As we recall, a high-profile event at the White House in May 2009 brought together most of the major corporate stakeholders in the U. S. health care system in an effort to build momentum toward reform. The Obama Administration welcomed the cooperative spirit and combined pledges of some stakeholders to shave 1.5 percent off the growth in health care spending over ten years, amounting to “savings” of about $2 trillion. The meeting was proclaimed “an historic event” boding well for the goals of reform — gaining near-universal coverage to affordable health care while reining in costs and improving quality of care.

Having considered the voluntary, unenforceable pledges, together with the agendas and subsequent actions by five of the major stakeholders, it is now useful to re-assess the impacts on reform by the corporate “alliance” struck at that time. Table 1 summarizes the pledges and agendas, as well as the tactics and likely rewards, for the Big Five stakeholders.

As is evident from Table 1, all five stakeholders, with the possible exception of some
Large employers, will do well with health care reform along the lines of bills now before Congress. The House bill (H.R. 3200), with a cost of some $1 trillion over 10 years and without effective cost containment mechanisms, would add greatly to the revenues of all corporate stakeholders in the medical industrial complex. Their revenues, of course, are our costs, especially since the insurance industry will likely be protected by lenient standards (such as by a requirement being considered by the Senate Finance Committee that insurance should have to cover only 65 percent of health care costs).

The Big Five that we have looked at are only part of the cost problem. There are many other major players in the health care industry, mostly investor-owned, with a primary mission to make money, not save the money of either patients, their families or taxpayers. These players range from medical device and medical equipment industries to nursing homes to information technology. As just one example, General Electric, the 12th largest corporation in the world, has a big market share for imaging equipment and information technology. It has initiated a big national advertising campaign supporting health care reform, while its lobbyists fight against cuts in Medicare reimbursement for imaging procedures.

Congress goes on break, health lobbying heats up. Wall Street Journal, August 5, 2009: A1) The 3,300 lobbyists now in Washington, D.C. lobbying for one or another health
care interest, for or against specific provisions in the proposals before Congress, are
consuming $1.4 million dollars a day in this effort.

Most health care industries welcome government subsidies to grow the insured
population, but not at the price of burdensome regulation. There is little common ground among the stakeholders in the medical industrial complex except the goal to expand markets and grow future profits for each industry The “alliance” is in name only, hardly partners in most instances. When their respective interests conflict with other corporate stakeholders, the circular firing squad starts shooting. Examples include the insurance trade group AHIP’s battle against physicians’ high out-of-network fees, while medical organizations sue insurers for non-payment of fees and call for elimination of overpayments to private Medicare plans.

As the battles rage on between and among corporate stakeholders, their lobbyists, and reformers in and out of government, the public interest is being overlooked as stakeholders work toward carving out a bigger piece of an expanded pie for themselves. The neutering of the public option is but one of many examples whereby the public is losing out. (Link to Blog 21) Instead of cost-containment in a reform bill, we can expect to see continued inflation of health care costs at rates much higher than cost-of-living or median wages. Judging from the bills taking shape in Congress, the outcome will be a bonanza for health care industries and a bail-out for an unaffordable and dying insurance industry.

Bob Herbert, well-known Op-Ed columnist for the New York Times, is right on target with this observation:

“The drug companies, the insurance industry and the rest of the corporate high-
rollers have their tentacles all over this so-called reform effort, squeezing it for
all it’s worth. Meanwhile, the public — struggling with the worst economic
downturn since the 1930s — is looking on with great anxiety and confusion. If
the drug companies and the insurance industry are smiling, it can only mean that
the public interest is being left behind.”

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. With permission of the publisher, Common Courage Press

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How much will reform cost me?

Posted by on Friday, Sep 4, 2009

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

KHN Exclusive: Congressional Documents Show Health Cost

Kaiser Health News
September 4, 2009

These documents, prepared by the House Committee on Ways and Means and obtained by KHN, show the maximum premiums and out-of-pocket costs low- and moderate-income people might face under the House health overhaul plan, called America’s Affordable Health Choices Act (HR 3200).

