PNHP

Malpractice lessons from Texas

Malpractice lessons from Texas

Liability Limits in Texas Fail to Curb Medical Costs

by David Arkush, Peter Gosselar, Christine Hines and Taylor Lincoln
Public Citizen
December 2009
Supporters of limiting health providers’ liability have touted Texas’ medical malpractice experiment as the solution for improving national health care. For example, Minnesota Rep. Michele Bachmann held up Texas as a successful liability “pilot program” in an address in September, stating, “The state of Texas did a wonderful job of lawsuit reform and actually saw medical costs come down. We know it works.”
But most of the claims touting positive effects of the Texas law – which took effect in September 2003 and included a $250,000 per defendant liability cap – are flatly contradicted by the data.
By the measures commonly used to evaluate health care – such as cost, the uninsured rate, and access to care – Texas has regressed since its liability law took effect. Collectively, these measures show that Texas has one of the worst health care systems in the United States. Moreover, since 2003 Texas has either failed to improve or grown even worse compared to other states on almost every measure.
Since the liability laws took effect:
* The cost of health care in Texas (measured by per patient Medicare reimbursements) has increased at nearly double the national average;
* spending increases for diagnostic testing (measured by per patient Medicare reimbursements) have far exceeded the national average;
* the state’s uninsured rate has increased, remaining the highest in the country;
* the cost of health insurance in the state has more than doubled;
* growth in the number of doctors per capita has slowed; and
* the number of doctors per capita in underserved rural areas has declined.
http://www.citizen.org/documents/Texas_Liability_Limits.pdf

The malpractice system does not serve injured patients well. It needs to be reformed. It needs to be redesigned with incentives to reduce exposure to error, and to appropriately compensate patients when error does occur, all in a non-hostile environment that serves the interests of both patients (compensation for injury) and health care professionals (performance enhancement). This is not the topic of today’s message.
The Republican grandstanding has been sending a message calling for a blanket rejection of any reform advanced by the Democrats, and instead substituting the opening of insurance markets across state borders and the enactment of malpractice reform.
Since expanding insurance markets across state borders is not the topic of today’s message, we’ll quickly dismiss it as an unsound policy that would flood the market with less expensive underinsurance products that would fail to provide financial security for those who need health care. That is the worst possible way to expand health care coverage.
Regarding malpractice, when Republicans and some Democrats (except those beholden to trial attorneys) call for reducing health care spending through malpractice reform, they don’t really mean reform. They are merely calling for a cap on general damages (pain and suffering), such as the $250,000 cap enacted in Texas. They contend that this would reduce costs by eliminating excessive awards for “junk lawsuits,” and especially by reducing the pressure on physicians to order unnecessary tests. Many contend that the excess CYA testing is a major cause of our very high health care spending.
So what has happened in Texas after the cap was applied? Health care costs have increased at double the national average! Spending increases for diagnostic testing have far exceeded the national average! The cost of health insurance has more than doubled!
As an isolated policy, malpractice caps were ineffective in reducing spending and diagnostic testing in Texas. The issue of general damages needs to be addressed as part of a process leading to comprehensive malpractice reform, but it should be dismissed as the be all and end all for comprehensive health system reform.
The debate over malpractice should not distract us from our mission to support comprehensive reform that would ensure that absolutely everyone receives the health care that they need, under a financing system that eliminates the burden of medical debt. (Hint: a single payer national health program – an improved Medicare for all)

UnitedHealth wields a machete

Insurer Steps Up Fight to Control Health Care Cost

By Anemona Hartocollis
The New York Times
January 24, 2010

A front in the national health care battle has opened in New York City, where a major hospital chain and one of the nation’s largest insurance companies are locked in a struggle over control of treatment and costs that could have broad ramifications for millions of people with private health insurance.

The fight is between Continuum Health Partners, a consortium of five New York hospitals, including Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital Center, both major teaching hospitals, and UnitedHealthcare.

The prestigious hospitals and the major health insurer have been in bitter contract negotiations, not just over rates but also over UnitedHealthcare’s demand that the hospitals notify the insurance company within 24 hours after a patient’s admission. If a hospital failed to do so, UnitedHealthcare would cut its reimbursements for the patient by half.

UnitedHealthcare says the proposed rule is meant to improve the quality of care and cut costs by allowing insurance case managers to jump in right away. The hospitals say that having their reimbursement cut in half is too much to pay for a clerical error, and that the revenue drain would ultimately hurt their patients.

