PNHP

Employers support competing market of benefit administrators

Employers support competing market of benefit administrators

A New Benefit Platform for Life Security

The ERISA Industry Committee
May 2007

The ERISA Industry Committee (ERIC) is a non-profit association committed to the advancement of the employee retirement, health, and compensation plans of America’s major employers.

Overview

* The new proposed structure would give employers an alternative method for providing benefits without the “entanglements” of traditional provider sponsorship.

* This structure complements but would not require replacing the current system for those who find the current system more appropriate.

* The new benefits offerings would be administered by competing Benefit Administrators.

* Benefit Administrators, in many respects, would assume the role of today’s plan sponsors and, particularly with regard to health care, would be organized on a geographic basis.

* Employers and individuals would share funding of benefits.

* In addition, the structure would also provide a way for individuals to purchase coverage independent from an employer relationship.

This is an urgent debate. The life security of millions of Americans, as well as the viability of many American businesses, depends on the outcome. Through ERIC, the major employer community welcomes the dialogue that will change the status quo in a way that meaningfully addresses the life security needs of all Americans while improving the competitive position of American employers.

The foundation of ERIC’s proposal is our belief that health care and health care financing are best managed in local/regional major medical markets. The Benefit Administrators that are the core of ERIC’s proposed new structure and their affiliates would be in a much better position than individual employers to bring entire communities together to create a rational and accountable health care system.

Community-based systems

ERIC’s proposal would require the federal government to establish, or facilitate the establishment of, community-based structures with the following attributes:

* Standard benefit plans – Low-cost benefits options also would be available.

* Individual access to health plans – independent from employment

* Individual mandate – There would be a federal mandate (with standards established at the federal level) that every American individually be covered by a plan sponsored by a qualified Benefit Administrator or through some other qualified system.

* Subsidies for financially disadvantaged persons

* Employer role in funding health benefit plans – Each employer would determine the contribution it would make available for the purchase of a standard health benefit plan. The employee would be required to pay the difference.

ERIC believes a properly designed pluralistic system will be far superior to a single-payer system for correcting the deficiencies in the current system and for producing significant improvements in both cost and quality.

http://maxx.eric.org/uploadFiles/B86A00000009.filename.ERIC_New_Benefit_Platform_FL0614.pdf

Comment:

By Don McCanne, MD

Most of America’s largest employers are self-insured for their employee health benefit programs. Rather than insurers, they use benefit administrators in compliance with the Employee Retirement Income Security Act (ERISA), which are exempt from the requirements of state insurance regulators.

Traditionally, large employers have provided very generous health benefits for their employees. Current trends have increased the financial burden on employers as they try to meet these legacy costs. Factors include an increase in the ratio of retirees to the workforce, international price competition, escalating health care costs, and a shift from a manufacturing economy to a service economy.

Large employers want relief. But they do not want to have their employees’ health benefits controlled by either the government or private insurers. They want to maintain the role of benefit administrators operating in a less intrusive regulatory environment.

They realize that the medical bills must still be paid. So what do they recommend? They say let’s continue to use benefit administrators, but let’s shift the responsibility of funding the heath care reserves to the employees through a federal individual mandate, while allowing the employer to decide what optional contribution it would like to make toward the employees’ mandated obligations. Sounds like a good deal – for the employers.

Who are these benefit administrators anyway? Well, quite simply they’re administrators who administer the health benefits offered by employers to their employees. But they are not insurers. Their medical loss ratio is zero. 100 percent of revenues are spent on administrative services plus profits. They are part of the administrative excesses that plague our health care system (though not quite as wasteful as the private insurance industry).

ERIC recommends creating a market of competing benefit administrators, enabling the individual employee/consumer to select the greatest value in health care administration. What are they selling? Administrative services theoretically designed to reduce spending on actual health care services. Allegedly an ever increasing amount of administrative services would produce even greater decreases in health care spending. Just imagine what they could sell us or broker for us: claims processing, provider contracting services, provider discount cards, medical debit cards, disease management contracting, information technology services for personally-owned medical records, club memberships for preventive exercise regimens, discount membership programs for healthy food choices, financial services to manage our own personal health accounts, travel arrangements for outsourced health care services, etc. With new innovations that characterize the free marketplace, the potential list is endless.

Big business knows that if they quit paying the bills, single payer is inevitable. But what a feeble response – pretending that dumping more administrative excesses on us will magically reduce health care spending while keeping the government out.

Big business does need relief. But what they really need is an administratively-efficient, equitably-funded single payer system. If they were smart, they would realize that it’s time for them to schedule retirement banquets for their benefit administrators to thank them for their many years of service. Some will find employment in the single payer system, but with the superior health benefits that we would all enjoy.

Actuarial values of individual coverage plummet

Trends In The Golden State: Small-Group Premiums Rise Sharply While Actuarial Values For Individual Coverage Plummet

by Jon Gabel, Jeremy Pickreign, Roland McDevitt, Heidi Whitmore, Laura Gandolfo, Ryan Lore, and Katy Wilson
Health Affairs
June 14, 2007

Using multiple databases, this paper examines recent trends in the affordability and comprehensiveness of small-group and individual health insurance markets in California. Both became less affordable over the study period.

Actuarial value is the proportion of claims expenses for covered services paid by the insurance plan for a large standardized population.

From 2003 to 2006, the actuarial values of plans purchased in the small-group market remained statistically unchanged at 0.83; they ranged from 0.54 to 0.96 in 2006. In contrast… actuarial values in the individual market declined from 0.75 to 0.55. In 2006, actuarial values for these products ranged from 0.32 to 0.85.

Premiums adjusted for their financial protection increased 65 percent, from $246 to $405, in the small-group market over the study period. Although absolute premiums in 2006 were considerably lower in the individual insurance market than the small-group market ($259 versus $382), there were no statistical differences between adjusted premiums in the 2006 individual and small-group markets.

