PNHP

System Isn't Healthy But Insurers' Bottom Lines Are

System Isn't Healthy But Insurers' Bottom Lines Are

Malcolm Berko
Copley News Service

Dear Mr. Berko: When you spoke at the fundraiser for our church about the future of our country, you pointedly said that we must have a single-payer health care system. You noted that there are 41 million uninsured in the country who can’t afford health care. You said they must have medical access but (and the following are your words) “the health insurance industry’s intentional high costs exclude them from participation.”

Are you nuts or something? How can you preach such socialistic ideas in a capitalistic society? They would be able to afford health care if they were worth more to their employers so they would be paid better. Do you know how much our leftist government has screwed up our country? And it would do the same without a private health care system if we allowed it to happen.

You have no idea of the wonderful things that health insurance companies like Aetna have done to help Americans. Their contributions to health care are unequaled in any other country in the world. You shouldn’t preach left-wing, pinko communist ideas to people who invite you to their homes. Shame on you.

C.S.
Elkhart, Ind.

Dear C.S.: Why do I suspect that my friend Charming Charlie, the insurance agent from Kokomo asked you to write? And why do I believe that you may be employed by one of the Big Eight (Aetna, Cigna, Coventry, Health Net, Humana, WellPoint, the Blues or United) health companies?

I’m not going to touch your comment about the federal government except to say that the voters are as much to blame as those they elect. My dad, who voted in 19 presidential elections, said, “We get what we pay for.” And your comments about the health care industry’s “wonderful things” are true because no other country in the world allows private industry to make tens of billions of dollars a year from the suffering of its citizens.

I’d like to know why you don’t “gritch” about a $30,444 hospital bill plus $3,882 in medical supplies for an appendectomy patient who had a five-day stay. And how fair is a $7,809 emergency room charge to X-ray and cast a fractured fibula? But I’d really like to know why Aetna and Blue Cross paid those outlandish charges without a peep (but nickel and dime every doctor) using our premium dollars.

There’s the problem: It’s not the doctors nor the government but rather the insurers themselves. Their pockets are so heavily lined with our premium dollars that paying a huge hospital bill is no more meaningful to them than would be the advent of another fly to a slaughterhouse.

Now would you please tell Charming Charlie that last year the Big Eight reported net profits of $19 billion plus free cash flow of $22 billion? Holy moly! That’s $41 billion – easily enough to pay the health care costs for all of those 41 million uninsured. And I think you ought to tell Charming Charlie that the top five officers at each of the Big Eight health insurance companies received $237 million in compensation last year. That’s a shameful use of our premium dollars. Those Big Eight health insurers employ more than 300,000 people, each of whom is paid a salary with benefits averaging $40,000. Well, that number computes to $12 billion and not a penny of that is used for health care. Certainly a shameful use of our premium dollars.

And then there are billions of dollars spent each year for desks, computers, rent, utilities, thousands of tons of paper and millions of paper clips. Those billions are not spent on health care but they are paid with your premium dollars. Can you imagine how many hundreds of thousands of telephones are owned by Aetna, Cigna, United, Health Net, Coventry, WellPoint, Humana and the Blues? Then count the myriad thousands of copy machines, computers, cubicles, pencils, legal pads and so on, all of which are shamefully paid with premium dollars that could be used for medical costs.

Finally, one must count the commissions paid to people like you who sell health insurance policies. It’s estimated that last year the Big Eight paid close to $12 billion in commissions, shamefully using premium dollars that could be used to pay doctors, hospitals, drug companies and other health care providers.

And that’s just the Big Eight. There are countless smaller companies selling health care policies, shamefully skimming billions from your premium dollars. Tell this to Charming Charlie.

So, like it or not, those tens of billions of wasted premium dollars persuasively argue for a single-payer government-controlled health care system. It’s obvious from those wasted billions that health care premiums would be less by half with a single-payer system.

Please address your financial questions to Malcolm Berko, P.O. Box 1416, Boca Raton, FL 33429 or e-mail him at malber@adelphia.net.

Copyright 2007 Copley News Service

Visit Copley News Service at www.copleynews.com.

Physician advocates single payer in letter to the Centre Daily Times in Central Pennsylvania

Health-care, pension solution

The recent Associated Press series correctly identified rising health-care costs as a cause of the looming state-pension crisis but left the impression that our only choice is to raise taxes or cut pension benefits.

If the cost of health care is the problem, isn’t reducing those costs the obvious solution?

Ballooning pension liability is only one result of our health-care crisis. Here are others gleaned from recent articles in American medical journals:

* 46 million Americans have no health insurance.

* We spend twice as much per capita on health care as other advanced nations, yet we consistently rank near the bottom in public-health indicators.

* Medical bills are our leading cause of personal bankruptcy.

* Most Americans bankrupted by medical bills had health insurance.

* Most Americans would be bankrupted by a single serious illness or accident.

* Major manufacturers are locating plants in Canada instead of the U.S. to save money on employee health care.

* Our poor get too little health care. Our wealthy often have poor outcomes because of lucrative excessive testing and unnecessary procedures.

* One-third of every dollar spent on health care is consumed by insurance bureaucracy and paperwork.

We can solve all of these problems as well as the medical-malpractice issue by joining the rest of the industrialized nations with a single-payer “Medicare for all” system. Otherwise, we will continue to lose our health and wealth at the hands of insurance, pharmaceutical, and medical corporations.

