By Kyle Cheney
Dorchester (Mass.) Reporter
State House New Service
Sept. 3, 2009

As state-subsidized health care for 31,000 legal immigrants lapsed Tuesday, the result of budget cuts imposed by the Legislature, advocates for a single-payer health care system blasted the cuts as “discriminatory” and said a backup plan endorsed Monday by the Patrick administration could leave them worse off than if they relied on a state fund for the uninsured.

“It’s deplorable,” said Dr. L. Toni Lewis, president of the Committee of Interns and Residents for Service Employees International Union, speaking at a press conference in the State House’s Nurses Hall.

Officials of the Massachusetts Nurses Association, the National Association of Social Workers, immigrant advocacy groups and labor unions said the Legislature should have made cuts across the board, rather than singling out the 31,000 immigrants. Known as “aliens with special status,” these immigrants are ineligible for federal matching benefits because they have been in the country for less than five years.

Rep. Marie St. Fleur (D-Dorchester) said the Massachusetts State Constitution forbids discrimination based on immigration status.

“If we go down the slippery slope of making decisions about who we think should be covered, we should take a step back,” she said.

St. Fleur said that even if the immigrants in question aren’t eligible to vote, their family members and friends should let lawmakers know “there will be a price” if they support policies that disadvantage immigrants.

Lawmakers cut coverage for the immigrants, estimated to cost $130 million this fiscal year, to help balance this year’s budget. Gov. Deval Patrick countered, seeking to fund coverage at $70 million, a figure lawmakers reduced further to $40 million. Legislators said they made the cuts because without them, other essential services for vulnerable populations would need to be cut further.

The administration announced Tuesday a deal with CeltiCare, a new Boston-based insurer, to provide coverage for most basic health services — excluding skilled nursing, dental, vision and hospice care — for the immigrants. The immigrants would be enrolled in the new plan on a rolling basis beginning Oct. 1, with all slated to be enrolled by Dec. 1. In the interim, the uninsured immigrants would have their care funded by the state’s Health Safety Net Trust Fund, a fund that covers certain services for the uninsured.

Benjamin Day, executive director of the Boston chapter of Physicians for a National Health Program, which organized the press conference, said the scaled-back plan for the immigrants could actually provide worse coverage than the immigrants would receive from the Health Safety Net. He cited increased co-payments for services like brand-name medication and emergency care, which the immigrants will see with CeltiCare.

At the press conference in the capitol’s Nurses Hall, Physicians for a National Health Program also gathered 500 signatures of doctors and health care professionals calling for “a single payer reform” and to “fully restore funding for the 30,000 immigrants who face imminent exclusion.”

Opponents of single-payer health care argue that it places bureaucratic barriers between patients and care, requires government involvement in health care decisions, and imposes too great a strain on public finances.

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http://www.dotnews.com/2009/immigrant-health-plan-called-unfair

By NICHOLAS D. KRISTOF
Op-Ed Columnist
New York Times
September 3, 2009

Here’s a paradox.

Health care reform may be defeated this year in part because so many Americans believe the government can’t do anything right and fear that a doctor will come to resemble an I.R.S. agent with a scalpel. Yet the part of America’s health care system that consumers like best is the government-run part.

Fifty-six to 60 percent of people in government-run Medicare rate it a 9 or 10 on a 10-point scale. In contrast, only 40 percent of those enrolled in private insurance rank their plans that high.

Multiple surveys back that up. For example, 68 percent of those in Medicare feel that their own interests are the priority, compared with only 48 percent of those enrolled in private insurance.

In truth, despite the deeply ingrained American conviction that government is bumbling when it is not evil, government intervention has been a step up in some areas from the private sector.

Until the mid-19th century, firefighting was left mostly to a mishmash of volunteer crews and private fire insurance companies. In New York City, according to accounts in The New York Times in the 1850s and 1860s, firefighting often descended into chaos, with drunkenness and looting.

