Archives for 2008

By AMY F. ISAACS
Great Falls Tribune
Nov. 25, 2008

WASHINGTON — It’s no longer news that at least 47 million Americans lack health insurance, and an additional 50 million are “under-insured” — meaning whatever ails you is excluded. But we seldom hear that private health insurance wastes $350 billion every year, enough to pay for high-quality comprehensive health care for everyone.

Nearly one-third of our health-care costs are eaten up by overhead: marketing, billing, profits, denying coverage, and hassling patients and doctors.

While 30 cents of every dollar of health costs pays for overhead, Medicare costs 3 cents on the dollar. Today, rising health-care costs cause one-half of all personal bankruptcies, three-fourths of whom have insurance.

Politicians promise us “universal health care,” a phrase now devoid of meaning.

The government would help us buy private insurance, especially through employers. As the economy hemorrhages more than 200,000 jobs every month, insurance costs soar, and with employers large and small — including state and local governments — unable to afford to insure their employees, an employer-based system has become a non-starter.

In fact, relieving the auto and steel industries of the burden of providing health insurance for their employees and retirees would make those vital industries more competitive with industries around the world whose governments have assumed health-care costs.

Besides, Americans want free choice of a doctor, rather than a free choice of an insurance company, each of whom offers a confusing array of benefits, deductibles, co-pays, annual and lifetime caps.

A single-payer system simply means government-financed, privately delivered health care: no deductibles, no co-pay.

The Expanded and Improved Medicare for All Act, sponsored by Rep. John Conyers, D-Mich., and more than 90 fellow representatives in the 110th Congress is the answer.

It provides for doctor, dentist, prescription drugs, mental health, nursing home and home health care, eyeglasses and hearing aids. ADA and a broad coalition of groups representing doctors, nurses, medical students, labor unions, grass-roots citizen and faith-based advocates support the Conyers legislation.

Under his bill, everybody would have a card to present to a health-care provider. No more hassle or cost. Doctors can already bill Medicare electronically. That would be their only “paperwork.” There are other benefits for patients. For instance:

* The government would negotiate prices of prescription drugs.

* Electronic records would foster continuity of care and reduce medical errors.

* Complete data would be available so a professional board could determine best practices: what treatments work and which don’t.

* Doctors would emphasize prevention.

* Hospitals would be paid based on a global budget negotiated to cover their costs, rather than current practice of billing for each aspirin and each test.

We know the powerful $500 billion-a-year insurance industry and the super-rich pharmaceutical industry — reluctant to lose their bonanza — will barrage the airwaves with ads to scare and confuse the public.

They’ll argue that people will run to the doctor unnecessarily, that patients’ bad practices are causing soaring costs. The data show otherwise.

Rising costs are attributable to overuse of emergency rooms by people who have no family doctor or available clinic, by doctors over-ordering expensive technology, and by unnecessary surgery performed by for-profit hospitals.

In fact, Medigap policies purchased to cover unaffordable co-pays and deductibles are another insurance industry cash cow. Not to be forgotten, an insurance company’s fiduciary responsibility is to its stockholders, not to patients. Insurance companies are the problem, not the solution.

In 2003 Barack Obama said a single-payer system was a good idea, but he feared it was not politically feasible.

ADA members worked tirelessly for his election this November, and we agree with him that health care is a human right.

We believe that the American people will convince politicians that a single-payer system is politically feasible and an economic and moral imperative.

With soaring personal bankruptcies and unemployment, state governments forced to cut back on our tattered safety net, the question is not whether we can afford to enact single-payer health care, it is whether we can afford not to.

Editorial
Charleston Gazette
November 18, 2008

America’s for-profit medical system is the world’s most expensive. For people with good insurance, it provides high-quality care. But 45 million “working poor” Americans – and many among the 1.2 million who lost their jobs so far this year – have no coverage. They must seek charity care or do without. That’s shameful.