One example selected from the tables:

Family of four with an income of 400% of the federal poverty level ($88,200):

Maximum monthly premium: $809 ($9708 per year)

Out-of-pocket cap (in addition to premium): $10,000

Under the House bill for reform (HR 3200), a family of four with an income of $88,200 that had health care needs could be responsible for $19,708 of their health care costs, which is 22% of their income (23% under the Energy and Commerce amendments). That would leave them with an income of $68,492 for all of their other needs and wants (and some of that could be burnt up in out-of-network costs and non-covered services that do not apply to the cap).

When people want to know what reform is going to cost them, it is usually the numbers in these tables that they want to see. Because of concerns about federal budget deficits, it is likely that the financial responsibility for individuals and families will be even greater than these tentative tables depict.

What is not included here is the amount that we are paying through the tax system for government-financed health care, which is roughly one-half of all health care expenditures (including health plans purchased for government employees, but excluding tax subsidies of employer-sponsored plans which have an uncertain future).

Health care is very expensive, and Congress is selecting the most expensive model that has ever been devised to pay for it.

We’re retired and on Medicare, so the numbers above have little meaning for us. But they mean a lot to our children and will mean even more to our grandchildren. Selecting reform using numbers that don’t work this year and will be even worse in future years is not a legacy that we want to leave to our children and grandchildren nor anyone else’s either.

Let’s improve the least expensive model – Medicare – and then share it with all of our future generations. That’s an American solution of which we would all be proud, and, to the point, one which we could afford.

More lessons from Massachusetts

Posted by on Thursday, Sep 3, 2009

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Consumers’ Experience in Massachusetts: Lessons for National Health Reform

By Carol Pryor and Andrew Cohen
Kaiser Family Foundation
The Access Project
September 2009

In developing its health reform initiative, designers of the Massachusetts system tried to ensure that programs were available to help almost everyone get either insurance coverage or assistance in paying for health care. MassHealth continues to serve traditional populations, such as low-income families with children. Commonwealth Care plans are designed for low-income adults without access to other sources of coverage. People with employer-sponsored coverage are expected to keep that coverage. For higher income people without access to employer-sponsored coverage, non-subsidized Commonwealth Choice plans were created to provide what was considered affordable non-group coverage. And for people who still “fell through the cracks,” the Health Safety Net subsidizes certain costs for uninsured people or people with inadequate insurance.

One issue for consumers is that the protections provided to Commonwealth Care and MassHealth enrollees regarding limits on premium and out-of-pocket health care costs were not extended to all lower and moderate income people. As a result, workers in employer-sponsored coverage, especially those with lower incomes, may end up with insurance premiums and out-of-pocket costs that are unmanageable given their incomes. For moderate income workers without access to employer-sponsored coverage, especially those just over the limits for Commonwealth Care eligibility, the options available to them may be an improvement on what was available prior to health reform but still unaffordable. Although the HSN (Health Safety Net) provides some back up coverage, it does not cover everything and the support it provides may not be adequate for everyone.

These problems in part reflect affordability decisions that set coverage limits based on the state resources available. They may also reflect misconceptions about the costs that people at various income levels are able to absorb. People generally think of financial problems resulting from health care costs as the result of catastrophic bills people incur because of major illness. However, a recent study found that most people who reported problems paying medical bills had relatively modest levels of out-of-pocket spending.

The second issue is that the reformed system is complicated for consumers to navigate, which may lead to gaps in coverage as people move among different types of insurance, both public and private.

The Massachusetts experience shows that to make affordable health care accessible to consumers, it is not sufficient to ensure that programs are available to cover everyone. The quality of the coverage provided and the interrelationships between the programs are also important.

Although there are many reports on the deficiencies of the Massachusetts reforms, this report stresses two serious design flaws that impair affordability and access for low and middle income patients: 1) both public and private plans often fail to provide adequate financial protection even for those with only modest health care needs, and 2) the complex maze of programs and plans are very difficult to navigate with ever changing eligibility for the various programs, leading to frequent unavoidable lapses in coverage or no coverage at all.

Many have recommended that we use the Massachusetts model as the basis for national health reform. Basically, that is what Congress is doing. If you read this full report to see what the authors believe are the lessons for national reform, you will see that they recommend yet another half dozen or so patches to be applied to this system with a failing financing infrastructure – failing because it began as a patched together system in the first place.