The dispute signals a “ratcheting up” of a long tradition of insurers trying to cut costs, said Jeffrey Rubin, an economics professor at Rutgers University.

http://www.nytimes.com/2010/01/25/health/policy/25insure.html?ref=health&pagewanted=all

Comment:

By Don McCanne, MD

The leadership of America’s Health Insurance Plans (AHIP) and Physicians for a National Health Program (PNHP) do agree on one crucial point: the current health care reform proposal does very little to control the intolerable escalation of health care costs. Both agree that Congress must provide the remedies to control spending and improve health care value.

What will occur without government action? Cost containment will remain in the hands of the private insurance industry. The tools at their disposal are very intrusive and are what resulted in the managed care backlash by unhappy patients and their providers. With the continuing increase in costs and the need to avoid pricing premiums totally out of the market, more intensive and extensive intrusions can be anticipated.

Look at this provision that UnitedHealth is demanding in its contract negotiations with a prominent New York hospital chain. If a hospital commits the clerical error of failing to notify UnitedHealth of a patient’s admission within the first 24 hours, the hospital is penalized 50 percent of its already reduced contracted rate! When the insurer is notified, they have the “insurance case managers jump in right away.” Although they claim that it is to improve quality, no sane person is deceived by the budget machete that they wield.

Without effective reform, it will get much worse since premium increases must be limited – they’re already too high – so insurers will be left with no alternative but to whack away at spending. Whacking spending means whacking patient care. Insurers really don’t want to do that. It is not for altruistic reasons, but it is rather the fear that their business model could suffer irreparable harm under the wrath of enraged patients and their health care providers (not that it hasn’t already).

It is no wonder that AHIP wants Congress to enact cost containment so the government becomes the bad guys. But do they really expect Congress to establish a government bureaucracy of machete-wielding case managers while the insurance industry gets a free ride? Yet that is the form of cost containment that fits with the model in which the private insurers retain control of the funds.

We’ll say it again. Private health insurance plans are an obsolete model of financing health care. Affordable premiums, adequate benefits, and affordable out-of-pocket costs are incompatible under the private insurance model because of the very high health care prices in the United States.

Methods of cost containment is where PNHP and AHIP part ways. PNHP recommends eliminating the obsolete private insurance industry and replacing it with a single payer national health program – an improved Medicare for everyone.

An improved Medicare for all would save hundreds of billions of dollars in wasted administrative excesses. Although some claim that this is a one-time benefit, it is a profound waste that never returns, providing savings every year thereafter. The system would be operated under a global budget, adjusted for demographics, inflation, and beneficial advances in technology, maintaining spending at a sustainable level. Hospitals would be funded through global budgets, eliminating the need for armies of clerks attempting to obtain reimbursement from a multitude of payers for each itemized expenditure of the hospital. Health professionals would negotiate compensation to meet their costs and provide fair profits. Bulk purchasing at negotiated rates would enable fair pricing for pharmaceuticals and medical supplies. Capital improvements would be separately budgeted to correct for both excessive and deficient supply side capacity, avoiding excess costs by improving efficiency.

The differences could not be more clear. Private insurers want government interventions to protect their businesses. Advocates of an improved Medicare for all want everyone to have the health care that they need, while making the health care system affordable for all – individuals, businesses, and the government and its taxpayers.

Thank you for writing your representatives!

  • We must act now if we want to get corporate greed and waste out of the system.

  • We must act now if we want to save the lives of the thousands upon thousands that die each year because of a failing healthcare system driven by profit.

  • We are the people, patients, families, and communities that face the burden of a failing system and we want it to change!

  • And we need your help.  Don’t wait.  Act now.  Contact your representative by phone and email, and make sure that they know that you demand a better system.

  • Act now and demand the only reform that is universal, high quality, and affordable because it eliminates insurance industry waste and greed.

  • Support SB 810 and don’t let corporate interests get away with destroying healthcare reform.

  • Fight for California.  Fight for Single Payer.  And Act now!

For more information please visit PNHP.org

Better odds for Medicare for all?

By Kristen Gerencher
MarketWatch, Jan. 22, 2010

[The following is an excerpt from an article titled “Unexpected lessons from Massachusetts” about the impact of Scott Brown’s election to the Senate from Massachusetts. For the full article, click on the link at the end.]

The message from Massachusetts voters was “rather muddled,” said Dr. Steffie Woolhandler, professor of medicine at Harvard University and an internist in Boston.