So almost every country moved to what today’s health insurance lobbyists might label “socialized firefighting.” In effect, we have a single-payer system of public fire departments.

We have the same for policing. If the security guard business were as powerful as the health insurance industry, then it would be denouncing “government takeovers” and “socialized police work.”

Throughout the industrialized world, there are a handful of these areas where governments fill needs better than free markets: fire protection, police work, education, postal service, libraries, health care. The United States goes along with this international trend in every area but one: health care.

The truth is that government, for all its flaws, manages to do some things right, so that today few people doubt the wisdom of public police or firefighters. And the government has a particularly good record in medical care.

Take the hospital system run by the Department of Veterans Affairs, the largest integrated health system in the United States. It is fully government run, much more “socialized medicine” than is Canadian health care with its private doctors and hospitals. And the system for veterans is by all accounts one of the best-performing and most cost-effective elements in the American medical establishment.

A study by the Rand Corporation concluded that compared with a national sample, Americans treated in veterans hospitals “received consistently better care across the board, including screening, diagnosis, treatment and follow-up.” The difference was particularly large in preventive medicine: veterans were nearly 50 percent more likely to receive recommended care than Americans as a whole.

“If other health care providers followed the V.A.’s lead, it would be a major step toward improving the quality of care across the U.S. health care system,” Rand reported.

As for the other big government-run health care system in the United States, Medicare spends perhaps one-sixth as much on administration as private health insurers, although the comparison is imperfect and controversial.

But the biggest weakness of private industry is not inefficiency but unfairness. The business model of private insurance has become, in part, to collect premiums from healthy people and reject those likely to get sick — or, if they start out healthy and then get sick, to find a way to cancel their coverage.

A reader wrote in this week to tell me about a colleague of hers who had health insurance through her company. The woman received a cancer diagnosis a few weeks ago, and she now faces chemotherapy co-payments that she cannot afford. Worse, because she is now unable to work and has to focus on treatment, she has been shifted to short-term disability for 90 days — and after that, she will lose her employer health insurance.

She can keep her insurance if she makes Cobra payments on her own, but she can’t afford this. In her case, her company will voluntarily help her — but I just don’t understand why we may be about to reject health reform and stick with a dysfunctional system that takes away the health coverage of hard-working Americans when they become too sick with cancer to work.

On my blog, foreigners regularly express bewilderment that America may reject reform and stick with a system that drives families into bankruptcy when they get sick. That’s what they expect from the Central African Republic, not the United States.

Let’s hope we won’t miss this chance. A public role in health care shouldn’t be any scarier or more repugnant than a public fire department.

By Carla K. Johnson
Associated Press
San Jose Mercury News
Sept. 3, 2009

CHICAGO — Janie Johnson has no health insurance, so when she cut her toe while giving herself a pedicure, she limped to the emergency room at one of Chicago’s safety net hospitals and waited her turn.

“I’m 44, but I probably look about 55 right now,” Johnson joked in Stroger Hospital’s emergency department where more than 100 patients sat waiting. Urgent cases, from chest pains to gunshot wounds, are rushed to doctors first. Johnson was glad to have somewhere to go for health care.

“I don’t know what I would do” without the hospital, she said. “My health would probably get worse.”

To all the knotty issues involved in health care overhaul, add one more: The proposals in Congress may threaten the funding and future of the nation’s already-struggling safety net hospitals.

It’s an irony hospital leaders are expressing quietly as Congress reconvenes to take up health care again. Hospital leaders support expanding insurance coverage to more Americans, but they worry financing the expansion will cause some teetering urban hospitals to deteriorate and close.

They point to Massachusetts, the laboratory for health care overhaul, where one safety net hospital, Boston Medical Center, is suing the state claiming it’s covering too much of the cost for expanding coverage. Another safety net standby, Cambridge Health Alliance, has closed health centers and cut services; its Somerville Hospital no longer keeps patients overnight.