Perhaps the most telling of their recommendations: “Even in a reformed health system, a health care safety net will be needed.” They assume that we will always have significant numbers of uninsured and underinsured individuals. Providing everyone adequate health care is not possible, that is unless we adopt an improved Medicare program for everyone. But that isn’t feasible.

That last line reminds me of a comment Andy Rooney once made after noting that so many people were told by a doctor that they had only six months to live and yet they lived on for years or decades longer. He said that we should conduct a national manhunt to find that doctor and arrest him.

Likewise, we need to find the person who is telling everyone that the one health care reform program that would actually work isn’t feasible, and then arrest him. At least the people who went to the doctor Andy Rooney mentioned survived his bad advice. This guy who is blocking reform because of some “feasibility” nonsense is killing people wholesale. We have to stop him.

Paying for community health centers

Posted by on Wednesday, Sep 2, 2009

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Using Primary Care to Bend the Curve: Estimating the Impact of a Health Center Expansion on Health Care Costs

By Leighton Ku, PhD, MPH, Patrick Richard, PhD, Avi Dor, PhD, Ellen Tan, MSc, Peter Shin, PhD, MPH, Sara Rosenbaum, JD
The George Washington University
School of Public Health and Health Services
Geiger Gibson / RCHN Community Health Foundation Research Collaborative
September 1, 2009

This research brief, the third in a series examining the link between national health reform proposals and community health centers, estimates the cost savings that would be realized by making important investments in non-profit health centers as an element of national health reform.

These projected savings to the nation’s health care costs become possible because of the insurance reforms on which they build, supplemented by a direct health center investment. Health insurance coverage expansions, coupled with investments in the nation’s primary health care infrastructure, can spur high quality and sustainable primary health care in medically underserved rural, urban, and suburban communities, and help bend the curve of health care cost growth.

Under the health reform proposals, a large number of people will gain insurance coverage from the health insurance exchanges, which will primarily offer private plans (although the House bill also offers a public plan option). As reported earlier, private insurance plans tend to pay health centers considerably less than the actual costs of providing care at health centers; data from the 2007 Uniform Data System indicate that private insurance underpays by about 43 percent. One option under health reform would be to require plans offering care under the exchange to pay health centers according to the prospective payment system (PPS) used in both Medicaid and Medicare, which comes much closer to paying full costs. In 2007, Medicaid payments were about 15 percent below health centers’ estimated costs.

As has been demonstrated by a number of studies, in addition to this one, health centers are a cost-effective means to furnish primary health care, which can lead to better health and lower health care expenditures. Investments in health centers can serve as a complement to health reform efforts to expand the number of people with health insurance, by ensuring that there is an increased availability of primary health care providers to serve the newly insured, as well as those who remain uninsured. This will be particularly important in medically underserved areas where there is already an insufficient supply of primary care providers. Thus, this is a case in which the national economic value of the investment is further enhanced by its ability to bring better health to the nation’s most underserved communities.

Regardless of what proposals for health care reform are adopted, it is essential that financing be included for non-profit community health centers in underserved rural, urban and suburban communities. Would these centers be better served by health insurance exchanges and their private plans, or by a public financing program?

Although the insurance industry whines that public plans would provide unfair competition because they pay less than private plans, what is the record with community health centers? Unfortunately, Medicaid does underpay – by about 14 percent below the health centers’ estimated costs. But the private plans, which the members of Congress are so diligently protecting, are underpaying by about 43 percent!

There are two financing considerations for community health centers: 1) capital investments to build and expand the facilities, and 2) operating expenses, including payment for health care services.

Capital investments can be authorized through various legislative efforts, including as a component of the current health care reform legislation. But such efforts tend to be sporadic and not always well aligned with need. In contrast, the single payer model separately budgets capital improvements, providing more coordinated capital allocations based on community need. It ensures a perpetual resource that is responsive to fluctuating needs.

