PNHP

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

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

Dr. Claudia Chaufan: Hispanics worst served by Affordable Care Act

By Silvia Casabianca
VOXXI News, June 18, 2012

An Argentinean medical doctor, Claudia Chaufan arrived in California as a single mom of a 7-year-old in 1997. She had been accepted to a one-year postgraduate training in science and medical communication. Destiny had it that she’d fall in love with a man that eventually became her husband, and with a cause that is now her passion.

She changed plans and stayed in the United States to get a doctorate in sociology at the University of California in Santa Cruz and now works as an assistant professor of sociology and health policy at the Institute for Health and Aging of the Department of Social and Behavioral Sciences at the University of California in San Francisco.

Chaufan gives presentations on diabetes and on comparative health policies, and writes for the general public and for expert audiences in the United States and abroad. She is also active in professional and community organizations, among them the Physicians for a National Health Program (PNHP).

Experiencing a single-payer health care system

Chaufan just returned from teaching a one-term course on Comparative Health Care Systems at the Taipei Medical University in Taiwan. There she got to experience first hand what she preaches about every day – that single-payer health care systems might be the best option.

“We had just arrived in Taiwan and my husband had this extremely bad headache,” Chaufan recalls. “I thought he had a ruptured brain aneurysm. The next day the headache was still there. I didn’t know what to do. We were staying next door to the hospital where I was teaching. We walked into the emergency room and I said we needed a doctor who could rule out the possibility of such and such.”

After a wait of only 20 minutes a doctor came. He agreed that an aneurysm was a possibility and ordered a CAT scan right away.

Fortunately the results were negative.

“The whole ordeal took us barely 90 minutes,” said Chaufan who was ready to pay in cash whatever the cost of the services were. Even though she knew the system really well, she had never experienced it by herself and she was surprised when she got the bill.

“I was thinking to myself, a CAT scan costs thousands in the United States. They asked us for our insurance card and we said we didn’t have one. They charged us $205. Two doctors had seen my husband, plus the stay at the hospital, and all they had asked us for was a name and an address!”

The medical system is simply not there for Hispanics

Before setting her residence in California, Chaufan’s medical practice had focused on clinical diabetes. She had attended medical conferences in the United States and briefly visited public hospitals.

Since in Argentina the health care system is underfunded, when compared, the hospitals in the U.S. looked great, clean and spacious to Chaufan.

“I thought they were wonderful,” Chaufan said. “I had seen unequal access to care in my country and thought the system here was great.”

But then she started to hear stories from people.

An NGO hired her to do diabetes education with Latino communities and she found that immigrants – documented or undocumented – had basically no access to health care.

“I felt embarrassed to talk to these people. How do you tell them to go eat broccoli when they could hardly make ends meet? Economy has not been working for them. It’s not the crisis. They live in a recession forever! They can’t even pay for transportation [to go to the doctor], and if they have a car, it’s falling apart.”

Chaufan decided to quit this job.

“I realized the problem was not education, it was poverty,” Chaufan said. “The medical system was simply not there. These people needed strips to test their blood sugar, they needed medication!”

Affordable Care Act (ACA) is not the way out

Chaufan started to rethink the health care system in the United States. She saw the problems and wanted to participate in solutions but didn’t know how until she found the PNHP.

“ACA doesn’t grant equal access to health – it excludes undocumented immigrants, who would not be allowed to buy insurance even with their own money,” said Chaufman. “People need to know that Latinos are the worst-served, and will be the worst affected by the reform.”

“If ACA is overturned, in whole or in part, I predict that the ‘liberal’ media is only going to talk about the role of the ‘bad Republican’ opposition, and ignore that 50 PNHP doctors (myself included) presented an Amicus Brief that also challenges the constitutionality of ACA,” she added. “And we did not do it because we are pushing for an imaginary free health care market, but because we wanted to make the point that you can bring universal affordable care to all Americans with a publicly financed health care system.

“They won’t mention that, because it is not in their interest. Everybody, Democrats, Republicans and the media are in bed with insurance companies and Big Pharma.”

