PNHP

The Lagging Poor

The Lagging Poor

Washington Post
Editorial Page
Tuesday, September 6, 2005

THe poverty level edged up last year, to 12.7 percent — the fourth straight annual increase. Overall median income remained flat at $44,389, down 3.8 percent from its peak in 1999. This is a robust economic recovery?

The Census Bureau’s annual report on income, poverty and health insurance in the United States is not alarming — but neither is it cheering, or even reassuring. Rather, the numbers underscore the lagging and uneven nature of the economic recovery since the 2001 recession. According to the new data, 4 million more people were living in poverty in 2004 than in 2001, and 4.6 million more people lacked health insurance.

Administration officials counsel patience, pointing to the downturn of the 1990s, when it took several years for the poverty rate to start to fall. “The last, lonely trailing indicator of the business cycle,” Commerce Department official Elizabeth Anderson said of the poverty rate.

This has about it more than a whiff of wishful thinking. For one thing, the increase in poverty between 2003 and 2004 is in fact out of the ordinary; such a rise hasn’t happened between the second and third years of an economic recovery since the federal government began collecting poverty data in 1960. For another, the poverty rate may be a lagging indicator, but in this case it’s not lonely: See, for example, the median income of working-age households, which declined 1.2 percent.

Another ominous signal involves health insurance coverage. Although the percentage of people with coverage remained unchanged from 2003 to 2004, that masked a shift from employer-provided insurance to government coverage. The percentage of people with employer-based health insurance fell for the fourth year in a row. Most of this slack has been taken up by Medicaid, the shared federal-state health program for the poor and disabled. But with state budgets under increasing strain from Medicaid costs and with Congress poised to make cuts in the program, it’s not at all certain that states will be willing or able to maintain coverage for working Americans hovering at the edge of poverty.

In the wake of this data and the devastation caused by Hurricane Katrina, Senate Majority Leader Bill Frist (R-Tenn.) was wise to postpone this week’s planned vote to repeal the estate tax. Lawmakers need to remember in the weeks to come that this is an economic recovery that continues to leave too many Americans behind.

Free corporations from health expenses

OPINION
The Business Journal (Milwaukee)
From the September 2, 2005 print edition
Guest Comment
By Jack Lohman and Dr. Eugene Farley

It is by historical accident that U.S. businesses provide health care to their employees, and it has now placed them at a serious disadvantage when competing globally or against imports whose manufacturers do not have to add this extra 8 percent to 15 percent to the price of their products.

In other countries, health care is a taxpayer burden. It is here too, but we pay through many circuitous routes that have caused jobs to leave the country. We add these costs to our product prices, and it makes us uncompetitive with products that come from countries that already have taxpayer-paid medical systems. Corporations in Canada pay only an $800 annual per-employee tax. The result, as just one example: The Big Three auto companies now make more cars in Ontario than in Detroit, and Toyota just selected Canada over the United States for its new Rav4 manufacturing plant. Jobs are leaving our country because they are doing it right and we are doing it wrong!

The United States must adopt a universal health care system like Canada’s, but long wait times do not have to be a part of our system. We can do better and we will do better. With universal coverage, Canadians have longer life expectancy (by two years), 35 percent lower infant mortality, and 100 percent of the citizens are covered with 40 percent less in total costs. They’ve paid for it with a system that has 8 percent rather than 30 percent administrative costs. More than 90 percent of the patients love it, as do most of the physicians.

But who would pay for our system? The same people who are paying for it today: the taxpayers. We all pay for our health care system, which costs $1.6 trillion each year nationally, and 100 percent of this money comes from we the people, through taxes, premiums, co-pays, deductibles, purchases, employer tax breaks and the other methods we use for collecting money. When we buy product, that company adds its health care costs to the price and we pay at the cash register.

Jobs at stake

But that added price is killing American jobs, and if the feds aren’t willing to fix it the state must. We are only talking about changing how we collect and use the same health care money. Such a system would also replace our Medicaid and BadgerCare costs, assume 40 percent of worker compensation costs, and even replace Medicare if the feds were willing to buy in.

Even if it were zero savings we’d be market winners. And we’d have more than adequate coverage, though it would not cover non-essential lifestyle enhancement surgeries or drugs. Gap insurance would be an option for employers and those wanting to pay for those procedures themselves. That leaves a job for the 400 insurance companies.

