UnitedHealthcare Expands Availability of Quicken Health Expense Tracker to Nearly 700,000 Consumers

Intuit
Press Release
August 3, 2009

UnitedHealthcare, a UnitedHealth Group (NYSE: UNH) company, is expanding the availability of Quicken Health Expense TrackerSM to help nearly 700,000 of its commercial health plan enrollees nationwide better manage their health-related finances and information.

UnitedHealthcare… expects to make it available to more than 20 million commercial health plan participants by year end.

Drawing on claims data, Quicken Health Expense Tracker automatically assembles a complete financial picture of an individual’s medical-related savings and expenses into one easy-to-use location.

Peter Karpas, senior vice president and general manager, Quicken Health Group: “Our goal is to transform the way people interact with the health care system and make the financial side of health care easier for consumers, health plans, employers and providers. And it starts with the support of forward-thinking companies like UnitedHealthcare.”

Quicken Health Expense Tracker was developed by Intuit and Ingenix, a UnitedHealth Group company that is a leader in health information solutions. Ingenix played a key role in designing the security and connectivity between the software and enrollees’ health information.

http://about.intuit.com/about_intuit/press_room/press_release/articles/2009/UNITEDHEALTHCAREEXPANDS.html

And…

The Health Insurers Have Already Won

How UnitedHealth and rival carriers, maneuvering behind the scenes in Washington, shaped health-care reform for their own benefit

By Chad Terhune and Keith Epstein
BusinessWeek
August 6, 2009

As the health reform fight shifts this month from a vacationing Washington to congressional districts and local airwaves around the country, much more of the battle than most people realize is already over. The likely victors are insurance giants such as UnitedHealth Group (UNH), Aetna (AET), and WellPoint (WLP). The carriers have succeeded in redefining the terms of the reform debate to such a degree that no matter what specifics emerge in the voluminous bill Congress may send to President Obama this fall, the insurance industry will emerge more profitable.

UnitedHealth followed up on June 30 with another report for lawmakers pinpointing $332 billion in savings through better use of technology and administrative simplification. If enacted, those changes would potentially benefit UnitedHealth’s Ingenix data-crunching unit. Ingenix, with annual revenue of $1.6 billion, is poised to establish a national digital clearinghouse to ensure the accuracy of medical payments and provide a centralized service for checking the credentials of physicians.

During a media presentation in May in Washington, (UnitedHealth’s Simon) Stevens said medical costs incurred by UnitedHealth’s corporate clients were rising only 4% annually, less than the industry average of 6% to 8%. But that claim seemed to conflict with statements company executives made just a month earlier during a conference call with investors. On that quarterly earnings call, UnitedHealth CEO Hemsley conceded that medical costs on commercial plans would increase 8% this year.

http://www.businessweek.com/print/magazine/content/09_33/b4143034820260.htm

What a nice thing UnitedHealthcare is doing. Being dedicated to the health care consumer, they are helping their commercial plan enrollees manage their health-related finances and information through the Quicken Health Expense Tracker developed by Intuit jointly with their own Ingenix division. This is the industry’s solution for reducing the administrative complexity and waste of our fragmented, multi-payer system. Or is it?

Anything that UnitedHealthcare does is designed to benefit its investors. That’s what capitalism is all about. The for-profit insurers’ primary product is administrative services – the more the better. The Quicken Health Expense Tracker does absolutely nothing to reduce the administrative excesses in health care financing; in fact, it merely adds one more administrative product that the consumer ultimately pays for. It increases the cost of health care without providing any direct health benefit. That is not the reform we need.

But the next question should scare all of us. What does UnitedHealthcare intend to do with this very rich trove of information on the health and health-related finances of tens of millions of health care consumers? UnitedHealthcare’s Ingenix already has a track record of using a data bank of much more limited information to cheat health care consumers out of billions of dollars. Although they surely will not duplicate that same stunt, can you imagine UnitedHealthcare executives sitting back and simply staring at this treasure trove without diving in to find the gold to distribute amongst the shareholders, including themselves? Under the principles of capitalism it is their amoral obligation to start digging.

Perhaps we need a study by The Lewin Group to inform us on the costs and the benefits, or lack thereof, of this program. Er… uh… now that they are owned by Ingenix, maybe that’s not such a hot idea.

Read the cover story in the current BusinessWeek (link above). It’s long, and it’s depressing. UnitedHealth and rival carriers “have already won.”

Wait! How could they have won? It’s not over. At stake are both the health and the financial security of the people of our nation. This is war! Man your battle stations! This is the most honorable war we will ever fight because we are saving lives instead of destroying them.

