PNHP

Meet the New Health Care Reform, Same as the Old Health Care Reform

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Meet the New Health Care Reform, Same as the Old Health Care Reform

By Aaron E. Carroll
Associate Professor of Pediatrics, Indiana University School of Medicine
The Huffington Post
October 26, 2009

We’re so close to health care reform! Even Paul Krugman is starting to talk about what comes next. Me? I’ve been thinking about what comes next for a long time. I think this bill will pass. We will get the incremental reforms we were promised. Things will likely get better in the short term. Then, since we didn’t contain costs, we’ll need to enact real reform. Or, things will go right back to the status quo.

How do I know that? We’ve been here before.

President Obama said, in his address to Congress, that he was determined to be the last president to deal with health care reform. That’s not going to happen. He should have read his history. At least, he should have read the New York Times.

Governor Romney thought the same thing in Massachusetts in 2006. I saw it – right there in the New York Times:

The bill does what health experts say no other state has been able to do: provide a mechanism for all of its citizens to obtain health insurance.

“This is really a landmark for our state because this proves at this stage that we can get health insurance for all our citizens without raising taxes and without a government takeover. The old single-payer canard is gone.”

But wait. I’d heard that before. In the New York Times. In 1988:

Massachusetts last week ventured where no state had gone before: It guaranteed health insurance for every resident.

The plan requires that by 1992 every employer of six or more pay $1,680 per worker per year for insurance. The employer may buy the insurance directly for his workers and their dependents, thereby earning a tax credit…The Massachusetts plan recognizes the value of an employer-based approach, which it would expand by forcing more businesses either to insure or pay.

That time was under Governor Dukakis. He was going to be the last one to deal with health care reform, too. Just so you know, the rate of uninsurance in Massachusetts was 8.4% in 1998 around the time of the first “unique” reform and 5.5% in 2008, after two times they said they were going to achieve universal coverage. I don’t think they understood the concept of “fixed”.

And that’s just Massachusetts. Look at Tennessee. They went all out with incremental reform in 1994. There’s that New York Times again:

The Tennessee program, which went into effect last Jan. 1, covers 803,800 people who were formerly on Medicaid and 335,300 who had no health insurance. Gov. Ned McWherter, a Democrat, said that 94 percent of the state’s residents were now insured. He predicted, “Tennessee will cover at least 95 percent of its citizens with health insurance by the end of 1994, seven years faster than the most aggressive goal set for the nation under legislation being debated in Congress.”

Tennessee’s rate of uninsurance was 10.2% in 1994 and 15.1% in 2008.

Governor Dean, no stranger to the cause of health care reform, “fixed” the problem of health care reform way back in 1992. Per the New York Times:

Gov. Howard Dean, the only Governor who is a doctor, signed a law here today that sets in motion a plan to give Vermont universal health care by 1995.

The Vermont law creates a state agency, the Health Care Authority, that will have the power to bargain for health insurance for the state’s residents, using what Governor Dean called “enormous leverage” to gain better coverage at lower rates.

Wow. That sounds like… a public option! Let’s go to the scoreboard: Vermont’s rate of uninsurance was 9.5% in 1992 and 9.3% in 2008.

Minnesota tried this, too, in 1992. Of course, how would anyone know about that? It was only in the New York Times:

Minnesota is enacting a program that will be the most sweeping effort yet to provide health insurance to people who lack it.

The legislation, called HealthRight, provides state-subsidized insurance coverage for people of modest income, a provision that is expected to cost Minnesota $250 million a year, along with steps to control the health-care industry’s steeply rising charges.

Subsidies to buy insurance. That must have worked, right? Minnesota’s rate of uninsurance was 8.1% in 1992 and 8.7% in 2008.

Washington State? 1993. New York Times:

Washington will have one of the most aggressive health-care experiments in the nation, a program that would extend medical benefits to all 5.1 million residents of the state and try to control costs through a cap on insurance premiums.

The plan would require all employers to pay at least half the cost of health insurance premiums for their employees… “We weren’t going to create some huge new government bureaucracy, so we took that away from the critics.”

God forbid! A government system might actually… I don’t know… do something. Anyway, Washington’s rate of uninsurance was 12.6% in 1993 and 12.4% in 2008.

Since the administration has put Senator Snowe somewhat in charge of health care reform, you would think they would at least know about efforts in Maine. Right? To the New York Times, please!

The Maine Legislature today passed a comprehensive health insurance plan that will make low-cost coverage available to all state residents by 2009.

The legislation will create a semiprivate agency that provides private coverage to the state’s 180,000 uninsured residents, businesses and municipalities with fewer than 50 employees and the self-employed. Employers would pay up to 60 percent of an employee’s premium.

That looks like it could have come right out of HR 3200. You’d never know if was from 2003. How did that pledge to achieve universal coverage by 2009 go? Maine’s rate of uninsurance was 10.4% in 2003 and 10.4% in 2008.

