PNHP

Anthem Blue Cross uses bait and switch tactics

pnhpf3a

Anthem Blue Cross uses bait and switch tactics

Anthem Blue Cross sued over higher medical insurance deductibles

By Duke Helfand
Los Angeles Times, November 15, 2011

For the second time in eight months, California health insurer Anthem Blue Cross is being sued over allegations that it has breached contracts with individual policyholders for hiking annual insurance deductibles in the middle of the year.

The latest lawsuit, filed Monday by the group Consumer Watchdog, says that California’s largest for-profit health insurance company used “bait and switch” tactics to raise deductibles and other out-of-pocket costs for some customers May 1.

The lawsuit says the Woodland Hills insurer improperly changed policy renewal periods Aug. 1 from one year to one month, allowing the company to alter its benefits, co-pays and other costs repeatedly throughout the year.

Some of those Anthem customers have seen their annual deductibles rise in the middle of the year to $550 from $500, according to the consumer lawsuit. Other deductibles have gone to $1,750 from $1,500 and to $2,950 from $2,500.

http://www.latimes.com/business/la-fi-anthem-lawsuit-20111115,0,7684974.story

Comment: 

By Don McCanne, MD

WellPoint’s Anthem Blue Cross has found yet another way to shift insurance risk from itself to its beneficiaries. Individuals who purchased or renewed their health plans did so while assuming in good faith that their costs and risk exposure would be set for another year. No. Anthem Blue Cross included in the fine print the condition that these were only one month renewals, allowing them to change the terms of the insurance contract repeatedly throughout the year.

“Bait and switch” is a despicable business practice, and the nation’s largest insurer, WellPoint, is not above it. At the current rate of insurer consolidation, WellPoint’s plans will likely be amongst only a few choices, if that, in the state health insurance exchanges to be established under the Affordable Care Act. And surely the other insurers will adopt the same despicable practices in order to remain competitive.

Now the nation is awaiting a Supreme Court decision on the individual mandate that will tell us whether we will be required to purchase a plan from a selection of these despicable private programs or if we will have the right to remain uninsured – a right that many will exercise simply because these plans will be unaffordable, even with the proposed subsidies.

We wouldn’t have to tolerate the despicable behavior of the private insurers if only Congress would improve and expand Medicare. Medicare belongs to the people. We should all be able to benefit from it.

Despicable?

Despicable: “So worthless or obnoxious as to rouse moral indignation.”
(It’s the right word, so we should use it.)

Local ‘Occupy’ movement finding its voice

By Susan Frick Carlman
Naperville (IL) Times, November 14, 2011

Occupy Naperville has settled in.

Now a month old, the Saturday morning demonstration against economic inequality that operates under the credo “we are the 99 percent” continues to attract several dozen participants to its weekly walk from Ogden Avenue into the retail core and back.

About 55 people came to last weekend’s protest, a slightly smaller group than the 70 who had taken part in each of the previous two weeks. The demonstrators again processed to the amphitheater on the Riverwalk to share ideas.

By group vote during each week’s general assembly, the participants are building a platform. They agreed at an early gathering to support the effort to reinstitute a limit on corporate campaign donations. Last time they adopted support for a single-payer health care system, making that another tenet of the local movement.

“Another way to say that is improved Medicare for all,” said Warrenville resident Steve Alesch, 56, a software engineer and founding member of the Occupy Wall Street movement’s Naperville arm. “There’s no political will in the current makeup of the Congress and the White House … they’re not representing the 99 percent on that.”

Addressing the group Saturday for a second consecutive week was Winfield resident Dirk Enger, who serves on the DuPage County Board. He said he doesn’t agree with all of the protesters’ issues, but he supports the movement itself and encourages citizens to speak out.

“When you really look at it, all they’re asking for is (for) people that they elect to keep their word, and they’re not getting that,” said Enger, 50. “A Congress that comes to work 125 days a year is a disgrace. They’re absolutely right. I also stand strongly against the bailout of Wall Street.”

The marchers also agreed during their general assembly to seek a waiver that would let them use a bullhorn earlier than the noon start time stipulated in the city code, and they made plans to host a food drive in support of local hunger relief.

“There was talk of moving the time due to the (bullhorn) permit restrictions, but the GA voted to try and work with the city instead,” said Evelyn Thompson, 22, a Naperville resident and another of the local organizers. “Future locations were discussed for winter contingency plans — members will collect various ideas and present them to a vote at next Saturday’s GA.”

Alesch acknowledged that as the weather turns colder, it will make sense to have an indoor option for the general assembly. Discourse goes on continuously at the group’s website, www.occupynaperville.org, which has a link to its Facebook group, but all of the voting takes place at the weekly gatherings.

“I would certainly support marching rain or shine,” Alesch said. “I think it’s important to continue having a presence in the community every week.”

Eventually the local group will devise a set of core positions to be shared with candidates in next year’s elections.

