PNHP

Emergency infrastructure deteriorating

Emergency infrastructure deteriorating

American Medical News
March 24/31, 2003
California emergency departments close after hemorrhaging money
By Markian Hawryluk

According to a new study by the California Medical Assn., California emergency departments provided $540 million in uncompensated care in fiscal year 2001, up 24% from the previous year.

… since 1990, 60 emergency departments — nearly 15% of California’s EDs — have shut their doors.

The closures have left entire communities without emergency departments and have led to increased patient volume. Waits of more than four hours are common as physicians and nurses struggle to treat high volumes of patients, the study found.

John Whitelaw, MD, California Medical Association president:

“What we are seeing here is an astonishing growth in losses, and it shows no sign of abating. People depend on their emergency rooms to be there for them, but these losses point to a crisis of extreme proportions and underline the threat to emergency care around the state.”

http://www.ama-assn.org/sci-pubs/amnews/pick_03/gvsd0324.htm

Comment: No amount of personal wealth can protect you from the threat of the deteriorating infrastructure of our emergency system. Rich people will die, along with the poor, because of the failure of our system.

Providing comprehensive coverage for everyone, funded at our current level of spending (15.2% of our GDP), with a level of efficiency available only through public administration, would ensure that our emergency system would be well funded, always there for all of us.

Suggested testimony for Democratic Party Hearings

This is the piece that is being sent to every member of the Democratic Party Action Agenda Committee. You can use it to shape your own testimony if you wish. In any case you should put in your own or your group’s perspective.

SUPPORT INCLUDING SINGLE PAYER HEALTH CARE IN THE
2003 MASSACHUSETTS DEMOCRATIC PARTY PLATFORM ACTION AGENDA

The Massachusetts Democratic Party Platform supports the creation of a single payer health care for system in Massachusetts. The support is stated as, ā€œOur Party supports the creation of single payer health care system both in Massachusetts and in the nation in order to achieve the goal of universal health careā€. This support has been included in every Massachusetts Democratic Party Platform and Action Agenda since 1993. It is even more important that it be included in the 2003 Action Agenda.

Single Payer Health Care is a unifying issue

Over the last 10 years the Republicans have gotten themselves in trouble whenever they try to attack or undermine Social Security or Medicare. There is a simple reason for this: they are universal programs. Every American resident is entitled to participate in these programs and that means that the programs enjoy the wide political support that programs that target certain populations can never enjoy. In Massachusetts, all of the programs that expanded health care coverage over the last 15 years are under attack. This is because most residents do not feel they benefit from these programs.

A single payer health care system would guarantee every resident of Massachusetts quality health care. Once established, it would enjoy broad political support that would make it very hard for special interests to undermine. Single payer health care also has the additional benefit of being the only fiscally responsible way of achieving universal health care, this has been validated by every independent study on the subject. Single payer health care provides universal health care by capturing the waste that is endemic to our current multi-payer system. Studies have determined that between 30% and 35% of our health care dollar is spent on administration and overhead. This is compared to the 10% that is the highest that is spent in any country with a unified and universal health care financing system. A single payer system would eliminate more than half of the money presently wasted and would use that money to provide quality health care to every resident of Massachusetts.

We must learn the lessons of Medicare and Social Security and create a universal single payer health care system in Massachusetts. Support for this position should be featured in the 2003 Massachusetts Democratic Party Action Agenda. This is the type of program that can help re-establish the Massachusetts Democratic Party as the party that represents the interests of all working people and their families.

Support for a government solution grows

The Washington Post
March 16, 2003
Health Insurance Back as Key Issue
By Ceci Connolly and Amy Goldstein

Sen. Susan Collins (R-Maine):

“My brother, a conservative small businessman, is saying maybe it’s time for the government to take over health insurance. The one change I’ve noticed in the last few months is that businesspeople for the first time are questioning whether private health insurance can survive. It is just an extraordinary thing.”

http://www.washingtonpost.com/wp-dyn/articles/A30115-2003Mar15.html

"Lower class" not entitled to essentail benefits under Medicare?

The Washington Post
March 14, 2003
Editorial

Medicine for Medicare

DO NOT BE MISLED by the loud noises coming from congressional Democrats and health care activists. The Medicare modernization plan the president has finally presented to Congress, after much hemming and hawing, is not radical. It does not force anyone to leave the current system. It does not make anyone switch doctors. It adds $400 billion over the next 10 years to pay for extra drug benefits, a number far higher than some have mentioned. Unlike leaked versions of the administration’s proposal, this one does not even provide full details of what the reform would look like, instead leaving Congress to fill in many of the blanks. As a result, it’s difficult to say whether the proposal would produce much change.

