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Our health care dollars at work

Blue Cross CEO collects $16.4 million

By Susanne L. King
Berkshire Eagle
Wednesday, November 28

For all you boomers who are looking retirement in the eye, cast your gaze on a recent Boston Globe article entitled “Blue Cross gave chairman $16.4 million in retirement pay.” William C. Van Faasen, 58, collected those benefits in 2006, even though he didn’t leave the company. He merely stepped down as chief executive of Blue Cross and Blue Shield of Massachusetts, but retained his position as chairman, receiving nearly $3 million in salary and bonuses the same year he collected retirement benefits. This astonishing gift went to the chairman of a non-profit organization that does not pay income taxes to a state that is trying to provide universal health insurance to its citizens.

According to a survey conducted by the non-partisan research group, the Employee Benefit Research Institute, the rising costs of health care are cutting into the ability of workers to contribute to their retirement accounts. The researchers found that 63 percent of Americans have experienced an increase in costs they had to pay under their health plans in the past year. Of those, more than 50 percent reduced their household savings because of increased health care costs, and 30 percent decreased the amount they saved they saved for retirement.

On the other hand, Van Faasen retires at an early age, wealthy beyond one’s wildest dreams thanks to our health care dollars. And we work longer and find it harder to fund our retirement years.

Massachusetts, meanwhile, is having trouble finding enough money for its new health care program, as more previously uninsured people have signed up for the government-subsidized health plans than was anticipated. The Berkshire Eagle reported last week that the state may need an additional $146 million to pay for the program this fiscal year.

In a separate article, The Eagle also reported that insurance companies estimated that prices for the Commonwealth Choice health plans that are not subsidized by the state will be raised 10-12 percent by the insurance companies next year. In addition, the cheapest and most heavily subscribed plan will be dropped. The lack of affordability of the insurance plans for the state, individuals, and businesses makes Van Faasen’s salary and retirement benefit package, and Blue Cross /Blue Shield’s non-profit status, even more astonishing.

If we had a single-payer health insurance program, either in our state or nationwide, insurance companies, with their bloated administrative expenses that include CEO salaries and retirement benefits, would not exist. Health care funds would be administered by either the state or federal government, and administrative expenses would be 3 percent instead of more than 30 percent. Nationally, this would save $350 billion annually in administrative costs, enough to provide comprehensive health care for the 47 million uninsured people in our country. Everyone would be in the same risk pool, and cherry-picking of healthy workers by the insurance companies would not exist. There would be no drain of our hard-earned retirement funds to line the pockets of health insurance company executives.

Single-payer legislation in our state is called the Massachusetts Health Care Trust, Senate Bill 703 (full text at www.mass.gov/legis/bills/senate/185/st00/st00703.htm).

The federal legislation for single-payer health care is H.R. 766. You might be interested in the covered services in the state single-payer bill, in order to compare them to your current Massachusetts health insurance coverage. The benefits in the single-payer bill include prevention, diagnosis and treatment of illness and injury, both inpatient and outpatient, as well as mental health and dental care, acupuncture, physical therapy, chiropractic and podiatric treatment. Covered benefits also include all prenatal and maternity care, rehabilitation of sick and disabled persons, prescription drugs, and medical equipment and appliances-all the services that you would expect in a comprehensive health plan.

Of especial interest to all you baby boomers (and your children), other covered benefits are home health care, including personal care, and long-term care in nursing homes. The legislation specifically states: “No deductibles, co-payments, co-insurance, or other cost sharing shall be imposed with respect to covered benefits.” Now that would improve your retirement planning — no need to buy long-term care insurance and health insurance policies to supplement Medicare and pay for your prescriptions. If we did not have to fill the coffers of the insurance companies and their executives, we would all be better off financially.

Health insurance companies have money and powerful lobbying forces; you have your voice. Call, write or e-mail your legislators and tell them what you think.

Susanne L. King, M.D. is a Lenox practitioner.

Dr. Bret McFarlin to Question Candidates During Heartland Presidential Forum in Des Moines Iowa on Saturday, December 1, 2007

Des Moines (November 27, 2007)–On Saturday, December 1, Dr Bret McFarlin representing Iowa Citizens for Community Improvement will take part in the Heartland Presidential Forum in Des Moines, Iowa by asking a presidential candidate a question regarding healthcare reform. Candidates participating in the forum are Sen. Hillary Clinton, Sen. John Edwards, Sen. Christopher Dodd, Congressman Dennis Kucinich and Sen. Barack Obama. The entire forum, which is sponsored by the Center for Community Change (CCC) and Iowa Citizens for Community Improvement (CCI), will live on C-SPAN at 2:00 PM Central time.

The Heartland Presidential Forum, which is expected to draw 5,000 attendees, differs from other forums with its unique format. Top-tier candidates will take their turn onstage and will be asked real questions by real people, rather than giving canned speeches. This design is meant to put power back in the hands of the people and hold candidates accountable to what we the people really value.

Dr McFarlin points out that, “Universal health insurance reform is a high priority domestic issue this caucus season. As ever increasing number of Americans find healthcare inaccessible or unaffordable, our social solidarity and shared commitment to the greater good is called into question.”

The forum is an important part of the Campaign for Community Values, a multi-issue and multi-year effort to challenge the divisive message of the right and to promote Community Values. The Campaign for Community Values is a collective by more then 100 community-based organizations from all over the country to have an impact on public opinion and the 2008 elections.