America’s for-profit medical system is the world’s most expensive. For people with good insurance, it provides high-quality care. But 45 million “working poor” Americans – and many among the 1.2 million who lost their jobs so far this year – have no coverage. They must seek charity care or do without. That’s shameful.

Every other advanced democracy has universal health insurance for all citizens, suppressing costs and removing a heavy burden from employers. It’s disgraceful that America cannot do as well as other countries. Incoming President Barack Obama must push with deliberate speed to create all-encompassing U.S. coverage.

Meanwhile, it’s disturbing that many people overseas enjoy better health than Americans do, even though their countries have lower medical expense. In an editorial titled “Tied with Thailand,” the St. Louis Post-Dispatch said:

“Roughly seven of every 1,000 babies born in the United States die before their first birthday. That puts America on a par with the rates in Serbia and Lithuania. In a ranking of countries’ infant mortality rates, with number one being the best, the United States is tied with Thailand in 29th place. We rank slightly lower than Poland, Hungary, Croatia and South Korea. Our rate is more than twice as bad as the rates in Japan, Sweden, Cyprus and Italy, and three times worse than Iceland’s.”

The U.S. Centers for Disease Control and Prevention say America is substandard in various other health measures as well. For example, Americans have a “healthy life expectancy” – the number of years one lives before ailments set in – of 69 years. “That’s about the same as residents of Slovenia and Portugal, two fewer years than the British, three fewer years than the French and six fewer years than the Japanese,” the Post-Dispatch noted, adding:

“Yet we spend about twice as much on care as the British, French or Japanese. At least $1,000 of our health care spending per person, on average, pays for paperwork: administrative expenses. Unlike Americans, every citizen in Britain, France, Japan and every other developed country has government-paid health care.”

Why does America’s system cost twice as much, yet result in poorer health? This situation is outrageous. The cheapest, best, national insurance format is a Canada-style “single-payer” operation run by the government. We hope that President Obama and the new Democrat-dominated Congress move America swiftly toward that goal.

By Rep. Jesse Jackson Jr.
The Huffington Post
Posted November 26, 2008

Today’s economic crisis, and the federal government’s response, is like putting a finger in the dike to avert a major catastrophe — possibly even a depression.

But as quickly as we plug one leak, another springs forth.

Congress is seeking to avoid deflation by pumping up public confidence and economic demand to encourage consumers who have lost faith and are operating on a psychology of fear. Most immediately and importantly, the credit crunch and consumer withdrawal is affecting the automotive industry. Millions of jobs and thousand of related suppliers are at stake if the auto industry fails, or if Congress fails to act. If this iconic sector collapses it’s likely the American people will feel even greater economic pain over a more protracted period of time than is currently anticipated.

The truth is $25 billion may not be enough to save the auto industry. Worse, other troubled economic institutions may soon surface needing help. At some point Congress is going to run out of enough fingers, toes and elbows to plug the holes in our economic dike.

President Barack Obama will soon have to make a judgment to reform the nation’s “wall” if he is, as he so often says, to build a more perfect union. The wall I refer to is the U. S. Constitution.

Candidate Obama said he can’t bring the change we need on his own. He needs the American people to stay actively involved. At noon on January 20, he will say the following, “I do solemnly swear (or affirm) that I will faithfully execute the office of President of the United States, and will to the best of my ability, preserve, protect, and defend the Constitution of the United States.” If Barack Obama is going to be a truly transformative President I suggest he also can’t bring the change we need, and he wants, with the Constitution as it is.

The Constitution is the wall that surrounds everything within it. The current wall consists of material from two central sources: a supreme law and the free enterprise system. The Constitution gives direction and authority to Congress, the president, federal agencies and to the states (under the Tenth Amendment). It is this sacred document that also grants the free market, our laissez-faire capitalist system, the legal authority to operate.