Paul K. Simpson
State College

Editor’s note: Paul K. Simpson is a physician in State College.

Original Link: http://www.centredaily.com/mld/centredaily/news/opinion/16340988.htm

The slippery slope of market-based medicine

By Rose Ann DeMoro
Sacramento Bee
Published Saturday, December 30, 2006

As Gov. Arnold Schwarzenegger recovers from his fractured leg, he has access to the finest medical care California has to offer, as he should. But don’t all Californians deserve the same degree of medical attention and health care security?

In a few days, the governor is expected to unveil a sweeping health care proposal, following the leaders of the Senate and Assembly, who already have proposed changes to the state’s dysfunctional system.

Yet for all the talk of a “bipartisan” consensus for reform — following years of inaction despite a worsening crisis — it appears most options being suggested will exacerbate the problem, retard efforts to achieve genuine reform and further enrich the corporate elite in the health care industry who produced the present shambles.

If your head is spinning from reading all the various ideas being thrown around, here’s a CliffsNotes version. Essentially, all the choices can be distilled into two general areas — patient-based reform with public accountability, or market-based approaches.

In the market category fall most of the alternatives being swooned over today by the insurance companies and others invested in pure market-based solutions, the politicians who cater to them and those pundits who counsel us to lower our expectations. Among these proposals are laws to force individuals to purchase their own insurance; starting health savings accounts; and expanded mandates that employers provide benefits for their employees or pay into a pool for coverage for those without insurance.

Their common theme is a reliance on commercial mechanisms that created the present crisis by sacrificing quality, affordability and access for private profit. And all these solutions are doomed to repeat that cycle.

Consider the current fashion of the moment, the Massachusetts model. Every adult in that state is required to buy insurance coverage by July or face penalties. Subsidies are provided for low-income residents.

But the plan has gaping holes. Parents are not obligated to buy insurance for their children. Moderate-income or even middle-income adults who would have to spend hundreds of dollars more each month for full family coverage may choose to gamble with their children’s health or just cut back on other basic needs.

Further, the plans available to middle-income residents typically have deductibles that can run into thousands of dollars. Consumers are likely to foot the bill for many health care services in addition to the premiums the law would require them to pay. And, in the event of a serious illness or accident, they may find their cut-rate plan abandons them to financial ruin.

Consumers are even likely to lose the choice of a physician because they will be forced to pick among the doctors whose services are covered by the low-cost plan they can afford.

The Massachusetts plan is loved by the health care industry because it transfers huge pots of public money to private health care corporations.

Health savings accounts, marketed as “consumer-directed” solutions because they pair a high-deductible plan with a tax-free personal spending account, are similarly catastrophic. HSAs simply shift the cost of coverage from insurers to individuals, promote rationing of care and do nothing to reduce the number of uninsured.

Rather than reduce the bloated 30 percent of every health care dollar spent on administrative overhead and waste, HSAs actually increase administrative costs with servicing fees paid to the financial institutions that are climbing over each other to grab their chunk of this new lucrative market.

By contrast, consider the approach in every other industrialized nation in the world: either a national health system with public administration and public hospitals and clinics, or a single-payer system, with one entity that pays for all health care services with adequate funding to the private caregiver, hospital and clinic of the consumer’s choice.

Poll after poll documents that Americans overwhelmingly support either approach. A single-payer system is not just a dream, it’s legislation — HR 676 in Congress, and a measure in California by Democratic state Sen. Sheila Kuehl of Santa Monica, Senate Bill 840, which was vetoed by Schwarzenegger in September. It will be reintroduced in 2007.

While politicians clamor to come up with inferior alternatives, it will be up to all of us to remind them why this country’s inferior market-based plans will simply extend our national disgrace.

About the writer: Rose Ann DeMoro is executive director of the California Nurses Association. She can be reached at execoffice@calnurses.org.

Silent majority for single-payer

By Marcia Angell
Boston Globe
December 31, 2006

IN SEPTEMBER, an ABC News/Kaiser Family Foundation/USA Today survey found that 56 percent of Americans preferred a government-run universal health system “like Medicare” to our current employment-based system run by private insurers. That is, they want a single-payer system. Among the causes of rising costs, respondents were most likely to name private insurance and drug company profits.

If this were a presidential election, it would be a landslide. Yet policy makers and the media dismiss single-payer by telling us the public doesn’t want it. They falsely raise the specter of rationing and restricted choice of doctors. So we end up with schemes like Massachusetts’s squeeze-blood-from-a-turnip health plan, which preserves the insurance industry while requiring individuals to pay most of the costs.

Why is this? The insurance lobby has succeeded not only in blocking single-payer health care, but in keeping it out of public discourse. We are the only advanced country with market-driven private health care. Other countries spend about half as much per person, cover everyone, and get better health results. Shouldn’t this option be on the table?

Marcia Angell, MD, is senior lecturer in social medicine at Harvard Medical School.

A 10-Step Program For Democrats

Jonathan Tasini
January 02, 2007

Jonathan Tasini is the the executive director of Labor Research Association. He is returning from a hiatus to write his occasional column for TomPaine.com, “Working in America.” His blog, Working Life, chronicles the labor movement and other issues affecting American workers.

