PNHP

Slow start for health coalition

Slow start for health coalition

By David Lazarus
San Francisco Chronicle
Friday, February 9, 2007

It caused quite a stir when some of the biggest names in the business world came together this week to declare that they want nothing less than” a new American health care system by 2012.”

Among those seeking this revolutionary change are Wal-Mart, the country’s biggest private employer, and the Service Employees International Union, the country’s biggest labor union.

“What unites us here today is our shared belief that it will be a far greater America when we get affordable health care for all Americans,” Andy Stern, president of the union, said at a news conference Wednesday.

And no one would dispute that. But what precisely are these powerful economic forces seeking?

At this point, not even they seem to know.

“It’s symbolic — all these people coming together,” Dave Tovar, a Wal-Mart spokesman, told me Thursday. “Now we need to get some ideas on paper and figure out how we’re going to do this.”

Yeah, that’d be a good start.

Health care experts are reluctant to dismiss this private-sector initiative as a headline-grabbing publicity stunt. Any discussion of health care reform is better than none, they say.

But they point out that everyone knows the health care system is broken. What’s lacking now is a serious plan to fix things.

“Unless they’re actually willing to give us a plan, they’re being dishonest,” said Steffie Woolhandler, an associate professor at Harvard Medical School and longtime advocate of overhauling the U.S. health care system.

“They’re saying that they want to give us an omelet but they don’t want to break any eggs,” she said.

Wal-Mart and SEIU are being joined in the “Better Health Care Together” campaign by AT&T, Intel, Kelly Services, the Howard H. Baker Jr. Center for Public Policy, the Center for American Progress, the Committee for Economic Development and Communications Workers of America.

(Many Chronicle employees, including me, are represented by the Newspaper
Guild, a CWA labor group.)

Here, in their words, are the “four common sense principles” that the coalition partners announced this week as the cornerstone of their efforts:

* We believe every person in America must have quality, affordable health insurance coverage.

* We believe individuals have a responsibility to maintain and protect their health.

* We believe that America must dramatically improve the value it receives for every health care dollar.

* We believe that businesses, governments and individuals all should contribute to managing and financing a new American health care system.

The first principle is a commitment to universal coverage, but it doesn’t say how this can be achieved. The second points to a need for greater personal accountability in limiting health care costs, but once again avoids saying how this can be accomplished.

The third principle reflects statistics from the Organization for Economic Development and Cooperation showing that the United States spent an average $6,102 per person on health care in 2004 (the latest year for which figures are available). By contrast, Canada spent $3,165 per person, France $3,159, Australia $3,120 and Britain a mere $2,508.

At the same time, life expectancy in the United States was lower than in each of these other countries as of 2004, and infant mortality was higher.

And the fourth principle, well, it doesn’t say anything at all, except that nobody should be off the hook when it comes to paying for any of the changes that the group hasn’t actually called for.

“We want better health care for all Americans,” said Wal-Mart’s Tovar. “If that were simple, it would have been accomplished already.”

True, but there are no shortage of proposals already on the table, ranging from expansion of our current employer-based insurance system to switching to a government-run system similar to programs that exist in all other industrialized democracies.

The problem isn’t a shortage of ideas. The problem is finding the political will to make changes that would reinvent how medical coverage is delivered in this country and, in so doing, potentially devastate the powerful insurance and pharmaceutical industries.

Colin Evans, director of policy and standards for Santa Clara’s Intel, said members of the coalition deliberately avoided making any specific proposals in their news conference this week.

“We want to have a discussion about health care, and we want to have the right discussion about health care,” he said.

By that, Evans said he means that people shouldn’t just focus on the financial aspects of health care reform.

“That’s the wrong question,” he said. “The real question is why does health care in America cost twice as much per capita as it does in any other country with running water?”

Not much of a mystery. According to researchers at Harvard, about a third of the $2 trillion spent each year on health care in the United States is squandered on bureaucratic overhead — the result of having a wide variety of insurance plans and a wide variety of clerical procedures.

Yet despite the vast amount of money devoted to medical coverage annually, 47 million Americans remain uninsured.

“The burden of paying for health care can’t just be placed on individuals, and it can’t just be placed on business, and it can’t just be placed on the government,” said Sara Howard, a spokeswoman for SEIU. “We need to figure out a way to get all these sectors together.”

Again, not much of a mystery. A government-run insurance system funded by individual and business taxes could serve as the basis of a universal-coverage program, with private insurance plans providing additional coverage for anyone who desires it.

In 2005, the Lewin Group, a health care consulting firm, was commissioned to study the economic impact of a government-run insurance system proposed for California.

It determined that if such a system had been in place in 2006, the state would have saved about $8 billion in health care spending. From 2006 to 2015, the group concluded, total savings would run as high as $343 billion.

Nationwide, of course, the savings would be even greater, thus allowing for coverage of all uninsured Americans without an additional cost to taxpayers.

As it happens, a government-run system is one of four proposals already put forward by the National Coalition on Health Care, a separate grouping of business, financial and labor entities that for years has been calling for change in the U.S. system.

However, the National Coalition on Health Care (which includes the California Public Employees’ Retirement System but not Wal-Mart, SEIU and most other members of the new coalition) has yet to place its collective weight behind a single proposal.

Therefore, like the new coalition, it isn’t advocating anything specific — just change.

But Henry Simmons, president of the National Coalition on Health Care, said his group is already out front in seeking reform. The implication is that another business coalition will only muddy the health care waters on Capitol Hill.

