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The problems with private health care plans

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The problems with private health care plans

Letter to the Editor
The Gainsville Sun
Article published Feb 9, 2007

It is time to dispel the myth that only the uninsured have problems with our health care system. My wife and I worked for over 25 years and had medical insurance all that time. We retired recently and sought health insurance coverage with two major companies. We were both in good health but, much to our dismay, were denied coverage on the pretext of “pre-existing medical conditions.”

Letters from our doctors documenting non-existence of the alleged conditions were of no avail. To illustrate the absurdity of the insurance companies, I allegedly had a pre-existing condition of nodules of the lung and thyroid when, in fact, the nodules were harmless as shown by multiple follow-up CAT scans. My wife allegedly had chronic back problems when, in fact, she had a minor, temporary back strain totally corrected by simple chiropractic care.

The insurance companies gave us other fabricated “conditions.” Evidently, any history of use of the health care system tags an individual as a poor insurance risk. The fact we paid premiums for decades and had no chronic or major health problem carried no weight.

What is wrong is a profit-driven health care industry whereby the guiding principle is: Pay for coverage but don’t use it. I strongly support a single-payer health care system, as provided in Rep. John Conyers’ proposed bill H.R. 676 – The United States National Health Insurance Act.

It will provide everyone with health care, without exclusion and less cost to taxpayers.

Because a single-payer system benefits the people, not the insurance companies, H.R. 676 faces formidable opposition from our corporate-driven politicians.

Larry Thompson,
Gainesville

Genetic discrimination by insurers

Individuals with Genetic Conditions Twice as Likely to Report Denial of Health Insurance than Individuals with Other Chronic Illnesses

Johns Hopkins Berman Institute of Bioethics
February 12, 2007

A new study published in the February 2007 issue of the American Journal of Medical Genetics reveals that individuals with genetic conditions are twice as likely to report having been denied health insurance than individuals with other chronic illnesses.

In the study, more than a quarter (27 percent) of individuals with genetic conditions and serious medical conditions reported having been denied health insurance or offered it at a prohibitive rate.

Almost all of the individuals in the study (89.7 percent) said they obtained their health insurance through either their employer (59.4 percent) or their spouse’s employer (30.8 percent). Nearly half of employed individuals (48.9 percent) said they felt they could not leave their jobs because they would lose their health insurance.

At the federal level, the Americans with Disabilities Act proscribes discrimination against persons with disabilities which includes those with genetically-related conditions. The Health Insurance Portability and Accountability Act (HIPAA) expressly forbids a group health insurance plan from using genetic information to establish rules for eligibility or continued eligibility. HIPAA also prohibits insurance companies from treating genetic information as a “pre-existing condition in the absence of the diagnosis of the condition related to such information.” Individuals cannot be denied health care coverage for a medical condition as a result of a genetic marker for the condition. However, individuals can be denied if they have symptoms of genetic disease. As such, HIPAA provides no protection for the vast majority of respondents in the new study.

Brandi Braud Scully, MD

And…

Genetic anti-bias bill is back

By Doug Trapp
American Medical News
February 19, 2007

The seventh time may be the charm for backers of a bill to ban genetic discrimination in health insurance plans and the workplace.

The Genetic Information Nondiscrimination Act (HR 493) would make it illegal for insurers to deny coverage to a healthy individual based solely on a genetic predisposition to a specific disease and for employers to use individuals’ genetic information in personnel decisions.

President Bush also supports the measure.

The U.S. Chamber of Commerce has been a key opponent of the bill because the organization feels it goes too far, according to Michael Eastman, executive director for labor policy.

Employers shouldn’t have to face potential compensatory and punitive damages for accidental disclosures of genetic information.

“Ultimately, it will be difficult to separate genetic information from medical information,” Eastman said.

http://www.ama-assn.org/amednews/2007/02/19/gvsa0219.htm

Comment:

By Don McCanne, MD

Should genetic information ever be used to deny an otherwise healthy person health care coverage? Should actual genetic disease ever be used to deny a person health care coverage? Is there any reason at all to separate genetic information from medical information in making decisions about health care coverage?

Although the Genetic Information Nondiscrimination Act certainly should be supported, shouldn’t we also be supporting legislation that would ensure that everyone has genuinely effective health care coverage?

At this pace of incremental reform, global warming will get us before we can ever hope for comprehensive health reform.

Restructured health insurance for So. California grocery workers

Declining Health Coverage in the Southern California Grocery Industry

By Ken Jacobs, Arindrajit Dube and Felix Su
UC Berkeley Center for Labor Research and Education
January 2007

In March 2004, after a four-and-a-half month strike and lockout, the United Food and Commercial Workers (UFCW) and three major grocery chains signed a contract that significantly restructured health insurance coverage for grocery workers in Southern California.

Among other provisions, the new contract in Southern California:

* Increased waiting periods from four months to twelve months for individual coverage (18 months for clerks) and 30 months for family coverage.

* Increased co-pays, co-insurance and deductibles under the new plan, while restricting plan options.

In addition to the changes in health benefits, wages rates for new hires were reduced.

