PNHP

NHIS report on insurance coverage

NHIS report on insurance coverage

Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2011

By Robin A. Cohen, Ph.D., and Michael E. Martinez, M.P.H., M.H.S.A.
CDC, Division of Health Interview Statistics, National Center for Health Statistics
June 2012

The Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is releasing selected estimates of health insurance coverage for the civilian noninstitutionalized U.S. population based on data from the 2011 National Health Interview Survey (NHIS).

* In 2011, 46.3 million persons of all ages (15.1%) were uninsured at the time of interview, 58.7 million (19.2%) had been uninsured for at least part of the year prior to interview, and 34.2 million (11.2%) had been uninsured for more than a year at the time of interview.

* In 2011, the percentage of children under age 18 years who were uninsured at the time of interview was 7.0%.

* Among adults aged 19–25, the percentage uninsured at the time of interview decreased from 33.9% (10 million persons) in 2010 to 27.9% (8.4 million) in 2011.

* Among adults aged 19–25, 56.2% were covered by a private plan in 2011, an increase from 2010 (51.0%).

Estimates of enrollment in HDHPs and CDHPs
 
Based on data from the 2011 NHIS, 29.0% of persons under age 65 with private health insurance were enrolled in an HDHP (high-deductible health plan), including 9.2% who were enrolled in a CDHP (consumer-directed health plan) and 19.9% who were enrolled in an HDHP without a health savings account (HSA). Enrollment in HDHPs increased from 25.3% in 2010 to 29.0% in 2011. There was a significant increase in enrollment in HDHPs without HSAs, and in CDHPs, between 2007 (when NHIS started collecting this information) and 2011.

Based on data from 2011, among persons under age 65 with private health insurance, 26.9% with employment-based coverage were enrolled in an HDHP, compared with 52.4% of those with a private plan that was directly purchased or obtained through means other than employment. The percentage of persons covered by employment-based private plans who were enrolled in HDHPs increased from 15.6% in 2007 to 26.9% in 2011. The percentage of persons covered by directly purchased private health plans who were enrolled in HDHPs increased from 39.2% in 2007 to 52.4% in 2011. 

Insurance coverage by poverty status

The percentage of poor children who were uninsured at the time of interview decreased from 1997 through 2011. During the same period, the percentage of poor adults who were uninsured remained relatively stable.

Among children, all poverty status groups experienced an increase in public coverage between 1997 and 2011. However, the largest increase was seen among near poor children, for whom coverage by a public plan increased by 36.5 percentage points during the same period.

The rate of private coverage among near poor children was 25.1 percentage points lower in 2011 than in 1997. Among near poor children the percentage without health insurance and the percentage with private health insurance coverage have declined since 1997, while public coverage has increased. Private coverage generally decreased among near poor adults aged 18–64, from 52.6% in 1997 to 35.4% in 2011, so that the uninsured rate is now higher than the private coverage rate for this population. Private coverage among not poor adults aged 18–64 generally decreased from 1997 through 2011.

http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201206.pdf

Comment: 

By Don McCanne, MD

The good news is that the percentage of individuals uninsured at the time of the National Health Interview Survey declined from 16.0% in 2010 to 15.1% in 2011. The improvements were primarily due to an increase in enrollment of children in public programs, and an increase in enrollment of young adults in their parents’ private insurance plans.

If the Affordable Care Act is upheld, we can anticipate a further increase in enrollment in Medicaid. If not, at least public coverage for low-income children should be maintained.

The more alarming news in this report is the increase in high-deductible health plans, both those acquired through employment and especially those purchased in the individual market. The increase in private coverage made possible through the establishment of state insurance exchanges will be in lower-actuarial value plans – primarily high-deductible plans. Also employers are expected to shift more of their plans to high-deductible coverage.

High-deductible plans equate with underinsurance. These plans leave people with health care needs vulnerable to financial barriers to care. With this report, once again we see that underinsurance is becoming the new standard in America. That wouldn’t occur if we were to adopt an improved Medicare for all.

What SCOTUS ruling might mean to Vermont's single-payer plan

By Mike Miliard, Contributing Editor
Government Health IT, June 18, 2012

“The Affordable Care Act doesn’t do a whole heck of a lot for Vermont,” says Deb Richter, MD, president of Vermont Healthcare For All. “Most of the provisions in it, we’ve already done. It’s kind of a shame, in a way. We would have momentum, and probably could’ve gotten further with single-payer, if the ACA had not happened.”

Vermont comes by its reputation for progressive politics honestly. And one of its signal achievements on that front is a piece of legislation known as Act 48, signed into law by Democratic Governor Peter Shumlin in June 2011, which lays the initial groundwork for the Green Mountain State to make the pioneering move to a single-payer system.

“Because of the growth of our healthcare expenditures every year, we had to do something,” says Peg Franzen, president of the Vermont Workers’ Center, which labored for years to build momentum behind the bill. “Insurance companies are doing what they’re supposed to do; they’re making profits for their shareholders. But that’s not the way we should have a health system set up. Healthcare shouldn’t be a commodity.”

But there’s a long road ahead before so-called Green Mountain Care – tagged by opponents with the predictable epithet of “ShumlinCare” – becomes a reality in Vermont. Political pitfalls on the state and national level mean a single-payer future is far from certain. But since Act 48’s passage a year ago, work on the policy front has been ongoing, aimed at improving the state’s healthcare system, regardless of the outcome.

Seeking to offer near-universal coverage for Vermont’s 626,000 citizens, the state-funded insurance pool is still years away from coming to fruition, and has many questions still to be answered.