In essence, it adds options, instead of removing them. For those who want it, traditional “fee-for-service” Medicare would be preserved more or less intact, with the addition of a prescription drug discount card as well as some catastrophic insurance. No extra payments would be required, it seems. At the same time, Medicare recipients would also be able to opt into a new program — “enhanced Medicare” — that would look a lot like the current federal employee health insurance plan. Those who chose this option would pay a part of the cost themselves. In return, they would get a private plan and better benefits.

Both the administration and its supporters in Congress seem to hope that over time more people (and particularly younger people, by now accustomed to a plethora of health care choices) would select this second option. If this happened, the costs of Medicare to the federal government might not come down dramatically — private insurance isn’t necessarily cheaper, particularly for the elderly — but at least Medicare recipients would have some incentive to choose plans more suited to their specific health needs. Because they pay for more than just emergency visits to the doctor, integrated plans could also care more sensibly for the chronically ill. As a recent report by the Progressive Policy Institute points out, Medicare currently will pay if you’ve been hospitalized for a stroke but will not pay for the anti-hypertension drugs to prevent it. This is the kind of absurdity that a plan designed specifically to meet the needs of older people could avoid.

“Could” and “might” are the operative words here, however. The president’s proposal is not a panacea but rather a set of suggestions that reflect the politics of the moment. Clearly, this president does not want to be accused of “abandoning” Medicare. On the contrary, he wants to be able to say that “Medicare will always be there, just how it’s always been, if you want it that way.” If Congress chooses to stick too closely to this mantra, and to keep benefits the same across the board, there will be little incentive for anyone to opt out of the current system or to contribute to the costs of his or her care. However politically difficult it appears to be, Congress must make it possible for Medicare to change with the times.

http://www.washingtonpost.com/wp-dyn/articles/A23255-2003Mar13.html

Comment: Neither of the “either-or” options behind this editorial can be good news. Either the editorial staff has failed to do its homework in understanding the fundamental principles of social insurance, or the editorial position of The Washington Post is to support a system that ensures comprehensive services for those able to afford them, but relegates lower-income beneficiaries to a program that falls short on basic health care needs. Have the editors demonstrated incompetence by failing to inform themselves adequately on the issues, or, worse, are they suggesting that personal wealth should determine whether Medicare beneficiaries should have access to all essential services?

Adding a drug discount card to the program would cost nothing, which is exactly what it is worth under this “budget-neutral” administration. And the $6000 deductible catastrophic drug coverage would benefit only the affluent. Prohibiting any other improvements in the benefit package of the traditional program would perpetuate the impaired access to care for those who are unable to afford essential services that are not currently a benefit of the program. The most immediate need is for a bona fide prescription benefit.

The Washington Post supports the FEHBP model of “enhanced Medicare,” making available a private plan, with BETTER BENEFITS, by PAYING A PART OF THE COST themselves, while still prohibiting coverage of the “better benefits” in the traditional program. This would end Medicare as an egalitarian program of social insurance.

The Washington Post is supporting the shift to “consumer-directed” Medicare, not only by shifting costs to beneficiaries when offering more plan options, but also by providing “incentive to choose plans more suited to their specific health needs.” But it is impossible to select a plan that will be the best choice for medical events that cannot possibly be predicted. Also, for those with chronic disorders, providing options creates all of the inequities characteristic of risk segmentation. Lower-income beneficiaries with chronic disorders would be locked into the traditional program. The Washington Post states that covering a stroke but not covering the medications that would prevent it is “the kind of absurdity that a plan designed specifically to meet the needs of older people could avoid.” Yet The Washington Post has endorsed precisely this type of absurdity.

Is this editorial incompetence, or is it support for the concept that there is a “lower class” that is not entitled to all essential health care? Perhaps The Washington Post does not want them to have their “cake,” but, rather, “Let them have strokes.”

State Sues Drug Companies, Claiming Price Gouging

By WILLIAM HATHAWAY
Courant Staff Writer

March 14 2003

Seven drug manufacturers have bilked patients and state drug programs of tens of millions of dollars in a complicated price-gouging scheme, the state attorney general and consumer protection commissioner charged Thursday.

“These companies raided state coffers and patients’ pockets,” said Attorney General Richard Blumenthal. “The victims were people paying for vitally needed medicine.”

The Department of Social Services, which pays most of the $600 million Connecticut spends annually on pharmaceuticals, joined lawsuits that seek reimbursement of overcharges to state agencies and patients.

The companies allegedly inflated the costs of some drugs – chiefly those used for cancer treatments and respiratory problems – that are reimbursable under several state programs. The companies in turn sold the drugs at deep discounts to providers such as pharmacies or doctors, who were allowed to keep the difference between the reimbursement amount and the discount cost as an inducement to prescribe and sell the drugs.

