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Highmark’s Healthcare Gift Card

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Highmark’s Healthcare Gift Card

Highmark offers the ultimate get-well card

By Bill Toland
Pittsburgh Post-Gazette
November 2, 2007

Highmark Inc., the Pittsburgh-based health insurer, hopes its new Healthcare Gift Card will encourage people who might be reluctant to visit the doctor or spend their money on prescriptions… to do so.

The card itself costs $4.95 (plus shipping and handling), and can be loaded with as little as $25… to as much as $5,000.

“Ultimately, we think this product may go national,” said Kim Bellard, Highmark’s vice president of e-marketing and consumer relations. He expects other insurers will be interested in using the “intellectual technology,” which Highmark hopes to patent.

“We do expect other people to follow,” he said. “We certainly expect phone calls from other Blues plans. … I would love to get a phone call from AARP.”

If the patent is received, any insurer or organization that tries selling a similar gift card may owe Highmark royalties.

Highmark partnered with Visa in developing the card, which can be used just like a Visa credit card or debit card, but only at merchants that Visa has categorized as health-related.

But couldn’t you just take the gift card to Rite Aid and spend it on a case of Coca-Cola and a bag of Snickers bars? “We obviously don’t advertise that,” Mr. Bellard said. But the answer is, yes — for now.

http://www.post-gazette.com/pg/07306/830560-85.stm

To purchase the cards:
http://www.givewell.com/

Comment:

By Don McCanne, MD

Any innovation that the health insurance industry can devise to drum up more administrative fees, they’ll do. In this instance, Highmark wants not only more fees, but they also want other insurers’ administrative fees as well, claiming its patent rights to the intellectual capital.

As long as we leave the private insurance industry in charge, we’ll see more and more of these efforts to soak us with additional administrative costs. It reflects the fundamental differences in the mission of the private insurance plans (profitable business model), and what would be the mission of our own single payer national health program (health care justice for all).

Is covering the state’s uninsured worth $1.1 billion?

The Daily Camera
Saturday, November 3, 2007

The state’s blue-ribbon health-care-reform commission figures it would cost $1.1 billion to implement a sweeping measure under which all Coloradans would have to buy health insurance. The commission’s work is aimed in part to address the fact that nearly 790,000 residents are uninsured. The numbers are preliminary, but the question remains: Is this the right direction for Colorado? That question was posed this week to the Camera’s editorial advisory board.

Requiring people to buy health insurance is better than nothing, but it is not a comprehensive solution to the health-care and cost crisis.

There appear to be two major issues that health-care reform needs to address. First, our current system of multiple for-profit insurance companies wastes enormous amounts of money on duplicate administration, risk-avoidance and coverage disputes, estimated by some at 30 percent of total health care costs. And second, medical costs are hugely increased by uninsured people delaying diagnosis and treatment and then ending up in emergency rooms. Mandating the purchase of health insurance covers the second problem, but does nothing for the first.

A much more efficient and cost-effective approach would be to have a single-payer approach, like Medicare, available to all citizens, with this single entity paying hospitals and doctors for people’s basic needs. Clearly, setting the level of basic coverage would be a real political issue. And forcing health insurance companies to use common administrative procedures, to make supplemental coverage available to all, and to have their policies be fully transferable could be another bowl of hot potatoes. But these issues are not insurmountable, and taking them on will need to be done in any case.

Finally, the single-payer approach provides savings from eliminating unnecessary costs that will help to cover the increased level of basic care that currently is simply not provided, so the final societal bill may not increase dramatically, and may even be reduced.

Steve Pomerance

Highmark's Healthcare Gift Card

Highmark offers the ultimate get-well card

By Bill Toland
Pittsburgh Post-Gazette
November 2, 2007

Highmark Inc., the Pittsburgh-based health insurer, hopes its new Healthcare Gift Card will encourage people who might be reluctant to visit the doctor or spend their money on prescriptions… to do so.

The card itself costs $4.95 (plus shipping and handling), and can be loaded with as little as $25… to as much as $5,000.

“Ultimately, we think this product may go national,” said Kim Bellard, Highmark’s vice president of e-marketing and consumer relations. He expects other insurers will be interested in using the “intellectual technology,” which Highmark hopes to patent.

“We do expect other people to follow,” he said. “We certainly expect phone calls from other Blues plans. … I would love to get a phone call from AARP.”

If the patent is received, any insurer or organization that tries selling a similar gift card may owe Highmark royalties.

Highmark partnered with Visa in developing the card, which can be used just like a Visa credit card or debit card, but only at merchants that Visa has categorized as health-related.