“It’s not that people in Massachusetts are profoundly unhappy with the [reform] in Massachusetts but seem to feel it’s irrelevant,” said Woolhandler, co-founder of Physicians for a National Health Program.

People are rightfully concerned that the benefits of the bills are too meager compared with the costs, she said.

A Medicare-for-all approach would produce hundreds of billions of dollars in annual savings due to the lower administrative costs that come from cutting out the middleman, Woolhandler said.

“I know that’s not what the private insurance industry wants to hear and they’re very powerful, but the only way that we can afford universal health care is through a Medicare-for-all model,” she said.

“We need to learn from other countries what works, and the message is national nonprofit health insurance works and what they’re doing in Washington and what we’ve done in Massachusetts is not the solution.”

Woolhandler said she didn’t root for Scott Brown’s victory, but that his election raised the chances for a Medicare-for-all approach down the line “because it’s obvious we have to do something else, something different from what we’ve been doing.”

Such a large-scale change is less of a long shot now, [John] Holahan [director of the Health Policy Center at the Urban Institute in Washington] said. If health reform dies this year, within a decade there will be demand at least for Medicare as an option, with income subsidies similar to what’s in the current bills — and the potential for Medicare for all isn’t out of the question either, he said.

“I almost think you’d have to because of the budget implications and the health implications and financial pressure on health-care institutions,” Holahan said. “If the uninsured rate goes to 60, 70 million over next decade, that’s an awful lot of people who can’t afford to pay.”

Kristen Gerencher is a reporter for MarketWatch in San Francisco. MarketWatch is part of the Wall Street Journal Digital Network.

http://www.marketwatch.com/story/why-health-reform-may-survive-browns-win-2010-01-22?pagenumber=1

'Single-Payer' left out of health care debate, but many doctors want it in

By Mike Rose
Austin (Minn.) Daily Herald, Jan. 23, 2010

When the current health care debate began in earnest last year, one potential topic of discussion was largely left out — “single-payer” insurance.

Perhaps most indicative of the exclusion were remarks early in the debate from Sen. Max Baucus, D-Mont., who chairs the Senate Finance Committee and has been an influential player in the health care reform process. On several occasions, the senator said everything was on the table, except for the possibility of establishing a national health insurance plan that would supplant private insurers.

Leaving single-payer off the table, said Dr. Quentin Young, has been a great injustice.

“The health care system is going to hell rapidly,” the retired Chicago physician said. “(And single-payer) is mentioned only in passing.”

Young is working to change that. He is currently the national coordinator for Physicians for a National Health Program, a 23-year-old non-profit that counts 17,000 doctors as its members.

The organization is not alone in pushing for single-payer health insurance, but PNHP is among a number of groups focusing on the issue through the lens of the medical profession.

“Physician support (of single-payer) is getting stronger every day,” Young claims. “We’re doing a good job of publicizing.”

Numbers seem to support Young’s claim. According to a survey done by the Indiana University School of Medicine in 2007, 59 percent of physicians in the country supported legislation to establish national health insurance — up 10 percent from five years earlier. In Minnesota, 64 percent of doctors polled in 2007 said they favored a single-payer plan, according to an article in the journal Minnesota Medicine.

The doctor said the reason for moving toward national health insurance is simple — it would expand coverage to more people and reduce administrative costs that come from a complex private insurance industry.

But Young said his organization is willing to accept options short of a full-fledged single-payer plan, as long as coverage increases and prices decrease.

“We’re not single-payer or nothing,” he said. “We certainly welcome other reforms.”

However, that doesn’t include reforms in front of Congress now, Young said — the doctor believes the proposed legislation would do more harm than good.

“They’re both bad,” he said of the House and Senate health care bills. “They’re not tiny steps forward, (but rather) important steps backward.”

Dr. Ann Settgast, a St. Paul-based physician who is also in PNHP, said perhaps proposed legislation making its way through committees in the Minnesota Legislature could pave the way for national health insurance.

The state House and Senate health care reform bills, known collectively as the Minnesota Health Plan, would make Minnesota a single-payer state.

With 71 co-authors in the Legislature, Settgast said it is clear the plan has initial support. Now, she wants to see it move forward and see Minnesota become a pioneer by instituting a single-payer system.

If it does pass, Settgast said it could start a ripple effect, leading other states and perhaps the country as a whole to adopt similar measures.

Like the Chicago-based Dr. Young, Settgast said she sees more and more support along these lines, though she acknowledges true change will come slowly.

“Single-payer is very well supported,” Settgast said, though adding that “it was needed years ago. The sooner the better.”

