PNHP

Birthday wishes for a better Medicare

Birthday wishes for a better Medicare

By Susanne L. King, M.D.
The Berkshire Eagle (Lenox, Mass.), July 13, 2011

Celebrating 46 years this month, Medicare continues to pay for the health care of 47 million Americans. Medicare has improved the health of our seniors, reduced their risk of poverty, and improved the financial security of their families.

Unfortunately, there are those who would like to “cut Medicare” by raising the age of eligibility, or by increasing the co-pays and deductibles of beneficiaries. Rep. Paul Ryan (R-Wisconsin) even proposed ending the Medicare program, replacing it with a system of vouchers to buy private insurance. The vouchers would decline in value over time, leaving seniors with increased financial hardship when they became ill.

The current Medicare program does have its funding problems that need to be addressed, but Medicare is the victim of skyrocketing health care costs, not the cause. As the past director of Medicare and Medicaid programs, Bruce Vladeck, said recently, “the current so-called crisis is in fact an artifact of broader problems with the federal budget and budgetary politics and should not be used as an excuse to dismantle one of the most important programs the federal government has ever operated, or to renege on the commitment this government has made to generations of working people as it has collected taxes from them.” He goes on to say that we are not having a “Medicare crisis” but rather, a “revenue crisis,” with federal revenues at a much lower percentage of the gross domestic product (GDP) than in 1999, when we had a balanced budget rather than a deficit.

How can Medicare be improved and strengthened? The financial integrity of the program could be stabilized by an upturn in the general economy, by additional federal appropriations from general tax revenues, or by increasing the payroll tax by a small fraction of a percent (the last system-wide adjustment was in 1985). In addition, money could be saved by allowing Medicare to negotiate drug prices with pharmaceutical companies, and by stopping the current practice of paying private Medicare plans more than traditional Medicare.

However, to reap maximum health benefits and cost savings, Medicare should be improved and expanded to include everyone. Rather than providing coverage only for the elderly and disabled who have the highest medical costs, the program would be strengthened if Medicare coverage included the young and healthy.

In our current system, private insurance companies cover younger, healthier workers and their families, screen out the sick, and deny care for people who become sick. At the same time, private insurers reap obscene profits and afflict our health care system with mountains of paperwork and unnecessary administrative costs, which devour 31 percent of our health care dollars. Private insurance companies also pay multimillion-dollar salaries to their CEOs, who continue to dream up new ways to game the health care system and increase profits.

First quarter earnings for all major health insurance companies were up this year. United Health Group’s profit during the first three months of 2011 rose 13 percent to $1.35 billion, from $1.19 billion last year, and the company’s CEO, Stephen Helmsley, was at the top of Forbes 2011 Executive Pay List. His total compensation of $101.96 million last year made him the highest paid corporate executive in the United States. To make this kind of money, insurance companies have to spend far less paying their policyholders’ medical claims than anyone thought possible. In contrast, the administrative overhead for Medicare is less than 3 percent, because there are no CEO salaries, no shareholder profits, and no marketing campaigns.

The bottom line for private insurance companies is their profit. The bottom line for patients, health care providers, and our society is medical coverage to care for everyone, in a cost-effective manner. The way to do this is not to cut Medicare, but to eliminate private insurance companies. The solution to our health care crisis is to establish a national “improved Medicare for all,” publicly financed but privately delivered, a single-payer health care program for everyone in our country. Unfortunately President Obama’s new health care law builds on the faulty foundation of private insurance companies.

The numerous benefits of a national “improved Medicare for all” would include:

* Universal, comprehensive coverage, with no co-pays or deductibles. Everyone would be covered, and coverage would no longer be tied to a job.

* Freedom to choose doctors and hospitals.

* $400 billion in savings by eliminating the administrative waste of the private insurance industry.

* Medicare’s negotiation for decreased prices for drugs and other medical supplies.

* Savings from the use of global budgets for health facilities.

* Elimination of personal bankruptcy due to medical expenses.

* Improved health and productivity of workers, because they have access to health care they can afford.

* Stimulation of the economy, because families would have more money to spend.

* Elimination of the onerous administrative burdens of doctors, thereby freeing them to see more patients.

* Relief for small businesses and towns, who would no longer have to pay for health insurance for their employees.

Legislation exists in Congress to establish this single payer program, the Extended and Improved Medicare for All Act, H.R.676. Pass this bill and everyone can celebrate, while saving enough money to provide every American with health insurance coverage.

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

http://www.berkshireeagle.com/otheropinions/ci_18465922

Health insurers' errors wasting billions

By Dave Zweifel, Cap Times editor emeritus
The Capital Times (Madison, Wis.), July 13, 2011

The American Medical Association, the organization that represents most of the nation’s doctors, claimed at its recent convention in Chicago that health insurance companies are inaccurately processing nearly one in five medical claims.

In its annual report on the health insurance industry, the AMA reported that commercial insurance companies had an error rate of 19.3 percent in 2010, 2 percent higher than the year before.

Dr. Barbara McAneny, a member of the AMA board of directors, said the error rate “represents an intolerable level of inefficiency that wastes $17 billion annually.”

“Health insurers must put more effort into paying claims correctly the first time to save precious health care dollars and reduce unnecessary administrative tasks that take time and resources away from patient care,” she added.

These commercial health insurers, it should be noted, are the very people who Rep. Paul Ryan and some of his Republican colleagues in Congress insist ought to be handling Medicare a few years from now.

Somehow, Ryan and his allies deduce that letting private insurers into the Medicare business would save money. That’s a strange notion since private insurers spend as much as 20 percent on administrative costs while the government-run Medicare program has overhead costs of from 2 to 3 percent. Perhaps Ryan’s voucher plan would somehow save the government money, but it would shift those costs onto the country’s senior citizens, those in most need of medical care.

Indeed, it’s the United States’ multilayered and convoluted health care system that has American citizens and the companies they work for spending roughly double the amount it costs most countries in the free world. Yet Congress refuses to come to grips with the problem, yielding to the lobbying and campaign contributions by the health industry, whose only interest is protecting the status quo.

Congress won’t even discuss a single-payer system that, in effect, would expand Medicare to everyone, from birth to death, a system that Canada, England, Germany and countless others have been using for years. Instead, we wind up about once a decade tweaking a system that already is unwieldy and confusing and making little gains in covering uninsured Americans and harnessing the skyrocketing costs of American health care.

Yes, the Medicare payroll tax would need to be increased, but the savings for both individuals and companies, who would no longer need to pay the premiums and administer their own health care plans, would far exceed those costs. Although President Obama’s new health care reform is a step forward, it still is confusing and the savings won’t be anywhere close to what a true single-payer system would generate.