A recent post on the National Center for Policy Analysis’s (NCPA) web site by Dr. Scott Atlas of the Hoover Institute and Stanford University expounded on 10 “surprising facts” about our health care system.  After an opening statement that U. S. health care has been denigrated compared to other developed countries around the world, Atlas proceeds to present ten under-recognized “facts” that we should consider before turning to a larger role of government in health care.(1)

This piece comes across as cherry picking of the literature to make the political point that we already have a good health care system, mostly because of the private sector and our advanced medical technology.  It fits in well with the NCPA’s announced goals “as a nonprofit, nonpartisan public policy research organization, established in 1983, with the goal to develop and promote private alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial private sector.” (2)

The NCPA is one of the well-funded right-wing think tanks that uses its sizable corporate funding base to influence public opinion through hard-news coverage, television, talk shows, Op-Ed’s and guest editorials in major newspapers, and Congressional connections.  In a 2005 article in the International Journal of Health Services, I rebutted 20 of the NCPA’s conservative claims as disinformation and myths. (3)

So now Atlas brings forward 10 more “facts” that will surprise us — except they are distorted and wrong.  They again fit in well with the NCPA’s agenda (4):

•  Alleged Fact 1: Americans have better survival rates than Europeans for
common cancers.

•  Alleged Fact 2: Americans have lower mortality rates than Canadians.

•  Alleged Fact 3: Americans have better access to treatment for chronic diseases
than patients in other developed countries.

•  Alleged Fact 4: Americans have better access to preventive cancer screening
than Canadians.

•  Alleged Fact 5: Lower income Americans are in better health than comparable
Canadians.

•  Alleged Fact 6: Americans spend less time waiting for care than patients in
Canada and the U.K.

•  Alleged Fact 7: People in countries with more government control of health
care are highly dissatisfied and believe reform is needed.
•  Alleged Fact 8: Americans are more satisfied with the care they receive than
Canadians.
•  Alleged Fact 9: Americans have much better access to important new
technologies like medical imaging than patients in Canada or the U.K.

•  Alleged Fact 10: Americans are responsible for the vast majority of all health
care innovations.

Atlas concludes that “Despite serious challenges, such as escalating costs and the uninsured, the U.S. health care system compares favorably to those in other developed countries.”

So let’s examine some of these claims, which are supported by 16 carefully selected references to the literature, to see whether they hold any water.  Rather than deal with all 10, this will look at four in enough detail to see the trends.  We will soon see this presumably authoritative document is just another opportunistic use of data disguised as scholarship.

Fact 1 claims that Americans have much higher survival rates for cancer of the breast, prostate and colon than their counterparts in Germany, the U.K and Norway.  “Fact 2″ claims that Americans have lower mortality from breast and colon cancer than Canadians.  However, as described in some detail in my most recent book The Cancer Generation: Baby Boomers Facing a Perfect Storm, these conclusions are based on five-year survival rates, a flawed method of evaluating outcomes.  Although the five-year survival rates for Americans are higher for all cancers in this country compared with both men and women in Europe, researchers tell us that these figures are deceptive and incorrect because of several kinds of bias.  For example, the study used by Atlas has no information on clinical stage of cancers.  For valid cross-national comparisons, patients have to be matched for stage, since advanced-stage cancers will obviously have worse outcomes than early-stage cancers.  There are other technical but crucial kinds of bias which have to be accounted for before drawing conclusions that we do better than other countries.  The NCPA’s “facts” did not consider other sources of bias, such as how much screening was done in each country, and are biased to a political conclusion that fits with its agenda.

Fact 3 claims, on the basis of one reference and a reported difference in use of statins for cholesterol reduction, that Americans have better access to care of chronic diseases than do our counterparts in other developed countries.  But that conclusion disregards solid evidence to the contrary as shown by a 2007 report by the Commonwealth Fund of a study of health system performance in seven countries — Australia, Canada, Germany, the Netherlands, New Zealand, the U.K. and the U.S.  That study asked a much broader question than the use of statins, asking respondents how often during the past year they did not see a doctor, did not get recommended care, or skipped doses/did not fill Rx because of cost?  The results completely discredit “Fact 3″– 42 percent of Americans answered “yes” to this question, three times the number of Canadians and almost five times the number people in the U.K. (5)