But couldn’t you just take the gift card to Rite Aid and spend it on a case of Coca-Cola and a bag of Snickers bars? “We obviously don’t advertise that,” Mr. Bellard said. But the answer is, yes — for now.

http://www.post-gazette.com/pg/07306/830560-85.stm

To purchase the cards:
http://www.givewell.com/

Comment:

By Don McCanne, MD

Any innovation that the health insurance industry can devise to drum up more administrative fees, they’ll do. In this instance, Highmark wants not only more fees, but they also want other insurers’ administrative fees as well, claiming its patent rights to the intellectual capital.

As long as we leave the private insurance industry in charge, we’ll see more and more of these efforts to soak us with additional administrative costs. It reflects the fundamental differences in the mission of the private insurance plans (profitable business model), and what would be the mission of our own single payer national health program (health care justice for all).

Is covering the state's uninsured worth $1.1 billion?

The Daily Camera
Saturday, November 3, 2007

The state’s blue-ribbon health-care-reform commission figures it would cost $1.1 billion to implement a sweeping measure under which all Coloradans would have to buy health insurance. The commission’s work is aimed in part to address the fact that nearly 790,000 residents are uninsured. The numbers are preliminary, but the question remains: Is this the right direction for Colorado? That question was posed this week to the Camera’s editorial advisory board.

Requiring people to buy health insurance is better than nothing, but it is not a comprehensive solution to the health-care and cost crisis.

There appear to be two major issues that health-care reform needs to address. First, our current system of multiple for-profit insurance companies wastes enormous amounts of money on duplicate administration, risk-avoidance and coverage disputes, estimated by some at 30 percent of total health care costs. And second, medical costs are hugely increased by uninsured people delaying diagnosis and treatment and then ending up in emergency rooms. Mandating the purchase of health insurance covers the second problem, but does nothing for the first.

A much more efficient and cost-effective approach would be to have a single-payer approach, like Medicare, available to all citizens, with this single entity paying hospitals and doctors for people’s basic needs. Clearly, setting the level of basic coverage would be a real political issue. And forcing health insurance companies to use common administrative procedures, to make supplemental coverage available to all, and to have their policies be fully transferable could be another bowl of hot potatoes. But these issues are not insurmountable, and taking them on will need to be done in any case.

Finally, the single-payer approach provides savings from eliminating unnecessary costs that will help to cover the increased level of basic care that currently is simply not provided, so the final societal bill may not increase dramatically, and may even be reduced.

Steve Pomerance

Access to health care a question of justice

Letters to the Editor
The Baltimore Sun
November 4, 2007

I applaud the comments in The Sun’s column “Say yes to national health care” (Opinion – Commentary, Oct. 29).

As a medical student, I see the impact our broken health care system has on individuals and communities every day.

Figures from the Institute of Medicine show that the lack of health insurance causes about 18,000 unnecessary deaths every year in this country.

Medical students see the faces behind this number in our free clinics and emergency rooms. The patients who die under our care largely die from preventable diseases. We need a single-payer health care system to prevent these deaths.

We have tried the market-driven model of medical care – with its underlying motto of “We feel for you, but our shareholders come first.”

Many states are trying hard to come up with solutions. But although well-intentioned, these approaches often put too much financial burden on workers who are forced to buy insurance.

It is clear that we need a fundamental change to stop the human suffering we now have, and cut the health care costs that are hurting the economy.

I believe we have reached a point in history at which this is no longer just a political or economic issue; it is a justice issue.

Jay Bhatt
Philadelphia

The writer is a former president of the American Medical Student Association and board member of PNHP.

Oregon rejects health care for children?

Health plan gets burned after state's costliest race

By Janie Har
The Oregonian
November 7, 2007

After the most expensive political campaign in Oregon history, voters Tuesday overwhelmingly rejected a tobacco tax increase to pay for children’s health care.

The 3-to-2 vote against Measure 50, which would have increased Oregon’s cigarette tax by 85 cents a pack, follows similar defeats in California and Missouri after tobacco makers spent millions to oppose the measures.

In Oregon, Reynolds American and Philip Morris, the makers of Camel and Marlboro cigarettes, spent a record $12 million, primarily on a TV commercial blitz.

The decisive failure kicks a complex public health issue back to the Legislature and Gov. Ted Kulongoski, who have been unable to make health care more accessible for an estimated 576,000 Oregonians who lack insurance.

http://www.oregonlive.com/news/oregonian/index.ssf?/base/news/1194420305233310.xml&coll=7

Comment:

By Don McCanne, MD

What is it that we keep hearing?

“Only incremental steps can get us to comprehensive reform.”

