News

Reason
November 2004
Mandatory Health Insurance Now!
By Ronald Bailey, Reason’s science correspondent

Unfortunately, there is no prominent political or intellectual figure on the national scene offering a comprehensive free-market alternative to socialized medicine.

Why not just tell Americans they are responsible for buying their own health insurance from now on? If people couldn’t pay for medical care, either through insurance or out of pocket, they wouldn’t get it. “After people begin to notice the growing pile of bodies by emergency room entrances,” Tom Miller (Cato Institute) wryly suggests, “they will quickly get the message and go get medical coverage.”

Since it’s unlikely that Americans will allow their improvident neighbors to expire without medical care in the streets, is there a politically palatable alternative that can preserve and expand private medicine in the United States? Yes: mandatory private health insurance.

Maintaining our private medical system is vital because American health care and medical science are the most advanced and innovative in the world. If a national single-payer health care system is adopted, most medical progress will be stopped in its tracks.

http://www.reason.com/0411/fe.rb.mandatory.shtml

Comment: For those not familiar with Reason, it is a monthly magazine of “free minds and free markets,” representing libertarian views.

This particular article is of interest because it describes the problems with our health care system from the libertarian perspective. But more importantly, rather than coming to the conclusion that health care must be left solely to the free marketplace, the author concludes that the government must mandate health insurance for everyone.

PNHP and single payer are mentioned several times in the article. The promise of affordable, comprehensive care for everyone through a public program is a frightening thought for libertarians, thus they challenge our proposal with absurd and untrue charges such as the inevitable suppression of innovation. Yet most libertarians are also very human and are repulsed by the concept of a “growing pile of bodies” that lacked affordable access to health care. And they recognize that single payer has been identified as a program that would actually work. To stave off a single payer system, they have had to provide an alternative. It is ironic that they abandon their fundamental cause of freedom by supporting a model that requires patients to include private insurance bureaucrats in their health care relationships.

The point is that all of us (moderates, conservatives, liberals, libertarians, and authoritarians) are now convinced that we must pool resources in some manner to be certain that those with needs will have affordable access to health care. All proposals involve the government to some degree. So let’s finally sit down and agree on which specific polices would be most effective in providing affordable, comprehensive coverage for all. For those who need help, we have a document that clarifies the issues:

http://www.physiciansproposal.org/proposal/Physicians%20ProposalJAMA.pdf 1. Libertarian support of mandatory health insurance (Don McCanne)

Posted by pnhp at 11:50 AM | Permalink

1. CMS projections for health spending - 2005 (Don McCanne)
2. The California Health Insurance Reliability Act (CHIRA)
(Don McCanne)
3. What is CHIRA? (Don McCanne)

Health Affairs
February 23, 2005
U.S. Health Spending Projections For 2004-2014
By Stephen Heffler, Sheila Smith, Sean Keehan, Christine Borger, M. Kent Clemens, and Christopher Truffer

Projected National Health Expenditures (NHE) for 2005:

$1,936.5 billion - Total NHE

$6,423.1 - NHE per capita

15.6% - NHE as percent of GDP

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.74

Comment: These numbers are from the Office of the Actuary, Centers for Medicare and Medicaid Services (CMS). These are very useful numbers for your advocacy work since they represent what we are spending this year on health
care, qualified as “CMS projections for 2005.”

———————————————————————————————————————————
Message: 2
Date: Thu, 24 Feb 2005
Subject: The California Health Insurance Reliability Act (CHIRA)

California State Senate
SB 840, The California Health Insurance Reliability Act (CHIRA)Introduced by Sen. Sheila Kuehl, February 22, 2005

For the bill, at this link in the block “House:” enter “Senate” and then for “Bill number:” enter “840”

http://info.sen.ca.gov/cgi-bin/pagequery?type=sen_bilinfo&site=sen&title=Bill+Information

Comment: Many will be curious about the funding. The bill describes the intent of utilizing funds that are currently directed to other government programs such as Medicare, Medicaid, and SCHIP. But under “Article 2. Revenues” it merely states “(Reserved).”

California has a requirement that any new tax requires a two-thirds vote in the Senate and in the Assembly. This statement from Sen. Kuehl’s press release suggests her strategy: “Means-based premiums, assessed according to income and payroll, would replace all premiums, deductibles, co-pays and out of pocket expenses.”

————————————————————————————————————————————-
Message: 3
Date: Thu, 24 Feb 2005
Subject: What is CHIRA?

CHIRA, The California Health Insurance Reliability Act, SB 840, is Sen.Sheila Kuehl’s single payer bill for the state of California.

Posted by pnhp at 12:01 PM | Permalink

Rutland Herald
February 22, 2005
Editorial
Clarity on health care

As Vermont legislators confront the burdens and the irrationality of Vermont’s health care system, they face numerous obstacles. One of the most fundamental obstacles is conceptual. A new book written by three Vermonters and to be released within days from now goes a long way to clarifying the conceptual confusion and pointing the way to meaningful reform.

The authors are Cornelius Hogan, a longtime public servant who has served in the Cabinets of Republican and Democratic governors; Dr. Deborah Richter, a
physician and expert on health care reform; and Terry Doran, a journalist who has helped put together a book of unusual clarity and insight. It comes at a crucial moment in Vermont history and ought to be read by every member of the Vermont Legislature.

One of the authors’ central insights can be encapsulated in a number. They point out that about 70 percent of health care costs represent costs of infrastructure. By infrastructure, they mean the hospitals, clinics and personnel that are always available to us whether we are using them at a given moment or not. It is important to address the costs of pharmaceuticals and other supplies, but they only account for about 16 percent of health care costs. Reforming the health care system means taking a look at how we finance the health infrastructure.

The authors refer to this infrastructure as a “shared service.” It is a service we expect to be on call for us whenever we are in need. It so happens that about 10 percent of Vermonters account for about 70 percent of health care spending. And yet it would be impossible for that 10 percent to shoulder the entire cost of the hospitals, physicians and other fixed expenses that were there waiting for them when they got sick.

We spend most of our lives among the 90 percent who are not piling up huge
medical expenses. But we know that if we want those services ready for us
when we need them, we must share the expense even when we are not using
them. That is why we have health insurance.

The problem is our health financing system is disorganized, erratic and unreliable. In the past four years, about 20,000 Vermonters have lost insurance. The Medicaid program for low-income Vermonters is stacking up an enormous deficit. The costs to businesses and individuals continue to escalate at double-digit rates. One of the reasons is that our helter-skelter system of health financing requires an enormous administrative expense for chasing or denying payments. About $1 billion out of $3 billion in health expenditures in Vermont goes to administration.

Past attempts at cost controls have not worked, mainly because they have focused on the individual rather than the system. Managed care was an attempt to curb usage by focusing on individual claims. Thus, HMOs and insurance companies set up bureaucratic systems for screening out what were deemed to be unneeded services. The public rebelled at the interference, and the system failed to control costs.

The focus on individual demand is appropriate in its place. Gov. James Douglas has proposed programs for managing chronic disease better and for promoting good health. These are useful for the individual and, to an extent, for the system.

But we are always going to have a predictable level of health care needs- births, broken legs, heart attacks, diabetes, end-of-life illnesses - and we will continue to need to maintain the infrastructure necessary for coping with these demands. The authors note that it is the capacity of our system that costs us, not its use. It is good to encourage heart health, but medical specialists know that in a population the size of Vermont’s there will always be a certain level of heart disease. Our medical facilities and personnel will have to be there to deal with it, and the underlying assumption of our system is that we will share the cost.

It is an underlying but not fully acknowledged assumption. We share the cost at present by means of insurance provided, if we are lucky, by our employers. Many Vermonters are not so lucky. They are underinsured or not insured at all. A high percentage of all personal bankruptcies occur because of health care crises - a sign that the system is not working.

If we acknowledge the assumption that our system depends on shared costs, like our highways or our schools, then we could put in place a more dependable way of financing it and controlling its costs.

That will be the topic of another editorial.

http://rutlandherald.com/apps/pbcs.dll/article?AID=/20050222/NEWS/502220310/1018/OPINION

Comment: The concept is straightforward. If we want health care to be there when we need it then we must all participate in funding the health care infrastructure so that it is always available. Expecting it to be funded primarily by individuals at the time of expensive, on-demand use is totally unrealistic. Thus insurance.

But what is the trend in insurance today? Under the banner of consumer empowerment, there is a drive to make insurance much less expensive for the
80-90% who are relatively healthy. This is accomplished not only by reducing
benefits and increasing cost sharing, but, more ominously, by gradually transforming the insurance market into one that places the majority who are
healthy into low cost pools (i.e., low cost, high deductible insurance) while leaving the few with high costs in very expensive (unaffordable) pools or with no coverage at all. Only the government would have the capability of funding these high risk pools.

But then where does the government get its money? From taxes paid primarily
by the majority who are healthy. In fact, 60% of our health care system is already funded through the tax system. So why are we wasting health care dollars on insurer middlemen who are creating innovative, rinky-dink pseudo-insurance policies for the healthy?

Since we’re paying for it anyway, why don’t we adopt an equitable method of
funding our “shared service.” None of us use all of our highways, but we want them there when we need them. Can any less be said about our health care system?

Posted by pnhp at 01:53 PM | Permalink

A haven south of the border
Douglas Bower - For the Atlanta Journal-Constitution

Guanajuato, Mexico —- I had become too sick to live in America.

Even with private insurance, even with Medicare, we couldn’t keep up with my medical bills. So we found a country where we could, and we left.

Picture this: A childless, middle-aged couple, both gainfully employed, both college-educated, living a frugal but happy life near Kansas City. The husband is diagnosed with a chronic, incurable illness. He has to quit work because the illness is very serious.

But, not to worry: After four long years and a legal battle, he gets on Social Security disability and therefore qualifies for Medicare. There is also the added security of the wife’s health insurance to cover the expensive prescriptions and everything else Medicare doesn’t. Everything will be fine because they are insured, and they will continue to live a happy yet frugal life. Or will they?

By the fall of 2002, my wife and I could no longer afford my illness. I was afflicted with fibromyalgia syndrome, a pain and fatigue disorder that eventually leaves most of those afflicted unable to work. The decrease in my income, plus the 10 prescriptions I took (not counting the drugs my wife had to take), were breaking us financially. We were insured, but the co-pays, deductibles and non-covered expenses were eating away at our financial security, bite after bite.

We found a sort of bitter consolation in the fact that millions of Americans share our plight. It turns out that more than 50 percent of bankruptcies filed in 2001 were medically related and were by middle-class homeowners who not only had an income but also health insurance. The prevailing myth that most bankruptcies are related to credit card debt is not true. Less than 1 percent of filed bankruptcies result from credit card debt.

All-too-common plight

Researchers found that 1.9 million to 2.2 million U.S. residents filed a “medical bankruptcy.” The average person filing for bankruptcy during 2001 spent $13,460 on co-payments, deductibles and uncovered services even though they had private insurance.

“Our study is frightening. Unless you’re Bill Gates you’re just one serious illness away from bankruptcy. Most of the medically bankrupt were average Americans who happened to get sick. Health insurance offered little protection,” said Dr. David Himmelstein, an associate professor of medicine at Harvard Medical School who led the study.

Another one of the study’s authors, Elizabeth Warren, said, “It doesn’t take a medical catastrophe to create a financial catastrophe. A larger share of American workers are going to have insurance that’s like a paper umbrella. It looks good, and it might even protect you in a sprinkle, but it melts away in a downpour.”

In the fall of 2002, the sprinkle on our paper umbrella turned into an unstoppable downpour. We had to do something before it tore the paper umbrella to shreds and our lives along with it. Little did we suspect that our search for more affordable prescriptions would not only find us financial relief but also end up changing our lives.

An attractive option

We heard rumors that prescription drugs were cheaper in Canada and Mexico. Our research showed this was indeed true. But this, to be honest, was a scary proposition. I also read that the U.S. government was trying to shut down many of the Web sites through which you could order these drugs.

That’s all I needed —- to get arrested for smuggling drugs through the U.S. Mail. Many Americans who live in border towns simply cross the border to get a prescription filled at substantially lower prices with no hassles. Moving to a border town was not what we wanted to do. But what did catch my eye was that, in Mexico, not only were my prescription drugs cheaper. Just about everything else was, too.

Digging deeper, we discovered that a large population of American expatriates, about 1 million, already live in Mexico, taking advantage of a significantly lower cost of living. This was a stunning revelation to us. Moving to Mexico hadn’t been a remote possibility; now it appeared to be salvation.

We began our new lives in a beautiful colonial city, the capital of Guanajuato state, also called Guanajuato, in August 2003.

We stepped into a new reality where everything—- prescription drugs, housing, utilities, food, transportation, entertainment —- is 25 percent to 75 percent cheaper than it is in America. My Social Security disability income more than adequately covers our expenses here in Guanajuato. An example is that I can buy all my needed prescriptions for less than the co-pay I forked over for one drug in the United States. I get a month of Prozac for less than $16. Same drugs, only affordable.

Is moving to Mexico an alternative for everyone? I doubt it. But it is working for us on so many levels that we have no plans anytime soon to return to the land of our birth.

The solution? I don’t know. What I do know is that we, and many other Americans, cannot sit idly by waiting for our elected officials to work it out. We had to take action, drastic as it was. That paper umbrella won’t last long.

Posted by pnhp at 03:31 PM | Permalink

BCBS HealthIssues.com
Association Health Plans
A Step Backward for Small Employers and Consumers
February 2005

Congress is considering legislation to exempt association-sponsored health insurance plans (called Association Health Plans or AHPs) from existing state consumer protections. While promoted as a way to address health insurance affordability problems facing small businesses and their employees, the research overwhelmingly indicates that this proposal will make health insurance less accessible, less affordable and less secure for the vast majority of small employers and individual consumers.

A large number of organizations oppose AHP legislation due to concerns about the impact that it would have on access to dependable and affordable health
insurance, including: the American Academy of Pediatrics, the American Cancer Society, the American Diabetes Association, Association of Health Insurance Advisors, the Blue Cross and Blue Shield Association, the Coalition Against Insurance Fraud, the National Association of Insurance and Financial Advisors, the National Partnership for Women and Families, and the National Small Business Association.

This compendium is intended to inform policymakers about this legislation by summarizing the research examining the impact AHPs would have on healthcare
coverage. Taken together, these studies provide a comprehensive economic,
policy and legal analysis of this proposal.

The overwhelming conclusion reached by these studies is that AHPs would:

• Increase premiums for the vast majority of small employers and their workers;

• Fail to address the problem of uninsured small businesses and workers;

• Lead to widespread plan insolvencies and fraud among these AHPs;

• Make it difficult or impossible for small businesses with older, sicker workers to have access to affordable health coverage; and

• Take away state-based consumer protections that millions of Americans rely on today, including the right to appeal when a health plan denies reimbursement for medical care.

http://bcbshealthissues.com/relatives/100240.pdf

Comment: This report is a compendium of conclusions from fifteen different
sources, all indicating significant adverse consequences of policies supporting Association Health Plans (AHPs). It is quite obvious that this is a political document. But it is crucial to understand whose politics this represents. A cursory glance through the list of opponents to AHPs is revealing:

http://www.protectyourhealthcare.org/allies.html

Though some interests may be on the list partially for self-serving reasons, the great majority are concerned about patient-consumers. AHPs would reduce
affordable access to health care.

If AHPs represent flawed health policy, why is there support for them? The following statement from the National Federation of Independent Business (NFIB) sheds light on this issue:

“AHPs would allow small-business owners to band together across state lines through their membership in a bona fide trade association, like NFIB, to purchase health coverage for their families and employees. For example, many small-business owners are members of several associations such as NFIB, the U.S. Chamber, the National Restaurant Association or other trade groups. If AHPs became law, a small-business owner could purchase health benefits through any one of these entities that would act much as the human resources department of a large company.”

http://www.nfib.com/page/AHPs.html

Should health care reform be about adding the NFIB and the U.S. Chamber of
Commerce into the equation as additional middlemen, or should it be about
ensuring affordable access to care for everyone?

Posted by pnhp at 12:56 PM | Permalink

As Vermont legislators confront the burdens and the irrationality of Vermont’s health care system, they face numerous obstacles. One of the most fundamental obstacles is conceptual. A new book written by three Vermonters and to be released within days from now goes a long way to clarifying the conceptual confusion and pointing the way to meaningful reform.

The authors are Cornelius Hogan, a longtime public servant who has served in the Cabinets of Republican and Democratic governors; Dr.Deborah Richter, a physician and expert on health care reform; and Terry Doran, a journalist who has helped put together a book of unusual clarity and insight. It comes at a crucial moment in Vermont history and ought to be read by every member of the Vermont Legislature.

One of the authors’ central insights can be encapsulated in a number. They point out that about 70 percent of health care costs represent costs of infrastructure. By infrastructure, they mean the hospitals, clinics and personnel that are always available to us whether we are using them at a given moment or not. It is important to address the costs of pharmaceuticals and other supplies, but they only account for about 16 percent of health care costs. Reforming the health care system means taking a look at how we finance the health infrastructure.

The authors refer to this infrastructure as a “shared service.” It is a service we expect to be on call for us whenever we are in need. It so happens that about 10 percent of Vermonters account for about 70 percent of health care spending. And yet it would be impossible for that 10 percent to shoulder the entire cost of the hospitals, physicians and other fixed expenses that were there waiting for them when they got sick.

We spend most of our lives among the 90 percent who are not piling up huge medical expenses. But we know that if we want those services ready for us when we need them, we must share the expense even when we are not using them. That is why we have health insurance.

The problem is our health financing system is disorganized, erratic and unreliable. In the past four years, about 20,000 Vermonters have lost insurance. The Medicaid program for low-income Vermonters is stacking up an enormous deficit. The costs to businesses and individuals continue to escalate at double-digit rates. One of the reasons is that our helter-skelter system of health financing requires an enormous administrative expense for chasing or denying payments. About $1 billion out of $3 billion in health expenditures in Vermont goes to administration.

Past attempts at cost controls have not worked, mainly because they have focused on the individual rather than the system. Managed care was an attempt to curb usage by focusing on individual claims. Thus, HMOs and insurance companies set up bureaucratic systems for screening out what were deemed to be unneeded services. The public rebelled at the interference, and the system failed to control costs.

The focus on individual demand is appropriate in its place. Gov. James Douglas has proposed programs for managing chronic disease better and for promoting good health. These are useful for the individual and, to an extent, for the system.

But we are always going to have a predictable level of health care needs— births, broken legs, heart attacks, diabetes, end-of-life illnesses — and we will continue to need to maintain the infrastructure necessary for coping with these demands. The authors note that it is the capacity of our system that costs us, not its use. It is good to encourage heart health, but medical specialists know that in a population the size of Vermont’s there will always be a certain level of heart disease. Our medical facilities and personnel will have to be there to deal with it, and the underlying assumption of our system is that we will share the cost.

It is an underlying but not fully acknowledged assumption. We share the cost at present by means of insurance provided, if we are lucky, by our employers. Many Vermonters are not so lucky. They are underinsured or not insured at all. A high percentage of all personal bankruptcies occur because of health care crises — a sign that the system is not working.

If we acknowledge the assumption that our system depends on shared costs, like our highways or our schools, then we could put in place a more dependable way of financing it and controlling its costs.

This editorial is written by the editorial board at the Rutland Herald. He is a Pulitzer prize winning journalist and a very big deal in Vermont.
http://rutlandherald.com/apps/pbcs.dll/article?AID=/20050222/NEWS/502220310/1018/OPINION

Posted by pnhp at 10:37 AM | Permalink

Published in Times Argus, Vermont
By Stuart E. Williams, M.D. Family Physician Berlin

It is time for Vermont to establish a universal coverage, single-payer health-care system. We already have a network of excellent non-profit hospitals and well-trained health professionals in Vermont. Our quality of health care ranks with the best states in the nation. Yet high administrative costs, underfunding of Medicaid, and especially, the increasing numbers of uninsured and under-insured Vermonters are threatening our ability to maintain this quality of care.

We can overcome these threats by making a bold move in Vermont. A unified system for health-care reimbursement would reduce administrative costs by 30 percent, eliminate cost-shifting, increase our purchase power for medications and, most importantly, provide equitable health-care coverage for all Vermonters. This can be done in a way that distributes the financial burden fairly and maintains patients’ choices of providers. We are fortunate to have imaginative and compassionate leaders in state government who are capable of forming a state-wide unified health payment system, but they need our encouragement and support. Many communities will offer voters a chance to support a universal health referendum on Town Meeting day. Legislators also pay attention to calls and letters from their constituents. Let us broaden this discussion and encourage debate on specific plans to achieve reform. All Vermonters deserve access to quality health care.

Posted by pnhp at 10:22 AM | Permalink

Hsieh outlines his strategy
Taipei Times, Monday, Feb 21, 2005,Page 3

Premier Frank Hsieh defines the goals of his Cabinet as promoting negotiation and stability. `Taipei Times’ staff reporters Ko Shu-ling and Jimmy Chuang recently spoke with the former DPP chairman and Kaohsiung City mayor to find out more about his views on how he plans to approach `negotiation,’ especially on divisive issues such as health insurance, tax reform and cross-strait relations

(excerpt)

TT: Some have criticized as “unfair” your plan to increase the ceiling on indexed health insurance premiums and let the rich pay more. What do you think of this criticism?

Hsieh: A recent opinion poll shows that over 73 percent of voters support the measure. As the national health insurance program is, to some extent, a social insurance mechanism, I believe, as do other highly paid Cabinet officials, that it makes sense to have better-off Taiwanese pay more. The bottom line is that the program is only beneficial as long as society is stable, which is a more important consideration than how much the rich pay in their premiums.

If criticism of the new measure is justified, I’d like someone to explain how. I am not an expert on this, but I listen to the experts’ opinions and do the calculations myself. It’s not a good thing to listen to one person’s opinion and assume that something is wrong.

The change should be made based on three convictions. First, the national health insurance program must continue to work because it is extremely convenient, especially for the underprivileged. Second, because national health insurance is a social program, government intervention is necessary and we are obliged to shoulder certain financial burdens. Finally, we have to come up with strategies not only to save money, but to generate more. I firmly believe our national health insurance policy is among the world’s best.

