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By Susanne L. King
Boston Globe
March 2, 2009

Massachusetts has been lauded for its healthcare reform, but the program is a failure. Created solely to achieve universal insurance coverage, the plan does not even begin to address the other essential components of a successful healthcare system.

What would such a system provide? The prestigious Institute of Medicine, part of the National Academy of Sciences, has defined five criteria for healthcare reform. Coverage should be: universal, not tied to a job, affordable for individuals and families, affordable for society, and it should provide access to high-quality care for everyone.

The state’s plan flunks on all counts.

First, it has not achieved universal healthcare, although the reform has been a boon to the private insurance industry. The state has more than 200,000 without coverage, and the count can only go up with rising unemployment.

Second, the reform does not address the problem of insurance being connected to jobs. For individuals, this means their insurance is not continuous if they change or lose jobs. For employers, especially small businesses, health insurance is an expense they can ill afford.

Third, the program is not affordable for many individuals and families. For middle-income people not qualifying for state-subsidized health insurance, costs are too high for even skimpy coverage. For an individual earning $31,213, the cheapest plan can cost $9,872 in premiums and out-of-pocket payments. Low-income residents, previously eligible for free care, have insurance policies requiring unaffordable copayments for office visits and medications.

Fourth, the costs of the reform for the state have been formidable. Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009, which is not sustainable.

Fifth, reform does not assure access to care. High-deductible plans that have additional out-of-pocket expenses can result in many people not using their insurance when they are sick. In my practice of child and adolescent psychiatry, a parent told me last week that she had a decrease in her job hours, could not afford the $30 copayment for treatment sessions for her adolescent, and decided to meet much less frequently.

In another case, a divorced mother stopped treatment for her son because the father had changed insurance, leaving them with an unaffordable deductible. And at Cambridge Health Alliance, doctors and nurses have cared for patients who, unable to afford the new copayments, were forced to interrupt care for HIV and even cancers that could be treated with chemotherapy.

Access to care is also affected by the uneven distribution of healthcare dollars between primary and specialty care, and between community hospitals and tertiary care hospitals. Partners HealthCare, which includes two major tertiary care hospitals in Boston, was able to negotiate a secret agreement with Blue Cross Blue Shield of Massachusetts to be paid 30 percent more for their services than other providers in the state, contributing to an increase in healthcare costs for Massachusetts, which are already the highest per person in the world. Agreements that tilt spending toward tertiary care threaten the viability of community hospitals and health centers that provide a safety net for the uninsured and underinsured.

There is, though, one US model of healthcare that meets the Institute of Medicine criteria: Medicare. Insuring everyone over 65, Medicare achieves universal coverage and access to care, is not tied to a job, and is affordable for individuals and the country. Medicare simplifies the administration of healthcare dollars, thereby saving money. We need to improve Medicare, and expand this program to include everyone.

A bill before Congress, the United States National Health Insurance Act, would provide more comprehensive coverage for all. The bill includes doctor, hospital, long-term, mental health, dental, and vision care, prescription drugs, and medical supplies, with no premiums, copayments, or deductibles.

People would be free to choose doctors and hospitals, and insurance would not be tied to a job. Costs would be controlled because health planning in a national health program can reestablish needed balance between primary/preventive care and high-tech tertiary care. A modest, progressive tax would replace what people currently pay out of pocket. This program would pay for itself by eliminating the wasteful administrative costs and profits of private insurance companies, and save $8 billion to $10 billion in Massachusetts alone.

We must let Congress know we want improved access to affordable healthcare for all, not more expensive private health insurance we can’t afford to use when we are sick. Massachusetts healthcare reform fails on all five Institute of Medicine criteria. Congress should not make it a model for the nation.

Susanne L. King, M.D., practices in Berkshire County.

http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2009/03/02/mass_healthcare_reform_is_failing_us/

Statement of Sidney Wolfe, M.D., Director, Public Citizen’s Health Research Group, and James Floyd, M.D., Researcher, Public Citizen’s Health Research Group
Feb. 26, 2009

This morning, President Obama announced he will create a $634 billion reserve fund over the next decade to provide a down payment for expanding health coverage. The announcement comes a week before a White House health care summit that marks the beginning of the first serious effort to reform health care since the Clinton task force in 1993.