“Let’s not make the perfect the enemy of the good.”

“Everyone’s second choice for reform is the status quo.”

“We don’t need a government system. We need to build on what is working.”

Because of perceptions of lack of political feasibility, we continue to reject comprehensive reform and instead direct our efforts to supporting measures that we believe are actually doable.

This measure couldn’t fail. Everyone supports health care for children, and almost everyone supports tobacco taxes that would give smokers a greater incentive to quit. Only the evildoers in the tobacco industry would be opposed.

Well, people in Oregon watch TV, and the vested interests with a lot of money control the message. The tobacco companies were able to frame this as an issue over taxes and government accountability. Who believes that we need more taxes? Who supports the ubiquitous inefficiencies of government bureaucracies?

Our goal is affordable, comprehensive, high-quality care for everyone. The vested interests that stand to lose will always be opposed. But they will also vigorously oppose the “politically feasible” incremental measures that do not serve their interests.

Don’t dilute our message. Continue to speak up loud and clear in support of the comprehensive reform that we need. But reject the self-serving framing of the opponents and use our moral framing of EMPATHY and RESPONSIBILITY for us to see that the health care needs of all of us are met.

The United States needs a 'single-payer health care system

James Clancy addresses Physicians for a National Health Program in Washington

Washington (6 Nov. 2007) – Time has validated Canada’s publicly-funded national health care system and the United States should move toward a similar system, says James Clancy, president of the National Union of Public and General Employees (NUPGE).

Speaking to an American group called Physicians for a National Health Program (PNHP), Clancy said only a small minority of people in Canada favour private health care solutions such as private insurance, user fees, medical savings accounts and parallel for-profit care.

“The vast majority of Canadians have repeatedly said No to these proposals, because the principles on which these proposals rest cannot be reconciled with the values at the heart of our medicare,” Clancy said.

“The opponents of our single-payer system claim it’s a perversion of Canadian values that they can’t use their own money to purchase faster treatment from a private for-profit provider,” he added.

“But the consensus view of Canadians on this issue is clear: It’s a far greater perversion of Canadian values to accept a system where money, rather than need, determines who gets access to health care.”

Medicare defines Canada

Clancy said medicare defines the values of Canada. “Sickness doesn’t discriminate. And in Canada we’ve made the collective decision that health care shouldn’t discriminate either,” he said.

“Overwhelmingly, Canadians strongly support the core values on which our system is premised: equality, compassion and social solidarity. In fact, our medicare system is now tied to our understanding of citizenship – more than a social program, medicare to us represents a birthright and an identifying mark of Canadian-ness.”

On five occasions since national public health care was established in Canada more than 40 years ago, the system has been reviewed by high-profile political and judicial leaders, he noted. “All came to the same conclusion: single-payer, publicly-funded health care is more equitable, more efficient and more effective,” he said.

He acknowledged that problems, such as wait times, exist within the Canadian system but he said solutions also exist and will be far less costly to implement than in the U.S. Canada spends about 10% of GDP to finance its health care system, which covers all citizens. The U.S. spends roughly 15% of GDP yet leaves millions with no coverage at all, he noted.

Clancy said wait times are not caused by Canada’s single-payer system.

Health professionals

“The main source of the problem is something most countries around the world are experiencing: we’re facing a health human resources crisis,” he argued.

“There’s a serious shortage of health professionals in Canada. They’re retiring in big numbers. And we’re just not recruiting and training enough new health professionals.

To be successful in reducing those waiting lines, we’re working with Canadian governments to invest in a national strategy that will lead to a greatly expanded workforce of health care professionals.”

Clancy said the challenge is for groups such as NUPGE and PNHP to work together to bring “a single-payer system in the U.S.” while continuing to defend and expand the system that exists in Canada.

“If we continue to fight with passion and conviction and hold out for what we want, we’ll do more than make a difference in health care. We’ll create a world of which we can all be truly proud. Working together – we can make that happen,” he said.

Nurses Across Nation Host SiCKO House Parties to Urge Guaranteed Healthcare as DVD Released

Registered Nurse Response Network
Press Release

OAKLAND, Calif., Nov. 5 PRNewswire — Michael Moore’s healthcare “horror” film SiCKO will continue its unique impact on American society and politics with its Nov. 6 DVD release, which will be commemorated with more than 125 nurse-led house parties around the nation, the Registered Nurse Response Network (RNRN) reports today. Call for information about house parties in your area.

The house parties, stretching from Alabama to Idaho, build on the “Scrubs for SiCKO” campaign during the movie’s summer debut which saw over 10,000 nurse volunteers gathering outside theaters and talking to the public about achieving genuine healthcare reform.