Once we eliminate employer-paid medical coverage, which now represents from 8 percent to 15 percent of U.S. employee costs, companies and jobs will stop leaving the state and new companies and jobs (and the tax revenues that result) will start flowing into the state. A properly run universal health care system is the most business-friendly and public-friendly system available.

If our state is the first to do this we will gain jobs from other states. If we are last, they will get our jobs. We must be the leaders, and business leaders must sideline the health care interests to make it happen here.

Jack Lohman of Colgate is the retired CEO of an independent diagnostic lab. Dr. Eugene Farley is a retired physician in Madison.

NMA Aids Hurricane Katrina Victims

September 7, 2005

Dear Colleague:

As African American physicians who live and work in the affected communities hit hardest by Hurricane Katrina, the nation is turning to us for guidance and support as the recovery continues. We are actively involved in the evolving participation of the NMA in this ongoing relief effort. By extension, this is an American crisis, and the NMA is addressing it as such.

To date, the NMA has several physicians: Drs. Rahn Bailey of Houston; Leonard Weather of New Orleans currently residing in Shreveport, LA; Roosevelt McCorvey of Montgomery, Alabama; Reginald Rigsby of Madison, Mississippi; Claudette Shepard of Memphis, Tennessee; Niva Lubin Johnson of Chicago, Illinois; Walter Faggett, D.C. Department of Health, Washington, DC; Ingrid Taylor of St. Louis, Missouri; Christopher Ervin of Atlanta, Georgia; and Wilma Wooten of San Diego, California among others who are serving as points of contact in these affected areas.

We are in the process of updating the NMA’s website www.nmanet.org with the latest information regarding our efforts. This portal, we hope, will become your destination of choice in the coming weeks. We will include relevant contact and resource information, as well as opportunities for volunteering and collaboration. Inquiries about NMA members’ involvement in this effort should be directed to our Membership department at (202) 347-1895 ext. 220 or to jwilson@nmanet.org. Media-related inquiries and suggestions should be directed to External Affairs, at (202) 347-1895, ext. 262 or to rstone@nmanet.org.

Finally, we are anxious to receive your feedback about how well the process is working and how we can improve. Please let us hear from you. We can be reached at 800-662-0554 and/or visit www.nmanet.org for regular updates of the hurricane relief efforts.

Below are updates from Dr. Bailey regarding his recent findings, experiences and needs in caring for the evacuees in Houston, TX. We appreciate his efforts and we will keep you apprised of the latest developments.

Sincerely,
Sandra L. Gadson, M.D.
President

September 2, 2005

Dear Fellow NMA members,

Many thanks for your phone calls and emails. I am honored to take lead role on coordinating efforts by way of a medical team of physicians to provide assistance to the victims of Hurricane Katrina not only in the Houston, Texas area but all across the United States. We are very concerned with the growing and compounding health issues not only in New Orleans and surrounding areas and states but for those victims transported to the Houston Area. The NMA is encouraging all members to please volunteer your time and give to the charities to help aid this national disaster. Taking lead role in combining our efforts to assist, I’m asking each of you to give of your time (1-2 weeks) working onsite at the Astrodome and shelters throughout the city. We are asking for all types of physicians. If you are not licensed in the State of Texas, you can contact the Harris County Medical Society at (713) 524-4267 or website www.hcms.org. The website gives information on how to obtain a provisional license as well as list information on insurance coverage for those with concerns on protection of malpractice lawsuits. The reason for the 45 day temporary license was intended for Louisiana (or Mississippi) physicians) to come over and care for their own patients. Other uses of that provision are being discouraged unfortunately. For MDs inside of Texas though, they can contact the TMA at 800-880-1300 and speak with Gayle Love.

For more information on insurance needs, you can call Texas Department of Insurance at (800) 252-3439 or visit their website at www.tdi.state.tx.us. Please assist by way of contacting any physicians you may know to help us in our joint efforts to better serve the Hurricane Katrina victims. They may contact me, my coordinator or any of the agencies that will be listed at the end of this letter. Your assistance doesn’t stop with aid by way of food, shelter, clothing, etc. We encourage each of you to speak with your pharmaceutical contacts regarding donating medical supplies and medicines. In your efforts to ask for donations by colleagues and pharmaceutical contacts, we must get a political response via our most powerful tool, which is our voice. We need all the states across the US to be challenged to adopt families. The City of Detroit adopted 500 families for which they are providing total support. All states must ban together and assist the multitude of displaced families. Also, we need to get our voice out to all African American radio and television stations and newspapers both local and national to become our media vehicle and aid our efforts to magnify the overall adversities and needs of African American victims.