We pretend these problems are new; we pretend that these solutions are new. Subsidies have been done. Community ratings are old news. “Public plans” have been around for a while. Mandates, both individual and employer, weren’t invented this year.

In 1988, before the first of these plans went into effect, 13.4% of Americans were uninsured. In 2008, it was 15.4% of Americans. They don’t work. Not in the long run.

We need comprehensive reform. This plan will pass; it won’t be enough. President Obama will not be the last President to deal with this problem.

We keep doing the same thing and expecting a different outcome. What does that signify?

Read more about health care policy and get your questions answered at Rational Arguments.

http://www.huffingtonpost.com/aaron-e-carroll/meet-the-new-health-care_b_334847.html

OECD Bias in Evaluating U.S. Health Care Reform

The Organization for Economic Cooperation and Development and Health Care Reform in the United States

By Don R. McCanne
International Journal of Health Services
Issue: Volume 39, Number 4 / 2009
Pages: 699 – 704

Abstract: Among OECD nations, the United States is an outlier in having the highest per capita health care costs in a system that unnecessarily exposes many individuals to financial hardship, physical suffering, and even death. President Obama and Congress are currently involved in a process to reform the flawed health care system. The OECD has contributed to that process by releasing a paper, “Health Care Reform in the United States,” which describes some of the problems that must be addressed, but then provides proposed solutions that omit consideration of a more equitable and efficient universal public insurance program. The same omission is taking place in Washington, DC. By reinforcing proposals that support the private insurance industry, the source of much of [he waste and inequities in health care, the authors of the OECD paper have failed in their responsibility to inform on policies rather than politics.

****

It would be an understatement to say that, when it comes to the effectiveness and efficiency of the health care financing system, of all member nations of the Organization for Economic Cooperation and Development (OECD), the United States is a highly exceptional outlier. With a per capita spending at twice the average of the OECD nations, the United States is receiving the worst value for its health care investment (1).

Not only is population health lower in the United States than OECD averages, but the nation’s fragmented, dysfunctional health care financing system has allocated spending in a manner that fails to prevent financial hardship for those individuals with health care needs. No other nations would tolerate the numbers of people without health insurance coverage, now at about 46 million, nor would they tolerate the explosion in underinsurance products that fail to provide adequate financial protection for those who are insured. In spite of spending more than 16 percent of gross domestic product (GDP) on health care, or $2.5 trillion, excessive financial burdens and even personal bankruptcy have become commonplace for those who must access the health care system (2).

Although the growing problem has been recognized for decades by legislators and the policy community in the United States, they have been overwhelmed with inertia, partly due to anti-government, pro-market ideology, and partly due to the tremendous influence of special interests that fare well under the current financing system. Particularly influential has been the private insurance industry, especially through its lobby organization, America’s Health Insurance Plans.

Advocates of health care justice have long supported reform that would remove financial barriers to access for everyone who has health care needs, but egalitarianism is so weak in the United States that it has failed as a driving stimulus for reform. The failure to act has gradually magnified a problem that all sectors recognize as being intolerable. The payers of health care are crashing into the solid barrier of unaffordable costs. Employers have had increasing difficulties in paying for their employee health benefit programs, and they have responded by reducing the coverage or even dropping it altogether. The federal, state, and local governments have struggled with budget constraints and have responded by reducing payments to the health care delivery system, shifting costs to other payers. Especially threatened are the safety-net institutions.

Most severely affected by health care affordability are the individuals with health care needs. Health care is now so expensive that the premiums for insurance products that cover necessary services are no longer affordable for average-income individuals and families. To make the premiums more affordable, the private insurers have introduced innovations in their products that shift more of the costs to those accessing health care. Thus health care is now frequently unaffordable even for those who have private insurance. The Milliman Medical Index for 2009 shows that a family of four with employer-sponsored coverage (a healthy sector and lower-cost risk pool) now has average annual health care costs of $16,771, clearly a burden when the typical household income is about $60,000 (3).

It is a sad commentary that egalitarian concern for our brothers and sisters was not enough to mobilize the president and Congress, but we do have some consolation that pecuniary interests may now actually move the process. Most observers of the U.S. health care scene believe that we are in another window of opportunity to achieve the reform that has eluded us for so many decades. Although other nations should learn from the United States what not to do, the United States has an opportunity to learn from other nations what has worked well.

The OECD has been a particularly valuable resource for highly credible studies of the health care systems of its member nations and for the international comparisons provided. As an example, the OECD-WHO-Eurostat Health Accounts database has been particularly helpful for economists in the United States (4). It is probably more than a coincidence that the OECD has just released a new paper, “Health Care Reform in the United States,” by David Carey, Bradley Herring, and Patrick Lenain (5). David Carey and Patrick Lenain work in the OECD Economics Department, and Bradley Herring is a professor at the Johns Hopkins University. The paper includes the usual disclaimer that the views are those of the authors and do not necessarily reflect the position of OECD. The only role of OECD was to provide two of the three authors and to publish and distribute the document at the time that an intensive effort for reform is taking place in the United States.