The state of Vermont recently became the first state to pass a universal single-payer plan, which will be phased in over the next few years. The state will pool its Medicaid funds with other state resources to provide health coverage to every Vermonter. Harvard economist William Hsiao predicts that the Vermont plan will produce savings of 24.3 percent of total health care expenditures between 2015 and 2024.

Perhaps the rest of the country will learn from Vermont just as the country of Canada learned from Saskatchewan, which started its own single-payer plan years ago and the rest of the provinces followed suit when they found it worked.

If our politicians truly want to reduce health care costs for both working people and the companies that employ them, they’d begin a debate on how the United States could offer all its citizens a single-payer plan that is fair to all.

Instead, we’re debating how to reduce Medicare coverage for our seniors and, at the same time, directing more taxpayer money to the sector most responsible for already out-of-control health care costs.

Dave Zweifel is editor emeritus of The Capital Times.

Read more: http://host.madison.com/ct/news/opinion/column/dave_zweifel/article_efffe9ef-2ec1-56c8-8878-11ecce2fe927.html#ixzz1S5YTj4Qc

How would Walmart cover part time, seasonal and other short term employees?

Employers Lobby to Weaken Insurance Mandate

By Janet Adamy
The Wall Street Journal, July 13, 2011

It is three years before most of the new health-care law kicks in, but already some of America’s largest employers are peppering the Internal Revenue Service with concerns that making the changes will be far more complex than they anticipated.

At issue is one of the law’s central requirements: employers with 50 or more full-time workers must offer affordable insurance or pay a penalty. It sounds simple enough. But in crafting the rules, the IRS and two other federal agencies are now tackling basic yet messy questions, such as who counts as a full-time worker and how do companies measure whether insurance is “affordable.”

Retailers, restaurants and other companies that rely on seasonal, temporary and other workers with flexible schedules, say it’s hard to figure out who is a full-time worker. That could cause the employer to enroll and drop them from coverage, potentially churning them through new state-run insurance exchanges or the Medicaid federal-state program for the poor, as their hours fluctuated.

Census Bureau data shows that six million, or 5.6% of private-sector employees, work variable hours.

The debate centers on how federal agencies define a full-time worker. The law itself, signed by President Barack Obama in March 2010, defines a full-time employee as one who works at least 30 hours per week on average in a given month.

Once classified as a full-time worker, the employer is obligated to provide affordable health care or pay a penalty of $2,000 per worker, excluding the first 30 workers.

In response, the IRS in May floated the idea of giving employers a “look-back” period of between three and 12 months to determine whether certain workers met the full-time definition. Only then, if the employee hit the target, would the employer have to start providing insurance or pay the penalty.

Meanwhile, employers cheered the idea and are pressing the IRS to go further. An umbrella group called Employers for Flexibility in Health Care, which represents at least four dozen big employers and trade groups, last month asked the IRS to ensure that all part-time, temporary and seasonal hires wait up to 12 months, plus an additional 90-day waiting period, before they qualify for insurance.

In one of more than 200 submissions made recently to the IRS, Wal-Mart Stores Inc., Gap Inc., United Parcel Service Inc., Hilton Worldwide Inc. and others have pushed for a lengthy grace period that could stave off penalties for a year or more after certain workers are hired. The result could undermine some of the law’s intent to insure those who can’t afford coverage.

http://online.wsj.com/article/SB10001424052702304584404576440093426726656.html

And…

Letter

June 17, 2011
From: Employers for Flexibility in Health Care
To: Internal Revenue Service

RE: Request for Comments on Shared Responsibility for Employers Regarding Health Coverage (IRC §4980H, as created by PPACA §1513)

(excerpt)

A. Definition of Full-time Employee Under the “Look-back” Methodology

1. Employers should be granted flexibility to utilize the look­back period for new part­time, temporary, and seasonal hires. Of primary importance to employers with variable workforces is the treatment of new and newly eligible employees, as our workforce fluctuates on an ongoing basis throughout a given year with new employees entering our systems sometimes on a daily basis. Notice 2011-36 indicates that the Department is considering applying the proposed safe harbor “only in a limited form” for such employees. A limited application for newly hired employees would be extremely problematic for employers with variable workforces. Employers with variable workforces must be able to utilize the look-back period primarily in the first year of an employee’s service to determine whether the employee has worked sufficient hours to reach full-time status and become eligible for the employer’s health plan. In many cases in our industries, employees may choose to leave before completing one year of service. In addition, under the individual mandate in 2014, these employees may be receiving coverage through other sources (e.g., Exchange, Medicaid, dependent or parent coverage). Because these employees may be in the middle of a plan year for other coverage and do not want to lose their annual benefits (i.e., restart their annual deductible or out of pocket maximum), they may choose to retain that coverage rather than enroll in the employer plan in the first year of service.

Employers should have the flexibility to choose the length of the look-back period ranging from 3 to 12 months depending on the nature of their business and their workforce.

For employers offering health plans, the 90-day wait period would begin once an employee’s eligibility for the employer plan is established.

Utilizing this form of a look­back not only allows for a longer measuring period, but also a longer stability period to reduce churn between employer and Exchange coverage. Not applying the look-back period to new part­time, temporary and seasonal employees would be a strong deterrent to employers’ giving employees the opportunity to work more than 30 hours per week on average and employing seasonal workers beyond 90 days.

C. Maintaining the Employment Connection During the Stability Period

The Notice states that if an employee is determined to be full time during the look­back period, then the employee would be treated as a full-time employee during a subsequent stability period, regardless of the number of the employee’s hours of service during the stability period, so long as he or she “remained an employee.”

The Coalition recommends that employees maintain a connection with an employer and meet a minimum work threshold during the stability period. This is particularly important for employers with large numbers of part­time, temporary, or seasonal workers whose hours and patterns of work fluctuate considerably.

D. Penalties

1) Penalties should not apply during any look­back or wait periods.

2) Seasonal employees should not be included in the total number of full­time employee for purposes of calculating employer tax liability.

For full 10 page letter, including signers, click on this link:

http://www.restaurant.org/pdfs/advocacy/20110617_EFHC-Re_Notice2011-36-FINAL.pdf

Comment:

By Don McCanne, MD

When supposedly the intent of the health reform legislation was to try to provide health insurance for everyone (well, not quite), it is particularly disconcerting to see large employers such as Walmart, Gap, United Parcel Service, Hilton, and even health insurer Aetna propose rules that would relieve them of the requirement to cover as many as half or even more of their employees. But these employers do have a point. Is it reasonable for them to provide health benefits for a highly unstable workforce that works seasonally, part time, or temporarily, especially when that turnover creates instability and fragmentation in the employees’ health care coverage?