“It looks like a national plan will be modeled on Massachusetts and it’s a disaster for poor people,” said Dr. Steffie Woolhandler, Harvard Medical School professor and a doctor at Cambridge Hospital.

“The insurance offered doesn’t cover everyone,” she said. “It’s filled with gaps like copayments and deductibles. Patients can’t afford it, so they turn to the public sector and the public sector isn’t there anymore.”

What worries Woolhandler and others are proposals to finance national reform that would reduce payments gradually to hospitals handling more than their share of uninsured patients. One proposal would reduce these funds — called DSH payments for “disproportionate share hospital” — by $20 billion, in three large annual chunks starting in 2017.

About 2,700 U.S. hospitals receive DSH payments. That’s about half the nation’s hospitals, according to the American Hospital Association.

A small segment of those hospitals provides most of the nation’s charity care to the poor. These institutions, largely supported by reimbursements from Medicaid and other government insurance programs, receive 12 percent of their revenues from DSH payments.

Lawmakers reason that when more Americans have insurance, there will be less need for the payments. Instead, hospitals would get paid by their newly covered patients’ insurance plans. A trigger in the House health care legislation would start the cuts only after the nation achieved a significant increase in insurance coverage.

But critics say illegal immigrants, the mentally ill and drug addicts will keep arriving at safety net hospitals without insurance. Illegal immigrants will be ineligible for the expanded coverage proposed by Congress. The mentally ill and addicted will be unlikely to sign up.

“If they start cutting, I’m scared,” said Dr. Simon Piller, who cares for patients at a county clinic that’s part of the same health system as Stroger Hospital. He describes patients who’ve lost jobs, are living with friends and ran out of medications for chronic conditions months, or years, ago.

Safety net hospitals will continue to have unusual expenses, such as translation services and security, to deal with. Some newly insured patients won’t be able to afford the out-of-pocket copays and deductibles.

“Copays for us are no-pays,” said Dr. Steven Safyer, president and CEO of Montefiore Medical Center in New York City. “Health care reform to me is an issue of humanity. How you can have 47 million uninsured in this country is shocking. But you can’t throw the baby out with the bathwater.”

DSH cuts are part of a deal the White House reached with the American Hospital Association and two other hospital groups. When the hospitals agreed to cuts totaling $155 billion over 10 years, a group of public hospitals wasn’t at the table.

“We were never part of the negotiations and did not sign onto the agreement,” said Larry Gage, president of the National Association of Public Hospitals and Health Systems. The group contends DSH payments also help maintain trauma centers, burn units and other community assets that could be threatened.

Nancy-Ann DeParle, who directs the White House health reform office, said there’s adequate protection for safety net hospitals in the House bill. The payments would be reduced — gradually and starting only after the rate of uninsured Americans declines — in a way that differs greatly from what happened in Massachusetts, DeParle said.

President Barack Obama supports phasing in DSH reductions over 10 years.

“As people get insurance, there will be less of a need for hospitals to get additional funds,” DeParle said. She acknowledged it may be “scary” for hospital administrators to shift from getting these additional payments to a reality where more of their patients have insurance cards.

But hospitals can and must adapt, DeParle said. “We will always need safety net hospitals.”

It’s unclear how much would be cut. The House legislation calls for cuts of $20 billion, representing 8 percent of what the Congressional Budget Office projects in federal outlays to DSH over 10 years. The White House supports larger cuts.

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http://www.mercurynews.com/politics/ci_13267257?source=email

PacifiCare’s Denials 40%, Cigna’s 33% in First Half of 2009

From California Nurses Association/National Nurses Organizing Committee

For Immediate Release
September 2, 2009

Contact: Charles Idelson, 510-273-2246, Shum Preston, 510-273-2276, or Liz Jacobs, 510-273-2232

More than one of every five requests for medical claims for insured patients, even when recommended by a patient’s physician, are rejected by California’s largest private insurers, amounting to very real death panels in practice daily in the nation’s biggest state, according to data released today by the California Nurses Association/National Nurses Organizing Committee.