In a bid to generate more money, we believe it is good to let the better-off pay a little more. While the current ceiling on indexed health insurance premiums is NT$87,600, it will be increased to NT$131,700. In other words, those who make NT$10 million a month will pay the same health premium as those who make NT$131,700.

I also believe the costs of promoting better health, education and disease prevention should be paid by the government rather than the health insurance program.

In addition, we have decided to raise the “health tax” on cigarettes. Our plan is to increase it from NT$5 to NT$10 per pack. It is estimated that such an increase will bring in an extra NT$1.5 billion to NT$2 billion each year. About NT$2 billion from air pollution fees will also be injected into the program.

In addition, we are considering requiring those responsible for public disasters, food poisoning, and major traffic accidents to pay the medical expenses of the victims. However, I don’t think it is right to channel lottery revenues into the program.

I hope to finalize the measure on how to better execute the hospital transfer system and its supplementary plan by July 1 or Jan. 1.

With the implementation of all the measures, I hope we will be able to keep the health insurance program afloat for two or three more years before the second-generation health insurance policy is in place. I believe most people will approve of the measure

Posted by pnhp at 10:59 AM | Permalink

San Francisco Chronicle
February 20, 2005
Medicare not easy to salve
By David Lazarus

“We cannot solve the problems that face Medicare without dealing with the broader problems that face health care in America,” said Robert Reischauer, president of the nonpartisan Urban Institute — a Washington think tank— and former director of the Congressional Budget Office.

…Reischauer at the Urban Institute said single-payer may ultimately hold the answers not just for Medicare but also covering the 45 million Americans now lacking health insurance.

“If push came to shove, I would want a single-payer system instead of the system we have now,” he said. “But the political obstacles to that are considerable.”

http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2005/02/20/BUG27BDFVP1.DTL&type=business

Comment: If more individuals of the caliber of Robert Reischauer join with him in speaking up, the political obstacles will melt away.

Posted by pnhp at 10:12 AM | Permalink

By David Lazarus

There’s no simple or straightforward solution to Medicare’s funding woes. At least with Social Security’s looming troubles, the remedies can be narrowed down to three fundamental (albeit unpleasant) options: raise taxes, reduce benefits or borrow a big pile of money.  It’s not so easy with Medicare.

“We cannot solve the problems that face Medicare without dealing with the broader problems that face health care in America,” said Robert Reischauer, president of the nonpartisan Urban Institute — a Washington think tank — and former director of the Congressional Budget Office.

Medicare and Social Security are plagued by the same demographic challenge— the pending retirement of millions of Baby Boomers. Both programs face huge funding shortfalls as fewer workers pay into each system and more retirees take money out.

In the case of Medicare, however, the fiscal difficulties come sooner and are considerably larger. Also, Medicare’s situation is greatly exacerbated by runaway prices for medical treatment and medication.”You can’t solve this by looking at Medicare alone,” Reischauer said. “There are systemic issues that have to be addressed as well. That’s the real problem.”
  
Medicare is the $350 billion-a-year federal health insurance program primarily for people over 65 or those with disabilities. It has about 42 million beneficiaries. (Medicare’s sister program, Medicaid, provides health coverage for about 44 million low-income recipients.)

As I reported Friday, Medicare costs are expected to surpass those of Social Security by 2024. By 2078, Medicare’s annual expenditures will be twice as large as Social Security’s.

The portion of Medicare that pays for hospital stays — the largest component of the program — is expected to be in the red five years from now. It will then have to start spending reserve funds.

By 2019, those reserves are expected to be gone and the program will no longer be able to pay full benefits. Medicare’s deficit over the next 75 years is projected to run as high as $27.7 trillion, compared with a $3.7 trillion shortfall for Social Security over the same period.

Leslie Norwalk, deputy administrator of the Centers for Medicare & Medicaid Services, the government agency overseeing Medicare, said a funding gap of nearly $28 trillion appears daunting, but “within a 75-year window, a lot can happen.”

“There’s a long time between now and then,” she said. “When you think about how much the health care system has changed, it’s very hard to sit in my chair and imagine how things will be 75 years from now.”

Much could happen, Norwalk believes, that could bring down the cost of health care for future generations. But Robert Moffit, director of the Center for Health Policy Studies at the conservative Heritage Foundation, said it’s far more likely that researchers will come up with new drugs and new treatments that will further extend people’s life spans.

“These kinds of breakthroughs will be terribly expensive,” he said. “This will only add to Medicare’s costs.” Reischauer at the Urban Institute said he would tackle Medicare’s issues by effectively reinventing the nation’s health care system.

“I would start at ground zero,” he said. “I would spend a significant amount of money on an independent body charged with evaluating all the procedures and devices in health care and writing practical guidelines.”
  
By following such national guidelines, Reischauer argued, health plans and health care providers throughout the country would be able to eliminate redundancies and introduce new efficiencies.

“We need to begin building a new system brick by brick, and the system needs to be evidence-based,” he said. That’s all well and good, responded Heritage’s Moffit, but it’s not politically realistic to think that the United States can simply throw its existing health care system out the window and start again from scratch.
  
“We can’t do it all at once,” he said of fixing Medicare’s problems. “It’s too big to do all at once.” Moffit’s solution involves changing the Medicare program at first only for the Baby Boomers — those turning 65 after 2010. He would replace the average $6,500 now spent annually on Medicare beneficiaries with a yearly subsidy, perhaps in the form of a tax credit.

Recipients in turn would use the money to choose their own health care plan based on individual needs. If someone wants to spend all his cash on Viagra — which is covered under President Bush’s costly new Medicare drug benefit — that would be his decision.

“This would address some of the long-term cost issues,” Moffit said. “It would not be an open-ended entitlement. “We’re going to be spending a lot more on the Baby Boomers than we did on the World War II generation,” he pointed out. “There’s just a lot more of them. “

Medicare’s Norwalk called Moffit’s suggestion “a very interesting proposal.” But, she added, “I don’t see it as politically viable.” Ida Hellander, executive director of Physicians for a National Health Program, a Chicago advocacy group, said Medicare’s woes demonstrate the need for universal medical coverage in the United States.

The clear solution, she said, is a so-called single-payer system similar to national health plans in Canada and elsewhere. “You can’t control costs,” she said, “until you have a uniform system.”

Under a single-payer system, any citizen could be treated by any doctor at any hospital. Payroll taxes would replace all existing premiums,deductibles and co-pays.
  
Medicare could serve as the bedrock for creation of a single-payer system. Between that program, Medicaid and Veterans Affairs, Hellander said, taxpayer funds already account for about 60 percent of U.S. health spending.

In California, state Sen. Sheila Kuehl, D-Santa Monica, plans to introduce legislation this week that would establish a single-payer system for state residents.

A recent report by the Lewin Group, a well-regarded health care consulting firm, determined that universal coverage along the lines of what Kuehl is proposing would reduce health care spending in California by $8 billion next year alone.

It also would provide coverage for the nearly 6 million uninsured people statewide and result in lower costs for virtually all California companies now providing insurance to employees, Lewin found.

Heritage’s Moffit rejected the notion of a single-payer system in this country. “That’s exactly the way to go if you want to reduce quality and personal freedom,” he said.
  
However, Reischauer at the Urban Institute said single-payer may ultimately hold the answers not just for Medicare but also covering the 45 million Americans now lacking health insurance.

“If push came to shove, I would want a single-payer system instead of the system we have now,” he said. “But the political obstacles to that are considerable.”
  
There it is again — politics. Proposals for improving health care from both the left and right are routinely dismissed as being politically unrealistic.

All that remains is a sense of chronic crisis and a leadership vacuum when it comes to tackling some of the most important issues facing this country.

Medicare, like Social Security, can be salvaged. It won’t be easy. It will be damned painful, in fact. But we’ll never know how painful unless we try. David Lazarus’ column appears Wednesdays, Fridays and Sundays. He also can be seen regularly on KTVU’s “Mornings on 2.”

Send tips or feedback to: dlazarus@sfchronicle.com.

Copyright 2005 SF Chronicle

Posted by pnhp at 03:13 PM | Permalink

By Dr. James Cockey

It’s wonderful to see the recent interest by The Daily Times in health care policy. Our current health care financing system is simply not working. It costs too much and is giving us far too little in return.

I do want to correct The Daily Times’ editorial of Feb. 11, in which the following statement was made: “If we expect coverage for everything, we should take another look at socialized medicine.”

The only socialized medicine model I have seen in the United States with full centralized government control is the Veterans Health Administration system.

No one I know is advocating full government control of health care. Many of us are advocating universal health care coverage, along the lines of Medicare. No one currently considers Medicare “socialized medicine,” although its detractors used this epithet in 1965 when it was being created.

I appreciate the comments of my friend and colleague, Dr. Frank Arena. I do, however, dispute a few of his positions. While the health care of the VHA system has historically not always been the best, recent studies in major medical journals document its superiority to community hospitals on most quality indicators, largely due to extensive use of computerization to meet quality standards.

I also disagree on the relative complexity of Medicare billing. Billing the multitude of private insurers is far more difficult, requiring more employee expertise and time, than the comparatively straightforward and uniform Medicare regulations.

Our patients also have the added advantage of knowing Medicare will cover expected services and do not face the horror of huge uncovered bills due to fine print exclusions of coverage.

The virtues of high deductible health insurance are not as clear to me as they are to Arena. As soon as we advance the idea that “your premiums are fixed and you can’t be canceled as long as you pay the premium,” we are out of a marketplace insurance system and instituting a variation on national health insurance, with premiums fixed either by the government or some quasi-governmental organization. The for-profit health insurance industry depends on risk and premium stratification to maintain profitability.

A high-deductible, catastrophic coverage health plan creates the illusion of increasing consumer choice. It works for well-off, healthy people who can afford the high deductible for routine care and low-cost procedures. It does not work well for poor people, who can barely afford housing and food for their families. It does not work at all for sick people, who would be priced out of the catastrophic market.

Arena’s letter described single-payer, universal health care as “Utopian socialist.” “Utopian” literally means “nowhere.” Variations on single-payer, universal health care are firmly in place every where — in every other industrialized nation on earth. The United States is the only industrialized nation on earth that does not have such a system.

We also spend twice as much per capita on health care as most of the rest of the industrialized world, with health outcomes that place us low compared to other countries. It’s difficult for me to see where universal health care is any more “socialist” than universal public school education or universal rights to libraries or public roads.

Our health care system endangers our economic competitiveness. It bankrupts too many of our friends and neighbors, and does not effectively protect our health compared to the rest of the world. The only reform on the table which addresses all these problems is a single-payer, universal health care system: Medicare for all.

I hope there will be more articles in The Daily Times about health care financing, more letters to the editor and increased pressure on our politicians to act on this very real crisis.

* Dr. James Cockey lives and practices medicine in Salisbury.

Posted by pnhp at 11:58 AM | Permalink

Andy Calman, MD, PhD responds to the message on physician behavior under the Medicare Sustainable Growth Rate:

Wow. Where to begin? Time does not permit a full response so I’ll summarize.

You equate “cost-effectiveness” with “noble” behavior. The fact is that technology enables us to help people who previously could not be helped.

This month, in my field of ophthalmology, a new drug was approved for macular degeneration, the leading cause of legal blindness in Medicare-age Americans. This treatment is inordinately expensive ($1000 per injection just for the drug cost, and about $200 to the doc). But should we withhold this treatment, which is the first to offer the possibility of actual visual improvement? Would it be noble to do so? How would I explain this to my father-in-law, an engineer now blinded and unable to practice his profession because such treatments did not exist when he lost his vision to this disease?

Don’t assume that performing more service is ignoble or equates to “gaming the system” or “lacking integrity”. We pay more than we used to, and we get more than we used to (we pay more than other countries do, but that is a different issue). Whether it’s hip replacements, cataract surgery, arthritis meds, psychotherapy, or laparoscopic surgery, the recipients of these services are generally delighted that they are able to get on with healthier lives as a result. They do not view their physicians as ignoble because they made these services available.

Policymakers need to make rational decisions about how much it is worth to society to have the benefits of advanced medical care. I am not swayed by the arguments that we devote increasing amounts of our GDP to healthcare. We get real benefits for large numbers of people as a result of this investment. Sure, we could spend more of our GDP on other things that people want, like consumer electronics and SUV’s, but is this automatically the best public policy?

Also, be careful how strongly you defend the SGR. The SGR has some serious flaws: it does not adequately account for the increase in the over-80 demographic,it inappropriately ties services to GDP, and it includes in-office prescription drugs in the calculation — a component which has tripled in the last several years in its percentage of overall part B services.

I’m with you in general, but this editorial really turned me off. I want to see universal access to healthcare just as much as you do, and am working hard to help bring it about. But demonizing the physicians (or ennobling our critics) will not gain you many converts among our ranks. And universal access to substandard care is only marginally better than what we have now.

Andy Calman MD PhD
Founder and National Chair
Physicians for a Democratic Majority

Don’s response: We emphatically agree that beneficial technological advances are clearly desirable and should be incorporated into the payment structure of the health care system, even if that results in an increase in the health care component of the GDP.

The dispute is over whether the increases in physician spending represent the increased costs in technological advances. Keep in mind that we are addressing physician compensation only, which excludes most of the capital investments in operating rooms, imaging centers, specialty hospitals, and the purchase of prosthetic devices or of most drugs. From the physicians’ perspective, most of the impact of new technology is on the time and effort that the physicians devote to added services necessitated by the technology.

For 2003, this was estimated to be about a 1.5% increase, and another 1% for
2004. Intuitively about 1.25% per year seems reasonable since there has
not been an explosion of technology in the past two years that required an inordinate increase in physician effort. In fact, because of time constraints, some older, less effective interventions are abandoned, freeing up more time for the new.

Beginning with 100% of physician spending in 1996, a target level of spending was recalculated yearly by adding adjustments for demographics, for inflation, and for increased physician time and expense for newly approved technological advances (as above). The target amount for 2004, including the factor for technological advances, was $77.1 billion, but actual physician spending was $84.9 billion. It seems highly unlikely that physicians increased their effort an additional 15% over that which already includes a correction for new technology. And we know that they didn’t increase their working hours by 15%.

I think that it is much more likely that the physician adjustment factor (PAF) demonstrates what we feared: that physicians are pushing the limit on coding in an attempt to achieve income levels to which they believe they are entitled. I do not believe that this represents unethical behavior, but, rather, represents the fact that they are making the most of the somewhat flawed system that we have. I still stand by my position that we should investigate whether we could make changes that, instead, incentivize the most noble behavior on the part of physicians.

Posted by pnhp at 02:37 PM | Permalink

By Elizabeth Ziegler - Journal Writer

Two winters ago, Cheryl Alvarez received a phone call from her son telling her that he had been in a car crash. Now Alvarez lives in a nightmare of debt that she won’t be able to escape for years.

The brain trauma and liver damage suffered by her son, Miguel Luna, eventually healed. But Alvarez, a single mother of five, has $200 taken from every paycheck for medical debt. And even with her wages garnisheed, Alvarez still earns too much to qualify for assistance from the state.

The bills from two area hospitals that treated her son’s injuries forced her to declare bankruptcy and rely upon the charity of friends. “It’s been a struggle. Any time you’re raising five kids on your own with no child support, it’s hard to prepare for things like this,” she said. “It is hard asking for help, but there are so many people who have been so good to us -that’s how you get through medical bankruptcy.”

Miguel dropped out of school at age 17 and took a full-time job to help. Now, at 18, he has a GED along with a family of his own to support. He plans to attend Idaho State University in the fall. “When I look at him with his three little kids, I am so thankful. I am so proud of him,” she said. “He’s fine now … it’s a miracle.”

Alvarez’s story is common among the roughly 4,500 personal bankruptcies resulting from unpaid medical bills in Idaho last year. That’s just over half of the personal bankruptcies filed in 2004 in the state. According to a Harvard Medical School Study released two weeks ago, Idaho’s statistics are in line with national figures. The study found that half of all personal bankruptcies in the United States are caused, at least in part, by unpaid medical bills.

Because Alvarez had medical insurance coverage for her son through her job as a clinical assistant and lactation educator for the health department, her story further parallels the study’s findings. According to the Harvard researchers, three-quarters, or 75.7 percent, of the medically bankrupt actually have insurance at the onset of the bankrupting illness or accident. Sixty-eight percent still had medical insurance when they filed for bankruptcy and 62 percent had continuous coverage, as did Alvarez.

But her medical plan had a high deductible and co-pay and she ended up thousands of dollars in debt. “The people out there who are middle-class and have health insurance believe that it will keep them from financial ruin if they should get sick. The reality is that ain’t so,” said Dr. Bill Woodhouse, a physician for Pocatello Family Medicine and a member of Physicians for a National Health Program.

Health West Director Stephen Weeg said often, unexpected medical expenses propel a family into poverty. “An emergency health issue is always an unplanned expense,” Weeg said. “Especially if you are middle to lower income, most folks end up with their budgets pretty tight, so there’s not a lot of discretionary money available.”

The cost of the illness is complicated by lost wages and the fact that many people live paycheck to paycheck. And when you’re maxed out already, Weeg said medical bills can tip you over the edge into bankruptcy. “For a lot of people, going bankrupt is only a matter of a few thousand dollars,” said Scott Greaves, director of the Bannock County Indigent Office. “If you go into the hospital and spend one night, the bill comes out to be $3,000 to $4,000. One night can put some people over the edge.”

For many who are insured and wind up bankrupt, high co-pays and deductibles in addition to paying the costs that exceed coverage limits often are the culprits.
“You are looking at insurance covering $30,000 of the bill, but then you are still owing thousands of dollars,” Greaves said. “Some insurances are 50 percent co-pay, and a lot of deductibles are up to the $2,000 to $3,000 range. And depending on your financial situation, just the deductible can put you over.”

When people can’t pay medical bills, they often end up in the Bannock County Indigent Office, where Greaves sees 400 to 450 cases a year. In Idaho, a state law makes counties responsible for the medical expenses of people unable to pay medical bills. The county pays the bills, a lien is put on the person’s property and eventually the cost of the bills is repaid to the county.

The indigent wear a lot of different faces, Greaves said. They are the unemployed, the working poor and increasingly, middle-class people. “That is who we see in our office -average, middle-class people who don’t have insurance,” Greaves said.

Because the cost of medical insurance rises incessantly, many healthy, middle-class people are opting out of medical insurance and many employers are priced out of offering comprehensive coverage to employees.

“The number of uninsured people is increasing, and nationally, one of the fastest growing segments of uninsured are those who have an income of over $50,000,” said Georganne Benjamin, spokesperson for Regence BlueShield of Idaho.”When people say uninsured, they think of the poverty-stricken, but they might be a college student who just graduated, who is uninsured short-term until he or she is employed.”

Idaho has one of the highest uninsured rates in the nation. Eighteen to 20 percent of Idahoans have no health insurance, compared to 16 percent nationally. The increase in uninsured people adversely affects the cost of medical insurance, Benjamin said, because in order for insurance companies to keep costs down, they need to have virtually everyone share the costs.

“We are trying to raise the number of people who have insurance, because the last thing we want is more uninsured,” Benjamin said. “The more people we have covered, the better it is for everyone overall.” But for many, paying for insurance seems like a waste of money. Benjamin said increasing numbers of typically younger, healthy people are opting to go without insurance. “They are opting out of the insurance market, because to them, it is not worth paying for the services. They don’t see the value,” Benjamin said. “But in order for the system to work appropriately, everyone needs to pay in preparation for a catastrophic event that may happen later down the road.”

People with chronic diseases know better than to opt out of the system, Greaves said, because insurance saves them thousands of dollars. With the pool of insured people growing increasingly sicker, and more expensive to cover, insurance companies raise their premiums, which causes even more healthy people to drop out. At this time last year, Greaves said medical insurance premiums increased about 45 percent.

To compensate, employers and individuals are stuck with a difficult decision: Either pay higher premiums, or pay the same amount for a skimpier policy. For those people who can’t pay more, the policy they can afford is essentially an umbrella with a hole in it, and they are depending on luck. The situation has representatives from both sides of the political divide re-evaluating medical care in the United States.

Some say a national health care system is the answer, and others say medical savings accounts can salvage the present system. “Rising health care costs are a critical concern for us,” Benjamin said, speaking on behalf of Regence BlueShield. “We have to look at product options for our members that still allows them to have insurance at an affordable price, and so, the newest thing is health savings accounts.”

Health savings accounts work, Benjamin said, because money put into the account that isn’t needed one year, rolls over into the next. Over the years, people would save enough money to provide a safety net in case of a medical emergency.

The savings account would work in conjunction with a health insurance policy, she said, to help pay off the deductible, co-pay or the cost of services above a coverage limit.

But critics of the system claim that would not help the growing number of people who cannot afford medical insurance. “I think that is an excellent idea for people who can afford that and take that risk upon themselves,” Woodhouse said. “But we know already that one in five people cannot afford health insurance.” And, it’s not just liberal/progressives who doubt that medical savings accounts can save the current health care system.

Woodhouse is a self-proclaimed conservative, and represents a number of people in the medical field who advocate for a single-payer national health program. “While many claim that we have the best health care system in the world, I know of nobody who believes we have the best way of paying for health care, as evidenced by the high number of the uninsured and medical bankruptcies,” Woodhouse said. “I feel our health care financing system has failed everyone, including the providers. It’s an extractive industry right now. I’ve very reluctantly come to believe in the single payer national health program. I am a pretty conservative person, but this is one thing in which the free market has failed.”

Posted by pnhp at 03:25 PM | Permalink

Back-breaking bills/Uncovered medical expenses are leading to bankruptcies
By Victoria Colliver, Chronicle Staff Writer

Jeannie Brewer is a physician married to a surgical resident. She and her family have health insurance. She’s not the kind of person you’d expect to be pushed to the verge of financial collapse by medical expenses. Yet Brewer is considering filing for bankruptcy, and part of the reason is the $16,500 in health care costs her family incurs each year that are not paid for by insurance.