“I’m not sure what their principles are,” Simmons said of the new group. “It’s not enough to just say that we ought to work on this problem.”

No, it’s not.

David Lazarus’ column appears Wednesdays, Fridays and Sundays. He also can be heard Saturdays, 4 to 7 p.m., on KGO Radio. Send tips or feedback to dlazarus@sfchronicle.com.

Copyright 2007 SF Chronicle

The problems with private health care plans

Letter to the Editor
The Gainsville Sun
Article published Feb 9, 2007

It is time to dispel the myth that only the uninsured have problems with our health care system. My wife and I worked for over 25 years and had medical insurance all that time. We retired recently and sought health insurance coverage with two major companies. We were both in good health but, much to our dismay, were denied coverage on the pretext of “pre-existing medical conditions.”

Letters from our doctors documenting non-existence of the alleged conditions were of no avail. To illustrate the absurdity of the insurance companies, I allegedly had a pre-existing condition of nodules of the lung and thyroid when, in fact, the nodules were harmless as shown by multiple follow-up CAT scans. My wife allegedly had chronic back problems when, in fact, she had a minor, temporary back strain totally corrected by simple chiropractic care.

The insurance companies gave us other fabricated “conditions.” Evidently, any history of use of the health care system tags an individual as a poor insurance risk. The fact we paid premiums for decades and had no chronic or major health problem carried no weight.

What is wrong is a profit-driven health care industry whereby the guiding principle is: Pay for coverage but don’t use it. I strongly support a single-payer health care system, as provided in Rep. John Conyers’ proposed bill H.R. 676 – The United States National Health Insurance Act.

It will provide everyone with health care, without exclusion and less cost to taxpayers.

Because a single-payer system benefits the people, not the insurance companies, H.R. 676 faces formidable opposition from our corporate-driven politicians.

Larry Thompson,
Gainesville

Instability of federal employees’ premiums

Health fees pain federal workers

By Gilbert Chan
The Sacramento Bee
February 11, 2007

Wayne Forbess did a double take after seeing that his monthly premium for health insurance from Kaiser Permanente would shoot up by 50 percent this year.

The 78-year-old Folsom resident and thousands of other federal workers and retirees in Northern California are coping with double-digit increases in the monthly payments for HMO coverage. Federal workers enrolled in three other plans have seen their monthly payments increase by more than 20 percent.

The OPM administers 284 insurance choices for 8 million federal workers and retirees and their family members, spending more than $31 billion a year. About 25 percent of the members are signed up in one of the 209 health maintenance organization programs.

Most of the remaining 75 percent are enrolled in major national fee-for-service plans such as Blue Cross and Blue Shield, according to the Government Accountability Office.

Moving to turn around six straight years of increases in these PPO plans, the government opted to pull $500 million from reserves to reduce premiums. But the government did not make a similar buy-down with HMO rates.

Under the government premium formula, those who prefer richer benefits have to pay more. The formula is aimed at directing workers into the plans with less expensive rates. In general, these plans often offer smaller premiums but require larger co-payments or fewer benefits.

At the same time, the law limits how much of the premium the government will have to pick up. The employee’s share is at least 28 percent — and much more if the insurer’s rates take a leap, as Kaiser’s did this year in Northern California.

“The idea is to keep the government share the same from year to year. The enrollee is stuck paying the difference,” said Mark Merlis, a health-care consultant and expert on federal health benefits.

“There is a cap on what the government pays. But there’s no cap on what the employee pays. We pay a bigger share every year,” said Jacqueline Simon public policy director of the American Federation of Government Employees, the largest federal employee union, representing 600,000 members.

http://www.sacbee.com/103/story/121316.html

Comment:

By Don McCanne, MD

So you would like to have the health care coverage that members of Congress have – even if that means that your premium could increase 50 percent in one year?

It’s important to understand the Federal Employees Health Benefit Program (FEHBP) since many reform proposals recommend using similar private plans to expand coverage to everyone. The plans are mostly PPOs and HMOs. They do vary in their benefits and in their required cost sharing. Consequently, premiums vary considerably.

PPOs have had greater flexibility in keeping their premiums competitive by reducing benefits and increasing cost sharing, especially through large increases in the deductible. HMOs, such as Kaiser, have had less flexibility in that they are not only insurers but also health care delivery systems. As such, their benefits tend to be more comprehensive, now requiring higher premiums than the less comprehensive PPO plans. FEHBP requires the beneficiaries to pay much of the premium difference, allowing them to buy up to richer plans if they so desire.

But there is a political purpose that may not be so obvious at first glance. The administration wants federal employees to select plans with fewer benefits and with more of the costs shifted to the employees. Obviously that reduces the government’s funding of health care for federal employees.

This year they went one step further. They used reserves to minimize premium increases for low-cost PPO plans while allowing full premium increases for high-cost HMO plans. This advances the Bush “ownership society” agenda of having federal employees own more of their own medical debt.

The FEHBP program perpetuates inequitable access to health benefits, inequitable funding of health care, profound administrative waste, and, in so doing, takes away choice of health care providers, limiting access to the insurers’ network providers. And now the FEHBP program is increasing the financial burden of those who do need health care, limiting access because of the lack of affordability.

Why would we ever adopt the highly flawed FEHBP model for reform of our health care system when a single payer national health insurance program would dump this wasteful, middleman industry and provide all of us with affordable, comprehensive coverage?

The next congressperson who says that we should all have the same coverage that they now have, tell him or her that they can keep their lousy program for themselves, but let the rest of us have our own comprehensive national health insurance program that would let us access the care we need without creating unnecessary financial burdens.