It is my goal to send updated emails periodically of the NMA efforts to aid the victims of Hurricane Katrina who are being housed in the Astrodome, Reliant Arena, and soon at the George R. Brown Convention Center as well as surrounding Red Cross agencies and shelters in Fort Bend, Baytown, and throughout the Houston area.

Our strong commitment to assist African American patients and support of our medical students exemplify the integrity for which the NMA was founded. The National Medical Association (NMA) was established in 1895 to address the specific needs of a culturally diverse population. We represent over 25,000 minority physicians in 24 specialty medical disciplines. The National Medical Association’s Scientific Assembly is acclaimed as the nation’s foremost forum on medical science and African American health.

Given all the devastation, we cannot forget our future medical students who were displaced from all the schools in New Orleans and surrounding areas with regards to books, tuition, and other college expenses that was once covered by scholarships that are now questionable. As Section Chair of Psychiatry, I have proposed that our physicians adopt a medical student. We must not let our future medical students have interrupted education or financial difficulties. Some of the students displaced from Xavier, Tulane, Loyola and other area medical schools within the New Orleans area have lost everything. Some students are not from Louisiana and were recruited and supported by school scholarships and mentor programs. Their backgrounds are diverse and families are poor and/or unable to help them with their medical education and needs.

I’m sure many of you have watched the news channels and are inundated with information of donations, relief efforts, horrific and touching rescue scenes and much more. My NMA Psychiatry Coordinator and Executive Assistant noted that her company and many other companies within the Houston area have donated amounts of $2 million and more to the Red Cross and other charities. Many Houstonians are opening their homes to assist. The last news broadcast mentioned that over 100,000 people from New Orleans have come to the Houston area. The City of Houston and other local area towns have tried their best to accommodate and are doing an outstanding job but we are not equipped to handle this multitude of victims for an extended period of time. As members of the NMA, we must meet our responsibilities as a medical organization in a medical crisis.

Many contribution websites are listed on the NMA website www.nmanet.org. I’ve listed more local websites below:

American Red Cross: www.redcross.org.
Houston Local Number: 713-313-5480

Salvation Army: www.salvationarmyusa.org
800-435-7669 (800 HELP NOW)

Texas Southern University (Admitting displaced students)
713-313-1059/713-313-7071

Houston Independent School District (For evacuee students)
713-892-6699

Texas A&M Galveston: 409-740-4448 or 877-322-4443

Harris County Housing Resource: 713-578-2055

FEMA: www.fema.gov
800-621-FEMA
Volunteer Houston: 713-965-0031

Employment for Evacuees: 1-888-469-5627

Food Stamps: 800-500-4266
(Displaced Families can get assistance in Houston area)

WIC: 800-942-3678

Sources for homes that are available: www.nola.com

To open your home to evacuees: www.openyourhome.com

Local news: www.abc13.com and www.click2Houston.com, www.KHOU.com and many more give more information.

Kindly forward this information to all your colleagues and other physicians in all specialty areas. When contacting us via phone or email, be sure to include email addresses, phone numbers, physical addresses and any other contact information so we can update our database and add more physicians to our communication updates. Please be in prayer for everyone. Thank you for your continued support and assistance in getting the word out and for your many donations and ongoing contributions.

Sunday September 4, 2005

I want to let all of my NMA colleagues know what is truly going on here regarding health care for the Hurricane Katrina victims from New Orleans currently housed in the Astrodome and Reliant Arena.

The stories I’m going to share are indicative to the many stories that was heard over and over again given by victims in dire need of medical treatment and comfort.

My first patient was an African American woman who cried uncontrollably the whole night. I did my best to sedate her but within an hour she was back up crying. Her story was about her lost 13-year-old daughter. She said that as the water kept rising in their home, her daughter was with her. However, when they got out of the house, her daughter along with others floated away in the raging waters and lost in the night. She doesn’t know if her daughter is alive or dead. Another African American woman lost both her daughter’s ages 6 and 16 the same way. She literally screamed to the top of her lungs much of the night in grief.