In essence, the companies used state funds to help increase the market share of their drugs, the suits allege.

“It’s an absolute disgrace on the part of these companies,” said Consumer Protection Commissioner James T. Fleming.

The defendants in lawsuits being filed at Hartford Superior Court are Schering-Plough Corp., GlaxoSmithKline, Aventis, Dey Inc., Warrick Pharmaceuticals, Pharmacia Corp and Roxanne Pharmaceuticals, a division of Boehringer Ingelheim, which is based in Ridgefield.

Under state drug programs, the state reimburses drug manufacturers for drugs based on their average wholesale price, minus 12 percent. However, drug companies report the costs themselves to national databases and state officials have no way of corroborating them, according to Michael P. Starkowski, deputy commissioner at DSS.

As an example, a drug company might report a price of $100 for a drug that actually costs $20, state officials said. The reimbursement paid by the state would then be $88. Drug companies then offer the difference between the actual cost and the government reimbursement – a “spread” of $68 in this example – as an inducement to help market the drug.

Among the drugs “overcharged” to the state in this manner were the asthma drug Albuterol and chemotherapy drugs Zofran and Anzemet, according to officials.

“In some cases, the companies actually market the spread to doctors,” Blumenthal said. “The practice is industrywide.”

Four or five other states have initiated similar actions against a number of different drug manufacturers, Blumenthal said.

Bruce Lott, senior director of public affairs for the Pharmaceutical Manufacturers Association declined to comment, saying the association does not comment on business practices of individual members.

“We haven’t seen the complaint,” said Pamela DeMala, spokeswoman for Boehringer Ingelheim. “But Roxanne markets its products in full compliance with the law and we are confident in our business practices.”

State officials said the practice hurts all consumers, but particularly those on Medicare, who pay 20 percent of the cost of some cancer treatments as a co-payment.

State officials are still trying to calculate the total amount overcharged, but initially will seek a $15 million reimbursement to the state and possibly a similar amount for consumers.

Copyright 2003, Hartford Courant

http://www.ctnow.com/news/health/hc-drugs0314.artmar14,0,571487.story?coll=hc%2Dheadlines%2Dhealth

“Lower class” not entitled to essentail benefits under Medicare?

The Washington Post
March 14, 2003
Editorial

Medicine for Medicare

DO NOT BE MISLED by the loud noises coming from congressional Democrats and health care activists. The Medicare modernization plan the president has finally presented to Congress, after much hemming and hawing, is not radical. It does not force anyone to leave the current system. It does not make anyone switch doctors. It adds $400 billion over the next 10 years to pay for extra drug benefits, a number far higher than some have mentioned. Unlike leaked versions of the administration’s proposal, this one does not even provide full details of what the reform would look like, instead leaving Congress to fill in many of the blanks. As a result, it’s difficult to say whether the proposal would produce much change.

In essence, it adds options, instead of removing them. For those who want it, traditional “fee-for-service” Medicare would be preserved more or less intact, with the addition of a prescription drug discount card as well as some catastrophic insurance. No extra payments would be required, it seems. At the same time, Medicare recipients would also be able to opt into a new program — “enhanced Medicare” — that would look a lot like the current federal employee health insurance plan. Those who chose this option would pay a part of the cost themselves. In return, they would get a private plan and better benefits.

Both the administration and its supporters in Congress seem to hope that over time more people (and particularly younger people, by now accustomed to a plethora of health care choices) would select this second option. If this happened, the costs of Medicare to the federal government might not come down dramatically — private insurance isn’t necessarily cheaper, particularly for the elderly — but at least Medicare recipients would have some incentive to choose plans more suited to their specific health needs. Because they pay for more than just emergency visits to the doctor, integrated plans could also care more sensibly for the chronically ill. As a recent report by the Progressive Policy Institute points out, Medicare currently will pay if you’ve been hospitalized for a stroke but will not pay for the anti-hypertension drugs to prevent it. This is the kind of absurdity that a plan designed specifically to meet the needs of older people could avoid.

“Could” and “might” are the operative words here, however. The president’s proposal is not a panacea but rather a set of suggestions that reflect the politics of the moment. Clearly, this president does not want to be accused of “abandoning” Medicare. On the contrary, he wants to be able to say that “Medicare will always be there, just how it’s always been, if you want it that way.” If Congress chooses to stick too closely to this mantra, and to keep benefits the same across the board, there will be little incentive for anyone to opt out of the current system or to contribute to the costs of his or her care. However politically difficult it appears to be, Congress must make it possible for Medicare to change with the times.

http://www.washingtonpost.com/wp-dyn/articles/A23255-2003Mar13.html

Comment: Neither of the “either-or” options behind this editorial can be good news. Either the editorial staff has failed to do its homework in understanding the fundamental principles of social insurance, or the editorial position of The Washington Post is to support a system that ensures comprehensive services for those able to afford them, but relegates lower-income beneficiaries to a program that falls short on basic health care needs. Have the editors demonstrated incompetence by failing to inform themselves adequately on the issues, or, worse, are they suggesting that personal wealth should determine whether Medicare beneficiaries should have access to all essential services?