Both Settgast and Young say the main obstacle to a single-payer plan is the health insurance industry. Settgast for one said groups like PNHP simply can’t compete with insurance lobbyists in Washington.

“Certainly, if your campaign contributions are resting on (insurance industry) money” that makes it hard to listen to other sides, she said. “The single-payer voice is largely underrepresented in the debate.”

But Robert Zirkelbach, strategic communications director for America’s Health Insurance Plans, the country’s largest health insurance trade association, said the industry has not been a “bully” during the reform debate.

Instead, he said AHIP represents the majority of Americans who don’t believe in a single-payer plan.

“The American people do not support a government takeover of the health insurance system,” Zirkelbach said.

The spokesman said the private insurance industry has pioneered a number of innovative health care ideas, adding that a vast majority of Americans were satisfied with their current plans.

A single-payer insurance system, Zirkelbach said, would not lower costs and would only reduce services.

“Moving toward an entirely government-run system would turn back the clock on health care,” he said.

Editor’s note: This is the last in a three-part series examining the health care debate from the perspectives of different social groups.

http://www.austindailyherald.com/news/2010/jan/23/heath-care-perspectives-part-3/

‘Single-Payer’ left out of health care debate, but many doctors want it in

By Mike Rose
Austin (Minn.) Daily Herald, Jan. 23, 2010

When the current health care debate began in earnest last year, one potential topic of discussion was largely left out — “single-payer” insurance.

Perhaps most indicative of the exclusion were remarks early in the debate from Sen. Max Baucus, D-Mont., who chairs the Senate Finance Committee and has been an influential player in the health care reform process. On several occasions, the senator said everything was on the table, except for the possibility of establishing a national health insurance plan that would supplant private insurers.

Leaving single-payer off the table, said Dr. Quentin Young, has been a great injustice.

“The health care system is going to hell rapidly,” the retired Chicago physician said. “(And single-payer) is mentioned only in passing.”

Young is working to change that. He is currently the national coordinator for Physicians for a National Health Program, a 23-year-old non-profit that counts 17,000 doctors as its members.

The organization is not alone in pushing for single-payer health insurance, but PNHP is among a number of groups focusing on the issue through the lens of the medical profession.

“Physician support (of single-payer) is getting stronger every day,” Young claims. “We’re doing a good job of publicizing.”

Numbers seem to support Young’s claim. According to a survey done by the Indiana University School of Medicine in 2007, 59 percent of physicians in the country supported legislation to establish national health insurance — up 10 percent from five years earlier. In Minnesota, 64 percent of doctors polled in 2007 said they favored a single-payer plan, according to an article in the journal Minnesota Medicine.

The doctor said the reason for moving toward national health insurance is simple — it would expand coverage to more people and reduce administrative costs that come from a complex private insurance industry.

But Young said his organization is willing to accept options short of a full-fledged single-payer plan, as long as coverage increases and prices decrease.

“We’re not single-payer or nothing,” he said. “We certainly welcome other reforms.”

However, that doesn’t include reforms in front of Congress now, Young said — the doctor believes the proposed legislation would do more harm than good.

“They’re both bad,” he said of the House and Senate health care bills. “They’re not tiny steps forward, (but rather) important steps backward.”

Dr. Ann Settgast, a St. Paul-based physician who is also in PNHP, said perhaps proposed legislation making its way through committees in the Minnesota Legislature could pave the way for national health insurance.

The state House and Senate health care reform bills, known collectively as the Minnesota Health Plan, would make Minnesota a single-payer state.

With 71 co-authors in the Legislature, Settgast said it is clear the plan has initial support. Now, she wants to see it move forward and see Minnesota become a pioneer by instituting a single-payer system.

If it does pass, Settgast said it could start a ripple effect, leading other states and perhaps the country as a whole to adopt similar measures.

Like the Chicago-based Dr. Young, Settgast said she sees more and more support along these lines, though she acknowledges true change will come slowly.

“Single-payer is very well supported,” Settgast said, though adding that “it was needed years ago. The sooner the better.”

Both Settgast and Young say the main obstacle to a single-payer plan is the health insurance industry. Settgast for one said groups like PNHP simply can’t compete with insurance lobbyists in Washington.

“Certainly, if your campaign contributions are resting on (insurance industry) money” that makes it hard to listen to other sides, she said. “The single-payer voice is largely underrepresented in the debate.”