A 50-year-old African American man, Vietnam Veteran, had virtually the same story. Water was rising in the house so Monday night they slept in the attic. The next day with the water continuing to rise, they were told to evacuate to the Superdome. They did. They stayed from Tuesday to Thursday in the most deplorable conditions. At the Superdome, he reported three (3) girls were raped, men getting physically assaulted, and people walking through human waste down the hallway that leads onto the floor of the Superdome. People were sleeping in this same waste filled hallway because they had nowhere else to go and nowhere to sleep. His 22-year-old son lived through the flood but was shot at the Superdome. He said it was total ciaos everywhere you turned. No running water, no air, too many people, no security, no food, and nothing to drink. He told me the police in New Orleans were taking food and water from nearby stores and selling it to them. After the officers left the stores, other people went in to find food and water and were thought to be looters. How could this be? Where was the city government? Where is the law enforcement? Where was the local disaster relief groups located in the city? One would think if you were t! old to evacuate to a specific location, that the location would be prepared to accommodate as many as the location could hold and at the very least have bare necessities of water, food, place to use the restroom and somewhere to sleep. The Superdome had 40,000-50,000 people that couldn’t get out and had no means of transportation to evacuate the city. Most are poor African Americans. As I looked into our infamous Astrodome, I saw rows and rows of cots for people to rest, portable restrooms, food and water, clothing areas, designated shower areas for men and women, and medical areas to receive treatments.

I treated many opiate dependent patients. They had chills, cramps, sweating, diarrhea, and other symptoms associated with withdrawals. Many of these patients were on methadone and had been on it for years. By now they are four to five days without medications and are in withdrawals. Something that made me frown was to hear that it was good for these patients to go through these symptoms. How inconsiderate! It is bad medicine to ignore any healthcare conditions with real symptoms if they were caused from dependent medicines or not. We as physicians took an oath to help everyone from all walks of life in need of medical treatment regardless of ethnicity, background, religion, etc.

One dependent male told me his heartfelt story. Again, same beginning of rising water in their home. The water was 3-4 ft. on the first floor and rising by the minute. He grabbed his elderly grandmother and put her on his back then left the house wading in deep water and swam down to the St. Bernard Parish High School. They got up on the second floor where it was safe. He continued going back for others that were located on his street using a raft to help move them and their belongings safely to the school.

Three small boys came to me with Attention Deficit Hyperactivity Disorder (ADHD). One of the boys was shivering like a leaf. His mother told me that he had seen a man get shot in the Superdome. The mother went on to tell of all the children crying with no milk, formula and diapers. Some women had children that didn’t belong to them as they were displaced from their families.

These heartfelt stories go on and on. The loud screams and crying were so mentally exhausting as we tried our best to comfort the patients.

Something positive did come out of the evening. I must report that the medical services team of physicians was very organized in helping to treat the victims. I applaud the massive response from the pharmaceutical companies for supplying such neuroscience medications like Strattera, Concerta, Cymbalta, Prozac and many more. These were actual medicines and not samples. The kind humanitarian effort of the pharmaceutical companies is greatly appreciated by the medical staff in efforts to administer appropriate medical care to these victims.

In conclusion, I cannot accept nor understand our inability to respond to rudimentary and basic necessities like transportation, food and clothing, law enforcement, etc. This is totally pathetic, ridiculous, intolerable, and unacceptable coming from people in positions that should be prepared for these kinds of crisis and were caught off guard. How can FEMA, a national government agency to aid in such disasters, allow these victims to go over three (3) or more days without the basic human necessities?

We cannot sit idle by and see this happen again. We must be prepared at all times to take care of our own.

Rahn K. Bailey, M.D., F.A.P.A.
Board Certified, General and Forensic Psychiatry
Chairman, NMA Psychiatry Section

And

Holly L. Blackmon
NMA Psychiatry Section Coordinator

NMA is the National Medical Association, and they endorse single payer. We encourage people who wish to volunteer to work with NMA.

Garamendi’s “Priced Out”

Priced Out
Health Care in California
2005
John Garamendi, Insurance Commissioner

Table of Contents

Chapter 1
The State of California Health Care:

* The National Context
* Crisis in Health Insurance: Skyrocketing Health Insurance Premiums
* Crisis in Health Insurance: Paying More for Reduced Coverage
* Health Costs and the Economy
* Crisis in Health Insurance: Growing Uninsured Overall, Greater Reliance on Public Safety Net
* What Happens to the Uninsured?
* Health Status is Declining in California
* California Faces Unique Challenges in Public Health Care Funding Including Lack of Federal Support
* Health Care Quality and Cost Containment

http://www.insurance.ca.gov/PRS/PRS2005/priced-out-health-care-in-california.pdf

Comment: This certainly is not an exciting or provocative quote. So why was it selected?