Although Walmart has been a favorite whipping boy for the health justice community, should Walmart alone really bear that much of the blame? As long as we have a system that is dependent on a patchwork of private health plans, public programs, and no programs at all, no matter how much Walmart tries, their employees cannot possibly be assured of having stable, comprehensive coverage throughout their pre-Medicare years.
We should dismiss Walmart (and all other employers) as the keeper of health insurance (while encouraging them to apply the savings toward living wages). But to do that, we need to end our fragmentation of coverage and care by establishing a single, comprehensive health program that will include everyone – from birth, throughout life – through an improved Medicare for all.

I mean… look back over a year of employment? … and then start another three month waiting period before eligibility is established? … and then find that this “associate” is no longer employed? (Check… more bucks for the Walton family.) Come on!

How would Walmart cover part time, seasonal and other short term employees?

Employers Lobby to Weaken Insurance Mandate

By Janet Adamy
The Wall Street Journal, July 13, 2011

It is three years before most of the new health-care law kicks in, but already some of America’s largest employers are peppering the Internal Revenue Service with concerns that making the changes will be far more complex than they anticipated.

At issue is one of the law’s central requirements: employers with 50 or more full-time workers must offer affordable insurance or pay a penalty. It sounds simple enough. But in crafting the rules, the IRS and two other federal agencies are now tackling basic yet messy questions, such as who counts as a full-time worker and how do companies measure whether insurance is “affordable.”

Retailers, restaurants and other companies that rely on seasonal, temporary and other workers with flexible schedules, say it’s hard to figure out who is a full-time worker. That could cause the employer to enroll and drop them from coverage, potentially churning them through new state-run insurance exchanges or the Medicaid federal-state program for the poor, as their hours fluctuated.

Census Bureau data shows that six million, or 5.6% of private-sector employees, work variable hours.

The debate centers on how federal agencies define a full-time worker. The law itself, signed by President Barack Obama in March 2010, defines a full-time employee as one who works at least 30 hours per week on average in a given month.

Once classified as a full-time worker, the employer is obligated to provide affordable health care or pay a penalty of $2,000 per worker, excluding the first 30 workers.

In response, the IRS in May floated the idea of giving employers a “look-back” period of between three and 12 months to determine whether certain workers met the full-time definition. Only then, if the employee hit the target, would the employer have to start providing insurance or pay the penalty.

Meanwhile, employers cheered the idea and are pressing the IRS to go further. An umbrella group called Employers for Flexibility in Health Care, which represents at least four dozen big employers and trade groups, last month asked the IRS to ensure that all part-time, temporary and seasonal hires wait up to 12 months, plus an additional 90-day waiting period, before they qualify for insurance.

In one of more than 200 submissions made recently to the IRS, Wal-Mart Stores Inc., Gap Inc., United Parcel Service Inc., Hilton Worldwide Inc. and others have pushed for a lengthy grace period that could stave off penalties for a year or more after certain workers are hired. The result could undermine some of the law’s intent to insure those who can’t afford coverage.

http://online.wsj.com/article/SB10001424052702304584404576440093426726656.html

And…

Letter

June 17, 2011
From: Employers for Flexibility in Health Care
To: Internal Revenue Service

RE: Request for Comments on Shared Responsibility for Employers Regarding Health Coverage (IRC §4980H, as created by PPACA §1513)

(excerpt)

A. Definition of Full-time Employee Under the “Look-back” Methodology

1. Employers should be granted flexibility to utilize the look­back period for new part­time, temporary, and seasonal hires. Of primary importance to employers with variable workforces is the treatment of new and newly eligible employees, as our workforce fluctuates on an ongoing basis throughout a given year with new employees entering our systems sometimes on a daily basis. Notice 2011-36 indicates that the Department is considering applying the proposed safe harbor “only in a limited form” for such employees. A limited application for newly hired employees would be extremely problematic for employers with variable workforces. Employers with variable workforces must be able to utilize the look-back period primarily in the first year of an employee’s service to determine whether the employee has worked sufficient hours to reach full-time status and become eligible for the employer’s health plan. In many cases in our industries, employees may choose to leave before completing one year of service. In addition, under the individual mandate in 2014, these employees may be receiving coverage through other sources (e.g., Exchange, Medicaid, dependent or parent coverage). Because these employees may be in the middle of a plan year for other coverage and do not want to lose their annual benefits (i.e., restart their annual deductible or out of pocket maximum), they may choose to retain that coverage rather than enroll in the employer plan in the first year of service.

Employers should have the flexibility to choose the length of the look-back period ranging from 3 to 12 months depending on the nature of their business and their workforce.

For employers offering health plans, the 90-day wait period would begin once an employee’s eligibility for the employer plan is established.

Utilizing this form of a look­back not only allows for a longer measuring period, but also a longer stability period to reduce churn between employer and Exchange coverage. Not applying the look-back period to new part­time, temporary and seasonal employees would be a strong deterrent to employers’ giving employees the opportunity to work more than 30 hours per week on average and employing seasonal workers beyond 90 days.

C. Maintaining the Employment Connection During the Stability Period

The Notice states that if an employee is determined to be full time during the look­back period, then the employee would be treated as a full-time employee during a subsequent stability period, regardless of the number of the employee’s hours of service during the stability period, so long as he or she “remained an employee.”

The Coalition recommends that employees maintain a connection with an employer and meet a minimum work threshold during the stability period. This is particularly important for employers with large numbers of part­time, temporary, or seasonal workers whose hours and patterns of work fluctuate considerably.

D. Penalties

1) Penalties should not apply during any look­back or wait periods.

2) Seasonal employees should not be included in the total number of full­time employee for purposes of calculating employer tax liability.

For full 10 page letter, including signers, click on this link:

http://www.restaurant.org/pdfs/advocacy/20110617_EFHC-Re_Notice2011-36-FINAL.pdf

When supposedly the intent of the health reform legislation was to try to provide health insurance for everyone (well, not quite), it is particularly disconcerting to see large employers such as Walmart, Gap, United Parcel Service, Hilton, and even health insurer Aetna propose rules that would relieve them of the requirement to cover as many as half or even more of their employees. But these employers do have a point. Is it reasonable for them to provide health benefits for a highly unstable workforce that works seasonally, part time, or temporarily, especially when that turnover creates instability and fragmentation in the employees’ health care coverage?

Although Walmart has been a favorite whipping boy for the health justice community, should Walmart alone really bear that much of the blame? As long as we have a system that is dependent on a patchwork of private health plans, public programs, and no programs at all, no matter how much Walmart tries, their employees cannot possibly be assured of having stable, comprehensive coverage throughout their pre-Medicare years.