Fact 7 alleges that Americans are more satisfied with our health care system than citizens in countries with more government involvement in health care.  Atlas cites the above Commonwealth study to support a claim that “more than 70 percent of German, Canadian, Australian, New Zealand and British adults say their system needs ‘fundamental change’ or ‘complete rebuilding.’  That is true, but what Atlas doesn’t tell us is that more Americans (82 percent) respond that way, more than respondents in any of the other countries.  In fact, that study found that 34 percent of Americans believe that our system should be completely rebuilt, compared to only 12 and 15 percent in Canada and the U.K., respectively. (6)

As is well known, access, cost and quality of health care are interdependent and intertwined such that you can’t evaluate one without the others.  If many people cannot get past financial barriers to get access to needed care, they obviously have low quality of care.  So it is cavalier and distortional for the NCPA paper to disregard our system’s cost and access problems while claiming that our system compares favorably with other developed countries. Here are just a few objective cross-national comparisons among many that completely discredit any assertion of American superiority, or even equivalency in quality of health care compared with other developed countries:

•  A 2008 report by the Commonwealth Fund found that the U.S. dropped from
15th in 2006 to last among 19 countries in 2008 on a measure of mortality that
is amenable to medical care. (7)

•  A 2007 report ranked the U.S. 42nd in the world for life expectancy, lower than
most of Europe and Japan. (8)

•  A 2006 study found that Americans in late middle age are less healthy than
their counterparts in England for cancer and five other chronic diseases. (9)

•  A 2007 study found that Canada has at least the quality of care as in the U.S.,
often with better outcomes, despite spending little more than one-half what we
spend on health care. (10)

•  An earlier study showed conclusively that poor women with cancer in
Toronto have better outcomes than their counterparts in Detroit, even after
accounting for race and standards of measuring poverty (for example, the
Canadian women had survival rates more than 50 percent higher for lung,
stomach and pancreatic cancer compared to American women in Detroit’s poorest
districts). (11)

•  The U.S. has a weaker primary care system than other developed countries; it
has been found to rank 11th among 11 countries on eleven performance criteria
(12); our primary care base is in crisis with less than 10 percent of
medical graduates now opting for careers as primary care physicians (13);
moreover, patients living in parts of our country with larger number of specialists
(and greater use of technology) are more likely to have late-stage colorectal
cancer when first diagnosed. (14)

So much for the NCPA’s latest surprising “facts”, intended as they are to perpetuate the problems (and profits) of our unaccountable market-based system and protect private markets from health care reform.  This kind of article by the NCPA does not advance the debate over how to fix our system, and instead is just another poorly disguised assault on the truth.

1.Atlas, S. 10 surprising facts about American health care. National Center for Policy Analysis, No. 649, March 24, 2009.

1. National Center for Policy Analysis. www.ncpa.org/abo/.
2. Geyman, J.P. Myths and memes about single-payer health insurance in the United States: A rebuttal to conservative claims. International Journal of Health Services 35:1, 2005.
3. Ibid # 1.
4. Schoen, C, Osborn, R, Doty, M M et al. Toward higher-performance health systems: Adults’ health care experiences in seven countries, 2007. Health Affairs Web Exclusive 26, w 717-34, 2007.
5. Ibid # 5.
6. The Commonwealth Fund Commission on a High Performance Health System. Why not the best? Results from the National Scorecard on U.S. Health System Performance. Vol 97, July 17, 2008.
7. Associated Press. U.S. ranks just 42nd in life expectancy. Lack of insurance, obesity, social disparities to blame, experts say. August 11, 2007.
8. Banks, J, Marmot, M, Oldfield, Z et al. Disease and disadvantage in the United States and England. JAMA 295: 2037-45, 2006.
9. Guyatt, G H, Devereaux, P J, Lexchin, J et al. A systematic review of studies comparing health outcomes in Canada and the United States. Open Medicine 1 (1), 2007.
10. Gorey, K M et al. An international comparison of cancer survival: Toronto, Ontario and Detroit, Michigan metropolitan areas. Am J Public Health 87: 1156-63, 1997.
12. Starfield, B. Primary Care: Concept, Evaluation and Policy. Oxford University Press. New York, 1992.
13.American College of Physicians. The impending collapse of primary care
medicine and its implications for the state of the nation’s health care.
Washington, D.C. January 30, 2006.
14.Roetzheim, R G, Pal, N, Gonzalez, E C et al. The effects of physician supply
on the early detection of colorectal cancer. J Fam Pract 48 (11): 850-8, 1999.