Dr. McFarlin is Director of Internal Medicine at Broadlawns Medical Center, Polk County’s safety net hospital, a member of Physicians for a National Health Program, and an advocate for universal healthcare reform.

Visit www.iowaheartlandforum.org for more information on forum.

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SiCKO Cure Road Show Rolls into New Orleans, Joins Voices Calling for Charity Hospital Reopening

By Donna Smith
Progressive Democrats of America, Colorado member
November 27, 2007, New Orleans, LA

The SiCKO Cure Road Show rolled into New Orleans on Saturday, and the road show team immediately joined a meeting of local activists fighting the demolition of thousands of public housing units. Though some relatively powerful groups oppose the loss of some 3,900 public housing units, the demolitions will begin on December 4 unless an unexpected court ruling or an even more unlikely change of heart occurs to halt the tearing down of this vital housing for low income residents of the area.

Many people believe that the rebuilding of New Orleans includes a significant shifting of resources and effort toward private ownership and operation of formerly public facilities and services. Charity Hospital, which, prior to Katrina, provided vital health care and out-patient services to more than 500,000 people annually has never reopened. If those displaced by Katrina are ever to return to their homes in New Orleans, and if the city is ever to rebuild the full richness of its character and its people, the gutting of those places and services that allow societal diversity-race, class and otherwise-must be halted.

The road show has the mission of bringing the message of HR676, single-payer universal health care (The National Health Insurance Act), to the people of the area, and the issues of homelessness and lack of public facilities serving the poor and uninsured often go hand-in-hand with a lack of access to health care and other issues surrounding poverty. Donna Smith, who appears in ‘SiCKO,’ is on the road show team, and it also includes Liv Boykins, special assistant to Rep. John Conyers of Michigan, Julia Atkins of Florida, Joe Friendly of New York City and Bill Hill of Tucson. The team pulled into New Orleans after visiting cities in Indiana, Kentucky, Tennessee, Alabama and Mississippi.

More than two years ago, Hurricane Katrina and the levy breaches that followed claimed the lives of thousands in New Orleans as a horrified world watched. Though the FEMA debacle and the ‘Heckuva job Brownie’ moments made us all ashamed of the U.S. government’s response to the disaster, the continued failure of the local, state and federal government responses now cry out for more than shame and outrage-and most especially for action.

Brad Ott of New Orleans leads The Committee for the Reopening of Charity Hospital, and he explained after the viewing of SiCKO on Saturday evening at the Ashe’ Cultural Arts Center that one of the group’s efforts will be to bring a class action legal case on behalf of those who now find themselves unable to access health care and who were formerly patients at Charity Hospital. Ott is looking for plaintiffs in the case and urges those who may be interested to contact him.

Additional efforts to stop the demolition of public housing continue as well. For more information on that effort in new Orleans, click here.

The SiCKO Cure National Road Show team pushes off for Tallahasee next, and for more information on the tour and its stops please visit healthcare-now.org. The road show is being co-sponsored by Healthcare-Now, the California Nurses Association, Physicians for a National Health Program, and other groups along the way.

Join Donna Smith and other PDA healthcare activists in the PDA Healthcare for All/Single Payer Healthcare Issue Organizing Team. Contact Diane@pdamerica.org.

Study finds immigrants' use of healthcare system lower than expected

UCLA researchers find that Latinos in the U.S. illegally are 50% less likely to visit emergency rooms.

By Mary Engel
Los Angeles Times Staff Writer
November 27, 2007

Illegal immigrants from Mexico and other Latin American countries are 50% less likely than U.S.-born Latinos to use hospital emergency rooms in California, according to a study published Monday in the journal Archives of Internal Medicine.

The cost of providing healthcare and other government services to illegal immigrants looms large in the national debate over immigration.

In Los Angeles County, much of the focus of that debate has been on hospital emergency rooms. Ten have closed in the last five years, citing losses from treating the uninsured, and those that remain open are notorious for backlogs.

By federal law, hospitals must treat every emergency, regardless of a person’s insurance — or immigration — status. Illegal immigrants, who often work at jobs that don’t offer health insurance, are commonly seen as driving both the closures and the crowding.

But the study found that while illegal immigrants are indeed less likely to be insured, they are also less likely to visit a doctor, clinic or emergency room.

“The current policy discourse that undocumented immigrants are a burden on the public because they overuse public resources is not borne out with data, for either primary care or emergency department care,” said Alexander N. Ortega, an associate professor at UCLA’s School of Public Health and the study’s lead author. “In fact, they seem to be underutilizing the system, given their health needs.”

Ira Mehlman, media director for the Federation for American Immigration Reform, a group that lobbies for tougher immigration controls, said that usage rates are just one measure of illegal immigrants’ effect on healthcare. The other factor, he said, is the cost to taxpayers, which Ortega’s study did not examine.

Cost estimates vary widely. A Rand Corp. study published last year in the journal Health Affairs put the cost of healthcare for illegal immigrants nationwide at $1.1 billion a year, excluding care for those younger than 18 and older than 64.

FAIR called the Rand number a “low-ball” estimate. Its own study of healthcare costs of illegal immigrants and their dependents, including U.S.-born children, estimated California’s portion alone to be about $1.5 billion a year.