For operating expenses, the thousands of private health plans each do whatever they can to avoid paying health care costs. Community health centers serving vulnerable populations do not have the clout to demand that their expenses be met by the private insurers. Medicaid, a chronically underfunded welfare program, comes much closer, but still falls short. In contrast, a single payer system is designed to pay for the legitimate costs of appropriate health care. The community health centers would be served much better by an improved Medicare-like plan that covers everyone.

Community health centers have strong bipartisan support. Now if only we could could get our legislators to agree on adopting an efficient and equitable system of financing the centers…


Posted by on Tuesday, Sep 1, 2009

I walked several blocks from the hospital at lunch time the other day. A basement storefront sign at a hair dresser’s read “walk-ins welcome.” Impulsively I went in.

The young woman made pleasant small talk. I am a clod when it comes to small talk.

I said that yes, the weather seemed suddenly hot instead of cold and rainy. But what was really on my mind was how real health care reform would come to the United States.

“Health care. Oh my god. What is wrong with this country?” she started.

The young woman’s many points precipitated in an expository flurry:

“I thought that maybe with Obama it would be the great change and at last it would happen. But it doesn’t look that way, does it?” she said.

“Do you know that we here pay $600 a month for insurance?” she confided. “600 a month! And it doesn’t have dental. It doesn’t cover the eye doctor. Mental health – maybe 2, 3 visits maximum, no more. And the co-pays! Then the doctor says you need a test – but they deny it! How can an insurance company make the diagnosis or prescribe the treatment?”

She said she was shocked that some friends’ opposed any kind of health reform.

“My friends said, ‘Oh I like my insurance. I don’t want to lose that.’” She rolled her eyes. “So I asked them, ‘what about your insurance do you like? Paying the premium? Is it the co-pays? Or maybe that you have to pay cash to see a dentist? Do you like asking permission to see a specialist or get a test?’”

“‘Ok,’ my friends said, “we hate our insurance company. But we don’t want to pay for someone else to have health care.”

“Oh my god!” her story continued, “We are talking about health care. God forbid something really bad should happen! Everyone should have health care! I mean, in this country they have the idea that health care is a privilege. That some people don’t deserve it? C’mon! No one really believes that. No one. You can go to Europe. France or Italy or England or any country in Europe. If you get sick they will take care of you. They will help you. If I get sick, god forbid, that’s what I will do: Go back home.”

She explained that she paid $600 per month but that was not her real insurance policy. Her real insurance policy was that she could return to Europe if she became seriously ill.

“They will take care of me there, without question. It will not be about the money. What is wrong with this country?”

When the G-20 meet in Pittsburgh this month there will be only one nation represented in which millions of people suffer bankruptcy due to medical debt, only one nation in which health care is deemed a privilege instead of a right, only one nation where more than one sixth of the population lacks access care: the United States of America. The U.S. also sits dead last, 20th out of the G-20, on major health indicators while spending money than all the rest, per person per year, on medical care.

What is wrong with this country?

Single-payer national health insurance is the very least we can do to improve health care in the United States. It will liberate hundreds of billions of dollars now wasted in the private insurance industry, for the good of our health. Everybody in, nobody out.

Having considered four of the major corporate stakeholders in our medical industrial complex — the insurance, drug, and hospital industries as well as business — it is now time to turn our attention to organized medicine. Since physicians order almost all services that are provided within our health care system, they are obviously a key player and interest group in the debate over health care reform.

Organized medicine has a poor track record in terms of reform. Although a universal system of health insurance was considered favorably for a short time by a committee of the American Medical Association (AMA) during Teddy Roosevelt’s abortive attempt to establish such a program during the 1912 to 1917 period, the AMA has played a consistently reactionary role against such reform since then.

During the 1930s the AMA was a much stronger political force than it is today, to the extent that FDR did not include national health insurance as part of his New Deal policies. Three decades later, the AMA fiercely opposed Medicare as socialized medicine and a government takeover. It jumped on the bandwagon only after the American Hospital Association and Blue Cross got together in its support. Its initial opposition, however, soon turned to making best use of the program. Physicians’ fees jumped almost eight percent in the first year after the program was enacted, more than twice the rise in the consumer price index.

