out of it. Unless, of course, business leaders force the issue and demand change.
AMERICA'S TRAGIC HEALTH RECORD
PAUL VALLELY, INDEPENDENT, UK - Parts of the United States are as poor as the Third World, according to a shocking United Nations report on global inequality. The US is the only wealthy country with no universal health insurance system. . .
The annual Human Development Report normally concerns itself with the Third World, but the 2005 edition scrutinizes inequalities in health provision inside the US as part of a survey of how inequality worldwide is retarding the eradication of poverty. It reveals that the infant mortality rate has been rising in the US for the past five years - and is now the same as Malaysia. America's black children are twice as likely as whites to die before their first birthday. . .
AUGUST 2005. . .
HEALTH BILLS LEADING CAUSE OF BANKRUPTCY
MALCOLM GLADWELL, NEW YORKER - The leading cause of personal bankruptcy in the United States is unpaid medical bills. Half of the uninsured owe money to hospitals, and a third are being pursued by collection agencies. Children without health insurance are less likely to receive medical attention for serious injuries, for recurrent ear infections, or for asthma. Lung-cancer patients without insurance are less likely to receive surgery, chemotherapy, or radiation treatment. Heart-attack victims without health insurance are less likely to receive angioplasty. People with pneumonia who don't have health insurance are less likely to receive X rays or consultations. The death rate in any given year for someone without health insurance is twenty-five per cent higher than for someone with insurance. Because the uninsured are sicker than the rest of us, they can't get better jobs, and because they can't get better jobs they can't afford health insurance, and because they can't afford health insurance they get even sicker.
JULY 2005 . . .
U.S SPENDS DOUBLE ON HEALTHCARE COMPARED TO 29 INDUSTRIALIZED NATIONS
ST PETERSBURG TIMES - America's fragmented health care system is the costliest in the world. The latest study, conducted by Johns Hopkins University researchers and reported this month in Health Affairs, offers more evidence of the same. The United States spent $5,267 per person on health care in 2002. That's more than double, per capita, what 29 other industrialized nations spent. The total amounts to 14.6 percent of the U.S. gross domestic product. The United Kingdom, by comparison, spent 7.7 percent.
MAY 2005. . .
IT'S INSURANCE FEES, NOT AWARDS, THAT ARE COSTING DOCTORS
LIZ KOWALCZYK, BOSTON GLOBE Re-igniting the medical malpractice overhaul debate, a new study by Dartmouth College researchers suggests that huge jury awards and financial settlements for injured patients have not caused the explosive increase in doctors' insurance premiums. The researchers said a more likely explanation for the escalation is that malpractice insurance companies have raised doctors' premiums to compensate for falling investment returns.
The Dartmouth economists studied actual payments made to patients between 1991 and 2003, the results of which were published yesterday in the journal Health Affairs. Some previous studies have examined jury awards, which often are reduced after trial to comply with doctors' insurance coverage maximums or because the plaintiff settles for less money to avoid an appeal. Researchers found that payments grew an average of 4 percent annually during the years covered by the study, or 52 percent overall since 1991, but only 1.6 percent a year since 2000. The increases are roughly equivalent to the overall rise in healthcare costs, said Amitabh Chandra, lead author and an assistant professor of economics at the New Hampshire college.
AMERICA'S LOUSY HEALTHCARE
RICHARD SCHWARTZ, NY DAILY NEWS - America doesn't have the world's best health care system, just the most expensive. For those of you who worry about your health and wealth (i.e., everyone), that's mind-bogglingly bad news. The numbers are grotesque. The United States spends 15.5 percent of its gross domestic product on health care, about $1.7 trillion a year. No other country comes close. Yet for all that money - equal to the entire economic output of France - 45 million Americans go without health insurance.