One not-inconsequential detail: how it will be funded. A variety of new taxes are under consideration, but won’t be voted on in the near future.

Act 48 also contained provisions to launch a health insurance exchange as required by the ACA, set up pilots to explore medical home and bundled-payment reforms and established the Green Mountain Care Board – a panel of policy experts to set rates, design benefits packages and suggest funding strategies.

Those are just first steps. As noted above, one stumbling block along the way could be the federal Affordable Care Act – which itself is up in the air, of course – with the Supreme Court ruling due by June’s end.

Vermont hopes to use money disbursed by the ACA to help build those insurance exchanges. The federal law says every state must have one by 2014, but it also allows states to petition for a waiver from the national rules if they can prove they’re providing equal or better coverage of their own.

“One major advantage it could (provide) is help bring in federal dollars when people buy health insurance on the exchange,” Richter says. “And then that sum of money is what we would expect to get as a subsidy when we finally do single payer.”

But waivers won’t be available until 2017. In today’s political climate, five years is an eternity. Whether that necessary bit of dispensation ever comes depends “on the administration in Washington,” Richter adds.

If it could happen today, there would be “a good chance” of success, she adds. “Obama has said if he could do it over, then single payer would be the way he would go. He’s also said he believes in states’ rights to innovate and do some models on their own.” If it’s the Romney administration? “I don’t think so.”

The next few years will be pivotal – on policy, politics and public opinion fronts.

“There’s a lot of misinformation out there,” Franzen says. “There’s been a real attempt to spread a lot of fear. Which we knew would happen. When we got into this, we all knew it was going to be a five year or more battle.”

In the meantime, work toward a better healthcare system has been moving forward in earnest. In the year since Act 48 was passed, the Green Mountain Care board has been hard at work on projects around cost containment, says its chair, Anya Rader Wallack.

“Right now we’re very focused on trying to implement payment reform models in the state, moving away from fee-for-service,” she says. “And we’re working with providers around the state to develop some models for doing that.”

Other responsibilities include “a whole realm of benefit design, for both our health benefit exchange and the single-payer financing plan that the governor’s office will be bringing back to the legislature next year,” Wallack says. “For both of those purposes we have to sign off on a benefit package that would form the floor, essentially, for everyone in Vermont. We are waiting for recommendations on those and will have to delve into whether to approve them.”

In terms of the single-payer law, “there’s still a lot of work to be done,” she says. But, “as for our work, we’re sort of off and running. We have those responsibilities, regardless of what happens in the future with the single-payer plan.”

Nationally, whether the ACA stands or falls “doesn’t really affect our work at all,” she adds, referring to the Green Mountain Care board. “It affects the single-payer plan, and it affects our implementation of the health benefit exchange, because if the [individual] mandate is removed, it means the state will have to determine whether to pass a mandate at the state level to assure everybody’s covered.”

Single-payer may have far to go before it’s a reality. But even if it ends up a vanishing pipe dream, Vermont is in much better shape, when it comes to keeping its citizens covered, than most other states.

By the same token, even if the Affordable Care Act is upheld and goes into full effect, “at best, it will bring the rest of the country to where Vermont already is,” Richter says. “Act 48 was intended to go beyond that.”

“Regardless of what happens with [single-payer], or with ObamaCare,” Wallack adds, “if we do our job right, we’ll have a more sustainable, higher-quality healthcare system, I think, than anywhere else in the country.”

http://www.govhealthit.com/news/what-scotus-ruling-might-mean-vermonts-single-payer-plan?page=0,1

What SCOTUS ruling might mean to Vermont’s single-payer plan

By Mike Miliard, Contributing Editor
Government Health IT, June 18, 2012

“The Affordable Care Act doesn’t do a whole heck of a lot for Vermont,” says Deb Richter, MD, president of Vermont Healthcare For All. “Most of the provisions in it, we’ve already done. It’s kind of a shame, in a way. We would have momentum, and probably could’ve gotten further with single-payer, if the ACA had not happened.”

Vermont comes by its reputation for progressive politics honestly. And one of its signal achievements on that front is a piece of legislation known as Act 48, signed into law by Democratic Governor Peter Shumlin in June 2011, which lays the initial groundwork for the Green Mountain State to make the pioneering move to a single-payer system.

“Because of the growth of our healthcare expenditures every year, we had to do something,” says Peg Franzen, president of the Vermont Workers’ Center, which labored for years to build momentum behind the bill. “Insurance companies are doing what they’re supposed to do; they’re making profits for their shareholders. But that’s not the way we should have a health system set up. Healthcare shouldn’t be a commodity.”

But there’s a long road ahead before so-called Green Mountain Care – tagged by opponents with the predictable epithet of “ShumlinCare” – becomes a reality in Vermont. Political pitfalls on the state and national level mean a single-payer future is far from certain. But since Act 48’s passage a year ago, work on the policy front has been ongoing, aimed at improving the state’s healthcare system, regardless of the outcome.

Seeking to offer near-universal coverage for Vermont’s 626,000 citizens, the state-funded insurance pool is still years away from coming to fruition, and has many questions still to be answered.

One not-inconsequential detail: how it will be funded. A variety of new taxes are under consideration, but won’t be voted on in the near future.

Act 48 also contained provisions to launch a health insurance exchange as required by the ACA, set up pilots to explore medical home and bundled-payment reforms and established the Green Mountain Care Board – a panel of policy experts to set rates, design benefits packages and suggest funding strategies.

Those are just first steps. As noted above, one stumbling block along the way could be the federal Affordable Care Act – which itself is up in the air, of course – with the Supreme Court ruling due by June’s end.