The goal of the house parties is to build support for the kind of guaranteed, single-payer healthcare systems that are succeeding in every other industrialized democracy — a point Moore makes powerfully in the movie. Nurses will strategize about how to use patient advocacy to help pass single-payer/Medicare-for-all-type legislation such as Rep. John Conyers’ HR 676 now pending in Congress, and make it a central focus of the presidential campaign.

Nurses are crucial to the public education campaign about how single-payer healthcare, guaranteeing comprehensive, quality healthcare with an expanded and improved Medicare for all, is far superior to the profit-driven, industry-centered healthcare sector that has come to dominate American medicine.

“SiCKO” profiles a number of Americans with insurance who have been denied needed care by their insurance companies, describes how the insurance-based healthcare system is structured to keep it that way, and provides examples of other industrialized nations where insurance companies do not stand in the way of medical care.

HR 676 and similar bills in several state legislatures would have one public entity collecting and disbursing all revenues for care delivered by our current, mostly private hospitals, clinics, and doctors, similar to how Medicare works.

The Registered Nurse Response Network is a project of the California Nurses Association/National Nurses Organizing Committee which represents 75,000 RNs in all 50 states.

Registered Nurse Response Network

Worsening the Odds

Being Uninsured is a Major Cause of Death

Bob Herbert
New York Times
November 3, 2007

Lonnie Lynam, a self-employed carpenter in Pipe Creek, Tex., specialized in spiral staircases. Friends thought of him as a maestro in a toolbelt, a whiz with a hammer and nails.

“His customers were always so pleased,” his mother told me. “There was this one family, kind of higher class, and he built them one of those glass holders that you would see in a bar or a lounge, with the glasses hanging upside down in different sizes. It was awesome.”

Lonnie had a following, a reputation. He was said to have a magic touch.

What he didn’t have was health insurance.

So when the headaches came, he tried to ignore them. “We’ve had migraines in our family,” said his mother, Betty Lynam, who is 67 and lives in Creston, Iowa. “So he thought that was what it was.”

Lonnie’s brother, Kelly, said: “He wasn’t the type to complain. And since he didn’t have insurance …”

Kelly, 45, worked on different jobs with his brother. He was the one who rushed Lonnie to an emergency room one day last fall when the headaches became so severe that Lonnie couldn’t stand up.

It would be great if there were something unusual about this story: A person without health insurance gets sick. The person holds off on going to the doctor because there’s no way to pay the bill. The person is denied the full range of treatment because of the absence of insurance. The person dies.

Lonnie Lynam’s headaches had been caused by cancerous tumors in his brain. During surgery, doctors discovered that the cancer had spread from other parts of his body.

Cancer is no longer the all-but-automatic death sentence that it once was. Extraordinary progress has been made in fighting the myriad forms of the disease.

But, as the American Cancer Society has recently been stressing, the health coverage crisis in the U.S. is a major drag on this fight.

“A woman without health insurance who gets a breast cancer diagnosis is at least 40 percent more likely to die,” said John Seffrin, the cancer society’s chief executive.

According to the cancer society: “Uninsured patients and those on Medicaid are much more likely than those with private health insurance to be diagnosed with cancer in its later stages, when it is more often fatal.”

The uninsured (and underinsured) are also much less likely to get the most effective treatment after the diagnosis is made.

There are 47 million Americans without health insurance and another 17 million with coverage that will not pay for the treatments necessary to fight cancer and other very serious diseases.

The bottom line, said Mr. Seffrin, is that “the number of people who are suffering needlessly from cancer because they don’t have access to quality health care is very large and increasing as I speak.”

Part two of the Lynam family’s nightmare began when Lonnie returned home from the hospital. Lonnie had very little money, so Kelly stepped in and began paying most of his brother’s nonmedical bills.

Betty Lynam flew to Texas as often as she could to be with her son. She said he needed chemotherapy and radiation treatment, but since he couldn’t afford it, he couldn’t always get it.

“He was trying to pay a little bit at a time for the doctors and for the different treatments,” she said. “But he didn’t have a savings account or any collateral, except for his tools.

“I’d ask how he was feeling, and he’d tell me, ‘Well, I didn’t get the treatment today.’ And I’d say, ‘Why?’ And he’d say, ‘Well, I got in there and they found out I didn’t have any insurance and the woman told me I’d have to come back another time because she’d have to check with the doctor or somebody.’

“He suffered a great deal. Yes, he did.”

After awhile, as his condition deteriorated, Lonnie Lynam, carpenter extraordinaire, became all but consumed by the fear of death. Toward the end, he would sleep with a light and the television on, his mother said, “because he wanted to see something or hear something as soon as he woke up to know that he was still alive.”