Fulfilling its role of providing an objective assessment of health care problems within the United States, the paper is helpful when it describes the very high health expenditures along with a population health status that is falling behind other nations. More specific to the need for financing reform, the paper explains the growing proportions of both the uninsured and the underinsured. Individuals over age 65 and individuals with long-term disabilities are covered by the public Medicare program. Many, but not all, lower-income individuals are covered by the public welfare programs, Medicaid and CHIP (Children’s Health Insurance Program). Everyone else either relies on private insurance or has no coverage at all, primarily because they cannot afford it.

With heavy reliance on pro-market ideology, especially since the Reagan years, the nation has been waiting for the private insurers to solve the problems. The private insurers did exactly what any reasonable business would do. They made the premiums for their insurance products competitive by reducing spending on health care through marketing practices that targeted the healthy, especially the healthy workforce and their young, healthy families, and through innovative product design that shifted more of the responsibility of paying for care to those with health care needs. Yet, except for instituting contracted rates with health care providers, they did nothing to slow the rapidly escalating costs of health care. Clearly, comprehensive reform is no longer an option, but a necessity.

Although the OECD paper helps us understand the deficiencies in the U.S. financing system, the recommendations are problematic. To maintain academic purity, the discussion should have included the benefits and deficiencies of a public insurance model such as single payer, a model built on private plans, and a hybrid model of public and private plans. The authors remain silent on a public insurance model. They primarily discuss changes in private insurance coverage to address insurance market failures. They recommend greater risk pooling, providing income-related subsidies for the purchase of private plans, and paying for the subsidies by eliminating the tax exclusion for employer-sponsored plans. In spite of having cited the growing problem of underinsurance, they recommend avoiding moral hazard by increasing cost sharing, which can only further accelerate the problem of underinsurance. They also recommend a few tweaks in the Medicare program that would have a very small impact on future trends. The recommendations would greatly increase health care spending while falling short of the goals of equity, universality, and cost containment.

A previous OECD report stated that “whatever the role played in a health system, private health insurance has added to total health expenditure” (6). A WHO report stated that “evidence shows that private sources of health care funding are often regressive and present financial barriers to access. They contribute little to efforts to contain costs and may actually encourage cost inflation” (7). Several micro-simulations of proposed models of health care reform in the United States have shown that a single-payer national health program would be the most effective model in providing all necessary health care services for absolutely everyone, while being the least expensive model of beneficial, comprehensive reform.

The 30 member nations of the OECD are “countries dedicated to democracy and the market economy” (8). This may explain why the two authors who are OECD employees produced a paper that limits its recommendations to private insurance markets, without discussing the possibilities of a public insurance program. However, as an academic, Professor Bradley Herring should not be constrained by a mission to limit consideration of policy options to those in a market economy.

It is not as if Professor Herring does not clearly understand the single-payer model. In a very recent Kaiser Commission/Alliance for Health Reform forum, he discussed four models of reform for the United States (9). He described single payer as “very elegant and simple.” “You pay taxes into the system and in return you get the medical care that you need.” He stated that single payer is probably the only model that is going to get everyone covered, and that there would be large reductions in administrative costs. In response to a question about the ability of the various options to control costs, he said: “I would think that the single payer approach yields the most promise towards reducing health care costs.” His academic ethics would have been better served had he included these comments in the OECD paper on reform in the United States.

A single-payer national health program is precisely what the United States now needs. It would establish a single universal risk pool, funded equitably through progressive taxes, and it would remove financial barriers to care so that absolutely everyone could receive the care that they need, when they need it. The $2.5 trillion that we are already spending is more than enough to ensure adequate capacity in the health care delivery system.

Senator Max Baucus (D-MT) is leading the closed-door process wherein the reform legislation is being crafted. He has said that all options are on the table, except single payer. In this last election cycle he received over a million dollars from the insurance and pharmaceutical industries (10).

President Barack Obama recently held a health care summit at the White House. Representatives of every sector and interest were invited except single-payer advocates, who were specifically excluded. Less than 24 hours before the summit, the president of Physicians for a National Health Program, a single-payer advocacy organization, was invited to attend, in exchange for agreeing to cancel the planned white coat demonstration in front of the White House, which would have been composed of physicians, nurses, and medical students. Although President Obama has previously expressed his support for single-payer reform, he has decided that political pragmatism requires him to support inclusion of the private insurance industry within the framework of reform.

As innumerable polls now demonstrate, a majority of Americans support national health insurance. It is what we want, what we need, and what we are already paying for. Yet the politicians, working with the moneyed special interests, continue to conspire to deprive us of health care justice. The political opponents to a public insurance program have been effective in excluding single payer from more than a token representation in the legislative process. The people of the United States do not benefit when representatives of the OECD join in that conspiracy merely to advance the ideology of the market economy. Continued financial hardship, suffering, and death are far too great a price to pay.