Mehlman said $1.5 billion “is still a significant amount of money, unless you’re Bill Gates.”

Ortega’s study is not the first to find that illegal immigrants use fewer healthcare services than people born in the U.S. But his study used the largest sample, analyzing data from 42,044 participants of the 2003 California Health Interview Survey, a randomized telephone survey conducted by the UCLA Center for Health Policy Research and the California Department of Public Health.

And while other studies have attributed lower usage to immigrants simply being younger and healthier than the overall population, the study published Monday took into account age, health status, insurance status and poverty level. All such factors being equal, it found, immigrants still made fewer visits to physicians and were 30% less likely than U.S.-born Latinos to have a regular source of healthcare.

Dr. Felix Nuñez, a Los Angeles-based family physician and former medical director of the South Central Family Health Center, said the findings confirm what he sees in clinics.

Illegal immigrants are infrequent patients for primary care visits, he said, because being asked for ID cards, Social Security numbers and employment histories makes them nervous. They fear being reported to authorities, even though the information is used only to determine Medi-Cal eligibility or to set a sliding-scale fee.

What did surprise Nuñez was the relatively low use of emergency rooms by illegal immigrants.

“My gut would have told me that they’d be higher users of emergency services because they’re not coming in for routine, preventive care,” he said. “This kind of study is really important because it forces you to look at the data and rethink your assumptions.”

mary.engel@latimes.com

Just Off Insular Senate Floor, Life of the Uninsured Intrudes

By ROBERT PEAR
The New York Times
November 25, 2007

WASHINGTON, Nov. 24 — When senators debate health care, they usually speak in abstract terms about soaring health costs and the plight of the uninsured.

But just 20 feet from the Senate chamber is a young man who knows those problems all too well from personal experience. The man, Sergio A. Olaya, runs the Capitol elevators on which the senators ride. Whenever the Senate is in session, he is on duty.

Mr. Olaya, 21, is struggling with $255,000 of medical bills incurred by his mother before she died in April from an aggressive form of brain cancer.

A local hospital and its collection agency have been hounding him in an effort to collect from his mother’s estate, Mr. Olaya said. To pay the bills, he is selling the Maryland home where he lived with his mother, Clara Ines Olaya, 61.

His experience highlights the problems of the uninsured, from which members of Congress are usually insulated. The leading Democratic presidential candidates say all Americans should have coverage as good as what Congress has.

As a government employee, Mr. Olaya has health insurance. But his mother, like 47 million other Americans, was uninsured.

“I wonder how many senators have been in the elevator with Sergio, talked to him, shared a smile with him, but had no idea of the terrible burden he and his mother were carrying,” said Senator Richard J. Durbin of Illinois, the Senate Democratic whip, who learned of Mr. Olaya’s problems from an aide.

In an interview, Mr. Olaya said: “I’m just a college kid. I don’t have financial support from anyone. Paying $255,000 for medical bills derails my ability to pay for college.”

Senators have access to a wide range of insurance options through the Federal Employees Health Benefits Program. Congress has its own “attending physician” — actually, a team of 5 doctors and 14 nurses who work in the Capitol and nearby Congressional office buildings. Lawmakers can fill prescriptions at a small pharmacy in the Capitol. For more serious problems, they can use nearby military hospitals.

But Congress is far from agreement on any comprehensive proposals to help the uninsured. Even legislation to cover children has been caught up in a furious battle with President Bush over the proper role of government in providing insurance.

Senators are not normally exposed to the fears that strike many workers as employers reduce health benefits and insurers increase premiums year after year. Annual increases of 20 percent or more are not unusual for small businesses. The National Federation of Independent Business, a lobby for small business owners, says health costs are their top concern.

Since 2000, the number of uninsured, as reported by the Census Bureau, has increased by 8.6 million, or 22 percent. Some private studies suggest that one in three Americans under the age of 65 may have been uninsured at some time in the last two years.

“The truth is, almost every family is at risk because of a fraying health care safety net,” Mr. Durbin said. “Almost all of us could be one pink slip, one election, one bad diagnosis or one serious accident away from a health and economic disaster. This affects Sergio, a member of our Senate family. It affects all families.”

One lawmaker, Senator Sherrod Brown, Democrat of Ohio, has refused to accept the health insurance available to members of Congress. He says he will not take it until all Americans have access to affordable coverage.

Former Senator John Edwards, a candidate for the Democratic presidential nomination, said, “There is no excuse for politicians in Washington having health care when America has no health care.”

Mr. Edwards has been conveying that message to Iowa voters in 30-second television commercials. On his first day in office, he said, he will “submit legislation to end coverage for the president, all members of Congress and all senior political appointees in the legislative and executive branches of government on July 20, 2009 — unless Congress has enacted universal health insurance.”

One of his rivals for the nomination, Senator Hillary Rodham Clinton of New York, said she would “give all Americans the same set of insurance options that their members of Congress have.” This, she said, could be done “without any new bureaucracy.”

Another Democratic presidential contender, Senator Barack Obama of Illinois, said that under his proposal for universal coverage, everyone would have access to “health care that is as good as the health care that I have as a member of Congress.”

While waiting for such coverage, many Americans will wrestle with debts like those facing Mr. Olaya, the Senate elevator operator. He had been a student at the University of Delaware, but said he would not return until he paid his mother’s medical bills.