She said: “Some nights he’d be so frightened he’d come crawl into bed with me and just say, ‘Hold me, mom.’ I just slept right with him in the hospital and just held him, you know?'”

Lonnie died on March 26 at age 45. The cause of death was cancer, aided and abetted by an absurd, unnecessary and utterly unconscionable absence of health insurance.

New York Times
Letters, November 6, 2007

In Such a Rich Land, a Health Care Disgrace

To the Editor:

Re “Worsening the Odds” (column, Nov. 3):

As always, Bob Herbert compellingly illustrates the devastating effects policies have on real people. If only all of those who view themselves as “pro-life” would read his account of Lonnie Lynam’s tragic death, perhaps their advocacy would expand to life beyond birth. That a vibrant and gifted young man should have to die because he can’t afford health insurance in the richest country on earth is immoral and obscene.

Such a shame is a measure of how much those in power in American truly value life.

Mary McGill
Colorado Springs, Nov. 3, 2007

To the Editor:

I commend Bob Herbert for continuing to point out the disgrace that our health care system has become. It is appalling that nearly 20 percent of the United States population is either uninsured or underinsured.

Before my husband and I moved to Denmark in August, we were increasingly frustrated with a system in which even people with “good” insurance spend too much time begging for approval for medical treatments. As a physician, my husband felt he was in a daily fight with midlevel bureaucrats whose sole job was to deny care.

Here in Denmark, taxes are high, but everyone has health coverage (not to mention free university education). Yes, it’s “socializedmedicine,” but it works. How much worse does the American system need to get before it moves to the top of the public agenda? Will we get a workable health care system before or after we bomb Iran?

Emily Clark
Copenhagen, Nov. 3, 2007

Why Not Single Payer? Part 2. What's Wrong With The Clinton / Obama / Edwards Health Care Plans

Miles Mogulescu
The Huffington Post
Posted November 2, 2007 | 04:23 AM (EST)

In Part 1 of this multi-part Huffpost series on the health care debate, I criticized the leading Democratic candidates — Hillary Clinton, Barack Obama, and John Edwards — for surrendering, without firing a shot, to the insurance and drug companies by opposing universal single payer health care.

In this second installment, I elaborate on the difference between universal single payer health care and the Clinton/Obama/Edwards universal insurance mandate plans and argue that universal mandates are bad social policy.

First, let’s define our terms:

“Universal Single Payer Health Care” (aka “Medicare For All”): From the moment that you’re born until the moment that you die, you will be covered by single quasi-public non-profit health insurer that will pay for both preventative care and for all necessary medical procedures and medications. You choose whatever doctor you want to see and you and your doctor decide on the care you need. It won’t matter whether you’re employed or not or whether your employer offers health coverage. You can never be denied insurance.

“Universal Insurance Mandate:” If you like your employer’s health plan, you can keep it. If your employer doesn’t provide health insurance and you don’t qualify for Medicaid, the government will make you pay for your own health insurance out of your own pocket. If you’re too poor to afford the premiums, at tax time every year the government will give you a credit to reimburse you for part of last year’s premiums. If you’re middle class, the government tax credits may be too small to make the insurance really affordable, or you may have to buy a less expensive high deductible policy in which you have to pay for your doctor visits out of your own pocket, unless you get really sick and need major surgery or an extended hospital stay. You and your doctor will still have to fight with your insurance company on whether it will cover procedures your doctor thinks are necessary. If you try to avoid buying your own insurance or think you can’t afford it, the government will penalize you.

To be fair, the Clinton/Obama/Edwards plans have some positive points. By banning “pre-existing conditions”, they would allow people to buy insurance who are simply uninsurable now. By requiring insurance companies to charge the same premiums regardless of age or health, they would make insurance more affordable to middle aged people. (Conversely, they would make insurance more expensive for younger people.) By providing tax credits, they would help lower middle class people afford at least lower priced, high deductible “catastrophic” policies. Most of the plans include a Medicare-like public alternative that individuals may purchase and whch competes with private insurance.

But overall, a universal insurance mandate is bad public policy compared to universal single payer health care. Some of the reasons:

1. It’s a colossal waste of money. While the administrative cost of Medicare is about 2-3 percent, approximately 30 percent of private insurance premiums go to overhead, profits and executive salaries. In 1999, the last year for which I could find numbers, health care administrative costs totaled $294.3 billion or $1,059 per capita, compared to $307 per capita in Canada. With insurance premiums having climbed 87 percent in the past decade, it would be a fair guess that administrative costs now exceed $400 billion per year. That’s more than enough to cover all of the uninsured without raising taxes.