We should dismiss Walmart (and all other employers) as the keeper of health insurance (while encouraging them to apply the savings toward living wages). But to do that, we need to end our fragmentation of coverage and care by establishing a single, comprehensive health program that will include everyone – from birth, throughout life – through an improved Medicare for all.

I mean… look back over a year of employment? … and then start another three month waiting period before eligibility is established? … and then find that this “associate” is no longer employed? (Check… more bucks for the Walton family.) Come on!

ALEC Exposed: Sabotaging Healthcare

By Wendell Potter
The Nation, July 12, 2011

Days after President Obama signed the Affordable Care Act into law, I arrived at the spring 2010 meeting of the National Association of Insurance Commissioners (NAIC) in Denver, where a fellow consumer representative introduced me to one of the hundreds of industry lobbyists swarming the convention center. “She’s somebody we can work with,” he said, clearly convinced that she would deal with us in good faith, even if we might disagree on certain policy issues. Over the next several months, other consumer reps agreed that she really did seem to want to do what was right for patients, even if the organization that paid her salary often seemed to care more about profits than people.

I was skeptical. I knew from my two decades as an insurance company executive that the industry often conducts duplicitous charm offensives, assuring the public that insurers support consumer-focused reform while executives work surreptitiously to block any reform that might curtail profits. So I was not shocked when I found out that Joan Gardner, executive director of state services for the Blue Cross and Blue Shield Association’s Office of Policy and Representation, had been keeping something important from us. As a leading member of ALEC’s Health and Human Services Task Force, she’d been helping write legislation designed to ensure that any healthcare reform implemented at the state level would benefit insurance companies far more than their policyholders. She was also leading an effort to recruit more dues-paying members to ALEC.

I learned of Gardner’s clandestine work when a reform advocate alerted me to a story about a resolution her ALEC committee had drafted in 2008 to forbid “government-mandated health care.” Apparently fearful that a bill would reach Obama’s desk that would allow states to establish single-payer systems, ALEC crafted the Freedom of Choice in Health Care Act, which, despite its Orwellian name, was written to deny the citizens of any state that passed it the freedom to set up such a system. By declaring that Congressional attempts to regulate health insurance at the federal level would be unconstitutional, it would effectively ban not only a federal single-payer proposal but also a federally created health insurance exchange and a federally operated public insurance option. ALEC has boasted that some forty-four states have introduced its Freedom of Choice in Health Care Act (which itself would not withstand a constitutional challenge). What it hasn’t acknowledged is that attempts to pass healthcare-nullification bills have failed in at least twenty-five states. Only eight states have passed the act so far.

Reviewing ALEC’s healthcare-related bills and resolutions from the past few years makes it clear that insurers realized early on that the best way to block the profit-threatening provisions of any federal reform would be to attack them at the state level through ALEC. With Democrats in control of both houses of Congress and the White House in 2009, insurers assumed some kind of healthcare reform was inevitable, so they adopted a strategy to shape rather than stop reform. Its top five goals became:

– Keeping single-payer proposals off the table;

– Ensuring that the final bill contain a clause requiring all Americans not eligible for an existing federal program to buy coverage from a private insurance company;

– Preventing the new law from establishing a government-run plan (the “public option”) that would compete with private insurers;

– Making sure that the reform law is implemented primarily at the state level, to keep the federal government from assuming any significant new oversight of private insurers’ business practices; and

– Keeping any new regulations and consumer protections to a minimum.

Insurers achieved their first four goals, with ALEC playing a key role in a well-coordinated effort to keep the most progressive proposals from being enacted at the state or federal level. Where it fell short was in blocking provisions of the law that will impose more rigorous oversight of insurance companies’ business practices. After Obama signed the bill into law, the industry turned its attention to influencing how the new regulations would be written (by the NAIC and federal bureaucrats) and how the law would be implemented in the states.

As its archive reveals, ALEC has been at work for more than a decade on what amounts to a comprehensive wish list for insurers: from turning over the Medicare and Medicaid programs to them—assuring them a vast new stream of revenue—to letting insurers continue marketing substandard yet highly profitable policies while giving them protection from litigation. Republican lawmakers continue to promote model bills from the 1990s. Some of the most far-reaching and industry-favorable measures adopted by ALEC over the years:

– The Resolution Urging Congress to Create Private Financing of the Medicare Program, initially adopted in 1998, calls on Congress to privatize Medicare by permitting the creation of Individual Medical Accounts, similar to Health Savings Accounts that accompany high-deductible health plans and that have become attractive tax shelters for well-to-do Americans. Individual Medical Accounts, along with vouchers, are a feature of Representative Paul Ryan’s federal proposal to privatize Medicare.

– The Resolution on Medicaid Funding Through a Federal Block Grant, adopted in 2008, urges Congress to replace the current financing mechanism for Medicaid with block grants, as Ryan proposes. In another proposal to privatize the program, the Access to Medicaid Act, beneficiaries would receive vouchers to buy insurance policies in the private market.

– The Health Care Choice Act for States, adopted in 2007, would permit the sale of individual health insurance policies across state lines, which would not be subject to the mandated benefits required by in-state policies. The effect would be to make comprehensive policies significantly more expensive than they already are. (Wyoming was the first state to enact this model bill, in 2010, followed by Georgia and Maine this year.)

– The Non-Economic Damage Awards Act, adopted in 2002, would limit medical malpractice awards for damages like pain and suffering to $250,000, making such lawsuits infeasible. (Few lawyers would be willing to represent patients if the total award were limited to that amount because they probably would not be able to cover their costs.) Insurers and the American Medical Association have joined forces in lobbying for such tort reform.

In sum, ALEC’s model legislation would not only undermine the consumer protections in the Affordable Care Act; it would shred the social safety net for the most vulnerable among us: older, disabled and poorer Americans, and those who become victims of a system that is supposed to heal, not harm.

This article is part of a Nation series exposing the American Legislative Exchange Council, in collaboration with the Center For Media and Democracy. Wendell Potter is senior fellow on health care for the Center for Media and Democracy. He previously served as head of communications for Cigna, the giant health insurance company.

http://www.thenation.com/article/161975/sabotaging-healthcare

Malpractice reform lessons from abroad

Administrative Compensation for Medical Injuries: Lessons from Three Foreign Systems

By Michelle M. Mello, Allen Kachalia, and David M. Studdert
The Commonwealth Fund, July 2011

Medical malpractice reform is a perennial issue for state legislatures and, more recently, for the U.S. Congress. The American medical liability system is widely acknowledged to perform poorly in several important respects. Few patients with injuries due to negligence file claims, in part because of the difficulty of obtaining attorney representation and the arduousness of the litigation process. Many meritorious cases do not result in compensation to the patient, while many non-meritorious cases do lead to settlements or jury awards. The amounts awarded are highly variable across similar injuries, inadequate in some cases and excessive in others. The highly adversarial litigation process destroys physician–patient relationships and involves considerable emotional strain for both plaintiffs and defendants. Fear of litigation chills open discussion about medical errors, resulting in missed opportunities for learning and patient safety improvement, and leads physicians to order extra tests, referrals, and other services primarily for the purpose of reducing their liability exposure. Such defensive medicine, together with the high cost of malpractice insurance premiums that increases providers’ overhead costs and the prices they charge, contributes to the upward growth of health care expenditures.