The president wants this process to be open and transparent, with the goal of achieving universal coverage. However, groups representing physicians, nurses, and consumers who advocate for a single-payer system of national health insurance have thus far been excluded from the summit.

Under a single-payer system, doctors, hospitals and other health care providers are paid from a single fund administered by the government. The system would eliminate the wasteful spending and high administrative costs of private insurance, saving almost $400 billion annually. This savings is enough to provide every American with the same high-quality care, including those who currently have insurance but still cannot afford medications and treatment.

If health care is a key to fixing our national deficit and providing the economic stimulus that we need to recover from this recession, it is unacceptable to ignore the only system that will provide true universal coverage. If the only people who have input on health care reform are the lobbyists who represent the interests of insurance and drug companies, the final result will be a system that benefits the insurance and drug companies.

The Clinton task force on health reform made a similar mistake of excluding the voices of those who support a single-payer system, and the result was a complicated, inadequate reform proposal that catered to the interests of insurance companies and failed to garner public support. At a time when public support for single-payer is greater than ever – more than 60 percent in recent polls – we urge President Obama not to make the same mistake. He must include single-payer advocates in the health care summit next week.

Andrew Coates MD

COBRA is a law that allows you to keep your employer-sponsored health insurance for 18 months if you lose or change jobs. To do so, you have to pay 102% of the cost (the full premium plus a 2% surcharge).

The stimulus package just passed provides for laid off workers, who had health insurance on the job, to receive a subsidy of 65% of the health insurance premium for up to nine months.

According to a report by FamiliesUSA, the national average unemployment benefit is $1,278 monthly. Under COBRA, national family coverage averages $1,069 per month. So laid off workers, in order to keep health insurance for their families, will have to pay more than $375 a month but after nine months will have to come up with the full $1,069.

To keep family coverage under COBRA, with the subsidy, it will cost people who are laid off, on average, almost one-third of every unemployment check. This money will go to a health insurance company, instead of food, housing and school expenses for the family.

A recent study by the Commonwealth Fund reported that only 9% of unemployed workers continued health insurance under COBRA. The 65% subsidy should allow some to consider keeping health insurance under COBRA, where before it would have been just unthinkable. This can help those with chronic illnesses, or those with very sick family members, or where a spouse continues working.

But while the subsidy makes private health insurance through COBRA slightly more affordable for the unemployed, purchasing it remains a Faustian bargain. What “stimulus” is there in asking a person who has just lost their job to give almost a third of each unemployment check to the private insurance industry? And what will they do after nine months have come and gone?

Despite the good intentions in Congress and the White House, subsidized COBRA payments are not feasible for the unemployed — and terrible policy for the nation. There is no reason why Congress should shovel our money into an industry that pits its profits against our health, with a program that holds almost one-third of our limited unemployment check hostage and only lasts nine months.

If the leaders of this nation wanted to provide health security for all they would enact a single-payer mechanism to finance health care.

Single payer would mean that no one would ever be without health care. Not first time job seekers, not workers changing jobs, not laid off or striking workers. Everyone would be covered.

A single payer health program would save at least $400 billion in health spending per year, and create millions of new jobs. It would mean enormous savings for employers (including federal, state and local governments as well as schools and not-for-profit agencies) who now pay private health insurance premiums, and allow unions to get back to bargaining for wages and working conditions instead fighting over reduced benefit levels, bigger premiums, more co-pays and deductibles. Everyone would be relieved from the worry about health coverage that now comes with the loss of a job.

Now that would be a stimulus! We really need single payer national health care.

Andrew Coates MD works on the staff of a state hospital near Albany, NY He is a member of the Professional Employees Federation (PEF) a joint statewide affiliate of AFT and SEIU.

By Timothy P. Carney
DC Examiner
Beltway Confidential blog
2/25/09

Although President Barack Obama promised that he would freeze out the lobbyists in order to finally reform our broken health-care system, his nascent push to overhaul the industry already shows signs of becoming a lobbying feeding frenzy, with health insurers, drug makers and employers all poised to benefit from government’s expanded role.

We don’t yet have the specifics of Obama’s plan, but we do know its centerpiece: an individual mandate on health insurance. Obama has said — and corporate-labor lobbying coalitions have agreed — that Washington should require Americans to buy health insurance. When healthy people opt out of the insurance pool, the theory goes, risk is not adequately spread.