By the way, in France, which on a per-capita basis spends about half what we do on health care, everyone is insured. In fact, under France's universal health system, patients can visit doctors, even specialists, virtually any time they wish. . .We're only No. 22 among industrialized nations in life expectancy (77 years). Japan is No. 1 at 81 years. We're No. 25 in infant mortality rate (6.8 infant deaths per 1,000 births). Sweden leads with only 3.5 deaths per 1,000. .
PROGRESS REPORT - In a study conducted by the Robert Wood Johnson Foundation, 41 percent of uninsured adults said they were unable to see a doctor when they needed to during the previous year and 56 percent did not have a personal doctor or other health care provider. In 2003, chronically ill uninsured adults were more than four times more likely to go without medical care or prescription drugs than chronically ill insured adults." Nevertheless, more than one in five uninsured adults with chronic conditions report spending at least $2,000 out of pocket in a year for medical care. In last week's Los Angeles Times, Barbara Ehrenreich pointed out the "average visit to an ER now costs a little over $1,000, which is a high price to pay for an asthma attack or an infant's fever."
RWJF estimates that 20 million working Americans are uninsured and the Washington Times reports rising health care costs are forcing companies to pass "more of their health care costs on to employees in an effort to cut business expenses." General Motors Corp., the nation's largest buyer of health plans, recently reported it lost $1.1 billion in the first quarter of 2005, its largest quarterly loss in more than a decade." The company "cited the cost of providing health coverage for its workers and retirees as a main culprit."
The first element of the Bush administration's response to America's health care crisis has been to cut funding for coverage and offer half-baked privatization plans like Health Savings Accounts that exacerbate existing problems and would help only 0.3 percent of uninsured adults. In his latest "victory," President Bush successfully lobbied Congress to cut federal funding for Medicaid, the nation's largest insurance program for the poor. Medicaid was already facing increased costs driven by "enrollment growth due to the economic downturn" during Bush's first term. In addition, Congress recently passed the White House-backed Bankruptcy Bill, which will make it harder for uninsured Americans to recover from crippling debt brought on by medical problems.
The second part of the Bush administration's response appears to involve pretending health care problems don't exist. For instance, the 2004 Economic Report of the President concluded "many [of the uninsured] may remain uninsured as a matter of choice," perhaps because "they are young and healthy and do not see the need for insurance." Others, the report offered, are probably covered but do not report it, maybe because the "survey questions are confusing." A more recent report funded by the Department of Health and Human Services set out to prove the number of uninsured is overstated
PAUL KRUGMAN, NY TIMES - In 2002, the latest year for which comparable data are available, the United States spent $5,267 on health care for each man, woman and child. Of this, $2,364, or 45 percent, was government spending, mainly on Medicare and Medicaid. Canada spent $2,931 per person, of which $2,048 came from the government. France spent $2,736 per person, of which $2,080 was government spending. . .
U.S. health care is so expensive that our government spends more than the governments of other advanced countries, even though the private sector pays a far higher share of the bills than anywhere else. . .
Most Americans probably do not know that we have substantially lower life-expectancy and higher infant-mortality figures than other advanced countries. . . Social factors, notably America's high poverty rate, surely play a role. Still, it seems puzzling that we spend so much, with so little return.
UNINSURED COST TAXPAYERS MONEY EVEN WITHOUT NATIONAL HEALTHCARE
A KAISER COMMISSION STUDY on Medicaid and the uninsured study finds that uninsured Americans could incur nearly $41 billion in uncompensated health care treatment in 2004, with federal, state and local governments paying as much as 85 percent of the care. Even with uncompensated care, the study shows that people uninsured for the entire year can expect to receive about half as much care as people fully insured.
Another major finding of the study, authored by Urban Institute researchers Jack Hadley and John Holahan, is that if the country provided coverage to all the uninsured, the cost of additional medical care provided to the newly insured would be $48 billion - an increase of 0.4 percent in health spending's share of the gross domestic product.