“I have got creditors all over me. I am at the point where I don’t know what else to do,” said Brewer, 44, of Alameda. Brewer is one of a growing number of Americans who are discovering that health insurance doesn’t protect them from financial troubles caused by medical expenses. There are several reasons for the trend. Employers have been offering skimpier health care benefits and requiring their workers to pay more for coverage. Policies with high deductibles have become increasingly popular as a way for employers to manage unaffordable premiums.

Between copayments, requirements to pay certain percentages of medical bills and services that just aren’t covered, large numbers of people with insurance are facing burdensome out-of-pocket expenses. Many of them wind up in debt. And a significant percentage of those turn to bankruptcy Court for relief.

“There is a trend toward insurance being viewed as sort of catastrophic protection,” said Jeff Morris, resident scholar at the American Bankruptcy Institute. “The problem, of course, is it doesn’t take a lot of hours at a hospital to generate a bill that is very difficult to pay.”

In Brewer’s case, financial problems stem in part from her daughter’s diabetic condition. Three-year-old Lara must be constantly monitored and tested at least eight times a day. That has prevented Brewer from working normal hours for her employer, Alta Bates Summit Medical Center in Oakland, and held her income to just $35,000 last year.

Her credit card debt has spiraled to about $140,000, including some medical bills, but mostly daily expenses. She and her husband, who earns a modest salary as a resident, also have a combined $360,000 in medical school debt.

Brewer said that if she files for bankruptcy, she will do so as an individual to preserve her husband’s credit rating.

Loopholes in insurance

A Harvard University study of medical bankruptcy released earlier this month found that financial hardship caused by medical bills is not a problem that affects only the uninsured. Most people who file for personal bankruptcy because of health care expenses, like Brewer, actually have health insurance, the study found.
  
“Even the best policies in this country have so many loopholes, it’s easy to build up thousands of dollars in expenses,” said Dr.Steffie Woolhandler, a Harvard associate medical professor and one of the study’s authors.

The study looked at 1,771 bankruptcies filed in 2001 in five states,including California. Almost half of those filers — 46.2 percent — cited illness and medical bills as a major cause of bankruptcy. More than three-quarters had insurance at the onset of illness.

The problem seems to be largely a middle-class phenomenon. Typical medical bankruptcy filers are in their early 40s and have children. Most have at least some college education and own their homes.

Even if people have health insurance to begin with, many lose coverage because they are unable to keep their jobs because of medical problems.

Need for disability insurance

The health insurance industry says the lack of proper disability income protection could be the primary reason for medical-related financial problems.

Disability insurance “doesn’t pay your doctor, but gives you income for food,” said Susan Pisano, spokeswoman for America’s Health Insurance Plans, a trade group for the health insurance industry.

Pisano said it’s difficult to separate medical debt from other financial pressures associated with a health problem, especially loss of income due to an individual’s inability to work full time or to keep a job at all.
  
Even if bankruptcy is averted, the financial strain of an illness can set finances back for years. Berkeley resident Connie Taylor found herself $38,000 in debt when her daughter had to be hospitalized for a psychiatric condition. She didn’t realize that the treating physician was not among her health insurance company’s covered network of doctors.

Extra expenses

“I thought if you had insurance, you had insurance. You would be OK,” said Taylor, 53, a hospital housekeeper. She said she did not know there was such a thing as an out-of-network provider under her policy and was not informed that her daughter’s doctor would cost extra.

The hospital, through its collection agency, placed a lien on her home. Although the episode occurred in 1993, Taylor did not pay off the bill until 2001, with the help of her church and her ex-husband.

For San Francisco resident Anna Chavez, the event that prompted her financial woes was a happy one: the birth of her first child in 2000. While she was glad to get pregnant, it was unplanned. She and her husband had just opened a restaurant in San Mateo and had bare-bones insurance through Blue Cross that didn’t cover childbirth. Unable to change her policy after becoming pregnant, Chavez figured that the couple would be responsible for about $4,000 in out-of-pocket insurance expenses and $1,000 in physician fees.

The couple balked when the hospital charged them $2,300 more than they had estimated. Chavez said she asked the hospital to arrange a payment plan. Instead, she said, the hospital filed a lawsuit, which the couple lost by default. She estimates that after the attorney’s fees and court expenses, the birth of their child cost the couple $10,000.

Understand the terms

A Blue Cross spokeswoman declined to comment on Chavez’s situation, citing privacy concerns. She said customers should work carefully with their brokers to understand the terms of their policies.

Chavez, 35, who is currently uninsured, has since qualified for the state’s Healthy Families program, which covers low- to moderate-income children. She had her second child essentially for free under another state program. That makes her uncomfortable. “I just feel like I was rewarded for not having insurance, and I was not rewarded for trying to do the right thing,” Chavez said.
  
Jeannie Brewer, MD is a CaPA member
E-mail Victoria Colliver at vcolliver@sfchronicle.com.

Posted by pnhp at 02:26 PM | Permalink

Health Services Research
February 2005
From Medicaid to Uninsured: Drop-Out among Children in Public Insurance Programs
By Benjamin D. Sommers

Of the children enrolled in Medicaid or CHIP, 27.7 percent were no longer enrolled 12 months later. Of those, 45.4 percent dropped out despite apparently remaining eligible and having no other insurance-corresponding to 3.0 million children annually.

Drop-out from Medicaid and CHIP is a significant policy concern and helps explain the persistence of uninsurance among millions of eligible children.

http://www.ingentaconnect.com/content/bpl/hesr/2005/00000040/00000001/art00006

Comment: We have a fragmented system of health care coverage that depends on multiple factors such as income, age, employment status, dependent status, disability, military service, incarceration, Native American heritage, union membership, employers’ dedication to the welfare of their employees, and innumerable other factors which result in instability in the adequacy of health care coverage and whether it will even be there when needed.

If we had a single, universal, cradle-to-grave program of health care coverage, we would not have to be worrying about these three million eligible but uninsured children who have dropped out of Medicaid or CHIP.Nor would we have to worry about health care coverage for anyone else.

Now isn’t it ludicrous that we are still talking about this very simple concept and not doing anything about it? Well, no. If it were ludicrous, it would be laughable. This isn’t.

Posted by pnhp at 12:09 PM | Permalink

By Robert Kuttner  

AT DINNER, two sets of parents of college seniors are discussing their dreams for their soon-to-be newly minted graduates. Doctor? Lawyer? Scientist? Entrepreneur?

”I just hope she gets a job with health insurance,” says one mom, breaking the spell. ”The insurance cuts off the day they graduate.” A dad chimes in: ”COBRA coverage costs over $400 a month.” (COBRA is an acronym for a consolidated budget act that allows you to keep your coverage by paying the premium costs out of pocket. It is well named.)

In a country with a rational system of health insurance, your coverage would not be subject to the quirks of when you graduated college, where you worked, or whether you had been sick earlier in your life. But the American system is a patchwork mess of coverage, noncoverage, and inadequate coverage, slightly tempered by well-intentioned efforts to fill in the cracks, which only add to the fragmentation and cost.

Meanwhile, President Bush’s budget proposes to cut some $45 billion out of Medicaid funding over 10 years. The Massachusetts share of the loss would be $1.26 billion.

Medicaid is becoming the monster that’s devouring the rest of state budgets. In recent years, Medicaid costs have been rising at between 9 and 12 percent while state budgets are just about keeping pace with inflation.

But Medicaid costs are rising not because states are becoming more generous with what they cover or because states are liberalizing Medicaid eligibility rules. On the contrary, rules are being tightened and coverage restricted. The Urban Institute finds that actual Medicaid per-patient costs are growing at only about half the rate of private insurance, and a study by the Kaiser Family Foundation reports that 23 states have already taken actions to freeze enrollment or cut benefits.

So why is Medicaid such a drain on state treasuries? Because it is the health insurance of last resort. As fewer employers provide coverage that employees can afford, more and more people are being dumped into the Medicaid pool, leaving states holding the bag.

Not content to cut the federal share, Bush also proposes to turn the program into a capped block grant, which would pass even more of the costs to the states. This, in turn, would lead to even further benefit cuts and more people going without basic medical care or flooding emergency rooms.

Another government health program, the State Children’s Health Insurance Program, was intended to cover kids whose parents made a little too much money to qualify for Medicaid. There are millions of families where one or both parents have inadequate employer-provided insurance or no insurance and the kids are covered under SCHIP. And because parents’ income fluctuates, kids can be bounced from program to program — SCHIP, Medicaid, private insurance — with different eligibility rules and different doctors.

Continue the tour of our absurdly fragmented health system. As part of the same 2005 budget proposal, the president admits that his crown-jewel program, drug coverage under Medicare, will cost not the $400 billion over 10 years that he projected when he jammed the bill through Congress in 2003 but $1.2 billion. Bush officials helpfully explain that with changes in various formulas — in other words, benefit cuts — the cost can be held to a mere $720 billion.

The Medicare drug law, which doesn’t even become effective until 2006, is so outlandishly expensive because it was written to drug industry specifications. The law explicitly prohibits the government from negotiating bulk discounts with drug companies the way VA hospitals and the Canadian national health insurance program do. Seniors covered by Bush’s Medicare drug program and their partner, the American taxpayer, will pay sticker price.

Gentle reader, this is all insane. We have the world’s most expensive medical system and the least reliable insurance coverage. Yes, I know Clinton-care was a political disaster, but it wasn’t true national health insurance. Clinton naively tried to give the insurance companies a big piece of the action, and they gratefully responded by spitting in his eye.

Ordinary people are absolutely sick of the health insecurity and the endless and wasteful paper chase. So, by the way, are doctors. We have what the political scientist Walter Dean Burnham calls a ”politics of excluded alternatives.” If some nervy politician, or group of politicians, called for true universal national health insurance, they would get broad public support. It’s called leadership.

Robert Kuttner is co-editor of The American Prospect. His column appears regularly in the Globe.

Posted by pnhp at 10:23 AM | Permalink

EMBARGOED UNTIL 12:01 a.m. EST
February 14, 2005

Contact: David Himmelstein, MD
Steffie Woolhandler, MD
(617) 497-1268
(617) 312-0970
Nicholas Skala (312) 781-6006
nick@pnhp.org

1,700 Doctors: “Bankruptcy Bill Threatens Patients”

Harvard Study Shows Legislation a Danger to Millions Bankrupted by Medical Bills
Physicians Urge Congress to Reject S. 256

On the heels of a major Harvard University study showing that half of all personal bankruptcies are due to illness or medical bills, more than 1,700 American physicians signed a letter released today opposing legislation that would remove protection from patients financially ruined by medical costs.

Bankruptcy law currently offers some protection to the millions of Americans affected by medical bankruptcies each year. If passed, the bill would effectively close bankruptcy as an option and allow creditors to take the homes, cars and other assets of families who suffer a serious illness or injury.

“It’s a sad fact that bankruptcy courts have become the last line of defense for the victims of our broken health system,” said Dr. David Himmelstein, an Associate Professor of Medicine at Harvard Medical School and lead author of the study. “For many families affected by a costly illness, the limited protections of bankruptcy are the only chance to get back on their feet.”

In the letter to the leaders of the Senate Judiciary Committee, which is currently considering the bill, the doctors expressed concern that the new bankruptcy rules would further restrict the ability of patients suffering from medical costs to get needed care for themselves and their families.

“Medical debtors’ access to care is already severely compromised: more than 60 percent go without a needed doctor visit and half don’t fill a prescription because of the costs,” said Dr. Steffie Woolhandler, who is also an Associate Professor of Medicine at Harvard and co-author of the study. “For those unable to seek relief from their debts, the situation will undoubtedly get worse,” she said.

The epidemic of medical bankruptcies, which affect 2 million Americans (including 700,000 children) every year, emphasizes the need for comprehensive health insurance coverage under a national health insurance plan according to the signers, who include former U.S. Surgeon General Julius Richmond.

“Current insurance policies offer paltry protection for the average American,” said Dr. Quentin Young, National Coordinator of Physicians for a National Health Program. “Most of those who are bankrupted by medical bills are middle class people who had coverage but were ruined by the massive holes in their policies. Rejecting this new bankruptcy legislation is just the first step we need to take in healing our sick health system. We need a system of universal, comprehensive Medicare for all.”

A full list of signers of the letter can be viewed at: www.pnhp.org/signers

###

Physicians for a National Health Program is an organization of 13,000 physicians advocating for non-profit national health insurance. PNHP has chapters and spokespersons across the country. For contacts, call (312) 782-6006

Posted by pnhp at 04:20 PM | Permalink

The Urban Institute
January 2005
Understanding Expenditure Patterns in Retirement
By Barbara A. Butrica, Joshua H. Goldwyn and Richard W. Johnson

Health Care Expenditures
For typical older adults, budget shares for health care expenses are second to housing costs. However, health care expenditures warrant special attention because they tend to be much more unpredictable than housing costs, especially for those without private supplemental health insurance.

In this section, we break out the health care expenditures of older adults. Health insurance premiums represent the largest health care spending category (8 percent of total expenditures) for married individuals. Additionally, they spend 6 percent on prescription drugs, 4 percent on health services, and 1 percent on medical supplies. This finding is consistent with Rubin and Nieswiadomy (1997) who found that the increase in health care expenditures between the 1980s and 1990s was driven primarily by insurance premiums, followed by drugs and medical supplies, and health services.

Older married adults in poor health allocate twice as much of their overall spending to prescription drugs than those in excellent or very good health. As expected, individuals with nongroup insurance spend a larger-than-average share of their overall expenditures on health insurance premiums, but they also spend a larger-than-average share on prescription drugs. These patterns are very similar for nonmarried adults.

http://www.urban.org/UploadedPDF/411130_expenditure_patterns.pdf

Comment: It is important to realize that health insurance premiums represent the largest health care spending category in retirement. For many individuals, the premium paid is for Medicare supplemental insurance (Medigap). With the decline in employer-sponsored group coverage for retired individuals, the need for Medigap coverage is increasing.

It is instructive to look closely at the actual benefits provided by the Medigap plans. For most individuals, the amount of claims payment for which the insurer is obligated is nominal. That is because, by Medicare regulations, most of the balance of the medical charges must be adjusted off by the provider of services. Medigap pays only that small amount which is the difference between the Medicare payment and the Medicare allowed charges, an amount far less than the charges billed.

With typical PPO plans, such as those offered by Blue Cross and Blue Shield, the premium pays not only for the allowed charges, but it also pays for the insurer’s administrative costs in contracting with providers for lower rates. With Medigap plans the allowed charges are set by Medicare, so the insurer is providing almost no additional value when it offers lists of contracted providers. And since the primary payment is made by Medicare, the Medigap plan is paying only the very modest coinsurance and deductible.

This Urban Institute study confirms that health insurance premiums in retirement are very significant. Yet the Medigap policies offer amongst the poorest values in health care coverage. Using my own coverage as a typical example, the Senior Classic F Medigap policy of Blue Cross of California had a loss ratio of 62% (2001). That means that they kept 38% of the premium.

That administrative waste is on top of the administrative burden that our fragmented system places on the providers of care. The combined administrative waste amounts to over one-half of the Medigap premium!

Medigap policies are only one more example of the private insurance industry fulfilling its mission to sell us excessive, wasteful administrative services, in this instance placing a major financial burden on retired seniors (and anger each time the premium notice arrives). We can do far better financially by throwing out the private plans, fixing Medicare so it works better, and then establishing Medicare for All.

Posted by pnhp at 03:03 PM | Permalink

Upon reading about Lisa Adams’ bankruptcy (2/3, A-1, “Medical bankruptcies: Double dose of trouble”), we were reminded again of the grim prognosis of the current U.S. health-care system.

More than 45 million Americans are uninsured, yet Americans continue to spend more per capita on health care than most of our world community. Despite these exorbitant expenditures, the United States performs poorly on leading World Health Organization health indicators (37th among the developed world). We propose that a single-payer national health-care plan is a solution to this crisis.
A national health-care plan would ensure quality coverage for all, would redirect excessive administrative costs into directly serving patient needs, and would establish health care as a basic human right.

Real solutions to medical bankruptcies and rising health-care costs are within our reach. Let’s start by supporting bipartisan proposals of Gov. Kathleen Sebelius and Insurance Commissioner Sandy Praeger to provide health care to low-income, uninsured Kansans.

Blair Thedinger, Abby Snavely and Lindsay Rome: KU Medical Center Students for a National Health Program
Jonathan Jacobs, Andrea Charbonneau, Kathryn Ellerbeck, Allen Greiner, Stephen Lauer, Joshua Freeman and Dan Swagerty: Mid-America Physicians for a National Health Program ( www.pnhp.org)

Posted by pnhp at 04:02 PM | Permalink

By Winthrop Quigley Albuquerque Journal Staff Writer

A coalition of more than 75 organizations are asking the state Legislature to replace conventional health insurance with a single statewide insurance plan that bases premiums on the insured’s income.

The Health Security for New Mexicans Campaign argues that health care financing is too badly broken to be repaired and should be replaced. The campaign contends that millions of dollars can be saved on administrative costs if a single health insurance plan replaces the variety of products offered by health insurance companies.

The plan faces tough sledding in the state Legislature. Similar bills have been defeated in the past, and Gov. Bill Richardson has consistently said he opposes a single-payer health system.

Richardson prefers allowing uninsured New Mexicans to voluntarily join state-supported insurance plans already in place, including the plan covering state employees. He has also proposed tax credits to help small businesses afford health insurance for employees.

However, the Health Security for New Mexicans Campaign boasts a number of marquee names among its members, including the League of Women Voters in New Mexico, Albuquerque Health Care for the Homeless, several labor unions, the New Mexico Public Health Association, and several health policy and social policy advocacy groups.

Jerry Montoya, health promotion specialist in Valencia County for the New Mexico Department of Health, said Valencia County residents are especially hurt by the high costs of health insurance because of the county’s high poverty level. Montoya said the response the coalition has received in Valencia County has been very positive.

“We are a poor community,” he said. “We’re impacted even more. … One of the things that the Health Securities Campaign has been doing here in Valencia County is going out and doing presentations to various groups. Those presentations have been very well-received, because people are actually wanting to talk about health care reform, because they know there is a problem. They are eager to hear solutions.”

In two Journal-sponsored public opinion polls, a majority of New Mexicans have said they support a single taxpayer-funded health plan.

The campaign’s proposal faces almost certain opposition from the statewide business lobby, the Association of Commerce and Industry, according to J.D. Bullington, the group’s lobbyist.

The basics of the proposal have been offered off and on over the years by former Sen. Manny Aragon, D-Albuquerque, and former Rep. Max Coll, D-Santa Fe. The 2005 legislation is expected to be introduced by Santa Fe Democratic Rep. Luciano “Lucky” Varela, according to the Health Security for New Mexicans Campaign.

“I haven’t read the latest proposal,” Bullington said. “However, our organization is adamantly opposed to a government-run, single-payer health care system.”

The Health Security for New Mexicans Campaign would pool public and private monies, including Medicaid funding and health insurance premiums paid by individuals and employers, into a single fund. The health plan would be required to provide insurance at least as good as that offered to state employees. The coverage offered each insured would be identical, regardless of the member’s age, income, employment or health status would be based on income, not health status or age.

In an interview, campaign executive director Mary Feldblum said she could not estimate how much administrative costs would be cut, but she cited studies by The Lewin Group in several states, including a 1994 study in New Mexico, that show large state-sponsored insurance pools could offer meaningful savings.

John Sheils, a Lewin Group vice president, said in a telephone interview, “What we’ve generally shown is that a carefully designed single-payer plan can result in covering more people for more services for a tad less money. There is not a lot of money saved.”

Savings in most states Lewin Group has studied would pay for providing “most of the care you’d provide to the uninsured or underinsured.” But Sheils cautioned, “It’s going to be harder to achieve that result in New Mexico because you have lots of uninsured people.”

An estimated 414,000 New Mexicans are without health insurance.

Local health insurance plans say their own administrative costs are about 10 percent or less of total spending.

A single risk pool containing most of the state’s residents “will have some market clout” when negotiating with providers and drug companies, Feldblum said. “We have too many tiny pools,” which increases the insurance company’s risks, she said.

Sheils agreed, saying, “If you put everyone in one program with one benefit package, you probably could generate some sizable administrative savings.”

But when plans include spending constraints, technology isn’t upgraded as rapidly, providers stop offering some services, and quality of care and access to care can erode.

“There are more MRI (machines) in San Francisco than in the entire nation of Canada,” which operates a single-payer health plan and restricts spending, Sheils said. “If you are 68 years old in Britain and need kidney dialysis, you’re going to die.”

“I think as a nation, we’re really strange about this,” Sheils said. “We don’t seem to make the connection that to have the miracle of modern medicine coming our way, we have to pay for it.”

Under the coalition proposal, health care providers would operate the same way they do today. Patients could choose which providers to use. Providers would negotiate payment with a 15-member commission that would run the health plan. Premiums could be changed only with approval of the state Legislature.

The plan’s commissioners, appointed by the governor, would also have authority to review providers’ budgets to “ensure that resource allocation is based on the health care needs of different communities.”

Capital spending by providers such as hospitals would have to be certified.

The campaign in its literature promises unspecified “cost containment measures” that will produce “savings that can be invested in needed health care services.”

Federal retirees and active and retired military health plan members could not join the pool because of federal legal restrictions. Indian tribes could choose to join the pool. Plan members could choose to buy additional commercial insurance.

Bullington said the experience of Tennessee, which expanded its Medicaid program to encompass adults without health insurance, and the problems New Mexico has affording its own, more limited Medicaid program demonstrate the campaign’s ideas won’t work.

The Tennessee program “is imploding,” Bullington said. “It will bankrupt and fail.”

The Tennessee program in 1994 extended Medicaid benefits to cover the working poor, uninsurable adults and traditional Medicaid-eligible populations. The program eventually consumed one of three state tax dollars. Last year, Gov. Phil Bredesen began dismantling it and reinstating traditional Medicaid.

“We still steadfastly believe that we have not exhausted market solutions,” Bullington said. “We believe the existing structure can be salvaged and improved to provide affordable health care without overhauling the entire system and increasing the role of government.”

