PNHP

Out-of-Pocket Costs for Some Cancer Patients Top $700 Monthly

Out-of-Pocket Costs for Some Cancer Patients Top $700 Monthly

By Katherine Hobson
The Wall Street Journal, June 6, 2011

The cost of cancer treatment is high and, according to the National Cancer Institute, growing. And at the individual level, the financial burden can be very heavy, even for patients with insurance.

A new study from Duke University Medical Center and Dana-Farber Cancer Institute covers 216 cancer patients, mostly older females with breast cancer. It found their self-reported, out-of-pocket, cancer-related costs averaged $712 a month. Some 30% of respondents said their expenses were a “significant burden” and 11% called them a “catastrophic problem.”

All but one of those surveyed had insurance, mostly Medicare, and 83% had prescription-drug coverage.

There are some caveats to the findings. Most of the patients found their way to the study via the HealthWell Foundation, a nonprofit group that provides financial assistance for out-of-pocket health-care costs, mostly prescription-related. (The rest of the study participants were being treated at Duke.) Most of the study participants had a household income of less than $40,000.

So the findings may not represent the experience of all cancer patients.

But study lead author Yousuf Zafar, an assistant professor of medicine at Duke, tells the Health Blog the findings do reflect the plight of the “underinsured” cancer patient. As the WSJ’s Laura Landro wrote in an Informed Patient column on this topic, about 25 million people are considered to fall into this category, meaning they have insurance but it doesn’t cover all their medical needs, leaving them with high out-of-pocket costs.

That $712 figure includes insurance premiums and costs including lost wages and travel to appointments, as well as co-pays for medications and physician visits.

Other research has backed up the notion that the cost of insurance plus out-of-pocket costs can weigh heavy on cancer patients and survivors. A study published recently by the Journal of Clinical Oncology found that about 13% of cancer patients spend more than 20% of their income on health care and insurance premiums. A  survey by the cancer-survivor advocacy group Livestrong — which, like the Duke study, is being presented at the American Society of Clinical Oncology meeting — found that 33% of post-treatment cancer survivors cited debt as a practical concern.

The consequences can affect care. The Duke study found that 26% of patients surveyed had not filled a prescription because of cost, 22% said they had filled a prescription part-way and 20% had taken less than the prescribed amount. (Another recent study found that 10% of cancer patients failed to fill new prescriptions for oral cancer drugs.)

“People forgo treatment, cuts pills in half and are often forced to choose between medications and food,” Mary Sundeen, president of the HealthWell Foundation, tells the Health Blog.

Physicians can help out by talking with their patients about the costs of care — for example, there may be a less expensive drug that works just as well, says Zafar.

Our friends over at the WSJ’s Bankruptcy Beat blog pointed out a study, also presented at ASCO, that 2.1% of cancer patients filed for personal bankruptcy in the years following a diagnosis.

http://blogs.wsj.com/health/2011/06/06/out-of-pocket-costs-for-some-cancer-patients-top-700-monthly/

N.Y. lawmakers introduce bill for single-payer health care system

By Cara Matthews
The Journal News (White Plains, N.Y.), Jun 07, 2011

Democratic lawmakers in both houses introduced a universal health care bill today, under which publicly sponsored coverage would replace coverage by insurance companies. Instead of premiums, there would be broad-based public financing of health care based on people’s ability to pay. It would be funded through a graduated income tax, and the system wouldn’t have deductibles or co-payments. Delivery of care would remain primarily private.

Assembly Health Committee Chairman Richard Gottfried and Sen. Thomas Duane, both of Manhattan, introduced the legislation, which is being co-sponsored by 62 other legislators. However, it does not have a Republican sponsor in the Senate, which is controlled 32-30 by Republicans. Democrats hold the majority in the Assembly. The legislative session is scheduled to end June 20.

“We can get better coverage, get all of us covered, and save billions by having New York provide publicly sponsored, single-payer health coverage, like Medicare of Child Health Plus but for everyone,” Gottfried said in a statement.

Vermont Gov. Peter Shumlin signed legislation May 26 to create a single-payer system in that state.

“New Yorkers need and deserve security when they are sick or injured, and should not fear for how they will pay for medical bills,” Duane said in a statement. “Primary care and access to health care should be a right. A single-payer system is not only cost-efficient, but the fair and moral choice for New York.”

The national health care law doesn’t ensure that everyone has access to quality health care or control costs, according to Mark Dunlea, co-chairman of Single Payer New York and co-chairman of the Hunger Action Network of New York State.

New York is in the process of setting up a health-insurance exchange to comply with the federal Affordable Care Act. Individuals and small businesses will be able to purchase health insurance through the exchange. Gov. Andrew Cuomo’s administration is expected to introduce legislation soon.

http://polhudson.lohudblogs.com/2011/06/07/lawmakers-introduce-bill-for-single-payer-health-care-system/

‘Health care for all New Yorkers’ bill introduced

‘New York Health’ single-payer plan for comprehensive health coverage, regardless of income

By Single Payer New York
 
All New York residents would receive comprehensive health coverage under “New York Health,” a universal health care bill introduced by key legislators today. Under the plan, publicly sponsored coverage would replace insurance company coverage, and premiums would be replaced by broad-based public financing based on ability to pay. The bill, A.7860/S.5425, introduced by Assembly Health Committee Chair Richard N. Gottfried and Senate Health Committee Ranking Member Thomas K. Duane, is co-sponsored by 62 other legislators.

Gottfried and Duane were joined at the Albany press conference today by Dr. Garrett Adams, national president of Physicians for a National Health Program; Shaun Flynn of the New York State Nurses Association; Mark Dunlea, co-chair of Single Payer New York and executive director of Hunger Action Network of NYS; and Laurie Wen, executive director of Physicians for a National Health Program, New York Metro chapter.

“We can get better coverage, get all of us covered, and save billions by having New York provide publicly sponsored, single-payer health coverage, like Medicare or Child Health Plus but for everyone,” Assembly Member Gottfried said.

“New Yorkers need and deserve security when they are sick or injured, and should not fear for how they will pay for medical bills. Primary care and access to health care should be a right. A single-payer system is not only cost-efficient, but the fair and moral choice for New York,” said Senator Duane.