The first chapter of “Priced Out” describes the health care problems in California, but in a national context. With over 12% of the nation’s population, California exemplifies the national problems and our failures to address them.

This first chapter serves as an excellent, stand-alone report of the some of the more important deficiencies of our entire health care system. We cannot hope for reasonable solutions unless we understand the problems. This report provides a foundation for that understanding. You should consider downloading the first chapter (if not the entire report) for use in your activism for reform.

The report is peppered with specific recommendations that some might describe as incremental tweaking of the system. They should not be lightly dismissed since many of the recommendations would be of value in a universal system of funding health care.

Although some might be distracted by these specifics, Garamendi does list his overriding health care principles. His first principle: “Universal health care coverage is the only real answer.”

The first chapter makes it very clear that the complexities of our dysfunctional system cannot be adequately addressed by simple measures that merely tweak the system, as important as they are. Thorough restructuring of the way that we fund health care will be required to achieve equitable, affordable, comprehensive health care for everyone.

73% of workers want a national health care system

Health care tops a growing list of worries
By John Sweeney, President of AFL-CIO
The Philadelphia Inquirer
Sep. 5, 2005

Despite the “recovery,” economic dissatisfaction among working Americans is increasing. Nearly 60 percent are not happy with the country’s economic situation, according to new research by Peter D. Hart Research for the AFL-CIO.

Rising health-care costs are eating away at Americans’ security. Fifty percent of working people say they personally worry very or somewhat often about not being able to afford health care. With more than 40 million uninsured, too many Americans can’t afford to pay the doctor and soaring health bills are one of the top causes of bankruptcies in this country.

Americans are also worried about what health-care costs are doing to the country. In fact, 73 percent say establishing a national health-care system should be a top priority for Congress and the President.

http://www.philly.com/mld/philly/12563348.htm

Comment: Unions have long supported comprehensive health benefit programs for their members. Many union leaders still support a strong role for unions in dictating the terms of coverage, even though the shift from a manufacturing-based economy to a service-based economy has significantly weakened their negotiating power. This weakness is exemplified by the reduced health benefits that California grocery workers received after a painful, prolonged strike.

Nevertheless, 73% of workers do want Congress and the President to establish a national health care system. Since only 12.5% of wage and salary workers are union members, the union leadership is not in a position to demand, specifically, universal, employer-sponsored coverage, but it is in a position to add political support to the movement for a universal system that would cover everyone, including the 87.5% of workers who do not belong to unions.

Employer-sponsored coverage has many deficiencies, including regressive funding, job lock, affordability for small businesses, administrative waste, deficiencies in family coverage, higher costs than public programs, and other features which characterize our fragmented system of funding care.

Union leaders would best serve the interests of their own members and the interests of all workers and everyone else, if they would support a truly universal, comprehensive, publicly administered program of national health insurance. 73% of workers are ready for it, and so are we.

Is Regence BlueCross BlueShield selling retirement plans?

Regence BlueCross Blue Shield of Oregon

Regence Health Savings Account
Frequently Asked Questions

For employers:

Q: What are the advantages to the employer?

A: Employer contributions to a health savings account are tax-deductible in year in which the contributions were made. For small employers without a retirement plan, funding a health savings account could be a way to offer retirement savings to employees.

http://www.or.regence.com/needCoverage/individual/hsa/index.html

Comment: Are Health Savings Accounts (HSAs) a form of health insurance, or are they retirement plans? Pension planning involves setting aside funds to be used as an income source by each individual in his/her retirement. In contrast, health insurance is a method of pooling funds to pay for health care, health care which will be used disproportionately by those with greater health care needs.

When Congress authorized policies to combine retirement planning and health insurance in the form of HSAs, they created a product that serves neither function well. Individuals with significant health care needs automatically lose their retirement benefits as they draw down their accounts. As health insurance, the pooled funds are split up into small, individual accounts, providing inadequate funding for those with greater health care needs.

Congress recognized that HSAs are not a form of health insurance and would not provide adequate financial security in the face of medical loss. As a result, the legislation requires that participants in HSA plans must have what? Health insurance! This has created new opportunities for insurers to market highly profitable, high-deductible PPO plans that fail to provide adequate financial and health security for the majority of moderate-income individuals.