In both the small-group and individual insurance markets, people buying family coverage would spend an even larger share of their income on medical expenses and premiums. For example, in the small-group market, a family with the median family income ($71,025) would spend 8.2 percent of income, whereas a family earning poverty-level income would spend 28.9 percent of income. Corresponding figures for the individual insurance market are 19.1 percent for families earning the median income and 67.9 percent for families earning poverty-level incomes.

Our findings suggest that responses to rising health care costs have differed in the small-group and individual insurance markets. In the former, premiums rose more than 50 percent from 2003 to 2006, as insurance has maintained its actuarial value, paying for roughly 83 percent of medical bills of a standardized population. In the latter, premiums increased a modest 23 percent from 2002 to 2006, but plans’ actuarial value fell dramatically, from 0.75 to 0.55.

Findings from this paper suggest that when out-of-pocket medical expenses are added to premium payments, single people would need to earn approximately $50,000 a year (almost $20,000 above the median income for single people in California) to drive expenses below 10 percent of family income.

Some policymakers and thought leaders seek to move increasing numbers of Americans into the individual insurance market. Our findings suggest that although premiums might seem attractive in the individual insurance market, the out-of-pocket expenses in an unreformed individual market would leave many people with expenses that would constitute “catastrophic costs” to those of average means.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.26.4.w488v1

Comment:

By Don McCanne, MD

No surprise. As has been shown over and over, for average-income individuals either insurance premiums are unaffordable, or out-of-pocket expenses for health care are unaffordable (or both).

Perhaps the most shocking numbers in this report are the actuarial values of plans in the individual insurance market in California. In 2006, the plans would pay an average of only 55 percent of health care costs. Worse, some would pay as little as 32 percent, leaving the insured individual responsible for two-thirds of the health care bill!

So the solution is to require individuals to purchase plans that don’t provide adequate financial protection with premiums that they can’t afford? When will the nation understand that private health plans are obsolete? They simply don’t work anymore.

With the $2.2 trillion we are already spending on health care, we could fix the problem by establishing a single risk pool that includes everyone, and fund it equitably through progressive tax policies. What is there about this simple concept that our policymakers can’t fathom?

Michael Moore's Latest Target: An 'Immoral' Health Care System

The Controversial Director on the Story Behind His New Film "Sicko"

By SARAH BAKER and KATIE ESCHERICH
ABCNews | Nightline
June 13, 2007

Polarizing — that’s one way to describe the work of filmmaker and activist Michael Moore, whose new film, “Sicko,” takes on the U.S. health care system.

“Nightline’s” Terry Moran spent a day with the director in Sacramento, Calif., where Moore teamed with the California Nurses Association to hold a rally at the state capitol.

The nurses wore red “Sicko” T-shirts and cheered for Moore as he criticized America’s health care system.

“I am honored to be able to be here today to be able to join with you in a very important movement that is already taking place all across this country,” he said. “Because the American people are fed up with this broken health care system. And & it’s the nurses who are on the front lines of this war. And it is a war. It’s a war against greed.”

While the group was walking through the state senate chambers, a group of teenagers recognized Moore and immediately swarmed him, shouting things like ‘Oh my God!’ and ‘I love your work!'”

Moore is known for producing films that inspire love and hate, and stir political debate, but he said in some ways he feels like a failure.

“There’s a big part of me that feels like a failure, in the sense that I started out by making a film about General Motors to save my hometown of Flint, Mich., and … Flint today is in far worse shape than when I first made the movie,” Moore said.

“I made [“Bowling for Columbine”] in the hopes that there wouldn’t be anymore school shootings, and look? We’ve gone through another tragic school shooting. & ‘Fahrenheit 9/11’? Bush was re-elected a few months later. You have to understand that there’s a part of me that feels like, geez, when are you going to make a movie that can actually get something done? So I’m hoping that this film, ‘Sicko’ will do just that.”

Health Care’s Haves and Have-Nots

Moore’s hope for the film is that it will inspire change and help find a solution to the massive problems facing the U.S. health care system, and said that making the movie inspired him to change his own life and to take better care of himself. He began to diet and exercise, dropping more than 30 pounds during the course of the film’s production.

Moore hopes that people who see “Sicko” will realize that the current health care system needs an overhaul and will start a “political movement” of change, but he also said that fixing the health care system isn’t strictly a political issue.

“It’s not really a political issue,” Moore said. “I should say, it’s not a partisan issue. It’s political in the sense that our laws make it so that people have a difficult time getting the care they should get. Until those laws change I think we’re going to have this ‘haves and have-nots’ society that we have when it comes to health care.”

Moore believes that the U.S. needs a universal health care system, and tried to drive home that point by comparing the American system to those around the world. That goal brought Moore and his production team to Cuba, and as a result, Moore has run into trouble with the U.S. government because of the trade embargo with that country.

“The mainstream media has done such a good job of telling us how horrible Castro is and whatever the violations are down there,” he said. “I think we all know what the situation is in Cuba. What we don’t know is the other side of the story, and that’s what I try to fill in. Ć¢ā‚¬Ā¦ In my movie you see Cubans getting help whenever they get sick, and that is the truth. The U.N. supports that fact. They have an excellent health care system, probably the best in the Third World.”

‘I’m Not a Democrat’

Most people would say that Moore’s films are liberal-leaning, but the director said he doesn’t categorize himself as a Democrat or Republican.

“I’m not a Democrat. I’m not a part of the Democratic Party,” he said. “My wife, she’s the vice chair of the local Democrats up in northern Michigan, where we live. She keeps trying to get me to join. & I have always voted for whoever I thought was the best person.”

Moore was widely criticized for the statement he made at the 2003 Academy Awards, saying, “We live in the time where we have fictitious election results that elect a fictitious president.” Moore now acknowledges that if he had it to do again, he probably should have said it differently, but he takes issue with those who called his actions un-American.