But Robert Zirkelbach, strategic communications director for America’s Health Insurance Plans, the country’s largest health insurance trade association, said the industry has not been a “bully” during the reform debate.

Instead, he said AHIP represents the majority of Americans who don’t believe in a single-payer plan.

“The American people do not support a government takeover of the health insurance system,” Zirkelbach said.

The spokesman said the private insurance industry has pioneered a number of innovative health care ideas, adding that a vast majority of Americans were satisfied with their current plans.

A single-payer insurance system, Zirkelbach said, would not lower costs and would only reduce services.

“Moving toward an entirely government-run system would turn back the clock on health care,” he said.

Editor’s note: This is the last in a three-part series examining the health care debate from the perspectives of different social groups.

http://www.austindailyherald.com/news/2010/jan/23/heath-care-perspectives-part-3/

We need to provide Medicare to all

By GEOFF THOMAS
Daily Record (Morris County, N.J.)
January 24, 2010

I am a health care reform activist, yet I cannot support the current health care finance reform bills moving through Congress. The current bills provide no real long-term savings, continue to enrich the bloated and inefficient for-profit private health insurance industry, and fail to address the crippling economic burden that every American worker must carry versus all competitors abroad.

To those on the right who say we cannot have a national health plan, I ask: Why must American companies continue to support the bloated and inefficient private health insurance industry, while upstart competitors can shed these costs by stiffing workers with a cheap plan, and international competitors are covered by efficient, nonprofit national plans?

Unethical bosses have the edge today, and under these bills, responsible bosses get shafted.

The Republicans always claim to be in favor of states’ rights. So why aren’t they supporting enabling states to set up their own single-payer systems? Conservatives claim to be in favor of competition, so why do they oppose competitive bidding for national bulk purchases of pharmaceuticals? Why are these principles never applicable when they would benefit ordinary people?

To those on the left who insist that any bill is better than no bill, I say, “Wake up and smell the coffee.” With the new bill, the United States will continue to remain inefficient and uncompetitive — losing jobs overseas while not bringing corrective needed reforms to our health care system. We need a simple, efficient and humane system that is carefully audited to detect and eliminate fraud and waste. The public option will not achieve that goal. It’s not really even a step on a path toward that goal.

We need a national nonprofit system of providing access to health care, as every other industrialized nation already has. We need to eliminate the role of private, for-profit insurers in providing access to necessary medical care in the United States.

We need a system that provides care for the sick at no cost out of pocket. All of the other developed nations have achieved something at least very close to that goal.

Yet early on, the Democratic majority refused to discuss national single-payer solutions to our health care morass. Why? Because senators in thinly populated states were fed a mind-boggling amount of cash by health industry backers to scuttle real reform.

I urge our public officials to educate themselves on the savings that HR 676, a national expanded Medicare system, would bring to New Jersey’s budget woes on all levels.

New Jersey could save $2.6 billion yearly under this bill, while erasing the unfunded and not often discussed current $58 billion health care liability already facing the state. This is a budget-busting, tax-bloating liability that will wreck New Jersey’s economy for years to come if not removed by HR 676.

Read more on health care finance reform at www.healthcare-now, and at www.PNHP.org.

Geoff Thomas is a resident of Madison.

http://www.dailyrecord.com/article/20100124/OPINION03/100123023/1096/OPINION/We+need+to+provide+Medicare+to+all

'Cadillac' health insurance is far from luxurious

By Suzanne Gordon
Salt Lake Tribune
Progressive Media Project
01/15/2010

I’ve had enough of the derisive talk about “Cadillac” health insurance plans. They’re not all that they are cracked up to be, and they are not what is driving health-care costs skyward.

My husband has been a union member and staffer for many years, and his employer provided my family (as a hard-won benefit of union negotiating) with what is now considered an unnecessarily “luxurious,” “wasteful” insurance vehicle.

So let me tell you how we’ve used our insurance plan over the past few years and how, in turn, it has misused us.

Three and a half years ago, I had an emergency appendectomy. During the surgery, I suffered several preventable complications, one that has proved to be quite serious. As a result, I needed extra visits to multiple doctors and physical therapists, as well as MRIs, ultrasounds and a variety of painkillers and other medications.

My husband was bitten by a feral dog in El Salvador and had to get 10 rabies shots when he got home.

Our daughter needed a variety of pills and shots before going to Rwanda to work for a group that helps women who were raped and infected with HIV/AIDS.

How have we fared when we’ve taken the Cadillac for a ride? Not well.