Abstract:

The United States requires patients injured by medical negligence to seek compensation through lawsuits, an approach that has drawbacks related to fairness, cost, and impact on medical care. Several countries, including New Zealand, Sweden, and Denmark, have replaced litigation with administrative compensation systems for patients who experience an avoidable medical injury. Sometimes called “no-fault” systems, such schemes enable patients to file claims for compensation without using an attorney. A governmental or private adjudicating organization uses neutral medical experts to evaluate claims of injury and does not require patients to prove that health care providers were negligent in order to receive compensation. Information from claims is used to analyze opportunities for patient safety improvement. The systems have successfully limited liability costs while improving injured patients’ access to compensation. American policymakers may find many of the elements of these countries’ systems to be transferable to demonstration projects in the U.S.

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/1517_Mello_admin_compensation_med_injuries.pdf

Comment: 

By Don McCanne, MD

Our medical liability system is very expensive, highly inefficient, extremely adversarial thereby inflicting much emotional pain on all involved, and leaves most individuals with medical injury uncompensated. It is a very lousy system. This report describes far better systems in three other nations, providing very valuable lessons for the United States.

There are two important stumbling blocks if we were to decide to adopt a more rational liability system based on these models. First, these nations demonstrate greater social solidarity than the United States, such as having other social insurance programs (health care, disability, unemployment) obviating the need for for filing as many medical injury claims.

Second, just as we seem to be incapable of displacing our wasteful, inefficient, highly expensive private insurance industry, we would likely find similar resistance in displacing our wasteful, inefficient, highly expensive legal system. Health insurers and tort attorneys have the ear of Congress.

What can we do? Citizen activism. It’s empowering.

Medicare under threat: now's the time to speak out

July 13, 2011

Dear PNHP colleagues and friends,

With the 46th anniversary of Medicare only a few weeks away (July 30), the program is in serious danger. PNHP members are encouraged to join our special Thursday night conference call with former Medicare head Bruce Vladeck (details below) to learn more, and to speak out in their communities on the issue, including via letters to the editor.

You may have seen the Washington Post story last week that said, “President Obama is pressing congressional leaders to consider a far-reaching debt-reduction plan that would force Democrats to accept major changes to Social Security and Medicare in exchange for Republican support for fresh tax revenue,” and as that part of his pitch he’s proposing “significant reductions in Medicare spending.”

Yesterday’s New York Times reports that the president has “agreed to consider a change in Medicare, which would have pushed up the eligibility requirement for recipients from the age of 65 to 67.” Others, such as Sen. Joseph Lieberman, I-Conn., have made similar proposals and are also pushing for increased cost-sharing by Medicare beneficiaries, e.g. much higher deductibles for doctors’ visits.

Such measures would unquestionably reduce access to health care by our nation’s elderly and severely disabled, worsen their health outcomes and increase financial hardship.

Still worse, others such as Rep. Paul Ryan, R-Wis., would dismantle the Medicare program altogether, replacing it with vouchers to buy private insurance.

As you know, PNHP has joined with others in calling for the protection of the Medicare and Medicaid programs, even as we have pointed out their limitations and advocated for a single-payer national health insurance program, an improved Medicare for all, as the best way to assure truly universal coverage and control costs.

We urge you to speak out on this issue and to submit a letter to the editor or an opinion piece to your local newspaper along these lines. You can find tips on how to do so here. Already a number of PNHP activists had their comments published, as illustrated by this op-ed by Dr. Jim Recht in Massachusetts and this letter by Ann Molison in Colorado.

This Thursday night, July 14, PNHP is hosting a special conference call on the status of Medicare featuring Bruce Vladeck, Ph.D., at 9 p.m. Eastern time. Vladeck, the former top administrator of the Medicare and Medicaid programs, will be followed by several PNHP national board members who will lead a discussion on “Medicare and single payer.” Dr. Claudia Fegan, past president of PNHP, will moderate the call. RSVP today and get call-in details by clicking here!

Cordially,

Garrett Adams, M.D., M.P.H.
President

P.S. In case you missed our recent announcement, PNHP’s Annual Meeting is set for Oct. 29 at the Gallaudet University Kellogg Conference Hotel in Washington, D.C. Click here for details about the meeting and the Leadership Training Institute that takes place the day before our meeting. Please join us there!

Obama's Proposed Medicare Age Hike Means a 12 Percent Benefit Cut for the Average Senior

By John Nichols
The Nation blog, July 12, 2011

The word in Washington is that President Obama has, in negotiations with Congressional Republicans, offered to raise the Medicare eligibility age from 65 to 67.

A report in the Washington Post quoted “a Democratic official familiar with the discussions,” while other media outlets quoted multiple unnamed sources with knowledge of the talks the president and Congressional leaders have been engaged in with regard to raising the debt ceiling. All the reports suggest that Obama would trade the change in the eligibility age for a Republican agreement to accept some new taxes.

Obama essentially acknowledged as much Monday, when he said: “I’m prepared to take significant heat from my party to get something done.”

He should take significant heat.

The president’s proposal does not resemble a plan that mainstream Democrats would suggest, let alone support. In fact, it roughly resembles a plan advanced last month by Senators Tom Coburn, R-Oklahoma, and Joe Lieberman, I-Connecticut.

That the White House appears to be peddling proposals that parallel those of conservative senators represents an exceptionally troubling development, as even considering a hike in the Medicare eligibility age represents the worst of Washington-insider thinking.

The problem with this play is four-fold:

1. Raising the eligibility age represents a huge benefit cut for older Americans.

The average life expectancy for an American who makes it to age 65 is in the range of 82 years.

That would give an American who reaches retirement age under the current system roughly seventeen years of Medicare coverage.

That number would under Obama’s proposal drop to fifteen years.

That’s a roughly 12 percent cut in benefits.

2. Raising the eligibility age would not save the money that proponents of the cut suggest.

Raising the eligibility age creates new pressures on a healthcare system that is already dysfunctional for older workers who are laid off or under-insured. Far from saving money, a spike in the eligibility age simply shifts the problem to other accounts. For instance, if the federal government is providing aid to the uninsured under the healthcare reform plan, folks aged 65 to 67 will just have to seek that aid —as opposed to tapping into the already functional and efficient Medicare program.