“The current system doesn’t work for patients or health care providers, or for the employers, individuals, and taxpayers who pay for care and coverage today,” Mr. Gottfried said.

Under this plan, no one would have to give up the doctors or other providers they use. Instead of individuals and employers paying high premium costs, the coverage would be funded through a graduated tax on income, the legislators said. Deductibles would also be eliminated and co-payments would be nonexistent.

“Federal health care reform made major improvements, but it still leaves insurance companies with too much control over premiums. Premiums are unrelated to a consumer’s ability to pay. Too often, patients and their doctors are left trying to figure out what is covered and then trying to get reimbursed. New York State can do better,” Mr. Duane said.

“Health coverage should be accountable to the people of New York, not to insurance company stockholders,” said Assembly Member Gottfried.  We should get the administrative and cost savings of a single-payer system – which have been documented in repeated independent studies.  It should be fairly funded based on ability to pay.”

“Physicians for a National Health Program salutes Assembly Member Gottfried and Senator Duane for their vision for social justice for New Yorkers. ‘New York Health’ is model health reform legislation, not only for the people of New York but for the nation,” said Dr. Adams.

Mr. Dunlea said: “Two critical elements missing from the recent national health care package were ensuring that everyone had access to quality health care and controlling costs. That is why this state single-payer proposal is so critical. Canada’s universal health care system started at the province rather than the national level, and it will be up to states like Vermont and New York to show how to make health care an affordable right at a sustainable cost.”

“Doctors and patients are sick of a system controlled by private insurance companies,” said Ms Wen. They don’t provide the services they overcharge us for and they make huge profits by denying care. What we need instead is a system accountable to the public, not to CEOs and shareholders. The Gottfried/Duane bill would restore the doctor-patient relationship and give doctors the freedom to take care of patients.”

In 2009, the “Partnership for Coverage” report by the New York State Health and Insurance Departments, based on an analysis by the Urban Institute, found that a single-payer plan would be the lowest-cost alternative for universal coverage, compared to plans relying on insurance companies and employment-based coverage.

Single-payer plans like New York Health would save billions of dollars, including excess insurance company administrative costs and profit; and billing and collecting for hospitals, physicians and other health care providers. Current federal, state and local expenditures for health care services – primarily through Medicare and Medicaid – would be incorporated into the New York Health Plan to help pay for the program.

Assembly Member Gottfried added, “By eliminating the need for any employer to provide health coverage for its workers, we would make New York dramatically more job-friendly, especially for small businesses, start-ups and low-margin businesses, while offering better and more secure coverage to every New Yorker.”

Single-payer health coverage is a system in which a single public or quasi-public agency pays for health care for all residents, but delivery of care is primarily private, as it is now. Patients would have freedom of choice of health care providers, and health care decisions are made by patients and their doctors, not by insurance companies. All New Yorkers would be covered for all medically necessary services, including primary, pr
eventive, and specialist care; hospital; mental health; reproductive health care; dental; vision; prescription drug; and medical supply costs.

The cost of New York Health would not be new spending, the legislators said.  For most people, it will be a substantial reduction in what they are now spending. When employers and individuals aren’t “taxed” by out-of-control insurance company premiums and deductibles, most people’s take-home pay will go up.

Union Nurses Call for Single-Payer System

By Emily P. Walker
MedPage Today, June 7, 2011

WASHINGTON — Several hundred members of National Nurses United held a rally here on Tuesday to call for a single-payer healthcare system, an end to tax breaks for big corporations, and workers’ rights.

The nurses started their march in front of the White House and walked across the street to the U.S. Chamber of Commerce chanting “Hey Chamber, you can’t hide, we can see your greedy side.”

The union wants Congress to levy higher taxes on Wall Street, which would include the big companies that the Chamber of Commerce represents, Dan Rec, RN, of Jamaica Plain, Mass., explained.

The nurses then bussed over to the Capitol where they were serenaded by a singer/guitar player who belted social justice tunes, and then heard brief speeches from Sen. Barbara Boxer (D-Calif.) and Sen. Bernie Sanders (I-Vt.).

Sanders, like the 175,000-strong nurses union, is a major proponent of a single-payer healthcare system.

“If you have the money, you have good healthcare,” Rec told MedPage Today. “If you don’t have the money, it’s ‘oh well.’ It needs to be healthcare for all.”

Boxer spoke out against Rep. Paul Ryan’s plan to drastically change Medicare for those who are currently under 65, saying many in Congress don’t want to change the insurance program for the elderly.

http://www.medpagetoday.com/nursing/Nursing/26909

Nurses Union Keeps Pressure On Health Care Overhaul

By Jessica Marcy and Shefali S. Kulkarni
Kaiser Health News, June 10, 2011

Nurses converged on Washington in their fight against Wall Street this week.

Hundreds of nurses from across the country rallied to support broader access to health care and to call for higher taxes on corporations and the wealthy.

They gathered Tuesday near the White House and then picketed the U.S. Chamber of Commerce with large red banners that read: “RNs say Heal America, Tax Wall Street.” National Nurses United, the nation’s largest nurses union, sponsored the event to promote its “Main Street Contract for the American People,” a campaign that broadly calls for improved living conditions, including guaranteed health care, better wages and quality education.

They plan to rally on Wall Street later this month.

In response to the Washington rally, Blair Latoff, director of communications for the U.S. Chamber of Commerce, released the following statement: “The Chamber welcomes all voices to the debate, but the debate has to remain focused on creating American jobs and keeping our economy growing. Right now U.S. businesses are saddled with one of the highest corporate tax rates in the world, which is undercutting our global competitiveness.”

Some nurses spoke about the need for improved working conditions by increasing pay and enforcing adequate nurse-patient ratios. Many held signs that read: “I am a patient advocate” and “Medicare for all.” Participants finished the rally by gathering at a park near the Capitol, where Sen. Barbara Boxer, D-Calif., spoke about the need to protect Medicare and Sen. Bernie Sanders, I-Vt., told the crowd of red-shirted nurses that the nation needs a single payer system like that recently promoted in his own state.