Since World War II, organized medicine was fragmented into many smaller specialty and sub-specialty groups. As specialization advanced in following years, the AMA lost much of its political influence. Its membership dropped by 20 percent between 1993 and 2004. Of the approximately 900,000 U. S. physicians today, the AMA’s membership is less than one-quarter, and the “house of medicine” is split into some 180 specialty and sub-specialty organizations and societies.

In the late spring of 2009, President Obama was busy getting the major stakeholders aboard his train for health care reform. We have seen how the insurance, drug and hospital industries made specific pledges in an effort to help pay for reform. While organized medicine made no such specific pledge, it was offered a deal by the White House if it would give its general support to the reform effort.

Once again, it was all about money. Whereas physicians had been facing cutbacks each year in Medicare reimbursement, usually reversed by Congress, the Obama Administration offered $245 billion to physicians as the “doc fix”. At first, the Administration did not want to count this amount as costs of reform, but the CBO soon scored it as the additional costs that they are, coming up with a $239 billion increase in the federal deficit over the next ten years.

So what are the attitudes among these many physician organizations toward the various reform proposals working their way through Congress? True to form, the AMA and most groups are supportive of anything that will increase their  reimbursement while opposing much else in the proposals. Reassured that the “doc fix” would provide more generous Medicare reimbursement (about 20 percent higher than it would have been under the original formula), at least for a time, the AMA and American College of Surgeons (ACS) expressed their support for the center piece of the reform bills — efforts to expand affordable health insurance through employer and individual mandates, subsidies for lower-income people to purchase insurance, and expansion of Medicaid. But for the AMA and most medical organizations, that is where their support melts away. Instead, they vigorously oppose these provisions:

• The public option. In a letter to the Senate Finance Committee, the AMA had this to say: “Creating a public health insurance option for non-disabled individuals under age 65 is not the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”

• An empowered independent Medicare rate-setting commission. The AMA and ACS quickly expressed their opposition when White House budget director Peter Orzag proposed a new federal commission with the authority to set payment policy for physicians, hospitals, and other providers.

• Targeted Medicare reimbursement cuts. In July 2009, the Administration  proposed a plan to cut Medicare payments to cardiologists and oncologists by  more than 10 percent each while increasing reimbursement to family physicians by 8 percent and nurses by 7 percent. This prompted leaders of the American College of Cardiology to warn that “The cuts could have the unintended consequences of rationing care, especially in rural regions with a large number of Medicare patients. In other areas, specialists may decide to pull out of Medicare, or ask patients to make up the difference with higher out-of-pocket payments.”

Organized medicine has become so fragmented that no one group speaks for the profession. In fact, some groups have endorsed major health care reform, even to the point of single-payer national health insurance (NHI). As the second largest medical organization in the country with some 125,000 members, the American College of Physicians (ACP) has endorsed single-payer as one of two major options to reform our system. The American Public Health Association (APHA) has come out in favor of NHI. And of course, Physicians for a National Health Program (PNHP), a growing organization with 16,000 members, has pushed strongly for NHI since it was established in 1989. Meanwhile, many physicians across most specialties have come to see NHI as the only way to provide universal access to affordable health care. A large national survey involving more than 2,200 U. S. physicians in 2008 found that 59 percent support government legislation to establish national health insurance.

In our next post, we will reassess how the “alliance” of these five major stakeholders stack up for or against reform proposals being fought over in Congress.

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. With permission of the publisher, Common Courage Press

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The politics and attitudes of business toward health care reform can be summed up in two words — fragmented and disunity. Unlike the insurance and drug industries, American business is by no means monolithic. There are big differences between the interests of big business, with its many multi-national corporations, and small business, which employs the majority of Americans. And there are also big differences within the large and small business sectors that put many members at odds with each other over health care reform.

Again, the driving factor driving business attitudes toward health care reform is money, and whether any bill in Congress will cost them more or less than they are now paying. Business of any size needs a healthy work force, but the costs of providing employer-sponsored insurance (ESI) have become an unsustainable burden for those employers providing coverage as well as unaffordable for many, if not most small businesses.