His mother, an expert on health and nutrition, was born in Colombia, received a master’s degree from Stanford in 1981 and became a United States citizen in 1994. She had health insurance in most of her jobs over the last 20 years, at the Centers for Disease Control and Prevention, the United States Agency for International Development, Unicef and other organizations.

But she had been unemployed and uninsured since December.

Mrs. Olaya had applied for a new federal job. When the job offer finally came in March, her son said, she had just suffered a stroke and could not get out of bed to answer the telephone. In another month or two, she might have had health coverage through her new job. In another four years, she would have been eligible for Medicare.

“Instead,” Senator Durbin said, “she had the bad luck and bad timing to fall through one of the gaping holes in America’s unraveling health care safety net. Now her only child, her son, is paying the price.”

Physicians for a National Health Program Health Justice Organizing Internship

Dates: July 24 – September 1, 2017 (Flexible start and end dates)
Hours: 15-20 hours/week, including some evening and weekend work
Compensation: Weekly stipend

The American healthcare system is under attack. Take part in the resistance while working directly with healthcare providers who are at the front lines of organizing for improved Medicare-for-all. Physicians for a National Health Program (PNHP) seeks an energetic, passionate intern to assist with concrete projects during the August 2017 congrssional recess.

PNHP is a single issue organization advocating a universal, improved Medicare-for-all national health program (also known as single payer). PNHP has more than 21,000 members and 100 chapters across the United States. Since 1987, we’ve advocated for reform in the U.S. health care system. We educate physicians and other health professionals about the benefits of a single-payer system–including fewer administrative costs and affording health insurance for the 30 million Americans who have none. PNHP performs vital research on the health crisis and the need for fundamental reform, coordinates speakers and forums, participates in town hall meetings and debates, contributes scholarly articles to peer-reviewed medical journals, and appears regularly on national television and news programs advocating for improved Medicare for all.

Tasks of the Health Justice Organizing Intern will include:

Assisting PNHP staff and members with the implementation of a month-long organizing blitz during the August congressional recess
Turn out health care providers to town hall events across the country
Attend and take minutes for strategy meetings with PNHP staff, activists and allies
Help develop and distribute activist materials to our 100 student and physician chapters

Benefits include:

Gain experience implementing campaign strategies
Exposure to cutting-edge health policy and the physicians and health professionals at the forefront of reform
Engage with local and national healthcare advocacy organizations; gain experience with various organizing models, strategies and tactics
A weekly stipend and flexible hours
Will work with academic institutions to qualify for class credit

Qualifications:

Commitment to health justice through the implementation of a national health program
Desire to work in the field of grassroots organizing, social justice, human rights or health policy
Strong organizational and time-management skills
Must be an outgoing, creative self-starter with excellent interpersonal skills
Current health professional, public health, pre-med or medical student a plus
Must be based in Chicago; some evening and weekend work required

How to apply:

Please send CV or resume and a personal statement to e.henkels@pnhp.org. Applicants will be considered immediately.

Study finds immigrants’ use of healthcare system lower than expected

UCLA researchers find that Latinos in the U.S. illegally are 50% less likely to visit emergency rooms.

By Mary Engel
Los Angeles Times Staff Writer
November 27, 2007

The cost of providing healthcare and other government services to illegal immigrants looms large in the national debate over immigration.

But the study found that while illegal immigrants are indeed less likely to be insured, they are also less likely to visit a doctor, clinic or emergency room.

Mehlman said $1.5 billion “is still a significant amount of money, unless you’re Bill Gates.”

Dr. Felix Nuñez, a Los Angeles-based family physician and former medical director of the South Central Family Health Center, said the findings confirm what he sees in clinics.

What did surprise Nuñez was the relatively low use of emergency rooms by illegal immigrants.

mary.engel@latimes.com

Access barriers for low-income families

Insurance + Access (does not equal) Health Care: Typology of Barriers to Health Care Access for Low-Income Families

By Jennifer E. DeVoe, MD, DPhil, Alia Baez, BA, Heather Angier, BA, Lisa Krois, MPH, Christine Edlund, MSc and Patricia A. Carney, PhD
Annals of Family Medicine
November/December 2007

This study was designed to identify barriers faced by low-income parents when accessing health care for their children and how insurance status affects their reporting of these barriers.

Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs.

In summary, obtaining and maintaining insurance was the most important theme among all families. Comparing families in all insurance groups, insurance coverage issues were more often reported by families with uninsured parents or uninsured children. Access concerns were mentioned most often among those with public health insurance, whereas privately insured families more commonly mentioned unaffordable medical costs.

http://www.annfammed.org/cgi/content/full/5/6/511

Comment:

By Don McCanne, MD

This is yet another study of coverage, access and costs for low-income families. The findings are intuitive, not to mention having been supported by many other studies.

* For families with no coverage, obtaining insurance was their greatest concern.

* For families with public insurance such as Medicaid, access to care was their greatest concern.

* For families with private insurance, unaffordable medical costs were their greatest concern.

What does this mean?

For the uninsured, the consequences are obvious. In the event of medical need, being uninsured threatens both health security and financial security.

For those covered by public insurance targeted to low-income families, chronic underfunding remains a problem because of the lack of adequate political support for welfare programs. This results in a lack of willing providers, especially for specialized services. Thus access is a problem simply because the care is not available. Community Health Centers, if accessible, provide some basic needs, but cannot ensure access to more expensive, high-tech services.