“What’s the crime that I’ve committed here? Because I first stood on an Oscar stage and said I don’t think the president is telling us the truth? That we were being led into war for fictitious reasons? & I can’t think of anything more pro-American than standing up and saying our leader is making a mistake. If you think your leader is making a mistake, you should stand up and say something. It is your duty as an American.”

‘People Are Dying’

In addition to being a filmmaker and an activist, Moore is also a deeply religious man, an Eagle Scout who at one point decided to go to the seminary and become a priest. He said that “Sicko” comes from “a spiritual place.”

“I don’t like putting my religious beliefs out there,” he said. “But I do believe that this film is coming from a very deep place, from a spiritual place in the sense that I believe as a Christian and a Catholic that it is my responsibility to make sure that not only am I covered if something happens to me, but that everyone else is covered. & I belong to the Directors’ Guild. I have a great health plan, and I’m going to get help, but 47 million people aren’t going to get help. There’s something wrong with that. It’s very immoral.”

“Sicko” contends that people are dying because of the flaws of the current system, and Moore places some of the blame for these failures on insurance and pharmaceutical companies.

“There’s no getting around the fact that people are dying in this country as a result of the decisions that get made by these health insurance companies. People are dying in this country because they can’t afford the pharmaceuticals because of the price gauging that takes place. & I don’t think it’s a dirty little secret anymore, I think it’s pretty much out in the open.”

And what does Moore say to people who tell him he should leave the United States if things are so bad?

“I’m here to stay. It’s the country that has to change. I’m not changing. I think there are millions like me who feel the same way,” he said. “We’re Americans, and the most patriotic thing we can do is to work to make this country a better place. Things are going to have to change, because I’m not leaving. We’re going to have to have universal health care for all Americans. I’m not leaving. This war has got to end. I’m not leaving. I’m going to continue my work, to do these things because I believe it is a requirement of me as an American.”

Copyright 2007 ABC News Internet Ventures

Michael Moore’s Latest Target: An ‘Immoral’ Health Care System

The Controversial Director on the Story Behind His New Film “Sicko”

By SARAH BAKER and KATIE ESCHERICH
ABCNews | Nightline
June 13, 2007

Polarizing — that’s one way to describe the work of filmmaker and activist Michael Moore, whose new film, “Sicko,” takes on the U.S. health care system.

“Nightline’s” Terry Moran spent a day with the director in Sacramento, Calif., where Moore teamed with the California Nurses Association to hold a rally at the state capitol.

The nurses wore red “Sicko” T-shirts and cheered for Moore as he criticized America’s health care system.

“I am honored to be able to be here today to be able to join with you in a very important movement that is already taking place all across this country,” he said. “Because the American people are fed up with this broken health care system. And & it’s the nurses who are on the front lines of this war. And it is a war. It’s a war against greed.”

While the group was walking through the state senate chambers, a group of teenagers recognized Moore and immediately swarmed him, shouting things like ‘Oh my God!’ and ‘I love your work!'”

Moore is known for producing films that inspire love and hate, and stir political debate, but he said in some ways he feels like a failure.

“There’s a big part of me that feels like a failure, in the sense that I started out by making a film about General Motors to save my hometown of Flint, Mich., and … Flint today is in far worse shape than when I first made the movie,” Moore said.

“I made [“Bowling for Columbine”] in the hopes that there wouldn’t be anymore school shootings, and look? We’ve gone through another tragic school shooting. & ‘Fahrenheit 9/11’? Bush was re-elected a few months later. You have to understand that there’s a part of me that feels like, geez, when are you going to make a movie that can actually get something done? So I’m hoping that this film, ‘Sicko’ will do just that.”

Health Care’s Haves and Have-Nots

Moore’s hope for the film is that it will inspire change and help find a solution to the massive problems facing the U.S. health care system, and said that making the movie inspired him to change his own life and to take better care of himself. He began to diet and exercise, dropping more than 30 pounds during the course of the film’s production.

Moore hopes that people who see “Sicko” will realize that the current health care system needs an overhaul and will start a “political movement” of change, but he also said that fixing the health care system isn’t strictly a political issue.

“It’s not really a political issue,” Moore said. “I should say, it’s not a partisan issue. It’s political in the sense that our laws make it so that people have a difficult time getting the care they should get. Until those laws change I think we’re going to have this ‘haves and have-nots’ society that we have when it comes to health care.”

Moore believes that the U.S. needs a universal health care system, and tried to drive home that point by comparing the American system to those around the world. That goal brought Moore and his production team to Cuba, and as a result, Moore has run into trouble with the U.S. government because of the trade embargo with that country.

“The mainstream media has done such a good job of telling us how horrible Castro is and whatever the violations are down there,” he said. “I think we all know what the situation is in Cuba. What we don’t know is the other side of the story, and that’s what I try to fill in. Ć¢ā‚¬Ā¦ In my movie you see Cubans getting help whenever they get sick, and that is the truth. The U.N. supports that fact. They have an excellent health care system, probably the best in the Third World.”

‘I’m Not a Democrat’

Most people would say that Moore’s films are liberal-leaning, but the director said he doesn’t categorize himself as a Democrat or Republican.

“I’m not a Democrat. I’m not a part of the Democratic Party,” he said. “My wife, she’s the vice chair of the local Democrats up in northern Michigan, where we live. She keeps trying to get me to join. & I have always voted for whoever I thought was the best person.”

Moore was widely criticized for the statement he made at the 2003 Academy Awards, saying, “We live in the time where we have fictitious election results that elect a fictitious president.” Moore now acknowledges that if he had it to do again, he probably should have said it differently, but he takes issue with those who called his actions un-American.