Worse yet, the aid would be for the buying of insurance from the private sector, which will charge its highest prices for insuring the older and more vulnerable uninsured. Thus, more cost to the taxpayers.

3. Raising the eligibility age harms the struggle with unemployment.

The smartest move for older workers who do not have access to Medicare until they are 67 will be to keep working.

That means that jobs will not come open for younger workers who are entering the labor market or have been laid off.

4. Raising the eligibility age undermines the argument that Democrats want to preserve Medicare and helps Republicans such as Paul Ryan to define the debate.

When a Democratic president joins Republicans in advancing the largest cut in Medicare benefits in modern history, that takes the steam out of the argument that Democrats want to preserve Medicare, Medicaid and Social Security while Republicans want to make cuts.

Democrats had their most significant victory in the past two years when Kathy Hochul won the special election in New York’s 26th District. Hochul grabbed a traditionally Republican seat by campaigning as a stalwart and unyielding defender of Medicare, Medicaid and Social Security. She offered real alternatives for voters who were concerned about deficits and debts: arguing for fair taxation and a broad examination of waste, fraud and abuse in federal programs.

That was a powerful, winning argument. But it cannot be made by a president or a party that imposes deep and unnecessary cuts in Medicare. Accepting that so-called “entitlement” programs are the source of America’s fiscal challenges effectively endorses House Budget Committee chairman Ryan’s false premises.

The voters rejected those false premises in the New York special election, and they will continue to do so —unless Barack Obama hands the issue to Ryan and the Republicans on the silver platter of a proposal to raise the Medicare eligibility age.

http://www.thenation.com/blog/161927/if-obama-hikes-medicare-eligibility-age-will-be-12-percent-benefit-cut

My warning for the NHS

I quit a private health industry built to deny care to millions. This is what Lansley wants here

By Wendell Potter
The Guardian (U.K.), July 12, 2011

Andrew Lansley’s controversial National Health Service bill is premised on “choice and competition” and the creation of a market in health care. These three stories below from the U.S. show choice and competition at work on the ground. They also explain why 45,000 Americans die every year because they can’t afford – and in many cases can’t even obtain – health insurance.

But first, let me introduce myself – as I did in June 2009 when I testified before a congressional committee that was investigating the many abuses of the private insurance industry in the U.S. “My name is Wendell Potter, and for 20 years I worked as a senior executive at health insurance companies, and I saw how they confuse their customers and dump the sick – all so they can satisfy their Wall Street investors.”

I described how insurance companies, in their constant quest to meet profit expectations, routinely cancel the coverage of sick policyholders and strive to spend less and less of premium dollars on medical care so they can divert more and more of those dollars to executive salaries and dividends for investors.

A few months before my testimony I had left my job as head of communications for one of the largest U.S. insurers, Cigna. I could no longer in good conscience continue to serve as a spokesman for a profit-obsessed industry that I had come to realize was largely responsible for the American health care system’s descent into dysfunctionality.

Last month a man in North Carolina was arrested for robbing a bank for $1 so he could get government-provided health care in prison. Richard James Verone, 59, has a tumor in his chest and two ruptured discs but, like 51 million Americans, no job or health insurance. Verone told reporters he asked for only a dollar to show that his motives were medical, not monetary. Because of his “pre-existing” conditions, no private insurer would have anything to do with him. He wasn’t poor enough to qualify for Medicaid – the government program for low-income Americans – or old enough to qualify for Medicare, for those aged 65 and over.

Verone and millions of Americans with a history of illness are considered “uninsurable” by private insurers. Even non-profit insurers refuse to sell coverage to a third or more of Americans who apply because they have been sick in the past. Of those they turn down, many are children born with birth defects.

Shortly after Verone staged his robbery, a contestant in the Miss USA pageant revealed during a nationally broadcast interview that she is homeless. Why? Her sick mother could not pay both the rent and her mounting medical bills, so 23-year-old Blair Griffith was evicted with her mother and brother just weeks after winning the title of Miss Colorado.

Griffith’s mother, a widow, lost her health insurance soon after suffering a severe heart attack. She was unable to get another policy. Debt collectors were relentless in pursuing money she owed for her medical care. She and her children eventually had no choice but to join the millions of Americans who are homeless because they can’t pay their medical bills.

The third story hasn’t made headlines. A few days ago a young rape victim sent me an email to ask if I might be able to help her find insurance. Unfortunately there is little that I or a broker, or anyone else for that matter, can do to help her get the coverage and access to care she needs. She is a victim not just of rape, but also of an unjust system that has devolved into dysfunction.

There are millions of other other stories, many of which are just as maddening and heartbreaking. And so it is alarming to see David Cameron and his health secretary being sold the “choice and competition” bill of goods by American insurers and other health care companies that have made the U.S. system the most expensive and one of the most inequitable on the planet.

Competition sounds good in theory – but in practice, especially among hospitals, it has fueled rather than contained medical inflation. U.S. hospitals spend billions of dollars needlessly to obtain the latest technology and equipment just so they can compete with other hospitals in the same market.

This has led to a costly duplication of services and a kind of health care “arms race”. It has not led to better outcomes or equal access to care. Lansley’s proposals for the NHS are to privatize and commercialize funding and delivery. The new structures and funding mechanisms are modeled on those of the U.S. health care industry. In abolishing the duty to secure and provide comprehensive health care for all, he is abolishing the NHS – the envy of American citizens.

The bill will replace the NHS with insurance structures – GP commissioning consortiums/clusters, which under current plans will have discretion to redefine what is NHS care and introduce charges, insurance fees and top-up fees, as well as to contract commercial companies and other American insurers. The U.S. department of justice has indicted many of those companies for fraud, embezzlement and denial of care. And many of these same companies are now hustling and lobbying the U.K. government for business. The denial of care is commonplace in the U.S. It need not happen in the U.K.

http://www.guardian.co.uk/commentisfree/2011/jul/12/nhs-reform-lansley-warning

Malpractice reform lessons from abroad

Administrative Compensation for Medical Injuries: Lessons from Three Foreign Systems

By Michelle M. Mello, Allen Kachalia, and David M. Studdert
The Commonwealth Fund, July 2011

Medical malpractice reform is a perennial issue for state legislatures and, more recently, for the U.S. Congress. The American medical liability system is widely acknowledged to perform poorly in several important respects. Few patients with injuries due to negligence file claims, in part because of the difficulty of obtaining attorney representation and the arduousness of the litigation process. Many meritorious cases do not result in compensation to the patient, while many non-meritorious cases do lead to settlements or jury awards. The amounts awarded are highly variable across similar injuries, inadequate in some cases and excessive in others. The highly adversarial litigation process destroys physician–patient relationships and involves considerable emotional strain for both plaintiffs and defendants. Fear of litigation chills open discussion about medical errors, resulting in missed opportunities for learning and patient safety improvement, and leads physicians to order extra tests, referrals, and other services primarily for the purpose of reducing their liability exposure. Such defensive medicine, together with the high cost of malpractice insurance premiums that increases providers’ overhead costs and the prices they charge, contributes to the upward growth of health care expenditures.