Our central findings were as follows:

* In September 2003, prior to the strike, 94 percent of the union grocery workers in Southern California had health coverage through their employer; by September 2006 that number had fallen to 54 percent. Coverage for workers hired under the new contract was a mere 7 percent.

* As of September 2006, 66 percent of all workers and 29 percent of the workers hired under the new contract were eligible for health benefits in Southern California. The low eligibility rate is a result of longer waiting periods combined with increased worker turnover.

* Prior to the strike, the annual turnover rate for grocery workers in Los Angeles was 19 percent; after the new contract went into effect, annual turnover rose to 32 percent. Turnover of grocery workers in their first year of employment rose from 30 percent to 52 percent.

* Our survey of union members found important impacts on health care utilization due to the reduction in coverage. Of workers with a chronic health condition hired under the new contract, 20 percent fewer of were receiving treatment as compared to their co-workers who were eligible for the higher tier plan. This controls for differences in age, gender and health status between the two groups of workers. All things equal, 20 percent more of the workers hired under the new contract reported to have delayed care when they needed it compared to their coworkers.

Conclusion:

Unionized groceries in Southern California have long been a source of family supporting jobs with full family benefits. The changes in grocery health plans and reduction in starting wages in April 2004 has dramatically reduced health coverage in the grocery industry in the Southern half of the state. Jobs that once provided full time work and full family benefits are now much more likely to be part-time and un-benefited.

The member survey confirms what we would expect from the literature about health care utilization. Workers without health insurance are more likely to delay needed care and less likely to receive treatment for chronic health conditions. Treatment delays may have long term adverse effects on both health and health costs.

http://laborcenter.berkeley.edu/healthcare/grocery_industry07.pdf

Comment:

By Don McCanne, MD

In this age of two-worker households, employment as a grocery worker provided a very important benefit. Not only was the job a good second income source, it also provided the family with generous, union-negotiated, employer-sponsored health benefits coverage. This allowed the spouse greater options in employment, including self-employment, as quality and availability of employer-sponsored coverage continued to decline.

Faced with ever-rising health care costs, the grocery industry decided that it would no longer be the source of this important benefit for many Southern California families. Most of you remember the very painful strike and lockout of three years ago that ended in an agreement which achieved this goal of the grocery industry.

This study confirms the fully predictable results of that settlement. Family breadwinners are being replaced with an unstable part-time workforce with high turnover and no benefits. Employment as a grocery worker is no longer suitable for an individual looking for family health coverage. Also, the lack of coverage for this part-time workforce has predictably impaired health care access.

This study is presented not so much to decry the Walmartization of the grocery industry (though certainly an important issue), but more to point out that private group plans and private individual coverage are no longer effective in ensuring affordability and access of adequate coverage. It has taken only three years for coverage to fall from 94 percent to 54 percent of grocery workers.

Reasonably comprehensive coverage must be 100 percent automatic for everyone. Regardless of employer mandates, individual mandates, tax credits, or whatever, private group and individual plans will never get us there. We truly do need a single payer program of national health insurance.

Timid ideas won't fix health mess

By Marie Cocco
Columnist
Sacramento Bee
Published 12:00 am PST Saturday, February 10, 2007

John Edwards is trying to get ahead of the political curve, but he would send us back to the future. To 1993, to be exact.

Edwards would repeat the mistake that was at the heart of Hillary Rodham Clinton’s misadventure in trying to fix a health insurance system that was then, and is now, so out of whack that it manages to cover fewer and fewer Americans at higher and higher cost.

Like Clinton did, Edwards seems to believe that you can get the private insurance industry to do something it refuses to do because, in essence, doing what Edwards wants would put the industry out of business. He wants insurers to cover everyone, no matter how sick and expensive they are. He wants employers to continue to carry on their ledgers a cost that is ever more burdensome to them and to their workers, onto whose shoulders more of the health-insurance tab is being shifted.

The 2004 Democratic vice presidential nominee and 2008 presidential hopeful knows that no matter how many times our health insurance crazy quilt is ripped up and stitched back together, it still will fail to cover millions of Americans.

So Edwards wants them to be able to buy a new public insurance plan that would be like Medicare, but not exactly. And he wants affluent people to pay more taxes to support coverage of the less fortunate, but not directly.

Instead of simply asking for a straightforward tax to pay for covering the uninsured, Edwards falls back on that popular circumlocution, the tax credit. The credits are indirect subsidies that would be given to individuals so they could then purchase insurance. The political virtue of tax credits is that their cost is always half-hidden beneath a pile of budget documents — unlike tax hikes that show up as money withheld from paychecks, but pay directly for a government service. Because of this obfuscation, politicians in both parties love tax credits.

Edwards wants congratulations for being the first serious presidential candidate to offer a comprehensive idea for universal health insurance coverage, something every Democratic aspirant is bound to do eventually. Edwards is a smart man and a cunning politician. But his health insurance plan suffers from an odd combination of ailments.

One is political amnesia. This Clinton-like plan that would have both individuals and employers buy into closely regulated health insurance pools failed more than a decade ago — in part because it was so complicated as to be incomprehensible. Another is timidity.

Edwards won’t acknowledge that the current system of private insurance is irreparably broken.