For more than 25 years, I was on the rolls as Suzanne Gordon, but then the insurer suddenly renamed me Suzanne Early (giving me my husband’s last name) when I submitted bills for my emergency appendectomy. Since there is no Suzanne Early (at least
Advertisement
not one who’s actually me), it was no surprise that they couldn’t identify me as an enrollee. Claim denied. That took months to sort out.

When my husband got his rabies shots, the insurer denied the $1,000 claim because somehow the services weren’t coded as “medically necessary.” In his lengthy conversations with the insurer, he reminded them that since rabies is invariably fatal, dying of the disease would cost the company a heck of a lot more than $1,000.

No matter. To get the bill paid, it took a year of haggling, including receipt of many threatening letters from not just one but three bill collectors. And for months after the problem was resolved and the bill paid, we still were receiving dunning notices from one bill collector.

When my daughter needed more than the formulary-allotted supply of malaria pills (you can’t easily get them in Rwanda), it took dozens of calls to pharmacists, doctors’ offices and the union’s human relations department to get them and renew them.

Driving a Cadillac, it turns out, is almost a full-time job.

Like so much else in our health care debate — “death panels,” “socialized medicine” — the depiction of the so-called Cadillac option is a scare tactic meant to deceive and derail.

The tragedy is that in this instance, the scaremongers and derailers include President Obama, some of his party and too many of the progressive policy commentators.

Instead of blaming unions for bargaining for better (but still insufficient) health benefits for their members, we should be clear on who is really to blame for the real cost escalators in health care: a for-profit private insurance and a pharmaceutical industry that puts us all at risk.

Suzanne Gordon is the co-editor of the “Culture and Politics of Health Care Work” series at Cornell University Press. She wrote this for Progressive Media Project, a source of liberal commentary on domestic and international issues; it is affiliated with The Progressive magazine. Readers may write to the author at: Progressive Media Project, 409 East Main Street, Madison, Wis. 53703; e-mail: pmprojprogressive.org.

http://www.sltrib.com/opinion/ci_14202903

‘Cadillac’ health insurance is far from luxurious

By Suzanne Gordon
Salt Lake Tribune
Progressive Media Project
01/15/2010

I’ve had enough of the derisive talk about “Cadillac” health insurance plans. They’re not all that they are cracked up to be, and they are not what is driving health-care costs skyward.

My husband has been a union member and staffer for many years, and his employer provided my family (as a hard-won benefit of union negotiating) with what is now considered an unnecessarily “luxurious,” “wasteful” insurance vehicle.

So let me tell you how we’ve used our insurance plan over the past few years and how, in turn, it has misused us.

Three and a half years ago, I had an emergency appendectomy. During the surgery, I suffered several preventable complications, one that has proved to be quite serious. As a result, I needed extra visits to multiple doctors and physical therapists, as well as MRIs, ultrasounds and a variety of painkillers and other medications.

My husband was bitten by a feral dog in El Salvador and had to get 10 rabies shots when he got home.

Our daughter needed a variety of pills and shots before going to Rwanda to work for a group that helps women who were raped and infected with HIV/AIDS.

How have we fared when we’ve taken the Cadillac for a ride? Not well.

For more than 25 years, I was on the rolls as Suzanne Gordon, but then the insurer suddenly renamed me Suzanne Early (giving me my husband’s last name) when I submitted bills for my emergency appendectomy. Since there is no Suzanne Early (at least
Advertisement
not one who’s actually me), it was no surprise that they couldn’t identify me as an enrollee. Claim denied. That took months to sort out.

When my husband got his rabies shots, the insurer denied the $1,000 claim because somehow the services weren’t coded as “medically necessary.” In his lengthy conversations with the insurer, he reminded them that since rabies is invariably fatal, dying of the disease would cost the company a heck of a lot more than $1,000.

No matter. To get the bill paid, it took a year of haggling, including receipt of many threatening letters from not just one but three bill collectors. And for months after the problem was resolved and the bill paid, we still were receiving dunning notices from one bill collector.

When my daughter needed more than the formulary-allotted supply of malaria pills (you can’t easily get them in Rwanda), it took dozens of calls to pharmacists, doctors’ offices and the union’s human relations department to get them and renew them.

Driving a Cadillac, it turns out, is almost a full-time job.

Like so much else in our health care debate — “death panels,” “socialized medicine” — the depiction of the so-called Cadillac option is a scare tactic meant to deceive and derail.

The tragedy is that in this instance, the scaremongers and derailers include President Obama, some of his party and too many of the progressive policy commentators.