Rose Ann DeMoro, executive director of National Nurses United, suggested that nurses offer a unique perspective on the struggles that patients and their families face because of the direct care they provide. “Everywhere the fallout of this system is felt, and it’s felt and experienced by the registered nurse,” she said.

Sue Gray, 51, who has been a nurse for more than 30 years and cares for cardiac surgery patients at Minneapolis Children’s Hospital, says that her own experience as a cancer patient has given her insight into the financial and emotional pressures that patients and their families experience. Diagnosed with breast cancer 12 years ago, Gray continues to work two days a week despite her cancer, which returned five years ago and has spread to her liver and bones. She does so to provide financial support and health insurance to her self-employed husband and three children.

“We really need to get some type of universal health care so that people going through my situation or families that I see at work that are struggling don’t have to worry about not getting health care,” Gray said.

Web version includes slideshow and audio of nurses’ demonstration in Washington:
http://www.kaiserhealthnews.org/Slide-Shows/2011/National-Nurses-United-Washington.aspx

Media Release: Legislation for Single Payer Medicare for All Legislation Would Make Health Care a Right, Cut Costs

Single Payer New York
Media Advisory
www.singlepayernewyork.org

For Immediate Release: June 6
For More Info: Mark Dunlea, SPNY, 212 741-8192 xt 5#
Laurie Wen, PNHP-NY Metro, 917-446-1610

Notice of News Conference

Date: Tuesday, June 7
Topic: Introduction of state legislation for a state single payer Medicare for All health care system
Time: Noon
Location: Rm. 130, LCA press room, Legislative Office Building, State and Swan St., Albany

Single payer advocates will join with leaders of the Legislative Health Committees on Tuesday June 7 at noon to announce the introduction of legislation to create a Medicare for All style universal health care system in NY.

The announcement, in the LCA news conference room in the Legislative Building, will include Dr. Garrett Adams, national President of Physicians for a National Health Program; Assembly Health Committee Chair Richard Gottfried; Senator Tom Duane, ranking minority member of the Senate Health Committee; Shaun Flynn, Director o f Government Affairs for the NYS Nurses Association; Danielle Alexander, Albany Medical College class of 2013; and representatives of the faith community.

Last month the state of Vermont became the first state to make health care a right, adopting a universal health care system that they intend to end up as a single payer system. California is also considering a single payer system; the state legislature has twice recently passed single payer only to have it vetoed by the former Governor.

Like Vermont, state legislators several years ago under the leadership of As. Gottfried commissioned an independent study of the best way for New York to provide universal health care. Like Vermont and the other states that have examined the issue, the report found that a single payer system was the most-cost effective option, covering all residents while reducing overall health care expenditures in the state by $20 billion annually by 2019. The study found that single payer would save $28 billion annually compared to the insurance mandate model that Congress adopted.

Text of the bill

As physicians change, will the AMA?

By Aaron Carroll
Washington Post, May 31, 2011
Ezra Klein blog

There was a fascinating piece in the NYT yesterday that discussed the apparent shift in politics among physicians:

Doctors were once overwhelmingly male and usually owned their own practices. They generally favored lower taxes and regularly fought lawyers to restrict patient lawsuits. Ronald Reagan came to national political prominence in part by railing against “socialized medicine” on doctors’ behalf.

But doctors are changing. They are abandoning their own practices and taking salaried jobs in hospitals, particularly in the North, but increasingly in the South as well. Half of all younger doctors are women, and that share is likely to grow.

There are no national surveys that track doctors’ political leanings, but as more doctors move from business owner to shift worker, their historic alliance with the Republican Party is weakening from Maine as well as South Dakota, Arizona and Oregon, according to doctors’ advocates in those and other states.

When I was a fellow, back at the turn of the century, a colleague and I conducted a national survey of physicians to determine their level of support for national health insurance. At the time, I was sure physicians would oppose it en masse. Surprisingly, they did not — at least not to the levels that I had thought they might.

In 2007, we repeated the survey to see whether opinions had changed. I grant you that this is not a pure tracking survey of doctor’s political leanings, but it does provide some insight on how physicians’ leanings on this one issue changed:


(Annals of Internal Medicine )

Remember this was support for federal legislation to establish National Health Insurance. That’s far more radical than the PPACA. And 59 percent of physicians supported it. That was an increase of 10 percent from what we found five years earlier, and it was statistically significant. More than half the respondents from every medical specialty supported it, with the exception of surgical subspecialties, anesthesiologists and radiologists. That means support included a majority of general surgeons, medical subspecialists and obstetricians/gynecologists.

Most significantly, in pretty much every specialty we measured in both years, support went up from 2002 to 2007.

I think that demographics likely play a part in this. I also think that this is a potential problem for the American Medical Association.

An unpublished part of our analysis showed that members of the AMA were significantly less likely to support national health insurance than were non-members. Moreover, AMA members were not like other physicians; they were more likely to be older, male and surgical subspecialists.

While still regarded as the “voice of physicians,” less than 30 percent of physicians are actually AMA members. And, as we see from above, it’s not a random sample.

The AMA has, unfortunately, been slow to react to changes before. For instance, in 1921, Congress sought to provide funding to reduce maternal and infant mortality through The Sheppard-Towner Act. The AMA fiercely opposed this piece of legislation. In defiance to what many saw as an organization that was not promoting the welfare of children, a group of motivated pediatricians separated from the pack and formed a new group, the American Academy of Pediatrics. Today the AMA is, of course, a strong supporter of efforts to reduce maternal and infant mortality. Perhaps if they had adapted faster, pediatricians would still play a larger part in the AMA.

We’ll never know for sure, but I think it’s possible that the about-face that the AMA made in support of the PPACA, after strenuously opposing health-care reform in the past, was due to recognition of the changing positions of physicians. I remember hearing many anecdotes of doctors vigorously opposed to the law, but a large survey conducted in 2009 showed that physicians, as a group, supported progressive elements of health-care reform that were eventually dropped.

At some point, the AMA has to decide whether to represent physicians or represent its members. I think that in the past few years, the AMA has tried harder to do the former. I think that they decided to adapt, and widen their tent, lest they risk alienating a majority of physicians on this issue. Whether they can continue to adapt, and maintain their influence in the face of changing demographics, remains to be seen.