Adapted from Do Not Resuscitate: Why The Health Insurance Industry Is Dying, and How We Must Replace It, and The Cancer Generation: Baby Boomers Facing a Perfect Storm, with permission from the publisher, Common Courage Press.

John Geyman, M.D. is the author of The Cancer Generation and Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It, 2008 by John Geyman. With permission of the publisher, Common Courage Press

Buy John Geyman’s Books at: http://www.commoncouragepress.com

Health Debate: Costs and Benefits

The New York Times
Letters
August 4, 2009

To the Editor:

Universal coverage and cost control are not conflicting aims.

Canada spends 10 percent of gross domestic product on health care, and everyone is covered. The United States spends 16 percent of G.D.P., but tens of millions lack coverage. The cost difference is almost entirely due to higher administrative costs and higher prices, which are directly related to the economics of a multi-payer system.

The lessons from Canada and other countries are clear. If you focus on cost control, you will fail. If you cover everyone because it’s decent and just, you will also achieve economic sustainability.

America, it’s time to do the right thing and then reap the rich rewards of moral public policy.

Michael M. Rachlis
Toronto, Aug. 2, 2009

The writer, a doctor, is a health policy consultant.

http://www.nytimes.com/2009/08/05/opinion/l05health.html?ref=opinion

And…

U.S. Health Spending Breaks From the Pack

By Catherine Rampel
Economixl
The New York Times
July 8, 2009

The following graph shows that the United States is the only nation that has failed to slow the growth in health care costs in spite of also being the only nation of those listed that has not provided universal coverage.

health spending per capita in US 2000 PPP dollars, OECD countries

If there is no image in this message, the graph can be accessed at this link:
http://economix.blogs.nytimes.com/2009/07/08/us-health-spending-breaks-from-the-pack/

And…

Senators Closer To Health Package

By Shailagh Murray and Lori Montgomery
The Washington Post
August 6, 2009

The emerging Finance Committee bill would shave about $100 billion off the projected trillion-dollar cost of the legislation over the next decade and eventually provide coverage to 94 percent of Americans, according to participants in the talks. It would expand Medicaid, crack down on insurers, abandon the government insurance option that President Obama is seeking and, for the first time, tax health-care benefits under the most generous plans. Backers say the bill would also offer the only concrete plan before Congress for reining in the skyrocketing cost of federal health programs over the long term.

Spurred by the CBO director’s startling assertion last month that measures drafted by other committees would not bend the “cost curve,” negotiators on the finance panel are also studying a plan to fine insurance companies that do not pay providers electronically, a plan to reduce payments to providers to force them to increase efficiency and a plan to study the comparative effectiveness of various medical treatments.

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/05/AR2009080503996.html?hpid=topnews

Once again. The stated goals of health care reform are 1) to cover everyone, and 2) to slow the growth in health care costs so that health care is affordable. So what is Congress doing?

The Senate Finance Committee now would leave 6 percent without coverage, and none of the other bills are truly universal either. Based on the policies contained in the bills, it is likely that the estimates of individuals that would be left out are very conservative, and many more will remain uninsured. So much for universal coverage.

What about bending the cost curve? Most of the legislative measures are aimed at controlling federal spending on health care. Very few of the policies would have any real impact on slowing the growth of our total national health expenditures. This means that more health care costs will be shifted from the government to individuals and employers. Bending the cost curve of the federal budget is of no value if the cost curve of our national health expenditures continues on its current trajectory.

Will private insurance reform slow cost increases? All Congress is asking of the insurance industry is that they guarantee the availability and renewability of insurance coverage. That can have no impact whatsoever on total health care costs, but it does increase health insurance premiums since those high-cost individuals who are currently shut out would then be allowed to purchase coverage in the private plan risk pools. Higher private insurance premiums is not exactly what most Americans want.

Michael Rachlis is right. Look at the curves. Every other nation has adopted health care financing systems – social insurance programs – which have allowed them to moderate the trajectory of health care spending, while providing universal coverage. The United States remains the outlier on both counts.

The members of Congress are diddling with policies that they wish would control costs, but at best will only sanitize the federal budget, while they insist in leaving in place our unique, American-style multi-payer system that can never provide affordable health care for all of us.

An improved Medicare-for-all program would bend our cost curve into the sustainable path shared by all other nations, and would take care of all of us. Let’s go for it!

Building a National Insurance Exchange: Lessons from California

California HealthCare Foundation
Issue Brief
July 2009

Among the deliberations now taking place in the nation’s capitol regarding federal approaches to expanding health coverage, virtually all incorporate the idea of an insurance exchange – an entity to which people can go to select a health plan from a broad range of offerings. Over the past 15 years, California gained extensive experience in designing and operating just such an exchange, an effort that ultimately proved unsustainable.