Abstract:

The United States requires patients injured by medical negligence to seek compensation through lawsuits, an approach that has drawbacks related to fairness, cost, and impact on medical care. Several countries, including New Zealand, Sweden, and Denmark, have replaced litigation with administrative compensation systems for patients who experience an avoidable medical injury. Sometimes called “no-fault” systems, such schemes enable patients to file claims for compensation without using an attorney. A governmental or private adjudicating organization uses neutral medical experts to evaluate claims of injury and does not require patients to prove that health care providers were negligent in order to receive compensation. Information from claims is used to analyze opportunities for patient safety improvement. The systems have successfully limited liability costs while improving injured patients’ access to compensation. American policymakers may find many of the elements of these countries’ systems to be transferable to demonstration projects in the U.S.

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2011/Jul/1517_Mello_admin_compensation_med_injuries.pdf

Our medical liability system is very expensive, highly inefficient, extremely adversarial thereby inflicting much emotional pain on all involved, and leaves most individuals with medical injury uncompensated. It is a very lousy system. This report describes far better systems in three other nations, providing very valuable lessons for the United States.

There are two important stumbling blocks if we were to decide to adopt a more rational liability system based on these models. First, these nations demonstrate greater social solidarity than the United States, such as having other social insurance programs (health care, disability, unemployment) obviating the need for for filing as many medical injury claims.

Second, just as we seem to be incapable of displacing our wasteful, inefficient, highly expensive private insurance industry, we would likely find similar resistance in displacing our wasteful, inefficient, highly expensive legal system. Health insurers and tort attorneys have the ear of Congress.

What can we do? Citizen activism. It’s empowering.

HHS's proposed rule on risk adjustment

Insurers Will Share Revenue Under U.S. Health Market Rules

By Alex Wayne and Drew Armstrong
Bloomberg, July 11, 2011

Insurers with healthier, lower-cost patients would share revenue with rivals whose customers run up higher bills under U.S. rules to stabilize insurance markets within the 2010 health-care law.

Insurers such as UnitedHealth Group Inc. (UNH) would also qualify for $20 billion in subsidies from 2014 to 2016 when they take on the sickest patients, according to the regulations. The money would come from fees levied on the insurance industry.

Rules issued by the Obama administration today attempt to make good on the law’s goal of discouraging private health plans from cherry-picking patients while easing market disruptions when top changes in the medical system take effect in 2014.

The rules create a “risk-adjustment” program that would take money from insurers in a state with low-cost patients and give it to plans whose customers run up the highest bills. The policy applies both to insurers selling coverage within the exchanges and those operating independently.

http://www.bloomberg.com/news/2011-07-11/states-face-new-rules-to-establish-markets-for-health-coverage.html

And…

Affordable Insurance Exchanges: Standards Related to Reinsurance, Risk Corridors and Risk Adjustment

HealthCare.gov (HHS)
July 11, 2011

Risk Adjustment

The Affordable Care Act provides for a program of risk adjustment for all non-grandfathered plans in the individual and small group market both inside and outside of the Exchange. Under this provision, the Secretary of Health and Human Services, in consultation with the States, will establish criteria and methods to be used by States in determining the actuarial risk of plans within a State. The risk adjustment program serves to level the playing field, both inside and outside of the Exchange. Risk adjustment ends the incentive for issuers to avoid the sick and market only to the healthy by transferring excess payments from plans with lower risk enrollees to plans with higher risk enrollees. For this reason, plans will have to compete on the basis of price, quality and service. This allows consumers the ability to pick the plan that best meets his or her needs. The proposal suggests that a constant set of data for risk adjustment be considered, preventing a health insurer that offers qualified health plan in different States from having different reporting requirements. It proposes that risk adjustment calculations occur at the State, rather than plan or Federal level, given States’ role in the system. And while a Federal risk adjustment methodology would be developed, States could use an approved alternative. We welcome comments on the risk adjustment program design.

http://www.healthcare.gov/news/factsheets/exchanges07112011e.html

And…

Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment

Department of Health and Human Services

Proposed rule

(Excerpt)

§153.320 Federally-certified risk adjustment methodology.
  (a) General requirement. Any risk adjustment methodology used by a State, or HHS of behalf of the State, must be established as a Federally-certified risk adjustment methodology. A risk adjustment methodology may become Federally-certified by one of the following processes:
    (1) A risk adjustment methodology developed by HHS, with its use authorized and published in a forthcoming annual Federal notice of benefits and payment parameters; or
    (2) An alternative risk adjustment methodology submitted by a State in accordance with §153.330, and reviewed and certified by HHS. After HHS approves a State alternative risk adjustment methodology, that methodology is considered a Federally-certified risk adjustment methodology.
  (b) Publication of methodology in notices. A State must use one of the Federally-certified risk adjustment methodologies that will be published by HHS in a forthcoming annual Federal notice of benefits and payment parameters or that has been published by the State in the annual State notice described in §153.110(b). Each methodology will include:
    (1) A complete description of the risk adjustment model, including –
       (i) Factors to be employed in the model, including but not limited to demographic factors, diagnostic factors, and utilization factors if any;
       (ii) The qualifying criteria for establishing that an individual is eligible for a specific factor;
       (iii) Weights assigned to each factor; and
       (iv) The schedule for collection of risk adjustment data and determination of factors; and
    (2) Any adjustments made to the risk adjustment model weights to determine average actuarial risk.
  (c) Use of methodology for States that do not elect an Exchange. HHS will specify in the forthcoming annual Federal notice of benefits and payment parameters the Federally-certified risk adjustment methodology that will apply in States that do not elect to operate an Exchange.

Proposed rule (103 pages):
http://www.ofr.gov/OFRUpload/OFRData/2011-17609_PI.pdf

Comment: 

By Don McCanne, MD

Private insurers have been gaming the system for many decades. They have been selectively marketing their products to the healthy workforce, their young, healthy families, and to healthy individuals who purchase their coverage in the individual market. The costs of higher needs patients have been shifted to the taxpayers through programs such as Medicare end-of-life care, Medicare long-term disability care, Medicaid nursing home and other care, and safety-net institutions for the uninsured. So what has changed that requires us to now look at risk adjustment?

