Speaker – Page 697

Free clinic is vital till single-payer health care system arrives

By Andrew D. Coates
The Daily Gazette (Schenectady, N.Y.), Nov. 7, 2010

The Schenectady Free Health Clinic provides high-quality care to some 2,600 patients, about 18 percent of Schenectady County’s uninsured, free of charge. The need for the clinic is increasing.

The Census Bureau recently reported a one-year 10 percent increase in the uninsured – to 50.7 million people, or 16.7 percent of our population. A jump of 4 million people is alarming. Harvard researchers recently showed that for every 1 million with diminished access due to no health insurance, roughly 1,000 people die.

Daunting out-of-pocket expenses, co-insurance payments, co-pays and high deductibles, together with unaffordable premiums, weigh upon everyone. Our nation spends, per person, more than twice what any other nation spends for health care.

Yet for all the money, our health outcomes remain mediocre. Among many health indicators the United States continues to rank dead last among developed nations. In life expectancy our rank in the world is now number 49.

Awareness of the ongoing health care crisis led the Capital District chapter of Physicians for a National Health Program to sponsor a fundraiser for the Schenectady Free Health Clinic on Oct. 29. As physicians we know intimately that preventable tragedy can result when money causes a person to postpone or forgo necessary care.

Because perverse financial incentives so often undermine the practice of medicine, we also recognize the Schenectady Free Health Clinic as an oasis of compassionate care. The event brought over one hundred people together to celebrate the best of our community, including its physicians, people who refuse to forget those most in need. We are pleased to report over $8,500 in new donations for the clinic.

But is something wrong with this picture? Health care crisis? Free clinic? Aren’t we supposed to be “status post health reform”?

The omnibus bill signed by President Obama earlier this year promises to decrease the number of uninsured starting in 2014. Even so, the Congressional Budget Office estimates that if the new health law works just as planned, 10 years from now there will still be about 23 million people with no health insurance.

The cornerstone of the reform is compulsory private health insurance. Curiously, although passed by Democrats, the individual mandate was first proposed by GOP leaders (including George H.W. Bush) and first enacted in 2006 in Massachusetts under Republican Gov. Mitt Romney. The legislation President Obama signed will make it federal policy in 2014.

From the Massachusetts experience we know that the individual mandate can neither control costs nor cover everybody. Because health insurance is simply not affordable for millions who will be required to purchase it, under the new law federal taxpayers will give an estimated $447 billion by 2019 to private insurance companies to subsidize premium payments for those with low incomes.

The reform also aims to add some 16 million people to Medicaid by increasing income eligibility to 133 percent of the federal poverty level (excluding all undocumented immigrants and also legal immigrants who have lived here for six years or less).

Overall, regrettably, reducing by half the number of uninsured while expanding the influence of private insurance companies, means we still need free health clinics. Health reform worthy of the name should eliminate that need.

At the fundraiser for the Schenectady Free Health Clinic, Dr. Paul Sorum, founder of the local chapter of Physicians for a National Health Program, made a spirited appeal. He pointed out that the Schenectady free clinic reminds us all of the way medicine ought to be practiced. Everyone should have access to comprehensive, quality care, with no payments for individual services, he explained, for user fees undermine the doctor-patient relationship.

A system of single-payer national health insurance remains the best way to provide access to care for everybody, with each person paying a fair share. Out of pocket expenses including co-pays, for necessary care, would be eliminated.

Fiscally responsible, single-payer would save about $400 billion annually, eliminating the wasteful paperwork and bureaucracy associated with multiple private insurers while creating strong cost-control tools, like bulk purchasing, needs-based planning and the elimination of profiteering from the sick.

Sooner or later a Medicare-for-all finance system will begin to heal our broken health system. Until then, Schenectady Free Health Clinic will remain vital to our community.

—
Dr. Coates practices internal medicine in Albany. He is assistant professor of medicine and psychiatry at Albany Medical College and newly elected chair of the Capital District Chapter of Physicians for a National Health Program.

http://www.dailygazette.com/news/2010/nov/07/1107_coates/

A Doctor Speaks About Healthcare, Big Business and Justice

The following article was originally posted at Health Reform Watch at the Seton Hall University School of Law, Health Law & Policy Program on Sept. 28, 2010.