Posted by pnhp at 02:05 PM | Permalink

American Diabetes Association
February 8, 2005
Gaps found in all components of private health insurance coverage for people with diabetes

The American Diabetes Association in conjunction with the Georgetown University Health Policy Institute today announced the results of a 14-month study examining barriers to accessible, affordable and adequate health insurance for Americans with diabetes.

Common problems highlighted by the report document serious flaws in the private and publicly financed health insurance system in America. These flaws include health insurance policies that did not cover basic diabetes needs; high risk pools with pre-existing condition exclusions that deterred people from enrolling; health insurance premium surcharges for diabetes that drove premiums above what individuals and small businesses could afford; medical underwriting practices that designated diabetes as “uninsurable;” Medicaid eligibility limits that left many low income people unable to access this safety net; cumbersome insurance processes that fail to help people navigate complex rules and deadlines; and application procedures that drove many to give up on seeking coverage altogether.

“This study observed many instances in which having diabetes can make it harder to get and keep health insurance — a profound irony given the purpose of health insurance is to protect people when they are sick,” said Karen Pollitz, MPP, Project Director, Georgetown University Health Policy Institute. “People in transition following a job loss or change in family status often could not obtain new health coverage. Safety net options created to help in these circumstances often didn’t work because the help they offer is incomplete. People with stable coverage also had problems when they were underinsured, lacking coverage for blood glucose test strips and prescriptions or burdened by high deductibles. The people we talked to needed coverage that was available, affordable and adequate. Two out of three just didn’t work…”

R. Stewart Perry, Chair, Advocacy Committee of the American Diabetes Association added, “…most of the policy solutions currently being considered by our state and federal policymakers do little to fix the problems identified by the report.” “…it is time for policymakers to seriously rethink the flawed health insurance solutions up for debate that harm as opposed to benefit people…”

Press release:
http://www.diabetes.org/for-media/2005-press-releases/insurance-coverage.jsp

Executive Summary of the report:
http://www.healthinsuranceinfo.net/diabetes_and_health_ins_Exec_Summ.pdf

The full report:
http://web.diabetes.org/Advocacy/healthresearchreport.pdf

And some numbers from the study:
Problems studied were resolved when people could find health coverage that was simultaneously available, affordable and adequate. For most, however, health insurance and other safety net protections - such as COBRA and high-risk pools - often met only one or two of these three requirements, and so did not help. In particular:

• Individual health insurance - 395 people needed coverage in this market but only 15 could buy policies
• COBRA - 377 people lost or were losing job based coverage but only 31 took
  COBRA
• HIPAA - 87 people were HIPAA eligible but only 11 bought HIPAA coverage
• High-risk pools - 344 people needed coverage and lived in high-risk pool states but only 7 enrolled

http://www.healthinsuranceinfo.net/newsyoucanuse/08.html

Comment: More recent policy developments have placed a much greater emphasis on the importance of adequate coverage for ever expanding problems
of chronic disease. In the report above, if you merely replace the term “diabetes” with “chronic disease” you would have an inkling of the enormity of the problem that we are facing.

Current policy trends are to make health premiums more affordable and to reduce the responsibility of employers and the government for financing health care. The tragedy of these approaches is that they will only compound the problems of availability, affordability and adequacy of access and coverage presented in this report.

When our policymakers tell us that we can cover these problems with tax credits for individual plans, COBRA coverage, HIPAA coverage, high risk pools, Medicaid or any other “incremental” program, then stick this report in their face. With these programs, affordable access to comprehensive care is WORSE, not better! If we don’t take action now, the next incremental program will be “Friendly Universal Consumer Kare” (forgive the acronym).

Well we’ve been (same acronym)’d over enough! Let’s throw out our policymakers and bring in some people who care and will do the job right!

Don McCanne

(Disclaimer: The acronym was used without the knowledge or consent of the
PNHP leadership but is simply an expression of my profound, personal outrage
at our failure to introduce health care justice to the United States. Please feel free to share my vituperation with others.)

Posted by pnhp at 10:07 AM | Permalink

The Wall Street Journal
February 9, 2005
Health-Care Overhaul: GM CEO Weighs In
By Alan Murray

General Motors Chief Executive Rick Wagoner… runs not only the world’s largest auto maker (a position threatened by Toyota Motor), but also the nation’s largest private health-care purchaser (a position threatened by no one.) He’s responsible for the health of some 1.1 million people, most of them retirees and their families, and paid $5.2 billion last year for the privilege. The cost of health care now adds more than $1,500 to every vehicle sold, and is rising at double-digit rates.

So it’s no surprise that health care has become Mr. Wagoner’s obsession. He’s taken the maxim attributed to Charlie Wilson — “What’s good for General Motors is good for America” — and turned it inside out. To cure what ails General Motors, he has to cure what ails America: a very sick health-care system.

“It’s not that manufacturing cars and trucks, and quality and productivity, are not important,” Mr. Wagoner said in an interview this week. “But we have processes in place to deal with those.” The health-care system, on the other hand, reminds him of the General Motors of old, with pockets of excellence but also wastelands of inefficiency. “We can do better as a country than we are doing,” he says. “We can have higher-quality services supplied at a lower cost.”

Mr. Wagoner opposes the ultimate bailout, a government-run national health-insurance system, which would take the cost off the back of big business but put control in the hands of a government bureaucracy. Instead, he favors a consumer-driven, competitive marketplace, with better health-care information systems, better research on the clinical effectiveness of different drugs and therapies, and better information on the quality of care available to consumers. He also favors curbs on malpractice suits, and a “bipartisan national strategy to address catastrophic health-care expenses.”

http://online.wsj.com/public/article/0,,SB110790726260549399,00.html?mod=todays%5Ffree%5Ffeature

Comment: Advocates of an equitable system of universal, comprehensive health care coverage have recently become enthused over statements from executives of the auto industry that we need a national solution for our health care problems.

But is the industry ready to join advocates of national health insurance in supporting an equitable, universal, comprehensive system? If you believe that we are close to bridging that divide, you also may believe that you can cross the Grand Canyon in a single leap.

Posted by pnhp at 02:21 PM | Permalink

By
David Lazarus
  
So we learned from President Bush’s budget this week that the new-and-improved Medicare prescription drug benefit won’t cost Americans less than $400 billion over 10 years as originally proposed, but instead nearly twice that amount.

A pig in a poke? Quite possibly.
A lousy health care system? Definitely.

Boston University researchers released a study this week concluding that about half of all health care spending in the country is squandered on administrative waste, excessive pricing and fraud. Yet Californians may soon have an alternative, at least if a state lawmaker succeeds in her latest effort to introduce universal health care.

State Sen. Sheila Kuehl, D-Santa Monica, told me Thursday that she plans to unveil her California Health Insurance Reliability Act on Feb. 23. It will be Kuehl’s third stab at getting a universal-care bill through the Legislature. But this time things are a little different.

For one thing, disenchantment with the existing health care system continues to grow among both ordinary people and businesses saddled with skyrocketing insurance premiums.

Meanwhile, advocates of universal coverage have brought a new level of seriousness to their cause by hiring a prominent political operative, Andrew McGuire, to spearhead fund-raising and lobbying efforts. Less money, more coverage. And most importantly, a new report by the Lewin Group, a well-regarded health care consulting firm, finds that a system along the lines of what
Kuehl is proposing would reduce health care spending in California by $8 billion next year alone.

It also would provide coverage for the nearly 6 million uninsured people statewide and result in lower costs for virtually all California companies now providing insurance to employees. “This is an independent report proving that we can achieve universal coverage in California while reducing health spending,” Kuehl said. “It’s a very important development.”

It’s not a slam dunk, though. Kuehl acknowledged that almost as soon as she introduces her legislation this month, the insurance and drug industries will unleash all their political firepower to protect their interests.
  
“When they do, I plan to raise questions about the obscene profits these companies are making,” Kuehl said. “I love a good fight.” Her bill would create a so-called single-payer health system in California— the first in the nation (although similar efforts are under way in other states). Single-payer systems have existed in Canada and other nations for decades.

Under a single-payer system, any California resident could be treated by any doctor at any hospital anywhere in the state. Commissioner to oversee. The state’s medical resources would be overseen by a newly created health commissioner, who would ensure that money is spent wisely.

According to the report issued last month by Virginia’s Lewin Group, funding for a California single-payer system could come in part from an 8.2 percent payroll tax for employers. The tax would replace all current health care benefits paid for workers, dependents and retirees. Lewin estimates that this change would result in a 16 percent average saving in 2006 for all employers now offering health
benefits.

Meanwhile, salaried workers would pay a 3.8 percent payroll tax that would replace all existing insurance premiums, deductibles and co-pays. According to Lewin’s projections, this would reduce the $2,788 expected to be paid by the average California family next year for health services and insurance by about $340 per family.

Exact funding breakdowns in Kuehl’s legislation are still being tinkered with. Industry likely to oppose “If people can get past industry’s propaganda, I think they’ll see that this is really good for them,” said McGuire, who was hired several weeks ago to serve as executive director of Health Care for All — California, a
grassroots organization backing universal coverage.

McGuire’s past political efforts have included campaigns for gun control and safer cigarettes. He also serves as head of San Francisco General Hospital’s Trauma Foundation, which seeks to prevent serious injuries. “If people in the corporate world get religion and realize this is in their best interest, we could really have a chance,” McGuire said of Kuehl’s bill.

That may be true for many companies, but not for the health insurance business, which would be effectively decimated by creation of a single-payer system. Bill Wehrle, acting president of the California Association of Health Plans, which represents about three dozen HMOs statewide, said people should be wary of single payer.

“There could be some amount of administrative savings under a single-payer system,” he acknowledged. “It all depends on what trade-offs people are prepared to make to get savings.”

Long waits in Canada
In Canada, for example, Wehrle said the country’s single-payer plan has resulted in longer waits for treatment and lower pay for doctors. “We think higher quality at lower cost is achieved when you have competition in the private sector,” he said.

Perhaps, but a poll this week by Research America, a Virginia nonprofit organization focusing on medical issues, found that nearly two-thirds of respondents believe most Americans are not getting the health care they need.
And a study last month by the Kaiser Family Foundation revealed that 63
percent of adults believe that lowering the cost of health care and insurance should be a top priority for political leaders.

Kuehl said her bill stands a good chance of passage in the state Senate. The Assembly might be rougher sledding as the legislation’s tax components are scrutinized by various committees. As for what California’s unabashedly pro-business governor might do when presented with a single-payer bill to sign, that’s a whole other matter.

“We have to show him the data on who would save money here,” Kuehl said.
“Eight billion in savings is a lot.” It is. And with the stakes this high, an open mind on everyone’s part isn’t too much to ask for.
  
David Lazarus’ column appears Wednesdays, Fridays and Sundays. He also can be seen regularly on KTVU’s “Mornings on 2.” Send tips or feedback to
dlazarus@sfchronicle.com.

Posted by pnhp at 01:57 PM | Permalink

By Ceci Connolly
Washington Post Staff Writer
Friday, February 11, 2005; Page E01

American manufacturers are losing their ability to compete in the global marketplace in large measure because of the crushing burden of health care costs, General Motors Corp. chairman and chief executive G. Richard Wagoner Jr. said yesterday as he called on corporate and government leaders to find “some serious medicine” for the nation’s ailing health system.

In a speech at the Economic Club of Chicago, the auto executive, who is responsible for providing health insurance for more people than any other private employer in the nation, graphically detailed how rising medical bills are eating into his company’s bottom line and ultimately threatening the viability of most U.S. firms”The cost of health care in the U.S. is making American businesses extremely uncompetitive versus our global counterparts,” he said. “In the U.S., health care costs have been rising at double-digit rates for many years. In 2003, they were about 15 percent of GDP, at least 30 percent higher than the next-most-expensive country.”

“Failing to address the health care crisis would be the worst kind of procrastination,” Wagoner said, “the kind that places our children and our grandchildren at risk and threatens the health and global competitiveness of our nation’s economy.”

After spending several years on the health policy sidelines, Wagoner is launching a mini media blitz, hoping the competitiveness argument will be the one that finally prompts lawmakers to take on an increasingly expensive system rife with inefficiencies and inequities. Wagoner said he intends to press his case personally in Washington and with the nation’s governors.

Though self-interest may be at the heart of Wagoner’s crusade, he and a range of corporate leaders and policy analysts warned that GM’s woes are a harbinger of what lies ahead.

“GM is the canary in the coal mine for Medicare and everyone else,” said Sean P. McAlinden, chief economist at the nonprofit Center for Automotive Research. “There are many, many more companies out there in trouble because of health care costs than just the auto, steel and airline industries.”

McAlinden, a labor expert sympathetic to union views, said many in Washington have mistakenly concluded that GM and other carmakers are simply whining about costly union contracts.

“GM and the United Auto Workers didn’t cause this double-digit inflation in health care,” he said. And if GM pushed for sharp reductions in health benefits, the powerful union would likely strike and send the company into Chapter 11 bankruptcy protection, he predicted.

Last year the automaker, known for its innovative approach to health care, spent $5.2 billion to cover 1.1 million retirees, employees and their families. Prescription drugs cost GM $1.9 billion, and the company projects overall medical spending will increase by $400 million this year. That could be offset by a provision in the Medicare drug benefit to pick up a portion of firms’ retiree drug costs.

But the figure that prompted Wagoner to raise his voice is $1,500. That is the amount of money added to the price of every single vehicle to cover health care, a cost that his foreign competitors do not bear.

Paul Hughes-Cromwick, senior analyst at the nonprofit Altarum Institute in Ann Arbor, Mich., said executives are alarmed that benefit costs are rising far more rapidly than wages. Total compensation costs for U.S. firms rose about 3.7 percent in 2004, mirroring previous years, he said, citing Bureau of Labor Statistics data. But salaries increased just 2.4 percent, while benefit costs rose 6.9 percent. The gap is the largest he has seen in two decades.

“That huge benefit hit is chewing up the salaries and wages we would be receiving,” he said. “That’s the key.”

Yesterday, Wagoner broke his silence on an idea proposed by Sen. John F. Kerry (D-Mass.) in the 2004 presidential campaign, saying he supports some type of national catastrophic reinsurance program. Senate Majority Leader Bill Frist (R-Tenn.) has also endorsed the concept of a separate government-backed insurance pool to cover the most expensive medical cases.

“If we can create a comprehensive insurance model to better share these catastrophic costs among all consumers, then we can take a big step toward providing affordable health care coverage for all our citizens,” Wagoner said.

Wagoner and fellow executives find much to be frustrated with in the health care system.

“It’s simply not acceptable for over 45 million Americans to be without health care coverage,” he said, echoing a point made recently by Jack O. Bovender Jr., chief executive of health care giant HCA Inc. “And it’s unfair for those of us who do provide health care benefits to have to pay higher bills to cover the costs of the uninsured. Talk about ‘no good deed goes unpunished.’ “

The business leaders cannot understand why the health care industry has been slow to institute the sort of technological changes that helped them improve quality and reduce costs.

“Only in health care does bad service and bad quality get paid for in the same manner as good service and good quality,” said Humana Inc. chief executive Michael B. McCallister, chairman of the Business Roundtable’s health care task force.

The CEOs agree that the double-digit premium increases will continue as long as individuals are sheltered from the true cost of health care.

“Companies, to manage health care costs, are going to have to have employees who understand that this is something you are consuming and you have a responsibility for,” Wal-Mart Stores Inc. chief executive H. Lee Scott Jr. said in an interview.

Staff writer Michael Barbaro contributed to this report.

Posted by pnhp at 10:41 AM | Permalink

Boston University School of Public Health
Health Reform Program
February 9, 2005
Health Costs Absorb One-Quarter of Economic Growth, 2000 - 2005
By Alan Sager, Ph.D. and Deborah Socolar, M.P.H.

From the Summary:
The expected $621 billion rise in U.S. health care spending from 2000 to 2005, we find, will consume nearly one-quarter of the nation’s projected economic growth (rise in GDP) of $2,579 billion ($2.6 trillion).

Had health spending in those five years grown only as fast as GDP, the U.S. would have saved $280 billion in 2005 (one-seventh of expected health cost), and $1 trillion in five years. Health spending growth averaged 8.1 percent yearly-more than two-thirds (69 percent) over GDP’s 4.8 percent.

Traditional competitive and regulatory cost controls have failed in health care. The administration urges a new strategy, cost shifting, which it touts as empowering consumers.” By promoting underinsurance, this strategy pushes
patients to deny themselves care. There is no evidence that this is clinically safe or durably contains costs. Patients are the wrong target for cost controls.

The alternative is to engage physicians in marshaling inevitably finite dollars to care for all Americans. Doctors are key to cutting cost because their decisions control 87 percent of personal health spending.

One-half of health spending goes to clinical and administrative waste, excess prices, and theft. Physicians can identify clinical waste. Careful cost controls should rest on physicians’ decisions about services needed by each patient. Pathology is remorseless but resources are finite, so trade-offs are essential. There are no blank checks. Trustworthy methods of paying doctors should minimize incentives to over- or under-serve. Variations on this approach have been called “bedside rationing” or “professionalism within a budget.”

From the report:

When single payer reformers and others design and test payment methods that
doctors understand and accept-and when a political deal between doctors and
payers is successfully negotiated-doctors will urge their patients to vote for reform.

This process of designing and testing of payment methods and related arrangements-seeking trustworthy ways to channel inevitably limited resources to meet a defined population’s health care needs-is a vital stage of reforming health care. To win physicians’ and the public’s confidence, much of that testing will probably have to come before passage of national legislation, rather than after. Indeed, actually enacting single payer legislation may well be one of the later steps in the process of health care reform, not one of the first.

For the links to the press release and the full report:
http://www.bu.edu/dbin/sph/departments/health_services/health_reform.php

The full report:
http://dcc2.bumc.bu.edu/hs/Health%20Costs%20Absorb%20One-Quarter%20of%20Economic%20Growth%20%202000-05%20%20Sager-Socolar%207%20February%202005.pdf

Comment: The report is a melding of highly credible data with “out loud thinking” on the part of the authors. The excerpts listed cover only a few of the concepts discussed in this report. But one of the more important targets for policy discussion is the control that physicians have over health care spending. Policies that improve the physician decision process obviously would be very beneficial.

Because of my own “out loud thinking,” I pulled out from the report the recommendation to design and test newer and better concepts to improve
health care spending and utilization before embarking on the enactment of the single payer model. I would suggest instead that we move forward as fast as possible with single payer reform, but include in the program the flexibility to evaluate and adopt improvements in the physician decision process. There certainly are significant political barriers to reform, but we need to move forward with actions designed to break down those barriers. Strong grassroots advocacy of the most equitable and effective model of reform should move us closer to a just health care system, sooner rather than later.

This informative and appropriately provocative report is well worth downloading.

Posted by pnhp at 03:24 PM | Permalink

Published on Thursday, February 10, 2005 by CommonDreams.org
Progressives and Democrats: Assert Your Brand!
by Thom Hartmann
 
Politics is all about branding. And brands are not about issues or details - they’re about identity.

When progressives and Democrats think of how Bush voters understand the word “Republican,” they assume these folks are thinking “pro-life”; “moral values”; privatization and deregulation; “free trade”; lower taxes; and stripping power from what Republicans call “special interests,” like labor unions and groups advocating rights for women, gays, and other minorities.

But that’s not the picture average Americans think of when they hear the words “Republican” or “conservative.”

Instead, like any good brand, the words “Republican” and “conservative” evoke feelings as much as pictures. The main feeling is one of identity: “My tribe.” The main picture is the brand’s logo - the American flag. At a deeper level, they carry pictures, stories, and feelings of NASCAR, Budweiser, the American flag, “standing tough” and “standing tall” in the world, and pulling yourself up by your bootstraps

Not only are most Republican voters largely unaware of the details of the issues facing our nation, studies show that most are badly misinformed. In some part this is the fault of the media, but the larger reason is that when a person has bonded to a brand, it becomes part of their identity. They then develop a psychologically sophisticated and largely unconscious internal system to filter out and reject contradictory information.

Progressives, liberals, and Democrats have failed to apply this simple reality, and therefore have allowed conservatives to define our brands for us. The very sophisticated effort to do this has been led by Gingrich, Luntz, and Limbaugh, three men who understand the psychology of branding, and have used it to sell the Republican party and the word “conservative” to Americans with all the zeal - and all the cash - used by other famous brands like Coke, Levi’s, and Wal-Mart.

This is not rocket science, and it’s not a secret. There’s an entire industry devoted to teaching these concepts (in which I worked for two decades). So why haven’t progressives and Democrats figured this out?

We’re still letting cons define our brand for us, and they’re still doing it aggressively. In the month of February, 2005, timed to coincide with the Academy Awards, a con group has rented prominent billboards in Hollywood that will show a smiling picture of George W. Bush with the slogan: “Thank you, Hollywood!”. In a row under the prominent and smiling Bush are less flattering photos of Michael Moore, Whoopi Goldberg, Ben Afleck, and other outspoken liberals.

There are no Democratic billboards showing the biggest supporters of the Republican Party - corporate fat-cats like Ken Lay, with private jets and limousines, living in baronial mansions.

In classic marketing theory, there are two foundational concepts. Features (“what is it?”) without benefits (“why should I care?”) lack relevance. And, benefits without features lack credibility.

Once these are mastered, you “chunk up” (to use NLP terminology) to branding: “Features and benefits without identification (“Who am I when I use this product?”) lack “stickiness” or persistence.

Progressives and Democrats are still working on features - the details of programs.

Most progressives know all the features they’re interested in: Universal single payer health care, a viable social safety net, prison and sentencing reform, a livable wage, support for unions and the repeal of Taft-Hartley and its heirs, voting (and voting machine) reforms, revoking corporate personhood and getting corporate money out of politics, moral leadership in the world, and working for a reduction of crime and poverty at home and towards stable, lasting worldwide peace (to name a few).

But there’s no “benefit statement” in lists like these. Sure, some people think they’re obvious, but the cons know - as does any good marketer - that you have to lead with the benefit, and only then do you follow with the features. Sell “lower taxes” to everybody before rolling out tax cuts for the wealthy. Sell “personal accounts” for Social Security before rolling out benefit cuts for future generations. Sell “protect your children” before rolling out homophobia and theocracy.