Vermont hopes to use money disbursed by the ACA to help build those insurance exchanges. The federal law says every state must have one by 2014, but it also allows states to petition for a waiver from the national rules if they can prove they’re providing equal or better coverage of their own.

“One major advantage it could (provide) is help bring in federal dollars when people buy health insurance on the exchange,” Richter says. “And then that sum of money is what we would expect to get as a subsidy when we finally do single payer.”

But waivers won’t be available until 2017. In today’s political climate, five years is an eternity. Whether that necessary bit of dispensation ever comes depends “on the administration in Washington,” Richter adds.

If it could happen today, there would be “a good chance” of success, she adds. “Obama has said if he could do it over, then single payer would be the way he would go. He’s also said he believes in states’ rights to innovate and do some models on their own.” If it’s the Romney administration? “I don’t think so.”

The next few years will be pivotal – on policy, politics and public opinion fronts.

“There’s a lot of misinformation out there,” Franzen says. “There’s been a real attempt to spread a lot of fear. Which we knew would happen. When we got into this, we all knew it was going to be a five year or more battle.”

In the meantime, work toward a better healthcare system has been moving forward in earnest. In the year since Act 48 was passed, the Green Mountain Care board has been hard at work on projects around cost containment, says its chair, Anya Rader Wallack.

“Right now we’re very focused on trying to implement payment reform models in the state, moving away from fee-for-service,” she says. “And we’re working with providers around the state to develop some models for doing that.”

Other responsibilities include “a whole realm of benefit design, for both our health benefit exchange and the single-payer financing plan that the governor’s office will be bringing back to the legislature next year,” Wallack says. “For both of those purposes we have to sign off on a benefit package that would form the floor, essentially, for everyone in Vermont. We are waiting for recommendations on those and will have to delve into whether to approve them.”

In terms of the single-payer law, “there’s still a lot of work to be done,” she says. But, “as for our work, we’re sort of off and running. We have those responsibilities, regardless of what happens in the future with the single-payer plan.”

Nationally, whether the ACA stands or falls “doesn’t really affect our work at all,” she adds, referring to the Green Mountain Care board. “It affects the single-payer plan, and it affects our implementation of the health benefit exchange, because if the [individual] mandate is removed, it means the state will have to determine whether to pass a mandate at the state level to assure everybody’s covered.”

Single-payer may have far to go before it’s a reality. But even if it ends up a vanishing pipe dream, Vermont is in much better shape, when it comes to keeping its citizens covered, than most other states.

By the same token, even if the Affordable Care Act is upheld and goes into full effect, “at best, it will bring the rest of the country to where Vermont already is,” Richter says. “Act 48 was intended to go beyond that.”

“Regardless of what happens with [single-payer], or with ObamaCare,” Wallack adds, “if we do our job right, we’ll have a more sustainable, higher-quality healthcare system, I think, than anywhere else in the country.”

http://www.govhealthit.com/news/what-scotus-ruling-might-mean-vermonts-single-payer-plan?page=0,1

NHIS report on insurance coverage

Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2011

By Robin A. Cohen, Ph.D., and Michael E. Martinez, M.P.H., M.H.S.A.
CDC, Division of Health Interview Statistics, National Center for Health Statistics
June 2012
The Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) is releasing selected estimates of health insurance coverage for the civilian noninstitutionalized U.S. population based on data from the 2011 National Health Interview Survey (NHIS).
* In 2011, 46.3 million persons of all ages (15.1%) were uninsured at the time of interview, 58.7 million (19.2%) had been uninsured for at least part of the year prior to interview, and 34.2 million (11.2%) had been uninsured for more than a year at the time of interview.
* In 2011, the percentage of children under age 18 years who were uninsured at the time of interview was 7.0%.
* Among adults aged 19–25, the percentage uninsured at the time of interview decreased from 33.9% (10 million persons) in 2010 to 27.9% (8.4 million) in 2011.
* Among adults aged 19–25, 56.2% were covered by a private plan in 2011, an increase from 2010 (51.0%).
Estimates of enrollment in HDHPs and CDHPs
Based on data from the 2011 NHIS, 29.0% of persons under age 65 with private health insurance were enrolled in an HDHP (high-deductible health plan), including 9.2% who were enrolled in a CDHP (consumer-directed health plan) and 19.9% who were enrolled in an HDHP without a health savings account (HSA). Enrollment in HDHPs increased from 25.3% in 2010 to 29.0% in 2011. There was a significant increase in enrollment in HDHPs without HSAs, and in CDHPs, between 2007 (when NHIS started collecting this information) and 2011.
Based on data from 2011, among persons under age 65 with private health insurance, 26.9% with employment-based coverage were enrolled in an HDHP, compared with 52.4% of those with a private plan that was directly purchased or obtained through means other than employment. The percentage of persons covered by employment-based private plans who were enrolled in HDHPs increased from 15.6% in 2007 to 26.9% in 2011. The percentage of persons covered by directly purchased private health plans who were enrolled in HDHPs increased from 39.2% in 2007 to 52.4% in 2011.
Insurance coverage by poverty status
The percentage of poor children who were uninsured at the time of interview decreased from 1997 through 2011. During the same period, the percentage of poor adults who were uninsured remained relatively stable.
Among children, all poverty status groups experienced an increase in public coverage between 1997 and 2011. However, the largest increase was seen among near poor children, for whom coverage by a public plan increased by 36.5 percentage points during the same period.
The rate of private coverage among near poor children was 25.1 percentage points lower in 2011 than in 1997. Among near poor children the percentage without health insurance and the percentage with private health insurance coverage have declined since 1997, while public coverage has increased. Private coverage generally decreased among near poor adults aged 18–64, from 52.6% in 1997 to 35.4% in 2011, so that the uninsured rate is now higher than the private coverage rate for this population. Private coverage among not poor adults aged 18–64 generally decreased from 1997 through 2011.
http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201206.pdf