REFERENCES

1. OECD. OECD Health Data 2008: Statistics and Indicators for 30 Countries. www.oecd.org/health/healthdata
2. Himmelstein, D. U., et al. Illness and injury as contributors to bankruptcy. Health Aff, w5.63, February 2, 2005, doi 10.1377/hlthaffw5.63.
3. Milliman. 2009 Milliman Medical Index. May 2009. www.milliman.com
4. OECD. A System of Health Accounts. www.oecd.org/health/sha
5. Carey, D., Herring, B., and Lenain, P. Health Care Reform in the United States. Economics Department Working Paper No. 665. ECO/WKP(2009)6. OECD Economics Department, 2009. www.oecdwash.org/PDFILES/ECO_WP_Health_Reform_US.pdf
6. OECD. Privale Health Insurance in OECD Countries. OECD Policy Brief. September 2004. www.oecd.orgldataoecd/42/6/33820355.pdf.
7. World Health Organization. What Are the Equity, Efficiency, Cost Containment and Choice Implications of Private Health-Care Funding in Western Europe? July 2004. www.euro.who.int/document/e83334.pdf
8. OECD. Mission Statement. www.oecd.org/pages/Q,3417,en_36734052_36734103_1_1_1_1_1,00.html
9. HealthCast. Covering the Uninsured: Options for Reform. kaisernetwork.org, March 2, 2009. www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=3120
10. Center for Responsive Politics. Sen Max Baucus (D-MT). OpenSecrets.org. www.opensecrets.org/politicians/summary.php?cid=N00004643

Direct correspondence to: don@mccanne.org

International Journal of Health Services, Volume 39, Number 4, Pages 699-704, 2009 (c) 2009, Baywood Publishing Co., Inc.

The actuarial squeeze on low and middle income families

Provision Under Consideration for Merged Senate Health Bill Would Harm Needy Families

By January Angeles and Judith Solomon
Center on Budget and Policy Priorities
October 26, 2009

A family of three earning $27,465 a year before taxes — that is, at 150 percent of the poverty line — would have to pay $1,318 a year for health coverage under a proposal that Senate negotiators are considering for a merged health reform bill that they would bring to the Senate floor.

This is related to efforts that Senators working on the merged bill are making to cap the cost of insurance premium contributions at 10 percent of income for households that earn between 300 and 400 percent of the poverty line, rather than at 12 percent of income as under the Finance Committee bill. To help pay for this change, they reportedly are also considering increasing the amounts that very low-income households would be required to pay.

http://www.cbpp.org/cms/index.cfm?fa=view&id=2962

And…

Trends In Underinsurance And The Affordability Of Employer Coverage, 2004-2007

By Jon R. Gabel, Roland McDevitt, Ryan Lore, Jeremy Pickreign, Heidi Whitmore and Tina Ding
Health Affairs
June 2, 2009

Health plans covered slightly fewer expenses in 2007 than in 2004, but out-of-pocket spending grew more than one-third because of growth in overall health spending.

Underinsurance rose from 2004 to 2007 as the actuarial value of employer-based health insurance declined slightly, from 81.4 percent of the bill to 80.1 percent. The major change in benefit design during these years was an increase in the percentage of plans with deductibles and an increase in the average deductible level.

In the United States, if you are sick and earn a modest income, then you are probably underinsured–even if you have employer-based health coverage.

http://content.healthaffairs.org/cgi/content/full/28/4/w595

Comment:

By Don McCanne, MD

The best private insurance available today – employer-sponsored health plans – have an actuarial value of 80%. That means that the insurance pays 80% of the covered costs of health care and patients are responsible for the other 20%. Patients also are usually responsible for out-of-network services and for services and products that are not benefits of the plans.

The Health Affairs article by Jon Gabel and his colleagues shows that plans with an 80% actuarial value are not providing adequate financial protection to individuals with modest incomes who need health care. Having a plan with an 80% actuarial value can place you in the ranks of the underinsured.

Basic coverage under the proposals before Congress would provide an actuarial value of 65% or 70%. That means that the patients would be responsible for the remaining 30% or 35% of health care costs, although the proposals would limit the total amount for which the patients are responsible under the plans. Patients also would be responsible for out-of-network services and for services and products not covered by their plans.

If there is a cap on out-of-pocket spending, then why should the precise actuarial value make difference? Simply, the lower the actuarial value, the greater the likelihood that the patient will have to spend the full amount up to the cap. Thus more individuals will be negatively impacted. Also, the amount of the cap makes a very big difference. The proposed caps on out-of-pocket spending, when added to the patient’s share of the premium, create a financial hardship for most low and middle income individuals and families.

Members of Congress are particularly concerned about the high costs for those at income levels wherein the subsidies supporting the premiums are phased out. Not only do they understand that making health care unaffordable is not wise policy, but they also understand the backlash that would likely occur when the most productive sector of our society finds out what hit them.

The report from the Center for Budget and Policy Priorities demonstrates how desperate our legislators are to find a way out of this highly flawed financing proposal that hits their base supporters the hardest. To soften the impact on middle income individuals and families, they are investigating a proposal to increase the amounts that low income families would have to pay, even though they already can’t pay the current levels proposed. Perhaps they calculate that, at election time, bankrupting individuals without a political voice is a safer than facing a backlash from the base supporters.