2. Universal mandates punish the middle class who make too much to receive government subsidies, but too little to afford the cost of health insurance that the government will coerce them into buying. Massachusetts passed a state universal mandate program in 2006 which proponents of a universal mandate point to as the model for a national plan. According to recent a study by the Greater Boston Interfaith Organization, the premium for the minimum insurance plan is unaffordable for households earning between 300%-500% of the poverty level. Premiums for the minimum plan are free for those earning up to 150 percent of the federal poverty level of $10,210 for individuals and $13,960 for couples. Premiums are reduced for those earning up to three times the poverty level. Those earning more than that (i.e more than $30,630 for individuals, $41,880 for couples) must pay 100 percent of the premiums themselves. Premiums range from $1464 per year for young adults to $9600 per year for those over 55. So a 55-year-old couple earning $42,000 a year would have to pay $19,200 a year in premiums, nearly 46 percent of their pre-tax income, for a plan with deductibles of $2,000 per individual and $4,000 per family and out-of-pocket expenses of up $5,000 per year for individuals and $7,500 for families. A government mandate requiring people to pay these kinds of premiums, even if a national plan had somewhat higher subsidies, is effectively a huge hidden tax increase for the middle class and a huge boondoggle for the private insurance companies to whom the government delivers large numbers of new customers.

3. The universal mandate plans assume that most people will continue to be covered by their employers and therefore they won’t have to reach into their pockets to pay the full cost of meeting the government mandate. But employer-based health insurance is a dying dinosaur. Each year fewer employers offer insurance. Between 2000 and 2006, the percentage of employers offering some type of health insurance declined from 64.2 percent to 59.7 percent and it continues to decline. Even many people whose employers now provide health insurance are underinsured — according to a Consumer Reports survey, 29 percent of people with health insurance are “under-insured,” with coverage so meager that they often postpone medical care because of cost. Moreover, as insurance premiums escalate at a far greater rate than inflation or wage increases, more and more employers increase their employee’s share of premiums, raise deductibles and co-pays and reduce benefits. If you lose your job, you lose your insurance. In the larger picture, leaving the burden of health insurance on employers makes American companies less competitive in the world economy, compared to other capitalist democracies where the government pays for health care. Recently, Toyota named the savings in health care costs as the main reason for deciding to open a new auto plant in Canada rather than the U.S.

4. Large numbers of people opting for lower-cost, high deductible plans will lead to many middle class people avoiding preventive care and necessary treatment until they are already very sick, leading to worse health outcomes and in the long-run resulting in higher costs from waiting to treat preventable diseases until they become serious. If, after paying thousands of dollars a year in premiums, a middle class family has to pay $2,000-$4,000 in deductibles before their insurance kicks in, many won’t go to the Doctor until it’s an emergency. For example, someone with a chest infection won’t seek care, thus infecting others, and possibly ending up in the hospital with pneumonia. Men won’t get their PSA checked, women won’t get pap smears and breast exams, people won’t get colonoscopies, thus leading to cancers not being found at the early treatable stage.

5. The strongest argument by progressives who support a universal mandate is that the plan would include a Medicare-like public alternative that would compete with private insurance and, because it would so clearly be superior to private insurance, would eventually evolve into a single payer system. If this plan is modeled on Medicare, it would be a fairly generous plan in which you can choose your own doctor, in which most treatments your doctor recommends are covered, and in which deductibles and co-pays are low. This means that, even after greatly reducing the administrative costs associated with private insurance, it will still be expensive compared to high deductible plans. This leads to “adverse selection.” The young and healthy would opt for the cheaper plans. The people who will buy the Medicare-like plan will be those who think their health care costs are likely to exceed their premiums — in other words, the older and sicker. Far from slowly evolving into a single payer system, as its progressive supporters like Paul Krugman argue, the Medicare-like plan is likely to become more and more expensive as time passes, making it less and less affordable and forcing more and more people back to bare bones private insurance.

End of Part 2

Coming in Part 3: Why Universal Mandates represent not just bad social policy but a losing political strategy.

The United States needs a ‘single-payer health care system

James Clancy addresses Physicians for a National Health Program in Washington

Washington (6 Nov. 2007) – Time has validated Canada’s publicly-funded national health care system and the United States should move toward a similar system, says James Clancy, president of the National Union of Public and General Employees (NUPGE).

Speaking to an American group called Physicians for a National Health Program (PNHP), Clancy said only a small minority of people in Canada favour private health care solutions such as private insurance, user fees, medical savings accounts and parallel for-profit care.