And, even worse, the left hasn’t yet defined its brand.

What is our logo? Bill Moyers briefly talked about wearing a flag on his lapel, trying to re-brand the flag as the logo of the liberals, but because there was no national effort behind it, it died.

What is our identity? The cons have succeeded in making much of America think that to be liberal is to either be a wealthy actor or a scruffy gadfly. While many people wouldn’t mind being either, few identify themselves in such terms.

The largest lights of the Democratic Party - it’s founder, Thomas Jefferson, and it’s two most famous recent presidents, FDR and LBJ - knew their brand and their identity, and brought the majority of Americans along with them. The largest landslide Democratic election victories of the 20th century were FDR’s after he introduced the New Deal, and LBJ’s after he introduced the Great Society. Their logo was the flag, and their identity was average working people, and those who aspire to the economic and educational middle class.

Jefferson not only defined the identity of the Democratic Party that he founded - the longest-lasting political party in world history - but defined the identity of America as well. He defined us in positive terms (what we’re for) in the Declaration of Independence, as well as in contrasting terms (what we’re against like the “ban on monopolies in commerce” he tried to write into the Bill of Rights).

For example, in a February 8, 1786 letter to James Madison, Jefferson made clear his thoughts on what he considered a great international immorality-national belligerence that leads to a war of choice.

“And it should ever be held in mind,” Jefferson wrote, “that insult and war are the consequences of a want of respectability in the national character.”

Later, Madison - also a member of Jefferson’s Democratic Republican Party (which dropped the “Republican” from its name in the 1830s, although the www.whitehouse.gov website now lists Jefferson, Madison, Monroe, and John Quincy Adams - the first four Democratic presidents - as “Republicans”) would write, “No nation could preserve its freedom in the midst of continual warfare.”

FDR brought us back to Jefferson’s ideals with his third inaugural address, sometimes called his “Four Freedoms speech,” on January 6, 1941, when he said:

“The basic things expected by our people of their political and economic systems are simple. They are :

“Equality of opportunity for youth and for others.

“Jobs for those who can work.

“Security for those who need it.

“The ending of special privilege for the few.

“The preservation of civil liberties for all.

“The enjoyment of the fruits of scientific progress in a wider and constantly rising standard of living.

“These are the simple, the basic things that must never be lost sight of in the turmoil and unbelievable complexity of our modern world. The inner and abiding strength of our economic and political systems is dependent upon the degree to which they fulfill these expectations.”

In that, FDR created a brand, a packaging concept, a place for people to anchor their identity. It’s name was the New Deal, but it was far more inclusive than just that.

Twenty-three years later, in his first State of the Union speech after the death of JFK, Lyndon B. Johnson said:

“This administration today, here and now, declares unconditional war on poverty in America. …

“These programs are obviously not for the poor or the underprivileged alone. Every American will benefit by the extension of social security to cover the hospital costs of their aged parents. Every American community will benefit from the construction or modernization of schools, libraries, hospitals, and nursing homes, from the training of more nurses and from the improvement of urban renewal in public transit.”

In declaring his Great Society program and starting the Medicare program, LBJ cut poverty in America in half. And he, too, created a brand. (Had he not gotten caught up in Vietnam, he may now be remembered as one of our greatest presidents, as the impact of his social programs on America were tremendous.)

And, like Jefferson, both FDR and LBJ were overwhelmingly re-elected by the American people after declaring sweeping social programs that benefited average working people and those who aspired to the middle class.

The brand - the identity - of progressive ideals doesn’t need to be reinvented. It’s been with us since the founding of this nation. It long predates the Republican’s Faustian deal with the Robber Barons and war profiteers. And when the Democratic Party has been strongest, it’s been because Democrats have asserted a clear brand that stood in opposition to Republicans and their fat-cat owners. We are the - truly - We the People.

If the Democratic Party is to survive, it must embrace the progressive concepts that led to its founding in the late 1700s. It must tell average Americans what’s in it for them, and once again give Americans a “brand” with which they can identify. It must stop playing defense, letting the Republicans define the agenda of public debate, and instead reinvigorate traditional progressive rhetoric, legislation, and identity.

Democrats must reassert their brand, and establish their identity. To do this, the Party must say, loudly: “We’re for the average working stiff in America, and we’ll prove it by bringing jobs back from overseas by pulling out of the WTO and NAFTA, supporting organized labor, strengthening the social safety net, and keeping government from being a honey pot for either churches or corporations.” And then they must come up with a simple name for it, like Newt’s “Contract” or Roosevelt’s “New Deal” or LBJ’s “Great Society” to provide voters with a hook for identification.

They must further back this up by working with Greens and progressives for Instant Runoff Voting (IRV), the end of Republican-affiliated corporations programming our voting machines, and advocate social, economic, and environmental reforms - and bringing them into the Party.

Only then will the Party of Jefferson, Roosevelt, and Johnson again be able to advance social justice at home and peace around the world.

Thom Hartmann (thom at thomhartmann.com) is a Project Censored Award-winning best-selling author and host of a nationally syndicated daily progressive talk show. www.thomhartmann.com His most recent books are “The Last Hours of Ancient Sunlight,” “Unequal Protection,” “We The People,” “The Edison Gene”, and “What Would Jefferson Do?.”

Posted by pnhp at 10:20 AM | Permalink

By Elizabeth Warren
Wednesday, February 9, 2005

Nobody’s safe. That’s the warning from the first large-scale study of medical bankruptcy.

Health insurance? That didn’t protect 1 million Americans who were financially ruined by illness or medical bills last year.

A comfortable middle-class lifestyle? Good education? Decent job? No safeguards there. Most of the medically bankrupt were middle-class homeowners who had been to college and had responsible jobs — until illness struck.

As part of a research study at Harvard University, our researchers interviewed 1,771 Americans in bankruptcy courts across the country. To our surprise, half said that illness or medical bills drove them to bankruptcy. So each year, 2 million Americans — those who file and their dependents — face the double disaster of illness and bankruptcy.

But the bigger surprise was that three-quarters of the medically bankrupt had health insurance.

How did illness bankrupt middle-class Americans with health insurance? For some, high co-payments, deductibles, exclusions from coverage and other loopholes left them holding the bag for thousands of dollars in out-of-pocket costs when serious illness struck. But even families with Cadillac coverage were often bankrupted by medical problems.

Too sick to work, they suddenly lost their jobs. With the jobs went most of their income and their health insurance — a quarter of all employers cancel coverage the day you leave work because of a disabling illness; another quarter do so in less than a year. Many of the medically bankrupt qualified for some disability payments (eventually), and had the right under the COBRA law to continue their health coverage — if they paid for it themselves. But how many families can afford a $1,000 monthly premium for coverage under COBRA, especially after the breadwinner has lost his or her job?

Often, the medical bills arrived just as the insurance and the paycheck disappeared.

Bankrupt families lost more than just assets. One out of five went without food. A third had their utilities shut off, and nearly two-thirds skipped needed doctor or dentist visits. These families struggled to stay out of bankruptcy. They arrived at the bankruptcy courthouse exhausted and emotionally spent, brought low by a health care system that could offer physical cures but that left them financially devastated.

Many in Congress have a response to the problem of the growing number of medical bankruptcies: make it harder for families to file bankruptcy regardless of the reason for their financial troubles. Bankruptcy legislation — widely known as the credit industry wish list — has been introduced yet again to increase costs and decrease protection for every family that turns to the bankruptcy system for help. With the dramatic rise in medical bankruptcies now documented, this tired approach would be no different than a congressional demand to close hospitals in response to a flu epidemic. Making bankruptcy harder puts the fallout from a broken health care system back on families, leaving them with no escape.

The problem is not in the bankruptcy laws. The problem is in the health care finance system and in chronic debates about reforming it. The Harvard study shows:

• Health insurance isn’t an on-off switch, giving full protection to everyone who has it. There is real coverage and there is faux coverage. Policies that can be canceled when you need them most are often useless. So is bare-bones coverage like the Utah Medicaid program pioneered by new Health and Human Services Secretary Mike Leavitt; it pays for primary care visits but not specialists or hospital care. We need to talk about quality, durable coverage, not just about how to get more names listed on nearly-useless insurance policies.

• The link between jobs and health insurance is strained beyond the breaking point. A harsh fact of life in America is that illness leads to job loss, and that can mean a double kick when people lose their insurance. Promising them high-priced coverage through COBRA is meaningless if they can’t afford to pay. Comprehensive health insurance is the only real solution, not just for the poor but for middle-class Americans as well.

Without better coverage, millions more Americans will be hit by medical bankruptcy over the next decade. It will not be limited to the poorly educated, the barely employed or the uninsured. The people financially devastated by a serious illness are at the heart of the middle class.

Every 30 seconds in the United States, someone files for bankruptcy in the aftermath of a serious health problem. Time is running out. A broken health care system is bankrupting families across this country.

The writer is a law professor at Harvard University.

Posted by pnhp at 04:02 PM | Permalink

Missourians For Single Payer (MoSP)
Presents

“WE WON‘T BE FOOLED AGAIN“
April 1, 2, 3

April 1 - April Fools’ Day Street Theater Actions around the St. Louis Area on “The Absurdities of Rationing Health Care Amidst Great Abundance”.

April 2 - Citizen/Congressional Hearings on “Solutions to the National Health Care Crisis”, with focus on single payer as a both equitable and affordable solution.

The first of several nationwide citizen/congressional hearings on solutions to the national health care crisis will be hosted by MOSP in conjunction with the Campaign for a National Health Program NOW (cnhpNOW) and the Congressional
Universal Health Care Task Force. U.S. Representative John Conyers, (D-MI),
chairs the 46-member committee and will encourage members to attend. Citizens
will testify regarding their problems with health care access, the quality of health care, and its affordability. 9:30 AM-1 PM, THE HEIGHTS, 8001 Dale Avenue, Richmond Heights, MO 63117.

April 3 - Platform Address on Health Care Ethics by Ohio Congressman Dennis
Kucinich, former U.S. presidential candidate, our nation’s leading proponent
for universal single payer health care. Program: 11 AM-12 PM, Reception: 12PM-1 PM, Ethical Society of St. Louis, 9001 Clayton Road, St. Louis, MO 63117. Public Reception to follow.

Only one Congressman has been a longtime, outspoken and eloquent supporter
for single-payer health care: U.S. Representative Dennis Kucinich of Ohio and
presidential candidate during the last election.

We’re proud that he’s agreed to give the main speech on Sunday, April 3, the
finale of our Health Care Weekend. His talk will be about 30 minutes on health
care ethics, followed by a 15-minute Q & A period, and a public reception, all at the Ethical Society of St. Louis.

Many of you know what makes Dennis Kucinich “a progressive’s progressive.” One of seven children born to working class parents in Cleveland, he scrubbed
floors as a boy to help pay his way through Catholic schools. He paid his way
through Case Western University by working as a proofreader at two Cleveland
daily newspapers, and as a surgical technician at a city hospital. He was elected
to Cleveland’s City Council at age 23, held various city posts and his strong labor- and blue collar- support made him mayor of Cleveland at age 31, the youngest ever to become mayor of a major city.

His refusal to privatize Cleveland’s municipal power system brought the wrath
of banks and corporate leaders, who forced the city into bankruptcy by calling in a few million dollars in bank loans. That cost him reelection as mayor and no company would give him a job. He ended up as a radio talk show host, TV
reporter and then started his own media consulting firm. He returned to elected
office as a State Senator in 1994, then as U.S. Representee from Cleveland in
1996.

As a presidential candidate, he joined union picket lines, attended antiwar rallies and advocated canceling trade pacts such as NAFTA. In Congress, he voted against the war, against Bush’s $87 billion war budget and the Patriot Act. He continues as one of the chief critics of Bush’s foreign policies and goals of privatization of Medicare and Social Security.

This is the third year MoSP has sponsored a health care weekend of educational programs to highlight single payer and to generate support for our cause. We are especially proud of this year’s program. As you have seen it is a very ambitious program schedule. We are grateful for Congressman Kuchinich’s participation. I know that you are proud of your officers and board for securing this very important program. This is the time for MoSP to shine! In order to have the very best success we need your help in many ways. This is your chance to “walk the walk.” Show your support!

MOSP asks for your support in any or all of the following ways:

1. Volunteer to help with the programs. We need many willing hands to complete these projects. Contact Julia or Roger Signor.

2. Attend our free programs. Do attendance building — bring friends.

3. Promote these events to all your friends, coworkers, organizations, church, etc. .… via emails, mailings, or newsletter. We have a video and printed materials for your use.

4. Recruit members to testify at the health care hearings. More about this later.

5. Make a donation to be a cosponsor of the Health Care Weekend Program. Your
name will be listed as a cosponsor on the program literature. As you can imagine, this program will be a costly affair. We believe that we can support it.
MoSP operates on small yearly membership dues and special donations. This
is the time for special donations. Members of MoSP spend many hours and donate freely of their resources to help present our message. If you believe in what we are doing please show your support by donating towards this programming.

Make checks to: MoSP and mail to MoSP at 438 N. Skinker, St. Louis, MO 63130.

Posted by pnhp at 10:31 AM | Permalink

By Mike Sweet

Ask anyone to describe someone who files for personal bankruptcy and the description most likely fits an uncomplimentary stereotype.

It’s someone who’s maxed out their credit cards buying things they didn’t need (even though their president said it was patriotic and would rescue the economy).

It would include those who took out a second mortgage on their house to consolidate bills or redecorate, or even a third mortgage to buy a summer home that they couldn’t live without because no one can own too much stuff in an ownership society.

It also can include people with all the above over-commitments, who in addition face those numbing SUV and gasoline payments and paying heating bills that literally go up in smoke, thanks to the Enrons of this world.

Generally, the bankruptcy filer is defined and denigrated as a lowlife who knowingly lived beyond their means and then tries to get out of paying their creditors, who bear neither burden nor guilt for encouraging them to overextend. The only pity permitted is for those unfortunates whose financial crisis is due to losing their job. And then it’s slim pity.

A new Harvard University study done by its law and medical schools has identified a major cause of bankruptcy -that has not been considered previously - medical costs.

Using 2001 data involving 1,771 bankruptcy cases, researchers found that illness and medical bills were the key factor in 54 percent of those bankruptcies.

Further eviscerating the everyone’s-a-deadbeat theory, the study found that most filers were middle class. They were buying homes and had college degrees and good jobs. Three of four had health insurance when they or their family member first got sick.

But as the coverage maxed out, or the insurers dropped them, or they lost their insurance along with their jobs and the ability to pay the premiums, the medical bills piled up beyond their ability to pay.

Steffie Woolhandler, the report’s co-author, concluded “Unless you’re rich, we found you’re one serious illness away from financial ruin.”

Many millions of Americans already knew that. They can do the math for income versus outgo. But they soldier on, making their daily commutes and praying that they don’t get sick or get their job cut in one of those mergers that delight Wall Street.

After a century of progress in which government and law made life better for people, we are headed back into that pre-20th century Darwinian netherworld of dog-eat-dog where we must all walk alone and die in silence, without protestation.

Big business rules. People are just worker bees to be used up. Government is there only to help the rich.

There are skeptics who reject the Harvard conclusion as political. Woolhandler and others invite flak because they belong to the National Health Program, whose members believe that “the only solution to solving the United States’ many health care problems is a single-payer system,” an idea many doctors agree with.

Woolhandler: “Every other developed nation in the world has a single-payer health-care system. There is no reason we can’t make it work in this country.”

Actually there is. It is the view of powerful conservatives like George W.Bush that such a system is socialism, which it would not have to be to work.

The only welfare conservatives countenance is for defense contractors, and for politicians, of course. After all, those taxpayer-paid salaries, generous pensions and health care are not earned in the Darwinian corporate world they insist everyone else must compete in.

Their benefits are provided by the painful contributions of a society that not only does not get equal benefits, but also endures hypocritical lectures about how they must fend for themselves.

And who are told if they go bankrupt or die for lack of health insurance, then so be it.

Posted by pnhp at 10:23 AM | Permalink

To the editor:

Regarding the Plain Dealers Feb. 2 lead article, Medical bills blamed in half of bankruptcies, a reference is made to Physicians for a National Health Program, which advocates a single-payer system as the only solution to the United States many health care problems. The article goes on to quote Dr. Steffie Woolhandler as saying, every other developed nation in the world has a single-payer health-care system. There is no reason we cant make it work in this country.

The Single-Payer Action Network Ohio (SPAN Ohio) fully concurs with this view. That is why our coalition, which includes many physicians and health care providers, the Ohio AFL-CIO and UAW, political leaders, faith groups and community organizations is sponsoring an initiative petition to make the Health Care For All Ohioans Act (HCFAOA) the law of Ohio. If passed by the voters, this measure would guarantee all Ohio residents comprehensive medical care as a matter of right from birth to end of life. 

Single-payer means that one fund, administered by a non-profit government agency, would make payments for all medical services. Medicare is an example of a single-payer system. We would like to see Medicare broadened to include all residents, regardless of age, employment status, or pre-existing conditions.  Under HCFAOA, there would be no co-payments, no deductibles, no premiums and no limits. 

There is no prospect at present for winning adoption of single-payer on a federal level so efforts are being made to achieve it first on a state level. Some state has to be first. Why not Ohio? 

Jerry Gordon
Cleveland

Gordon is secretary of the Single-Payer Action Network Ohio.

Posted by pnhp at 11:46 AM | Permalink

The Journal Gazette
(FortWayne.com)
Feb. 6, 2005
Lawmakers eye insurance with no frills
By Niki Kelly

After mandating numerous health insurance benefits over the past decade,
lawmakers this year might allow small-business owners to purchase no-frills policies for their employees that don’t include those required services.

The proposal – often called “mandate-light” – is backed by Gov. Mitch Daniels and is included in House Bill 1487, which will receive a hearing Feb.17.

http://www.fortwayne.com/mld/journalgazette/10832440.htm

Indiana House Bill No. 1487

Synopsis: Health benefit mandate option. Allows, under certain circumstances, an accident and sickness insurer or a health maintenance organization to provide a policy or contract without complying with all health benefit mandates.

Sec. 5. Notwithstanding any other law, an insurer may offer to a prospective purchaser a policy of accident and sickness insurance without complying with all health benefit mandates if:

(1) when the offer is made the insurer provides a list of the health benefit mandates with which the offer does not comply; and
(2) the policy offered includes the following:
(A) Newborn coverage required under IC 27-8-5.6.
(B) Diabetes related coverage required under IC 27-8-14.5.
© If the prospective purchaser is described in section 4(2) of this chapter:
(i) breast cancer screening related coverage required under IC
27-8-14;
(ii) prostate cancer screening related coverage required under IC
27-8-14.7; and
(iii) colorectal cancer screening related coverage required under IC 27-8-14.8.
(D) Adopted child coverage required under IC 27-8-5-21.

http://www.in.gov/legislative/bills/2005/IN/IN1487.1.html

Comment: In order to make health insurance affordable for small businesses, Indiana’s governor is supporting a list of mandates that excludes almost all medical care. For the great majority of individuals, the mandates include only screening (but not treatment) for two malignancies (colorectal plus one other sex-specific cancer).

There is one important if unintended benefit of this proposal. It demonstrates the fallacy of targeting health care cost containment exclusively to the insurance premium, a process that is most effective when over 99% of benefits are eliminated. Of course, sponsors of this legislation would contend that that the benefits could be tailored to only those needed.

But 80% of health care services are utilized by only 20% of the population. So those of us who are healthy now, but will later become part of the 20% with greater needs, will have to buy the plan that will cover our specific needs. But which plan do we purchase? The cardiac plan? But which one? The one that covers coronary artery hospital benefits? Surgeon benefits? Or maybe the one that covers less invasive angioplasty with long term drug therapy? Or will we need the coverage that includes the implantable defibrillator? But maybe the problem will be with the aortic valve, requiring a valve replacement instead of angioplasty. Or maybe both? But then what about hypertension and stroke? Or cancer? And which type? And should coverage include surgery? Chemotherapy? Radiation? Hospice?

The obvious point is that coverage needs to be comprehensive. Even though only about one-fifth of us will have need for expensive services, all of us need to have the protection of comprehensive coverage. Since about half of the four-fifths of us who will remain healthy will have financial difficulties meeting their modest health care needs, coverage must meet that contingency as well. That leaves about 10% of health care that does not expose individuals to financial risk. But the administrative complexity of funding that individually is not worth the waste of resources. Let’s just include that 10% in with the other 90% and simply provide comprehensive coverage for everyone.

Or would you really rather have your insurance cover only your cancer screening test, and then be left on your own to figure out how you’re going to pay for treatment? And any other care you may eventually need?

———————————————————————————————
Subject: qotd: Is regulation of the individual health insurance market the answer?

The Commonwealth Fund
February 2005
Insuring The Healthy Or Insuring The Sick?
The Dilemma Of Regulating The Individual Health Insurance Market
By Nancy C. Turnbull and Nancy M. Kane

From the Executive Summary:
Federal and state policymakers are considering a variety of policy approaches—such as tax credits—to expand health insurance coverage through the individual health insurance market. For these policy approaches to succeed, there must be a well functioning individual health insurance market where reasonably comprehensive coverage is both available and affordable.

The individual market currently is quite small, covering approximately 17 million nonelderly Americans, or about 6.7 percent of the population. This market historically has not worked well for many people seeking coverage, in particular for those who need coverage the most. Policies frequently have been unavailable to people with existing health conditions;premiums have been expensive and usually have risen faster than group insurance rates; and benefits have generally been far more limited than those in group policies.

Key Findings:

• Stricter regulation has made an important difference, but affordability is still a major problem.

• Older or less healthy consumers face a range of problems in the weaker-regulation states.

• State high-risk pools are not an adequate alternative to stricter regulation.