Single-payer proponents say state health care system ‘broken’

By Kyle Chene
Belmont (Mass.) Citizen-Herald
Wed Oct 21, 2009

Boston, Mass. – Although state leaders have bristled at the pointed, dismissive and sometimes downright false claims made about the Massachusetts health care system by outsiders, they have said little about the dissent from within.

A quarter of the Legislature has signed onto a proposal to scrap the state’s landmark health care system, which still relies on private insurance companies to cover millions of residents, in favor of a single-payer system, publicly run and available to all residents.

Backers of the single-payer plan (H 2127) argued Tuesday that the state’s current system has failed to control costs, prevented even insured residents from obtaining needed care and left as much as 5 percent of the population without coverage.

The legislative supporters include Rep. Ellen Story (D-Amherst), a member of House Speaker Robert DeLeo’s leadership team and a stable of reliably liberal legislators. Officials from the League of Women Voters, the National Association of Social Workers, the Massachusetts Nurses Association and other social advocacy organizations were also on hand to register support. While such proposals have sparked fierce opposition nationally, no opponents spoke at the hearing.

The proposal by Rep. Matt Patrick (D-Falmouth) would establish a “Massachusetts Health Care Trust” reimbursing providers for health care costs, investing in health care facilities, streamlining health care bureaucracy and incentivizing quality of care. The trust would be funded by a “dedicated tax” on employers, workers and citizens, intended to replace funds currently spent on insurance premiums. The trust would also consolidate all municipal and federal health care dollars.

The trust would be overseen by a board that includes the secretary of health and human services, the secretary of administration and finance, the commission of public health, three gubernatorial appointees, three appointees of the attorney general and eight members elected by state residents.

All Massachusetts residents would be eligible to receive health care through the trust, as well as non-residents who work more than 20 hours a week in Massachusetts, pay Massachusetts income and payroll taxes and pay premiums established by the trust. Benefits would include prescription drugs, emergency care, doctor visits, hearing, vision and dental care, home health, maternity coverage and various other medical procedures.

The debate comes at a time that the governor and top lawmakers are eyeing a fundamental overhaul in the way the state pays for care. A special commission of legislators, administration officials, doctors, hospitals, insurers and health care experts recommended over the summer that Massachusetts implement a system of “global payments” aimed at curbing health care costs by coordinating individual patients’ care among various providers.

Gov. Deval Patrick has said he expects legislation enshrining such a system to be ready by the end of the month, and stakeholders from across the health care system voiced conditional support for ending the state’s current “fee-for-service” model.

Noting that the commission report “sounded the alarm” about soaring health care costs, Rep. Patrick questioned the recommendations because the members did not consider a single payer system.

“I dare you to read the report and tell me how it will work,” he said.

Sen. Patricia Jehlen (D-Somerville), a sponsor of the proposal, said passing it this year would be “politically unrealistic,” although she said health care costs would crowd out other government programs if left unchecked.

Despite the criticism of the state’s current system, aimed at offering universal access to health insurance, there is a wide array of support. Backers of the existing structure, while acknowledging that health care costs have continued to climb, note that the state has covered about 430,000 residents since the inception of health care reform in 2006. Individuals are required to purchase health insurance, and low-income residents without access to health care through their employers may obtain partially or fully-subsidized care through the state’s Connector Authority, an exchange that pairs consumers with private plans.

Opponents of single-payer care worry that it places government bureaucrats in charge of important health care decisions, would add layers of bureaucracy to the existing system, would reduce the quality of care and would disrupt relationships between doctors and patients, arguments that single-payer backers reject.

For much of the hearing, single-payer backers spoke to a sparse panel of legislators, as House members flitted between a Democratic caucus and the basement hearing room. In addition, Senate Chair Susan Fargo (D-Lincoln) and Vice Chair Mark Montigny (D-New Bedford) were absent, leaving Sen. Jennifer Flanagan (D-Leominster) with the gavel for much of the hearing. House Chair Jeffrey Sanchez (D-Boston) and Reps. Jason Lewis (D-Winchester), Cleon Turner (D-Barnstable) and Michael Brady (D-Brockton) attended parts of the hearing.

Single-payer advocate Benjamin Day, executive director of MassCare, said his favored system often fails to gain political traction because of intense lobbying efforts by the insurance industry.

“I think it’s tough because single-payer contains effective cost control,” he said. “Every bill that contains cost control is a political slugfest.”

He and other proponents of a single-payer system argued that every ambitious health care reform plan enacted by states has ultimately failed because of unsustainable costs.

Dr. Steffie Woolhandler, a Harvard University professor and advocate with Physicians for a National Health Program, questioned a 97.4 percent health insurance rate in Massachusetts, a figure highly touted by the Patrick administration.