The First Amendment illustrates the interaction between these two wall-building materials — the public and the private sides. That familiar amendment states that Congress shall make no law prohibiting or abridging the freedom of speech, or of the press. That’s it! The Constitution doesn’t say USA Today, New York Times, Chicago Sun-Times, Chicago Tribune, Chicago Defender, AM, FM, Satellite Radio, Newsweek, Time, Channels 2, 5, 7, or 9, PBS or CNN. Nor does it state cell phones, i-phones, the internet, and on-and-on. So, while it’s impossible to truly determine the economic impact of the First Amendment, the Constitution clearly has a major impact to our nation’s economic vitality.

Because our current economic crisis is forcing us to think outside the box, one topic worthy of renewed discussion is health care. What if the Constitution said: “All citizens shall enjoy the right to health care of equal high quality and the Congress shall have the power to implement this article by appropriate legislation?”

Beyond the obvious benefits of greater and better health care itself, imagine the economic consequences: thousands of doctors and nurses being trained; new medical colleges established and older ones expanded; increased medical research; a massive preventive health care industry springing up; new hospitals in needy urban and rural areas with the private sector, federal, state, county and local governments all working cooperatively under the authority granted by the Constitution and Congress.

The absence of this human right as a health care constitutional amendment has major economic consequences as well. Preventive medicine is almost entirely missing from our current health care system, which costs taxpayers billions.

Of course, even without an amendment, Congress can pass legislation granting universal and comprehensive health care to all Americans. That’s possible and candidate Barack Obama promised to do so in his first term in office. However, while high quality health care for all Americans can be established without a constitutional amendment, it can’t be sustained without such an amendment. Future presidents and Congresses are under no legal obligation to continue past legislative programs. For the new wall of health care to be built and sustained for as long as the nation exists it must have a constitutional foundation!

How can we afford such a system? Without a constitutional right to health care we already spend nearly twice as much as any other developed nation in the world — about $2.5 trillion or 16% of our GDP — yet nearly fifty million Americans are without health insurance and often receive their care in the most expensive manner possible, in the local hospital emergency room.

With a health care constitutional amendment, instead of plugging a hole in the dike, we would be building a wall with a strong and solid foundation. Instead of spending money on more band-aids, a revised Constitution would give direction to a unique American purpose and, over time, solve an historic problem. And with American innovation we could put millions of Americans to work expanding a more balanced economic system on the solid foundation of health care for all. Health care would be a human right protected by the American people in our Constitution.

Congressman Jackson is a seven term Member of Congress serving on the Labor Health and Human Services Appropriations subcommittee. He is the co-author with Frank Watkins of A More Perfect Union, Advancing New American Rights.

Rising Unemployment Threatens Health Care of Even Those Who Keep Their Jobs

By DAN CHILDS
ABC News Medical Unit
Nov. 24, 2008

Last year at this time, health coverage may well have been among the last things on Terri Rushing’s mind.

Her husband, David, was 55 years old and working for Champion Homes in McKenzie, Tenn. It was a job he had held for nearly a decade and a half. He had a good Blue Cross and Blue Shield health care plan through his employer, and it was also affordable. Terri Rushing said that she and her husband paid less than $200 in premiums each month.

“We never worried because we always had insurance,” she said. “My husband has worked all of his life. We’ve always had health care; we’ve never had to worry about not having it.”

But on Feb. 7, everything changed. Rushing said her husband went to work as usual, only to find that state troopers blocked his way. The factory had burned to the ground. And with the loss of the plant came the loss of the job David Rushing had worked for the past 14 years.

It is a story that is becoming more common as the country weathers the worst economic downturn in decades. And health policy experts say it may not be long before all Americans feel the impact of what is shaping up to be a national health care disaster.

Today, Terri Rushing’s job as an office worker affords her a catastrophic health coverage plan that only kicks in once she is hospitalized. David Rushing, an insulin-dependent diabetic, was able to maintain his health coverage through the health program known as COBRA. But even though it covers only him, the plan costs nearly $400 per month — twice what they were paying before.

As difficult as the situation is, eligibility for the COBRA program expires after 18 months.

“The COBRA is just going to last until the first of September of next year,” she said. “After that, we have no way to pay.”