Instead of blaming unions for bargaining for better (but still insufficient) health benefits for their members, we should be clear on who is really to blame for the real cost escalators in health care: a for-profit private insurance and a pharmaceutical industry that puts us all at risk.

Suzanne Gordon is the co-editor of the “Culture and Politics of Health Care Work” series at Cornell University Press. She wrote this for Progressive Media Project, a source of liberal commentary on domestic and international issues; it is affiliated with The Progressive magazine. Readers may write to the author at: Progressive Media Project, 409 East Main Street, Madison, Wis. 53703; e-mail: pmprojprogressive.org.

http://www.sltrib.com/opinion/ci_14202903

Who Really Won in 2008?

By James Thindwa
In These Times
January 19, 2010

The voters who made Barack Obama’s historic election possible rightly expected far-reaching policy change. Yet what they have gotten is the same old corporate-driven politics.

Frustrated Obama supporters are told that the “machinery of Congress” grinds slowly; that only incremental change is possible; and that folks on “the left” are demanding too much and letting “the perfect be the enemy of the good.” Thus, we get a healthcare bill that rewards a predatory insurance system with millions of new customers—at taxpayer expense.

Apparently, it is paranoid to suspect that undue corporate influence might account for the rejection of demonstrably reliable governmental underwriting of healthcare. We are told the gradual degrading and then jettisoning of the public option and the proposed Medicare expansion—not to mention exclusion of single-payer from debate—is just a part of legislative deal-making.

But, delivering billions of taxpayer dollars to a monopolistic industry by forcing millions of people to purchase its product—with no option to join a public plan—is not inevitable. Nor is it good politics. How will Democrats defend forcing people to buy such tainted goods?

In recent weeks, some Democratic pundits have sought to silence the left. Instead of encouraging progressives to heed the example Obama himself once set as a community organizer, they countenance the sacrifice of core liberal principles such as reproductive rights, corporate accountability and inclusion of immigrants.

Writing in The New Republic, editor Jonathan Chait grumbled that progressives have an “irrational attachment to the public plan” and that criticism of Obama reflects the “bizarre convergence of left-wing and right-wing paranoia.”

Obama, in his September 9 address to Congress, also propagated this false parallel between left and right opponents when he decried the “unyielding ideological camps that offer no hope of compromise.” He even assigned motive to critics, saying they have “used this as an opportunity to score short-term political points.”

In other words, the President represents the “sensible center.” The left—those who demand a healthcare program that does not further enrich greedy insurance companies—are the extremists. The center is occupied by the likes of Sens Joe Lieberman (I-Conn.) and Ben Nelson (D-Neb.), who would hold hostage millions of uninsured in order to protect corporate profits. The center belongs to conservatives such as Rep. Bart Stupak (D-Mich.), whose obsession with abortion trumps any concern for the 45,000 people who die every year for lack of health insurance.

By reducing left-right differences on healthcare to merely “unyielding ideological camps,” the president and his defenders ignore the deep moral divide between progressives and conservatives. The left’s push for universal healthcare is grounded in the long-held principle of social justice, the same one that produced the New Deal, gave us Medicare in 1965 and ushered in a new era in civil rights.

Instead of dismissing progressives and apologizing for the President, Beltway liberals could have led the charge to dismantle the structurally conservative elements of our political system, from the undemocratic filibuster to the undue influence of corporate money in elections. Further, since progressives, liberals, the left—whatever we are calling ourselves—support universal healthcare, let us from now on, together, create a national echo chamber around “Medicare For All.” If this had been our collective mantra for the last 15 years, we would be in a better place today, and perhaps more unified.

James Thindwa is a member of In These Times’ Board of Directors and a labor and community activist.