By Timothy Shaw, M.D., F.A.C.S.
HEALTH REFORM WATCH, Nov. 9, 2010

Twenty years ago, upon entering private medical practice for the first time it took me about a month to realize that the United States needed “Health Care Reform.” After serving the previous fifteen years in the US Army Medical Corps, I started my first civilian medical job. I was asked to come to a hospital by another surgeon to perform an ear operation on a 3 year old boy at the same time as he would be performing an eye operation. This would save the child from two anesthetics on two different days. Since I had never worked at that hospital, and apparently in order to set me straight from the start, one of the head doctors at this hospital, came up to me in the preoperative holding area, and boldly shoved the child’s chart in my face, pointed to the child’s insurance (Medicaid (Welfare)) and shamelessly told me, “if all you are going to do, is to bring this “****” in here, then we don’t need you to come here.” The poor little guy sitting in the corner with his Mom, was smiling at us with his cute partially toothless grin, and coke-bottle glasses. He didn’t realize what one of his doctors called him because of his health insurance coverage.

Again, several months later I was called to a different hospital (one that I normally did not work at either) in the same city by an operating nurse who asked if I took Medicaid “welfare patients.” She asked me if I would come to their operating room to take a coin out of a 2 year old child’s esophagus. She informed me that their hospital doctors in my specialty did not take welfare patients and they were looking for someone to do the operation as the child had choked on a coin. “Apparently someone forgot to screen this child’s insurance before he came to the operating room.” I canceled my clinic patients and drove across town, performed an esophagoscopy and removed the coin.

Obviously, the doctors in these above scenarios did not support “the Public Option” (Medicaid).

What had happened to our Health Care System? What had changed? Where was the honor that we had in the Army Medical Corps? We treated everyone from Generals to Privates and their families with the same respect. In accordance with Geneva Conventions, we even treated enemy soldiers during the Iraq War in our Combat Support Hospitals with the same care that we treated our own.

In a significant measure the United States Private Health System had changed into “Big Business.” In some measure the humanitarian emphasis had eroded.

Although spurning the pharmaceutical industry as “conflict of interest” entities, not suitable for proper patient care, surprisingly, doctors saw no apparent conflict of interest in merging with the Health Insurance Industry. Doctors and the Health Insurance Business became so closely aligned that their DNA intertwined to form a new species. This powerful new combined-arms team became the forme fruste of our new United States Health Care Industry. Doctors armed with new found business tactics, and the Health Insurance Industry armed with the legitimacy of the Doctor’s legal authority to limit health care to patients became the de facto United States Health Care System.

The business meeting replaced the medical conference to discuss “patient care” issues. To cope with the ever burgeoning bureaucracy, more and more doctors went into administration. More doctors have their MBA’s then carry black bags and make house calls. Mergers, Acquisitions, Expansions, Contracts, Covered Lives, Marketing Strategy, Demographics, Competition Threat Forecasts, Actuarial Science, and Health Insurance became the focus of many doctors. Time was spent on avoiding insurance business risk, trying to avoid the high risk patients, finding the better payer groups, etc. Hospitals became less hospitable. Doctor’s began to discharge patients so rapidly, that in the mid 1980’s the majority of States passed consumer protection laws (”Drive By Delivery Laws”) to protect mothers/newborns from being discharged from the hospital too soon.

Currently, the U.S. health care system is outrageously expensive, yet inadequate. Despite spending more than twice as much as the rest of the industrialized nations ($7,129 per capita), the United States performs poorly in comparison on major health indicators such as life expectancy, infant mortality and immunization rates.

Expenditures in the United States on health care surpassed $2.2 trillion in 2007, more than three times the $714 billion spent in 1990, and over eight times the $253 billion spent in 1980. The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers. Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.

Moreover, the other advanced nations provide comprehensive coverage to their entire populations, while the U.S. leaves 45.7 million completely uninsured and millions more inadequately covered. Spain has a constitutional law guaranteeing health care for all of its citizens. The United States is the only industrialized nation that does not have a single payer government national health plan covering all of its citizens.

More Americans die of lack of health insurance than terrorism, homicide, drunk driving and HIV combined. Lack of health insurance kills 45,000 American adults a year, according to a new study published in the American Journal of Public Health. One out of three Americans under age 65 had no private or public health insurance for some or all of 2007-2008. Even with health insurance, many Americans are a medical crisis away from bankruptcy. Research shows 62 percent of all bankruptcies in 2007 were medical, a share up 50 percent since 2001. Most of the medically bankrupt had health insurance. American Manufacturing is down, but not American Manufacturing of poor people. In Canada, where they have a single payer government managed health insurance system, bankruptcy filings due to medical bills are precisely zero (0).