It has failed to expand coverage to millions of workers who are employed by small business, or who work part time, or who toil at low wages — companies with high proportions of low-wage workers are far less likely to offer insurance than those whose employees earn more, according to research by the Kaiser Family Foundation. Since 2000, the portion of businesses that offer any insurance to even part of their work force has fallen from 69 percent to 61 percent.

Over the past year, a solid majority of those who do have coverage — 60 percent — experienced an increase in the amount they are responsible for paying under their plan, the Employee Benefit Research Institute says. Almost a third of covered workers reported difficulty in paying for basic necessities such as food, heat and housing because of rising health-care costs.

This isn’t much of a foundation upon which to construct a new system. In the years since Clinton tried to build on this inhospitable terrain, the ground has eroded further. It makes no sense to try to shore it up with an awkward hybrid of public requirements and private insurance that would keep in place unnecessary complexity and bureaucratic expense.

Edwards’ advisers say the candidate didn’t push public, single-payer insurance — like Medicare — because the employer-based system is what we have today and therefore, it would provide the quickest way to cover the uninsured.

But we also have Medicare today. The elderly still get care from private doctors and hospitals, and administrative costs are a fraction of what they are in the private insurance industry. And people tend to like it.

It would be just as easy — and certainly simpler — to use Medicare as the foundation for a new insurance system to eventually cover everyone. But that would require candidates to be leaders — and show more courage than those politicians who simply say they have a plan.

Candidates need to speak out now on health care

Portsmouth Herald Editorial
Sunday, February 11, 2007

Major health-care reform has become an urgent political and economic issue that, along with energy policy, likely will dominate the domestic agenda battle in the 2008 electoral campaign.

Of course, there is no news here. Major health-care reform has been an endless headline loop stretching back for more than five decades. What is different in 2007 is the culmination of evidence that the 20th-century innovation of an employer-based health-care system has reached its latest exhaustion point.

According to a variety of government and private nonprofit reports, between 44 million and 47 million Americans are without health care. More revealing, according to the U.S. Census bureau, in New Hampshire an estimated 135,000 people, including 17,000 children, are without health insurance. According to government estimates, in 2005 some 41 percent of moderate and middle income Americans went without health care for part of the year — while 53 percent of those earning less than $20,000 went without insurance for all of 2005. And the number of uninsured full-time workers has continued to grow across the country, either because insurance premium costs have become too expensive for employers or their employees.

Not unlike the recent call by some major energy companies for federal mandates on carbon dioxide emissions to combat global warming, a newly formed coalition of major corporations, labor unions and bipartisan activists has set a goal for universal health care because the current system is proving to be a competitive economic drain on American business.

In an era of rapid globalization, this matters to businesses small and large and it crosses all state borders. The United States is ranked 37th in the world for health system performance by the World Health Organization and pays twice as much for health care than are the other developed countries while getting fewer benefits.

The oddity of our system is that if one has a comprehensive and economically viable insurance plan, the system works just fine. But for those on the financial edge, the scenario is less pleasant — which is why medical-related bankruptcies continue to rise at an alarming rate. We can no longer afford to fit a predominant free market solution circle into the complicated square peg of health care — or allow entrenched financial interests such as insurance companies to determine health-care cost and access.

We all pay one way or another for the massive inefficiencies in the system through higher premiums and higher costs.

“The path we’re on now is not sustainable,” said Thomas Clairmont, a physician at Portsmouth Regional Hospital, at a local health-care reform presentation last month.

Clairmont is a member of Physicians for a National Health Program, a group that advocates a publicly financed, privately delivered health-care program available to all U.S. residents.

This is but one of many plans being debated across the country among doctors, citizens, health-care industry experts, insurance companies and elected leaders in Congress.

Some plans take an incremental approach and others call for bolder reform. President Bush’s latest reform plan calls for using the tax code to broaden access to health care. Democratic presidential candidate and former Sen John Edwards of North Carolina told the Herald recently of his plan to enact “transformational change” to create universal health care for all Americans with competing public and private insurance plans as a foundation.

We expect all the presidential candidates will present their own comprehensive plans to voters as the New Hampshire primary campaign unfolds. While we withhold advocating a specific approach, we encourage our readers to use the unique access we have to the primary candidates and not let them off the hook.

We need to engage — or “grill,” as Dr. Clairmont said — the candidates and our congressional delegation with specific questions. What is their plan? Their philosophy? How will they finance it? What sacrifices will be asked of every individual and their families?

Acting and speaking out now does not insure necessary reforms to a dysfunctional system. Not speaking out guarantees an unaffordable and unhealthy path to more of the same.

— Herald Sunday

Study: Minnesota doctors prefer single-payer universal health system

by Carissa Wyant
Staff Writer
Minneapolis / St. Paul Business Journal
Monday, February 12, 2007

A new study by the University of Minnesota has found that most of the state’s physicians surveyed prefer a single-payer universal health insurance system.

The study, conducted by the University of Minnesota School of Public Health and the Universal Health Care Action Network-MN and published in the February issue of Minnesota Medicine, found that 63.4 percent of state physicians believe that a single-payer universal health insurance system would offer the best health care to the greatest number of people. According to a press release, almost 25 percent of Minnesota physicians thought health savings account systems were best, and 11.8 percent were in favor of managed care.