CNA/NNOC researchers analyzed data reported by the insurers to the California Department of Managed Care. From 2002 through June 30, 2009, the six largest insurers operating in California rejected 31.2 million claims for care — 21 percent of all claims.

The data will be presented by Don DeMoro, director of CNA/NNOC’s research arm, the Institute for Health and Socio-Economic Policy, at CNA/NNOC’s biennial convention next Tuesday, Sept. 8 in San Francisco. The convention will also feature a panel presentation from nurse leaders in Canada, Great Britain, and Australia exploding the myths about their national healthcare systems.

“With all the dishonest claims made by some politicians about alleged ‘death panels’ in proposed national legislation, the reality for patients today is a daily, cold-hearted rejection of desperately needed medical care by the nation’s biggest and wealthiest insurance companies simply because they don’t want to pay for it,” said Deborah Burger, RN, CNA/NNOC co-president.

For the first half of 2009, as the national debate over healthcare reform was escalating, the rejection rates are even more striking.

PacifiCare denied 40 percent of all California claims in the first six months of 2009. Cigna, which gained notoriety two years ago for denying a liver transplant to 17-year-old Nataline Sarkisyan of Northridge, Calif. and then reversing itself, tragically too late to save her life, was still rejecting one-third of all claims for the first half of 2009.

“Every claim that is denied represents a real patient enduring pain and suffering. Every denial has real, sometimes fatal consequences,” said Burger.

PacifiCare, for example, denied a special procedure for treatment of bone cancer for Nick Colombo, a 17-year-old teen from Placentia, Calif. Again, after protests organized by Nick’s family and friends, CNA/NNOC, and netroots activists, PacifiCare reversed its decision. But like Nataline Sarkisyan, the delay resulted in critical time lost, and Nick ultimately died. “This was his last effort and the procedure had worked before with people in Nick’s situation,” said his older brother Ricky.

California Blues rejected 28 percent of claims in the first half of 2009. In 2008, six days before RN Kim Kutcher of Dana Point, Calif., was scheduled to have special back surgery, Blue Cross denied authorization for the procedure as “investigational” even though the lumbar artificial disc she was to receive had FDA approval.

At the time of denial, which she calls “insurance hell,” Kutcher notes she had “already gone through pre-op testing, donated a unit of blood, had appointments with four physicians.” Kutcher paid $60,000 out of pocket for the operation and is still fighting Blue Cross.

Kaiser Permanente, which denied 28 percent of all claims in the first half of 2009, was one of two systems to reject options for radiation and chemotherapy for 57-year-old Bob Scott of Sacramento after his diagnosis of a brain tumor in 2005. The reason cited was his age, says wife Cheryl Scott, RN. “He had been in perfect health all of his life. This was his first problem other than a sprained ankle. He died six months later.”

Rejection of care is a very lucrative business for the insurance giants. The top 18 insurance giants racked up $15.9 billion in profits last year.

“The routine denial of care by private insurers is like the elephant in the room no one in the present national healthcare debate seems to want to talk about,” Burger said. “Nothing in any of the major bills advancing in the Senate or House or proposed by the administration would challenge this practice.”

“The United States remains the only country in the industrialized world where human lives are sacrificed for private profit, a national disgrace that seems on the verge of perpetuation,” she said.

CNA/NNOC supports an alternative approach, expanding Medicare to cover all Americans, which would give the U.S. a national system similar to what exists in other nations. Data released in late August by the Organization for Economic Co-operation and Development, which tracks developed nations, found that among 30 industrial nations, the U.S. ranks last in life expectancy at birth for men, and 24th for women.

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CNA/NNOC represents 86,000 registered nurses in all 50 states, and is working toward unification with the Massachusetts Nurses Association and United American Nurses to build a new 150,000 member national nurses organization.