The only way for the family to enjoy the same health coverage they had before would be for David Rushing to find another job that offers similar health coverage benefits as his old position. But now at age 56, and living in a community with two other major plant closings in recent months, David’s job prospects are grim.

Terri Rushing has started to shop around for health plans she and her husband can afford.

“I did call several plans when we found out that we were going to start paying for COBRA, basically because we could not afford coverage for both of us,” she said. “I was told over and over again that we couldn’t qualify.”

And she has encountered little sympathy. In one conversation with a health insurance company she contacted, she explained to the customer service representative her difficult situation.

“I asked him, ‘So, basically, what you’re telling me is that we have a choice between having a house payment and having health insurance.’ And he says, ‘It sounds like you have a problem.’

“That’s it. That’s all.”

No Longer an Isolated Story

While the number of Americans in a situation like the Rushings’ grows, solutions remain elusive.

“There is a huge, looming problem about what to do with people who are unemployed,” said Dr. David Nash, dean of the Jefferson School of Health Policy and Population Health in Philadelphia. “The short answer, regretfully, is that there is no good answer for these people.”

According to the Bureau of Labor Statistics of the U.S. Department of Labor, the unemployment rate rose to 6.5 percent in October, with the number of unemployed people increasing to 10.1 million. Since last year, unemployment rolls have increased by 2.8 million.

And more bad news arrived last week: the number of newly laid-off workers is officially at a 16-year high.

As these workers face the loss of their employer-provided health insurance, about 1 in 5 looks to COBRA (an acronym for the Consolidated Omnibus Budget Reconciliation Act of 1986) for help. Through COBRA, a laid-off worker can maintain the same insurance coverage he or she had through their previous employer, but at a cost. Specifically, they must pay the portion of their premiums that they had been responsible for, plus the portion that their employers previously paid — as well as an extra 2 percent of this combined premium.

The increases are a bitter pill to swallow for someone who has just lost a job and likely has less money to spread around. And the small relief provided is only temporary. Those who cannot find another option within 18 months face a new scramble for coverage once this window expires.

“Unfortunately, the COBRA legislation guarantees laid-off workers the right to continue coverage at their own expense, but does not make that coverage affordable,” said Dr. David Himmelstein, associate professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program.

“Under COBRA, health insurers may charge higher premiums to sick individuals, so anyone with a chronic condition who really needs insurance will face astronomical premiums,” he added. “As a result, the vast majority are likely to become uninsured quite quickly.”

“The cost for coverage, coupled with no or substantially reduced [income], may force additional steps to secure cash flow, including mortgage leveraging, credit card and family borrowing, to the extent it is even available,” said Jay Wolfson, associate vice president of Health Law, Policy and Safety at the University of South Florida. “And then, without new employment — perhaps even before COBRA expires — there is no reservoir for cash, and the cascade of additional economic difficulties may create a deadly flood.”

Uwe Reinhardt, professor of economics and public affairs at Princeton University, has studied the U.S. health care system for the past two decades. He agreed that if the economic picture gets much worse, many families could be heading for disaster.

“If this recession gets any deeper and lasts several years, many Americans may lose whatever savings they have, should they or their family members get sick,” Reinhardt said.

Will Everyone Be Caught in the Collapse?

But the problems may not be limited to the growing ranks of unemployed. Nash said that even if you have a secure job with a good health care plan, there is still reason to worry. The massive uptick in job losses, he said, are setting into motion a domino effect within the health care system.

The first domino falls when those who lose their jobs seek assistance through COBRA. If they can afford it, they will remain under their old policy and still pay premiums. But if they cannot, they will join the ranks of the uninsured.

For every person who becomes uninsured, health insurance companies lose revenue from monthly premiums. The situation worsens 18 months later, when those who opted for COBRA but have not yet been able to find a new employer-based plan, become ineligible for coverage. The insurance companies will take yet another hit.

“Insurance carriers, even the not-for-profit Blue Cross plans, are going to suffer mightily as layoffs accrue,” Nash noted.