The good news is that the percentage of individuals uninsured at the time of the National Health Interview Survey declined from 16.0% in 2010 to 15.1% in 2011. The improvements were primarily due to an increase in enrollment of children in public programs, and an increase in enrollment of young adults in their parents’ private insurance plans.
If the Affordable Care Act is upheld, we can anticipate a further increase in enrollment in Medicaid. If not, at least public coverage for low-income children should be maintained.
The more alarming news in this report is the increase in high-deductible health plans, both those acquired through employment and especially those purchased in the individual market. The increase in private coverage made possible through the establishment of state insurance exchanges will be in lower-actuarial value plans – primarily high-deductible plans. Also employers are expected to shift more of their plans to high-deductible coverage.
High-deductible plans equate with underinsurance. These plans leave people with health care needs vulnerable to financial barriers to care. With this report, once again we see that underinsurance is becoming the new standard in America. That wouldn’t occur if we were to adopt an improved Medicare for all.

Health care system a major factor in African Americans' poorer health

By Jonathan D. Walker, M.D.
Frost Illustrated (Fort Wayne, Ind.), June 13-20, 2012

Part one of two

When it comes to overall health, African Americans tend to do much worse than average. A few examples: according to the Center for Disease Control, death rates for black Americans surpass those of Americans overall for heart disease, cancer, diabetes and HIV. According to a study published in Health Services Research, white males live approximately seven years longer than African American males, and white women live more than five years longer than black women. Finally, African Americans fare far worse when it comes to infant mortality-their rate is almost double the national average.

There are a lot of different reasons for all this. Part of this is genetic – some diseases are simply worse for African Americans, such as prostate cancer and glaucoma (a disease of the eye). Another part of the problem is cultural; African Americans as a group tend to be more apprehensive of the health care system and are less likely to go to a doctor. Other factors include a person’s level of education and income – these can play into lifestyle choices regarding smoking, diet and exercise.

But there is also one huge problem that contributes to this negative outlook for African Americans: lack of insurance. And nowadays, most private insurance plans include such high out-of-pocket expenses that it can be too costly to see a doctor, even if someone has insurance. This is known as “under-insurance,” and it is becoming as much of a problem as having no insurance at all.

How did we end up with so many people – and especially African Americans – struggling to get the health care they need? The answer is complicated, but the basic problem is that we have a very fragmented health care system that consists of a lot of different entities that are looking for ways to maximize profits. Insurance companies deny coverage to anyone they think might cost them money, and keep huge amounts of money that should be used to take care of patients. Drug companies have seen to it that our government cannot bargain over drug prices – as taxpayers, we have to pay whatever price they want. Hospitals are built where the most profitable patients are, often leaving poorer areas with little coverage. Doctors may refuse to see patients who don’t have enough money. The bottom line is that if there are people who aren’t profitable, those people are left out.

It would be great if we could point to one thing to fix. But, there isn’t one thing – the whole system is broken. And, it is even more complicated because everyone in the system feels like they are doing the right thing. They feel they are helping people and want to get their fair share, and it is really hard to convince someone that they might be part of the problem if they believe in what they are doing. The only way people really learn about how cruel our system can be is if they happen to get sick – then they experience firsthand what it is like to have to worry about going broke or bankrupt to stay alive. But most people don’t get sick, so they think everything is OK and they keep the broken system we have because they are afraid to change – especially if their income depends on keeping the system the way it is.

America is the only country in the developed world that is like this. Every other developed country has realized that it is better to make sure that everyone gets the treatment they require. And, that’s something to think hard about. No one in those countries has to worry about whether they can pay the bill for themselves or someone they love – they just get the care they need.

Now, we have been trained to think that all those other countries must be bad; that people have to wait for care and that they are always letting people die to save money. No health care system is perfect, but you should study the problem yourself – don’t just accept what the special interests are saying. You will see that a lot of what we hear is either an exaggeration or just plain wrong. It is hard to imagine how all those people, in all those countries, would be putting up with health care systems that don’t take care of them.

There are a number of ways to design a health care system so that everyone gets the care they need, and even have it be cheaper and with better results compared to our current system. But, no one looks closely at this because powerful special interests work very hard to keep it off the table – special interests like insurance companies, drug companies, hospital associations and doctor organizations. However, there is one man who is trying to change that. He is Representative John Conyers Jr., an African American congressman from Michigan, and in the next installment we will look at what he is trying to do to make all of our lives better.

Dr. Walker is an ophthalmologist in town and a member of Physicians for a National Health Program.

http://www.frostillustrated.com/atf.php?sid=10446

Eye on health

By Jonathan D. Walker, M.D.

Part two of two

In the last installment of this story, we reviewed how African Americans tend to do much worse in our health care system. For instance, death rates for black Americans surpass those of Americans overall for heart disease, cancer, diabetes and HIV. We also discussed that there are a number of reasons for this disparity, ranging from genetics to personal lifestyle choices. But there is one other very important reason — there are more African Americans without insurance. And, that problem arises because we have a very fragmented health care system that has placed profits over patients, so that too many people are left out. And, people who are left out get sicker and die sooner no matter what race they are.