“I think we’re going to have a positive impact on the elections in 2012,” Alesch said of the nationwide movement, which has triggered protests in more than 100 U.S. cities. “I would think it’s going to change the presidential election. It needs to.”

Single-payer plan prompts docs to bargain with the state on reforms

By Alan Panebaker
VTDigger, November 14, 2011

In reaction to the Shumlin administration’s push for a single-payer style health care system, doctors have resuscitated a bargaining group that will represent the interests of physicians.

The Green Mountain Care board is developing plans for reforms that will likely have an impact on doctors’ earning power, and members of the Vermont Medical Society are worried about their future compensation and working conditions.

At the Society’s annual meeting last month, members voted to reconvene a bargaining group called the Physician Policy Council that was originally formed in the 1990s.

Unlike a union, where employees negotiate with their employer for fair wages and benefits, the council will bargain directly with the state as it creates a benefits package for all Vermonters and possibly implements a “single pipe” payment mechanism for health care providers as part of a reform effort that would set the stage for a universal health care system. Payment reform plans will likely result in a uniform pricing system for physician care.

Paul Harrington, executive director of the Vermont Medical Society, told the Vermont Press Bureau last week that the group’s aim was to provide the Green Mountain Care Board with the “best information possible reflecting the experiences of Vermont physicians.”

The vast majority of physicians working for Fletcher Allen Health Care, the state’s largest health care provider, are members of the Vermont Medical Society, according to Mike Noble, a spokesman for Fletcher Allen.

The commissioner of the Vermont Department of Banking, Insurance, Securities and Health Care Administration will need to approve the group’s status under the agency’s regulations.

Madeleine Mongan, vice president for policy with the Vermont Medical Society, said the organization formed a bargaining group in 1994 when the law first allowed health care provider bargaining groups to negotiate with the state regarding provider regulation, reimbursement and quality of health care.

Physicians say the purpose of a collective bargaining group is to ensure doctors can talk to each other and negotiate with the state without running afoul of antitrust laws, which are designed to promote or maintain market competition by regulating anti-competitive conduct by companies, essentially prohibiting monopolies.

Dr. Paul Reiss, a family practitioner in Williston, said the original idea of allowing a collective bargaining group was to permit doctors to negotiate and discuss rates with each other in anticipation of more control by the state over setting rates for plans like Medicaid and Catamount Health.

“It will be very important if there’s limited options for physicians to contract; physicians naturally will have to have the ability to talk to each other in terms of the fee schedules that the board comes up with,” Reiss said.

Essentially, this is what happens in Canadian provinces with single-payer systems, Reiss explained. Physicians and other health care providers bargain for rates of compensation. In a single-payer system, one entity, run by the government, would collect all health care fees and pay out all health care costs. Although Vermont’s health care reform bill, Act 48, does not specifically use the words “single-payer,” it permits an appointed board to develop a payment system to move away from a “fee-for-service” model and toward an alternative method of compensation.

Reiss said, “The payer will control the flow of all health care dollars essentially.”

The payer would effectively be the state, and doctors would be subject to the reimbursement rates it sets. Reiss said other organizations can and probably will apply to be recognized as a bargaining group. For example, the group Healthfirst, which works to promote independent health care practices, will likely want the ability to bargain as well. Reiss is vice-chair of that organization’s board of directors.

Jim Daily, CEO of Porter Medical Center in Middlebury, said physician participation in reform is a good thing.

“For us collectively to solve health care problems takes as many people pulling together as possible,” Daily said.

The Vermont Association of Hospitals and Health Systems will be working on budget issues and payment reform as well, Daily said.

Act 48 includes a reference to the statute allowing bargaining groups in its definition of “payment reform.” The Green Mountain Care Board will spearhead the effort to shift payment for health care providers away from a “fee-for-service” model where providers receive compensation for each separate service.

One option, called “bundling,” compensates physicians and hospitals for “episodes” of care. For example, a provider could receive payment for an entire surgery rather than separate payments for individual visits, MRIs, and the actual procedure.

The idea is to reduce costs by discouraging unnecessary care and encouraging coordination. Proponents of the idea say it will improve overall quality of care.

Anya Rader Wallack, chair of the Green Mountain Care Board, said the bargaining council will give physicians a vehicle for negotiating fair compensation.

The question is, “how do we change reimbursement and make it fair?” Wallack says.

She said there appears to be some nervousness in the specialty medical community (physicians who practice in a specific area like orthopedics) about what the plan means for them. Critics of the federal efforts to reform health care have said an expansion of access to care for more patients could result in decreases in pay for highly-compensated specialists.