“What’s the crime that I’ve committed here? Because I first stood on an Oscar stage and said I don’t think the president is telling us the truth? That we were being led into war for fictitious reasons? & I can’t think of anything more pro-American than standing up and saying our leader is making a mistake. If you think your leader is making a mistake, you should stand up and say something. It is your duty as an American.”

‘People Are Dying’

In addition to being a filmmaker and an activist, Moore is also a deeply religious man, an Eagle Scout who at one point decided to go to the seminary and become a priest. He said that “Sicko” comes from “a spiritual place.”

“I don’t like putting my religious beliefs out there,” he said. “But I do believe that this film is coming from a very deep place, from a spiritual place in the sense that I believe as a Christian and a Catholic that it is my responsibility to make sure that not only am I covered if something happens to me, but that everyone else is covered. & I belong to the Directors’ Guild. I have a great health plan, and I’m going to get help, but 47 million people aren’t going to get help. There’s something wrong with that. It’s very immoral.”

“Sicko” contends that people are dying because of the flaws of the current system, and Moore places some of the blame for these failures on insurance and pharmaceutical companies.

“There’s no getting around the fact that people are dying in this country as a result of the decisions that get made by these health insurance companies. People are dying in this country because they can’t afford the pharmaceuticals because of the price gauging that takes place. & I don’t think it’s a dirty little secret anymore, I think it’s pretty much out in the open.”

And what does Moore say to people who tell him he should leave the United States if things are so bad?

“I’m here to stay. It’s the country that has to change. I’m not changing. I think there are millions like me who feel the same way,” he said. “We’re Americans, and the most patriotic thing we can do is to work to make this country a better place. Things are going to have to change, because I’m not leaving. We’re going to have to have universal health care for all Americans. I’m not leaving. This war has got to end. I’m not leaving. I’m going to continue my work, to do these things because I believe it is a requirement of me as an American.”

Copyright 2007 ABC News Internet Ventures

Why do nurses support Moore's Sicko?

On a mission for health care

By Bobby Caina Calvan, Aurelio Rojas and Carla Meyer
The Sacramento Bee
June 13, 2007

Michael Moore, the filmmaker and provocateur, rode to the Capitol on Tuesday, delivering impassioned — and sharply barbed — pleas for guaranteed health care.

He was embraced by throngs who bestowed on him the kind of hoopla usually given a rock star.

It was an opportunity for Moore to promote “Sicko,” his latest film to take a jab at a powerful American institution. This time: the health care industry.

“There is no room for the concept of profits when taking care of people when they are sick,” Moore told a crowd of nearly a thousand nurses who swarmed the west steps of the Capitol.

“It’s not a Democrat or Republican film,” Moore said. “When you get sick, the sickness doesn’t care if you are a Democrat or a Republican.”

But the California Nurses Association, which sponsored the rally and one of two screenings of Moore’s film at the Crest Theatre, is betting that public furor will swell against the health care industry as the issue takes a prominent role in the presidential race.

“The insurance companies are the problem,” said Rose Ann DeMoro, the executive director of CNA, during a briefing with Moore that was hosted by Sen. Sheila Kuehl, D-Santa Monica. She’s the leading sponsor of Senate Bill 840, which seeks to provide every Californian with universal health care and has Moore’s support.

http://www.sacbee.com/111/story/219530.html

Comment:

By Don McCannem MD

(as posted by dmccanne on the sacbee.com website):

Listen to the nurses

Our nurses really do care about patients. They are in a unique position to recognize the tragedies caused by the barriers to care erected within our fragmented method of financing care, using a multitude of private insurance plans. The nurses have had it. When we are spending more than enough to provide comprehensive care for everyone, they want the private insurance industry that is interfering with their care to be removed from the scene. Moore’s contribution is that he shows us that many who are insured face some of the same financial burdens and impaired access as the uninsured. Moore and the CNA (nurses) and PNHP (physicians) have partnered to bring home the message that our health care system is about patients, not middleman business entities.

National health insurance makes sense for work force

By Roger Ray
Springfield News-Leader
Voice of the Day
Published Wednesday, June 6, 2007

In the mid 1970s, the then-largest insurance company in the world, Prudential, added auto and homeowners insurance to its product offerings. The reason given for this move was, are you ready?…. because there was about to be a national health program in the United States that would end the need for health insurance! Prudential wanted to give its agents another product to sell to make up for what they would lose in commissions on health insurance. However, the Carter administration failed to overcome the objections of health care providers and insurance companies and abandoned health care reform.

Twenty years later, the newly installed Clinton administration made health care reform a priority. Insurance premiums had risen by more than 3,000 percent since the Carter administration; clearly, something had to be done before health care bankrupted the American economy. But a multimillion dollar campaign, including shamefully deceptive TV ads, was launched by the insurance industry, and the Clinton reform initiative not only failed but was replaced by a reform that not only further empowered insurance companies but reduced medical services and physician salaries while increasing out of pocket expenses to the insured!

Now, as the presidential election season is heating up, candidates are presenting their plans for how to fix a health care delivery system that is so sick there is a reasonable question as whether to take the patient into the emergency room or just head straight to the graveyard. Interestingly, in 2007, no one seems willing to talk about a universal health care program that cuts insurance companies out of the system. Insurance and pharmaceutical companies have become so powerful that no politician who has even the slightest hope for winning an election will dare to challenge them. Our democracy is not “for sale” because it has already been purchased, and the owners are the for-profit corporations in the health care field. There are three lobbyists for every elected official in Washington, D.C. representing the pharmaceutical companies, which is why any legislation addressing medical services or prescription meds is written by and for insurance and pharmaceutical companies, not the elderly, the ill or the poor.

As a member of the clergy, I approach the issue of health care from the vantage point of concern for the poor and the sick. I am outraged that 47 million Americans are simply priced out of the world of health insurance and tens of millions more do not have adequate coverage.