Aaron Carroll is a pediatrician, health services researcher and associate professor of pediatrics at Indiana University School of Medicine. He blogs at The Incidental Economist and tweets via @aaronecarroll.

http://www.washingtonpost.com/blogs/ezra-klein/post/as-physicians-change-will-the-ama/2011/05/31/AGVTtPFH_blog.html

Single payer system a 'credible alternative' to Medicare's woes

By Dr. David Knutzen
Letters, Madison.com (Wis.), May 31, 2011

I take exception to the May 23 editorial, “Don’t let Medicare go bankrupt.” After praising Rep. Paul Ryan for a Medicare plan which would dramatically shift the increasing costs of Medicare from the government onto the recipients of Medicare, you stated: “Those who disagree with Ryan’s Medicare prescription haven’t offered credible alternatives.”

I disagree since the most credible solution to the rising costs of Medicare, and all health care, has been offered repeatedly for many years and certainly during the health care discussions leading up to the health care reform law.

It’s a single payer system similar to those used by every other industrialized country where health care for all is provided for between 8.5 percent and 11 percent of gross domestic product.

That would improve on the 17 percent to 18 percent of GDP we in the United States now pay. With that huge decrease in the cost of health care, Medicare would not be in danger of bankruptcy and other U.S. citizens would have affordable health care.

Currently, 20 percent to 30 percent of every health care dollar spent is paying for administrative costs and profits, including huge CEO remuneration for the insurance companies.

Medicare’s administrative costs are 4 percent. A single payer system would offer savings of administrative costs, provide health care for everyone and prevent Medicare from going bankrupt.

http://host.madison.com/news/opinion/mailbag/article_4aa9d250-895a-11e0-b232-001cc4c03286.html

The Sheriff of Nottingham rides again, but this time through our Medicare funding

By Samuel Metz, M.D.
The Oregonian, May 24, 2011

Robin Hood was legendary for stealing from the rich and giving to the poor. Now Rep. Paul Ryan proposes to do the opposite: He will rob poor seniors of their health care dollars and give tax breaks to the rich.

Rep. Ryan’s gallantly titled “Path to Prosperity” proposal will convert government Medicare spending to a lump-sum voucher program. This looks like a heck of a deal if you are rich enough to pay for your family’s current health care (and rich enough to pay for your own when you are old, gray, retired and living on a fixed income). But if you already struggle to pay your health insurance premiums (presuming you are lucky enough to have coverage at all) and have no money left to pay for deductibles, co-pays, excluded conditions and medications, Sherwood Forest starts to look like your best retirement home.

Ryan’s proposal is so simple that even the Sheriff of Nottingham would envy it. By reducing federal spending on the health care needs of our seniors, well, we reduce federal spending. What’s not to love about that?

If you’re not among the privileged nobility, there’s a lot not to like. Remember that even under current Medicare rules, seniors who need health care (roughly all of them) pay 40 percent of their health care expenses with out-of-pocket dollars. Under the Sheriff of Nottingham plan — sorry, Ryan’s “Path to Prosperity” plan –seniors in the year 2030 (that’s all of us who are at least 48 years old) will pay half our total incomes on health insurance premiums. The other half will pay for deductibles, co-pays, excluded conditions and medications.

And where will we get money to pay for food, rent, heat and clothes? The way the poor burghers in old Nottingham did: We won’t.

Even the purchase of a policy won’t guarantee health care. There’s nothing in the “Path to Prosperity” that requires an insurance company to offer anything other than a one-page statement, “This is a health insurance policy.” If that’s all you can buy for your lump sum, you might as well use the policy for compost. The Center for Economic Policy and Research estimates that under this plan, our soon-to-be starving, homeless, freezing, dressed-in-rags seniors will cough up an extra $20 trillion of their own money to get health care in the next 75 years. We better start selling our chickens at yard sales right now.

The Sheriff of Nottingham would be insanely jealous of this revolutionary plan. Tax the poor and give them no services? Spare yourself and other wealthy nobles any taxes at all? Brilliant!

But when the sheriff celebrates his 65th birthday, he might find himself roasting hot dogs around the campfire with Friar Tuck, Little John and Robin if he wants to get health care.

Samuel Metz, an anesthesiologist who lives in Portland, is a member of Mad As Hell Doctors and the Portland chapter of Physicians for a National Health Program.

http://www.oregonlive.com/opinion/index.ssf/2011/05/the_sheriff_of_nottingham_ride.html

Spending more doesn’t improve health in U.S.

Dr. Tom Duncan provides The Daily Astorian with this report from a meeting at the Clatsop County (Ore.) Medical Society, where Dr. Paul Gorman spoke about single-payer health reform

By Tom Duncan, M.D.
The Daily Astorian (Ore.), June 2, 2011

Even though Americans spend twice as much on medical care than people in any other industrialized country, our health outcomes are consistently worse. Life expectancy at birth in the United States is rated 36th in the world, lower than Chile or Cuba, and only slightly higher than Portugal or Slovenia. U.S. infant mortality rate falls in 33rd place, well below all of continental Europe, the UK, Ireland, Slovenia, Cyprus and Cuba.

At its May meeting, the Clatsop County Medical Society hosted Dr. Paul Gorman, an internal medicine specialist at Oregon Health & Science University, who spoke about the ongoing health care crisis and the future of American medicine.

Gorman, who formerly practiced internal medicine in Astoria, has become a proponent of the Medicare for All or “single-payer health plan,” which he defines as “publicly financed, privately delivered” medical care. He contrasted the different systems of various industrialized countries with the U.S. system, and pointed out that although U.S. technology and expertise is second to none, our ability to organize and deliver medical care to our people is severely deficient, resulting in major and unnecessary inequalities. The most successful countries have figured out how to combine private and public resources to provide better care for less money.

Gorman points out that although the values of “free choice” and “free markets” are admirable and are touted as the strengths of the American system, most Americans do not have free choice in health care because our employers choose it for us. 

If we are unemployed, we may be eligible for a government plan (if we qualify,) or simply go without if we cannot afford the market price of health insurance.