Genetic discrimination by insurers

Individuals with Genetic Conditions Twice as Likely to Report Denial of Health Insurance than Individuals with Other Chronic Illnesses

Johns Hopkins Berman Institute of Bioethics
February 12, 2007

A new study published in the February 2007 issue of the American Journal of Medical Genetics reveals that individuals with genetic conditions are twice as likely to report having been denied health insurance than individuals with other chronic illnesses.

In the study, more than a quarter (27 percent) of individuals with genetic conditions and serious medical conditions reported having been denied health insurance or offered it at a prohibitive rate.

Almost all of the individuals in the study (89.7 percent) said they obtained their health insurance through either their employer (59.4 percent) or their spouseĆ¢ā‚¬ā„¢s employer (30.8 percent). Nearly half of employed individuals (48.9 percent) said they felt they could not leave their jobs because they would lose their health insurance.

At the federal level, the Americans with Disabilities Act proscribes discrimination against persons with disabilities which includes those with genetically-related conditions. The Health Insurance Portability and Accountability Act (HIPAA) expressly forbids a group health insurance plan from using genetic information to establish rules for eligibility or continued eligibility. HIPAA also prohibits insurance companies from treating genetic information as a Ć¢ā‚¬Å“pre-existing condition in the absence of the diagnosis of the condition related to such information.Ć¢ā‚¬Ā Individuals cannot be denied health care coverage for a medical condition as a result of a genetic marker for the condition. However, individuals can be denied if they have symptoms of genetic disease. As such, HIPAA provides no protection for the vast majority of respondents in the new study.

Brandi Braud Scully, MD

And…

Genetic anti-bias bill is back

By Doug Trapp
American Medical News
February 19, 2007

The seventh time may be the charm for backers of a bill to ban genetic discrimination in health insurance plans and the workplace.

The Genetic Information Nondiscrimination Act (HR 493) would make it illegal for insurers to deny coverage to a healthy individual based solely on a genetic predisposition to a specific disease and for employers to use individuals’ genetic information in personnel decisions.

President Bush also supports the measure.

The U.S. Chamber of Commerce has been a key opponent of the bill because the organization feels it goes too far, according to Michael Eastman, executive director for labor policy.

Employers shouldn’t have to face potential compensatory and punitive damages for accidental disclosures of genetic information.

“Ultimately, it will be difficult to separate genetic information from medical information,” Eastman said.

http://www.ama-assn.org/amednews/2007/02/19/gvsa0219.htm

Comment:

By Don McCanne, MD

Should genetic information ever be used to deny an otherwise healthy person health care coverage? Should actual genetic disease ever be used to deny a person health care coverage? Is there any reason at all to separate genetic information from medical information in making decisions about health care coverage?

Although the Genetic Information Nondiscrimination Act certainly should be supported, shouldn’t we also be supporting legislation that would ensure that everyone has genuinely effective health care coverage?

At this pace of incremental reform, global warming will get us before we can ever hope for comprehensive health reform.

Restructured health insurance for So. California grocery workers

Declining Health Coverage in the Southern California Grocery Industry

By Ken Jacobs, Arindrajit Dube and Felix Su
UC Berkeley Center for Labor Research and Education
January 2007

In March 2004, after a four-and-a-half month strike and lockout, the United Food and Commercial Workers (UFCW) and three major grocery chains signed a contract that significantly restructured health insurance coverage for grocery workers in Southern California.

Among other provisions, the new contract in Southern California:

* Increased waiting periods from four months to twelve months for individual coverage (18 months for clerks) and 30 months for family coverage.

* Increased co-pays, co-insurance and deductibles under the new plan, while restricting plan options.

In addition to the changes in health benefits, wages rates for new hires were reduced.

Our central findings were as follows:

* In September 2003, prior to the strike, 94 percent of the union grocery workers in Southern California had health coverage through their employer; by September 2006 that number had fallen to 54 percent. Coverage for workers hired under the new contract was a mere 7 percent.

* As of September 2006, 66 percent of all workers and 29 percent of the workers hired under the new contract were eligible for health benefits in Southern California. The low eligibility rate is a result of longer waiting periods combined with increased worker turnover.

* Prior to the strike, the annual turnover rate for grocery workers in Los Angeles was 19 percent; after the new contract went into effect, annual turnover rose to 32 percent. Turnover of grocery workers in their first year of employment rose from 30 percent to 52 percent.

* Our survey of union members found important impacts on health care utilization due to the reduction in coverage. Of workers with a chronic health condition hired under the new contract, 20 percent fewer of were receiving treatment as compared to their co-workers who were eligible for the higher tier plan. This controls for differences in age, gender and health status between the two groups of workers. All things equal, 20 percent more of the workers hired under the new contract reported to have delayed care when they needed it compared to their coworkers.

Conclusion:

Unionized groceries in Southern California have long been a source of family supporting jobs with full family benefits. The changes in grocery health plans and reduction in starting wages in April 2004 has dramatically reduced health coverage in the grocery industry in the Southern half of the state. Jobs that once provided full time work and full family benefits are now much more likely to be part-time and un-benefited.

The member survey confirms what we would expect from the literature about health care utilization. Workers without health insurance are more likely to delay needed care and less likely to receive treatment for chronic health conditions. Treatment delays may have long term adverse effects on both health and health costs.

http://laborcenter.berkeley.edu/healthcare/grocery_industry07.pdf

Comment:

By Don McCanne, MD

In this age of two-worker households, employment as a grocery worker provided a very important benefit. Not only was the job a good second income source, it also provided the family with generous, union-negotiated, employer-sponsored health benefits coverage. This allowed the spouse greater options in employment, including self-employment, as quality and availability of employer-sponsored coverage continued to decline.