Since I never indulge in New YearĆ¢ā‚¬ā„¢s resolutions, I thought, instead, it would be worth drawing up an economic to-do list for the Democratic leaders. It would be a guidepost for the Congressional leadership, or for presidential-wannabes so that we, the voters, can find out what they stand for besides simply audacity and hope. The lesson from the 2006 election is that people want dramatic change, not poll-tested, cautious half-measures. So, be bold.

The threat to a progressive agenda is not the lack of hugs and soaring rhetoric. Rather, the challenge is pretty clear: Will Democrats be willing to break from the false worship of the twins gods of the so-called “free market” and so-called “free trade”? This worship has made Democrats quiver, tremble and crumble in the face of policies that have been devastating to our country and the world for the past several decades, and made them incapable of advancing ideas and proposals that people so desperately need.

“Free market” and “free trade” are both marketing phrases. There is no such thing as a “free market” because every corporation in America profits thanks to subsidized public goods like education, roads, the electric power grid, and (albeit, too permissive) regulatory management of the stock market, which imposes stability and deters dishonest behavior. So-called “free trade” is a mirage–nothing is free about a global trading regime that has iron-clad protection for capital investment and corporate intellectual property, and thrives on controlling and suppressing wages of workers, particularly in China.

Will Democrats stand up and clearly say that the real choice is not over politically empty slogans or accusations of Ć¢ā‚¬ĖœprotectionismĆ¢ā‚¬ā„¢ but over what rules we want to govern how the economy operates for the benefit of our families and communities? Do we want rules that support people and their communities or rules that help powerful, global corporations? Once Democrats do so, the political road is easy because such a plea has broad support across the country, no matter how people define themselves ideologically. It comes down to this: Are you for everyone having health care, a fair wage, solid retirement, and being able to live in a democratic system that allows the people to decide how corporations behave?

Here are three things to do, pronto:

Health Care: A Universal Right–With Sen. Ron Wyden, D-Ore., leading the way, we can expect all sorts of half-measured, warmed-over Clinton-lite national health care plans, all of which will fail to solve the long-term moral and economic health care crisis. Most Americans who support a national health program favor a single-payer system, which keeps the private delivery of health care in the hands of physicians and hospitals, but takes away the moving of money from the insurance industry and places it under a single public agency. Sound familiar? Sure, itĆ¢ā‚¬ā„¢s called Medicare, which is why the bill by Rep. John Conyers, D-Mich., H.R. 676, is often referred to as “Medicare For All.” Only a single-payer system will wring out the administrative savings–as much as $300 billion per year–that we can use to cover the current uninsured and make up the cost to provide full benefits to every American. Single-payer will increase our individual personal wealth far more than a minimum wage increase.

The rest of this article can be read here: http://www.tompaine.com/articles/2007/01/02/a_10step_program_for_democrats.php

The Quest for Health Care Reform

How insurance companies control our heath care

By Jerry Ortiz y Pino
Alibi
V.15 No.50 | December 14 – 20, 2006

Last week, as it has each year for the past decade, the Center for Policy Alternatives, a progressive think tank in our nation’s capitol, convened a meeting of state legislators, advocates, state analysts and savvy resource people from academia and the halls of Congress.

They call it “The Summit of the States” and it has become a marketplace of innovative ideas and legislative proposals from across the country, a gallery for the “next progressive agenda” and a peek into which inspirations are building momentum in the legislative arena.

This year’s sessions were carried out in an atmosphere charged with the excitement engendered by last month’s great shift in electoral tides. Many first-time legislators who’d benefited from the wave of Democratic victories in previously red states were at the summit, boning up on topics like stem cell research, electoral reform, juvenile justice…and health care.

But in the midst of the general optimism over the prospects for hammering out important reforms in the states and nationally, the topic of health care financing stood out as an island of realism, stolidly withstanding all attempts at significant change.

It was astonishing to discover that the drift of the session on health care reform was not so much zeroed in on “universal health care” or “health care as a right,” but on the microscopic focuses of “how to make corporations like Wal-Mart pay their fair share of health care costs,” or how some states (like Massachusetts) are making employer-provided insurance the foundation for their health care efforts.

What rapidly became clear is that the concepts of single-payer health care or universal health care access are no longer in the middle of the public policy bull’s-eye. They are now further toward the fringe, secondary concerns, even for the progressive community .

This is distressing. It is, I suggest, a function of the political punch wielded by the insurance industry, that it has been able to change the focus of the national debate from how to provide health care for all Americans into how to provide medical insurance for more Americans.

They have thereby achieved the policy equivalent of transforming a mountaineer’s quest for Mount Everest’s summit into a walk up the La Luz Trail: not an insignificant trek, but certainly not a heroic one … and one that falls completely short of the need.

What is beyond dispute is that the American system of financing health care is incredibly successful and lucrative, the best in the world … for insurance companies. What remains undemonstrated is whether insurance companies are good for our health care system.

I have come to doubt whether the concept of “insurance” adds any value at all to our provision of medical care. It complicates life for medical care providers–the hospitals, doctors, pharmacists, clinics and labs who actually save lives and restore health, but who have to master the hundreds of billing forms, coverage and drug formularies used to discourage payments.

Entire departments of hospitals and full-time clerks in every doctor’s office are devoted to negotiating the complexities of this chaotic system. That in itself adds billions to the cost of American health care, a shuffling of paper which drains resources. In return we get … ?

Oh, we get a lot, in fact.

We get dropped if we actually develop a chronic condition.

We get denied treatment recommended by our doctor.