Adding a drug discount card to the program would cost nothing, which is exactly what it is worth under this “budget-neutral” administration. And the $6000 deductible catastrophic drug coverage would benefit only the affluent. Prohibiting any other improvements in the benefit package of the traditional program would perpetuate the impaired access to care for those who are unable to afford essential services that are not currently a benefit of the program. The most immediate need is for a bona fide prescription benefit.

The Washington Post supports the FEHBP model of “enhanced Medicare,” making available a private plan, with BETTER BENEFITS, by PAYING A PART OF THE COST themselves, while still prohibiting coverage of the “better benefits” in the traditional program. This would end Medicare as an egalitarian program of social insurance.

The Washington Post is supporting the shift to “consumer-directed” Medicare, not only by shifting costs to beneficiaries when offering more plan options, but also by providing “incentive to choose plans more suited to their specific health needs.” But it is impossible to select a plan that will be the best choice for medical events that cannot possibly be predicted. Also, for those with chronic disorders, providing options creates all of the inequities characteristic of risk segmentation. Lower-income beneficiaries with chronic disorders would be locked into the traditional program. The Washington Post states that covering a stroke but not covering the medications that would prevent it is “the kind of absurdity that a plan designed specifically to meet the needs of older people could avoid.” Yet The Washington Post has endorsed precisely this type of absurdity.

Is this editorial incompetence, or is it support for the concept that there is a “lower class” that is not entitled to all essential health care? Perhaps The Washington Post does not want them to have their “cake,” but, rather, “Let them have strokes.”

Getting medical coverage to all

Posted on Thu, Mar. 13, 2003
Too many fall through the cracks of inadequate insurance programs.
By Gene Bishop
http://www.philly.com/mld/inquirer/news/opinion/local2/5378484.htm
The Philadelphia Enquirer

More than 18,000 young adults died last year in a major epidemic in the United States that managed to escape the headlines.

Those 18,000 – six times the number who were killed in the attacks on the World Trade Center – died, according to an Institute of Medicine report, because they lacked health insurance. No alert has been issued to help those who daily live in terror of becoming sick and being unable to pay.

There is the college graduate working as a waiter while trying to succeed as an artist. At work he has a seizure and is rushed to a hospital. He is discharged two days later with a prescription for medication and instructions to make an appointment to see a neurologist.

Although emergency medical assistance (Medicaid) may pay for the hospitalization, he is not eligible for Medicaid once outside the hospital because he is able to work. An appointment with a neurologist in Philadelphia could cost $250 or more, in addition to the cost of medications, blood work, and further diagnostic testing. He doesn’t have the money.

His is hardly an isolated story. As a physician who cares about access to health care, I consider myself knowledgeable about health-system problems. But having spent the last 18 months working with the Pennsylvania Health Law Project, a statewide legal services organization, I am overwhelmed. I am filled with anger as I hear story after story about Pennsylvanians who are struggling to take care of themselves or their families, but are unable to pay for doctors, hospitals or medicine.

The Health Law Project’s toll-free helpline for low-income Pennsylvanians having difficulty accessing or using the health system documents a system that is falling apart. There is the call from the social worker at a low-cost clinic. Her client has been diagnosed with a brain tumor and needs radiation therapy. The woman’s income is too high for Medicaid, and three hospitals have refused to register her for a specialist appointment because she is uninsured.

Or the man with diabetes, employed and uninsured, who sees a physician at a low-cost community health center where he pays for his medicines and physician visits. When his doctor tells him he needs an eye specialist and possible laser treatments to prevent blindness from diabetes, he doesn’t have the money. He and his lawyer make numerous phone calls trying to obtain affordable care. One hospital says it has “used up all the charity care for the year.” He becomes overwhelmed by the obstacles in his path, and the possibility of large debt. He takes his chances with his sight.

Few uninsured people come to my practice, but the underinsured are plentiful. Every day, people tell me they aren’t taking their medications because they can’t afford them. Insurance companies have shifted the cost of care to consumers.

Low-cost coverage now available to a limited number of Pennsylvanians is also inadequate. Special Care insurance, sold by Independence Blue Cross, allows four physician visits per year and doesn’t cover medications. One serious illness or accident can use up those visits. Adult Basic Coverage – funded by the tobacco settlement and run across the state by private insurers – began in July and filled its 48,000 capacity almost immediately. Even without coverage for prescriptions, mental health or drug and alcohol treatment, it has a long waiting list.