Chaufan believes the ACA would institutionalize the worst of the current health care system.

“It makes people buy their junk. Even if it were universal insurance, as it is presented, with 26 million that will not be covered – according to a 2019 estimate – it’s underinsurance.”

The Argentinean health care system is underfunded and not strong, Chaufan said, but there exists a public hospital network where everybody can go.

“As a medical student, I went to one of those hospitals for services. Everyone who walks in gets care,” she said. “Non-profit mutual funds created by unions offer services to the community. There are also prepaid medical services, not cheap but never the horror that I see here with the price for tests, seeing a doctor, pharmaceuticals.”

The Affordable Care Act won’t eliminate financial barriers, she affirmed.

“Every country has a standard, including Taiwan,” Chaufan said. “If it’s publicly financed, the government says, you put a certain percentage of your salary, we buy services in bulk, buy for the whole country or the whole province, like in Canada. Here, we don’t know – it all depends on the individual insurance … that, the administration will not change.”

http://voxxi.com/dr-claudia-chaufman-hispanics-worst-served-affordable-care-act/

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

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.

Small businesses support beneficial health reform policies

Small Business Owners’ Views on Implementing the Affordable Care Act

Small Business Majority
June 14, 2012

Executive Summary

The rising cost of health insurance has been and continues to be one of the biggest problems facing American small business owners. To help relieve them of that financial burden, the Affordable Care Act was signed into law on March 23, 2010—a piece of legislation that is already reining in Americans’ health coverage costs. More than two years later, the law’s fate rests in the hands of nine Supreme Court justices who are expected to issue their decision this month in the case against the law. According to scientific opinion polling, only one-third of small business owners would like to see them overturn it. On the other hand, half would like to see it upheld with, at most, only minor changes. This support grows after learning more details about its key provisions.
 
The poll, conducted in eight states with diverse political profiles—Florida, Illinois, Louisiana, Michigan, Missouri, New York, Texas and Virginia—found that once small business owners hear more about the healthcare law, their support for keeping it intact—either as is or with minor changes—rises to a 56% majority, while the desire for repeal falls to 28%—a 2:1 margin. Moreover, entrepreneurs strongly support many of its key provisions affecting small business owners.

One of the law’s crucial components, which has tremendous small business support, is the health insurance exchange—an online marketplace where small business owners will be able to pool their buying power when they purchase coverage. By a striking 8:1 ratio, owners say they would use their state exchange or at least consider using it, compared to those who say they would not consider using it when they provide benefits. The majority of entrepreneurs find possible features of the exchange very appealing, and, by a 2:1 ratio, they support their state applying for federal funds to set one up.

Furthermore, half of entrepreneurs report they’d be more likely to purchase insurance through the exchange beginning in 2014 when the small business tax credit will be available only to those using the exchange. That’s more than three times the number (14%) who say they’d be less likely to purchase from the exchange. Of respondents who fall into the basic qualification parameters for the tax credit, more than half are already taking advantage of it. Of eligible employers who aren’t claiming it, nearly half say it’s because they are not aware it exists. And nearly half of entrepreneurs say that if their company qualified for the credit, they would be more likely to provide or continue providing healthcare to their employees.

Significant majorities of small business owners also support nearly all the other provisions we asked them about: medical loss ratio, rate review, pre-existing condition exclusion bans, eliminating annual dollar limits on insurance benefits, preventing rating based on health status or sex and more.

Finally the poll revealed a strong interest (67%) in workplace wellness programs, if these programs would help lower coverage costs.

http://www.smallbusinessmajority.org/small-business-research/downloads/Small_Business_Owners_Views_on_ACA.pdf

Comment: 

By Don McCanne, MD

Rather than asking about a broad spectrum of health reform policies, this poll was limited to questions about policies contained in the Affordable Care Act. From this poll no conclusions can be drawn about opinions of policies specific to single payer, but we can conclude that small business owners clearly do want reform that serves them and their employees better than the status quo in health care.

