Posted by Marisa Treviño
29 November 2007

As the presidential debate deepens, or gets more desperate, it won’t be surprising to hear more and more candidates who are scared of the immigration issue spouting off just plain WRONG information.

What’s sad is that they and their staff are relying on sources whose only intent is not to present the facts but drive public opinion against any facet of humanely resolving the plight of undocumented immigrants.

Whenever studies are released actually supporting the true facts, these same sources are quick to pounce on it and tear it apart like African lions devouring a kill. They accuse the study’s authors of being biased or twisting the statistics in their favor.

So, it’s more than gratifying when two different entities on two different coasts of the nation, independently release studies that say the same thing: “Undocumented immigrants are not a burden on society.”

This week in California, the University of California’s School of Public Health released a report that found undocumented Latino immigrants do not cause a drag on the U.S. healthcare system as they are always being accused.

In fact, the vast majority of undocumented immigrants don’t even have a regular doctor or healthcare provider and only visit the ER as a last resort.

“Low rates of use of health-care services by Mexican immigrants and similar trends among other Latinos do not support public concern about immigrants’ overuse of the health care system,” the researchers wrote.

“Undocumented individuals demonstrate less use of health care than U.S.-born citizens and have more negative experiences with the health care that they have received,” they said.

It’s a finding that is repeated in today’s released study by the Immigration Policy Center (IPC), the think tank of the American Immigration Law Foundation.

The IPC study found that:

per capita health care expenditures were 55 percent lower for immigrants than for natives in 1998. On average, immigrants received about $1,139 in health care, compared with $2,546 for native-born residents. Although all immigrants are eligible for emergency medical services, they had lower expenditures for emergency room visits, doctor’s office visits, outpatient hospital visits, inpatient hospital visits, and prescription drugs.

But the IPC study doesn’t stop there.

It also addresses the accusations by defamation critics who say undocumented immigrants overuse government services, increase the poverty rate and don’t pay taxes. The IPC authors are puzzled at where the defamation critics are getting their “supposed” information.

Immigration increases the U.S. Gross Domestic Product by approximately $37 billion each year. And national and state studies find that immigrants pay more in taxes than they use in government services. As for undocumented immigrants, it is a myth that they do not pay taxes. Up to 75% of them pay federal and state income and payroll taxes and all immigrants (legal and undocumented) pay sales taxes and property taxes.

while the poverty rate for U.S.-born citizens increased slightly, it fell slightly for immigrants. And, as immigrants integrate into U.S. society, they work their way out of poverty. For example, the children and grandchildren of Hispanic immigrants have made great strides in closing the economic gap with native-born whites by getting an education, getting better jobs, and earning higher incomes than their parents and grandparents. As a case study, homeownership reflects the economic advancement of the immigrant population, and, in California, the homeownership rates for Latino immigrants rose from 16.4 percent among those who arrived in the U.S. in the last 10 years to 64.6 percent among those who have lived here for 30 years or more.

Some immigration critics exaggerate immigrants’ welfare use by measuring the welfare costs of “immigrant households.” These studies include welfare benefits paid to U.S.-citizen children as “immigrant welfare costs” if any member of the child’s household is an immigrant. But, in fact, most legal immigrants are not eligible for publicly financed benefits and undocumented immigrants are not eligible for any public benefits. In addition, the participation rates of non-citizens in some federal benefits programs have been declining.

Putting this study out there is like dangling fresh meat in front of those same hungry lions who can’t digest what the truth is.

Luckily, there’s a whole herd ready to deliver the same message until either the lions give up or wake up — their choice.

By BRAD WARTHEN
Editorial Page Editor
The State
Posted on Sun, Dec. 09, 2007

CAN ANYONE among those with a chance of becoming president say “single-payer?” If not, forget about serious reform of the way we pay for health care.

It doesn’t even necessarily have to be “single-payer.” Any other words will do, as long as the plan they describe is equally bold, practical, understandable, and goes as far in uprooting our current impractical, wasteful and insanely complex “system.”

And the operative word is “bold.” Why? Because unless we start the conversation there, all we might hope for is that a few more of the one out of seven Americans who don’t have insurance will be in the “system” with the rest of us — if that, after the inevitable watering-down by Congress. And that’s not “reform.” Actual reform would rescue all of us from a “system” that neither American workers nor American employers can afford to keep propping up.