During this national “Covering the Uninsured Week,” it is time to focus again on providing universal coverage for all Americans. We already have more than enough resources in our health-care system to provide comprehensive health-care benefits to all. A national health insurance program, which would eliminate the high overhead and profits of insurance companies, offers the promise of adequate health care for all Americans.

U.S. Rep. John Conyers (D., Mich.) recently introduced a resolution calling for a national health program. On the Web, there is a national physicians’ proposal backing such a program (www.physiciansproposal.org).

As a physician in such a system, I could treat patients without checking on the rules, medication lists, or billing requirements of 10 to 20 insurers. As a patient in such a system, you or I could visit any doctor or hospital we choose, rather than the ones chosen for us by our employer, our insurer or our income. Only national health insurance allows us to expand coverage without expanding costs.

A patchwork quilt of inadequate insurance programs, each with its own set of rules and administrative costs, is not the answer. It is time to trade this torn quilt for a well-sewn blanket of universal coverage. It is time to save 18,000 lives – and save ourselves.

Living sicker, dying sooner with no health plan

By REKHA BASU
Register Columnist
03/12/2003
The Des Moines Register
http://www.dmregister.com/opinion/stories/c5917686/20705781.html

My teen-age son has a thing for Ultimate Frisbee. Such a thing that he kept on playing last week even after hurtling into a fence, splitting open his knee and getting an egg-size bump on his cheek. Later that evening, we sat in the hospital emergency room as one doctor stitched him up and another checked for a concussion.

It’s not pleasant, but it’s life: People are active. Sports come with risks. You just brace yourself for the occasional accident and feel lucky if the worst result is a superficial scar and a $75 hospital co-pay.

But it’s not that simple for everyone. The same minor accident that costs one family an evening can force another to fall behind on rent or car insurance.

Ask Anna Dianas of Des Moines. Her $7-an-hour job for a non-profit group provided no health insurance. Her husband, who does seasonal construction work, gets none either. They couldn’t afford to buy it and don’t qualify for any government program. So when her husband split his head open in a soccer collision, a hospital visit similar to ours set a struggling family back $500.

“We barely make it,” Dianas sighed. She racked up another $3,000 in hospital bills after she got chest pains and an EKG at a free clinic was abnormal.

Dianas was one of the people showcased Monday by the organizers of Cover the Uninsured Week, as panelists brainstormed about the health-care crisis and Lt. Gov. Sally Pederson read a proclamation urging solutions.

Dianas will soon get coverage thanks to a job change. But that still leaves more than 230,000 Iowans without insurance. Eighty-six percent of them work. They live with untreated illnesses, turn up at clinics created for the poor, rely on the good graces of doctors to slip them free samples of medicine. They live sicker and die younger, says Families USA, a consumer organization.

People variously lay the blame on: premiums that shot up 30 percent in three years; rising co-pays and deductibles; struggling small businesses unable to cover their workers; costly medical technology and drugs; poor federal reimbursement rates for Medicaid and Medicare; and an aging population using more services. You could also look further, to the loss of manufacturing jobs with union protection that ensured health benefits. In America, 1.4 million people lost their coverage in 2001; 41 million are uninsured.

For all its wealth, ours is the only industrialized country without a national health-care program, says Senator Tom Harkin. “We have the best hospitals, the best personnel and yet we can’t cover people.”

Working people often are caught in a Catch-22 because their jobs don’t come with benefits, but they are paid too much even for their kids to get government help. That’s Lorri Swigart’s problem. She’s a full-time property manager earning around $2,000 a month. Her income puts her 16-year son, who has juvenile diabetes, above the guidelines for Hawk-I, the state’s medical program for low-income children. His insulin-related expenses alone run $150 to $175 per month. She takes heart medicines.

They lost their coverage in January after she got divorced, and when she finally found an insurer that would cover them, it cost too much. “You just put things off for as long as you can,” she said. “You don’t go to the dentist, or you have a tooth pulled vs. a root canal or a cap. I just went to the dentist. I want to save my tooth but it’s $1,500 vs. $75.”

If something catastrophic led one of them to be hospitalized, she says, she’d have to file for bankruptcy. Medical bills are in fact a leading cause of bankruptcy.

Chances are that someone you know has no medical coverage. My friend Kim Davenport, who lives in Dallas County, works as a waitress and discontinued her employer-supported plan when the premium shot up to $700 a month. Her husband is self-employed, so there’s no coverage for them or their two teenage daughters.

“I’m just hoping nothing happens, that’s all,” she said.