Congress and the President decided to cover a larger percentage of our population by expanding the market of private health plans, plus expanding Medicaid for low-income individuals. It is the expansion of private insurance that has forced the realization that these plans now will have to include individuals with higher health care costs.

Since the model chosen for reform is a market of private plans competing within and outside of the exchanges, insurers have great incentives to market to the healthy while dumping the more costly patients onto their competitors. The higher costs that their competitors would face would have to be reflected in higher premiums, causing a plunge in market share and an eventual exit from the market – a process known as the death spiral. Pro-market enthusiasts certainly understand the consequences of this anti-competitive behavior.

The solution that has been promoted is risk adjustment. Those insurers that have been successful in enrolling a healthier population are required to take some of the savings and pass that on to insurers who have had to cover the higher costs of less healthy beneficiaries. This transfer of funds penalizes insurers who have deliberately avoided covering those with greater needs, while protecting the insurers who have included in their rolls a disproportionate share of these high cost patients. The alleged advantage is that it preserves a competitive market, even if not through a true laissez-faire free market.

There is some controversy over the effectiveness of risk adjustment. Most proposals do not transfer the full difference in spending caused by the variation in risk exposure, still leaving those insurers with higher risks at a disadvantage. Also, the insurers who find that their gaming operations are under attack can be quite innovative in finding new games to play. One of the more common is to upcode to make their patient population appear sicker than they really are. Although auditing can be used in an attempt to discover such chicanery, it is an expensive and not very effective process. Proving that each patient was not as sick as the insurer claimed is arduous and very frequently does not exceed the benefit-of-the-doubt threshold.

Because of these problems, we have been anxiously awaiting HHS’s proposed rule on how they were going to approach risk adjustment that would be fair to all and not cause yet further increases in health care costs. Unfortunately, the proposed rule doesn’t help much. They have not yet presented their model for actuarial risk adjustment, merely stating that “a Federal risk adjustment methodology would be developed.”

Regarding costs, the transfer would be budget neutral (the amount taken from some insurers and given to others would not change total spending on actual health care), but the costs of administering the program, including extensive data collection and the high costs and complexity of the auditing processes, would be assessed against the insurers and passed on to patient/consumers in the form of higher insurance premiums.

Risk adjustment is yet one more expensive, administratively burdensome, and often inequitable consequence of insisting on using private insurers to provide health care coverage. Nefarious risk gaming would not occur in a single payer national health program. But games the private insurers play, and with our money!

Nurses Call for Tax on Wall Street Trades, Not Cuts in Medicare, Social Security, Medicaid — Urge National Protests

Nurses Won’t Endorse Candidates who Cut Social Security

From National Nurses United

Media Advisory, July 7, 2011
Contact:  Carl Ginsburg, (917) 405-1060, Donna Smith, (773) 617-4493, Charles Idelson, 510-273-2246

The nation’s leading nurses’ organization, National Nurses United, today called on the Obama administration and Congress to oppose cuts in Medicare, Social Security, and Medicaid, and instead increase national revenues with a tax on major Wall Street speculative activity.

NNU also urged national action, including swamping Congress with calls, to block cuts they say would endanger lives for those who count on these vital programs, especially in an economy that has not recovered for millions of Americans.

Data continues to pour in about how far the U.S. is already falling on healthcare barometers, indicators that could become far worse under the cuts now being discussed in Washington, the nurses say. (see examples below)

Earlier this year, the NNU national board voted to withhold election endorsements for any federal candidate who votes or acts to cut Social Security. NNU has some 170,000 members across the U.S.

NNU members issued the call ahead of a debate being held Friday in Washington between supporters and opponents of a financial transaction tax similar to an FTT currently on the books in more than 15 countries, including Great Britain, and under active consideration by the European Union.

A bill to enact such a measure for the U.S., which had an FTT from 1914 to 1966, is expected to be re-introduced soon.   Proponents, including NNU, say hundreds of billions of dollars could be raised annually through even a modest tax rate on financial market trades of stocks, bonds, derivatives, credit default swaps, and similar financial transactions that could be used to help rebuild America.

The debate will be held Friday, July 8, at 11:30 a.m. at the Carnegie Institute, 1530 P St. NW.

Nurses warn that further cuts to vital basic programs, especially to Medicare, Social Security, and Medicaid could substantially accelerate a broad decline in health and living standards linked to the ongoing recession experienced on Main Streets across America.

In June, NNU members, joined by labor and community activists, rallied in support of such a Wall Street tax on Wall Street in New York across from the Stock Exchange, and outside the U.S. headquarters of the Chamber of Commerce in Washington DC.

Deborah Burger, RN, co-president of National Nurses United:   “America’s nurses see and feel broad declines in health and living standards for their patients, and their own families that are directly tied to the collapse in jobs, housing, healthcare, and other basics of what used to be called the American dream,” says NNU Co-President Deborah Burger, RN. “Nurses are calling for a change in priorities because they have seen enough, and want to stop the bleeding now.”

NNU Executive Director Rose Ann DeMoro: “America has the wealth to end the despair and deprivation.  To reclaim this nation, we have to start by making Wall Street pay to undo the damage that has caused immeasurable suffering while the high rollers on Wall Street, who created this crisis, are rewarded with bailouts, bonuses, tax cuts, and regulatory rollbacks.”

More background about the nurses’ campaign is available at www.mainstreetcontract.org.

·  A University of Washington’s Institute for Health Metrics and Evaluation in mid-June disclosed that life expectancies, relative to other developed nations, fell in more than 80 percent of U.S. counties from 2000 to 2007.  In 40 percent of U.S. counties, life expectancy for women fell five years behind countries that fared better. In five Mississippi counties, women’s average life spans trailed such poorer nations as Honduras, El Salvador, and Peru.

· A study just released today by the National Bureau of Economic Research illustrated the consequences of cuts to Medicaid: “When poor people are given medical insurance, they not only find regular doctors and see doctors more often but they also feel better, are less depressed and are better able to maintain financial stability,” the New York Times reported.

· Between 2003 and 2007, the average maternal mortality rate – defined by deaths that occur within 42 days of childbirth – has risen to 13 deaths per 100,000 live births, approximately double the low of 6.6 deaths per 100,000 live births recorded in 1987. Today, the United States ranks 41st in the world for maternal mortality, one of the worst records among developed countries. (Guardian, UK, July 5, 2011)

· The U.S. already ranks just 19th among 29 industrial nations in public expenditure on pensions, according to OECD data, a stat that could plummet further if Social Security is cut.

·  A UNICEF report last December found the U.S. ranks just 22nd in health wealth being for children and 23rd in material well being for children among developed nations.