Dr. Charles Oberg, the study’s co-author and associate professor at the University of Minnesota School of Public Health, commented, “Many doctors are becoming increasingly disappointed and frustrated with the health care system as it stands. Insurance hassles, heavy paperwork, and patients’ inability to get the care they need make it very problematic.”

The study also found that 71 percent of Minnesota doctors said they would accept a 10 percent reduction in fees for a “very significant” reduction in paperwork, and 63.8 percent favored physician payment under a salary system.

Researchers mailed surveys with questions on health care financing and medical practices to a random sample of 1,061 Minnesota physicians drawn from the Minnesota Board of Medical Practice. Thirty-nine percent of the surveys were completed and returned. Data was compiled and analyzed by the University of Minnesota School of Public Health.

cwyant@bizjournals.com | (612) 288-2108

Timid ideas won’t fix health mess

By Marie Cocco
Columnist
Sacramento Bee
Published 12:00 am PST Saturday, February 10, 2007

John Edwards is trying to get ahead of the political curve, but he would send us back to the future. To 1993, to be exact.

Edwards would repeat the mistake that was at the heart of Hillary Rodham Clinton’s misadventure in trying to fix a health insurance system that was then, and is now, so out of whack that it manages to cover fewer and fewer Americans at higher and higher cost.

Like Clinton did, Edwards seems to believe that you can get the private insurance industry to do something it refuses to do because, in essence, doing what Edwards wants would put the industry out of business. He wants insurers to cover everyone, no matter how sick and expensive they are. He wants employers to continue to carry on their ledgers a cost that is ever more burdensome to them and to their workers, onto whose shoulders more of the health-insurance tab is being shifted.

The 2004 Democratic vice presidential nominee and 2008 presidential hopeful knows that no matter how many times our health insurance crazy quilt is ripped up and stitched back together, it still will fail to cover millions of Americans.

So Edwards wants them to be able to buy a new public insurance plan that would be like Medicare, but not exactly. And he wants affluent people to pay more taxes to support coverage of the less fortunate, but not directly.

Instead of simply asking for a straightforward tax to pay for covering the uninsured, Edwards falls back on that popular circumlocution, the tax credit. The credits are indirect subsidies that would be given to individuals so they could then purchase insurance. The political virtue of tax credits is that their cost is always half-hidden beneath a pile of budget documents — unlike tax hikes that show up as money withheld from paychecks, but pay directly for a government service. Because of this obfuscation, politicians in both parties love tax credits.

Edwards wants congratulations for being the first serious presidential candidate to offer a comprehensive idea for universal health insurance coverage, something every Democratic aspirant is bound to do eventually. Edwards is a smart man and a cunning politician. But his health insurance plan suffers from an odd combination of ailments.

One is political amnesia. This Clinton-like plan that would have both individuals and employers buy into closely regulated health insurance pools failed more than a decade ago — in part because it was so complicated as to be incomprehensible. Another is timidity.

Edwards won’t acknowledge that the current system of private insurance is irreparably broken.

It has failed to expand coverage to millions of workers who are employed by small business, or who work part time, or who toil at low wages — companies with high proportions of low-wage workers are far less likely to offer insurance than those whose employees earn more, according to research by the Kaiser Family Foundation. Since 2000, the portion of businesses that offer any insurance to even part of their work force has fallen from 69 percent to 61 percent.

Over the past year, a solid majority of those who do have coverage — 60 percent — experienced an increase in the amount they are responsible for paying under their plan, the Employee Benefit Research Institute says. Almost a third of covered workers reported difficulty in paying for basic necessities such as food, heat and housing because of rising health-care costs.

This isn’t much of a foundation upon which to construct a new system. In the years since Clinton tried to build on this inhospitable terrain, the ground has eroded further. It makes no sense to try to shore it up with an awkward hybrid of public requirements and private insurance that would keep in place unnecessary complexity and bureaucratic expense.

Edwards’ advisers say the candidate didn’t push public, single-payer insurance — like Medicare — because the employer-based system is what we have today and therefore, it would provide the quickest way to cover the uninsured.

But we also have Medicare today. The elderly still get care from private doctors and hospitals, and administrative costs are a fraction of what they are in the private insurance industry. And people tend to like it.

It would be just as easy — and certainly simpler — to use Medicare as the foundation for a new insurance system to eventually cover everyone. But that would require candidates to be leaders — and show more courage than those politicians who simply say they have a plan.

Expanding uninsurance through premiums

Insurance Premium Cost-Sharing and Coverage Take-up

Kaiser Family Foundation
February 2007

One of the many reasons an individual may be uninsured is that she or he decides an employer’s offer of health insurance is too expensive. Several studies have noted the likelihood that a worker will decline an employer’s offer of health insurance increases with the amount he or she is required to contribute. Alternatively, employees may obtain coverage through a spouse, opt for publicly provided coverage if eligible, or decide to do without coverage entirely. This issue brief looks at the connection between premiums and the percent of workers who enroll in employer plans using the two most recent years of the Kaiser/HRET Employer Health Benefits Survey (EHBS). Several of these analyses suggest that the required worker share of the premium can be an obstacle to coverage that raises concerns about the affordability of private health coverage.

http://www.kff.org/insurance/snapshot/chcm020707oth.cfm

Comment:

By Don McCanne, MD

As long as individuals are required to pay some portion, if not all, of the premium for health insurance, take-up will never be 100 percent. Even with an individual mandate to purchase insurance, take-up will still not be 100 percent since too many individuals simply do not have the funds to pay the required contribution.