It is important to understand that America is the only country in the developed world that is like this. Every other developed country has realized that it is better to simply make sure everyone can get the treatment they require. Think about that. No one in those countries has to worry about whether they can pay the bill for themselves or someone they love — they just get the care they need.

But, special interests work hard to keep us from exploring those other health care systems. And, they especially like to scare us with stories about Canada. There are problems up there, but the situation is actually much better than you
might think — most Canadians would never switch to a health care system like ours. Besides, Canada is only one of many countries — we don’t have to use their approach.

There are many other ways to design a better health care system. For instance, back in the ’90s, Taiwan was having the same health care problems we are having here. So they looked at every other system in the world, and they ended up deciding that our Medicare system looked pretty good. (Medicare is the government insurance plan for people who are disabled or over 65.)

In the end, Taiwan actually ended up improving on Medicare and now the government negotiates with doctors, hospitals and drug companies to set fair prices, and everyone pays a small tax that is much less than what we pay private insurance companies for coverage in America. Citizens even have smartcards that hold their medical history, so their records are always available. The Taiwanese can see any doctor they want, anytime, and no one worries about getting sick and going broke. And, their health care is as advanced as anywhere in the world. Plus, their businesses are freed from the burden of providing insurance; they can compete much better in the global market because everyone is automatically covered from birth to death.

And, remember that their system is based on our Medicare. Medicare is not perfect, but Americans with Medicare are happier than those with private insurance, and much happier than those with no insurance or under-insurance. All you have to do is ask anyone on Medicare if they want to give it up and buy private insurance — you will see. Plus, you are paying into Medicare with your taxes already. But, you are forbidden to use Medicare for yourself unless you are over 65 or disabled — insurance companies have seen to it that you can’t have something that you are paying for. And, Medicare certainly has problems, but most of them stem from the fact that lobbyists and special interest groups have rigged Medicare to pay out far more than it should. Our health care system would be much better if we improved Medicare and expanded it to cover everyone. This approach is known as a “single payer” system — everyone is paid by one entity rather than by a host of different payers.

It so happens that an African American congressman, Representative John Conyers Jr. from Michigan, has introduced a bill known as “The Expanded and Improved Medicare for All Act,” H.R. 676. This bill would: (1) automatically enroll everyone in the plan, (2) provide comprehensive services covering all medically necessary care and drugs, (3) allow free choice of doctor and hospital, (4) eliminate all co-pays and deductibles, (5) create a public, nonprofit agency to pay all the bills, simplifying administration, paperwork, and bureaucracy while saving an estimated $400 billion annually, (6) finance care through progressive taxation, with people paying less than what they are paying now for private insurance, (7) boost job growth by reducing the burden of health costs on businesses, (8) provide powerful cost control tools like bulk purchasing and global budgeting for long-term, sustainable savings.

It would not introduce “government rationing”— it would be really hard to ration anything if we all were depending on it and paying close attention to how it is run. It would eliminate the real rationing that we have right now that is based on the patient’s ability to pay — if you have money you get care and if you don’t, you won’t. In fact, such a system would restore the doctor-patient relationship by removing barriers created by both private insurers and lack of money. It would be transparent and publicly accountable, fair and efficient — if there were problems we would all want it fixed because we would all be part of it. No one would ever have to worry about getting sick and going broke again, and it would be cheaper because we wouldn’t be wasting money on insurance companies, bureaucracy and paperwork.

Dr. Martin Luther King Jr. once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhuman.” And he was not just talking about African Americans — he was talking about anyone that is afraid to see a doctor because they can’t afford it. Every other developed country in the world has figured this out, but we ignore them. Our politicians are so influenced by special interest groups, and we are so stuck in thinking that we have to keep the system we have, that we put up with the same expensive, fragmented mess – even if it means that any one of us could be bankrupted at anytime if we get sick.

It would be great if people would look at Rep. Conyers’ bill and realize how much sense it makes. It would be even better if people started to demand that we at least try what he is suggesting — if for no other reason than we are all already paying for it but can’t have it. Mostly, it would be best if no one ever had to fear going to a doctor because of medical bills, and no one ever had to grow up experiencing the inequality of health care that Dr. King was talking about.

Dr. Walker is an ophthalmologist in town and a member of Physicians for a National Health Program.

http://www.frostillustrated.com/atf.php?sid=10477

Health care system a major factor in African Americans’ poorer health

By Jonathan D. Walker, M.D.
Frost Illustrated (Fort Wayne, Ind.), June 13-20, 2012

Part one of two

When it comes to overall health, African Americans tend to do much worse than average. A few examples: according to the Center for Disease Control, death rates for black Americans surpass those of Americans overall for heart disease, cancer, diabetes and HIV. According to a study published in Health Services Research, white males live approximately seven years longer than African American males, and white women live more than five years longer than black women. Finally, African Americans fare far worse when it comes to infant mortality-their rate is almost double the national average.

There are a lot of different reasons for all this. Part of this is genetic – some diseases are simply worse for African Americans, such as prostate cancer and glaucoma (a disease of the eye). Another part of the problem is cultural; African Americans as a group tend to be more apprehensive of the health care system and are less likely to go to a doctor. Other factors include a person’s level of education and income – these can play into lifestyle choices regarding smoking, diet and exercise.

But there is also one huge problem that contributes to this negative outlook for African Americans: lack of insurance. And nowadays, most private insurance plans include such high out-of-pocket expenses that it can be too costly to see a doctor, even if someone has insurance. This is known as “under-insurance,” and it is becoming as much of a problem as having no insurance at all.