“That’s a single organization, the Urban Institute, that gives that number,” she said. “The problem of underinsurance, being unable to afford care despite having insurance, has actually gotten worse in the state … We’ve tried a reform in this state that’s left 5 percent of the people uninsured, costing the commonwealth $1.3 billion this year.”

Rep. Timothy Madden, a freshman Democrat from Nantucket, said his family has “been through the mill” with insurance companies.

“I think the system is broken,” he said. “We should set the tenor in the leadership and the message to Washington.”

http://www.wickedlocal.com/belmont/news/x927260116/Single-payer-proponents-say-state-health-care-system-broken

Why Isn’t 122 Dead Americans Every Day a National Health Emergency?

By Donna Smith
CommonDreams.org
Published on Monday, October 26, 2009

Why does H1N1 call for a Presidential designation as a national emergency while the preventable deaths of 45,000 Americans every year (122 every day) is not?

Swine flu leads the news. You can die from swine flu, or should we say H1N1, even if you have no underlying health conditions. Young people have died, and pregnant women are at risk. People are lining up to be vaccinated. Health professionals are at risk due to poor preparations at some health facilities. As many as 1,000 deaths have occurred due to this flu outbreak. It’s scary out there.

But the swine flu is no match for the killing going on at the hands of the for-profit healthcare system in these United States. We bury kids, pregnant moms, babies, teens, young fathers, mid-lifers and older folks too without even batting an eye in the chambers of power in this nation.

Some have termed it the spine flu as they say it is the failure of our leadership to stand up to the money interests promoting and protecting this system. But it is worse than simply failing to stand up to the for-profit insurance industry, the big pharmaceutical companies, the large hospital conglomerates, the medical equipment profiteers and the financial service industry salivating at the prospects of more suffering and more want for healthcare in this nation.

There is no lack of spinal fortitude in this lot of legislators or in the Oval Office. They stand up to the American people just fine. We voted for a man who told us he knows healthcare is a basic human right yet we have a President who is not willing to issue a cease fire in this profit-driven healthcare war upon his own citizens. We swept in with him large numbers of Congressional members who said they got it — they would stop the carnage at the hands of the broken system.

But we are told to wait. It’s hard — they say — to get their bipartisan reform done. Blue Dogs might be upset. The Republicans want to protect the free market of death-care, and the Democrats want to stay in office. So they all stand up all right, they stand up for their own self-interests and the death count rises ever higher each day.

Yet, they dribble and dawdle and bumble and act as though it’s just too damned difficult to immediately stop the losses. Extend Medicare like coverage to all, right now, and then haggle about the details later boys and girls.

Issue an executive order, President Obama. Declare a national emergency. No one else denied care when it is available. Save the lives of as many as you can right now. It could be that simple. Really.

It is a national health emergency in this nation when pregnant 24-year-olds like Jenny Fritts of Indiana are turned away for appropriate care because she doesn’t have a way to pay for it and she dies along with her baby. It is a national emergency when teenagers like Nataline Sarkisyan are denied lifesaving treatments until protests grow loud enough to pressure the insurance industry and she dies due to that delay and the need to protest.

So, if the hospital that killed Jenny Fritts had treated her (and her unborn child) and was then worried about the money to cover her care, is that something we can fix? That’s an issue we have time to haggle over. But the time to save Jenny came and went. We allowed her to be killed. And because we all know these deaths are happening every single day in every single state in this nation, we are all to be held to account.

The media doesn’t help either. They are leading the news with the swine flu fears but completely ignoring the kids and moms and dads and neighbors dying underfoot for a lack of healthcare of any kind when they need it. Shameful excuse for journalism in most cases, I’m afraid.

A public health emergency is defined as “an occurrence or imminent threat of an illness or health condition, caused by bioterrism, epidemic or pandemic disease, or novel and highly fatal infectious agent or biological toxin, that poses a substantial risk of a significant number of human fatalities or incidents of permanent or long-term disability. Such illness or health condition includes, but is not limited to, an illness or health condition resulting from a national disaster.”

What do we not understand about the appropriate role of our elected and democratic government to protect us from such a threat killing 122 of us every day? As far as I am concerned, the whole lot of them is not fulfilling their legal duties to me or to the rest of the citizens of this nation. They are failing in the most fundamental way to protect for the common welfare and common good of this nation.

Declare the emergency, Mr. President. Back him up, Speaker Pelosi and Senator Reid. Treat the sick. There is time to fight the payment battle. Healthcare is a basic human right in America.

Donna Smith is a community organizer for the California Nurses Association and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

Is health insurers’ profit 2% or 22%?

Health insurers’ profits 35th of 53

By Calvin Woodward
The Washington Post
October 26, 2009

Health insurance profit margins typically run about 6 percent, give or take a point or two.

Health insurers posted a 2.2 percent profit margin last year, placing them 35th of 53 industries on the Fortune 500 list. As is typical, other health sectors did much better – drugs and medical products and services were both in the top 10.