While important details are still in flux in Congress, we can expect that the House bill, as represented by H. R. 3200 will introduce an employer mandate requiring employers to offer health coverage to their employees and contribute at least 72.5 percent of the premium cost for single coverage (65 percent for family coverage) or pay 8 percent of payroll into the Health Insurance Exchange Trust Fund. This is the so-called “pay or play” approach. Small business employers with annual payrolls less than $400,000 would see reductions in their payments to the Exchange and would be exempted entirely if their payrolls are less than $250,000. Amendments by the House Energy and Commerce Committee (E & C) would provide hardship exemptions for employers adversely affected by job losses because of this requirement, fully exempted employers with annual payrolls of less than $500,000 and would reduce the payment schedule for those with payrolls from $500,000 to $750,000. Meanwhile, over in the Senate, under pressure from many business interests, the Finance Committee is considering dropping the employer mandate altogether or just requiring employers to pay for those workers receiving government-subsidized coverage.

Big business, as expected, is wary of the costs of the employer mandate and threatened by new requirements likely to be imposed by the government on their coverage plans. Large employers have long been protected by a little-known 1974 law, the Employee Retirement Income and Security Act (ERISA), which exempts all self-funded employee benefit programs from government regulations. Fearing weakening of ERISA protections, a coalition of large corporations, ranging from American Airlines to Xerox, are objecting to new federal “one-size-fits-all” standards after a five-year grace period.

But Wal-Mart, as the world’s largest private sector employer in the county as well as the world (1.4 million employees in the U. S. and 2 million overall), recently threw a bombshell into the large business community by coming out strongly in favor of an employer mandate. This is a surprise turnabout for Sam Walton’s non-union company, with its long history of avoidance of minimum wage laws and its track record of offering high-deductible health insurance that less than one-half of its low-income labor force can afford to buy.

Reacting to Wal-Mart’s endorsement of the employer mandate, the National Retail Federation (the primary lobbyist for the retail industry) strongly urged its members, which includes 1.6 million businesses and employs about one in five working Americans, to oppose Wal-Mart’s action. Within the retail industry, only 45 percent of retailers provide ESI. Wal-Mart’s break from the retail pack was seen by industry observers as a shrewd tactic to gain political advantage over its competitors.

Other big lobby groups that represent the interests of small business, including the National Federation of Independent Business (NFIB) and the U. S. Chamber of Commerce have long been allied with Republicans and lobbied hard against both an employer mandate and a public option. The Chamber of Commerce, for example, sent more than 50,000 letters to Capitol Hill expressing serious concerns with the pending legislation in Congress. Other new, less conservative groups, such as the Main Street Alliance, took the other side in support of the employer mandate. (Small business owners deliver mixed messages to Capitol Hill. Kaiser Daily Health Policy Report, July 9, 2009)Since the current cost to employers of providing ESI is about $5,000 for individuals and $13,000 for family coverage, most small employers cannot afford to provide coverage. They may have a lot to gain from a government-subsidized individual mandate. The non-partisan Congressional Budget Office has recognized that some employers would likely reduce wages to compensate for the costs of providing new health benefits, but has concluded that most non-exempt small businesses would see little adverse impact on employment or profits. But many employers still worry that they may have to pay more for coverage than they do now, and that health care reform may be a job-killer.

Although lobbying efforts of the business community concerning health care reform are energetic and well funded, they are conflicting and incoherent. While many business groups were generally in favor of reform, as more details emerge in bills taking shape in Congress, many fall into internecine warfare. As an example, although an early coalition had been formed in favor of reform, including the National Federation of Independent Business, the Business Roundtable, the Service Employees International Union (SEIU) and the AARP, only the AARP and SEIU supported H. R. 3200 when it was introduced in the House.

How whatever reform bill that is enacted into law, if any, will affect business is anyone’s guess. The financial impact on business will depend on arcane provisions buried in the small print of a 1000-plus page bill, which will be best understood by accountants and financial analysts. These kinds of provisions will make all the difference to employers — how small business is defined (eg., by less than 25 or 50 employees?); whether or not an employer mandate will be enacted?; what new requirements are added to ERISA?; and what will the penalties be for employers not participating in an employer mandate?.