How did we end up with so many people – and especially African Americans – struggling to get the health care they need? The answer is complicated, but the basic problem is that we have a very fragmented health care system that consists of a lot of different entities that are looking for ways to maximize profits. Insurance companies deny coverage to anyone they think might cost them money, and keep huge amounts of money that should be used to take care of patients. Drug companies have seen to it that our government cannot bargain over drug prices – as taxpayers, we have to pay whatever price they want. Hospitals are built where the most profitable patients are, often leaving poorer areas with little coverage. Doctors may refuse to see patients who don’t have enough money. The bottom line is that if there are people who aren’t profitable, those people are left out.

It would be great if we could point to one thing to fix. But, there isn’t one thing – the whole system is broken. And, it is even more complicated because everyone in the system feels like they are doing the right thing. They feel they are helping people and want to get their fair share, and it is really hard to convince someone that they might be part of the problem if they believe in what they are doing. The only way people really learn about how cruel our system can be is if they happen to get sick – then they experience firsthand what it is like to have to worry about going broke or bankrupt to stay alive. But most people don’t get sick, so they think everything is OK and they keep the broken system we have because they are afraid to change – especially if their income depends on keeping the system the way it is.

America is the only country in the developed world that is like this. Every other developed country has realized that it is better to make sure that everyone gets the treatment they require. And, that’s something to think hard about. No one in those countries has to worry about whether they can pay the bill for themselves or someone they love – they just get the care they need.

Now, we have been trained to think that all those other countries must be bad; that people have to wait for care and that they are always letting people die to save money. No health care system is perfect, but you should study the problem yourself – don’t just accept what the special interests are saying. You will see that a lot of what we hear is either an exaggeration or just plain wrong. It is hard to imagine how all those people, in all those countries, would be putting up with health care systems that don’t take care of them.

There are a number of ways to design a health care system so that everyone gets the care they need, and even have it be cheaper and with better results compared to our current system. But, no one looks closely at this because powerful special interests work very hard to keep it off the table – special interests like insurance companies, drug companies, hospital associations and doctor organizations. However, there is one man who is trying to change that. He is Representative John Conyers Jr., an African American congressman from Michigan, and in the next installment we will look at what he is trying to do to make all of our lives better.

Dr. Walker is an ophthalmologist in town and a member of Physicians for a National Health Program.

http://www.frostillustrated.com/atf.php?sid=10446

Eye on health

By Jonathan D. Walker, M.D.

Part two of two

In the last installment of this story, we reviewed how African Americans tend to do much worse in our health care system. For instance, death rates for black Americans surpass those of Americans overall for heart disease, cancer, diabetes and HIV. We also discussed that there are a number of reasons for this disparity, ranging from genetics to personal lifestyle choices. But there is one other very important reason — there are more African Americans without insurance. And, that problem arises because we have a very fragmented health care system that has placed profits over patients, so that too many people are left out. And, people who are left out get sicker and die sooner no matter what race they are.

It is important to understand that America is the only country in the developed world that is like this. Every other developed country has realized that it is better to simply make sure everyone can get the treatment they require. Think about that. No one in those countries has to worry about whether they can pay the bill for themselves or someone they love — they just get the care they need.

But, special interests work hard to keep us from exploring those other health care systems. And, they especially like to scare us with stories about Canada. There are problems up there, but the situation is actually much better than you might think — most Canadians would never switch to a health care system like ours. Besides, Canada is only one of many countries — we don’t have to use their approach.

There are many other ways to design a better health care system. For instance, back in the ’90s, Taiwan was having the same health care problems we are having here. So they looked at every other system in the world, and they ended up deciding that our Medicare system looked pretty good. (Medicare is the government insurance plan for people who are disabled or over 65.)

In the end, Taiwan actually ended up improving on Medicare and now the government negotiates with doctors, hospitals and drug companies to set fair prices, and everyone pays a small tax that is much less than what we pay private insurance companies for coverage in America. Citizens even have smartcards that hold their medical history, so their records are always available. The Taiwanese can see any doctor they want, anytime, and no one worries about getting sick and going broke. And, their health care is as advanced as anywhere in the world. Plus, their businesses are freed from the burden of providing insurance; they can compete much better in the global market because everyone is automatically covered from birth to death.

And, remember that their system is based on our Medicare. Medicare is not perfect, but Americans with Medicare are happier than those with private insurance, and much happier than those with no insurance or under-insurance. All you have to do is ask anyone on Medicare if they want to give it up and buy private insurance — you will see. Plus, you are paying into Medicare with your taxes already. But, you are forbidden to use Medicare for yourself unless you are over 65 or disabled — insurance companies have seen to it that you can’t have something that you are paying for. And, Medicare certainly has problems, but most of them stem from the fact that lobbyists and special interest groups have rigged Medicare to pay out far more than it should. Our health care system would be much better if we improved Medicare and expanded it to cover everyone. This approach is known as a “single payer” system — everyone is paid by one entity rather than by a host of different payers.

It so happens that an African American congressman, Representative John Conyers Jr. from Michigan, has introduced a bill known as “The Expanded and Improved Medicare for All Act,” H.R. 676. This bill would: (1) automatically enroll everyone in the plan, (2) provide comprehensive services covering all medically necessary care and drugs, (3) allow free choice of doctor and hospital, (4) eliminate all co-pays and deductibles, (5) create a public, nonprofit agency to pay all the bills, simplifying administration, paperwork, and bureaucracy while saving an estimated $400 billion annually, (6) finance care through progressive taxation, with people paying less than what they are paying now for private insurance, (7) boost job growth by reducing the burden of health costs on businesses, (8) provide powerful cost control tools like bulk purchasing and global budgeting for long-term, sustainable savings.