“The vast majority of Canadians have repeatedly said No to these proposals, because the principles on which these proposals rest cannot be reconciled with the values at the heart of our medicare,” Clancy said.

“The opponents of our single-payer system claim it’s a perversion of Canadian values that they can’t use their own money to purchase faster treatment from a private for-profit provider,” he added.

“But the consensus view of Canadians on this issue is clear: It’s a far greater perversion of Canadian values to accept a system where money, rather than need, determines who gets access to health care.”

Medicare defines Canada

Clancy said medicare defines the values of Canada. “Sickness doesn’t discriminate. And in Canada we’ve made the collective decision that health care shouldn’t discriminate either,” he said.

“Overwhelmingly, Canadians strongly support the core values on which our system is premised: equality, compassion and social solidarity. In fact, our medicare system is now tied to our understanding of citizenship – more than a social program, medicare to us represents a birthright and an identifying mark of Canadian-ness.”

On five occasions since national public health care was established in Canada more than 40 years ago, the system has been reviewed by high-profile political and judicial leaders, he noted. “All came to the same conclusion: single-payer, publicly-funded health care is more equitable, more efficient and more effective,” he said.

He acknowledged that problems, such as wait times, exist within the Canadian system but he said solutions also exist and will be far less costly to implement than in the U.S. Canada spends about 10% of GDP to finance its health care system, which covers all citizens. The U.S. spends roughly 15% of GDP yet leaves millions with no coverage at all, he noted.

Clancy said wait times are not caused by Canada’s single-payer system.

Health professionals

“The main source of the problem is something most countries around the world are experiencing: we’re facing a health human resources crisis,” he argued.

“There’s a serious shortage of health professionals in Canada. They’re retiring in big numbers. And we’re just not recruiting and training enough new health professionals.

To be successful in reducing those waiting lines, we’re working with Canadian governments to invest in a national strategy that will lead to a greatly expanded workforce of health care professionals.”

Clancy said the challenge is for groups such as NUPGE and PNHP to work together to bring “a single-payer system in the U.S.” while continuing to defend and expand the system that exists in Canada.

“If we continue to fight with passion and conviction and hold out for what we want, we’ll do more than make a difference in health care. We’ll create a world of which we can all be truly proud. Working together – we can make that happen,” he said.

Why Not Single Payer? Part 2. What’s Wrong With The Clinton / Obama / Edwards Health Care Plans

Miles Mogulescu
The Huffington Post
Posted November 2, 2007 | 04:23 AM (EST)

In Part 1 of this multi-part Huffpost series on the health care debate, I criticized the leading Democratic candidates — Hillary Clinton, Barack Obama, and John Edwards — for surrendering, without firing a shot, to the insurance and drug companies by opposing universal single payer health care.

In this second installment, I elaborate on the difference between universal single payer health care and the Clinton/Obama/Edwards universal insurance mandate plans and argue that universal mandates are bad social policy.

First, let’s define our terms:

“Universal Single Payer Health Care” (aka “Medicare For All”): From the moment that you’re born until the moment that you die, you will be covered by single quasi-public non-profit health insurer that will pay for both preventative care and for all necessary medical procedures and medications. You choose whatever doctor you want to see and you and your doctor decide on the care you need. It won’t matter whether you’re employed or not or whether your employer offers health coverage. You can never be denied insurance.

“Universal Insurance Mandate:” If you like your employer’s health plan, you can keep it. If your employer doesn’t provide health insurance and you don’t qualify for Medicaid, the government will make you pay for your own health insurance out of your own pocket. If you’re too poor to afford the premiums, at tax time every year the government will give you a credit to reimburse you for part of last year’s premiums. If you’re middle class, the government tax credits may be too small to make the insurance really affordable, or you may have to buy a less expensive high deductible policy in which you have to pay for your doctor visits out of your own pocket, unless you get really sick and need major surgery or an extended hospital stay. You and your doctor will still have to fight with your insurance company on whether it will cover procedures your doctor thinks are necessary. If you try to avoid buying your own insurance or think you can’t afford it, the government will penalize you.

To be fair, the Clinton/Obama/Edwards plans have some positive points. By banning “pre-existing conditions”, they would allow people to buy insurance who are simply uninsurable now. By requiring insurance companies to charge the same premiums regardless of age or health, they would make insurance more affordable to middle aged people. (Conversely, they would make insurance more expensive for younger people.) By providing tax credits, they would help lower middle class people afford at least lower priced, high deductible “catastrophic” policies. Most of the plans include a Medicare-like public alternative that individuals may purchase and whch competes with private insurance.