We get drained by the astronomical increases in premiums, co-pays and deductibles the companies are able to levy with impunity if their profit margin dips below double digits.

So the resistance to change in our system of financing is, not surprisingly, orchestrated by the insurance industry, primary beneficiary of the current morass. Therefore, we should be forewarned about that industry’s tactic of lowering our expectations from providing care to providing (surprise!) insurance.

There is no more classic an example of the tail wagging the dog than the private insurance industry calling the shots on reforming the system, particularly when in New Mexico 75 percent of the health care dollar comes from government and only 25 percent comes from insurance and private pay.

Health insurers are the problem, not the solution. Requiring (or alternatively, incentivizing) employers to pay all or a portion of the cost of health insurance is a stop-gap measure, not real reform. That’s a path that will continue to cost taxpayers enormous amounts of unregulated expenditures on behalf of those ill and infirm citizens the private payers choose to exclude (i.e. anyone who costs them money).

Health insurance is a trillion-dollar industry in the U.S. It is by far the largest industry unregulated by the federal government, even though Medicare and Medicaid generate enormous profits for the industry every year. Bonanza!

By leaving it up to the separate 50 states to regulate the industry, Americans are essentially allowing big insurance to call the shots. If people’s lives and our national treasury weren’t at stake, perhaps we could let the insurers continue in their pleasant pursuit and consumption of tax dollars unimpeded.

But this is too important to continue laissez faire. It is time to stop the charade. And we should stop letting insurance companies set the agenda for discussion of health care reform.

BATTLE LINES FORMING OVER HEALTH CARE

By Mark Gruenberg
PAI Staff Writer
A PAI news analysis

NEW YORK (PAI)–With the Democratic-run 110th Congress set to open on Jan. 4 and with several top Democrats making clear health care will be part of the agenda, battle lines are already forming around competing plans.

And unionists, their families and their allies have an interest in the outcome, since if lawmakers undertake radical revision of the nation’s $2 trillion health care system, it could also determine the future of employer-based health insurance.

That insurance covers almost everyone. Exceptions include those on Medicaid, the elderly on Medicare and 47 million uninsured. But private health insurance has a high cost for workers: Large deductibles, increasing co-pays, at least 20 percent of its funds wasted on overhead, and insurers’ demands for hospitals to cut staffing and care.

Worst of all, the private insurers feature company bean-counters ordered to both pocket workers’ hard-earned money while denying coverage. That denial kills people.

The coming fight on health care has multiple sides:

• On one side is the private health insurance industry. Insurers and their allies–including the pharmaceutical companies that get a $140 billion windfall from GOP President George W. Bush’s prescription drugs law–will lobby for the status quo, and their own pockets, using advertising spin, outright lies, and huge campaign contributions.

• On another side is Bush. He and his business backers want to shove more of the health insurance costs onto workers. They claim, wrongly, that forcing workers to make decisions on how to spend their money on health care will induce “competition,” which will moderate prices. Health care inflation has been running in double digits yearly.

• On third side are the state of Massachusetts, Sen. Ron Wyden (D-Ore.), Service Employees President Andy Stern, Families USA President Ron Pollack and Safeway CEO Steve Burd. They espouse a plan, which Wyden crafted and which is similar to legislation passed and signed in the Bay State last year, which requires individuals to buy health insurance, just as they buy car insurance. Wyden plans to use his Senate Finance Committee seat–the panel handles health legislation–to push his plan.

Wyden claims individuals could pay for insurance because his “Healthy Americans Act” would require employers to take the money they now pay insurers to cover workers and instead give it to them as raises. Wyden’s bill does not say how it would guarantee that.

States would set minimum coverage standards that all insurers must meet before they can sell policies, and there would be subsidies for the poor and working class. What neither Wyden nor Massachusetts have is any method of controlling health care costs.

• On the fourth side are advocates of government-run single-payer health coverage, similar to Medicare or to Canada’s system. They include Senate Health, Education, Labor and Pensions Committee Chairman Edward M. Kennedy (D-Mass.) and Reps. John Conyers and John Dingell (both D-Mich.), who will chair important committees in the new Congress. Dingell’s committee is one of those handling health care.

All three, along with the Steel Workers and Physicians for a National Health Plan (PHNP), advocate some form of universal health care that cannot be taken away when workers switch jobs. They, especially Conyers, would virtually abolish the private insurance industry, cutting overhead and duplication, while allowing wide consumer choice of physicians and hospitals, advocates say. But their big political problems are cost, and who pays. Solutions range from payroll taxes to elimination of waste.

USW President Leo Gerard is a particular advocate of single-payer government-run health care. Like other union leaders, he’s seen health care costs damage negotiations and destroy raises for his members. By contrast, Gerard, a Canadian, knows the edge firms and individuals there have from government-run single-payer health care.

The debate over health care has been relatively dormant ever since the insurers’ lies and a business-backed Senate GOP filibuster doomed President Clinton’s health care plan. Debate started to rise during the campaign and took a recent heated turn with Wyden’s proposed Healthy Americans Act. Stern, backing Wyden, warned “the perfect should not be the enemy of the good,” but PNHP says the Wyden plan is far from good.

PHNP New York research director Len Rodberg calls Wyden’s scheme “one of the most radically destructive proposals ever put forward to address the failings of the American health care system. It would eliminate the system of employer-based health insurance on which more than 90 percent of the insured depend today.” Everyone would have to buy insurance–a windfall for the companies–with the subsidies for the poor afterwards.