The California Exchange

The Expectation

1. Provide an easy to navigate single point of entry where people could go to choose among several health plans.

2. Reduce the cost of coverage, using three primary mechanisms:

* Reduce administrative costs by achieving economies of scale
* Command lower prices
* Foster market competition

3. Enhance portability of coverage

The Reality

The actual experience of the California exchange taught some hard lessons. It showed that none of theses objectives is easily achieved.

The Participation Problem

… as long as the exchange is not the exclusive source of coverage for some populations, health plans may be reluctant to participate…

Insurers do not particularly like the head-to-head competition that is a feature of the exchange concept… Insurers always prefer to insure whole groups directly rather than compete in the exchange.

The Elusiveness of Savings

* Few administrative efficiencies
* A lack of pricing power
* Exposure to adverse selection

People involved in the operations of the California exchange agreed that when there is competition for the same customers within and outside the exchange, the exchange is in “extreme peril” of becoming a victim of adverse selection… Eventually the exchange will fail.

Choosing the Right Model

But once individual choice is part of the exchange design, insurers will prefer to generate business outside of the exchange, as occurred in the California experience… The insurers will still have an incentive to direct higher-risk people to the exchange rather than insuring them directly, in hopes that they might pass off some of the “bad” risks to other insurers.

http://www.chcf.org/documents/insurance/BuildingANationalInsuranceExchange.pdf

For a description of the Health Insurance Exchange proposed in the House Tri-Committee bill, insert H.R.3200 in the Thomas search box and read Title II:
http://thomas.loc.gov/

Most progressive policy wonks observing the reform process taking place in Washington have been quite smug. As the battles take place over a public option, over taxing employer-sponsored plans, or over the eligibility thresholds for government subsidies, these wonks are complacent knowing that the really important reform taking place is the establishment of the Health Insurance Exchange. Or so they believe.

Within the Exchange the regulated private insurance industry will have to provide standard benefit packages, at affordable premiums made possible by competition, and without the intrusive perversities that currently permeate the industry and its products. What could be wrong with this?

President Obama and the Democrats in Congress are currently facing a barrage of criticism for supporting the government takeover of health care. To fend off this criticism, what are the very first words out of President Obama’s mouth? “You can keep the insurance you have!” So much for an insurance exchange market of comprehensive, affordable private health plans.

Why would a phenomenally successful private insurer ever want to compete with itself by offering a heavily regulated Health Insurance Exchange product that has unaffordable premiums because of adverse selection? Because of the requirement of risk adjustment within the Exchange, and because individuals and employers with high health care costs will seek relief in the Exchange, all products offered by the Exchange will be too expensive.

The Health Insurance Plan of California (later PacAdvantage) was designed not unlike the current federal proposals – an insurance exchange especially geared for small businesses. Because of adverse selection, it became a victim of the death spiral, and closed in 2006.

The only way a Health Insurance Exchange could work would be if we moved all existing private plans into the Exchange, and established a system that would effectively pool risk. Even then it would be very expensive, partly because of the profound administrative inefficiencies, and it would still fall short on universality and equity. And at that we would still have to address the problem of the very large sector of our population who would not qualify for subsidies but who still could not afford the high premiums and out-of-pocket expenses of private insurance.

The least expensive, most efficient, and most effective method of ensuring that everyone has affordable access to the health care that they need is a single payer, Medicare-for-all, national health program. There will be a lot of noise on health care reform during the August recess. Just make sure that our noise is the loudest!

Marilyn Clement’s Speech at Celebration Held in Her Honor

June 7, 2009

Closing comments of Marilyn Clement’s last speech:

Keep it up! We’re going to win single payer!

Video of speech (10 minutes):
http://www.healthcare-now.org/marilyn-clements-speech-at-celebration-held-in-her-honor/

Healthcare-NOW!
http://www.healthcare-now.org/

Marilyn never gave up, though she left us yesterday, August 3, 2009.

A Canadian doctor diagnoses U.S. healthcare

By Michael M. Rachlis
Los Angeles Times
August 3, 2009

Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians’ services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.

The U.S.’ and Canada’s different health insurance decisions make up the world’s largest health policy experiment. And the results?

On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.

On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.

Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.

Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.

Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.

The Canadian system does have its problems, and these also provide important lessons.

However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas.

On closer examination, most of these problems have little to do with public insurance or even overall resources.

Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.