But the operative word to describe the health care plans put forward by the major, viable candidates is “timid.”

“Single-payer” is definitely not that — at least, not within an American context. Seen from the perspective of most advanced nations — which accept medical care as just another part of a nation’s infrastructure, like roads and post offices — it’s no big deal.

Not here, though — not by a long shot. Here, we have too many people preprogrammed to go ballistic at the mention of “single-payer.” That’s because of the identity of that payer.

It’s… well, it’s the government!

This column will now take a short break while libertarians run around shrieking until they turn blue and fall over… da-da-dum-dum, hmmm… readers might want to go look at the Sunday comics until we resume… da-dee-da-dahhh… Still screaming, so let’s get another cup of coffee… Ah, that’s good stuff…

OK, we’re back, and they’re still screaming, but we’ll just have to accept that they’re going to do that, and proceed.

“Government,” in America, is a word that we use for a free people banding together to do something that we can do far better working together than working separately. Some people don’t accept that fact. They seem to believe that “government” is some scary thing that intrudes on their lives from out there somewhere, like a spaceship full of aliens with ray guns that will turn us all into toads or something.

Those people are one of the two big reasons why you don’t hear any presidential candidates saying “single-payer” except Dennis Kucinich. You may recall recent reports that Mr. Kucinich had a close encounter with a UFO, and it was a positive experience, so I guess he’s just not scared of the aliens any more.

But the major candidates are. Or rather, they’re scared of being labeled as extremists. Also, they don’t want to offend the health insurance companies whose reason for being would disappear under “single-payer.”

Last week, I got a press release from a labor union that complained “that no Republican candidate has a plan to ensure all Americans have access to health care.” That’s true. But the union, which represents blue- and pink-collar workers in health care, was missing the fact that the leading Democrats are little better.

“Sens. Hillary Clinton and Barack Obama have been engaged in a bitter back-and-forth over whose health plan covers more people,” The Wall Street Journal reported last week. “Former Sen. John Edwards has jumped in, saying his plan is the best of all.”

But what they’re fighting over are plans that would pull varying numbers of the uninsured into the same overly expensive, wasteful, maddening system of private health insurance that the rest of us are caught in. Conveniently, they say their plans would be paid for by repealing the “Bush tax cuts for the wealthy.”

Maybe you could pay for a health plan that way — as long as it doesn’t provide real reform.

Make no mistake: A single-payer national health plan would cost a lot of money, and you would pay for it in new taxes. The good news is that most of us would probably still pay less than we currently pay in premiums.

According to the Web site of Physicians for a National Health Program, which promotes single-payer, “This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”

But when not even touchy-feely liberal Democrats have the guts to say it’s worth paying a new tax to make health care affordable for all, even when that’s the hottest domestic issue among voters (which would not be the case if the insured majority were happy), we’re in trouble.

Little wonder that Dow Jones’ MarketWatch reported last week that “Those who hope the 2008 presidential election will finally bring about drastic health-care reform may well end up finding it’s a case of politics and business as usual, experts say.” The same article noted that Hillary Clinton has received $1.8 million in contributions from accident and health insurers, followed by Barack Obama with $1.45 million, Mitt Romney with $1.09 million and Rudy Giuliani with $1.08 million.

That, by the way, is money that you and I and the guy down the street paid for health care that didn’t go to health care.

Given the odds against substantive reform — between the government haters, the insurance industry and Big Pharma, all of whom have a demonstrated willingness to outlast the rest of us in any protracted political fight — the only way we’re going to see significant change is if a president is elected with a mandate for bold reform. Only a president is elected by the whole nation, so only a president would ever have that kind of juice.

Unfortunately, as previously noted, none of the viable candidates will say “single-payer.”

But I will: Single-payer. Single-payer, single-payer! Now, do you have anything better to say?

Louisville Courier-Journal
Readers’ forum
Monday, December 3, 2007

The results of the studies have been released and they prove what every hospital nurse knows from experience. Understaffing endangers patients.

For each additional patient assigned to an RN, the likelihood of death within 30 days increases by 7 percent. Four additional patients increase the risk by 31 percent (JAMA, 10/22/02).