Regence BlueCross BlueShield is passing the HSA off as a retirement savings plan, but absent the disclaimer that the retirement benefits will be denied to individuals with health problems. What a perversity!

Two American Disasters

The faces of disaster
Editorial
The Philadelphia Inquirer
Aug. 31, 2005

The images were stunning: rooftop rescues, submerged casinos, a high-rise hotel bereft of windows, and the Superdome’s roof peeled back in places like a banana peel.

As the floodwaters along the Gulf Coast begin to recede, aid for the areas devastated by Hurricane Katrina will begin to flow in.

Charities will send money donated by Americans whose emotions and morals were stirred by the plight of citizens who suddenly lost loved ones, homes, pets and all trace of modern convenience to Katrina’s lash.

Even larger amounts will flow from federal and state governments, doing what governments must do to cope with catastrophe on this scale.

Few Americans will begrudge the hurricane-haunted people of New Orleans, Mobile, Biloxi and Gulfport the dollars that will flow their way to undo the harm that hellish Katrina did.

Yet, sure as the sunrise, some of that money will be wasted. Some of it will go to help people who are, truth be told, of imperfect moral fiber. Some of it, in the sad way of the world, will be skimmed by profiteers who feast on others’ misery.

Yet no one will suggest those facts as reasons not to spend the money, just as no brave emergency workers declined Monday to rescue folks whose stubborn folly in ignoring evacuation orders left them in peril.

When lives hang in the balance, you don’t withhold help just because the people in trouble may have contributed to their own predicament.

In the midst of sudden, natural calamity, citizens of this nation are usually clear about that truth.

Why is it, then, that things get so muddy, so sour when the calamity that grips millions of Americans is man-made, subtle and slow-moving? Why, in those cases, are so many so slow to help, so eager to find excuses for inaction and to blame the victims?

Think, for example, of the scandal of the uninsured in this land. The U.S.
Census Bureau reported yesterday that, despite a decent economy, the number of Americans without health coverage rose again to an all-time high last year, to 45.8 million, up 800,000 over 2003.

This quiet calamity harms millions, as surely and as grievously as Katrina did. But it doesn’t yield dramatic rescue footage. It doesn’t entice CNN correspondents to yell into gale-force winds. Its dramas happen out of camera’s sight, in doctor’s offices, hospitals, workplaces, classrooms and glum kitchens.

Lack of health coverage costs people health, jobs, diplomas, quality of life and peace of mind. It’s the leading cause of personal bankruptcy in America.
It costs lives.

Yet the flood tide of the uninsured keeps rising, with no sense of national urgency. Political leaders do little, or even worse than nothing. Some of the “solutions” now in vogue amount to blaming the victim, as though wanting good health care were some kind of moral failing.

If only we could summon the better angels of our nature to cope with such man-made disasters as well as we do when it’s Nature, not politics, that deals out the damage.

http://www.philly.com/mld/inquirer/news/editorial/12518551.htm

USA Today-KFF-Harvard Health Care Costs Survey

USA Today/Kaiser Family Foundation/Harvard School of Public Health September 1, 2005
Health Care Costs Survey

Survey Findings

Health care costs are more than a barrier to access to care, our findings show that medical bills create a significant challenge for many American families, including those with insurance, impacting their lives in a variety of ways…

Health care costs create a significant barrier to getting healthcare for many Americans.

More than 4 in 10 adults (44%) report having a chronic condition such as heart disease, cancer, asthma or diabetes, or a handicap or disability that limits their daily lives. This group has a significantly harder time accessing health care specifically because of the costs.

Moderate and lower-income, working adults report significantly more problems paying for medical care compared to their higher-income peers and insured seniors.

Uninsured adults (18% of the public) report considerably greater problems accessing health care because of the costs than those with insurance and say it’s costs that keep them out of the health insurance market.

It appears that people see few alternatives to lower their health care bills beyond skipping care. Few report negotiating prices with their health care providers or seeking cheaper providers via the internet.

Many Americans worry about paying for medical care.

.and many are experiencing rising health care costs. The public lays blame for these rising costs on profits made by drug and insurance companies; few view doctors as being part of the problem.

Prescription drugs play an important role in many people’s lives, and many report problems paying for these drugs.

Lastly, it is important to note that the survey also shows that many Americans are at least somewhat satisfied with the cost of health insurance and feel the health care system works well for them personally, perhaps illuminating why there isn’t a greater public outcry for health system reform. These findings set the context for the significant challenges faced by those who are most dependent on the system.