But beyond the whole issue of compassion and social ethics, the way this nation is operating its health care delivery system is insane from a purely economic viewpoint. We provide free public education, not out of the goodness of our hearts but because we know that we need an educated populace to have a strong society. We build road and bridges, not for the convenience of our citizens but to make our citizens productive. We regulate certain utilities, the food industry, pollution and establish standards for construction, automobiles, and even beauty products, to protect our population from harm and to help keep our society strong and productive. Providing health care is just a part of the social network of services that make the country work. We are already paying more for health care than it would cost to have universal health care. The costs of health insurance make our American manufactured goods too expensive to compete in the world market and the number of workers who are sick, disabled or unable to be creative or innovative in new careers is killing our global competitiveness.

From a perspective of sheer greed, we should provide universal health care so that we can export products rather than jobs. It makes no sense to just demonize the insurance industry because for-profit companies have no motivation for self-regulation. For them, the sky is not the limit. They are interested in patients in the same way that fleas are interested in dogs; that’s just the way capitalism works. For the sake of our country’s economic future and for the sake of our very souls, we must make basic health care available to everyone and at a cost that allows people to still earn a living wage. We must regulate the insurance industry until such time that we can do what every other developed nation in the world has already done: make it unnecessary.

Roger Ray is the senior pastor at National Avenue Christian Church (Disciples of Christ). “From the Left” appears every Wednesday. Coming Tuesday: “From the Right.”

Moore lobbies Sacramento for healing

Filmmaker, health care activists promote 'Sicko' while demanding reforms in industry

Joe Garofoli, Chronicle Staff Writer
San Francisco Chronicle
Wednesday, June 13, 2007

(06-13) 04:00 PDT Sacramento — As Michael Moore stood on the west steps of the Capitol on Tuesday and led 1,000 activists in chanting “It’s time for them to go” — health insurance companies, that is — he looked less like a Hollywood director promoting his new takedown of the health care industry and more like the frontman of a national political campaign.

That’s because he is both.

In the days before Moore’s film “Sicko” opens June 29 in 3,000 theaters nationwide, the director will be the centerpiece of a campaign that melds activism, policy, politics and Hollywood into a media force like no other widely released film. The campaign premiered Tuesday in Sacramento — complete with nurses wearing red surgical scrubs and chanting “Hey-hey! Ho-ho! Private health care is sick-o!”

Moore’s day started with a closed-door tete-a-tete with Assembly Speaker Fabian Núñez, D-Los Angeles, followed by a joint news conference before 15 TV cameras, where Núñez was flanked by posters for the movie and Moore diplomatically praised their “excellent meeting,” even though Núñez supports a plan that doesn’t immediately offer universal coverage, as Moore wants.

Then it was off to an “unofficial” public briefing led by state Sen. Sheila Kuehl, D-Santa Monica — whose single-payer plan Moore supports — followed by a Capitol rally and march anchored by 1,000 members of the California Nurses Association, whose anecdotes over the years helped to inspire Moore to make the film. Then Moore screened the movie.

The word echoing around the Capitol building Tuesday wasn’t “movie.” It was “movement.” Funny, Moore said, “how they both have the same root word: ‘movie,’ ‘movement.’ ”

“I always set out to make a movie that people will enjoy, have a good time watching on Friday night,” Moore told The Chronicle on Tuesday. “I’m asking for a little something here. I’m going to provide the entertainment, but I’m hoping that a certain percentage of the audience will be thinking about the issues that I raised, and a certain percentage of them will go out and do something.”

The film is a godsend for those like the powerful nurses union and assorted health policy wonks who support its single-payer, free universal coverage message.

“This movie validates what we do every day,” said Margie Keenan after seeing the movie Tuesday. The Long Beach registered nurse flew north to attend the festivities. She hopes it will spur a public dialogue. “This is going to change everything.”

When the movie opens, Keenan will be among activist members of the California Nurses Association and doctors with the Physicians for a National Health Care Program who will stand in front of theaters handing out information on the legislative bills and telling filmgoers how they can get involved.

Everybody gets something in this movie-movement deal. The film gets real-life promotion from those working on health care’s front lines. Reform advocates get star power from Moore. And, both filmmaker and activists believe, the public could ultimately receive better, less expensive health care if they’re successful.

Today, Moore’s campaign stops in San Francisco, where the filmmaker will meet with Mayor Gavin Newsom at City Hall to discuss the city’s groundbreaking health coverage plan. Over the next few weeks, similar stops by Moore are planned in Los Angeles, Chicago, Washington, D.C., and New Hampshire. The online activist hub MoveOn.org plans to ask its 3.2 million members to support the film, distribute information outside theaters and lobby Congress, much as it received pledges from 110,000 members to see Moore’s previous film, “Fahrenheit 9/11,” on opening weekend.

Rep. John Conyers, D-Mich., whose congressional health care bill the campaign supports, said Tuesday: “The release of Michael Moore’s ‘Sicko’ is one of the most important developments in the national debate on our health care crisis since the Clintons attempted to pass universal health care legislation in 1994.”

A more subdued Moore has been doing the talk show rounds over the past few weeks during which his newfound, more apolitical approach — Republican bashing was comparatively infrequent Tuesday — found support from Oprah Winfrey. Last week on her show, Winfrey praised Moore, saying, “You are opening the door (on this issue), but we need to get Americans talking about it. Republicans talking about it, Democrats talking about it.”

Chris Lehane, the San Francisco-based political communications consultant who is coordinating the Hollywood-activist-policy campaign for the Weinstein Co., producers of the film, said: “Michael Moore approached this film from day one as a call to action. So we’re putting together the types of events and activities around it as though it was a political campaign.”