In 1989 Louisville nurses formed the Nurses Professional Organization with the goal of organizing their union so that they could win better staffing and conditions for their patients and themselves.

The nurses took on the giants of corporate health care. Staff nurses stood their ground before high salaried CEOs, anti-union consultants, and supervisors who, under threat themselves, threatened the jobs and licenses of nurses who continued to speak up. Nurses threw themselves into the struggle with hope. The hospitals hired consultants to spread fear.

By committing mountains of unlawful actions, Norton Healthcare as well as Columbia/HCA blocked the nurses’ efforts. But these powerful corporations did not violate the law unchallenged. In almost every case in which the NPO filed charges against the hospitals, the nurses won. NPO nurses have exposed the understaffing, testified on patient care issues in Frankfort, won back the jobs of nurses unjustly dismissed, called in the state inspectors, testified before the JCAHO, spoken to the press, and kept alive the hope that staff nurses can organize and make things better. Bruised but never broken, the NPO has now won another victory. The turtle’s pace of labor law enforcement in our nation allows employers to delay interminably. First Columbia/HCA, and then Norton Healthcare, stalled the progress for the 13 years since the 1994 election at Audubon. In August, the NLRB turned down Norton Audubon’s appeal of one of NPO’s cases.

In November, Norton Audubon paid over $171,000 to three nurses who were unlawfully denied positions. Nurses at Audubon and in Louisville now have a new opportunity to organize and to win the right to practice under truly professional conditions.

The Nurses Professional Organization has affiliated with the California Nurses Association/National Nurses Organizing Committee. This 75,000 strong organization has empowered nurses to win the best contracts and the best patient protections in the nation. CNA staff nurses used their power to advocate for patients. Now they have minimum staffing ratios in hospitals that are enforceable — written into both California law and into union contracts. No more than five patients per nurse on a medical/surgical floor. No more than two patients per nurse in Intensive or Critical Care. No more than four patients on a step down unit — advancing to no more than three in 2008. No more than four patients per nurse in ER; no more than 2 ICU patients per nurse in the ER — no more than one ER Trauma patient. No more than five patients per nurse in telemetry moving to no more than four in 2008. In addition, nurses must be increased above these ratios whenever acuity levels require. Plus the ratios apply on all shifts at all times including during lunch and breaks. (www.calnurses.org) Nurse power makes a difference.

Bringing good conditions to patients and nurses ends the nursing shortage. Actively licensed RNs in California increased by more than 60,000 following enactment of the staffing ratio law. Since the ratio law was signed, actively licensed RNs have grown by nearly 10,000 a year, compared to just 3,200 a year prior to the law. (Board of Registered Nursing data).

We cannot solve the nursing “shortage” in Louisville without solving the conditions that force good nurses from the bedside and from their chosen profession. Many can’t sleep after their 12-hour shifts for thinking about what almost happened and what could happen. The lack of organized nurse power to change these conditions and win truly professional standards of care and benefits has stifled health care progress in Louisville.

When Norton Healthcare, called Alliant at the time, purchased Audubon Hospital, there was an NLRB bargaining order in place. Norton Audubon didn’t sit down and bargain with the nurses. Instead Norton Healthcare spent our community’s health care dollars on a nine year oppositional path of challenges to NLRB orders and to nurses’ rights.

Among Norton Healthcare’s numerous unfair labor practices are: unlawful discipline for protected activity, unlawful termination, unlawful denial of a position, unlawful restriction of the right to distribute literature in the cafeteria and non-work areas, unlawful restriction of the right of a nurse to speak about the union in the break room, unlawful institution of a more restrictive distribution policy in response to a union campaign, unlawful attack on a nurse’s license, and unlawful interrogation.

The NLRB overturned the unfair election at Audubon Hospital and has ordered a new election. Audubon nurses are talking and organizing and will move forward to advocate for their patients and to build their union. Nurses across Louisville are once again hopeful. When nurses organize, the patients and the community are the beneficiaries. Silencing nurses endangers patients.  

KAY TILLOW

Director of Organization

Nurses Professional Organization/CNA/NNOC

Louisville 40202

By Mary Ann Garnar
OP-ED
Special to The Courier-Journal
Monday, December 3, 2007

Most thoughtful people in the United States recognize that the difficulties of obtaining health insurance — with the resulting lack of access to quality medical care — must be remedied.

