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Stephanie Woolhandler shares her views on universal healthcare

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Stephanie Woolhandler shares her views on universal healthcare

Harvard Medical Labcast

Click here to listen to the podcast (mp3)

Stephanie Woolhandler, an associate professor of medicine at the HMS-affiliated Cambridge Health Alliance, investigates disparities and inequalities in healthcare and medicine. In recent years, she has published studies on the relative cost and effectiveness of the Canadian healthcare system. In published editorials and on Capitol Hill, Dr. Woolhandler has argued for full-scale reform of the current system here in the U.S. Last year, she uncovered insurance shortfalls for American military veterans, and her most recent research found unexpected disparities in the way free prescription drug samples are distributed.

As part of her ongoing efforts to increase care for the underserved, Dr. Woolhandler helped found Physicians for a National Health Program in 1986. The group is a single-issue organization that advocates single-payer national health insurance for all Americans.

Millions of chronically ill, lacking insurance, can't get needed care

Copies of the study are available at http://www.annals.org/cgi/content/abstract/149/3/170

Embargoed until:
August 4, 2008
5:01 p.m. EST

Contacts:
Andrew P. Wilper, M.D., (503) 260-4948, wilp9522@u.washington.edu
Mark Almberg, (312) 782-6006, mark@pnhp.org

Over 11 million Americans with chronic physical illnesses like heart disease, diabetes and asthma are not getting the medical care they need because they don’t have health insurance, a new study shows. The study provides the first national estimate of the number of uninsured adults with these potentially serious but treatable conditions.

According to an article published in the Aug. 5 edition of Annals of Internal Medicine, a leading medical journal, working-age adults with one or more chronic illnesses who reported they were uninsured were nearly four times more likely than their insured counterparts to have not seen a health professional within the past year (22.6 percent versus 6.2 percent). They were also six times more likely to identify a hospital emergency room as their standard site for care when sick (7.1 percent versus 1.1 percent).

“We have made dramatic advances in treatment of chronic illnesses like heart disease and high blood pressure,” said Dr. Andrew Wilper, the study’s lead author. “But many Americans are locked out of the system because they are uninsured and cannot afford this life-saving care.

“Many of these individuals end up with preventable emergency room visits, hospitalizations, amputations, kidney failure or worse because their chronic condition has gotten out of control,” he said.

Wilper’s team analyzed data from surveys conducted by the National Center for Health Statistics. The team found that there are 11.4 million nonelderly adults with one or more chronic conditions who lack health insurance, including 1.3 million who survived a heart attack or stroke, 5.9 million with high blood pressure, 1.4 million with diabetes and 3.5 million with asthma or emphysema. Individuals with at least one of these conditions, or with high cholesterol or prior cancer (excluding minor skin cancers), were considered to have a chronic illness.

The 11.4 million figure represents about one-third of the total number of uninsured people in the United States between the ages of 18 and 64. Altogether, about 47 million Americans lacked health insurance in 2006, according to the U.S. Census Bureau.

The authors say they may have underestimated the number of chronically ill persons who lack insurance because the survey did not query participants about depression or other chronic mental illnesses, and because undiagnosed physical diseases among the uninsured may be common.

Uninsured people with chronic illnesses face serious obstacles to getting needed care, Wilper said. But he also observed that people who are enrolled in high-deductible health plans often face similar barriers to getting regular medical attention.

“Some plans, for example, require people to pay medical bills of $5,000 out-of-pocket before their insurance kicks in,” he said. “These plans put people in the precarious state of being underinsured, which is not that much better than lacking health insurance altogether.”

Wilper, who currently teaches at the University of Washington School of Medicine in Seattle, was a fellow at Harvard University and the Cambridge Health Alliance when the study was carried out.

Dr. Steffie Woolhandler, a co-author of the study, is an associate professor of medicine at Harvard and a primary care physician in Cambridge, Mass. Woolhandler noted: “Some claim that uninsured Americans can get the care they need in emergency rooms. But emergency rooms may provide too little, too late for the millions of uninsured with chronic conditions. They need regular medical monitoring, and a steady supply of medications to control their illnesses, and a whole array of services that are out of reach for the uninsured.

“Only national health insurance can fix this broken system and save thousands of lives each year,” she said.

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Copies of the study are available at http://www.annals.org/cgi/content/abstract/149/3/170

“Chronically Ill and Uninsured: A National Study of Disease Prevalence and Access to Care in U.S. Adults,” Andrew P. Wilper, MD; Steffie Woolhandler, MD, MPH; Karen E. Lasser, MD, MPH; Danny McCormick, MD; David H. Bor, MD; and David U. Himmelstein, MD. Annals of Internal Medicine, August 2008. Annals of Internal Medicine is published by the American College of Physicians.

Physicians for a National Health Program, a membership organization of over 15,000 physicians, supports a single-payer national health insurance program. To contact a physician-spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Winners and losers in balance billing

DMHC Builds on Efforts to Protect Patients from Unfair and Unexpected Bills

State of California
Department of Managed Health Care
August 1, 2008
The California Department of Managed Health Care (DMHC) today announced that it has finalized new regulations to restrict the practice of “balance billing” in emergency care settings – a practice that makes patients, not providers or health plans, responsible for paying the disputed difference between their provider’s bill and the health plan’s coverage. The regulations restrict balance billing by making it an unfair billing practice, thus allowing DMHC enforcement actions against those providers who engage in activities that unfairly burden consumers.
“Consumers, employers and taxpayers pay millions of dollars each year in health care premiums in exchange for a promise to protect them from unexpected bills when a health emergency strikes,” said Cindy Ehnes, Director of the DMHC. “The practice of balance billing breaks this promise to consumers and is unacceptable.”
Balance billing happens most often when an HMO patient receives emergency care from a physician or hospital that is not contracted with their health plan.
The DMHC has a strong record of aggressively protecting consumers from unfair balance billing. It recently filed a lawsuit in the Orange County Superior Court to stop Prime Healthcare Services, a Southern California-based hospital chain, from balance billing more than 3,500 HMO patients for services received at its hospitals.
http://www.hmohelp.ca.gov/library/reports/news/prbbregs.pdf

The issue of balance billing stems from a conflict between contracts (health plans) that patients have with their managed care organizations and contracts that physicians and hospitals do not have with the managed care organizations covering patients that they are required to provide services for in emergency situations.
This action by the California Department of Managed Care requires that hospitals and physicians comply with contracts between patients and their managed care organizations, even though a contract to provide services has never been negotiated with these private managed care entities. Thus the providers are required to accept fees that may be lower than their costs – fees that are dictated by the private health plan.
The example of Prime Healthcare Services demonstrates why it was necessary to adopt regulations to prevent patients from being gouged at unfair rack prices. But this action, in protecting patients, also protected the private managed care organizations, often at the cost of ripping off the health care providers.
In contrast, our public insurance program, Medicare, does set rates with which providers must comply (with slight variations depending on accepting assignment or contracting as a provider). Recently, in many regions, Medicare rates have been declining in relation to provider costs. A greater effort must be made by the administrators of Medicare to establish rates that cover legitimate costs and provide fair profits. Only then is it fair to demand compliance with government regulated rates.
If we had a universal single payer national health program, a unified effort would be made to demand fair compensation at a level that would ensure that our health care delivery system would be there when we need it. What we don’t need is private intermediaries that manipulate patients and providers to accomplish their business goals. We’ve had enough of that.