More than a decade ago, Lehane was an aide in the Clinton White House when then-first lady Hillary Rodham Clinton was trying to overhaul the nation’s health care system. “We lost control of the debate,” Lehane said of the Clinton health care effort. This time, however, he thinks it will be different. For one, after concerns about the Iraq war, Americans tell pollsters that health care is their biggest worry.

Last month, Moore invited Rose Ann DeMoro, executive director of the California Nurses Association, to a private screening of “Sicko” in New York for 50 people, including many of those who appeared in the film. Afterward, DeMoro said she asked Moore “to do Sacramento with us.” He quickly agreed, and the campaign snowballed from there.

“Very early on, (the nurses) were out front on this issue and have been very supportive of me,” Moore said. “And I was very supportive of them in terms of hoping that this issue would come to the forefront. And now it is.”

Changing a multibillion-dollar system will take a lot of bipartisan effort. But forget reshaping policy for a moment. How can Moore persuade conservatives just to see his film? Many not only loathe him for the Bush-bashing in “Fahrenheit 9/11,” they mistrust him.

“They don’t anymore,” Moore told The Chronicle, alluding to how many of the points he made in “Fahrenheit” about the run-up to the Iraq war have become common knowledge. “Some of my strongest letters of support (now) come from conservatives, former Republicans who feel like they’ve been had. They realize that I was actually standing up for them and trying to speak the truth,” he said.

But no big-name conservatives have stepped up yet to support his universal health care campaign.

“Well,” Moore said. “Fox News reviewed the film at Cannes and called it ‘brilliant’ and ‘uplifting.’ That’s a start.”

“Sicko” isn’t kind to Hillary Clinton, who is now running for president. The audience hissed Tuesday when the film noted she was among the Senate leaders in campaign donations from health industry companies, just a few years after she failed to change the system.

But in searching for an apolitical tone to talk about “Sicko,” nurses union leader DeMoro said Moore may have found an apolitical target.

“Oh, come on,” DeMoro said. “Who likes the insurance industry?”

Chronicle staff writer Victoria Colliver contributed to this report. E-mail Joe Garofoli at jgarofoli@sfchronicle.com.

This article appeared on page A – 2 of the San Francisco Chronicle

Why do nurses support Moore’s Sicko?

On a mission for health care

By Bobby Caina Calvan, Aurelio Rojas and Carla Meyer
The Sacramento Bee
June 13, 2007

Michael Moore, the filmmaker and provocateur, rode to the Capitol on Tuesday, delivering impassioned — and sharply barbed — pleas for guaranteed health care.

He was embraced by throngs who bestowed on him the kind of hoopla usually given a rock star.

It was an opportunity for Moore to promote “Sicko,” his latest film to take a jab at a powerful American institution. This time: the health care industry.

“There is no room for the concept of profits when taking care of people when they are sick,” Moore told a crowd of nearly a thousand nurses who swarmed the west steps of the Capitol.

“It’s not a Democrat or Republican film,” Moore said. “When you get sick, the sickness doesn’t care if you are a Democrat or a Republican.”

But the California Nurses Association, which sponsored the rally and one of two screenings of Moore’s film at the Crest Theatre, is betting that public furor will swell against the health care industry as the issue takes a prominent role in the presidential race.

“The insurance companies are the problem,” said Rose Ann DeMoro, the executive director of CNA, during a briefing with Moore that was hosted by Sen. Sheila Kuehl, D-Santa Monica. She’s the leading sponsor of Senate Bill 840, which seeks to provide every Californian with universal health care and has Moore’s support.

http://www.sacbee.com/111/story/219530.html

Comment:

By Don McCannem MD

(as posted by dmccanne on the sacbee.com website):

Listen to the nurses

Our nurses really do care about patients. They are in a unique position to recognize the tragedies caused by the barriers to care erected within our fragmented method of financing care, using a multitude of private insurance plans. The nurses have had it. When we are spending more than enough to provide comprehensive care for everyone, they want the private insurance industry that is interfering with their care to be removed from the scene. Moore’s contribution is that he shows us that many who are insured face some of the same financial burdens and impaired access as the uninsured. Moore and the CNA (nurses) and PNHP (physicians) have partnered to bring home the message that our health care system is about patients, not middleman business entities.

California's Battle of the Blues

California Coalitions on Health Reform Pit Health Insurers Against One Another

By Fran Mayso Lysiak
BestWeek
June 11, 2007

Two coalitions have launched media campaigns on how best to fix the state’s troubled health-care system on the heels of Gov. Arnold Schwarzenegger’s and Democratic lawmakers’ proposals to extend affordable coverage to the state’s 6.5 million uninsured. One coalition, so far only comprised of Blue Cross of California, is pitted against another coalition, comprised of three other health insurers, along with a diverse group of business, labor interests and health-care providers.

Tom Epstein, vice president of public affairs for the nonprofit Blue Shield of California, a member of the “Together for Health Care” coalition, classified each group’s position this way: “We call ours the coalition of the willing and theirs is the coalition of the unwilling.”

Those statements are “100% wrong,” said Blue Cross’s (Nick) Garcia. “In fact, those folks that say that they’re for reform in this other coalition, they need look at what they’ve been doing in the California market — dropping members and getting out of rural counties — and determine if they are truly for reform,” he said.

Blue Cross’ ad campaign says it is against guaranteed issue, “which means they are not in favor of universal coverage,” Epstein contends. Blue Cross doesn’t support everyone being able to buy health insurance “and we believe that’s an essential element for the people of California,” he said.

Blue Shield has supported “guaranteed issue,” which means health insurers can’t deny coverage because of a person’s health status, “but only when paired with an individual mandate,” Epstein said. “That would ensure that you get a broad risk pool of both the healthy and those who need health care,” he said.

That’s “fantastic — if we can achieve a 95% compliance rate with the individual mandate,” said Blue Cross’s Garcia. “We believe that you cannot achieve a high enough compliance rate with an individual mandate to keep our current members’ insurance costs some of the lowest in the nation.”