• A few carriers in each state dominate the individual health insurance market, a trend that has strengthened over time. (As of 2002, loss ratios in the individual market in the study states were in the 70 percent to
  85 percent range.)

http://www.cmwf.org/usr_doc/71_Turnbull_insuring_healthy_or_sick_findings.pdf

Comment: Current political trends suggest that the individual insurance market will play a much greater role in the future. This study adds to the abundance of health policy literature that confirms that the individual market is highly flawed. It is both inequitable and ineffective in ensuring affordable access to health care.

There are two options. Increase the regulatory oversight of not only the individual market but the group market as well. Regulations must ensure both equity and affordable access to care. Such a highly regulated market would dramatically increase administrative costs and increase overall health care spending in order to cover those without adequate access today.

There is another option. We can throw out the highly flawed private individual and group plans and replace them with a single, administratively efficient program that ensures both equitable funding and affordable health care access. Is there really any choice here?

Posted by pnhp at 12:07 PM | Permalink

FOR IMMEDIATE RELEASE—February 7, 2005
Kim Becker, Director of Public Relations
Phone: (703) 620-6600, ext. 207
Email: prel@www.amsa.org
Web: www.amsa.org

MEDICAL STUDENTS EXPOSE DIFFERENCES WITHIN U.S. AND CANADIAN
HEALTH CARE SYSTEMS

Reston, Va. - The American Medical Student Association (AMSA), the nation’s largest, independent medical student organization, announces the second annual “Sea-Couver,” a hands-on study tour in Seattle, Wash. and Vancouver, British Columbia that provides medical students the opportunity to compare the U.S. and Canadian health care systems. Students will gain first-hand knowledge of health care delivery in the two countries by touring clinics, talking with patients, and learning from physicians, medical students and policymakers.

The students will compare the publicly-funded, privately-administered Canadian health care system to the fragmented, public-private U.S. healthcare financing system. The United States, while spending over $1.6 trillion on health care annually, remains the only industrialized nation that does not guarantee health care for all citizens. Canada spends far less on health care and guarantees coverage for all its citizens. In addition, students will discuss and compare health care quality indicators, prescription drug costs, medical education and physician satisfaction. At the end of the excursion, students will present their findings at their individual medical schools and facilitate additional education for future
healthcare providers.

As a continuation from last year, participants will videotape “man-on-the-street” interviews. Students interview citizens, policy experts, physicians and patients on their experiences within the two systems. AMSA used last year’s footage to compile a documentary on universal health care. The documentary captured real views on healthcare and is now used as an educational tool on medical school campuses nationwide.

“This generation of physicians inherits a disjointed healthcare system that leaves 45 million people without insurance and millions more without a continuous relationship with the doctor of their choice,” says Dr. Brian Palmer, AMSA national president. “As medical schools often lack adequate health policy education, AMSA offers this opportunity for students to educate themselves and their colleagues about the two health care systems, as we continue to build a better system to serve all patients.”

Filmmaker Michael Moore is working on an expose of the U.S. healthcare system for his next documentary. AMSA believes that universal health care is long overdue and commends the project, as it should bring immense public exposure to the effort of creating affordable healthcare for all.

For over 50 years, AMSA has empowered medical students to continually improve our health care system locally, statewide and nationally for the benefit of our future patients. For more information on AMSA’s universal health care strategic priority, please visit: www.amsa.org/hp/uhcinitiative.cfm.

About the American Medical Student Association
The American Medical Student Association (AMSA), with more than a half-century history of medical student activism, is the oldest and largest independent association of physicians-in-training in the United States. Founded in 1950, AMSA is a student-governed, non-profit organization committed to representing the concerns of physicians-in-training. With nearly 50,000 members, including medical and premedical students, residents and practicing physicians, AMSA is committed to improving medical training as well as advancing the profession of medicine. AMSA focuses on four strategic priorities, including universal healthcare, disparities in medicine, diversity in medicine and transforming the culture of medical education.

To learn more about AMSA, our strategic priorities, or joining the organization, please visit us online at www.amsa.org.

Posted by pnhp at 10:54 AM | Permalink

A new study finds fewer employees receive coverage as medical costs soar
By Aurelio Rojas
Sacramento Bee Capitol Bureau

What was once a social compact - work, and chances were you would get health insurance through your employer - is fraying as medical costs soar, according to a new study.

The UCLA Center For Health Policy Research, which provides lawmakers with data to formulate policy, found that in 2003, only about half (53.8 percent) of non-elderly Californians were covered throughout the year by insurance from their employer.

That represents a drop of 2.6 percent between 2001 and 2003.

“Three-quarters of all of the uninsured in the state are in families that work,” E. Richard Brown, director of the center, said in an interview. “Sixty percent are in families headed by someone who works full time.”

As health costs rise, a growing number of policy-makers - including President Bush - are promoting personal responsibility as an alternative to the job-based system that covered most working Americans for the past half-century.

In California, Assemblymen Keith Richman, R-Northridge, and Joe Nation, D-San Rafael, plan to introduce legislation that would require all Californians to have health care. The state would subsidize low-income workers.

More than 6.5 million people in the state were without insurance at some point in 2003, including nearly 1 million children, according to the UCLA study.

The percentage of uninsured adults increased slightly from 2001. But the overall rate remained flat as enrollment of children surged in the state’s Medi-Cal and Healthy Families programs.

Brown said the overwhelming majority of the uninsured live in families whose low income puts health insurance out of financial reach.

“For workers who are trying to buy family coverage through their employer, the average increase in the share of the cost they have to pay rose 79 percent between 2001 and 2003,” Brown said. “That’s huge.”

Anthony Wright, spokesman for Health Access California, a coalition of consumer and labor groups, said the move away from employer-based health insurance has been gradual.

“It’s very rare that a business says, ‘You have health care coverage this month, but we’re going to drop it next month,’ ” he said.

“What’s more likely is that for new hires, they change the rules. The Southern California grocery strike is a classic example.”

In October 2003, 59,000 union members went on strike or were locked out. When a settlement was reached 4 1/2 months later, they retained their health benefits.

But new hires now have to wait more than a year before qualifying for coverage. The trend, repeated in other industries, has put a strain on state programs.

“The reason the costs of Medi-Cal and Healthy Families are increasing is because more people are getting on them,” Wright said. “What happens when the state begins cutting costs?”

Hospitals are bearing an added burden as emergency rooms turn into primary care providers of last resort.

Because of uncompensated care, a growing number of hospitals have shuttered their emergency units. In Sacramento, UC Davis Medical Center soon will begin turning away patients who do not need emergency care.

In the aftermath of November’s narrow defeat of Proposition 72, which would have required employers to provide insurance for workers, several proposals are taking shape in the Capitol.

Sen. Sheila Kuehl, D-Santa Monica, has introduced a “single-payer” universal health care plan designed to reduce administrative costs by squeezing out insurance companies. State Senate President Pro Tem Don Perata, D-Oakland, supports her bill.

Assembly Speaker Fabian Núñez, D-Los Angeles, said he will soon announce his support for a proposal. But he believes many employers are shirking their responsibilities.

“They ought to be ponying up and paying a bigger share of the premiums, and we need to contain health care costs,” he said. “Because if we don’t contain health care costs, the premiums are going to continue to rise.”

Gov. Arnold Schwarzenegger, however, has indicated he may be receptive to requiring individuals to have health insurance to address the issue of the uninsured.

“We have to really address this once and for all and figure out a way of how we do it, like with car insurance, where we make it law that people carry insurance, and they are really insured,” the Republican governor said last fall.

President Bush’s “ownership society” also calls for shifting the nation from an employer-based insurance system. Workers would buy higher-deductible catastrophic insurance policies to cover major medical needs.

Routine medical costs would be paid with money set aside in tax-sheltered health savings accounts. Poor families would received $3,000 annual subsidies.

Brown said most poor families still will not be able to afford coverage, because the average cost of health care purchased through an insurance pool is about $7,000 for a family of four.

The Richmond-Nation proposal, he said, likely will face the same problems.

“It’s a tough problem, and there aren’t going to be any easy answers,” he said. “But the solutions really need to match the reality.”

Posted by pnhp at 10:46 AM | Permalink

The Commonwealth Fund
January 27, 2005
Half of Insured Adults with High-Deductible Health Plans Experience
Medical Bill or Debt Problems

About half of insured adults with a high-deductible health plan have medical bill problems or debts, compared with less than one-third (31%) of those with lower-deductible plans, according to new research from The Commonwealth Fund. Individuals with high-deductible plans are also more likely than those with lower-deductible plans to experience access problems such as not filling a prescription, or skipping a medical test, treatment, or follow-up when needed, due to cost.

“Health savings accounts coupled with high deductible health plans have potential pitfalls, especially for families with low incomes or individuals with chronic health conditions, who are at greater risk of accruing burdensome medical debts and facing barriers to needed health care,” said Commonwealth Fund President Karen Davis. “The evidence is that increased patient cost-sharing leads to underuse of appropriate care.”

http://www.cmwf.org/newsroom/newsroom_show.htm?doc_id=257751

Comment: Since half of individuals who have high-deductible health coverage are already experiencing medical bill or debt problems, the current policies to shift more individuals into high-deductible plans certainly should be challenged.

But the comparison group, those with lower-deductible plans, should not be ignored. 31% of this group also have medical bill problems or debts!

In their report, The Commonwealth Fund suggests several administrative measures that could be introduced to reduce the negative impact of the higher deductibles. Do not be lulled! Adding to the profound administrative inefficiency of our current system is no solution. But more importantly, since low-deductible plans already are not providing adequate financial protection, nothing short of comprehensive reform will do.

Posted by pnhp at 11:52 AM | Permalink

Friday, February 4th, 2005

A new study in the journal Health Affairs has found that half of all personal bankruptcies in the United States are now caused by soaring medical bills. We speak with the author of the report, Dr. Steffie Woolhandler. [includes rush transcript]

—————————————————————————————————————
In addition to focusing on restructuring Social Security, President Bush also spoke about the rising costs of healthcare in this country.

• President Bush, State of the Union address, February 3, 2005:
  To make our economy stronger and more productive, we must make health care more affordable, and give families greater access to good coverage — (applause) — and more control over their health decisions. I ask Congress to move forward on a comprehensive health care agenda with tax credits to help low-income workers buy insurance, a community health center in every poor county, improved information technology to prevent medical error and needless costs, association health plans for small businesses and their employees — (applause) — expanded health savings accounts and medical liability reform that will reduce health care costs and make sure patients have the doctors and care they need.

President Bush in his State of the Union address. His comments come as a new study has found that half of all personal bankruptcies in the United States are now caused by soaring medical bills. The Harvard University study - published in the online journal Health Affairs - estimated medical bankruptcies affect about 2 million Americans every year, including 700,000 children. Many of those filing for bankruptcy had insurance, at least at the start of their illness.

*Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard University and co-director of the Harvard Medical School General Internal Medicine Fellowship program. She is a co-founder of Physicians for a National Health Program. She co-authored the study on medical bankruptcies.
Read the report.
—————————————————————————————————————
RUSH TRANSCRIPT

This transcript is available free of charge, however donations help us provide closed captioning for the deaf and hard of hearing on our TV broadcast. Thank you for your generous contribution.
Donate - $25, $50, $100, more…

AMY GOODMAN: In addition to calling for tort reform, President Bush also speaks about the rising costs of health care in this country.

GEORGE W. BUSH: To make our economy stronger and more productive, we must make health care more affordable and give families greater access to good coverage, and more control over their health decisions. I ask Congress to move forward on a comprehensive health care agenda with tax credits to help low income workers buy insurance, a community health center in every poor county, improved information technology to prevent medical error and needless costs, association health plans for small businesses and their employees, expanded health savings accounts and medical liability reform that will reduce health care costs and make sure patients have the doctors and care they need.

AMY GOODMAN: And that was President Bush. Juan.

JUAN GONZALEZ: Yes, his comments come as a new study has found that half of all personal bankruptcies in the United States are now caused by soaring medical bills. The Harvard University study published in the online journal, Health Affairs, estimated medical bankruptcies affect about 2 million Americans every year, including some 700,000 children. Many of those filing for bankruptcy had insurance at least at the start of their illness.

AMY GOODMAN: Today we’re joined by Dr. Stephie Woolhandler, Associate Professor of Medicine at Harvard University, Co-Director of the Harvard Medical School General Internal Medicine Fellowship program and one of the co-founders of the Physicians for a National Health program. She joins us in the studio in Boston. Welcome, Dr. Stephie Woolhandler.

DR. STEPHIE WOOLHANDLER: Nice to be here.

AMY GOODMAN: Well, can you talk about the study that has just come out?

DR. STEPHIE WOOLHANDLER: Well, this is the first study to collect detailed financial and medical information from a large cross-section of people filing for bankruptcy in bankruptcy courts. As Juan indicated, we found that fully half of all bankruptcies in the United States are caused by medical illness and medical bills. We’re talking about three-quarters of a million American families pulled through the bankruptcy courts every year by medical illnesses and medical bills. When you count the debtors and their dependents and their children, we’re talking about 2 million Americans every year in bankruptcy due to medical illness and medical bills.

JUAN GONZALEZ: I think most of us would assume that these were folks that did not perhaps have insurance before, but your study found that most of them had insurance when they began, so what happened in the process? Did their insurance stop paying, or what were you able to tell from you study of those bankruptcy files?

DR. STEPHIE WOOLHANDLER: We most certainly were. Surprisingly, we found that 76%, more than three-quarters of all people in medical bankruptcy had health insurance at the onset of the illness that bankrupted their family. So, when the illness started, more than three-quarters of the people had health insurance. Many of them had private health insurance through their jobs. But about one-third of people with private health insurance lost their coverage during the course of the illness. Most often because a breadwinner became too sick to work, and when they couldn’t work, they lost their job-related health insurance. But another very common scenario was people hanging on — hung onto their health insurance throughout the illness, but over the course of two or three years of illness, they accumulated so much out of pocket payments, co-payments, deductibles, and especially excluded items like physical therapy, home care, drugs. Over a period of years, they accumulated so much in out of pocket expenses that they were bankrupted despite having health insurance throughout the illness.

AMY GOODMAN: Can you give us some examples, a particular personal example of someone who has gone bankrupt because of their soaring medical costs?

DR. STEPHIE WOOLHANDLER: Oh, absolutely. One woman was a school teacher. She suffered a major heart attack. She was out of work for many months, lost her health insurance because she was unable to work. She had a hospital bill of $20,000, which was not covered by any insurance. She went to the hospital, and talked to them, and got them to write off the hospital bill. But she was bankrupted nonetheless by doctors’ bills and by the costs of her medications. Eventually, she went back to work and was able to gain insurance again, but she had already been through bankruptcy because of the initial illness. That’s actually fairly typical story of how people ended up in bankruptcy.

JUAN GONZALEZ: But now, normally, wouldn’t someone — let’s say who is working and becomes sick and can no longer work, so they lose their private health insurance, wouldn’t they then fall into the category of a disabled worker who would not only get disability payments but possibly Medicaid coverage as well? In other words, what’s happening to the safety net that should be existing in these kinds of cases?

DR. STEPHIE WOOLHANDLER: Well, most of these people were — had too much money to qualify for Medicaid, but not enough money to pay for private health insurance, if they weren’t working. The average income of these families in the year they filed for bankruptcy was about $25,000 a year. So, they would not qualify for Medicaid, nonetheless, they’re not in a position to be paying $10,000 a year, which is the average cost of family coverage in this country, if you have to pay for it yourself.

AMY GOODMAN: In the piece, the study that came out, illness and injury, as contributors to bankruptcy, you say even universal coverage could leave many Americans vulnerable to bankruptcy unless such coverage is more comprehensive than many current policies. Talk about what you mean.

DR. STEPHIE WOOLHANDLER: Well, many people think they have good insurance. They think they have good insurance, until they get one of these major illnesses that goes on for months or years at a time. And then those co-payments and deductibles and uncovered services start to add up. In our study, the typical person who went into bankruptcy had accumulated about $4,000 a year in out of pocket expenses over a period of two or three years. So that they had about $12,000 in out of pocket medical expenses by the time they went into bankruptcy. But $4,000 in medical costs out of pocket is very easy to accumulate, even with the very best private policy. I happen to know because my own insurance policy through Harvard Medical School is absolutely the Cadillac plan. We get the best plan with the best coverage for our family, and when my daughter had a series of serious orthopedic injuries, two sports injuries in a row one year after another, we accumulated $5,000 in out of pocket costs between the co-payments, deductibles and particularly physical therapy, which her plan only covered two months of, and she needed seven months. We were $5,000 out of pocket a couple years in a row. Now, both her father and I were able to work. We weren’t disabled. It didn’t bankrupt us, but in the situation where a breadwinner is sick, and income falls, $4,000 or $5,000 a year in medical expenses will bankrupt you, and in fact that is what happened to the people in our study, and that’s with the Cadillac plan. That’s with the best of the private health insurance plans. So, what we really need is the kind of national health insurance that they have in much of Western Europe and in Canada where it’s not only universal, that is everyone has it, but it’s comprehensive. Anything that’s medically necessary is covered. Without limits, and artificial limitations that the insurance companies put on the care that people need.

JUAN GONZALEZ: But given the enormous problems that individuals are having with soaring medical costs and even health insurance costs at the same time that many, many large companies and certainly small businesses are also being tremendously squeezed by rising health costs, how is it that the public movement for national health insurance has not solidified in a more systematic or vocal way?

DR. STEPHIE WOOLHANDLER: Well, we do have a lack of political leadership out of both parties, an unwillingness to talk about national health insurance that we were very pleased to hear that Senator Kennedy recently made a major speech advocating what he calls Medicare for all, which would be a form of national health insurance. That would certainly be a good step on the road to covering everyone and giving them comprehensive coverage. I think many Americans are fooled, and they have that private insurance policy, and they think they’re covered. But for so many Americans, private insurance policy is like an umbrella made out of tissue paper. You know, it may look good. It may even help you out in the sprinkle, but it’s totally useless in a downpour. People have umbrellas that literally melt in the rain. When they get so sick that they can’t work, their private health insurance is gone or fails them.

AMY GOODMAN: We’re talking to Dr. Stephie Woolhandler, one of the people who did the study showing that more than half of the personal bankruptcies in the country are due to soaring medical costs. Also one of the leaders of the universal health care movement. What do you think it would take right now, Dr. Woolhandler, for this national movement to solidify? I mean, businesses, as you say, have an interest in this because they’re crushed by the cost. Certainly individuals who have no health insurance, those who have partial health insurance. The sense is that this would cost the country a tremendous amount. The Canadian system has been vilified. What do you think it would take?

DR. STEPHIE WOOLHANDLER: Well, first of all, people need to know that national health insurance would not cost a tremendous amount. For the money we’re now spending we could provide universal coverage, that is cover everyone. We could provide comprehensive coverage, that is, improve the coverage that middle class and insured people now have. Part of why you can do that is by going to national health insurance you generate tremendous savings on administration and paperwork. We have estimated that if the United States health care system were as administratively simple as Canada, we could save $300 billion a year just in paperwork and bureaucracy costs. That $300 billion is plenty of money to cover all of our 45 million uninsured and close the loopholes in the policies of people who now have insurance to make sure that everyone is insured for all medically necessary care and that no one would ever again have to go into bankruptcy because of medical bills.

JUAN GONZALEZ: And in terms of the Bush administration now, in the President’s words this week in his state of the union, what are going to be the initiatives over the next year or two by the Bush administration as you understand them in this arena, and what should people be looking for?

DR. STEPHIE WOOLHANDLER: Okay. Well, Bush left a lot unsaid, including a lot unsaid about what his big initiatives are going to be in health policy. One thing that he is pushing for is what we call nanoinsurance. Insurance policies that are so tiny you cannot see them. Insurance policies that amount to your name on a piece of paper and little else. His new Secretary of Health and Human Services, Mike Leavitt pioneered nanoinsurance when he was Governor of Utah, when he offered Medicaid enrollees an insurance policy that covered $1,000 in primary care, but had no coverage for specialty care, no coverage for hospitalization. He claimed that was insurance. That’s why we call it nanocoverage. Now Secretary Leavitt is saying we’re going to allow any state that wants to do whatever they want and call it health insurance. So, we’re going to be seeing much more of these state policies to shrink down Medicaid, to give people these tiny little policies that are really not protective, and certainly here within our own state, our Governor Romney has been saying, Oh we need to have affordable policies, by which he means these skimpy, nanocoverage policies. Unfortunately, many employers are going the same route. They use a different terminology. They call it consumer driven health care. But what they’re really talking about is saying to workers, You have to have skimpy coverage, stripped down coverage with huge deductibles, and we forget to tell you the fact that in fact if you get sick, you’re going to be bankrupted because the coverage is so skimpy. Similarly with the health savings accounts, the health savings accounts are typically, say, $1,000 in your health savings account, but coupled with a high deductible policy with a $5,000 or $10,000 deductible, meaning that a family could easily accumulate $4,000 to $9,000 in health insurance expenses if someone got seriously ill. What we found from our study is that $4,000 to $9,000 of health expenses particularly if you have it several years in a row, particularly if the breadwinner cannot work, is enough to bankrupt American families.

JUAN GONZALEZ: You mentioned also the states in this — and initiatives to get new state programs to reduce the Medicaid load, now, isn’t it a reality that states themselves should be another constituency in this battle because all of the states are being hit by soaring Medicaid costs. A big part of many state budgets now are just being able to pay for Medicaid, so you would think that they would be another constituent group that should seek some sort of a national comprehensive solution.

DR. STEPHIE WOOLHANDLER: Well, unfortunately many state governments are in the hands of conservative allies of the Bush administration. Even though the Bush cuts in Medicaid will be disastrous for their states, they are not being very vocal and speaking out about that. I mean the real constituency for national health insurance is the American people. Its not just poor people, its not just the 45 million uninsured people, but it’s solidly middle class American families who think they have good insurance until they get sick. The families bankrupted in our study were middle class. 56% of people in bankruptcy had gone to college. 56% owned their home. When we looked at their occupational status, they were in the middle range of occupations, secretaries, schoolteachers, nurses. These were not the poorest of the poor. These were families literally ripped out of the heart of the American middle class when they had the double disasters of getting sick, and often losing their jobs.