Poignant as these stories are, they’re not presented for your pity, but your outrage. Something is terribly wrong when working Americans have to worry about a sports injury delaying the rent.

There is a solution, but no political will for it: a nationalized health-care system like Canada’s, which spends less per person and covers everyone (see Andie Dominick’s Feb. 14 Register essay). Canadians have a higher life expectancy, and their overall taxes are not higher.

President Bush decried such a system in his State of Union speech, and insurance-industry advocates are fond of spreading horror stories about waits for service and lack of choice in doctors. But there’s not much choice in health care for many Americans now.

The good news is that political will can be forced. If you doubted that, just look at how Des Moines schools capitulated to a public outcry last week within 24 hours of floating a proposal to merge 40 high school sports teams into eight. Imagine if such energy were channeled into demands for a better health-care system.

This national solution is best, but for whom?

Seattle Post-Intelligencer
March 12, 2003
National solution best for health care
By Mary O. McWilliams

Here, in the midst of Cover the Uninsured Week, it is important that this be said: All Americans should be covered by health insurance.

To that end, I offer the following principles to guide the debate. These ideas center on the values of individual responsibility, collective accountability and equality.

* Coverage for all is a national public policy matter.

* We should focus on adding to the coverage that exists today.

* We must acknowledge that solutions will have a cost.

* We need a basic set of health benefits as the floor.

* This is a collective responsibility.

* Government-sponsored programs must be adequately funded.

* We must improve the current system.

* Consumers must have a direct relationship with the cost of care.

It is to be hoped that these concepts will further spark a meaningful debate, which must continue in earnest beyond the focus of this week.

Mary O. McWilliams is president of Regence BlueShield.

http://seattlepi.nwsource.com/opinion/112031_regence12.shtml

Comment: During Cover the Uninsured Week, there is a unified voice stating clearly that everyone should be covered by health insurance. Listening to the various interests, it almost sounds like we finally agree that we must have a universal, egalitarian system. But then there are always the details.

Ms. McWilliams believes in a national solution, as long as that solution protects her industry, funds it more generously, and allows it to shift the burden of actually funding health care to the individual patients, to “encourage cost- and quality-conscious purchasing.” What will her position be if it is decided to reduce expensive administrative excesses by eliminating middleman health plans and adopting a single public payer?

Cover the Uninsured Week should not only end with a resolve to cover everyone, but it should also end with a resolve to put the interests of patients above all others. Without such a resolve we will flounder and founder.

Real terror: no health insurance

March 12, 2003
BY CINDY RICHARDS
The Chicago Sun-Times

For 30 years, Rebecca Sawyer-Spoon and her husband, Joe, lived the American dream. They ran a small business, paid their taxes and prospered. Now, she’s a statistic.

Sawyer-Spoon is one of the 41 million Americans without health insurance, even though she works full time and brings home a comfortable, middle-class living.

She was one of several victims of the Great American Health Debacle to speak during a moving town meeting Monday at the Harold Washington Library, one of a score of events being staged this week in Chicago–and hundreds being staged across the country–as part of ”Cover the Uninsured Week.” The week is supposed to raise awareness of the growing number of working Americans who either can’t get health insurance or can’t afford the insurance they could get. The message, however, is getting lost amid the media scramble to cover the war on terror.

”Why isn’t health care considered protection by the government? We feel so much more terrorized in our daily lives by our lack of access to health care than we do by foreign terrorist attacks,” said Sawyer-Spoon, a resident of rural Downstate Charleston.

The Spoons had health insurance until their provider went out of business. She had been diagnosed with a mild case of asthma, and her husband was diagnosed with high cholesterol. Their pre-existing conditions precluded them from finding other insurance.

Now, when she goes to the doctor to renew her asthma prescription, Sawyer-Spoon said, ”I won’t let him touch me.” What if he found some other health problem?

She could get the necessary treatment and then file bankruptcy to avoid paying for it. That’s what doctors suggested Chicagoan Frances Camberis do when she was diagnosed with a fibroid tumor and spent four uninsured days in the hospital. She hadn’t been able to get health insurance, Camberis said, ”because I’m fat.” The bill for that hospital stay was $28,000. She liquidated her retirement plan to pay it.

Not only do the uninsured wait to get necessary treatment, ensuring that they will need more costly care, they pay more for the care they get. A study released last week by the Service Employees International Union shows people who pay medical bills themselves are charged more for the same services. Large insurance companies, large employers and the federal government (which pays for 60 percent of health care through Medicare and Medicaid) use their buying power to negotiate better rates from doctors and hospitals.