Jerry Flanagan, health-care policy director for the Foundation for Taxpayer & Consumer Rights, a California-based watchdog group, said compared with Blue Cross, Blue Shield and Health Net are relatively small players in California, with about one-third of Blue Cross’s enrollment of about 8 million.

“This is a basic issue of, if you’re the big guy on the block like Blue Cross, you don’t want to see any changes because a change….poses a risk that you might lose some enrollees or another insurer will get an edge,” Flanagan said.

The Together for Health Care coalition’s health insurers see legislation that requires people to buy health insurance as a way to expand their business. “That’s where the lines are being drawn,” Flanagan said.

http://calibre.mworld.com/m/m.w?lp=GetStory&id=257253321

Comment:

By Don McCanne, MD

If you want to know why the private insurance industry should no longer have a role in financing health care, just ask representatives of the private insurance industry to comment on their competitors.

In the California battle of the Blues, one position harms patients by excluding those with health care needs from risk pools that are limited to healthy enrollees. The other position harms patients by requiring them to purchase coverage that is either inadequate or unaffordable for average-income individuals.

It’s not about policies that benefit patients. It’s about policies that protect and improve market share for the private insurers.

Suppose we established our own single public insurance program. Everyone, including those with health care needs, would be included in the single risk pool, and and it would be comprehensive and affordable, made possible through administrative efficiencies and an equitable system of funding.

The irony is that the California battle of the Blues will likely result in a victory for both sides of the private insurance war. Only the patients will lose.

Health care is the focus

By Mark Fischenich
The Free Press
June 12, 2007

MANKATO– Uninsured people are often the focus of debates about America’s troubled health care system, but even those with insurance are struggling with issues of cost and access.

That was a consistent theme as Mankato-area residents told their stories to the Minnesota Senate Health, Housing and Family Security Committee Tuesday. Committee Chairman John Marty and other committee members are taking public testimony at a handful of hearings around the state leading up to the 2008 legislative session, when health care is expected to be a major focus.

Marty said a couple of pieces of testimony would stick with him.

There was the North Mankato resident with cerebral palsy who couldn’t find a local practitioner who would accept the minimal reimbursement offered by his Medical Assistance.

There was the Comfrey farmer undergoing chemotherapy who saw the charge for the exact same treatment rise from $1,200 to $9,500 from one treatment to the next.

There was also plenty of testimony that members of the committee have heard before about people agonizing over how to get the medical treatment they need.

“We all understand that access to affordable health care has reached a crisis point in Minnesota,” Marty said during the hearing at Minnesota State University.

Of the 10 people who testified, most work for agencies or organizations that help those who don’t have access to affordable medical care.

John Thormodson, a rural Madelia farmer, was one of the regular folks.

A farmer with a 10-year-old daughter and 7-year-old son, Thormodson described a typically idyllic farm life in his introductory remarks. Then he started talking about health care.

In Thormodson’s case, it isn’t about tragic bad luck or catastrophic illnesses. It’s about the standard eye infections and ear aches, and the need to balance health and finances.

Even paying $650 a month for insurance and prescription drugs, Thormodson and his wife faces deductibles that make a trip to the emergency room a hardship. With nearby clinics closed on weekends, it’s the ER or nothing on Saturday or Sunday.

“When you have kids, eye infections come up and ear infections come up, and it’s not always Monday through Friday when this happens,” he said.

They took their son to the emergency room with one bad ear infection that hit on a weekend. The bill was $500. Now, Thormodson said, he and his wife wonder if they should try to wait until Monday when a medical issue arises on the weekend.

“Why should parents have to debate whether or not to take their child for medical care — whether it’s Monday or Saturday,” he said. “It’s frustrating.”

Another farmer testified a bit later. Alfonse Mathiowetz lives near Comfrey, saw his farm mostly wrecked by a 1998 tornado, found out four years ago that his wife had cancer and recently began cancer treatments himself.

Matiowetz described driving to Mankato for his chemotherapy treatment, paying $1,200 a visit. The same provider also served a facility in New Ulm. So, looking to save time and some gas money, Mathiowetz asked if he could get the same treatment there.

He could. But when the bill came for the exact same treatment, it was $9,500.
“I think this is highway robbery in broad daylight,” Mathiowetz said, adding that he never got a good explanation for why two facilities could have such extreme variations in price for the same treatment.

He wrote a letter to the New Ulm facility: ” I said I may not die of cancer, but I could die of a heart attack getting bills like this.”

Others who testified included Ann Vogel, the physician at Mankato’s Open Door Health Care Center for the uninsured; Lynn VanDervort, the regional director of the Minnesota Senior Federation; and Lynn Solo of the Nicollet County Social Services Department.

Vogel said thousands of people use the free and reduced-price clinic each year.

“We’re the safety net for southern Minnesota,” she said.

But she warned that the facility can’t meet growing needs of the uninsured projected in the future.

VanDervort talked about how the aging of America’s population is presenting extraordinary challenges for the health care system. She said people as young as 5 years old have joined the Senior Federation to take advantage of its prescription drug benefit, which includes bus trips to Canada where more affordable drugs are available.
The government’s response has been short-term fixes, VanDervort said.

“But these stopgap measures will not hold back the tidal wave of spending ahead of us,” she said.

And Solo told of the 22-year-old North Mankato man with spastic quadriplegia who needed dental work. His parents asked Solo to help find a dentist who would take him and his government-provided insurance.

Hoping he could use his motorized wheelchair to get to the appointment, their preference was the clinic four blocks from their home. Their second choices was a facility a half-mile away.

Solo contacted both. Then she worked her way through the nine pages of dental clinics in the Mankato Yellow Pages. Then she expanded her search to find a dentist willing to take the man and Medical Assistance reimbursement rate.