For those with private insurance, health care costs remain a barrier to care. As this report states, “there is a growing number of low- and middle-income families with private health insurance who gain access to most services, but the high deductibles and co-pays prevent them from getting necessary care.”

The last statement above should concern us all. The financial barriers erected by private plans impact not only low-income families but also middle-income families as well. Yet most of the leading proposals for reform are based on a market of these private insurance plans. Lack of affordability is already a major concern, and it will only grow worse under these proposals.

The fact that this study indicated that public insurance causes access problems should not concern us since it represents a peculiarity of an underfunded welfare program – Medicaid. Our other public insurance program – Medicare – is funded at a level that assures an adequate number of willing providers, primarily because of continuing political advocacy for a popular program that eventually serves us all.

Medicare does have one problem that Medicaid does not, and that is excessive out-of-pocket cost sharing that creates affordability problems for some beneficiaries. But a new and improved Medicare for All, a single-payer national health program, would rectify that problem. Cost sharing that creates financial barriers to care would be removed.

We can have it all: health care that is universal, accessible and affordable.

Insurance payment confusion leads to bad credit reports

Why medical debts shouldn't count

For many, the road to ruined credit is pockmarked with medical collections, often for tiny amounts or billed in error. The truth is that medical debt rarely indicates whether a borrower is high risk.

By Liz Pulliam Weston
MSN Money
November 19, 2007

The Your Money message board is littered with complaints from folks whose otherwise pristine credit was sabotaged by a medical collection. Sometimes their records were besmirched over absurdly small amounts that nonetheless had big impacts on credit scores.

Medical collections are surprisingly common, at least according to a 2003 Federal Reserve study of consumer-credit reports. Nearly one in three consumers (31%) with a credit report had at least one collection account reported, and more than half of those were medical collections.

The amounts owed weren’t substantial: 36.5% of the medical collections were for $100 or less, and 86% were for $500 or less.

Yet any collection account is considered a major negative to lenders and to the credit-scoring formulas they use. Though the impact of a collection on your scores fades over time, it will shave off points for as long as the negative mark remains on your report — typically seven years.

Your chances of having your credit ruined by a medical bill are soaring for a variety of reasons:

* More people are uninsured or underinsured.

* Medical-debt collection has become big business.

* Medical billing is a mess.

Even when a consumer is covered by insurance, confusion abounds. Doctors and hospitals often insist the consumer is ultimately responsible for the bills, saying medical providers bill insurers only as a courtesy. Yet frequently the providers have agreements with insurers and government agencies to accept discounted reimbursement as payment in full; the providers aren’t supposed to pursue patients for payment.

Meanwhile, insurers are constantly changing what’s covered and by how much, and providers move in and out of covered networks. Providers also claim some insurers deliberately drag their heels on reimbursements, adding to the chaos and uncertainty.

“Insurance companies are often contributing to the false reporting of medical debt,” said (Travis Plunkett, a spokesman for the Consumer Federation of America), as tussles over payment increasingly get turned over to collection agencies.

http://articles.moneycentral.msn.com/Banking/YourCreditRating/WhyMedicalDebtsShouldntCount.aspx?page=all

Comment:

By Don McCanne, MD

So you have excellent coverage. About six months ago you received medical care for what proved to be a minor problem. The care included a couple of office visits, a few laboratory tests, medical imaging, two prescriptions, and you’re fine now.

Since then you’ve received numerous statements from your insurer documenting the physician visits, laboratory tests, medical imaging facility services, radiologist’s fee for interpretation of studies, and documentation from the pharmacy benefit manager. Each statement included many numbers, but the only number that really caught your attention was the dollar amount after the statement, “You are not responsible for paying this amount.” That appeared on several of the forms, though the amount noted was confusing since it didn’t seem to fit with any of the other numbers on the page. In the meantime, you have received statements from each of the medical professionals and health care institutions involved stating that your insurance has been billed and that this is the amount due (the total, non-adjusted charge), but since no payment yet appears you decide to wait until payment is actually made by the insurer and the disallowed amount is adjusted off. Otherwise you really don’t know what you should pay.

Within the past week, you have received notices from two different collection agencies representing two of the billing entities. Since your coverage is excellent, it is clear that there is some error here. What do you do?

The first step is to take out your insurance contract to see what is covered. Check for deductibles, copayments (dollar amount), coinsurance (percentage of the charges), tiering of benefits (different coverage for different levels of products or services), capping of benefits (maximum to be paid under specific categories), amounts to be paid by a fund such as a health savings account, and any other innovative features specific to your coverage. Then check to see if each professional and institution is contracted with your insurer. Since the list you have is a few years old, be sure to obtain a current list of providers. Then determine precisely how much is to be paid by the insurer, how much is to be adjusted off, and how much you are responsible for paying. The set of numbers will likely vary depending on whether or not the professional or the institution is currently contracted. Now retrieve from your records every notice of change in benefits that you received from the insurer at each annual renewal. Go back and change the numbers based on these notices, being certain that you apply the changes in chronological order.

Okay. Now that you’ve done this, you find that you do owe the amounts for which you are responsible after payments were made to the providers and the disallowed amounts were deducted. But the amounts demanded by the collection agencies are greater than the amounts that are your responsibility.