You can guess who’s most enthusiastic about the individual mandate: the insurance companies. Sure enough, The New York Times reported last week that America’s Health Insurance Plans, the trade association representing health maintenance organizations, has been working with Sen. Edward Kennedy, D-Mass., to help draft a plan that includes a mandate.

Another player in Kennedy’s backroom meetings is the Pharmaceutical Research and Manufacturers of America, usually a bete noire for liberals because it represents the drug companies. PhRMA’s primary stake in this fight is also obvious. It wants mandates and subsidies, and it wants to limit cost-control measures that would favor cheaper generic drugs.

La Merie, a “business intelligence” publisher, wrote in a recent pharmaceutical industry report: “Obama’s new universal health-care program will increase demand for drugs, both branded and generic, reduce the need for free drug programs due to universal health-care coverage, and boost pediatric drug and vaccine programs.” Sounds like a good deal for drug makers.

Groups lobbying on health-care policy include the Coalition to Advance Healthcare Reform, led by Safeway Chief Executive Officer Steve Burd, who actively backed Arnold Schwarzenegger’s plan to require all California businesses to cover their workers or face a new 4 percent tax. The coalition’s lobbyists include Judith Lemons, the former chief of staff for House Speaker Nancy Pelosi.

Lobbying powerhouse General Electric is a champion of Obama’s proposals to create a national health database — a database GE plans to build, manage or both.

What about the small-business coalitions that were crucial to killing HillaryCare in 1993? “They’re going to have to buy off small business,” says Cato Institute health-care expert Michael Tanner. Subsidies for small employers to afford health insurance are likely to do the trick.

To be sure, drug makers and insurers will have to bear the brunt of new regulations that come with increased government involvement. A priority for Kennedy and Obama is the pair of policies called “guaranteed issue” and “community rating.” The latter means insurers may not charge customers different premiums based on their health or age. Because this would encourage insurers to simply refuse to insure older customers or those with pre-existing conditions, government would require “guaranteed issue,” meaning that insurers could not turn down applicants.

Requiring insurers to charge one price and accept all comers would boost prices and drive away younger customers, who would find it cheaper to pay medical expenses out of pocket. Then only sick people, old people and families with kids would buy insurance — a high-risk pool, requiring even higher premiums. That’s why government will force younger and healthier people to join the pool with the individual mandate. Even so, the addition of high-risk and newly insured people will drive up the cost of health insurance — and taxpayers will get stuck with the bill.

Regulations spur mandates, which spur regulations, which spur subsidies. Insurers love the subsidies and the mandates, and the regulations don’t bother them too much — huge regulatory burdens, after all, keep out competition.

The great irony is that Kennedy and Obama, when calling for universal health care, have portrayed themselves as battling big business and freezing out the lobbyists. But it’s not as if Obama’s victory has cowed big business to the point of surrender. Many big businesses have long called for a greater government role in health care.

Insurers, drug makers, General Electric, regulators and employers will all benefit, and Obama will declare it a great group effort and a win-win solution. In truth, not everyone wins. “In the end, the taxpayers are going to lose,” says Tanner, “because the taxpayers are going to pay to buy everyone off.”

Excerpt from Democracy Now
2/25/09

AMY GOODMAN: And healthcare? He’s called for universal healthcare, but he does not call for single-payer healthcare.

JOSEPH STIGLITZ: I think that there are some fundamental problems in the efficiency of our healthcare system. And what we’ve seen is that the private healthcare insurers do not know how to deliver an efficient way.

AMY GOODMAN: Do you support single-payer healthcare?

JOSEPH STIGLITZ: I think I’ve reluctantly come to the view that it’s the only alternative. You know, we’ve tried a lot of other things. And we’ve been–you know, I was in the Clinton administration, and we debated a lot of alternatives, and I’ve watched things as they’ve emerged and, you know, evolved over the last twelve, sixteen years, and I think there’s a growing consensus that the private market exclusion is not going to work.

AMY GOODMAN: Joe Stiglitz, I want to thank you for being with us, the Nobel Prize-winning economist, professor at Columbia University, co-author of The Three Trillion Dollar War: The True Cost of the Iraq Conflict.