Solo finally found one who would take him — in Savage, 63 miles away.

California’s Battle of the Blues

California Coalitions on Health Reform Pit Health Insurers Against One Another

By Fran Mayso Lysiak
BestWeek
June 11, 2007

Two coalitions have launched media campaigns on how best to fix the state’s troubled health-care system on the heels of Gov. Arnold Schwarzenegger’s and Democratic lawmakers’ proposals to extend affordable coverage to the state’s 6.5 million uninsured. One coalition, so far only comprised of Blue Cross of California, is pitted against another coalition, comprised of three other health insurers, along with a diverse group of business, labor interests and health-care providers.

Tom Epstein, vice president of public affairs for the nonprofit Blue Shield of California, a member of the “Together for Health Care” coalition, classified each group’s position this way: “We call ours the coalition of the willing and theirs is the coalition of the unwilling.”

Those statements are “100% wrong,” said Blue Cross’s (Nick) Garcia. “In fact, those folks that say that they’re for reform in this other coalition, they need look at what they’ve been doing in the California market — dropping members and getting out of rural counties — and determine if they are truly for reform,” he said.

Blue Cross’ ad campaign says it is against guaranteed issue, “which means they are not in favor of universal coverage,” Epstein contends. Blue Cross doesn’t support everyone being able to buy health insurance “and we believe that’s an essential element for the people of California,” he said.

Blue Shield has supported “guaranteed issue,” which means health insurers can’t deny coverage because of a person’s health status, “but only when paired with an individual mandate,” Epstein said. “That would ensure that you get a broad risk pool of both the healthy and those who need health care,” he said.

That’s “fantastic — if we can achieve a 95% compliance rate with the individual mandate,” said Blue Cross’s Garcia. “We believe that you cannot achieve a high enough compliance rate with an individual mandate to keep our current members’ insurance costs some of the lowest in the nation.”

Jerry Flanagan, health-care policy director for the Foundation for Taxpayer & Consumer Rights, a California-based watchdog group, said compared with Blue Cross, Blue Shield and Health Net are relatively small players in California, with about one-third of Blue Cross’s enrollment of about 8 million.

“This is a basic issue of, if you’re the big guy on the block like Blue Cross, you don’t want to see any changes because a change….poses a risk that you might lose some enrollees or another insurer will get an edge,” Flanagan said.

The Together for Health Care coalition’s health insurers see legislation that requires people to buy health insurance as a way to expand their business. “That’s where the lines are being drawn,” Flanagan said.

http://calibre.mworld.com/m/m.w?lp=GetStory&id=257253321

Comment:

By Don McCanne, MD

If you want to know why the private insurance industry should no longer have a role in financing health care, just ask representatives of the private insurance industry to comment on their competitors.

In the California battle of the Blues, one position harms patients by excluding those with health care needs from risk pools that are limited to healthy enrollees. The other position harms patients by requiring them to purchase coverage that is either inadequate or unaffordable for average-income individuals.

It’s not about policies that benefit patients. It’s about policies that protect and improve market share for the private insurers.

Suppose we established our own single public insurance program. Everyone, including those with health care needs, would be included in the single risk pool, and and it would be comprehensive and affordable, made possible through administrative efficiencies and an equitable system of funding.

The irony is that the California battle of the Blues will likely result in a victory for both sides of the private insurance war. Only the patients will lose.

WellPoint delivers on its promises (to Wall Street)

Bank of America Health Care Conference
June 1, 2007
WellPoint, Inc.

Angela Braly, President and CEO, WellPoint, Inc.:

Let me conclude with a few investment considerations for you to take away from this presentation. Health-care costs continue to rise at a faster pace than overall inflation and are now projected to comprise approximately 20% of the gross domestic product by 2016. We believe that our strategic plan positions us very well to address this continued rise in health-care expenditures as we bring a superior value proposition to the marketplace and a strong voice in the community that helps in advocating a choice-based private health-care market.

The health insurance sector is continuing an era of consolidation. Back in 1995, the ten largest companies enrolled just 27% of the market, whereas today, the ten largest plans have about 52% of the market. Considering the investments required to effectively compete in new areas like consumer-directed health-care and comply with ever-changing regulations, many smaller plans are deciding to leave the industry or partner with larger plans to improve their competitive position.

WellPoint has a consistent track record of delivering on our financial promises to Wall Street and we expect this to continue. With our projected earnings of $5.54 per share for 2007, our compound annual EPS (earnings per share) growth rate will be 22% over a six-year period.

So in summary, we believe that WellPoint is a compelling investment opportunity with strong growth prospects, and I hope that you agree.

Wayne DeVeydt, EVP and CFO, WellPoint, Inc.:

I think one of the questions that I will get from many of you over the near term will be my philosophy, and I want to make sure everybody in this room understands and on the webcast that I’m fully committed to the 15% earnings per share growth and believe that that is sustainable for not only the near term, but the longer term.

Unidentified Participant:

We think it’s a compelling opportunity as well for investment and we appreciate very much you coming out, especially on such short notice. Congratulations on your promotion, both of you.

http://insurancenewsnet.com/article.asp?n=1&neID=20070601560.2_b27102f26f3269f2

Audio and slides
http://www.veracast.com/webcasts/bas/healthcare07/id47301336.cfm

Comment:

By Don McCanne, MD

For those of us who continue to fight for comprehensive, affordable health care for everyone, listening to this webcast or reading the transcript is a very painful half-hour experience. WellPoint is 100 percent committed to “delivering on our financial promises to Wall Street.”

This presentation by the new leadership of WellPoint, Inc. should be mandatory listening for those policymakers who insist that the private insurance industry must be included in our models of reform.

One important caveat: Members of the policy community who believe that health care is about patients should take an anti-emetic before accessing this presentation (though those on Wall Street may wish to break out the champagne).