DETAILS OF THE CONYERS MEDICARE BILL
JOHN CONYERS - The United States National Health Insurance Act (HR676) establishes a new American national health insurance program by creating a single payer health care system. The bill would create a publicly financed, privately delivered health care program that uses the already existing Medicare program by expanding and improving it to all U.S. residents, and all residents living in U.S. territories. The goal of the legislation is to ensure that all Americans, guaranteed by law, will have access to the highest quality and cost effective health care services regardless of one's employment, income, or health care status.
With over 42 million uninsured Americans, and another 40 million who are under insured, the time has come to change our inefficient and costly fragmented health care system. The USNHI program would reduce overall annual health care spending by over $50 billion in the first year. In addition, because it implements effective methods of cost-control, health spending is contained over time, ensuring affordable health care to future generations.
In its first year, single-payer will save over $150 billion on paperwork and $50 billion by using rational bulk purchasing of medications. These savings are more than enough to cover all the uninsured, improve coverage for everyone else, including medication coverage and long-term care.
Employers who currently provide coverage for their employees pay an average of 8.5% of payroll towards health coverage, while many employers can't afford to provide coverage at all. Under this Act, all employers will pay a modest 3.3% payroll tax per employee, while eliminating their payments towards private health plans. The average cost to an employer for an employee earning $35,000 per year will be reduced to $1,155, less than $100 per month.
95% of families will pay less for health care under national health insurance than they do today. Seniors and younger people will all have the comprehensive medication coverage they need.
Who is Eligible
Every person living in the United States and the U.S. Territories would receive a United States National Health Insurance Card and i.d number once they enroll at the appropriate location. Social Security numbers may not be used when assigning i.d cards. No co-pays or deductibles are permissible under this act.
This program will cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices.
Conversion to a Non-Profit Health Care System
Private health insurers shall be prohibited under this act from selling coverage that duplicates the benefits of the USNHI program. They shall not be prohibited from selling coverage for any additional benefits not covered by this Act; examples include cosmetic surgery, and other medically unnecessary treatments.
Cost Containment Provisions/ Reimbursement
The National USNHI program will annually set reimbursement rates for physicians, health care providers, and negotiate prescription drug prices. The national office will provide an annual lump sum allotment to each existing Medicare region, which will then administer the program. Payment to health care providers include fee for service, and global budgets.
The conversion to a not-for- profit health care system will take place over a 15 year period, through the sale of U.S. treasury bonds; payment will not be made for loss of business profits, but only for real estate, buildings, and equipment.
Funding & Administration
The United States Congress will establish annual funding outlays for the USNHI Program through an annual entitlement. The USNHI program will operate under the auspices of the Dept of Health & Human Services, and be administered in the former Medicare offices. All current expenditures for public health insurance programs such as S-CHIP, Medicaid, and Medicare will be placed into the USNHI program.
A National USNHI Advisory Board will be established, comprised primarily of health care professionals and representatives of health advocacy groups.
Proposed Funding For USNHI Program: $1.86 Trillion Per Year
A payroll tax on all employers of 3.3%. Maintain employee and employer Medicare payroll tax of 1.45%. Implement a variety of mechanisms so that low and middle income families pay a smaller share of their incomes for health care than wealthiest 5% of Americans; i.e, a health income tax on the wealthiest 5% of Americans, a small tax on stock and bond transfers, and closing corporate tax shelters. A repeal of the Bush tax cut of 2001. For more details, see PNHP's "Financing National Health Insurance."
*For more information, contact Joel Segal, legislative assistant, Rep. John Conyers, at 202 225-5126, or e- mail at Joel.Segal@mail.house.gov
VOICES YOU MAY NOT HAVE HEARD ON MEDICARE
CONSUMERS UNION REPORT FINDINGS: "The funds set aside for this 'benefit' - $400 billion over 10 years - cover just 22 percent of the anticipated drug costs, leaving consumers to foot the rest of the bill.". . . "Medicare is being moved down the road to privatization by requiring competition between private health plans and Medicare". . . "Private Pharmacy Benefit Managers get to pick what drugs are covered under the plan, with no transparency, methodology or public accountability. This means patients who are sensitive to the choice of drug will be out of luck if their needed drug is not on the plan.". . . The deal "actually prohibits the government from negotiating deep prescription drug discounts for consumers, meaning the average Medicare beneficiary will pay more out-of-pocket for drugs in 2007 when the benefit begins, than what they currently pay now without the 'benefit.'"