U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada’s, or any other nation’s, experience than ever. Why?

American democracy runs on money.

Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our “socialized” system doesn’t let us choose our own doctors. In fact, Canadians have free choice of physicians. It’s Americans these days who are restricted to “in-plan” doctors.

Unfortunately, many Americans won’t get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.

(Michael M. Rachlis is a physician, health policy analyst and author in Toronto.)

http://www.latimes.com/news/opinion/la-oe-rachlis3-2009aug03,0,538126.story

August will be the month of sound bites on health care reform.

One of these sound bites is “unfair competition.” It is really a silly argument designed to suppress even the most feeble of reform efforts.

But the really unfair competition this month will be between those who can explain the relatively complex health policies that can benefit everyone (except those who are wasting our resources), and those who have at their command the very effective tool of simple sound bites. These sound bites relieve the listener of any responsibility to try to understand these complex issues.

Should the dialogue on reform move into discussions of effective health policies, the opponents will be ready with their sound bite diversions, including those based on the caricature of the Canadian experience suggesting that their government takeover of health care has caused Canadians to flee to the United States should they need health care – a lie supposedly “proven” by rare, bizarre anecdotes.

When the distortions and lies about Canada are brought up, interrupt (they do) with the response that Canada has a health care financing system that includes everyone and keeps health care affordable.

The United States needs the same. We need to include everyone in a system that is affordable. The problem for single payer advocates is that the program that the administration is trying to sell us will leave five percent of us out and make affordability even worse.

The real tragedy is that this war on health care financing reform will be settled by sound bites. On that war, the bad guys always win.

From Greg M. Silver, MD (Clearwater, FL)

Lots of activity in the Tampa Bay region. As the battle heats up, I have appeared on WEDU-TV, our local PBS affiliate, for a Special Roundtable presentation on Health Care Reform on 7/17, as well as the “Kathy Fountain Show” on WTVT 13 our local Fox affiliate on 7/29. Yesterday, I was interviewed on WTAN radio in Clearwater for a program focusing on reform efforts. I am also scheduled for another discussion at the University of South Florida in September. More to come as soon as I can take a breath!

(Video links below)

Last night as the House Energy and Commerce Committee completed its markup of HR 3200, the House health reform bill, Chairman Henry Waxman interrupted Representative Anthony Weiner of New York to say that House Speaker Nancy Pelosi had promised that single payer legislation, HR 676, The United States National Health Care Act would come before the entire House of Representatives. Chairman Waxman:

The Speaker has said that she will allow this to be brought up on the House floor, and debated, and voted on.

Representative Anthony Weiner (NY-9, Brooklyn/Queens) had placed an amendment before the Energy and Commerce Committee that would have replaced the text of HR 3200 with the text of HR 676, the United States National Health Care Act. He was joined by fellow Energy and Commerce committee members Peter Welch (VT, Vermont), Mike Doyle (PA-14, Pittsburgh), Tammy Baldwin, (WI-2, Madison), Jan Schakowsky (IL-9, Chicago), Bobby L. Rush (IL-1, Chicago), Eliot L. Engel (NY-17, Rockland/Westchester).

Chairman Waxman asked for the single payer amendment to be withdrawn from committee debate in exchange for a debate and vote on the House floor. Representative Weiner hailed this victory in a brief statement:

Single-payer is a better plan and now it is on center stage. Americans have a clear choice. Their Member of Congress will have a simpler, less expensive and smarter bill to choose. I am thrilled that the Speaker is giving us that choice.

On the Mouth of the Potomac blog, NY Daily News Washington Bureau journalist Michael McAuliff reported:

The Brooklyn-Queens Rep. looked a little surprised when Chairman Henry Waxman said Pelosi would allow that vote, and made Waxman repeat the deal to be sure it was clear and on the record. It’s an especially big deal for advocates of a single health care system — who see it as cheaper and simpler than the complicated measure being drawn up — because they have been complaining that they have not even been able to get an airing of their position.

And having the vote of the floor of the House will force members to declare a position, and bring much more attention to the idea.

Reporting for The Hill Mike Soraghan wrote:

Legislation creating a single-payer system would be expected to lose, but would allow liberal members to record their support for the proposal. It will also be a tough vote for some Democrats who will be wary of upsetting the liberal base.

Many liberal lawmakers feel that the controversial “public option” that would compete with private insurers is a compromise from single-payer.