Summary and Chartpack of the Survey:
http://www.kff.org/newsmedia/upload/7371.pdf

USA Today three part series (third part to be published tomorrow, Sep.2):
http://www.usatoday.com/money/industries/health/health-care-crunch-digest.htm?LOC=vanity

Survey Toplines:
http://www.kff.org/newsmedia/7372.cfm

Comment: Use the time that you would have spent reading my comment to save these links. You will need to set aside time to review this study and the USA Today series. As an advocate of health care reform, it will be well worth your time.

WMC Wrong on Health Care and Attorneys

By Jack E. Lohman
8/30/2005

Somehow it doesn’t surprise me that Wisconsin Manufacturers Commerce opposes the recent state Supreme Court decision that declared the limits on malpractice awards unconstitutional and that lead paint trials can move forward. WMC was extremely quick to take the side of its business, health care and insurance members, but to the detriment of the public. WMC is wrong on a number of accounts.

Indeed the malpractice and health care systems need fixing, but removing physician and hospital accountability and victim protection is not the way to do it. Two wrongs don’t make a right, though it does get certain WMC members off the hook at the expense of their business members and the public.

Let’s dispense with a major myth: it is true that health care costs are rising at five times the rate of inflation, but the malpractice industry is not the monster driving the system. Having been a health care provider for 25 years before retiring in 2004, I’m as testy toward trial lawyers as the next guy. But this one is not their doing, and WMC should look inward to its own health care members for the solution.

Malpractice awards have remained essentially flat for five years at less than 0.5% of our state’s total health care costs. But insurance premiums have soared by 120% because of a runaway insurance industry that is allowed to make up its losses incurred elsewhere. Besides, only 9 awards in the last 10 years exceeded the cap we would have had in place. Most awards are settled out of court because doctors won’t testify against doctors.

Rising health care costs are the result of only one thing, a medical community that has switched from being humanitarian centers to for-profit corporations. The industry is running amok. They are inefficiently operated and they love it, because inefficiency is where they make their profits.

Both Medicare and private insurers are incurring 20% to 30% of their costs from unnecessary and inappropriate medical testing, and another 30% in exorbitant administrative waste (compared to Canada’s 8% and Medicare’s 3.5%). Wisconsinites are supporting 400 for-profit insurance companies compared to the ONE non-profit in each Canadian province.

It is true that jobs are leaving Wisconsin, but it’s because of runaway health costs and not because of attorneys. That will not change under the Supreme Court ruling. If WMC really wants to get behind its manufacturing members (and the public at the same time), it will sideline its health care and insurance members and support a universal health care system like that in Canada, one which would also cover the 15% of our uninsured population.

To cover health care costs in Canada, their employers pay only a small per-employee tax of $800 and the taxpayers pick up the rest. They use one medical administrator, like Medicare uses WPS in our state. All physicians and hospitals remain independent and patients keep their physician choice.

We don’t have to have the wait times that they do; we don’t with Medicare and we can properly fund any universal system we develop. Over 90% of Canadian patients prefer their system to ours, and only a handful per year come to the states to speed up elective surgeries. Another handful of physicians move south because they can become millionaires here and not there.

So what would happen with the jobs WMC claims will leave the state? With a repaired health care system the nation’s second-highest health care costs would drop to the lowest, our malpractice costs would remain at the lowest in the nation, more manufacturers would move to and stay in Wisconsin, workers would immigrate and state tax revenues would increase, unemployment would decrease, WMC membership would increase, and patients would increase for the medical community.

So, WMC, what’s not to like about this fix?

Lohman is a retired business owner, is volunteer director of www.WiCleanElections.org and can be reached at jlohman@execpc.com

Mass voters may get a new angle on health care

Health Reform Program report makes the case for single-payer program
By Rebecca Lipchitz
BU Today
August 31, 2005

A once unpopular plan for health care reform in Massachusetts is gaining support from legislators and with an upcoming vote on an amendment to the state constitution, it may have a new chance to enter the spotlight.

The plan calls for a single-payer health care system, and Alan Sager, an SPH professor, and Deborah Socolar, an SPH health sciences project manager, hope Massachusetts voters will support it. Sager and Socolar codirect the BU-based Health Reform Program. Their recent report, titled $1 Billion Per Week is Enough, asserts that the money wasted on health care overhead and other unnecessary costs in Massachusetts would cover the health care costs of every resident.