Entering “universal coverage” into Google just now produced over 23 million responses. Everyone is calling for universal coverage. Yet when you look at the new proposals and the various coalition efforts, none of them would result in universal coverage. Either the proposals have serious flaws such as the individual mandate requirement, or, worse, many of the hyped coalition efforts have no substantial proposals at all.

Right now many are calling for solutions that involve “shared responsibility.” That is code language for reducing the employers’ responsibilities for funding care and shifting more of it to individuals, especially in the form of individual mandates to purchase insurance and in greater cost-sharing when accessing care.

If we are serious about achieving universal coverage, we will have to adopt policies that will make enrollment completely automatic for absolutely everyone. That means that we cannot make enrollment dependent on partial or full payment of a premium.

There is only one proposal that would automatically achieve 100 percent enrollment: single payer. And, oh yes, it’s also the only proposal that would make both health care coverage and health care access affordable as well.

When these coalitions and pseudo-reform advocates claim that they are supporting “universal coverage,” there seems to be an aura of political correctness that prevents us from using the four-letter “l” word that would describe them precisely. But at least we could tell them that their pants are on fire!

(Is anyone up for a national “PANTS ON FIRE” campaign?)

Urban Institute report on SCHIP

Coverage Patterns Among SCHIP-Eligible Children and Their Parents

By Genevieve M. Kenney and Allison Cook
Urban Institute
February 9, 2007

SCHIP was enacted in 1997 to expand health insurance coverage to low-income uninsured children. Under SCHIP, states could use enhanced federal matching dollars to expand public coverage for children beyond Medicaid eligibility levels.

This study finds that most SCHIP enrollees do not have access to employer-sponsored insurance through their parents.

In addition, our analysis indicates that just 25 percent of all SCHIP enrollees live in families where one parent (in single-parent families) or both parents (in two-parent families) have employer coverage.

Following the implementation of eligibility expansions under SCHIP and the significant investments in outreach and enrollment simplification under both Medicaid and SCHIP, uninsurance rates have fallen for low-income children. Coverage gains have slowed, however, and the most recent CPS even indicated that uninsurance may be on the rise for children.

This brief has three important implications for SCHIP as it faces reauthorization. First, federal funding will have to be increased substantially if the allotments are to include coverage for the close to 2 million uninsured children who are eligible for SCHIP but not yet enrolled. Second, many children stand to lose coverage altogether if federal funds are inadequate to meet existing program need. Finally, addressing the insurance coverage needs of low-income parents through SCHIP would likely improve the lives of both low-income children and their parents but would require a substantial expansion in the federal funding commitment to the program.

http://www.urban.org/publications/311420.html

Full report: http://www.urban.org/UploadedPDF/311420_Coverage_Patterns.pdf

And…

HHS Proposes Nearly $700 Billion Budget for Fiscal Year 2008

U.S. Department of Health & Human Services
February 5, 2007

The President’s budget proposes to reauthorize State Children’s Health Insurance Program (SCHIP) for five more years, to increase the program’s allotments by $5 billion over that time, and to target SCHIP funds more efficiently to those most in need.

http://www.hhs.gov/news/press/2007pres/20070205.html

Comment:

By Don McCanne, MD

The State Children’s Health Insurance Program (SCHIP) continues to fall far short of its goal to insure all lower-income children who qualify. The fact that uninsurance in children is on the rise again suggests that the SCHIP program may have reached its fully predictable steady state in which attrition in enrollment offsets new gains.

An increase in outreach and enrollment efforts might be able to slightly shift the steady state threshold, but it can never be effective in enrolling all eligible children and keeping them enrolled.

Nevertheless, current efforts at reform are targeted to expanding the coverage of children, and perhaps even their uninsured parents. At a minimum, there does seem to be a consensus that the SCHIP program does need to be reauthorized this year, or it will be terminated.

What does the Bush administration propose? No funds for expansion of eligibility, inadequate funds to maintain even the deficient current level of enrollment, and, most ominously, targeting SCHIP funds “more efficiently to those most in need.” What does that mean? In testimony before Congress this week, HHS Secretary Michael Leavitt explained that existing state expansions of SCHIP eligibility would no longer be partially funded by the federal government because it is more important to apply those funds to the budget deficit.

The 2 million children currently eligible for SCHIP but not enrolled are only one-fifth of the uninsured children in the United States. While ignoring the other four-fifths of the children plus everyone else without insurance, the politicians are entering a debate to show which of them are the least heartless in their efforts to salvage, in a somewhat tattered state, this program that falls so far short of our goals to remove financial barriers to health care.