Single payer advocates should not be surprised by this turn of events. Chairman Waxman himself was a co-sponsor of HR 676 in the 109th Congress. Speaker Pelosi has also supported single payer in the past. Only this spring, at an event sponsored by the Christian Science Monitor, the Speaker told the audience:

… over and over again, we hear single payer, single payer, single payer. Well, it’s not going to be a single payer. …

Just one day before the Energy and Commerce Committee meeting, on July 30th, over one thousand single payer supporters swarmed through the halls of Congress to celebrate Medicare’s 44th birthday. Congresspeople and staff told us over and over again that back home grassroots clamor for single payer continues to build. In other words, across the nation, representatives have had the same experiences as the Speaker of the House.

Anthony Weiner’s initiative has created a new opening for us to educate our colleagues, our patients, our elected representatives, indeed everyone, about the need for a single payer program of national health insurance. A strong single payer vote in the House will mark a turning point in history.

As we accumulate momentum, we find steady support and fresh creativity for our great cause. What a wonderful time to join Physicians for a National Health Program. We need your voice!

**************
Video links:

The full Weiner amendment discussion at the Energy and Commerce Committee can be viewed here. Look at the bottom on the screen. The session is 6 hours 5 minutes and 38 seconds long. The Weiner piece begins at 3 hours 15 minutes and 40 seconds and ends at 3:32:53.

Representative Weiner introduces the single payer amendment at the Energy and Commerce Committee.

Representative Tammy Baldwin (Madison, Wisconsin) speaks for single payer at Energy and Commerce Committee

Representative Eliot Engel (Westchester/Rockland, New York) speaks for single payer at Energy and Commerce Committee.

Chairman Waxman interrupts Representative Weiner to ask that the amendment be withdrawn because Speaker Pelosi has promised to allow single payer before the entire House of Representatives.

As the debate over health care reform becomes all-out warfare between parties and within the Democratic party, Congress will adjourn shortly for its August recess with many of the key questions unresolved.  However, the bill as shaped by two or three House committees (H. R. 3200, America’s Affordable Health Choices Act) gives a point of departure to consider the most that we might expect out of such a bill.

As described in our last three posts, this bill calls for both an individual and employer mandate as well as a small public option to be available to the uninsured and employees of small employers through a national insurance exchange.  Individuals would be subsidized by the government to offset their premium and out-of-pocket costs.  People with household incomes up to 400 percent of the federal poverty level (FPL) would be eligible for subsidies.  Tax credits would also be provided to small employers with fewer than 25 full-time workers, covering up to 50 percent of their premium costs.  These new subsidies, of course, are in addition to the many subsidies the government already provides to individuals and employers through long-standing tax-exemptions of  insurance costs.  H.R. 3200 also calls for expansion of Medicaid for all individuals with incomes up to 133 percent of the FPL (about $14,000 for an individual and $88,200 for a family of four).

The CBO projects the cost of H. R. 3200 to be about $1 trillion over 10 years, not including the increased costs of Medicaid, for which it lacks jurisdiction to score.  “Conservative” projections estimate that the bill will increase the U. S. budget deficit by $239 billion in 2019.  Governors have already weighed in against the increased costs of Medicaid expansion, pleading for an increased federal role in paying for it, and political opposition to the bill’s inflationary trends seems certain to spread beyond the Republicans and Blue Dog Democrats to others.  As the debate intensifies, we can expect that eligibility for subsidies will be tightened up.

Returning to the affordability of health insurance, the supposed reason for reform legislation, there is an obvious disconnect from the impacts of a deepening recession.  Much of the population, including the broad middle class, are in increasingly dire straits in their ability to pay for necessary health care.  Average annual health care costs for a family of four are now $16,771, including insurance premiums, deductibles and other out-of-pocket costs.  For a family of four with an income of $88,200 (four times the FPL and much more than the median U. S. median income), these average costs exceed 19 percent of family income, well above the 10 percent considered by the Commonwealth Fund as a hardship level.

We have to remember that the costs of health insurance often have little to do with the total costs of health care for individuals and families.  For those with significant health problems, their costs will be much higher.  And although the current proposals in Congress call for annual limits on out-of-pocket spending ($5,000 for individuals and $10,000 for families), insurance premiums and out-of-network charges are not counted against these limits.

This bad situation is getting worse. The unemployment rate is poised to soon rise above 10 percent, and the broader unemployment rate is already more than 20 percent in a number of states.  Tax revenues have fallen precipitously in many states, and 16 states are now paying for unemployment insurance in borrowed funds.  Draconian cuts are being made in safety net programs all across the country.