Rodberg also targeted Wyden’s lack of cost controls: “Literature from Wyden (says) the Healthy Americans Act relies on competition to drive down costs and promote quality. But nothing would make competition among insurers work any better than it has.” Wyden’s reliance on the insurers could lead to fewer of them and less competition.

“Why should millions who now receive insurance from employers, including members of unions which fought for decades for those benefits, give up this coverage for the uncertainties and inequities of the private for-profit insurance market? In the face of continuing increases in the cost of health care exceeding general inflation as well as the

growth in average wages, why should workers want to take over responsibility for paying for their health care? It is not the employer base that is collapsing, it is the entire system of private insurance which is becoming increasingly unaffordable,” he says.

On the Front Lines of Care: Primary Care Doctors' Office Systems, Experiences, and Views in Seven Countries

In the article, “On the Front Lines of Care: Primary Care Doctors’ Office Systems, Experiences, and Views in Seven Countries” (Health Affairs Web Exclusive, Nov. 2, 2006), the authors report on survey results that reveal striking differences in primary care practice internationally–differences that highlight the importance of having national policies in place to support primary care. According to the survey, U.S. physicians are among the least likely to have extensive clinical information systems or quality-based payment incentives, the least likely to provide access to after-hours care, and the most likely to report that their patients often have difficulty paying for care.

The 2006 Commonwealth Fund/Harris Interactive survey included more than 6,000 PCPs in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States (including more than 1,000 U.S. physicians).

For many people, the primary care physician (PCP) is their first point of contact with the health care system, as well as their main source of preventive and essential care. Recognizing the central role of PCPs in health care, international initiatives to improve health system performance have focused on developing systems and policies to enhance the effectiveness and efficiency of primary care practice. These include the use of clinical information systems, which assist doctors in treatment decisions and enable them to provide patient-centered care; multidisciplinary care teams and disease management programs for patients with chronic illness; and enhanced access to care, such as after-hours appointments.

Use of Information Technology
The survey revealed stark differences in PCPs’ access to information systems. Only 28 percent of U.S. doctors and 23 percent of Canadian doctors said they used electronic medical records (EMRs), compared with overwhelming majorities of doctors in the Netherlands (98%), New Zealand (92%), the U.K. (89%), and Australia (79%).

Canadian and U.S. doctors are also the least likely to have systems that provide decision support, such as computerized alerts about potentially harmful drug doses or interactions. Only 10 percent of Canadian doctors and 23 percent of U.S. doctors receive computerized alerts; rates elsewhere ranged from 93 percent (Netherlands) to 40 percent (Germany). Furthermore, at least two of five U.S. and Canadian doctors find it “very difficult” or “impossible” to identify patients overdue for a test or preventive care, versus one of five or fewer in the other countries.

Patients’ Access to Care
Doctors in the U.S. were least likely to say that their practices allow patients to see a nurse or doctor after regular office hours, without going to an emergency room–just 40 percent have such arrangements. In contrast, between 95 percent and 76 percent of doctors in the other countries provide after-hours care.

U.S. doctors were the most likely to report their patients have difficulty paying for care. Half (51%) of U.S. PCPs reported that patients often have difficulty paying for medications, compared with between 7 percent and 27 percent in the other countries.

Availability of Financial Incentives
Despite growing U.S. interest in financial incentives to improve performance, U.S. primary care doctors are among the least likely to receive such incentives. Just 30 percent reported receiving, or having the potential to receive, payments for managing chronic disease, achieving clinical targets, enhancing preventive care, or other quality improvement activities. The U.K. stands out as a leader in this regard: 95 percent of its doctors receive, or are able to receive, financial incentives for improved performance.

Chronic Care Management
Regarding the highly important dimension of managing chronic disease, a high proportion of doctors in all countries (25% to 30% or more), except Germany (7%), said they are not well-prepared to care for patients with multiple chronic conditions. There are wide variations in the use of care teams and systems known to improve outcomes for such patients.

Conclusions
Primary care physicians in the seven countries share many common challenges, among them improving coordination of care for patients with chronic disease. Yet, the survey highlights sharp differences in the availability of incentives, IT capacity, use of care teams, and patient access to care. These divergent experiences often reflect their country’s underlying policy choices, and the extent to which policies in place are national in scope. As physicians’ responses suggest, national policies in support of primary care matter. The U.S.–which lags well behind in use of health IT–appears to be the only country without a national IT plan. Moreover, the difficulty U.S. patients experience in paying for care signify a failure of the U.S. health insurance system to support primary care. “Cohesive, broad-based policy changes in the United States,” the authors conclude, “could lead to improved absolute and relative performance.”

Facts and Figures:

* Of 14 health information system functions assessed in the survey (e.g., automated alerts/reminders, electronic prescribing), fewer than one of five U.S. and Canadian physicians reported their offices supported seven or more of these functions. In the other countries, 59% to 83% of doctors reported such multifunctional capacity.

* Use of clinical teams to manage chronically ill patients varies widely, ranging from 73% in the U.K. to 25% to 38% in Canada, the U.S., and Australia.

* The U.K. stands out for their ability to track medical errors: 79% of U.K. doctors have systems to document all adverse events, compared with 7% to 41% in other countries (37% in the U.S.).