Advances in the field of medicine, dazzling new diagnostic tools, the ever-increasing range of procedures and the proliferation of new and better drugs have driven the cost of medical care beyond the reach of far too many people of even average means, if they lack health insurance.

At the same time, health insurance premiums continue to rise to unconscionable levels, in large part to satisfy stockholders’ demands for higher and higher profits, to the point that purchase of health insurance is an impossibility for millions.

Those of us with insurance take for granted our routine medical examinations, blood work, X-rays, inoculations, etc. If we have the flu, we don’t hesitate to see the doctor, who prescribes the needed medicine and off we go to the pharmacy, hardly giving a thought to the actual cost of it all. We spend a few days recovering and then return to work.
If the gall bladder goes bad, we are not troubled beyond anxiety about the actual surgery. We yield to the surgeon’s knife, spend a day or two in the hospital being looked after by doctors, nurses and attendants, and don’t worry too much about the co-pay.

But there are millions of people whose asthma, aching joints, chest pains and even more serious ailments go untreated because they lack health insurance. Critical diagnostic procedures are missed because they cannot afford to pay the doctor. Drugs are not bought. The consequences can, and often do, escalate into something more difficult and more costly to treat.

Allowing this crisis to continue is morally and economically indefensible. Because of damage to the health, finances and dignity of people affected, and to the larger economy, we must find a solution — and find it soon.

People of conscience are earnestly trying to sort through the many plans being proposed to correct the inequities in order to determine which plan will provide a remedy that is both affordable and covers the cost of needed medical care. And they are beginning to understand that the solution must not be piecemeal; it must be one which guarantees insurance for everyone. No one can be left out.

Most people now agree that government must be a part of any solution.

A realistic and honest assessment of the proposals leads to the inevitable conclusion that the best solution for the greatest number is what is called universal, single-payer health insurance. That is, health insurance for all residents of the United States, largely funded with a tax based on income, and benefits paid out by the federal government. (A bill now in Congress, HR 676, the United States National Health Insurance Act, if passed, would establish just such a plan.)

Single-payer insurance is the most efficient use of available health care resources because there is no profit motive and administrative waste is eliminated. Medicare, the model for a universal, single payer system, spends only 3 cents of every dollar paid into the system on administrative expenses. Fully 97 cents on the dollar is spent on patients’ medical bills. Private insurance companies and health maintenance organizations (HMOs), on the other hand, spend 20-30 cents on the dollar for administrative costs and only 70-80 cents for patient care.

Single-payer insurance is not “socialized medicine.” Those who now have private insurance would receive the same medical care from the same doctors, dentists, psychiatrists, hospitals, etc., as they do now. Those currently without insurance would have their medical needs met. And the joy of it is that, for most people, their costs would be less than the costs of their private insurance, because the unnecessary costs of the private health insurance industry would be removed.

Opponents’ claims to the contrary, we can afford to do this.

No new government program will be free of problems. But people of goodwill will be prepared to give such a program a chance to work.

We cannot continue to allow people to go without medical care because they cannot afford to pay the doctor or buy insurance. And we must not treat inability to pay as a moral failure.

The moral failure would be to allow the crisis to continue.

Mary Ann Garnar lives in Louisville and is a retired attorney. She is a 2007 Forum Fellow.

Center on Budget and Public Policies
December 5, 2007

This week, the Senate Finance Committee is planning to consider Medicare legislation averting a scheduled cut in Medicare physician payments. The legislation is also expected to modestly reduce the sizable overpayments now being made to private insurance plans that participate in the Medicare Advantage program. (In July, the House voted to fully eliminate these overpayments as part of legislation to strengthen Medicare and children’s health coverage.) “Leveling the playing field” in payments between Medicare Advantage and traditional Medicare would be a sound move for Congress to take before its year-end recess, for several reasons:

* The government pays Medicare Advantage plans roughly $1,000 more per beneficiary per year than it would cost to cover the same person through traditional Medicare. Even though private plans were brought into Medicare to lower costs, the Medicare Payment Advisory Commission (“MedPAC,” Congress’ expert advisory body on Medicare payment policy) and the Congressional Budget Office (CBO) have found that they are paid 12 percent more, on average, than it would cost traditional Medicare to cover the same beneficiaries. These overpayments currently average about $1,000 per beneficiary, according to The Commonwealth Fund. Moreover, CBO says the average overpayment will likely rise in the future because Medicare Advantage enrollment is growing fastest in the areas with the highest overpayments.