Faced with ever-rising health care costs, the grocery industry decided that it would no longer be the source of this important benefit for many Southern California families. Most of you remember the very painful strike and lockout of three years ago that ended in an agreement which achieved this goal of the grocery industry.

This study confirms the fully predictable results of that settlement. Family breadwinners are being replaced with an unstable part-time workforce with high turnover and no benefits. Employment as a grocery worker is no longer suitable for an individual looking for family health coverage. Also, the lack of coverage for this part-time workforce has predictably impaired health care access.

This study is presented not so much to decry the Walmartization of the grocery industry (though certainly an important issue), but more to point out that private group plans and private individual coverage are no longer effective in ensuring affordability and access of adequate coverage. It has taken only three years for coverage to fall from 94 percent to 54 percent of grocery workers.

Reasonably comprehensive coverage must be 100 percent automatic for everyone. Regardless of employer mandates, individual mandates, tax credits, or whatever, private group and individual plans will never get us there. We truly do need a single payer program of national health insurance.

Timid ideas won't fix health mess

By Marie Cocco
Columnist
Sacramento Bee
Published 12:00 am PST Saturday, February 10, 2007

John Edwards is trying to get ahead of the political curve, but he would send us back to the future. To 1993, to be exact.

Edwards would repeat the mistake that was at the heart of Hillary Rodham Clinton’s misadventure in trying to fix a health insurance system that was then, and is now, so out of whack that it manages to cover fewer and fewer Americans at higher and higher cost.

Like Clinton did, Edwards seems to believe that you can get the private insurance industry to do something it refuses to do because, in essence, doing what Edwards wants would put the industry out of business. He wants insurers to cover everyone, no matter how sick and expensive they are. He wants employers to continue to carry on their ledgers a cost that is ever more burdensome to them and to their workers, onto whose shoulders more of the health-insurance tab is being shifted.

The 2004 Democratic vice presidential nominee and 2008 presidential hopeful knows that no matter how many times our health insurance crazy quilt is ripped up and stitched back together, it still will fail to cover millions of Americans.

So Edwards wants them to be able to buy a new public insurance plan that would be like Medicare, but not exactly. And he wants affluent people to pay more taxes to support coverage of the less fortunate, but not directly.

Instead of simply asking for a straightforward tax to pay for covering the uninsured, Edwards falls back on that popular circumlocution, the tax credit. The credits are indirect subsidies that would be given to individuals so they could then purchase insurance. The political virtue of tax credits is that their cost is always half-hidden beneath a pile of budget documents — unlike tax hikes that show up as money withheld from paychecks, but pay directly for a government service. Because of this obfuscation, politicians in both parties love tax credits.

Edwards wants congratulations for being the first serious presidential candidate to offer a comprehensive idea for universal health insurance coverage, something every Democratic aspirant is bound to do eventually. Edwards is a smart man and a cunning politician. But his health insurance plan suffers from an odd combination of ailments.

One is political amnesia. This Clinton-like plan that would have both individuals and employers buy into closely regulated health insurance pools failed more than a decade ago — in part because it was so complicated as to be incomprehensible. Another is timidity.

Edwards won’t acknowledge that the current system of private insurance is irreparably broken.

It has failed to expand coverage to millions of workers who are employed by small business, or who work part time, or who toil at low wages — companies with high proportions of low-wage workers are far less likely to offer insurance than those whose employees earn more, according to research by the Kaiser Family Foundation. Since 2000, the portion of businesses that offer any insurance to even part of their work force has fallen from 69 percent to 61 percent.

Over the past year, a solid majority of those who do have coverage — 60 percent — experienced an increase in the amount they are responsible for paying under their plan, the Employee Benefit Research Institute says. Almost a third of covered workers reported difficulty in paying for basic necessities such as food, heat and housing because of rising health-care costs.

This isn’t much of a foundation upon which to construct a new system. In the years since Clinton tried to build on this inhospitable terrain, the ground has eroded further. It makes no sense to try to shore it up with an awkward hybrid of public requirements and private insurance that would keep in place unnecessary complexity and bureaucratic expense.

Edwards’ advisers say the candidate didn’t push public, single-payer insurance — like Medicare — because the employer-based system is what we have today and therefore, it would provide the quickest way to cover the uninsured.

But we also have Medicare today. The elderly still get care from private doctors and hospitals, and administrative costs are a fraction of what they are in the private insurance industry. And people tend to like it.

It would be just as easy — and certainly simpler — to use Medicare as the foundation for a new insurance system to eventually cover everyone. But that would require candidates to be leaders — and show more courage than those politicians who simply say they have a plan.

Candidates need to speak out now on health care

Portsmouth Herald Editorial
Sunday, February 11, 2007

Major health-care reform has become an urgent political and economic issue that, along with energy policy, likely will dominate the domestic agenda battle in the 2008 electoral campaign.

Of course, there is no news here. Major health-care reform has been an endless headline loop stretching back for more than five decades. What is different in 2007 is the culmination of evidence that the 20th-century innovation of an employer-based health-care system has reached its latest exhaustion point.