Most important, none of the proposals now being considered by committees in Congress will rein in health care costs, so employers, employees and their families can look forward to continued escalation of health care prices and costs well above the cost of living and median wages. Business groups are starting to look sideways at industries that will clearly profit from health care “reform”, such as the insurance and drug industries, their Alliance “partners”, fully realizing that their revenues will be passed along to them as increased costs and decreased opportunities.

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. With permission of the publisher, Common Courage Press

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Over 2.2 million Californians have medical debt

Posted by on Tuesday, Sep 1, 2009

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Insured and in debt: Even with coverage Californians struggle to pay medical bills

UCLA Center for Health Policy Research
August 31, 2009

More than 2.2 million California adults report having medical debt.

1.4 million have medical debt despite having insurance.

Individuals with medical debt are twice as likely as those without debt to delay or forgo needed health care.

“That even insured people are forced to take on medical debt to pay for their health care is another glaring inadequacy in our current system of health insurance,” said E. Richard Brown, director of the UCLA Center for Health Policy Research and lead author of the report, “The State of Health Insurance in California.”

Full report (102 pages):

Most individuals who are following health care reform are already aware of the fact that medical debt often contributes to personal bankruptcy, even for those who had been insured. This report adds to that data by demonstrating that medical debt is much more common than is reflected in the bankruptcy data, and is serious enough to have adverse consequences since it often results in individuals delaying or forgoing needed health care.

Two-thirds of Californians with medical debt were insured. The current proposal before Congress calls for a mandate to purchase private plans with very high premiums, with inadequate subsidies, and with an inadequate actuarial value which results in excessive out-of-pocket expenses. This flawed proposal would be a guarantee that medical debt and its adverse consequences shall remain a problem for far too many of us.

Members of Congress may feel that they have too much time and effort already invested in the current proposal to change course now. But that personal investment for a few hundred legislators is absolutely nothing compared to the impact that the legislation will have on the health care of over 307,000,000 of us. They need to start over – now – and do it right.


Posted by on Monday, Aug 31, 2009

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Rules rein in Medicare Advantage marketing

By Tom Murphy
Associated Press

Regulators clamped down last fall on shady sales practices for privately run Medicare health insurance for the elderly.

But customers and advocate groups say the plans’ confusing nature still leaves room for pitches bordering on the deceptive, and abuses still crop up.

Medicare Advantage plans are privately run versions of the government’s Medicare program, which provides health coverage for the elderly and disabled. The government subsidizes these plans, and the industry has developed what can be a mind-numbing array of them.

Seniors report being pressured with unsolicited phone calls or home visits that are clearly prohibited. Some have signed up for plans that didn’t include their longtime doctors or hit them with unexpected costs, things they learn weeks later.

CMS learns every year about areas that need more vigilance, said Timothy Hill, deputy director for the Center for Drug and Health Plan Choice.


Some question private Medicare plans’ advantage

By Matt Sedensky
Associated Press

Seniors have flocked by the millions to Medicare Advantage, privately run plans offered as an alternative to traditional, government-run Medicare.

In the debate on overhauling the U.S. health care system, Advantage has been criticized as an example of a broken system that costs too much, confuses enrollees and suffers from a lack of oversight.

But even many backers acknowledge one of its toughest problems is few seniors understand the essential difference in private plans: Even services covered by traditional Medicare that doctors deem medically necessary routinely need the insurers’ advance approval and are sometimes denied.

Participants have been denied visits to specialists, rehabilitation to help them walk again and countless other services they’d be entitled to under traditional Medicare.

“Every decision is based on not what’s right for the patient, but what’s right for the bottom line,” said Dr. Michael Sedrish, who coordinates HMO payments for Medisys Health Network, which runs three New York City hospitals.

With basic Medicare, seniors generally know what sort of coverage they’re getting. That’s not the case with the roughly 7,000 Medicare Advantage plans, where one person’s coverage could be completely different from a next door neighbor’s.

A 2008 Government Accountability Office report found wide differences in enrollee costs depending on the plan, including home health service costs that could be up to 84 percent more than traditional Medicare.

“The plans tell them they have the same coverage,” said Delores Bowman, who handles calls to the Medicare Rights Center, “and they don’t.”