Wallack said the board welcomes the input. “It’s the state discussing with providers fair, adequate, value-based compensation,” she said.

http://vtdigger.org/2011/11/14/single-payer-plan-prompts-docs-to-bargain-with-the-state-on-reforms/

Occupy Protesters Interrupt Chamber of Commerce Health Care Event

By Think Progress

Protesters disrupted a U.S. Chamber of Commerce event on health care today, interrupting speaker Scott Serota, the CEO of Blue Cross & Blue Shield. Chanting “we are the 99 percent,” the protesters stood at the luncheon event and used a “human microphone” technique to read a statement about how the “the one percent in the health care industry” is only interested in profit “at the expense of human suffering and preventable death.” The protesters decried the influence that the health insurance industry wielded in the debate over the Affordable Care Act, and called for “Medicare for all” or a “single payer health system.” Watch it:

Occupy disrupts Blue Cross Blue Shield CEO’s speech at Chamber luncheon

By Tim Mak
Politico, Nov. 14, 2011

Occupy Wall Street protesters disrupted a U.S. Chamber of Commerce luncheon featuring the President and CEO of Blue Cross Blue Shield this morning.

The interruption at the Chamber’s office in D.C. was caught on C-SPAN, which was broadcasting Scott Serota’s speech about the future of the health care insurance industry.

ThinkProgress, which quickly posted C-SPAN’s video of the encounter, reports that the protesters chanted, “we are the 99 percent.”

The Occupy demonstrators, using a call-and-repeat method of speaking, complained about Serota’s $2.5 million annual salary, and said that he “is an example of the 1 percent in the health care industry.”

Serota, the protesters allege, put profit ahead of human suffering.

The demonstrators appear to have been sitting at tables at the luncheon. As each protester was led out of the room, another would stand and continue reading from a prepared statement. This happened several times.

According to the video, those who interrupted the luncheon were led out of the room peacefully.

Read more: http://www.politico.com/news/stories/1111/68320.html#ixzz1diPX3jcg

The full video of the disruption and the speech is at C-SPAN:
http://www.c-span.org/Events/Blue-Cross-CEO-Discusses-Health-Care-Business/10737425491/

Mad As Hell Doctors Receive Prestigious Award

By Oregon Single Payer Coalition
The Lund Report, Nov. 8, 2011

The Oregon physicians group Mad As Hell Doctors received a prestigious award in Washington, D.C., on Oct. 29 at the annual meeting of the Physicians for a National Health Program. The Dr. Quentin Young Health Activist award was accepted by Dr. Michael Huntington, a Corvallis doctor and a founder of the group, on behalf of MAHD.

Mad as Hell Doctors traveled the country in a caravan in 2009, singing, speaking, and showing videos in 30 towns in 15 states to raise awareness of the need for universal health care in this country,  and to point out a single-payer health plan as the way to get there. The caravan ended with a rally in Lafayette Park outside the White House, and was followed by a dozen more caravans in Oregon and California.

Members of Mad As Hell Doctors have organized at rallies across the country, published in The New York Times, assisted with a Portland single-payer conference with 600 attendees, participated in a National Public Radio panel on health care, and helped draft Oregon’s statewide single-payer bill, whose public hearing last March drew hundreds of supporters from around the state. The group continues to tour, speak and advocate for health care reform.

In accepting the award, Dr. Huntington said, “It helps you to inform and motivate the listener if you are having fun while you are doing it.” He noted, “Single-payer health care works for our veterans and their families. It will work for the rest of us. All we need is to convince our legislators to do the right thing.”

http://www.lundreport.org/resource/mad_as_hell_doctors_receive_prestigious_award

Health care spending is killing us

By the Editorial Board
Newsday, Nov. 14, 2011

Imagine a health insurance system with runaway costs, millions left without coverage, administrative headaches galore and unhealthier people than in many other countries spending less.

Actually, you don’t have to bother imagining such a system. You’re already living with it. And it’s bankrupting our country.

Curing the ills of our health care delivery system is a topic that has been and will be addressed extensively by the editorial board. More specifically, health care “entitlements” are at the very heart of our nation’s fiscal troubles, so they are a crucial factor in our financial recovery.

Medicare and Medicaid account for 23 percent of federal spending and cover more than 100 million Americans. But the problem is even larger, because government at all levels pays 45 percent of the nation’s $2.6-trillion annual medical bill. Private spending is outlandish too, which also matters; money spent by individuals and companies on exorbitantly priced health care is money unavailable for investing in business, rebuilding bridges or paying off loans.

In general, compared with other rich countries, we spend perhaps $1 trillion a year too much on health care, a sum that would all but solve our fiscal troubles if it could be put to better uses. So applying the brakes to increases in public and private medical spending is critical — especially because it doesn’t buy us much.

Thirty years ago, our health-care spending was in line with that of other advanced nations, but now we spend about twice as much proportionately — nearly 18 percent of national output. Yet in countries that spend far less, people live longer. The cost burden on the unlucky in this country is particularly crushing; one study found that medical bills caused 62 percent of bankruptcies in 2007. The researchers said their findings show that “the U.S. health care financing system is broken.”
 