Theoretically, we all have free choice of our doctor, but the reality is that our only practical choice is a doctor who belongs to the same health plan we do, or if we have no health plan, we may simply go to the emergency room in a crisis. We supposedly can choose, together with our doctors, the treatment we think will work best, but in reality, the treatment we receive is that which the insurance company “allows.”

“The medical insurance and pharmaceutical industries have such huge influence in the government – three lobbyists to every congressman in Washington, D.C.,” Gorman says, “that even discussing a reasonable medical care system is difficult in the U.S.” 

Many people, including physicians, have been arrested in Washington, D.C., and other American cities for simply trying to speak in support of a single-payer-type system.

Gorman argues that the “market forces” which bring efficiency to other economic endeavors – like selling bananas, for instance – do not usually apply to the provision of medical care. He reminds us that when people are ill, they are not able to hunt for the best bargains, and must rely on experts to help them navigate through the system. 

What is more, the government/insurance payment system essentially fixes prices, so there is no price correction – efficient providers who have lower costs are penalized in this system, not rewarded as in a true free market. The basic requirement of a free market, that is – an informed and willing seller, informed and willing buyer – does not apply to the American system, because both the patients and the physicians are effectively excluded from the market by the intermediaries, leading, as expected, to higher costs and poorer performance.

Gorman believes there should be market competition, but there must be an actual market of doctors, patients and hospitals, and not the present market of insurance companies and the government. The proof of this contention is the demonstrable success of health-care provision in Japan, Germany, France, Canada and many other countries, with better outcomes at far less cost than the United States.

There is no lack of resources, and there is plenty of money in the system, Gorman insists. At the present time, the U.S. already spends as much or more public money per capita on health care as any European country – we just have to figure out how to use it more effectively. 

Many people would be surprised to know that we already have a cost-effective system in America, called Medicare  – a system of medical care that is publicly financed, but privately administered through contractors, and privately delivered by participating physicians. While there are obvious deficiencies, we should build on its strengths, not tear it apart because of its weaknesses, Gorman said.

The Clatsop County Medical Society is an association of physicians, nurse-practitioners and physicians’ assistants engaged in the ongoing assessment and improvement of health care in Clatsop County. It is a component part of the Oregon Medical Association.

http://www.dailyastorian.com/opinion/columns/guest-column-spending-more-doesn-t-improve-health-in-u/article_cb5eba6a-8d4b-11e0-841d-001cc4c002e0.html

Vermont's first steps toward single payer

By Tristin Adie
The Indypendent (N.Y.), June 1, 2011

On May 26, Vermont Gov. Peter Shumlin signed into law H. 202, a bill that is intended to set the state on the road to a single-payer health care system. While the legislation puts off the creation of such a system for a number of years, this is an important initial victory for thousands of activists in the state who have been agitating for years for a truly universal system.

James Haslam, director of the Vermont Workers’ Center and the Healthcare Is a Human Right Campaign, called the bill “a victory for our movement, for all Vermonters and for the country as a whole …. Our success shows that when people come together, make their voices heard and demand their rights, we can overcome well-funded special interests and change what’s politically possible.”

The bill establishes that “all Vermont residents shall be eligible for Green Mountain Care, a universal health care program that will provide health benefits through a single payment system.”

However, Green Mountain Care would not go into effect for several years. And the law’s initial effects will be quite modest: The legislation empowers Shumlin to create a five-member board that will “lay the groundwork” for a state-run system. The board is charged with crafting proposals for funding the system, determining what types of benefits will be covered and setting payment rates for health care providers.

The law also mandates that the state set up a health care “exchange” of various insurance plans by January 2014, to conform with the requirements of President Obama’s Patient Protection and Affordable Care Act (PPACA).

The exchange would then be replaced by Green Mountain Care sometime between 2014 and 2017, depending on when — and if — federal officials grant the state a waiver to “innovate” its own system. This would enable Vermont to utilize whatever funds are provided by PPACA in the creation and maintenance of a single-payer system.

As many activists have pointed out, including leaders of Physicians for a National Health Program (PNHP), this is far from the ideal of establishing a single-payer system in the immediate future. PNHP President Garrett Adams called attention to the fact that the law will allow private insurers to operate in the state indefinitely, even when Green Mountain Care is put in place: “Allowing multiple insurers in the system will deny Vermonters the enormous administrative savings they would otherwise get under a true single-payer plan. Having multiple insurers also nullifies the potential bargaining power of a ‘single payer’ to negotiate reduced prices for pharmaceutical drugs and other goods and services.”

And while it may be seen as an interim measure until Green Mountain Care kicks in, the exchange created by 2014 will be a “marketplace” of competing private insurance plans — hardly a step forward for the thousands of people in the state currently paying high premiums, co-pays and deductibles for inadequate coverage.

The exchange would only be phased out once Vermont has obtained a waiver from the federal government to proceed with a single-payer system, in addition to waivers that will fold Medicare, Medicaid and veterans’ benefits recipients into this system.

The inclusion of the exchange in the law and the slow timeline for the creation of a single-payer system reflect the current national reality, which is a product of the federal health care law championed by the Obama administration that bargained away genuine reform measures under pressure from the insurance industry. Establishing single payer on a statewide basis will be very expensive and can only succeed if the state receives federal money to supplement its own revenues.

Vermont Sens. Bernie Sanders and Patrick Leahy have introduced a bill to move the timeline for the waivers up to 2014, but this effort has gained little momentum so far.

This leaves Vermont hamstrung for the time being by the disastrous compromises enshrined in the federal health care law. The Obama administration is clearly uninterested in helping any state establish a single-payer system, and is likely to grant necessary waivers only if pressure is brought to bear by activists, both within the state and nationally.

This pressure must be organized through the creation of grassroots networks that can demand single-payer health care in their own states, while also calling for national reform. As an important first step, PNHP has launched an online petition drive to call on the Obama administration to grant these waivers and “provide the state of Vermont with maximum flexibility to help achieve affordable health care for all.”

Activism will continue to be important as the process moves forward in Vermont.