DON McCANNE, M.D., PHYSICIANS FOR A NATIONAL HEALTH PROGRAM - "The prescription drug benefit fails miserably on its alleged purpose: making drugs affordable for seniors. It provides a blank check for pharmaceutical firms to continue to gouge seniors, and introduces the pharmacy benefit manager middlemen who profit by taking away our choices in drug access. Worse, the legislation provides financial incentives for the healthy and wealthy to exit the traditional Medicare program and enroll in private PPO plans. This concentrates high-cost, chronically ill patients in the traditional program, driving up program costs. When forced to compete with the private HMOs, which will be subsidized, the higher costs will be shifted to Medicare beneficiaries in the form of unaffordable premiums. This 'death spiral' of ever-higher Medicare premiums will force patients into the private plan marketplace. To keep premiums affordable, the plans will strip out benefits and require unaffordable cost sharing. Then Medicare will no longer ensure either health security or financial security for our seniors."
JOHN HESS, HEALTH WRITER - "Once again, the AARP has stabbed America's elderly in the back. For more than 30 years now, it's been held up as a scarecrow - a monster representing 35 million greedy geezers. . . Briefly, the AARP is not a league of the elderly, but a marketing agency with a shady past. It peddles insurance, travel, advertising, and anything else it can get its hands on. It has a mailing list - not a membership - of 35 million customers. If you turn 50, they'll try to get your name on it. It calls itself an 'association' and goes through the motions in an effort to dodge taxes and commercial mailing rates, and it's been in constant trouble with the IRS and the Postal Service."
THE CLINTONS AND NATIONAL HEALTHCARE
SAM SMITH, 'SHADOWS OF HOPE,' 1994 - During the first months of the Clinton administration, one of the biggest national policy changes of the past fifty years was being forged by a secret committee led by Mrs. Clinton under procedures that periodically defied the courts and the Government Accounting Office and whose public manifestations consisted of highly contrived media opportunities, carefully staged "town meetings," and similar artifices.
Despite the contrary evidence of public opinion polls, the concept of Canadian-style single-payer insurance was dismissed early. Tom Hamburger and Ted Marmor in the Washington Monthly tell of a single-payer proponent being invited to the White House in February 1993. It was, he said, a "pseudo-consultation;" the doctor was quickly informed that "single payer is not politically feasible." When Dr. David Himmelstein of the Harvard Medical School pressed Mrs. Clinton on single payer, she replied, "Tell me something interesting, David."
In other words, write Hamburger and Marmor: "Fewer than six weeks into the Clinton presidency, the White House had made its key policy decision: Before the Health Care Task Force wrote a single page of its 22-volume report to the President, the single payer idea was written off, and "managed competition" was in."
If there was any popular, grassroots demand for "managed competition" it never appeared. Managed competition had not been tested anywhere. Nonetheless, reported Thomas Bodenehimer in Nation:
"Around Hillary Rodham Clinton's health reform table sit the managed-competition winners: big business, hospitals, large (but not small) commercial insurers, the Blues, budget-worried government leaders and the 'Jackson Hole Group,' the chief intellectual honchos of the managed competition movement. . . Adherence to the mantra of managed competition appears to be the price of a ticket of admission to this gathering. "
What was finally proposed involved a massive transfer of the American health industry - by some accounts now larger than the military-industrial complex - to a small number of the largest insurance companies and other major corporations. These were companies that had the assets to play the game being offered - a medical oligopoly that would dispense health-care under the rules of the Fortune 500 rather than according to those of Hipprocrates.