Since obviously there is an error, you now contact the administrative staff of one of the providers that are dinging you. The staff member insists that their ledger for your account is correct and that the insurer has obviously made an error. They don’t have time to help you further and insist that you contact your insurer since that’s your responsibility anyway.

After hours of punching through automated phone systems with endless times on hold, dropped calls, referrals to other departments, you finally end up where you began, and a real person in India tells you that all of their numbers are correct. She explains that the provider apparently did not adjust off the full disallowed amount, assuming, of course, that you did pay the deductibles and coinsurance that you owed. Oh.

So you call back the provider and explain that you will send payment for the deductible and coinsurance that you owe, but you want them to adjust off the balance that was disallowed. Sorry. The account has already been turned over to the collection agency and you will have to deal with them.

The collection agency responds by stating that they have nothing to do with insurance contracts. All they have is the amount that the provider turned over to them for collection, and that is the amount that you must pay. If you want an adjustment made, you’ll have to contact the provider.

Take a break from this one, and start the process over with the other collection agency. (Repeat the last six paragraphs here.)

Enough. Just pay the whole d*** thing and consider later whether to go through the grief of trying to obtain refunds from the providers. But at least this will keep your credit report clear. Sorry. These delinquencies have already been reported by both collection agencies. You can receive a free credit report if it’s been over a year since your last request, but you’ll have to pay a fee to find out how many points were deducted from your credit score.

What is really sad is that, with what you believe to be a really great health insurance plan, and with an honest effort to comply with the rules of your plan, and in spite of considerable personal inconvenience, you can become one of the more than 15 percent of individuals who end up with an impaired credit rating merely because of the administrative complexity inflicted on us by the private insurance industry.

With a single payer national health program, you go to your health care professional, receive your tests, and then follow the treatment program that you decide on after further consultation with your healthcare professional. The bills go to the single payer; you receive a statement of services and payments only to keep the process transparent.

Why are our politicians telling us that this isn’t politically feasible? Do we really want to continue to include screwed up credit reports on our list of the perverse features of an exclusively American health care system?

Do we really want to protect the thriving big business of medical-debt collection? After all, aren’t they merely an extension of the medical insurance administrative profession that we prize so highly?

Looking for a Bright Side

Republican and Democrat promote hospital coverage for all as Catamount fails Vermonters

By Peter Freyne
Seven Days: Vermont’s Independent Voice
11/21/07

Health Care Solved? — This month, the Vermont television airwaves are full of the well-done, funny ads with the farmer saying how he’s “healthy as a horse” — just before the horse behind him keels over!

The TV ads, centerpiece of a $1.6 million marketing campaign (http://www.greenmountaincare.org), were unveiled recently at Rutland Regional Medical Center by a bipartisan contingent that included Republican Gov. Jim Douglas, Democratic House Speaker Gaye Symington and Democratic Rep. Harry Chen, M.D.

The pitch is to get uninsured Vermonters over 18 who’ve been uninsured for at least 12 months to contact Green Mountain Care and sign up for the highly touted Catamount health insurance plan. That’s the one which was agreed upon by both the Democratic leadership under the Golden Dome, who surrendered on single-payer, and the best friend the insurance industry has in Vermont: Gov. Jim Douglas.

But Cambridge, Vermont, physician and health-care-reform firebrand Dr. Deb Richter doesn’t fool easily. Yours truly asked the good doctor recently for her take on what the state’s leading politicians are touting as progress.

“The governor is right, Catamount is a very good insurance product,” answered Dr. Richter. “And it will be wonderful for the few thousand people the state can afford to subsidize. But it won’t do a thing for the tens of thousands of Vermonters who are struggling to pay for health insurance policies that have huge co-pays and deductibles and barely cover their needs,” she added. “The Catamount solution is akin to putting a high-quality Band-Aid on a wound that is getting larger by the day. It won’t solve the problem. But it will get the governor re-elected. And that is the point, isn’t it?”

Richter doesn’t mince words. And she’s part of a growing body of medical doctors across the country who also want America to join the rest of the civilized world with regard to health care. They have an increasingly active national organization called Physicians for a National Health Program (https://pnhp.org). These docs share the “radical” notion with docs in France, Britain, Spain and Canada that “health care is a human right.”

Vermont’s health-care reform “Joan of Arc” was promoting Michael Moore’s illuminating film Sicko around the state this summer and fall. The other evening she brought the flick to a student audience at the University of Vermony. Good crowd turned out — almost 400.

When it was over Richter asked, “How many of you have health insurance?”

Almost all the hands in the theater went up.

“And keep your hands up if you have health insurance for life,” she added.

All but two or three hands dropped.

“See, that’s the problem,” said Dr. Deb. “Everyone in every other industrialized nation is guaranteed health care for life.”

But the “real” shame, noted this Vermont doctor, wife and mother of a college-age kid — and who does make house calls — “is that we’re already spending enough money in total to cover every single American with comprehensive coverage, eye care, dental care, prescriptions, doctor, hospital, everything!”

The audience of tuition-laden college folk was paying very close attention.

“You have to know a couple numbers,” said Richter. “Of the total amount we’re spending in Vermont, one-third of it is for administrative costs. It has nothing to do with health care. Not with people taking your blood pressure or doing any kind of surgery. You don’t need all these people in administration.