A majority of the state’s residents expect to get a single-payer system. This is because thousands of activists have spent the last several years holding rallies, forums, town hall meetings and debates, as well as sharing hours of health care horror stories in testimony to legislators. They have made an effective case for single payer, and now legislators have raised hopes further that we will win such a system with this latest legislation.

Grassroots activism also helped beat back efforts to include right-wing provisions in the bill, such as a last-minute add-on by state senators that would have excluded undocumented immigrants from coverage under the new system.

The backers of this addendum withdrew their proposal within days after diverse groups throughout the state peppered legislators with calls, e-mails and faxes. Particularly moving was the fact that a May 1 rally of 2,000 people organized by the Healthcare Is a Human Right Campaign was dominated by calls for the inclusion of undocumented workers in the new legislation.

The health care needs of Vermonters will be met only if activism continues. The bill calls for 80 to 87 percent of health care expenses to be paid by Green Mountain Care, for example. We need to demand 100 percent payment, so that money is never an impediment to obtaining needed care.

In addition, the bill leaves open the question of whether mental health and dental care will be covered under a single-payer system. Such care is every bit as necessary to people’s well-being as colonoscopies and immunizations, and must be covered in full.

Many Vermont activists have recognized that the fight is likely to intensify as the details of creating a new system are worked out. As physician Deb Richter, a longtime fighter for single-payer health care, said: “We’re going to hear all kinds of scare stories that this is a thoughtless experiment or that it is too bold. But I would remind you that every other industrialized country is doing what we are trying to do. And they do it for far less money, they live longer and they get better-quality care.”

The challenge for activists in Vermont and across the country is to crank up the pressure until we win the kind of health care system we need and deserve.

Tristin Adie is a nurse practitioner in Vermont and member of the Vermont Federation of Nurses and Health Professionals. This article first appeared at socialistworker.org.

http://www.indypendent.org/2011/06/01/vermonts-first-steps-toward-sngle-payer/

Medicare for All!

By the Editors
The Nation, June 20, 2011

The day after Democrat Kathy Hochul scored an upset victory in a special election deep in upstate New York’s Republican territory, former President Bill Clinton was getting real chummy with Congressman Paul Ryan, whose plan to privatize Medicare was widely seen as costing the Republicans the race and imperiling as many as a hundred GOP House seats in next year’s Congressional elections. Backstage at an event on national debt at the Peter G. Peterson Foundation, Clinton told Ryan, “I hope the Democrats don’t use it [the election] as an excuse to do nothing” on Medicare. Clinton may be right — but not in the way he seemed to mean.

The Democrats do need a winning Medicare plan, but they’re not going to find it by meeting Republicans in the middle (as Clinton’s former budget chief Alice Rivlin does with her Ryan-lite voucher proposal). And they’re not going to find it by only running against Republican ideas.

Indeed, the main strategy Democrats seem to have adopted in the wake of Hochul’s victory is to force Republicans to double down on Ryan’s agenda and pray that voters, particularly seniors, remain alarmed enough about the right’s shock doctrine tactics to throw the bums out. That might be a winning electoral formula, but how about some leadership and a plan to deal with rising healthcare costs? Where Democrats should look is Medicare itself — Medicare for all.

The chief lesson Democrats should take from the backlash to Ryan’s Medicare privatization scheme is that when faced with a choice between a market-based healthcare system and a government-run plan, voters overwhelmingly favor the latter. Nearly 80 percent oppose cutting Medicare benefits and two-thirds support raising taxes to continue to fund them. That’s because Medicare works — not perfectly, but compared with private health insurance, it’s far more efficient at keeping down costs while ensuring a baseline of coverage.

Contra Ryan, the problem with Medicare is that it’s not big enough; in countries like France and Canada as well as the United Kingdom, where government plays a much bigger role in financing healthcare and bargaining down prices, healthcare costs are about half what we currently spend, and they have comparable or better health outcomes.

Instead of just hoping that Republicans continue to play to their Tea Party base and implode in a general election, Democrats should be taking this moment to lead and to educate, not just on the practical virtues of Medicare for all but on the principle of social solidarity behind it.

They have the perfect opportunity now that Vermont Governor Peter Shumlin signed a single-payer healthcare plan on May 26. Vermont’s plan isn’t the single-payer system die-hard advocates want (there’s no funding for it yet, for example) — but it’s a start. If Vermont succeeds in providing its citizens with quality healthcare while keeping costs below market rates, other states may emulate its pioneering plan.

But in order to act as a national model, Vermont will need a federal waiver to bypass some of the requirements of the Affordable Care Act, passed in 2010. Obama has said he supports granting such waivers, but under current law he can’t do so until 2017. Vermont Senators Bernie Sanders and Patrick Leahy and Congressman Peter Welch have proposed legislation that would move the window up to 2014. That’s a bill worth going to the mat for.

http://www.thenation.com/article/161084/medicare-all

The 2011 WellPoint/Anthem Shareholders' Show: "One Thing You Can't Hide is When You’re Crippled Inside."

By Rob Stone, M.D.
Counterpunch, June 3, 2011

Tuesday, May 17, 2011.  The traffic in downtown Indianapolis was moving  slower than an insurance company clerk preparing a reimbursement check, backed up for blocks, and if we were one second late the doors to the WellPoint annual shareholders meeting would be sealed, protected by armed guards.  We jumped out of the car, leaving it our friend Donna Smith to find a parking spot, and started running up the street, dodging traffic, past the phalanx of police cars and into the Hilton.

Breathlessly rushing through the lobby we asked which floor for the WellPoint meeting, and luckily didn’t wait long for an elevator.  When we reached the 9th floor with minutes to spare, the WellPoint staff at the registration desk greeted us like old friends, “Dr. Stone, we were afraid you weren’t going to make it.”

My wife and I bought 5 shares of WellPoint (or Anthem, or Blue Cross) in 2005 and have been coming to these annual meetings since.  We’re all getting to know each other.  Many of the WellPoint employees seem to genuinely like us.  But not all.

WellPoint holds its annual brouhaha in a drab meeting room high up in the Hilton.  Security is easier there than at their corporate headquarters a block away.  WellPoint employees outnumber the stockholders, but most of the chairs are empty.  The Board and the brass fill the first three rows.  This year there were more stern faces with ear buds standing around than ever, including, as we later learned, plainclothes officers from the Indianapolis Police Department. 