According to a variety of government and private nonprofit reports, between 44 million and 47 million Americans are without health care. More revealing, according to the U.S. Census bureau, in New Hampshire an estimated 135,000 people, including 17,000 children, are without health insurance. According to government estimates, in 2005 some 41 percent of moderate and middle income Americans went without health care for part of the year — while 53 percent of those earning less than $20,000 went without insurance for all of 2005. And the number of uninsured full-time workers has continued to grow across the country, either because insurance premium costs have become too expensive for employers or their employees.

Not unlike the recent call by some major energy companies for federal mandates on carbon dioxide emissions to combat global warming, a newly formed coalition of major corporations, labor unions and bipartisan activists has set a goal for universal health care because the current system is proving to be a competitive economic drain on American business.

In an era of rapid globalization, this matters to businesses small and large and it crosses all state borders. The United States is ranked 37th in the world for health system performance by the World Health Organization and pays twice as much for health care than are the other developed countries while getting fewer benefits.

The oddity of our system is that if one has a comprehensive and economically viable insurance plan, the system works just fine. But for those on the financial edge, the scenario is less pleasant — which is why medical-related bankruptcies continue to rise at an alarming rate. We can no longer afford to fit a predominant free market solution circle into the complicated square peg of health care — or allow entrenched financial interests such as insurance companies to determine health-care cost and access.

We all pay one way or another for the massive inefficiencies in the system through higher premiums and higher costs.

“The path we’re on now is not sustainable,” said Thomas Clairmont, a physician at Portsmouth Regional Hospital, at a local health-care reform presentation last month.

Clairmont is a member of Physicians for a National Health Program, a group that advocates a publicly financed, privately delivered health-care program available to all U.S. residents.

This is but one of many plans being debated across the country among doctors, citizens, health-care industry experts, insurance companies and elected leaders in Congress.

Some plans take an incremental approach and others call for bolder reform. President Bush’s latest reform plan calls for using the tax code to broaden access to health care. Democratic presidential candidate and former Sen John Edwards of North Carolina told the Herald recently of his plan to enact “transformational change” to create universal health care for all Americans with competing public and private insurance plans as a foundation.

We expect all the presidential candidates will present their own comprehensive plans to voters as the New Hampshire primary campaign unfolds. While we withhold advocating a specific approach, we encourage our readers to use the unique access we have to the primary candidates and not let them off the hook.

We need to engage — or “grill,” as Dr. Clairmont said — the candidates and our congressional delegation with specific questions. What is their plan? Their philosophy? How will they finance it? What sacrifices will be asked of every individual and their families?

Acting and speaking out now does not insure necessary reforms to a dysfunctional system. Not speaking out guarantees an unaffordable and unhealthy path to more of the same.

— Herald Sunday

Study: Minnesota doctors prefer single-payer universal health system

by Carissa Wyant
Staff Writer
Minneapolis / St. Paul Business Journal
Monday, February 12, 2007

A new study by the University of Minnesota has found that most of the state’s physicians surveyed prefer a single-payer universal health insurance system.

The study, conducted by the University of Minnesota School of Public Health and the Universal Health Care Action Network-MN and published in the February issue of Minnesota Medicine, found that 63.4 percent of state physicians believe that a single-payer universal health insurance system would offer the best health care to the greatest number of people. According to a press release, almost 25 percent of Minnesota physicians thought health savings account systems were best, and 11.8 percent were in favor of managed care.

Dr. Charles Oberg, the study’s co-author and associate professor at the University of Minnesota School of Public Health, commented, “Many doctors are becoming increasingly disappointed and frustrated with the health care system as it stands. Insurance hassles, heavy paperwork, and patients’ inability to get the care they need make it very problematic.”

The study also found that 71 percent of Minnesota doctors said they would accept a 10 percent reduction in fees for a “very significant” reduction in paperwork, and 63.8 percent favored physician payment under a salary system.

Researchers mailed surveys with questions on health care financing and medical practices to a random sample of 1,061 Minnesota physicians drawn from the Minnesota Board of Medical Practice. Thirty-nine percent of the surveys were completed and returned. Data was compiled and analyzed by the University of Minnesota School of Public Health.

cwyant@bizjournals.com | (612) 288-2108

Timid ideas won’t fix health mess

By Marie Cocco
Columnist
Sacramento Bee
Published 12:00 am PST Saturday, February 10, 2007

John Edwards is trying to get ahead of the political curve, but he would send us back to the future. To 1993, to be exact.

Edwards would repeat the mistake that was at the heart of Hillary Rodham Clinton’s misadventure in trying to fix a health insurance system that was then, and is now, so out of whack that it manages to cover fewer and fewer Americans at higher and higher cost.

Like Clinton did, Edwards seems to believe that you can get the private insurance industry to do something it refuses to do because, in essence, doing what Edwards wants would put the industry out of business. He wants insurers to cover everyone, no matter how sick and expensive they are. He wants employers to continue to carry on their ledgers a cost that is ever more burdensome to them and to their workers, onto whose shoulders more of the health-insurance tab is being shifted.

The 2004 Democratic vice presidential nominee and 2008 presidential hopeful knows that no matter how many times our health insurance crazy quilt is ripped up and stitched back together, it still will fail to cover millions of Americans.

So Edwards wants them to be able to buy a new public insurance plan that would be like Medicare, but not exactly. And he wants affluent people to pay more taxes to support coverage of the less fortunate, but not directly.

Instead of simply asking for a straightforward tax to pay for covering the uninsured, Edwards falls back on that popular circumlocution, the tax credit. The credits are indirect subsidies that would be given to individuals so they could then purchase insurance. The political virtue of tax credits is that their cost is always half-hidden beneath a pile of budget documents — unlike tax hikes that show up as money withheld from paychecks, but pay directly for a government service. Because of this obfuscation, politicians in both parties love tax credits.