“Put it all in one pot and there’s more than enough money,” said the good doctor. “So this whole idea that we can’t afford to cover every single person in America is bullshit, and we should call it that!”

The audience burst into applause. Who doesn’t like a doctor who talks straight? In fact, Richter’s straight talk has prompted a few to suggest the candidate-strapped Vermont Left consider her as gubernatorial material in 2008.

Richter says she’s not interested. At least not at the moment.

So if there’s more than enough money to cover everyone, why isn’t everyone covered?

“You have to wipe out the insurance industry from health care. It’s a little bit of a problem,” she said with a tinge of sarcasm.

Yes, indeed.

Only in America, eh?

When it comes to your health, the middle man comes first!

The horse may topple over in the million-dollar Catamount TV ad campaign, but Dr. Deb isn’t giving up. Richter is organizing her troops behind H.304, a bill that would at least provide some hospital coverage to all Vermonters. A foot in the door, though not in the operating room.

The bill is sponsored by Barre Town Republican Rep. Topper McFaun and former Democratic Speaker of the House Michael Obuchowski of Bellows Falls.

Interesting duo, eh?

P.S. If you haven’t seen Sicko because you think you know what it’s about, do yourself a favor this holiday season. Rent it. Buy it. Sit down and watch it. Mr. Moore’s best by far.

Only in America.

Advocacy Group for Single-Payer

Mark Gruenberg, Editor
Press Associates
Union News Service

NEW YORK (PAI)–As the debate over the future of national health care heats up–at least among the Democratic presidential hopefuls–an advocacy group for single-payer government-run health care has published a leading medical scholar’s point-by-point criticism of the health care plans offered by the top three Democrats.

Not surprisingly, Len Rodberg, research director the New York affiliate of Physicians for a National Health Plan, concludes that the plans offered by Sens. Hillary Clinton (D-N.Y.) and Barack Obama (D-Ill.) and former Sen. John Edwards (D-N.C.) would be inferior to Canadian-style government-run national health care.

Single-payer government-run health care is drawing increasing grass-roots support among local unions and particularly central labor councils, even though the two union federations–the AFL-CIO and Change to Win–have taken no stand on exactly how to achieve universal health care coverage in the U.S.

Instead, both federations vow to put universal health care, type unspecified, atop the domestic agenda for the 2008 election, forcing candidates from both parties to take the issue on. The unionists would then decide, after the election, what method to back to achieve that goal. The AFL-CIO has not ruled out single-payer health care. Change to Win has taken no official position on any health care alternative.

Several leading unions, notably the Steel Workers, the California Association of Nurses, the International Longshore and Warehouse Union, the Auto Workers and at least one building trades union, support government-run single-payer health care.

By contrast, Andy Stern, president of the Service Employees–the union with the most health care workers–does not rule out single-payer but says it may well be politically unachievable.

Many of those unions endorse the single-payer bill (HR 676) offered by veteran Rep. John Conyers (D-Mich.). His district includes many Auto Worker retirees and present UAW members who see their health care benefits dwindle or in possible danger, while the not-so-Big-any-more-Three dumped health care on the union.

HR 676 would virtually extend Medicare and its government-run system to the entire nation, trashing the health insurance companies, their co-pays, denial of coverage and care, high premiums and the 18,000 yearly deaths they cause–according to government estimates–due to denial of payment for treatment of their policyholders. Insurers’ overhead now takes at least 20% of health care dollars, while Medicare’s overhead is 3%.

One of the other Democratic hopefuls, Rep. Dennis Kucinich (D-Ohio), is a lead co-sponsor of Conyers’ plan, but Rodberg’s analysis does not mention that.

In his critique, Rodberg makes several key points:

* In their details, none of the three leading Democratic hopefuls offer “universal” coverage. Rodberg points out Obama’s plan is universal only for children. The senator claims his plan cuts costs so much it would become universal for adults, too.

But Rodberg disputes that. He says none of the three plans cuts costs, because all three leave the insurers in place to run the system–with no cost controls.

* “Large employers must provide insurance for their employees or–in the case of Edwards and Obama–pay into a fund to subsidize insurance for their employees,’ Rodberg notes. But he says the plans are silent on minimum coverage requirements the insurers must meet, relying on “competition’ to produce improved health care coverage. That could produce minimal, Wal-Mart-like coverage at high cost.

Clinton, Rodberg noted, even used the health insurers’ phrase “American Health Choices Plan” as a label for her plan. That “suggests that what consumers want is a choice of plan,” not universal coverage, Rodberg added.

* Workers and their families would be forced to buy insurance individually, again without cost controls. Rodberg says the three hopefuls’ plans would offer “income-related subsidies through the tax system” to help those who cannot afford insurance.

* Insurers would be barred from rejecting people for pre-existing conditions and Clinton’s plan would also ban “large premium differences based on age, gender, or occupation.” But again there would be no cost controls, leaving insurers free to declare that they would insure certain people–the elderly and those who ‘cost’ more–at enormous prices, Rodberg states.

“Since multiple payers would remain–even if one of them might be a public payer (similar to Medicare)–few of the savings and simplifications that are possible with a single payer plan can be achieved,” he contends.

“Consumers must purchase insurance, but no limits are proposed on what insurers can charge them. No regulations are proposed to assure the adequacy of benefits or that would affect either the restrictions insurers now impose on the choice of doctor and hospital or the way they handle, and deny, claims.