All in all, it was a rather depressing two hours. Having been a statistic in the past–my union’s health insurer collected our premiums but never paid our providers and ended up in receivership, leaving hundreds of us uninsured and hounded by bill collectors–this is a subject near and dear to my heart. During the time I was uninsured, a nasty cold turned into pneumonia, which triggered asthma. I doubt I will ever be able to buy an individual health insurance policy again.

While Monday’s meeting was long on emotion, it was woefully short on solutions. Sen. Dick Durbin (D-Ill.) opened the session by lamenting the lack of leadership on this issue in Washington, then headed off to catch a plane before explaining why he hasn’t stepped up to the plate. Rep. Rahm Emmanuel (D-Ill.), who worked in the Clinton White House the last time health care topped America’s political agenda, will introduce a bill soon that would expand coverage for lower-income Americans.

But this is no longer a lower- income problem. It is a mainstream problem. The flagging economy is sapping employers’ ability to offer health insurance, the high cost of technology and malpractice insurance is raising the cost of health care, and the risk aversion of insurers is leaving more and more Americans unable to get coverage at any cost. Even those of us who have health insurance today have no guarantee we’ll still have it tomorrow should a layoff, the death of an insurance-providing spouse or even a costly illness mean the end of our insurance benefits.

This is the terror President Bush should be fighting.

The hidden cost of a fragmented health insurance system

United States Senate Special Committee on Aging
March 10, 2003
Testimony of Karen Davis, President, The Commonwealth Fund

Time for Change: The Hidden Cost of a Fragmented Health Insurance System

Executive Summary

We have entered the 21st century encumbered by a health system that is not up to the challenge of ensuring a healthy and productive nation. Set in motion over 50 years ago, the system is costly, complex, and confusing. Most important, it is failing to achieve the twin objectives of health insurance: to ensure that people have access to needed medical care and to protect them from the financial burdens of costly medical bills.

There are five types of costs inflicted by our fragmented health insurance system:

* Costs of a growing number of uninsured

# 41 million Americans in 2001 fell through the cracks of the American health care system because they were not lucky enough to be covered by employer-based coverage, Medicare, Medicaid, or the Children’s Health Insurance Plan

* Health and economic consequences of gaps in health insurance coverage

# 18,000 deaths of adults ages 25 to 64 occur each year as a result of the absence of health insurance coverage – making it the sixth-leading cause of death in this age group, ahead of HIV/AIDS or diabetes

* Cost-shifting that occurs in a fragmented financing system, especially as health care costs accelerate

# 70 million American workers are covered by their own employer; 20 million by a family member’s or previous employer; 30 million are not covered by an employer

# Our “pass the buck” system of health insurance perpetually shifts costs from one employer to another, employers to workers, federal government to state governments and back, and to safety-net hospitals serving the uninsured

# Far more energy goes into shifting costs than enhancing efficiency or quality of health care; insurance companies are profitable by attracting favorable risks, not through innovative incentives to improve quality and efficiency

* Costs of churning in health insurance coverage, as people’s economic and personal circumstances change

# Churning results in frequent gaps in insurance. Sixty-two million – one of four – were uninsured during 2000; 75 million were uninsured in 2000 and 2001. These people were at high risk of not getting care when needed and facing unaffordable medical bills when care could not be postponed.

# The U.S. spent $111 billion in 2002 on private insurance and government administrative costs – not including administrative costs incurred by hospitals and other health care providers or by individuals as they enroll, disenroll, and re-enroll and change insurance coverage and plans.

* Costs of complexity from a pluralistic system of health insurance without an integrating framework and consensus on basic principles

# Cost of large numbers of individuals eligible for but not enrolled in public programs

# Cost of lost productivity, health, anxiety, sick days, and valuable time of uninsured patients spent seeking care

# Cost of resources wasted on administration – jobs underwriting, screening, and verifying eligibility; new administrative apparatuses to cover narrow target groups of eligible individuals; costs of enrolling and disenrolling for public and private insurers and for individuals

# Costs of inefficient and low-quality care – high costs in emergency rooms for preventable conditions and hospitalizations; costs of differing standards of care depending on insurance status

# The U.S. spends twice as much per capita on health care as other industrialized OECD nations and is the only one to fail to cover everyone

There has to be a better way:

* Automatic and affordable coverage for all

(Truncated. See “Comment” for the solution suggested.)

http://www.cmwf.org/programs/insurance/davis_senatecommitteetestimony_622.pdf

Comment: Karen Davis has provided the rationale for ending our fragmented health insurance system. The obvious conclusion is that we need a single, publicly-funded and publicly-administered insurance program. But here is the solution that Karen Davis offers:

“We have built an incredibly complex, costly, and confusing health insurance system. We need a single guiding framework for coverage. It can include multiple sources of financing, multiple choices of public and private coverage, and multiple benefit packages, but it needs to be integrated within a single framework. Certainly, we should have a system that preserves innovation, flexibility, and choice, but some standardization will be required to cut through the maze of complexity in our current system. Reaching consensus on the parameters of choice versus standardization is an important part of public debate on this issue.”