AMY GOODMAN: Finally, Dr. Woolhandler, we have a Democratic Party — you mentioned that Kennedy was talking about universal health care, but overall, the Democratic Party has not called for universal health care. Hillary Clinton in the ascendancy, she did not propose it when she had the ability to propose it, in fact was taken down in a very big way, even preserving the insurance companies. So, who will represent this alternative, this block for universal health care?

DR. STEPHIE WOOLHANDLER: Well, what we need to do is organize a movement to hold the politicians’ feet to the fire and say to them, Unless you support universal health care you will not get re-elected. That was something that was going on in the early nineties and late eighties, congressmen and senators who were being elected at least partially because they said they supported universal health care. So thats what its going to take. Its going to take a movement to raise the issue, to pressure our politicians to listen to their constituents rather than listening to the drug industry and insurance industry that now just about the only people benefiting from the current health care finance system.

AMY GOODMAN: Dr. Stephie Woolhandler, thank you very much for being with us, one of the people that did the study on the personal bankruptcies.

JUAN GONZALEZ: If people want to copy of the study —

AMY GOODMAN: If people want to get a copy, where can they go on the web?

DR. STEPHIE WOOLHANDLER: It’s on the website on healthaffairs. Its called a web exclusive but the journals name is Health Affairs. You can find them on the web. It will be on the web for a couple of weeks, and probably for a couple of months.

AMY GOODMAN: We’ll also link to it at democracynow.org.

DR. STEPHIE WOOLHANDLER: Thank you.

AMY GOODMAN: Dr. Stephie Woolhandler, Associate Professor of Medicine at Harvard University, Co-Director of the Harvard Medical School General Internal Medicine Fellowship and one of the co-founders of the Physicians for a National Health program.
http://www.democracynow.org/article.pl?sid=05/02/04/1537243
www.democracynow.org

Posted by pnhp at 10:28 AM | Permalink

Thursday, February 03, 2005
By Christopher Snowbeck

If you think government bureaucracy is bad, Mike Stout thinks you should look at the current state of private health insurance.

Stout, who owns a small printing business in Homestead, recently underwent treatment for a kidney stone at a local hospital. Since then, he’s received 56 separate documents from both his health plan and the hospital detailing his benefits and the various charges for his care.

When he underwent the same procedure at the same hospital seven years ago, Stout received just one statement of his benefits.

“My own insurance company can’t even explain all this,” Stout said. The flood of paperwork is indicative of a broader problem with administrative waste, Stout said yesterday at a Downtown news conference, where he joined union leaders and a physician in calling for a government-run national health insurance plan.

The group took as its point of departure a study released yesterday showing that about half of all personal bankruptcies in the United States strike people in the wake of a family illness or injury. The study found that many of those bankrupt households were led by middle-class workers who had health insurance at some point in their illness.

Using the study, researchers estimate that about 29,000 people in Pennsylvania were caught up in medically related bankruptcies last year, said Dr. William Wood, a Pittsburgh physician and member of Physicians for a National Health Program.

While some attorneys who handle personal bankruptcy cases in the Pittsburgh area questioned the study, at least one longtime practitioner said the findings matched her experience.

“I would say that about one-third of the bankruptcies are people who do have illnesses going on, or are elderly with medical issues,” said Carlota Bohm, a Downtown attorney who deals with personal bankruptcies.

Many households’ credit card debts are driven by medical bills, Bohm said, adding that she’d seen a significant increase in such cases in recent years.

————————————————————————————————————
(Christopher Snowbeck can be reached at csnowbeck@post-gazette.com or 412 263-2625.)
 

Posted by pnhp at 01:33 PM | Permalink

California HealthCare Foundation
February 2, 2005

California Employers View Health Care Cost-Sharing as Double-Edged Sword
Employers believe cost sharing encourages workers to spend wisely, but may
result in foregoing needed care

Increasing employee cost-sharing is now the most common strategy used by
California employers for reining in health care costs. But even as they shift costs, employers are concerned about the effects, according to recent surveys commissioned by the California HealthCare Foundation (CHCF) and conducted by Harris Interactive of California employers, residents, and adults who are chronically ill.

While the strategy has led a majority of employers to feel that their health care costs are more under control today than they were a couple of years ago, more than 75 percent of them now say cost-sharing causes consumers to forgo needed medical care and has a negative impact on individuals with chronic conditions. Over 40 percent of employers also believe that cost sharing reduces the productivity of workers.

Consumers confirmed employer concerns. The survey of the general population of adults in California found that one in seven adults had a medical condition but did not obtain care due to cost in the past year. Non-compliance with recommended medical treatment is particularly common among those with low incomes and those in fair or poor health, according to the survey.

http://www.chcf.org/press/view.cfm?itemID=108787

And…

kaisernetwork.org
Daily Health Policy Report
February 03, 2005
Survey Indicates Millionaires Not Insulated From Rising Health Costs

A new survey (by North Trust) of 1,312 people with “at least $1 million to invest, not including the value of their residences” indicates that significant assets do not “eliminate worries over increasing health care costs,” Dow Jones/Wall Street Journal reports.

North Trust Senior Vice President Thomas Hines said, “What happens is that when you’re no longer part of a larger group, health care plans have restrictions. If you have a catastrophic illness over a significant period of time, this can quickly” deplete benefits (Chu, Dow Jones/Wall Street Journal, 2/3).

http://www.kaisernetwork.org/daily_reports/rep_hpolicy.cfm

Comment: These two reports make it much easier to understand yesterday’s
Health Affairs article confirming that 76% of individuals with medical bills filing for bankruptcy had insurance coverage at the start of their illness. The CHCF/Harris Interactive survey confirms that three-fourths of employers now recognize that current employer-sponsored plans are no longer providing enough protection to ensure financial security in the face of medical debt.

But when millionaire investors are worried about the personal financial impact of health plan restrictions, we know that we’ve got a problem! (For those who are new to this list, I’ll say once again that we can remove all financial barriers to care and provide comprehensive coverage for everyone, without spending any more than the $1.8 trillion that we already spend, merely by adopting a universal single payer system.)

Posted by pnhp at 12:13 PM | Permalink

A Healthy Choice
A movement builds to take on Wal-Mart
By Hans Johnson January 25, 2005
In These Times
 
Until last year, Wal-Mart, the global retail chain known for undercutting local competitors by curbing wages and benefits, enjoyed so much clout that it placed its sprawling warehouse stores practically at will. But grassroots challenges to the healthcare practices of Americas largest employer have stalled its expansion bids, exposing a bullying streak beneath its homey veneer of red, white and blue.
 
The skirmishes feature charges that Wal-Mart racks up huge profits while covering health care for just 45 percent of its workers and freeloading on taxpayers, who are stuck with the tab for the uninsured and their family members. The conflict pits a wide alliance of interfaith, labor and community groups against a retail chain whose profits topped $9 billion in 2003, with 3,200 outlets and 1.2 million employees in the United States alone.
 
In defending the very premise of the New Deal and reasserting the notion of a social contract, the campaign to rein in Wal-Mart could define the next decade of progressive organizing, policy and politics.
 
The platform that Wal-Mart keeps advocating is bringing in jobs to low-income communities? says Rev. Michael Pfleger of St. Sabinas Catholic Church in Chicago. But low-wage jobs, often without health care, keep families in poverty and keep people in shackles.
 
Pfleger marshaled a diverse coalition of ministers, small business owners and union activists that in May headed off Wal-Marts drive to change zoning laws and open a mega-market on his citys South Side. A Wal-Mart spokesman even had to refute charges that the companys wage and health policies are exploitative. We are not the evil empire he told USA Today. A majority of the aldermen were poised to block the proposal, and the bid was withdrawn.
 
At Wal-Mart, full-time workers have to endure six months ”and part-timers, two years” before applying for health coverage through the company. Wal-Mart told the New York Times in November that about 77 percent of its employees are eligible for health coverage through the company plan. But since Wal-Mart saddles its staff with 33 percent premiums, the coverage often costs more than $200 a month per worker to maintain”a steep price for workers making between $8 and $10 per hour. As a result, just 58 percent of those eligible, less than half of all workers, or about 537,000 people, actually have the insurance.
 
This compares with the complete coverage that became common for workers and their dependents after World War II. The rise of collectively bargained union contracts in the era of Franklin Roosevelt and Harry Truman gave rise to the notion of a so-called social contract. It stipulated that a worker receive livable wages and health benefits in return for loyal hard work.
 
Not all companies have torn up the social contract. Costco, a competitor in the large-scale retail business, provides insurance to more than 19 out of every 20 of its workers and pays more than 90 percent of the premium.
 
When Wal-Mart bows out on covering the healthcare costs of staff members, the public often picks up the tab. More than 10,000 Georgia children whose parents work at Wal-Mart are on a state health program, thus neatly passing on the $10 million yearly expense to state residents. And in California, taxpayers are footing the bill for about $32 million in healthcare costs from Wal-Mart workers that the employer would typically cover.
 
Such revelations are the latest black eye in a string of high-profile setbacks. In August, community activists along with union members involved in the Metropolitan Washington Council of the AFL-CIO discouraged Wal-Mart from plunking down a mammoth store in the citys northeast quadrant. Facing rising community hostility and the threat of bad publicity, Wal-Mart backed down.
 
The triumphs in Chicago and Washington follow an April victory near Los Angeles. By a two-to-one margin, voters in Inglewood rejected the retailers bid to circumvent a zoning board and approve a superstore widely seen as disruptive to local businesses, traffic patterns, and the quality of life.
 
Wal-Mart has fought back, joining with California Gov. Arnold Schwarzenegger in attacking a state ballot measure that would have mandated either corporate coverage for workers or payments into a state plan. Opposed by half a million Wal-Mart dollars, Proposition 72 very narrowly failed on November 2.
 
Local coalitions and policy-makers remain keen to put some checks on the retail giant. Wal-Mart executives chose to remove the responsibility from themselves. Mike Kreidler, former congressman and current state insurance commissioner for Washington state told the New York Times. He is working with state lawmakers to pass a measure similar to the California proposition.
 
Having succeeded in moving the debate about Wal-Mart beyond the publics almost religious fixation on low prices and into the realm of healthcare, activists are adhering to theologian Reinhold Niebuhrs encouragement to be wiser than our creed. Niebuhr, a mentor of Martin Luther King Jr., understood the danger of Americans being seduced into undermining their own way of life. Faced with a grave threat to healthcare, labor and community leaders are reasserting Kings vision of a beloved community and rising to the occasion to create it.
 
Hans Johnson, a board member of the BISC Foundation, writes about labor, religion and politics from Washington, D.C

Posted by pnhp at 11:13 AM | Permalink

We dare not follow
Bush, Frist, Thomas have healthcare dreams
others might call nightmares
 
Story originally published January 31, 2005
Written by Todd Sloane, Assistant Managing Editor Op/Ed Modern HealthCare
 
 
Visionaries see problems differently than the rest of us, conjuring up solutions we ordinary folks could never divine. These are essential people, and yet there are times to beware of them, such as when they are thinking of running for president or are feeling the pressure of term limits. At such times be very cautious about following them. You could fall off a cliff.

Healthcare providers and their patients are treading close to such an abyss. President Bush, Senate Majority Leader Bill Frist (R-Tenn.) and House Ways and Means Committee Chairman Bill Thomas (R-Calif.) are dreaming the dreams of men with near absolute power and a short deadline.

Frist, who has promised to retire from the Senate in 2006, may be floating a bit higher than the others, having recently revealed his vision of healthcare in the year 2015 in of all places the New England Journal of Medicine. His alien dream is filled with accounts of injected nanorobots that detect and fix cancers and implanted radio frequency devices that continuously monitor goings on in our abdomens. At the head of this brave new healthcare system is the informed public, presumably the same erudite masses that would send the good Dr. Frist to the White House in 2008.

Not all of his visions are out of “Fantastic Voyage.” He returns to terra firma long enough to call for an end to tax incentives for employers who offer health coverage, which would effectively end that insurance system. The credits would go to those all-powerful individual citizens, who would brave the private insurance market armed with the latest outcomes and clinical research data. Mind you, he has no plans to end the current discrimination in that market against anyone who has actually been sick. Bemoaning the fact that the average family policy now costs $9,000 per year, Frist wants to come to the rescue by promoting health savings accounts as a panacea. It seems that paying a far lower premium but shelling out $5,000 to $10,000 from your pocket for these catastrophic policies is much more “empowering.”

Thomas’ ideas come wrapped in less interstellar prose, but the net effect is much the same. The chairman, who would lose his coveted post under House Republican rules in 2007, has his eye on the infernal payroll tax that funds Medicare and Social Security. The tax discourages hiring, Thomas says, and he hints at lowering it or scrapping it in favor of an income tax, either of which would lead to cuts in benefits or an increase in the retirement age. A less onerous method of trimming Medicare costs, of course, would be to allow HHS to negotiate prices for the new prescription-drug benefit with drug companies, but that is off the table. Apparently, the “ownership society” that conservatives love to talk about does not allow for such government interference, even in a marketplace the government itself established.

President Bush, meanwhile, still has Medicaid firmly in his rifle sights as he staves off the lame-duck label. His brother Jeb has proposed privatizing the program in Florida, handing poor beneficiaries a check they can use to brave the managed-care market, which I am sure will be thrilled to have them. The prez won’t go that far on a national basis, but he will try to cap spending on a program that has been rising in cost but at a significantly lower rate than overall health spending. His favorite buzzword here is “flexibility” for state programs, a word that for providers and patients translates roughly to “screwed.”

All these visions have me swooning, a state that many providers may be experiencing as well. I wonder if my employer-sponsored insurance plan covers this condition. If you have a health savings account, you may want to just lie down.

Posted by pnhp at 03:33 PM | Permalink

EMBARGOED for release                  
Wednesday, Feb. 2, 2005, 12:01 a.m. EST        

Contact: Jon Gardner                
jgardner@projecthope.org
301-347-3930

Middle-Class Workers With Health Coverage Represent Most Medical Bankruptcies In America, Health Affairs Article Says

Authors Say Trend Shows Need For Safety-Net Program For Chronically Ill, Importance Of Separating Health Coverage From Employment

BETHESDA, MD—About 2 million Americans a year are in families that experience a bankruptcy following illness or injury, representing about half of all bankruptcies in the United States. Most of those filings were middle-class workers who had health insurance at the onset of their medical difficulties, according to an article posted today on the Health Affairs Web site.

David U. Himmelstein, associate professor of medicine at Harvard Medical School, and three colleagues reviewed 1,771 personal bankruptcy documents in five federal judicial districts in 2001, and conducted follow-up surveys with 931 of those debtors to determine how illness contributes to bankruptcy in America.

While the number of overall bankruptcies was 3.6 times higher in 2001 than in 1980, the number of health-related bankruptcies increased 23-fold over the same period, which suggests that high medical bills were a major contributor to the growth in the number of individuals seeking federal bankruptcy protection.

“The medical debtors we surveyed were demographically typical Americans who got sick,” Himmelstein says. “They differed from others filing for bankruptcy in one important respect: They were more likely to have experienced a lapse in health coverage. Many had coverage at the onset of their illness but lost it. In other cases, even continuous coverage left families with ruinous medical bills.”

Among the survey’s findings:

—Between 1.9 million and 2.2 million Americans (filers plus dependents) were affected by medical bankruptcies in 2001
—Three-quarters of the debtors had insurance at the onset of the bankrupting illness
—Out-of-pocket costs for those bankruptcy filers since the onset of illness or injury averaged $11,854
—Medical debtors were 42 percent more likely than other debtors to experience a lapse in health insurance coverage
—As they experienced financial trouble, 61 percent of the filers failed to seek medical treatments they needed

“As in Canada and most of western Europe, health insurance should be divorced from employment to avoid coverage disruptions at the time of illness,” Himmelstein says. “Insurance policies should incorporate comprehensive stop-loss provisions, closing coverage loopholes that expose insured families to unaffordable out-of-pocket costs. Additionally, improved programs are needed to replace breadwinners’ incomes when they are disabled or must care for a loved one.”

Himmelstein’s coauthors are Elizabeth Warren, a professor at Harvard Law School in Boston; Deborah Thorne, assistant professor in the department of sociology and anthropology at Ohio University in Athens; and Steffie Woolhandler, associate professor of medicine at Harvard.

You can read the article at content.healthaffairs.org/cgi/content/abstract/hlthaff.w5.63

####

Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Additional peer-reviewed papers are published weekly online as Health Affairs Web Exclusives at www.healthaffairs.org. Health Affairs Web Exclusives are supported in part by a grant from the Commonwealth Fund.

Posted by pnhp at 11:52 AM | Permalink

Kaiser Daily Health Policy Report
Wednesday, February 02, 2005
Coverage & Access

Medical Conditions, Resulting Financial Issues Contributed to Half of Bankruptcies in 2001, Study Says

About half of bankruptcies filed in 2001 were because of medical bills, according to a study published Wednesday on the Health Affairs Web site, the Chicago Tribune reports (Rubin, Chicago Tribune, 2/2). For the study, researchers from Harvard Medical School and Harvard Law School surveyed 1,771 U.S. residents who filed for bankruptcy in 2001 and interviewed 931 of them (Abelson, New York Times, 2/2). People interviewed had cases involving injury or illness, unpaid medical bills of more than $1,000 in the two years prior to filing for bankruptcy, loss of two weeks of work because of illness or injury or mortgaging of a home to pay medical bills, the Los Angeles Times reports (Dickerson, Los Angeles Times, 2/2). According to the study, 46.2% of people reporting bankruptcy in 2001 cited illness and medical bills as the cause. The rate rose to 54.5% when births, deaths and gambling addictions were considered as factors, the AP/San Jose Mercury News reports (Jewell, AP/San Jose Mercury News, 2/2). The number of bankruptcies filed in the United States tripled between 1980 and 2001, to nearly 1.5 million couples and individuals. The number of medical-related bankruptcies increased twenty-threefold during that period, the study says (Los Angeles Times, 2/2).

More Findings

According to Steffie Woolhandler, one of the study authors and a doctor at Cambridge Hospital, 76% of people who had a medical-related bankruptcy had health insurance when they first became ill (Kowalczyk, Boston Globe, 2/2). According to the study, 38% of those who filed for bankruptcy lost their health coverage at least temporarily by the time they had declared bankruptcy (AP/San Jose Mercury News, 2/2). Most of those who filed for bankruptcy because of medical costs were middle-income homeowners, the study indicates (Los Angeles Times, 2/2). For people filing bankruptcy, out-of-pocket medical costs averaged $13,460 for those who had health insurance, compared with an average of $10,893 for the uninsured, the study says. The highest costs — $18,005 on average — were incurred by people who had private health coverage at the beginning of their illness but later lost it, according to the study. For patients with cancer, average out-of-pocket costs were $35,878, the study finds (Kerr, Long Island Newsday, 2/2). The study also says that employer-sponsored health insurance does not seem to shield families from high medical costs because an illness can lead to job loss and loss of health coverage, the Los Angeles Times reports. In addition, people who cited medical bills as a cause for filing bankruptcy were more likely than others to have experienced a gap in health coverage because of costs or because they switched to a new plan and then lost coverage because of pre-existing medical conditions, the study says. In addition, about 33% of those who filed for bankruptcy because of medical costs said they still have difficulty paying bills, such as mortgages, utilities and rent (Los Angeles Times, 2/2).

Researchers’ Reaction

Elizabeth Warren, a Harvard law professor and one of the study’s authors, said, “It doesn’t take a medical catastrophe to create a financial catastrophe” (New York Times, 2/2). Woolhandler said, “A larger share of American workers are going to have insurance that’s like a paper umbrella. It looks good, and it might even protect you in a sprinkle, but it melts away in a downpour” (Rackl, Chicago Sun-Times, 2/2). David Himmelstein, another author and Harvard Medical School professor, said, “Unless you’re Bill Gates, you’re just one serious illness away from bankruptcy. Most of the medically bankrupt were average Americans who just happened to get sick. Health insurance offered little protection” (Rapaport, Sacramento Bee, 2/2). Warren said, “These are hard-working, ‘play-by-the-rules’ people who have health insurance and have discovered that they were just one bad diagnosis away from financial catastrophe. I think that’s the real heart of the story. This is about people who thought they were all safe” (Los Angeles Times, 2/2). Woolhandler said, “We need to rethink health reform. Covering the uninsured is not enough. We also must upgrade and guarantee continuous coverage for those who have insurance” (AP/San Jose Mercury News, 2/2). The Tribune reports that Himmelstein and Woolhandler, who are married, are co-founders of Physicians for a National Health Program, a group that advocates a national health insurance system (Chicago Tribune, 2/2).

Other Reaction

Some health policy analysts said they believe the findings highlight the “limitations” of the employer-based health insurance system, according to the New York Times. For instance, as employers shift more health care costs to workers, increasing copayments and deductibles could exacerbate the problem of medical-related bankruptcies, the Times reports. Joseph Antos, a health policy researcher with the American Enterprise Institute, said, “You can lose [health insurance] because it’s tied to employment” (New York Times, 2/2). Attorney Andrew Thaler, a bankruptcy trustee in New York, said that “a lot of people are having to file bankruptcy because of medical reasons. Lots of times people with medical debts will have other debts as well” (Long Island Newsday, 2/2). Greg Scandlen, director of the Galen Institute, said, “I don’t doubt there are people who lose their jobs due to a medical problem and hence lose their income and insurance. But this ‘study’ tells us absolutely nothing about those people because it is trying so hard to exaggerate the problem” (Chicago Tribune, 2/2).
The study is available online.

Posted by pnhp at 11:18 AM | Permalink

Bankrupted by illness
Researchers find that medical problems contributed to about half of all 2001 filings in the United States
February 2, 2005

Medical problems and their financial fallout - such as job loss and inability to pay soaring health care bills - contributed to about half of all bankruptcies in the United States in 2001, Harvard researchers found.

Even people with medical insurance were not safe from financial ruin resulting from illness, the researchers wrote in an article posted this week on the Web site of the journal Health Affairs. In fact, most people bankrupted by illness did have health insurance, the researchers found.
 