But overall, a universal insurance mandate is bad public policy compared to universal single payer health care. Some of the reasons:

1. It’s a colossal waste of money. While the administrative cost of Medicare is about 2-3 percent, approximately 30 percent of private insurance premiums go to overhead, profits and executive salaries. In 1999, the last year for which I could find numbers, health care administrative costs totaled $294.3 billion or $1,059 per capita, compared to $307 per capita in Canada. With insurance premiums having climbed 87 percent in the past decade, it would be a fair guess that administrative costs now exceed $400 billion per year. That’s more than enough to cover all of the uninsured without raising taxes.

2. Universal mandates punish the middle class who make too much to receive government subsidies, but too little to afford the cost of health insurance that the government will coerce them into buying. Massachusetts passed a state universal mandate program in 2006 which proponents of a universal mandate point to as the model for a national plan. According to recent a study by the Greater Boston Interfaith Organization, the premium for the minimum insurance plan is unaffordable for households earning between 300%-500% of the poverty level. Premiums for the minimum plan are free for those earning up to 150 percent of the federal poverty level of $10,210 for individuals and $13,960 for couples. Premiums are reduced for those earning up to three times the poverty level. Those earning more than that (i.e more than $30,630 for individuals, $41,880 for couples) must pay 100 percent of the premiums themselves. Premiums range from $1464 per year for young adults to $9600 per year for those over 55. So a 55-year-old couple earning $42,000 a year would have to pay $19,200 a year in premiums, nearly 46 percent of their pre-tax income, for a plan with deductibles of $2,000 per individual and $4,000 per family and out-of-pocket expenses of up $5,000 per year for individuals and $7,500 for families. A government mandate requiring people to pay these kinds of premiums, even if a national plan had somewhat higher subsidies, is effectively a huge hidden tax increase for the middle class and a huge boondoggle for the private insurance companies to whom the government delivers large numbers of new customers.

3. The universal mandate plans assume that most people will continue to be covered by their employers and therefore they won’t have to reach into their pockets to pay the full cost of meeting the government mandate. But employer-based health insurance is a dying dinosaur. Each year fewer employers offer insurance. Between 2000 and 2006, the percentage of employers offering some type of health insurance declined from 64.2 percent to 59.7 percent and it continues to decline. Even many people whose employers now provide health insurance are underinsured — according to a Consumer Reports survey, 29 percent of people with health insurance are “under-insured,” with coverage so meager that they often postpone medical care because of cost. Moreover, as insurance premiums escalate at a far greater rate than inflation or wage increases, more and more employers increase their employee’s share of premiums, raise deductibles and co-pays and reduce benefits. If you lose your job, you lose your insurance. In the larger picture, leaving the burden of health insurance on employers makes American companies less competitive in the world economy, compared to other capitalist democracies where the government pays for health care. Recently, Toyota named the savings in health care costs as the main reason for deciding to open a new auto plant in Canada rather than the U.S.

4. Large numbers of people opting for lower-cost, high deductible plans will lead to many middle class people avoiding preventive care and necessary treatment until they are already very sick, leading to worse health outcomes and in the long-run resulting in higher costs from waiting to treat preventable diseases until they become serious. If, after paying thousands of dollars a year in premiums, a middle class family has to pay $2,000-$4,000 in deductibles before their insurance kicks in, many won’t go to the Doctor until it’s an emergency. For example, someone with a chest infection won’t seek care, thus infecting others, and possibly ending up in the hospital with pneumonia. Men won’t get their PSA checked, women won’t get pap smears and breast exams, people won’t get colonoscopies, thus leading to cancers not being found at the early treatable stage.

5. The strongest argument by progressives who support a universal mandate is that the plan would include a Medicare-like public alternative that would compete with private insurance and, because it would so clearly be superior to private insurance, would eventually evolve into a single payer system. If this plan is modeled on Medicare, it would be a fairly generous plan in which you can choose your own doctor, in which most treatments your doctor recommends are covered, and in which deductibles and co-pays are low. This means that, even after greatly reducing the administrative costs associated with private insurance, it will still be expensive compared to high deductible plans. This leads to “adverse selection.” The young and healthy would opt for the cheaper plans. The people who will buy the Medicare-like plan will be those who think their health care costs are likely to exceed their premiums — in other words, the older and sicker. Far from slowly evolving into a single payer system, as its progressive supporters like Paul Krugman argue, the Medicare-like plan is likely to become more and more expensive as time passes, making it less and less affordable and forcing more and more people back to bare bones private insurance.

End of Part 2

Coming in Part 3: Why Universal Mandates represent not just bad social policy but a losing political strategy.