It is astounding to see the efforts that are being made to avoid a program of social insurance but instead to build on our current fragmented system. To present compelling arguments on why the fragmented system does not and cannot work, and then to suggest that we build on it, defies all logic.

Need stitches on that gash? Try living without health insurance

By Jamie Smith. Jamie Smith lives in Pearl River, N.Y

March 11, 2003
Chicago Tribune

I don’t have health insurance.

Unlike many of the 40 million Americans without health insurance, I could get coverage fairly easily. I am a speech pathologist by training, and it would not be hard for me to get a job with health benefits. But I have three small children, and when the oldest was a baby I decided to do what it took to stay home. What it takes is living without good health insurance.

We live, the five of us, on my husband’s modest income. We live simply, in a small apartment. We have no car and we eat a lot of lentils. Mostly, we prefer it that way. I like lentils. The problem is health care.

We practice preventive medicine as far as possible. I breastfeed; I childproof; I serve my family nutritious food; I am a hand-washing fanatic. But breastfed babies can still get ear infections. Toddlers can split their heads open on a worrisome array of innocuous-looking objects. And 4-year-olds can still get pneumonia, vitamin C and hand-washing notwithstanding.

We have almost always had some sort of coverage–cheap policies with high deductibles from companies you never heard of. But we have never gotten a dollar back from one of these policies. We buy them just in case–just in case somebody gets cancer, or falls out of a window, or gets hit by an uninsured driver. When we received the notice that the premium for our last policy was rising by 35 percent, I went rampaging around my apartment. “I could have stood on the roof and flung the money into the wind for all the good this policy has done me, and now they want more money for the useless thing?” And then I paid the bill.

Just in case.

I follow the newspaper coverage of the health-care crisis. The articles are all too familiar. “Doctors raise charges for patients without insurance,” the paper tells me, as I observe grimly that I have been charged $140 for a 10-minute well-child exam. An insurance company has the clout to announce that it will pay only a third of that amount; the uninsured patient who tries that strategy will quickly find himself in the hands of a collection agency.

“Premiums rising,” the headlines say. Don’t I know it.

I used to think that was just the way things were–until we moved to Scotland for two years. While the National Health Service has many flaws, it was a revelation to see how well universal coverage could work. When my oldest son fell and needed stitches, I took him to our local children’s hospital. We were treated promptly and professionally; he has a tiny white scar and pleasant memories of the hospital. We chose to have our second child while we were living there, and I was struck again and again by the wisdom of the British system of perinatal care: cheaper, safer, smarter, accessible to any pregnant woman regardless of the vagaries of her employer’s benefits plan.

When we returned to the U.S. I found myself questioning the third-party payer system. Why do we pay so much money to insurers, who make a profit based on how little of it is passed along to the people who provide the services?

What if we cut out the middleman? Why have for-profit entities been afforded so much decision-making power?

Back in the U.S. my second son fell into an end table on a Saturday afternoon.

As I surveyed the gash on his forehead, I found myself wondering how much an emergency room visit would cost and how big his scar would be if we didn’t go–hating myself for making the calculation, making it anyway. A friend had been billed $1,000 to repair a comparable injury. We stayed home. With shaking hands and butterfly bandages I brought the edges of the cut together. But I am no doctor. His scar is not conspicuous but it is present. And every time I see it I feel guilty.

I know I am far from alone in my frustration. Every time health insurance comes up in conversation, more questions surface about the long-term cost of the third-party payer system. How many children lose out on having a sibling because of the cost of maternity coverage? How many people abandon the dream of owning a business because of the cost of providing health coverage for a family? How many retirement-age employees slog on at work to provide health insurance for a spouse?

In the busy pediatric clinic where I worked before my first child was born, almost all the receptionists who became pregnant returned to work after their maternity leaves. The pay was meager (especially given the cost of child care) but the benefits were good; they needed the insurance.

After his second post-doctoral research position, my husband decided to switch career directions and get off the academic track. I was relieved at the prospect of having health benefits, but I found myself with more questions.

Would it be unethical to participate in a system which is so fundamentally unjust? Would I really have the gumption to decline health benefits on ethical grounds? I didn’t need to worry; another headline intervened–“Employers cutting dependent coverage.” My husband’s company offers no benefits to dependents. I could buy insurance if I paid 15 percent of his monthly take-home pay to do so.

I declined. You can buy a lot of lentils with that amount of money. But the questions remain: Is it right to participate in a profoundly unjust system?

How many people have to demand other options before other options become available?

I’m still waiting for answers.