It would not introduce “government rationing”— it would be really hard to ration anything if we all were depending on it and paying close attention to how it is run. It would eliminate the real rationing that we have right now that is based on the patient’s ability to pay — if you have money you get care and if you don’t, you won’t. In fact, such a system would restore the doctor-patient relationship by removing barriers created by both private insurers and lack of money. It would be transparent and publicly accountable, fair and efficient — if there were problems we would all want it fixed because we would all be part of it. No one would ever have to worry about getting sick and going broke again, and it would be cheaper because we wouldn’t be wasting money on insurance companies, bureaucracy and paperwork.

Dr. Martin Luther King Jr. once said, “Of all the forms of inequality, injustice in health care is the most shocking and inhuman.” And he was not just talking about African Americans — he was talking about anyone that is afraid to see a doctor because they can’t afford it. Every other developed country in the world has figured this out, but we ignore them. Our politicians are so influenced by special interest groups, and we are so stuck in thinking that we have to keep the system we have, that we put up with the same expensive, fragmented mess – even if it means that any one of us could be bankrupted at anytime if we get sick.

It would be great if people would look at Rep. Conyers’ bill and realize how much sense it makes. It would be even better if people started to demand that we at least try what he is suggesting — if for no other reason than we are all already paying for it but can’t have it. Mostly, it would be best if no one ever had to fear going to a doctor because of medical bills, and no one ever had to grow up experiencing the inequality of health care that Dr. King was talking about.

Dr. Walker is an ophthalmologist in town and a member of Physicians for a National Health Program.

http://www.frostillustrated.com/atf.php?sid=10477

Uncovered in Life

The New York Times, Science Times, June 18, 2012

To the Editor:

Re “The Reward for Donating a Kidney: No Insurance” (The Consumer, June 12): Health insurers’ refusal to cover kidney donors after their donation is patently unjust. But our health care system’s injustice is also evident among cadaveric, brain-dead donors. As we found in a 2008 study, 17 percent of organ donors are uninsured while fewer than 1 percent of transplant recipients lack coverage. The health care system denies adequate care to many of the uninsured during life. Yet, in death, the uninsured often give strangers the ultimate gift.

This pattern surely does not reflect the values or intentions of the transplant community. Rather, it is inflicted by a payment system that prioritizes insurers’ profits over human needs.

Steffie Woolhandler, M.D.
David U. Himmelstein, M.D.

http://www.nytimes.com/2012/06/19/health/uncovered-in-life-1-letter.html

Gov. Scott’s double standard on health, wind insurance

By Howard Green, M.D.
The Palm Beach Post, Letters, June 9, 2012

On the first day of hurricane season, Gov. Scott suggested a national pool for windstorm insurance. The governor has proposed that a “public option” be made available for high-risk homeowners to purchase windstorm insurance if they cannot purchase private coverage.

Someone should ask the governor why he believes it is so important to have a national public option for windstorm and flood insurance while he vilifies and runs against a national public option for health insurance. Why does Gov. Scott consider windstorm insurance a necessary right for Americans worthy of optional, government-managed insurance, yet he considers government-managed health insurance for the 50 million uninsured and 100 million under-insured American citizens and businesses to be a socialistic privilege?

Dr. Howard A. Green is a member of Physicians for a National Health Program. He resides in West Palm Beach.

http://www.palmbeachpost.com/news/news/opinion/letters-scotts-double-standard-on-health-wind-insu/nPPrk/

Massachusetts model fails to provide financial security for the sick

SICK IN MASSACHUSETTS: Views on Health Care Costs and Quality

Harvard School of Public Health/WBUR/Blue Cross Blue Shield of Massachusetts Foundation/Robert Wood Johnson Foundation
June 2012

This poll examines the views of sick adults in Massachusetts regarding the cost and quality of health care in the state as well as their perceptions about their own health care in the past year. “Sick” adults in Massachusetts (27% of adults) are defined as those who said they had a serious illness, medical condition, injury, or disability requiring a lot of medical care or had been hospitalized overnight in the previous 12 months. Focusing on the experiences and opinions of those who have had significant recent medical care yields special insight into the current problems and opportunities facing Massachusetts’ health care system.

Today most sick adults in Massachusetts see the cost of health care as a serious problem for the state, and they view the problem as having gotten worse over the past five years. Sick adults are more troubled by costs than they are by quality.

Although Massachusetts has nearly universal health insurance coverage, the costs of health care are a serious financial problem for many sick adults and their families. Some sick adults report having been refused medical care for financial or insurance reasons. Additionally, some sick adults say they did not get needed medial care because they could not afford it. Taken together, these finding suggest that insurance coverage does not protect some Massachusetts residents against the financial hardships of illness, likely reflecting recent trends in higher deductibles and co-payments.

http://www.scribd.com/doc/96682782/Sick-in-Massachusetts

Comment:

By Don McCanne, MD

This survey is particularly important because it provides the real life health care financing experiences of patients who have serious medical problems – precisely those for whom the system should be designed to serve.

In Massachusetts, “Forty percent of sick adults in the state said the out-of-pocket costs of medical care are a ‘very serious’ (16%) or ‘somewhat serious’ (24%) problem for them.” Obviously the financing system is not serving well those individuals with major medical needs.

Another significant finding: “About a quarter of sick adults (24%) who have been insured at any time during the past year say they have had a problem with their insurance paying a hospital, doctor, or other health care provider in the past 12 months.” Thus the insurers are not doing their job either.

Since the Affordable Care Act uses a financing design similar to that of Massachusetts, we can anticipate the same miserable performance for the nation, or more likely even worse because of other design flaws in ACA.