Citation: C. Schoen, R. Osborn, P. Trang Huynh, M. Doty, J. Peugh, K. Zapert, On The Front Lines of Care: Primary Care Doctors’ Office Systems, Experiences, and Views in Seven Countries, Health Affairs Web Exclusive (Nov. 2, 2006):w555–w571.

Credit cards and the “medically indebted”

Borrowing to Stay Healthy: How Credit Card Debt Is Related to Medical Expenses

By Cindy Zeldin and Mark Rukavina
Demos
The Access Project
January 16, 2007

The cost of health insurance continues to outpace overall inflation and wage growth, placing added pressure on already stretched family budgets. A family health insurance policy is now equivalent to 18 percent of median family income.

In general, the trend for health insurance policies has included higher deductibles and co-payments for hospitalizations, office visits, and prescription drugs, which, in turn, increases the financial burden for people who get sick. Medical debt can also be tied to less-comprehensive insurance. As Health Savings Accounts (HSAs) and high deductible health plans grow more common, patients face higher first-dollar expenses and may become more susceptible to medical debt.

Key findings from the report include:

* Low- and middle-income medically indebted households had higher levels of credit card debt than those without medical debt — on average 46 percent higher. ($11,623 versus $7,964).

* Low- and middle-income medically indebted households had higher debt-to-income ratios than non-medically indebted households.

* Among the medically indebted, young adults between the ages of 18 and 34 had the highest level of average credit card debt of any age group. Credit card debt levels of medically indebted young adults ($13,303) were considerably higher (79 percent higher) than credit card debt levels for non-medically indebted young adults ($7,450).

* The medically indebted are more likely to be called by bill collectors than the non-medically indebted (62 percent versus 38 percent).

Against a backdrop of declining economic stability, trends such as rising health care costs, changes in health insurance benefit design, and an ever-increasing reliance on credit cards forecast dire conditions for America’s family finances.

Policymakers must address the twin problems of health care cost and coverage in a comprehensive manner to protect American families from financial insecurity and the deleterious health outcomes that result from the current system. We believe that the ultimate solution is a system that provides universal access to comprehensive benefits.

Press release:
http://www.accessproject.org/adobe/borrowing_to_stay_healthy_release.pdf

Report “Borrowing to Stay Healthy:”
http://www.demos.org/pubs/healthy_web.pdf

Comment:

By Don McCanne, MD

We are seeing a flurry of proposals for universal coverage that depend on mandates to purchase affordable insurance options – options that are possible only by accelerating the trend to shift more costs to patients.

Affordable, stripped-down private insurance options will further compound debt problems for patients. Comprehensive private plans are not a solution either, because those plans are unaffordable. A family policy is now 18 percent of median family income!

Keep in mind that this and other studies show that medical debt is a problem for middle-income families, not just low-income. The average American can no longer pay the full pro rata tab for comprehensive health care and coverage.

Proposals that would insure everyone in essence are proposing the establishment of a de facto universal risk pool, even though fragmentation introduces complexities. Equitable risk pooling requires that funds be shifted from the healthy to the sick and from the wealthy to middle- and low-income individuals with health care needs. Average Americans now need either more money to purchase comprehensive plans, or more money to pay out-of-pocket expenses not covered by skimpier plans.

How do you do that? Do you use an administratively complex and inefficient system of means-tested insurance vouchers and health care stamps? Should we humiliate ourselves in this way merely because we want to keep the wasteful, intrusive private insurers in play? Or do you give up and decide to expand Medicaid to 70 percent of us? Has the divide become so great that average Americans should be entitled to a welfare program? (Let’s not go there.)

Assuming that the national clamor to insure everyone is genuine, we should turn to the most efficient and equitable system of doing so. That would be to establish a single, universal risk pool that is equitably funded. Then health care would be affordable for everyone.

We already have the money. All we need is the political will.

System Isn’t Healthy But Insurers’ Bottom Lines Are

Malcolm Berko
Copley News Service

Dear Mr. Berko: When you spoke at the fundraiser for our church about the future of our country, you pointedly said that we must have a single-payer health care system. You noted that there are 41 million uninsured in the country who can’t afford health care. You said they must have medical access but (and the following are your words) “the health insurance industry’s intentional high costs exclude them from participation.”

Are you nuts or something? How can you preach such socialistic ideas in a capitalistic society? They would be able to afford health care if they were worth more to their employers so they would be paid better. Do you know how much our leftist government has screwed up our country? And it would do the same without a private health care system if we allowed it to happen.

You have no idea of the wonderful things that health insurance companies like Aetna have done to help Americans. Their contributions to health care are unequaled in any other country in the world. You shouldn’t preach left-wing, pinko communist ideas to people who invite you to their homes. Shame on you.

C.S.
Elkhart, Ind.

Dear C.S.: Why do I suspect that my friend Charming Charlie, the insurance agent from Kokomo asked you to write? And why do I believe that you may be employed by one of the Big Eight (Aetna, Cigna, Coventry, Health Net, Humana, WellPoint, the Blues or United) health companies?

I’m not going to touch your comment about the federal government except to say that the voters are as much to blame as those they elect. My dad, who voted in 19 presidential elections, said, “We get what we pay for.” And your comments about the health care industry’s “wonderful things” are true because no other country in the world allows private industry to make tens of billions of dollars a year from the suffering of its citizens.