Leading the list: network and other communications equipment, at 20.4 percent.

http://www.washingtonpost.com/wp-dyn/content/article/2009/10/26/AR2009102600229.html

And…

Morningstar
October 26, 2009

Health care plans – net profit margin: 3.3%

http://biz.yahoo.com/ic/522.html

And…

American Medical News
August 24, 2009

Medical loss ratios of largest publicly traded health plans:
Average 85.2% (non-weighted, range 82.9% – 86.8%)

http://www.ama-assn.org/amednews/2009/08/24/bisb0824.htm

Comment:

By Don McCanne, MD

In simple accounting terms, profit represents the difference between gross revenues and the cost of producing and marketing the products or services sold. So what is the product that the private insurers are selling us? Administrative services.

Unlike most other businesses, the revenues of the private insurers include our own funds that essentially are held in trust for the eventual payment of medical claims – currently 85.2% as represented by their medical loss ratios. Their business costs relate strictly to their product – the administrative services – currently 14.8% of their revenues. Thus their profit margin, to make sense, should be calculated based on their business model of providing us administrative services, but not on the funds held in trust which involve negligible expenses but which provide them with long term investment income. (Profit statements for the notorious financial services industry should also be adjusted accordingly since that is also our money that they are jerking around.)

The 3.3% profit margin reported by Morningstar includes the funds held in trust, but if adjusted to include only all costs of their legitimate business operations of producing and marketing their administrative services then their profit margin is actually 22.3%. That moves them into first place on the Fortune 500 list of profitable firms, in front of the network and communications equipment industry (20.4% profit).

To be realistic, playing with these numbers does not change the fact that eliminating these profits would have only a very small direct impact on our total national health expenditures – saving less than 1% of our health care dollars. What would have a tremendous impact would be to eliminate an industry that has the incentive of a 22% profit margin on a product that is designed to reduce our access to the health care that we need, not to mention a product that places a costly administrative burden on our health care delivery system. Eliminating the private insurance industry could have a hugh direct impact on our health care spending – diverting perhaps $4 trillion over the next ten years from administrative waste, and redirecting it to patient care.

We need to take heed of this comment in today’s Los Angeles Times:

“As President Obama’s push for a healthcare overhaul moves toward its final act, the oft-vilified health insurance industry is on the verge of seeing a plan enacted that largely protects its financial interests.”

http://www.latimes.com/business/la-fi-health-insure26-2009oct26,0,11741,full.story

Is health insurers' profit 2% or 22%?

Health insurers’ profits 35th of 53

By Calvin Woodward
The Washington Post
October 26, 2009

Health insurance profit margins typically run about 6 percent, give or take a point or two.

Health insurers posted a 2.2 percent profit margin last year, placing them 35th of 53 industries on the Fortune 500 list. As is typical, other health sectors did much better – drugs and medical products and services were both in the top 10.

Leading the list: network and other communications equipment, at 20.4 percent.

http://www.washingtonpost.com/wp-dyn/content/article/2009/10/26/AR2009102600229.html

And…

Morningstar
October 26, 2009

Health care plans – net profit margin: 3.3%

http://biz.yahoo.com/ic/522.html

And…

American Medical News
August 24, 2009

Medical loss ratios of largest publicly traded health plans:
Average 85.2% (non-weighted, range 82.9% – 86.8%)

http://www.ama-assn.org/amednews/2009/08/24/bisb0824.htm

Comment:

By Don McCanne, MD

In simple accounting terms, profit represents the difference between gross revenues and the cost of producing and marketing the products or services sold. So what is the product that the private insurers are selling us? Administrative services.

Unlike most other businesses, the revenues of the private insurers include our own funds that essentially are held in trust for the eventual payment of medical claims – currently 85.2% as represented by their medical loss ratios. Their business costs relate strictly to their product – the administrative services – currently 14.8% of their revenues. Thus their profit margin, to make sense, should be calculated based on their business model of providing us administrative services, but not on the funds held in trust which involve negligible expenses but which provide them with long term investment income. (Profit statements for the notorious financial services industry should also be adjusted accordingly since that is also our money that they are jerking around.)

The 3.3% profit margin reported by Morningstar includes the funds held in trust, but if adjusted to include only all costs of their legitimate business operations of producing and marketing their administrative services then their profit margin is actually 22.3%. That moves them into first place on the Fortune 500 list of profitable firms, in front of the network and communications equipment industry (20.4% profit).

To be realistic, playing with these numbers does not change the fact that eliminating these profits would have only a very small direct impact on our total national health expenditures – saving less than 1% of our health care dollars. What would have a tremendous impact would be to eliminate an industry that has the incentive of a 22% profit margin on a product that is designed to reduce our access to the health care that we need, not to mention a product that places a costly administrative burden on our health care delivery system. Eliminating the private insurance industry could have a hugh direct impact on our health care spending – diverting perhaps $4 trillion over the next ten years from administrative waste, and redirecting it to patient care.