It’s a form of single-payer already

President Barack Obama spent enormous political capital to push a health-care plan through Congress, and it is designed expand coverage. Yet even if it survives legal challenges and unrelenting Republican opposition, it will still leave millions of people uncovered — and do far too little to rein in costs.

The salient fact about health care in America is that we already have a single-payer system. That payer is you. You pay for your neighbors, they pay for you, and everyone pays for the uninsured, unless of course they simply die untreated. By its nature, after all, insurance collectivizes costs. Our system is also riddled with tax deductions, employer coverage and other cost-shifting features that effectively hide who’s paying what and how much it really amounts to.

Overall, it’s a recipe for out-of-control spending, which is just what it’s given us. Indeed, in Australia, Britain, Japan and some other affluent countries, the sum spent here by government alone (on a per-person basis) would be enough to cover everybody without a dime of additional spending.

Once we acknowledge that we already have a single-payer system, we might as well go ahead and make it a sensible one.

What would such a system look like?

First, it will have to change how health-care providers are compensated, so that they’re paid for producing health rather than performing costly procedures. Second, it would have to turn back the tsunami of paperwork that threatens to inundate American health care in costs, errors and frustration. And third, it would have to cover everybody. Hospitals already have to treat any emergency patient — they just pass the costs along to everyone else — and universal coverage, according to a Harvard study, might prevent the deaths of nearly 45,000 Americans annually, which is more than die each year on U.S. roads.

It would also have to find ways to change behavior, since so much of what ails us — obesity, for instance — is self-inflicted. Since the health insurer would be the same outfit that makes the laws, the government would have strong incentives to abandon policies that make us less healthy and support ones that make us more so.

While we’re at it, let’s acknowledge that any sane single-payer system must ration care — just as our current system does — only based on science rather than affluence or insurance-company fiat. Today, a third of health-care resources are spent on patients in the last year of life, when it often does more harm than good. Ending some of this tragic waste will require a change in attitudes. But spending that money on hospices, prevention and coverage for the uninsured would be vastly more beneficial, both for the elderly and for everyone else. Hospice care, for example, can actually prolong life even while saving money.
 
Leverage to hold down costs

Most of all, a sensible single-payer system would be basic, providing decent care for all while allowing anyone with the money and inclination to buy a private add-on plan to upgrade coverage. Since people would pay for these plans from their own pockets, market forces should work to keep costs down. Such add-on coverage could pay for a private hospital room or procedures not covered by the basic government plan. But the cost of such extra coverage can’t be tax-deductible, because that would encourage people to overspend and pass the bill to their fellow taxpayers.

A basic single-payer plan could mean Medicare for all, or it could just as well mean 50 single-payer programs in 50 state capitals. Vermont has already started building a single-payer plan that would pay health care providers a set fee to care for patients. Either way, the entity that increasingly pays our medical bills — government — would finally get the hammer it needs to tamp down costs. And the United States would finally have a prescription for solvency.

Watch videojournalist Meredith Soaring interviewing editorial board member Daniel Akst about how U.S. medical spending poses a mortal threat to our fiscal health, yet we’re unhealthier than comparable countries and leave 50 million without insurance: http://www.newsday.com/users/user-content/balancing-act-ii-an-editorial-series-1.3311755

A better health care system now within reach

By Nicholas H. Anton, M.D.
The Press Democrat (Santa Rosa, Calif.), Nov. 12, 2011

Occupy Wall Street emerged as a grass-roots campaign against excessive corporate wealth and political power. Having been bailed out by the U.S. government, large banks are making record profits and paying huge bonuses while lobbying for less regulation of the activities largely responsible for our country’s financial collapse.

Embedded in this corporate culture is the health care industry, composed of insurers, pharmaceutical companies and medical device manufacturers. Their lobbying efforts and extensive financial resources — spending $1.4 billion on the recent health care reform debate — resulted in a watered-down bill.

The Patient Protection and Affordable Care Act was passed in 2010. It preserves the major contributor to high-cost health care — the private insurance industry — while leaving 23 million uninsured and failing to address the skyrocketing cost of the U.S. health care system.

Of every health care dollar spent in the private sector, 25-30 cents goes for administration, profit and marketing. Compare this to Medicare, which spends 3 cents. The average CEO salary of the 10 largest insurance companies is $11.7 million per year.

A single-payer system, patterned after Medicare and with additional benefits, would provide health care for everyone while creating a system allowing patients access to any physician or hospital of their choice. In addition, such a system would lower costs and improve the quality of health care. Gridlock at the national level currently makes such sweeping reform impossible. Senate Bill 810, sponsored by state Sen. Mark Leno, would establish a single-payer system in California. This concept has been passed twice by the Legislature, only to be vetoed by Arnold Schwarzenegger.

Canadian Medicare started in one province, Saskatchewan, on Jan. 1, 1947, before being adopted by all Canadian provinces in 1964.