SCHIP does need to be reauthorized, but only as an urgent stopgap measure while we move forward briskly toward reform that would automatically enroll absolutely everyone in a comprehensive national health insurance program. But if the past few decades are any indication, we can anticipate the celebration of the reauthorization of SCHIP, and then… nothing further. That would be heartless.

SEIU President Andy Stern Rams Ahead with Corporate Partnerships in Healthcare Industry

By ALAN BENJAMIN

Reprinted from January-February 2007 issue of Unity & Independence, a supplement to The Organizer Newspaper, San Francisco.

A few weeks ago, The Wall Street Journal ran yet another glowing article about SEIU President Andy Stern and his drive to press the unions to carry out “an attitude adjustment.”

The Journal asked Stern if he thought the unions would ever be able to organize Wal-Mart in the United States. Stern’s answer was revealing. “We have not been trying to organize them but to change their business model. A traditional organizing drive is not going to be successful because the laws are so tilted on behalf of a company as big as Wal-Mart, not to mention the fact that Wal-Mart has an emergency-response team that flies out of Bentonville at the moment the word ‘union’ is used in the store. I think Wal-Mart has the opportunity to create an entirely new model of worker representation. The question is, do they want partners?” (Jan. 22, 2007)

Working people across the country understand full well that corporate America, beginning with Wal-Mart, is on a search-and-destroy mission to dismantle the unions and lower their labor costs. If unions are to survive as instruments to defend the interests of their members and of the working-class majority in this country, they have to challenge all the unjust laws and return to the fighting stance and traditional organizing drives that built the unions in the first place.

Dr. Martin Luther King, Jr., and the Civil Rights Movement did not shy away from challenging the unjust Jim Crow laws because these laws were so tilted on behalf of a system of racism and oppression against Blacks. They did not seek to become partners with the Ku Klux Klan in the hope the Klan could be brought around to a new model of race relations in this country.

But isn’t this what Stern is proposing?

“Healthcare Partnership” with Wal-Mart

In his interview with The Wall Street Journal, Stern explained his reasons for seeking healthcare partnerships with the employers.

“We must try to be partners with our employers, who have told us we should change and understand their competitive issues and try to add value, not create problems,” Stern said. “Unions need to appreciate there are ways in which we add value and can be helpful. This is especially the case in relation to healthcare. The employer-based healthcare system is dead. It’s a relic of the industrial economy, and it makes corporations unable to compete fairly when America is the only country that asks its employers to put the price of healthcare on the cost of its products.”

These are not just empty words. Stern has been working overtime offering his “helpful” services to some of the most anti-union and retrograde sectors of Big Business in this country.

As we go to press, Stern and Wal-Mart have just announced a healthcare partnership “aimed at attaining universal healthcare coverage.” The partnership also includes Intel Corp., AT&T Inc. and Kelly Services Inc., a temporary staffing agency. According to the Associated Press release of Feb. 7, “no specific policies were proposed to achieve this goal. Wal-Mart CEO Lee Scott said that Wal-Mart is not committed to spending more on healthcare or making any immediate promises to provide health coverage to more workers.”

Labor activist Marnie Goodfriend of Labor Beat in Chicago lambasted Stern for “rubber stamping” Wal-Mart’s empty-rhetoric support for universal healthcare. “Stern should be putting intense public scrutiny and pressure on Wal-Mart for its exploitative and degrading work conditions,” Goodfriend noted, “not using Wal-Mart’s paper-thin public support for healthcare to undermine his own campaign against the company.”

It is hard to believe that just two years ago, SEIU leader Anna Burger publicly denounced the Congressional Black Caucus for organizing a joint fundraiser with Wal-Mart.

The Washington Post on May 15, 2005, reported that Burger wrote caucus members “to express SEIU’s disappointment that the Congressional Black Caucus has given Wal-Mart an opportunity to fashion a false image as a friend of African Americans and of working people generally by organizing the April 27 joint fundraiser.”

“As the largest employer in the world,” Burger wrote, “Wal-Mart’s labor relations model is now undermining standards for all American workers. The average salesclerk makes below the poverty line, and a majority of Wal-Mart workers cannot afford the company’s health insurance plan. … Wal-Mart has forced its more than 600 suppliers to shift operations overseas to exploit workers there at even lower wages while destroying good American jobs.”

How true. At the time, SEIU was still part of the AFL-CIO and its campaign to organize Wal-Mart employees into genuine unions. But as Stern revealed in his new book, “A Country that Works: Getting America Back on Track,” it was necessary for the SEIU to break with the AFL-CIO, “because of the failure on the part of the AFL-CIO to modernize its strategic approaches to employers in order to take into account their competitive business needs.”

Today, instead of organizing Wal-Mart workers into unions, Stern’s goal is to “change Wal-Mart’s business model” by doing exactly what Anna Burger accused the Congressional Black Caucus of doing two years ago — giving Wal-Mart an opportunity to fashion a false image as a friend of working people, when in fact Wal-Mart is one of its main enemies.

Any more doubts as to the nature of Stern’s split from the AFL-CIO?

From the Business Roundtable to Safeway

The Wal-Mart partnership is only one of many so-called “healthcare partnerships” Stern has been building of late.