“And there is no simplification of the complex and wasteful private insurance sys-tem with its co pays, deductibles, exclusions, and claim denials,” Rodberg ends.

###

Press Associates, Inc. (PAI) — 11/26/2007

Former Brooklin, Maine Couple Applaud Canadian System

by Tom Walsh
The Ellsworth American
Thursday, November 22, 2007

BEAR RIVER, Nova Scotia — Along the stretch of Nova Scotia highway that leads to Paul and Gretchen Volenik’s new home is a road sign that reads “Paradise, Next Right.”

The Voleniks are convinced that’s exactly where they have settled.

“We love it here,” Paul says. “This area is like Maine was 35 years ago. We’re just delighted every day that we are here.”

Last spring, after first moving to Nova Scotia in 2005, the Voleniks put down permanent roots in the picturesque village of Bear River, an artists’ colony not far from Digby.

Now living near Digby, Paul and Gretchen Volenik are enjoying all that rural Nova Scotia has to offer, including tax-funded medical care.

Through “Bear River Bargains & Books,” Paul, 59, sells old books and other collectibles, while Gretchen, 56, devotes her attention to expanding the garden she’s designing for self-sufficiency.

For Paul the cross-border move came after 35 years of living in Maine, the last nine in Brooklin. Between 1994 and 2002, he served as a Democratic state representative in the Maine Legislature.

Until term limits pulled the plug on his political career, Volenik was a tireless and vocal advocate for a state-funded universal health care system that would provide health insurance and medical care to every citizen of Maine.

That never happened. Ironically, as permanent foreign residents of Canada, the couple now have access to universal health care through Nova Scotia’s tax-funded medicare program, a system that provides cradle-to-grave, unlimited access to medically necessary health care services.

“Paul worked very hard over eight years in the Maine legislature, fighting to get health care for everybody,” Gretchen says. “Now we have it. It wasn’t our intention that it would just be he and I, but we do have it now. And it’s too bad that Maine, and the United States, doesn’t have it.”

Paul Volenik said he’s studied the issue of single-payer universal health care long enough to know its doable in Maine. What’s lacking, he feels, is the political will to scrap the existing multi-payer system, with its well-entrenched special interests eager to protect the profits inherent in the status quo.

“Through what was known as the Health Security Board, we did the most advanced study in the country on single-payer health care systems,” he said. “The report that came out said that we could keep the current system of private delivery of health care but with totally public funding, folding in all of the health care dollars coming into the state, including Medicare.

“By adding a payroll tax, we could cover everyone in the state with not Cadillac coverage, but good, basic coverage — better than most insurance policies — for less money than was currently being spent in Maine on the total cost of health care. And that was keeping the private delivery system. We didn’t propose going as far as Canada, which is not just publicly funded, but involves publicly owned hospitals and, in some places, doctors on salary. We didn’t go that far, but we did prove we could cover everyone for less money.”

As governor, Angus King Jr. threatened to veto any single-payer legislation, Volenik said.

When Governor John Baldacci took office, he embraced the Dirigo approach, which Volenik described as an “incremental” system that doesn’t confront the issues that keep driving up the costs of medical care and health insurance.

“The Baldacci system and any of the other incremental systems that have failed in the past is like a train,” Volenik said. “The engineer is driving the health care train, and he stops at each stop and picks up a few more people, maybe children, or a group of low-income people. But he fails to notice that the train is on fire and that people are leaping off in all directions, because the system is ridiculous.

“An incremental system doesn’t work,” he said. “Until you get rid of the insurance companies, until you get rid of the immense power of the drug companies, until you get rid of the inflated salaries of hospital administrators, you will never have an effective health care system.”

Paul and Gretchen Volenik don’t have a family doctor. The Digby region, like other rural areas within Nova Scotia, is enduring a shortage of doctors. Fortunately, they said, they don’t need a doctor.

“We don’t have a physician; we have a nurse practitioner, and it’s the best medical care I’ve ever had,” Paul says. “Instead of, like in Maine, going into the office for an annual physical and having the doctor see you for 10 or 15 minutes, every time I’ve seen her she’s spent at least an hour, with real interaction as to your total medical situation.”

Gretchen said both she and Paul have also required services provided through a small hospital located 17 miles from home in Annapolis Royal.

“Although we continually hear about wait times, we have not experienced that at all,” she said. “When we went to Halifax to have physicals to become permanent residents, I figured we’ll be there all day long, and that didn’t happen.”

Gretchen realizes the system isn’t “free,” that hefty income, sales and other taxes cover the $2.8 billion annual cost of providing health care services to Nova Scotia’s 935,000 residents. She says she doesn’t mind paying more than $4 a gallon for gasoline because she knows that fuel taxes help pay for Nova Scotia’s health care system.

“It’s a fair way to do it,” she said. “Everybody pays those taxes. We all pay into it. It’s not like the wealthy get the good health care, and the working stiff gets some kind of health care, but with big deductibles. And then there are the people who can’t get health care. There are all these tiers in the United States. Here, it’s the same for everybody, and we all pay.”

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UCLA researchers find that Latinos in the U.S. illegally are 50% less likely to visit emergency rooms.

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For many, the road to ruined credit is pockmarked with medical collections, often for tiny amounts or billed in error. The truth is that medical debt rarely indicates whether a borrower is high risk.

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