SB 810 would cover inpatient and outpatient medical care, OB and pediatric care, mental health services, emergency services, adult day care, substance abuse treatment, prescription drug coverage, vision care, dental care, skilled nursing services, chiropractic care and durable medical equipment, all with no co-pays or deductibles. This publicly financed and privately delivered system would provide high-quality health care to all Californians regardless of income, employment or health status.

Too good to be true? Emphatically, no.

In 2005, the Lewin Group, an independent health care consulting firm, determined that such health care reform would save California $343.6 billion over 10 years.

Imagine a health care system demonstrating real American freedom to choose your doctor and hospital while creating competition based on quality. Imagine a system where Californians care for one another and where health care would become a necessary public service, like police and fire protection. Individuals would be relieved of the prospect of unforeseen health care expenses; large and small businesses as well as state and local governments would no longer have to face rising health care costs of 6 percent to 9 percent annually; employment in the health care sector would grow dramatically to care for the newly insured; physicians and hospitals would be able to reduce much of the administrative overhead required now to deal with the more than 6,000 health plans offered in California.

For more information on SB 810, go to http://pnhpcalifornia.org.

Dr. Nicholas H. Anton practiced internal medicine in Santa Rosa for 34 years, retiring in 2009. He is a member of Physicians for a National Health Program – California.

http://www.pressdemocrat.com/article/20111112/OPINION/111119843?p=1&tc=pg

Better health coverage needed

By Pippa C. Abston, M.D.
Letters, The Huntsville Times, Nov. 11, 2011

Thomas Parker wrote in a letter to the editor, “since when have people been denied medical care just because they have no coverage?”

He asks us to check out the facts. Where has he been? Has he been living in one of the other developed countries that does provide health care for everyone? Here in the U.S., we do not.

Not only do uninsured people get denied care, but they die because of it.

Go to www.namesofthedead.com and read some of the stories their grieving families tell.

It is true that for a real emergency, the emergency rooms cannot turn people away. By the time a person’s high blood pressure or cancer or diabetes gets that bad, it is often too late.

I agree with him that we should not vilify hard work.

We should insist that the insurance corporations stop getting rich off our hard work while we get less and less coverage.

We can work together to fund our own health care, through Medicare for all.

Pippa C. Abston, M.D., Ph.D., resides in Huntsville, Ala., and is a member of Physicians for a National Health Program.

http://blog.al.com/times-views/2011/11/find_education_efficiencies_be.html

UK Health Minister Lansley on patient accountability for costs

Perspectives on Health Care Reform in the U.K.: A dialogue with UK Secretary of State for Health Andrew Lansley

Brookings, Engelberg Center for Health Care Reform
November 9, 2011

Q&A

Mark McClellan, Director of the Engelberg Center:  Another point (that you mentioned) was the availability of care at a low or at really no cost to patients, to consumers. That is a big difference from the United States, obviously, where not just the more conservative members of our legislatures, but others as well believe that patients should have some accountability, some responsibility for some of the costs, and, conversely, if they make decisions to stay healthier, if they make decisions to use care more effectively, that they should get some of the savings. You put a big emphasis on how these reforms are going to lead to more patient choice in terms of GPs, in terms of hospital care, in terms of specialist teams, and so on. As you said, money following the patient. Is that going to be enough? There are a lot of people here who believe that you really need even more consumer involvement, consumer stake in care to drive real reforms in care.

UK Health Minister Andrew Lansley:  Well, I understand the view that says if people pay directly for something, they value it more. I actually think, in the British context, where health care is concerned, people understand the value of the health care that is provided to them. They don’t need to have it itemized in a bill sent to them and pay for it out of their own pocket to realize that the National Health Service provides them something that they should attach enormous value to. I think, generally speaking, it isn’t the case that people in Britain consume large amounts of health care, that they don’t need to, because it’s free. And in particular, I think through the intermediation process with general practitioners the relationship that is built up between the British public and their general practitioners is instrumental to the process of managing demand in a way that is responsible and effective. Now I think it’s not perfect, and I think that’s one of the central reasons why I think we need to give patients a greater say in decision making. I don’t think, in a free system, as a consequence of that we are going to see irresponsible or excessive demand. I think patients themselves, given good information and opportunities to make choices, on balance, will make decisions that are probably less costly, less invasive, less interventionist because they want to have care that supports them at home and very often they don’t want to be in the hospital. So issues like avoiding admissions to hospitals, I think patients are with us on this. They’re not conflicting with us. See, the one thing I would say is important in terms of access, that we don’t necessarily achieve, where we do need to act is to ensure that patients do have access to the latest and most effective treatments and medicines. And there, particularly, we acted, since the election, in the creation of the Cancer Drug Fund because we knew that, in Britain for example, there was a very low take-up of cancer medicines within five years of their being introduced. And I think that is absolutely an area where the public have an expectation and a right to expect that they should have access to whatever their clinicians regard as the most effective treatment available. Some of it’s cost effective but, you know, on that basis, with clinical judgement, they should be able to get access to it. I have to say, when you look at the cost, literally the transaction cost alone, of moving away from a taxpayer funded service as the NHS is, in the way in which we’re organized, at the moment we have something like five percent of NHS costs consumed in administration. I’m planning to bring that down to about three to three and a half percent over the course of the next four years. That alone will save us about one and one-half billion pounds a year. But that is very modest administration costs relative to the costs of administration of insurance systems in the United States. So on that basis alone I think there is, in a constrained financial bound, there’s no intrinsic merit in moving away from the structure of the system we have.