The Robotic Barbie Doll

At the dais, Angela Braly, CEO and Chair of the Board, ruled over the meeting like a robotic Barbie doll, smiling as she nodded and looked around the room, mouth moving but nothing meaningful emerging.  Wendell Potter, author of Deadly Spin, calls it “being obscure clearly.”  She’s been well coached. 

This 2011 meeting was as tightly scripted as a professional wrestling match.  The outcome was never in doubt. Years past it was more informal, with a reception afterward where common stockholders could actually mix with the elite.  Now the Directors come and go through a separate door.  This time they didn’t even introduce the Board, which includes luminaries like Susan Bayh, wife of former Indiana Senator Evan Bayh, Don Riegle, former Senator from Michigan, and William “Bucky” Bush, brother of the first President Bush and uncle of GW.

WellPoint finds itself trapped within its internal contradictions, afraid of its own stockholders who speak truth to power and dare to say the Empress wears no clothes.  This year’s meeting felt like a siege, like those in control were clenching their teeth and couldn’t wait to for it to be over.

Those brave ones who dared to ask a question were faced with a massive flat screen hanging in the front, counting down 120 seconds like a shot clock.  Once the two minutes was up, the mike was turned off.  Ms Braly, on the other hand, was free to wax on in her clear obscurity, unlimited by time.  Another first this year – WellPoint planted shills in the audience to ask softball questions.

John Lennon sang, “One thing you can’t hide is when you’re crippled inside.” 

WellPoint is the for-profit monstrosity created from the mergers and acquisitions of 14 formerly nonprofit state Blue Cross and Blue Shield plans.  The crown jewels are the former Blues in California and New York, but as history would have it, the national HQ is just up the road from me in Indianapolis.

In 1937, in the early days of American health insurance, Blue Cross plans were required to be nonprofit and have a mission that was “charitable and benevolent.”  In the late 1980’s Indiana’s Anthem Inc. began a series of transformations culminating in 2001 with “demutualization,” followed by an initial public stock offering.  Anthem subsequently merged with WellPoint, the former Blue Cross of California in 2004.  WellPoint covers more lives than any other health insurance corporation in the world.

Lying With a Straight Face

Although WellPoint/Anthem loves the Blue Cross brand and uses it in advertising today, in this year’s proxy statement they lied with a straight face.  Our group, Hoosiers for a Commonsense Health Plan, sponsored a shareholder resolution calling on WellPoint to fund a feasibility study for returning to its nonprofit roots.  In their statement advising a shareholder vote against our resolution they said, “The proposal states that we were formerly a nonprofit entity.  That is not correct,” followed by legalistic gobbledygook which attempts to obscure their Blue Cross ancestry. 

Contradictions abounded during this meeting.   Lip service only was given to the needs of patients (“customers” in their lingo), but the main course served was for their Wall Street masters.  WellPoint is making record profits and sitting on record piles of cash.  What are they doing with it?  Like so many other Fortune 500 companies these days, they are buying up smaller companies, not insurance companies this time, but health-related companies involved in things like medical information technology and expanding their presence in China. 

In 2011, for the first time in their history they paid a dividend, which Ms. Braly explained would make the stock more attractive to investors. 

While they claim to be investing in “infrastructure, new products and programs that improve the quality of service to customers and members,” data suggest otherwise.  Since 2008 the company has spent $66.9 million on federal lobbying as well as millions on campaign donations.  Over the past 10 years WellPoint’s total compensation to its CEO’s has totaled over $164 million.

If they are spending on infrastructure, why did they announce in June 2010 that a security breach may have exposed the social security numbers and medical records of 470,000 people?  The same month the Indiana State Medical Society reported that WellPoint has the worst claims accuracy rating among the largest health insurers.   

Most outrageous of all, from 2003 through 2010, WellPoint spent $21.6 billion (that’s billion with a “B”) of patients’ premium dollars to buy back its own stock.

Spending billions on stock buybacks benefits a tiny elite of CEOs and top officers who are compensated with stock options which increase in value as the share price is manipulated upward.  This is an enormous transfer of wealth from hard-pressed employers and patients to CEOs and Wall Street. Not only do the stock buybacks allow executives to line their own pockets, the process strips companies of resources that could otherwise be used reduce premiums, improve benefits, create jobs and bring innovation to the business of health insurance.   

The only thing Ms. Braly made clear and unobscure during her comments was that this is a company committed to growth, growth in profits, growth in stock price, and there was
nary a mention about the uninsured, the underinsured, medical bankruptcy, denial of care and coverage, or WellPoint’s signature profit-making ploy:rescission, policy cancellation after an insured patient becomes ill.

A Stunning Vote of No Confidence

At the 2010 shareholder meeting our shareholder resolution caught WellPoint with their pants down.  In this year’s proxy statement they claimed “an overwhelming majority of our shareholders voted against this proposal last year.”  That’s one way to look at it.  Thirty million shares, 9.6% of the shares voted, were in support of our return to nonprofit.  A more accurate description might be “a stunning vote of no confidence in the company leadership.”

This year there were three shareholder resolutions, all opposed by the Board.  At the close of the meeting they announced all three had been defeated, but the official vote tallies weren’t released until three days later.  This time our resolution polled “only” 1.2 million votes.  By the rules governing shareholder resolutions set by the Securities and Exchange Commission, we would have needed 17 million shares voted in our favor in order to bring our resolution back for a third round at the 2012 meeting.

What happened this year?  There is healthcare “issue fatigue.” The Tea Party is on the rampage. The unions have been diverted, fighting for their lives.  This spring I wasn’t able to generate nearly as much interest in supporting the resolution. 

After the meeting I was no longer in a rush as I passed through the Hilton’s lobby. I saw a local reporter speaking to a well-groomed man wearing a WellPoint ID badge.  The WellPoint fellow was telling the reporter that he was confident our resolution would not meet the SEC threshold this year.  When he realized I was listening, he was only flustered for a second before regaining his composure.  I introduced myself (although he clearly recognized me), and he adroitly avoided revealing anything about his duties at WellPoint.  After he left, the reporter answered my questions.  His name was David Palombi, Senior Vice President for Corporate Communications, the top PR guy in the company.