Edwards wants congratulations for being the first serious presidential candidate to offer a comprehensive idea for universal health insurance coverage, something every Democratic aspirant is bound to do eventually. Edwards is a smart man and a cunning politician. But his health insurance plan suffers from an odd combination of ailments.

One is political amnesia. This Clinton-like plan that would have both individuals and employers buy into closely regulated health insurance pools failed more than a decade ago — in part because it was so complicated as to be incomprehensible. Another is timidity.

Edwards won’t acknowledge that the current system of private insurance is irreparably broken.

It has failed to expand coverage to millions of workers who are employed by small business, or who work part time, or who toil at low wages — companies with high proportions of low-wage workers are far less likely to offer insurance than those whose employees earn more, according to research by the Kaiser Family Foundation. Since 2000, the portion of businesses that offer any insurance to even part of their work force has fallen from 69 percent to 61 percent.

Over the past year, a solid majority of those who do have coverage — 60 percent — experienced an increase in the amount they are responsible for paying under their plan, the Employee Benefit Research Institute says. Almost a third of covered workers reported difficulty in paying for basic necessities such as food, heat and housing because of rising health-care costs.

This isn’t much of a foundation upon which to construct a new system. In the years since Clinton tried to build on this inhospitable terrain, the ground has eroded further. It makes no sense to try to shore it up with an awkward hybrid of public requirements and private insurance that would keep in place unnecessary complexity and bureaucratic expense.

Edwards’ advisers say the candidate didn’t push public, single-payer insurance — like Medicare — because the employer-based system is what we have today and therefore, it would provide the quickest way to cover the uninsured.

But we also have Medicare today. The elderly still get care from private doctors and hospitals, and administrative costs are a fraction of what they are in the private insurance industry. And people tend to like it.

It would be just as easy — and certainly simpler — to use Medicare as the foundation for a new insurance system to eventually cover everyone. But that would require candidates to be leaders — and show more courage than those politicians who simply say they have a plan.

Expanding uninsurance through premiums

Insurance Premium Cost-Sharing and Coverage Take-up

Kaiser Family Foundation
February 2007

One of the many reasons an individual may be uninsured is that she or he decides an employer’s offer of health insurance is too expensive. Several studies have noted the likelihood that a worker will decline an employer’s offer of health insurance increases with the amount he or she is required to contribute. Alternatively, employees may obtain coverage through a spouse, opt for publicly provided coverage if eligible, or decide to do without coverage entirely. This issue brief looks at the connection between premiums and the percent of workers who enroll in employer plans using the two most recent years of the Kaiser/HRET Employer Health Benefits Survey (EHBS). Several of these analyses suggest that the required worker share of the premium can be an obstacle to coverage that raises concerns about the affordability of private health coverage.

http://www.kff.org/insurance/snapshot/chcm020707oth.cfm

Comment:

By Don McCanne, MD

As long as individuals are required to pay some portion, if not all, of the premium for health insurance, take-up will never be 100 percent. Even with an individual mandate to purchase insurance, take-up will still not be 100 percent since too many individuals simply do not have the funds to pay the required contribution.

Entering “universal coverage” into Google just now produced over 23 million responses. Everyone is calling for universal coverage. Yet when you look at the new proposals and the various coalition efforts, none of them would result in universal coverage. Either the proposals have serious flaws such as the individual mandate requirement, or, worse, many of the hyped coalition efforts have no substantial proposals at all.

Right now many are calling for solutions that involve “shared responsibility.” That is code language for reducing the employers’ responsibilities for funding care and shifting more of it to individuals, especially in the form of individual mandates to purchase insurance and in greater cost-sharing when accessing care.

If we are serious about achieving universal coverage, we will have to adopt policies that will make enrollment completely automatic for absolutely everyone. That means that we cannot make enrollment dependent on partial or full payment of a premium.

There is only one proposal that would automatically achieve 100 percent enrollment: single payer. And, oh yes, it’s also the only proposal that would make both health care coverage and health care access affordable as well.

When these coalitions and pseudo-reform advocates claim that they are supporting “universal coverage,” there seems to be an aura of political correctness that prevents us from using the four-letter “l” word that would describe them precisely. But at least we could tell them that their pants are on fire!

(Is anyone up for a national “PANTS ON FIRE” campaign?)

Urban Institute report on SCHIP

Coverage Patterns Among SCHIP-Eligible Children and Their Parents

By Genevieve M. Kenney and Allison Cook
Urban Institute
February 9, 2007

SCHIP was enacted in 1997 to expand health insurance coverage to low-income uninsured children. Under SCHIP, states could use enhanced federal matching dollars to expand public coverage for children beyond Medicaid eligibility levels.

This study finds that most SCHIP enrollees do not have access to employer-sponsored insurance through their parents.

In addition, our analysis indicates that just 25 percent of all SCHIP enrollees live in families where one parent (in single-parent families) or both parents (in two-parent families) have employer coverage.

Following the implementation of eligibility expansions under SCHIP and the significant investments in outreach and enrollment simplification under both Medicaid and SCHIP, uninsurance rates have fallen for low-income children. Coverage gains have slowed, however, and the most recent CPS even indicated that uninsurance may be on the rise for children.