We need to take heed of this comment in today’s Los Angeles Times:

“As President Obama’s push for a healthcare overhaul moves toward its final act, the oft-vilified health insurance industry is on the verge of seeing a plan enacted that largely protects its financial interests.”

http://www.latimes.com/business/la-fi-health-insure26-2009oct26,0,11741,full.story

Dr. Steffie Woolhandler on CSPAN

Dr. Steffie Woolhandler talked about a study she co-authored. According to the report, 62 percent of all bankruptcies are caused by illness and medical bills. Dr. Woolhandler also responded to telephone calls and electronic communications. Dr. Woolhandler participated by remote access from West Newton, Massachusetts. C-SPAN Radio’s Nancy Calo read news headlines at the end of the program.r talked about a study she co-authored. According to the report, 62 percent of all bankruptcies are caused by illness and medical bills. Dr. Woolhandler also responded to telephone calls and electronic communications. Dr. Woolhandler participated by remote access from West Newton, Massachusetts. C-SPAN Radio’s Nancy Calo read news headlines at the end of the program.

Lack Of Insurance Compounds Chronic Disease Burden

By Joseph Shapiro
NPR
October 20, 2009

It’s dangerous enough to deal with a chronic illness like diabetes or cholesterol. But Americans who don’t have health insurance often have these conditions and don’t even know it.

Chronic health problems can lurk undetected for the uninsured.

The result is that the uninsured often don’t get the medical care they need to maintain their health, says a study just published online by the journal Health Affairs.

Researchers found that about half of all uninsured people who have diabetes (46 percent) or who have high cholesterol (52 percent) had no idea they had those diseases. By contrast, among the insured, only about a quarter were unaware when they had those chronic diseases (23 percent for diabetes; 30 percent for high cholesterol).

Dr. Andrew Wilper, who practices at a Boise, Idaho, clinic affiliated with the University of Washington and a co-author of the study, said there’s sometimes a misperception that even people without insurance get the care they need to manage chronic illness. “I’ve read in the media multiple times that the uninsured do, in fact, have access to health care,” says Wilper, “and I think that notion runs totally counter to my clinical experience and this data reflects the same.”

Wilper and his co-authors, looked at a federal data from the physical exams of sixteen thousand Americans, under the age of 65.

Among the study’s co-authors are two prominent advocates for a single-payer health care system: Dr. Steffie Woolhandler and Dr. David Himmelstein, both of whom teach at Harvard Medical School. Woolhandler said the “shocking” percentage of people with insurance who still go without discovery or treatment of chronic illness probably reflected high co-payments and deductibles that “often make care and medications unaffordable”. In a press release with the report, she argued, “only single-payer national health insurance would make care affordable for the tens of millions of Americans with chronic illness.”

An earlier study by the same researchers, published last month in the on line edition of the American Journal of Public Health, said that about 45,000 deaths a year can be attributed to a lack of health insurance–more than the deaths caused by kidney disease.

The government estimates 46 million people in America are without health insurance.

http://www.npr.org/blogs/health/2009/10/lack_of_insurance_compounds_ch.html

Doctor panel advocates Medicare-for-all legislation

By Patricia C. McCarter
Huntsville Times
October 21, 2009

HUNTSVILLE, AL — Asked how many people knew someone who had died because they couldn’t afford medical care, five of the 70 people at the Health Care is a Human Right physicians panel discussion stood up.

Asked how many knew someone who “suffered unnecessarily” for the same reason, almost everyone at the Tuesday night meeting at St. Bartley Primitive Baptist Church rose.

Huntsville pediatrician Pippa Abston, a leading voice for the all-volunteer North Alabama Healthcare for All, called those numbers “abominable.”

“These are real people,” said Abston, adding that 19 Alabamians die every week because they can’t afford care.

North Alabama Healthcare for All has sponsored other forums since national medical insurance became such a hot topic this summer, but this one was designed to focus on how people of color are impacted.

Dr. Celia Lloyd-Turney is medical director of the nonprofit Choice Medicine clinic in Toney and local chapter president of the National Medical Association, which is composed of African-American doctors. She said that poverty has caused blacks to get lesser medical treatment than other patients, and that her race tends to suffer more from diabetes, high pressure and kidney failure.

But even if all Americans had the same insurance, she said some doctors wouldn’t give blacks the same level of care because of prejudice.

Abston said Medicare-for-all couldn’t erase prejudice, but it would at least enable all people to get a doctor’s appointment. The pediatrician also agreed with a woman who commented that it would be hypocritical and morally wrong to leave out 13 million illegal immigrants.

The third doctor on the panel was Birmingham’s Wally Retan, state coordinator of Health Care for Everyone. He said most people who don’t approve of such an “incredibly simple” single-payer program distrust government, already like what they have, fear enormous tax increases or feel “better the devil you know than the devil you don’t.”

Regardless, he said he believed that reform could happen, and he even began a brief chant of “Yes, we can,” President Barack Obama’s campaign slogan.

The group endorses HR676, proposed by Democratic Congressman John Conyers of Michigan.

http://blog.al.com/breaking/2009/10/doctor_panel_advocates_medicar.html