At a minimum, we should expect the health care financing system to work well for those with serious problems. The ACA design won’t cut it. We really do need a single payer national health program that would work well for all of us.

The Right Thing for the Wrong Reason

By Marcia Angell
Room for Debate, The New York Times, June 17, 2012

If the Supreme Court strikes down the Affordable Care Act’s mandate to buy insurance, it will have done the right thing for the wrong reason. The court’s Republican majority will have used the Constitution as an excuse to undermine President Obama. (Anyone who still thinks the Supreme Court is not a political body hasn’t been paying attention.)

But the mandate is a terrible idea. It requires people to buy a commercial product from investor-owned businesses at whatever price the companies set. The point of health reform was to expand coverage while reining in the unsustainable inflation in costs. Yet, in making the insurance industry the linchpin of his reform plan, Obama ensured that health costs would grow even faster. By throwing the industry millions of new customers and billions of federal dollars, the law with its mandate is inherently inflationary. No health reform can work if it’s not affordable. As premiums mount, so will deductibles and co-payments, until many Americans will have insurance that they can’t afford to use (which is the current situation in Massachusetts).

So if the mandate is struck down, I will not be sorry. We will no longer be tempted to think we’ve solved the problem of providing universal care. The rest of the law will probably go down with it or unravel (even though there is no reason why the provision to extend Medicaid, which accounts for fully half the additional coverage, couldn’t stand alone).

We should see this as an opportunity to undertake real health reform. The only way to provide health care to all Americans at an affordable cost is by instituting some form of publicly administered nonprofit system like those in other advanced countries. After all, they manage to provide universal care at less than half the cost. I favor expanding Medicare (our single-payer subsystem) gradually by lowering the eligibility age one decade at a time, while phasing out for-profit health facilities.

Just as it is irresponsible for Republicans to oppose the Affordable Care Act to weaken the president, it is irresponsible for Democrats to support it for short-term political reasons. We need to evaluate it on its merits, and I believe it fails.

Marcia Angell, M.D., is a senior lecturer in social medicine at Harvard Medical School. She is the former editor in chief of The New England Journal of Medicine.

http://www.nytimes.com/roomfordebate/2012/06/17/what-will-change-after-the-supreme-courts-health-care-ruling/striking-down-the-individual-mandate-is-right-and-wrong

There’s a Better Way

By David Himmelstein and Steffie Woolhandler
The New York Times, Room for Debate, June 17, 2012

Occupy Wall Street wasn’t born in time for the 2009 health care debate. But that debate was a quintessential display of the power and privilege of the 1 percent.

Drug and insurance firms dictated the terms of reform: “do it our way or do nothing at all.” The result was a lopsided bargain: the American people were allowed to expand Medicaid, ship a few scraps to community health centers and impose feeble insurance regulations. Insurers got hundreds of billions of taxpayer dollars and a mandate ordering the middle class to buy their defective products.

The plan’s demise would offer peril and possibility. The corporate-backed “do nothing at all” option would perpetuate disaster: about 50,000 annual deaths from the lack of insurance; about 800,000 medical bankruptcies each year, mostly among families with coverage; a continuing spiral of rising costs and shrinking coverage; and continuing assaults on Medicare. But we need not meekly acquiesce to the dictates of the 1 percent.

A single-payer reform — a public, national health insurance plan that pays virtually all medical bills — would fix the health care mess; and, like Medicare, it’s clearly constitutional. Single-payer would save $400 billion wasted each year on insurers’ overhead and the paperwork burden they impose on doctors and hospitals. It could redirect this money to cover the uninsured and upgrade coverage for the rest of the 99 percent. As nations with single-payer systems have found, cutting out the insurance middlemen and driving a hard bargain with drug firms makes universal coverage affordable and lowers death rates. And single-payer would restore Americans’ right to choose any doctor and any hospital.

Of course, the impetus for such measures can’t come from inside boardrooms or the Beltway. The overturning of the Obama reform could add fuel to the Occupy impulse, stoking the broad social movement that’s essential for achieving real health care reform, and for rebuilding American democracy. Certainly, many doctors and nurses will be prepared to join our patients in the streets.

David Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H., are internists and professors of public health at the City University of New York. They are co-founders of Physicians for a National Health Program.

Equal opportunity? Not in health care

By Li-hsia Wang and Henry Abrons
San Francisco Chronicle, Letters, June 6, 2012

The California HealthCare Foundation’s report on Medi-Cal (“Recipients give Medi-Cal mostly high marks,” May 31) might lead Chronicle readers to believe that low-income residents feel secure in California’s safety net for health care.

As doctors who served low-income families, we have strong convictions that Medi-Cal has design flaws that must be addressed. Medi-Cal reimbursements to providers are so low that patients often have difficulty finding a doctor for primary care, and access to specialists can be particularly difficult.

In many urban areas, Medi-Cal recipients receive health care mainly at overburdened county hospitals and community health centers where dedicated staff and administrators are continually challenged by inadequate funding and threats of further cutbacks. We view the stories told by Medi-Cal recipients as testaments to their individual resiliency and not an assurance that society is providing them with full access to high-quality care.

In spite of our lofty ideal of equal opportunity, the United States is unique among industrialized countries in segregating our poor in a separate and definitely not equal health insurance program. Isn’t it time we provided one high standard of universal health care? We need an improved and expanded Medicare for all.

Li-hsia Wang, M.D. and Henry Abrons, M.D., reside in Berkeley, Calif.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2012/06/05/EDDD1OT1EM.DTL#ixzz1xWPChjxQ