This brief has three important implications for SCHIP as it faces reauthorization. First, federal funding will have to be increased substantially if the allotments are to include coverage for the close to 2 million uninsured children who are eligible for SCHIP but not yet enrolled. Second, many children stand to lose coverage altogether if federal funds are inadequate to meet existing program need. Finally, addressing the insurance coverage needs of low-income parents through SCHIP would likely improve the lives of both low-income children and their parents but would require a substantial expansion in the federal funding commitment to the program.

http://www.urban.org/publications/311420.html

Full report: http://www.urban.org/UploadedPDF/311420_Coverage_Patterns.pdf

And…

HHS Proposes Nearly $700 Billion Budget for Fiscal Year 2008

U.S. Department of Health & Human Services
February 5, 2007

The President’s budget proposes to reauthorize State Children’s Health Insurance Program (SCHIP) for five more years, to increase the program’s allotments by $5 billion over that time, and to target SCHIP funds more efficiently to those most in need.

http://www.hhs.gov/news/press/2007pres/20070205.html

Comment:

By Don McCanne, MD

The State Children’s Health Insurance Program (SCHIP) continues to fall far short of its goal to insure all lower-income children who qualify. The fact that uninsurance in children is on the rise again suggests that the SCHIP program may have reached its fully predictable steady state in which attrition in enrollment offsets new gains.

An increase in outreach and enrollment efforts might be able to slightly shift the steady state threshold, but it can never be effective in enrolling all eligible children and keeping them enrolled.

Nevertheless, current efforts at reform are targeted to expanding the coverage of children, and perhaps even their uninsured parents. At a minimum, there does seem to be a consensus that the SCHIP program does need to be reauthorized this year, or it will be terminated.

What does the Bush administration propose? No funds for expansion of eligibility, inadequate funds to maintain even the deficient current level of enrollment, and, most ominously, targeting SCHIP funds “more efficiently to those most in need.” What does that mean? In testimony before Congress this week, HHS Secretary Michael Leavitt explained that existing state expansions of SCHIP eligibility would no longer be partially funded by the federal government because it is more important to apply those funds to the budget deficit.

The 2 million children currently eligible for SCHIP but not enrolled are only one-fifth of the uninsured children in the United States. While ignoring the other four-fifths of the children plus everyone else without insurance, the politicians are entering a debate to show which of them are the least heartless in their efforts to salvage, in a somewhat tattered state, this program that falls so far short of our goals to remove financial barriers to health care.

SCHIP does need to be reauthorized, but only as an urgent stopgap measure while we move forward briskly toward reform that would automatically enroll absolutely everyone in a comprehensive national health insurance program. But if the past few decades are any indication, we can anticipate the celebration of the reauthorization of SCHIP, and then… nothing further. That would be heartless.

SEIU President Andy Stern Rams Ahead with Corporate Partnerships in Healthcare Industry

By ALAN BENJAMIN

Reprinted from January-February 2007 issue of Unity & Independence, a supplement to The Organizer Newspaper, San Francisco.

A few weeks ago, The Wall Street Journal ran yet another glowing article about SEIU President Andy Stern and his drive to press the unions to carry out “an attitude adjustment.”

The Journal asked Stern if he thought the unions would ever be able to organize Wal-Mart in the United States. Stern’s answer was revealing. “We have not been trying to organize them but to change their business model. A traditional organizing drive is not going to be successful because the laws are so tilted on behalf of a company as big as Wal-Mart, not to mention the fact that Wal-Mart has an emergency-response team that flies out of Bentonville at the moment the word ‘union’ is used in the store. I think Wal-Mart has the opportunity to create an entirely new model of worker representation. The question is, do they want partners?” (Jan. 22, 2007)

Working people across the country understand full well that corporate America, beginning with Wal-Mart, is on a search-and-destroy mission to dismantle the unions and lower their labor costs. If unions are to survive as instruments to defend the interests of their members and of the working-class majority in this country, they have to challenge all the unjust laws and return to the fighting stance and traditional organizing drives that built the unions in the first place.

Dr. Martin Luther King, Jr., and the Civil Rights Movement did not shy away from challenging the unjust Jim Crow laws because these laws were so tilted on behalf of a system of racism and oppression against Blacks. They did not seek to become partners with the Ku Klux Klan in the hope the Klan could be brought around to a new model of race relations in this country.

But isn’t this what Stern is proposing?

“Healthcare Partnership” with Wal-Mart

In his interview with The Wall Street Journal, Stern explained his reasons for seeking healthcare partnerships with the employers.

“We must try to be partners with our employers, who have told us we should change and understand their competitive issues and try to add value, not create problems,” Stern said. “Unions need to appreciate there are ways in which we add value and can be helpful. This is especially the case in relation to healthcare. The employer-based healthcare system is dead. It’s a relic of the industrial economy, and it makes corporations unable to compete fairly when America is the only country that asks its employers to put the price of healthcare on the cost of its products.”

These are not just empty words. Stern has been working overtime offering his “helpful” services to some of the most anti-union and retrograde sectors of Big Business in this country.

As we go to press, Stern and Wal-Mart have just announced a healthcare partnership “aimed at attaining universal healthcare coverage.” The partnership also includes Intel Corp., AT&T Inc. and Kelly Services Inc., a temporary staffing agency. According to the Associated Press release of Feb. 7, “no specific policies were proposed to achieve this goal. Wal-Mart CEO Lee Scott said that Wal-Mart is not committed to spending more on healthcare or making any immediate promises to provide health coverage to more workers.”

Labor activist Marnie Goodfriend of Labor Beat in Chicago lambasted Stern for “rubber stamping” Wal-Mart’s empty-rhetoric support for universal healthcare. “Stern should be putting intense public scrutiny and pressure on Wal-Mart for its exploitative and degrading work conditions,” Goodfriend noted, “not using Wal-Mart’s paper-thin public support for healthcare to undermine his own campaign against the company.”