http://inthesetimes.com/article/5430/who_really_won_in_2008/

UnitedHealth wields a machete

Insurer Steps Up Fight to Control Health Care Cost

By Anemona Hartocollis
The New York Times
January 24, 2010
A front in the national health care battle has opened in New York City, where a major hospital chain and one of the nation’s largest insurance companies are locked in a struggle over control of treatment and costs that could have broad ramifications for millions of people with private health insurance.
The fight is between Continuum Health Partners, a consortium of five New York hospitals, including Beth Israel Medical Center and St. Luke’s-Roosevelt Hospital Center, both major teaching hospitals, and UnitedHealthcare.
The prestigious hospitals and the major health insurer have been in bitter contract negotiations, not just over rates but also over UnitedHealthcare’s demand that the hospitals notify the insurance company within 24 hours after a patient’s admission. If a hospital failed to do so, UnitedHealthcare would cut its reimbursements for the patient by half.
UnitedHealthcare says the proposed rule is meant to improve the quality of care and cut costs by allowing insurance case managers to jump in right away. The hospitals say that having their reimbursement cut in half is too much to pay for a clerical error, and that the revenue drain would ultimately hurt their patients.
The dispute signals a “ratcheting up” of a long tradition of insurers trying to cut costs, said Jeffrey Rubin, an economics professor at Rutgers University.
http://www.nytimes.com/2010/01/25/health/policy/25insure.html?ref=health&pagewanted=all

The leadership of America’s Health Insurance Plans (AHIP) and Physicians for a National Health Program (PNHP) do agree on one crucial point: the current health care reform proposal does very little to control the intolerable escalation of health care costs. Both agree that Congress must provide the remedies to control spending and improve health care value.
What will occur without government action? Cost containment will remain in the hands of the private insurance industry. The tools at their disposal are very intrusive and are what resulted in the managed care backlash by unhappy patients and their providers. With the continuing increase in costs and the need to avoid pricing premiums totally out of the market, more intensive and extensive intrusions can be anticipated.
Look at this provision that UnitedHealth is demanding in its contract negotiations with a prominent New York hospital chain. If a hospital commits the clerical error of failing to notify UnitedHealth of a patient’s admission within the first 24 hours, the hospital is penalized 50 percent of its already reduced contracted rate! When the insurer is notified, they have the “insurance case managers jump in right away.” Although they claim that it is to improve quality, no sane person is deceived by the budget machete that they wield.
Without effective reform, it will get much worse since premium increases must be limited – they’re already too high – so insurers will be left with no alternative but to whack away at spending. Whacking spending means whacking patient care. Insurers really don’t want to do that. It is not for altruistic reasons, but it is rather the fear that their business model could suffer irreparable harm under the wrath of enraged patients and their health care providers (not that it hasn’t already).
It is no wonder that AHIP wants Congress to enact cost containment so the government becomes the bad guys. But do they really expect Congress to establish a government bureaucracy of machete-wielding case managers while the insurance industry gets a free ride? Yet that is the form of cost containment that fits with the model in which the private insurers retain control of the funds.
We’ll say it again. Private health insurance plans are an obsolete model of financing health care. Affordable premiums, adequate benefits, and affordable out-of-pocket costs are incompatible under the private insurance model because of the very high health care prices in the United States.
Methods of cost containment is where PNHP and AHIP part ways. PNHP recommends eliminating the obsolete private insurance industry and replacing it with a single payer national health program – an improved Medicare for everyone.
An improved Medicare for all would save hundreds of billions of dollars in wasted administrative excesses. Although some claim that this is a one-time benefit, it is a profound waste that never returns, providing savings every year thereafter. The system would be operated under a global budget, adjusted for demographics, inflation, and beneficial advances in technology, maintaining spending at a sustainable level. Hospitals would be funded through global budgets, eliminating the need for armies of clerks attempting to obtain reimbursement from a multitude of payers for each itemized expenditure of the hospital. Health professionals would negotiate compensation to meet their costs and provide fair profits. Bulk purchasing at negotiated rates would enable fair pricing for pharmaceuticals and medical supplies. Capital improvements would be separately budgeted to correct for both excessive and deficient supply side capacity, avoiding excess costs by improving efficiency.
The differences could not be more clear. Private insurers want government interventions to protect their businesses. Advocates of an improved Medicare for all want everyone to have the health care that they need, while making the health care system affordable for all – individuals, businesses, and the government and its taxpayers.

Americans need single-payer for all

Letter to the Editor
The Tennessean, Jan. 20, 2010

Jack Irby of Smyrna is to be applauded for his stand on the issue of health care for Americans as being a right and not a privilege.

He is on solid, rational ground when he concludes that the evidence is overwhelming that we must end the private insurance domination of health care in our country and move toward a publicly financed, single-payer Medicare for all approach.

Unfortunately, our Congress and the leadership in the White House “just don’t get it.” More likely, campaign financing dollars trump reason in America.

In either case, the meager progress so far made in the name of “reform” represents a shamefully disappointing effort.

James Hudson, M.D.
LYNNVILLE, Tenn.

http://www.tennessean.com/article/20100120/OPINION02/100119059/1008/OPINION01/Americans+need+single-payer+for+all