So it seems certain that federal payments for subsidies will far exceed any projections that are now being discussed. There are at least 100 million Americans less than 65 years of age with incomes below 400 percent of FPL.  If eligibility for federal subsidies is set at that level, the CBO projects that their cost will be about $773 billion between 2013 and 2019. Concerning Medicaid expansion, the CBO has also estimated that extending Medicaid to an additional group of Americans with incomes for a family of four up to $33,000 a year would cost about $500 billion over 10 years.

We can be sure that the Senate will restrict subsidies below these levels and that any final health care reform bill, if ever enacted, will further exacerbate the problems Americans face in paying for health care.  And to boot, federal law would mandate them to purchase health insurance, under penalty of fine, and an underinsurance product at that.  A working draft of the “actuarial value” of insurance coverage in the Senate Finance Committee last month stated that a policy of “bronze” or “silver” value would cover 65 and 73 percent of total health care costs, respectively — undercoverage by any standard.  A family of four with an income at 300 percent of FPL would pay 15 percent of their income on health care. So we would end up with a mandate for inadequate coverage which much of the population, as well as taxpayers, cannot afford.

The strong conservative challenge that is building against H. R. 3200 is largely due to its deficit-busting certainty as well as its increase in entitlement to health care without credible cost containment requirements.  As a progressive advocate of real health care reform, I can only agree with these concerns.  What is likely to emerge from Congress on health care reform this year, if anything, will not be real reform and will only add to our problems.

Although still very much under-recognized and fought against by the medical industrial complex and complicit corporate media, there is only one solution to cost containment of our runaway market-based health care system.   H. R. 676, coupled with a private delivery system, is a paygo alternative that assures universal coverage of necessary health care for all Americans.  It would save up to $400 billion a year and provide a structure within which to put in place other cost-saving efficiencies.

The private health insurance industry is an impediment to reform, not part of the solution.  It has survived to this time only through generous subsidies from the government, whether in the employer-based or individual markets or privatized Medicare and Medicaid programs.  Until we recognize this, all of our incremental approaches to build on our multi-payer system will be of no avail.

Adapted from Do Not Resuscitate: Why The Health Insurance Industry Is Dying, and How We Must Replace It, and The Cancer Generation: Baby Boomers Facing a Perfect Storm, with permission from the publisher, Common Courage Press.  Order link
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John Geyman, M.D. is the author of The Cancer Generation and Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It, 2008 by John Geyman. With permission of the publisher, Common Courage Press

Buy John Geyman’s Books at: http://www.commoncouragepress.com

From Jeoffry Gordon, M.D., M.P.H. (San Diego, CA)

We had a good Medicare birthday rally on July 30th.

Next week is busy for me.
Sunday: Single payer presentation at Mission Hills United Church of Christ.
Tuesday: Medical Grand Rounds on Single Payer Reform at Sharp Coronado Hospital
Wednesday: I will represent PNHP and single payer on local PBS affiliate KPBS’s “These Days” show (you can get a podcast) which is presenting a four day series on problems with the health care and reform proposals.

From Wendy Ring, M.D., M.P.H. (Bayside, CA)

A group of us have been performing The Sound of Moolah, a show about health reform and why we need single payer, around southern Oregon and Northern CA recruiting new single payer activists wherever we go. There have been several newspaper articles and radio interviews.

From David A. Cimino, M.D. (St. Petersburg, FL)

I have had two letters to the editor published in the St. Petersburg Times in the past 4 months. The most recent was on July 22 and was a push for a Single Payer System. Tomorrow July 31 I have been asked to appear on a local news program on Channel 13 WTVT Fox News at 12:30 PM to discuss health care reform. I again will push for a Single Payer System as the only way to achieve affordable, quality health care for all. I am a semi-retired general pediatrician and for the past 20 years limited my practice to adolescents.

From Cynthia Haq, M.D. (Madison, WI)

Dr. Cindy Haq on Wisconsin Public Radio:
http://www.wpr.org/hereonearth/archive_090722k.cfm

Health Care Reform Rally 7/25/09 in Madison in Memory of Lindy Farley, MD

http://www.youtube.com/watch?v=TOc-2wwQYKk

Dr Jeff Patterson at the Farmer’s Market in Madison 6/28/09

http://www.youtube.com/watch?v=QaMU4-IYESc

Dr Gene Farley at the Farmer’s Market in Madison 6/28/09

http://www.youtube.com/watch?v=KeUjrW-UMZs

Farmer’s Market Madison 6/28/09
http://www.channel3000.com/health/19884995/detail.html