Contrary to myth, the United States does not have the world’s best health care. We’re No. 1 in health care spending, but No. 50 in life expectancy, just before Albania. In Japan, people live four years longer than Americans. Canadians live three years longer. Forty-three countries have better infant mortality rates.

Our Health Care System is unjust. It is unjust in part for some of the following reasons:

Much of the medical research in our country is supported with public tax money through the National Institute of Health Grants. At present, this benefits only those lucky enough to have “good health insurance.”

Many of our hospitals were founded by the hard work of ALL citizens, not just corporate health care institutions. In the late 1800’s Catholic nuns from St. Louis hitched their horses to wagons and rode into the North West Territories armed with a Mission Statement from God to “cure the sick, care for the poor, comfort the dying” and built our first hospitals. They built these hospitals for ALL citizens, not just the patients with “good” insurance.

Our health care system is unjust because patients of minority background get less care and inadequate care compared to white patients, based on evidence published in numerous medical studies. The same arguments which justified slavery as an institution in the 1860’s are used today to justify our current for-profit health care and health care insurance industries — “we don’t want government telling us what to do; we can’t change our lifestyle and our way of life; we don’t want interference with our benefits; we don’t want you to
interfere with our economy, the jobs of the health insurance industry.” These statements are made notwithstanding the basic injustice perpetrated on others by our current health care system.

Our Health Care System is unjust because patients are discriminated against based on their ability to pay. Some doctors and dentists will not see “No insurance / Self Pay ” or Medicaid patients, even though their degrees were issued by publicly funded medical and dental schools.

Our Health Care System is unjust because Doctors charge different patients different prices for the same service based on their insurance or employer. If one would go to a gas station and be told that you have to pay $6 a gallon of gas but that your neighbor has to pay $3 because of who you work for — there would be civil war. But this is how health care is billed. Often the person without insurance is charged more for the same service.

It is unjust because patients do not have the liberty to pick their own doctor. Every time their employer switches health insurances as a business decision, the employees often have to switch doctors. This is an inefficient system, particularly for those with chronic diseases, such as cancer, asthma, etc.

Our healthcare system is unjust because of cost. A man showed me his mother’s hospital bill when she delivered him in 1937. For 5 days in the hospital, room, meals, nursing care and the delivery – $175. Today if you go to a clinic to get earwax removed by a doctor taking only two minutes – it costs almost twice that !!

It is unjust because, although many of the discoveries of medicine were not the work of American Medical/Insurance Industry, the discoveries are then used to create private profit for our present Health Care System. For example, when the Austrian Pathologist Karl Landsteiner won the Nobel Peace Prize for his 1903 discovery of the ABO Blood Groups which made blood transfusions safe, saving billions of lives, he gave his discovery to humankind, not a patent lawyer.

Our healthcare system is unjust for the reason that people without health insurance just as likely had fathers and grandfathers who laid on the sands of Normandy and Iwo Jima, and whose sons and daughters are serving and dying in the service of our country today.

Our health system is unjust because of huge profit taking. Health insurance executives don’t worry about going bankrupt from getting sick. Forbes reports that two large Health Care Corporation CEO’s made $121 million and $57 million respectively in the last five years. While The Medical /Insurance Industry, and Pharmaceutical industries make billions in private profits, our citizens are lining up at a county fair, in neglected health, with their teeth rotting from their heads, just to be seen once at a free medical/dental clinic set up in a barn with freshly swept farm animal stalls.

Health Care is an essential human service which should be part of a public trust, not sold as a for-profit commodity. It has the same essentiality as Clean Air, Clean Water, Roads, Rivers, Police and Fire Protection and should be afforded the stature of Public control.

I’ve often wondered why educated people and our leaders cannot see the injustice of our healthcare system. In a historical context however, it is inconceivable to think that the man who wrote “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness,” could see his slaves working in his fields as he looked out his window.

To right the injustices perpetrated by the British against his countrymen, Thomas Jefferson would write the words which lent justification and strength to his fellow patriots to fight the world’s most powerful army and navy. However, Jefferson’s quill had not the power to convince his countrymen to right an injustice perpetrated by themselves against another people. This would be a conflagration for another time, another generation.