http://www.brookings.edu/events/2011/1109_uk_health_care.aspx

Comment: 

By Don McCanne, MD

Health Minister Andrew Lansley of the United Kingdom is currently at the center of a storm of controversy over his efforts to further privatize their health care on the theory that expanding market competition for the National Health Service will improve quality and reduce costs. So it is instructive to ask if his views extend to include the U.S. concept of empowering consumers by requiring an even greater financial stake “to drive real reforms in care,” as former CMS Secretary Mark McClellan phrases it.

Although holding very conservative political views, Lansley almost scoffs at the suggestion that British citizens would consume large amounts of care merely because it is free. When you think about it, the suggestion that patients need price sensitivity to prevent over-consumption of health care  is almost an insult. Patients want to consult with their physicians to obtain the most appropriate care for their medical circumstance, in an environment removed from financial considerations. They are not looking for bargain basement deals.

This is about health care, for Pete’s sake. It’s not like deciding whether you are going to purchase a garment at Walmart or at Nordstrom. The assumption in the United Kingdom and in all other wealthier nations, except the United States, is that public stewards will ensure that health care will always be there for you when you need it. It is not a commodity that wise shoppers will follow and then purchase only after it goes on sale.

The advocates of consumer-directed health care are going to have to do a better job of explaining how requiring patients to pay out of their pockets or savings accounts when they access care is an answer to a problem, when that problem doesn’t seem to even exist. As Minister Lansley states, “it isn’t the case that people in Britain consume large amounts of health care… because it’s free.” Further, “the relationship that is built up between the British public and their general practitioners is instrumental to the process of managing demand in a way that is responsible and effective.”

How about that! The traditional physician-patient relationship works!

The per capita health care spending in the United Kingdom is less than half that of the United States. The British did not have to use consumer empowerment through price sensitivity to control their health care spending.

It appears that the only significant impact of increasing the financial stake of the health care consumer has been to erect financial barriers to beneficial health care services. So this detrimental intervention is being offered as a solution to the problem of high health care costs that other nations effectively manage using a responsible relationship between patients and their physicians? Talk about a disconnect between a problem and a solution!

McClellan says, “There are a lot of people here who believe that you really need even more consumer involvement, consumer stake in care to drive real reforms in care.” We could scoff at those people, but they’re in charge now. That’s tragic!

Vouchers for Veterans

By Paul Krugman
The New York Times, Nov. 13, 2011

American health care is remarkably diverse. In terms of how care is paid for and delivered, many of us effectively live in Canada, some live in Switzerland, some live in Britain, and some live in the unregulated market of conservative dreams. One result of this diversity is that we have plenty of home-grown evidence about what works and what doesn’t.

Naturally, then, politicians — Republicans in particular — are determined to scrap what works and promote what doesn’t. And that brings me to Mitt Romney’s latest really bad idea, unveiled on Veterans Day: to partially privatize the Veterans Health Administration (V.H.A.).

What Mr. Romney and everyone else should know is that the V.H.A. is a huge policy success story, which offers important lessons for future health reform.

Many people still have an image of veterans’ health care based on the terrible state of the system two decades ago. Under the Clinton administration, however, the V.H.A. was overhauled, and achieved a remarkable combination of rising quality and successful cost control. Multiple surveys have found the V.H.A. providing better care than most Americans receive, even as the agency has held cost increases well below those facing Medicare and private insurers. Furthermore, the V.H.A. has led the way in cost-saving innovation, especially the use of electronic medical records.

What’s behind this success? Crucially, the V.H.A. is an integrated system, which provides health care as well as paying for it. So it’s free from the perverse incentives created when doctors and hospitals profit from expensive tests and procedures, whether or not those procedures actually make medical sense. And because V.H.A. patients are in it for the long term, the agency has a stronger incentive to invest in prevention than private insurers, many of whose customers move on after a few years.

And yes, this is “socialized medicine” — although some private systems, like Kaiser Permanente, share many of the V.H.A.’s virtues. But it works — and suggests what it will take to solve the troubles of U.S. health care more broadly.

Yet Mr. Romney believes that giving veterans vouchers to spend on private insurance would somehow yield better results. Why?