It remains our task to inform them that the policies of the single payer model will serve them far better than the meager policies of the Affordable Care Act. The majority of small business owners would support an improved Medicare for all if they had a clear understanding of the policies behind it, since it’s far better for them than ACA.

Let’s get to work and let them know the possibilities.

Poorer nations push for universal health coverage as U.S. squabbles

By Philip Caper, M.D.
Bangor Daily News (Maine), June 14, 2012

A few weeks ago, an article by Noam Levey of the Los Angeles Times caught my eye. It was titled “Global Push to Guarantee Health Coverage Leaves U.S. Behind” and it described how “even as Americans debate whether to scrap President Obama’s health care law and its promise of guaranteed health coverage, many far less affluent nations are moving in the opposite direction — to provide medical insurance to all citizens.”

Among those other countries are China, Thailand, Mexico, Rwanda and Ghana. The article went on to explain that, “Two decades ago, many former communist countries in Eastern Europe and elsewhere dismantled their universal health care systems amid a drive to set up free-market economies. But popular demand for insurance protection has fueled an effort in nearly all of these countries to rebuild their systems. Similar pressure is coming from the citizens of fast-growing nations in Asia and Latin America, where rising living standards have raised expectations for better services.”

Many other countries are moving full speed ahead to guarantee health care for all their citizens, not only because it is morally and ethically right but because it is a powerful economic development tool that will ensure these countries have healthy populations and an efficient and effective health care system.

Meanwhile, the U.S. seems stuck in a state of political paralysis and may soon move full speed astern. What explains this striking and unfortunate example of American exceptionalism?

I attribute it to motivators often used to explain the behavior of Wall Street: fear and greed.

I would also add a third: ignorance. There are those who still believe (or claim to), despite all the evidence to the contrary, that the U.S. has the best health care system in the world. This belief is demonstrably contradicted, both by the facts and everyday experience. We have the most expensive health care system in the world and some of the fanciest technology, but our arrangement for getting health services to our people ranks far down the scale, behind about 40 other countries.

Fear is a major factor in the political stalemate we are now witnessing surrounding health care reform. About 50 million people in the U.S. are uninsured and increasing numbers are badly underinsured. Bankruptcies and other financial hardships due to medical costs are becoming more and more common.

Despite this, we are treated almost daily to distracting arguments, many unfounded and ridiculous, about “death panels,” “government tyranny,” “rationing” and other largely mythical or irrelevant threats to our well-being. Some of the critics responsible for these fear tactics are simply misinformed, but others are dissembling to pursue obstructionist political agendas.

Much of the fear-mongering around the health care reform debate is induced by the second motivator: greed. Health care in the U.S. is almost a $3 trillion industry. It is credibly estimated that about a third of our spending does not contribute to the health of our people in any meaningful way. The proof is that other wealthy nations provide health care to their people for about half of what we spend yet get better results.

Elimination (or more accurately redirection) of some of that money would mean moving funds away from a few people and toward the rest of us, thereby reducing the income of influential industries such as large pharmaceutical and medical supply companies and corporate providers of health care services. Many of these companies are enjoying windfall profits thanks to American public policy. Greed and the political muscle that goes with money are a major source of resistance to changes that would benefit the vast majority of Americans.

Our market-driven health care system is disintegrating. Many are being harmed in the process. How can people of good conscience allow this to continue? We need to change the ways we finance, pay for and deliver health care.

Our for-profit insurance and delivery systems must be transformed (not just reformed) into nonprofit ones, like most other countries. Coverage must be expanded to include everybody. Firm, fair and effective cost controls need to be put in place. In order for widespread support for such a system to be sustained, everyone must be in the same system.

In other words, we must replace our existing system sustained by fear, greed and ignorance with one that is fair, inclusive, efficient, effective and mission-driven. Such transformation has occurred elsewhere. Given the political will, we in the U.S., including Maine, could do it too. We’d all be much better off.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.

http://bangordailynews.com/2012/06/14/health/poorer-nations-push-for-universal-health-coverage-as-u-ssquabbles/