I’d like to know why you don’t “gritch” about a $30,444 hospital bill plus $3,882 in medical supplies for an appendectomy patient who had a five-day stay. And how fair is a $7,809 emergency room charge to X-ray and cast a fractured fibula? But I’d really like to know why Aetna and Blue Cross paid those outlandish charges without a peep (but nickel and dime every doctor) using our premium dollars.

There’s the problem: It’s not the doctors nor the government but rather the insurers themselves. Their pockets are so heavily lined with our premium dollars that paying a huge hospital bill is no more meaningful to them than would be the advent of another fly to a slaughterhouse.

Now would you please tell Charming Charlie that last year the Big Eight reported net profits of $19 billion plus free cash flow of $22 billion? Holy moly! That’s $41 billion – easily enough to pay the health care costs for all of those 41 million uninsured. And I think you ought to tell Charming Charlie that the top five officers at each of the Big Eight health insurance companies received $237 million in compensation last year. That’s a shameful use of our premium dollars. Those Big Eight health insurers employ more than 300,000 people, each of whom is paid a salary with benefits averaging $40,000. Well, that number computes to $12 billion and not a penny of that is used for health care. Certainly a shameful use of our premium dollars.

And then there are billions of dollars spent each year for desks, computers, rent, utilities, thousands of tons of paper and millions of paper clips. Those billions are not spent on health care but they are paid with your premium dollars. Can you imagine how many hundreds of thousands of telephones are owned by Aetna, Cigna, United, Health Net, Coventry, WellPoint, Humana and the Blues? Then count the myriad thousands of copy machines, computers, cubicles, pencils, legal pads and so on, all of which are shamefully paid with premium dollars that could be used for medical costs.

Finally, one must count the commissions paid to people like you who sell health insurance policies. It’s estimated that last year the Big Eight paid close to $12 billion in commissions, shamefully using premium dollars that could be used to pay doctors, hospitals, drug companies and other health care providers.

And that’s just the Big Eight. There are countless smaller companies selling health care policies, shamefully skimming billions from your premium dollars. Tell this to Charming Charlie.

So, like it or not, those tens of billions of wasted premium dollars persuasively argue for a single-payer government-controlled health care system. It’s obvious from those wasted billions that health care premiums would be less by half with a single-payer system.

Please address your financial questions to Malcolm Berko, P.O. Box 1416, Boca Raton, FL 33429 or e-mail him at malber@adelphia.net.

Copyright 2007 Copley News Service

Visit Copley News Service at www.copleynews.com.

On the Front Lines of Care: Primary Care Doctors’ Office Systems, Experiences, and Views in Seven Countries

In the article, “On the Front Lines of Care: Primary Care Doctors’ Office Systems, Experiences, and Views in Seven Countries” (Health Affairs Web Exclusive, Nov. 2, 2006), the authors report on survey results that reveal striking differences in primary care practice internationally–differences that highlight the importance of having national policies in place to support primary care. According to the survey, U.S. physicians are among the least likely to have extensive clinical information systems or quality-based payment incentives, the least likely to provide access to after-hours care, and the most likely to report that their patients often have difficulty paying for care.

The 2006 Commonwealth Fund/Harris Interactive survey included more than 6,000 PCPs in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States (including more than 1,000 U.S. physicians).

For many people, the primary care physician (PCP) is their first point of contact with the health care system, as well as their main source of preventive and essential care. Recognizing the central role of PCPs in health care, international initiatives to improve health system performance have focused on developing systems and policies to enhance the effectiveness and efficiency of primary care practice. These include the use of clinical information systems, which assist doctors in treatment decisions and enable them to provide patient-centered care; multidisciplinary care teams and disease management programs for patients with chronic illness; and enhanced access to care, such as after-hours appointments.

Use of Information Technology
The survey revealed stark differences in PCPs’ access to information systems. Only 28 percent of U.S. doctors and 23 percent of Canadian doctors said they used electronic medical records (EMRs), compared with overwhelming majorities of doctors in the Netherlands (98%), New Zealand (92%), the U.K. (89%), and Australia (79%).

Canadian and U.S. doctors are also the least likely to have systems that provide decision support, such as computerized alerts about potentially harmful drug doses or interactions. Only 10 percent of Canadian doctors and 23 percent of U.S. doctors receive computerized alerts; rates elsewhere ranged from 93 percent (Netherlands) to 40 percent (Germany). Furthermore, at least two of five U.S. and Canadian doctors find it “very difficult” or “impossible” to identify patients overdue for a test or preventive care, versus one of five or fewer in the other countries.

Patients’ Access to Care
Doctors in the U.S. were least likely to say that their practices allow patients to see a nurse or doctor after regular office hours, without going to an emergency room–just 40 percent have such arrangements. In contrast, between 95 percent and 76 percent of doctors in the other countries provide after-hours care.

U.S. doctors were the most likely to report their patients have difficulty paying for care. Half (51%) of U.S. PCPs reported that patients often have difficulty paying for medications, compared with between 7 percent and 27 percent in the other countries.

Availability of Financial Incentives
Despite growing U.S. interest in financial incentives to improve performance, U.S. primary care doctors are among the least likely to receive such incentives. Just 30 percent reported receiving, or having the potential to receive, payments for managing chronic disease, achieving clinical targets, enhancing preventive care, or other quality improvement activities. The U.K. stands out as a leader in this regard: 95 percent of its doctors receive, or are able to receive, financial incentives for improved performance.