Well, Republicans have a thing about vouchers. Earlier this year Representative Paul Ryan famously introduced a plan to convert Medicare into a voucher system; Mr. Romney’s Medicare proposal follows similar lines. The claim, always, is the one Mr. Romney made last week, that “private sector competition” would lower costs.

But we have a lot of evidence about how private-sector competition in health insurance works, and it’s not favorable. The individual insurance market, which comes closest to the conservative ideal of free competition, has huge administrative costs and has no demonstrated ability to reduce other costs. Medicare Advantage, which allows Medicare beneficiaries to buy private insurance instead of having Medicare pay bills directly, has consistently had higher costs than the traditional program.

And the international evidence accords with U.S. experience. The most efficient health care systems are integrated systems like the V.H.A.; next best are single-payer systems like Medicare; the more privatized the system, the worse it performs.

To be fair to Mr. Romney, he takes a somewhat softer line than others in his party, suggesting that the existing V.H.A. system would remain available and that traditional Medicare would remain an option. In practice, however, partial privatization would almost surely undermine the public side of these programs. For example, one problem with the V.H.A. is that its hospitals are spread too thinly across the nation; this problem would become worse if a substantial number of veterans were encouraged to opt out of the system.

So what lies behind the Republican obsession with privatization and voucherization? Ideology, of course. It’s literally a fundamental article of faith in the G.O.P. that the private sector is always better than the government, and no amount of evidence can shake that credo.

In fact, it’s hard to avoid the sense that Republicans are especially eager to dismantle government programs that act as living demonstrations that their ideology is wrong. Bloated military budgets don’t bother them much — Mr. Romney has pledged to reverse President Obama’s defense cuts, despite the fact that no such cuts have actually taken place. But successful programs like veterans’ health, Social Security and Medicare are in the crosshairs.

Which brings me to a final thought: maybe all this amounts to a case for Rick Perry. Any Republican would, if elected president, set out to undermine precisely those government programs that work best. But Mr. Perry might not remember which programs he was supposed to destroy.

http://www.nytimes.com/2011/11/14/opinion/krugman-vouchers-for-veterans-and-other-bad-ideas.html

The One Percent turns class war into generational war

By Dean Baker
Truthout, Nov. 7, 2011

Major news outlets like The Washington Post and National Public Radio constantly bombard us with news pieces on the budget deficit. Invariably these stories focus on the cost of “entitlements,” which most of us know as Medicare, Medicaid and Social Security. The story pounded home in these pieces — often explicitly — is that these programs, that primarily benefit the elderly, are creating the basis for a generational war between the young and the old.

The media focus both contributes to and follows the Washington policy debate. At the moment, we have the Congressional “supercommittee” scheming to produce a deficit reduction plan that will almost certainly involve large cuts to all three programs. There is a commonly repeated view in Washington policy circles, based on no evidence whatsoever, that there will be a disaster if the supercommittee comes up empty handed. This means that members of the committee are feeling great pressure from the 1 percent to produce a package with big cuts to Medicare, Medicaid and Social Security.

It is truly impressive how the Washington elite have managed to make these modest protections for the country’s working population (the 99 percent) into the greatest problem facing the country. The obsession with cutting these programs is occurring at a time when we have more than 25 million people unemployed, underemployed or who have given up looking for work altogether. One might think that Congress would convene a supercommittee to get people back to work rather than figuring out a way to undermine programs that people need, but it’s the 1 percent that pay for elections, not the 25 million workers suffering from their greed and incompetence.

Since almost no one can be immune to the hysteria that the media have created around the cost of these programs, it is worth putting it in some context. Starting with Social Security, the latest projections from the Congressional Budget Office show that the program can pay all benefits through the year 2038 with no changes whatsoever.

Even if we never did anything, the program would be able to pay more than 80 percent of scheduled benefits well into the next century. Since the value of benefits is projected to rise through time, 80 percent of the projected benefit in 2040 is considerably higher than the average benefit received by retirees today. Therefore, the often repeated comment that there will be nothing there for our children or grandchildren is a telltale sign of ignorance or dishonesty.

The cost of making the program fully solvent for its 75- year planning horizon is projected at 0.58 percent of gross domestic product (GDP). By comparison, the increase in annual spending on the military as a result of the wars in Iraq and Afghanistan is 1.7 percent of GDP, almost three times as much. The upward redistribution from the rest of us to the 1 percent over the last three decades was 6 percent of GDP or more than ten times as much as this shortfall. But it is only the shortfall in Social Security that the media want us to see as a crisis.

The health care programs, Medicare and Medicaid, pose more of a problem, but this is because the U.S. health care system is dysfunctional. We pay more than twice as much per person as do people in other wealthy countries with little, if anything, to show in the form of better outcomes. (We rank near the bottom of wealthy countries in life expectancy.)