On Jan. 12, 2007, Stern announced the launching of a partnership with AARP and the Business Roundtable called Divided We Fail. Their purpose, as a press release puts it, “is to work together to urge action from political leaders to attain health and long-term financial security for all Americans.”

The Los Angeles Times (Jan. 16) noted that, “two seemingly strange bedfellows, the president of SEIU and the director of the Business Roundtable, which represents the nation’s leading corporations, have joined hands with AARP to overhaul healthcare along the lines of the Massachusetts Plan, the only comprehensive state proposal that has been enacted.”

The Times continues, “Divided We Fail relies primarily on a requirement that individuals must purchase private health insurance. The state would redirect funding that had been used to cover hospital care for the uninsured to subsidize health-insurance premiums. The plan also levies a token fee on employers that do not provide coverage.”

One month earlier, on Dec. 13, 2006, Stern joined up with Safeway CEO Steve Burd and Oregon Democratic Senator Ron Wyden to unveil the “Healthy Americans Act.” The details of this plan are worth examining, as they illustrate everything that is wrong with all the partnerships that Stern is putting together with these giant corporations.

The Healthy Americans Act would mandate individuals to purchase private insurance — just as the Divided We Fail plan does — and it would slash and cap costs to business. Depending on size and income, businesses would be required to pay a tax of 2% to 25% of the average private insurance premium. The tax would be used to subsidize private insurance premiums for low-income people. (At this time, employers pay an average of 75% of health insurance premiums.)

Individual workers would then be required to buy private insurance. Employers who offered health insurance prior to enactment of Wyden’s legislation would contribute lump-sum wage payments to their employees equal to the cash value of the health insurance they provided. In this scenario, the burden of rising healthcare costs is thus shifted from the employer to the worker. This means that the employee is now left to his or her own to buy their own healthcare insurance package.

This is a major shift of wealth from working families to corporations.

Don Bechler, chair of the California Universal Health Care Organizing Project and a former UAW and IAM negotiator, said: “The Wyden proposal is not something labor can support. It eliminates the collective bargaining tool for working people and leaves them to the mercy of insurance industry. It destroys the concept of defined benefits. It sells the plan with a capped wage payment to workers with no caps on insurance costs. It is a windfall for the employers and a new economic burden on workers. It is a plan that no labor negotiator should ever try to sell to the workers of America. I do not know why Stern is supporting this, but I would not want him negotiating my health plan.”

SEIU Locals Resisting Stern’s New Course

When Stern tells The Wall Street Journal that unions today need an “attitude adjustment” he is saying that unions need to abandon the traditional model of trade unionism based on the notion that bosses and workers have contradictory interests due to their respective roles in the sphere of production, and instead should seek “partnerships” with the employers aimed at helping their bottom line.

But SEIU locals across the country are resisting this new course.

SEIU Local 73 in Chicago announced Feb. 7 that its 100-member executive board voted unanimously to endorse and campaign for passage of HR 676, the “Expanded and Improved Medicare for All Act” introduced by Congressman John Conyers (D-Mich). This single-payer legislation is also known as the “United States National Health Insurance Act.”

SEIU Local 73 represents over 25,000 city, state and county public workers, including school employees and bus drivers throughout Illinois and Northwest Indiana.

HR 676 would institute a single-payer healthcare system in the United States by eliminating healtcare insurance companies altogether and expanding a greatly improved Medicare system to every resident.

HR 676 would cover every person in the United States for all necessary medical care — including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, chiropractic and long term care. HR 676 ends deductibles and co-payments. HR 676 would save billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

Isn’t this what all SEIU members want and deserve? Isn’t this what all union members and all working people in this country deserve?

Edwards on Healthcare – He Should Go Back to Being a Populist

By Rose Ann Demoro
Huffington Post
02.07.2007

In his latest campaign, John Edwards has taken promising steps in an effort to burnish his credentials as an “economic populist” – as the New York Times put it – from his opening announcement in New Orleans’ devastated 9th Ward to his regular visits to picket lines to his timetable for pulling our troops out of Iraq.

But his disappointing and shortsighted healthcare proposal shows he still has a long ways to go.

It’s hard to open a newspaper today without seeing another pronouncement of a new coalition for “universal” health care or new legislative initiatives, from Capitol Hill to the state capitols.

But, with the notable exception of single payer bills, HR 676 in Congress, and SB 840 in California, virtually all of the proposals have a common thematic of expanding the role of an insurance industry already gorged on profits from denying needed care.

Sadly, Edwards has joined this camp with a “universal” healthcare plan that is neither universal nor populist.

In fact, the Edwards plan looks a lot like the healthcare plans being touted by other decidedly non-populist politicians including George Bush, Mitt Romney and Arnold Schwarzenegger, in addition to Hillary Clinton’s dismal 1993 plan.
To sum it up, the Edwards plan is a soggy mix-and-match, including tax credits (from Bush), mandates on employers to provide benefits or pay to buy insurance (Schwarzenegger), requirements that individuals buy insurance (Romney and Schwarzenegger) and health market pools for purchasing insurance (Clinton, 1994).

Universal insurance means universally more profits for the industry that has gorged itself off the pain and suffering of others, mostly by denying them care. It is not, however, universal healthcare.