Chronic Care Management
Regarding the highly important dimension of managing chronic disease, a high proportion of doctors in all countries (25% to 30% or more), except Germany (7%), said they are not well-prepared to care for patients with multiple chronic conditions. There are wide variations in the use of care teams and systems known to improve outcomes for such patients.

Conclusions
Primary care physicians in the seven countries share many common challenges, among them improving coordination of care for patients with chronic disease. Yet, the survey highlights sharp differences in the availability of incentives, IT capacity, use of care teams, and patient access to care. These divergent experiences often reflect their country’s underlying policy choices, and the extent to which policies in place are national in scope. As physicians’ responses suggest, national policies in support of primary care matter. The U.S.–which lags well behind in use of health IT–appears to be the only country without a national IT plan. Moreover, the difficulty U.S. patients experience in paying for care signify a failure of the U.S. health insurance system to support primary care. “Cohesive, broad-based policy changes in the United States,” the authors conclude, “could lead to improved absolute and relative performance.”

Facts and Figures:

* Of 14 health information system functions assessed in the survey (e.g., automated alerts/reminders, electronic prescribing), fewer than one of five U.S. and Canadian physicians reported their offices supported seven or more of these functions. In the other countries, 59% to 83% of doctors reported such multifunctional capacity.

* Use of clinical teams to manage chronically ill patients varies widely, ranging from 73% in the U.K. to 25% to 38% in Canada, the U.S., and Australia.

* The U.K. stands out for their ability to track medical errors: 79% of U.K. doctors have systems to document all adverse events, compared with 7% to 41% in other countries (37% in the U.S.).

Citation: C. Schoen, R. Osborn, P. Trang Huynh, M. Doty, J. Peugh, K. Zapert, On The Front Lines of Care: Primary Care Doctors’ Office Systems, Experiences, and Views in Seven Countries, Health Affairs Web Exclusive (Nov. 2, 2006):w555–w571.

Healthcare packages all inferior, except for one

By Deborah Burger, RN
January 10, 2007

With Gov. Arnold Schwarzenegger unwrapping his long-anticipated healthcare package Monday and talk about reform building in Sacramento, Californians may well be wonder if our long healthcare nightmare is finally coming to an end.

Sadly, virtually none of the proposals now being touted in the Capitol is universal, strengthens quality of care or reduces rising costs to consumers.

The sole exception is a single-payer approach, as contained in a bill by state Sen. Sheila Kuehl, D-Santa Monica, that was vetoed by Schwarzenegger in September, but will be reintroduced soon.

Under single-payer, one public entity collects all the financing and pays for all medical services through the existing private-care delivery system, with adequate funding for our doctors, hospitals, clinics and other care.

All the other approaches are fundamentally flawed. They continue to rely on a wasteful insurance industry whose focus is on making money by denying care to those who need it the most and other market-based mechanisms that created the current mess.

Californians should be especially wary of legislation requiring individuals to buy insurance. The likely result is to criminalize the uninsured, and saddle far too many with cut-rate plans with huge out-of-pocket costs and caps on payments that expose you to financial ruin in the event of a serious illness or major accident.

There’s a better way, the course charted by every industrialized nation in the world. That’s the main reason why the U.S. spends more than the 21 other wealthiest countries on healthcare yet Americans trail them all in life expectancy, infant mortality and a host of other health barometers.

Here’s 10 ways a similar, single-payer-type system, would benefit all Californians, not only those who profit in healthcare:

1. Everybody in, nobody out. Universal means access to healthcare for everyone, period Ć¢ā‚¬ā€ the desire of 81 percent of all Californians, as reported in a recent Field Poll.

2. Portability. Even if you are unemployed or lose or change your job, your health coverage goes with you.

3. Uniform benefits. No Cadillac plans for the wealthy and Moped plans for everyone else, with high deductibles, limited services and no protection in the event of a catastrophe. One standardized level of comprehensive care no matter what size your wallet.

4. Prevention. By removing financial roadblocks, a single-payer system encourages preventive care that lowers an individual’s ultimate cost and pain and suffering when problems are neglected, and societal cost in the overutilization of emergency rooms or the spread of communicable diseases.

5. Choice of physician. Most private plans restrict what doctors, other caregivers or hospital you can use. Under a single-payer system, patients have a choice and the provider is assured a fair reimbursement.

6. Ending insurance industry interference with care. Caregivers and patients regain the autonomy to make decisions on what’s best for a patient’s health, not what’s dictated by the billing department or the bean counters. No denial of coverage due to pre-existing conditions or cancellation of policies for “unreported” minor health problems.

7. Reducing administrative waste. One third of every healthcare dollar in California goes for paperwork, such as denying you care, and profits, compared to about 3 percent under Medicare, a single-payer, universal system.

8. Cost savings. Numerous studies suggest a single-payer system would produce the savings needed to cover everyone, largely by using existing resources without the waste. Taiwan adopted a single-payer system in 1995, boosting health coverage from 57 percent to 97 percent with little if any increase in overall healthcare spending.

9. Common sense budgeting. The public system sets fair reimbursements applied equally to all providers while assuring all comprehensive and appropriate healthcare is delivered, and uses its clout to negotiate volume discounts for prescription drugs and medical equipment.

10. Public oversight. The public sets the policies and administers the system, not high-priced CEOs meeting in secret and making decisions based on what inflates their compensation packages or stocks.

While our politicians debate inferior alternatives, it’s up to all of us to insist that Californians deserve the best.

Deborah Burger is president of the California Nurses Association.