Let us encourage our congresswomen and men to have the moral courage to pass legislation long overdue, to create equality in health care. They should establish a national healthcare insurance plan as a civil right of American citizenship. Let’s abandon our current “Lobbyocracy” and create a true “Democracy.” They should forgo the influence of lobbyist’s money, and “establish justice and promote the general welfare” by creating a health care system that serves and cares for the people.

Some say that we don’t want a Canadian or British style healthcare system. I say let’s make America’s healthcare system look like the United States space program compared to Britain’s or Canada’s! If we put our nation’s collective will together — Americans can do anything. Let us create a publicly funded national health insurance plan to restore to every American their dutiful respect and “unalienable rights.”

Thomas Jefferson’s last words in the Declaration of Independence ring true today: “And for the support of this declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our lives, our fortunes and our sacred honor.”

Timothy Shaw, M.D. F.A.C.S.
Fitchburg, Wisconsin

http://www.healthreformwatch.com/2010/09/28/a-doctor-speaks-about-healthcare-big-business-and-justice/

Health insurers sit pretty at their customers' expense

'People aren't getting the care they need because they have to pay more out of pocket,' says the president of Consumer Watchdog.

By David Lazarus
Los Angeles Times, November 9, 2010

It’s a good time to be a health insurer.

Three of the biggest names in the insurance game reported rock-solid profits last week. Aetna said its third-quarter net income jumped 53% over the same period last year, to $497.6 million. WellPoint, parent of Anthem Blue Cross in California, said its profit rose 1.2% to $739.1 million. Health Net posted a net income of $62.7 million, compared with a loss of $66 million a year earlier.

Angela Braly, chief executive of WellPoint, attributed the company’s strong performance to “disciplined administrative expense control.”

Aetna CEO Ronald Williams was more expansive. He cited “a reduction in utilization of healthcare services after the surge we saw in 2009, combined with appropriate pricing and effective medical quality and cost management.”

Well, that sounds fine and dandy until you parse what exactly he’s saying.

That “reduction in utilization of healthcare services” basically means fewer people went to the doctor. Did we all suddenly become healthier? Not likely.

Jamie Court, president of Consumer Watchdog, a Santa Monica advocacy group, said Americans are skipping doctor visits because they’ve switched to plans with higher deductibles or their employers have jacked up co-pays.

“People aren’t getting the care they need because they have to pay more out of pocket,” he said.

This raises an interesting question about the looming reform of the nation’s healthcare system, under which everyone will be required to have insurance. If available coverage is too pricey for people to use, will Americans be any better off, health-wise?

While most insurance policies will cover catastrophic events, it’s entirely possible that healthcare costs will be too high for the sort of routine care or preventive treatment that can head off illnesses before they become debilitating.

Then there’s that bit from Williams about “appropriate pricing.” What’s that mean?

“Rate increases,” answered Sabrina Corlette, a research professor at the Georgetown University Health Policy Institute. “It means higher rates, as well as more aggressive underwriting that excludes people for certain conditions or charges them higher premiums.”

In September, the California Department of Insurance approved a 19% rate increase for 65,000 Aetna policyholders.

This followed rate hikes of as much as 29% for Anthem Blue Cross, Blue Shield and Health Net, affecting more than 1 million policyholders.

According to the Kaiser Family Foundation, workers now pay 47% more for family health coverage they receive through their jobs than they did five years ago, while wages have gone up only 18%.

And what about “effective medical quality and cost management”?

Court at Consumer Watchdog said this is just another way of saying that insurers are denying more claims. “It’s code for some bureaucrat somewhere telling people that a treatment isn’t necessary,” he said.

The average health insurance agent now receives more than 200 requests annually from clients to provide assistance in pursuing a claim, according to a survey released this month by the National Assn. of Insurance and Financial Advisors, an industry group.

Most agents say they have to contact an insurer at least twice on behalf of a client, the survey found. Eleven percent say they have to make six or more calls in trying to help resolve a claim.

“The most effective cost management for insurers is to decline services,” said Ron Pollock, president of the advocacy group Families USA. “And when there’s a dispute, it’s often very difficult to get a satisfactory result from an insurance company.”

It’s a good time to be a health insurer. For patients, clearly, not so much.

http://www.latimes.com/health/la-fi-lazarus-20101109,0,1116186.column

Health insurers sit pretty at their customers’ expense

‘People aren’t getting the care they need because they have to pay more out of pocket,’ says the president of Consumer Watchdog.