If we had the same per person health care costs as people in Germany, Canada, or any other wealthy country we would be looking at long-term budget surpluses, not deficits. But controlling costs involves reducing the income and profits of the 1 percent. It means reducing payments to insurers, drug companies, medical equipment manufacturers and highly paid medical specialists.

Rather than control costs, the folks in Washington would rather make people pay even more for health care. This is why we see proposals like raising the age for Medicare eligibility to 67 or turning the program into a voucher system. Both plans are likely to protect the income of health care industry, while making it even more difficult for current or retired workers to cover their health care costs.

The public should realize that “generational warfare” is an agenda that was deliberately designed by the 1 percent to distract the rest of us from the class war that they have been successfully waging over the last three decades. Rather than have a public debate on the policies that have redistributed so much income upward, the 1 percent want to pit children against their parents and grandparents, forcing them to fight over crumbs.

In this context, the only victory that the supercommittee can hand to the 99 percent is a blank sheet of paper. People will have enough things to worry about this Thanksgiving without adding a Congressional plan to slash their Social Security and Medicare.

http://www.truth-out.org/one-percent-turns-class-war-generational-war/1320680738

Why the Occupy Movement is Good for Our Health

By Julie Matthaei and Neil Wollman
CommonDreams.org, Tuesday, November 8, 2011

Recently, the Congressional Budget Office released a report on income inequality which found that the incomes of the top 1% nearly tripled between 1979 and 2007, whereas those of the middle class increased by less than forty percent. In his 2007 study, Jared Bernstein  found that the after-tax income of the top 1% was 21 times higher than that of middle income families in 2005, compared to “only” 8 times higher in 1979. Indeed, inequality has been on the increase.

The burgeoning Occupy Wall Street movement, and its slogan, “We are the 99%,” is drawing critical attention to the grossly unequal distribution of income and wealth in the U.S.  Critiques include the injustice of the high incomes (and lack of incarceration) of Wall Street executives, given that their illegal actions caused the unemployment and homelessness of millions; the corrupting influence on the democratic process of the concentration of wealth in the hands of a few; and the basic indecency of the top 1% having much more than they could ever spend, while millions of Americans lack housing, health care, even food. 

But there any many other serious societal problems associated with inequality which are not so obvious, and which have received little attention from the Occupy movement or the media.  According to researchers Richard Wilkinson and Kate Pickett, more equal societies outperformed less equal ones in fifteen key ways:

– PHYSICAL HEALTH:  People in more equal societies live longer, a smaller proportion of children die in infancy, and self-rated health is better.
– MENTAL HEALTH:  People in more equal societies are far less likely to experience mental illness.
– DRUG ABUSE:  People in more equal societies are less likely to use illegal drugs.
– EDUCATION:  Children do better at school in more equal societies.
– IMPRISONMENT:  Unequal societies are harsher (in that) they imprison a higher proportion of people.
– OBESITY:  Obesity is less common in more equal societies.
– SOCIAL MOBILITY:  There is more social mobility in more equal societies.
– TRUST AND COMMUNITY LIFE:  Communities are more cohesive and people trust each other more in more equal societies.
– VIOLENCE:  Homicide rates are lower and children experience less violence in more equal societies.
– TEENAGE BIRTHS:  Teenage motherhood is less common in more equal societies.
    CHILD WELL-BEING: UNICEF measures of child well-being are better in more equal societies. 

In sum, income inequality is bad for our health, and for our society.  This finding greatly strengthens the case for policies aimed at making our income distribution more equal.

The Occupy Movement’s call for greater income equality also receives support from another finding of Wilkinson and Pickett.  They found that reductions in the level of inequality improve social well-being more than do increases in GDP.  This finding runs counter to a basic tenet of our economic policy – that GDP is the best measure of well-being.  It suggests that pro-growth policies which lead to increased inequality may in fact make people worse off, even if they increase GDP.   Conversely, increasing taxes on the rich would not only increase fairness, but also could increase well-being, even if they were to reduce GDP by discouraging capital investment. 

It is time that we the people, and our representatives in Washington, realize how unhealthy inequality is for us and for our society.  We should all applaud the Occupy Movement for bringing this problem to public attention, and we should join them in demanding that public officials act decisively to reverse this unhealthy trend.  While the top 1% can use their economic advantage and associated power to further enhance their wealth, we encourage them instead to join the 99% in pushing for more equality–as Warren Buffet has–and, perhaps, also improve their health and well-being in the process.  We should all seek the redistribution of income — to “spread the wealth around’ as put by then candidate Barack Obama to Joe the plumber — with more benefits then either likely considered at the time.

Julie Matthaei is a professor of economics at Wellesley College, and a co-founder and board member of the U.S. Solidarity Economy Network; jmatthae@wellesley.edu

Neil Wollman is Senior Fellow, Bentley Alliance for Ethics and Social Responsibility; Bentley University. He is concerned with issues of corporate responsibility; NWollman@bentley.edu

http://www.commondreams.org/view/2011/11/08-2