It is hard to believe that just two years ago, SEIU leader Anna Burger publicly denounced the Congressional Black Caucus for organizing a joint fundraiser with Wal-Mart.

The Washington Post on May 15, 2005, reported that Burger wrote caucus members “to express SEIU’s disappointment that the Congressional Black Caucus has given Wal-Mart an opportunity to fashion a false image as a friend of African Americans and of working people generally by organizing the April 27 joint fundraiser.”

“As the largest employer in the world,” Burger wrote, “Wal-Mart’s labor relations model is now undermining standards for all American workers. The average salesclerk makes below the poverty line, and a majority of Wal-Mart workers cannot afford the company’s health insurance plan. … Wal-Mart has forced its more than 600 suppliers to shift operations overseas to exploit workers there at even lower wages while destroying good American jobs.”

How true. At the time, SEIU was still part of the AFL-CIO and its campaign to organize Wal-Mart employees into genuine unions. But as Stern revealed in his new book, “A Country that Works: Getting America Back on Track,” it was necessary for the SEIU to break with the AFL-CIO, “because of the failure on the part of the AFL-CIO to modernize its strategic approaches to employers in order to take into account their competitive business needs.”

Today, instead of organizing Wal-Mart workers into unions, Stern’s goal is to “change Wal-Mart’s business model” by doing exactly what Anna Burger accused the Congressional Black Caucus of doing two years ago — giving Wal-Mart an opportunity to fashion a false image as a friend of working people, when in fact Wal-Mart is one of its main enemies.

Any more doubts as to the nature of Stern’s split from the AFL-CIO?

From the Business Roundtable to Safeway

The Wal-Mart partnership is only one of many so-called “healthcare partnerships” Stern has been building of late.

On Jan. 12, 2007, Stern announced the launching of a partnership with AARP and the Business Roundtable called Divided We Fail. Their purpose, as a press release puts it, “is to work together to urge action from political leaders to attain health and long-term financial security for all Americans.”

The Los Angeles Times (Jan. 16) noted that, “two seemingly strange bedfellows, the president of SEIU and the director of the Business Roundtable, which represents the nation’s leading corporations, have joined hands with AARP to overhaul healthcare along the lines of the Massachusetts Plan, the only comprehensive state proposal that has been enacted.”

The Times continues, “Divided We Fail relies primarily on a requirement that individuals must purchase private health insurance. The state would redirect funding that had been used to cover hospital care for the uninsured to subsidize health-insurance premiums. The plan also levies a token fee on employers that do not provide coverage.”

One month earlier, on Dec. 13, 2006, Stern joined up with Safeway CEO Steve Burd and Oregon Democratic Senator Ron Wyden to unveil the “Healthy Americans Act.” The details of this plan are worth examining, as they illustrate everything that is wrong with all the partnerships that Stern is putting together with these giant corporations.

The Healthy Americans Act would mandate individuals to purchase private insurance — just as the Divided We Fail plan does — and it would slash and cap costs to business. Depending on size and income, businesses would be required to pay a tax of 2% to 25% of the average private insurance premium. The tax would be used to subsidize private insurance premiums for low-income people. (At this time, employers pay an average of 75% of health insurance premiums.)

Individual workers would then be required to buy private insurance. Employers who offered health insurance prior to enactment of Wyden’s legislation would contribute lump-sum wage payments to their employees equal to the cash value of the health insurance they provided. In this scenario, the burden of rising healthcare costs is thus shifted from the employer to the worker. This means that the employee is now left to his or her own to buy their own healthcare insurance package.

This is a major shift of wealth from working families to corporations.

Don Bechler, chair of the California Universal Health Care Organizing Project and a former UAW and IAM negotiator, said: “The Wyden proposal is not something labor can support. It eliminates the collective bargaining tool for working people and leaves them to the mercy of insurance industry. It destroys the concept of defined benefits. It sells the plan with a capped wage payment to workers with no caps on insurance costs. It is a windfall for the employers and a new economic burden on workers. It is a plan that no labor negotiator should ever try to sell to the workers of America. I do not know why Stern is supporting this, but I would not want him negotiating my health plan.”

SEIU Locals Resisting Stern’s New Course

When Stern tells The Wall Street Journal that unions today need an “attitude adjustment” he is saying that unions need to abandon the traditional model of trade unionism based on the notion that bosses and workers have contradictory interests due to their respective roles in the sphere of production, and instead should seek “partnerships” with the employers aimed at helping their bottom line.

But SEIU locals across the country are resisting this new course.

SEIU Local 73 in Chicago announced Feb. 7 that its 100-member executive board voted unanimously to endorse and campaign for passage of HR 676, the “Expanded and Improved Medicare for All Act” introduced by Congressman John Conyers (D-Mich). This single-payer legislation is also known as the “United States National Health Insurance Act.”

SEIU Local 73 represents over 25,000 city, state and county public workers, including school employees and bus drivers throughout Illinois and Northwest Indiana.

HR 676 would institute a single-payer healthcare system in the United States by eliminating healtcare insurance companies altogether and expanding a greatly improved Medicare system to every resident.

HR 676 would cover every person in the United States for all necessary medical care — including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, chiropractic and long term care. HR 676 ends deductibles and co-payments. HR 676 would save billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

Isn’t this what all SEIU members want and deserve? Isn’t this what all union members and all working people in this country deserve?