And this hit from lost revenue gets passed on to employers, who, in turn, pass it on to existing policyholders.

“Many employers have faced double-digit increases in the costs of their share of health benefits this year, and that is going to continue,” Wolfson said. “In response, many employers elect to shift or eliminate cost burdens associated with health benefits to employees.”

Nash calls this additional cost burden on the average family “catastrophic.”

“The average family of four with private health insurance in the U.S. already spends $10,000 a year [for health insurance coverage],” he said. “That’s in addition to what their employers provide. … It’s staggering.”

For such a family, an increase in premiums or a decrease in employer support could mean thousands of dollars more per year — even if none of the wage earners in the family suffer a layoff.

For the health industry, the outlook may be even bleaker, at least in the short term. Nash said the signs of the U.S. medical system’s imminent catastrophe are already being seen. Along with postponement and cancellation of elective surgeries and an increase in bad medical debt, more people are experiencing decreased access to medical services. Likewise, more people are unable to afford their medication.

Unpaid health care bills are the single leading cause of personal bankruptcy in the United States. A surge in this statistic, combined with unemployment and bad medical debt, could be enough to capsize some major players in the health care industry, Nash said — an industry that contributes 17 percent of the country’s GDP.

“Nobody ever thought of this toxic byproduct of health insurance being tied to the work place,” Nash said. “This is a really dreadful knockout punch that you are not hearing anybody in positions of authority talk about.

“Very soon you can predict that the American Hospital Association will be at the White House looking for the same kind of handouts that we’re giving the auto industry.”

‘There Is Not a Silver Lining’

Most health policy experts said that, while the future of the American health care system remains uncertain, what is clear is that a change is needed.

“As someone who grew up in Germany and lived for some years in Canada and got used to portable, life-cycle health insurance, I have always been amazed that Americans preferred the ephemeral health insurance that comes with the job at a particular firm and is lost with losing that job.” Reinhardt said. “Now, the foolishness of that preference is becoming clear to many middle-class Americans who spent their life denigrating ‘government’ health insurance.

“Frankly, I find it hard to muster much sympathy for people who are waking up only now.”

“There is not a silver lining,” Nash said. “What’s coming home to roost here is the historical accident of having private health care insurance tied to the place of employment. There is no way out if it is tied to the source of where you work.”

Some options still exist for those who need health care coverage, but still need to make ends meet after a layoff.

“One is a high-deductible plan, or a limited-benefits plan,” said Merrill Matthews, executive director of the Alexandria, Va.-based Council for Affordable Health Insurance. “In addition, there are what’s known as ‘bridge’ or ‘gap’ policies. These are very easy to get, with usually only one page to fill out and they will cover you immediately, assuming you don’t have AIDS or a life-threatening heart condition.”

“To be very clear: these aren’t comprehensive policies,” he added. “But they can be a good option for someone with limited means who needs some coverage.”

Nash said families should also plan to see health care spending encroach into other areas of the family budget.

“I would urge families to have an emergency health care cash fund available, and I would tell them to think very carefully about what they’re spending for Christmas,” he said. “I know retailers don’t want to hear that, but 18 months from now, there are people who are going to regret very much that Christmas spending.”

But for some, like the Rushings, frugal living proved to be no sanctuary.

“We don’t live extravagantly,” Terri Rushing said. “We have a three-bedroom, two-bath house. We don’t drive fancy cars; we drive older cars.”

Now, she and her husband have used the money in his 401(k) to keep up with their costs of living. David received his second to last unemployment check Thursday.

“As far as surviving, we’re looking at the possibility of losing our home,” Terri Rushing said. “It just feels like our lives have been turned upside down and put in a paper bag, and now we’re waiting for someone to come by and shake us out.”

Her advice for others who find themselves on the brink of a personal health care disaster is brief.

“Expect nothing. Prepare for everything. And pray,” she said.

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Scott Mayerowitz contributed to this report.

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