* These overpayments significantly weaken Medicare’s finances. The overpayments will total $54 billion over the next five years and $149 billion over ten years, according to CBO. That puts an added strain on Medicare, moving up by two years (from 2021 to 2019) the date when its trust fund will become insolvent, according to the chief actuary at the Centers for Medicare and Medicaid Services (CMS). It also means restoring solvency will require much larger benefit cuts and/or tax increases than would otherwise be needed; as MedPAC chairman Glenn Hackbarth warned Congress, Medicare faces “a very clear and imminent risk from this overpayment that will put this country in an untenable position.” Similarly, CBO director Peter Orszag has testified that if current trends in Medicare Advantage continue, “the result would be a fundamental change in the nature of the Medicare system that may then be hard to reverse.”

* The overpayments also force beneficiaries in traditional Medicare to pay higher premiums. According to both MedPAC and CMS’s chief actuary, the overpayments raised the premiums for Part B of traditional Medicare (which includes physician visits and other types of outpatient care) by $2 per month per person, or $48 a year for a couple, in 2007. This means that the 35 million seniors and people with disabilities enrolled in traditional Medicare are charged higher premiums every month in order to help subsidize overpayments for private plans that serve approximately 8 million beneficiaries. (For about 7 million of these 35 million beneficiaries — low-income people whose premiums are paid by Medicaid — the added costs are borne by the federal government and the states, which jointly fund Medicaid.)

* Medicare Advantage plans do not have to provide all the benefits available through traditional Medicare — and many do not. While the plans use part of their overpayments to offer services that Medicare otherwise does not cover or to reduce premiums and costsharing (the rest goes to administrative costs, marketing, and profits), some of the private plans have scaled back benefits available through traditional Medicare that are used primarily by sicker individuals, evidently to deter sicker people from enrolling. As a result, some beneficiaries in poorer health can wind up significantly worse off if they enroll in Medicare Advantage. Analyses by the Medicare Rights Center, The Commonwealth Fund, the Kaiser Family Foundation, and MedPAC all have found that Medicare Advantage beneficiaries who need hospital care, home health care, or another specialty service may have to pay more for it — or may receive less of it — under the private plans. Even CMS has acknowledged this problem. CMS recently stated it will scrutinize cost-sharing levels among the private plans for services such as physician-administered chemotherapy drugs and dialysis services.

* The private plans have not been shown to provide better care. Some plans have sought to justify their overpayments as promoting better quality of care. The lack of suitable measures makes it hard to compare the quality of care in Medicare Advantage and traditional Medicare, but MedPAC reports that their levels of beneficiary satisfaction are similar, and people in traditional Medicare are less likely to report problems seeing specialists. MedPAC has also found that more Medicare Advantage plans are reporting poor health outcomes and that the plans are failing to keep pace with commercial and Medicaid plans in improving quality of care. In addition, CBO has stated that “though Medicare Advantage plans cost more than care under [traditional Medicare] does, on average, they would be more cost-effective if they delivered a sufficiently higher quality of care. The limited [quality] measures available suggest that Medicare Advantage plans are not more cost-effective” than traditional Medicare.

* The overpayments have contributed to the marketing abuses committed by some Medicare Advantage plans. Over the past year, numerous media reports and several congressional hearings have documented a pattern of misleading and abusive marketing practices by some insurance agents, who seek to lure Medicare beneficiaries into Medicare Advantage plans without explaining how they differ from traditional Medicare. In one recent survey, 37 of the 43 states responding reported complaints about inappropriate or confusing marketing practices. The overpayments encourage such abuses by giving private plans a significant incentive to maximize their enrollment; many private plans have established lucrative financial inducements for agents who sign up new enrollees. In sum, by reducing wasteful private plan overpayments, Congress can strengthen Medicare and better serve the millions of seniors and people with disabilities who rely on it for health coverage.

http://www.cbpp.org/12-5-07health.pdf