What’s beautiful about the Medicare Advantage program is that it has provided us with a real-life laboratory experiment which allows us to compare the functioning of highly-regulated private insurance plans as contrasted with the functioning of a public insurance program: traditional Medicare. The results are in, though that would be tough to ascertain if you simply observe the response of Congress.

What have we learned? The private plans take away the choice of health care providers that the traditional public program offers. The private plans insert intrusive interventions between the patient and the physician – interventions that are not found in the public plans. Private plans divert more resources to excessive, wasteful administrative services while increasing the administrative burden on the health care providers and on the public stewards who must provide oversight of our tax dollars that are diverted to this industry. Private plans also provide more entry points for the criminal element to cheat the taxpayers, patients, and providers. And for this we are paying far more of our tax dollars than we do in the traditional Medicare program for comparable levels of care. The obvious lesson is that we should dump the private plans.

What has Congress learned? They have decided that we should provide more subsidies to the private plans so that they can expand their markets!? And they have apparently decided that we will not even have a genuine public plan because it would provide unfair competition to the private plans because of Medicare’s greater efficiency and lower costs!?

It is true that a fragmented, multi-payer system is much more expensive and much less equitable, leaving too many exposed to suffering and financial hardship. But our Medicare Advantage experiment has demonstrated that it is the private plans that must be jettisoned, and it is Medicare that must be granted to everyone after modest, appropriate reengineering so that it works even better than it does now.

We need to send this urgent message to Congress and the administration, immediately:


Former Jasper County Republican Chairman on Single Payer

Posted by on Friday, Aug 28, 2009

This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.

Beware health-industrial complex

By Jack Bernard
August 23, 2009

I am a Republican, former chairman of the Republican Party in Jasper County, Ga., and chair of that county commission. Under our two-party system, it is easy to see why we Republicans oppose Democratic Party reform proposals. We are the opposition party and do not want them to get the political credit for solving a nasty problem.

Since the Democrats are in the driver’s seat, it is up to them to lead and bring their stragglers in line. However, the Democrats are fighting internally, failing to articulate a straightforward vision of the future or even one bill (Obamacare, if you will).

Republican pundits are sitting back and chuckling, as they always do when reform is mentioned, and repeating the same self-serving platitudes.

What amazes me is that no one is calling these individuals to account. In my view, it is unpatriotic to continue to lie to the American public about the situation facing us. Over the last 10 years, wages have gone up by about one-fourth. Health insurance premiums have gone up well over 100 percent. We cannot continue along this path to fiscal destruction. Inaction is not an option.

It is also against American values to mislead the public into believing that everyone can get good care even if they do not have insurance. The mark of a great nation is not how well it treats its privileged, but rather how well it treats its downtrodden. On this measure, we fail miserably; strange for a nation that prides itself on being the most religious democracy in the world.

Very few health or insurance professionals advocate for a single-payer system, the best way to control costs and ensure access. I hear all sorts of reasons: rationing (really, like HMOs do not do that now), paperwork (apparently insurance company bureaucracy does not count), socialism (come on — practitioners will still be independent and we all know it) and so forth. It is rare that we hear the underlying cause openly stated: greed. It will cut my income.

The members of Physicians for a National Health Plan are an exception to this rule. If you take a look at their Web site,, the rationale for a single-payer system is clearly articulated.

Universal Medicare will both control costs and achieve universal access to high quality care. Congressmen would get the same insurance as you and I. You better believe your coverage would be just as good as or better than what you are getting now.

The problem is not technical; it is political. It is high time we put the country ahead of ourselves and establish a single-payer system.

(Jack Bernard is CEO of Monticello (Ga.) Health Care Solutions and a former chairman of the Jasper County Commission and the Jasper County Republican Party.)

If you set politics aside and look at proposed policies for reform, the logic of a single-payer, improved Medicare for all should unite those with views as diverse as a Democrat fighting for health care justice and a Republican demanding common sense business principles that would provide all of us with much greater value in health care.

The Republicans would do well to listen to former Jasper County Republican Party chairman Jack Bernard. But it’s also the Democrats who must lay down their swords and health insurer lobby money, and listen to this gentleman. The price of maintaining a partisan barrier is too high.

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