By Bill Boyarsky
Truthdig
Sept. 3, 2009

While the media are transfixed by all the screaming in town halls and on television, the real work of health care reform is being done in secret by congressional staff technocrats, government bureaucrats, health industry lobbyists and sometimes even a member of the Senate or House.

The controversy over the so-called public option is a prime example of what is happening. Under this arrangement, government health insurance plans are supposed to compete with those offered by private insurance companies, with the hope of forcing the private companies to lower prices and expand benefits. Advocates of this scheme offer it as an alternative to what’s known as universal medical care, Medicare for all or “single payer,” which would eliminate the role of insurance companies altogether in favor of a government-only plan. Many liberals say such far-reaching reform is unattainable. As a compromise, they support the public option.

The fight over the public option has occupied much of the media coverage, but left unsaid is the fact that weeks of behind-the-scenes negotiations have weakened the public option proposal to the point that it is hardly an option at all.

I discussed the matter with Rep. Dennis Kucinich, D-Ohio. Kucinich favors universal health insurance coverage, not the public option. So do I.

A health care reform bill was approved by the House Energy and Commerce Committee in July. Kucinich said that a final version–the real bill–is now being rewritten and will be presented to committee chairs and other leaders, who will bring the revised version to the House floor. “It’s happening now,” he said. “It’s being done by the leadership, and we [members of Congress] don’t know what’s going on.”

Kucinich is the author of an amendment to the House bill that would ease federal barriers to states wanting to enact universal care plans of their own. Legislators are engaged in such efforts in California, Colorado, Illinois, Minnesota, Montana, New Mexico, New York, Ohio, Pennsylvania and Washington. He told me it “was one of the few provisions in a badly flawed bill that could provide benefits.”

Kucinich suggested I read articles written by health insurance expert Kip Sullivan on the Web site of Physicians for a National Health Program, which advocates government-run universal health care. Sullivan, he said, has figured out the real story.

Sullivan writes that public option advocates once promised a program as far-reaching as Medicare but “now promote something entirely different. To make matters worse, they have not told the public they have backpedaled. The campaign for the ‘public option’ resembles the classic bait-and-switch scam: Tell your customers you’ve got one thing for sale, when in fact you are selling something very different.”

Sullivan documents how the public option has been watered down since Jacob Hacker, now a political science professor at the University of California at Berkeley, proposed it several years ago. Hacker first estimated that 129 million would be covered, drawn by its generous terms. But the public option plans now before Congress would cover no more than 10 million, Sullivan said. Reducing subsidies to low-income people has cut the number covered, while limits on private insurance benefits have been eased.

In addition, the public option would actually be run by insurance companies such as Blue Cross, acting as contractors for the federal government. What is everyone arguing over? Heads they win, tails they win.

Referring to a bill approved by the Senate Health, Education, Labor and Pension Committee, Sullivan writes that the language of these provisions is so complex “it requires at least two readings to understand it.” The language of this and the other bills is no doubt designed to be purposely incomprehensible to most lawmakers, who will receive the final bill only at the last moment. The bills certainly are not being written to be understood by the general public.

Another important issue being decided in private is what precisely will Americans get from the new plan. “What level of subsidies [will] be available to make coverage more affordable for people?” asked Drew Altman, president of the Henry J. Kaiser Family Foundation. “What kind of coverage will people receive, and will it meet the public’s expectations?”

Kucinich doesn’t like the secret process. Neither does a newspaper that seldom, if ever, agrees with him on anything: The Wall Street Journal. Noting that President Barack Obama has complained that critics have misrepresented him, the paper said, “Who’s to know what’s reality and what’s a myth when the public and Members of Congress aren’t able to read a bill that would restructure one-seventh of our economy.”

So far, the loser in this game of backroom politics is the consumer or, in this case, the patient. The winner is the medical care industry.

President Obama is scheduled to speak to Congress on Wednesday on the issue. He’ll have to assure the rest of us that we’ll be winners, too.

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http://www.truthdig.com/report/item/20090903_dont_be_fooled_by_the_public_option/?ln