As many as 10 percent of the Commonwealth’s more than six million residents are uninsured, yet individuals and businesses spend $52.7 billion a year on health care, according to the report, which served as testimony on behalf of Senate Bill 755. The proposal to establish the Massachusetts Health Care Trust is now in the lap of the Joint Committee on Health Care Financing.

The proposal would cover all the state’s residents and contain costs by allowing doctors to manage the budget, but not benefit from it. One budget would compensate doctors, another would go toward health care expenses. Doctors would manage only the latter. A large portion of excess cost in the current health care system is paperwork, Sager says, “and the mistrust is the largest source of paperwork. The clerks and the doctors and hospitals fighting insurance companies are not adding an ounce to human health or security. Only when doctors have to make tradeoffs will they have the ability and willingness to weed out clinical waste.”

In the past, such effective solutions lacked political support. “What won’t work can pass,” he says, “but what will work won’t pass.” But efforts to reform the Massachusetts health care system could take an unexpected turn this fall.

An amendment that would require the Commonwealth to provide health insurance to all residents passed overwhelmingly at last year’s constitutional convention. If the amendment passes again at this year’s convention, scheduled for September 14, it would be put before the voters. (Proposed amendments must be approved twice by the legislature before being placed on a ballot.) If voters endorse it, the Commonwealth must find a plan to achieve it. New debates on how to best cover all residents would be sparked, giving new relevance to ideas once cast aside.

The proposal to establish a Health Care Trust is not the first attempt to create a single-payer health care system in Massachusetts, but the idea has not always been marketed very well, Sager says. “The phrase ‘single-payer’ is four syllables,” he says, “and includes two of the most unpopular words in America.” But such a solution is increasingly relevant, according to bill cosponsor Senator Steven Tolman (D-Boston).

“Once you hear the facts about what’s going on in our health care system, you don’t have to be a rocket scientist to realize that we have a major problem,” Tolman says “A third of our dollars are not going to direct care.”

In addition to covering all residents, regardless of whether they can afford it, a single-payer system has other benefits, such as taking the pressure off businesses and municipal governments to provide health benefits and unemployment insurance.

Tolman, who has supported a single-payer solution in the past, says the public is likely to accept such a measure only incrementally. “People are afraid of change,” he says. “We know that, but the work [Sager and Socolar] have done has clearly given us the evidence that the money is in the system.”

CBO: The Price Sensitivity of Demand for Nongroup Health Insurance

The Price Sensitivity of Demand for Nongroup Health Insurance
Congressional Budget Office
August 2005

This paper examines the sensitivity of decisions to purchase insurance in the individual, or “nongroup,” insurance market to the price of that insurance-a central aspect of tax credits and other price-based incentives to stimulate the purchase of private health insurance. The paper focuses on those without access to group insurance through an employer-in other words, those for whom nongroup insurance may be the only coverage option. Surveys by the Census Bureau and others help identify such people and allow an examination of their economic and demographic characteristics. However, those surveys do not contain information on the potential premium (or price) of insurance for those who do not purchase it.

This paper uses two alternative methods to estimate that premium for single workers partly on the basis of information about their health status. It then uses exogenous differences in insurance premiums attributable to (1) the tax deductibility of premiums for self-employed individuals and (2) the effect of state-level premium compression and community rating regulations to estimate the responsiveness of otherwise similar people to different levels of price. Using a reduced-form ordinary least squares (OLS) regression model, this analysis estimates a price elasticity of demand for health insurance of -0.57. For example, a 10 percent reduction in insurance premiums is estimated to result in a 5.7 percent increase in health insurance coverage in the nongroup market in our sample of single workers, 16 percent of whom had nongroup coverage at the time of the survey in 2002. Analyses of poor and less-healthy subgroups find largely insignificant results, though the less-healthy appear to be less responsive to premium changes than the more-healthy.

http://www.cbo.gov/ftpdocs/66xx/doc6620/08-24-HealthInsurance.pdf

Comment: Sorry to distribute a message that’s nearly lost in technical jargon, but this one is important.

Most current administration efforts to adopt policies that would reduce the numbers of uninsured are targeted toward the individual insurance market. In order to make premiums affordable, tax credits have been proposed. This study confirms, once again, that reducing premium costs for individuals, through the tax system, will have very little impact in reducing the numbers of uninsured.

The importance of this study is that in our debates we can now say, “The Congressional Budget Office says that tax credits won’t work! Now let’s talk instead about reform that really will work!”