Out-of-pocket medical costs averaged $13,460 for people who had private health insurance when they became ill, versus $10,893 for the uninsured, the researchers found. The highest costs, which averaged $18,005, were incurred by people who had private insurance when they first became ill, but later lost it. Cancer patients’ out-of-pocket costs averaged $35,878.

“I think the message is, in this country, no one’s safe, even if you’re solidly middle class and have insurance coverage,” said Dr. David Himmelstein, lead author of the study and a professor at Harvard Medical School. Some people had insurance, but gaps in coverage resulted in large bills, Himmelstein said. Others who were sick for long periods lost the jobs that provided health care coverage.

Himmelstein is a founder of Physicians for a National Health Program, which advocates national health insurance. Several local attorneys confirmed yesterday that in New York, medical problems often figure in a decision to declare bankruptcy. Researchers estimate that in New York State in 2004 there were 38,645 medical bankruptcies.

Medical problems contributed to bankruptcies in about 700,000 U.S. households in 2001, the Harvard researchers concluded from legal filings in five states - California, Illinois, Pennsylvania, Tennessee and Texas. They used that data and interviews with bankruptcy filers to determine the extent of the national problem.
Westbury attorney Andrew Thaler, a bankruptcy trustee in the Eastern District of New York, confirmed that “a lot of people are having to file bankruptcy because of medical reasons. Lots of times people with medical debts will have other debts as well.”

Posted by pnhp at 11:00 AM | Permalink

By Reed Abelson

Sometimes, all it takes is one bad fall for a working person with health insurance to be pushed into bankruptcy.

Hundreds of thousands of Americans file for personal bankruptcy each year because of medical bills - even though they have health insurance, according to a new study by Harvard University legal and medical researchers.

“It doesn’t take a medical catastrophe to create a financial catastrophe,” said Elizabeth Warren, a Harvard law professor who studies bankruptcy and is one of the authors of the study.

The study, which is scheduled to appear today on the Web site of Health Affairs, an academic journal, provides a glimpse into a little-researched area connecting bankruptcy and medical costs. About 30 percent of people said they filed for bankruptcy because of an illness or injury, even though most of them had health insurance when they first got sick.

Many lost their jobs - and their insurance - because they got sick, while others faced thousands of dollars in co-payments and deductibles and for services not covered by their insurance.

One person cited in the bankruptcy study, for example, broke a leg, missed a couple of months of work and then had $13,000 in unpaid medical bills, though his employer-based health plan had already paid for much of his care, Ms. Warren said.

Another respondent to the survey was able to pay for hospital stays for lung surgery and a heart attack but could not return to his old job. When he found a new job, he was denied coverage because of his pre-existing conditions, which continued to require costly medical care and contributed to his bankruptcy.

Policy analysts say these findings underscore the limitations of the nation’s current system of providing health insurance largely through employers. Some argue that even for those with insurance, benefits can be ephemeral.

“You can lose it because it’s tied to employment,” said Joseph Antos, a health policy researcher with the American Enterprise Institute, who said people were also at risk if their employers went out of business.

To understand the effect of illness or injury on bankruptcy, the researchers surveyed 1,771 people who filed for bankruptcy in 2001 and interviewed 931 of them. They discovered a complex web of factors leading to bankruptcy, particularly as illness caused people to lose their jobs or cut back the hours they worked just as they were facing high medical bills.

Many of those families, Ms. Warren said, then “endured a one-two punch.”

The researchers examined those who specifically reported that their bankruptcies were precipitated by financial burdens caused by medical illness. They also included in a broader category of medical-related bankruptcy people who had more than $1,000 in unpaid medical bills at the time of the bankruptcy filing or had mortgaged their home to pay those bills.

The researchers acknowledged that often there was no single reason why someone went bankrupt. “There’s definitely overlapping reasons,” said Steffie Woolhandler, an associate professor of medicine at Harvard and one of the authors of the report.

They also pointed to gaps in coverage that left people vulnerable to financial crisis - particularly when workers switched jobs or were temporarily unable to afford contributions to a health plan. The high cost of continuing coverage under Cobra, the federal rule that allows former employees to stay on health plans for a time if they pay the entire cost, “is a cruel joke to these people,” Ms. Warren said.

Even when people remain insured, the study also notes that many health plans have limits on certain kinds of coverage, like physical therapy or prescription drugs.

“If you’re sick enough long enough, you’re in deep trouble in our society,” said David Himmelstein, an associate professor of medicine at Harvard Medical School, another of the study’s authors.

While some policies do offer catastrophic coverage, which pays for care after costs reach a certain threshold, Dr. Himmelstein said that coverage “often kicks in after people are bankrupted” because they must incur high medical bills to qualify.

And employees, who often have little choice of plans and frequently do not understand the differences among plans, are increasingly offered policies with less and less coverage, some policy analysts say.

“There’s a race to the bottom in terms of what health insurance means today,” said Ron Pollack, the executive director of Families USA, a consumer advocacy group in Washington.

This area is ripe for additional research, said Uwe E. Reinhardt, a professor at Princeton University, who said that there had not been enough hard evidence about working Americans who became ill and then went broke. “We put together vignettes, but they are not powerful enough,” he said.

The findings also raise questions about the effect of asking employees to bear a greater share of health cost through higher co-payments and the like. Many employers are shifting the increasing cost of care onto their employees, arguing that that trend gives workers an incentive to make judicious use of health care. But the researchers say higher co-payments and deductibles may well exacerbate the problem of medical bankruptcies.

Cornelia Dean contributed reporting for this article.

Posted by pnhp at 10:59 AM | Permalink

By Mark Jewell, AP

BOSTON (Feb. 2) - Costly illnesses trigger about half of all personal bankruptcies, and most of those who go bankrupt because of medical problems have health insurance, according to findings from a Harvard University study to be released Wednesday.

Researchers from Harvard’s law and medical schools said the findings underscore the inadequacy of many private insurance plans that offer worst-case catastrophic coverage, but little financial security for less severe illnesses.

”Unless you’re Bill Gates, you’re just one serious illness away from bankruptcy,” said Dr. David Himmelstein, the study’s lead author and an associate professor of medicine. ”Most of the medically bankrupt were average Americans who happened to get sick.”

The study, to be published online Wednesday by the journal Health Affairs, distributed questionnaires to 1,771 bankruptcy filers in 2001 in California, Illinois, Pennsylvania, Tennessee and Texas. That year, there were 1.46 million personal bankruptcies in the United States.

More than 900 of those questioned underwent more detailed interviews about their financial and medical circumstances for what the authors say is the first in-depth study of medical causes of personal bankruptcies, which have risen rapidly in recent years.

Illness and medical bills were cited as the cause, at least in part, for 46.2 percent of the personal bankruptcies in the study. Himmelstein said the figure rose to 54.5 percent when three other factors were counted as medical-related triggers for bankruptcies: births, deaths and pathological gambling addiction.

The study estimates medical-caused bankruptcies affect about 2 million Americans each year, counting debtors and their dependents, including 700,000 children.

Most of those seeking court protection from creditors had health insurance, with more than three-quarters reporting they had coverage at the start of the illness that triggered bankruptcy. The study said 38 percent had lost coverage at least temporarily by the time they filed for bankruptcy, with illness frequently leading to the loss of both a job and insurance.

By the Numbers
2 million
Estimated number of people affected annually by medical bankruptcies
76 percent
Portion of medical bankruptcy filers in the Harvard study who had health insurance
$11,854
Average out-of-pocket costs for the illness that led to bankruptcy
Source: Reuters

Out-of-pocket medical expenses covering co-payments, deductibles and uncovered health services averaged $13,460 for bankruptcy filers who had private insurance at the onset of illness, compared with $10,893 for those without coverage. Those who initially had private coverage but lost it during their illness faced the highest cost, an average of $18,005.

”We need to rethink health reform,” said Dr. Steffie Woolhandler, a study co-author and associate professor of medicine at Cambridge-based Harvard. ”Covering the uninsured isn’t enough. We also must upgrade and guarantee continuous coverage for those who have insurance.”

Susan Pisano, a spokeswoman for America’s Health Insurance Plans, representing nearly 1,300 health insurance providers, said the study did not adequately explore the role that disability income protection plans and personal savings can play in helping someone with a medical problem avoid bankruptcy.

”It’s very important to ask questions about what the financial stressors are for American families, but we don’t think this study digs deeply enough,” Pisano said.

The findings indicate medical-related bankruptcies hit middle-class families hard - 56 percent of the filers owned a home, and the same number had attended college.

”Families with coverage faced unaffordable co-payments, deductibles and bills for uncovered items like physical therapy, psychiatric care and prescription drugs,” Himmelstein said.

The study, funded by the Robert Wood Johnson Foundation, did not examine how many bankruptcy filers were from dual-income families where both partners had insurance, Himmelstein said.

Jeff Morris, resident scholar at the American Bankruptcy Institute, founded by Congress in 1982 to analyze bankruptcy trends, said the Harvard findings roughly mirror those of a 1996 ABI study in which 57 percent of bankruptcy filers cited medical problems as a primary bankruptcy cause. Respondents in that study were more likely to cite three other factors as primary causes, including easy access to credit, job loss and financial mismanagement.

Morris said he was aware of no data indicating that the Harvard study, which was based on 2001 bankruptcy filings, does not accurately reflect current trends in medical-related bankruptcies.

”Medical coverage is becoming more for catastrophic loss than for intermediate expenses,” Morris said.

Copyright 2005 The Associated  Press

Posted by pnhp at 10:45 AM | Permalink

EMBARGOED UNTIL 12:01 AM EDT
February 2, 2005

Contacts: John Geyman, M.D. (360) 378-6264
Claudia Fegan, M.D. (312) 689-1581
Nicholas Skala (312) 782-6006 nick@pnhp.org


Bankruptcy Study Highlights Need For National Health Insurance

Most Bankrupted by Illness Had Insurance

Physicians’ Group Decries Fake Reforms and “Counterfeit Coverage”

A new Harvard study of medical bankruptcies highlights the growing number of Americans with dangerously skimpy health insurance coverage and the need to address the problems of the insured as well as the uninsured, according to Physicians for a National Health Program (PNHP). The study, published today as a Web Exclusive by the journal Health Affairs found that half of U.S. bankruptcies, affecting 2 million people annually, were attributable to illness or medical bills. (Copies of the article can be accessed at: www.pnhp.org/bankruptcy/uninsured.html)

The physicians’ group pointed out that three-quarters of those bankrupted by illness were insured when they first got sick. While politicians acknowledge the need to cover the uninsured, they have ignored the worsening plight of those with coverage. Rising health care costs, skimpier policies and the cancellation of coverage when illness causes job loss have augmented the financial risk for those with insurance. This heightened risk is reflected in the 2200% increase in medical bankruptcies since 1981 found in the Harvard study.

PNHP highlighted two causes of the high rate of medical bankruptcy among the insured. First, many employers are cutting back coverage through larger co-payments, deductibles and exclusions – often under the euphemism of “consumer-driven health plans.” Second, the current link between coverage and employment means that insurance often evaporates when it is needed the most – when illness is so severe that breadwinners are unable to work. The COBRA law, which allows people to continue their coverage when they lose a job, has failed to address this problem because the premiums for continued coverage are unaffordable (often $10,000 per year or more).

Only national health insurance (NHI) can solve the problem, according to the group. The NHI plan proposed by the group in the Journal of the American Medical Association (see www.physiciansproposal.org for text of proposal) would de-link coverage from employment, cover all medically necessary care without co-payments or deductibles, and cover all Americans. Previous studies have shown that the administrative savings under NHI from eliminating private insurance companies could fund comprehensive care for all Americans without any increase in overall health costs.

Dr. Claudia Fegan, Director of Ambulatory Care at Provident Hospital in Chicago and Immediate Past President of PNHP commented “Only national health insurance can fix the health care mess. Without national health insurance, the best we can do is rob Peter to pay Paul – cut back coverage for the insured in order to cover a few of the uninsured. But with national health insurance we can achieve massive savings on insurance bureaucracy and profits – more than enough to guarantee full coverage for every American.”

“It’s a cruel irony that in trying to help our patients we often ruin them financially. We heal their bodies, but inflict lasting financial wounds.” said Dr. John Geyman, PNHP President and former Chair of the Department of Family Medicine at the University of Washington. “The huge number of people affected by medical bankruptcies – 2 million each year - means the average doctor has two or three of them in their practice. Yet I suspect that few of us have been aware of this epidemic.”

Dr. Quentin Young, PNHP National Coordinator remarked “The paradox is that the costliest health system in the world cannot provide decent, accessible health care to all Americans. In contrast, all other industrial democracies have the answer: national health insurance financed by progressive taxes. In American terms, Medicare for all.”

Copies of the paper are available from PNHP at (312) 782-6006 or info@pnhp.org
To read the pdf version of the articles please go to www.pnhp.org/bankruptcy/uninsured.html

“Illness and Injury as Contributors to Bankruptcy,” Himmelstein et al, Health Affairs Web Exclusive, February 2, 2005.

To Reach the Author:
David U. Himmelstein, M.D., Harvard University: (617) 497-1268

###

Physicians for a National Health Program is an organization of 12,000 physicians advocating for non-profit national health insurance. PNHP has chapters and spokespersons across the country. For contacts, call (312) 782-6006

Posted by pnhp at 10:25 AM | Permalink

Low outlay for labour, benefits cited for ranking
Report analyzes cost of operating in 11 countries

Neco Cockburn
Business Reporter

Despite a rising dollar, Canada remains the cheapest industrialized country in which to do business, according to KPMG.

Lower labour and benefits costs are the main reasons Canada is the most cost-competitive of 11 countries, the consulting firm said in its 2004 “Competitive Alternatives” study, released yesterday.

“Canada means business when it comes to promoting our country as the global business partner of choice,” International Trade Minister Jim Peterson said at a news conference.

Australia finished second, while Japan and Germany are the most costly countries.

It’s the fifth consecutive time Canada has ranked Number 1, although the gap between it and the United States, which finished seventh, has decreased.

The study found startup and operation costs for small and medium-sized businesses in Canada are 9 per cent lower than in the United States. In 2002, the last time the study was conducted, costs were 14.5 per cent lower in Canada.

Although the change results mainly from a weaker American dollar, the study’s co-author said Canada’s advantage would remain even if the loonie were worth more than 90 cents (U.S.).

“The Canadian cost advantage is very robust in terms of not being all that sensitive to the changes in the U.S. dollar,” said Stuart MacKay, president of MMK Consulting in Vancouver.

The Canadian dollar was pegged at 75 cents (U.S.) for the purpose of study calculations. It closed at 75.48 cents yesterday, down 0.83 of a cent, and has risen about 15 per cent in a year.

Analysts say the findings don’t mean fingers should be crossed for an extremely high dollar.

“I think we’ve already seen that there are a number of industries that have faced a very real competitive threat, even from the move (dollar’s rise) over the past year,” said Doug Porter, senior economist at BMO Nesbitt Burns.

“I think if we actually did have the currency move up into the 90s, there would be sectors in the manufacturing industry that would be in serious jeopardy,” he said. “I doubt that all of Canadian industry would be anything close to comfortable with a currency of above 90 cents.”

Labour costs and benefits, which accounted for 56 to 85 per cent of all location-sensitive costs in the study, are major reasons for Canada’s competitiveness.

The study, which reported all figures in U.S. dollars, found the average labour cost in Canada was $50,919 (U.S.), compared with $63,379 in the United States

But if the Canadian dollar rose sharply, Porter said, it would “tend to erase that labour cost advantage.”

KPMG’s eight-month study looked at 17 industries in the Group of Seven countries” Canada, the United States, Britain, Italy, Japan, Germany and France. Australia, Iceland, the Netherlands and Luxembourg were also included. Canada was the lowest-cost country in nine of those industries, which included aerospace, biomedical research and development and pharmaceuticals.

Consultants looked at the cost of starting and maintaining a business for 10 years, taking 27 factors into account, including land and offices, salaries and benefits, utilities, financing, taxes and transportation. The countries were then compared with the United States, which acted as an index.

For example, a startup software company with revenue of $14.2 million might have annual costs of $12.7 million in the United States. The same company could expect to spend $11 million in Canada and $14.6 million in Japan.

The study found Canada has the lowest electricity cost, at 6.3 cents per kilowatt hour, compared with 15.7 cents in the Netherlands.

Canada ranked fifth lowest in natural gas costs, and third in telecom costs.

The study also analyzed the cost-competitiveness of 30 large international cities. Toronto finished third behind Montreal and Melbourne.

The study didn’t look at other factors that affect company decisions, such as business environment, cost of living or quality of life. It also omits security, legal issues and government incentives.

KPMG released similar reports in 1996, 1997, 1999 and 2002. More than 60 sponsors, including international governments, corporations and consulting firms backed this year’s study.

Downloaded from www.competitivealternatives.com

Posted by pnhp at 12:57 PM | Permalink

by Karen Winstead 

Winstead, of Rocky Mount, is a certified nurse midwife working as a nurse at a local hospital.

I agree with Dr. Eric Swisher, whose commentary was published Dec. 30 regarding malpractice insurance premiums. As more obstetricians get out of the business, the few left have to pay out even more money for premiums to cover the cost of malpractice claims.

I attended many of the sessions of the Governor’s Working Group on Rural Obstetrical Care and was disappointed with the amount of discussion and ideas regarding malpractice insurance. For some, the crisis is here, and we see little help from government.

However, I disagree with Swisher about the American health-care system being the best in the world. Malpractice insurance is just part of the picture. Swisher apparently has been covered by decent health insurance or has been healthy most of his life.

There are more Americans than ever without the means to pay for health care and going without health care. Free clinics and indigent services, while valuable, are often like treating a bleeding artery with a Band-Aid. We have more obesity, diabetes, heart disease, depression, preterm babies, etc., than ever.

We have a system that treats every pregnant woman as if she is sick, and does not utilize the resources we have wisely. We have a system where healthy, well-off people and some poor get medical treatment, but the working middle and lower classes often do not.

According to Dr. John Bower, a member of Physicians for a National Health Programwho presented at Carilion Health Care Systems Annual Ethics Conference last fall, one-half of all bankruptcies in the previous year were due to a medical reason or large medical debts. Most of us are just one major illness or injury away from bankruptcy.

Look at Canada’s national health-care system. Who gets more kidney transplants, Canadians or Americans? Well, to my surprise, it’s the Canadians. They found it more cost-effective to pay for transplants than to keep people tied to a dialysis machine. Private companies in America make big bucks on dialysis, so Americans stay on dialysis.

And guess what? Canadians can choose their own doctor, midwife, chiropractor, etc. No insurance company tells you whom you have to see. Payments are made in two weeks to the health-care provider. No waiting for months for insurance companies to pay. Liability insurance rates are much lower because the government health system pays for future medical needs.

Who has better maternal and neonatal outcomes? Places like Germany, Sweden, Britain and other developed countries that utilize midwives to care for pregnant women. In the United States, however, attempts were made to systematically eliminate midwives. And, despite decades of research showing their benefits, the Virginia Medical Society continues to work against midwives, who could alleviate some of the shortages of maternity care in Virginia.

The United States spends double the money of other countries on health care and gets half the benefit. To say we have the best health-care system in the world is to be out of touch with reality and the majority of Americans.

There must be fundamental changes in the health-care delivery system that benefit everyone, not just physicians, hospitals, lawyers, insurance companies and drug companies. We all want a better health-care system and less litigation. Let’s use this malpractice crisis to get the ball rolling toward a better system that works for us all.

Posted by pnhp at 11:02 AM | Permalink

By Sarah Baker

Based on comments made and stories told at the Kentucky Health Insurance Research Project public forum Tuesday in Elizabethtown, physicians and patients alike are disgusted.

The forum was the first of 15 scheduled across Kentucky to gather information
about the uninsured and the underinsured.

“This is an attempt to put a face on the problem,” said the project director Michal Smith-Mello of the Kentucky Long-Term Policy Research Center.

About 20 people, several of whom work or volunteer in the medical field, attended the forum at the Pritchard Community Center, and many were eager to point out the insurance industry’s downfalls.

Lela Williams expressed the great need for more accessible health insurance. As a State Health Insurance Program volunteer through the Central Kentucky Senior Corps, Williams helps the uninsured find community and government programs to meet their medical needs. She said the paperwork alone is a barrier to health care for the uninsured.

“As a person who sits and helps people fill out forms, I was astounded,” she said. “People can’t walk through the bureaucracy. The forms are mind-boggling.”

Dr. Syed Quadri, of the Community Health Clinic of Hardin and LaRue Counties, said the uninsured put off seeking medical attention and grow sicker. At the free clinic, he’s treated patients who haven’t seen a doctor in six years. Their ailments reach critical levels and become more expensive to treat.

Quadri and other physicians associated with Physicians for a National Health Program touted national health insurance at the forum, noting that taxpayers are already paying for Medicare, Medicaid and indigent care.

“I think this is the only way this problem can be dealt with,” Quadri said.

Charles Zoeller, who is self-insured, countered that he would participate in a program only if he approved of the health plan’s standards.

Some attendees blamed the industry for health insurance problems. Zoeller suggested the health insurance industry pay for alternative medical treatments rather than only paying for pharmaceuticals that are “poisonous to our systems.”

Edgar Lopez, a retired reconstructive surgeon, complained that “corrupted, fragmented managed-care systems” spend too much money on administration. He said insurance company CEOs earn excessive salaries.

Many in the group said they believe no one is serious about cutting the number of uninsured. Quadri pointed out that no state or national agency has set a goal or time frame for improvement.

The research project is funded by a $713,000 grant from the U.S. Health Resources and Services Administration, Smith-Mello said. Most other states have already received the grant, she said.

In addition to public forums, the research group plans to survey the public and small employers, who are less likely to provide insurance, and hold focus groups with the uninsured and underinsured. The research project’s findings are expected to be used to identify ways to reduce the number of uninsured Kentuckians. The findings and solutions are expected to be presented to state lawmakers.

“The good thing about this grant is it demands you propose solutions,” Smith-Mello said.

Sarah Baker can be reached at 769-1200, Ext. 428, at
sjbaker@thenewsenterprise.com.

Posted by pnhp at 10:38 AM | Permalink