The subtitle of Wendell Potter’s book Deadly Spin is An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans.  Mr. Potter was the VP for Corporate Communications at the giant insurance company CIGNA until he saw the error in his ways and came over to our side.  For anyone who has read Deadly Spin, it’s not hard to imagine that one of Mr. Palombi’s tasks this spring was to make certain that the shareholders who voted in our favor in 2010 were “educated” to follow the Board’s urging this time around.

David versus Goliath

Our resolution was crushed, but we not need shed any tears.  WellPoint was never going to return to nonprofit. We were a David-sized fly to their Goliath.  But we’re not done yet. 

The lesson to be learned from the last few years is that the health insurance industry cannot be reformed.  Not from the inside by shareholder resolutions or from the outside by the Affordable Care Act.  They are just too powerful.  They have amassed too much money and own too many politicians.

They will not be reformed.  They can only be counted on to protect their profits over their patients.  They must be replaced by a simple single payer plan like an expanded Medicare For All, guaranteeing health care, not just “coverage,” starting at birth. 

These behemoth health insurers may be powerful and appear invincible, but they are deeply unpopular with patients, physicians and hospitals.  They are corrupt and parasitic middlemen who add no value to our healthcare system, only layers of cost, aggravation and bureaucracy, covered over with a shiny gloss of PR.  

David sometimes wins.  Think colonists against the British. Cesar Chavez against the grape plantation owners. Si, se puede.  Ask the good people at Tahrir Square.  Ask Hosni Mubarak. 

Wall Street is for Wealth Care, not Health Care.  All around the country, people are figuring that out. Vermont’s governor has signed a bill to move that one small state toward guaranteed health care for all, without insurance companies.

Imagine a world without health insurance corporations sucking out huge profits.  It’s easy if you try.

It will take pressure from every point, from the grassroots right up to Congress.  There is a new pressure point growing, divestment.  Begin by checking your savings investments and retirement funds.  Then examine the portfolios of your church and alma mater.  Divest from these immoral companies.  Be like David and let it fly. 

http://www.counterpunch.org/stone06032011.html

Vermont’s Move Toward Single-Payer Health Insurance

By NANCY FOLBRE
The New York Times Economix blog, June 6, 2011

New England seems to be the testing ground for health insurance reform. The Affordable Care Act, now often called Obamacare by its critics, was modeled on health-insurance mandates put into place in Massachusetts under the governorship of Mitt Romney, a Republican, who announced last week that he was formally seeking his party’s presidential nomination in 2012.

Now Vermont has passed legislation moving the state toward a Canadian-style universal, single-payer health-insurance system, to be phased in alongside national health-care changes. The plan relies heavily on the prospect of waivers that will allow it to reallocate some federal Medicaid funds and on other sources of money that have not yet fully specified.

The new law calls for establishment of a five-member board to set reimbursement rates for health-care providers and streamline administration into a single, unified system called Green Mountain Care that will cover all Vermont residents. In the long run, it aims to replace fee-for-service payment with a system that will pay health-care providers a specific amount of money to care for a specific population, providing incentives for preventive care.

The basic outlines represent a left-wing alternative to the health-insurance changes being put in place under the Obama administration, with a stronger commitment to equitable public financing, a single insurance pool and less reliance on the market.

Why has Vermont moved into the vanguard? The possible explanations range from the structural to the personal.

Vermont has less income inequality and racial and ethnic diversity than Massachusetts (despite increasing inequality and diversity in recent years) and probably has higher levels of “social capital.”

It is a small state, with a population of less than 650,000. Private health-insurance companies have less to lose in Vermont than elsewhere, and their lobbyists may have been distracted by the national debate.

Single-payer advocates organized effectively around a “health care is a human right” campaign. The Vermont Workers’ Center, affiliated with the national organization Jobs With Justice, played a vital role in building a robust political coalition in support of change.

Vermont has long been represented in Congress (first as a representative, currently as a senator) by Bernard Sanders, who calls himself a democratic socialist and is a longtime advocate of universal single-payer health insurance.

Gov. Peter Shumlin, a successful small-business owner, was elected in November after he made a strong case during his fall campaign for the positive impact that single-payer insurance could have on small businesses and job creation.

All these factors enhanced the political impact of economic evidence, which shows that single-payer health insurance can create a simpler, more streamlined payment system, cut administrative costs and expand access to high-quality care.

In testimony before the Vermont State Legislature, William Hsiao, a professor at the Harvard School of Public Health, described his experience designing single-payer health-care systems in several countries, most recently Taiwan. He also presented the results of a detailed analysis of the health-care system of Vermont, providing estimates of potential savings from three different strategies and making a strong case for the single-payer option. (A report written by Professor Hsiao, Steven Kappel and Jonathan Gruber provides more detail.)

My University of Massachusetts Amherst colleague Gerald Friedman, active in efforts to promote a single-payer system in this state, estimates that similar changes in Massachusetts could sharply reduce the cost of billing and processing insurance claims, generating savings of 17 percent. As he puts it, a universal single-payer approach is not just more affordable; in the long run, it may be the only affordable option.

The current Massachusetts health-insurance system, like that emerging on the national level, requires residents to buy health insurance and provides subsidies only to low-income families. As a result, it leaves many people vulnerable to increases in the cost of insurance and may also create political resentments among those with incomes just above the subsidy eligibility level, who are forced to buy insurance they can ill afford.

The system is not “wildly unpopular,” as some conservatives assert, but it’s not wildly popular either.

As Vermont moves forward with its plan, a fascinating standard of comparison should emerge. The Canadian single-payer system grew out of successful innovations in the province of Saskatchewan, which led other provinces to follow suit. Here in Massachusetts, many of us are looking hopefully over our shoulder at the Green Mountain State.

Nancy Folbre is an economics professor at the University of Massachusetts Amherst.

http://economix.blogs.nytimes.com/2011/06/06/vermonts-move-toward-single-payer-health-insurance/