And, like the varied proposals by his political counterparts, the Edwards plan fails to crack down on insurance company premiums that from 2000 to 2005 rose by 73%.

Without controls on the ever-climbing premiums, the mandate that all individuals must buy health insurance which Edwards joins Schwarzenegger and Romney in demanding, looks like little more than criminalizing the uninsured and guaranteeing that many will end up with unaffordable, substandard plans.

Consider what more and more residents of Massachusetts and California are discovering about their much touted “universal” plans forcing everyone to buy insurance.

With no controls on premium costs, even many middle-income families will be squeezed into cut-rate, bare bones plans with deductibles of up to $10,000 per family, meaning many will end up paying most for most of their medical expenses out of their pocket on top of their premiums – or simply just forgo using their plans entirely.

If that sounds like a insurance CEO’s dream come true, it is. As UnitedHealth CEO Stephen Hemsley said of Schwarzenegger’s plan, it’s “an interesting set of proposals that represent real opportunities for our business.” Presumably they’ll soon look at the $1.2 billion in profits they amassed in the last quarter of 2006 as the lean years.
Another area in which Edwards falls down the same black hole as his political comrades in arms is an uncritical embrace of new technology in healthcare and promotion of so-called evidence based medicine, without any recognition of the serious dangers in both areas. Much of the new technology, for example, is being promoted to replace the professional judgment of caregivers with standardized protocols that fail to notice that humans are not widgets and every patient has individual health needs that computers and robots are not programmed to see.
Edwards does deserve some credit for proposing that at least one plan in each health market be a public program based on Medicare.

But, if a public program, as he implies, is more likely to assure affordable alternatives to the private insurance model, why get off in Chicago when your plane is going to New York?

Repeated polls have shown that wide majority of Americans want the US to move to a universal healthcare system that guarantees quality care for all patients “like Medicare.”

A single-payer plan like Medicare is far simpler, more universal, and more comprehensive than Edwards’ proposal or any other plans that are premised on the insurance industry which created our current healthcare nightmare by placing their profits ahead of quality, access, and affordability.

When it comes to healthcare, an issue that rightfully belongs at the center of his campaign, Edwards should step away from the policy wonks and the purveyors of realpolitik who are working feverishly to sabotage the only healthcare reform that will actually work.

We’d encourage Edwards to go back to the drawing board and rework his position to stand up to the insurance industry robber barons and support HR 676 and other single payer solutions, the real populist solution to our healthcare nightmare.

Buy or die

Universal plan can cost under $300, insurers say

By Alice Dembner
The Boston Globe
February 5, 2007

Many state residents will probably be able to buy basic health insurance for less than $300 a month to meet the new state mandate that everyone obtain coverage, insurers and observers said last week.

Although it might still be too expensive for some people, that would bring the price closer to what the Legislature envisioned when it passed the universal health insurance law last April.

The state’s largest health insurer, Blue Cross Blue Shield, said that with more flexibility from the state, it could offer slimmer coverage for an average of $210 a month — near the price originally suggested by former governor Mitt Romney.

“If it’s buy or die, they could buy at $210 or $220,” said Allen Maltz, chief financial officer for Blue Cross.

That plan, however, would not satisfy requirements proposed by the state board overseeing the law’s implementation because of the plan’s high deductible and out-of-pocket limits.

http://www.boston.com/yourlife/health/other/articles/2007/02/05/universal_plan_can_cost_under_300_insurers_say/?page=full

Comment:

By Don McCanne, MD

Massachusetts is proving to the rest of the nation what we already know: the traditional model of a multitude of private insurers is obsolete.

Health care has become too expensive to be financed by this model. Segregated insurance pools which include primarily the healthy workforce and their healthy families are the least expensive pools, with the lowest premiums. But the high costs of health care for even the healthy are now so high that comprehensive coverage is possible only with insurance premiums that are no longer affordable for most average-income Americans.

With the current drive towards universal coverage, the pools will have to accommodate those with greater health care needs. The upward pressure on premiums can no longer be tolerated, which is resulting in the trend to shift more of the responsibility of paying for care to the patient with significant needs. With segregated private risk pools, insurance premiums are affordable only when access to health care is made unaffordable.

Risk pooling is intended to shift funds from the healthy to the sick. But since the cost of health care for healthy pools is now so high, we have to accept the principle that the health care risk pools must also shift funds from the wealthy to both low- and average-income individuals with health care needs, if we expect to have effective universal coverage. Segregated private insurance pools cannot do that.

We need to remove the function of pooling risk from the control of the private insurance industry and shift that control to a universal risk pool using progressive tax policies to fund it (i.e., single payer). If we don’t, we’ll end up with a profoundly expensive administrative boondoggle of tax credits and government reinsurance, which will still perpetuate the “shared responsibility” of the sick to pay unaffordable expenses of their health care.

Blue Cross’ Allen Maltz suggests that the Massachusetts individual mandate to purchase insurance could be accomplished by forcing citizens to either buy low-premium plans or die. Unfortunately, since the coverage provided by the low-premium plans makes health care access unaffordable, Blue Cross will have to change their “buy or die” slogan. The new slogan? Buy and Die!